“Everyone Has Value.” with Beau Henderson & Dr. John Kruse

Everyone Has Value — I would like us to expand even further our understanding of the diversity of how each human brain operates, and combine this with the power of modern computing to help devise activities and societal roles for each and every individual so that they can, if they wish, contribute in fulfilling and meaningful […]

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Everyone Has Value — I would like us to expand even further our understanding of the diversity of how each human brain operates, and combine this with the power of modern computing to help devise activities and societal roles for each and every individual so that they can, if they wish, contribute in fulfilling and meaningful ways to life on this planet. This would help render any labels (racial, gender, orientation, mental health…) into signifiers of the potential modalities for an individual to add to the human mosaic, rather than existing as categories for valuing and ranking different populations.

As a part of my series about the “5 Things, Anyone Can Do to Optimize Their Mental Wellness” I had the pleasure of interviewing Dr. John Kruse.

The suicide, at age 22, of John Kruse’s sister, nudged him from thinking for years about running a marathon, to actually running one, and then completing ninety-nine more during the ensuing three decades. Meanwhile, he garnered awards in writing while completing his medical degree, a Ph.D. in neuroscience, and starting a psychiatric practice in San Francisco. His expertise in adult ADHD led him to write “Recognizing Adult ADHD: What Donald Trump Can Teach Us About Attention Deficit Hyperactivity Disorder,” despite inaccurate objections from right-wingers who feared that the book attacked the president, liberals who thought it might excuse Trump’s bad behavior, organized psychiatry who wanted Dr. Kruse to stay silent, and members of the ADHD community who believed Trump might tarnish the diagnosis.

Thank you so much for doing this with us! Our readers would love to “get to know you” a bit better. Can you share with us the backstory about what brought you to your specific career path?

Within weeks of starting my psychiatric practice, the university clinic where I had trained referred Frank to me. Frank was 42 years old but acted like an 8-year old boy with ADHD. He would show up late, forget to take medications, and walk around the office berating himself out loud for having stopped to talk to strangers when he knew he was already late for our appointment. His previous psychiatrist, after six years of weekly sessions, had made no progress helping Frank, and had sent him to the clinic to be assessed for ADHD. The university’s testing indicated that Frank “looks like he has ADHD,” but decided that this couldn’t be the case, because “ADHD doesn’t exist” in adults. I took weeks to evaluate all other possibilities before concluding that only ADHD completely and reasonably explained all of Frank’s symptoms. I realized that I had to educate myself about ADHD in adults in order to help Frank and others. This experience taught me to be wary of experts, especially when my eyes contradicted their claims.

Can you share the most interesting story that happened to you since you started your career?

Frank had been on numerous psychiatric medications with horrible results, largely because he had been incorrectly diagnosed and had been put on inappropriate medications. After months of working together, he understood enough about his ADHD and trusted me enough to try something new to him, Ritalin. This medication helped him to be more organized, more attentive, more able to complete tasks and even improved his mood. Every week I checked with Frank regarding how consistently he was taking his medication, and he would reply that he knew that he had “missed a few days.” We worked on behavioral approaches and cognitive tricks to help him remember to take it daily. Despite all of our efforts, Frank would refill his monthly prescription not once a month, not every two months, not every four months — but every thirteen months! This pattern continued over a span of many years. He was taking the “daily” medication only once every two weeks! Half the time when he reported he had “missed a few days” he hadn’t even taken it at all during that week! This really highlighted how powerfully disruptive severe ADHD could be, and that ADHD can be a serious condition, not just a trivial case of “Oooh there’s a squirrel!” We know that ADHD disrupts educations, destroys careers, and derails relationships, as well as contributing to substantially higher rates of injury and death.

Can you share a story with us about the most humorous mistake you made when you were first starting? What lesson or take-away did you learn from that?

After a few years of working out of a small office building, I had the opportunity to move my office to an “in-law apartment” in the home we had bought. I consulted experts for advice on maintaining “good boundaries” for a psychiatric home office. Being a methodical person, I was careful to instruct each new patient that the home and the office had separate entrances, with the door to the office being at the end of the driveway. I was mortified when one of my new patients rang the home doorbell and was greeted by my husband, who had just gotten back from a run. The patient initially thought my sweaty husband was the doctor! My husband graciously redirected the patient to the lower, office entrance.

Both in writing, and orally, I continued to give new patients the same, precise, directions to my office. What I realized over the subsequent months was that the ONLY patients who showed up at my home door were those with ADHD. Given a set of details regarding the first visit, many individuals with ADHD missed half the information and were happy just to find the right building, if not the right door. Upon arrival, I now ask every new patient whether they had already gone to the house door first. Many individuals, embarrassed by their mistake, do not volunteer this information. I’ve incorporated this “wrong door mistake” into my evaluation for ADHD, and numerous times it has provided the most useful introduction into exploring further ADHD symptoms particularly for those who thought they were only dealing with anxiety, or depression, or impulsivity, or explosive tempers.

