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Adolescent Psychiatry: Exploring Development in the Digital Age

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 [00:00:05] Thank you. Dr. Blaise Aguirre Harvard University psychiatrist an international expert on the social and emotional wellness of adolescents in our youth. We're so so grateful appreciative that you made some time for us today.

 [00:00:19] Yeah, that's awesome. Thank you so much. I'm sitting in my living room in a very cold Boston Day.

 [00:00:28] Well it's not much warmer where I am so dark as we as we get into this I think important conversation and glean some important insights that you've developed over years of practicing and psychiatric medicine.

 [00:00:41] How did you get interested in psychiatry and your work with children and adolescents.

 [00:00:46] So I was actually interested in philosophy at the start. And because I loved thinking about the nature of the human mind and how people saw the world the search for meaning and all that sort of stuff. But one of the things that got me thinking about was do we actually all see the world in exactly the same ways and how does environment into how we see the world how does our biology or development influence how we shoot it was somebody from philosophy to psychology. And then once I started thinking about these psychological questions, I also wondered about well what happens is there is a chemical upset in the brain or if someone had trauma. And how does that influence how you see the world. And then I realized that I was actually much more interested in medicine as it pertained to brain development and psychiatric symptoms. So I then decided to go into psychiatry. What happened then was that I saw that a lot of people adults with depression and anxiety and other disorders had been suffering for a very long time. And I wondered if there was a way to intervene at a much earlier stage in development or certainly when so many of the conditions that begin to manifest so that as a person grew up at the time of suffering would have been much less than having to wait for adults. I decided that my own training, I would do Child and Adolescent Psychiatry.

 [00:02:37] I resonate with that idea of intervention and prevention early on in the work I've done over the years in behavioral threat management in educational settings one of the core concepts and principles of the work is is intervening early and soon and quickly so that things don't manifest in real crises later on it could've been avoided.

 [00:02:58] So I I understand that, and it's a good thing for me to hear that from a psychiatric perspective which makes complete sense in what that looks like. So you've been working with without a license primarily through Harvard at the McLean Hospital in Massachusetts Belmont if I'm correct.

 [00:03:17] Yes it's a moment that for correct. You have done Massachusetts for many many years.

 [00:03:24] And I'm curious having been practicing for as long as you have. What's changed in the regarding the state of mental health or the social-emotional context for our youth today. What's different now than the day you put your white coat on and went into medicine.

 [00:03:43] Yeah. So quite a few things have changed and kind of break them down into different categories. The first is how human beings connect with each other. So when I left Boston University in nineteen ninety-six, I started that train hospital in 2000 at Harvard in 2000 so. So when I left Boston University in 1996 as a child psychiatrist, I know there was no social media when people spoke to each other. There were face to face communication. Sometimes you speak to them by telephone. Fast forward to today, many of the communications I have with my patients are just social media or through texting. I don't have to see them many more I don't have to hear them anymore and sometimes they don't even want to communicate that way. So so one thing is that social media came along. The second thing is that with which the media and with the acquisition of the Internet, people became far more educated about mental health conditions. And now that was a double-edged sword because, on the one hand, you could see people self-diagnosing could wonder about their symptoms by using a search engine. On the other hand, there's a lot of misinformation out there, and people often get mistaken or bad or erroneous information, but they just pick things up online. So that's one thing. The other thing that's happened is that there has been an explosion of different kinds of medications and we often see children on up to eight or nine different psychiatric medications in an attempt to try to control their behavior. So the days of kids on many medications have increased to another inadequate in recent times in recent times, the number of kids with no medications is far more evident than it was when I first started. So those are just two areas in which you know that I've changed.

 [00:06:17] Now 21 years since I finished my residency so I think it's fascinating on a couple of connections that my my mind's making first of all when we talk about school safety and community safety we often talking talk about you know meeting the our students in our community where they are you know what I recall is a new police officer the best advice I got was if you're going to be an effective public servant around public safety and policing. You have to meet the community where they are you have to get out of your car to go talk to people and engage them in conversation and then you know years later as I was finishing my own doctoral studies in the education a comment made around to be an effective educator effective teacher effective, caring, adult. You have to meet your students where they are, and that didn't necessarily mean in the classroom right.

