Episode 38: The Mindset for Longevity with Dr. Gina Clark

What if living longer wasn’t just about adding years to your life but adding life to your years? In this episode of the I AM Well MD Podcast, Dr. Gina Clark joins us for a deeply insightful conversation on aligning your health span with your lifespan.

Dr. Clark has cared for over 6,000 patients across 4 continents, holds US Board Certifications in Psychiatry and Addiction Medicine, and earned her DPhil (PhD) in neuroscience from Oxford University. With experience ranging from HIV work in Africa to physician wellbeing and forensic psychiatry, she brings a unique and holistic perspective to mental health and longevity.

We explore:

• How her unconventional career path shaped her medical practice
• The difference between health span and lifespan and why it matters
• Practical ways to cultivate an “evergreen mindset” for personal and societal wellbeing
• The surprising coexistence of happiness and sadness in a healthy life
• Why sometimes taking your foot off the gas is the healthiest way forward

Whether you’re a healthcare professional or simply someone seeking a more fulfilling and healthy life, this episode offers wisdom you can start applying today.

Connect with Dr. Gina Clark:
Website: drginaclark.com
Instagram: @drginaclark
LinkedIn: linkedin.com/in/drginaclark

Dr. Tanikella practices General Pediatrics, Integrative Medicine, and is an expert in Mind-Body medicine. She has traveled the world to learn more about the intersection where mind, body, health, personal beliefs, and motivation meet. She is founder and CEO of Integrative Approaches to Mastering Wellness, where she brings the wisdom of mind body medicine and the power of life coaching together to help her clients break through their glass ceilings.

Learn more at iamwellmd.com.
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Disclaimer: The information shared on the I AM Well MD Podcast is for educational purposes only and should not be considered medical advice. All health-related decisions should be made in consultation with your personal medical provider.

The views expressed by me are my own and do not reflect those of my guests, employers, or affiliated institutions. The views of any guest do not represent my personal or professional opinions. The content shared on this podcast is intended to inspire thoughtful reflection, not to provide medical diagnosis or treatment.

Transcript

Are you a busy parent? Do you feel like you're being pulled in multiple directions all at once? Are you exhausted and overwhelmed? Meet my mom. Her name is Santi Tanikella. She's a pediatrician, expert in mind body medicine, and a life coach. She can help you break free from guilt and overwhelm, so that you can enjoy the life that you've worked so hard to create. She can also teach you how to support your family in a more holistic way.

 Hi everyone. Welcome to another episode of the I Am Well MD podcast. Today I'd like to introduce Dr. Gina Clark. She has cared for more than 6,000 patients on four different continents and currently practices holistic mental healthcare in California. She has US board certifications in psychiatry and addiction medicine and a doctorate of philosophy in neuroscience from Oxford University.

She's also worked in HIV in Southern and East Africa, as well as domestically. She serves peers via confidential physician wellbeing work, and is involved with the Harvard Global Mental Health Trauma and Recovery Program. After being stalked by a former patient, she became a subject matter expert on forensic psychiatry and justice issues.

Dr. Gina Clark, welcome to the podcast. Thank you. Thank you so much for having me. We are so excited to talk more about all of the work that you've been doing. Give us a little bit of an idea of your path. Your path has been a little bit less straight and narrow than other people in medicine.

How has that influenced your day-to-day practice? 

So,  like you mentioned, I did a PhD in England before I went to med school.  I had intended to go to med school here in the States throughout. I had been pre-med in my undergrad and took the MCAT right before I went to England and so forth.

 And then I did, this HIV work in Africa during med school and residency on NIH fellowships.  I know that's not wildly divergent,  but I also recognize that a lot of doctors are a little bit more straight through. Like they go to college, they go to med school, they do their residency, and then they practice.

For me, it kind of hangs together and there's a thread throughout. I actually feel like I've  spent my time in areas of medicine and health that are like particularly sensitive. And so that's one kind of,  continuous thread. So my PhD was on brain structure and schizophrenia.

I practice, yes, psychiatry and addiction medicine. Now I've done a lot of HIV work, like,  sexual health, mental health,  addiction issues, like these are just particularly sensitive areas within medicine,  and areas that, you know, might be a little bit hard for people to talk about.  I've enjoyed being there for them and being able to work with them, with a pretty broad frame of reference about such issues.

And, and therefore I think being able to kind of hear and validate their experiences,  with a depth that's maybe not super common.  And along those lines, I think that  everything I've done along the way informs my practice every day. Like it affects how I take care of patients every single day. so that's been really nice.  it's been a great career.

 It seems like it. It feels like you've gone everywhere. 

 It's a big world out there, so it's like once you go out and see some of it, it, the world just seems bigger. Not, you know, not smaller. So it just makes you recognize how big the world is.

But also that, you know, there's more that unites us than kind of distinguishes us.  and that there's just so many universals and what people are doing in Zambia and what people are doing in San Francisco or like rural Iowa where I come from- it's all kind of the same. And there's something really beautiful and humbling about that.

I fully agree. I have done my share of traveling too, between college and medical school,  and it really has shifted my perspective on life, purpose, meaning, healthcare and where all of these things tie together. Yep. Something that I'm really passionate about is being able to live well, not just live, mm-hmm.

But to thrive. And so I hear that you wanted to talk a little bit about longevity today,  which is a super trendy topic, especially in Silicon Valley and amongst economists and scientists.  How can we sensibly connect it to some of what we know in medicine? Yeah, 

I would confess maybe that I was a little late to the Longevity party.

