Blossom Your Awesome Podcast Episode #126 Talking About Mental Health With Dr. Josh Bess

Blossom Your Awesome Podcast Episode #126 Talking About Mental Health With Dr. Josh Bess

On the show for episode #126 Dr. Josh Bess is here with us. Dr. Bess is a psychiatrist and we are talking bout mental health. What is happening in terms of improvements in treatment and why some choose to look for treatment while others don't.

Dr. Bess is a highly regarded teacher and psychiatrist. His clinical interests include ECT and other brain stimulation therapies, thoughtful pharmacotherapy

If you'd like to learn more about Dr. Joshua Bess click here.

Join us for an insightful conversation.

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Transcript

Sue Dhillon:
Hi there, today on the show, we have got Dr. Josh Bess here with us. I am so honored and delighted to have you here. Thank you so much for being here. Welcome to the show.

Josh Bess:
Thank you for inviting me.

Sue Dhillon:
Oh, I'm so excited to get into the work you do, your background. So give us a little bit of the background, why you became a psychiatrist.

Josh Bess:
I intended in medical school to be a pediatrician or a family doctor because that's what I knew from growing up. And several of my friends kind of nudged me into thinking about psychiatry. And when I did a rotation, my third year of medical school, I just fell in love with it. I had a great mentor and I was working with people who really needed help and I felt like I could connect with them. And it was a complete, you know, I guess I wouldn't say 180, but a definite departure from the original plan, but then jumped in just full on from there.

Sue Dhillon:
Okay, and now Dr. Best, tell us, I mean, did you feel that,

Josh Bess:
you

Sue Dhillon:
you know, for you kind of making this transition and saying, I wanna go into psychiatry

Josh Bess:
you

Sue Dhillon:
instead, did you sense or feel that there was a need for just more or like a lack of kind of help and treatment that people are getting or a lot of kind of, you know, not clear understanding around how to get the help?

Josh Bess:
Oh, for sure. You know, very quickly in medical training you learn that, you know, there are some things that just aren't taken as seriously or some people who aren't taking it seriously or who aren't getting the help that they need. And then they will be in some other setting like the emergency room or the primary care clinic. And you're working with physicians and providers who aren't too shy about letting you know that they're not really feeling equipped to handle this type of problem or to give this person the help that they need. And that there aren't enough resources for mental health or for psychiatric purposes. problems in those settings. And so that was apparent very, very early on. My hope is that that has changed somewhat since I was in training some years ago. And I know that the psychiatry programs at least have been expanding and have been matching more residents over the last 10 to 15 years. So that's good news. But we still are woefully understaffed. And the, you know, the workforce is aging and a lot of people are getting out of medicine, especially in the last several years through the pandemic. And so, you know, the problem is kind of shifting, but there isn't enough help even yet.

Sue Dhillon:
Okay, and you know, this is really interesting that you say that, you know, there's this dynamic happening where the professionals are aging. There aren't as many younger professionals coming into this field, but it seems like we're having a younger and, you know, correct me if I'm wrong. I know it seems like it's always been prevalent, but we're just talking about it more, especially with the younger, you know, kids, teens,

Josh Bess:
That's right. Right.

Sue Dhillon:
right?

Josh Bess:
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Sue Dhillon:
So it's always been there, it's always been an issue, but it's now we're more aware of it because there's more conversation.

Josh Bess:
Both there's more conversation and less stigma and shame, although both those are still a problem. I also think that life has changed and demands are increased. And somebody can be neurodivergent, let's say, or have something like attention deficit disorder. But if they're not expected to perform in an academic setting, or at some high level tech job, maybe they wouldn't even need or come to attention for help. Back when more than half of the people lived on farms and it was an agricultural economy, people were somewhat tolerant of the cousin that was a little bit different. And now we have such demands on us, and humans, especially in the Western world, And people are expected to live independently and support themselves and be productive members of society, etc. etc. And I think that also contributes to the increased attention on problems that people have when they're not able to do that. So it's coming from different directions. And I think it's great that the stigma is less and that the shame has decreased and people are more out in the open. helps me working with my people that I work with, but there's also the other side where you know you could probably be okay in previous decades or previous centuries and that's just not the case now.

