Dear Readers, Today is World Mental Health Day and it is a good moment to share with you some of the behind-the-scenes work. I’ve had a short sabbatical from blogging while working on grant proposals, and partnerships, and identifying the next steps in light of my current situation and related resources.
The pandemic derailed major pledges, especially from some well-known musicians who had offered to do benefit concerts, and I have been challenged me to find alternate ways to keep the mission going. Violence prevention and depression prevention, along with related issues such as the prevention of distress and chronic stress have never been more urgent.
The pandemic has exacerbated psychological needs while access to psychological care continues to be difficult to locate for many, and is financially out of reach for many. Rates of violence continue as well.
In light of all this, I have decided to soon embark on teaching the public, especially anyone who is in a position of leadership within their community, organization, school, etc. about the science of prevention.
Currently, I am in the process of evaluating various online teaching platforms and accompanying technology that allows us to create communities of practice, such that people who learn about prevention can support one another, encourage one another and learn from one another as we work collectively to take prevention modalities to the tipping point.
I have also been active behind the scenes, getting ready to scale my violence prevention pilot and proof of concept conducted in Ethiopia and which reached 20 million listeners. This was carried out with grants from UNICEF and the American Psychological Foundation. I am now preparing to mobilize support for a three-year-long serial drama intended to reach 200 million people, in the first of its kind effort to prevent sexual violence and change related harmful social norms via mass media.
Fingers crossed, I recently submitted a grant to a US source to train media personnel in violence prevention, but won’t know until March of next year if that comes through or not. Regardless of what one funder may or may not do, the work needs to be carried out urgently around the world and I will soon launch crowdfunding efforts to that end.
We are still in the midst of the pandemic, but it appears that the worst is behind us. This means we can resume our focus on other equally urgent matters such as the global epidemic of violence which affects over a billion people as well as the global epidemic of depression and chronic emotional distress.
As part of my regrouping in light of the challenges of the past couple of years, and in light of a recent milestone birthday, I’ve decided to focus on two major goals in this body of work:
a. teach people from various countries, about the primary prevention of violence, depression, and emotional distress, such that they are empowered to take action within their spheres of influence; b. infuse mass media with pro-social content that models alternatives to violence and promotes healthy social norms.
In the language of goals and targets, that translates into “teach (at least) a million and reach (at least) a billion people.
Last but not least, lest you think that all this talk of prevention science risks being stuffy and overly serious, I leave you with a video my sister the epidemiologist created for World Mental Health Day. As she is extraverted, she took the lead in making the video below, while I remained in the background, taking up the task of writing this post. She hopes it makes you smile and we both thank you for sharing this post and the video with your family, friends, and colleagues.
By sharing our messages, and encouraging people to sign up for the list and the forthcoming prevention courses, you are helping to advance prevention in this world.
P.S. For the prevention courses, I will be following the concept of Langar, namely that no one will be turned away if they cannot pay, and those who are inspired to support the worldwide teaching efforts will be gratefully acknowledged and appreciated.
What do you get when you mix a pediatric dentist with a clinical psychologist, and toss in a master’s degree in public health?
Someone who wants to get the whole world brushing – brushing their teeth, and their minds!
Let’s face it. Preventing depression and violence is a hard sell, even harder than preventing dental caries.
Sure, we have lots of data from experts informing us about the extent of these problems, and we even have research-based information on how to prevent them. We know we can often prevent depression and violence, but why haven’t our efforts taken hold?
What I discovered in the course of my public health journey is that most people are not interested in these issues – even though they affect millions of people around the world. Among those who are interested, many are discouraged or unclear about what to do.
I believe, however, that the “Brush Your Mind” concept just might be a useful way forward.
Where we are Today
I admire and respect the late George Albee, Howard Markman, and Ricardo Muñoz for their work in prevention science. Although they’re world-renowned experts in their fields, their work has yet to be integrated into the mainstream, the way it deserves to be.
Howard Markman has had best-selling books and he’s even been on Oprah. But some years ago when I asked him about the extent to which his work had diffused within society, he responded “a drop in the bucket.”
Unfortunately, he’s right!
What will be Psychology’s Space Program?
Various fields have broken barriers and reached milestones, resulting in a collective shift of imagination. For aviation, it was defying gravity, reaching the moon and going beyond. What might it be for psychology?
I propose that for psychology, the public first needs to know and believe that it is possible to prevent or reduce psychological distress – because people cannot desire something that they don’t even know exists. Then we will be poised to vaccinate (metaphorically) our world against violence and depression – two of the most widespread public health issues of our time.
The behavioral sciences offer us the psychological equivalent of vaccines. These include programs that can prevent violence and depression. Just as vaccines don’t prevent all illnesses, these “psychological vaccines” cannot prevent all problems. Nevertheless, when used in a systematic and ongoing way, they will yield the following benefits to millions of people:
Improve quality of life
Reduce health care costs
Reduce the incidence of depression and violence.
Challenges in Translating and Communicating Psychological Research
One of the challenges in improving health through the translation of psychology is that we have a plethora of theories. If we dig around enough in the literature, we find that they all, in some way or another, account for some degree of change.
