Bipolar 101: Preventing Symptoms Of Mental Illness With Ruth White

 

There is huge wisdom to be found in someone who has been through the same situations as you. When it comes to living with a mental health disorder, gathering insights from those who have been through the same struggles is nothing short of value. In this episode, Timothy J. Hayes, Psy.D., sits down with Ruth White to talk about living with bipolar disorder and what she found would work, not only for those with chronic mental illness but those with no diagnosis as well, on improving mental health and well-being. Ruth White is a Clinical Associate Professor for the School of Social Work at the University of Southern California. With her book, Bipolar 101, she takes us across her research and intimate knowledge about bipolar disorder and the mental health services system in the USA and what people can do to control their symptoms and live better. Join in on this conversation to learn more about not only treating your symptoms but also preventing it as well, which tends to be an overlooked aspect of this space.

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Bipolar 101: Preventing Symptoms Of Mental Illness With Ruth White

Dr. Ruth White has earned a Bachelor of Social Sciences from the University of Ottawa in Canada and a PhD in Social Welfare from the University of California, Berkeley.

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Dr. White, thank you so much for joining us.

Thanks for having me.

It’s a pleasure to meet you finally. I was wondering if you could tell us a little bit about how you got started in this and what drives your passion for this work?

I am a Social Worker by training. I have a Bachelor’s Degree in Social Work and a Master’s Degree in Social Work. I also have a PhD in Social Welfare. I used to work in mental health settings. It wasn’t particularly my focus of work, however. What social workers do is assist people with mental health but it wasn’t the focus of the work that I did as a Social Work professor. What happened to me is a personal connection. I was diagnosed with bipolar disorder. I had a hospitalization and the follow-up and the experience of that and all the medication journeys got me into advocacy because of my own experiences at work and in various settings. I realized that mental health was stigmatized. The way people were dealing with people who had mental illnesses was much different than if you had cancer.

I started by writing. What happened is I saw a book that had come out around the stigma of mental illness by Dr. Stephen Hinshaw who is now at UCSF. He used to be at Berkeley. He had written the first comprehensive book on the stigma of mental illness. Instead of broken up into little chapters, he was a single author. I reached out and I told him how important I thought the work was. I got it as a notice in my alumni newsletter and we had a conversation and he asked me to write a piece for the book. I told him I wasn’t interested in sharing that part of my story. I thought being a professor, having a mental illness was not necessarily going to be good for my reputation in terms of competence. However, he convinced me partly because as an assistant professor at the time, I needed publications for tenure.

I thought that in a book that was academic and put out by Oxford Press, that not a lot of people would read it. I contributed to that book. I got a lot of positive feedback from people who had read it. I hadn’t realized the reach it would have. From then on, I started opening my mouth, writing words about it, and having people reach out. I talked for NAMI, which is the National Alliance on Mental Illness. I did some work for them. As part of that journey, what happened is because, after hospitalization, I realized that I didn’t want to be on a lot of medications because of the side effects. I wanted to keep my career as a professor. I had to figure out ways to alleviate my symptoms of bipolar disorder without medication. I spent a lot of time, hundreds of hours reading neuroscience and behavioral stuff. I realized that there was a lot of research on how to alleviate certain kinds of symptoms in many different ways.

There are lots of ways that we could behaviorally, nutritionally, and psychologically relieve symptoms without medications. Click To Tweet

I was encouraged by the psychiatrist that saw me in the mental health facility as well as my personal psychiatrist to write a book. They said all the knowledge I was learning I should share and that turned into Bipolar 101 in which I shared ways of mitigating symptoms. I was taking meds at times so I’m not anti-medication. I was aware that there were lots of ways that we could behaviorally, nutritionally, and psychologically relieve a lot of symptoms without medications. The side effects of a lot of medications are why people don’t want to take it when they talk about noncompliance with treatment. That’s how I started doing this work.

Was that book published in 2009?

That was 2009. What was interesting is I wrote a lot of it while depressed. I wrote a book and it got published. I happened to be in London at the time and I was doing my sabbatical. I hadn’t gotten royalties to check. I reached out to the publishers and I said, “How was the book launch?” They told me it was successful in the publishing sector that I was in. I got a nice check and I realize that I had something to say and that there was a demand for that information. I started my Bipolar 101 blog and I don’t maintain it anymore. It’s something that I’m thinking about going back to. Because of the book, Psychology Today, a blogging platform, asked me if I would write a blog about the intersection of culture and mental health. I started writing for Psychology Today blog and that led to a lot of media attention from various outlets and I still maintain the Psychology Today blog.

One of the things that comes to me when I hear you talk about this and the title of the book, Bipolar 101: A Practical Guide to Identifying Triggers, Managing Medications, Coping with Symptoms, and More, is that so much of talk about this is that you’ve got this disorder, disease, and this thing. When in truth, it’s more about a pattern of symptoms than an identifiable problem. Go say some more about that.