Sue Dhillon:
And you know, you as an expert and a professional here, what is your take on, you know, I mean, social media, we just had another school shooting today, right? I think in

Josh Bess:
Yeah.

Sue Dhillon:
Nashville, and it was a girl, a female this time, which was just,

Josh Bess:
Surprising, right?

Sue Dhillon:
yeah, very surprising, but you know, social media, online bullying, I mean, all of this stuff, such a huge contributing factor, right?

Josh Bess:
Yeah, yeah, it's, and it is a comparison. It's a, you know, it used to be called keeping up with the Joneses. And there is so much, even if you're not being, say, bullied or if there isn't, you know, active negative comments coming at somebody who's on social media, specifically adolescent or young person, they're still comparing with, you know, what they look like to other people and what clothing they're wearing and what they're doing. And there is this fear of missing out and just the things that are going through the minds of people who are still developing and still trying to figure out who they are and where they fit in. And it can be both a great way to connect with people, but also very isolating. I just read an article yesterday, and I don't hide the fact that I'm a father as well as a and I have teenage kids too. And I just read an article yesterday about, in a way, our kids are blessed to have these avenues, these networks to connect with people who are like them. When I was growing up or the generation ahead of me was growing up, we were friends with people who were just around. And maybe they weren't our best friends, but they were people that we spent time with. And I think the article even called them good enough friends, right? But now our kids can connect with people who have their exact same interests, who have, you know, maybe they're, you know, interested in the same subset of anime, or they're interested in this type of engineering, or this type of video game, which is fantastic. But then, of course, on the flip side of that, it's isolating because they're in their room, they're not out playing in the neighborhood, hey, why don't you go outside, you know, they're not connecting necessarily face to face. parents and as people in the caring professions who are working with kids, we have to understand that yes, it's different, but still be on the lookout for the dangers or the things that could be harmful to them. And so maybe instead of a van pulling up and taking somebody from the park, which was my mom's fear, it's the social media bullying or the social media comparisons or predators in that space too, which is a lot harder to be aware of and track.

Sue Dhillon:
And I think also just this idea of like kids kind of growing up so fast because they're being

Josh Bess:
Yeah.

Sue Dhillon:
exposed, right? And so they kind

Josh Bess:
Right.

Sue Dhillon:
of think, oh, they know stuff or they feel like adults because they're interacting and seeing things that, yeah, it's all so unfortunate. So now, Dr. Bess, talk to us about, you know, as far as treatment goes for certain mental health conditions. Things evolving there from a medical front, like are there better treatments? Is there better medication? Is that being enhanced? Because we don't on the outside really hear much about that, right? It seems like a lot of times people are still, you know, being given these kind of old school, you know, therapies or treatments or drugs or things. So talk to us about that.

Josh Bess:
It's a pretty exciting time to be in this field. There are things that are happening at a really fast clip, a surprisingly fast clip, actually, now that even, let's say, 10 or 15 or 20 years ago, I don't think would have been expected. It's sort of focusing on the here and now. There's a lot of attention on psychedelic, medications or psychedelic substances for helping people who have either mood disorders like depression or post-traumatic stress disorder or have been traumatized in some way. There's real pharmaceutical industry-backed, government-sanctioned research going on, clinical studies of compounds either based on arrived from psilocybin and MDMA. And there probably will be some FDA approvals coming in the next year or two. And in addition to that, some states, Oregon comes to mind, have started to relax some of the regulations around people possessing or taking these substances. And they're trying to put programs into place to have guides and psychedelic experience. that experiences that people can have. So that's happening really fast in a way you know some of the old guards so to speak are you know worried about it and are saying you know kind of raising some warnings which I think is appropriate and we all should you know be skeptical and be cautious and you know kind of as things evolve make sure that we're doing things for the right reasons. But there's that whole space ketamine gotten a lot of press in the last five to 10 years and is much more widely available than it used to be as a treatment for mental health conditions, specifically depression is where most of the research is, but other things too. And I see people who, they may have actually tried a course of ketamine treatment before they did try any of the more quote unquote traditional antidepressants. As far as what we would think of as antidepressants go, yeah, it is kind of mostly the same kind of thing. There are these brain networks that haven't been as explored before. Some of this is coming out of the ketamine and psychedelic research. And so then pharmaceutical companies and researchers at academic institutions are trying to figure out is there a way to make a medication that can take advantage of some same receptors or some of the same, you know, networks and connections in the brain as ketamine or the psychedelics do. So there's some work going on there. But for a lot of people, it does then sort of go back to, you know, an SSRI like Prozac or Zoloft or, you know, an SNRI or some of the other medications for depression, at least that we've had for some time.

