The Impact of Community

Oct 3

Psychologist Dr. Nicholas McAfee, a member of the affiliate faculty at the University of Mississippi Medical Center, joined co-hosts Meagen Rosenthal, Ph.D, and Alexis Lee for The Mayo Lab’s sixth episode of Season 2. Dr. McAfee explained the complexities of defining mental health and wellness, highlighting how stigma plays into discussions about mental health.

In their conversation, Dr. McAfee noted the positive shift in younger generations with mental health, in which discussing feelings and seeking help is more normalized. And yet, diagnoses of depression, anxiety, and related mental health conditions are rising.

“How do we reconcile this?” said Dr. McAfee. “For at least the past decade, probably the past two decades, we’ve seen a consistent rise in diagnoses. Fortunately, we’ve also seen a consistent rise in people seeking services … So while we’re glad people are coming out and finding us, our wait lists are getting much longer. It doesn't matter if you're a psychologist, psychiatrist, master’s level therapist, any sort of mental health provider, it’s getting difficult.

“So in the face of people having less stigma,” he said, “we’re also needing to rethink how do we reshape our services to make sure that people who are wanting help, who need help can actually get it.”

“I think a lot of people have good ideas. I think we’re headed in the right direction. I think community’s a big part of that, but that’s the one thing I want to put out there is that this is real. It’s affecting a lot of people. And the only way to truly start chipping away at this trend is to do exactly what you’re all talking about, is to break that stigma, to open up those dialogues and to pay attention.”

— Dr. Nick McAfee

Dr. McAfee suggested practical approaches for improving mental health, such as seeking help earlier rather than waiting until mental health issues worsen and maintaining consistent well-being practices, such as noting three good things as an exercise to cultivate a positive mindset. “How do we make sure that we're in a good space emotionally? It takes intentionality, it takes paying attention, and it takes maybe even tracking it,” he said.

They also discuss the importance of community for mental health. Being intentional and making the effort to foster connections, though it can be hard work, can be incredibly helpful for people struggling with mental health issues. Dr. Rosenthal likened this to “social fitness,” in which one builds up social connections and interactions slowly as a muscle.

“Just slowly working and starting with one slow interaction and building that up based on where you feel comfortable,” she said.

When asked what communities can do differently to acknowledge and celebrate human connection, Dr. McAfee recommended finding ways in your everyday life to engage with someone, regardless of status quo or societal structure, involving leaders to promote mental health messages, and leveraging religious and spiritual hubs to facilitate conversations about mental health. Change at the community level, he said, can have a significant impact.

To hear more from Episode 6 of Season 2, scroll down to listen to the episode or read the transcript.

Watch the podcast on YouTube:

Meagen Rosenthal:
I am Meagen Rosenthal.
Alexis Lee:
And I'm Alexis Lee, and this is The Mayo Lab Podcast. Well, hello everyone and welcome back to the Mayo Lab Podcast and welcome back to our viewers to our second episode in the lovely University of Mississippi Medical Center. We're so thrilled to be here. It's been very exciting. We have felt very at home and welcome. So we love it here. And we are joined today with Dr. Nick McAfee and he will introduce himself and tell him about us or about himself. We will not talk about him in front of him, but we are so thrilled to start the conversation on stigma in the mental health specific arena. So Dr. McAfee, welcome to the podcast and if you'll just give us a little overview of your background, how you got here, and why mental health specifically was your field of choice.
Dr. Nick McAfee:
Yeah, absolutely. So I'm not originally from Mississippi. I'm originally from Savannah, Missouri, which if you haven't heard of it's about an hour north of Kansas City, Missouri. And I, for whatever reason I think about this, a lot of how did I get into this field? And honestly, I think it's as simple as I just was kind of interested in psychology all the way back in high school. So I tracked along that way and it was sometime during the early part of college where a couple folks that I was pretty close to and that I knew actually were dealing with pretty severe substance use disorders and I got to speak to them kind of before and after treatment and it was intriguing to me their stories. And so I wanted to learn more about that. Time goes along, I get involved in research labs, decide, yeah, basic science isn't for me, I actually want to help people directly.
So ended up getting my PhD in counseling psychology focused specifically on substance use and management of that and helping people make positive changes in their life. And that led me to internship in Jackson, Mississippi where I ended up getting my degree and staying on as a faculty member and transitioned more a little bit into the broader student mental health domain. So I started with substance use, kind of transitioned to this more broad mental health practitioner role. And that kind of leads me to where I am today looking at both wellbeing and substance use and super excited to be working with the students at Ole Miss.
Alexis Lee:
We are very excited to have you. So to dive in right away, in your own words, can you kind of tell us big definition technically and definition wise, what is mental health? And then also as a caveat, there's these words kind of flying around wellbeing, mental wellbeing, mental wellness. Are those the same? Are they different? How have we kind of evolved in that area?
Dr. Nick McAfee:
Yeah, it's a million dollar question, I feel like if you wait another week, you'll get another term that we need to learn or a subtle change in them. This is, I think a fantastic question because it's so hard to disentangle these terms. I think in many ways they're obviously related. When I think about mental health, I honestly think about somewhat of a failing of my profession because when we think about mental health, we don't think about it as a glass half full type of construct. We think of the deficiency of mental health. So when we're talking about our mental health, it's usually of what we don't have and what we wish we had. Mental wellness I think is probably pretty similar to that, but I think one of the big differences between wellness, wellbeing and mental health is really that it's a much more broad concept. So yeah, mental health definitely goes underneath that umbrella of wellbeing and wellness, but it's only maybe one domain.
