Episode 32: Dr. Jess Shatkin on his new book “Born To Be Wild” – Podcast Transcription

If there is one book that I think every parent, educator, coach, and health care provider should read to under stand the preteen/teen brain and the way decisions are made by OUR youth it is “Born To Be Wild” by Dr. Jess Shatkin.

Here is the podcast.

Dr. Denise: This is the Dr. Denise Show. I’m Dr. Denise McDermott an adult and child psychiatrist specializing in an integrated approach to mental health. I believe in prescribing the least amount of medication, coupled with a comprehensive treatment plan. My goal is to empower you to thrive and I take a multi-dimensional approach to wellness, not illness. You are not your symptoms. Call upon your best and highest self to embrace your mental health. On this program you will meet many doctors, experts and pioneers who have helped pave the way to shift the paradigm of getting rid of the stigma of mental illness in our society. This show was created for those of you who would like new ways of thinking and understanding about mental health and helping your loved ones to thrive and cope in empowered ways. Today I have the honor of interviewing a nationally recognized child and adolescent psychiatrist Dr. Jess Shatkin. He is one of the country’s foremost voices in Child and Adolescent Mental Health. He serves as Vice Chair for Education at The Child Studies Center and Professor of Child and Adolescent Psychiatry Pediatrics at New York University School of Medicine. Dr. Shatkin has been featured in top print, radio, TV and Internet outlets including The New York Times, Good Morning America, Parade, New York Magazine, to name a few. In addition, for the past eight years, Dr. Shatkin has been the host of About Our Kids, a two-hour radio call-in show radio broadcast live on Sirius XM Doctors radio. He lives in New York City with his wife and two teenage children. His book, Born to Be Wild: Why teens take risks and how to keep them safe will be released on October 3rd 2017. I’m so excited to have him on the show today. Hi Dr. Jeff Shatkin it’s so great to have you on the show today. And have you back on the show.

Dr. Shatkin: Thanks for having me. I’m thrilled to be with you.

Dr. Denise: Thank you. And so we are going to be discussing Dr. Shatkin’s new book Born to Be Wild : Why teen take risks and how we can help keep them safe. You know, I have to tell you Dr. Shatkin, that this book and how we as a society can prime our teens and our tweens and our young adults for self-efficacy and self-regulation is near and dear to my heart as a mother, as a child psychiatrist and a kindred spirit of your vision. And so I just want to thank you right now because I think you just knocked it out of the park with this book and you have done an amazing job of bridging the science, the clinical, your clinical expertise and your personal experience as a parent of teens.

Dr. Shatkin: Well thank you Denise. That’s lovely to hear. It makes me so very good. I’m glad that it resonates and, you know, when you start a project like this you have all these big ideas and I hope that they came to fruition on this. I’m pleased with it. And I hope that it speaks to people like it’s spoken to you. So thank you for saying that, I really do appreciate it.

Dr. Denise: Well and also my understanding is this is has been a seven year journey right?

Dr. Shatkin: So I started, this book really comes out of, you know, like so many things in our lives as clinicians we cross so many different boundaries all the time, and for me what happened was I started working with a high school in New York City on the Lower East Side, trying to help them build a resilience program, or a sort of a mental health prevention program, so wellness program of sorts, basically trying to help their kids to have resilience against things like drugs and alcohol and taking risks. And in the process of starting that in 2010, I started reading a lot of research to help me understand really what does enhance resilience because so often in mental health, psychology, psychiatry, social work, we learn about what goes wrong and we learn about how to help identify that and then treat that. And that’s a big and important mission and journey. But we don’t often learn about what goes right and how to enhance that. So standing things on their head and thinking about things from a resilience perspective in terms of adolescent development and risk taking was novel for me and I started reading a lot of material in that area. I started recognizing where we could intervene and that led me to understand risk taking a lot better. As so often happens in so many fields, the research starts 30 years before it gets in the hands of the clinicians. And what I tried to do is speed that process putting this information in the hands of parents and teachers and clinicians as soon as possible.

Dr. Denise: That’s fantastic and I think we’re living at such an amazing time with the ability to have access to so much information and you address that in your book how fast society is moving. And so for us as doctors there’s been some old myths that we were taught in medical school. And I think one of the things that you started talking about is sort of the myth that teens think they’re invincible. Can you sort of take us through your aha moment that ignited this myth busting realization?

Dr. Shatkin: Yeah that’s a really great one, I started reading a review article by a woman named Valerie Reyna and Charles Brainerd. And it’s a wonderful review, but it literally took me about three nights to read it. And I was reading this as part of this development of this program. It’s about a 30 page, single-spaced, two or three-column paper with lots and lots of details. And I remember, I underlined every other sentence in that article, which I don’t tend to do very often. And one of the first sections of that article was the idea that kids actually don’t think they’re invincible, and that’s what I, and perhaps you, and so many other people have been taught when we think about why adolescents take risk? Why would you have unprotected sex when you know that the risk of pregnancy is there at least? Why would you drive 100 miles an hour down the freeway while drunk? Why would you jump off of a bridge into a river that’s moving swiftly? Why would you be drinking on the shores of the lake and then swim across the lake when you had a few beers in you, who would do something like that? What the hell are people thinking? And so for me, what I’ve been taught and what I learned to think, was that adolescents think they’re invincible. And many people have thought this for many years and there was a lot written about this in the 60s and 70s and 80s about this. So clinicians were even taught this very straight message that adolescents think they’re invincible. So I read this article, I couldn’t believe what it said, and I did what probably any parent would do was go home and ask their kids, so my daughter at the time was 13. And, I know this sounds like a funny thing to ask your daughter, but she knows I’m a Child Psychiatrist and she knows what I think about and what I do when she heard these words before so it wasn’t shocking to her. But I said, my daughter’s name is Parker, and I said Parker if you were to have sex one time unprotected with a man or a boy what’s the risk that you would get pregnant? And she looked at me very straight and thought about it and said 90 percent. And I said what’s the risk that you don’t know anything about this boy’s sexual history, you don’t know if he’s straight or gay or anything in between, you don’t know if he’s ever had sex before, what’s the risk that he would pass HIV to you? And she said 75 percent. Now the risks for those things are so much lower. But what that did then was start me on a journey of asking some of my patients and my students in college and different things. What are the risks of these things? What do you think? And what you find when you ask these questions of young people, older people too, but particularly young people that they do not think they’re invincible at all, in fact, they think they are very vulnerable to these things happening. Ask them about a bad thing an earthquake or a hurricane, dying this year, or getting a sexually transmitted infection, they will tell you the risks are enormous. And so that can’t account for why they take risk. That was the first aha moment.

