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This is the art of charm.
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Learn everything you need to know to crush it in business, love, and life.
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Today we re talking with Dr. Melanie Watkins.
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It s sort of a special installment, actually, of AOC.
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We re gonna talk about mental illness and mental health, mental health treatment as well, warning signs, red flags, how to get help if there is concern for yourself or for others, and barriers and challenges to getting help, stigma, ego, and shame here on The Art of Charm.
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Welcome, I m Jordan Harbinger, your host here, and I m with producer Jason.
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Good day, sir.
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The Art of Charm brings together the best thought leaders, teachers, and exceptional individuals to teach you how to be a top performer in life, love, and at work.
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We may not have all the answers, but we definitely have some of the questions.
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All right, let s talk to Dr. Melanie Watkins.
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So tell us what you do in one sentence.
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As a psychiatrist, I emphasize the importance of making mental health a priority, and I minimize the mystery and sometimes the misery of mental illness and addiction treatment.
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Nice.
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That was pretty good.
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Did you rehearse that before the show?
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Yes, I did.
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I wanted to make sure that I had a sentence that really, really described everything that I do.
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That s good because, you know, whenever we do this, we ask everybody to start off with that.
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And I ll tell you, most people go, whoa, one sentence.
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I don t know how to do that.
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And I was like, well, you would if you read the document we sent you before the show.
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which you clearly did.
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So, excellent, I appreciate that.
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And I agree, there s a lot of getting treatment, there s stigma, there s the ego from the patient themselves, and we can get into all that, but I think a lot of people just don t even realize they have.
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anything in the first place, or they think, it s normal to be sad for three months and not get out of bed.
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I ve done this my whole life, seasonally, or something like that.
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So I think this is an important topic, and I know that it s, again, not talked about a lot because people who don t think they have anything wrong, they kind of don t want to hear about it, and people that do kind of don t want to hear about it.
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You know, it s not a popular subject that people gravitate towards.
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Have you found that to be true in your work as well?
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Yes, that s very true.
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Oh, my goodness.
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You know, by the time patients come in to see me, they have struggled with this for a long time.
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I mean, they themselves have tried to sort out what s going on.
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They re trying to get more exercise, try supplements, pray through it.
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And people around them have told them, oh, just feel better.
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Just do this.
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Just do that.
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Change your mindset, you know.
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Have you tried not being depressed every day?
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And none of that is working, you know, and sometimes people start self-medicating and they re really, really in a bind by the time they come in to see me.
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So the first thing that I do is I validate what they re experiencing because it s very lonely because of what you said, the shame and the stigma keep people from getting treatment.
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Yeah, and I think that s a shame, because it s just like getting coaching or treatment for anything.
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If you re bad at math, you get a math tutor.
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If you re depressed, you go get a therapist or a psychiatrist, and there shouldn t be anything wrong with either of those things, but I would wager that most people would sooner get a math tutor than a psychiatrist for a serious problem, even though failing math, eh, not the end of the world, not great, but being depressed and losing years of your life or worse, catastrophic.
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Yes, and that s why I think that we need to talk about these things.
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And I m so happy that I m a guest on your show to educate people about this, that there shouldn t be any shame in getting treatment.
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In fact, I think it s a sign of strength.
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You know, the fact that they can even make the phone call and make an appointment to come in.
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And they may have relatives and friends who are saying, you don t need a psychiatrist.
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It s not that bad.
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And it s totally invalidating because then the person really feels like maybe I m making too much of this, you know.
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Right, that of course has to do with the family s weird stereotypes of what therapy is, or the fact that, especially older generations, I ve noticed, if something s wrong with a kid, they re like, that means something s wrong with the parents, so they re like, don t go get therapy, because then the neighbors will find out, and they ll think we re bad parents, and it s like, who cares what people think about you, your kid is depressed, get over yourself, you know?
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Yes.
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And there s a lot of that.
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I saw a lot of that growing up.
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I see a lot of it now.
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And I get, you know, I get a lot of email to that effect as well.
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How do we even start to see whether or not there is something wrong with us or wrong with someone around us?
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I mean, I think we should start with things like warning signs or red flags because I know just from personally having sort of, I guess you would call stress-induced depression back in the day,
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You go, oh, well, I m just stressed because I m working hard.
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Or, you know, oh, it s normal to sleep until 11 sometimes just because, you know, I m tired from all this work.
