Defining Optimal Mental Health and How to Achieve It – Keith Kurlander & Dr. Will Van Derveer- HPP 67

SPEAKERS

Keith Kurlander, Dr. Will Van Derveer

 

Keith Kurlander  00:01

This is more of like an evolutionary conversation for me and a personal development conversation of being able to recognize where we’re struggling that we would call it you know, on the spectrum of mental health, being able to recognize this so that we can constantly improve in ourselves in our lives, and get to higher levels of fulfillment and gratitude and joy and love in our lives.

 

Dr. Will Van Derveer  00:27

Thank you for joining us for the Higher Practice Podcast. I’m Dr. Will Van Derveer, with Keith Kurlander. And this is the podcast where we explore what it takes to achieve optimal mental health. Today, Keith, and I decided to have a conversation, to explore our current thinking about how we define optimal mental health and how to achieve it. Because this is an ever evolving topic that is critical to how we think about our efforts to help people get well from mental illness. We really feel strongly that if we don’t have a good definition of what optimal health is, then it makes our efforts much harder to support and guide people toward that outcome, which is the goal that we share in our work with people and also in our institute where we teach mental health providers to deliver the tools with this aim in mind. So I hope you enjoy this conversation. I know Keith and I did, and we look forward to hearing your comments about it. So today, we thought we would get into the topic of what the definition is of mental health. Because this is such a problem in mental health care and psychiatry in general is that we don’t even really define what we’re trying to get to. And this is something Keith and I like to think about and talk about a lot because it’s such a priority for us to build a new normal in mental health care. And if we don’t know where we’re trying to get to, then we’re not going to get there.

 

Keith Kurlander  02:17

Yeah, I think we have; it’s sort of like the best shot at this was the DSM. Right? That was the major way that people have tried to understand the spectrum of mental illness, mental health, and obviously, there’s using that, but there’s so many limitations, it doesn’t really define a healthy human being and, well, that spectrum is properly,

 

Dr. Will Van Derveer  02:41

Right, and the whole pathology based way of looking at human beings, which to some degree, the positive psychology movement came in and added some layers there. They’re useful. But the notion of really looking at people in the clinic through the lens of what diagnosis does this person have, what box do we fit them into is not how we want to approach things.

 

Keith Kurlander  03:07

And I think that the biggest limitation with that model is it doesn’t; I mean you see sometimes the usefulness in it, but it doesn’t seem to really understand first of all, anything about why the human being is operating with these symptoms, and it doesn’t really even have a mechanism to say where are we going with the pathology model? It’s just very much putting people in these boxes, and it doesn’t really examine anything about causes, or I think where I get interested is the DSM is just about categorizing symptoms. Right? It’s really a categorization manual of symptoms.

 

Dr. Will Van Derveer  03:50

And the potential benefits are, I think, limited to insurance reimbursement. That’s important. We need to have a diagnostic code to get reimbursement. And then to some degree, when we have constellations of symptoms that fit around, potentially a root cause that we’re going to go after and try to resolve then it can point us in a good direction. So it’s not entirely useless. That’s not how we’re talking about but it is limited in its utility.

 

Keith Kurlander  04:18

I can definitely see how it’s very useful in research to have categories as well as in pharmacology, there’s usefulness for sure. In terms of understanding, to some degree, what medications might work well in certain types of symptom clusters. So that’s one sort of philosophy, right? We could call it a philosophy of defining mental illness through categorization of symptoms.

 

Dr. Will Van Derveer  04:44

Right. And another criticism, of course, is the reductionistic perspective of five out of nine symptoms says a person has major depressive disorder, and then there’s also the people with post traumatic stress who don’t fit the categories that are outlined in the DSM, which is a huge issue. So it’s a tool. It’s a blunt tool that can be used for certain purposes, but we just don’t want to get defined by it or over rely on it.

 

Keith Kurlander  05:14

Seems like our conversations are always going toward more like what actually is mental health? Why do people get sick in their mind in their bodies? And how do we then have tools to help people get well? And I think if we start first with the conversation of what is mental health, and then back into what is mental illness, I always like to go that direction.

 

Dr. Will Van Derveer  05:40

Yeah. I think that’s a good place to start. Yeah, for sure.

 

Keith Kurlander  05:45

So I don’t know where you’re at with it right now, I definitely think of, in my mind, I’m always like, well, if we could have like, some kind of bio-tracking device at this point, like, what would it track to know someone’s really optimally mentally well? What are the things we’d be looking at if we had all the metrics to kind of rate so on? So that’s something I think about, like will we be looking at certain types of brain functioning, and we would be looking at would be also liking data on behaviors and how people are behaviorally. And I kind of think about it right now. Like, if we get tracked the complex web of what leads to mental health, like, if we go back into it that way, like what would we be looking at?

 

Dr. Will Van Derveer  06:33

That’s a great question. Well, maybe we could explore that in the three categories that we teach in the Institute, that we practice in the clinic, because I think that’s a good way to kind of break it down and keep it simple. So the categories are the body, which by body, we’re talking about functional medicine. So that’s where we might see some of the more physical biomarkers that you’re talking about. And then we have the mind, which of course has a massive impact on mental health or mental illness, depending on the level of empowerment and regulation there. And then lifestyle medicine. So the behaviors that you’re talking about; exercise, diet, sleep, hygiene, etc. So let’s get into it.

 

Keith Kurlander  07:13

Yeah, totally. I mean, it’s exciting. So, we’re basically talking about these three main areas, sort of physical organisms. The software, which we often talk about is the operating system, which is more of the cognitive sphere, and then behavior, and what we do with our behavior, and what we put in our body and how we live in the world. And then we should start with behavior, because it’s a pretty interesting area. Like what is it? What are the behaviors and to look like someone who’s really mentally well? It’s an interesting conversation.