Dr. Denise: Well that’s a big aha moment, because now we can kind of look back and I think you and I should go back and share some of our own teen stories because we’re obviously, we’re at a different phase of our life, just to kind of really connect with our audience. But that realization that we’re not, that we don’t as teens think we’re invincible and then understanding the why, Dr. Shatkin’s going to take us through that in many ways. But what I want to say is, when you started your book, I loved how you shared your experiences that colored probably who you are as a man, as a doctor, as a psychiatrist and as a health educator. So can you share some of your teen experience and tween experiences that you did in the book and I’d love to just hear that and how that relates to this book?

Dr. Shatkin: Sure. So you know, I was born in the early 60s and I’m the youngest of five kids. So the 60s were a funny time and I was living just a few miles north of San Francisco in a rural, semi-rural kind of suburb area. And my brothers and sisters, I have two of each, all older again. They were, you know, my brothers were a little bit of hellions. They were out there, you know, smoking grass and driving fast cars. Everybody was fooling around with the opposite sex and different things of that nature as I grew up and I would see this and I was exposed to a lot of it very early I remember very early, at seven years of age, I remember my brother handing me a joint, you know, a reefer, a marijuana cigarette and saying, you can’t smoke this but smell it. You can hold it, and me knowing that that was a drug of some sort. And I remember the next year, my third grade and at eight years of age my friends and I used to be able to grab cigarettes sort of from behind the check register at a grocery store and we would steal cigarettes now and again. And we lived in Davis for a few years. Davis, California. My parents moved for a couple of years and during those years my friends and I we would steal cigarettes and then we would go to the dorms, the college dorms and we would go up on the rooftop because you could access the rooftop of these eight or ten story dorms in Davis and we’d sit on the top. And I remember sitting on the rooftop with our legs hanging over the edge of the roof cause there was a rail you could hold on to, our legs would hang over. And college students would come up and bum cigarettes off us when we were eight years old.

Dr. Denise: Oh my goodness. Wow, that’s precocious.

Dr. Shatkin: Yeah. So there was a lot of that going on, you know, other things happened, I was pulled over by the police, not pulled over, I was apprehended. We were smoking in a field and a couple of us. And some of the cops, I guess the neighbors heard us coughing. We were using a metal pipe and they called the police and the police came and confiscated our pipe and took a lot of information from us and never told our parents which is wild. But all sorts of things like that happened growing up. I was drunk when I was 11 at my brother’s wedding. I pulled a bottle of champagne with a buddy of mine and went off into a room and got drunk and then embarrassed my father and were dancing around the wedding clinging cans together saying here comes the bride. So, you know, I told these stories in the book.

Dr. Denise: Yes

Dr. Shatkin: I didn’t want to make it the feature of the book. I wanted to say that, you know, I think that what happened with me is that I was exposed to a lot. I had a lot of opportunity to make a lot of mistakes and it happened early and my parents finally sort of got the message and sat on top of me and when they did it made a huge difference and a lot of my plea in the book is for the role of parents to sit on their kids a little bit more carefully than they want to, it’s not comfortable or fun for us, but it makes a big difference. I mean really monitor them, and be with them and engage with them, you know, spend time with them. This is a big part of what helps our kids to stay safe.

Dr. Denise: Well we’re going to go there. I just wanted to have everyone here, kind of a human approach that Dr. Shatkin was once a child and teen. And I know that your parents really clamped down when your grades were dropping, they had you quit the band and football and then you went from B to A’s. And then I can share, when I was, I think 13, one of my wildest friends, she was just so much fun, her dad on New Year’s Eve was like took us up to the counter Jess, I couldn’t believe, this is like an example of what not to do as a parent, and he sort of let us pick alcohol to drink and this was our first time drinking alcohol and we got, we literally blacked out that night. We were 13 years old and I remember one time, you know people would drag race. And I remember going 100 miles per hour at one point down a street. So we’re going to dip in now to why the tween brains, the teens and young adults, which by the way we know extended it’s, we’re going to talk about the time span of that. And so I wanted to make it real that you and I both were with this age at one time and you know we have resiliency and self- efficacy that’s gotten us to this point, but let’s go there. Let’s start now about why our teens and tweens and young adults take risks from a neuro developmental standpoint, hormonal and peer standpoint.

Dr. Shatkin: Yes, so there are a bunch of reasons, and invincibility isn’t one of them. Now I just want to give credit where credit is due in terms of the idea of invincibility, while almost every young person, with rare exception, and I haven’t found exceptions yet, so I say rare, extremely rare exception. Well most young people will tell you that the risk of these terrible things happening is very, very high. Some of them, not most in my experience, but some of them will say that they do certain things to prevent these bad things from happening. So they may have unprotected intercourse, but they pull out in time. And they know how to do that. And that would be considered optimistic bias. There is some of that with some young people, and for those few people who have optimistic bias being clear with them about the fact that, in the example I just gave, that men often have some, or boys often have some pre-ejaculation, some sperm does come out of your penis before you actually have an ejaculation and that you can get pregnant that time. You know, some bits of information for some people are important, but the vast majority do not believe that they’re, well no one believes they are invincible, as far as I can tell, and a few people have optimistic bias, but the reality is that adults actually have just as much, if not more, optimistic bias as young people. So while I want to give credit to the fact that some people do have some optimistic bias, it doesn’t account for risk taking still. The reasons people take risk, are really, it looks like a neuro-biological based on everything we understand at this point. And there’s a handful of reasons and I’ll lay them out and we can go into much detail as you want. But the first thing is how the brain is actually purposefully designed and how it comes online in terms of how it talks to itself and the kinds of parts of the brain that develop, namely that the emotional part of the brain limpic system develops earlier than the prefrontal cortex and is better integrated with the rest of the brain earlier than the prefrontal cortex and takes a while for the prefrontal cortex, which is really the brains CEO, the chief executive officer, the guy who makes the decisions and plans and is organized and has good memory of recent events, that part of the brain takes a longer time to get networked. And I don’t think that that’s a mistake, I think that’s a purposeful outcome of nature. So that young people will take risks. I think born to be wild is the title, which is a pop title, but the goal really is of that title is to say, hey this is actually, you know, adolescents are doing just what they’re supposed to do according to evolution – take risks, because we need some thousands of people in our species to run across the hot savanna, find the new water source, find the new mate, outrun the elephant and take it down in a battle so that we can have food. And if we don’t sacrifice some thousands, we’re going to die, of course the millions in our species won’t survive. So we are built this way, some of us are going to do those things, and then they’re going to pass those risk taking genes, those risk taking memes, or ways of approaching the world, on to their prodigy. So that’s the first, and really overall arching concept, then there’s a number of others, the fact that dopamine is higher in the brain, how the hormones work, which is new to us in terms of how we understand them now, how peer effects work and why peers are important to how we engage in behavior, how the social attachment to the pain system work in the brain. So all of those things I’m happy to talk about in more detail. But the first example I gave is the overarching kind of reason…

