06-04-2020

Mental Wealth

TL;DR

• When it comes to mental health, our society approaches it like we did with physical health 50 years ago. We only think about it when something goes wrong.

• To the wider public, mental health is synonymous with mental illness. Our notion of physical health is, however, very different than our notion of physical illness.

• We might benefit from approaching mental health like we invest in anything else in our lives (finances, relationships, careers, physical health, etc), where one builds wealth in this area by continuous, conscious investment.

• Estimates say that 83% of us will be hit with a mental health crisis in our lives, we can all make the choices to invest wisely in this area to improve our ‘mental durability’ to deal with it properly.

• In my 19 years of paying close attention to mental health, my experience has taught me that there are five foundations towards a concept I will call ‘mental wealth’ — sleep, diet, exercise, stress management, and exogenous compounds (anything from coffee to alcohol to prescription medication).

• There are simple tips one can adopt for these five areas to invest in one’s mental wealth.

The biggest risk in investing is not losing money; it’s missing out on the upside.

After 19 years of thinking about mental health, watching it go from hidden epidemic to a much discussed one, I still think there is a fundamental flaw in how we view mental health holistically.

To give a sense for how big of an issue this is, some estimate that 83% of people will have a life-interrupting event with mental illness at some point — from acute things like a panic attack to pervasive anxiety to bouts with depression or life-long symptoms of bipolar disorder (depression alone is the leading cause of disability for working age adults in America). [1]

When I say these terms and diagnoses, I want to point out that we don’t really know what they are or what they mean… we have names for them (and those names change about every 20-30 years, like the term PTSD, which has consistently changed over the last few decades), but we don’t really know what they mean. Like our medical terms “spina bifida” (split spine in Latin) or “arthritis” (meaning “joint”), we are accustomed to naming symptoms in our culture, with fancy sounding names, but we often have no idea what we’re really pointing to when it comes to causes or what is going on beneath that symptom. And we don’t really know how to treat the underlying causes of these, especially when it comes to mental illness symptoms. Outside of the recent scientifically based interest in psychedelics, pharmacology has all but abandoned it as a field of study. This is evidenced by the fact that you could have been a psychiatrist in 1999, left medicine for 20 years, and come back… and it would be the same prescriptions that you would write today as you did 20 years ago. This is not hyperbole, there genuinely has been almost an institutional abandonment of these confounding, complex illnesses by the pharmaceutical companies that are the most incentivized to make headway into such widespread epidemics and illnesses.

But here’s the shift in thinking I’ve had in recent years — which is that we only think about mental health in terms of illnesses.

When it comes to our mental health, as a society, we’re where we were 50 years ago with regards to physical health. In other words, we pay attention to it when something is wrong. And we fix (and name) symptoms instead of pursuing an understanding of the underlying issues.

Having trouble falling asleep? Oh, that’s called insomnia. Here’s a pill.

Feeling sad for more than two weeks straight? Oh that’s depression. Oh it’s really bad? It’s clinical major depression. Well, the singular important goal is to feel happy in life, so let’s fix it and try these 10 drugs sequentially to see if any of them work.

Panic attack? “Oh that’s, when panic of some sort sets in, and it feels like it’s attacking you. I’m a psychiatrist — four syllables and a shit-ton of medical school, so I know what I’m doing. Doctors 50 years ago might have prescribed (literally prescribed) cigarettes to pregnant women. Doctors back then, LOL. We’re all totally in control of the landscape of your physical and mental health now though… Here is something that will relieve the discomfort of that thing that we medically call a ‘panic attack.’”

In trying to think about why we have such little humility when it comes to physical and mental health within our medical professional realms, I struggle to find an answer (when history has shown us that it’s prudent to have a healthy dose of it). Perhaps the equation of 12 years of schooling, mounting student debt, and charging you $300 for a visit is not an inviting situation for the words “I don’t know.”

Still — I want to be clear that there is great work being done by countless medical professional individuals and groups. And there is great work, amazing work being done in the realms of destigmatization and non-medical interventions with approaches like cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), among others. And these are creating the current environment where we can explore these topics in the abstract collectively — or the acute symptoms we are feeling with loved ones and therapists alike with more positive encouragement from others than ever before, and that helps us zoom in on our individual underlying root causes… and for better or worse, it seems more and more clear that optimal mental health is an individual sport.