 

Dr. Will Van Derveer  07:49

Yeah.

 

Keith Kurlander  07:52

I mean I would start by saying that at least at this moment of time in my life, it seems to me that behaviors for people that are really stable mentally seems like behaviorally, we see more consistency in behavior, we see more adaptability, more flexibility, less impulsivity in behaviors. Would you agree with that?

 

Dr. Will Van Derveer  08:20

I would agree with that. Yeah, I think having the ability to perform in, like you said more reliably, more consistently, not being driven by impulses, and by emotionality, which we all feel in our mind, but to have the behavior not vary a lot from day to day, based on whatever the challenges are that are going on.

 

Keith Kurlander  08:46

And I think when we think of like, if we go back, you know, Freudian pleasure principle stuff of behaviors that are really driven by intense pleasure-seeking and avoidance of pain, I think that when we see in more optimal mental health, like, to me, it seems like there’s a much higher degree of balance of short term and long term gratifying behaviors that a person’s operating throughout the day, doesn’t seem like that person is controlled by short term gratification throughout the day. Seems like there’s a lot of long term gratifying actions that lead to pleasure over time. And there is obviously still short term gratification but it doesn’t seem like the sort of the modus operandi is constantly seeking short term gratification every turn you can get.

 

Dr. Will Van Derveer  09:37

Yeah, absolutely. I mean, I think that we should just pause and say we’re talking about adults here.

 

Keith Kurlander  09:43

We’re talking about adults.

 

Dr. Will Van Derveer  09:44

Yeah. It’s important.

 

Keith Kurlander  09:45

That’s important because about a two year old.

 

Dr. Will Van Derveer  09:47

No. And we’re also not talking about adolescence. So, Keith, I think what you’re talking about is you’re speaking to when behaviors are executed in the service of long term goals and values and standing for the behaviors that are part of their life are moving them toward some kind of bigger goals that they have than just immediate gratification.

 

Keith Kurlander  10:16

Yeah, so if we stick with just the adult conversation, because I think it is a really different conversation with children, and what does mental health look like in a child, I think it’s really different. Yeah, that’s a good point. And so if we’re just sticking with adults, I think you could say there’s a spectrum here of where we see lower levels of mental health is higher levels of addictive spectrum behaviors, which are much more based in the short term gratifying type of cycles of seeking rewards, and paying the price of getting those rewards. And I think these addictions exist in all kinds of areas of life. If we’re talking about behaviors, there’s drugs and alcohol, but there’s also entertainment addictions and sexual addictions and money addictions and spending addictions and all kinds of stuff, right? And work addiction. Right. So it seems like on the spectrum, in terms of just looking behaviorally, we see that people who are more optimally well in their mind, tend to be more focused on long term strategies in their life, right? They tend to be a little more disciplined with their behaviors, less impulsive, they can be spontaneous, but less impulsive. So spontaneous being probably more of the flexibility to be freed up to do what you need to do, what you’re inspired to do in a day. I’m wondering how you would define impulsive behaviors?

 

Dr. Will Van Derveer  11:42

To me impulsive behaviors are sudden decisions and actions based on avoiding pain or seeking pleasure.

 

Keith Kurlander  11:50

So behaviorally, and what does this look like practically just like probably helpful for us to tease out some examples? So like, if we start with diet, I think that’s a great place to talk about how people eat. Right? And, you know, this is one I’ve wrestled with my whole life, is how I eat, and I can go still into cycles of being more impulsive with my food choices. And I think the constitutional diet of an individual’s unique to that individual, I don’t think there’s any one prescription. I don’t know on how you feel about that.

 

Dr. Will Van Derveer  12:19

I agree. Yeah, very personal.

 

Keith Kurlander  12:21

Right. But I do notice that when there’s consistency in the way I eat, and I know what works for me at this point in my life. I’m very clear on it that when there’s consistency in the way I eat, and I’m not impulsive, and all of a sudden, if I start eating, let’s say, a little ice cream regularly, daily, within two weeks, I’m destabilized. And like, I know that myself, right. And it’s all impulse driven when I do that. it’s not connected to a more long term strategy in my life or being well, and that’s just me, I just happen to have that impact from ice cream. Not everyone does. But the need for nutritionally what I kind of go to is just I think that when there’s consistency, not rigidity, which is, you know, there’s two ends of a spectrum of impulsivity.

 

Dr. Will Van Derveer  13:11

Not too tight, not too loose. Right?

 

Keith Kurlander  13:12

Right. Consistency, and really the willingness to discover what nutrition works for an individual and then a large percentage of timing, and we’ll stick with that. I think that’s an example of a behavior that is more from the executive part of the brain, and it’s their self governance. And I think that’s just one example. Obviously, we’ve talked about tons of things which you don’t need to like exercise and all the different areas of lifestyle, but

 

Dr. Will Van Derveer  13:42

Right, right. Yeah, I mean, there’s definitely a lot of personalization that needs to go into diet, as we talked about before. And there’s also a lot more information that we now know about what people need to be eating, and what they definitely need to not be overdoing. So, overdoing it with sugar, overdoing it with alcohol, overdoing it with carbohydrates, or processed foods, I mean, these are things that can be very addictive. And so again, I think it’s what we were talking about before about the discipline of being able to make choices that serve the long term goals of health, and to not get carried away or become ungoverned in our choices of the immediate gratification but also, as Keith was alluding to having the discipline to actually look into what is our personal path with nutrition and what do we need. One person functions very well, maybe better on significant amounts of carbohydrates and another person is not going to be mentally well if they have the same amount in their diet. Right? It’s very personal.

