♪♪
-Overcoming the stigma while struggling to find help
is a daunting challenge for many
coping with mental health issues.
-I don't just want to talk about it.
I really want to help people know,
"Here's some steps you can take.
Here's the therapies that you can pursue.
Here's how your mind works."
-A lot of people don't even recognize
what they're going through.
And that's the biggest challenge,
is that there's stigma as well as there's a lack of awareness.
-That's next,
on "Seattle University Conversations."
Now, your host, Professor Larry Hubbell and Joni Balter.
-Good evening.
Tonight, we are talking about mental health challenges,
the personal and the political.
Our special guests are ninth District Congressman Adam Smith
and Washington State Health Secretary Dr. Umair Shah.
Thank you both for being here. Really appreciate it.
Congratulations, Congressman, on this book, "Lost and Broken."
I really found a lot of lines in the book
that I found memorable, but I want to read one to you
that maybe you could elaborate a little bit on for us.
"The aim of psychotherapy is not to correct the past.
It is to help the patient confront
their history and grieve over it."
For some reason, this kind of resonated with me,
and I wondered if you would just elaborate on it a little bit.
-Sure.
Well -- Well, part of my challenge
was just beginning to even understand
what mental health is.
And I point that out.
When I started having anxiety --
and there was a long history back to childhood,
and all manner of different things.
But I just didn't think of mental health
as something that you had to worry about.
The way I've described it --
and forgive me for the ignorance contained in this statement --
was "either your normal or you're crazy.
And as long as you're on the normal side of the line,
you don't have to worry about mental health."
So I didn't.
All right, physical stuff, I would worry about that.
And as I developed these problems, I was desperate.
"Okay, what the hell is this?"
I mean, I didn't know what was going on.
And I tried to sort through people,
and get it explained to me.
And there are multiple layers to this.
But if you do have issues
that are going on from throughout your life
that you haven't properly dealt with,
those issues can trigger anxiety or depression.
And there's a long, elaborate explanation of that.
I went through a lot of cognitive behavioral therapy,
which is great, but didn't really work for me
because I had underlying issues that hadn't been addressed.
More on that later.
But so -- so they started talking about,
"Well, you have to address repressed issues."
Okay? "And get them out."
And I was struggling to understand that.
And actually, I read that quote in a mystery novel
that I was reading about a British psychologist
dealing with someone who had witnessed a murder,
and wouldn't -- and hadn't spoken since.
And the book had quotes.
And that was a quote from a --
I think Alice Miller is the woman's name,
who was a psychiatrist.
And it really sort of made sense to me,
because a lot of what I was trying to do
was correct the past.
I had some things that had happened in my childhood
with my family that I felt bad about,
that I wanted to be different.
And I was -- I was gonna analyze.
I was going to figure it out. I was gonna fix it.
So, to have that sentence say,
"You're not trying to correct it,
all right, you're not gonna be perfect.
You're gonna make mistakes. You need to understand it."
And then, the interesting part of that is
"grieve for what you have lost."
And at the time I thought that was like,
"Yeah, I mean, whatever, it's over."
You really do have to absorb that.
And frankly, the biggest thing that -- that helped me
wasn't so much things that had been done to me.
And certainly, I had problems and issues
and feelings I had about my family growing up.
But it was things that I felt guilty about
that I hadn't done enough,
I felt like, to help my family at the time.
and just to honestly remember that, express it, talk about it,
cry about it for a minute or two, was enormously helpful.
So, of all the things people will tell you
about psychotherapy,
I felt that that one sentence or two, or whatever it is,
really gives you the best guidepost
to begin the process.
Three and half years worth of psychotherapy, by the way.
It's not like you read that sentence,
and you wake up the next day, and everything's fine.
But it gives you an idea of what the -- what's the path?
How does this work?
-Before I ask my first question,
both of our participants said,
"Just call us by our first name."
So we usually call people by their titles.
So, we'll be calling you "Adam' and "Amir."
So, Amir, I have a question for you.
How would you characterize the overall mental health
of Washington residents?
And would you say, are we in a crisis?
-That's a --
thanks for that tough question right off the bat.
-We like to get it going.
-It is gonna be hard for me to --
I am gonna try to transition
by not calling you "Congressman,"
and I will try to call you "Adam."
I'll do my best, but I -- I will.
-Either one works, actually, -...if that's okay.
I just -- If I could just go back, very quickly,
and just make -- make a couple quick comments.
One, first of all, thank you for having me,
and just appreciate all of you spending your evening with us.
And those who are watching.
And also, Congressman, just --
I just want to say how important it is
to tell the story of what you went through,
as that is so important and impactful for so many people
who are equally going through those stories,
and just can't identify with --
with -- with people who have also been challenged.
And so, just want to say kudos to you.
Thank you for writing this.
That's a great question.
You know, there, we --
we do have a crisis, not just in our state,
I would say across the -- across the country.
You could even go as far as saying
across the globe, when it comes to this.
But really across our nation, there is no state,
there is no community, there's no locality,
there is no family that has not been impacted
by the challenges that all of us are here to talk about.
We know that those challenges are significant.
We know that health is a combination
of all sorts of inputs,
but ultimately, we -- they all play out for us differently.
And when we think about health,
it's really about that combination,
that intersection, of physical health, our nutritional health,
and our emotional or spiritual
our our behavioral health all -- all together.
And that's what has really helped.
But that's also what's wellness.
And I think one of the big challenges
we have in this country, and across our state,
is that we have designed healthcare systems --
and we call them "healthcare systems,"
but they are truly disease care systems,
or they're injury care systems.
You get sick, you get injured,
you go to your healthcare provider.