It’s like any other syndrome or disorder in the body whether it’s irritable bowel syndrome or it’s migraines. There is a unique experience for people who have these illnesses. If you have migraines, you might be sensitive to sound or you might not. You might be sensitive to light, but you might not. Some people I know have nausea and they vomit and other people might not, but the experience is the headache. Bipolar disorder to me is a unique experience for each individual in terms of what symptoms people have, how they experienced them, etc. To me, it’s not an identity. For some people, it is part of their identity. For me, it is not. It’s something that I experienced. I hadn’t had symptoms though for years and a lot of that I know has to do with the changes in my lifestyle, the amount of sun I get, how much rest I get and the pressure that I’m under in terms of stress at work.

All of that has been ameliorated and has changed to give me more control over how I engage with the world and when I engage with the world. I’ve been assertive I would say about asking for what I need and want from my job, from what I’m working in consulting, etc. That’s made a huge difference. I do better in the afternoon than in the morning so I ask for an evening schedule. That’s made a huge difference in terms of being able to get sleep. If I stay up late and don’t get sleep, I can sleep in. Getting enough sleep and getting sunshine has been life-changing. I live in Oakland, California where it’s sunny most of the time. That’s helped me with my ability to go outside, exercise outside, and engage in ways that support my mental health and wellbeing.

Central to what you’re saying is that while the symptom pattern can look different from one person to another who has the same diagnosis or label, the cause can be different. One of the things that Dr. Lila Massoumi, who’s a psychiatrist who does integrative psychiatry and Dr. Jodie Skillicorn, another psychiatrist, both talk about an integral part of trauma and childhood trauma in the development of the symptom patterns in adults. Many people who go in for the traditional approach of, “It’s an illness and a disorder. We need to give you this medication for that symptom and this medication for that symptom.” They don’t even take a look at the underlying causal factors, whether it’s in your work schedule and stress as an adult, the things you’re talking about, or whether it’s an unresolved issue from childhood or young adult trauma. That’s one of the things that I love about a book that says, “We’re going to look at identifying triggers. We’re going to look at managing medications, coping with the symptoms, building a reserve of coping skills and your own personal treatment strategy for what you’re dealing with.”

That was the point for me. Out of that work has grown my stress management work because it was clear that stress is the number one trigger for mental health disorders, whether it’s an episode for a schizophrenic or depression, anxiety, and a lot of these things. I was lucky to have a psychiatrist named Dr. Donna Lowman. She worked at Group Health in Seattle. She’s now retired, but she had a holistic view of mental health. She was a psychiatrist who did not take visits from pharmaceutical sales reps, which makes her unusual. Her philosophy was, “You behave your way out of as many symptoms as you can and then you medicate the rest.”

She wasn’t a medication first, which is generally how psychiatry works. They give you medication. If you’re not taking your medication, that becomes the focus of treatment is to get you to take your medication instead of talking about symptoms. It’s more like, “Did you take your pill at 3:00 PM? You didn’t? You’re not being compliant.” She was focused on finding holistic ways. She was open-minded. I remember when we first started talking about Omega-3s at the time. It wasn’t as mainstream as it was now, but her attitude was eating salmon can’t kill you. Do what we can and sunshine became a huge strategy. I lived in Seattle at the time and I am a dark brown, African-American woman.

Even the public health department in Seattle now recommends that people with brown skin take vitamin D supplements because of the impact that has on physical and mental health. She was open to trying things that weren’t medication-based because of the side effects that I was having. Back then, it was hard to find lights for Seasonal Affective Disorder or for people who weren’t getting a lot of sunlight. I remember she had this photocopied ad for this guy who sold grow equipment for marijuana in Fremont in Seattle, hippie area. She said to me, “If you find it cheaper than he will match the price. She’s like, “If you find this grow light on the internet for cheaper, this guy will match your price.” She was focused.

She was advocating for you.

Yes, but also it wasn’t even the advocacy part. I liked the fact that her approach was that if you can’t manage your symptoms with diet, exercise, a support system, and therapy, then we will use medication. Her attitude towards medication was not, some other experiences I’ve had, which is, “Let’s start with a high dose and if it works, you can’t get psychiatrists to put you on a lower dose.” It’s a struggle. They say, “This dose is working. Why are we going to lower it?” Her attitude was you start at the lowest dose and if that doesn’t work, you slowly increase it. What ended up happening is I was on low doses of medication and she was responsive to me if I said, “I had symptoms I wasn’t willing to live with.”

I did not want to be on disability. I wanted to be performing at work. As a professor, there were certain symptoms. For example, I remember getting the shakes my hands would shake badly that I couldn’t write on the board. I became PowerPoint heavy in my lectures, so I wouldn’t have to write on the board. I had to buy a stamp for my signature because my signature was horrible. After a few weeks, I said, “No, I can’t do this. You need to find another medication or another strategy.” We collaborated on getting me on as little medication as possible and for me to take control of my life. I am aware after doing the advocacy I’ve had being in certain spaces that my experience is unusual. That medication and its side effects can become the center of treatment in a way that I think patronizes people with mental health diagnoses or people with mental health symptoms.