 

Keith Kurlander  14:56

Yeah. So for me like this conversation when it opens up is when we move outside of categorizing mental illness just based on a set of symptoms, and then symptom clusters, and well, now we start looking at one area which is behavior, it’s very interesting to just look at what really is optimal mental health and by looking at people’s behaviors, we can actually come to a consensus probably with the people we’re working with, or there’s certain ways we’re not well, and our behaviors are gonna tell the story, typically, right?

 

Dr. Will Van Derveer  15:32

Absolutely. Yeah. There is another dimension here, a behavior that’s really critical, which is sleep. And just speaking from my own personal journey with that, I remember being in high school and sitting around with my friends, I remember having the conversation of like, I’ll sleep when I’m dead. I don’t, I don’t want to sleep. Now I’m gonna miss out on something important. And then that kind of fed into medical school and residency of all nighters of admitting patients all night and feeling like some kind of hero that I could do that in my 20s, and then turning 50 this year feeling like, you know what; my relationship to sleep is very different now from what it was in my 20s. And I still have these flashes of impulsivity of like, well, I think I can stay up until midnight tonight, and still get up at six and feel okay, and then I don’t feel okay. It’s really interesting, as I’ve gone down the rabbit hole of sleep medicine, and you know, because I understand what the actual health implications are of not getting good, consistently good sleep every night. It’s like, Whoa, you begin to appreciate why it’s important.

 

Keith Kurlander  16:47

Yeah, and it’s good that you’re bringing this up in the conversation of behavior. Because a lot of sleep health is driven by behavior. Right? And that’s why CBTI is one of the best interventions. Because a lot of this is driven by behavior.

 

Dr. Will Van Derveer  17:05

Exactly.

 

Keith Kurlander  17:05

Yeah. So sleep is key, and then when we’re still thinking about what we could think about in terms of behaviorally? And if we like kind of social, also in the behavioral category for the moment of just relationships. Then, of course, that goes just beyond behavior. But relationships are such an important manifestation of how we’re doing in ourselves, right?

 

Dr. Will Van Derveer  17:31

Absolutely. And while there are some significant variations in terms of kinds of relationships people want to have and that feels nourishing to them, we are social primates, and relationships are a critical part of our mental well-being, and can also be a really important part of our mental illness, as well, depending on how empowered and how stable we are in how we conduct ourselves in relationships,

 

Keith Kurlander  17:57

Even when we talk about the relationship. So it also brings up for me the philosophy that we’re speaking to here, which is that this is not even a pathology conversation. This is more like an evolutionary conversation for me and a personal development conversation of being able to recognize where we’re struggling, that we would call it, you know, on the spectrum of mental health. Being able to recognize this so that we can constantly improve ourselves in our lives, and get to higher levels of fulfillment and gratitude and joy and love in our lives. So, I think that just came up for me right now because I think that often, like right now, maybe your a listener and you are going, oh, gosh, like, I’m not doing well when they hear what we’re talking about, like I’m struggling, I feel addicted and my relationships aren’t going well right now, my diet sucks. And to me, these are ways in which to work with ourselves to continually optimize as human beings. And I think everyone is constantly fluctuating to some degree on the spectrum of health and illness. And I think it’s just good to kind of state that this is really talking about a view that’s about growth. It’s a growth oriented view. Right?

 

Dr. Will Van Derveer  19:16

Exactly. Yeah, because we’ll get to this a little more when we get to the mind category and talk more about the mental aspects of mental health. One of the things that comes up a lot in my world anyway, in my thinking is the ways that I keep learning about possibilities that exist for my life, and also in my relationships that I could not see before because I had not had those experiences before in the past. And so new heights of health in my life has become possible when I educate myself about for example, in relationships, attachment theory has been something I’ve been studying pretty intensely now for a few years and it’s really changed what is possible in my life, not just with my wife, but with friendships and how I am in the world. It’s really different.

 

Keith Kurlander  20:07

It’s really different. Well, maybe it’s a good segue to the mind, which is always a fun topic to explore. I don’t think we should spend the whole time defining the mind today. Because that’s kind of like its own conversation. Right? So for the purposes of this conversation, when we’re talking about the mind, let’s just kind of hash out what we’re actually referring to. Right.

 

Dr. Will Van Derveer  20:30

Yeah, exactly. I think you mentioned the cognitive dimension when we named it earlier. And I just want to throw in too that I think, obviously, emotional material and emotional regulation is also a really important part of the mind. And the interplay between thoughts and emotions is just an endlessly fascinating area to look at.

 

Keith Kurlander  20:52

Right. So, maybe for today, we’re sort of defining that we’re going to speak like, sort of this sensate cognate experience, it’s a sensory, it can be a thinking, but it doesn’t have to be discursive thoughts to be talking about the mind. It can also be a sensate experience that has feelings and unconscious beliefs that are tied into that. So it’s kind of this interplay, right?

 

Dr. Will Van Derveer  21:15

Yeah. And I would just throw into that the warehouse of somatic memory that lives in the subconscious that is deeply, intimately involved in the body, as well. And so the way that we can, again, have a journey of growth from being driven by unconscious memories that from earlier in our lives toward a more empowered, more sovereign experience of life.