However, we still have a long way to go on these fronts as well. Today, from a first symptom of major depression to treatment, the average timespan is 10 years. From the first insomnia symptom to a discussion with your doctor is 15 years. Progress is being made, but we have a long way to go in continued open, public dialogue and destigmatization of these common ailments. So when you get a chance to talk about your direct or indirect experience with a mental illness, seize the opportunity to talk about it openly. There’s never been more receptivity to open dialogue than now.

Though the destigmatization and personalization of each person’s direct and indirect experience has allowed us to zoom in more openly on one illness or another, my shift in the last few years has been to zoom out.

Instead of symptoms or treatment, which much smarter people than myself are focusing tirelessly on, I’d like us to collectively zoom out to a viewpoint similar to where we are with physical health — more and more in the preventative realm rather than solely the treatment realm. More and more physical healthcare dialogue centers around things like leading indicators of illnesses (like high blood pressure, diet and nutrition, and the most innovative and head-turning fields are in longevity)… quite literally the long-view on health and prevention of the most destructive of physical illnesses.

I think it’s time for us to view mental health in that same light, something I call “Mental Wealth” rather than mental health… where it’s not a term synonymous with illness, but is an area in which even the mentally healthiest of us can still pay close attention. Can still invest in. And can increasingly raise our consciousnesses around (for ourselves and those around us), when “an ounce of prevention is worth a pound of cure.”

It goes from a lens of “fixing” to “investing” — in other words, instead of fixing something that is by implication broken, it’s investing in its durability to withstand the wear and tear that comes with modern life. And this begins well before the internal or external life-interrupting event itself (in fact, that is the whole point).

For example, instead of just thinking about fixing an acute financial problem like personal debt, wiser heads are thinking about investing in the optimal outcome with almost every economic decision; financial freedom.

Instead of fixing a mental illness when it comes across your path, it’s investing in the optimal goal with daily and weekly habits beginning as a teenager; mental freedom. After all, optimal outcomes are planned years and decades in advance. We have this understanding in other investments in our lives… financial, career, relationships, acquired skills, hobbies, etc, and we’re starting to have that with regards to mental health, and I want to further encourage that with the concept of mental wealth.

So what does investing in mental health look like?

Well, there are very few generic pieces of financial investing advice (the details and application of those details are where the yield is) — but I still think we can establish and normalize some fundamental areas, and as someone that has paid close attention to this cross-lattice work of interweaving disciplines for a while now (but is wholly not an expert on any one of them), I will kick this conversation off with what I’ve noticed.

Side-bar: Why has our medical system conventionally only cared about acute care when something goes wrong? It’s because the Western medical system evolved from medical treatments during warfare. In 2020, our medical system is phenomenal at acute interventions like surgery, and this is because the first medical professionals were surgeons saving a soldier’s life (or fixing a less terminal issue) so they could fight again in the next battle. 150 years ago, there was no consultation with the village doctor on prevention of disease. There was no discussion with a scientifically informed expert on approaches to optimal health or longevity. It was on the basis of… “I have a problem. Can you fix it?” This is in contrast to Eastern approaches like Ayurvedic medicine that is primarily focused on prevention versus cure, and though it is not well understood by Western medicine (and lacks the amazing progress we’ve made on acute treatments among other favorable comparisons towards Western medicine), it predates our mainstream medical acknowledgment of diet, exercise, and lifestyle by a few thousand years (going back as far as 6,000 BCE). You’d have to ask a scholar of why they were so attuned to this “investment” versus “fixing” attitude 8,000 years ago, but it may have something to do with the Hindu tradition of revering the human form as an expression of God (versus something akin to a proto-slavery culture in the Judeo-historical sense or the “inherently broken compared to the perfection of God” in the classical Christian viewpoint. After all, before there was a medical profession, it was the village priest or rabbi that one saw for assistance with an ailment, be it physical or mental).

Note: This concept and this list below are not meant to be points of “reference” that stand the test of time. The concept of mental wealth is meant to be a point of “departure” from how we conventionally think of mental health (ie, synonymous with mental illness).