So you've got physical wellness and wellbeing, might have financial, spiritual, so on and so forth. If you look it up on the internet, you're going to find about six different models. Some of them have five domains, some of them have like 12. So I think that's one of the big differences. So wellness and wellbeing seems to be a little bit more glass half full approach. What can I do to improve my wellbeing? What can I do to improve my quality of life? Whereas mental health, it's more of what diagnosis might I have or what problems do I have? So I think that's a couple of the main differences.
Meagen Rosenthal:
I think that one of the reasons that we started by asking you about those definitions is because there's so much confusion in the broader world and conversations about what these terms mean and how we can start making changes in our own lives to achieve that goal of whatever that wellness looks like. But I think one of the things that you point out there is that thinking through those domains of financial and physical and mental, what it looks like for you and what it looks like for me are not the same, right? Because we are different people in different spaces and have different expectations and all of those different kinds of things about what our lives ought to be. And I think diving into that a little bit further in the topic of conversation for this fall session of the podcast is around stigma. And so from your perspective as it relates to mental health, what is the definition or understanding that you bring to the table of stigma and how does that stigma or stigmas impact mental health in your work with college age students?
Dr. Nick McAfee:
Yeah, I think with stigma kind of as most people think of it as usually this internalized belief towards the negative. And when we're talking about mental health, so internalized belief that there's something maybe bad or wrong about talking about mental health or how you feel. Or that there might be something wrong or bad about seeking out help formally from someone aside from a peer or a family member. So I think generally speaking, that's how we can talk about stigma. So it can be this internalized belief, but it may not be one that we actually have conscious access to. So I think that complicates things because there might be some folks who say, "No, I don't really have a problem with it. This is fine. I'm happy to talk about my feelings." And then behavior may not actually reflect that because we all have internalized unconscious biases
And stigma towards talking about our feelings and mental health and seeing a mental health provider happens to be one of those domains that could fit into. So how does it affect people I've worked with, I think this is the positive end of the spectrum. I think this has been such a difficult topic to address for so many years, and I think we're finally seeing some fantastic headway in the sense that folks I work with under the age of 25, ain't no big thing to talk about how I feel, and maybe to whomever is close to them or maybe not so close to them.
It's just so much more normalized now versus folks who let's just say are in older generations might have a much harder time because it wasn't as normalized, it wasn't as much part of society really, or any part of conversations we're having in a broader scene to say, "Hey, I don't feel very good today and it's not because my leg hurts or I'm sore here, it's because I kind of feel sad." I think that conversation's changing a lot and I'm seeing that in just a lot of the students that I've been working with over the past few years.
Meagen Rosenthal:
I think that's absolutely fascinating. We certainly... I won't speak for Alexis, I certainly came to this conversation and assuming that that stigma was still something internally for our student population was something that we were still battling against that they weren't interested or couldn't fathom how to have conversations about their feelings. So I guess I have a couple of questions, but my first question around this, what do you think has changed generation to generation that has enabled this population of young people to have more comfort in having and starting those conversations at least?
Dr. Nick McAfee:
Yeah, that's a really good question. I suppose it's an empirical one. Someone's probably asked the question and studied it and I just haven't seen it. But from my own kind of anecdotal perspective, it just seems like it's this slow subtle change that we see across generations in different domains too. But I just think that as times gone along, people have maybe understood the importance of expressiveness in the background has kind of been the mental health revolution where it's more than just secretly seeing your psychiatrist to get your prescription refilled, and that's the extent of the mental health services that are provided to you. So I think that normalization is in the background and I don't know how much effect the pandemic has had where people have just been so... I think this is one of the double-edged swords of social media is it's just so common for folks to share, "Here's going on in my life. Here's also maybe the not so good."
And so it's been normalized via that platform, especially among Gen Z. But yeah, what's actually specifically happened I think is super complicated. But something definitely has where if you look at just different attitudes, some of the literature on this shows there is a huge difference when you ask people who are, for example, baby boomers versus Gen Z or maybe even millennials, what are your thoughts about this? I don't know that they're diametrically opposite or opposed from one another, but they're very different in terms of permissiveness or openness towards talking about mental health or willingness to seek a provider.
Meagen Rosenthal:
The other thing that this makes me think about, because I love the perspective that you've taken to the work that you've done in alignment with for the positive psychology movement, we're looking at this from the perspective of glass half full. You're not deficient, but we're just trying to add to and assuming that kind of baseline, what's the right word? The baseline kind of level that you're at around these things.
And I think about what you just talked about as it relates to this permissiveness of the current generation of students out there in relation to all of the news that we've heard around the mental health epidemic that we're facing and all of these bad things that have come. Really were ramping up pre-pandemic but really came to the fore in terms of the news media post-pandemic. Everything has been related back to the pandemic, has caused all of these kinds of things. How do you reconcile those. This idea that students are now more comfortable having these conversations than they might have been in the past, but then also that we're seeing this growth, this explosion of diagnoses of depression or diagnoses of anxiety or all of those kind of concurrent conditions in this space.