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And you see friends doing it too, like, hey, John hasn t gone out with us for like six months.
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Has anyone hung out with him?
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No, you know, he s busy and he s stressed from work.
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Oh, that s totally normal.
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Anyway, how s your weekend?
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I mean, it s like, wait a minute.
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There s just kind of no concern expressed.
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Right, right.
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And that is part of depression.
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Some people will isolate.
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They don t want to be around friends or do some of the things they enjoy doing in the past because they feel all this pressure that I have to be fun and I have to talk and I just don t even want to be bothered because this depression is such a huge weight that I can t even come up with
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the energy or the motivation to move forward.
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Some of the easiest things to think about when we think about those changes that might signal that someone might have a mental health concern, such as depression or anxiety, are changes in sleep.
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You know, sleeping too much, sleeping too little.
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Changes in appetite, eating too much, eating too little.
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Changes in energy level,
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You know, having very, very low energy, not being able to focus and concentrate.
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And of course, we get very concerned when people have suicidal thoughts.
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And so one of the things that I do when patients come in is I ll say, sometimes some of my patients, when they re really, really having a difficult time,
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with their depression, they have these thoughts that can scare them a bit, you know?
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They would never maybe act on them, but the thoughts come up.
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Has that ever happened to you?
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And in that way, I just kind of normalize a bit what that s like because it can be very, very scary to have those thoughts popped up when you ve never, ever had any thoughts like that before.
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Yeah, that way it sort of takes the pressure off.
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Are you having suicidal thoughts?
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God, no.
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I mean, why would you think that?
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I mean, sometimes, but let s not talk about that because it makes me sound crazy, right?
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That s what we want to avoid.
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Right, and so having an experienced therapist or psychiatrist who knows the types of questions to ask and also can ask them in a way that s not off-putting, because it s very scary to talk about these things.
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Many patients have never talked with anyone about this before, and they don t know what s going on, and there may be people around them who ve experienced the exact same thing, but they don t talk about it because of the shame and the stigma.
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Something else, too, that can happen when people are very depressed is turning to substances to cope.
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So I might say something to a patient who has depression or anxiety like, you know, it s not uncommon for people to start drinking a little bit more.
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You know, one glass leads to two glasses, leads to three, or maybe they start using marijuana.
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Have you ever found that you turn to alcohol or other substances to cope with your sad feelings?
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And you d be amazed at how many people, because they haven t been able to get the mental health treatment that they really need, will do what is easiest, you know, turning to substances to try to escape the feeling.
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But the irony of that is that many of these substances are central nervous system depressants.
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They actually make depression worse and they affect sleep.
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Patients get sleepy after using alcohol, but they don t get the quality sleep.
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And then they wake up feeling tired.
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And that just adds to their already overwhelming depression symptoms.
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Right, yeah, because you go to sleep, and what little sleep you re getting is your body s still trying to process all this poisonous booze or whatever, so you wake up feeling like crap.
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I mean, that s like the essence of a hangover in many ways, right?
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Dehydration plus bad sleep plus whatever, sugar or something like that.
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And going back to asking about substance abuse and asking about depression, are you saying we can talk to our own friends like this, or is this something that a doctor would ask?
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Well, that s a good question.
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So ideally, in a perfect world, people would be willing to talk with their primary care doctor, nurse practitioner, therapist, psychiatrist, and get some help with some of these things.
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But I think there needs to be more discussion amongst friends about some of the resources available.
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You know, it s interesting.
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I had a patient who really had a good experience in working through some anxiety he had as he was approaching divorce.
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And someone approached him in the locker room and he was saying, Oh, I went to see this doctor.
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She was great.
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And we talked about some things and you might want to talk with her.
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And I was so delighted to hear my patients say that and for his gym buddy to come in because people don t talk about these things.
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And so he was able to say, look, you know, I got better, I got treatment and there are resources available.
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But if he didn t feel comfortable in being able to share that with someone else, then his friend may never have come in to receive treatment.
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So I think that there needs to be more discussion amongst people in general.
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But then also, too, there needs to be more dialogue with mental health professionals
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And also there s practitioners and physicians about what to do with patients regarding these issues because with my primary care colleagues, sometimes it s very difficult to talk with a patient about seeing a psychiatrist because then the patient
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might think, well, is my depression that bad that I need to see someone like that?
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What are you saying?
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I can t be treated by you.
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You know, it s hard enough to talk with you about it.