As I always say, our control center’s not working. Everybody feels like, “If your control centers not working, you can’t make decisions for yourself so we will make them for you. If you don’t comply, that means that you are a bad patient and you need to behave yourself and do what I say.” Mental health also does not focus on prevention. You can go to a primary care physician for physical health. I keep pushing for, and I need to write more about that, the integration of mental health screenings into primary care. When I ask my social work students if that’s a reality, sometimes in a class, I’ll have no one who’s ever been screened at by their primary care physician.

Stress is the number one trigger for mental health disorders. Click To Tweet

What happens is in psychiatry, we wait until you have a problem, and then we try to fix the problem. There are no billing codes for prevention. I found that out when I would say, “I feel like something’s coming on.” The psychiatrist would say, “We don’t deal with you think something’s happening. We deal with do you have symptoms or no?” I found that frustrating because that’s so much of what people with mental illnesses experience could be avoided if we had a prevention-focused industry. I don’t think that’s where we are. Most psychiatrists never talk about behavioral changes. They want to talk about more exercise. They just don’t.

What I hear from psychiatrists who are trained in the traditional model and then move over into integrative, functional, or holistic approach is that it’s not taught to them. They’re not given that set of tools in their toolkit. To a hammer, everything looks like a nail. Everything needs to be pounded on. One of the things that I liked was listening to a discussion of functional medicine from a medical doctor, a psychiatrist, and a woman philanthropist. They’d each started their clinics. Dr. Mark Hyman talked about how the recipe for a healthy satisfying human life isn’t complex. We know what it takes. It takes the connection to the community. It takes a certain amount of good food, sleep, and exercise. It takes love in your life and life purpose. These are identifiable things that should be on the checklist of, “If I’m trying to help somebody who has any unsatisfying symptomatology, those things should be part of the treatment plan.”

As you said, doctors don’t get this training. One of my primary care physicians once said he had a come to Jesus moment in his own practice that made him realize that medication was always the first resort. That was because he had one class in nutrition in his medical training. Like you say, if you don’t know that this is an issue, you don’t know that that’s an issue. You don’t get psychiatrists going, “Let’s monitor your exercise and make sure that you’re doing something at least 4 to 5 times a week to get outside in the sunshine moving.” That alone will change people’s lives. The research is irrefutable about the mental health benefits of being outside in nature and working out there, whether it’s going for a walk in the sunshine, etc. The research shows that for cases of depression that are mild, it is as effective as low doses of antidepressants to go outside and exercise.

What are the side effects of that? The side effects of exercise are you improve your cardiovascular health, lose some weight, feel better and sleep better, which is big for people with mental health disorders. Doing that and a lot of the medications that we take to make people have increased in weight. If you prescribed an exercise program for people, that would make a huge difference in symptoms. Are they eating a certain food? I wrote a piece once on Mood Food and it got a positive response. Twenty-five thousand people or so read that piece. There are nutrients and micronutrients, which improve people’s moods. We also know that mental health disorders make it hard for people to sleep. When you don’t sleep, it is a trigger for mental health problems. Fixing sleep, for example, helping people develop good sleep hygiene around when they sleep or do they eat before they sleep, what are their behaviors before they sleep, etc., leads to positive outcomes in people’s mood.

As we talked about the social support that having loved ones around you, giving love, getting love back, all of those things I call SNAP, which is Sleep, Nutrition, Activity, and People. That’s my four-piece strategy for building emotional resilience. It’s the book I want to write next. Understanding that and those four things, if you listen to Deepak Chopra or you read any book on holistic medicine or any primary care physician will tell you that those are the four pillars of good health, whether mentally or physically is to sleep well, to eat well, to move and to have people that care about you and you care about them. I would say that in psychiatry and mental health discussions, that’s not the focus.

I’m one psychologist, but I have had a number of people in my private practice over the years who’ve been given a diagnosis of bipolar or manic depressive and they’re miserable on the medications. At one point or another, they either come to me for help with getting off the meds or they come to me saying, “I’m on all these meds and I’m still miserable. What can I do?” A number of them have gotten phenomenal results by paying attention to your SNAP: Sleep, Nutrition, and I put Attitude in for your A but yours is Activity, and People.

Many of these people find that they’re intelligent and emotionally sensitive if they, for whatever reason, don’t get enough sleep or have a little bit much of the wrong foods 3 or 4 days in a row or have low alcohol on the weekends and then don’t sleep right because it disrupts their sleep. They’re in for a crash even if they’re still on their meds. The question has to be if these meds are curing something if they’re doing something, “Why am I still crashing? Why am I on 3, 4, 5, 8 medications?” I’ve had people show up in the office on eight medications. I’m not criticizing the medications. I’m saying if they’re working and you’re on five of them, why do you need a therapist?