Congressman, I talked about I was an E.R. doc for 20 --
20 years through the VA hospital in Houston,
and will tell you, as a clinician,
the biggest thing that I always was surprised by
is how do you prevent people
from getting sick in the first place,
and how little do we have the conversation about that?
And why that's important to that question is that,
when you continue to invest in healthcare
or the downstream effects, and not the upstream aspects
of all the inputs that go in to true health and wellness,
then, you do start to have a crisis.
You have an urgent issue across our state, across our country,
and even across the globe, and the underappreciation
of where mental health really comes in,
and how that impacts people --
every day Washingtonians every single day
who are worried about food on the table,
getting their kids to school,
all of you making sure that your your grades
are -- I guess your grades are here.
You're at the library.
All the -- All the things that you're supposed to be doing.
You should be doing that rather than being here, but I digress.
And yet, we know that, really,
the challenge is that, when you bring that all together,
we just spend a lot less time talking about
and articulating the importance
of mental health and true wellness
when it comes from an emotional or behavioral standpoint.
So, I do think we have that crisis.
-Do you think, since the pandemic has lifted somewhat,
although people are still getting COVID,
that that crisis has been at all lessened?
-You know, I think I would actually go one further
and say that I think this pandemic
accentuated that crisis.
There is no doubt that the social disconnects that we had,
the policies that were put in place,
the -- the urgency of every situation,
the -- the fact that you could not get away from the pandemic,
right -- you turn the news on, or you talk to a neighbor,
and immediately there would be --
but you couldn't talk to the neighbor next to you, right?
Right? Physically.
So, it would be almost with some isolation,
separation, and anxiety --
that's a key word -- anxiety about what is happening,
and the real concern that you might get sick,
or a family or a loved one might get sick,
or you might pass COVID on to someone else.
And so, I think that really helped further the --
the -- the mental health challenges that we've had.
But then, I really am concerned about our kids,
that next generation
who have had so many real contentious issues
as they've been trying to get their education,
schooling, et cetera.
So I do think we -- we've had this pandemic
that has absolutely impacted
and made the mental health aspects
of what we've seen across the country and in our state worse.
-Congressman -- still calling you "Congressman."
You are a veteran congressman from a relatively safe --
I mean politically -- district.
But I wonder -- when I was reading your book, I wonder,
did you ever worry that by being so candid
and forthright about your condition,
and all the things that -- the demons that you were fighting,
that some kind of fidgety opponent
might try to use some of that against you?
Did you -- Did you think about that?
-Not by the time I was writing the book.
Now, early on --
and I had a severe bout of anxiety in 2005
that required me to see a psychiatrist
and take some medication.
And then, it came back in 2013.
When I was trying to figure out,
"How do I seek treatment for this?"
I was worried about being too public about that.
By the time I got to the point
where I was writing the book, in 2020,
I had kind of figured out that being honest and open
is both one of the key important things
in terms of dealing with your own mental health
and also just the right way to do public policy.
So, no, I was doing -- I figure I'll be honest,
and let the chips fall where they may.
And I think it's actually the better way to get there.
Now, yeah, I'm sure someone might use it against me,
but in the aggregate, whatever, I'll deal with that.
I do think, by the way, that the crisis in mental health
predated the pandemic.
The pandemic certainly made it worse,
but I think we've had a real problem in this country
dealing with the basics of mental health prevention
and then how to treat it for a long time.
And that's what I sort of fought my way through
to try to figure out what are those basics?
And one of my biggest messages I want to get out to people is
there -- help exists, basically.
Because again, that was one of my worries is, like,
"If I have this problem, there is no solution to it."
Right? "It's just my brain.
How am I gonna change the way I feel?
How am I gonna change the way I think?"
I quote from the satirical magazine The Onion.
I remember reading this a while ago.
There was a headline that said
"Psychiatrist Actually Cures Someone."
And that's the way I felt about it, is, like,
"I guess I can talk to this guy for what, the next 20 years?
And what are gonna do about this."
-It's working for them sometimes, right?
-Indeed. 200 bucks an hour or 200 bucks a 50 minutes,
I guess is the way it goes,
but I really want to emphasize
that you can learn the basics of mental health.
What is it that triggers the anxiety
and triggers the depression?
There are some basic things that we can all learn,
both prevention and to deal with problems as they come up,
and I just think we haven't dealt with that
in our healthcare system,
and long before the pandemic.
So, folks don't know how to deal with it,
and also, I think the psychiatric profession
doesn't do a great job of explaining that to patients.
I went through about a dozen different
psychiatrists and psychologists
until I found someone
who could actually explain to me,
and I've got about a little three or four minute riff
that explains that, which I won't hit you with right now,
but there are some basics to mental health
that if we all understood it better from a young age,
we could see the signs,
we could know how to deal with them
without necessarily always having to go
and pay a psychiatrist for years or whatever.
So I think we haven't gotten to those basics,
and certainly, the pandemic -- gasoline on the fire,
but the kindling was already there.
-Dr. Shah, you mentioned younger folks,
and a Census Bureau survey said
that roughly half of young adults --
we're talking about people 18 to 24 --
reported anxiety and depression symptoms
in a survey that was done this year.
That compares, just for reference point,
to about a third of the overall group of adults.
Why are the numbers so high, particularly for younger people?
Just really want to hear you elaborate on that.
-Yeah, that survey I think really tells
two or three stories.
The first is that, and as Congressman just mentioned,
this is really about all of us have to really be thinking
about reconciling what we have learned
and how to unlearn some of that, right?
The I think you made the comment about normal and crazy.