Dr. Denise: Well and I think educating, I think one of the points you made in the book is also the way now, how do we talk to our teens? How do we talk to our preteens? And, I what I love is that programs like Scared Straight and all those don’t work. And I think we should just jump in and discuss why they don’t work, and how important, you were sort of stating that the quality of how we give the gist of what would happen for the kids. For instance, I want to kind of go through like a specific example Jess, like that one about unprotected sex. I think you talked about if there’s a 5 percent chance what we would do, you and I as clinicians, and also as parents, how we can talk to our teens and tweens and explain what is going to work in helping them because we can’t hijack, I think one of the big things you talked about is that, we can’t give our children when they’re 14 years old the experience, the life experience, that you and I’ve had, and what we can do as parents, clinicians and educators, as we can effectively communicate with our teens and provide the support system so they can make the best decisions, so that they don’t get into crisis. So can we go through some examples of that so that people get some real ideas and tips and tools on what they can do in their homes and we can then integrate it with your concepts of the book?

Dr. Shatkin: Sure. Well, do you want to start with, you mentioned why those programs like DARE and things don’t work?

Dr. Denise: Perfect. Let’s do that.

Dr. Shatkin: Maybe we start there; DARE, Scared Straight, even driver’s education, sex education. In many cases these programs have zero tolerance policies, and in many cases these programs have actually made things worse. There is effort to improve these programs and some of the newer iterations that programs may be better, the data isn’t really there yet. But what I can say about what’s been done in the past is that most of our effort in health education and risk prevention with kids has been focused on teaching them that they are at risk, because we have assumed, erroneously as we described already, that kids think that they’re invincible because we assume they believe they’re invincible and that’s why they take risks. All of our efforts have been focused on, don’t you see you’re not invincible? Don’t you see that driving 100 miles an hour while drunk can get you in an accident, if you have an accident boy you’ll be sorry, you’ll be dead or you’ll be maimed the rest your life or maybe worse you’ll kill someone else and have to live with that. You don’t want to go through that. So therefore don’t drive drunk and don’t drive fast. So these kinds of admonitions succeed in so far as kids believe the risk is really high these things are happening. I think it’s because we talk to our kids this way through DARE and Scared Straight that our kids think wow bad stuff could really happen, the risk is really high. They get that but it doesn’t change their behavior. And, in fact in many cases, it works against us and we see more risk from kids who’ve gone through these programs because these programs scare the hell out of them and then they get a little bit older and they find their friends are smoking grass and still getting pretty good grades, or still on the swim team or we find that they’re not becoming heroin addicts or whatever else it is so maybe it’s OK to smoke grass and maybe the cops who told me it was so bad were really full of crap. They didn’t really know what they were talking about and so they kind of rebel against the message and even go far the other way. So there are a lot of reasons related to this idea of invincibility and are unclear understanding of that historically that has led to the programs that we’ve developed that have essentially not been working. So what we know now is that if we understand the reasons kids take risks, the way the brain is built, the way the hormones work, the way the brain’s pain system works, then we could actually target interventions, some of which can’t change that of course, but we can have empathy for our kids, understand where they’re coming from, recognize that they’re not doing these things because they’re personally angry at us or trying to get back at us or trying to show us that they’re so smart and capable, but really understand where they’re coming from, and then we need much more thoughtful about the kind of strategies we employ.
Dr. Denise: Right. And I think the neuro developmental piece is so key. So when you’re explaining to your kids, teens or patients that the CEO the brain is the logical part that really has a deeper connection to the limbic system and the emotional part after age 26. Right? So when I was explaining that I drew a brain to someone, a teen in my practice, and obviously I relate to them, they tell me if they’re smoking pot… But I said to them listen, you’re at the age where you’re going to want to do things because your friends think it’s cool. And this is why, because in the moment, and I think you called it hot cognition versus cold cognition. Right?

Dr. Shatkin: Yes

Dr. Denise: In the moment, you’re like, oh my gosh, like your limbic system which is your excitement part of your brain, if we just want to make it really simple. And you’re like wow that seems like fun and that seems like my peers are going to want to do it. So when you’re in the moment, when you’re faced with should I smoke a joint or should I have unprotected sex. That’s the time when you’re wanting the most social acceptance. And we’re hardwired neurologically because our limbic system isn’t fully myelinating and kind of develop with our CEO of the brain; and then also all the hormones, the dopamine system, the hormones, the testosterone of all wanting that connection, that human connection. And so I think the education piece, I think you made a really great point in the book, is that when we are talking to our kids, our teens, our patients, to do it in a state where they’re not, they’re in cold cognition. Can you talk a little bit about hot and cold cognition and sort of the best time to teach and maybe the qualitative tips to give someone?

Dr. Shatkin: Sure. So that’s a great place to start. So we know that when kids hit about 16 their frontal lobes are well developed enough that they can have logical conversations on just about any topic and they can make really good decisions. They can make decisions just about as well as adults can often. You know they don’t have the experience and sophistication and knowledge of a lot of areas, but still they can make some really good decisions that are as good as any adult would make. But when they are around peers, when they are observed by peers, or think a peer might be watching them, their behavior changes a lot and they start to take more risks. So we would call that a moment of hot cognition, hot because there is some pressure or intensity there that is making them engage with the world a little bit differently. And, you know, my son said to me the other night, this is so funny, literally last night he was in bed. It’s Monday today when you and I are talking, so this was a Sunday night. It’s a little of a Sunday night anxiety blues as you head into the week sometimes, and you say, you know, I don’t want to go to school tomorrow. You know. It’s so relaxing to be home or with my friends on the weekend and I go to school and there’s so much pressure and I feel like I’m not even the same guy I used to be. He’s 16 now, almost 17, he says you know he used to be so friendly and so brave with everybody. And now I sometimes feel a little shy around people or a little bit like I need to just act a certain way and I’m thinking about what they’re thinking about me. And the reality is he’s exactly where he should be, his brain is exactly where it should be. That’s typical, if he weren’t thinking that he would be strange. And so first of all acknowledging that, you know, instead of saying to your kids get over yourself or stop thinking that way, it’s like no, that’s exactly what he should be thinking because this is the time, evolutionarily speaking, when our kids would go off and mate and they would procreate and they were lucky to get the best mates and the best most fit mate and the healthiest, most attractive, whatever it is mate. And so you have to be concerned about what your peers are thinking so get that mate.