Since it was adopted by like tech people in Silicon Valley nearby, um, where I'm based and  economists and just all sorts of people who, who have kind of a different way of seeing the world from what I do. I was not very engaged with the topic for a while, and then I realized like, Hey, this is actually interesting.

It's something that we're all dealing with,  and certainly scientists, medical professionals, like we should be at that table having, you know, collaborative talks with,  like all the people who are interested in this, for whatever reason, they consider themselves stakeholders and like, we're basically all stakeholders because we're all, you know, on average living longer than we ever had before.

And that's a global phenomenon. It's not just about high income countries. You know, correspondingly we've known in like the global health arena for a while that noncommunicable chronic diseases are really like the chief concern pretty much globally. That's a difference from how it had been in the past and how, how some people might still think of it kind of intuitively, where there some people might think there's still more of a  divide between high income countries and, um, lower income countries in terms of communicable versus non-communicable diseases.

But really non-communicable chronic diseases, you know, diabetes, stroke, dementia, cardiovascular disease- these are major issues for the whole planet at this point. Um, so we're all in it together and, you know, and we're all living longer and we're facing some  challenges that go with that.

So like, let's just, you know, talk about it and think,  think about what we bring to the table. And I think in medicine, you know, maybe obviously we should have so much to offer and from sort of different areas of medicine,  kind of historically, I think that. Obviously preventive healthcare really matters a lot.

Everyone should be getting their age appropriate cancer screenings and cardiovascular screenings and so forth, getting our cholesterol checked, our blood sugar checked,  pap smears, colonoscopies, all that really fun stuff.  um, getting vaccines, all the, all the usual preventive stuff.

 and then I think also, you know, kind of as I alluded to, we can learn a lot from actually even global health because, you know, thinking about how different societies are faring as, as we all tackle,  increased longevity.  Thinking about some of the differences in terms of how health systems work across the planet,  and what we can learn from that.

 There's a really interesting book called Turning the World Upside Down, I think it's called by the. Former head of the National Health Service in the UK.  And it's about it, it came out a little while ago now, but it was fundamentally about what lessons kind of higher income countries can learn from lower income countries about healthcare provision actually.

So it that, you know, flip some, um, maybe outdated narratives on  those scripts and,  turns things on their head.  And also thinking about things from a sort of medical anthrop, anthropological point of view, um, with like collectivist versus individualistic societies.

And that's a very broad strokes thing and there's been, you know, a lot of rich literature digging into that.  but again, just how longevity plays out in, in those different places and how,  how we can learn from each other.  so I think global health is relevant. I also think things like palliative care, end of life care,  is relevant.

People who work in palliative care, people who've had experiences,  maybe with a loved one, having some palliative care, like, it really brings into relief that that's a time of life when,  things really get distilled down to their essentials.

 and what matters most, like, love, relationships, um, purpose,  the kind of big and small purposes that people felt that they served in their lives. Thinking about some of those issues that come up in palliative care just points to what the opportunities are for us to be focusing on throughout our lives. We don't need to wait until the end to be thinking about the stuff that really matters and setting aside the stuff that doesn't matter.

 so I think,  we can learn a lot  from palliative medicine, and then of course I'm in mental health.  I think we can apply things from mental health in terms of thinking about longevity and how to,  help try to superimpose our healthy lifespan or healthspan on our lifespan insofar as possible so that all the years we have, all the days and weeks and hours that  we try to fill them up in a way that feels good for us.

 There's been some really interesting studies with, with mental health and it's impact on longevity.  it can be a pretty profound impact. And some of it's like. Pretty, not easy to do, but simple.  things like avoiding substance use problems can add up to 20 years of lifespan. I mean, that is incredibly impactful.

 That came from a meta-analysis of,  12 million people in 24 countries,  that the first author was, had a surname of Chan, and it was in The Lancet in 2023. So things like that are just really interesting. Yeah. Thinking about like how to lean into kind of a mentally healthy identity,  and really embrace our kind of inner strength and resilience and know that like life is not easy.

Mentally healthy doesn't mean happy all the time, or a life of ease.  that's not reality. Like mentally healthy means like managing stress and um, kind of coping with it, moving through it,  being kind of fine overall, not feeling great all the time.  Having a range of emotions, feeling sad when it's appropriate, feeling anxious when it's appropriate and so forth.

 so I think, you know, just  leaning into those kind of concepts can really help us, too. 

You know, I find this so interesting because I feel like this has come up,  when you're looking at it from this more spiritual standpoint mm-hmm. Of being "deserving of."  I've heard people say like, this is, again, during my training, but even outside of my training, like folks who have gotten a new diagnosis of cancer say things like, mm-hmm "I did something terrible and I probably deserve this."

Which it just, uh, like it hits me in the heart when I hear people say or think things like that because who deserves a terminal illness, right? Mm-hmm. Like, nobody, nobody. Coming from a mental health perspective, like how do we ameliorate those sorts of emotions, those sorts of mindsets around our illness, because right.

It's these people that are thinking, okay, well, "I'm deserving of it," or "I shouldn't have to go to the doctor," you know, or, "whatever's gonna happen is supposed to happen." Like, these sorts of thoughts surrounding their health. H ow would you address that? Yeah. 

And I hear you. that does sound really heartbreaking.

 and it's interesting. I come across those things sometimes too. I also come across the flip side where sometimes people have a kind of rare chronic illness,  like some of the rheumatologic diseases and so forth, and they'll, they don't feel like they did something wrong to deserve it. They do sometimes feel alienated because so many of the people around them are healthy and don't understand what they're going through.