You know, just -- we have in the -- you know,
in the ecosystem what we hear about,
whether it's watching TV or on the Internet or social media
or what have you, is that we learn a lot of things
and we take a lot of cues by what's out there,
and that particularly is the challenge for younger people,
and that survey really recognized
and it was really 2021,
where some of the data points came from is,
as Congressman just mentioned about,
that this predated the pandemic,
yet it got markedly worse or accentuated by the pandemic.
And so, it's no surprise that the coping mechanisms
aren't sometimes as maturated.
You may not have resources,
the availability.
So that's a second reason.
But the other is that there is this real challenge
that we have that the Surgeon General,
the US Surgeon General who made --
has released two reports,
and particularly, this concern around social media
and the challenge of communication,
and then a second one that's about loneliness
and the disconnectedness.
I think both of those play into this, that you have,
particularly in this regard, young girls
who have a particular challenge,
and we have to be thinking about as a society,
how do we come back up to --
-What is the particular challenge?
-The challenge is that
there's more of the isolation
or there's more of the social cues,
whether it's social media or otherwise,
that really drives some of the mental health or challenges
that we have in the young female population.
So that's one issue that we've got to really be mindful of,
but the second issue is just thinking about
how do we really, at the end of the day,
recognize the support that's needed in schools
and other academic and other social supports?
Because this real connection
that we've got with some of the others.
-On that point, another thing that I hope we'll think about,
and I just throw this out there
for the professionals in the room,
the difference between harm reduction
and teaching resilience is something else
that I think we've really struggled with,
that we want to teach young people
how to avoid being in a situation
where they are uncomfortable or stressed by something,
and so a lot of the structures that we've put in place
are to try to make sure that nothing ever happens to you.
That's going to be upsetting to you.
The whole helicopter parent thing does that too,
and that's just the wrong message.
You've got to learn to be resilient.
It's going to happen.
No matter how careful the bubble is built around you,
things are going to happen that are deeply upsetting.
It's life, at least as it's currently configured
and always has been.
How do we teach resilience?
And that's something that I struggle with in conversation.
It doesn't seem to be there as much,
and I understand there is a place for harm reduction,
but I think we've taken harm reduction too far
instead of teaching people
how to be resilient in the face of that.
And if you grow up not knowing how to deal with it
and then something hits you,
it's like if you've been a straight-A student
your whole life, and then you get a B
and you completely fall apart.
You have to be taught --
I've always said this for years and years.
You've got to know how to take a punch
and deal with it, metaphorically, by the way,
you know?
So I think that's part of the problem, too,
with where we've gone with education
and the way we teach young people
about how to deal with mental challenges.
-Mayor, deaths nationwide from drug overdoses,
especially fentanyl, have just skyrocketed.
In fact, in the last year,
it was estimated that 100,000 people died from drug overdoses.
Is this strongly related to the mental health crisis
that we're facing?
-I think it's all related,
and I think if we just want to take --
and this is one of the big challenges that we have,
both in government as well as in health,
is that we silo everything.
And so, we silo funding, we silo agencies,
we silo the work, we silo the initiatives,
and we silo the communities.
And so, absolutely, all of it is interconnected,
and I think that's one of the big messages
in Congressman's book
is about this real interconnectedness
of the entirety of that system,
and I think we have to be thinking
about all of this as interconnected.
Now, one of the things that we have --
we should be very proud of in the state of Washington
is our 988 crisis line.
How many people are familiar with this 988?
Okay, so about maybe half.
This is a crisis hotline
and you can call, you can text, you can chat.
This is 988. Simple.
988, just like 911,
and it's for suicide prevention.
But what we found in the midst of all this,
that it's not just about crisis.
It's not just about somebody
on the brink of doing harm to themselves.
It's also about people who are requesting some support,
some help in some capacity,
and in the first year of existence, we had nearly 90,000,
whether it's calls, texts, or chat messages
that came through to this 988 call center
within the state of Washington.
So we're very proud of this,
but also, we found that our native, our tribal population,
our tribes and tribal communities,
we had a particular increase in the number of real concerns
around suicides or overdoses from fentanyl
or from other kinds of substances,
and so, we actually are the first state
in the in the country to have a Native Strong line.
It is manned by native tribal people
who can answer the call,
chat, or text with people who have a concern
from what's happening in their community.
So, the point is that it's interconnected.
Overdoses, suicide, mental health,
the challenges that we've had throughout the system,
the pandemic -- all of this is interconnected.
We just can't keep siloing everything
because that's when we get in trouble.
-Adam, it's been very unusual for a politician
to write about their mental health challenges.
You and John Fetterman, senator from Pennsylvania,
have been open about it,
and I wonder, because you've been open and transparent,
does that help normalize the situation for other people
who might be facing similar challenges?
-Yeah, I think there's a lot of folks
who have come out publicly just in the last three or four years.
That has been enormously helpful in a lot of different fields.
And certainly that's one of the big initial challenges
on mental health, is the stigma around it.
Many, many cultures are like,
"No, we don't want to deal with that.
We don't want to talk about it."
And you can't seek help if you're afraid to do it.
So part of what I want to do
is to open up and improve that dialogue,
and I think that dialogue has improved.
Don't get me wrong, there is still a stigma problem.
People are afraid to come out for how people
will perceive them and what will come with it.
So, big part of it is talking about it.
What I really --
You know, I sort of have a problem solving mentality.
Talking about it's great.
Fixing it is even better.
So I don't just want to talk about it.
I really want to help people know,
"Here's some steps you can take.
Here's the therapies that you can pursue.
Here's how your mind works," to sort of move on
from just talking about it,
because some of the public stuff
takes on sort of a voyeuristic quality to me.
