Many of us experience anxiety. It’s normal to feel it before a big test, speaking in public, competing in a sporting event, and so on. Though a little bit of anxiety can be a good thing, we must be careful not to let these levels increase beyond the point of becoming a disorder. Dr. Gail Saltz, psychiatrist, psychoanalyst, columnist, podcast host, and television commentator joins Wes Moss to explain how anxiety can be alleviated with a little awareness and what happens when happiness and anxiety converge.
Dr. Saltz starts the episode by sharing her thoughts on anxiety and how it can go from good to bad, as well as the most generalized anxiety disorder. Dr. Saltz and Wes also discuss how anxiety would have been treated 100 years ago, her favorite book she’s written, and the most common diagnosis in children. To wrap up the episode Dr. Saltz opens up about the most effective way to help people struggling with anxiety, if she believes teletherapy works, where we are in the evolution of helping more people, and provides Wes with key advice for how he can be a better partner.
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Read Show Notes From This Episode (click to expand and read notes from the full interview)
- Retirement is a scary transition that brings a lot of anxiety for many people. Wes wants to talk about how COVID impacted children. Going virtual really threw off one of his kids.
Let’s start with your thoughts around anxiety in general and where it’s good but when it spills over to bad.
G: It’s natural, and it tells our brain when something needs to be worried about. There are systems like hunger or sex drive that shut down when you reach fight or flight feelings. Anxiety happens when there’s not something dangerous happening, but your body and mind react as though the bear is there. It might develop into an anxiety disorder.
Some anxiety is a good thing. Athletes having some anxiety before an event can lead them to perform better. But there’s a sweet spot. Too much and you freeze. You can’t feel the parts of your nervous system because it’s focused on anxiety.
Most common: generalized anxiety disorder. If you’re predisposed from family history or past experience with a traumatic event, or even the pandemic we all experienced, it can lead to this. Your mind focuses on the “what if.”
The issue is that it’s always something that could happen, but it’s less likely. You focus on the worst outcome.
W: Charting anxiety from 100 years ago to today, where would we fall?
G: Can’t do percentages. 100 years ago they thought that bile was different colors causing issues and ladies had wandering uteruses. So we don’t know about anxiety issues in the past. Just in the last few years, we’ve gotten better about educating and making people aware of these mental health issues. We diagnose things that were happening 100 years ago but remember that back then the solution used to be being bled by leeches.
We used to do lobotomies! We used to do terrible things to people because they didn’t realize that mental health was health.
To your point, is there more stress today culturally? I think yes. You think about the time during the pandemic, the numbers say yes. It’s not just the health risk, but there’s also economic strain and stress, a renewed awareness of racism and classism. A divide in the country with vitriol. A tremendous amount of stress for various groups and this stress means more anxiety disorders.
W: There’s a continuum of stress, but the last few years have pushed people more on the line the last few years have been pushed over. It’s been a challenging few years.
You’ve written children’s books, The Book On Being Different, you’ve written about sex! I’d normally ask for your favorite book, but what’s your favorite book that you’ve written?
G: The Link Between Disorder and Genius. I think it struck a chord with many people to think differently about children with mental differences.
2 – 5 years is how long it typically takes for parents to diagnose their child with a mental health diagnosis. It’s difficult for parents to see because it means their child is different. Many parent and child education groups recognize that it’s not necessarily a terrible diagnosis. It offers them tools to strengthen their child.
W: I hope our conversation today helps with this. As a father of 4 young boys, I understand this. The sooner we try to diagnose this, the better it can be.
We have famous artists over the years where they’re borderline depressed.
G: Anxiety and depression are both normal for kids, but ADHD is the most common diagnosis. It’s a faulty switch in the default network of the brain. It’s where fantasy and daydreaming happen. For most people, you can decide you want to pay attention even if you find it boarding. If you have ADHD it’s not that you can’t pay attention, it’s that the switch is faulty so it has to be something that you find very interesting.
You can hyperfocus on something that really interests you. But your ability to focus on something that doesn’t interest you whether in the classroom or with friends or family you have a hard time focusing. It also comes with impulsivity. The data shows that people with ADHD have an exceptionally high rate of exceptional and creative ideas.
A lot of CEOs of companies have ADD and they came up with their idea for their company out of their mind. They’re risk takers. As a child, it’s worrying, but you want an entrepreneur to take risks and think out of the box.
There are strengths and if parents are aware of them and nurture them it can be good.
Anxiety disorders offer their own strengths. They can read people and react as intelligent people. There’s an argument that worry has linked closely to high intelligence in our genetics. Not surprising.
Who got munched by the bear? Somebody who didn’t worry about it.
There’s a tremendously high number of people who are bipolar who are in the arts. Bipolar disorder is when you go between high and low feelings.
What’s true for all the things that I’m talking bout is the inverted U-shape curve
Mild to moderate on the curve has a high point on the U curve for creativity.
Moderate to severe disorder falls on the other side of the curve has low performance on the creative and
Being diagnosed early can help children reach the mild to moderate part of the U curve. Minds are plastic, so you want to treat things earlier so your brain is trained to handle things better.
W: What’s been the most effective way to help people? A population like today has emerged fully from COVID. And maybe someone who’s on the continuum of anxiety.