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And then that really can keep the patient stuck.
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And so there needs to be more education and discussion about how we can de-stigmatize the idea of people going to therapy and to psychiatrists and psychologists.
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Would you say that most treatment comes too late in the game?
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Not like there s no going back, but like, oh, you shouldn t have waited six months or whatever.
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Yes, people wait a very, very long time.
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Now, part of the challenge is there aren t enough mental health professionals available to treat people.
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And so that s something that I feel very strongly about is that we need to encourage more people to go into these fields.
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Very, very important.
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But also too, it s the fact that because of the diagnosis itself, the anxiety, the depression, the substance use, it s very difficult for someone to take that next step.
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Or sometimes they re just in denial.
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They don t recognize that their substance use issue is a concern.
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They don t recognize that
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not showering for days and isolating and not being able to focus and concentrate at work, that it is a problem that can be helped and can be treated.
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And so by the time people come in and get treatment, they ve struggled for weeks, months, sometimes years.
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And they re really at their wits end.
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You know, people will come in and say, I really, really tried everything I could do to avoid coming in.
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to see someone, but I have no other options.
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I need help.
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And it s really more so desperation versus being proactive and recognizing, as the question that you asked, recognizing some of the signs and symptoms that there might be a problem and being proactive before it gets to that point.
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What s the cause of a lot of this mental illness?
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I mean, does it just happen, or do you see a rise in this because of the way that we live our lives, or the things that we do in our lives, or the things we don t do in our lives?
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Has this stuff always just been equally a problem and mostly ignored, or is it on the rise?
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That s an interesting question.
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So I m not going to say that it s your mother that causes mental illness.
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You know, it s funny.
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A lot of people, when they first come into therapy, they say, oh, are you going to ask me about my childhood?
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Is this all going to be blamed on my mother?
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That s not the case.
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I mean, I think that we re recognizing it more and more.
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We re having more dialogue about it, but we still have a ways to go.
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So I wouldn t say the incidence is necessarily increasing, but that we re recognizing signs and symptoms much earlier.
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And it s really, really exciting what s going on in mental health treatment now.
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For example, young people who might have what we call prodromal symptoms right before developing schizophrenia, there ll be some changes that we can recognize and there s actually interventions that we can do early on that can make a difference in the young person s prognosis.
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And that s a really exciting thing.
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And so I think that we re recognizing that we really need to hit this
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you know, early and do what we can to help people to be able to function the best that they can versus waiting, waiting, waiting and symptoms getting worse and worse.
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So I think we re working towards recognizing it more and more.
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But these problems have been around.
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you know, for many, many, many years.
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You know, Freud, who was a physician, he had concerns with cocaine use and also nicotine use.
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He smoked many, many, many cigars and had oral cancer and surgeries.
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And he as a physician, even back then, knew the consequences of using those substances, but he continued to use them.
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And so, you know, I think about that situation, you know, there s a lot that we ve learned as far as how
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substances impact us both mentally and physically, but we still have a ways to go in terms of decreasing the stigma and increasing access to treatment.
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One of the people that I really, really admire is Patrick Kennedy who was a former congressman and he s the nephew of JFK and the son of Ted Kennedy.
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And as you know, the Kennedys
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They had a family with many, many traumas, much difficulty in being in the spotlight as they were, made it very difficult for them to be able to access treatment.
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You know, you might think that because they were wealthy, affluent, and had status that they would get access to treatment pretty easily.
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But actually, it s in part because of that status that made it difficult for them to have confidentiality without the news of their treatment being, you know, all over the press.
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And so he s been very vocal about his own struggles with bipolar disorder and addiction.
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I think more people that step up and talk about their personal concerns, that helps to break down some of the barriers.
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And people can say, oh, wow, if this person from this position is talking about his mental illness and addiction, then maybe I can seek some treatment myself, that it s not just
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me and I m not different from everyone else that I too can perhaps do better and get better with good treatment.
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And when we come back, I want to hear more about substance abuse, mental illness, and the treatment thereof.
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So what are the first steps to getting help and maybe some of the consequences of waiting?
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Well, I d say the first step is recognizing that there s a problem.
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And sometimes people don t.
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So when we talk about stages of change, you know, there s pre-contemplation when people don t even recognize that there s a problem and then there s contemplation.
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Oh, okay, I recognize I have a problem.