 [00:07:10] And even as a parent, you meet your children where they are through this. I'm hearing quite a bit of overlap and what I'm interested in just to the point you made about you know at the beginning of your career in social media and these online platforms didn't exist, and now they do. And in some ways, you're meeting your patients where they are, which is online just as important as those who need to meet you in person. Did I hear that, right? Are you able to effectively treat and engage in multiple set of modalities is the right word but engagement in what's best for your particular patient.

 [00:07:46] Well so yes and no. And I'll tell you why that absolute key keep the primary work out is the primary work that I do is face to face I I feel that the level of connection and I think it is also change in the patients as neuropsychological study of how human beings connect to face to face interactions is the mainstay of what I do.

 [00:08:18] There are, however, I also understand that human crises don't happen simply on the days when I'm having a session. They can happen on a Saturday night or Monday morning before school or whatever it is. And that part of our treatment the way that we use it is that kids reach out in the moment of needing help. And you know I often tell them, hey you know look at this thing that you have in your hand. It's called the phone, and there's a very interesting app on your phone, and it's called the phone app. But they all said Well you know what they do instead of a text you or in Europe they WhatsApp you and they'll say things like you know I'm having a difficult time getting others out of bed. I had a fight with my boss about text that information. It's something interesting that they speak to by phone are they're coming to see you.

 [00:09:19] Doesn't often work. That is the way that they're interacting. So engaging with them at that level in those moments of crisis I think is critical and helps them to get to that moment of crisis using this other technology that didn't exist because you know I mean 21 years ago if someone was having a difficult time with their parent they would have had to wait for the next session or maybe they would have called that office line and left a message so you could get the next day a petition does allow for much more real-time intervention which I think is one of the great benefits. Although there's obviously some downsides as well.

 [00:10:03] So it tends to be the technology of today while giving a platform for these kind of digital conversations something that we social circle are obviously very concerned about for safety security being more traditionally the tool of connecting to the face to face the opportunity for reaching out. And I. I agree. You know 20 30 years ago when I was a you know a young police officer the option in those crisis moments were often a trip to the hospital the emergency room or the community crisis team coming out.

 [00:10:41] Do you think the second thing you mentioned I thought was fascinating was medication. And so you know I think science and medicine has evolved in many right ways in good ways. And they give us more tools for engaging treatment practices have we become. I don't know if the word is too dependent, but if we become too free in relying on these medications to take the place of interactions and that's not a loaded question, it's just I'm curious. I mean, where does that word of the world the medication play out now as apparently you know compared to twenty-one years ago.

 [00:11:16] It seems to me that especially for kids who are really struggling with a lot of distress with a lot of suicidal thoughts a lot of stuff destructiveness a lot of turning to drugs and alcohol for self medication that parents go in to see a mental health specialist or psychiatrist and say My child is out of control. And because of the time, a lot should you know for a psychiatric evaluation which is typically not that long in most mental health practitioners and because parents want something to happen now. One of the things that happens is that children don't get a complete assessment and medications are prescribed. There are powerful stages of the brain. And so what you have is a child and maybe more sedated more exhausted less likely to behave in destructive ways. And so parents get a temporary relief they feel better because of the medications that all the medication does is it sort of dampening the brain. So shutting it down, it's teaching the adolescent anything about how to manage difficult moments. And you know when we see kids who had many medication trials or have come in on any medications it's not a surprise to me that they are so under control because the medications are preventing them from being able to think and act et cetera. So now that doesn't except that there is a lot of medication like with everything else with asthma diabetes rheumatoid arthritis. There is absolutely no role for medication. But even with as a diabetes are going to turn up right, we look of things that you can do in your environment change your behavior to mitigate some of the risk. You know in terms of lifestyle changes. So. So that yes there's a role for medication. There has to be accurate assessment and diagnosis, but it is my opinion that we are too quick to medicate our kids and often for conditions that don't require medication. A lot of areas or that haven't been fully assessed. People say I'm depressed. They get given an antidepressant, but there hasn't actually been a full diagnostic assessment circuitry.

 [00:13:57] So then when I think I hear you saying is that when medication becomes the solution, we may be missing the key opportunities. Medication if I hear you correctly is a tool to get to effective talk therapy effective family dynamic changes.

 [00:14:13] Because I'm as I'm listening and absorbing your insights and these incredible lessons. Well I also I think I'm hearing is you know as a youth an adolescent a child in distress to to treat and help them move through this is not just about them it's about the dynamic in which they live their family relations I mean and if medication is used as a tool to calm the environment as well as the individual. As long as it's not a tool to talk therapy, it may have a greater value. It's when I think are you saying it's in and of itself the solution that we run into problems.