Like, you know, you write a memoir.
"Oh, my gosh, look at how screwed up that person is."
Which is kind of interesting,
but no, it's like, "Okay, but what can we do
to make your mind work better and to deal with that?"
And that's what I think can be helpful
to a broader array of people
and where I'm trying to guide that conversation,
to walk through the therapies that are available
and the way your mind works,
and one of the biggest messages on that is you can, in fact,
change the way you think about things,
in the same way that, you know --
let's say that you weren't in very good shape
and you decided you want to get in better shape.
If you went out and ran or swam
or did something for a while, in a little while,
all of a sudden, you'd have more lung capacity,
you'd be able to run longer and be able to climb stairs.
You get better.
Your mind works the same way.
You can teach your mind to better process information
coming in
and to make it more resilient in what it faces.
And so I hope we can take that next step
and really help people get some of those basics.
Now, the mental health crisis really has two different layers.
One, we have an extreme mental health crisis
with people who have really, really serious problems,
which gets into a long conversation
about statewide institutions,
not enough beds, not enough treatment,
but I think the --
well, not bigger -- equal crisis is the number of people
who are simply struggling day in and day out.
They can function.
You know, they go to class,
they meet their obligations to their family, they do their job,
but they're in a lot of pain, a lot of anxiety,
a lot of depression.
It is very difficult,
and I think we need to get the message
to those folks to get out there
and get the treatment that can help them be better.
-And if I could just add, I think it's a lot of people
don't even recognize what they're going through,
and that's the biggest challenge,
is that there's stigma as well
as there's a lack of awareness,
and I think increasing that awareness
and telling the stories
and sharing that across all the different parts
of our community is so critical.
-And actually, I'm sorry, it's worth getting into
because as we're talking about this,
I haven't really sort of defined the terms.
I mean, what does it mean to be anxious?
And one of the easiest ways, I think,
to divide this is the normal stresses and strains
and ups and downs of life are one thing,
and those are mental health issues.
Don't get me wrong. There are absolute ways to deal with that.
That's kind of what cognitive behavioral therapy does,
is it teaches you how to process the information coming in
in a way that is less threatening.
There's a phrase they use in therapy
called catastrophizing, alright,
whereby something happens,
and I do this myself.
I have a long story.
Something will happen in a campaign,
and it's like, "Ugh, one bad thing,"
and I go through days --
"Oh, this is going to kill me. I'm going to lose."
And really, and in that moment,
you really think that that's what's happening.
You can teach your brain to better process that information,
but when you're talking about anxiety and depression,
what happened to me,
I was always a high stress person,
but when the anxiety hit, it was uncontrollable
and it wasn't directly related to anything,
alright?
There was nothing that dramatically different
about my life when I went to bed that night,
and all of a sudden,
my heart started going a million miles an hour,
and I couldn't stop being anxious, period, alright?
That's when you're talking about something that psychotherapy
is probably going to need to help with,
to really get at what's going on,
and the what's going on are two things.
One, you have to understand -- how to put this exactly --
that you have self-worth and that you have self-worth
regardless of what you do in your life.
That was a concept I really struggled with.
I always thought it was like, "Well, my self-worth
depends on how good I'm doing today," alright?
You know, "If I screw something up, eh."
So you got to get after that, and then you got to get after
whatever's going on in your life or has happened in your life
that you haven't properly dealt with.
So I sort of snuck in part of
my little three minute explanation there.
But that's what you need to understand
to get at those basics
of what can trigger that type of anxiety and depression.
-But you also argued in your book
that a lot of your self-worth
you thought was so tied to your job
and there had to be some learning around that as well.
-Yeah, well, that was the conversation I had
with the psychologist who finally helped me.
You know, I filled out this endless questionnaire
which I gave to him.
By the way, when you're in --
and I had physical pain, too, which we haven't
even talked about.
I've had three hip surgeries.
I highly recommend muscle activation therapy.
That's the quick point of that.
But anyway, I was going through all that,
and when I first saw this psychologist,
the first thing he said to me is,
"You don't think you have the right to exist,"
which I thought was like, "Eh, really?
That's what you got for me?"
But his point was, you know -- and it's true.
You have to have an inherent sense of your own self-worth
that is not connected to it.
Because I started to argue with him.
I said, "Well, come on, I'm good at my job.
I'm a good husband, I'm a good father."
And he's like, "You think that's where your self-worth comes from
and the things that you do?"
I was like, "Yeah, where else is it going to come from?"
It's supposed to be inherent.
You are supposed to have a self-worth
that is not dependent upon how good or bad you are at anything.
Because if it is, you're going to be stressed out every day.
If your basic self-worth -- It is an existential crisis
that can never stop.
If you fail at something,
if you do something wrong, to think
that that takes away your basic existence,
yeah, that's a tough way to go through life.
So that's one baseline element of it
that it took me a while to understand.
-Adam, I have another question for you,
and we're moving into the more political side of things.
And let's go back in history to 1972.
By saying that year, maybe it it evokes in you...
-I know where you're going, but go ahead.
-And that was when George McGovern,
who was the presidential nominee in '72,
named Thomas -- Senator Thomas Eagleton
as his vice presidential running mate,
and when McGovern found out that Eagleton
previously had been receiving electroshock treatments,
he dropped him from the ticket.
And my question for you is today, would someone,
do you think, be disqualified for political office
if that person had serious mental health issues
and didn't disclose them?
-Well, the last part of that question
makes it more interesting, but I don't think so,
and I think we have John Fetterman to thank for that.
I mean, he suffered from depression,
went in, got treatment,
and he proved that he can still do his job.
