Dr. Tai Mendenhall is a Medical Family Therapist and Associate Professor in the Couple and Family Therapy Program at the University of Minnesota (UMN) in the Department of Family Social Science. He is also the Associate Director of the UMN’s Citizen Professional Center and Director of the UMN’s Medical Reserve Corps’ Mental Health Disaster-Response Teams.
Our CEO Max sat down with Dr. Mendenhall late last year to discuss our mental health and our relationships with others, both at home and at work. Transcription follows.
Transcription
Max:
Alright, well, Dr. Mendenhall, thank you so much for taking the time today. It's a pleasure to meet you.
Dr. Mendenhall:
I'm happy to talk.
Max:
I'm really excited to have this dialogue with you because obviously right now, it's a difficult time for many as the pandemic goes on for months. And so I just wanted to open this conversation by asking you just generally, what does living healthy mean to you, and how has that changed, if at all, during the pandemic?
Dr. Mendenhall:
Well, I think that that question in and of itself is a very complicated one, because humans are complex creatures. If you look at a lot of current evolutions and health care, there have been developments in what we call integrated care or collaborative care, which means that instead of having different disciplines separate from each other across primary care, secondary care, tertiary care, other types of care that don't really fit in those boxes, mental health, physical health, I mean there's a number of ways to divide it up, is that we probably shouldn't divide it up. Right? And what the models of biopsychosocial health or biopsychosocial-spiritual health, and they're separate, because a lot of times people are more or less comfortable considering spirituality, and those models are much more holistic.
And so answering the question, what does living healthy mean to you, we need to connect all of those dots. I mean, we are biopsychosocial and I would argue, spiritual creatures. Whether you identify with a religion or faith, most humans, according to most research, says, at least during times of distress, we usually will look to or engage with some kind of faith or larger spiritual system too. So biopsychosocial-spiritual creatures are healthy, when all of those things are in-tune and imbalance. And when we're not doing well, a lot of times those things are out of tune or out of balance. And if you pick any healthcare problem, because most health care looks at problems first, you know, you don't get your insurance companies to prevent stuff, you get them to repair stuff, right? Most of us don't go to the doctor when we're healthy, we go when we're sick.
So just pick something, usually they're connected all those systems. So like depression, or anxiety, for example, is just as much connected potentially to serotonin or norepinephrine, or dopamine in the brain, which is physical to negative or self-defeating thought patterns or ways of perceiving the world, which is psychological to social isolation, problems in relationships, conflict, etc, which is social to having crisis of faith. And we're seeing a lot of that right now. We see it certainly in the context of a variety of different types of trauma, when, you know, the God that you got brought up with as all-knowing, all-loving and all-powerful was allowing, or is allowing, different things to happen, which really don't make a lot of sense. And so any of these presentations can look the same, but they can come from a lot of different places.
So, are you taking care of your physical body? Are you doing what we call sleep hygiene, because that's connected to everything, and I could talk more about that. Are you eating a healthy diet? Are you getting enough physical exercise, those are huge, and they affect all of our psychology and everything else. I mean, you know, if you're sleep deprived, nothing in your life is going to go well, right? If you're not physically healthy, you're not going to properly function in your relationships as well or certainly not at work as well.
Max:
Right. Yeah, so it's a matter of being well-integrated. And having the different aspects of your life well-integrated.
Dr. Mendenhall:
That's right. We have to attend to all of those things. We must. And you know, and on down, I mean you can just pick it, I rattled off some ideas about bio, but if you go into psychological, are you balancing work with the rest of your life? Are you effectively compartmentalizing those things? Or are you sitting there with your spouse and you can't get off your email with your cell phone as you slowly kill your own relationships because you can't leave work at work? Are you giving yourself the grace to hurt and to ask for help? Are you sucking it up? Pulling yourself up by the bootstraps and not reaching out. Are you isolating from friends or are you connecting with friends, even in the context of COVID? You know, we have the technologies to do that, and if you do, that can help. You gotta connect those dots.
