Dr. Lise Van Susteren: Emotional Inflammation: A Condition of Our Time

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You’re listening to Insights at the Edge. Today, my guest is Dr. Lise Van Susteren. Lise is a psychiatrist in private practice in Washington, DC. She served as an assistant clinical professor of psychiatry at Georgetown University. Along with her writing partner, Stacey Colino, they’ve written a very helpful and useful new book called Emotional Inflammation: Discover your Triggers and Reclaim your Equilibrium During Anxious Times.

Believe it or not, this book was conceived of and written before the COVID-19 global pandemic. Yet it addresses the emotional challenges many of us are feeling right now in a very helpful and direct way. Listen here to Dr. Lise Van Susteren:

Lise, I want to begin by talking about the title of your new book, Emotional Inflammation. You write right in the introduction of the book that this is the name for many people of how we’ve been feeling. As I encountered those words, emotional inflammation, I thought, “Yes, that is the name. That’s the name, but what is it?” Let’s start right there. Emotional inflammation.

Lise Van Susteren: Well, if you think about physical inflammation, we know what that looks like. It’s red. It’s inflamed. It hurts when we move it or when we touch it. It impedes us from doing the things sometimes that we would do naturally. If you take all of those attributes and you apply them to our emotional lives, our psychological state, you’ve pretty much got emotional inflammation. There we are. It hurts sometimes. Sometimes it impedes us from taking action. Even makes us angry that we can’t do what we want to do. But the end result is that it’s not a normal state. And it doesn’t feel good.

TS: Now, the interesting thing to me is this new book, Emotional Inflammation, was conceived and written, pre- the COVID-19 pandemic. That’s just so interesting. It’s almost like you were prescient in a certain way. I wonder how you see that?

LVS: Well, that’s a long “well.” I could drag it out a lot longer. But I won’t. But the pandemic really—for people who have been climate activists, as I have done for the last 15 years, associate what we are seeing the pandemic, with the things that have been warned about for climate disruption. There’s a—for us, it isn’t a surprise that we have a pandemic, and it isn’t a surprise looking at the warnings that scientists have been making. But what we do see which is so profoundly painful, and I think refers to so many other aspects and themes of the book is that the pandemic is so much worse because of many other structural social problems that we are experiencing here in the US and of course around the world. It’s racial issues. It is economic disparities, health concerns, job insecurity, political dysfunction. All of these elements are factoring in to what has made the pandemics worse. While I see it as having been a catalyst of climate disruption and biodiversity loss, which go hand in hand, again, it’s exacerbated by so many of these other factors.

TS: Do you see emotional inflammation as a condition that has been on the rise over the past number of years as a result of things like climate disruption? That maybe 100 years ago, emotional inflammation wasn’t what it is today, that this is really a contemporary diagnosis, if you will, of our condition?

LVS: Boy, I sure do. And I’m not the only one. Of course, it doesn’t really matter what I personally might think. I think that many, many other people share this, whether they’re sociologists, or behavioralists, or mental health professionals. I will say in my own practice that I’ve seen over the years, that I would have a certain type of patient coming in with certain types of complaints. Admittedly, I moved my office from what was a neighborhood setting to a downtown setting, so you get a different population of people.

But people are practically lining up with anxieties that they have, that they don’t always recognize. They come in with symptoms, “I can’t sleep, I can’t wake up, I can’t focus. I feel alienated. I feel depressed. I have no energy. I’m scrambling from running from one thing to another.” All of these things, these now symptoms that I’m seeing, are really one of the reasons the book came about.

I wrote about it, and of course, thank God for Stacy, Stacy Colino, my coauthor, because she’s just very talented, very skilled person, and was able to help to get these thoughts along with so many other aspects of the book on paper. But it was my personal experience, and I think that it is something that is widely shared. There are many reasons why. I wouldn’t mind going into those at some point too, if people want to know.

TS: Yes. Tell me the biggest drivers.

