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Mental Health Pathfinders: Positive Psychiatry with Dr. Dilip Jeste · The Medical Mind

• 0:02
  Hello and welcome to this episode of Mental Health Pathfinders.
• 0:05
  I'm your host, Erin Connors. These days it can be really easy to focus
• 0:10
  on the negatives in our lives when things are going wrong or we're struggling,
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  and this can be especially true when it comes to mental health.
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  But there is a branch of psychiatry that shines a light on the positive aspects
• 0:23
  of mental health by looking at the patient as a whole and focusing on well-being.
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  Here to talk about this today with us is and the practice of positive psychiatry.
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  And his brand new book is Dr. Dilip Jeste.
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  Dr. Jeste is president of the World Federation of Psychotherapy,
• 0:41
  Director of the Social Determinants of Health Network,
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  editor-in-chief of the journal International Psychogeriatrics,
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  and of course past president of the American Psychiatric Association.
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  Dr. Jeste, always a pleasure to speak with you.
• 0:56
  Thank you very much, Erin. It's a pleasure to talk with you also.
• 1:02
  Well, you know, you know, there's an interesting history here with
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  the practice of you know, 'cause there's been the practice
• 1:07
  of positive psychology for a while.
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  That's been around for a while.
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  But when you actually started looking for the idea of positive psychiatry,
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  and you kind of looked around for it,
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  you didn't find very much, did you?
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  That's exactly right. ~ in 2012,
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  I became the president of the American Psychiatric Association.
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  And my main job was to get the DSM V published.
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  And APA did an absolutely amazing job,
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  whole group. And the DSM V came out,
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  did very well. But during that time,
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  there was a lot of discussion about DSM everywhere.
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  And some people said that DSM is the Bible of psychiatry.
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  And I thought that DSM is very important,
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  but it is not exactly the Bible of psychiatry.
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  It in psychiatry includes a number of things other than what are in the DSM.
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  Psychiatry is defined as a branch of medicine that focuses
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  on diagnosis, treatment, and prevention of mental illnesses.
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  But I really think that psychiatry focuses on mental health.
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  Mental health is different from mental illnesses.
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  And I thought that really we should look at mental health from a broad perspective,
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  including a positive perspective.
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  And as you said, ~ positive psychology has been around
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  for several decades. And I did some literature review and found that there were
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  hundreds, if not thousands, of articles on that.
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  And I also did a review of
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  Positive Psychiatry in the title.
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  In 2012, there's not a single article or book
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  or paper that was titled Positive Psychiatry.
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  And I thought this is something really we need to do.
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  And that is why I made Positive Psychiatry my presidential theme.
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  And I found that kind of work really fascinating and very
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  Mm.
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  useful for our profession.
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  You know, it's understandable that with traditional practices,
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  psychiatrists often do have to focus on the negative since so many people
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  are really, really suffering. Tell us how this is actually different.
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  True. I mean, in a way, this is not restricted to psychiatry.
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  The whole of medicine also focuses on illnesses and their treatment.
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  And we really need to go beyond that.
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  Our focus should be on health.
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  That is what we specialize in,
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  not just illnesses, but health.
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  And for psychiatry, of course,
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  it is mental health. But going even beyond that,
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  we all focus on what is now called whole health.
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  Which is physical, behavioral,
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  spiritual, and socioeconomic well-being.
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  And this is the definition promoted by the National Academies of Sciences,
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  Engineering, and Medicine. And I really think that is important.
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  So as psychiatrists, we focus on,
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  we should focus on really health from that broad perspective.
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  So it is not just illnesses. About 20% people have mental illnesses.
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  20 to 24%, something like that.
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  100% people have mental health.
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  There are 8 billion people in the world,
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  and there are 8 billion people with mental health.
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  And as mental health experts,
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  it is really important for us to focus on mental health so we
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  can be useful not only to people with mental illnesses,
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  but for the entire population,
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  because that impacts
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  Even the mental illnesses.
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  Yeah, and and this makes sense because we've often heard ~ the people living with
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  serious illnesses like cancer,
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  they often do far better when they have a positive outlook on things.
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  You know, that's a very well taken point.
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  I mean, just think about let's say if we are looking at two patients with depression
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  and they have a similar level of depression,
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  but one of them has strong level of resilience,
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  optimism, very close family, ~ and feels in general very good with
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  all those things. Whereas the other patient doesn't have any of those.
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  ~ doesn't have much of a family,
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  ~ is not known to have much resilience.
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  What is the outcome? Very likely that the first one with resilience,
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  family support, social support,
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  will have much better prognosis and will do much better than the other one.
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  Although they have the same symptoms,
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  similar level symptoms. And that is why we need to go beyond the symptoms
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  and the risk factors. We also need to look at the positive factors.
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  And positive factors include positive,
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  psychological, social, biological.