None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?

I swam long-distance freestyle and butterfly on my high school swim team, and although not very talented, I tried out for the University of Rochester team as a freshman. I was encouraged because the coach, Bill “Buzz” Boomer, was more interested in each individual’s “feel” for the water, rather than how fast they swam. I was quickly promoted to the managerial ranks. Although initially devastated at not being chosen as a swimmer, this decision meant that I was managing and helping coach the swim team during some amazing years. Buzz was in the early years of developing innovative approaches to training competitive swimmers. Although he had never swum competitively himself, and Division III Rochester was not an athletic powerhouse, Boomer’s ability to rethink the whole essence of propelling bodies through the water led him to develop novel ways of teaching competitive swimming. He became a consultant to several US Olympic swimming coaches and developed a landmark system of videos for explaining his methods.

One of Buzz’s insights was that speed in the water was about getting out of your own way. Water creates much more drag and resistance than moving through the air, and those who could best carry forward the momentum from their racing start were those who arrived at the opposite pool wall first. “Getting out of your own way” applies to other realms of life — our emotional and cognitive baggage causes drag and resistance and so often blocks our personal successes. I’m still glad to have Buzz as one of my friends and mentors four decades after that “failed” swim team tryout.

What advice would you suggest to your colleagues in your industry to thrive and avoid burnout?

Identify what you like doing and that which rejuvenates you rather than depletes you. If your work is rejuvenating, then you don’t need to worry about how much or how exclusively you are working on it, because you are replenishing yourself. If you are feeling exhausted, examine your own baggage and the ways that you are creating resistance to your own forward motion.

What advice would you give to other leaders about how to create a fantastic work culture?

It helps to be focused, it helps to be precise in communications, but most important is sharing your enthusiasm for what you do and having a desire to help others derive satisfaction and pride from their own contributions to the group effort.

Ok thank you for all that. Now let’s move to the main focus of our interview. Mental health is often looked at in binary terms; those who are healthy and those who have mental illness. The truth, however, is that mental wellness is a huge spectrum. Even those who are “mentally healthy” can still improve their mental wellness. From your experience or research, what are five steps that each of us can take to improve or optimize our mental wellness. Can you please share a story or example for each.

Years ago, when dealing with some more-than-asthma-breathing issues, I worked with a superb meditation/relaxation hypnotist. I developed a four-word mantra, not just for my airways, but for life: open-clear-strong-fun-open…. I’ll explain what I mean by each word below, and provide examples from my professional psychiatric career, and from my life experience with running marathons. But first I offer a description of the recursive nature of the open-clear-strong-fun loop.

The more open we are, the more likely we are to find intelligent, lucid (clear) ways to experience and express our insight. The more clear we are in expressing our thoughts and feelings, the better aligned we are to apply effort (strong) to our tasks. The more strongly we apply our mind and body to our efforts the more likely they are to lead to joy (fun). And if we are having fun, then we are most likely to let down our guards and be open to new understandings, continuing the cycle. The open-clear-strong-fun mantra worked for my lungs — it inspired me to inspire better. And maintaining robust mental health requires practice with each of these elements.

Open: So often we enter new endeavors or stages of life with stale expectations and restrictive preconceptions. Getting out of our own way often requires being open to new experiences, new viewpoints, and new formulations, rather than accepting tired old dogmas and conceptualizations. Being open to new possibilities allowed me to look at unexamined, untrue assumptions underlying our old standard.

With my professional work using Donald Trump’s ADHD to promote societal awareness about this potentially serious mental health condition, I had to contend with the “Goldwater Rule” — the ethical constraint that psychiatrists aren’t supposed to talk about the mental health of public figures without personal evaluation and that individual’s consent. The unexamined dogma underlying this rule is the claim that an in-person evaluation delivers the best information for making a diagnosis. I had to be open to the possibility that this claim was not actually a confirmed fact before I could proceed with my book.

Years ago, when I told people that I had run a dozen or two dozen marathons, people would often be amazed. And I would shrug it off with the statement, “Once you’ve run one marathon, doing another is just repeating yourself.” I would follow this with “And if you really want to, most people can run a marathon.” For three years, beginning in 2001, I coached novices running marathons as a charity fund-raiser and saw my words put into practice. The vast majority of participants weren’t svelte, toned runners. We had a group of three twenty-year-old women who were each over two hundred fifty pounds, and a sixty-five-year-old woman of similar size. They were all there (and all of them completed the training and the marathon) because they had finally wondered, “Could I run a marathon?” If you can believe it, you can see it. Or run it. But they needed to be open to the possibility.