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And sometimes we see this with substance use where people really don t understand the impact of their substance use on the family, you know, and their coworkers.
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on their friends and so forth.
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So sometimes it s a matter of getting the person from pre-contemplation to contemplation.
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So how do you help them to recognize that there s a problem?
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And so it can be helpful to validate what they re experiencing and recognizing some of the concerns and changes that you ve observed and then working through how to take the next step.
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One of the questions that I get asked often is, well, let s say I think I might have a substance use problem.
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What do I do?
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And many people have heard of AA and NA, so Alcoholics Anonymous and Narcotics Anonymous.
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And when patients will come in, or I might hear from someone, maybe I m at a resort or at a conference and someone will ask me my recommendations, they re very, very reluctant to consider going to AA or NA.
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And in part because of the stigma,
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or what they may have heard about what AA or NA is all about.
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It doesn t work for everyone, but I found that for people who are reluctant, it can be helpful for them to just consider maybe doing an online meeting or a telephone meeting.
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You can go to the website and it can give you information to put in the show notes about that.
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So people don t feel like they have to go to a meeting and risk seeing someone that they work with or someone who s a client of theirs.
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And so I think for some people just even participating in these meetings online or telephone, they can hear stories and they can find out
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if maybe some of these stories resonate with them.
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And two, they can start working towards how do I take the next steps to get help?
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And so some of the easier ways to do that, if let s say someone wants to find a therapist or psychiatrist, is to go to one of these websites like psychologytoday.org or goodtherapy.org.
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And what s nice about those sites is they have bios of therapists and psychiatrists in the area.
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You can put in your zip code and find out a little bit about
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therapists, psychiatrists who are available to provide treatment, and also read a little bit about their specialty, which insurances they take.
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Now, the members of these sites, they do have to pay a fee, so the therapists and psychiatrists pay for the advertising, but I found that it s a very quick and easy way to help people who want to use their insurance and want to learn a little bit about the therapist or the psychiatrist before going in to see them.
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Oftentimes, I get asked from patients who don t have insurance or don t want to use their insurance what they should do.
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And so there are private mental health professionals who do not take insurance.
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And, you know, again, it s very interesting because people have this insurance to get mental health treatment, but they re concerned that that information might be used against them.
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And that keeps them from wanting to get the treatment.
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Yeah, I can see that.
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You know, that makes sense.
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I ve definitely heard from friends of mine who have maybe jobs in defense or government, and they say things like, I think I have depression, but I can t go see anyone because it ll come up in a background check and I won t get this job later.
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I mean, granted, most civilian jobs, that s never gonna be a problem, it s completely secret, but if you re trying to work for the Central Intelligence Agency, you can run into a wall, even though there s probably a million people working there that have these issues and never got them addressed, and it s causing massive problems, but the one guy who s got the sense to seek help is gonna run into a problem because of it.
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You re exactly right, exactly right.
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And so what I think should be done about this, and Patrick Kennedy also mentioned this too in his book, An Uncommon Struggle, is really having mental health parity and making sure that people have the access to mental health treatment and make it part of our normal
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So, you know, we go to the doctor, we get a physical exam, you would go to perhaps a master s level therapist to, you know, check in about how your mental health is.
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And then that master s level therapist could decide whether you need to be referred to a psychologist or psychiatrist or other therapists for further treatment.
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If we normalized it and made it like not a big deal, you re just going in to get your exam, just like you get a physical exam, then I think that would do so much, so much in terms of people getting access to treatment.
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Because if we normalize it a bit that way, then people will feel less ashamed about seeking out treatment and what the repercussions might be.
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But this all ties into this long history of stigma.
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You know, it s interesting.
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I m a marathoner and I ve run seven marathons and I had a really bad meniscus tear.
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And so when I talked with people about it, they said, oh, yeah, I know this great surgeon or I know this great physical therapist.
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They re so wonderful, blah, blah, blah, blah, blah.
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And, you know, I got surgery, got better.
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I m back to running.
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But I can only imagine if I told people something like, I ve been drinking so much alcohol because I just can t seem to function without it and I m really scared about my future and I m scared that I m gonna lose my job if I get treatment.
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People don t know how to respond to that.
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They don t know what to say.
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That s true.
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And that makes it even more shameful and isolating to not have people talking about mental health treatment.