Sue Dhillon:
Okay, and now, so tell us, you know, with some of these medications, I mean, it's like a band-aid really, because these aren't curing the ailment, right? We're not really getting to the root of this and kind of helping that go away. But is that, so just affirm that that's correct and then tell me as far as like the psychedelics and things, are those like having the same effect? Or will those potentially help cure a condition?

Josh Bess:
I tend to think of things in kind of very broad strokes and one of my instructors in medical school talked about lumpers and splitters and I'm definitely a lumper. And if you think about, if you look at all of the interventions that we have in mental health or in psychiatry. the goal is the same for all of them, which is to somehow correct something that isn't firing right in somebody's brain or isn't kind of the brain's not communicating with itself in a way that's helpful or maybe it's communicating too much in a way that's not helpful or that's deleterious to how the person's trying to live. And so there's lots of ways that you can make The final common pathway tends to be, for any of these interventions, tends to be there's genetic changes, there are receptors that are upregulated, downregulated, new connections are made, and the person can come out the other end and be more ready to live whatever life they want. And that's how I focus, that's where my focus is when I'm working with people, is to tell them, I'm not trying to turn you into something you're not or change your personality, have to change in any way at all. You're coming to me because you're not, you know, content, you're not happy with how things are. How can we get you to where you want to be, right? How can we get you to be able to have meaningful relationships or, you know, move on from this one if that's not working out for you or succeed in this job or find a new one, like whatever you really want to do. So I think that gets to your point, which is, you know, Prozac or ketamine have a nicer boss or make you be able to, you know, move to the city that you can't afford even though that's where you want to be, but can help you cope and can help you kind of start to work toward alongside psychotherapy or counseling, alongside some lifestyle changes, can help you get to where you're more capable of doing that. So it's not fixing your problems but it's helping you cope with your problems, giving you resilience to get through these tough times and eventually helping you earn or helping you work toward those skills. And so I see the interventions like what psychiatrists do as the ways to bolster people's resilience and to help get them through the phase that they need to get through to go on to what they want to achieve. You know, there's a lot of work that's done around. resilience and coping and how, you know, you're not born with depression. You're born with a certain amount of resilience and a certain vulnerability, right? And then life happens. So we're talking about the adolescents with social media or there's other traumatic events, of course, that can happen to somebody as they're developing through, through their childhood and adolescence and into their twenties. So you're, you have this set of resilience and, and coping and this set of vulnerability skills. And then something happens. and that kind of interacts, and then you might come out and you're in a depressive episode, or you have a post-traumatic syndrome, or you have an anxiety disorder because of these things that are happening to you. And so where treatments can come in and be helpful is to build up that resilience, to help you cope with, to get through either processing the one that happened before, or getting through the next one, or the current situation that you're in. What is getting some traction is the idea that psychedelics, for example, or ketamine can do that faster. It can short circuit some of the, I shouldn't say short circuit in this context, I guess, but it can kind of take a shortcut that used to take four to six weeks if you started medication or maybe even several weeks or months of psychotherapy. And it really, this concept where your mind or your brain to making new connections and to really healing itself, it can just, that happens in a shorter amount of time. And so I think that's how I see it. I don't see it as, you know, in that big broad view, fundamentally different from any other intervention, because it's still kind of the same idea that the brain is changing for the better, but it can happen very quickly. people who are in the right setting and who have the right support and help, that's great, you know, but it also then brings in some of the risks because you can have a bad experience or you can have a wrong dose or something like that. And so that's where, you know, the caution also needs to be paid attention to.

Sue Dhillon:
Mm-hmm. And now Dr. Best, tell us, you know, what are the myths around mental health that you're aware of, you know, that we kind of things we need to demystify here? Because I feel like there's a lot of bad information or, you know, misinformation

Josh Bess:
Mm-hmm.

Sue Dhillon:
out there.

