neither the el paso medical society its members nor pbs el paso shall be responsible for the views opinions or facts expressed by the panelists on this television program please consult your doctor [Music] may is national mental health month and don't we need a little bit of help with that right now the human brain is responsible for our cognitive abilities also our emotions and our behaviors we know that but we're going to talk a lot about that this evening there's everything that we think we feel and we do and it's all going on up here but also going on in here so we have some different emotional states that can be medically detected with some advanced brain imaging technologies that we've been doing for the last six seven eight years but there's more and more happening every day and in the near future we will uh help to understand and better serve those suffering with mental illnesses with a lot of these technologies that are happening now during this next hour we have some physicians that are answering your questions and my questions because i have a lot of questions your questions on mental health and as you know this is a live program so give us a call with some of the questions that you have that telephone number is 881 zero zero one three this evening's program is underwritten by peak behavioral health services and we also wanna say thank you to texas tech paula foster for the medical students that are being provided tonight to man our phones and the questions are gonna come to me via my telephone so please again if you have some questions call in that number 881-0013 we also want to say thank you to the el paso county medical society for bringing the show to you each and every month i'm katharine berg and you're watching the el paso physician [Music] thanks again for tuning in we're talking about mental health may is mental health month and it matters i think i don't know when that became a thing but i feel like mental health really over the last two decades is something that we're starting to talk about more and really the last decade has been something like you know what these are my issues let's talk about them we're here to talk about that this evening we have dr peter sangra with us and he is the child and adolescent psychiatrist at again pa peak behavioral health services and we also have dr harry silsby who is the vice president of medical services and i gave a quick decision of what your titles are but really you have so many things going on so dr sandra if you can talk about what encompasses what you do throughout the day i know that both of you get to have any questions that are thrown your way but when you're talking specifically about child and adolesce adolescent yes pardon me adolescent psychiatrist it's hard to say all together didn't even think about doing that out loud before i got here but what is it that if you can explain to home to the layman's audience what does that mean so you know this is usually a time when the families in transition are crisis and they need support so first thing first is explaining to the family what's going on right because their child just got taken away and they're in this strange building sometimes miles away from home sometimes even from a different state and it might be the first time that they even left home and you're talking about the immigration situation we have going on right now sometimes that too but more than frequently from different parts of new mexico different sometimes arizona we had one kid come from california so like really far away so they found me themselves and the children find themselves in this predicament with a serious mental illness and maybe thoughts of suicide right so the first thing is just educating the child and letting them know what's going on the process and then inviting the family in in that conversation and then getting more information of like what's going on what led up to this admission right and then just helping them guide to the treatment and we'll talk a little bit also about sometimes when there is not a family member involved when there is just the individual themselves and will build up a little bit as we as we get there as well um and with you i'm just gonna in my mentality i'll just kind of stop questions of 18. when you think about adolescence and or child psychiatrists is that about 18 to 21 what age group would that be sure so at peak we can see children from 12 to say 17. okay in my category but i have been trained to um you know five and under okay five to 12 or whatever you want yeah and there's a lot of issues there too and dr silsby um we know each other from different areas and dr silsby has served in the army and there's a lot of ptsd questions that we're going to talk about this evening and you are the vp for medical services um but i think you said you're in the army did you say 17 years or so you were a flight surgeon for seven years that's what it was flight surge for nine years oh for nine years was um a psychiatrist the rest of time was an administration and former deputy commander william beaumont and i've served 20 years and you've seen a lot in this time you were in vietnam as well okay um it's it's almost unfair to say what do you do all day every day because i know it encompasses a lot but if you were for the sake for this show uh this evening how would you describe to the audience at home what it is that you specialize in now well you know peter of course has had special training in child psychiatry and is really wonderful with the kids i didn't train in child psychiatry but i have special training in chemical defendants and what i do now is primarily treat adults and what the adults we're seeing now a lot of them have co-occurring disorders so they may have a psychiatric disorder or depression of bipolar disorder even schizophrenia but probably now about 50 percent of them have a co-occurring chemical dependency disorder so we do a lot of detoxification we do a lot of chemical dependency related things it's interesting that of course the milieu the family is always important but adults if they don't want us to talk to the family we can't we can't do that right so we try to set up a family with our therapist tries to set up a family session with these people