Dr. Nick McAfee:
That's the billion-dollar question and maybe trillion-dollar question because there is not an answer to how do we figure this out. We have all of these people who are now more open than ever and probably the most at risk generation from mental health concerns probably that we know about in terms of recorded scientific history, which is of course very modernly biased. But that's a great question. How do we reconcile this? I don't know that there are a lot of good answers, but I think when it comes to, it's good that people are willing to see their provider, but this is something that I've been doing a lot of thinking about too, which was, you're exactly right. If you talk to any college administrator at any university college, community college, anywhere across the United States, they'd say, "Yeah, the pandemic made things worse, but it was already getting pretty bad."
This was just something that people weren't paying attention to. Like you're saying, news media has picked it up and I think that's really important, but this isn't something that just sprung up overnight. For at least the past decade, probably the past two decades, we've seen a consistent rise in diagnoses. Fortunately, we've also seen a consistent rise in people seeking services with the issue being there's only so many people to actually see them. So while we're glad people are coming out and finding us, our wait lists are getting much longer. It doesn't matter if you're a psychologist, psychiatrist, master's level therapist, any sort of mental health provider, it's getting difficult. So in the face of people having less stigma, we're also needing to rethink how do we reshape our services to make sure that people who are wanting help, who need help can actually get it.
Meagen Rosenthal:
And I think that you bring up a really important point there, and we talk about this in some of the work that I've done in other spaces, you kind of have one shot. So when somebody comes and has finally decided, "Okay, I need some assistance," and then it's, "Oh, but it's six months before you can get in, or it's six weeks before you can get in." That lag time really has a negative impact on patient outcomes. Because you have to assume that they're going to have the guts to come back again, that they're going to be in the same kind of place that they haven't "solved" their problem in some other maybe negative kind of way in the meantime.
So from your perspective, what are some things, and I know that this is a big complicated problem that is decades in the making really and is not going to be solved overnight. And I appreciate and love your honesty in answering that question, saying, "I don't know." Because I think sometimes we assume that folks with fancy letters after their names and really great degrees should have all of these answers, but we just don't know yet. So from your perspective, what are things that we can start to do to chip away at some of those things, knowing that overnight we're not going to get a crop of a million psychologists, counselors, et cetera, that can really be working one-on-one with these people who are seeking these services?
Dr. Nick McAfee:
I think it really does go back to your point about stigma. Even if we're more likely to talk about this stuff, it doesn't mean that communities or families as a whole are open to it. So well yeah, I absolutely recommend go talk to a therapist if you feel like you need to talk to somebody. And we also, for many, many thousands of years didn't really have therapists. We had communities. We had our parents, our extended family, our friends, our social circles, people to confide in.
And I think there's still stigma that kind of lurks underneath the surface in these social structures, whether it be small or large, to where it might make it difficult to talk. And then your only resource if you want to talk to somebody is to seek it out formally. I think a lot of people obviously should and should take advantage of that. There might be some folks who could benefit if they didn't wait until they felt like, "Oh wow, I feel like I'm actually depressed." Whereas whenever they're first starting to feel maybe some sort of signs of feeling low or down or disinterested in things to go reach out and talk to somebody to make that connection.
So I think addressing stigma in broader, more social domains is important. And obviously there's been a lot of headway in that too, but I've heard a lot of stories from my own patients who talk about, yeah, you're really the only person I can talk to about this concern, or I can't talk to my parents about this because X, Y, and Z reasons, whether they're founded in reality or not isn't really important. If parents would actually be upset or not. I imagine many of them wouldn't be upset and I imagine a few would be. But the important point is that even if people don't have that stigma themselves, they worry about the people around them judging them for talking about it or maybe have been given explicit messaging around "We don't talk about this." So I think that's an important part of the conversation to get people access to their communities in addition to access to mental healthcare too.
Alexis Lee:
And I want to talk about a little bit the idea of being afraid to bring it up at home or in your community around there. And I know a lot of parents are listening to this podcast and they're thinking, "Well, I would be so open if my child would come to me," but it might be the subliminal messaging or unconscious communication. What would you suggest or how in your opinion, to open those doors at home in your home or in your community to say, "Hey, I'm open and I won't judge," or try and take that first step?
Dr. Nick McAfee:
Well, I think in the name of breaking down stigma, I'll share a personal story. I won't name names in terms of family members, but I'll give you an example of what it looked like to get that explicit messaging among family members who I bet you if you ask them the day, would say, "No, no, you can come to us about anything." And I do believe them. It's just it's we have these beliefs about ourselves and sometimes those unconscious biases come through. So I think I was about 12 years old. I was currently in the process of getting my swimming merit badge in Boy Scouts and being a little perfectionist that I was, I wanted to be perfect at it. But I was terrified of lifting my head above the water because I thought I would inhale a bunch of water, so I somehow managed to hold my breath the entire way back and forth. Which on the rubric, which I had a really good teacher, on the rubric for the merit badge, I wasn't technically passing the skill, I wasn't doing it correctly.
So no matter how hard I tried, I could not get my head to come up above water and at the end, I couldn't get the merit badge, which made sense to me. But I was so upset. So in front of these other boys and some other family members, I started to cry. I was super, super upset about it. The family member who will go unnamed, who I care about a lot and is a very kind person looked at me and said, "Don't ever embarrass me like that again." And it was so powerful to me because I learned in that moment, "I can't do this. I should not show external emotion." So that's coming from someone who I know is a caring, compassionate person who I've talked about other struggles with before.