Josh Bess:
Yeah, I mean, the one that just continues to plague us, and you mentioned the school shooting and the society here in the United States where we have that happen on such a regular basis, the thing that continues to plague us is that people with either mental health problems, mental illness, whatever you want to call it, are dangerous. That's part of the situation. The counter argument is that the vast majority of people who are struggling with something that we're working on with them or that see a doctor like me or see a therapist, the vast majority of those people are vulnerable. They're more likely to become a victim than be some sort of perpetrator. And yes, there is a tiny minority that grabs the headlines. And there are people out there who, for whatever reason, you know, do something terrible or horrific and affect other people's lives and, you know, end up on the news. But I can tell you almost to one, the psychiatry community, you know, we brace ourselves when something like I haven't read anything else about the shooter today except for that it was a girl and where the school was. the next thing, which will be she wasn't on her meds, or she was on meds, or she asked for help and didn't get it, or she was getting help and they didn't catch it. I mean, it's always kind of pinned on this inability that we have to predict when somebody is going to do something so terrible. And by and large, it's not the thing that they're seeing me for or seeing a therapist for that causes this thing to happen, that causes them out. There are exceptions, there are always exceptions, but that's the myth that I really wish people would be able to get past because then, you know, perpetuating that myth allows us to not do anything about it, to give lip service to, oh, we need to improve mental health programs or mental health treatment and then sort of walk away and look away. from other interventions which would be, and have been studied and are much more likely to be effective there. So there's one. The second one I would say is the bootstraps myth that you don't need help. I didn't need help when I was a kid or all the people in my family are mentally healthy. I don't know what your problem is. We actually see this every day like on our Facebook page you know, Facebook page where people are saying, I don't know why people can't just go outside and take a walk in the sunshine. And, you know, why do they need this ketamine or why do they need TMS, you know? And so that would be the second myth that I really wish people would just understand how hurtful it can be to someone who's suffering to hear that. And some people end up hearing it over and over again. And it can actually, you know, can actually dissuade them from seeking care. And I see a lot of people who've suffered for years because maybe their family wasn't supportive of them getting professional help, or maybe they just felt such shame needing to ask for it. And it can be such a eye-opening experience for them to actually feel better with either a therapy or a medication or some other treatment. They just didn't think that was possible. They thought that they had some sort of personality flaw. Those are the two big ones.

Sue Dhillon:
And then I also, you know, like I feel like people throw some of these terminology around so loosely, right? And don't realize that, okay, these are, you know, potentially really serious conditions that do require attention, right? Like, oh, he's got ADD or he's just, you know, dyslexic or, you know, just the different terms

Josh Bess:
Right.

Sue Dhillon:
that are thrown. You

Josh Bess:
My

Sue Dhillon:
know,

Josh Bess:
clothes

Sue Dhillon:
oh,

Josh Bess:
match.

Sue Dhillon:
he's,

Josh Bess:
I'm so OCD. Yeah, exactly. Yeah,

Sue Dhillon:
yeah,

Josh Bess:
yeah,

Sue Dhillon:
right.

Josh Bess:
yeah.

Sue Dhillon:
So

Josh Bess:
And.

Sue Dhillon:
Oh, okay, sorry, go ahead. You were gonna say.

Josh Bess:
I was just going to, right, or, or, you know, a celebrity who, who does some kind of outlandish stuff and then, you know, they're kind of vaguely admitted to the hospital for something and, and, you know, sometimes there's a real problem there. Like it's an actual, like you mentioned, bipolar or something like that illness. Other times, you know, it might be substances and might just be that they have an outlandish lifestyle that that's just what they do. Right. full.

Sue Dhillon:
Okay, and now, you know, for people who don't know, like, as far as some of these conditions go, I mean, they're, when people do, because it seems like a lot of people, some of your patients included, and just in general, people who go to get help, they've kind of been living and struggling with some of this stuff, right, for a long

Josh Bess:
Yeah.

Sue Dhillon:
time. Before they, what finally gets people to, you know, get over the fear of getting help, or get to that place where it's like, okay actually I need to go get help for this.