Max:
Well, I'm curious about that. You just mentioned self-isolation and the importance of being with people that we care about, but that that can be maybe more difficult than we're used to right now, especially for those who maybe are immunocompromised or are otherwise at higher risk as a result of the pandemic. And I'm curious if you have explored any of the ways in which people can connect in ways that are healthy for them, and still maintain their physical health, but might be able to foster some of those other, and balance those other aspects of their life that you were just mentioning.
Dr. Mendenhall:
Sure, I could probably speak to that all day. But a couple of things that pop up into my head right away are, first of all, people that are in social connection with each other all the time anyway, and then people who are not. And so beginning with the first, spouses, family members that see each other all the time but oftentimes are in situations where they're neglectful of those relationships. And so, my previous example of not being able to put down your phone, sitting at the dinner table, looking at your phone instead of at your partner, or even worse, just sitting at the dining room table watching TV, instead of talking to your partner. Those types of things I've heard, and I've engaged with a lot of my patients and colleagues and students who have said that that's actually better now because they appreciate the relationships that they have more, and they see and they understand more than before how corrosive constant scrolling through negativity on news and social media is, doing scrolling. And that really, the most important people in their lives are oftentimes the ones that are right in front of them. And these relationships that have been dying of neglect are actually starting to get more attention.
I think, you know, and there's a lot of different ways that we can do our relationships on purpose. And when we do, our relationships succeed. That's why everything's always exciting with a new person, you know, in the first six months of dating, because you're doing it on purpose, and then you complain that spark ran out, it's because you start getting passive. I think that, as it relates to family and friends that don't see each other every day, we've also seen really kind of a renaissance of connection that family members who used to give each other phone calls, you know, once a month, maybe, and then oftentimes felt kind of harried when they were having those conversations, a number of my students, colleagues, patients, etc, have talked about how now every single Sunday night, they have a family zoom call. And they have families that live in different parts of the country, or different parts of the world, and they look forward to that now, and they never did that before. And they they're able sometimes to just talk about kind of the, you know, the work of the week, if it was a routine, but then also have more substantive conversations about how hard this is right now in the context of COVID, or how much they miss being able to hug a colleague at work or to go out with somebody that lives nearby, have a guys night with their friends, for example, or have have friends over for dinner. To be able to talk to people like that about that is so good. And it's kind of a flip side of our social isolation is that the ways that we connect oftentimes can be more purposeful.
Max:
I was just gonna say, it's like we're all experiencing a shared trauma of sorts. It's a new experience for many of us. It is isolating and can be scary, but those connections that maybe were less, you know, it was less obvious how important they were to us. We have this touch point that we can all share. And that we can discuss.
Dr. Mendenhall:
Yes. At our core humans are social creatures. I mean, even in a test tube, none of us come to exist in this world without two other people somehow connecting artificially or not. Everything that we know, everything that we learn, everything that we come to believe, every habit that we gain, comes from somewhere. It comes from how we learned or got role modelled, to our own family support. And they're maintained by the families that we live in now. Everything that gets us in trouble happens in context, everything that gets us out of trouble helps us in our growth. Our healing, our happiness, our sadness, our joy, and our pain is in the context of others. We do not live in vacuums. And I think that with or without a pandemic, we need to figure out how to live what we call “in communion with each other”, no matter what.
Because no matter how independent, or how differentiated or individuated, or even how isolated we are, we are always doing all of those things in relation to other people. And I think that we need to do those relationships on purpose. With or without our technology, we’ve got to figure it out. Because I'll tell you, even before the pandemic’s influence on us now, I would have said a lot of the same things. We don't live in a vacuum, and we need to connect with others.
Max:
Actually, I'm glad that you brought up how maybe your perspective on this hasn't changed a lot. And I was reading some of your previous work about disaster behavioral health capacity. I wonder if you could maybe talk about that work and how it might apply, given what we're experiencing today?