Dr. Denise: Absolutely. And I think one thing you said is our adolescents are living with a caveman brain in modern day society.

Dr. Shatkin: Yeah, evolution happens really slowly, but our society moves at light speed. I mean, think about the fact that, you know, when I was born there were no color TVs and now everybody has color TV. You can’t find a black and white TV, and we didn’t have cell phones and you and I we were in residency when cell phones came out. And yet in the in the early 90s or something or late 80s I had a phone that they could be about 100 feet from the controller, you carry around your house the remote phone that was radical you know. So much has changed and our access to things has changed so much, our speed has changed and the knowledge moves so quickly. But our bodies, our biology change over millennia, they don’t change that quickly. So that’s exactly I think the point. As a result we need to be thoughtful about our strategies and recognize that in moments of hot cognition our kids need a lot of help with what to do. So one of the things you brought up a moment ago, was the idea of planning for these moments and acknowledging as parents that, yes I can have a conversation with my kids at the dinner table and say, don’t smoke, don’t drink or you know what. You know, be careful the party tonight, or don’t overdo it at the party tonight. But that’s not really going to have any effect because you’re having that conversation in a moment of cold cognition. And when the kids are around their friends, we know from lots of experimental evidence and studies and interviews observations, that when kids are around their friends they are going to behave differently. I talk about that in my own experience in chapter two when I talk about my trip to Germany how I behaved differently with my peers than I did at home. And you know when I was drinking or climbing Withal Tower or whatever dare I was taking, and the same thing happens with our kids. So we need to plan. One way to plan, to help them be prepared, is to actually talk about the likelihood or even inevitability of these situations unfolding. So you say, look I’m going to let you go to this party, which parents may not want to do ok, but if a parent decides, I’m going to let you go to this event or this party, you can be pretty sure as a parent if it’s high school party and it’s not well supervised there will be alcohol, there’s going to be marijuana, there might be cocaine. I mean it just happens. You know maybe not a ninth grade for everybody, but by 17 or so, that stuff is happening. And so how are you going to handle that? Are you going to forbid your kids to go to those events? Which is one way to do it and may make a great deal of sense. Are you going to make sure your kids are in very structured activities so that they don’t do those things? And that’s another good approach. If they do go how are they going to handle that? And even if they don’t go to these parties, just being in high school they’re going to be exposed to these things at lunch, outside the building and the after school time, at the gym when the gym teacher doesn’t show up. You know someone’s going to be smoking grass, someone is going to be doing something. So how do you prepare kids for that? You prepare them by having these very frank conversations, you prepare them by role playing. you prepare them by getting them ready for actually what they’re going to do and making their decisions in advance so they don’t make the decision at the moment of hot cognition because they’re much more likely to make a decision that puts them at risk.

Dr. Denise: And also, the data that you drew to this information is so important for everyone listening, we have the data, and this actually applies, not just to parenting, it would be your mentoring style, your style as a physician or an educator. I think we can kind of transfer that when we are looking at authoritative versus passive versus authoritarian style of giving information to our teens and tweens. Dr. Shatkin can you talk about that? That to me is a great template for how we then give the support and how we give the information to really have it be firm and caring boundaries that are given to our teens that actually respect us. Because if they respect our style of communication and the time we spend with them, whether it’s at our home or in our offices, they’re more likely to connect with the information and then follow through.

Dr. Shatkin: Yeah, absolutely. So back to the 1960s when a woman named Dana Boundrand??? at UC Berkeley was studying kids in preschool and she started to observe the styles of the kids and what the kids were doing and how their parents engage with them. And what she found was that the parents who were not permissive and indulgent, and the parents who were not authoritarian like you did just because I said so, but the parents who were, what she called authoritative, who had very clear limits and guidelines but were also loving and engaging to their kids. So they gave effective commands, they gave positive reinforcement. They selectively ignored what they could ignore. They were very clear with their kids, but they weren’t going to let the kids get away with stuff either, that those parents had kids who behaved better in school. And she followed those kids for a few years and she found they behaved better in not just preschool and kindergarten, but in elementary school. She followed them a few years more, she found they did better on their SAT’s in high school. The other kids who were raised by the other parenting styles, she found that even in adulthood they had more satisfying jobs, more satisfying relationships, and now we know that even in their 50s those individuals as parents are authoritative, not overly harsh and authoritarian, not overly permissive and indulgent, but those parents who drew clear guidelines, who were warm and loving, and they’d also say here is what your expectations are very clearly, that those parents have kids who are less obese, who are in better physical shape, who have less hypertension, diabetes, who have higher levels of education, more satisfaction with their jobs and their spouses. Those early onset sort of patterns that the parents created led to kids who are now adults who are happier and more successful.

Dr. Denise: Excellent and in Dr. Shatkin’s book there’s a section that talks about authoritative, warm and involved ways to be and there’s specific examples about praising the good behavior, what effective commands are, selectively ignoring, scheduling and positive rewards so you can, when you purchase his book, and get this book in your hands you can look at that and then I think Dr. Shatkin since you and I are both into prevention and well-being in mental health I want to jump to the points about screen time in social media, because I think you and I are in absolute alignment of how to handle that. But I think I was, one of my big points when I was just taking the launch into more of a global arena is that there’s been such an increased suicide rate in society and it’s really interesting that it parallels from the late 90s till now. And so I think your book Born to Be Wild and looking at the way the children, teens, tweens and young adults the way their brain is and the way people respond on social media, I think if you could talk about the study that the FMRI study that showed with the online gaming, if you could explain that so we can then have a discussion about prevention and mental health as well.

Dr. Shatkin: There’s so many studies that reference which one are you thinking of?

Dr. Denise: The one where they were playing a game on the computer and they thought it was a peer and the FMRI study showed that the way people experience pain because I think this is such a crucial topic that it almost is like its own other podcast. But couldn’t you just go for it?