but if they don't want to have it they they don't have to and a lot of them have been alienated from their family for years and so they have very little support system we see quite a number of people that are homeless right and and so that makes our job even more difficult to try to get them into a place where they're safe and free from drugs and so forth and so on and i'd like to expand on that as well because when we talk about mental health in general it's not something that just goes away on its own and i think those that are not in the world of mental health just think oh well it'll go away with time time heals everything so i do want to very much talk about that and how what i cued in on what you were talking about is like now there's about 50 of this population that you're speaking around about that are chemically dependent on something and unfortunately i feel like that's easier and easier to have access to chemical dependence situations and so i want to talk about that as we're going forward too i want to stop for just a moment because i failed to do this in the beginning but you will notice today is may 20th and we're here without our mason it is the first time in 15 months that that's the case but the reason i want to say that out loud is that all three of us are vaccinated both vaccines that have been vaccinated fully vaccinated i have at least for over the month and you all for quite some other time we are six feet apart um and it matters why does it matter because there are still uh certain guidelines in place and if you are not vaccinated yet it is absolutely best to keep your mask on and also those who are not vaccinated keep the mask on of that person that you're speaking with so um that's just due diligence because this is a medical show and it needed to go there really quick um i would like to dr sangra if we can talk about so you all are specific doctors in your specific areas but peak behavioral health services i'd like to talk about what that encompasses so what is peak behavioral health services and what all do you do there again we have you know it would be five days if we really said it all but you know what i mean okay yeah that's fine um so we serve like the greater region of texas new mexico arizona um even um the immigration populations that come in so we have inpatient so where someone comes and they stay with us for a certain number of days and they get treated and they get back home and we have a couple outpatient services we have a thing that's called partial hospi hospitalization so they spend their time at home but they come during the day for programs um so we have that for children and we have that for adults and the and the adult campus is in las cruces and we just started up a new program which is called the act team and that stands for assertive community treatment and that's for individuals that require just a little bit more attention a little bit more care need someone to be kind of on them for the medication maybe housing food issues monetary issues so they don't fall through the cracks and they don't become homeless so we have that service just kind of newly set up i think as of december um nice so when when i when you're talking about the act team i'm thinking that's for all ages or that's really more adult-focused it's more for adult focus right now that makes sense to me that makes sense to me okay i'd like to talk about also uh dr silsby the as as dr sanchez talking about the population that we're treating at your place are you treating everyone that comes through your doors are there specializations i talked a little bit about ptsd and again that we are fort bliss town we are a military area so what population do you treat unless i'm just throwing that all out there making it too big and if i am i i'm in respect of that and you can just katherine that's pretty big actually we treat anybody that needs treatment and especially anybody that walks into our door and they meet criteria they have to meet criteria so talk about that if you don't mind what criteria do they have certainly usually have to be a threat to themselves or others and are have a psychotic condition we sometimes get a lot of uh walking worried and the walking worried don't meet the criteria and but maybe need some counseling so we send them to our partial program or we try to set them up with local counselors in the community so i love the term the walking worried and dr sangro you're gonna say something uh which makes me think you're gonna expand on that because i wanted some expansion on that immediately was that was something you were going to talk about well the walking worry doesn't mean that you meet criteria you need to be admitted because there's a lot of worry and generally people walk around with anxiety you technically can't get rid of anxiety you need a little bit of anxiety to motivate you to kind of get you through the day so our goal is not to eliminate anxiety and but our goal is to speak life into people so they can actually carry on i would very much like to expand on that okay when we talk about anxiety i think it's almost an overused word but there are also people that have true physiological panic attacks um so maybe we can separate or maybe however you'd like to use the definition of separating anxiety which is walking worry which i i respect i mean don't we all have that to a point but there are people that we all know in our lives that really really take the level of anxiety and it's extended and extended until panic sets in and then where you're just overwhelmed with certain thoughts let's talk about that a little bit and i know that dr silsby was talking about criteria but how can these people find help where would they go first okay does that make sense yeah that makes sense and so generally what you want to do when that happens and um definitely you want to have help with a medical profession whether it's a pediatrician or your general practitioner therapy is usually the first goatee you want to start off with therapy and hopefully with that things can get better so therapy maybe a support group some friends a church group a small community to kind of help you and if it doesn't get better then there's next stage to kind of carry on that treatment so