So we like to think good things about ourselves, but sometimes there's some reality. And I don't even know if this family member would remember that. It's probably just a blip on the radar. So when it comes to talking to kids, I think it's really making sure that you take a good hard look in the mirror at what have I done to actively facilitate this? Have I actually reached out to my kids proactively just to check in with them? Of course, kids when you do that might not give you anything, but do I continue to proactively reach out to them?
So I think it comes back to that whole point of, yeah, we like to think of ourselves in a positive way, and that's probably a good thing that we do, but it may not be accurate. And we need to make sure that if we think we're doing a good job, that maybe we actually ask our kids. As parents, reach out to our children and open up that conversation, even if it's just incremental and doesn't lead to anything the first or second time, but making sure that that door is always open and making sure you can track what you're doing to say "Yes. I have definitely asked my kids about how they're doing. I've asked them about how they're feeling," as opposed to, "I think I have," or "I think they're doing okay."
Alexis Lee:
Yeah, I love that. And I want to circle back too to something else you said earlier about asking earlier before it's too late coming forward before it's too late. How do people know? How do they know of, maybe I've been feeling different, but what if it's just a bad day kind of thing? How can parents or students even register, self-identify themselves on the radar of when should I speak up or when is too late, too late? And then also on the flip end for parents of when you start noticing changes in your student, how long do you wait or when do you address those and how do you have those conversations?
Dr. Nick McAfee:
Yeah, I think that's a really great question. And of course there's going to be a point to where it's like you don't know, and that's a great time to reach out to somebody who's got the education and is paid to know this stuff. And if you're noticing your mood has changed for a couple days, that could be a change in the weather. I know for me, for example, I am so sensitive to lack of sunlight. So I know that whenever it's been a cloudy couple of days in the spring and I'm like, "Yeah, I'm really dragging." It's like, "Oh, it's been raining." So I've kind of learned that over time, but I didn't always know that. And so I think the answer to that is honestly paying a lot of attention to ourselves, which we are not really neurologically set up to do all that well.
So it takes a lot of practice in that domain. So paying attention, having that connection socially to reach out to people so that way if you know you're talking about something, maybe your friends can give you some advice or give you some feedback because sometimes our friends know more about us or family know more about us than we know about ourselves. We're pretty poor at self-reflection and assessment unfortunately. So doing that, and if you felt pretty poorly for a couple of weeks or more and you're noticing I'm not interested in things or I'm just more nervous about stuff that usually doesn't bother me, I think that's time to maybe reach out. If it's lasted half a month, that's a lot of times, especially for depression, if more than half the time for half a month you felt down, reach out to somebody, you might actually be in the middle of a depressive episode.
But if it's been a couple days, maybe it's just worth talking to somebody and getting ahead of it and at least expressing those emotions.
Meagen Rosenthal:
I think, I love how we've kind of bent and melded this conversation into those more practical things that folks can start to do. Because that's really, one of the goals that Alexis and I started the conversation for this season about is like, "Okay, what is the stuff we can do right now?" I don't have all the answers, but we have some good stuff that's in place already around thinking and doing check-ins and accessing resources. And I wanted to take a second to do, because something you just said peaked in my mind. And absolutely I fully and completely admit struggle with oftentimes is that self-assessment. So what are things that folks can do from the perspective of our parents that are listening, but then also for students who might be listening or parents of students who they can kind of pass through that information, what are things that we can do to figure out how to make that pause and do that real honest self-assessment, because it's obviously hard to do, but what are things that we can do to get that process going?
Dr. Nick McAfee:
I think it goes back to that point of individualization that we were talking about initially is that everybody might have a different way of doing this. I've heard a lot about folks who come to me talking about how they're journaling. There's certainly ways to journal about how you feel. Some ways it may be more helpful than others, but just writing about stuff we know to put it simply can actually be really effective. So jotting down how today was, what are some of the things you remember feeling or having regular check-ins with your friends just to talk about your day.
Maybe it's not specifically focusing on how you felt, but just reflecting or that process of here's what's been going on in my life over the past week or so. So I think connection with other people is actually a good way to check in with ourselves because inevitably they're asking about us and we have to tell them. Or even something more regimented. Some folks just like to keep not necessarily a journal per se, but maybe more like a checklist of what happened today or how did I feel today? What did I notice? There's also, it's not necessarily checking in, but it's actually a fantastic way of reflecting on the positives, an intervention called three good things.
So a lot of people in the wellness domain have heard of this. It's probably the most simplistic intervention that also we know from an evidence-based perspective actually does help people feel better if they do it consistently enough. So I don't necessarily, I guess, need to get out in the weeds on three good things. But writing good things about your day and what's been going on, not only is a good way to check in with yourself, but actually is a nice way to bias yourself in favor of the positive in your life as opposed to what we might do when we're feeling down, which is look at all the bad things and overgeneralize them and feel like I'm stuck in all this terrible stuff. So I think those are just some general ways that people can check in.
Meagen Rosenthal:
Those are all really great examples and I will share too. Most of those are things I've certainly engaged in my past. And I want to talk just for a second pause on the three good thing because I know, I think at least anyway, that there was a certain amount of time that you have to engage in that because you say doing it regularly. So what is that amount of time? So we're getting specific with our listeners this year, what is this amount of days in a row that you need to do that before you've got those neural pathways created so that you're biased in that positive direction?