Dr. Shatkin: Yeah. So this is the work of Nancy Eisenberger at UCLA and she’s done some really interesting work. She was a graduate student at UCLA in Cognitive Psychology and she wanted to understand why it is when you ask someone what’s the most painful experience in your life. Why it is that they almost never talk about something physical and almost always talk about something emotional. When you say what’s the most painful thing that’s ever happened to you people almost never say, oh when I broke my leg, when I had a surgery on my gall bladder, whatever, they may, but the vast majority of people say things like, oh God when my girlfriend in high school broke up at me or when my wife and I got divorced or when my child got cancer, these are the things that really hurt people. And so she started to wonder if the brain’s pain system is on the same plane as the brain’s emotional system in some way. So she set up an experiment, a really thoughtful experiment, where you bring a child, she’s done it with children, she’s done it with college students, she’s done it with young adults, adults and she basically brings them in and puts them in a scanning device functional MRI which looks at the blood flow in the brain and tells you which part of the brain is active as you do certain tasks or activities. And so she said I’m going to put you in pod B and you’re going to be here in this FMRI, you’re going to be watching the screen, you’ll be playing a game called Cyber Ball. And in this game you’ll just be playing catch with the other kids your age who are in FMRI’s screening room one and screening room three. You’re in room two and you guys will just be playing a little game back and forth and we’ll ask you some questions before the game and after the game and that’s it. It’s very simple. We’re learning about the brain and the kids would say fine, thank you and they go into their scanner and for the first five minutes or so they’re playing this game with these other kids in the scanner and the ball is being bounced back and forth and everybody’s playing nice fair catch and then after a few moments the kid in the middle scanner or the adult in the middle scanner starts to get passed by, that is the kids in the other two scanners on either side of them, which they don’t see because they’re in different rooms. They start playing ball and kind of doing monkey in the middle, beating that kid out. Now, in point of fact, there’s no one in the other two scanners. These are simply sort of a mock experiment where the kid believes there are other kids there, and the kid is being left out. And when you watch what’s happening with that kid’s brain. Well, first of all, when you survey the kid before the survey they’re nice, normal, typical kid, they like other people etc.. And when you survey them after they come out of the scanner they say you know I felt kind of bad, I got angry, I felt left out, I felt hurt because they started playing monkey in the middle and not letting me play catch. And when you look at their brains during this experiment, you find the same thing, you find that they actually felt real pain. The parts of the brain that signal pain, that get excited when you stub your toe or break an arm or get poked with something, that those same parts of the brain that register pain registered this emotional being left out and the conclusion of the research team, and this has never been replicated not only at UCLA, but elsewhere, the conclusion of the research team is that when you leave someone out, that painful feeling they get is due to this social attachment system which seems by evolution to have piggybacked on the brain’s pain system, and this makes a lot of sense because it’s so important for us to couple, and to be successful with other people because that’s how we succeed. We don’t pass our genes on without a mate. We don’t build a family without a mate. We can’t protect ourselves very well without other people in our tribe and people we connect to. So being left out, particularly when you’re an adolescent, has to really hurt you because if it didn’t you wouldn’t respond to it so acutely. So our kids will do anything to avoid the pain of social exclusion. And that’s what this research is really about. And this is one of the reasons kids take risks because they don’t want to be left out. So when you don’t get tagged in a Facebook photo, when you don’t get invited to a party, that has to hurt you a real lot so that you pay attention to it, and will do things to avoid that happening to you. One last thing just to top it off for people. This pain is so real, that if you take kids who have this painful experience in the scanner and you give them Tylenol, which is a non-steroidal anti-inflammatory-meds.com medication that’s available over-the-counter. their brain actually cools down and they don’t show as much pain in those sensors and they tell you they feel better. So, even these pain medications actually work to dull some of the pain, which also might help explain some of our addiction. Many people who become addicted to substances of abuse are people who are in a lot of emotional pain. And this helps to dull that pain.

Dr. Denise: The implications of that research in itself was so profound because it’s what I believe. So I think what’s happened with evolution and all of our technology, is as parents and educators and doctors, we have not caught up on how to educate our children. To me, Dr. Shatkin, we should have in our schools, which we’re going to jump to schools too, I’d like to see, we have an integrative kindness curriculum in my son’s school that I’ve talked to you about before, the Mind Up curriculum. But I think we need to have – how to know your own neuro style, how to understand the brain, why you would want so many likes, why you could start to feel not OK. And I’m wondering if, are you planning on doing another version of this book to kind of address, almost like a tips and tools book or maybe we can discuss that another time because I feel like there needs to be curriculum integrated, wide spread, so the people are educated so that the parents don’t just say, oh you shouldn’t be on your electronics as much or you shouldn’t… to me if they understand the quality of why we could have a lot more prevention.

Dr. Shatkin: Yeah I think it’s important. I think that, I don’t have another book planned on this at this moment to answer your question, but I do believe that we should be teaching neuroscience in schools and I think again, we’re just a little behind the curve. Much of the data I’m talking about really just came out in the past decade, and that’s why most people don’t know about it because clinicians can only keep up with so much stuff, and we have to keep up with the therapies and the medications and the diagnostic tools and their rating scales and all those things. We also have to make a living seeing patients, and so there is, it takes a while for this message to get passed on. But I think also since schools and parents are often concerned that we don’t do too much character education in schools, I think starting with neuroscience is a great place because what you find is that if you understand the brain you can make a lot of difference. So that’s one thing, I do want to also point to another thing I talk about in the book though, in a couple of chapters I talk about in how people make decisions. Our intentions only map to our behavior about a third of the time, which means that we might intend to do things like, you wouldn’t find anyone in America, or anywhere in the world probably, who doesn’t know that exercise is good for you or that eating a low fat diet or a modest fat diet is good for you. Or that being more slender as opposed to more heavy is good for you. But we don’t all get there in terms of maintaining that diet, doing that exercise regimen and managing our body weight well. Now some of this might have to do with biological reasons we don’t yet understand, but the point is that everybody knows this, but 30 percent of America is overweight or obese. So we’re not able to do it for some reason. That’s because our intentions don’t always match up with our behavior. So explain the why back to your point matters. There’s no question that we should be explaining the why and we have to do more than that because the why won’t make everybody change their behavior.