Okay? And, you know, serious depression
brought on in large part by a stroke
and other things that caused that,
but he's shown that he can do that job,
and I think this is a tough question
in the sense -- whatever the job is,
if you're talking about public service,
you have to evaluate whether or not somebody
is capable of doing the job, okay?
That's part of it,
but I think what we've learned is everyone's going to have
some struggles mentally.
That doesn't mean that they're not capable of doing the job.
Evaluate them on how they vote
and what they say and what they do,
and I think Senator Fetterman has really changed that
and shown that we all struggle.
I mean, I worked in Congress for 22 years with Jim Langevin,
who was in a wheelchair.
At 19 years old. He got shot accidentally
because someone in the police academy dropped a gun
and he was in a wheelchair, could barely --
He was an incredible member of Congress for
22 years on the Armed Services Committee,
everything else.
I think people like that are showing
it's not a matter of what is your physical --
Can you do the job? And if you can do the job,
you shouldn't be disqualified
because you've had a mental or physical challenge.
We all have some mental or physical challenges.
-Dr. Shah, you wrote -- -If I could just --
On that last point, I think is a really good one.
So if someone does have a physical challenge,
we're willing to dismiss it, ignore it, move past it,
but even your question, when we were asking a question,
if somebody has, you know, a knee issue
or they've got a heart condition,
we don't ask the same kinds of questions,
and so, I think inherently, that's the stigma piece
that's coming in, that we are still at a place in society
that we have not gotten past,
truly gotten past the perception.
It's the perception, not the reality,
but the perception that if you've got something
that's related to mental health, we've got to take a second look.
We have to get past something.
That's something we've got to continue to work towards.
-So, Dr. Shah, you wrote in a recent op ed
in "The Seattle Times",
"Openly sharing our own struggles
gives others the chance to support us,
and may make it easier for them to ask for support in return.
Remember that asking direct, compassionate questions
to those around us decreases risk."
A question I have always had,
and I have this because I blew it with somebody
who I was asking these kinds of questions about,
around suicide --
I've always wondered, how do you start that conversation?
Yes, you've given a little of yourself.
I have these struggles myself.
But to get to someone else's, you know, how do you start that?
What do you use as your cue?
Or do you go to some meeting ready to ask that?
-Well, there are a couple of things that I would say.
One is that you have to be willing to be vulnerable.
You have to be willing to share,
and I'll tell you that when I was
in the middle of COVID response,
as we talked about before this session started,
that I came to the state of Washington
as the Secretary of Health,
and I arrived the week
that COVID vaccines arrived in the state.
So you can imagine it was probably not the ideal time
to take a new position coming from Texas.
I will also tell you that what I learned in the process
was that we have oftentimes these political pieces,
and Congressman just spoke about some of this,
where we do very quickly get into not being vulnerable,
not being willing to talk about things.
So when COVID vaccines -- I'm just giving an example here --
When we had pediatric vaccines for children,
the first thing that was asked by my team was, like,
"Well, how are you going to talk about this?"
And I didn't talk about it as the Secretary of Health.
I didn't talk about it as a public health professional.
I didn't talk about it as a physician.
I talked about it as a father.
And the first thing I did was to say,
"Look, this is what my wife and I,
we talk about at home, is the health and well being
and the protection of our children."
And having that kind of a conversation
helped a lot of parents decide or make a decision
that they were willing to get vaccine for their kids.
And just in a very quick way, that's exactly what this is,
because a lot of folks were saying,
"Don't talk like that. Don't talk.
You've got to be the professional.
You've got to talk as a secretary,
you've got to talk as a physician,
as a public health practitioner."
But the answer is no. We have to be part of community.
We have to be willing to have the tough conversations.
So, yes, talk about it,
be vulnerable, be willing to share, but also listen,
and I think that's one of the biggest things
that we've lost in our communities
is this ability to listen,
and when you identify, the more we know what the symptoms are
or what the markers are of somebody
who might be either in crisis
or having some challenges related to mental health,
we're better able to open the door
to have those conversations.
So, knowing what the signs are,
opening the door for the conversation,
but also recognizing our ability to be vulnerable
and having the conversation,
I think all three of those elements come in.
-Adam,
the Trump MAGA Republican base seemed to thrive on grievance,
and in fact, much of that base
was made up of white working class people
who have been left behind economically
compared to other groups in this country.
To what extent do you believe
that their strong attachment to grievance is,
in fact, based on some, at least in some cases,
on unresolved psychological issues
that they may face, like depression?
-Well, let me amend your question ever so slightly.
And I'm in a dangerous place to do this.
The far right and the far left both exist
off of a certain amount of grievance.
I think it would be wrong to say
that it's just the right wing.
Grievance drives a lot of politics.
Anger and fear drives a lot of politics.
You motivate one group of people by convincing them
that they're getting the short end of the stick, okay?
You know, society's turned against them.
"You should be angry. You should be moving forward."
And that's certainly become a highly motivating factor,
whether it's on social media or wherever.
The more angry and the more divisive you are,
the more attention you get,
and if you want one of the signs of the apocalypse,
I'll go ahead and go back to embracing the base
of your question and say
that Marjorie Taylor Greene,
in the first quarter that she was a member of Congress,
raised $3 million, okay,
just by being online and just by being angry, right?
Just by attacking people
and playing to people's fears.
Instantly -- money.
I mean -- And so, it works.
Now, the question that you're getting at is,
"Why does it work?
Why do people respond to that?"
I will say, nationally --
I'll speak up for my party a little bit --
I think we've been able to resist that
more so than the other side.