So,  there's that. But yeah, I mean, I feel like there were a few like big take home messages in from med school. One was that there's no such thing as a good disease.  I had done a PhD on schizophrenia prior to that, and I was like, oh man, schizophrenia is such a terrible illness.

 you know, if you're messing with someone's mind in their ability to relate to people and their loved ones, like, ugh. Like that's just so heartbreaking and compelling and,  what could be worse than that?  then I went to med school and I was like, oh wow, schizophrenia is a bad illness.  it actually unfortunately hasn't cornered the market on bad illnesses.

Like, they're all really bad. So there's that, there's no such thing as a good disease. And then another big take home message from med school for me was that getting a disease is mostly a matter of bad luck. Helping people know that and internalize that. You know,  I work with people

with alcohol use disorder,  who may have liver disease or, or other kind of medical impacts of that. I work with people with HIV,  which can come about for different reasons. It can have to do with some, um, like unhealthy decision making in terms of,  sexual behavior. It can have to do with some unhealthy decision making in terms of substance use, IV drug use, or, substance use, and then how that relates to sexual behavior, decision making. Even in those circumstances where some people might wanna start to point fingers, like it's still, there's so many things about it that are just a matter of luck. Like,  Even things that you think would be really black and white, like you and I know from medical training, there's variability in terms of how susceptible people are to being infected by HIV.

So there's some genetic variation there. There's some gender differences actually. Like there's, there's just a lot going on, um, that you don't have control over.  Talking with people who might have,  some of this really yeah, heartbreaking kind of self-talk about being bad or doing something wrong and they're therefore deserving any bad outcome, including cancer or some other  terrible health situation.

Providing some more information like working through that self-talk, but also like just confronting them. I'm a medical doctor. I see a lot of things. Like, believe me, you know, getting a disease is mostly a matter of bad luck. I'm sorry this has happened to you.

I get that you're trying to make sense of it and therefore like this is a narrative that you constructed, but hey, like, uh, you need to recover, you need to heal, you need to be as well as possible. Sorry, I'm a psychiatrist. This is the sort of stuff I think about this negative self, self-talk isn't gonna help you get there,

so we really need to shelf that like asap.  and how, how can we work through that to, to get to that place. 

Yeah. And I think that's really helpful to hear is, you know, even from the point of view of a psychiatrist is there are thoughts that are gonna be helpful and there are thoughts that are gonna be harmful, and then there's a bunch that are neutral.

 so being able to kind of shelf the bad thoughts or the, the thoughts that are really gonna keep us stuck,  and really leverage the thoughts that are going to help us move through some of the hardest parts of being ill or chronically ill, that's really where the money is. It's being able to also take some responsibility for what happens next, right?

Mm-hmm. We can perseverate and perseverate on all the things that happened in the past leading up to the present.  We can try to seek meaning from them. But if it's, again, in a way that's not very helpful, I don't think that that's really going to help drive us forward. Mm-hmm. Um, one of the things I, I have also found was just being able to find a goal for the future, whether it's the near future or a distant future, right.

Like a child graduating from high school, like "I wanna be able to walk with my child or take pictures with my child on the day they graduate from high school," really helps us to be able to refocus our attention away from the  sadness surrounding illness so that we now have a

goal to work towards. So for a diabetic, for instance, one of the things that diabetics have to deal with is diabetic neuropathy or injuring themselves. Um, and not even realizing that they've injured themselves because they don't have that typical normal sensation in their legs and feet anymore.

Um, so how do we get our blood sugars under control again, so that we can in 10 years walk with our child at, you know, on graduation day. For me, this, this is the piece that I find really fascinating about health and medicine is how do we leverage the best parts of our humanity to be able to live well?

Yep. For me it's kind of harder 'cause I do it at a very young age. So reasoning with a three-year-old is not Exactly, yeah. "We don't run across the street, honey, because that's dangerous." Like, they're like, "okay, well you know what? I'm just not gonna listen to you." We're gonna be very, very, uh, impulsive with our behavior because we're three and you know Yeah.

Kinda how it rolls. But adults, like, I think it's a little bit easier to, to find and hang onto those meaningful things in our life that we wanna see more of. 

I agree.  

So another thing I wanna talk about was, you know, even just in terms of mental health. 'cause I, I am loving that you're on the show with me today because I'm so passionate about mental health and mindset.

Mm-hmm. And being able to create almost like a ladder or a staircase for ourselves to be able to get into healthier ways of thinking so that we can really enjoy our whole lifespan, and be able to pair that with good health. What are some words of advice that you have in that area?

Like what can we think and do to be able to match up our longevity with our lifespan? 

Well, you know, following from what you were talking about just now, sort of highlighting that, there's a lot within our power that we know about and, you've spoken quite eloquently to this prior episodes about the importance of physical activity, nutrition, restorative sleep,  avoiding risky substances.