 

Keith Kurlander  21:48

Yeah, so for me, if we throw in a Dan Siegel card, it’s also then the mind extends beyond ourselves and into the social sphere. And we’re influenced by other people’s experiences and intimately influenced in our minds. And so to me, like probably the simplest way to work with in the moment is that it seems like the mind is just sort of the software or the operating system that has our memories that are stored and the ways we can think and feel and operate in the world. Our reactions, and our strategies are coming from this thing we’re calling the mind.

 

Dr. Will Van Derveer  22:32

Right. Mentioning Dan Siegel, reminds me of a film a few years ago called “Inside out”, and I think, Dr. Siegel. Yeah. Some other folks from UCLA consulted on this interpersonal neurobiology team. And it’s just I thought it was a really great kind of explanation of the way that subconscious emotional memory can really drive behavior and the role of mindfulness and supporting people to get empowered there.

 

Keith Kurlander  23:04

Yeah. So what’s wellness in the mind? And what’s illness? Or what’s the spectrum? Probably a better way of saying it, right? What would you say about that?

 

Dr. Will Van Derveer  23:16

Well, I think our relationship with our thoughts is a really important indicator of our wellness in our mind. And you and I both have a deep background in meditation, and Eastern spirituality practices. And I think, for me, that I’m really grateful that I got to have good meditation instruction over the years and really learned that I’m not my thoughts. That was so huge in my early 30s, to come into contact with that, and to be able to actually stay in a witnessing position while thoughts arise and fall away, and then to be able to actually do that in real life and not just on the cushion is in massive empowerment, in my opinion.

 

Keith Kurlander  24:02

Yeah, totally. I mean, I’m learning every day, and then I’m not thinking. I’m trying to remember that constantly.

 

Dr. Will Van Derveer  24:08

Yeah. It’s a practice.

 

Keith Kurlander  24:10

And I think that mindfulness is obviously an aspect of the capacity for mindfulness is an aspect of mental health. But I would also say that the capacity for mindfulness is only one aspect of mental health and I think that my experience in spiritual communities for a long time is those communities can also get reductionistic in thinking that mindfulness or meditation or transcendent states is the answer, the only answer that is needed to be well, and then time and time again is some of these communities first of all with myself, I didn’t get well that way, just by doing but seeing a lot of people that weren’t well in different areas like they could sit on the cushion and handle that really well but they were messing their relationship or they had serious bipolar disorder on the side that they were trying to meditate away and it just wasn’t really working that way.

 

Dr. Will Van Derveer  25:04

Right? No, I totally agree with you. I mean, it was a big journey for me, as a young psychiatrist when I first found meditation, I thought, Okay, I’m gonna bolt on meditation to medication, and psychotherapy. And between the three of these, I’m going to have a complete toolkit, and it didn’t work out that way. And it also didn’t work out that way for me personally, either, because my relationships were an absolute disaster, during, you know, my early 30s, and even late 30s, as I started to realize that mindfulness was not the whole answer in terms of my own psychological health.

 

Keith Kurlander  25:40

Well I think what we’re speaking to here is that what you and I discovered, see if you agree with this, is that really the integrative path in life, integrating and synthesizing information is a very powerful path that achieves optimal states in one’s life versus reductionistic, passive, you know, I’m only going to be a meditator to transcend my problems, or I’m only going to take medication, or I’m only going to focus on nutrition or something. It seems like the integrative or, you know, obviously, there’s medical philosophy, but it just seems like the integrative path is a powerful path.

 

Dr. Will Van Derveer  26:22

It is a powerful path. And it can also feel overwhelming in terms of the complexity. But I think what Keith is talking about with regard to mindfulness and psychology and the integrative path is that we’re not looking for silver bullets in the integrative path. We’re not saying, Okay, this always works for this thing. The complexity begins when kind of; even just within the realm of psychology, you start to see that there’s trauma that needs to be literally addressed in the body as a healing procedure that is supported by mindfulness, but it’s not a substitute for mindfulness, nor is mindfulness a substitute for healing trauma. So part of what the integrative path is, to me, is bringing so many different aspects of wellness to bear on what a human being is as a very complex system with a lot of needs. And a lot of relationships with the habitat that we occupy in all of the relationships, not just with other people, but with the earth and with air quality and with soil quality. And like all the different things we’re dealing with. With the way that we choose to spend the majority of our time whether it’s parenting, or in a career there’s so many dimensions.

 

Keith Kurlander  27:44

So many dimensions. And yeah, so maybe this is a slight tangent, but getting into what are the qualities of if we talk just now about the mind, and what we see on the spectrum of sort of mental health and illness. One thing that I would say is, it seems like some qualities of vibrant mental health is that a human being feels purposeful, grateful, fulfilled, enthusiastic about their life. Not always, but the majority, the baseline seems to be some of those qualities, among other qualities, and I’m gonna throw other things in there. But it seems to be as we’re worn mental health, higher mental health states, I’ll speak from my own experience with people I’ve worked with, it seems like these qualities start to really show up in certain places.

 

Dr. Will Van Derveer  28:34

Right, the more you’re aware of, and living inside of what matters the most to you, it seems like the more fulfilled you can be. I can’t even begin to list the number of people I treated over the years who simply were in the wrong career or in the wrong relationship. And that was a massive reason why they were chronically depressed or unfulfilled. So taking the time, I think, to get to know our own software, like, kind of similar to what we were talking about with diet is like getting to know your own psychology, and really who you are and who you’re meant to be and what it might be very different from what you were groomed to be as a child.

 

Keith Kurlander  29:27

Yeah, right. That’s the purpose is, it seems to be one of the conditions of being in higher states of optimal mental health.