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  All of those factors are really important.
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  And similarly, not only look at the risk factors,
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  but also the protective factors.
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  I think when we do that, we have a much better access
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  to improving the outcome in any patient that we see.
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  Let's talk about positive psychiatry interventions here a little bit.
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  Are there specific treatments that you use or things that you focus
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  on with the patients, like specific questions you would ask them?
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  Yes, sure. As I said, we should look at factors in three ways:
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  psycho, biosocial. All of those are equally important.
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  So psychological factors include wisdom,
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  resilience, optimism.
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  Meaning in life and so on. So these are the factors that actually
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  go at different levels in different people.
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  Some people are much more resilient,
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  they are much more optimistic,
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  they have a higher level of wisdom.
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  Wisdom, by the way, is a personality trait that includes empathy and compassion,
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  self-reflection, emotional regulation,
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  acceptance of diverse perspectives.
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  So all of those things are important for our well-being.
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  And
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  We must ask this factor about these factors in every person we see because they have
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  great impact on overall health outcome.
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  So those are the psychological factors.
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  Social factors are also very important.
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  Social connection is the single most important determinant of health.
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  Positive social connections increase longevity by something like
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  50% when you compare it with people who do not have good social connections.
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  So these kinds of social factors,
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  and also there are both positive and adverse social determinants of health.
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  For example, close social connections,
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  as I mentioned. On the other hand,
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  people who are homeless or have major financial burden.
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  ~ so on. So those factors can will have negative impact.
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  But the positive factors for social is really family relationships,
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  ~ relationship at work, relationship with other community that they work with.
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  So, and then finally, biological factors.
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  And biological factors include,
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  for example, the level of inflammation,
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  ~ specific genes involved,
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  and the expression of those genes.
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  Which depends on so many other factors.
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  Epigenetics is even more important than merely what genes are present.
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  So even things like cut microbiome,
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  for example, they all impact health.
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  So the main point I want to raise is that we really,
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  in every person we see, we must look at not just their symptoms and risk factors,
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  but we must look at their
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  biological, psychological and social factors and not just adverse ones,
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  but also the positive ones.
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  Yeah, it's a whole the whole person,
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  the whole body. It it almost sounds too like you have to go into
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  it asking questions in a different way than you typically would.
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  That's exactly right. I think right now what happens typically in psychiatry
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  and in medicine as a whole, the focus has been on symptoms and the risk factors.
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  And that is how our system works.
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  That's actually not useful because we miss out a lot on things which actually
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  have greater impact on health than the factors we study.
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  So having this comprehensive
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  ~ assessment of psychobiosocial positive factors really would have
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  a great impact because it will actually reduce the cost of care because
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  the prognosis will improve. People will improve faster than if you didn't
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  ask for those factors and strictly went with risk factors and strictly
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  use the treatment that we focus on.
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  As a geriatric psychiatrist, do you do you see this focus on positive working well
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  with the aging population?
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  I think in geriatric psychiatry,
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  I think it is even more important than in other age groups.
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  There is a lot of ageism in the population that we think about old
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  age as something that is bad for us.
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  As we get older, we our brain shrinks and then heart shrinks
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  and everything happens and then we die.
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  In reality, the mental health improves with age.
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  Also,
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  In older people who are active,
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  there is improved functioning of different organs,
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  especially brain. So there is something called neuroplasticity of aging.
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  That people who are aging but they are physically,
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  cognitively, socially, psychologically active,
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  they actually have development of even new neurons and synapses
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  in specific regions of the brain.
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  This was almost unthinkable 30 years ago.
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  That time, when I went to medical school,
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  I was taught that the only thing that happens to the brain as we age
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  is that it shrinks. We lose neuron synapses,
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  and that's it. Research in the last 30 years shows that that is not true entirely.
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  That in people who are active,
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  as I mentioned, there are actually development of new even synapses
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  and even new neurons in some parts of the brain in some people.
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  That's so fascinating. And y I almost wonder,
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  could there be some misconceptions about this?
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  Since it's hard to be positive all the time.
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  You know, I think people always think,
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  gosh, can't can't do that all the time.
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  It it's hard to ignore some of those negatives in our lives.
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  I agree, and I think we must ask for the negatives.
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  I mean, there is no way that we can't ask for the negatives.
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  We have to. That's our job as clinicians.
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  We must ask for that. The problem is that we restrict ourselves
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  to asking negative factors. That is where the problem comes in.
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  And what we need is really broad assessment.
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  I mean, let me just give you an example.
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  Suppose somebody has a pain in the lower left side of the abdomen
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  and goes for treatment.
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  Would the physician only ask about lower left abdomen and not about
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  any other part of the body? No,
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  we have to ask about every single organ,
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  how they are functioning in different ways,
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  right? Same thing here. Why are we only focusing on symptoms and risk factors?