 [00:14:53] Exactly. Because not only that. So I think you stated the point extremely well. Not only that, but the other problem is is that these medications come with a pretty sharp Mexican effect separate rooms. Some of the antipsychotics will cause tremendous amounts of weight gain hyper cholesterol Demir another high blood fat cardiac side effects and so maybe you've helped some of the mental processes, but it comes at the cost of a lot of physical processes.

 [00:15:27] And so I think you know for many people we divide our organ systems into you know those are the kidneys, and that's the liver, and that's the brain and etc.. And I'm only taking care of the brain. I think it's very black and white thing to think about the human being because everything impacts everything else the brain and how you think will impact what you eat will impact you never dies will impact your weight will impact your kidneys. All of those sorts of things so so cute to know to give medications that may or may not work might only be part of the solution and cause tremendous side effects is one of them. But the other problem is to simply say that without teaching a person new ways of interacting it is at best doing a half solution to the problem. And there is no such thing as a child because a child cannot exist outside of the context of a larger community, especially a family shattered. So so really medication is only treat a very small portion of it if it's treating it at all without intervening with the family and the kids we're losing witnessing a great opportunity.

 [00:16:43] It sounds very much to me, and you know clearly I'm not a physician, so I see this really as a layperson to the medical profession. It appears to me to maybe highlight some of the foundational differences in western and eastern medicine and clearly absolutes and clearly what you're doing as a psychiatrist treating the emotional wellness instability of adolescence can ignore all those other issues. So given that.

 [00:17:12] And given what you've seen in this context what are the most pressing issues or concerns you're seeing today in our adolescence. I mean I'm sure it's different 20 years ago, or maybe it wasn't different 20 years ago but what do you think today's experience is Lessons Children from all over the world come to see you at MACLENNAN And what do you what are you send for them.

 [00:17:36] The issues one have been one of the terrible trends that we're seeing is that the level of suicide suicidal behavior suicide attempts self-injury self-destructive behaviors as extremely high, and in fact, suicide rates in adolescent girls, for example, are at the highest rate ever. And you know I mean suicide to the United States. You know we think about the tragedy of homicide you know about 19000 homicides a year. But there's 24000 suicides a year in the United States it is more than twice that number. And I don't think we're seeing the same kind of a catch up in adolescent suicide as the second leading cause of death. So after accidents tied in homicide and things like that so so the level of stuff destructiveness that the other part of it that I never used to see. And see a lot now is how much of it is mediated through social media.

 [00:18:43] OK so what are the sort of things that happen is that kids get admitted because they see that the boyfriend's ex girlfriend like a photo op Instagram and now in threat especially for very emotionally sensitive kids or kids who don't have the skills to manage their emotional actors very rapidly go from oh I saw my boyfriend's ex-girlfriend like one of his Instagram photos he must clearly be having an affair with her like as I was leaving I should myself. And we've had three kids admitted and we should most just because of an Instagram post.

 [00:19:27] The other thing is just it's how incredible social media influences many of these kids experience of day to day life.

 [00:19:39] So if they post something on Instagram and no one likes it then they feel rejected. So even just like people not liking something that social media can influence a lot of these young people's lives and you know back in the day we took the time our ratings went to the post office stuck in a mouse trap where they send it back to say I was quite nice. That was it took a couple of weeks, but now it's then there's the incident. But that those kinds of things or that the way people break up is by text. You know we've done things like that. And then the other thing is that the whole way of curating images. I have many people who feel very bad about themselves. To them, to me, I can't believe my friends are in. You know wherever they are. And then the fear of missing out. And then people use Photoshop to change how they look. And then people become jealous and those sorts of things. So so. So that's something that I am in today in terms of not only missing out not only the instance of cheating rejected but also cyberbullying a gap that a person who gets hold of an account or targets an account can suddenly get you know thousands of people to weigh in on the worthiness of the person before you know it your ability to take him you know behind tennis courts and teased or something like that. It was baffled that it happened between two or three people. Now it's whole communities that can really impact that and then also just things like videotaping of assaults videotaping of sexual aggression and those kinds of things. So those are just some things that are definitely something that a lot of things you said that I am so fascinated with.

 [00:21:39] I want to go back to the first thing that popped into my head.

 [00:21:42] When did you say so is the is the need to feel accepted. You know I think the need for self-worth the acceptance you know has existed as long as I'm guessing you know we've existed right.