that's kind of where you start okay and that's a nice transition dr silsby if we can talk about we are now just as i described why we're not wearing masks we are just now starting to open up again so the past year year and a half i want to say people who have had issues and have not been able to speak with friends face to face have not been able to do exactly what you're talking about dr silsby if you can maybe highlight the extra layer the ancillary portions of what covet 19 and how our lives have changed over the last year and a half with people who have already had existing mental conditions anyway you know i think we've seen our census go up our population go up people are worried about it families are worried about it and i think that it it creates a panic if you will on on its own technically i think the etiology of panic disorder of when it gets to be a disorder and i'm not talking about just natural anxiety the etiology is about the same as it is for ptsd for some reason a person triggers a fight-or-flight response right and bang all of a sudden uh they're having a panic they're thinking they're having a heart attack now if somebody would throw alligators in here we'd all have a panic attack right but nobody's doing that and these people don't have alligators in the room or rattlesnakes but they have a panic and they do think they're having a heart attack and and that is uh you know it can be treated right bingo and i i love that you said that i think that's what people at home need to hear it can be treated so sometimes at least in my head i feel like with whatever the situation is if i can logically wrap my head around what's happening then i feel like emotionally i can breathe a little bit so if there is a way to physiologically explain what and why and the why is the big one and i don't expect you to answer the why but why is it that some people really go into full-blown panic attacks sweating not being able to breathe getting nauseous almost fainting just you know with all intents just freaking out why is that some people get to that stage and other people are just kind of you know just breathe through it those aren't alligators those are just rocks that i need to walk through and it's fine well you know again it's a matter of reducing the arousal state that the body gets into with these stimulatory neurotransmitters and there's several ways to do that there's relaxation there's talking about it there so forth you can actually have people and i've done this before people come in with a panic and said i'm having a heart attack i'm really having you know a terrible panic i said well what would you think if you were having a heart attack how would you see yourself well i would see myself in an emergency room on a gurney with a lot of tubes and a lot of guys and white coats standing around me i said okay now get up and jog in place and how does this contradict what your mental image is of having a heart attack and they get up and jog in place they say well i'm not having a heart attack i'm doing okay i'm doing okay gracie there is slide number 15 that i like you to pull up when you get a chance um and i'd like to kind of walk ourselves through this so in a moment doctors you'll see this on the screen here but i was uh asking that question of this the sender and the receiver i mean there is the brain sending messages your body's receiving it one way etc but you were talking earlier about message receptors how is it and this is the stuff that fascinates me because i don't understand why one person is able to receive a message one way and another person receives it another way and how it physiologically affects their system so slide 15 as people are looking at it up on the air who would like to take explaining that one well that's my slide oh well there you go okay so um basically you know i don't know that we need to go into a course in neuroanatomy right but i'm going to try to simplify it and i tried to a few minutes ago with you i love the pre-show talks i feel like we should record and you didn't think it was simplified enough but let's see if maybe peter can help us but basically brain cells communicate with each other electrically and so electrical impulse will travel along a brain cell along a neuron until it gets to this junction up there you see that it says synaptic clef you can't cross that and so there are neurotransmitters some of them are stimulatory some of them are inhibitory so the parent cell releases the neurotransmitter and it goes out into that cleft now there's some other enzymes in there that try to destroy them but basically they go over and they bind in receptor sites on the receptor neuron and then they send the electrical impulse on its way so that's why it's important when you look at a psychiatric illness i i sometimes simplify psychiatric illness by saying you know it's a disease of disruption of neurotransmitters whether they're simulator perfect sense it's a disruption of rights whether whether they're stimulatory or inhibitory so dr sandra and you were going to say that just to help you understand why some people do have more panic attacks than other people and why is that it's if you think of a dirt road and a pathway and we're going to compare this to the neurons if if you travel down the pathway just couple times well it's easy to get lost you're not going to use it as much but if you use it quite frequently and then you start kind of laying down some cob stones and a nice pathway clear out the brush put some lights well then it's a little easier to get to right right right so if you keep practicing a certain kind of behavior whether it's appropriate or not appropriate whether it's a fear response or freeze response or flight response where you're telling the brain to kind of lay down that and so it's hard if the individual keeps laying down that pathway and keeps repeating that response it becomes easier for that patient or person to go down that kind of response that you're talking about versus the other way which is a challenge so i'd like to talk about i'd like to talk about medications but i really really would like to combine them with talk therapy okay and when i say talk therapy the way i'm reading what you're saying is that there's a way