Dr. Denise: So let’s jump in with real examples. I feel very fortunate, I live in a beach city where, let’s just talk about what the information in your book and sort of how to apply that to real life. So at my, at the Manhattan Beach schools, they have the Mind Up program, which is Goldie Hawn’s program, which includes a mindfulness, all based on neuroscience, like my son today was talking, my son’s eight, right before school he was talking about the hippocampus and memory. And so in our schools we have a program that’s teaching the kids about their brain impulsivity. They have mindfulness integrated. And then once a week, Jess, which I’m so happy to say, they have a school assembly on Wednesdays, which is outside, kids wear their school colors, and we do the Pledge of Allegiance, we sing the school song and then there’s Acts of Kindness Awards that are given from kindergarten to 5th. They also give awards for who’s been walking to school and also who’s been recycling. And they also, they do not allow sugar snacks for birthdays, there’s no sugar snacks allowed at all on campus, because they get nutrition. With the students and parents we have to volunteer to do to teach our kids different things so art, movement, all the things you talked about in your book that are so important are integrated into our elementary school curriculum. So my son would say, oh gosh mom, I just had a popsicle. I’m like, I know we got to limit the sugar, but I don’t say never have a popsicle because then he’ll probably binge eat later. So can we talk a little bit about kind of the research we have and how much that supports the resiliency and self-efficacy in tweens and teens and how that matches up.

Dr. Shatkin: Yeah there’s an increasing amount, you know, back in the 70s, it’s funny, I mentioned earlier that I grew up in the Bay area, just north, a stone’s throw from San Francisco. And so my upbringing was filled with things like playing new games where there were no winners and everybody competed, but they didn’t compete against each other, they competed against the game itself or where there was a lapset everybody would sit together and sing songs and there was always campfire things and there was mindfulness back then, there was practice on breathing. I learned to deep breathe and do restful breathing as a child. But there was no data for these things back then and so people kind of viewed it as a little goofy, a little, you know, hippy dippy, and that was OK for the 70s, but then the 80s came and more about making money and our whole society changed and a lot of those practices went away except for some fringe elements who kept them going. Well what’s happened in the last 20 years we’ve developed now, increasing amounts of research showing that, you know what, a lot of these practices actually work. Not only does breathing and meditation work, but yoga works and exercise works, and all of these things help to regulate the nervous system, calm us down, increase the contact, the connection between the emotional brain and the CEO, or the frontal cortex, so that the emotional brain can be a little bit better managed and controlled when it gets a little out of touch and it gets a little angry or a little too hurt or whatever it is. So these practices like breathing and meditation, again all the mindfulness things related to concepts like yoga and exercise, these really work. There are things that we don’t know work at this point, and we still try them, like there’s not a ton of data on gratitude and kindness these things. Most of the studies that have been done have been done amongst people who are doing these things without control groups. So we see improvements, but we see improvements in lots of practices when we don’t compare them against randomized control groups. That doesn’t mean they’re not worth doing, it’s just we don’t have the data on that yet, but there are a couple of things that we really know. We know that mindfulness meditation, mindful practices like mindful walks and mindful eating. We know that yoga and we know that exercise, cardiovascular exercise, really do work to help control emotions and calm us down and give us tools we can use. And I think strongly that we should be teaching those things in schools and having those as part of our practice. We just got a lot of data that they work.

Dr. Denise: Absolutely, a lot of the different guests I’ve had on my show, I talk about different forms of mind medicine, which is prevention, and so much of the literature is also showing the role of inflammation. So different food types that we choose can cause our fat cells to become inflamed. I had an interview with Dr. Lori Shemek, I’d love for you to meet her maybe you’ll even want to have her on your radio show. And so I think what you talked about in the book is very basic things of exercise, which I think from Dr. Frailties from Harvard, when I listen to her, we want 150 minutes of moderate exercise, vigorous 75 minutes. We want to have mostly leafy greens, nuts. We want to have our protein, but we really need to do more of a plant-based diet, and then we have the sleep study. And, by the way Dr. Shatkin, can talk about your sleep work at NYU and what you do with your students because I think those things right in there, if we can get nutrition, sleep and exercise, there’s a lot of prevention in those three care categories.

Dr. Shatkin: Absolutely, and that’s a big part of what I think we need to be doing in schools that we’ve left out. And that’s a chunk of my book as well. This idea that we have moved away, in education, from a lot of the things that we know are going to help our kids to regulate the engagement with good nutrition, that nutrition in schools is about as bad as it can be. On average, the exercise programs, which are shrinking in schools and the regulation of the time of schools so our kids can actually get the sleep they need, and the amount of homework we give them, and extracurricular activities we expect them in order for them to get into a quote unquote good college. So we have a lot of pressures working against us and getting back to some of those very basic things that that you and I thankfully had more of when we were growing up in schools; exercise, sleep, nutrition make a big difference and clearly help kids, the work I do at NYU. Years ago when you and I were both residents, I saw a case of a kid who had a very tragic outcome from a sleep disorder and that started thinking about sleep and I’ve spent a good chunk of the last 17, 18 years thinking about sleep and learning it and educating my peers and writing about it and doing studies in it. And we found that we can actually, with education alone, we can improve people’s sleep. And if we started that earlier, I do that work with college students at NYU, but we can start earlier and we’re just publishing a study now on students that took a class with us, a full semester course, but they improved their sleep based on that class. We build a unit into class where they actually had to log their sleep and do some practices and then follow it up again and write about it and so forth. But we haven’t done that randomized, controlled fashion, we will but some groups have and they found some benefit from that. If we start teaching sleep early that’s important. More important is building our systems and our own lives so that we actually get to sleep. And then our kids learn from us and we know that the problem is, of course Denise, is that we can get by without sleep.

Dr. Denise: I know and I have to admit I mean in residency we had to. Right? So you and I were sort of primed for getting not enough sleep.

Dr. Shatkin: Yeah. And, in fact, in our society it’s kind of a mark of courage or a badge of courage.

Dr. Denise: Like it’s sexy, like roar. I just did like only four hours of sleep and I can take my kids to the soccer field and start writing a book. You know what I mean?

Dr. Shatkin: That’s right. And so we have these real expectations of ourselves, imagining that five hours of sleep is probably enough and then on the weekends I get seven hours. You know, that’s not enough. They are very few people for whom that is enough. And most of us really do, as adults, need seven to nine hours of sleep and you can bank some of that sleep, yes you can catch up on the weekend or take a nap for what you don’t get at night. It’s not tragic. Our brains, particularly in adolescence, when we don’t get enough sleep, we can still do single brain function. So that if I don’t get a lot of sleep before math test I can still do the algebra problems for the most part. That’s OK. But what we can’t do is well we don’t get enough sleep, is integrate different parts of our brain. So yes I can do it an algebra problem, but when you give me a word problem and I’m under-slept and now I have to juggle lots of different ideas using reading parts of my brain, interpretive parts of my brain, math parts of my brain. Now I’m going to really struggle. So writing an essay is much harder under-slept than it is to do basic math, but doing math word problems makes it pretty hard too. So you and I study a lot of science to be physicians and some of those science problems we could do pretty well without sleep so we would do that. But what we’re counting on our adolescence to do all the time is make decisions. Should I have sex with this person or not? Should I drive drunk or not? Should I try this drug or not? Our kids are out there in the world, no matter how much we protect them, they’re faced with these situations and with less sleep, they’re going to make worse decisions.