Clear: Being open to new ideas or approaches is well and good, but one must then think clearly to evaluate whether the path before you is reasonable and whether it is a good fit for you. Clarity requires a deep and thorough investigation of your own approach and of available alternatives. It requires examination of any pre-existing attitudes that may oppose your innovations. Clarity involves developing an understanding from multiple angles of how your ideas improve upon the old standards or how they fall short. Some initial insights aren’t correct with further inspection, or can’t be operationalized in the current world.

For my book on Trump and ADHD, I had to learn how the Goldwater Rule arose, including the political, social, ethical, and professional rationale for it, in order to demonstrate the parts of it that no longer fit our current world. I had to examine the claim that the in-person evaluation was the gold standard for all mental health diagnoses. I needed to study the research and assemble my own observations that reveal that those with ADHD are notoriously incomplete and inaccurate self-observers and historians (problems common with a number of other mental health conditions as well). I also needed intelligent reasoning to detect that the criteria for diagnosing ADHD rely entirely on observable behaviors, and the public record for Mr. Trump provides far more examples of relevant behavior than one could obtain in any individual assessment of the president. Being open to examining the unspoken claims underlying the Goldwater Rule revealed their limited relevance to this situation. I needed to be clear before I could proclaim that “Mr. Trump’s ADHD throws cold water on the Goldwater Rule.”

Although some superb athletes might be able to complete a marathon with a minimum of training, most of us humans need clear thinking to come up with a plan for moving from running a mile or two to working up to the full 26.2-mile marathon distance. Being clear usually means using a plan that has worked for other humans, and evaluating whether it is likely to work for you. Fortunately, when I was training novice marathoners, we worked with Jeff Galloway’s run-walk program, which had proven to be effective for thousands of runners, and we placed individuals in groups with people of similar running abilities, so they could support and encourage each other. And it clearly worked.

Strong: Even if you have been open to new approaches and have thought clearly about your course of action, you still need to remain strong in pursuing your course of action. Even the best thought-out plans run into adversity, and strength and determination are what will carry you through these challenges. To push yourself beyond what were your previous limits require effort and strength and perseverance.

Even though I knew that I had an ethical and intellectually valid case for arguing that I can use Mr. Trump to teach the general population more about adult ADHD and that Mr. Trump himself remains incomprehensible without understanding this aspect of how his brain functions, I knew that my book would meet resistance. Some came from those with entrenched frameworks of right and wrong who weren’t willing to examine their own assumptions and biases. And some came from those with different value systems who may or may not have examined the origins of their own views. I have had to be strong in the face of resistance from organized psychiatry, ADHD communities, the political right, and even some on the left (who feel that ADHD excuses, rather than explains, Mr. Trump’s behavior). Having good ideas, and having accurate ideas, isn’t enough. You have to persevere in order to make others aware of your viewpoint and to convince those who are open to it.

Strength, or more particularly the display of strength-over-time we call endurance, epitomizes marathon running. Although some people feel that those running fast and hard — and finishing their first marathon in three or four hours — show who was strongest, my vote would be for those who were least inclined to be runners, and who persisted nevertheless. The first year of coaching we trained for the Honolulu Marathon. After I completed the run, I ran back to accompany our slowest training group, and encouraged them in their run/walk until the end of the race… nine hours after we had started. And they were the group who voiced the most appreciation for the whole program because they had worked the hardest to achieve their goal.

Fun: If one isn’t finding some amount offun and joy in the endeavor, one won’t be able to sustain the effort. Even if one feels righteous about their cause, anger only carries one so far.

For me, finding delight and humor in writing about a topic helps lighten the burden and makes it a pleasure to continue. Earlier this year, I discovered many individuals who think that Mr. Trump snorts Adderall and this practice causes much of his aberrant behavior, rather than understanding that when he takes stimulant medications many of his problematic ADHD symptoms diminish. I concluded a rather arid discussion of this topic with “rather than riffing on his sniffing we should be supporting his snorting.” Although I know that snorting stimulants pose health risks, the silly rapping rhyme delighted many of my readers and helped them remember the point I was making.

One of my marathon heroes is Terry, who didn’t start running until he was fifty, and is still running marathons after two major heart operations. He’s completed more than 200, which helps me look moderate. Terry was never the fastest runner, and he is not particularly outgoing, but he is friendly, polite, and would find companions to chat and tell jokes during every marathon. And at every marathon pasta feed, I’ve been to, runners regale me with stories of running marathons with Terry. He keeps it fun, memorable, and meaningful.