 

Dr. Will Van Derveer  29:35

Yeah, I would say also, resiliency is a big one in Psychology. Being able to bounce back from getting a really negative, let’s say, email, something that happened to me yesterday, and I was like, Oh, I really want to bounce back from this, but I’m just stuck on it. But I needed some help from my wife to kind of move through that. But I think that’s a big one, like when we take a hit emotionally or we get attached, how soon can we get back the saddle, right?

 

Keith Kurlander  30:02

How soon can we get back into the saddle? And so that brings up to me the conversation of the role of emotion in mental health. And I think optimal psychology has contributed quite a bit around flow states here, a great contribution, recognizing that, it seems like we’ll learn higher levels of optimal health, or more frequently experiencing flow states. Do you agree with that?

 

Dr. Will Van Derveer  30:26

Right, I would say more frequently. And also, they’re more accessible. This for me feeds into the default mode network research in the last several years looking kind of like the electrical signature of ego, and how much stronger that is in certain people who are more obsessive or more neurotic, and I definitely tend toward that end of the spectrum, myself. And that’s where meditation has been shown to really soften the signature of that. So I think the softer your signal in your default mode network, it seems like the easier it is for you to move into more of a flow state or a state of feeling connected and unified with the universe.

 

Keith Kurlander  31:08

Totally, a flow state, I mean, we could just define it our own way, maybe for the moment. For me, a flow state is where I’m not highly self-critical. I’m also not highly self infatuated with myself. There’s a quality of being present in the moment, being able to focus and inspired and there seems to be in flow states a little more net neutrality of emotion for me, but it doesn’t mean I can’t get sad or happy in those states, it just means that there’s maybe less attachment to the movement of the emotion, something like that.

 

Dr. Will Van Derveer  31:49

Yeah. I would add to that there’s a quality of curiosity. And just the whole structure, in my mind, it’s usually operating really strong of self consciousness is way diminished. I’m not tracking myself, and I feel more joyful and present.

 

Keith Kurlander  32:08

Right, so it seems like the other end of the spectrum here that we’re talking about. So, the ability to move in that flow states more rapidly, more easily stay in them longer, have them happen more often throughout the day, seems to be more one, we’re experiencing more optimal states in mental health and maybe experiencing sub-optimal mental health states, there seems to be more chronic emotionality that we get stuck in, can’t get out of whether we’re high or low. Right. It seems that there’s often a lot of distractibility in the mind, where we can’t focus our mind, we feel like we don’t have control over focusing our mind.

 

Dr. Will Van Derveer  32:53

I think there’s also more stickiness with who we think we are. So identity, negative self-talk, or positive self-talk, but the kind of self-talk that really kind of puts us in a psychological straitjacket, internally, of who we think we are and what we’re capable of, what can happen in our lives, not seeing possibility.

 

Keith Kurlander  33:16

Right. And it seems like when we enter these places, and so now if we talk more around these pathological terms, we can enter these states in these experiences and they can last days or for some people they can last years, we’re really struggling with our mind and our bodies. And getting very chronically stuck in emotionality. Seems like that’s more on the spectrum of mental illness that we talk about in terms of like we’re stuck there and how do we get out if we even use the term illness or ill. To me illness is really just, especially when we’re talking about mental illness, it seems to be more about being stuck in something and we can’t find our way out of it.

 

Dr. Will Van Derveer  33:59

Yeah, it’s like we’re stuck in a thought pattern. When we see very depressed people at the clinic, that’s almost always the case that there’s an extremely negative thought pattern that’s very dense, very stuck. And that can also happen with people who are dealing with obsessions and compulsions. Another dimension of it is the emotional dysregulation pattern. It’s another place people get stuck with like post traumatic stress patterns and the body and the mind where there’s just an extremely intense hyper reactivity to perceived threats, for example, that might not even be driven much by negative thinking. It might just be driven by reactivity in the body.

 

Keith Kurlander  34:42

Yeah, to me, it becomes conversations like how can we even talk about the spectrum of mental health and mental illness without talking about trauma? And what is trauma and how many human beings are not actually processing trauma in themselves? Are there any that are processing some version of trauma in themselves. I mean, I’m starting more and more as I gain more wisdom in this area, I’m starting to think that we’re all processing versions of traumas in ourselves, whether it’s ancestral and intergenerational in our bodies, or whether it’s personal with this lifetime or vicarious or that we’re constantly trying to integrate experiences that we were once overwhelmed by. It seems like that’s just a part of the human condition.

 

Dr. Will Van Derveer  35:30

Part of the human condition. And I also think that we are. It seems to me that the more chaotic and overwhelming the world becomes, the less resilience I see in the people around me and the people that I trade in my practice. There seems to be this weird paradox of you know, the more we progress, I don’t want to go too far in cultural tangent here, but the more we progress in terms of better technology, better science, more developed, in some ways, we’re less tested as we grow up. And the less tested we are, the less resilience we may have. It’s this weird paradox of the right dose of intense or difficult challenges. Kind of like hormesis, or you stress that concept that we need to be stressed, but only the right amount. So how we deal with it I mean, I agree with you, I think if we’re human, then we’ve by definition experienced overwhelming and difficult circumstances that are highly likely to be leaving a residue in our nervous system. I think it’s important to define what trauma is here, and how we’re talking about it. And I think you probably have your own way of defining it, which I want to hear about, I would say that for me, the best definition for me is a persistent dysregulated pattern in the nervous system. When I talk to people about trauma, that’s how I define it, resulting from an overwhelming experience that went beyond your capacity to fully be present to.