 [00:21:55] And given the social dynamic of human beings and I've ever I would imagine anywhere on the planet. Right.

 [00:22:02] So when self-worth what is self-worth justification or pride looked like before social media as opposed to now is this. We've always had the need for self-worth, which I think we have. And we did it in other ways. But now because it can be played out on social media, it's amplified. I mean. How did it happen before you IPO? If I can remember before social media was there.

 [00:22:25] Yeah. Well, I think I think that the the construct of self-taught in schools, for example, are assessed by certain things. So like on the sports field how good a sports person you were you know in the classroom. I'm good a of an academic.

 [00:22:48] How good a trumpet player you were for the band where you're a grad all of those sorts of things.

 [00:22:56] You know and now though I think you know even if you're popular because you know you had a girlfriend or boyfriend or whatever it is.

 [00:23:06] But I think that now it's the number of Instagram followers that you have. It's the number of likes that you have on a photo ID. It did a number of people who can leave you on your Snapchat or so that it's it's you know everything is back in the day. You'd have to afford very good friends, but now you know the idea of having thousands of friends on Facebook or something like that it's inconceivable to me so I can get that measures of self-worth interest at that. But let's just take it in different situations. When we when I plan for college, I could apply for four or five colleges, and that was that now because of a common app kids could apply for AP colleges. And so what happens is is that colleges are being flooded by applications. And I know that for instance, last year in Michigan has 8000 applications. There's no way that they've had enough readers to do to go through all the applications. So a lot of very qualified pick whenever you then sing and bam.

 [00:24:32] So electronics has made it easier to apply to medical schools. It's also flooded schools with applications and then keeps feeling rejected. They've worked so hard you've gotten straight A's whatever it is, but they're getting rejected just because you know there's so much competition for such short for spaces. So I think again the electronics that are making our lives so much easier anyways.

 [00:24:58] Also, complicating our lives is something like your point. I think the point you made around how we judge our value I think in some ways it is incredibly prophetic. I mean I I think to you know my experience in in in school in grade school and high school you know quite some time ago. And you know it really was our worth was based on you know how right how smart we thought we were we were or how good we were at athletics or music or acting or whatever other you know group activity or thing was happening. And now it's almost fame for the sake of fame. It's not about my skills abilities, knowledge, wisdom, insights, and such. It's about how many people I can get to want to follow me and I and I and the impact that I have and so leading into your conversation about you know electronics having done so much good. We see it. But then having so many challenges we see that Social Sentinel because we're paying attention to the you know an a massive communication dialogue you know a billion conversations a day happening and seeing some of the negative aspects of the harm and the potential for backstop so. And then the other thing you mention about you know recording things where you know curating and recording capturing information in the moment. You know I remember years ago having a conversation with students at the University around security cameras and one young man pulled out a phone from his pocket and said I have a camera on me all the time. I don't give it but went on that building. I thought that again was an interesting shift and kind of where we're going. So you're seeing all of this impacting them. The emotional and the mental wellness of our youth of our adolescents around self-harm around suicide.

 [00:26:57] What what's been your reception when you work with or speak with school leaders I know you travel the world you travel the country. I met you at a conference of school superintendents where you're talking about this. How have school leaders embraced this message and what have you been telling them.

 [00:27:16] So you know that's an interesting question. I've actually had three different so say Suppose three broad categories of responses.

 [00:27:27] One of the responses in this I mean sadly it tends to come from some of the more prestigious schools quote unquote private schools. And that is that they do not want attention on the topic so that they may try to use kids with mental illness of the schools they don't necessarily address in a public way when there's a lot of self-destructive nature when there's been a school suicide. And so so even if we have data that they're seeing in their health centers numbers of kids where for example such injury going up you know this school that is prestigious that is well-known and doesn't want to say are Ivy League type school has twelve percent of kids self-injuring or you know 3 percent making suicide attempts. It's not a way to promote the school. And so they really can't too.

 [00:28:34] So when one response has been to not address it just not even accept or deny that it does and then deal with it in some with some internal mechanisms that I'm not quite sure about. There have been some schools that have been proactive and say I lecture at parent academies in some public schools and what they do is they invite speakers to address different mental health concerns. And just being very proactive and discussing various topics and then and then there's the other type of the reactive type, and that is that they've denied and they say nothing. Have a very big section on that. And then all of a sudden you know insist on swooping in and doing all sorts of work in the moment, and then that gets to their chest a lot of the tension in that moment, but then it seems to diagnose and then goes back to business as usual.