While this may be a researcher’s dream, it’s also a translator’s nightmare.
Additionally, we’re flooded by masses of data informing us about complex problems with multi-factorial etiologies. This makes it difficult to create tidy sound bites – which are frequently the most that an oversaturated and time-starved public can realistically take in.
What we need is a means of addressing problems in a way that is simple, without being simplistic; and we need to do so in a way that promotes hope and self-efficacy on the part of the public.
Lessons from Preventive Dentistry
During my search for doctoral programs in psychology, I came across George Albee’s question “What is the mental health equivalent of fluoride?” It was a critical question that strongly influenced my approach to psychology.
In 2002, I immersed myself into the world of depression prevention and violence prevention. The various approaches to understanding behavior were intellectually interesting – but equally frustrating. It was difficult to find clarity and consensus.
In 2005, while leading an international nonprofit organization focused on violence and depression prevention, I attended a program for nonprofit leaders at Stanford. I heard Robert Sutton talk about innovation – and how one way to innovate is to look at advances in one field, and transfer those processes to another.
Sutton’s words empowered me to go to the next level – to go beyond fluoride and look for additional lessons within preventive dentistry that could advance the field of mental health.
Metaphors for Self-Regulation
I began with the widely-known phrase “mental floss,” to symbolize self-regulation – a construct common to the prevention of depression and violence. But in 2007, I discovered that term was copyrighted by a magazine. After having incubated “mental floss” in my head for some years, I was disappointed and frustrated.
During that time, I was a Visiting Scholar at Stanford University, where Albert Bandura and Philip Zimbardo were my sponsors. My time with them amounted to “marinating my brain” as I deepened my search for cost-effective public health methods to address the global problems of depression and violence.
Now I must confess that I don’t always floss my teeth everyday. I floss often and see its value. But each time I floss, it’s effortful, not automatic like brushing my teeth. My patients brushed daily, even when they didn’t floss regularly. And brushing one’s teeth is much more of a universal activity, as more people in the world brush their teeth than ever floss.
From these insights, I realized that it was no great loss to let go of “mental floss.” Even more important than flossing is brushing – and out of that I arrived at “Brush Your Mind.” And the act of brushing one’s mind meshed harmoniously with Albert Bandura’s writings on agency and self-regulation.
A Weird Idea that Works
Sometimes talking about “Brush Your Mind” was like a flash back to my high school nerd moments, when I spoke out about propellants in underarm sprays that harmed the environment. People were amused – but no one cared enough to let their under-arms stink or even switch to a roll-on. Now, here I was a grown-up talking about a goofy sounding concept to promote mental health and sometimes I got the same looks I got in high school.
So, I took solace in three things:
Pediatric dentistry gave me poetic license to use humor and silliness – because they are as essential to our profession as drills and needles.
Robert Sutton’s book, Weird Ideas that Work, gave me hope that “Brush Your Mind” just might be one of those weird ideas that work.
And most importantly, although other people ridiculed me, Albert Bandura and Philip Zimbardo never did. They took my ideas and idealism seriously.
After my time at Stanford, I continued R & D on my own, working out details of the mental toothbrush. In 2013, I produced an animation video of Brush Your Mind and showed it to Samuel Dworkin (also a dentist-psychologist at the University of Washington), and Donald Meichenbaum.
My peer-reviewed video received two thumbs up.
Post publication author’s note: In addition to these two colleagues above, this video has been reviewed by other psychologists and mental health professionals.
Emboldened, I submitted an editorial on this topic to the Arizona Republic. The responses I received from the Editor, mental health professionals, and lay readers (from the US, Canada, Europe, Asia and Australia) were gratifying.
Now I know.
As strange as “Brush Your Mind” might sound, it’s a sound idea after all!
Going Global to Reach the Tipping Point
The next step is to launch a public health campaign to promote the world-wide adoption of “Brush Your Mind.” For that, I continue to draw upon lessons from Robert Sutton, Philip Zimbardo, and Albert Bandura:
From Sutton: The lateral transfer of successTranslation: Roll out “Brush Your Mind,” modeled after “Brush Day and Night” – a global public-private partnership that extended to over 25 countries, and which I co-lead in 2010 when I was Head of Public Health at the World Dental Federation in Geneva.
From Zimbardo: Keep your messages clear, focused and easily understandable.Translation: Stay true to science, and make the content practical and accessible – even to children and adults of varying literacy levels.
From Bandura: Promote self-efficacy, model the desired behavior, and lots more…Translation: Join me and find out!
If we, as humans, can be so creative and ingenious as to explore the farthest reaches of outer space, surely we can make life here on Earth better for everyone. It doesn’t call for rocket science – we can do it with behavioral science.
Op-Ed piece by SD Shanti, originally published in the Arizona Republic, the leading newspaper of Phoenix and neighbouring region. February 2, 2014
The text of the entire article is placed here to facilitate translation.