Dr. Mendenhall:
Sure. And just as context for that question, I wear a lot of hats at the University of Minnesota, and one of them is I direct the mental health parts of our trauma teams. Our trauma teams are large and include a lot of disciplines and a lot of people. Our mental health teams integrate and oftentimes work alongside a lot of our other team members. We deploy to small scale stuff that nobody knows about, or hears about on the news, local shootings, motor vehicle accidents, suicides in our dorms. We deploy to a lot of large scale stuff, stuff that gets on the news like our 35 W bridge collapse a number of years ago, every year natural disasters, flooding, tornado, tornadoes, hurricanes, things like that. And I'll tell you, providers in health care whether it's mental health or biomedical, always function just under burnout. We function, but we're notoriously bad at practicing what we preach. You know, we're post-call living on caffeine and candy bars talking to our patients about the importance of a good diet, balanced lifestyle date night.
And we got socialized into that through our training. And we figured out how to function in a way that is good enough most of the time. But in the context of trauma deployments, we oftentimes find ourselves pushed over that line to where burnout and compassion fatigue are much more likely. And that's because the intensity of trauma, the intensity of these types of deployments is harder than our day jobs. Our day jobs are hard enough, but trauma deployments are tough. And there's process trauma, and there's event trauma. So if there's a tornado, it's an event that came and went, it's gone. There's process trauma that doesn't go away, at least not for a long time, like pandemics. And so we don't know when this is going to be over. It's like running a marathon without knowing where the mile markers are, where the finish line is. And there's some psychology to that. And so it's it's a lot harder.
Max:
And there's not a light at the end of the tunnel necessarily, or it's harder to see.
Dr. Mendenhall:
That's right. And the social isolation- we talk about social connections being so important. People in health care are, oftentimes, in situations where they must be, at least somewhat socially isolated from their loved ones, because they are not allowed to talk about work. At least not with very much detail. It's against the law. It's against privacy laws as it relates to health data and patients lives. So I can't come home and tell my wife all about the teenager that I met today, that I was suicidal for the third time and wound up doing X, Y, and Z because it's, it's not okay for me to do that. I can talk to my colleagues about it that are on the care teams, because we share that care effort. We share electronic medical records, we work at the same hospital. But I can't come home and have those normal “hey, honey, how was your day?” kind of conversations.
And in the context of trauma work, it can be even worse, you know, I've done trauma deployments where I have seen horrible things and heard horrible stories. And then I come home, and it's even harder to have, “hey, honey, how was your day?” conversations, and the disconnection from your spouse or your loved ones is felt more profoundly, in general. And then even more specific, a lot of times our spouses and families really have what I would call kind of bell curve, normal stress. And it feels if we're not careful, like, no big deal stress. So like, if I had two or three kids die on me that day and I come home and my spouse had a really tough day with the politics in her office job, then from my perspective, I'm like, “well, that's nothing I mean, you should hear about my day!” which isn't fair. It's not fair at all. Because actually, my spouse's difficult day is like most people's days that are hard. And right, I mean, you're comparing apples to oranges. And so now, not only can I not talk about it, can I not talk about my day. But now I have a hard time being empathic to your day because your day didn’t seem like a big deal. Now, that is poison in a relationship. And so the isolation or the disconnection from our spouses potentially, is increasingly corrosive if we're not careful.
And that's why in the context of COVID, we're seeing potentially more disillusion with the work, burnout, compassion, fatigue with the work, but also relationship stress and breakdown. Not only as it relates to this story, because I have colleagues who, all day and all shift long, you know, they're on shift for 12 or 24 hours, they've lost a half a dozen patients during that time, have had to notify a half a dozen families during that time, have had to tell a half dozen families that they can't go see their loved ones when we know that they're about to die, or even after they've died. And then you come home, and your spouse is like “honey, how was your day” and all of that stuff happens, and then you get up and do it again. This is hard.