 [00:29:38] It's a reactive response and not a proactive response. It's the crisis. It's what we started the conversation with.

 [00:29:45] What got you into psychiatric medicine this idea that you could intervene early enough it didn't escalate the crisis and so that I could think what I was saying is that in some of the conversations you've had with school leaders around the challenges you know the systems haven't been constructed to be preventative proactive in mitigating them. They've all been reactive in kind of crisis-oriented right.

 [00:30:10] I think that there are some progressive schools that that that usually what's happening to kids in terms of stress that I don't know.

 [00:30:19] I think that the other element to it is that you know the tragedy is that the biggest mental health system for adolescents in the country is the school because many students are medications and are receiving mental health services. And you know in the same way that in adults, the biggest mental health system is the prison system in the schools. And I think that that many teachers kindhearted well-meaning well-intentioned dedicated teachers never went home to schools to also be a kind of therapeutic supports for their kid.

 [00:31:02] We see that with security. You know superintendent you read English teachers or math people you do it in their career now have to understand access control math notification social media threat assignment monitoring, and there's so many examples of the complexity of the educational system as societies evolve.

 [00:31:20] So it is a parallel when you're saying nicely but fascinating.

 [00:31:27] You once said to me, or I once heard you say in a presentation that we've never been more connected in our history than we are today yet so isolated at the same time given I think your comments on online tonics and social media where are you in adolescence and are we if people are communicating. I also have heard you talk with great optimism and enthusiasm about treatment intervention about being there to be part of helping.

 [00:32:01] What keeps your drive growing and what's the message. I mean we can talk about suicide and depression and self-harm being you know such a prevalent issue because it is and it's an important conversation needs to happen. And what's the positive so that that school leaders are sitting back feeling completely overwhelmed. Lack of resources you know understaffed. What's the message of and kind of you know there is a pathway to helping this problem.

 [00:32:33] So here's it here's what I hope this is that as a species it's a clean animal I suppose and we've survived for millions of years.

 [00:32:43] And you know people are getting it right. A long time ago. I mean we didn't see those levels of disconnectedness and isolation years back, and that's because the distractions of today didn't exist yesterday. Now obviously we're not going to go back. If anything we're going to get much more technologically advanced every day. So sad that we can't go back that it takes a very very simple approach. Earlier on in and in childhood to intervene now.

 [00:33:24] So for example, you know it I feel very sad when I see 2-year-olds being able to play with iPods, not iPads after a while. But to my kids, they're so bright, and they are fighting, and they're able to manipulate things on screens. But it's coming at tremendous cost, and the cost is normal human connection. Now we have legislation for all kinds of things. You know when people can buy drugs and alcohol or cigarettes and alcohol when people care about guns when people can drive you know one thing would be to just say you know get these products are not harmful for children under certain age and that in schools particularly that we limit technology use to maybe getting homework or your classroom as a way of education but that that we never ever use it in case of a human teacher who can't connect directly with students. You know that introducing the concept of collaborative problem solving much earlier on having kids working together on projects interacting with each other teaching kids the skills of emotion regulation distress tolerance interpersonal effectiveness paying attention to their emotions early on are skills that they will take with them for the rest of their lives. But I think that by insisting on academic excellence we're leading to emotional poverty. And so so so the hope to ICE is when I'm very troubled kids using basic skills of behaviorism to get so much better. I think what would happen if we could use those technologies in less sick populations and maturity on through repeated practice I see tremendous help in that. And I think it will override the effects of the social media or social and media social media disconnectedness.

 [00:35:52] This concept that you raise of the emotional poverty I think it is powerful. I think that that the the image that conjures with the understanding and elicits of creating too much opportunity for instant gratification for lack of connection you know what you're seeing with what I mean I have I had children who were in high school and I I I I observed them and their friends interacting in this idea of important emotional connections happening via you know one dimensional texting and social media. And you know an ending relationships of starting relationships without even a face to face. You know I think is all. Maybe the result of this idea that you you've put forth this emotional poverty and what I hear you saying is simple engagement early on that that allows our art our children interact with themselves with each other with adults in their lives. It is a part of staving off some of the challenges and the issues that you're seeing everyday walk through your doors at the hospital in the clinic.