And,  I like how in a prior episode you spoke to like being really mindful about ingesting any sort of toxicity in our lives, whether it's in relationships or through the media and so forth. I, I thought that was, uh, a really good point. So there's all those things which we all know and we're all sort of executing on decisions with every single day.  and again, it's not complex. A lot of it's simple, but very hard. Simple does not equal easy. Like, um, it can be like very hard to execute on these things in a, a positive, constructive, healthful way.  and so I think, you know, following from the, some of what you said just now, it helps to drive like healthy decision making if we have  an underlying mindset that supports it.

 so that it's not just like, okay, do I have the salad or the  burger and fries, to have, you know, like you, you spoke about having, events to kind of hinge on, to work toward,  to guide moment to moment and day-by-day  healthy decision making. An additional way to 

Conceive of that is this concept of the evergreen mindset, which is something, well, I'll say one quick caveat about that, which is, it's a new concept to me makes a lot of sense, uh, is fairly intuitive. And when I looked into it, I saw that "evergreen mindset" gets used in a couple of different ways at least.

So there's a sort of long standing,  religious,  use of the word evergreen mindset or the term evergreen mindset. And that's not what I'm familiar with or addressing. So I just wanna recognize that, that this might be a term that's used by people for other purposes.  but I came across this evergreen mindset from a book on longevity called "The Longevity Imperative," by,  Andrew J.

Scott, who's a economics professor at the London Business School. And he made quite a compelling economic argument, for us to kind of reframe how we're thinking about longevity. He talked about things like,  older people are the largest emerging market in the world, but it's a very neglected emerging market.

Like, why don't we get on top of this in terms of some of the economic and business opportunities.  he addresses a lot of that, and I'll leave that sort of business and economic stuff to him, and his colleagues. But he also did touch on the, well, he talked about like the evergreen society, the evergreen economy, and an evergreen mindset, which is really about having a sustainable,  evolving- because we're different at different life stages,

we have different priorities and different strengths, so evolving, but yeah, sustainable,  approach to life where we're seeking to grow, contribute, work, have leisure, and again, a sustainable way throughout life. That's in contrast to, uh, a kind of, formula about life that's been in place maybe since World War II or so,    when longevity has been increasing and we have had maybe life chopped up into thirds,  might be kind of common right now where a third is about education. A third is about working.  and then a third is about retirement. I think in reality that's actually been like a quarter and then a half, and then a quarter for a lot of people out of baby boomers in particular.

And I think what that has resulted in is that at the end of the working life and heading into retirement, sometimes people are a little bit to like, their, their physical bandwidth, their kind of emotional and spiritual bandwidth is a little bit too,  consumed or chewed up, by all those working years and raising their families and taking care of aging parents and so forth.

 And so they kind do a lot, produce a lot and offer a lot to society. And then they kind of get sometimes a little bit spit out at the other end of it. And that,  doesn't feel right to me.  Like, what are we doing to ourselves? Or how are we letting this happen to our,  fellow citizens, friends and neighbors in society.

 So anyway, the evergreen mindset,  seeks to like, reconsider that and, and think like, okay, let's just again have a more kind of sustainable approach to this where we're not. Giving 110% for a while, but then inevitably being consumed by that, let's draw this out in a way where, again, we're kind of pacing ourselves differently and respecting that.

 also like in what would be typically retirement age. Now, maybe we want to find ways to still contribute or even work  and maybe that makes sense with some of the economic needs of a society,  a society with increasing longevity.  and, you know, whether it's France or the US, Denmark, it, you know, the, the equivalent of the social security system and Medicare systems and so forth are,  those systems are being challenged and strained by the, the current practices.

There's economic reasons to rethink this.  and I think also just in terms of. Like meaning  and purpose and structure in life- the things that can really help kind of buttress our mental health- there's reasons to reconsider it  and try to have a more evergreen approach.

I also think if we have more of an evergreen, that it will help us value all generations in  a way that's better than how we're doing it today. Especially in the states where I think we can undervalue people later in life. We can also undervalue young people, or we can be a little dismissive about some of their interests and priorities.

So I think this evergreen mindset would, would really  bridge some of those current intergenerational divides.  I think it would also get some later generations a little bit more on board with what some of the younger generations are saying about life work balance and so forth.  it would just 

just create more consonants society or societally around that.  I also think it could help kind of with that,  trough in midlife that can happen now with, you know, midlife crises and also burnout. and this kind of sandwich generation challenges. It could help just have more realistic expectations and, and kind of  lighten the load for that sort of midlife chapter for people.

So I think it could, you know, just have a lot of benefits that definitely help with like mental health,  in pretty intuitive ways.  and I think just make our society more functional and sustainable. 

That makes a lot of sense to me. You know, and I, I agree with you. I have seen that with the baby boomer generation, like my parents' generation, right?

Like. They got married, they worked, worked, worked, worked, worked. They were very loyal to their workplaces and they stayed until they hit retirement age.  and so it's a really, you know, I think you've hit the nail on the head here with this is, you know, when you're working so hard and you feel that your focus has to be on work and productivity, it leaves you in a place that is devoid of fun and joy and you actually place less emphasis on those things because you think that they are less important when in fact, actually we need those things in order to feel whole and healthy and,  and to want to live, right?

We have to want to live.  and, you know, who wants to live in a lifestyle where all they think that they're valuable for is the work that they do, right? That's a very two dimensional way to look at a, a human being.  and so I find that that's definitely the case. A lot of the parents that I work with in the clinic setting are, you know, twenties to fifties.  They're in this period of time in their life where they are trying to raise young children. They're trying to work, they're trying to make money. They feel like their head's about to fall off because they're so busy.

I have a lot of moms who are often in tears because they're just so exhausted and so, you know, how do we try to bring joy back into their lives? It is this use of community, it is being able to count on our elders to help us to raise our children, to be able to be a voice of reason, to, to help buffer the stress of all that, right?