Dr. Denise: Absolutely. And so one of the things I want to do is just kind of go through. So from a parenting standpoint Dr. Shatkin and I address the importance of authoritative parenting, which is firm, kind, caring, involved and having discussions with our children, role-play, things to give them an idea and a platform. We have the data that shows that they make better decisions and then from the school’s standpoint Dr. Shatkin and I spoke about the importance of integrating wellness strategies such as good nutrition, good sleep, good exercise, mindfulness, yoga, and character programs. And then Dr. Shatkin’s a book tag this, we have the data to show that from the specifically from the schools. Can you just discuss the Iceland data? The data and what happened cause I mean that’s just a fantastic example. Of how that can then have resiliency and prevention from a mental health standpoint.
Dr. Shatkin: Yeah Iceland has done some great stuff in the last decade, again which I don’t think has gotten enough airtime. They had, like every country, problems with kids smoking lots of cigarettes and drinking alcohol and getting drunk, and binge drinking and all of that and they instituted a few policies that would seem somewhat radical, like a weeknight curfew for kids under, I think, 16 of 10 P.M. on a weekend curfew of midnight, which helps because then kids have to stay in and not be hanging out in the city parks or roam the streets. They also built a lot of in-school programming and extended the school day so that everybody has after school programming. And the result of this is a longer school day, but the reality is that if you have your kids starting at 9:00 in the morning for high school, which is an ideal time, 9:00 or 10:00 in the morning. I know it’s hard to, but it’s for a variety of reasons, but that’s a good time because they’re more awake by then and you extend the school day to five or six at night. In fact, you don’t need our kids getting out of school at 2:00, 3:00 o’clock, like most of our high schools, cause they just go hang out at the mall a lot of these kids and they’re just sort of roaming the streets and they’re not doing their homework necessarily

Dr. Denise: Or they’re on their screens.

Dr. Shatkin: Or they’re on their screens, right. A lot of well-behaved kids who were just playing games and hanging out. So if we build conscious programs for them in the schools and the afterschool programs at the YMCA you have them doing arts and crafts, playing in a band, doing sports, doing theater or whatever it is they like doing and you give them some options. You find that the rates of smoking and binge drinking, premarital sex or unprotected sex, all those things tend to go down. And Iceland’s had great success with this. They’ve also, for families that don’t have much money, they’ve given leisure passes or leisure cards to them, and they give families of low income some money, a few thousand dollars a year. It’s not a ton, but it’s something so they can take their kids to amusement parks, so they can take their kids bowling, and do things with their kids on the weekend, evening, afternoons, so that their kids have some meaningful engagement with the parents. And these are really good uses of money and they’ve seen cigarette smoking drop many fold, which is a huge issue because cigarette smoking still is targeting teenagers and tweenagers, it’s basically designed to get kids addicted when they’re young age, because then they smoke their whole life, buy the product forever. Smoking is still the greatest cause of preventable death in every country in the world. We kill a half million people this year, just about, every year in this country from cigarettes and that’s a big chunk, that’s more than driver’s accidents, that’s more than the affects of obesity or diabetes or hypertension or whatever else.
Dr. Denise: Well and I’m glad you just brought that up because that ties back into our understanding of the neuro development of the teen and tween brain right than all the data supports. If you’re CEO of the brain isn’t sort of communicating with your limbic system, don’t do it, don’t take, don’t try that cigarette, don’t drink that alcohol, don’t have unprotected sex. We know that more mental health issues the earlier our children and teens start trying out substances there’s more of a chance for addiction, there’s more of a chance of mental health issues. And so one of the things that you and I both know, I don’t think we mentioned in this show is that 50 percent of our youth start having lifelong mental health issues before age 14 and 75 percent before what is it age 24? And so all of these tips and tools that Dr. Shatkin’s talking about. You know Dr. Shatkin has a master’s of Public Health. He went on a whole journey that he talks about in his book. But we’re talking about prevention Dr. Shatkin and I would prefer you not need to call a psychiatrist, that’s why we’re having this podcast, he’s writing these books. And, but here’s nothing wrong with calling a psychiatrist from a wellness perspective, but we’re talking about prevention. We’re talking about early intervention and even if you have a family history of depression, anxiety, ADHD. All of these tips and tools of good exercise, sleep, nutrition, mindfulness, are going to have you have a more resilient outcome in knowing your own specific neuro style.
Dr. Shatkin: I think that’s great and I think that’s exactly right. Our job is to put ourselves out of business. And yeah there are a lot of things that we can do for ourselves and sometimes we need a little help, we need a little therapy, a little medicine, that’s all good and that can affect everybody at every level. There’s nothing wrong with that. We also want to do everything we can do ourselves to prepare ourselves to manage these kinds of difficulties.

Dr. Denise: Yeah, I look at it as tools, I talk about things with my patients and my families. There’s just a lot of tools in our tool box and we don’t want to pass judgment but we want to do no harm. And we want to set a foundation for health and well-being and there’s nothing wrong if someone needs to go and see a physician or possibly be on meds, but it’s a very important decision to make and it should be done after all these other wellness strategies have been implemented. And then the other thing I just thought here wrapping up Dr. Shatkin, that I think. Can you discuss, this is so incredible, the way you address this in your book that extended adolescence is good for neuroplasticity and health for life and sort of the flexibility in cognition versus rigidity etc..