LVS: All right. Well, again, there are many. But among the biggest, and I will say that the anxiety that basically what we are talking about is stresses, and stress and anxiety. In the last several decades, the pace of everything that we are doing has eclipsed so many of the things that we used to do because we had a little bit of downtime. People don’t have downtime anymore. We don’t have time for our psyches to reset, for our attention to be restored. We don’t sit at a bus stop or walk someplace and muse about the world, allowing our brains to rest. We’re constantly pinged even with noises, worrying, and buzzes, and so many other sounds that tell us, “Pay attention, pay attention, pay attention.”

In the past years, not so many years ago, there was a much slower setting and pace to everything that we did. This is being lost in the pressure to keep up because we can. What is the underpinning to that? Of course, it’s the technology that has allowed us to be constantly—and I might add superficially—in touch with each other. So, so many of the underpinnings to a feeling of peace and self-awareness had been lost in the pressure to respond right now.

TS: That makes a lot of sense to me. Really, what you’re saying is that emotional inflammation, this description that you’re offering of how many of us feel, is a condition of our time, and that makes sense to me. I want to ask you a question, though—here as a practicing psychiatrist in Washington, DC, I imagine you were trained to get very technical and specific about various disorders, “challenges” people were presenting when they would come into your office looking for help.

Here, you’re offering something that’s a big, broad brushstroke, emotional inflammation. I can imagine people saying, “Really? She’s an MD. How did we get here? How did we get into this big, broad brushstroke of what’s happening during our time versus the specificity of what people are suffering with?” I wonder how you relate to that question. OK. Well, that’s a great question.

LVS: OK. That’s a great question. I got to tell you, people so appreciate that we can talk about bigger issues, and that we can get away from the specificity that usually their interactions with many mental health professionals—not all, but many. By that specificity, I mean that the patients will come in and say, “I have ADHD would you give me … I need stimulant medications for my ADHD, and then also I can’t sleep at night because the ADHD medicine keeps me awake and can you give me something to go to sleep?”

There’s a frantic quality as they hope to get these so-called specific symptoms addressed. What I do is I’ve been around the block a few times. So what I do when they come in with these requests, is that I will listen to them and listen to what they have to say and tell them that I’m happy, at least to start out with, to reorder their medications, and to respond to them where I find them. But I say, “Strike me a deal. Let me renew these prescriptions, then tell me that you will at least listen to some of the upstream causes for the conditions that you are experiencing.”

Most people hear this and thinks of themselves, upstream conditions? because in fact, people don’t like to think of themselves as pathological and full of symptoms and needing psychotropic medications. They walk out of my office, usually with a big smile, because I’ll say to them, “It’s really not you. It’s society, or it’s the culture, and we can take an awful lot of good, constructive actions so that you can think about whether or not you still will need to take these medications, and we’ll talk about the changes that you might be able to make that will free you from some of the pressures that have caught you in such a tight spot that you need to medicate yourself into some sort of compliance with the world around you.” They’ve actually really, really appreciate this.

TS: You might not be able to give me any statistical answer to this question, but I am curious to know if you think there’s a certain percentage of people who show up in psychiatric offices who don’t need medication, who could have their issues addressed—

LVS: Oh, boy.

TS: I know it’s tricky territory. Maybe you could even just say something—

LVS: No, no, no, it’s that—

TS: —more fuzzy about it. But you know, in your book Emotional Inflammation, you offer a whole program for reversing it that you call RESTORE. There’s tons of lifestyle recommendations, things that have to do sleep and diet and our mental condition and a lot more. I’m just curious how—if people actually followed a program like the RESTORE program, what kind of reduction do you think we might see in the need for psychiatric medicine?

LVS: Oh boy, just tempt me. I think it can help everybody. I’m not saying that it can bring people 100 percent of the way; some people really benefit from medication, and boy, am I glad to be able to have it in my pocket, my back pocket to prescribe for them. It certainly makes life easier for them and for me. But I haven’t the slightest shred of a doubt that anybody, even if you’re psychotic at times, with some major psychiatric illness. We know that mood and food, we know that air pollution, we know that exposure to nature, we know that sleep and so many other factors influence either the presence or the severity of our symptoms. So if you’re asking me, I’d say 100 percent could be helped by it. I’m certainly not saying that 100 percent could be cured, but I do stand by the fact that this is useful for everyone.