Josh Bess:
Right, so there's this concept of hitting bottom. I think that came out of alcohol use treatment where you're not gonna necessarily get help until you just can't get any worse, I guess, in a way. So I definitely work with people who never thought about getting help or didn't think they needed help until maybe they were admitted to the hospital or maybe even made a suicide attempt and we're meeting them after that part of the hospital. So that's hitting bottom. You know, there may be there's a relationship that's really meaningful to them and that's the incentive and the impetus for asking for help. You know, my wife said that she's going to leave me or, you know, my kids don't want anything to do with me because of my problems and so now that's my, you know, that's my incentive and that happens a lot. You know, work or school, evaluations and you know kind of feedback that you're just not meeting expectations or not something you're you're not performing or you're not living or you're not acting in a way that's expected I guess I would say and so that can you know get people get people's attention for sure you know it's a pretty common thing you know we're talking about ADD or ADHD and you know I used to I were you I used to see a lot more college students I I see some now, but not as many. But you work with all of these, I work with all of these really bright, super intelligent, and motivated people who got through elementary school and middle school and high school, and they get to college or maybe even get into graduate school or professional school before they're starting to struggle. And they just can't believe it because that's their identity. They've been a great student. And they don't know why they can't get it together in, say nursing school, right? And well, as it turns out, if you go back and look, they've built up these coping mechanisms or these other ways to kind of get through. And they're very bright, even though they obviously have had ADHD all along, or they've had anxiety or panic disorder all along. When things really, really get tough, when they can't use those sort of cobbles together coping mechanisms anymore, it's when they to see somebody like me, right? And so that happens too, like where if life just gets hard, first baby or big promotion or loss of someone, loss of a parent. And then I also see people, I talk about this a lot actually, I see people a lot, especially men, stereotypically, after they retire, because their whole identity has been their career, their job, their family, whatever. And suddenly this thing they've been looking forward to, like, I'm going to spend time on the of course, but they're not fulfilled. They don't know what to do with themselves, you know? And so that's another thing, like where, what do I do with myself is a reason why people get help.

Sue Dhillon:
Wow, and this is so fascinating to think. So a lot of people who could be doing a lot better with help are kind of just coping and getting by and managing.

Josh Bess:
Yep. And I'm always very careful because, again, I don't have an expectation for somebody. I really try not to say, well, you got straight A's in school, so you should have a high-level job. I think some of the smartest people out there have figured out that that's not worth the cost, that that's not worth the stress. And they would rather spend meaningful time with their family or other loved ones you know, or do other things that are important to them, then just go after the next promotion or the next big thing. But I do say, you know, we talk about what do you want to do though? Like are your problems, whether it's depression or anxiety or attention problems or whatever, are they keeping you from doing the things that you do actually want to do, right? So are you too depressed to take your dog out to the park, even though that's your favorite thing to do Are you so lonely after your breakup? And really, you want to make a connection with somebody, but you're too anxious. You don't leave the house because of your anxiety. That's what it comes down to, right? So people that could be doing better, like I guess I always try to make sure that it's clear that we're not talking about in like a society's view or in terms of income or fame or whatever, but in terms of what's meaningful for them and what they're able to put together in their lives. To make it. you know, something that they're wanting to live.

Sue Dhillon:
Mm-hmm. And now wanting to get into some of the types of treatment that you do. I know one of your specialties here is the electroconvulsive therapy. Can you

Josh Bess:
ECT.

Sue Dhillon:
talk to us about this and some of the other treatments and how does this go hand in hand with like medicine? Is it like a combination really wanting to know Dr. Best. So it seems like there's these alternative means of treatment, like aside from medication for

Josh Bess:
Yeah.

Sue Dhillon:
mental.