And it is made even worse by, and I know I have a couple of colleagues in my brain right now, who are in quarantine in the basement of their house are literally living in a tent with a space heater in the garage because they have potentially been exposed. They don't want to put their own families or kids at risk. But they can't not go to work because their workplace requires them to go to work until they test positive. So they're living with all that ambiguity. And now they don't even have the opportunities for “how is your day” conversations because they have to live in the garage. And so you're at the same address and physically disconnected, not even just psychologically disconnected. And it's like a double, triple quadruple Whammy for a lot of our workers.
Max:
I was just going to say, this brings my mind back to the very first thing that you were saying about leading a healthy life and in that it's very important, having those important facets of your life being interconnected. And that the pandemic in more ways than one, especially for the people who are on the front lines and are doing this really important but difficult work, are experiencing a severing of various aspects of their life.
Dr. Mendenhall:
Yeah, and the spouses and the families really feel it because they're like, you give all of your energy, all of your attention all of your self to others, and then I don't get that, and I'm married to you. I don't get that and I'm your kid. And they’re right. I mean, it's a disconnect, and coming back to the mental health providers, because we are oftentimes in relationship with patients and families where we're hearing these stories, listening to them trying to translate or triangulate in good ways between them and other providers that are part of the teams. You know, we come home and we're all listened out. And families are like, all you do all day long is engage and support and offer your compassionate presence to other people. And I don't get that. Why can't I, as your spouse, get your compassionate presence? And the reality is, because you're kind of burned out of offering compassionate presence by then. Which doesn't make sense, because if anybody deserves that from you, it would be your spouse, right? Or your kid.
Max:
And that expectation is reasonable and understandable. And that's why it's probably even more difficult for everybody involved. I wanted to just ask you, briefly about the first responder toolkit, and the work that you and your team have done to try and support, I would imagine, not just the care providers, but also the people within their lives as well. What did you learn?
Dr. Mendenhall:
The short version of how we created this is, for a number of years in our, when I say our I mean colleagues of mine and myself who have been involved in residence education with our our physicians, with mental health interns, and that's including a variety of sibling disciplines they're in so counseling, psychology, family therapy, medical family therapy, anybody that falls broadly under that umbrella of mental health, as knowing that we're a high risk group, collectively, for burnout and compassion fatigue. We do a lot of things for self care, preventing or mitigating those things. In the context of our trauma teams, because of the high risk, we've kicked that in in a variety of different more purposeful ways in the ways that our teams mobilize and deploy.
And what we found, long story short, is that in the context of the deployments themselves, it's hard to do. A lot of us know what to do, but it's still hard to do. And so because everybody, these days has a cell phone. And once an app is on your phone, you don't need an internet connection. And a lot of our deployments were going into context that internet connections are maybe there but maybe not. And once it's on your phone, it can be very uniquely private to you. It's not like you're telling the world how you're doing. We developed these apps, apps plural, because we have a couple of different versions over time, that serve to test, assess and track how providers are doing really on a day-to-day moment-to-moment basis. And it's your data, you look at the phone, you take a variety of different types of assessments as it relates to compassion, what we call compassion satisfaction. And that's connected to a whole pro-qual which means professional quality of life, series of questions that are publicly available. I did not design them, but they are publicly available, to risk factors that you have in your own life.
So for example, if you just lost a loved one, or went through a divorce, or physically sick or whatever, those are risk factors to be thinking about the context of a deployment. And then you track those and then connect them to what you're finding with these assessments. And they only take a couple of minutes to do. You know, the phone then pops up and says, “Go forth”, or it says, “Be careful, here's some resources” or something. So think about where it says “Probably not”, and our team leads on any of these things are not going to think negatively of you if you say “I cannot do this” because the reality is, is if you're functioning poorly, you're going to make mistakes, you're going to miss cues, important cues from people, and you can potentially hurt them.