Professor: Self-regulating behavior can make us healthier
When I graduated from dental school, I went to dental conferences and got free toothbrushes. When I graduated from a master’s-degree program in public health, I went to public health conferences and got free condoms. When I graduated from a doctoral program in psychology, I went to psychology conferences and got … nothing.
This story illustrates one of the biggest problems we face in the arena of mental health, namely that the issues we deal with are often intangible. Pharmaceuticals and caricatures of shrinks as portrayed in mass media offer us an incomplete picture of the world of mental health. What is missing is a means of describing mental-health promotion in such a way that speaks to broad audiences, from children to seniors across all countries and cultures.
Interpersonal violence and emotional distress and depression are widespread public health problems around the world, on the same scale as HIV/AIDS and dental decay. But their origins are predominantly behavioral.
There are no bacteria to vaccinate against, no viruses to vanquish, and there are no commercial products that drive an industry that supports disease prevention such as we have with toothbrushes and toothpaste.
According to the World Health Organization, violence affects one out of every three women. But violence is not only a women’s problem, as large numbers of men also experience it. Depression is a major cause of disability in the world — leading to lost productivity, distressed families and increased risk of suicide. Often, violence and depression go hand in hand.
We have seat belts and vaccines to prevent injuries and illnesses. Similarly, there exists within psychology the means of reducing, if not entirely preventing, violence and depression. However, the preventive methods are behavioral. They are intangible, yet their effects can be felt in terms of the emotions we experience and in our quality of life.
It is daunting to think about tackling these problems, especially when they affect millions of people. It’s like trying to cross the Alps on foot. But, as with any mountain climb, it all boils down to taking small and regular steps. One by one, they add up into something big and measurable.
Small steps, big progress
Self-regulation is one of those steps that will go a long way toward preventing violence and depression. If behaviors were vaccines, this would be one of them. Self-regulation is also at the heart of the folk saying: “You can’t control which way the wind blows, but you can adjust your sails.”
It can be broken down into two major realms: regulation of our actions and regulation of our thoughts and emotions. You can think of self-regulation as a psychological thermostat that keeps people from exploding in anger or spiraling into despair.
Consider road rage. Instead of reacting with irritation and aggression, if a person learns to use self-regulation in a preventive manner, he can think his way through the situation. Maybe the driver who cut him off did not mean to do so intentionally. What if he had an ailing relative he was rushing to see? Broadening one’s perspective and looking for alternate explanations of events is one way of diffusing negative emotions.
Mindfulness — the act of focusing on the present moment and letting extraneous thoughts fall by the wayside — is another means of self-regulation. It is a way of decluttering our minds, allowing us to turn off unwanted thoughts, especially those that undermine our confidence or fuel our fears.
Seeking emotional support is another way of dealing with negative emotions. Instead of withdrawing into isolation or seeking solace through chemical substances, we can turn to a trusted person such as a spouse, partner or friend.
Our bodies and minds are intricately interconnected. Exercise or any form of physical movement can also serve as an effective means of dealing with negative emotions, as anyone who has played a game of hoops to let off steam can attest.
There’s no doubt that self-regulation is important for our physical and emotional well-being. But the challenge lies in getting this concept across to a range of people of different ages, cultures and customs.
That’s where the power of metaphor comes in.
Brushing your mind
Toothbrushing is among the world’s most widely carried out acts of self-regulation. Nearly everyone does it, regardless of where the person lives or what language the person speak. What might happen if we all “brushed our minds” in the same way that we brush our teeth?
Negative emotions are a lot like dental plaque. No one escapes either; they are an inevitable part of life. In both instances, a little bit of plaque and a little burst of negative emotion are not likely to lead to serious problems. However, when left unchecked, both negative emotions and dental plaque can have a cumulative effect that will cause damage over time.
What if people learned from childhood onward how to brush their minds, just as we learn from a young age to brush our teeth?
Every health-care provider has his or her personal list of patient interactions that we never forget. One of mine was in Switzerland, where in my psychology practice, a woman sat on my sofa, Kleenex box at hand, upset and crying because of difficulties in her life. That was when it hit me, that what I was witnessing was the psychological equivalent of a toothache.
Certainly brushing one’s teeth is not a guarantee against developing a toothache. But it is definitely an important component of disease prevention and health promotion. Similarly, brushing one’s mind is not a guarantee against aggressive outbursts or sadness that impedes a person’s ability to function. But if we are to do something about the data mountains, and attempt to reduce these global statistics, we have got to start somewhere.
The formula for preventing psychological problems is similar to that of preventing other health problems. It’s complex and is influenced by a host of factors, including socioeconomic status and access to preventive services. But one of the key elements of this process is that of the individual taking action to help him or herself.
Does toothbrushing prevent all dental problems? Certainly not. Yet if large numbers of people did not brush their teeth, what might that look like? Similarly, brushing one’s mind is not going to be the end-all to the problems of violence and depression.
Yet if large numbers of people around the world regularly brushed their minds, how might their lives be different? And if large numbers of people around the world regularly brushed their minds, what impact might that have on the global data on violence and depression?
Prescriptions for Hope 