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We actually did an episode with Kim Seltzer a while back on how to find a therapist, and we ll link to that in the show notes if people want a kind of deeper dive, anyway, into some of that, because I think that people might even see that as an uphill battle, like, oh, I don t even know who to go to, and I don t know where they are, and I don t know how to pick one, or I went to one five years ago, and I didn t really like it, so I don t know how to find somebody different, so we want to sort of nip that in the bud as well, and take that objection off the table, because if it seems really hard to do, it s just one more obstacle in people s way to getting help.
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Yes, just one more obstacle.
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Exactly.
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And sometimes people will have a not so great experience with the first therapist.
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But just like with anything, you know, it doesn t mean that therapy itself would not be beneficial.
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Maybe a different therapist might be a better fit.
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And so people will say something like, gosh, you know, I went to see this therapist five years ago.
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It was horrible.
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It didn t do anything for me.
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I went for a few sessions and I just gave up.
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There are a lot of differences in terms of background and communication and experience and specialty as far as therapists.
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But again, if we were talking more about these things, people would be more open to saying, oh, I saw this great therapist.
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She really helped me with this.
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I highly recommend her.
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But people don t talk that way because they don t want other people to know that they re getting mental health treatment.
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Right, yeah, that s actually very, very true.
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People are always kind of pushing this under the table, even with some of their close friends, which is a shame.
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A lot of people, I think, are afraid of treatment because they don t want to replace one addiction with another, or, yeah, you know, I have depression, but I don t want to be put on some pills.
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I hear that objection a lot from people right in.
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They re like, I feel like I have this and I don t know what to do, but I don t just want to take Xanax and medication and float through my days.
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How would you address that?
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I tell people when they come in, just because you come in and see a psychiatrist doesn t mean you leave with a prescription.
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You know, ingestion is not always the solution.
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So there are many, many things that we can do to treat depression.
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So for people who ve never had a history of any mental health concerns, and they re brand new, and they just came in, I ll talk with them.
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And I might say something like, you might consider seeing a therapist regularly.
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And then I can be in contact with that therapist.
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And should the therapist
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decide to contact me because they think that medication might be an option for you, we can do that.
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But you may do just fine with therapy alone.
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I mean, so many people have difficulty in communicating their needs and having good boundaries, and sometimes just work with a good therapist can make a big difference.
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Now there are some situations where let s say someone has really struggled for years, they ve had suicidal thoughts, they have a strong family history of depression, anxiety, even psychosis, and they find that they re turning to substances, they can t function at work.
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they may benefit from being on an antidepressant.
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And so when I talk with them, I try to describe it the same way that I would describe any other physical illness or concern.
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So if a patient has anemia and it s iron deficiency anemia, we would give them iron, right?
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So same thing with depression.
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If someone has clinical depression, perhaps they have lower levels of serotonin, dopamine, norepinephrine, what have you.
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And I talk with them about
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how the medication can help.
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And I reassure them and say, it doesn t mean you need to be on medication lifelong.
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It doesn t mean that the medication is going to alter your change in some way permanently and you ll never be back to your usual self.
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The goal actually is to get you back to your usual self, how you felt before you began to have these symptoms.
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You know, what I like to describe to patients is something like, you know, let s say you really, really enjoy hiking.
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You re out on a hike with a friend and the friend can t see that you have this 50 pound backpack on.
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And the friend saying, come on, we ve done this hike so many times before.
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Just come on, keep up with me.
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And you can t because you re so weighed down.
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It s almost like the medication and therapy can help remove that pack.
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You re still yourself, but you re able to move forward the way you ve had in the past.
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And so that s the goal of treatment.
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And so people, once they hear that, and I reassure them and touch base with them over time through visits, they re just amazed, you know, and they feel so grateful and so appreciative.
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It s like people who are nearsighted and then they get glasses and it s like, wow, you know, I can see things more clearly.
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You know, I can now see, you know, angles and edges and things are so much more crisp.
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I didn t realize I was living in a fuzzy world.
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And that can happen with depression and anxiety.
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They re living in this foggy, fuzzy world.
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And so sometimes the medication can help them so they can really be functional again and really be able to participate in life.
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Essentially, the goal of this isn t to just, like you said, ingestion is not always the solution.
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I think people really worry about that.
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Do you think that s a real concern, or do you think it s mostly kind of another excuse not to get treatment that people are maybe putting in front of the problem?
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Yeah, so some psychiatrists, I ll be honest with you, some are more prone to write a prescription and others are less prone.
