As a part of my series about “Mental Health Champions” helping to normalize the focus on mental wellness, I had the pleasure to interview Kevin Gilliland, PsyD is a clinical psycholgist, mental health expert and Executive Director of Innovation360.
Thank you so much for joining us! Can you tell us the “backstory” about what brought you to this specific career path?
Funny, I told my college advisor that I like working with people when she asked what I wanted for my major — and that I suck at math! The next thing I know I’m finishing graduate school, licensed as a psychologist, and don’t really have a clue what I want to do in a really big field. I became very interested in things that are “good medicine” this that are outside our western view of medicine (medication, therapy, etc). That journey took me outside the mental health field and into physical medicine, exercise, nutrition, business management, and medical practices around the world. You don’t have to do that for very long to see how people talk about mental health issues. If someone has hypertension, do you say they are “physically ill”? What about obesity, do they have a “physical illness”? So why is it that if someone has major depression or generalized anxiety that we say they are “mentally ill”?
Then it starts to dawn on you that people don’t come to your office until their mental health gets really severe. We humans tend to wait until we are having thoughts of ending our life, are one more beer away from our spouse leaving us, and one more panic attack away from losing a really good job. We don’t have to do that but for some reason that’s all I was seeing. It’s the medical equivalent of only working in the emergency room. I’m glad we have them but nobody wants to need them. That’s when I started seeing the little signs of our broader attitude about mental health issues and how they interact to keep us stuck way too many times. I work with some really complex issues and have been fortunate to work with great people, but I’m tired of wondering “Why the hell didn’t you call me 2 years ago?” In my little corner of this world, I want to try to move that needle just a bit. Lower the hurdle just a little for at least one person. And if I can do that, I’m going to try to help just one more person.
According to Mental Health America’s report,over 44 million Americans have a mental health condition. Yet there’s still a stigma about mental illness. Can you share a few reasons you think this is so?
We tend to think that people with mental health problems are responsible for their condition. In some instances, that’s absolutely true. In others, not so much.
It’s one of the fascinating aspects contributing to the stigma about mental illness, people with mental illness are responsible for it because of their choices. What they did or didn’t do. It’s as if we don’t even think there may be a biological component to why someone gets a mental illness. Then we turn around and look at almost all physical illnesses as if they’re genetically determined and we have no behavioral choices or habits that influenced them. In spite of the skyrocketing rates of obesity, hypertension, and adult-onset diabetes — all significantly influenced by our choices, our behaviors. The epidemic of obesity in this country among adults and now children is a behavioral problem. Yes, it’s a mental health problem. We just struggle to see problems as being both genetic, behavioral, or maybe some combination. We humans don’t do that real well.
There are a number of facets that have led to some of our individual as well as our social beliefs about mental illness, those become stigma. First, there’s not an X-ray or a blood test that we can do to make a mental illness diagnosis. While research and interventions have come light years, it requires skilled training to be able to accurately diagnosis some individuals. We struggle in other areas of medicine, but it is more challenging in mental health. While TV and movies are making some improvements, they have not done much to decrease the overall fear of the unknown. Not to mention in general the beliefs that individuals with mental illness aren’t part of the working successful society. Research doesn’t support either of those myths, mentally ill people are not more violent and there are lots of examples of successful men and women that have struggled with mental illness. In the electronic age, it’s not unusual for me to see individuals that don’t want to use their managed care benefits or health insurance because they don’t want their illness to be part of their medical record. And if they have a license from the state because they’re a professional, they’re even more reluctant and hesitant. I always say that I understand. As much as I hate it, I understand their decision. It’s a reflection of stigma.
Depending on your culture, your sex, your religious beliefs, and which mental health condition you struggle with, there are also a lot of social, cultural, and economic reasons that people are reluctant to talk about their mental health symptoms and illness. For instance, I have spent a lot of time doing research in treatment for drug and alcohol addiction. I’ve worked with some truly wonderful men and women. I see it from a very different side. The rest of the world sees it from the side that sometimes people with addictions to drugs and alcohol steal, lie, hurt innocent bystanders, and negatively impact our society at times.
Can you tell our readers about how you are helping to de-stigmatize the focus on mental wellness?
I’m a big fan of data. One of the things I try to do is point out the data about mental illness or mental health symptoms that causes trouble in people that we respect and admire. I am drawn to people’s struggles and adversity because more times than not, it’s a part of what has made them so strong and so admirable. I try to remind people that I work with and any time that I speak, it’s our vulnerabilities, oddly enough, that people tend to respect us for. They tend to admire that in spite of our struggles with an anxious mind or a depressed mood, that we have still overcome to have wonderful meaningful lives.