to try to train yourself when you when you have found that you are a person that tends to have panic disorder meaning i'm just not anxious i mean i i'd go full-on in the panic attacks if you're that person there are tools that you can use just mentally and there's also medications yes again i feel like with everything today there it's such a big bucket so let's start first with medications with what we were talking about with slide 15 when you're talking about this disruptors and some medications that can help with either stimulatory or receptive issues and helping that let's start there and don't let me forget to go back to talk therapy you know both of you well and let me just segue into that just a minute before we start because statistically the best outcome is with both okay it's a combination of pharmacological therapy along with the talk therapies and and nowadays that's pretty much the reality therapies the cognitive therapies cognitive behavioral therapy cognitive processing therapy so those seem to work the best and you sort of you can't do one without the other right right and then the reason why that is is because the medications kind of work on the deeper inner structure of the brain that kind of tone down those responses and the talk therapy allow the uh the brain neurons get to like the frontal lobe where that is called the dorsal lateral prefrontal cortex is that's where it needs to get to in order to actually kind of stop those kind of really bad responses that are kind of taken away from the person's kind of quality of life so it was like the shock response that just and and if you don't mind gracie slide number 16 if you can get that at the ready um because we're we're kind of talking about that area so my apologies continue sometimes oh look at her she's good it's right there boom yeah no that's fine um so yeah so it's a lot of it is trying to reach the outer layers of the cortex and that's kind of where your logic and your planning kind of like the if you imagine like an executive assistant for you right and someone that has everything ready for you how's your time has your coffee has your gas in your car has that person has you has your coat pressed out the door right has your makeup ready has everything laid out for you i mean dr silsby has that every morning um but that that's a great way of looking at it because you have at your access then at your beck and call these things that you're talking about this is my way of getting ready for my day yes whatever way that would be um and with what we got on the stream screen right now it's the neurotransmitters and i like to go a little bit into this because as questions start coming in it's nice to have gone through these already so we're talking about simulatory and then inhibitory um issues and if we can just just describe what we're talking about here and then we can take it further after that does that make sense okay okay great dr sangro should i give that to you or should i give that dog but we're going to get back to that point let's talk about the neurotransmitters well basically you know they're stimulatory or inhibitory right and so a lot of uh psychiatric disease can theoretically be explained by absence or abundance of one or the other so if a person becomes psychotic that means they can't interpret the reality they're hearing voices and seeing things why the theory is there's an old dopamine hypothesis that there's too much dopamine in the brain right some of the drugs that we have called anti-psychotics go in and they block that on the other hand if you don't have enough serotonin which is responsible for well-being and for sleep and sex drive and so many other things then you become depressed and we have drugs that will go in and cause serotonin reuptake inhibitors and actually go back to going back to the other slide we'll block the reuptake once the parent cell releases the neurotransmitter into that synaptic cleft then it's smart enough to say shoot i don't want to get rid of all this stuff so i'm going to suck some of it back up and there's something called a reuptake pump and so what will happen is is that the serotonin reuptake inhibitor drugs will go in and they'll block that pump thereby you have a greater buildup of serotonin in the synapse no it's it but uh the way that you're describing it makes such sense to me so my question automatically as a layman a lay person would be okay there is some help with medication how does one's body know how does one's brain know i get that the medication is there it's got a very specific purpose just like with every medication we take for different things in the body i just feel like the brain is it's it's in its own creature in and of itself because then behaviors come in and it's not like behavioral that you know eat your wheaties and make sure you have more vegetables and exercise these are things that i feel like you can't put your arms around the technical aspect of it the logical aspect of it how can you stop yourself from thinking something does that make sense i know i know what i'm trying to ask i'm just not articulating it right how can you get yourself from stop the psychotic issues that were that we're speaking well let me just get back to what you were saying a little bit before because i think as a psychiatrist or of any physician you have to listen to your patient and your patient very frequently will tell you what works and what won't work and let me give you an example of that we we see there's there's two types of depression one type is standard depression that's where you don't have enough serotonin and you treat that with an antidepressant the other type is bipolar 2 depression which looks exactly the same but you need to treat that with mood stabilizers because if you treat it with an antidepressant it sometimes destabilizes so i have a number of patients who'll come in look depressed and i say what have you been on well i've been on prozac or i've i've been on you know lexapro and i said well how'd that work what didn't work at all so that sort of makes the diagnosis that was my next question how is a diagnosis so really it's listening to the patients and then put them on a drug and see how it works right right and if it's not working then