 

The thing is, why do you need five medications to begin with? If you are on three mood stabilizers, I would say that two of those stabilizers aren’t working which is why you got another one. The interactions of these medications, I always joke that I remember somebody who worked at Merck said, “We make the cures that kill you.” I thought it was a funny, ironic thing to say. It’s not deliberate on their part. If you take lithium, for example, you have to get kidney and liver functioning monitored on a regular basis. It also dehydrates you, so you have to drink a lot of fluids. If not, you’re going to have bad constipation. You might have the shakes and you might get sleepy. My thing is, “My mood is stable, but my kidneys might go into failure.” This happened to me years of being on lithium. I want to share a little bit of that experience. I was on lithium for a long time. It was working for me. I was on a lot of it. I was on 1,200 milligrams.

Somewhere along the line, I go to my primary care provider for my annual checkup and she has concerns about my pulse. I’m like, “What does that mean?” She does an ECG. She’s like, “I need to do this.” When she was done, she said, “Are you dizzy? Do you feel lightheaded?” I said, “No.” She said, “Your pulse is 32.” I went, “That can’t be so good since normal is around 70.” My sister is a nurse with 40 years’ experience and I texted her and she said, “You should be prone on a gurney in the emergency room now,” which is why they’re freaking out. They put me on a Holter for three days to monitor my heart rate. It turned out my heart was stopping for seconds at a time. What was interesting was she was a nurse practitioner in some way when she was having this discussion, she threw out sideways. She says, “It might be a rare side effect of lithium.” I said, “Okay.” She said, “You should probably talk with your psychiatrist about this but first we’re going to send you to a cardiologist because with your pulse at 32, your first symptom could be a heart attack.”

I go to the cardiologist and the interaction was focused on me choosing which pacemaker I wanted. “Here are two pacemakers. You can get pacemaker A or pacemaker B.” I mentioned to him, “I’m on lithium.” The primary care provider said, “This might be a possibility.” He said he hadn’t heard of it. I was texting my sister during the meeting and she said, “You should choose one.” My mom was on a pacemaker because we all have heart murmurs. I said to the doctor, “If I can get off this medication and it doesn’t make a difference, then I’ll come back and get a pacemaker. If there’s a possibility that me coming off of medication means I don’t need a pacemaker.” For liability reasons, he taught me how to self-resuscitate. For those who are out there, if you ever get a heart attack, you can count to ten and cough and keep coughing every fifteen seconds.

I go to my psychiatrist and they are at UCSF at the time at Langley Porter, one of the best mental health facilities in the country. I raised this issue of coming off lithium. They kept saying, “You’ve been on all these meds, this works.” I said, “It’s not working if my heart is not working.” I pushed and I pushed and finally, they said, “We’re going to put you on Seroquel.” I had never been on Seroquel. “Let’s see what happens.” Their whole thing was, “We can’t take you off meds altogether. You could be suicidal.” I said to them, “In no world do you go from a happy person to suicidal in a few minutes. If you monitor me, we’ll see it coming.” Three days after starting Seroquel, my daughter gets a concussion playing volleyball and she goes to Kaiser. While they’re there, I said to the medical assistant who was taking her pulse, “Do you mind taking my pulse? I’ve had issues.” Seventy-two hours after coming off lithium, my pulse was fine.

I tell this story because I could have had a pacemaker. It would have been good practice to get me a pacemaker, but it was how much I had to fight for somebody to consider the possibility of taking me off medication for a minute and off one particular medication. If I was not someone who had read all that I’ve read, wrote the books, talked to people, and felt comfortable as an educated person to engage with the medical field, I would still be on lithium. My kidneys probably would have been partly shot. Also one of the reasons I came down on dosage was because I was having early-stage renal failure is what it shows up with if you are having liver function problems. I would have had a pacemaker and everybody would’ve felt like they did good for me. The cost of that cardiologist, the copay for him was $900 and I had good insurance. My primary care provider wanted the cardiologist to sign off that I didn’t need a pacemaker anymore because my pulse was fine.

I said to them, “As long as the medical assistant could take my pulse because I’m not paying $900 copay so that cardiologists can take my pulse.” That was one story of how by advocacy, and I had to fight after a while to lower the dose of Seroquel, but I’m on as low a dose as treatment dose, which is 300 milligrams and my life is great. I don’t have any side effects. I don’t have them put on weight. That experience, not that I didn’t know it before, made me realize it wasn’t even psychiatry. That there’s such an interventionist approach to health in the United States and that it is hard for people to fight their way out of it. We’re asking people to fight at a time when they’re the most vulnerable. You’re not at your best, you’re feeling out of sorts, you’re probably emotionally, psychologically distressed. That’s when you somehow have to gather up all your resources to fight a medical system. It’s unfair.

For most people, it’s not just unfair. It’s impossible.