Talking about how normal some of our mental health symptoms and diagnoses are is exteremely important. I work with a wonderful company that screens for physical illnesses at employer worksites, called Catapult Health. One of their initiatives was to begin to ask about Major Depressive Disorder for employees but especially to have a mind that’s aware that one of the risk factors for cardiovascular disease is depression. Not to mention that almost one out of three or one out of four individuals with cardiovascular disease may experience a depressed mood. I talk about it as being a side effect to their cardiovascular illness. And the truth is, one of the side effects sometimes is a depression. That’s all it is, a side effect that we need to treat just like any other side effect.
One of the most important things to do is have a better balance, in my professional career, with the use of diagnoses and symptoms. When starting treatment or doing research, a diagnosis is incredibly valuable. I focus on the symptoms you’re struggling with that bother you and how we help to decrease those to improve how well you function in your life. I stress the same with family who can sometimes use a diagnosis in a negative and confining way.
I’m less concerned about what it’s called and more concerned about the things that you struggle with. We’ll step into that conversation. People will argue about a diagnosis, they won’t argue about what they miss or what they want to stop. If I tell you that I haven’t slept for more than two or three hours a night without waking up and worrying about things at the office or my children, I’m pretty open to talk about how to deal with that. It’s easier for me to hear it if we talk about that symptom rather than “my anxiety disorder”. And at the end of the day, I care more about having conversations that are easier for people. It increases the likelihood that they may move down the path of changing behavior.
Was there a story behind why you decided to launch this initiative?
Graduate School was a bit of a blur, I graduated college, got married, and moved half-way across the country. I don’t remember much, but one of the things I have never forgotten was a passing comment by a professor of mine. He said therapy is too good to only be used with the severely ill. To be honest, I don’t think I fully understood it at the time, but it stuck on my hard drive, and now I get it more than I ever have. Yes, therapy can help people that are struggling with severe diagnoses. But it’s too good and too valuable of a process to only be used with those that have the most severe of symptoms. That is something we’ve got to change as a field.
My desire to have an impact on how we view mental health, illness, and symptoms was actually by chance. It came from a lot of unexpected conversations with very successful individuals, across a variety of professions. When people know you’re a psychologist, quite a few of them get a sense of “this is somebody that gets it.” I’ve had the joy of sharing a lot of conversations and journeys in the most unexpected places. And they’ve left me with this unmistakable belief. Every single one of us will struggle at some point in our lives, to some degree. Sometimes because of our choices, sometimes because “it runs in the family,” and sometimes because we live in a world where through no fault of our own, painful things happen.
My desire is that we talk about our mental health problems just like we talk about our cholesterol. It’s not that big of a deal, and it certainly doesn’t define me or make a statement about the kind of individual I am. It’s a detail of my life I manage. There will always be people that have fixed beliefs, regardless of the data, and I try not to focus on that. I’m not trying to help blind people see. I’m just trying to help people that are trying to improve their vision if you will, those that have an interest in why we struggle mentally and how we get better. I’m just trying to do something to make my little corner of the world a little bit better when it comes to understanding the complexities of our mental health.
We have to change the way we talk about our mental health. We need to do it as matter of fact as we do our physical health. We also have to talk a lot more broadly about the things that help our mental health. Like the research and data comparing exercise to antidepressants for treating major depressive disorder. Yea, we did that as a field and guess what, it helps some people. A lot. Going back to the cardiovascular disease and those that get depression, about one in four or one in three, guess the number one symptom that accounts for their depression? Physical inactivity.
We have to be able to start conversations before something breaks, like our marriage, our jobs, or our bodies. And make no mistake about it, men are notoriously bad at waiting until something breaks to say, “Hey, I need a hand here”. We have to start those conversations sooner. We have to get rid of the irrational fear that usually prevents us from starting them.
In your experience, what should a) individuals b) society, and c) the government do to better support people suffering from mental illness?
For individuals, the first thing I would say is, “You probably are qualified and don’t be afraid to go see your friend or talk to them.” Now I say that because there are a lot of things that help people that struggle, one of the most powerful things is to have a friend or family member that cares and is willing to talk to you or sit with you. Even when we don’t have answers, there is tremendous comfort in knowing that we’re not alone. The most savage of all mental health symptoms is isolation. And that, the majority of the time, is something that everyone can help with. I think we get in our way at times because we don’t “know what to do”. I’ve been doing this for almost three decades and there are times I don’t know what to do. But I do know this, listening, trying to understand, and just being with people is very powerful. It’s good medicine. Especially when I can avoid overly simplistic responses that reveal my anxiety and inadequacy.
When it comes to society, this is actually one that I have seen some mildly encouraging things over the past four or five years. I get a chance to talk to a lot of journalists or news people about mental health issues especially when they involve things that rise to the level of public attention, whether that’s people or incidents. I have been impressed with their activities to provide education, awareness, and resources when people struggle. It may be a celebrity or an athlete or an official that comes to attention because of their struggle, but they have done a far better job of talking about how common those issues are and what we can do to address them ourselves.