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And so it really depends on who the prescriber is.
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Same thing with primary care doctors and they actually write prescriptions for more antidepressants than we as psychiatrists, which is kind of interesting because most people go to their primary care doctor, their nurse practitioner.
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I think that the patient really needs to be an advocate for themselves and say, you know what?
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I m not quite sure if medication is right for me.
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Can you tell me why you think I might benefit from this versus doing therapy?
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And have a good discussion and dialogue.
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I m very frank with my patients and I ll say, this is what I m seeing.
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This is why I m so concerned.
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This is why I think you need to start medication.
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Not everyone has started on medication, but given the way that you re presenting and what you described, I think a trial of medication might be appropriate in your situation.
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Other patients, I might say, have a regular exercise routine, work on journaling, gratitude, meditation, see a therapist weekly, and then let s touch base again if it turns out your symptoms
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aren t improving.
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Early on, I did.
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I did worry a lot about my patients.
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But over the years, I ve been able to better compartmentalize because you have to.
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And this kind of ties into the importance of making one s mental health a priority.
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So I can t be effective as a psychiatrist if I m constantly thinking about all of the patients that I treat.
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And I work at many different places.
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I cover psychiatric ERs.
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I work inside the hospital, outside of the hospital, private practice, all different types of settings.
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I work with kids, adolescents,
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I cover at jails sometimes.
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And so, you know, all these different patients presenting with so many concerns, I have to be able to move from patient to patient, from setting to setting and be able to be present.
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And so it s important for me to take care of my mental health.
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And so when I go home, I need to be able to leave that and be able to get massage and exercise and spend time with my family and my friends so I can feel rejuvenated and refreshed and so that I don t get burnout.
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Now I do have some patient situations and cases that have stayed with me as examples of things that I ve learned about myself as a psychiatrist and how I want to practice medicine.
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And those stories I keep with me and I ll always treasure those.
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I ve learned so much from my patients over the years.
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I graduated from medical school in 2003.
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And my patients have taught me so much about resilience and especially those who have substance use concerns and have made it through recovery, years and years of sobriety, what they ve learned about themselves in that process and what they shared with me.
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I really feel very grateful to do this kind of work.
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And I m also grateful, though, that I know that I need to take care of myself because I don t want to risk burning out and not being able to be effective in there for my patients.
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And when we come back, I wanna hear more about compartmentalization.
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I think this is a skill many people probably can use.
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How does the compartmentalization work?
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You said you got better at that.
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I would imagine there s a lot of people listening, not only physicians, but people like attorneys and even just people who worry about their job when they re not at work.
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How do you compartmentalize?
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Because this is probably a skill that a lot of people could use.
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Well, when I m with my patients, I m fully present.
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Obviously, you know, cell phone s not on.
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I m making eye contact with them.
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I m fully, fully present.
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But when I leave, if it turns out that I m still thinking about a particular case or situation, sometimes I ll journal about it.
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And that s actually very therapeutic for me.
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You know, I ll journal about my experience of that interaction with that patient and what I want to walk away with.
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And for me, that helps me to kind of make more sense and write out everything that I m feeling, experiencing, and that helps me be better able to release it.
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So actually writing about it is therapeutic for me and helping me to be able to let it go.
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It takes time, it takes skill, it s not something that you learn just like that.
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You know, especially with medical school and training, we were taught early on, you know, how to move from situation to situation and try to focus on whatever it is the patient is presenting with.
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Now, we as physicians, though, it can be very difficult for us and really any professional because when you start doing that so much, there s that risk that you won t have the feelings, concerns, compassion that you need to have as part of this profession.
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But I think that takes some years of experience and time to get to that point.
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But I m really, really proud of where I m at right now in terms of being able to work through that.
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I ll be honest with you too that I ve had my own therapy and I recommend that for any mental health professional that they work through their own issues and concerns that they can better be able to be present for their patients and help them through and they re not involving their past into what s going on in the session with the patient.
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It used to be years ago that it was mandatory that psychiatric residents receive psychotherapy during their training, and now it s optional.
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And I was so grateful, though, that I received that during my training, because it really shaped and influenced how I practice today.
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That s good advice.
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I mean, I think you kind of touched on two things here.
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Journaling slash kind of venting to let some of the pressure out through things like journaling.
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And then, of course, trying not to get that pressure bottled up and brought home with you to the living room.