There was this emergence of the nuclear family as being the end all, be all, and I think for some families that is necessary, right? It is necessary to, to have healthy boundaries when there is a grandparent that may very heavily disagree with you on parenting styles or may downright not have the best interest of the family at heart.

Um mm-hmm. Right. And, and I say that echoing the experience that I've had with child abuse,  unfortunately. so yes,  there are places where boundaries like that are necessary, but there are also areas where, you know, we have grandparents who dote on grandkids. And being able to let go of a little bit of control to be able to get them into our communities, to allow our grandkids and the grandparents to bond without interfering necessarily in that bond,

to use this time for our self-care and maybe some, you know, for work, right? And then to be able to come back to the family unit feeling a little bit more refreshed and not like we're a chicken with our head being cut off.  There's so much to be said for that community piece there.

 So many of the things that I heard you say, you know, were so important to me because,  Gosh, was it 2023? I wanna say it was 2023 that I was watching Netflix with my husband. And there was this  Netflix series called "Live to a Hundred: Secrets of the Blue Zones," featuring,  Dan Buettner. And he was talking about various blue zone communities in which they were known for their exceptional longevity.

 mm-hmm. And I think some of these places included Sardinia, which is in Italy, it was Okinawa. Mm-hmm. Uh, there was a place in Greece, is it Acaria? Acaria, I think. Yeah, sure. Area of Costa Rica. And even in California, actually, Loma Linda, California, where they looked at these sites and tried to figure out why these particular communities had such beautiful longevity.

And I don't wanna just talk about long lifespan. Yes, they exercised a long lifespan, but in their, in their older decades, these guys were still walking, talking, gardening, playing,  but what was it that they're, I think they were playing tennis or, something. But I was just like, wow, these folks are like, I hope when I'm in my eighties and nineties that I'm like that.

Like I want that lifestyle when I'm older.  and really what they found was that there were specific exercises that these populations were engaging in that allowed for this longevity to occur.  I believe part of it was dietary. They exercised mostly plant-based diets.  they. Uh, performed movement that was natural to them.

So whether it was climbing stairs or,  walking for distances to go to the grocery store and then coming back,  they had close social bonds with all of the generations that were after them and with their communities, and they felt a sense of purpose that they, they had a reason for getting up in the morning, which that, that piece was so profound to me.

 mm-hmm. To hear them say that for that generation, I was like, Ooh, yeah, why wouldn't it be important in my eighties and nineties? Of course it would be.  so yeah, I just feel like this, this is the stuff that I want

children to learn too. Like what is it that's important to you? Right? Because that's the sort of stuff that will carry them throughout the hardest parts of their lives, right? Whether it be becoming a new parent or starting a new job, or maybe getting the rejection letter from the college that they really wanted to go through, go to, you know, it's being able to have that higher goal in mind, which is, you know what, we don't have to go to Harvard necessarily in order to be an amazing social worker, as an example.

It's what I do with my life that makes me an amazing social worker. Like not the degree, necessarily. Um mm-hmm. So, so 

cool. Yeah, no, I agree.  I watched the  Blue Zones episodes as well.  and I think. I, I tend to be better with scientific literature than tv.

I just, I'm, I tend to be outta the loop about tv, but I did see that, and I also saw this Netflix film documentary called "Don't Die." And then it had like a subtitle, um, about this guy Brian Johnson, I think, who is, you know, very open about his like,  uber, you know, kind of approach to trying to slow his aging actually, and, and,  you know, improve his longevity and his health span and so forth.

And, and one thing that I noticed, like I paused it in the,  the Don't Die Show with Brian Johnson. There's times when in, in that movie, they,  they show text on the screen like different like metrics that he's, he's monitoring about himself and,  and other things. And there was one where it, it said,  good mental health and it said 15 years.

I think I, I could be wrong, haven't seen this lately. But,  it was listing different things that,  increased longevity and mental health was 15 years, which was one of the longest ones, if not the longest one. So again, it gets back to that  Chan study about, you know, up to 20 years of  increased longevity or increased lifespan if you can have an absence of, of mental health disorders.

Again, that was 20 years for substance use disorders, but it was,  15 to 17 years for schizophrenia, eating disorders and personality disorders, and then almost five years for other disorders.  Then about the Blue Zones.  I remember one thing quite strikingly from that, which illustrates a related point.

There was one of the women in Okinawa that was featured, I think it was a woman who was doing gardening, to your point about like physical activity and also kind of natural movements, um, and growing her own food, all sorts of good things. Okinawa suffered a lot in World War II. There was this moment in, in that documentary where it showed this woman, looking up with her garden in the background, she's got a big smile on her face. This like beautiful older woman saying about the terrible times she had in World War II and I think she lost family members, just, you know, she was a young girl, saying that she is so glad that she crawled out of that hell hole and survived. And that speaks to an interesting point that I touched on earlier where like, "mentally healthy" doesn't mean like an easy life or, being happy all the time. And I think there's a little confusion about this in American society right now anyway.

'cause there seems to be an expectation that things should be easy or you shouldn't get sad or   you should be happy. We have a real fixation with happiness in the United States. We need to let some of that go 'cause that's not reality, that's not life. There's a lot of interesting studies showing that we need to experience actually

some pain and some sadness to fully appreciate what joy and happiness are like. And, and we really like that poignancy like the contrast of the two because again, it just really gives meaning to the good if we've experienced bad to some extent. And there's another concept here that's relevant of the stress inoculum, which is, that we should experience and be exposed to a certain amount of stress, whether it's kind of physiologic strain on our immune system, for example, to make our immune system stronger, like,  with vaccines.