There's such an interventionist approach to health in the United States that it is hard for people to fight their way out of it. Click To Tweet

It’s financially costly.

There’s someone like you who’s got multiple advanced degrees and it was a challenge for you, as you say at one of your most vulnerable times. I don’t promote this book for patients or the general public, although they can read it if they want for more of the professionals, I highly recommend people read Robert Whitaker’s book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. It helps explain some of what you were talking about. The policies and procedures, he looks into the history of, “How did we get here from a position of most of the time when people were stressed out or depressed or having voices in their heads?” If they had good money, we put them in a restful place. It was more like a resort and took the stress off of them and tried to give them good food and teach them some coping skills. More often than not, it was an episode or two in their life. It was not a life sentence. Nowadays, how do we get from there to a place where if somebody comes into a doctor’s office and they had a depressive episode and/or a manic episode, they’re told, “You need to be on medications for the rest of your life?”

I say this all the time. There are lots of other episodic illnesses. People get cancer, for example. I say to people, “Can you imagine if you go in for cancer, you get radiation or chemotherapy and they said, ‘You need to be on this for the rest of your life?’” No. You stay on that stuff until you’re clear of cancer. They keep monitoring you for cancer. You eat right, take care of your health, and have better outcomes. In mental health, that’s not what happens. They tell you that whatever drug you were on at this low point in your life should stay on for the rest of your life when the rest of your life is not a manic episode or depression. The attitude in psychiatry is that, “If you needed it, then you need it forever.” I’m like, “Treatment is different from prevention.” You need to treat this episode, but where’s the prevention? What they will tell you is the medication is prevention. Be like somebody saying, “If you keep having chemotherapy, you won’t have another episode of cancer.”

Migraines are the same. Do you take medication the whole time for a migraine? No, you take the medication when the migraine is coming on. If you have a stomach disorder, you don’t keep taking medication if your symptoms go away. They always say, “Just because the symptoms go away doesn’t mean you should stop.” I’m like, “Where did this come from?” This is a pharma-driven approach to mental health. This is how I got into the stress management side of things. In the space of a month, I had three friends who showed up in emergency rooms with panic attacks. One of them I had wondered that her body was going to tell her no at a certain point. She had three kids. She had to take care of a sick mom by herself while having an incredibly successful corporate career as a corporate lawyer for big pharma.

I said, “You’re in a panic attack because your body is saying to you, you can’t do this anymore. If you take care of your stress and find someone to take care of your mom and ask for help and do all these other things, you won’t have this anymore.” You don’t have to take anxiety medication for the rest of your life because you had one panic attack. You need to figure out why did this panic attack happen and what can I do differently to prevent that panic attack from happening? I tell a lot of my participants in my stress management workshops, it’s the same thing, realizing for yourself what your particular triggers are. There are some people who are calm in their commute to work. They read blogs and they sing songs. Other people get in a car and they are frustrated. They get angry. They’re short-tempered. They get to work in a bad mood because everybody reacts differently to different things.

Once you figure out what the triggers are and then you start to figure out your own self-awareness, “What do I feel? Are my hands getting sweaty? Is my heart racing?” you can intervene before you have a full meltdown. When we start to consider that life is going to throw us challenges, but we don’t have to be medicated to get through them, that there are ways. I’m not saying that medication is categorically bad because they have saved my life. When I walked out of Fairfax in Seattle, they had me on three mood stabilizers. I could still be sitting in a corner fat, with my kidney and liver shot and on four medications. My doctor’s outside and I said to her, “This is not sustainable.” She listened.

A lot of people say that to their psychiatrist and they don’t listen. They pat them on the head and say, “What do you know? You have poor judgment because you have a mental health disorder.” Having somebody willing to listen and say, “What else can we do?” My kid suffers from depression at times, but she’s found her happy place. She didn’t like being at school and I kept telling her, “You can drop out. It is okay. Not everybody has to go to university.” She has started her own business and she’s happy. She lives in Montana. She expresses her creativity. She loves being outside. If she can get outside and be in the snow, ski, and snowshoe and hike and all of that, she feels better. It’s free, cheap and good for you. I can’t say that for any mental health medication that it’s cheap, free, or good for you.

One of the things that you point to here is the idea that I strongly encourage people to be good consumers, not just to consume, but to question what they’re consuming. Go for a 2nd, 3rd, or 4th opinion. If you’ve heard a story like Dr. White’s and you’re saying, “I went to two different psychiatrists. They told me the same thing. I assumed that had to be it.” keep looking. There are people out there and we’ve interviewed a number of them already on the show, who are looking at the whole person, not just a few symptoms who are willing to help you build a set of coping skills and lifestyle that will help you be a healthy, happy person.

You were talking about cancer and most of what I would call good cancer centers don’t give you the radiation, surgery and chemo. They want you on good nutrition. They want a sense of purpose in your life. They’re looking at the nutrient supplements they can give you to help your body recover. The Mensa Group talks about doing targeted nutrient therapy, specifically for people who have to have psychotropic medications and chemotherapy because, with the extra boost of specific nutrients, the detrimental effects of those medications are minimized.