We've all heard the dictates of do no harm, those are excellent across a variety of different care professions. But a lot of us don't realize that those are there because we really can do harm. And so with our team leads, not if, but as, our workers communicate to us that they are fragile, that they are in a place right now that they probably shouldn't be, then we deal with it. We figure out different ways to cover shifts, we figure out different ways to pull them out of deployments or connect them to different resources and support. Because that's important. I mean, they got to take care of the person, they're with 24 hours a day, kind of like the wisdom of the airplanes. Put on your own mask first, before you help others. And these apps, because they're so accessible, easy and private, we've been able to find that people that are actually taking these technologies and using them are good, people like them.
Max:
Adherence to use.
Dr. Mendenhall:
Yeah, exactly. And our hope moving forward, and it's been too soon to really systematically review or study this, but our hope is that the desired outcome of these apps, which is better functioning teams, and better outcomes with people that these teams serve, are happening. So stay tuned. I mean, that I think that that research will be ongoing. We have a number of students and colleagues that really like these apps, they've had a strong voice in participating in creating them with us. And we also have received in a number of offshoots or evolutions of the first responder toolkit to become, like a how to survive medical school app, or a how to get through graduate school app, or a how to survive this nursing program app. I think that graduate and medical educations, broadly defined, are really hard and arguably abusive. And I think that differs as our students and young professionals are learning how to prevent and mitigate that compassion fatigue now, and that our next generations of providers will be less high risk than our current ones, honestly. And I think I can say that because I identify as one of our current ones, so I'm not bad-mouthing anybody. I just because I do a lot of this stuff and teach a lot of this stuff doesn't mean I don't have to be vigilant about it myself.
Max:
Yeah, well, it sounds like a lived experience. I have several friends that work in the healthcare space who experienced some of that difficulty, and it reminds me of them going through med school. And abuse is a word that does come to mind.
Dr. Mendenhall:
I mean, if you pick a dependent variable, that's bad - depression, anxiety, insomnia, alcohol or drug abuse, or misuse, divorce, just pick one that's bad. And you compare people in graduate or medical education to the general population. Our health care providers, who are the people that are supposed to be caring for others are, across the board a higher risk group. And so it's essential, it's not just a warm and fuzzy thing. It's essential that we attend to this.
Max:
Yeah. Well I really love this adage of “go forth”. Sort of an invitation to the individuals who are using the apps to check in to track that they can keep progressing forward, but only if you are evaluating yourself and taking care of yourself. It's kind of predicated on that.
Dr. Mendenhall:
And oftentimes, I think one of the biggest wisdoms for that is compartmentalizing what we're up to. When I'm at work, I'm at work. And when I'm at work, I'm not looking at Facebook or I'm not trying to decide what to buy somebody for Christmas or I'm not distracted with anything else because I'm at work. And when I'm at home, I'm at home, and I'm not going to be checking email on my phone. I'm going to be with my wife because she means the world to me, and I'm not going to allow work to do that. And when I'm attending to my exercise or my personal life on purpose, then it's going to go better. When I'm attending to my work, and I'm doing that on purpose, it's going to go better. But if I'm doing work when I'm in my personal space, or am I doing my personal life when I'm at work, I'm not going to do either one as well.
Max:
Yeah, I've certainly found that to be true within my own life. I just wanted to maybe end by bringing up a book that you've written, and also an assignment that I've heard that you assign in one of your classes that's related to this.
Dr. Mendenhall:
You've been doing some homework, I have no idea what you're about to ask!
Max:
The book is about intimate relationships, and the subtitle is Where have we been, and where are we going? And I really liked that. There was something poetic about that. And as we continue moving into this pandemic, like you mentioned that there's this uncertainty, we don't know exactly where this ends, and when, but I was wondering if maybe you could help answer that. Where have we been? And where are we going? And what are the ways that we can maybe take care of ourselves as we keep moving forward?