Dr. Nick McAfee:
Yeah. So I said, "We're not getting in the weeds." Let's get in the weeds.
Meagen Rosenthal:
Let's get in the weeds. No, we're getting specific here for folks.
Dr. Nick McAfee:
I think that's a really important question because I love specificity too, and you're also highlighting a more general point, which is like this wellness stuff, this mental health stuff, it's not a one-off thing. So I love lots of wellness stuff and I'm very guilty of being like, "I did it this week and now I'm done and I don't really feel that different, but it was nice when I did it." Three good things we know probably at least a month of consistent writing every day. Of course, it's three good things. It takes probably maybe five minutes out of your day, but writing just three good things. And that's totally up to you, whoever it is that's writing the three good things.
And the most important part is why you thought those things happened to you that day. So we don't know why, but it's important to reflect on, well, what made it possible for that good thing to happen to me and to come into my life today? So it's totally your own interpretation, but it's kind of almost this savoring activity of this was something really good and I want to think about it a little bit. And we know that again, about a month or so, and you don't have to stop there. You can keep going.
I have a friend who I think has gone through at least two or three of the three good things notebooks that we've handed out at UMC for the Office of Wellbeing. So I know that some folks might have a hard time finding consistency in that, but I think that really is the key behind almost anything you do. If it's good for you and helps you feel better, don't stop doing it. Keep it consistent. Same thing for three good things. You can't just think about the good every now and again. You have to be consistent with it.
Alexis Lee:
And in that practice, is there evidence to do it in the morning versus the evening versus the afternoon? Is there a time of day that's-
Dr. Nick McAfee:
Great question because I like specifics.
Alexis Lee:
I do too. And I have a gratitude practice and I'm like, "I'm totally shifting to three good things." But where do I need to do it in my morning, evening, lunch? Do I need to take an after walk?
Dr. Nick McAfee:
Per the recommendations of the initial intervention before bed. At night before bed.
Meagen Rosenthal:
Interesting. Okay. I was totally doing it at the wrong time of day because I would usually get up in the morning and do it as part of the check-in and prep for the day. I had been doing it in the evening, but shifted just to do it then. So that's a recalibration for me around this space. And what I think that I like about getting a little bit into the weeds around these things and what your comment just was, I hear intentionality in what you're talking about is we have to make the time to engage in these practices to see the benefit of them.
And we often, from my observation of social media and those kinds of more publicly facing spaces, we get the impression often, and it's not that the wellness folks are, most of them, I would say some of them do. But most of them are not actively perpetrating this kind of idea that it's a one and done thing, but it isn't, right? It is this intentionality. It is this consistency and habit-forming process. So could you talk to us if you have any insights and guidance on how do we make this a practice that we can stick with and how do we get that rolling intentionally in our day-to-day lives where we're all busy with work and school and family and all the things that we're supposed to be doing? How do we build this in?
Dr. Nick McAfee:
I think that context you just provided is so important because the knowledge is not the hard part. Most people already know what's good for them. Most people already have a good idea of, "I used to really enjoy this, or it was meaningful to me." When you have in a clinical context, when I have those conversations, it takes almost no effort at all for that individual to immediately delve into all of this stuff that's like, "Ah, I missed doing this." But that context around, I'm busy, I have all these different things. Whether it's actually true in the sense of there literally is no time where your mind has come up with this concept of "I don't have any extra time."
It doesn't necessarily matter because there is just so much going on in people's lives. So how do you maintain a habit? How do you keep it consistent? If you think about, I guess the underlying theory behind this, the stages of change. How do I put something into action? A lot of folks in the wellbeing space might be in that kind of contemplation stage of like "I kind of want to do this, but I don't know if I'm ready." And then there's more stages to it than that. But one of the more forgotten stages of change that people don't talk about as much is the maintenance phase, because it doesn't just stick. You can make a change and then it goes away. So making things stick does take this intentionality. It takes specific thought. It is essentially the opposite of autopilot. The path of least resistance when it comes to health behavior change will typically mean you're going to go back to doing what you're doing.
So just like it is with the how do we make sure that we're in a good space emotionally, it takes intentionality, it takes paying attention, and it takes maybe even tracking it. And maybe one of the most helpful things that I have personally used is you can call it a lot of different things, but one of the, I guess you can just call it phoning a friend essentially. And I literally actually phone a friend to help me do some of the things I really dislike doing, but is good for me. In this sense, it's with writing. I do not like to write. It is not easy to do for me, and it's very important that I write. It contributes to the field. So what do I do? I literally will call one of my friends virtually and will join in on that call, set a goal with somebody for an hour and say, "All right, at the end of this, here's what I want to have accomplished."
So if I don't accomplish it, they know and I'm caught. And it's probably the most wildly effective way to do this because someone else is involved. So it kind of comes back again to that, even if it's not a whole community, just some sort of connection with someone else to help facilitate your goal. And usually the friend that I call will not have the exact same goal as me, but we'll be doing the same thing. So we're kind of working together. I think that's another really helpful strategy to help us maintain something, let someone else know what we're doing. Have check-ins and feel like we not necessarily beholden to that other person or that we're going to let them down, but to at least have a little bit of that in the background to motivate you. We don't always have the internal motivation, but we can create external motivation.
Voiceover:
You are listening to The Mayo Lab Podcast. For more information and resources, visit themayolab.com. Now back to the episode.