G: Whether it’s the results of trauma, treatment can pretty much be the same. Treatment means targeted psychotherapy, and if it’s severe include medication.
For anxiety, cognitive behavioral therapy can help with rewiring the brain. Psychodynamic therapy can look at your fears and help you move away.
There are other treatments depending on the disorder. People who’ve already struggled with a mental health disorder relapsed or got worse over the last few years with COVID.
There are studies that were looking at the positive results of Ketamine (when used properly). It’s been used for refractory depression (didn’t respond to normal drugs or therapy).
A lot of people with OCD really struggled with the pandemic because of germs.
Something that can really help is working out. Deep breathing. Progressive muscle relaxation. Having a support system where you can share how you’re really feeling.
W: Does teletherapy work?
G: Surprisingly, yes! For kids, it’s great since they can stay in the same space. For adults struggling to get out of their house, it’s very helpful. It’s important to have a therapist you trust, though.
Therapists aren’t regulated, so you have to be mindful of who you’re working with. Only a psychiatrist can give a prescription.
*Gain explains different types of therapists. Didn’t catch it all.
Yep! Love it! Do you want to take over? Sounds good! Did you get this bit, Mallory? Almost. Just need two more minutes.
A lot of CEO’s have ADD. They are risk takers with big imaginations. In childhood, that gets you in trouble but in business, it can lead to incredible outside-the-box thinking.
Worry has linked closely to high intelligence in the genetics that we pass on. If your ancestors were smart enough to avoid being, as Gail says, “munched by a bear,” it meant they were able to procreate, and eventually you came along.
Aren’t all talk therapies just talk therapies? Short answer, no.
There are similar approaches, but cognitive behavioral therapy is different in that it focuses on trying to surface memories and/or feelings from your past that drive some of your underlying behaviors. Surfacing those can help address those behaviors.
You want to be thoughtful in the specialty of the therapist that you work with.
W: If you watched Nurse Racket, there’s a
G: There’s a place in Vegas where they match doctors with writers because they realize that the majority of Americans learn about the medical field through TV medical dramas. I worked on the HBO show Entreatment.
Therapists have been shown on TV to be serial killers and terrible people, and it can make things soak into people’s minds and make them scared to work with us.
W: How did you feel about the end of “In Treatment” and the outcome?
G: I don’t remember how it ended! I worked on the second or third season. But they were great about making it realistic.
W: It was amazing work. One of the best shows out there. My wife was a pediatric nurse and got her CNS degree. So I’ve always had an interest in your profession. Have you seen your profession’s ability to help people? Where are we in the evolution of helping more people?
G: Stigma is drifting downwards because it brings more people to a therapist. I don’t think we’ve made great strides in treatment over the last decade. We’ve tried, and we have a collection of medication and most have been around for a long time.
We don’t have enough: money for research, clinicians, and training. We’re an older, top-heavy group who will be retiring or dying. We don’t have a dearth of people replacing them immediately. Right now, more people coming out of medical school want to do it but there’s a gap in the middle.
The pay for psychiatry is much less than that of other doctors.
If you’re in the middle of the country, it might be hundreds of miles before you find a psychiatrist. Teletherapy is helping but still, everyone I know has a waitlist.
A person who has real mental health issues can get worse if they talk to someone who isn’t qualified.
Gail started a podcast because she was getting so many random questions all the time. It started toward the end of 2020. She’s done about 60 episodes. Called “How Can I Help?” and it’s literally just that. Just trying to help. Wes loves that title.
COVID. ADHD. Wes has come full circle on ADHD because of his son.
Social media needs to be limited. And you need to talk about it with your child. Real relationships are more important. Put more of your energy there. They are more fulfilling. Make sure your kids know that or they won’t believe it. It must be reinforced.
For a long time, there has been a peak divorce rate involved with the empty nest. It’s often instigated by the woman. If you had children – and you put a ton of focus on the children and you were no longer putting a lot of focus into your relationship, then once the kids leave you’re thinking “who are you? I don’t even know if I like you.” You have to spend time nurturing your primary relationship. Keep communicating about what both your desires and dreams are. Don’t let the kids be the only glue that binds you.
Wes asks, how can I be a better husband? I have 4 kids. I have very little extra time. Practically, how? Gail says to take some time a couple of days a week, doesn’t have to be anything fancy, but just sit down and talk and communicate. Where are you? What do you like? Can we have a little fun? Can I hold your hand? Can I nuzzle your neck? Can I tell you how beautiful you look today, I can’t wait to have sex tonight. Affection, talking about your day. So that both people feel listened to and invested in each other so it doesn’t just become robotic. It’s important to have some play. Some new experiences. That increases dopamine and keeps you aroused and addicted to your partner. Newness. Surprise.
Wes says he would love to do this stuff, but he probably needs to be more intentional about planning it.
Gail says you can’t be together ALL THE TIME. It’s okay to have other things you like to do that aren’t even necessarily with your partner. Or the division of labor means different things.
Gail talks about her favorite books of hers. One of her children’s books sells a lot. “Amazing You. Getting Smarter About Your Private Parts.” It embarrasses her kids and will for the rest of time. Laugh.