 

Keith Kurlander  37:06

Yeah, I would agree and say that teasing apart this generalized term trauma from PTSD, for instance, or an acute traumatic event. I would view it more as the resilience of the nervous system and the health and regulation of the nervous system more so than talking about specific events that have happened. And saying that there’s probably in most, if not all, nervous systems and people, events that have left a residue that still are not processed. Right? And so to me when we’re talking about this way, it’s like we’re not defining trauma necessarily as the horrible events that happen in people’s lives. We’re talking about understanding how the nervous system operates, and either remains healthy, or it gets sidetracked in some way. And so I think we’re sort of lumping it under the mind category, even though it extends in all categories. But it’s such a relevant thing to be thinking about the resiliency and health of a person’s nervous system. I think what we’re talking about, is there more room to grow there if we’re trying to seek optimal mental health. And so from my perspective, there’s always room to increase the bandwidth and the container and capacity of a person’s nervous system. And the term trauma has negative connotations in our society in the world. I don’t think of this that way. I think of it more as this conversation around the bandwidth and resiliency of the nervous system, and just looking at trauma on a spectrum of health and wellness and struggle and dysregulation and illness, and that we’re just moving between those two. And as we keep increasing our capacity to deal with events that are overwhelming, and process those faster. To me. That’s the healthy nervous system.

 

Dr. Will Van Derveer  39:07

Absolutely. Yeah. And then there’s also the concept of post traumatic growth or what is well, let me put it this way, when I was working on MDMA assisted psychotherapy trials with maps, one of the things that blew my mind was seeing other people getting on the other side of a traumatic perspective about what happened to them. universally the people that I interacted with. When they were on the other side of that they had gratitude for what they had previously called a trauma because it changed them in ways that they loved about who they are now. And so it came to be kind of a benchmark for me of seeing how things like perceiving something as trauma is an experience that happens from not having the resources to meet the challenge. And then when the resources needed to process that trauma are put together, then it actually doesn’t register as a trauma anymore in the experience of the person, it registers as a growth experience.

 

Keith Kurlander  40:18

And that’s kind of a profound concept for people that aren’t on the other side of that, obviously, right. It’s not obviously always the starting point, or ever the starting point with someone that’s been through something that is digestible, and we wouldn’t say that is really horrific. And it seems to be that people who heal these events in their lives end up gaining meaning from them. Right, that seems to be consistent from everyone I’ve worked with myself, the people I’ve talked to, that are leading this space, that it seems to be that people tend to gain deep meaning from these very challenging experiences we go through.

 

Dr. Will Van Derveer  41:04

Yeah, and I think that’s a big part of why we define it as it. A persistent dysregulation resulting from not being able to digest the event in the first place, that a person who has the internal and or external resources to digest the event doesn’t walk away traumatized from the event, no matter how intense the experience was, you know, you could have people blowing up in front of you and not be traumatized if you had their internal and external resources to digest that experience. Right?

 

Keith Kurlander  41:40

Right. Well, you mentioned the tool. We haven’t talked about tools yet, but I think this particular tool, we should talk about just psychedelics. What’s the role of psychedelics in the process of illness to wellness and mental health? And it’s just so up right now. And it’s something we spend a lot of time teaching about, and we use it. We use ketamine in our clinics. And, yeah, it seems like it’s just very important to talk about psychedelics in the conversation.

 

Dr. Will Van Derveer  42:11

Absolutely. Yeah. I think for me, the word that comes to mind is catalyst. And so I think we use medication, traditionally, in psychiatry to suppress symptoms, to dampen down, panicky symptoms,  to dampen down feelings of depression, dampened down mania. And this way of thinking about medication as a catalyst is a totally different framework, from traditional perceptions in psychiatry, about medication. So a catalyst is something that can spark a big change in someone’s life, but it doesn’t represent the change itself. And we need to handle the sparks carefully. We don’t want to go burn the neighborhood down with a spark at the wrong time at the wrong place. So psychedelics, not handled properly, are dangerous. And I’ve treated a number of people in my practice who had PTSD from having an experience with a psychedelic out in public, where they had an interaction with the police or security and a concert or something and got very traumatized. So the flip side of it is that any tool can hurt you, a pocket knife can hurt you, a gun can hurt you. But these tools can also be used for a lot of good things. So it’s an important conversation about not only how psychedelics can be handled with a lot of care and a lot of safety considerations, but also to really understand what the role of psychedelics is in mental health. Because every time there’s a new wave, whether it’s a new SSRI that’s coming on the market, or we’ve got MDMA, and phase three trials, psilocybin and phase three trials, inevitably, there’s a huge wave of hype and excitement. And there’s a lot of desperate people who seriously need help. So it makes sense that would happen. But the notion that these compounds are going to be the panacea are going to fix everyone or good for everyone, or should be given to everyone is just a very deep misunderstanding about what the opportunity is for healing there.

 