Dr. Mendenhall:
I love that question. I think off the cuff, if you if I could say, a quick note about the process of that book, because it absolutely informs the answer to your question. And that is that the book was not a sole author project. I'm the lead editor for it. I wrote different parts of it. But as as context, what I was finding over a number of semesters in teaching about this at the university was that students didn't like any of the books that I tried, they said, they were too dry, they were too boring, they took something that was gorgeous, about our relationships and made it sterile. And academia does that a lot of times, we take things and we say it in three times the length, because it makes us sound smart. We use all of our big words, you know, we say things like “esoteric” instead of “understood by only those that are involved”, when you say things like “insofar as” instead of “to the extent of” or we say things like “as well” instead of “too”, and students were just disengaged. So we wrote a book together and the author, the multiple voices in the book, if you look at the different chapters across that book, is that the book was truly written by students and for students.
And we've had a number of different graduate students that were TAs for the class over the years, undergrads that took the class, offer their stories and their vignettes, to attach to the scientific stuff that we're trying to teach their own learnings, etc. And for the very first time in a number of years, we have a book that students who are saying they like! The student evaluations are like, I really like this book, because I can see and I can hear my own self in it. It's relatable. And I think that, that messy process of involving a lot of voices and constructing that book answers the question that you're asking about, and this is an essential point of view to understanding or providing narrative to where have we been and where we're going, because there isn't just one voice. We do not have a single panacea to this stuff. Humans for as long as there have been humans, have looked for one. I mean, that's why at any given day, you can Google or just look at the news and there's some new guru-du-jour that is like, for three payments of $19.95 you can lose 50 pounds by tomorrow. And if those things work, then there wouldn't be another one next month or next year, right? I mean, there is no single cure.
And so where have we been? I think we have a lot of different voices and stories of pain and of joy, and of learning, and of challenges and hardship and success. And I think that those different pieces influence and answer the question of where are we going, because we have wisdom that we didn't have before. We’re learning from our own experiences and from others, especially if and as we're in communion with others, and that we're listening more than we talk. Remember, God gave us two ears and one mouth for a reason. And understanding that, okay, if there isn't a single panacea, how do I, in my own path, figure out for me, what is the answer to where I'm going?
And if you come full circle to where we started with the biopsychosocial-spiritual framework, maybe for me it's more about how I attend to my physical health. Maybe for you it's more about how you attend to your psychological health. Maybe for somebody else it's because they're socially isolated, or their marriages or their relationships with their kids are dying of neglect. So they're going to do that differently. Maybe for somebody else, they're just having that total spiritual crisis, and they need to figure out or navigate that. And I think that understanding that complexity gives us latitude to figure out what works for us, instead of to be on a constant quest for “the answer that's coming from somebody else”. Because if it comes from somebody else, I don't think it's going to work. It has to come from you, because the only one that knows your life and your situation that well is you.
Max:
It's beautiful. It's inspiring, too. That the answer for each of us comes from within. And that it's by turning within, we're able to figure out what aspects of our life need tending. And I think that that's a message that a lot of us can benefit from, especially right now. And in the difficult social and political and health context that we find ourselves.
Dr. Mendenhall:
You know, I'm thinking of two metaphors that have consistently resonated with me. The first, and it came from one of my dear colleagues and mentors, is that we're building the ship as we sail it. And I think that knowing that and understanding that gives us some grace. And that then goes to the second metaphor that, and just to be transparent with you, I remind myself of just as much as I remind students or patients, that is if you're driving a car during the nighttime, and you think about it, you can only see about 50 yards out. In an objective way that might feel kind of scary, but you can make the whole trip that way. And I think that you have to trust in that process that you can see far enough out that you're good for now, and you start the journey. You don't have to know every single bend in the road, every single rough road, every single stop sign. You just need to get started. And I think that that influences again, some of those answers on “Where are we going?” Because where we're going is also a process. It's not a destination, it's not like you suddenly have gotten there, because what happens the next minute or the next day? I mean, you're always moving. And I think with that you're always growing. So let's just get started on the trip.
Max:
I love that. It's a beautiful image too, and I can just see that the end doesn't exist in any real way. You don't know what it is, all you see is the next couple steps in front of you.
Dr. Mendenhall:
That's right.
Max:
Well, Dr. Mendenhall. Thank you very much for your time. I appreciate you sharing some of your past experience and insights.