We also need to do a better job of integrating questions and treatment for mental health issues in physical medicine. It’s been almost ten years now since the US Preventative Services Task Force provided an update for the need to screen for depression in adults. The study encouraged more than just screening, they’ve encouraged primary care to also help with insuring an accurate diagnosis, effective treatment recommendations, and appropriate follow-up. We have the data and know that depression is one of the leading causes of disability. It affects us as individuals, families, and businesses. It is most commonly seen in primary care, not mental health offices.
When it comes to the government’s role in supporting people suffering from mental illness, we have got to do a better job. We have to look at providing information and knowledge and also lowering barriers to treatment entry. Stigma continues to be one of the reasons people don’t seek treatment. Ranging from 10 to 25 percent of the people actually get treatment for a variety of mental illnesses even when services are publicly available or provided through healthcare. Fears and concerns about diagnoses and it being part of their medical record have been reported in various surveys and research studies. That’s one of the places our education has made some inroads. We are starting to see movies, TV, and even articles that do an excellent job of showing that our mental health struggles cut across our entire society. It’s not the unemployed and homeless, it’s all of us.
We need to see services for the people that need them, not committees and layers of administration. We end up with more dollars and waste for systems and structures and meetings than we do for treatment. If our government had to do like many charitable organizations and report how much of the dollar went for administrative overhead and how much of the dollar went for treatment for people that need it, I don’t think anybody would donate to their charity.
For some of the more severe mental illnesses, we are seeing some trends that are promising, with considerably more people receiving the care that is available.
What are your 6 strategies you use to promote your own wellbeing and mental wellness? Can you please give a story or example for each?
First, I maintain and develop close meaningful relationships. One of my favorite studies was through Harvard (Study of Adult Development) and the summary of seven or eight decades of research was answering the question “What leads to happy and physically healthy lives?” The answer? Meaningful, loving relationships. Relationships are part of our DNA. If you don’t have them, you need them. And they need to be the kind of good relationships where people will tell you the truth. I’ve stayed close to five or six guys that I went to college with. We’ve now done a lot of life together and I know them really well and they know me really well. We get together every year as a group but then throughout the year individually. You don’t need back stories or explanations or to be as defensive as you would be with others. They know you and have seen you in the best of times and the worst of times. We need people to love and care for us but also tell us the things that are difficult to hear.
Second, I never forget that my mind and my body influence each other in ways I can’t fathom. The mind-body connection is far more than some nice saying on a t-shirt. It is a foundational principle for my health and happiness. I’ve gotten better at listening to both and respecting both. If I think I can work at a pace where I deprive my body of sleep and nutrition for weeks on end and still be mentally sharp, I have a hard life lesson that is going to hit hard any minute now. If I don’t take care of my body, my mind will follow. And if I don’t take care of my mind, my body will suffer as well.
I’ll also never forget my first life lesson on that subject. I was on my internship at the University of Texas Southwestern Medical Center and my brother-in-law happened to be finishing his residency in Otolaryngology (ear, nose, throat specialist). I thought he was the perfect person to ask about why my lower eyelid was twitching. I asked him and he said, “Does it feel like half your face is moving?” I said “yes”. Then he said, “Do you feel like everybody can see it?” I said “Yes”. He looked at me and said, “It’s just stress. You’re fine.”
That honestly was a watershed moment for me. Our stress and the pressures of life, which I had a lot of, definitely impact our physical health. We have all manner of illnesses and diseases that are very closely tied to the amount of stress we have in life. I try to listen to my body and I also spend as much time on my physical health as I do on my mental health. My physical health improves my mental health. And my mental health improves my physical health. Like two links in a chain, they’re inseparable.
Third, I unplug. I’m embarrassed to say I didn’t realize the demands in my personal life and professional life until, yes, I broke something. I simply wasn’t recognizing how much stress and commitment was in my life. I don’t wait for a vacation anymore to let off some of that pressure. If I can’t do it every day, I’m damn sure going to do it every week. And when I say unplug, I mean literally unplug. No TV, Instagram, or books. I try to get outside. I try to enjoy the things in life that are good medicine, like a drive to Colorado or to Laguna Beach. That’s good medicine.
Fourth, I stopped asking medicine (and physicians or therapists) to do more than they can or should. I think some of this is a byproduct of our Western science mindset. We ask medicine to do things it will never do. And then to make things worse, we’ll start a medicine and not think we have to do anything different. Medicine can and should do a little bit to help us. But there are a lot of things in life that are far more significant sometimes. As I said earlier, I stay pretty busy. I apparently enjoy that. It’s not unusual for me to have trouble slowing my mind down and settling into sleep. I started having sleep problems that were fairly significant, so I saw a physician. I took medications to help sleep for a couple of years. Then I realized I’d been pretty lazy about it. So, I started doing what I could do which was learn about sleep hygiene. I don’t drink caffeine late at night, I don’t watch TV in bed, and I try to keep some normal routines around sleep. I’ve developed good sleep hygiene and keep tinkering on other things to help me sleep like meditation. I don’t take medications any more to help me sleep, which is nice.