Since I’m supposed to have five steps to mental health, I’ll throw in Go Outside as the fifth. Research shows that even having a vista of a green garden outside of your hospital window leads to faster recoveries than no windows or looking at concrete walls. Other studies show lower incidences of depression and anxiety for those spending time outdoors, and improvement in ADHD symptoms with just a few hours a week in nature. It will help you stay open-clear-strong-and-having-fun.

Much of my expertise focuses on helping people to plan for after retirement. Retirement is a dramatic ‘life course transition’ that can impact one’s health. In addition to the ideas you mentioned earlier, are there things that one should do to optimize mental wellness after retirement? Please share a story or an example for each.

Put structures in place to stay engaged.

Although many individuals have ADHD severe enough that it trips them up in grade school and gains them the notice of parents or teachers, it is axiomatic that others with ADHD don’t present for treatment until other major life transitions. Some kids who were smart enough to sail through high school without doing homework or even showing up for class run into trouble when they go off to college and don’t have family guidance to keep them on track. I worked with one young man who was failing out of Stanford in his freshman year. His immigrant family hadn’t been doing his high school work for him, but mother and aunt had sat in the kitchen with him every day making sure he finished his homework before he went and did anything else. It is even common for young adults with ADHD to get through college (courses and homework break up the days and weeks into manageable tasks) but then fails when they reach the work world and have nobody to hold their hand and chart their hourly and yearly course. What I haven’t seen described, but I have detected in my own practice, is individuals with ADHD who weren’t diagnosed until retirement. With the transition out of the workforce, they had less structure to their daily lives, no boss to provide clear expectations or demands, and nobody else to be accountable to. Furthermore, many grew up in an era where ADHD wasn’t recognized, so nobody was looking for this condition as an explanation for feeling disconnected, at sea, and overwhelmed.

Although the majority of retirees won’t have ADHD, the lessons from those with the condition point out to everyone the importance not just of doing things, but having structures to engage you with your hobbies and your communities, and to create specific plans for this, because no teacher, mentor, or employer is going to arrange for and ensure that you are engaging in activities that are fulfilling and meaningful for you.

How about teens and pre-teens? Are there any specific new ideas you would suggest for teens and pre-teens to optimize their mental wellness? Be physically active.

As the father of sixteen-year old-twins, I see middle-schoolers and high-schoolers interacting with their electronic devices throughout the day. Even those that walk to work often do so with their eyes pasted to their cellphones. Our brain is our most important organ for navigating this life, but the brain lives within a body and is flesh and blood itself; the healthier its blood supply, its flow of oxygen and nutrients, and its ability to flush out toxins, the better supported the brain is. At the top of almost every geriatrician’s advice for preventing dementia is exercise, and we know that those who start earlier and get into the practice at a younger age, are most likely to continue such healthy activities and perpetuate optimal conditions for their own brain.

Is there a particular book that made a significant impact on you? Can you share a story?

We read “Watership Down” in seventh grade, and it opened my eyes by combining rigorous scientific research (Richard Adams learned a lot about rabbit behavior), compelling story-telling, and vivid characterization to deliver the message that “it takes a village.” We need contributions from everyone, even those who appear to be misfits or weak, to overcome the challenges society may face. I also loved that in addition to rabbits being clever and mischievous, Adams played against stereotypes and portrayed them as fierce, brave, and loyal. It wasn’t until reading it years later, out loud, as a counselor at a natural science camp, that I also appreciated how beautifully written it is.

You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

Everyone Has Value — I would like us to expand even further our understanding of the diversity of how each human brain operates, and combine this with the power of modern computing to help devise activities and societal roles for each and every individual so that they can, if they wish, contribute in fulfilling and meaningful ways to life on this planet. This would help render any labels (racial, gender, orientation, mental health…) into signifiers of the potential modalities for an individual to add to the human mosaic, rather than existing as categories for valuing and ranking different populations.

Can you please give us your favorite “Life Lesson Quote”? Do you have a story about how that was relevant in your life?

I came up with the adage “All generalizations are false.” when I was in medical school because I liked its self-referential paradoxical nature and whether the content of the statement is actually falsified because it is a generalization itself. But aside from the silly playing with logic and language, I like (and need) to be reminded to question rules that others decree.

As a closeted and virginal gay freshman in the early 1980s, I consulted a wise and worldly and sexually proficient upperclassman, who told me that I couldn’t be gay because “that didn’t really exist. And ridiculously, since he seemed to really know what he was talking about, and I had no life experience in this realm, I accepted it. Several years later, this quote helped me, as I was coming out in a generally homophobic world, to accept myself for who I am, not for what others might assume they know about me.

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Thank you for these fantastic insights. We wish you only continued success in your great work!

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