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or to the dinner table with your family because I feel like a lot of people could let this job kind of own them and drive them in a way that s unhealthy.
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Yes, that s true.
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One of the big topics that s being discussed right now amongst the medical community are physician suicides.
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And so 400 physicians complete suicide each year.
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And we re very concerned about that.
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And it s partly because we are trained to be able to deal with crises.
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And we re working with patients at very, very difficult times in their life.
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You know, the child that they longed for is diagnosed with leukemia or their husband
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was in a car crash and needs immediate surgery and is trying to work through all of these issues and then coming home and having pressures, right?
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So, you know, family members relying on you, friends relying on you, feeling like you need to be a leader, not cry in front of patients, not show weakness, be strong and not taking the time to take care of oneself.
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And so we re talking about this more and more.
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And what can we do early on, even in medical training, to help these young professionals so that they can learn how to take care of themselves and have good boundaries and get therapy, you know, and reach out and get help and support to help them become more effective physicians and also to have much fuller, richer lives.
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And so this is a big challenge that we experience.
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And I think many different professionals, I mean, not just physicians, but when you re in
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a role of being a leader and having a lot of people who report to you and people who depend on, you know, you writing the check and you being functional to be able to keep the business going.
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That s a lot of pressure, you know, and partners relying on you, kids relying on you, and you re really, really struggling.
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It s very hard to take out time and say, oh, I have to go to rehab because I m really struggling with my substance use.
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So you guys are going to all have to figure that out on your own.
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Or I m so depressed and anxious, I can t function.
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but I can t take the time off to be able to get the treatment for myself.
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And so you can imagine all that pressure on a professional to be at the top of their game all the time.
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And they have such a large impact on so many people, but they re not able to sometimes
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have that time to make their mental health a priority and get treatment that they might need.
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And they really, really suffer and struggle with that for far too long.
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And so that s something that s very, very important to me that we talk about those people who appear on the surface very, very successful and charming and wonderful and wow, they ve really, really got it together, but there might be a lot underneath the surface that s not being addressed.
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What s it like working with people who are incarcerated in jail?
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Yeah, that s very interesting.
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So what I ve noticed over the years is that the same patients I would treat in the psychiatric ER are also over at the jail.
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And that says a lot about our current mental health system, how we criminalize people who have
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mental illness, people who have substance use concerns, and they just kind of rotate, right?
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So, you know, they re seen in psych ER, they might be admitted to the inpatient unit, or they might stay in the psych ER, but then go over to the jail.
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And so it s very frustrating to see this happen.
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And so we really need to talk more about how we can get these patients good substance use treatment, and also good mental health treatment in general, because we re going to keep seeing the same pattern over and over again.
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And I remember when I was covered at the jail one time, I saw this inmate who was quite young, 18, 19 years old or so.
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And he seemed to perhaps have a developmental delay or intellectual impairment.
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And he said, well, I know it was wrong for me to break into that car, but I didn t have a place I could sleep and it was cold outside.
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And just my heart went out to him.
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My heart went out to him because
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He knew that was the wrong thing to do, that was illegal, but he felt like he had no other options.
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And, you know, one of the things that I ve talked with friends about is, gosh, you know, if I was in a position where I had no ID, no money, no family, really nothing, what would I do to survive?
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What would I do to function in this world?
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Would I do something illegal to be able to put food on the table for my kids?
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What would I do if I really had no resources whatsoever?
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And so I think sometimes we need to have more empathy and also figure out how we can help these people and advocate for them.
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Because on the surface, it seems like they did something wrong.
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They broke the law.
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They need to suffer the consequences of that.
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But as a psychiatrist, I see the layers and layers underneath.
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And what was it that happened to this young man that led him to be in this position and to make the decisions he s made?
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And what got missed here?
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What ball got dropped or multiple balls that got dropped along this young man s life course?
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Is there anything that I haven t asked you that you want to make sure you deliver?
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Well, I just want to say that one of the things that I m really, really concerned about
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is when I first started in private practice, I had many patients who were coming in describing the classic textbook symptoms of ADHD.
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And they knew what to say in terms of having difficulty with focus and concentration.
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And so many of them had valid concerns, but not all difficulties with focus and concentration are ADHD.
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And there s this big issue with
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Stimulants being overprescribed, people sharing stimulants, and people don t recognize that these aren t just harmless study drugs, that there are consequences to long-term stimulant use.