And,  but also like with our mental health, and I see this in my practice,  people who  have had. Kind of easier lives or just a lot of privilege or a lot of things going their way. When something hard comes their way, they, they're just really outta their depths. They don't know what to do with it, and it throws them for more of a loop than, than it should, kind of on average, and then it does for other people who've dealt with some kind of adversity along the way.

So with the stress inoculum, the, the concept is that there's kind of a Goldilocks spot where, you want to experience some, some adversity, some stress and strain because it shows you what you're made of. It shows you your limits, which is important to know to and to respect, and just kind of tells you who you are, and gives you depth, and character,

and deepens your ability to empathize with people . People who haven't had much stress along the way tend to have a more like shallow understanding of themselves and the world. All that said, it was kind of a sweet spot. A person can only endure so much, especially at once. So I, I really respect that too.

Yeah. 

Different people can tolerate a certain amount of stress before they snap.

Being respectful of one another's tolerance for stress is really important. Mm-hmm.  but also to your point, you know, being able to, and  I'm gonna say intentionally because sometimes stress comes and it's not intentional and the timing is horrible.

Like the loss of a loved one, like there's no good time for that, there's no good time for that.  But a different example would be like public speaking, right? Like mm-hmm. You know, being petrified of public speaking, and then learning how to do public speaking, and doing it anyway. Even if you've got the trembles.

I say this because even though I have a podcast, I definitely have gone through this before in my past. Mm-hmm. I hated public speaking when I was a kid.  And you know, you grow to be able to get used to it. Are there times where I still get nerves nervous about public speaking?

Absolutely. Absolutely. And I'm like, how old? Too old. Right. Too old to care. I shouldn't care anymore, but I still do. Right. In any case, it's being able to note a challenge, meet the challenge, mm-hmm, overcome the challenge, and reflect back saying, "wow, I did that. I did that. I'm capable." You know, and the beauty of that as, as being able to add that to your structural foundation as a human being,  being able to kind of use that as a stepping stone to be able to do more in small bite-sized pieces that are tolerable, right.

That provide eustress as opposed to distress. Right. It's just enough to light a fire, not enough to make you snap. That is, to me the definition of a sweet spot. I don't know what you, what your thoughts are on that, Gina. 

Yeah, no, I agree.  in kind of preparing for this,  podcast I was thinking about eustress versus distress and, you know, and also thinking about  healthy anxiety

which tends to be  associated with targets that need kind of extra attention and kind of extra oomph from us,  versus unhealthy anxiety where often that becomes too generalized and is showing up with targets that it doesn't need to be attached to.  so I was thinking about those things.

 but in terms of the sweet spot, I think also something that comes to mind is, 

yeah, it's interesting. I feel like part of like our responsibilities as  humans, especially adults,  but as humans is like being honest with ourselves about what our strengths are, what our relative shortcomings are or limitations, and then with the shortcomings and limitations, like figuring out which ones we can tackle and we can work through and we can kind of set aside, 

In the ways that you just described, like sort of in bite-sized chunks and then,  you know, and then you get there in the end. That sort of graduated exposure, if you will, is another way to think about that.  But also,  sometimes there's ways we can just compensate for our shortcomings, rather than sort of directly work through them.

We can just do workarounds that can make sense.  And then also figuring out like, what, what just are our limits?    People have different breaking points.  Like people's limits  are set in different places and I think, yeah,  as humans and as adults, we have responsibility  for just being honest with ourselves about

where our limits are.  I think just for what it's worth,  I think in medical training and med school and residency, part of the process of that is like pushing people to kind of feel out their limits to see like how far out they are. so that, you know, if it's five in the morning and you've been up for 26 hours already and another patient comes in with a heart attack and really needs all of your  energy and all your resources, you gotta dig deep and be able to do it.

 like so you haven't hit your limit yet.  or maybe you're kind of shoving it a little bit further out. There's some value in that. and yet there's this need to, you know, I've just been talking about the evergreen mindset and,  having a sustainable, approach to life. And that doesn't fit very well with like 30 hour shifts and whatnot that we did in residency.

And even as I was saying that, I was like, you know. I've worked hard a lot, like I work hard now. I like, I work really hard. I work really hard while I was dealing with the stalking situation and going to court on top of trying to manage  everything else in life. Definitely keep  my medical practice going.

I worked really hard in residency. I worked really hard in med school. I worked really hard when I was finishing up my PhD. It's sort of like, I don't, that's a bit of a default setting to me. Like, I know I can work really hard and so some people like myself, who just have a lot of irons in the fire and a lot of responsibilities and a lot of, things that they're really trying to live up to and, and perform for or, be there for really important things like their families, like.

Mm-hmm. Um. Recognizing that maybe your MO is to work really hard, but in a way that might not be serving you well or in the long run isn't gonna serve you well. So just thinking about like how to reshape that, or recalibrate where possible or try new things out, like do little experiments with, taking your foot off the gas in, in certain areas and so forth.

And this doesn't just apply to people out there. It's like, you know, something that I'm actively thinking about, as I'm mid-career and kind of midlife and thinking about like, where's this going? What do I want that to look like? How do I get there? And is is the way I've been doing things-

maybe that served me well in a lot of ways to get me to where I'm at. Maybe it's gotten in my way somewhere along the line, and I kind of downplay that. In any case, the way I've been doing things, is that how I wanna keep doing things or is that how I get to where I wanna get to? Maybe things have shifted or maybe things have changed, or maybe you just, we see things differently from how we did before.