TS: OK. I want to read a quote from the book and have you respond to it. Here it is, you’re describing in the beginning of the book, emotional inflammation as a condition of our time and you write, “It’s a condition afflicting millions of women and men who are currently living in our noisy, chaotic, confusing, and often contentious world. The symptoms can include a maelstrom of anticipatory anxiety, nameless dread, an ongoing state of high alert, or new levels of hyperactivity, agitation, and hypervigilance. Others experience post-traumatic or even what I have dubbed pre-traumatic stress symptoms.” It’s this last part that I really wanted to have you comment on. This idea that people could be experiencing pre-traumatic stress symptoms. I know you mentioned that you conceived and wrote this book before the COVID-19 crisis. So interesting.

LVS: Well, the pre-traumatic stress condition, actually people have asked me a lot about that. I actually thought I coined the term, but it turns out the US Army used it a while ahead of me. But I coined the term pre-traumatic stress, because I have it. I realized that I had it when I was writing, as I have done now for more than a decade, about climate issues, climate disruption, and against the backdrop of all the things that we’ve talked about—political dysfunction, sexual misconduct, racial discrimination, gun violence, all of the things that we recognize are major disruptive factors in what we think of as social justice, have been on the certainly on stage with me and with others.

But the backdrop of for me and what has defined my life other than my work with patients individually, has been the realization that just as the COVID virus and the pandemic was being warned about months ago by scientists, and they were—the scientists and the warnings were not met with the response that was necessary, so too the scientists who have been warning us now for decades about climate have been— and certainly people are waking up, more people are responding every day. But when I first was involved in writing about this, 10, 15 years ago, there was really very few people and very few of my colleagues.

I would see a beautiful picture of a coral reef or the Mediterranean or some other mountains covered with trees. And rather than thinking, “Oh my God, that’s so awesome. That’s so gorgeous,” and be uplifted, I would be thinking, “Oh my God, ocean acidification with the coral reefs, and marine life dying out, and mountains being deforested or dying from beetle infestations, and forest fires.” I was the one who ended seeing all of these beautiful images that ordinarily would have evoked such a sense of euphoria and that transcendent feeling of connecting with something larger than ourselves, and instead it was the source of stress.

The anticipatory anxiety and the pre-traumatic stress have all, for me and for many others now, increasingly—and that’s whether it’s conscious, Tami, or unconscious, and I can certainly get to that unconscious aspect—has been front and center in my life. Again, a backdrop for some people, front and center in my life. I have developed it with my obligations and called myself and others climate Cassandras, the people who have been warning, but to, in the past, no avail. Again, changing now every day—Mother Nature has assured that we can’t ignore her.

TS: I am curious when you point to how that could be impacting certain people at an unconscious level. What you mean by that? I think some people, when they’re out in nature, we’re not having the experience you’re describing. They’re just, “Oh my God. This is gorgeous.” They’re pushing it out of their mind that the Earth is endangered.

LVS: Yes. Those are special moments, and only a die-hard person with pretty traumatic stress would look at those beautiful vistas and be thinking dark thoughts. I don’t always think them when I’m in a beautiful, marvelous place, but I’m saying that there were threads of this. But in other people, the notion that the world is a safe place, that it’s a predictable place, that things are going to get better, and that we will be able to get along and go along with a sense always of prosperity, has been deeply compromised. Unconsciously, or consciously in some people.

But for the unconscious people, and in some, But for unconscious, and I see them all time coming into my office. People will come in and say they can’t sleep or they can’t wake up or they can’t think, or they can’t this, they can’t that. I’ll say, over time, “Are you anxious? Do you feel anxious?” People don’t always even know that they’re anxious. They’ll say, “No, I just can’t sleep.” I will impress upon them that possibly they’re suffering from anxiety. If I go slowly enough, they’re open to listening. Then we start talking about, we pop the hood and start looking about what could possibly be the causes.