Keith Kurlander  44:37

Yeah, I agree with that. And I love how you’re talking about as a catalyst, I think of them as an amplifier, which is really different from traditional psychiatric medications. I definitely don’t think of those as amplifiers by any degree. And I think there’s a time in place to amplify the root causes. We could say of what someone’s done within themselves and to sort of shine a light, sort of psychedelic experience on what’s either happening in the mind, or sometimes they’ll feel it in the body on psychedelic experiences. Or we’ll see something that’s happening in our life relationally or behaviors, we’re doing all that can get amplified. And so I see these as catalysts, there can be a spiritual amplification that can happen. And I like what you’re saying about, there’s a time and a place for it. And also, there has to be care and consideration because I like the movements headed right now medicine with psychedelics is. I really believe at this point in time in our human evolution, we really need very trained therapists involved when we amplify someone’s experience like that. Because I think a lot of times what happens is and you’re referring to the people you’ve treated who come in with PTSD, I treat a lot of people that they amplify their experience, and they come in and now they’re either in a bipolar state or. But really what I think is going on when I see these peoples are coming in, they amplify their PTSD, their trauma. And it shows up as these conditions we talked about, but they’ve kind of blown out, they didn’t do a session that was well integrated. They didn’t have therapists there, they didn’t even have a proper dosing. Some people are constitutionally dependent on their metabolism, they need a really small dose. And so they’re getting so amplified without the right support. Those are the people I’ve seen in my practice over the years and myself and my own personal story where nurses are doing cleanup work from too much amplification without the proper integration. But I think the real magic that I’m so excited about and that we’re seeing in our clinic with ketamine is just that, when we do amplify with the right support, these can be really amazing tools for the right person, at a certain time in their life. And so, to me, psychedelics are definitely, I think they’re going to be a big tool in the healing journey of individuals on this planet. And I think we’re gonna see them as a really positive healing tool, the more we use them in a way that’s responsible.

 

Dr. Will Van Derveer  47:12

Absolutely, yeah, I think we’re the kind of care and consideration and preparation and integration. All of these elements can create an acceleration of healing for the right person. And I think the shift from being more on the mental illness side of the spectrum to being more of the mental wellness side of the spectrum, sometimes can happen very dramatically with these tools. And then we get to dig into the work of Houston Smith was turning a state change into a trade change. So having a shift in your state during the psychedelic experience is one thing. But actually having long term change in your life is a completely different thing. That takes a lot of work. And oftentimes, people are, again, coming in very desperate, wanting a big change, putting a lot of hopes on the medication. In this case, we’re talking about a psychedelic, not an SSRI, but still the psychology of I need this medication to do this thing for me and not realizing that it will help you open things up in your healing path. But it’s actually not doing the work of the healing. It’s really important to understand that. And it’s like, if you’ve been depressed for 30 years, and you’re completely deconditioned. Imagine somebody’s been sitting on the couch for 30 years, and then you give them medication that suddenly makes them feel strong for about an hour. And now the real work begins of like, Oh, Wow, that was an experience that shines a light on what’s possible for me, but it doesn’t establish a new normal, there has to be a gradual workout plan to build the muscles and the conditioning from sitting on the couch for 30 years.

 

Keith Kurlander  49:02

And no matter how many times you do psychedelics, it’s not gonna establish the new normal just because you’re doing it a hundred times, you know, exactly that. Exactly. It’s an amplifier. It’s a catalyst, right? But, again, coming back to integrative, you have to find a way to integrate your experiences into your life. And it’s just another experience,

 

Dr. Will Van Derveer  49:23

right? And as these compounds become more popular, and more available, I just have a lot of concerns that the way that we’re going to implement these compounds is not going to produce, it’s not going to embrace the opportunity that they represent. If we’re not holding them, so well.

 

Keith Kurlander  49:46

Well, maybe we should spend a few minutes on the body as we wrap up here. You know, you and I focus a lot on the body and in our work on ourselves and with people and it seems like to me, the way I would say is that the body, so the body can get obviously impacted by the external environment. And it seems like there’s a two way street going on here with mental health, which is like, we just try to separate software and hardware out in the body being the hardware and the mind being the software. I mean, that’s a little rude to say that way, but it’s a two way street, they’re impacting each other, the body can impact the software, the software can impact the hardware. So it seems like for me, the body can really get out of balance is the simplest way to say it. And that’s coming more from I think the functional matter of some perspective, rather than reducing the body to neurotransmitters or just very specific things in the body, especially when talking about mental health seems like when we look at the whole body, and how different systems can get out of balance, and imbalance other systems in the body, and then we’re getting into functional medicine conversations. To me, I think there’s a lot of room for opportunity there looking at how we bring the body back into balance? How the body has been injured over time by certain things that have happened, whether it’s external or internal? And how do we bring that body back into balance. And what I’m really hopeful about here, we can maybe mention a few ways the body gets out of balance, typically, in the mental health arena, I think that would be helpful. But what I’m really hopeful about is that I’ve seen so many people now and myself included, like the body is just an amazing apparatus where it really can heal and get back in balance. And it wants to be in balance, if we just know how to direct it.

 

Dr. Will Van Derveer  51:39

Right? Absolutely. And the brain is also part of the body. And one of the really cool, optimistic things we’ve learned in the last 20 years is how plastic the brain is. And so I would just add that into what you’re talking about, of how resilient the body can be and how much the body really wants to function in a healthy way. I remember when I was in medical school, hearing surgeons talk about doing surgery on the body and how much easier their job is then the job of a plumber because the body tries to get well after the surgery. pipes are just as good as you fixed them. There’s this kind of ally we have in the body, if we are able to get in the right relationship with the body and understand what the challenges are. I think for me, the biggest issue that comes up in our clinical work is it really has to do with gut health, I would say. And gut health, not only in regards to the diet and nutritional choices that we make, but the role of the microbiome and the role of inflammation in the gut from the ubiquitous not so healthy chemicals in our environment, roundup in the soil, organic phosphates. So so many things that our body has to deal with, to contend with that are not necessarily part of our ancestral exposures.