Alexis Lee:
And I want to touch on community what you were just talking about, because there's a book that just came out about the good life, about the Harvard study, about talking about relationships and communities and how essential they are to your mental health. Can you speak to that a little bit of why and just the importance of that kind of more for our listeners who maybe don't know that study that well or have not heard more about that.
Dr. Nick McAfee:
So this is kind of the compendium of a lot of what we've been talking about for a long time as a field. And I'm so glad that we are having this empirical work in that domain to essentially validate that's like, okay, we need to connect with these structures that are so important to us that we know on their face are important to us. But it's always important when we actually have the empirical validation to it. And so I think we've become such an individualistic society over time, and so by that drifting, we've lost connection to these threads of our society. And so by coming together, we have support. We have all these essential needs met through our community where for a long time, and actually in a lot of different communities, we see this and we're actually, it's probably underlying a lot of the mental health concerns of our youth is this disconnection.
So by coming together as a community, what we're finding is that this is actually giving us the support that we need. It's giving us kind of essentially going back in time. So it's like this is our mental health provider now that we're so willing to access the people around me. So it really does take a village, and I think that's what's important for people to know is there's a lot of stuff out there on self-help, and that's good. We should definitely try to help ourselves if we need to. But through these types of studies we're learning, maybe it's actually connecting with the people around you who share similar values to you and people who you care about that might actually have as much or maybe even more of an effect as just trying to "pull yourself up by the bootstraps."
Meagen Rosenthal:
And I think that is such an amazing observation. And also I would like to offer to folks, we kind of assume sometimes in countries like the United States where that individualistic society cultural aspect is such a key component of how folks here visualize success. And what is the penultimate goal of our world that you almost, because we are human beings and human beings are inherently not super willing to expend energy, we're lazy. We do the easiest thing, we think of one to the exclusion of the other. So we can't have individual success whilst having a community, but that's not necessarily the case. And so finding a way for us to make a balance between those two things, because we know that as you just talked about, and that Harvard study that Alexis just referenced has been going on for minimally 50 years, probably longer. I can't remember the exact date. So we've got a huge amount of data supporting this idea of the importance of community, but reorienting our thinking that it doesn't have to be all or nothing.
There is a middle ground and we just haven't figured it out yet because we haven't spent a lot of time thinking about it. And so coming back again to this idea of intentionality and also this takes work and time and effort, and it's not just something that we can set on autopilot and assume is going to be okay. And I would like for us to just switch gears here for a second because I think what you've covered so far, Nick has been just incredible and amazing. But I also know you spend a lot of time working with young people and students, and I know you have ideas about how things could be better and what you would like to do in your future work.
So I'm going to give you a magic wand, and I'm going to say if you had a magic wand, we're not solving all of the world's problems, but if you had a magic wand and had an unlimited budget, which also you do not have in reality. But magic wand moment, what would you do in the next six months that you think would have the biggest impact on a student population or on young people around the issues that we've talked about so far today?
Dr. Nick McAfee:
If I had a magic wand, which you've turned the tables on me, this is such a therapist question to ask.
Meagen Rosenthal:
You're welcome.
Dr. Nick McAfee:
Yeah, I appreciate it. If I had a magic wand, I think the first word that comes to mind or concept is if we could just get rid of it with our billions of dollars that are in our budget, is removing loneliness and creating connection. I think it's not going to solve everyone's problems in every way, but it's hard to think of a problem that we have in our life that doesn't at least get better with people around us who care about us.
We are inherently a social species. We really not. We don't do well only by ourselves. We need people around us to support us, to help us accomplish goals. And if we don't feel like we have that, it's kind of hard. We're fighting upstream. It's not to say that people who are lonely can't be helped, it's just seems like if we could just improve that, we would see differences in youth mental health, we would see differences in youth substance use, we would probably see differences in youth attainment in school to feel like you're connected to that process. If you're lonely and you don't feel connected, why would you stay in that environment that feels like you don't belong? So I think that's my magic wand answer if I had one.
Meagen Rosenthal:
I love that, and I love that we have through themes about community and connectedness going through this entire episode so far. And I feel like that gets us really in a good place because I'm going to ask you to go in the weeds again on this. If you are experiencing loneliness yourself, you don't feel like you're connected, what are things that you could start doing tomorrow to begin to chip away at that and get you yourself into a position of feeling like you have that circle of folks around you who care about you? Because I would offer maybe for many people, you actually have those people around you already. You just maybe don't recognize them as such. So how can you start that process as an individual?
Dr. Nick McAfee:
Yes. Well, we'd want to probably avoid what in the business we call flooding. So kind of throwing yourself in the middle of the most social setting you could possibly find.
Meagen Rosenthal:
That gives me heart palpitations as an introverted person. I'm like, "Ooh, no."
Dr. Nick McAfee:
Yeah. So whether you're introverted or maybe somebody who struggles a little bit with social anxiety, it makes sense that you might have hesitancy. Or maybe you're just feeling lonely and you're feeling down and it just seems kind of like, "Ugh, I don't really want to get out and do this thing, or I don't want to even call this person." So I actually work with a lot of my patients on this exact thing, which is connection. You've become disconnected, how do we get you back in? So I think a useful algorithm is what do you need right now? Do you need just to chat? Do you just want to talk to somebody? Is that what you're in need of? So who's somebody in your life that you haven't talked to in a while who maybe you don't want to share all the difficulties you're going through, but you at least want to talk to somebody?
