Positive Psychiatry - with Rakesh Jain, MD
Positive Psychiatry with Rakesh Jain, MD explores the science and practice of fostering mental wellness, resilience, and flourishing through the lens of psychiatry. Join me as I discuss articles and opinions from expert clinicians, researchers, and thought leaders as they discuss emerging strategies to enhance well-being, purpose, and strengths—not just reduce symptoms. From gratitude and optimism to meaning and connection, this podcast brings evidence-based insights into the heart of mental healthcare.
I am additionally a proud member of the Steering Committee of Psych Congress. This year's annual meeting is September 17-21 in San Diego, California.
Positive Psychiatry - with Rakesh Jain, MD
Wellness Deficit Disorder: The Hidden Epidemic in Modern Psychiatry
'Wellness Deficit Disorder':
Could we be missing something crucial in mental healthcare? Beyond the familiar symptoms that define psychiatric disorders lies a hidden dimension of wellness that most clinicians never address—despite it being what patients value most.
I and Saundra Jain introduce the revolutionary concept of "Wellness Deficit Disorder," a condition not yet recognized in diagnostic manuals but profoundly present in clinical practice. Through compelling research, we reveals a startling disconnect: while clinicians focus primarily on symptom reduction, patients rank "feeling that life is meaningful" as their highest priority, with symptom reduction ranking only fifth on their list.
This isn't just philosophical musing. Using the HERO Wellness Scale (measuring Happiness, Enthusiasm, Resilience, and Optimism), research shows individuals with psychiatric disorders score 18-25% lower on wellness measures compared to those without diagnoses. Even more compelling, neurobiological studies reveal separate neural circuits for positive emotions versus negative ones, challenging our fundamental understanding of psychological health.
The implications transform how we should approach treatment. When patients engage with evidence-based wellness practices like nature reconnection, digital decluttering, nutrition optimization, and meaningful socialization, their psychiatric symptoms often improve more significantly than with symptom-focused treatments alone. In some cases, wellness deficits actually precede symptom emergence, suggesting preventative possibilities.
This approach doesn't reject conventional psychiatry but enhances it, offering a more complete path toward psychological well-being. By addressing both the absence of illness and the presence of wellness, we can finally help patients achieve what they've been asking for all along—not just survival, but genuine thriving. Are you ready to expand your understanding of what comprehensive mental healthcare really means?
www.JainUplift.com
Well, hello and welcome to another episode of Positive Psychiatry with Rakesh Jain. I am thrilled to welcome you to another episode really a heart-to-heart conversation I wanted to have with you regarding positive psychiatry, and today we're going to dive into a concept that's becoming really important and quite relevant in modern life, something that I and Dr Sandra Jain, about 20 years ago, started calling wellness deficit disorder. So this entire episode is going to focus on what that is and what can we possibly do and also teach. Well, not just ourselves, but perhaps be the source of inspiration for our family members, for our friends. And if we are clinicians, how do we bring about this notion of wellness deficit disorder in our clinical work and help our patients, you know, thrive not just survive, but to thrive? So, first of all, I will admit it's not a formal diagnosis. Well, not yet. If I and you succeed, perhaps in DSM-6 or 7, we will finally have what is so profoundly important, which is the importance of wellness. And if wellness is deficit, why don't we call it what it is? But while it's not a formal diagnosis, it does describe a pattern that's all too familiar, a persistent gap when our minds and bodies when they need to thrive, but they aren't. So we're going to explore today in some depth this wellness gap, what it looks like, why does it happen? What can we do about it to reclaim you know, the important things in life balance, vitality, joy, purpose, resilience All of those things are profoundly important. So here's my advice Settle in.
Speaker 1:I do think this is going to be a long podcast, so please do settle in. If you're on a walk, while you're listening to me and conversing back with me, I hope in your own mind, enjoy nature, enjoy people, and if you're in your car, please drive carefully. But I'm very glad that you are listening in with me. I really am glad you're here. This gives me a real opportunity to tell you what I've been thinking about for decades, but finally I'm bringing it out in a manner that really helps me be a better clinician. Before we go any further, I do want to thank all of you. This is only my second podcast and the first one, which I put out, I must say, hesitantly, has been incredibly enthusiastically accepted, and I am just so glad it has resonated with people. I looked at who's been listening to this podcast and it's people from 12 different countries Looks like every state in the union, almost, which makes me enormously happy, because when we think this whole issue of positive psychiatry together, good things happen. I really am very glad for those of you who have reached out to me publicly, and very many of you have reached out to me privately, and for that deeply grateful. Let's grow together, shall we folks?