Fifth, I am more proactive investing in the things that are deeply personal to me and one of those is my spirituality and religion. From the perspective of history, it’s unmistakable that humans are spiritual/ritual. If you look at the Egyptians, Romans, Jews, Christians, Buddhists, Hindu — it’s in our DNA. At any time of national tragedy, it’s the first place we go. Almost all religions promote healthy ways of thinking and behaving and living. It also gets me mindful of things beyond my own little world and troubles, which I (we) desperately need to do. I try to read something every day that presses my mind to think on values and principles that I’m striving for, especially when I’m not doing well. It anchors me, encourages me, and connects me with others. And I think broader about it than I used to, am curious about others. Recently, I’ve really enjoyed reading and learning more about the Jewish culture and religion (I’m not Jewish). I have thoroughly enjoyed it and it has really influenced my own religious views and perspectives in wonderful ways. Which is why I’m reading through James Michener’s The Source.
Sixth, I stay curious about everything in life, especially myself. I just try to be less certain and more open. If we do that, we can actually start to hear what people are saying, maybe have been saying for some time, and it might start to help us. One of those people has been my wife, which is great and painful all at the same time. I had a year where I seemed to catch every strain of the flu there was in spite of my obsessive hand washing (thanks CDC), vitamins, and healthy nutrition. And I said, “I don’t understand why I seem to get sick so much?” She said, “It’s probably because you do too much and you have a terribly stressful schedule.”
What caught my attention was how matter of fact she said it. I asked what she meant and she proceeded to describe my weekly schedule (complete with workouts) in pretty good detail and ended with “it’s too much”. Wow, I was impressed and wasn’t quite ready to totally agree but it made me more attentive to other conversations I had with friends and colleagues. I started noticing a few colleagues that I trust and know me very well and they would make subtle little comments along the same lines. I started asking them what they meant as well and it was incredibly helpful. After 4 or 5 conversations I knew I needed to make some changes, needed to start being more thoughtful about my commitments.
If I had been defensive or argumentative with my wife, I’m not sure I would have gotten the data that I needed to make a good decision. It’s been a rather fascinating thing to engage in, both personally and professionally. Give it a try, but I’ll warn you, it’s not easy. I don’t do it well all the time and still have to work at it with certain people and with certain topics, but it’s been incredibly helpful. I have so much more information to make decisions about my life.
What are your favorite books, podcasts, or resources that inspire you to be a mental health champion?
By far my favorite on this list are books. I read a broad range of books, but I clearly have patterns. I love biographies of fascinating people. I just finished Nelson Mandela’s aLong Walk to Freedom. Incredible man. And The Last Lionabout Winston Churchill. I’m also drawn to books about history and us as people. I just finished Ken Follett’s trilogy that starts with Pillars of the Earth. A fascinating time in our history. I also just finished Joan of Arcby Mark Twain. I’m a sucker for great writers and resilient people. Honestly, as bad as the current state of our news outlets and low quality of TV, it’s a great time to remember how much reading can entertain.
I also read a lot of research articles which makes me sound horrifically nerdish and studious. There are a lot of older adults (my former teachers) that don’t believe that one. But I actually love reading the research on all things about humans. One of the things about the internet is that we can read those articles pretty easy. The National Institute of Health and the CDC are great places to track the trends in healthcare research.
When it comes to podcasts, I end up seeing the same patterns, but I also find lots of those that have entertainment value. Yes, I’m one of those that is a huge fan of Joe Rogan’s Podcasts because he has some fascinating people and he has a depth and breadth of knowledge that I find really enjoyable. The other thing I like about Joe Rogan is he has an ability and interacts with his guests in such a way that they’re incredibly candid and vulnerable. I just listened to him interviewing Mike Theisen who has some very tragic chapters of his life, but he talked about it in such an insightful encouraging way and perspective. I also listen to The Dollop. It’s a little bit of history and a lot bit of funny. The rest are a mix of different podcast when I’m chasing an interesting subject.
When it comes to the resources or people that inspire me to continue to press on talking about how normal our mental health struggles are, I try to look for people that have risen to a level of success or public awareness. It doesn’t matter who they are, I’m drawn to those people who talk about it as achapter of their life and not thechapter of their life. We sometimes make the mistake of allowing our weakness to define us, and while I understand and appreciate that, I’m not drawn to that. I’m drawn to people that are able to talk about a struggle in the midst of their life or their story. It doesn’t define them. And thatI find refreshing.
Thank you so much for these insights! This was so inspiring!