Think about those people. Or maybe you need a little bit more support. Maybe you're established with a therapist, maybe you're getting the help you need in that way, but you're still feeling isolated. Who's somebody in your phone, in your social group or text message? Who can you contact that will listen to you, will talk to you even if you haven't talked to them in a really long time, who can you reach out to? So it's kind of creating that algorithm of not just randomly opening your phone and calling someone or going to the next social event where there's going to be 20 or 30 people there that you might not know. I think going for that low hanging fruit first, just to get your feedback out there, to have that successful experience of "I feel connected again," is a great place to start.
Meagen Rosenthal:
And I have two thoughts/comments/probably will be turned into questions, but one of them is the idea of social fitness. This was, I don't know where I read this or heard this about social fitness is just physical fitness. You're not going to pick up a hundred pound dumbbell and try and lift it on your own. You're not going to jump into this big pool of people if you're not comfortable. You have to start slowly. I'm not going to run a 5K tomorrow, but I could run five minutes.
And so just slowly working and starting with one slow interaction and building that up based on where you feel comfortable. And when that switched in my head, I became so much of a people person so much quicker because it felt more attainable in that way just to be able to, "Oh, it's just like fitness. You have to..." And then you have to maintain it too, kind of and continued to work at it. And then the second thought I just had was I just came out of a season of life where we had a family member pass away and situations.
Anecdote excluded from that, I needed different support in that time, and I was so ashamed and guilty that I wasn't going to my "best friend group" for that. I needed to go to another person or people for that. And it clicked for me just actually last week of that's okay, because what they're skilled in, that's what they have empathy, they've been through this. And it's okay to have multiple groups of people and friends for different seasons or instances in life, but I think society has told us that you need the one group and those are your people and kind of quantity over quality in that way of, but it's just going to be one group and they have to know everyone, and everyone has to know each other.
Dr. Nick McAfee:
You're bringing up the point of the shoulds and coulds that therapists get upset at if they're doing the old cognitive behavior therapy, right?
Alexis Lee:
Yeah. If my therapist is listening, don't. Yeah.
Dr. Nick McAfee:
So I should talk to this group of friends whenever the real answer is what's the most effective thing for me right now. Whether it be that scenario or anyone, there's the perfectly right thing that we'll probably never retain. And then there's the most effective thing for any situation.
Meagen Rosenthal:
I love that. I love that. Baby steps in a good direction, really. And again, coming back to that idea of an intentionality, you are making time for these things to happen. And so I'm going to build out one level of the circle around us. Now, if we are a family or a friend or somebody in an outer circle who's making an observation of someone in our space that may be being disconnected or have been disconnected, how do we as an external person bridge that conversation with that individual to begin to chip away at that social disconnect?
Dr. Nick McAfee:
So if you're the third party, you're noticing something different, you're wanting to reach out. So maybe it's you notice something different than someone else, or maybe you're wanting to reach out on the other end. I think if as third parties, I guess on the opposite end of how we've been talking about how do we make change. So as the friend, sometimes I think it's actually perfectly appropriate to call out what you see in a nonjudgmental way. It's like, "Hey, we haven't talked in two weeks. What's up?"
And not forcing someone to tell us how they feel, but at least just to let someone know, "Hey, I'm checking in on you. How are you doing?" Calling out specifically what you're noticing. So that way it doesn't look like it's some sort of judgment to that person, but a reality is. "So the fact is, I haven't talked to you in two weeks. Normally we talk every day, just been thinking about you." So I think paying attention to those things, and we do this, I even do this. I'm a mental health professional, and I'll come up with these rationalizations like, oh, I'm sure they're okay.
And a lot of times that's true. And then other times there's my friends who actually have been going through something difficult and maybe I've thought "I haven't heard from them for a while." And so the times I do reach out, I always feel... Even if it's just, "Oh, I'm totally fine. I've been on vacation and I haven't been able to talk to you." That's much better than knowing that, oh no, you were struggling. I may have noticed something and I didn't ask you about it didn't reach out. So I think as the third party to this, again, I guess back to that whole community, it takes a village is it's not all up to ourselves. It's as a social group, we should take care of the people that we care about just, and that could be as simple as just asking them how they're doing.
Meagen Rosenthal:
And what I love about that, particularly too when I have, because I'm not always great about it, is the reminder and reinforcement that there are people that do care about you and that you get that reciprocated when you have that check-in with somebody. Be like, "Hey, I haven't talked to you in a minute. How are you doing? I was thinking about you the other day. What's up?" They will often come back around and then re-engage in those conversations. And that helps me feel connected to the people around me in a different kind of way had I not thought to take the two seconds it took to like, "Hey, just thinking about you. How's your week going?"
And I think that for me at least, it reinforces that connectivity. The next piece of this, we're going at one more level. So around the people that you immediately can touch to our larger community, what do you think from your perspective that our communities on a larger scale can start doing differently to reinforce that engagement, to reinforce this and build structures. To acknowledge and celebrate the fact that, like you said, we are social creatures, we are social animals, we are not built to live in the world alone.
How do we do that on a larger scale?
Dr. Nick McAfee:
This almost sounds like a question from someone who's interested in sociology or something like that.
Meagen Rosenthal:
Well, you know, there's that.