you try something else and then i said right and then that's yeah with so many things too um i don't want to get into the whole drug as we could oh my gosh that's another four or five hours of getting into all the medications um dr sandra i would like to kind of switch our focus for a moment to pediatrics adolescence um and it just if you watch movies it'd be like oh so-and-so happened to that person when they were and you said below five years of age or between five years and 10 years of age 10 years and 15 years of age my question is how do different brains process different things that have happened to them and let's just say let's take ten children under the age of five and throw a case study out there throw a story out there as i know we talked a lot before the show and i almost feel like we shouldn't have because now i feel like those stories are all out there um but how does one individual carry on through their life in a different way than another individual would even if the exact same things happened to them when they were of that age and i know it's a loaded question but it's curious so you know um there's a there's a scientific word we call pruning and it's kind of like if you have a rosemary bush or some kind of bush and you kind of cut it the brain does that too as it learns and so when you're that young and have young children they really learn through parents and role modeling so they're watching they're listening they're trying to they're seeing how their parents react and how they react to them whether it's language through physical touch or anything like that so they're always constantly learning so now you know you have that individual that's just soaking everything up and learning from the environment looking learning from the parents um even learning language from the parents and and if that individual has a good parenting good solid house kind of like that nurtures that then chances are they'll be able to handle anxiety a lot better right right and so anxiety in kids that looks like well they have a stomachache they got a headache that's what it presents like mostly somatic complaints that's what they call like body aches and stuff that so because children have a hard time yeah explaining like so a child won't tell you that they're depressed because they don't know what depression feels like right right exactly and they don't know how to kind of intellectualize and kind of explain it of how anxiety looks like so if you have a child that's kind of i like to say kind of like a family system that's stressed there's lots of issues maybe a parent has died from covid i've had that you know the parents are fighting there's a potential divorce going on there's alcohol in the home that that children's gonna operate in a different level right right they're gonna have some anxiety already from just like what dr stillsby the um stimulatory you know neurotransmitters a little heightened and that impacts the brain and how it's formed so here's a question when i'm listening to that in uh the word normal which again doesn't have a definition either so when you're looking at someone young their normal is what's happening in their home absolutely yeah and so when i say that as they grow up and they realize oh well my home now that they're seven eight nine years old my home's a lot different than that home or this home or the other home i understand that when they're very young we were talking psychosomatic dissomatically there's the stomach aches the headaches i don't feel well and then it starts getting to be a little more now i'm having trust issues or i'm having this and that and the other in your experience and it's hard because it's a and i'm thinking in my opinion the way i'm looking at it's like you've got 20 years you're playing with but maybe from three to maybe 15 16 years of age how do some of these issues then manifest as the children get into adolescent years and you know try to figure out who they're going to be as grown-ups because that's the whole planning process our our bodies our brains who are we going to be when we grow up we try to start figuring that out when we're four or five um take that any way that you any any path you want to take that too that's that's what i'm curious so it's interesting you say that because that's kind of one of the first questions i ask as well too like in my evaluation is what they want to be when they grow up and another one is if they had three wishes any three wishes what would they be or what would they want and it kind of gives me a tool kind of guide like what their what their stressors are so let me give you an example just just to kind of make it sense absolutely if i ask the child hey what are your wishes well i really like to eat and i wish we had a home and i wish we had more money so that kind of tells me the family environment right away right versus another child might say well i want an iphone i want a ipad and i want the latest pairs of like nikes right right so right then i know yeah maybe i can kind of probably guess what the family environment's like and then i just kind of dig into the the goal thing what they want to be when they grow up some people are very kind of like specific like they might say i want to be a doctor i want to be a surgeon some people might say well i want to be a welder some people might say well i just don't know i don't know no one's ever become anything no one's ever become anything boy that's spot on on something right there okay or i never thought of that yeah and so it just tells me a little bit more of kind of how they've been shaped and so um i almost forgot the original question the original question was as i am i'm just mesmerized by this but again the the manifestation um again of how they're going to et cetera so that's very different from the ipad without medications and i and i feel like again this is a stigma and has been a stigma for so many years so people just don't talk about things that happen to you when you're a kid that were bad because i'm embarrassed by it but now people are starting to say you know what it's okay for me to say that this and that and the other happen because if i say embarrassed by it but now people are starting to say you know what it's okay for me to