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  That doesn't make sense. And that is not useful for the care of the person.
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  And this also applies to the population as a whole.
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  That if we really focus on positive mental health globally,
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  I think the overall
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  Societal function will improve.
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  What we are seeing for the last ~ 30 years now is a loneliness epidemic.
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  There are increased mortality,
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  suicides, ~ alcohol and drug abuse,
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  even dementia, ~ obesity,
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  heart disease, they are increasing in the last 30 years,
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  especially in younger people who should be otherwise not likely to develop this.
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  That is because the whole society is suffering from loss of mental well-being.
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  And what psychiatry needs to do is to help them actually look at
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  the positive side of the human humanity that we have.
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  You know, I mean, human species is called Homo sapiens.
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  Homo sapiens means a wise person.
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  So really improving the wisdom,
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  not just in individual but at the societal level,
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  will be very helpful for.
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  The society as a whole.
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  So
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  important. So you co-authored a brand new book just released from APA Publishing,
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  titled Positive Psychiatry A Clinical Handbook Second Edition.
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  Tell us more about how this is actually different from the first edition
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  of this book.
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  No, thank you. The first book was published in 2015.
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  And that is the first book on positive psychiatry.
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  So it really needed to talk about what is positive psychiatry,
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  what does it do, and so on. In the last 10 years,
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  there has been clearly considerable growth of work in this area.
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  It is really exciting. That,
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  and this is not only in the US,
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  but globally.
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  So we really know much more about the positive aspects of health and well being than
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  we did then. So in the second edition,
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  I should mention by the way, the second edition,
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  the editors include Sophia Mata,
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  who was at Harvard. Now she's in North Carolina ~ with
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  the Armed Forces Department. And Samantha Boardman,
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  ~ who is at Cornell.
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  And myself. So, and we have more than
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  30 international authors of different chapters in this book.
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  And it really is a broad perspective on positive mental health
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  at individual level and at societal level.
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  So it includes, for example, discussions of children,
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  adolescents, older people, similarly,
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  people from diverse communities.
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  People even in other countries,
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  not just in US. So just kind of focus
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  and looking at psychological,
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  social, and biological factors in different ways.
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  So I really think it is becoming more comprehensive and it also is meant
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  to be useful for psychiatrists,
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  psychologists, social workers,
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  nurses, even lay therapists to understand what we can do to.
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  improve the health of people that we see and also the population at large.
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  I think some of the more recent advances are in digital technology,
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  for example,
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  Mm.
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  even ~ artificial intelligence.
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  And so one of my areas of interest is actually converting artificial intelligence
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  into artificial wisdom. That is what is needed for improving the societal well-being
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  Because we need more than intelligence.
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  We need really empathy, compassion,
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  emotional regulation, etc. But all of these factors that
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  I mentioned with resilience, optimism,
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  social engagement, they should be part of the psychotherapies.
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  And they are becoming parts of psychotherapy.
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  So there is now increasing literature on even randomized controlled trials
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  for empathy, compassion, emotional regulation,
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  spirituality, etc. And these are all included now.
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  in the new version of the book.
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  So it really is a considerable advance over the first book because
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  of the research and other development that have occurred in the last ten years.
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  Could you have pictured this back when you went s looking back in twenty twelve
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  and you found nothing and here we are today?
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  And a new book coming out and and lots of things for people to to focus
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  on when it comes to the positive part of mental health.
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  I think it really is happening and it's really very encouraging and makes
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  you feel positive about the way the world
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  Yes.
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  is growing, which is again very optimistic.
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  And again, of course, it is not exactly where it should be,
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  in the sense it'll continue to grow.
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  It has to grow. Again, we have made some progress in ten years.
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  Ten years is not a long, very long period,
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  but still long enough to see the changes.
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  So I expect even more changes in the coming years.
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  Especially with AI, for example,
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  and with the growth of technology,
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  I think it will have even greater impact on overall health,
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  especially because many of these technologies that are out there
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  now are easily available to people across the world.
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  ~ even again, AI has downsides,
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  no question about that, but it also has upside.
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  And something like one billion people in the world use Chat GPT regularly.
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  And that really shows how we can use the technology and that is what I think
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  the f focus of the incoming positive psychiatry and positive medicine should be.
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  How can we use this AI technology to help improve people's mental health
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  and overall health and well-being?
• 19:29
  Positive Psychiatry, a clinical handbook,
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  second edition, is out now through APA Publishing.
• 19:34
  Dr. Dilab Jeste, thank you so much for being here today.
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  What a great discussion.
• 19:39
  Thank you very much. It's always a pleasure to talk with you again.
• 19:43
  And to our listeners, you can find new and past episodes
• 19:46
  of Mental Health Pathfinders on your favorite podcast platform.
• 19:49
  Thanks for listening.