Dr. Nick McAfee:
And honestly, I think this might be the most important level. So we've talked about a lot of what we can do, and I think that practicality definitely we should talk about. But because we have the limitations we do as human beings, our community, our social norms that generated by our communities and larger social structures are likely are going to have the most impact on us. So what can we do? I think it's changing different structures, and there's a lot of examples of how this has worked.
So I think the most common example I can think of, so we know that men have a really hard time talking about how they feel. Not all men, but in general, men seem to have a little bit more difficulty, and there's a lot of reasons for why that might be. It's probably counter to masculinity or these norms around what it means to be masculine, and that maybe talking about your feelings and reaching out to people doesn't fit that you've seen some of these interventions where barbershops, where you have people come in who are, it is their entire job just to talk to you about your feelings or barbers who get trained to just, "Hey, how's it going? Let's talk about these different things going in your life."
So changing those already existing structures in a way where it's maybe more comfortable for people to engage. And then actual engagement of leaders. So there's obviously does your governmental leaders where we can work towards making it more of a public health message around, "Hey, it's okay to reach out for help. Here's all the access to mental health resources in the community." Putting that message out there for everyone to hear equally of, "Oh, okay, this is something that we do." And then also maybe in more defacto community where a lot of times it might be centered around spiritual hubs or religious hubs, so churches, spiritual groups, having those leaders engaged in conversations with individuals about normalizing mental health, wellbeing, having conversations about that. And so tapping your way into all of that, so that way it kind of trickles down to all these things we've already talked about.
Because if you as an individual aren't hearing that message, it makes it even harder to implement it or it makes it harder to know how to achieve these goals you might have for mental health if you're not hearing about it or learning about it from these different structures that you care about and that you trust. And so I think that's the thing, is instilling trust from this social norm standpoint and organizational standpoint in the different levels of our community.
Meagen Rosenthal:
That's amazing. I love all of those ideas, I think, and unless Alexis has another question, the last question I wanted to pose to you. Because we told you obviously we were going to come down here today, and I'm sure you had ideas about what we might be talking about. So is there something that you thought we would talk about today or that you wanted to tell us that we haven't had a chance to cover yet?
Dr. Nick McAfee:
I think the one thing that we've addressed, but maybe not in depth that I think is important to me that I've been looking into is just the profound effect of adolescent, young adult mental health that it's having across the country. And we've already talked about how it was already on the rise, but I think the main thing I wanted to point out is that the Surgeon General has been really doing a fantastic job of highlighting probably two of the most important things, which is youth mental health is bad.
And also social media is probably playing a huge role in that. And so the point that I think if we're talking about practicality in today's episode is making sure that our kids feel heard, listened to, talked to, and checked in on. Even if they seem annoyed or upset, because I don't think it can be understated how severe some of these concerns actually are at a rate that we've never seen before.
And where people like me who again have the fancy letters and are supposed to know this stuff, have some ideas of how to address this, but honestly feel totally under equipped and unable to just address the widespread concern that we have. I think a lot of people have good ideas. I think we're headed in the right direction. I think community's a big part of that, but that's the one thing I want to put out there is that this is real. It's affecting a lot of people. And the only way to truly start chipping away at this trend is to do exactly what you're all talking about, is to break that stigma, to open up those dialogues and to pay attention. So I don't know if that it's anything new, but I guess if I had a closing message, it would be that is that our young people are struggling. Not everybody, but at rates higher than we've pretty much seen before. So we should pay attention to that, and we should focus on that and give them the support that they need.
Meagen Rosenthal:
Thank you for that, and thank you for that call out because I think that's a really important conversation that we're going to continue to have in this fall season and into the future. And I think the bonus for those of you all that have been listening so far is that we've got some really good tips and things you can start doing right now in your own family as an individual, and then for us to start thinking about on a larger scale within our communities on how to begin to address these issues. And I think the one idea I'd like to leave folks with is it's going to take time and effort and that word, again, intentionality is be thinking about these things in an ongoing and regular basis.
Thank you, Dr. McAfee for making the time to chat with us today and to share your expertise and your wisdom with our listeners. We're really excited about our ongoing partnership and our working relationship. Tune into our next episode, and we'll love to hear from y'all on social media. How are you doing with all of these things that we've been offering to you in your own spaces? Are you doing those check-ins? Are you journaling? Are you having those conversations with your kids where they're rolling your eyes going like, "Yeah, whatever, mom or dad, I'm fine." Are you doing those things on a regular basis? We'd love to hear. See you next time.
Voiceover:
Thank you for joining us on this episode of The Mayo Lab Podcast. The Mayo Lab Podcast is produced by Dr. Natasha Dieter, Dr. Meagen Rosenthal, Alexis Lee, Slade Lewis, and Hannah Finch. This podcast is recorded at Broadcast Studio in Oxford, Mississippi. The show was mixed and mastered by Clay Jones, and our original music was composed by Slade Lewis. The Mayo Lab podcast is brought to you by the William Magee Institute for Student Wellbeing. For more information on the Mayo Lab Podcast, head over to the mayo lab.com and follow us on social media at the Mayo Lab. If you enjoyed listening to the Mayo Lab Podcast, we'd love for you to subscribe, rate, and give a review on iTunes, Spotify, or wherever you are listening to this podcast. This podcast represents the opinions of Dr. Meagen Rosenthal, Alexis Lee, and their guests on the show. This podcast is not intended to be a substitute for the medical advice of a licensed counselor or physician. The listener should consult with their mental health professional in any matters related to his or her health, or the health of a child.