I made the comment during -- I think I tweeted this out
or X'ed it out, depending on how we go --
during our speaker fight
that if you're running in a Republican primary
across the country, the chances are if you say the nastiest,
dumbest thing possible --
boop! -- you go right to the top of the list.
And a lot of those folks got elected,
and now we're all shocked that they can't get along?
Eh. Not exactly surprising in terms of how it played out.
Now, to get to your question, I think absolutely.
I think the fact that so many people
haven't figured out their own mental health
and it brings with it insecurities
and that they are more responsive
to those messages than they would be
if they were in a more stable place,
and I also think that this makes it more difficult
to solve problems in public policy.
People get angry more quickly.
They don't want to listen. They don't want to get along.
One particular aspect of it,
and something you were talking about earlier
and I forget why it triggered this exactly,
the notion that it's okay to be wrong,
alright?
You are not going to get very far in life solving problems
if you're determined to prove that you've always been right,
just not going to get you to a good place.
I always say I consider myself
to be a reasonably intelligent person.
I'm wrong all the time and I'm perfectly okay with that.
I learn from it. I move forward.
Once you lock yourself into such an insecure position
that your idea of self is caught up in the idea
that you are always right...
I've tried to -- I've had to negotiate with people
like that a number of times.
It can be done, but it's extraordinarily difficult.
So, yes, once you get into that mentally insecure place,
you become more motivated by anger,
more motivated by fear,
more motivated by never compromising,
never giving anything up.
And I think the underlying mental health issues
that we've both talked about today
that have not been addressed, for one reason or another,
drive that sort of politics and make it a lot more difficult
to address the public policy issues we have.
Now, I'll say, I think we got that issue right here
in Seattle, King County, and we're 100% run by Democrats.
So it's not just the MAGA people,
but it's definitely a problem.
-So I have a question for both of you,
and I think you might know that I would talk about this.
"New York Times" columnist David Brooks
talks about, in a column called "Wake Up, America,"
he talks about the fine line between being honest
and talking about a mental health condition to get support
and to feel better through through that process,
and then the other side of that line where you allow
those revelations to sort of let you fall
into what some people would call victimhood as a defining trait.
Where do each of you draw the line on that?
Dr. Shah?
-Yeah. You know, it's a very -- I read that,
and I will tell you that --
And I would recommend, if you haven't had a chance
to look at this, this piece by David Brooks,
it is -- it's going to be different for everybody.
But we do need to be thinking very clearly about what is it
that ultimately we need to do to build resilience.
And I think Congressman mentioned this very,
very nicely, is about a lot of this
isn't a "I'm always right" or "I have to win,"
but it's really how do we build resilience in the communities
that are around us but also in ourselves, right?
The sheer incredible amount
of inputs that are coming from our social cues
are very difficult to manage.
And we talked about, for younger people,
it's even harder to manage
or there is even more of an onslaught.
Maybe it's better people like me
just stay off of X or Twitter or what have you.
So it's a lot easier. You don't know what's going on!
But I would say that this issue about victimhood is
a real challenging one. But the more you have
the resilience within to recognize
that there are things that all of us have been hurt by,
we have been impacted by,
but we also have to find that inner resilience,
that strength, some of it are the tools
and what Adam talked about is, like,
how do you -- how do we teach that?
Some of it is innate, but a lot of this is also recognizing
that we have to persevere
despite it all, that the challenges are there.
There are so many opportunities
that you want to feel sorry for yourself.
Gosh, you know, I was driving up here and I thought, oh!
-There's traffic in Tacoma. Imagine that.
-Yeah, This is really mean.
I mean, people are mean out there.
They're really tough.
And I'm driving and I got to get to Seattle Univer--
And I don't know if I'll be able to make it.
And that person just cut me off and I'm really upset.
But the inner resilience is it's okay, is to think through.
So I think there's a real issue here about, how do we build that
in a way that allows us to be successful
in whatever comes our way?
-And I completely agree with that.
I think the first and most important thing
is to acknowledge the difficulty contained in it.
Don't think that there's one side or the other.
Either if you make this decision,
you're always victim shaming,
or if you go the other way, you're always just trying --
you know, trying not to be resilient.
Individual questions are going to be very, very difficult.
It's very hard. It's not an obvious thing
when you're trying to build a policy, without question.
I'll tell you, experience --
I mean, again, I'm really very focused on
resilience and teaching people to do that
while acknowledging the challenges that they face.
And one thing that I think is helpful to understand
is humanity is basically equal in the sense
of what they've suffered and what they've gone through.
Whenever you're feeling about what's really upsetting you,
it's always helpful to think, okay, well,
what's that person's problem?
You know, understand the shared humanity in all of this.
And on the resilience point, I had this moment
in my life that was really positive.
My life was not going particularly well
at the age of 19 or 20. Details aren't important,
but I had an idea where I wanted to be.
I was very much not there and I was really angry about that.
You know, things would trigger me.
Eh, eh, be upset about it.
And finally, one day, a whole series of really,
really bad things happened that put me in a bad spot.
And I was standing there and I said, you know,
I don't want to feel like this.
I don't want to reach the point in my life
where I have a solid excuse for why my life sucks.
I don't want that, okay? I want to fix it.
I want to figure this out.
And I think that was a really transformative moment
in terms of how to, like,
how to begin to teach yourself to be resilient.
Now, when you're dealing with other people,
it's hard because you've got to respect that.
But again, I would say, understand it's not easy.
It's a balance. All right.
You know, you can come in. Sometimes you really --
People are victims. They need to be helped.
And there are other times when they are using it
to gain advantage in a situation.
You have to think through that.
Use your humanity to balance out that situation and make it work.