Speaker 1:Okay, let's move on to the next section of our conversation today, which is, of course, a better description of what is wellness deficit disorder. I will obviously stipulate it is not yet a clinical term, but you can, for the moment, be assured that when I have used this phrase in my clinical work for the last multiple years, it's been exceptionally well received by patients and clients. Often they have said that's it, that's what's wrong. Why do we always keep talking about my panic attacks and my sleep when in reality, what really matters to me is these elements of wellness that you never asked me about, and of course, I tell them they're right. I have been blind to the fact that life isn't about just getting rid of our symptoms, it's also the presence of wellness, and if you remember folks from the previous episode, I had told you Mark Zimmerman's study. Oh and, by the way, I should immediately tell you this.
Speaker 1:From now on, in every podcast, when I discuss a particular study, I will provide you with the citation in the notes, and I want to do that so that you can further expand your reading. These seminal articles that have radically changed my life. I should not keep them to myself. I want to share them with you. So, in the notes for this episode, please expect to find a lot of very important references, and you're welcome to pick and choose what you really enjoy. So, just to recap, I wanted to remind you that these important studies Mark Zimmerman is one of them.
Speaker 1:He's not the only one. In fact, the other person that I'm going to really highlight is a researcher from Europe, demetanere D-E-M-Y-T-T-E-N-E-E-R-E, who, in the Journal of Affective Disorders in 2015, looked at what clinicians think is important to their patients. And get this. I'm going to read to you the top five because it is so interesting. So, number five we clinicians wanted our patients not to feel tired and to be able to treat it. Perfect. We thought that not having symptoms disrupt our social life and leisure life is what Perfect. We thought that not having symptoms disrupt our social life and leisure life is what patients wanted. We thought number three most important was regain interest and pleasure in doing things. Number two was not feeling down, depressed or hopeless. And the number one thing we thought patients wanted was elimination of negative feelings like blue mood, despair and anxiety. You know what that looks like. A very commendable list, but here's the problem.
Speaker 1:In that exact same study, these researchers asked a different group of people and those people matter, guess what? Those are patients. Patients when removed away from the clinical room. When they were asked, what do you want, guess what? Number five was eliminate negative feelings. Did you hear me? Isn't this important? Number five, not one, not two, not three, not four. Number five. So patients do want their negative feelings eliminated, but look at the four things they wanted even more. The ability to concentrate was number four. And now comes absolutely important findings from this study. Feeling satisfied with yourself was number three. Ability to enjoy life was number two. And number one was feeling that life is meaningful.
Speaker 1:Now, where in DSM, where in the definition of major depression or GAD or a manic episode or all the disorders we take care of, where do we find in the diagnostic criteria this issue of patients saying life is meaningful? It's not there. Dsm is very important, my dear friends and colleagues, it is a beautiful compilation of understanding human psychopathology. What it's not is understanding humans. It's a different concept, right? We humans aren't just a bag of symptoms walking around going from clinician to clinician. Are we walking around going from clinician to clinician, are we? We're people with purpose. We're people with pleasures, we're people with fears. We're people who want a life to be meaningful.
Speaker 1:Now, I'm not for a second thing that our DSM is to be rejected not in the slightest bit. But I do think it needs to be expanded. Our thinking needs to be expanded, and that's why I wanted to devote this entire podcast to a deeper understanding of wellness deficit disorder. So here's the take-home message, colleagues Patients focus on positive psychology and positive psychiatry elements far more than we clinicians do, and what I will say is it's a mistake by us, not by the patients, but by us. We should fix that deficit in ourselves. And over the next oh, multiple minutes, I'm going to, if you will permit me, offer you an even deeper understanding of what wellness deficit disorder is and, of course, what do we do about it. One thing about me you will find out if you aren't already connected to me professionally or personally is that I am relentlessly practical. I really do like facts and research. I like esoteric facts, I like watching Jeopardy, but in my professional life I really like information that. But in my professional life I really like information that does something to improve the quality of care I can offer my fellow human beings.
Speaker 1:So let me now remind you of what the definition of positive psychiatry is, and this comes from Dilip Jeste. He published this in the Journal of Clinical Psychiatry. Well, 10 years ago. It is true today, it will be true 10 years from now, perhaps even a thousand years from now.
Speaker 1:Positive psychiatry may be defined as the science and practice of psychiatry that seeks to understand and promote well-being, through assessment and interventions involving positive psychosocial characteristics, in people who suffer from or are high risk of developing mental or physical disorders. Now, if you look at this definition, one is immediately drawn to the fact that even as a prescriber, I could totally embrace this definition. If what I do say 100% of my time is psychopharmacology, I could still, in 100% of my patients, employ the art of positive psychiatry, because by now it's well established. All patients what they deserve and they want, quite importantly, is not just symptom reduction and improved functionality. They are missing the third leg of the stool. They are asking for it.