 [00:37:07] Yeah I mean I think you know look the brains are extra reputation. I don't know of a single thing that people do in terms of a skill set. That they don't do it through repetition. He was driving a car playing the trumpet during a sport. Repetition repetition repetition. It's much harder to learn something later on in life that it is earlier on life and that's because of brain neuroplasticity. Learning takes hold much quicker when people are yet, so you know. That's why people have a harder time learning a language when they're adults and when they're children. So if you can teach interconnectedness intervene much earlier on than having to wait till they're 18 or 20 years old and saying What do you see when you look at my face.

 [00:38:00] But if you can have those kinds of connections which is what used to happen for thousands of years of human evolution if that peak this was the way that people connected, and so we saw you know levels of distress and dysregulation and upset us because they could read each other they understood each other. They were able to be curious about each other's experience. Now if you sent me a text and I must interpret it I don't hear a voice I don't see your face, and I can go back and automatically make assumptions you know as they say in science. Nature of course of action the brain abhors a vacuum of knowledge and so when you just see a text out of context a different body text you can't contextualize it. And so you've met in many cases sensitive they misinterpret. So the idea of just taking too much material you are having that get dirty and then play together you fight it allows for a level of brain teaching that is healthy for kids.

 [00:39:07] You don't you. Yes, I listen to you again.

 [00:39:10] I'm struck by this idea that we have a generation of teachers and principals and university administrators and staff who are you know like myself in the 50 plus category of age who are interacting with the adolescents of today. And it's not only understanding your meaning you said it's also recognizing there is a great potential for a communication barrier right between these generations and what that means I think to my son the other day was talking about applying for a position or some other thing, and I had said to him did you stop by or did you pick up the phone and call the people and he said well I sent them an email and I said OK.

 [00:39:57] Did you pick up the phone and go see them. No, I sent them an email and I that was the whole conversation about you know you need to go see them. They needed or typed in, and then you need to be more than one of ten thousand emails they've got today. And so I also wonder about what's the impact of the generational communication challenges. Not only understanding kind of the impact of technology on our social or emotional one us.

 [00:40:24] I remember one scene seeing a young woman and her father had a tractor because she has hooked up with three guys at a party and she saw that the child was headed for terrible mental illness outcomes. And you know the idea that in a very public way somebody may have done those kinds of things be seen photos taken put on social media. To me, it would have been tremendously shaming back in my day. And sort of abhorrent to think that my other kids were doing that. But I was talking to my own children about something like that. They seemed very nonplussed by it. So this is what they do. This is what we do up on contemporary social media. It's you know maybe it's a little bit out there, and everything but the idea that there would be embarrassing videos of them on public forums is the guy who's interviewing me who's my age is going to have his own side or so that you know it's not mainstream.

 [00:41:34] It's mortifying to do his parents though. I mean, I completely agree with you. There are going to be thousands of people who are listening to this podcast or watching it at some point you're going to have the same reaction. I'm going to have a conversation with my kids again.

 [00:41:50] It's not funny. Well yeah, I think I think that the other thing is that we're judging it from our point of view.

 [00:41:58] And you know I don't want to get into judging the specific behaviors by that's because I just you know nothing surprises me anymore with high-level politicians and social media rulers can you know take pictures of their private and intimate parts and send them all over the Internet to different people and everything OK. I mean that's not my thing. But at that. Yeah. These are the sorts of things that people do that behaviors are less worrisome in and off. How's that. The manifestation of whatever that behavior is as a consequence of.

 [00:42:50] Difficulties in and in regulating human connection regulating emotions and despair that comes along with that. So I think it's symptomatic that you know you know nothing of any specific behavior.

 [00:43:07] You know you have to be careful not to judge it necessary. 30-year-old wisdom. Right.

 [00:43:15] I think it's so well said I've taken so much from the conversation today. Dr. Aguirre and I I think that what I what I've heard from you is the solution to many of the problems that you may be seeing all comes back to a human connection we often talking about in our schools that the best dose of medicine for whatever might be going on in. In one of our students lives is a real genuine connection to an adult in the school who cares for them and is there for them. And I what I hear you saying is that today's technology has given us some of an opportunity to lose sight of some of that connection or to do it in a way that might not be as healthy. And a lot of upsides the technology we deal with today. And clearly, we all agree to that. And at the same time there is a downside in like you with social saying we'll see because of what we search for what we're able to share with schools districts universities colleges are those signals of harm those those those leaks so to speak from young adults who are crying out for help and so when I, when I get the sense, is that that's who's walking through your door that's who you're trying to help. And I think that it's such important work you're doing. But before we wrap up I mean I., By the way, I've taken so many notes that I feel like I I need to enroll in a classroom teaching and maybe come back for more. Is there anything about our youth in their development that we haven't talked about that you think it's important for school administrators and stakeholders were listening to this podcast or watching this video podcast to know.