Dr. Shatkin: Yeah. So you mentioned this earlier when we were talking about the brain, that one of the key developmental changes that happens during adolescence is that we lose gray matter, gray matter is the neuron cells themselves, and we use them naturally about 1 percent per year starting in our teen years or maybe around 11 or 12. And that’s replaced by white matter, so the volume of the brain doesn’t change, the weight of the brain doesn’t change. But the white matter is like the superhighways or the freeways that allow messages to be passed. This is the myelin coated fat, fatty sheave that coat the neurons and allow messages to be passed quickly and for the brains to recover more quickly between transmission of messages so that things can look 3,000 times faster. Which is why adults, as they get older, are able to make decisions often more quickly and to integrate more parts of the brain when making a decision. When the brain is tired as we were talking about before, these superhighways don’t work as well which is one of the reasons why when we’re tired our decisions aren’t as good because we don’t integrate our thinking as well as we could. So as we age, we replace gray matter with white matter that happens about 1 percent per year at least starting around 11, 12. We’re not sure how far it goes but probably until the early twenties and during this time that’s the usual progression. For people who end up in a job right away at 17 or 18 , they start working at a grocery store, they go off and they do something very serious a task that requires them to be an adult and grow up right away, that transition from gray matter to white matter happens more swiftly for those who go to college, travel the world for a year, have a lot of different ideas in their head, start thinking and learning new things, start learning a foreign language at 20 or continue learning that language, go live in a foreign country at 22. For those people, the prolongation of how long it takes for the gray matter to turn over to white matter is slower. And there seems to be a real advantage in that when you look at the animal kingdom. Animals that have a longer childhood have more flexible brains as adults and they have more, they’re more open to change and opportunity, so that if you have a lot of education growing up and if you have a, I’m not talking about an extended adolescence like drink for longer or have unprotected sex for more years, that’s not what I’m talking about, we’re talking about exposure to new ideas, exposure to types of thinking and cultures, exposure to languages and foods, those who are getting more diverse pallet of those things throughout their early years, teenage years, early 20s, will have more gray matter. They have a more flexible brain, what we call a more neuro plastic brain and they’ll be more flexible adults and they’re generally going to be people who are better at problem solving and thinking outside the box.

Dr. Denise: And that is a big key factor in resiliency. So if you’re having any mental health challenges and you have this level of resiliency you’re able to make better decisions that are more flexible, you don’t get stuck, cause a lot of times of rigid thinking, you know we can all have that at times, it’s just part of how are hard wired, but this flexibility gives us a more open mind to ways to be well to engage in the world and progress.

Dr. Shatkin: Absolutely. And I think that this is just all the more reason, and you know, there’s a lot of concern I think parents have. Are we being too indulgent with our kids or are we over babying them? I’m still paying for my kids cell phone and he’s 32. You know there are things to adjust and to think about. I think that parents have to handle some of those specific things on their own, but at some point around 26, 27, 25, whatever, we are ready to be grown up and there are still brain changes going on some of the more recent data suggest even till 30, but at least until the mid 20s having an open, exploratory perspective is very helpful. The average age at which medical students start medical school in the U.S. is now 25. The average age for my class over 20 years ago was 26. That’s actually a really good thing. It’s OK to go right into medical school from college but it’s also fine to take a few years off, play in a band, work at Starbucks, work in a lab, do something that, you know, travel the world, learn, go live in Mexico City for six months and help with the earthquake and learn Spanish. This kind of stuff really expands somebody’s mind and it helps them to see the world differently. We’ve known it observationally for a long time and we know neurobiologically it makes a difference too.

Dr. Denise: Excellent. So Dr. Shatkin, can you let us all know how we can reach you on social media, your web site, as well as how we can order your book that’s being released next week?

Dr. Shatkin: Yes. Thank you Denise.

Dr. Denise: October 3rd is the release.

Dr. Shatkin: October 3rd, the book comes out October 3rd, it can be bought from all booksellers, it’ll be in bookstores. It’s also online. It’s, the publisher is an imprint of Penguin/Random House so they have a good distribution it will be available all over. It’s in hardback, it’s in Kindle, it’s in audio book if you want to hear me read I, and it will be in paperback a year from now. There will be book events running all over the country. For the next year or two talking about the book, I’m going to PTAs, I’m really interested in going to PTAs and talking to parents and teachers so if you have a meeting and you’re interested me being there. Give me a shout because I would be very happy to do that. I have a website which is d r je s s p s h a t k i n dot com or Dr Jess P Shatkin dot com. I’m also on Twitter with the same handle. I’m on LinkedIn. I’m on Facebook, Dr. Shatkin page. So lots of places to reach me. But if you Google the book or my name Jess Shatkin and the book you’ll find a lot of information on it.

Dr. Denise: OK and I’ll link everything up with the show. The other thing that comes to mind is do you have a YouTube channel?

Dr. Shatkin: You know, I do but I don’t have anything on the book there. I have stuff about child psychiatry there, it’s child psych doc.

Dr. Denise: OK. You need to have a YouTube channel Jess.

Dr. Shatkin: Yeah, maybe, I got to probably make some videos first though.

Dr. Denise: I know, I’m just having fun with you. We’ve got to get this information out. I’m so appreciative of your work.

Dr. Shatkin: Yeah. Well thank you Denise, I really appreciate your appreciation and I appreciate you having me on the show and I’m thrilled to talk about this. So if people want to learn more take a look at the book, give me a call, shoot me an e-mail and I’m very happy to come speak with you more about it but I think there’s some basic understanding that most of us have not had and I know that if I didn’t have it, and I’ve been in this field for over 20 years, then obviously a lot of people don’t have it. And then beyond that, this translates into some of the tools that we’re observationally, we’re learning now, are great tools, but we’re also getting the data from them that they actually do work. So it leads to a whole new area of excitement.

Dr. Denise: Well that’s fantastic. So thanks again for being on the show and I hope to have you on again.

Dr. Shatkin: Yeah, my pleasure. Thanks for having me.

Dr. Denise: OK, thanks Jess. Bye. Thank you for joining us today on the Dr. Denise show. If you are interested in more mental health tips, tools and discussions. I’m also on the web at Dr. Denise md dotcom DRDENISE MD dot com. I’m also on Twitter at Dr. Denise MD and on Facebook. OK. Thank you again everyone. Have a nice week. Bye-bye.

Happy New Year!

I am truly humbled as I sit here and reflect on what an amazing year this has been on this journey of spreading positive messages about mental health and collective wellbeing!

WE are so powerful when remember that LOVE for self, family, community and ALL sentient beings is the key ingredient for physical and mental wellbeing. I am grateful for all of my guests on my podcast, my followers on social media, my friends, my family and ALL of you!

Cheers to 2018 being a year of manifestation of many seeds that WE all have been planting in honor of service and love.

I look forward to connecting with all of you daily @drdenisemd on Twitter and FaceBook! You inspire me and I thank you for that!

Love, light and Happy 2018!
~Dr. Denise

Dr. Denise and Cam Adair Parenting Video Series

It was such 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 and 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

#1 Dr. Denise and Cam Intro Video

#2 How To Build Resiliency in Kids

#3 How To Not Raise a Bully

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.