Speaker 1:In a minute I'm going to be walking you through two or three prominent studies that will tell us how bad a mistake that is on part of psychiatry to have ignored positive psychiatry. So let's not forget, wellness is the third important leg of this stool. And psychopharmacologists and therapists and, by the way, if you're neither, it still doesn't matter Wellness is a key human need. It's a human right. If there's a deficit in it, it behooves us to be aware of it and, of course, to be able to address it. And if you recall from our previous podcast, I had alerted you there's not one state in the union, out of our 50 states and all our territories, that, in fact, is showing a positive trend. It's actually showing a negative trend. So, in other words, we do have a wellness deficit, not just in our clinics, but in our society, in our homes, in our friend circle. It really is a problem all over the nation.
Speaker 1:But you might well say hey, rakesh, that's a lot of talk, man, can you provide me some data to back it up? I got a lot, but I'm going to start with data that I and Sandra Jin generated on our own. We created a scale. It's called the Hero Wellness Scale, h-e-r-o Wellness Scale. I will give you a link to that too, because it can be used in your own clinic. In fact, many, many of you are already using it. Good for you. Good for you. You're elevating the cause of wellness in your thinking, in your practice, and that's a wonderful thing.
Speaker 1:Well, we conducted a survey nationwide. In fact, that's not true. We made this survey international, but we really did focus on the American landscape. What we wanted to see is how bad is, in fact, wellness deficit in our patients and how bad is it in people who don't have a psychiatric disorder? How are they doing so? Here are the results of the Hero Wellness Survey, and it's been published. It's both been postered and been published, and I'll look up the references and I'll do my very best to provide them for you in show notes so that you can check it out.
Speaker 1:So each of the four items happiness, enthusiasm, resilience and wellness are indeed on a Likert scale scale. It goes all the way from zero to ten, zero being not at all, ten being extremely so. If you're feeling quite resilient, you would pick I don't know nine, ten. If you're feeling somewhat in the middle, you might pick four, five, six. If you're on the low end, you might pick, you know, one, six. If you're on the low end, you might pick, you know, one, two, three, something of that sort. I'm going to give you, I'm afraid, quite a bit of bad news. I really am. So why don't we do this? We can certainly first focus on happiness. It's the first word in the letter hero here.
Speaker 1:What we found is, if you don't have a psychiatric illness, your level of happiness was a 6.5, which is commendable. It should be improved. I don't think 6 is thriving. Perhaps 8 is thriving, perhaps 9 is thriving We'll talk more about that later.
Speaker 1:But if people in the survey reported a mental health problem, you know what? Their mental happiness level fell all the way to 4.9, which is a 24-point reduction. Can you imagine this? Can you imagine if DSM understood this and said that major depression is not just the presence of fatigue and sadness, but it's also an absence absence of wellness traits? Can you imagine what a broader, more holistic view of depression we would have right?
Speaker 1:By the way, this news does not just apply to happiness. We looked at enthusiasm. Here too, we found a 22% deficit in people who had psychiatric disorder compared to people who were self-reporting that they were doing fine. Well, what about resilience? Here too, we saw problems. If you did not have a psychiatric illness, you reported a 7.2. If you did have a psychiatric illness, you reported a 5.9, which, my dear colleagues, is 18% less, 18% less. Resilience day in, day out, in any human being, is a recipe for disaster, and you and I, as clinicians and as people, have always been told you gotta, you know, not get depressed, don't get anxious. Wonderful, wonderful sets of advice, but have we really talked about improvement in our wellness? Well, we haven't. Optimism, by the way, looked even worse If you had no psychiatric disorder. Our survey found that the self-report of this trait, optimism, was at 6.5,. But if individuals did havea psychiatric illness, it dropped to 5.0, which is a 23-point reduction. We also, by the way, asked people to take a snapshot of the entirety of the mental wellness and I've got genuinely heartbreaking news. If they didn't have a psychiatric disorder, 7.4, which, by the way, is quite good, quite good. It can be better, we should work on it. But if you did have a psychiatric disorder, it dropped to a 5.5, which is 25% less.
Speaker 1:Why don't I go ahead and make this bold statement. It's hardly bold, I think, but let me make that. I just don't think psychiatric disorders are monolithic. I do not think they're nothing but a set of symptoms that DSM defines for us. I genuinely believe that our patients and us, when we develop psychiatric pathology, in some ways have two sets of problems. Problem one is the presence of symptoms that define these psychiatric disorders, but the other is deficits in our wellness. Now, so far, what I've done is I've presented some of my own research, but that's not fair. I really should be looking at literature across from the world, and I'm going to do it right now. So let's do this.
Speaker 1:The first study I'm going to cite here is by Spinhoven. It was published in 2015 in PLOS, one Very impressive journal, and this is looking at 2,142 participants from the Netherlands Study of Depression and Anxiety, and you know what they found. This study is so good. It's so good because, in some ways, it's a slap across psychiatry's face, because it shows that traits such as happiness, emotional well-being, literally are dose-dependently reduced, depending on the degree of depression a patient faces. So now let me add another wrinkle to the story.