Josh Bess:
Yeah. Yeah. So, you know, ECT is a bit of an outlier in that it's been around for a very long time. We've been practicing ECT, you know, for almost 90 years and has been really just in some ways, it in some ways, it's probably the most and most misunderstood intervention in all of Western medicine. I go to conferences where there are active protests at the hospital where I've worked. There have been people protesting against the fact that this treatment even exists. And I can't think of other medical treatments that have that problem. I don't think the cardiology conferences are met with protesters. So it is both misunderstood. and it does have a dark history in some ways, but for the last 60 years has been an exceedingly safe and very effective treatment for people who don't have anywhere else to turn. And so ECT is the controlled induction of a seizure in somebody's brain that then the seizure itself and or the that the brain does in order to stop the seizure are the healing mechanisms. And those then make these new connections that I was talking about. They allow the genetic changes to happen with the up regulation and down regulation of different receptors to this final common pathway of being able to sort of move forward and go on building your life again after a severe illness. It is nothing short of life saving for some people. Like, you know, we see people who, you know, have not responded to other interventions, which you know and have had very good people trying to help them and very good trials of other things. And ECT is what finally turns them around, especially people who are suicidal or who are so depressed or have another neuropsychiatric illness where they're not eating and so then they're losing weight and that's a very bad situation. Things like that. Out of ECT in a way, or at least kind of adjacent to that, we now have an armamentarium of things that are in a way aimed at the same idea. We're stimulating the brain in some way to get the brain to communicate differently with parts of itself and then to sort of rewire these connections. The ones that are too active and get people stuck or the ones that need to be bolstered in order to get people, stuck. And so I would put the next thing would be TMS or transcranial magnetic stimulation. It's very far from ECT. There's no seizure. There's no other things like that. But we are directly stimulating the brain, a very specific spot in the brain, in order to then send signals deeper in the brain into other parts to where it can start to make these new connections in order to heal. something that has been a lot more available and accessible in the last 15 years. And it's helping a lot of people who before that may have ended up having to go to ECT, right? So we can have another option to offer people. And then there are people who benefit from a treatment called vagus nerve stimulation. That was FDA approved about 20 years ago or so, a little bit less than 20 years ago, and has been undergoing a resurgence. as we're trying to study it more to see who it really does help. And so that's an implant where there's an electrode then attached to your vagus nerve in your neck that is a way to get into the brain without actually having to go in to your brain with surgical instruments. And the implant sends electrical signals in a certain pattern in order to then make the same types of changes in the brain. And the remarkable thing about that is people who have these implanted, these are people often who have not even responded to ECT or TMS, and they are still suffering. Or maybe they've responded to one of those things, but it doesn't last. It doesn't stick. And you can't just keep doing ECT three times a week forever. And so we have one of these devices implanted. And over time, their symptoms and their suffering dissipates. these studies where they've looked at people over five years even, more and more people who have this implant have continued to get better and stay better, to stay in remission. And so that's a very promising and exciting intervention. There was a lot of excitement in the last several years about deep brain stimulation. So that's a technology used for Parkinson's disease and for tremor. It's been studied for OCD and was being studied for And it seems like the scientific community there kind of got a little bit ahead of itself and the study wasn't going so well. So we've since, you know, gone back and recalibrated and we're trying to, you know, kind of do it again and make sure that we take into account some of the things that weren't taken into account the first time around. And so that's still promising, but kind of a longer way off. And then there are other things that are variations on that theme, you know, different ways to potentially elicit a seizure. the electro part of it, and then different ways to stimulate the brain in specific spots that are in trials. And so there's that whole set of things called kind of brain stimulation or neuromodulation or neurostimulation, which then will, yes, go along with or be adjacent to or in conjunction with medication, including potentially ketamine, psychedelic medication, et cetera.

Sue Dhillon:
Wow, and now you would think and help me understand this. So some of this treatment seems like it would work for like even memory issues or things, right? Where you could kind of zap out some of that plaque and maybe help re, you know, form new neuro pathways and things.

Josh Bess:
Yeah, some of the, especially the TMS and then some of the related neuro stimulation devices have been and are being studied for that. It gets complicated, I think, in the level of severity of the, let's say, dementia that you need in order to then be able to measure improvement. And so I think it's a matter trying to figure out who's at risk or is there a prodrome so that we can intervene sooner. Because by the time somebody might come to medical attention, like we talked about, they may have been dealing with something for some time. And again, someone who is smart or has had a successful career, maybe they have a close family that sort of makes up for some of their deficits or maybe sometimes people are in denial about what's going on and a year or two goes by And then by the time they come to get tested or be seen by somebody, it's already moderate Alzheimer's disease or something like that. So if we can predict who's going to be at risk, if we can screen people or get them sooner, then I think that there is a lot of promise with either specific stimulation or other whole brain interventions that can help. And hopefully someday, and I didn't even get into some of the interesting kind of way out there technologies but there's ultrasound technology, there's infrared that people are using, there's optogenetics where you know you you can tag certain genes and then if you use a light you can activate them or turn them off. I think some of that's going to be really promising for something that seems to be quite quote-unquote genetic like Alzheimer's.