-We have a question from the audience for both of you.
Let me start with Umair. Same question.
"People are seeking treatment and help,
but are often met with lack of resources and availability.
How do we navigate this shortage?"
-So I think it's, first of all, a great question.
I think the first thing we have to acknowledge
is that we will never have enough services.
We'll never be able to build enough beds.
We'll never be able to have enough practitioners out there
if we do not do two things together simultaneously,
and we can walk and chew gum at the same time,
so it can be done,
which is we need to continue to build those services
and make sure that those resources are available.
But we also need to help make sure that message of prevention,
and before somebody gets into a situation that's difficult,
that we help promote the actions on a prevention scale.
So, services, to me, are downstream.
Downstream. Here's where we are.
You've got an issue. You've got a challenge.
You may have a crisis.
You may have a significant mental health
concern for an individual or a set of individuals.
Yes, we have to make sure we're doing
whatever we can to build those beds
and provide those services and have those practitioners
and have the tools available. Absolutely.
But let's also think about a future
where we don't need a 988 crisis hotline.
We need to be thinking about that future, as well.
It's not all about let's make sure
that we're doing something for the fire today.
We have to prevent the fire for the future.
So I really think you can do both.
And that's a critical piece of this.
But we do not have enough resources.
And some people have asked me or have asked the state system
like, well, you know, Washington is one of those states.
And my answer continues to be,
yes, America is one of those countries.
And that changes that. It's not an excuse, by the way.
We've got to do more in our state of Washington.
But we have a national phenomenon when it comes
to what's going on with mental health in our country.
And we are one of those states that continues to have
the challenge just like the other 49.
And we've got to be thinking about how do we build
and invest in prevention as we do service delivery.
And that's not just for our state, but for our country.
-I think, for me, it starts with the stat.
The United States of America spends more money on health care
per capita than any other country in the world.
And it's not even close.
I mean, I think we're like twice the next country.
And yet, we consistently rank
between 30th, somewhere in the 30s,
in just about every health care measurement.
So while we're focused on we need more therapists,
we need more of this,
we also need to focus on, where are we spending money
right now within the broad health care system
that isn't actually helping?
I mean, we're running a massive debt and deficit,
as you know, and there's a bunch of different ideas
for what we can do to get that under control.
But there's no scenario here where we can spend
even more money per capita on health care and deal with that.
Maybe a little bit on the edges here and there.
A lot more money is not coming, and we're spending so much.
So what's what's going on?
Why are we spending all this money
and not getting the results that we want?
Part of it, I think we -- as I say in my book --
we pay for quantity, not for quality in health care.
All right? You know, tests, drugs, surgeries,
these get paid for. All right?
And, so, you do a lot of them.
We prescribe way more drugs than people need,
in my humble opinion, we do way more surgeries than people need,
we do way more MRIs and all manner of other tests
than most people need,
and we really need to look at that.
And specifically in the mental health area,
we don't have a best practices
within the psychiatric or psychology profession.
It's the Wild, Wild West out there.
You know, you come up with a psychiatrist,
like I said, you go pay him 200 bucks an hour,
see him forever. What are they doing?
I don't know, but they're getting paid.
We need to figure out how to build our system around
getting results as opposed to simply getting inputs.
And there are ways to do that. We tried to do that
to some degree in the Affordable Care Act.
We tried to build -- For instance, you know,
emphasize primary care.
One of the problems is a doctor doesn't get paid any more
if they see you for two hours or they see you for two minutes.
So there's a massive incentive
to see you for two minutes, all right?
And you're not really going to figure out
the problem in two minutes.
If we were to emphasize primary care,
we could get to better results. We wouldn't order as many tests.
I will never know whether or not I actually needed
the three hip surgeries that I got.
Long story there.
But if I had gotten better information up front,
we wouldn't have had to spend as much money
on my health care as we did.
And the final thing I'll say,
just to keep the conversation uplifted,
we spend more money on end-of-life care in America.
And this is a facility of America
that I want us all to wrestle with.
Part of being American is to imagine
that there is no problem that you can't solve.
All right? You all went to school around here.
Somewhere in your classroom, there was a poster that said,
if you can dream it, you can do it.
You know, some little aphorism like that that.
That costs a hell of a lot of money,
because one of the things that we're convinced
that we can overcome is death.
And thus far, we really can't. All right?
But we're spending a whole hell
of a lot of money trying to drive that.
And maybe that's okay. All right?
Maybe that's what we want to do, and maybe we want to get there.
But the amount of money -- You look at these other countries,
you want to see where they're not spending money
that we're spending money?
It's the last two to five years of life.
If we went down to their level, you'd have all kinds of money
for all manner of different things.
Again, not telling you what the choice should be there,
but understand that's the options that we're facing.
And what makes America unique is the amount of money
we spend on other things, as much as the amount of money
we don't spend on certain things.
-So I have an audience question for each of you.
Umair, can you -- And I know that the state has focused
on this a little bit.
Can you speak on how the crisis impacts men and trans people?
-Yes. Well, thank you for raising this issue.
So, one of the things that we have to remember
are there are people
in our communities throughout the state of Washington
that are with higher rates of whatever the challenge is.
Now, it could be a diabetes,
it could be a high blood pressure.
But in this case, it's also when we're looking at mental health.
And what we're seeing with our trans populations,
we're thinking about LGBTQ+ populations,
there is a significant -- and I don't remember if it's
three or four times the increase in mental health concerns
or the concern about suicide,
that that is an option, suicide attempts or even potential
for, unfortunately, taking a life.