Speaker 1:Not only do we have wellness deficit alive and well, and well, I was going to say thriving, thriving is the wrong word. It is festering in the hearts and minds of our patients right along with their depressive symptoms or anxiety symptoms. But it's dose dependent More depression, greater the deficit in wellness. This is a wonderful study. If you got the interest, you might want to check it out. And the same study. They actually looked at other disorders dysthymia, agoraphobia, panic, social anxiety, generalized anxiety disorder. And one more time.
Speaker 1:Bad news, guys. The bad news is this problem wasn't simply limited to depression. All those other disorders brought with it significant wellness deficit. They are travelers on the same road to misery. Will you remember that, please? Psychiatric symptoms and wellness deficit disorder travel on the same road of misery and our poor patients have to deal with both of them.
Speaker 1:So perhaps a rhetorical question I would like to pose to myself and to you. I'm a clinician what should I be targeting? Well, if we do buy the concept that we just discussed that depression and low levels of wellness are indeed travelers on the same road to misery, it seems to me the obvious answer would be I would be targeting both. Well, that sounds very nice and kind and lovely, isn't it? But I'm going to make it an even better proposition and here's the proposition and I'll be talking quite a bit outside studies that if you do treat, address directly the wellness deficit, very interestingly, that depressive symptoms improve to a greater degree.
Speaker 1:Now, did I say anything that's a surprise to you? I don't think so. It's just flat out logic. If a patient has two problems and you address both of them, the patient is further helped. This is not only true. You are welcome to check out the data from an entirely different study, and this study comes from Menezes M-E-N-E-Z-E-S, also in plus one in 2013. And they found that the risk of depression rises sharply when less happiness is reported.
Speaker 1:In other words, guys, don't let this point get away from you. In other words, sometimes depression doesn't beget depression. Sometimes the presence of low wellness is indeed the start of a depressive episode or an anxiety episode. In fact, the first problem patients often face isn't the arrival of a psychiatric disorder, but, in fact, the arrival or the presence of low wellness, which sets them up for developing a psychiatric disorder. So I think I might have just given you one more reason to consider why you and I really do need to be wellness deficit disorder warriors.
Speaker 1:Yep, that's a tough word to use. Warriors, that's pretty aggressive. That's pretty in-your-face word, but I'm beginning to wonder if our field doesn't need to really wake up to the fact that 80-90% of our patients have significant wellness challenges. 90% of our patients have significant wellness challenges. 80 to 90% of our patients we're not addressing it, and 80 to 90% of patients. If we did address it, all the other treatments we offer them might, in fact, work better.
Speaker 1:Well, as we wrap up this part of the conversation, I wonder if it's time for us to say the following that there is a hidden epidemic of wellness deficit in psychiatry. So it's time to come back to the topic at hand, which is talking about wellness deficit disorder. And I do believe wellness deficit disorder can be defined in lots and lots of different ways, but we do need to operationalize it. We cannot leave it hanging in the air, nebulous, amorphous concept. So at least what I did and because I am a genuine believer in objective data, I and Sandra created the scale. We have now validated it and validated it in both people who do not have a psychiatric disorder and those who have one what you might want to do disorder and those who have one. What you might want to do is well, it's a nice challenge I can offer you Take that scale yourself. Take the scale. What I'm saying is self-administer the scale yourself, see on those five items where are you, and then perhaps tomorrow you can take a copy of that scale and give it to 20, 25 of your patients. See if that doesn't provoke a conversation, measure the level of wellness deficit our patients have. And then let's see if that doesn't open up fruitful channels of communication between us, the clinicians, and our patients so that we can help them improve it. And we may want to be reminded and remind others that going after wellness deficit doesn't just improve wellness, it also improves the psychiatric pathology and functionality. This is a win-win-win situation.
Speaker 1:So the deficit, by the way, shows up clinically in all kinds of ways. It can show up in relapses and recurrences, patients who initially got improvement and then's faded out. It can show up in apathy, irritability, of course, loss of joy in things that they once enjoyed. That brought them meaning. Sometimes physical symptoms pop up and we have to remember it's not just the presence of disorder that we should go after. We really do have to think about optimized health and mental wellness.
Speaker 1:I'm focused in this podcast primarily about mental wellness, though I am very strongly of the belief that one of the great ways to improving mental wellness is to improve physical wellness. More on that in a few minutes. My dear friends, okay, let's move on to. Well, just talking a little bit deeper about the causes of wellness deficit disorder that we face. There is also an important need for us to talk about the neurobiology of wellness, and the question, of course, is if there is such a thing as a wellness deficit disorder, where do we think it lives in the human brain? What neurotransmitters may be involved? Don't you think that's an important area of conversation on this podcast? I think it might be.
Speaker 1:There are many of us who are part of this burgeoning community who are very curious human beings. There's a lot of us who have advanced degrees and an ability to read literature very carefully. So, towards that goal, I'm going to tell you a little bit about the neurobiology of positive emotions. That way we will learn where does wellness deficit actually live? So one more time reminding you I tend to think of positive emotions as a very large basket of wonderful symptoms, wonderful character strengths we have.