 [00:44:58] Yeah, a collaborative thing that I think is that I should go. No, I haven't. I'm not saying that they don't exist but I just don't know of many children who wake up in the morning and think to themselves My life is perfect I'm going to go to school, and I'm going to screw things up today I'm going to make life difficult for my teachers I'm going to be the class clown I'm going to go to headship. And so. So I think that one of the things that happens is that when we see children behaving in ways that we don't like in the classroom you know, we often ask the question What the hell is wrong with that kid. We rarely ask the question. What happened to that child. And I think that if we can imagine that for most children our own children, our neighbors children in our community's children. Most kids want to do the right thing so that when we see difficult behaviors, it's upset because something that happens or because they don't have the ability to manage lives in a different way. And I just think that it's from that perspective. It's a more compassionate way of seeing it now. That doesn't mean that it's acceptable to have disruptive kids end up in a big classroom. But rather than simply punishing them for an inability to control themselves or with a lack of curiosity about what's happened we automatically then stigmatize kids we think of them as bad. And that's a message that day when you said out loud or implicitly; I think you begin to believe and then they start behaving in a more difficult place. Of course, there are two kids who maybe do intend to to to cause harm. I think it's a it's a tiny fraction of the tiny minority. So to sort of think about them with compassion. Think about them that whatever is going on in their lives in the present moment is probably impacting how they're behaving and being curious about that is more important than judging that behavior.

 [00:47:15] I like the message of compassion and empathy. I think it's deeply meaningful.

 [00:47:20] You know I in my own life thinking about that in relation to the work we do and internally it seems to be a central theme of what it's so it's it's meaningful to hear that coming from you because again what I hear you saying is before we point a finger and say what's wrong with such and such it's you know what happened to them. How are we supporting them? What's what is it about our environment that is helping or hurting them. And I think that message in that information is important and not leaving information not you know what did I do to cause this but how can impact. That person's life in a way that helps them given what they've been through and what they're doing.

 [00:48:05] Well, that is this is exactly right. I mean if you think about if you have a disagreement with someone you then say you know blah blah blah, and they respond in a way that you don't like as immature as a general rule we all have to feel that our position is justified, and we're in deadlock when the other person doesn't agree with us and then we start to think about the other person as a bad person or untrustworthy or whatever it is that they're thinking exactly the same thing because they're coming at it from their point of view given their neurobiology given their experience shows.

 [00:48:43] You know it's a little bit like when you're in traffic you turn around, and you say I can't believe it there's so much traffic, but you never say I am Traffic Light traffic you know. And the guy next year is also thinking Oh my God there's all this traffic. So you're a part of that.

 [00:49:00] So I think that this is the interaction that we all bring in really bringing that of us to what this transaction is instead of simply pointing the finger loses an opportunity to include our own contribution to what's going on. The upside of that is that if we bring some contribution to some comfort, we're also part of the solution because then we can bring part of the solution to that. It's not just on the other person makes me.

 [00:49:36] I have to pull in a reference that only a handful of people listen to this might get but it's it all goes back to the Burt Bacharach song.

 [00:49:45] What we you know all we need is a little love like what the world needs now is a little love a little compassion.

 [00:49:51] It makes good sense. And I think that level of introspection is important at the individual connection.

 [00:49:59] Like I'd like to know that every teacher and every coach and every adult that mind children Iraq within their school asks that question of those questions I'd like to know that every administrator and leader can find a little bit of mindfulness to be tied to them. And that's another thing that I've heard you speak about quite eloquently as I say the word eloquently and I get it outright. This idea of mindfulness I've heard you lecture on that I've heard you speak to this. What is that for our listeners when you talk about that in the school setting in interacting with our youth and even how the young people that come through your door go back to some of the technology discussion but can you just explain a bit more. Sure.