Part of the challenge is because people think once you have a mental health disorder, somehow you can’t have good judgment and what compliance looks like. I was surprised when the American Public Health Association accepted a proposal I had for a presentation at a conference because usually, you have to have original research to present. My topic was first to take your meds. I was shocked when they accepted it, but the room was full of people. I was surprised, but many people had the experience of being told that, “Unless you take your meds, you’re not compliant. If you do have a breakdown somewhere in there is because you weren’t paying attention.” I tell people this all the time. I look at American lives and we don’t have good childcare or when we do have it, it’s expensive. We get maybe 2 to 3 weeks’ vacation. We work these long hours. We don’t have good public transit. We’re in our cars and stuck on highways. Why wouldn’t that be stressful? Why wouldn’t the body go, “This is not optimal functioning?”

When you talk about mental health, when they send people to facilities, I always laugh that they never send you to a psych hospital in the middle of a city. The psych hospital is green grass and trees. You go outside and it’s bucolic, and I said, “The science says that’s good for you.” If you can find that, you’ll be a happy person. I think in Denver or Boulder. I know Colorado wants to be the healthiest state in America. One of the strategies they were proposing and I remember I was at a public health conference. The governor was talking about this. They wanted people to be within a mile of green space. There was some research put out in 2018 that looked at the impact of green spaces on mental health. This was done in Philadelphia. It got a lot of attention and it was a randomized control trial. It was the gold standard of experiments. There were 541 spaces that had garbage, graffiti, or whatever.

Some of them got cleaned up, others got clean and green. They got rid of the trash and then they planted green stuff. It took eighteen months before and eighteen months after. For poor communities that resulted in the community level a 68% decrease in depression. There are not enough therapists in a community to work with individuals, to get them to go down in depressive symptoms by 68%, but changing the environment in which people lived made them happier. I tell people if you’re a single mom with four kids and a $10 an hour job, you’re going to have mental health problems. Why? You’ve stressed out all the damn time. We need to look at those things. For some people, you can’t get rid of your kids and you can’t instantly get a better job, but to acknowledge that the person is in a stressful situation and figuring out how to ameliorate that stress and then think about medication.

There are some things you can do like you’re talking about. I interviewed Allison Davies, who’s in Australia and she talks about brain care, not behavior management. She’s a music therapist. One of the things she talks about is a hum or sing a mantra of positive thought. Use music, vibration, and rhythm in your life. She also talks about how the brain we have in our skull was evolved for an environment that’s far less stimulating than the one we’re constantly plugged in and bombarded. You practically can’t go anywhere on the planet where there isn’t noise pollution. Recognizing that doesn’t mean we all have to go off to some desert island. We wouldn’t all fit. Knowing what you said about how this layer upon layer of stress and the expectation I put on myself to be able to handle it all and still be bright and cheery is completely unreasonable.

If I start with that observation and say, “I need to be gentler with myself, calm down and find whatever ways work for me to get a little bit more peace, calm, nutrition, movement, and connection with people. Your SNAP: Sleep, Nutrition, Activity, People, in each one of those areas if I can make a little bit of an improvement.” As you mentioned in that study from Philadelphia, there are tremendous benefits. They didn’t take everybody and give them their own park and say, “You live in the park.” They put a park within a mile of these places and made it green.

Not everybody gets the opportunity to shape the life that they need because that's just the economy that we live in. Click To Tweet

I always say to people, it’s why when a lot of people go south to a tropical island for vacation and they go, “These people are poor, but they’re happy.” I said, “They’re not all happy.” First of all, you have sunshine. A lot of these places eat food close to the ground. My friends here in the Bay Area will call me a food snob. I say, “No, I’m a country girl from Jamaica where eating local is what people do. They don’t eat imported food.” My mom will have a friend drive up and he’ll go, “Here’s watermelon for your mom.” I’ll say, “Can you hold on. I’ll get you some mangoes?” I’ll go get him some mangoes. My dad and his friends will butcher a cow or a goat. There is a community that they’re connected to. They eat healthily. Nobody’s grabbing food to run. I was in Germany and I said, “Where’s the cup holders in this car?” My friend said, “For what cup?” I remember laughing about the fact that they didn’t even have takeaway coffee. You drink your coffee there, stand and talk. If you go to a cafe in Paris, there are these stand-up ones where they go to take your shot of coffee and go but there is a sense that you slow down.