Speaker 1:But but I had to narrow things down. I couldn't possibly study 40, 50 things, so I narrowed it down to four. If you like five, you go for it, but the four that I picked have very strong data in the literature supporting the validity that being happiness, enthusiasm, resilience and optimism. And there is a paper I would like to cite here from Berktoff and colleagues that was published in Neurosciences, biobehavioral Health Review. I will be providing with a citation for it as well. And they in fact were able to localize not depression, that we already have a pretty good sense but they're able to localize positive emotions.
Speaker 1:And four regions lit up as they did their research. The first is, interestingly, the ventral striatum. Ventral striatum, of course, is what makes humans humans right, so it seems like we might have been designed as a species with wellness in mind. It's also deeply found in the amygdala. So, despite my original incorrect belief that the amygdala was only an organ to create fear, it also is involved in novelty. Orbital prefrontal cortex, particularly the prefrontal orbital prefrontal cortex, is quite involved in the genesis of positive emotion, and so is the hippocampus, where we store memory. That's why when, in a few minutes, when we talk about the practical interventions we clinicians can use to target wellness deficit, you will see a lot of these interventions in fact are well thought out biological interventions to change the functioning and perhaps even the structure of these organs.
Speaker 1:Now, which neurotransmitters are involved, we think, in the pathogenesis of wellness deficit disorder, and it's an interesting bunch. It really is. It's not serotonin, it's, in fact, endogenous opioids, gaba, endogenous endocannabinoids, glutamate dopamine. As you and I continue researching this topic, we're going to really find ourselves very intrigued. And another paper two actually one of them from Lunin and colleagues that was published in Medical Hypotheses in 2016,. Published in Medical Hypotheses in 2016. Another paper by Berridge B-E-R-R-I-D-G-E and colleagues, published in Neuron in 2015,.
Speaker 1:Found this really, really interesting issue, which I was kind of blown away by, that being, there are separate circuits that control happiness and different circuits that control sadness. Now, they interact, but the circuits are different. This, I think, is a really important finding. Please don't let that get away from you. You might say why the heck is it so important? Why is Rakesh getting all excited about it? Here's why that, even in patients who have a dysfunctional circuit for depression, we can still recommend to them to engage in exercises that are specific for improving wellness. You get the point, don't you? Yeah, in other words, you don't need someone to be already you know a level five judo master in mindfulness, before we recommend these interventions. They can be recommended to anybody, even in the throes of moderate, mild, severe psychopathology, if the patient is receptive.
Speaker 1:Guess what? The neurobiology shows that the different circuits do not stop us from offering interventions that could help us. In fact, there does appear to be a hedonic brain circuit which has specific hotspots, and here I'm referencing a completely different paper. This is by Kringlebach and colleagues, and this paper appeared in Trends in Cognitive Sciences in 2009. Again, please don't worry, all of these references, all of these citations, are going to be listed in your notes for this podcast, so you are welcome to come and grab it.
Speaker 1:And then, finally, this one was so interesting. This was an imaging study where people were laid in a fMRI. Greenberg and colleagues published this in 2015 in Social Cognition and Affective Neurosciences, and what they showed is, when you show people uncertain photos, or aversive photos, or positive photos, the brain reacts differently. It reacts not just differently, it lights up in quite different parts of the brain, which should immediately intrigue you. It should remind us that different interventions have different pathways. These are intertwined, for sure, but we actually have a different system in the brain to feel sad and a different system in the brain to feel wellness, and maybe the wellness muscle is quite atrophied and you and I really do need to step in to make a change. One more time, I can almost hear you say, wow, he sounds a little too optimistic about all this. Is there any evidence that these interventions could be helpful and we do? We really do have longitudinal, cross-sectional. We got all kinds of evidence.
Speaker 1:Yang and colleagues in Neurosciences Letters in 2013 showed that a wellness trait like optimism and remember, optimism is a muscle. It's a muscle. If practiced enough, we can truly shift our level of optimism. It showed that those who had it get this had lower activation of amygdala when they viewed negative stimuli. Please hear me loud and clear on this. This is such an important point. Please don't let it get away from you. Having higher wellness creates resilience at the brain level. It diminishes the overactivity of amygdala, but at the same time, when you show these individuals something positive, they not only enjoy it, they enjoy it to a greater degree. Wellness appears higher. Wellness appears to be a diminisher of negativity but an enhancer of positivity. Diminisher of negativity but an enhancer of positivity.