 [00:50:49] You know I mean the when I had first heard about my this I was thinking about you know Tibetan monks up in the mountains and everything. So. So you know I mean some people like you practice very deeply mystical mindfulness. But if you were to just examine the contents of your mind at any given moment you know, you should think about that today. What do I have? What do I have, later on, you know? Do I have to? Do I have plans later on or what happened yesterday. And so is this image that you could just label the thought and that's just saying okay that's a future worry. That's a future worry. That's a past concern. So you would you say a future sort present sort past. And how quickly our minds get taken away from what's actually happening right now. Now thinking is what planning thinking is not a worry. Because often people get caught in ruminating thoughts spirals they say what happens is what happens. What is this is that you say OK it's time for that things happening so you can plan for something but then that rumination but then you can say you know we can get taken so much out of the present moment, but all we do is spend worrying about a part of a future that doesn't exist and the past that is no longer there. So, so that being present at least have a fighting chance of dealing with the present moment reality. So it's this idea of just like training the mind to focus on the present not to worry about the past or get into in a temporary thoughts tales about the future. So it's sort of a training in how you focus your attention. And you know actually, it's interesting that a lot of great sports teams are now introducing mindfulness as part of their curriculum and they'll often and say that it doesn't matter how many points we're down. All you have is the present moment. Do the best you can in the present moment. And many you know when you hear people being interviewed as well how did you guys do we can do this as I was just in the present moment. You know it's not thinking about the final outcome. It's just I can do the best I can right now. So so it's sort of teaching that rather than getting into religion because it or it can often people may feel offended by discussing mindfulness from a religious state. Well, that's not my tradition. But you don't have to go there. You just can go into the present moment awareness.

 [00:53:27] It gets me thinking about conversation I've had with friends personal friends who are who are therapists made their mark about that school of therapy which I only make the analogy of given your background in psychiatry obviously but that in the conversation in the room in the moment in that part therapy is is the one that in some schools of thought means the most and what I hear you saying is being present in the room what you can control in the moment and how it can influence you likely have the greatest impact on on on what will happen on the margins.

 [00:54:02] And I think that's another important.

 [00:54:06] Exactly. Because you're dealing with reality as it is. I mean you know whether you like it or you don't like it. Reality still isn't it is nice when you like where we are. Can really make it but not liking it isn't going to change it important.

 [00:54:23] So what I take away from this conversation in part if I can sum it up is are our youth are deeply affected by the technology their lives and the ability to communicate instantly and quickly and where their self-worth is is is is measured in that the antidote to some of the downsides because the risks from the upsides to the technology in our world. But the downsides clearly are personal, and the solution to some of that downside is the president.

 [00:54:55] Be mindful be in the moment be connected and help our art our youth know that there's somebody out there who cares for them and help them have a meaningful human interaction before they rely on the technology interaction. And when I hear you saying is that all these things together may help make today's youth a bit more resilient to some of the challenges they're facing around their social-emotional wellness.

 [00:55:22] And I think it's important that we do exactly that.

 [00:55:26] Also because you know parents themselves are overwhelmed that taking a little bit of side taking some time outside of school making it part of the curriculum is wonderful delays you know kids as a collective can get the best stretch of these ideas because I think you know you try to say to your own children Hey listen there's got to practice a match on this. I think one of my other friends are doing it, but he's doing it in schools as part of the curriculum. And then you know again that's just the expectation.

 [00:56:06] Powerful lessons doc. I as I listen to you and as I've gotten to know you. I.

 [00:56:12] I am so grateful that you are are doing the work you're doing at and that you are traveling the world and sharing these important messages with educators and parents and students and youth. And I know that we are we are all better given the insights you've been able to share so I want to just thank you so much for taking time out of your day for us and sharing your wisdom and insights and I'm looking forward to continuing our connection Well I think I think that first of all thank you very much for having me.

 [00:56:50] On this podcast. I just want to say also that I really appreciate what you're doing. I mean I also get opportunities to talk and to teach and order that. But I felt that the work that you're trying to do in terms of the upside of how we use technology in a thoughtful, compassionate way to address some of the worrisome concerns that we have for our kids is something I strongly support. And you know we were approaching similar programs through different methodologies, and this was definitely something I was willing to take some time off on a Saturday to do United worldwide means the world it was dark.

 [00:57:45] It really does. And with that, I want to thank Dr. Blaise Aguirre Harvard University psychiatrist and expert in the social and emotional wellness of adolescents working on the McLean Hospital in Belmont, Massachusetts. Thank you for making time for us today Doc and have the rest of a great day.

 [00:58:05] Thanks very much. Take care. Vega.

 [00:58:07] Taking a dive.