So, you know, just kind of allowing myself to, think that through and explore those spaces, I think is, part of the task right now. 

Absolutely. I mean, I feel like the version of myself from age 25 to now, there's a lot of similarities for sure. Like, I'm still that person who is hardworking, conscientious, you know, the people pleaser that, you know, like, I want to help, I'm here to help.

I feel that I'm, you know, that is part of my purpose here on this planet is to be of service.  perhaps elements of that people pleaser self have started to settle down a little bit, right? Like, I don't know, something magical happened when I turned 40 and I thought to myself, oh, I have hit midlife. That sort of shift kind of quietly internally happened to me where I was like, yeah, you know what?

I am an expert in my field. I have a right to feel good about what I've accomplished. I don't have to feel "less than" anymore and I don't have to accept it when people want to believe that I'm "less than." I can walk away from those individuals and keep self-esteem intact as opposed to dissolving into a puddle of tears about it.

 So, it's very interesting that this evolution happens and it can happen very quietly.  and we may not notice it. And I find that as that evolution is happening and, and we are outgrowing our shell,  that, that process of about growing the shell hurts. It hurts to come out of the shell. And then there's that period of vulnerability where you feel naked.

Like you've come outta the shell, you're naked and you're looking around. And which, which is the next shell that I'm going to inhabit? You know, is this a good fit? Does that fit me? Does that fit me? Does that fit me? And so, yeah, there's this process of let's try this on and see if it's a good fit.  and if it's not, we move on.

We move on, we move on, until we find something that suits us. mm-hmm. But there is so much fear going into that process of finding what fits, that this can, this can be a breaking point for many people.  and you know, when I think of what you do in your work, which is with addiction, right? Like sometimes this breaking point for people can be that slippery slope into addiction.

And, you know, for me, addiction, right, like in the pediatric population, it looks different, right? We have the classic, you know,  alcohol and drugs and stuff, but then there's like the stuff that's a little pettier, like shopping, addictions or mm-hmm. You know, device addiction or mm-hmm gaming addiction, right?

These are things that are real, right? They are maladaptive responses to the things that we are facing in our immediate environment as a means to be able to avoid the thing that's in front of us, because it's too hard to deal with it. Mm-hmm. So, you know, how do we then lean into the discomfort of what is really happening to us when we're trying to shift, you know, how, like, what words of advice might you have for someone like that who's just like, really tempted to go shopping Yeah.

Or hit the bottle, right? Like, 

you know. Yep. Yeah. No,  I hear you. One of the kind of fundamental, well, I'm gonna back up here again and say two of the fundamental things that happen in psychotherapy actually,  are one is,  identifying the ways in which we self-sabotage and stopping that.

 and I'm just really struck in my life and career, like going places, living in different places, working with lots of different patients one-on-one, but also kind of seeing how things play out societally and whatnot. Like it is in human nature to self-sabotage. We do it on an individual basis with many of those things that you just described.

we do it in relationships, we do it as societies and cultures, like we're actively doing it.  in many examples across the planet right now.  So that's a, like, why on earth would we do that as so like evolutionary, evolutionarily disadvantageous, and  like why do we get in our own ways? But boy, we do . One of the main points of mental health care often is to identify the ways in which we do that ourselves individually, and to stop it.

 so that definitely has to do with addictive behaviors, but it al also has to do with, you know, emotion regulation for some people.  some of the phenomena that go on  depression, like negative self-talk and, and,  seeing the world with a kind of a negative filter and so forth.

Like these are actually arguably ways to cope. Again, they're maladaptive though, like you, you spoke of maladaptive ways to cope. And so just like working that stuff out of a job, taking a different path. And then another big take home message from psychotherapy, I think is that,  it's about tolerating the discomfort of ambivalence and ambiguity, just tolerating discomfort,  about whatever.

Like we need to be able to sit with discomfort within reason,  and not have it drive us into some maladaptive coping strategy. So,  I, I mentioned the ambivalence part because very few things are crystal clear, kind of black and white in our lives. Most things are complex.

They're nuanced. They're in the gray zone. They're in the middle. That takes more cognitive work to, to manage, to get your head around.  and it. It's part of life, it's part of being a mature adult anyway. And if you're not kind of doing that well, then it just creates problems and starts to get in your way and self-sabotage you.

So, like those are things I think about for kind of psychotherapy targets and psychotherapy is just a microcosm of like life.  in psychotherapy is just one thing to think about. You know, people might, wrestle with some similar concepts, but maybe using different vocabulary through their kind of religion or their spiritual practice or,  you know, maybe some sort of, physical endeavors that they do, whether it's mountain climbing or, their exercise routine or whatever.

Like, or it could be things that they wrestle with, but again, using different vocabulary through meditation.  there's, you know, whatever works with people take it and run. But I think these are the sorts of things that we're fundamentally grappling with. 

I will say one thing in terms of just mindset, one thing that helped me immensely, like when I have hit periods of burnout in various stages of my life and career.

'cause , I've had burnout in life right after my first child was born and him never sleeping and never eating. It was very taxing for me.  But also with my career, right? The 30 hours of call straight every three days and then, you know, not being able to see family , or friends or loved ones for periods of time just because the workload was so high.

During these times, I would reflect back and say like, "okay, you know, I've come really far and can we do a little bit more? Can we eek it out a little bit?" Mm-hmm. But one day came where I couldn't, I just was just like, whatever happened in this situation was just so bad that I couldn't figure out my way out.