Speaker 1:I'm sure you will want to read this article for yourself by Yang and colleagues, neuroscience Letters 2013. You will see a citation for it. And then, of course, inflammation. Inflammation is, we thought you know, bacteria virus. That's what causes it. And then we thought it was obesity. All true, all true, but what about wellness? That's right, people who have higher perceived levels of happiness in fact have lower levels of interferon alpha. We have a study here, actually Matsunaga and colleagues published it in Neurology Endocrinology Letters in 2011 and interferon gamma the levels were in fact lower in people who felt happy. So happiness, perhaps, is not just an emotion, it is actually a neurobiological affect that is of great importance to us All.
Speaker 1:Right, I've bent your year quite a bit and I don't know how well I've succeeded I hope at least to a moderate degree in alerting you to the presence of wellness deficit disorder. Two, I hope I've defined it to your satisfaction. Three, I really hope I have motivated you to measure it. Anything not measured, I'm afraid we don't take care of it well in medicine, so please consider measuring it. In time, I will devote an entire podcast to the various measurement-based tools that we could utilize, even in everyday clinical practice, but for the time being, why don't you explore the Hero Wellness Scale. It's copyright protected, only so that people don't use it for commercial reasons. There is zero copyright issues if you're using it just for the sake of helping your patients. So that is, in fact, good news. Why don't we now start thinking about how do we actually start? You know affecting improving these symptoms in our patients, and I, in fact, have quite a few suggestions to offer for your examination, for your consideration, and by now, hopefully it's coming across to you.
Speaker 1:I'm not a big believer in good advice. I really am not. I'm, however, a profoundly good believer in good advice that I can back up scientifically. So nearly every okay, that's not fair. Everything I'm going to offer you from now will be exactly like I've done so far in the podcast. Up to this point, which is I want, up to this point, which is I want everything we think about to be scientifically validated. Otherwise, you know, it's just good advice.
Speaker 1:And while good advice has its value, positive psychiatry is a real specialty, my friends. It's not wishful thinking, it's a science-based practice of artful psychiatry. That's what I think and I'm very much hoping. Just like me, you too just don't want advice one could get anywhere. What we want is advice that is scientifically evolved. I've got a few things that I really think are worthy of our discussion. I've got a few things that I really think are worthy of our discussion.
Speaker 1:So one of the great challenges that we are currently facing is this deep disconnection from nature, and this is the reason why the whole concept of forest bathing, which, of course, originated in Japan centuries ago, pan centuries ago, is now becoming pretty standard practice amongst those of us who really believe in wellness deficit disorder and how to attack it. One of the easiest ways, and probably the most fruitful ways, to begin a patient's journey into wellness deficit disorder amelioration is to inquire about their connection from nature and, of course, how disconnected are they. So the evidence is quite striking on this and there will be a time and a place where I'll do a very deep dive into how nature is a pretty important part of positive psychiatry. We'll do a deep dive into it, but right now, for the sake of this conversation, I really encourage you, do an evaluation of your patient's connection or disconnection with nature and, no matter where they are, teach them, encourage them to not just spend more time in nature but a deeper quality of time with nature. So what I've often recommended and you may want to think about it and perhaps you can tell me when you write back to me about what do you do is to take a very intentional walk in nature and look up, look down, smell, feel, look, touch. Touch the leaves on the ground, touch the tree, caress the flowers, smell the flowers, look, let your eyes really absorb all the greenery. You might be saying what the heck does this have to do with psychiatry? He sounds like the male version of Oprah right now. But here's the thing the neurobiological evidence that all of these interventions in fact alter glutamate GABA balance rapidly, the fact that all of these interventions clearly have an anti-inflammatory effect an anti-inflammatory effect, generally speaking, is an antidepressant effect is quite considerable. One more thing you probably want to keep in mind the one part of the human brain that's overactive in people with depression and anxiety is the default mode network. Well, individuals who spend increasingly greater quality and quantity of time in nature in fact have a quieter default mode network. So please do think about that.
Speaker 1:Let me now talk about something else that could be a major, positive and relatively easy intervention to offer our patients is addressing the issue of digital overload. Now, like everybody else, I love my iPhone and, like everybody else, I've clearly found it's not a love, it is, in fact, addiction. Let me be the first to admit to you quite honestly I do not think my relationship with my phone, my iPad, my laptop is healthy anymore. It isn't, and I'm working on it. I genuinely am working on it. I need to work on it, dear friends, and so do our patients, and so do you, I think, because most of us Americans are imbibing so much digital time.
Speaker 1:I think that it's becoming very difficult for us to even know how to appreciate quiet, aloneness and solitude. So this one patients push back. They often say that's my only friend left and I say I understand, but it's not a good friend. It's a friend who has pulled you in, but it's more of an empty calorie friendship. So this is a little bit difficult to talk about, digital hygiene. But it's at a level now, dear friends, that if you are a clinician or a non-clinician, just living your life as a professional, digital hygiene is becoming a really important part of how we will go about fixing this issue of wellness deficit. So one more time this is a big enough topic that I will devote an entire podcast to how to both perform and recommend digital hygiene in order to improve mental wellness, but for the time being, just appreciating it is such a big issue. Hopefully begins the communication between us and us, and us and the people we take care of.