say that this and that and the other happen because if i say it out loud one of the bravest things that you can say is help whatever happened whatever happens in those magic 5 to 15 years to me that's best they start coming about this hypertension or something if you treat it early it's not as bad as later on right but if you don't treat it and you ignore it then what happens you've had a whole bunch of cardiologists on your show i know that i've watched it online and some of them talk a lot of stuff and they need intervention and all that kind of stuff a lot of people with mental illness have no idea that they have a mental illness they do they don't know that what they were going through wasn't normal absolutely so they may not know that for decades later and that's why kovid was so hard because when they were pulled out of school therapy shut down school shut down no counselors and we've seen a surge in the like the intensity of suicide the amounts of suicides in youth because they didn't know where to go to and they're stuck in that situation and the completed suicides in kids um our parents were surprised because they had no idea they didn't know yeah see that kills me i have two i have a 24 year old and an 18 year old and i have to tell you that you know they've got like all of us have issues and and i fortunately have known some parents that that understanding something or missing something um and dr silsby's i'm getting i'm gonna just kind of ping-pong it back over to you i don't particularly have a follow-up question with that but what i'd like to do is kind of start into ptsd whether it is something that happened you know be you know when you were very young and or this might be a good time to open up the idea of the fact again that we're for bliss we're a military town ptsd i think is you think that you think military doesn't necessarily mean it's military but just the idea of something happened to you way back when and for the lack of better wording i just can't get over it you know we can just start down there first of all because the talk that i gave to the rotary down there a while back was combat related ptsd there's certainly a great deal of ptsd and children in fact i cover his patients sometimes and i see all the ptsd diagnosis but i i think it's a misunderstood and often put aside diagnosis uh there's a lot of controversy about it especially in the military military uh sort of likes to think well just soldier on just suck it up just go on you don't have anything wrong with you and and that's very incorrect um so i think that you know we have to recognize it for what it is and then try to treat it if we don't while we're missing the boat but i think one interesting thing to go back to uh predisposition of the and i've treated maybe 2 000 ptsd soldiers with ptsd and about i would say 70 percent have had a bad childhood they either come from a disruptive family or they've been abused neglected sexually assaulted so their setup their nervous system as you as peter was saying uh you know develops these sort of pathways so they get into combat which is entirely different than anything anybody's ever experienced and bang they don't know how to experience right and so that sets off this chain reaction of this fight or flight response and then as you know they go along it becomes uh it takes over takes over their life and it just repeats itself repeats itself and they have nightmares and flashbacks and and disassociation and and depression and all these things that are associated with it so there is a predisposition and a lot and a lot of it you were on the right track and and you and dr zagler are going back to what happens in childhood and you were mentioning i don't know if it was when we were already on the air if it was prior to with in post-traumatic stress disorder um i didn't i didn't give the acronym out correctly earlier but um you were saying earlier that talk therapy combination what i got from during the when we were on the air the talk therapy tends to be super important when it comes to ptsd along with medication we talked a little bit about it too but it's about retraining yourself or training yourself unlearning some of the things that you've learned or that you know and then retraining if we can go down that path since that's our in fact i guess in my experience with with treating this many soldiers with with this problem i find that talk therapy is more important than the medication medications don't work quite that well if they've got a co-occurring disease like depression when about 50 percent of them meet the criteria for depressive disorder now you can treat those with with the antidepressants and so forth but it's a talk therapy they would take some veterans out fly fishing on the arkansas river and they would camp out and they'd take about eight of them at a time and they'd sit around the campfire at night and and just talk with each other and they found that they thought it was a fly fishing that uh that made them better but it was actually the talk therapy and and talking with each other and in this type of situation in as i'm hearing you i'm thinking the word cohorts so these are individuals that have experienced not necessarily these situations but similar situations and they are currently i think sometimes when you say group therapy it's again you go to the movies and the tv shows and it's like people roll their eyes like oh great i got to go to group therapy but in what you're saying it matters it's it's kind of like that that bug to a flame you you can't help but want to figure out okay so you know you kind of first discreetly go this kind of happened to you so how are you doing today and uh dr sangro if you can if you can talk a little bit about group therapy you know we've talked a little bit about medications but talk about people who have experienced similar things and now they're talking to not only it helps them because it first helps them identify they're not alone that's it right that's it that's it so i'm going to say it out loud over again it helps them identify that they're not alone they're not going to lose somebody else right and then and then it also helps them with knowing what other triggers and what happens and what other people