There's no amount of meditation, mindfulness, you know, like they're helpful for sure. That helps build awareness. But it didn't solve the problem. And it was really interesting because this was right when I was doing my life coach training. And what came to mind for me was from one of my teachers, and it was the thought of, "don't ask why this is happening to you.

Ask how this is happening for you." And this, this reframing changed everything for me. Mm-hmm. Because it took what was a bad situation that I had taken really personally- it made it objective and then it created a staircase out. And it was shocking to me how simple this one phrase was. Does it mean that I quickly, you know, got out of the situation?

No, but I was able to build a ladder and I com I continued to build that ladder to, you know, I built that staircase out of that situation so that it never happens again. And if it does, I have that sense of resilience, this, this knowledge of myself that I can really easily move out, you know, push it away or even avoid it in the first place.

Like, okay, I've seen that path before. We're not doing that again. You know why? 'cause I'm 40. No, that's the upside. The upside, right? Like, but, but no, I mean, it's not just about age, it's, it's really truly this, this piece on resilience, right? It's, "I've seen this before. I know where this can take me, here are the boundaries that I'm gonna put up. And if you are not okay with my boundaries, and this is, this situation was not meant for me."

Right? Yep. So that is how that old situation that brought me so many tears and, and really shook the, the foundation of my core, that is how I, I moved forward. So, mm-hmm. 

Thank you for sharing that. I think it's just so illustrative, little illustrative of so many, like, powerful and beautiful, but,  poignant actually things,  not just like exclusively good, of course,  but made all the more powerful because it's this mix of difficult and triumph.

and it makes me think of this, I'm no great Buddhist, but, there's some work by, I think by Pema Chodron who's a Buddhist nun, where. There's another one, another woman, I think Ann Halifax, I think Halifax, I, I'm pretty sure is the last name. So it's one of the two of them. But I think this is just common kind of Buddhist thinking that you can take the worst things that happen to you in your life and then think like, "okay, how do I turn this into a gift?"

 and it can be like, whoa, like that's a big ask. You know, like at first, like, that's a tall order.  or that's really,  putting lipstick on a pig or, you know, like it just can seem so farfetched. But I've thought that I've, I've drawn from that sort of, thinking in difficult times too, where it's like, this just seems bad and sometimes things are outta your control, like getting a disease.

Actually again, it's a matter of bad luck more than anything. And, I also, like, in my experience. Being stalked, by a, a former patient. And then, so just my experience of being the victim of crime, that's not unlike getting a disease. Like it's a bad thing that happened to you through no fault of your own, um, that screws up your life at a minimum.

You know, takes your time, energy, money, or hurts your relationships. You know, just potentially, has a lot of negative impacts can physically hurt you and even potentially, you know, obviously with diseases and even with some crimes could shorten your life. So, you know, things like that, just like pretty bad.

 and then to have some, some Buddhist come along and say, okay, how is this a gift? It's like, gimme a minute.  but then, you know, I think,  we do find that with time that there are silver linings and  things like post-traumatic growth and phenomena like this come in where there's good that comes from

the worst things we go through sometimes. Not always. I, again, I don't wanna actually put lipstick on a pig. Sometimes, the worst things we go through end up being kind of the richest times of our lives, or the most productive, and spur the most growth. Sometimes they don't,  sometimes bad is just bad.

 so I wanna recognize that too. But, but it's interesting kind of, you know, I, I'm with you.  I'm sorry to hear about the bad time that you've gone through. I get that you've come out stronger for it, like clearly and,  and more equipped to kind of slice and dice other challenges that come your way.

 so well done.  and yeah, it, you know, and I think that often happens, but it's not easy. It takes a lot of effort to get there. 

So, yeah, I, I agree. I don't wanna minimize Bad. Bad is bad. And my heart goes out to folks who have experienced all levels of that, you know, grief, loss, trauma, you know, it's not, the situation still happened no matter what.

Right. Yeah. It's, it's what we are able to make of it and yeah, sometimes it does take space and time and grief and 

mm-hmm. 

You know, to what you said about like, America's fixation on happiness, this is it, right? This is, it is living through the hard. Yeah. Recognizing that it is hard. We don't need to put lipstick on the pig, you know?

but at some point or another, there comes a time where there is a readiness to move on. It doesn't mean that we forget necessarily what we've been through, but that we honor what has happened to ourselves in those moments. So. Yeah, well put. So Gina, as we come to a close, I wanted to express my gratitude to you, and I also wanted to ask one last favor, which is that this podcast is really meant to heal ourselves, our children, and our children's children. Do you have any last words of advice for our listeners? 

I just really wanna echo what you just said about honoring our experience. I think that's so much of what all this about, you know, and if you wanna get into nuts and bolts of longevity or mental health or preventive care or lifestyle modifications, it's. It's all really in service of honoring each of us as a unique human with a lot of potential.

And then also the potential of the collective good when each of us does honor ourselves. That's a way of honoring humankind, en mass. I think that is a nice way to take a step back and think about the big picture. So thank you for bringing that up and I would just echo it.

Thank you, Gina. How can our listeners find you?  they can find me on LinkedIn,  Gina Clark, MDD Phil, or,  Dr. Gina Clark. I also have a website, drginaclark.com and I'm on Instagram with the handle Dr. Gina Clark. Awesome. 

Thank you so much Dr. Clark for being on the podcast. 

Thank you. Thank you for having me.

It's a pleasure.  

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