Speaker 1:All right, what's the third thing that I could perhaps recommend to start thinking about? How do we improve this wellness deficit? And that is nutrition. Yes, yes, yes, everybody talks about nutrition Our primary care, our cardiologist, everybody is talking about nutrition. But please remember, not a single neurotransmitter that you and I use in the human brain Let me be emphatic about it Not one single neurotransmitter that we use in our human brain. 200 plus can we actually eat de novo. We have to generate each one of them from our macro and micronutrients. So, just from a flat out logic perspective, if I like my brain, if I like my mood regulation, if I love my wellness, if I like my mood regulation, if I love my wellness, how is it ever going to be possible for me to have optimum levels of it if my nutrition isn't adequate?
Speaker 1:This is also a very big topic. It absolutely deserves an entire focus on a podcast on how we improve nutrition in those who have wellness deficit, which, as I said before is a lot of us. But for the time being, you may want to think about the Mediterranean diet, or also what's called the MIND diet, m-i-n-d. That in fact, has some of the world's best data. That in fact, has some of the world's best data in promoting good mental health. In fact, I and Sandra, in our own studies, have used the MIND study as our cornerstone and I'm happy to report to you we in fact haven't had a negative study yet of intervening in individuals' wellnesses, whether they have a psychiatric disorder or not, and nutrition plays a really, really, really important role. So for the time being, I just want to alert you that a conversation between us and us, and us and our clients, our family members, about the importance of nutrition is profound. You may want to brush up on the tenets of what constitutes Mediterranean diet and you may want to think about pulling that into our lives.
Speaker 1:And today I will then finally talk about this, which is, oh my god, this. It's no longer an epidemic, it's a pandemic, a pandemic of loneliness, a pandemic of genuine loneliness that has seeped into every part of America, and this may be the deepest wound America has faced in the last perhaps 20 years. We've become more affluent, we build bigger homes, we got bigger cars, but boy are we lonely, lonely creatures. And that's a problem because, if you recall the brain regions involved in the perception of hedonic drive, joy, pleasure, meaning those require social interaction. And loneliness is actually so bad from a physical health point of view, it's as bad as smoking 15 cigarettes a day. So said our Surgeon General, based on exceptionally good research. But you know what else he also? He said, while smoking 15 cigarettes a day is awful, obviously, what's much worse about loneliness is what it does to our mental health. And let's never forget mental health is not just symptoms of various psychiatric disorders, the absence of hero traits happiness, enthusiasm, resilience, optimism, community purpose. We are adrift.
Speaker 1:This also is a pretty big topic and I have plans to cover loneliness and how to perhaps address it, how to fix it, in some future conversation I have with you. But for the time being, maybe we can land on the following that we did forget to actually prescribe socialization. We did, and I want to talk to you about what I will call macro socialization and micro socialization. Both of those are very good techniques, very good tools. Sorry about that, I was just getting a drink. Those are very good tools to consider as you begin the art of prescribing wellness deficit disorder interventions.
Speaker 1:So macro interventions are joining clubs, going to your place of religious worship, perhaps joining a group activity. Those are macro, intentional. They are not on a regular basis but really important and we as a human species, particularly in the United States of America, have become surprisingly isolated. One of the most impactful books I've ever read it's actually called Bowling Alone in America. It came out some years ago and even back then, the fact that social cohesion, social interaction, was breaking down. 15, 20 years ago I paid no attention to it. I was like, yeah, yeah, yeah, whatever you know, yeah, so we don't see each other very often. We don't do group things. Yeah, what's the big deal? Well, I'm here to tell you I was flat out wrong. It's a toxin. To not be connected to human beings is a toxin to our wellness. So we should be promoting the cause of macro-socialization improvement.
Speaker 1:But there's another kind of socialization that I have been recommending for decades now and it's really worked well. It's called micro-socialization. What is that? Micro-socialization is improving our interaction with people that we're most likely only going to see once. So, for example, you go to a Starbucks, the barista, make eye contact, pick up a small conversation, chit, chat, that very tiny hit I'm calling it a hit of interaction. When you, for example, leave Starbucks, you're opening the door, someone walks in. You just say, hello, have a great day. I like your shoes. Those micro bursts of socialization interspread through the day, seem to have as large a positive impact on wellness as macrosocialization. I am here to report to you I have not, in the past, been a good microsocializer, but in the last two decades I have really worked on that skill. I'm also here to tell you it's one of my personal top wellness enhancing techniques and I think it's worth alerting our colleagues, our family members, our patients, whoever it is, that they consider doing that.