On the same trip because I’d gone to see different friends in Germany I knew. I was in Berlin and it was Sunday and my friend says, “What do you want to do?” I said, “I’d like to do a bit of shopping.” He said, “Where?” I was like, “There was this big mall.” He said, “We don’t have shopping on Sundays. Malls aren’t open.” I said, “Why?” I remember his answer that rolled off his tongue, perfectly natural. He goes, “They have families too and they need family time.” I thought, “Do we need to shop on Sundays? What are we buying at Walmart at 3:00 AM? What are we doing there? Why aren’t we sitting for hours when I’m with my friends in Paris?” They have demanding careers. I’m not talking about, “My friends aren’t painters. They’re bankers, government employees and economists. They have demanding careers.” Yet they somehow are able to sit down for a few hours and have a cup of coffee, lunch with a friend where or take a while for dinner and how much that changes?

I had a friend who decided to move back to Italy after being a successful metals trader in London. He said why he went back home to Naples for a while was that, whenever he would visit, he would contrast his family’s life in Italy with his life in London. What a meal looks like and how long it takes? I remember going to Spain, the same thing. People are out late at night, 10:30. I’m like, “Why are these kids outside?” I was looking outside going, “Is there a festival or something going on?” No, people are just out in the community. They’re sitting outside in a warm evening sharing a drink and a story and time with friends. They eat much healthier and fresher foods. I’m like, “This is why we go on vacation there.” They live life that is slower, calmer, and healthier. When people say, “The American healthcare system, we’re spending all this money, but we’re not any healthier.” I’m like, “It’s not about how much money we were spending in the healthcare system. It’s about our lives.” What happens between when we wake up and when we go to bed? That’s it right there. That’s why people live longer in these other places.

Jamaica has a life expectancy in the 70s. For a developing country, you’re thinking it’s not like they have stellar healthcare, but when you talked about silence, it’s amazing. My parents live 300 meters from the ocean. When you sit under a mango tree at night, all you hear is crickets and you might even hear the waves. That’s it. There are certain times when they have parties where the bass goes on forever and you’re like, “Noise, pollution,” like you’re talking about. On those evenings where it’s quiet, my daughter experiences the same in Montana. She’s like, “Do you know how little we see the stars where we live?” They call it big sky, but she’s like, “I look up at the sky and there are stars. It’s calm. It’s quiet.” That’s why people go on silent retreats. Silent retreats are a thing because humans are like, “I can’t do this anymore. Can I have no TV, no radio, and no phone, not even talk to anyone because my brain wants zero input?”

The more I can balance those factors, a little bit of improvement in each one of your four factors, SNAP: Sleep, Nutrition, Activity and People. A little bit of improvement in each of those areas is a wonderful start to a healthier life.

It is and a happier one. I’m about happiness. Not everybody gets the opportunity to shape the life that they need because that’s the economy that we live in capitalism and poverty. As much as possible, I have a friend that retired. He was C-Suite at one of the top banks in the world and he’s in his mid-50s. A lot of people are like, “Why is he retiring? His next position was to run a bank.” He was ready to check out and have some travel adventures and go to Nepal. The expectation was, you’re at the height of your career. Why are you getting out now? Bankers stay until their 60s, but what also happens? People die. The Vice-Chairman of the board of JPMorgan dropped dead on his treadmill.

Do you have to think about what is important for you? For me, there are certain jobs that I could have, I could make more money. I could spend more time working, but then I thought, “Why? Is that money going to alleviate the stress of my life? What am I going to have to do to cope with that? Am I going to have to take antianxiety medication?” There are a lot of people I know who do just to function because their anxiety level is so high. I’m thinking, “If you did this and this, you might not be anxious.” In fact, I would be shocked if people aren’t as anxious as they are, especially in the United States that support mental health and wellbeing.

 

That’s what Corona is getting a lot of companies to look at, is people are checking in with each other about mental health. I was on a panel for the Commonwealth Club with the head of Verizon Media. Guru was saying how normalized they have made it to have mental health check-ins even at the executive level when they’re having a Zoom meeting and how they’re going to keep that because people have said it’s made a difference. We’re not asking how you are just as a procedural thing, but that you’re asking, how are you?

It’s not just a box to check.

That you’re willing to listen. It says that you’re more than showing up at work. I was talking to a mental health somebody who was head of EAP at a big Fortune 500 company. He was saying that even in that company, what he sees because of confidentiality that he can’t share with managers, but people were blowing up deals because of their mental health status. They were falling apart, yelling and screaming at people and losing it because they couldn’t cope anymore and yet there’s this norm that, “If you’re a tough guy, then you can go out and make that deal. You can work 21 hours a week.” My stress management came out of some work that I was supposed to do for a Fortune 100 Company.

When I told them that if I do this stress management workshop, there were things organizationally that they would have to do. They said to me, “We have type-A personalities. You’re telling them that they should work less, but we’re incentivizing them to work fifteen hours a week.” I will tell you that the company later made public announcements of work limits. That they were going to limit work hours on the weekends. Goldman Sachs has no work Sundays. People were joking that. People worked longer on Saturdays, but at least they’re recognizing that as brilliant, as ambitious, and as type-A dragon slayers of the universe their employees were, maybe working seven days a week wasn’t the best thing.