have tried to actually when when you look at combat um and dr sillsby you could probably stop me if i'm wrong but when you look at combat in a war zone there's not much ptsd either and you fly back home that's when the ptsd happens and so with kids is when they come out of the abusive home or something them at home and you put them into a safe hospital setting now a normal what we might say well not normal but just kind of a supportive setting where we can support them and we've got great staff great nurses great therapists that are trained especially just to help children and adults and they provide them where they might not have then that's when you start seeing the symptoms of ptsd and then you you know the average combat soldier doesn't fight for four and so that's a tight-knit group fair there was a a book once written if you need to read it if you haven't called it a reaction acute combat relax reaction is if there was explosion right here in the studio we'd all have an acute panic reaction and the way they treat that in the service is with an acronym called pie proximity expectancy uh you see an expectancy so they bring the soldier off the front line give him a hot meal pat him on the butt and tell him he's okay but the expectancy he's going back to fight again and they usually get that out of his head he can't yeah and they usually want to they you want to go back to the unit yeah and the faster you normalize any kind of traumatic experience let's say the explosion normalizing being them getting them back to their routine kind of day-to-day functioning the less chances of those trauma goes okay happens so um so what i'm what i'm hearing is the comradeship or camaraderie as one would say um and it is about the shared experiences when you said and i and i hate using the word normal because that that doesn't even exist but normalcy what is around you is what you my normal to me and that's what we mean when we say normal exactly so um because there's so much going on we've talked about and vice versa you know i want to make sure that dr silsby is or anything i know we still have a couple of slides here we have slide 18 was the brain that could be going into all kinds of stuff that could be a whole show in and of itself well we've kind of talked about that i think i think as far as the combat ptsd goes i'd like to bring up the fact that when i was in vietnam i was a flight surgeon i was assigned to an assault aviation unit i didn't see any ptsd i saw none of it at all now there are a couple reasons for that one is i don't know what the heck i was looking for and and two is that the more highly trained units like aviators and seals and special operators this is what they expect and they're trained for that and the guys that have the trouble are the guys the cooks and the the guys that aren't expecting this and maybe they had childhood trauma and so something happens and and they're the ones who develop the symptoms because you know the the body and the brain's design because you need that sympathetic drive the fight-or-flight response right to actually protect you so it's built there for a reason and it's built to protect you but when it's too going on all the time that's when it kind of impacts functioning so and when dr silsby was talking too when you have uh when you said you take a person out of combat for a minute you give them a meal you give them you know would you like to go read a book or you want to go join your guys again and you said often it's well let me go join my guys yeah my life is at stake but there's something mentally emotionally and physically that they need to have that and uh dr sangro i'm going to ask about this uh you were talking i think was prior to the show again uh but we were talking about young ones that for whatever the situation is there is and feel free to go through a case study there's isolation which really has an effect later there are some situations we can talk about the immigrant situation here or not we can talk about other situations where young ones are isolated they don't have what they consider someone to be their caretaker someone needs to take care of me i don't have that right now talk a little bit about that because before the shows start i'm like oh that's golden i really would like to speak about that so you know isolation's been huge for since covet right right with the kids being isolated at home through zoom can't see their friends soccer practice council ballet council music like everything was council council all your comrades are gone right all of a sudden all your peer support right and that's huge for kids their peers are almost as equally sometimes just a notch i had about the parents and that was gone so isolation drove them into anxiety or depression if there's any core core morbidities let's say depression pre-existing anxiety or anything like that or medical issues the chances of having higher leverage oppressions were actually worse and suicide rates kind of corresponded to that right so isolation has been a huge factor and then they saw then they did the study and they're like well let's do study between depression anxiety and isolation we're pack animals i mean at the end of the day it's part of our dna as human beings most of us not all of us there's some of us that really like being alone not me though i like being a pack animal on that note cove it aside let's talk about some isolation issues that young ones can have and how that would manifest later we were talking about abuse and i know that's not pretty to talk about but we're talking about mental health this is a mental health month a lot of later issues happen with abuse as a young child um touch base on that a little bit because with abuse i understand there's a lot of isolation there because you're not allowed to talk about this and if you talk about this you're in trouble et cetera et cetera needs to become more and more alone talk about that and how that really affects a person's life later on that's a loaded question it is um it's it it affects everything i mean sadly to say um it affects the the way the brain is actually formed as well too because it can shift it can change because your brain is actually changing even as we speak it's changing it's it's