Speaker 1:So let's start winding down our conversation today. This has been a rather long podcast, but I thought you will forgive me for it, because we just needed to have a solid heart-to-heart conversation on this spectacularly important topic of what's wellness deficit? How do I address it? So let's kind of summarize it. So the healing strategies I'm recommending are rewilding. Let's learn the art, and teach the art of reconnecting with nature. Let us truly enjoy the morning, sunshine, exposure for circadian rhythm reset, gardening, hiking, sitting under a tree being with nature like we are with ancient friends, because they are. These are not trees, these are ancient creatures, millions of years older than us. Let's be with them. Let's be with them. They are quiet, but boy, they're fantastic teachers.
Speaker 1:The second thing I wanted to talk about was the importance of digital decluttering. I'm a work in progress, my friends, I am. I'm going to do better. I want to do better, to do better. I want to do better. So scheduling phone-free time, no screen in bed. I'm struggling with that, but pray for me, I really do want to work on that. And this is so interesting. Embrace boredom, embrace boredom. Don't let that hand immediately reach for that quick hit of abnormal amounts of dopamine by picking it up to check a social media link or whatever the case might be.
Speaker 1:Digital fasting may be as important as intermittent fasting. What a statement I just made. Let me say it again Digital fasting may be as important to us as intermittent fasting is to our physical health. Wow.
Speaker 1:The third thing I wanted to maybe alert you to is the importance of emotional hygiene. The mind needs to be examined, decluttered If it's not well organized. Let's learn the art of not being jealous. That actually is a skill I find jealousy, even in a country with nearly every citizen having so much jealousy still damages so many of us Jealousy envy. These are all things that positive psychiatry gently helps shape mold for the better.
Speaker 1:The fourth, of course, is we need to be thinking about food as medicine, as healthy medicine it is. We are what we eat. We genuinely, truly not figuratively are who we eat. So we'll have to learn we want to learn how to eat as much as we can. A Mediterranean diet Now you might say he sounds pretty biased. Well, I am, I really am. Just look at the data biased. Well, I am, I really am. Just look at the data. Look at the data, look at the value Mediterranean diet brings to mental health, to brain health, and all of those, of course, are prime tools for addressing this catastrophic wellness deficit disorder that we face.
Speaker 1:We of course, need to talk about gratitude. Gratitude is a huge topic, in fact, the very next podcast. Let me give you, if you are okay with it, just a quick preview that the next episode I'm going to devote entirely to a deep dive into gratitude using data, into gratitude using data, using practices and using information that we can actually apply into our clinics. So please stay tuned. But gratitude is a profoundly valuable skill to have. So, finally, let's perhaps wrap up this conversation which, may I tell you this, I really enjoyed. No, I don't see you, I don't see you, but I feel you. I feel you, you are my tribe, you're my colleagues, you're my friends, you are people I really like, you're people I really admire.
Speaker 1:And I did feel this driving need to bring to your attention that wellness deficit disorder is a major ailment in many of us, in many of our patients. No, it's not our fault that we don't know much about wellness deficit disorder. It is a challenge with traditional medicine that is far too often focused on organs and deficits. It's far too often focused just on disease and correction of the disease only. It's really important to fix it, these diseased symptoms, whether they be mental or physical. But healing is not correction of disease only. To heal, to thrive, requires you and I to be very thoughtful, and therein lies the reason why this conversation about wellness and wellness deficit disorder.
Speaker 1:I think it's incredibly important. It's a realignment with what we are designed for. Right, my dear friends, we're designed for connection, nourishment and peace and movement and meaning, purpose, joy. Listen to the words I'm sharing with you. Tell me how does it feel just to hear these words that you and I were simply not designed to live a life with absence of disease symptoms? Let me repeat this to you we were designed for to be nourished, to be at peace, to be in movement, to have meaning. So we don't need a dramatic life overhaul. We really don't. Small shifts, small shifts is what we're looking for, but those small shifts are done consistently and kindly, either by us or, as we suggest it to our patients, man, that can really help.
Speaker 1:So I thank you for spending this time with me. I hope something here does resonate with you and, if it did, share what you learned, because what I found with the first podcast is I got so much good, not out of what I shared with you, but what you shared right back with me, and so many read your comments. So many people offered to be on the podcast themselves, and you know what I'm reaching out to all of you folks. In time, you've got expertise that I desperately want. I want to learn from you, and so do the other listeners. This isn't my venture. This will become our venture. Are you with me? Well, I certainly hope you are.
Speaker 1:So remember we're not broken, but we could be whole. And to be whole, to be complete, I do think we cannot hide our heads in the sand and say there's no such thing as wellness deficit disorder. It's so evidently there. We cannot deny the fact that we have walked away from things that really matter to our nourishment, to our fulfillment, nor can we walk away from the fact that we, as clinicians, aren't providing our patients these profoundly important elements of positive psychiatry. Let's change that, but let's change that together. Okay, until next time. Stay well. My dear friends, this is Rakesh Jain, and you were with me on this podcast on positive psychiatry with Rakesh Jain. Goodbye for now.