Here are the five areas that I have spoken about in piecemeal in various episodes of the podcast and cover a few times in my book last year — and they are in this order:

*Sleep

*Diet

*Exercise

*Stress Management

*Exogenous Compounds

And all five are inter-related. In other words, are you not sleeping well? Audit what you’ve been eating or drinking (from those 3 glasses of wine before bed to a caffeinated drink at 4pm) to whether you have been exercising to sufficiently tire your body out before bed.

Really stressed? Try exercising. Really stressed and you’re getting plenty of exercise? By drinking a few cocktails before bed each night, that can disrupt your sleep, tiring you out the next day requiring more caffeine or more coffee that then keeps you too stimulated to fall asleep, and therefore, you feel the need for your nightly drinking routine.

So, let’s go over them again, and the two big takeaways I’d like you to have is just the order of paying attention to them in addition to the fact that they inter-relate — so in your own personal audit of all five, you can see which levers might be affecting the others. I will also add the biggest pro-tips from medical professionals and researchers that I’ve received over the years for each.

*Sleep

*Diet

*Exercise

*Stress Management

*Exogenous Compounds (from coffee to melatonin to Prozac to LSD, and anything in between)

Starting with sleep, my biggest pro-tip towards mental wealth here is that waking up every morning at the same time is perhaps the best professional and personal advice I’ve ever received.

Your body operates on a 24-hour circadian rhythm, so your energy isn’t just tied to the hours of sleep you get. It’s tied to an entire 24-hour cycle and rhythm that your body is biologically designed for. To get into a solid 24-hour rhythm, do the mental calculus on when that morning time would be for you (and it’s ok to break from this once a week, but even then, it is better to wake up at that time and take a nap later in the day). Let’s say it’s at 8:15am every morning, and you have a really late night that goes until 2am on a Friday night. Still, wake up at 8:15am on Saturday for a few hours, then fall asleep again as a nap for an hour if needed.

And by sticking to that biological alarm clock, you continue to reinforce it for all the days you want to wake up at that time. You will start to naturally, almost without fail, wake up at that time within 8-9 days of trying this out. So it doesn’t take very long to set this rhythm (and from personal experience, I can say that 2-3 days of waking up at different times is all it takes to get out of rhythm or reset the rhythm to another time).

There are fantastic books written on the topic of sleep, so if I try to go beyond one or two pro-tips, this will become too long, but check out books like “Why We Sleep” or even make an appointment with a trained sleep therapist to go further into this first foundational element of mental wealth.

Second, we have diet, and there are even more great scientific works on diet and nutrition in recent years (on things like an anti-inflammatory diet, eating whole foods, etc), but I am going to center my two pro-tips on this next foundational element of mental wealth on two things:

1) Get your food allergens checked and make sure you’re not consuming foods that your allergic to on a regular basis (I used Everlywell.com for their at home food allergy test recently, and it was great). This is my most recent pro-tip on here, but at 32-years-old, I found out that I was allergic to eggs… a food I would eat every single morning. The inflammatory response in our bodies to foods we’re allergic to (when it comes to mental and physical health) is like subjecting yourself to an infection or cold each day; if you’re consuming that food regularly. So first pro-tip on diet — figure out what foods you’re allergic to and avoid them.

2) Consuming multiple alcoholic drinks before bed can absolutely wreck your sleep, which is the first foundation to mental wealth.

So here is the first area in which one foundation is inter-related to the other. You can actually destroy the quality of your sleep with things like heavy meals or high carb meals before bed as well, but nothing is as scientifically pronounced than immoderate alcohol consumption (for me, it’s anything more than 1-2 drinks, and I’ll see it in my sleep tracker) before bed.

So my diet pro-tips are nixing your allergens and nixing alcohol before bed, especially excessive alcohol consumption.

Third up is exercise. I could go in many directions with this one, everything from weight training being one of the best ways for you to support the production of ATP (the body’s fuel currency and where we actually get energy from) to the fact that exercise improves mood, your metabolism, and sleep quality, but I’m going to zero in on the anti-inflammatory effects of high intensity aerobic exercise 3 times a week (which incorporates improvement to mood, detoxification, and anti-inflammation).