developing and the brain doesn't fully develop to the age of 25 and yeah and so with abuse happening and then when kids you know sometimes they start self-medicating with drugs and not meaning medication but drugs illicit drugs and that can actually destroy the brain alter their brain and it can force the brain to a different path such as a different disorder versus maybe just depression so then you can start getting to the bipolars the psychosis and stuff and then when that brain is fixated on that trauma and dissociativeness and then the self-harm the suicide the self-cutting you start developing patterns that aren't healthy right whether you're doing it for the first time or whether you're doing it for the thousand times it's just unhealthy and then eventually those unhealthy patterns can lead to even more destructive and what what is it that the child or the young person is seeking are they seeking relief are they seeking disappearance are they seeking fitting in is it all of the above the reason i ask this is that say it's someone that is in a family of means we can go to a therapist and now i'm going to a doctor and now you know a 10 year old is being put on antidepressants on anti-anxieties or an eight-year-old is etc again i know it's loaded i respect that it's loaded and this is that show that we need to have 10 million times a year but when these medications you were talking about substance abuse and just substances in general and children are being put on medications early on i'm not sure what my question is but that's something that's like within the last 50 years prior to that that wasn't even a thing how is that shaping people or just what are the trends maybe that's the question what are the trends that you're seeing over the last years that it's just been pretty common to put somebody on like adhd medication and or anti-anxiety medication and or anti-depression medication as their children okay so um there's a couple of different kind of ways i can go with that um in terms of answering the medication question i'll kind of aim at that first and then i'll kind of backtrack so medications have kind of more advanced and we understand the brain a little bit better in terms of like neural imaging what's going on and actually understanding it so we developed the medications they're a little bit more sophisticated than what they were before before it was just like throw a pill electric shock and see what happens bingo maybe and maybe talking about it maybe let's take a low boat let's just cut some of your brain out you don't need that party and that's what they used to do exactly because there's no really understanding and if you go back to i think they have a museum in pennsylvania where they did the first anatomy dissection because before to cut a human being was unheard of and it was almost like not sacred and don't touch the human being body or stuff that but since science has advanced or our understanding of the anatomy is advanced the brain is still it's the next frontier in other words in other words there's so much more we got to learn about it and there's so much more um understanding we're still developing or understanding like micro particles of the brain and neural chemistry and stuff so let me add to that in a minute because there was a book recently out called the brain and the brain is amazingly adaptable and it can heal itself it gives an example of a lady that lost her semicircular canal so she couldn't balance and they were developed left girls they put on her in her mouth and it would sort of bubble if you lean forward or not bubble if you lean back and it reached the brain recycled bypass the part that was destroyed destroyed and she gained her balance back and the brain is just amazing yeah and so i we have two minutes and i don't want to ask any more questions but dr sangro you're going to say something so go there because so so the other trend that we've seen is social media yeah and just media itself the transition from media to become more dark um almost having like kind of like pro-suicide like egging these kids on to actually do and videotape themselves like those are the kind of dark kind of images that are talking about so stress on the family where they're not home they're working they they don't have time to communicate with the child and the very stressful video games too i mean there are some really dark video games and so the child is always looking for acceptance they're looking for a peer a pure belonging something to connect with and if they connect with something that's leading down the wrong path and then it can be dangerous and you're right i mean i always think to myself too every time we do a program like this i think about the last program that's how i do my research i'm like okay when was the last time we did mental health what were the questions we covered then and i as you as you see in the audience i take all these notes everywhere but i take these back with me because a year from now we'll do this exact same show and it will be a year out of covid so we're going to have a complete different conversation of what we've learned with isolation that's forced isolation we didn't want to do that and that has nothing to do with abuse but there are going to be a lot of mental issues that result out of this as well um i'm going to wrap it up really quick because if we go into another question we're going to go over time but if you uh had some questions during the show and just didn't catch it because we're too fast because we're fast often you can go to pbslp there you can go to watch and programs you will find the all past positions and you'll be able to watch the show again we are currently streaming live on youtube so utep will have this on as well just again pbs el paso and then the el paso county medical society that brings the show to you and has for many many years epcms.com you can go there as well uh madeleine morris has been the person that's been sending questions our way and madeleine i thank you so very much and you've been watching again at pbs el paso with the el paso physician and it's mental health month so take care of yourself go take a walk go call someone tell them you love them i'm katherine berg good night [Music] [Music] you