That’s what it takes, unfortunately for some of those companies is it’s got to start affecting their bottom line. We would like to advocate for people changing it because it’s better for my personal health and bottom line and then let the corporations take care of themselves. It’s been a pleasure talking to you. I want to remind people that your book is Bipolar 101 and that’s available through Amazon and probably other booksellers.

I also want to tell people about my The Stress Management Workbook. I have another one, Everyday Stress Relief. Particularly in The Stress Management Workbook, I put it out there because I wanted people not to get to the bipolar stage. Not to get to the depression and the anxiety, but address the stress in their life, get aware of that, figure out strategies for themselves to manage the stress so that they don’t show up in your office or a psychiatrist’s office. I’m hoping that stress management and I’m realizing from all the calls I’ve been getting since I started doing this work that companies are realizing that their employees need this and that people generally need a toolbox to deal with the stress. Since it seems like we live in a country where we’re not going to have this systemic change in some ways, although I see it slowly coming, I would highly recommend The Stress Management Workbook. You can find that wherever books are sold.

The Everyday Stress Relief, what year was that published?

If you're taking care of your mind, you're taking care of your body. Click To Tweet

It’s in May 2020. That one is good when you are thinking about, “I’m having a divorce. I have a chronically ill child.” They’re focused strategies for different situations that people might find themselves in. I hope for the audience out there that taking care of mental health is something that is prioritized. I also say if you’re taking care of your mind, you’re taking care of your body. If you eat healthily, exercise, and sleep well it’s good for all parts of you. I’m not out there saying, “Throw all your pills in a toilet and flush away.” To think about, “Are you living a life that optimizes your physical and mental wellbeing?”

The website I know for you is at RuthCWhite.com. Is there another one?

RuthCWhite.com, that’s the one that everybody can find me at. I’m Ruth C. White on LinkedIn. I’m @RuthCWhite on Twitter and I am @RuthCWhitesLife on Instagram. I also have a Facebook page, Ruth C. White, PhD. It’s quite easy for people to find me. I was early to the social media and internet games. I was able to get everything lined up with my name.

Thank you so much for taking the time to talk to us. I look forward to following your next book and your next adventure.

Thank you so much for having me. I wish the best for your audience.

Thank you so much.

—

Dr. Ruth White has earned a Bachelor of Social Sciences from the University of Ottawa in Canada and a PhD in Social Welfare from the University of California, Berkeley. As a social worker and someone who lives with bipolar disorder, Dr. White has an intimate knowledge of The Mental Health Services System in the United States, both as a client and a provider. After being hospitalized more than a decade ago, she vowed that would be her last time. Determined to continue her career as an academic, she spent hundreds of hours researching brain science to find ways to improve her mental health. This culminated in her first book, Bipolar 101, which was a successful primer on the illness. While doing this research, she came to understand that what worked for her as someone with a chronic mental illness also works for everyday people with no diagnosis who are in search of ways to improve their mental health and wellbeing.

Important Links:

• Dr. Ruth White
• Bipolar 101
• National Alliance on Mental Illness
• Psychology Today
• Mood Food – article
• Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America
• Allison Davies – previous episode
• The Stress Management Workbook
• Everyday Stress Relief
• American Public Health Association
• Commonwealth Club
• RuthCWhite.com
• Ruth C. White – LinkedIn
• @RuthCWhite – Twitter
• @RuthCWhitesLife – Instagram
• Ruth C. White, PhD – Facebook

About Ruth White

Ruth was born in London, England of Jamaican immigrant parents, was raised in Jamaica and Canada, and has spent the past 25 years on the west coast of the USA. She studied at top schools in Canada, the UK and the USA and has worked as a social worker in all three countries. Her passion for exploring cultures and places has taken her around the globe, and along with her immigrant experiences, has inspired her work as a diversity consultant and educator.

As a social worker and someone who lives with bipolar disorder, Ruth has intimate knowledge of the mental health services system in the USA, both as client and provider. After being hospitalized more than a decade ago, she vowed that it would be her first and last time. Determined to continue her career as an academic, she spent hundreds of hours researching brain science to find ways to improve her own mental health. This culminated into her first book, Bipolar 101, which was a successful primer on the illness. While doing this research, she came to understand that what worked for her, as someone with a chronic mental illness, also works for everyday people with no diagnosis who are in search of ways to improve their mental health and well-being. Her public health background led her to focus on the prevention of mental illness – and the promotion of mental wellness – by managing stress and building emotional resilience.

An elite athlete in her youth, she was a champion sprinter and long jumper, and also played field hockey, netball and swam for her high school teams in Canada and Jamaica. She loves the outdoors and is an avid hiker, sailor, kayaker, and neophyte diver. When her schedule allows she is a model with representation in Paris and San Francisco, and she works as an extra on film sets in the San Francisco Bay Area. Her favorite role as an extra has been as a stand-in for Serena Williams in a Gatorade commercial. She is the mother of one awesome adult daughter.

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