And this is why, when we talked about that 988 crisis line,
that what we have is the ability,
not just for, as I mentioned, the native strong,
the tribal -- it's option four --
but we have for veterans,
we have those LGBTQ+ lines that really get to,
how do you connect with somebody who is having a challenge?
But I think one of the issues is really about stigma,
and we have to keep reminding ourselves
of the importance of stigma, stigma, stigma
because it continues to rear its ugly head,
and especially when you have communities that,
for whatever reason, or people in a community,
for whatever reason, are told or are
somehow made to feel that they are less than
or they are not part of or that somehow
they are not going to be getting the services or the activities,
or we're going to get the dollars
or do whatever we are from an initiative standpoint,
we have a real problem.
And I think that's what we have with our LGBTQ+,
as well as our, in particular, the trans community,
is that we have somehow, as a society, said,
"Less than, out of bounds.
We're not going to give you, we're not going to do,
we're not going to appreciate."
And when we do that, then guess what happens?
It is no surprise that we have an increase in rates.
And that's one of the biggest concerns that we have.
-Adam, what do you think about different efforts
to restrict social media,
which can be very, very difficult for folks,
especially younger people, for their mental health?
-Yeah. You know, I've always --
Again, I come back to my resilience point here
to some extent. And it's very, very difficult.
Believe me, I understand how much social media is out there.
You got to teach people how to deal with things.
I don't know that you're going to be able to ban it,
restrict it because there's just so many ways to get through it.
None of which is to say
that we shouldn't be trying to regulate it.
I just don't think that that's going to get us there.
I think we have to teach people more,
and it's a matter of understanding a balance.
And, again, it comes back to treating this stuff
with -- what's the word I want to use here?
Disdain was what occurred to me.
But understanding that just because...
It does not matter as much as you think it matters.
And we got to start educating people
younger and younger to not go down the rabbit hole
of following what's on social media and believing it.
I was thinking about this the other day
because I'm old enough to remember the days
when newspapers were... -Oh, thank you so much.
-Yeah, yeah, yeah. So -- -I still get a newspaper,
just so you know. -Right.
But, you know, and I go through social media
now more than I used to,
which I'm not sure that's a positive thing.
But anyway, I look at X and I look at Instagram.
I was trying to promote my book for a while there.
Without an enormous amount of success.
But I sort of looked at it and I'll see headlines in there
that I know are simply wrong. Okay, crazy, wrong.
But there they are. All right? And back in the old days,
I wouldn't necessarily read the newspaper,
but if I saw a headline, I'd be like, "Well, okay,
there's probably something to that."
All right? And it would it plant back there.
Now you're getting all that planted on you
a thousand times a day. And a lot of it's just
completely wrong.
Somehow we need to teach people
to treat all of that information with --
I'll go with disdain --- with the disdain that it deserves.
And one of the problems also is, on social media,
everybody's life looks better than yours.
Okay? You know, and it's because --
and I've said this before --
you walk around someone's house --
And we've got the same thing.
We've got pictures of our children.
They're now 23 and 20. All the pictures,
Everyone's happy, you know, here we are at the fair.
No one takes a picture at 2:00 in the morning
when the kid just woke up screaming
and threw up all over his bedroom,
and you and your wife are talking about who it is
who's going to deal with it tonight.
No one's taking a picture of that.
Okay? But it happens, so keep that in mind.
All right? I think it's a matter of processing social media
and understanding its limitations instead of all --
And it's hard. I know that.
You see it and it feels so real, you know?
But you've got to learn, hmm, no.
Just one little opinion point that we can move past.
I think we got to teach resilience on social media.
-In 1964, there were --
-That was before I was -- Just to be clear, before I --
Just -- Okay. -I was alive then, but...
In 196-- -Although my kids think
that I was been around since -- Yeah.
-In 1964, there were a substantial number
of psychiatrists and mental health professionals
who made comments about the mental stability
of the Republican presidential nominee, Barry Goldwater.
And as a result of that, in the '70s,
the American Psychiatric Association developed
what they called the Goldwater rule,
which said you shouldn't comment --
Mental health professionals should not comment
on somebody who they have not worked with.
Now, just recently, what's happened
in the past five or six years
is that there was a book that included
a variety of mental health professionals
called "The Dangerous Case of Donald Trump,"
in which a psychiatrist speculated
about Trump's mental state.
In your view, should mental health professionals
have breached what was a previously held dictum?
-Yeah, I think that's a great question for my colleague here.
-[ Laughs ]
-You know, I think what we have to remember is --
And there is a lot of politicizing on both sides,
and we have to recognize that, you know, to me,
health really transcends,
and we have to be able to figure out a way
to get health back into a place
where it transcends politics.
And that, obviously, in this pandemic,
the genie is out of the bottle. I don't think this is the time
necessarily to be able to get there,
but I think this question gets exactly to that,
which is that, look, we do need to be thinking about
what is the ability for somebody
to be fit for... and name whatever that office is
or that activity is.
But we also need to be thinking about what is it
that we as professionals can bring to the conversation.
So not answering your question,
but just adding in that I think health
has is a very important role, but we do need
to figure out a way to transcend that politics,
which, unfortunately, no matter what was written, either way,
is going to be taken a certain way.
-20 seconds.
-I would just say, don't diagnose people
over television, okay? I say that.
Now, on the night of January 6th on CNN,
I did call the president a narcissistic psychopath.
But I am not a mental health professional.
So, I mean, don't diagnose people
over television, mental health.
-And we have to stop it right there.
We have been talking about mental health
with Congressman Adam Smith
and State Health Secretary Dr. Umair Shah.
Thank you both so much for this time,
and thanks to you for watching.
[ Applause ]
♪♪