So this is all about using a stair-master or elliptical, cycling, or high intensity running for anywhere from 15-30 minutes, etc. 3x per week. Cycling has been shown to be superior to running for the aerobic effects, so I use our family’s Peloton for 20 min HIIT rides at least 3x a week, preferably more.

Side bar: Over the last decade, perhaps the most interesting scientific discoveries in my view, when it comes to mental health, have been primarily in two areas: psychedelics and inflammation. The first is pharmacologically interesting and the second is biologically interesting (with the second being the increased understanding that there is a strong relationship between inflammation in the body and our body’s mental health response). Inflammation is linked to everything from anxiety to depression to bipolar disorder. An anti-inflammatory diet, one that someone like Dr. Andrew Weil (who’s been on my podcast promotes is a great approach here), but I think an anti-inflammatory lifestyle that includes regular high intensity aerobic exercise is a powerful addition your diet.

Try this for 4 weeks and see what it does for your mental health (and your sleep).

Next up is stress management. From meditation to building and maintaining social connections to gratitude journaling to exercise as a form of stress management, this one is coming into the foreground more and more each year.

My pro-tip here would be that finding time to sit quietly for 15 minutes in the morning, with your cup of coffee or tea in-hand, to do three primary things has been extremely helpful for me:

1) Gratitude journaling of 5 things that I’m grateful for (nothing is too small here, from the sunrise to the laugh of my daughter will make the list),

2) 2-3 minutes of breathing exercises (google 4-7-8 breathing for a really simple breath work exercise),

3) Lastly, 5 minutes outline my to do list for the day. Taking thoughts out of your head and putting them to paper is so profoundly powerful for me. It’s like my mind gets to say “ok, great, I don’t have to keep track of all that anymore” when I put it on paper or in my digital to do list (and I just use the reminders app on my phone). My mind thanks me every time I lessen its burden with this practice.

In the effort towards simplicity over comprehensiveness, I won’t get into meditation here, but there are many other ways to naturally mitigate and limit stress (a few other personal favorites in this bucket are practicing the ‘art of undercommiting,’ being honest at all times, and morning meditation) — but if proactive stress mitigation is new for you, I don’t think there’s anything better to start with than gratitude journaling, physical to-do lists, and breathing exercises (after all, breathing is one of the only activities that is both voluntary and involuntary for the body, so it’s a way for you to communicate with the involuntary system).

You can also add the benefits of disconnecting to dopamine-inducing social media or fear-inducing mainstream news media to this list (you can read more about my viewpoint here; “The Information Pathology”).

And just to build on the point that these are in a prioritized list — no matter how much you meditate or practice a stress management / mitigation technique, it won’t make much of a difference on your mental wellbeing if you are only sleeping two hours a night if your body requires 7 or 8.

Alright, last up… exogenous compounds. Sorry for the lame, long term, but I haven’t found a better one.

As someone that wrote an entire book on this topic (“Beyond Coffee”) and started a side-project of my morning concoction ritual, I could tell you the pro-tip here is to read my book… But that’s not my pro-tip.

My pro-tip here is much simpler and a lot less work… it’s that these things, whether it’s a 5-hour energy shot, a Magic Mind shot, that third coffee, popping a melatonin pill before bed, or leaning on Xanax for anxiety… my pro-tip here is that any of these, from the innocuous to the Schedule II prescription, should be last on the list of your personal “mental wealth” audit.

In other words, it’s part of the personal audit, but the body of scientific literature that exists out there suggests strongly that this bucket should come after the fundamentals like sleep, diet, exercise, and stress management are properly managed.

So there you go.

A proposed shift in how we think about mental health as a society, from fixing to investing toward mental wealth — followed by some practical viewpoints on what that investment strategy could look like.

I hope you’ve found this interesting (and hopefully even useful).

From knowing financially uber-successful people in my career that plunge into depths of misery the moment they find out about a health crisis, there’s truth to the phrase “health is wealth”… However, if I balance that with also knowing athletes at their peak of physical health and still finding themselves in a daily, hidden depression — or knowing a paraplegic neighbor with one of the most consistent smiles and maybe the most consistent psychological/spiritual warmth I’ve ever come across — along with my own direct and indirect experience with mental illness, it makes me question our conventional notion that “health is wealth”… and makes me think that maybe, more accurately, “mental health is wealth.”

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