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You know, the dysphoria that patients can experience afterwards, there s potential cardiac effects, there are drug-drug interactions.
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And so people are using stimulants in the morning and then benzodiazepines and alcohol at night.
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And, you know, it s a big issue because more and more states are cracking down on this issue.
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And even in Tennessee, it s a felony.
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You know, if patients go into a doctor and they do not disclose to the doctor that they ve seen other physicians and getting prescriptions for controlled substances from other physicians, they could potentially be arrested.
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And so there s a lot that needs to be done as far as what people are doing, because I think that they re not really looking at the underlying issue.
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The underlying anxiety, the underlying depression, whatever it is they re experiencing that is making them think that they have to turn to a stimulant to be able to function and to a benzodiazepine to be able to sleep at night.
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The other issue too is opiate use.
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You know, people are doing things that they could never imagine that they would ever do.
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And some people are genetically predisposed to developing opiate addiction.
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Okay.
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And so there s so much shame in that, but it happens when people have a dental procedure and they find they have euphoria when they receive Vicodin and Vicodin leads to, you know, Dilaudid and Percocet.
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And next thing you know, they re using IV heroin, you know, and they re like, how did this happen to me?
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How did I end up?
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you know, trying to get medication off the street or through the internet.
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And they feel so much shame because they don t know anyone who s going through something like this.
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And that keeps them from getting help.
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No matter what you re going through, as far as your substance use concerns, your depression, anxiety, seek mental health treatment.
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There are people here who want to take care of you, who want to help you out, who want to see you do well and move forward.
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You re not alone.
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The help is available for you.
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Thanks so much, Dr. Melanie Watkins.
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Much appreciated.
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I know people listening have probably been on the fence about seeking treatment for something like this or even for themselves or for a friend.
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And I think that having the warning signs laid out in front of you as well as the consequences can spur people to action, which might save their life or the life of someone they love.
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Definitely.
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I agree.
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Thank you, Jordan.
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You know, not our usual beat when it comes to this stuff, Jason, but I think this stuff is important.
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I mean, like you had mentioned pre-show, it s not really my cup of tea, per se, normally, but if you re going through this, this can be a lifesaver.
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If someone you love is going through it, it can be a lifesaver.
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Yeah, the warning signs that Melanie put out at the beginning of the show are extremely important to look out for.
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Yeah, if you are sitting in bed for, you know, a couple weeks and you re just like, I don t feel like shaving or showering, that s generally a small sign of a larger problem.
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But there are other issues that she talked about that could really save somebody s life.
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So like you said, this is a special episode, but I think it s an important episode that we re putting out there.
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So I definitely hope people get something out of this one.
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Absolutely, and if you enjoyed this one, don t forget to thank Melanie on Twitter.
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We ll have that linked in the show notes as well as the other resources mentioned on the show as well as contact info for her.
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She does Skype consultations as well as the stuff here in California, so you can get info on that if you re interested in connecting with her and maybe even diving into something that you might think is a problem for yourself or for someone else.
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You can tap our album art in Most Mobile Podcast Players to see the cheat sheet for this episode.
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We ll link to the show notes right on your phone.
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I m also on Twitter, at The Art of Charm.
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You can find all of our amazing sponsors in the show notes, or go to theartofcharm.com slash advertisers, and also I want to encourage you to join our social capital challenge at theartofcharm.com slash challenge, or text charmed to 33444, that s C-H-A-R-M-E-D, to 33444.
4
SPEAKER_02
It s all about improving your networking and connection skills, and inspiring those around you to develop a personal and professional relationship with you.
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We ll also email you our fundamentals toolbox that covers topics like body language, nonverbal communication, persuasion, networking, negotiation, and a whole lot more.
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And I m also doing regular videos with drills and exercises to help you move forward every single week.
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It ll make you a better networker.
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and a better connector, so check it out, theartofcharm.com, slash challenge, or text charmed to 33444.
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This episode of AOC was produced by Jason DeFilippo.
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Jason Sanderson is our audio engineer and editor.
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Show notes on the website are by Robert Fogerty.
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I m your host, Jordan Harbinger.
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Go ahead and tell your friends, because the greatest compliment you can give us is a referral to someone else, either in person or shared on the web.
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Now stay charming, and leave everything and everyone better than you found them.
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Thanks for listening to the Art of Charm.
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Get more confidence, relationship skills, life hacks, and more at theartofcharmpodcast.com.