Sue Dhillon:
Wow, this is all so fascinating. And I feel like we're just kind of scratching the surface here.

Josh Bess:
Oh,

Sue Dhillon:
I have

Josh Bess:
yeah.

Sue Dhillon:
so

Josh Bess:
Yeah.

Sue Dhillon:
many more questions for you. But so a couple of things here. One, some of these conditions like bipolar and certain ADD, I mean, people aren't necessarily born with these conditions, correct? They can just,

Josh Bess:
Right.

Sue Dhillon:
I mean, they can develop them in adult.

Josh Bess:
Right. In a lot of cases, you're born with certain vulnerability. But there are people, and some of this is theoretical because we don't really know. I mean, we can do twin studies, right? So the twin studies are where identical twins for whatever reason are raised in different environments, right? They don't come out exactly the same. So that is the nature versus nurture thing, right? That's the classic example. But you're theoretically could be born with of vulnerability toward, let's say, bipolar disorder. You have all the genetic material there that could make that into something that happens. But maybe you never have the precipitant or the trigger or whatever it is that is that first episode. Or you do, but it's very mild and doesn't kind of come to clinical attention. So you have to have the second piece, which is the life event or the trauma or the thing happens. And for some people, it's not like, I shouldn't give the impression that you always know exactly what that was, right? We always ask people, was there something that seemed to correspond with this or that happened right before that was very significant or traumatic for you? And sometimes people don't know what it was, but maybe it was a series of things over time. There's an idea now with complex PTSD in a traumatic situation over a period of time. It's not just a single trauma, but maybe multiple traumas or just being in a stressful situation for a long period of time. But then sometimes people say, oh yeah, I got mono and I was really sick for three months and I missed school. And two months after that, I was more depressed than I've ever been in my whole life. And it all fell apart from there. So sometimes you do have that history, sometimes you don't. But yeah, you're born with this vulnerability. And it comes out, you know, if the right mix is also there. And sometimes you're, you know, people, and this is another reason why people sometimes don't get help right away. They think, well, what do I have to be depressed about? You know, my life is great and my relationship is great and I have these great kids and I'm, you know, partner in my law firm or whatever. And so maybe they're getting that message from the outside, they're thinking at themselves. I know these, all these other people, they're much worse off than me. I don't need help. I just need to figure it out. And that's what happens, and they don't get help for a long time.

Sue Dhillon:
Okay, now Dr. Bess, is there, there's got to be, or I don't know, tell us a component where like you're saying people don't get help because they're like, oh, I don't need it or this and that because there has to be an element of, you know, like anxiety when you do actually acknowledge it, right? I mean,

Josh Bess:
Oh yeah.

Sue Dhillon:
how could potentially trigger or make your condition worse?

Josh Bess:
Oh yeah, yeah, yeah, yeah. And you're, you know, you might have some self-developed coping mechanisms. You might have, you know, some, I mean, I guess this is another, this is a way that people get into substance use or alcohol use because they're treating, you know, medicating themselves, quote unquote. Um, this is also where, um, you know, this, you know, that things are kind of. The walls are closing in, so to speak. Um, and you don't really know why. And. things just aren't going well. And then they're going more poorly and they're going more poorly until, you know, whether you think of it as that hitting rock bottom or just things kind of falling apart or whatever it is, that thing happens. And then when you reconstruct and you go backwards, you can often, not always, but often put together, you know, at least several months or a year or a couple of years of things like, well, I just wasn't doing as well at work, because of a promotion, but then they took away my extra responsibilities. My kids moved out of the house, so I didn't have to deal with them. My wife and I didn't talk as much. You know, the kind of things that just happen in order. I don't want to minimize, however, how huge it is to ask for help. I mean, even if it was easy, it would be hard and we don't make it easy. You have to make phone calls. You have to be told no. You know, I have. I have children in my house with various things that they need help for. And I'm in the system. And I still have to be told, well, we're not taking any new patients, or we have a wait list, or there's no secrets that get them through the door. And that's frustrating. And sometimes if you don't have great insurance, or if you don't have any insurance, or if you just don't know how to navigate the very complicated system, that can be enough to make people just not bother or to put it off for a long time. to get it together to make you know five or ten phone calls just to be told no five or ten times is really hard.