 

Keith Kurlander  53:08

I think, I totally agree that basically, for me, the place to start, I would say for someone new to this or interested about the body’s role in mental health, I would say the place to start is the gut brain connection and really getting a handle on what that pathway access is. And understanding why gut health is so relevant in mental health. I think it’s so essential, I’m really moving beyond this notion of the single brain to the second brain and really understanding that like the brain’s nervous system, and I mean, Vagus nerves come all the way down into the gut like that. This is the whole track that is responsible as a baseline for mental health,

 

Dr. Will Van Derveer  53:57

right 80% of the immune system. In gut lining, for example, the huge role of inflammation in chronic disease in general and clearly playing a massive role in mental illness. For a lot of people not to say that all mental illness is related to inflammation, but a significant portion of it especially chronic. So starting with the guide, I agree it is a good place to begin, there’s a huge amount of shift in mental well being that can happen from addressing that issue alone. And then there are other maybe more esoteric or narrow areas like genetic variability with snips that people are dealing with that would make them more prone to accumulating toxins in their body or less able to manufacture certain important neurotransmitters are chemicals in their body. But in general, my experience as a clinician is that the gut brain connection and microbiome and nutrition Is 10 to 100 fold more impactful and not to be done last. It has to be done first.

 

Keith Kurlander  55:07

I totally agree. Yes. The first step. Yeah. And you know, not to say that, how a body detoxifies is an important thing? It’s definitely important, but it’s, it’s like you could spend 10 years trying to detox and mold mycotoxins or a line issue and healing that or whatever it is. But if you haven’t dealt with the gut brain access, you’re not going to get very far right. So to me, that’s right. I think detoxification pathways are something in mental health, for sure. And then gut brains kind of the central core. And then we obviously have other things like you mentioned, there’s the immune system’s health, just very related to the gut brain access. And then there are some other big ones to look at too obviously, like the metabolic function is something to really consider huge on how people process energy. And I think that’s a major one that isn’t talked about enough in mental health, how many people are dealing with some kind of metabolic syndrome type of issue when they’re not doing well? I think plenty of people are sure. So it’s another one that, but again, to me, it’s more like deal with that second, and third, because it’s like, you’ve got to get your gut healthy, if you’re even going to try and attack if you have any metabolic issues going on.

 

Dr. Will Van Derveer  56:32

Yeah, I mean, brain health, longevity, risk of Alzheimer’s disease, associations with depression, psychosis and major associations with childhood trauma, all of these things go into metabolic regulation, and in particular insulin sensitivity and what’s happening with your blood glucose and how that’s being managed in inflammation, that cascade of inflammation that’s causing, if it’s not well regulated, and so it’s a big issue,

 

Keith Kurlander  57:04

It’s a big issue. And then, you know, similar but different is the endocrine system and hormonal health, right, hormonal health is a major component of mental health. And I think that that’s another thing that’s often not looked at. But for me, I think just from our conversation right now, my takeaway is like, keep it simple, start with gut brain access. And just understanding that is such a like up in China optimizes human beings, from what the common knowledge base is about the body. And so much impact can happen just by working on that access, and gut health for some period of time in one’s life.

 

Dr. Will Van Derveer  57:45

Absolutely, I mean, for me, the two biggest levers that we can pull, borrowing from our committees and give me a lever, and I’ll move the world, the two levers that are most impactful are getting to know your psychology, and addressing the ongoing impact of traumatic material in your nervous system and optimizing the gut brain connection. So I’ve found that the behaviors fall into place, if a person has a reason to live, then their behaviors will reflect that. And you can get the behaviors lined up and optimized if you’re addressing the root causes that are underlying the lack of discipline or the maladaptive behaviors or the addictive patterns. But sometimes, when things have been dysregulated, for decades, now you’ve got to deal with a body issue that is continuing to drive the dysregulation, because you’ve injured yourself from having that in your system for so long.

 

Keith Kurlander  58:45

Yeah, so maybe that was good. It was a good summary. So maybe I’ll just wrap up this summary. Also, I think that was nice. I would say that when working towards optimal mental health, from the body perspective, if somebody’s not already doing this, I would really start with working with the gut and understanding the gut brain connection, first getting an understanding of the gut brain connection, because without that understanding, it’s very hard to actually get the discipline for the gut brain. So getting the understanding and then working on the gut, which also means working on nutrition that will inevitably follow when you’re working on the gut. And that’s where I would start in the body. And then in the mind, I would really focus on two key pieces, which is one just, you don’t always be mindful if we feel as if we’re being influenced by a traumatic process in our nervous system. Working and marking that and it might be as simple as deep breathing throughout the day to be working that in as well as doing the trauma work, whatever it is. And then the second component, I would say, is making sure that people are working on being purposeful and in their values. I think that can go such a long way here. It’s huge. And then lifestyle and behavior like I don’t tend to focus a ton on, just go change this behavior because I don’t think it works that way. I think it works better to focus more on values and things. But I would say in lifestyle, what I would focus more on is really gaining an education about how one’s environment influences us, in terms of what we are dealing with, with toxins and food and these kinds of things. And then also focusing on relationships and working hard to have secure healthy relationships where there’s a healthy amount of challenge and support both of those things. And I think if we’re focusing on these areas, we’re going to be experiencing a lot more states and experiences of optimal mental health. And then there’s all the detail. I mean, there’s so many things to focus on and work with throughout one’s lifetime to keep fine tuning the instrument. Yeah.

 

Dr. Will Van Derveer  1:01:07

Well, that was fun. Special thanks to my colleague and co conspirator in helping to revolutionize mental health care, Keith Kurlander really fun to riff with you about these very deep and important topic areas that are the essential ingredients of optimal mental health. And it’s an evolving conversation. So we will continue to explore this and update our thinking as we move forward in time, and we hope that you have received some good Nuggets to take away for yourself and your clients. And we look forward to connecting with you next time on The higher practice podcast.