Sue Dhillon:
And now, is there something as a clinician, you're a psychiatrist, you're doing this for a living, you're on the inside, some sort of consolation or guidance, something you could offer somebody who's on the fence here or thinks they need help or is questioning things, right? What can you tell that person to make them feel okay with? seeking the help.

Josh Bess:
I will very often tell people, there's no such thing as a perfect fit or a perfect match or program or treatment for you. People would do a lot of research. We have an amazing amount of information at our fingertips now. And so you can go down a rabbit hole of Google reviews and different programs and different treatments and reading all the literature and all the. I think it's important to make that connection first, to make some sort of connection with a professional. And whether that's a therapist or your regular doctor or a psychiatrist or a nurse practitioner or any number of people who can at least sort of start to help you with an objective point of view, navigate what is needed or navigate what they think might be helpful for you. And you know, that first person may not be the best for you. They may not work out. But you know, you've started. can kind of work from there. Maybe they can refer you to somebody who's more appropriate, or they can help you figure out what might be important for you and a provider. Putting yourself kind of being clear about what works for you and what doesn't is important. It's almost like they're kind of working for you, right? And if their personality doesn't jive with yours or if you don't trust them, that's not great, right? It was good to find somebody who you but at least get started because it's a journey for everyone. Even people who might know somebody like me, or they might work at a hospital, or they might know somebody who's researching the best, latest treatments, that's probably still not going to be the first thing that helps, right? You're still going to have to kind of put a team together and work through some things. And so I just would encourage people to start somewhere.

Sue Dhillon:
And then what about guidance for like a friend or family member? You know, if you've got someone who's resisting.

Josh Bess:
Who's resisting getting help?

Sue Dhillon:
Yeah.

Josh Bess:
Yeah, there's, you know, professional, professionally there are, you know, there are some coaches or there's programs where, you know, and a lot of this is online, of course, where the person can at least learn a little bit about what might be helpful. There's, there are programs in coaching for the family. This happens a lot, you know, especially if somebody, you know, I guess kind of the, kind of the classic example be a young adult who isn't doing so well, and maybe they have an undiagnosed illness, mental illness, maybe not, and the parents are trying to figure out why is this person still living in my house? Or how can we help them get on to the next step of their life? And people in their 20s generally feel kind of invincible, and they say, oh, I'll just figure it out, no big deal. And then the years start to go by. And so there are places where families and for support. And then, yeah, it's just a matter of, you know, if you can make some sort of connection, whether that's an outreach person from, you know, one of the local mental health advocacy groups or, you know, somebody that they trust can at least put the idea in their head, like, hey, why not at least give it a try, you know? And, you know, sometimes it's just, it won't go anywhere or they need to, they need to be more ready than maybe it's not quite as bad as, you know, maybe they don't feel quite as bad as you think they do or that you would in that situation, but, you know, just reaching out, friends, family, seeing if there's somebody who can make a connection that they'll listen to. That's really what's important.

Sue Dhillon:
Oh, I love that. That's such great guidance, Dr. Bass. Now, a couple of things. OK, first of all, you are just so awesome. You've had so many incredible insights here today. And I just,

Josh Bess:
Thank you.

Sue Dhillon:
again, feel like we're kind of scratching the surface here. I'd love to have you circle back and maybe take a deeper dive with

Josh Bess:
Sure.

Sue Dhillon:
one of these. So yeah, first and foremost, thank you so much for your time today. I feel so honored.

Josh Bess:
You're very welcome. Thank you.

Sue Dhillon:
You've been awesome. And now, Dr. Best, in closing, if there were one message, your hope for everyone out there, what's that closing message you would like to leave us with?

Josh Bess:
The closing message that I want to leave you with is. Connections are so important, but the connection has to work for you. And people get stuck in toxic relationships because they're scared. They don't want to be alone. But something has to also do something for you to support you, help you, give you, fuel you, feed you, do something that you're getting out of it too. And I think some people just aren't aren't raised or aren't programmed to take that into account when they're making their decisions about who to have in their lives. And so I think we all need those connections, but just make sure that you're getting something from it too.

Sue Dhillon:
Oh, I love that. That is such awesome guidance. Dr. Basheed, you've been so amazing. Thank you so much.

Josh Bess:
Thank you for having me. It's been fun.

Sue Dhillon:
Thank you.