People tend to want to look at the causes that bring up the least amount of stress first. They’ll say, “Well, I’m anxious because I don’t like my job and this and this and this.” Once you start peeling back those layers, you get down deeper and deeper and deeper, and the many times, the many of the—again, the backdrop, the feeling, they haven’t been living in a cave. They’ve heard that the ecosystems are collapsing. They may not read the articles or listen to the full report, but they haven’t—they’re not stupid. They’ve been hearing this now for many, many years.

I’ll say right now that I really believe that some of the opioid crisis, it’s not just—the CDC will say they’re baffled about why the opioid crisis—yes, we know pharmaceutical companies were criminal in some cases, and distributors and marketing and so many other doctors, et cetera. But why are people in such pain? This is before the pandemic, and I really do believe that the constant warnings that the world is suffering, that the planet is deteriorating and sometimes passing tipping points that that are so damaging that the question of survival is now on the line, means you can’t hear that stuff and not be upset.

Well, people are in pain. That has to be looked at as a reason why we have had the depths of despair that are being talked about—the suicide, the drug addiction, et cetera. These are examples—we know that anxiety has risen very sharply in the last decade, depression, and as I say, suicide. These depths of despair or these illnesses related to despair aren’t coming out of nothing.

TS: Tell me do you think it’s fair to say this, that if emotional inflammation was a low- to middle-grade challenge that we were suffering as a collective when you were writing the book, now that the book is being published here, in the spring of 2020, we’ve gone to high-grade collective emotional inflammation. When you’re talking about feeling that the world is a safe and predictable place, I don’t think anybody feels that way anymore in their conscious mind.

LVS: Right. Consciously or unconsciously. In the past, it was an unconscious, I think, sort of slow, an ember that was always burning inside that they—people could repress or that means unconsciously get it out of their mind, or bury it, or consciously suppress it. But now all bets are off, obviously, because our anxiety has blown through the roof. The pressure on us is just enormous with all of the backlog of things that were already unnerving us.

Now, obviously, all of the things that we were previously feeling have been violently reawakened and the sense that the pandemic alone is bringing us down or could bring us down is on a bedrock of already existing inflammation, emotional inflammation, anxiety, stress, whatever you want to call it. This is not an easy time for people. Let’s be very, very straightforward about it. But let’s also recognize that as awful as this pandemic is, and what I think probably hurts me more than anything is the notion that privileged people can stay at home and do their work at home and get paychecks, and that the so-called essential workers are out there on the line, public transportation, in grocery stores, and without personal protective equipment themselves—and I’m putting healthcare workers in a completely different category. But that those are the people that have been suffering before, and now there they are on the line, even more so with the disparity is so very apparent to us.

But having said that, the pandemic is time-limited. Will be another one? Well, that’s what the scientists say, sure. But the pandemic is time-limited. We will find medications and we’ll have a vaccination. We’ll have a vaccine. It will be effective, and we’ll mop our brows and move on. But Tami, here’s the one thing that we have to take away from this. It is that we have to learn that there are certain rules of nature, and that we have two choices. Either we continue like our parents are out of town—that we’re teenagers throwing a party, doing what we want to do whenever we want to do, whenever we want to do it, and encroaching in spaces that were meant to be preserved for wildlife; and that we don’t listen to scientists, we listen to talk show hosts or politicians, even when they have a reason to say things that might be different from what the science tells us. We’ve got to learn our lesson and have a takeaway from this that says, “You know what, this is what the science is talking to us about, the scientists, when they talk to us about climate.”

Hear what they have to say. We can make these changes. It’s not too late. But don’t do it after the pandemic. Do it before. Here’s our chance. Let’s honor all the people who have suffered and have died. In our continuing to worry, let’s honor all of them by now doing the right thing for the planet for the world, for everybody else, and respect that we have limits to our resources, and that we can live sustainably if we put our minds to it. We go essentially from being bystanders to upstanders in this battle.

TS: It’s so inspiring, listening to you. One of the points you make about emotional inflammation is that one of the ways that we can help reverse it in our lives is this notion of not just being a bystander where these things are happening to us that are out of our control, whether it’s what’s happening with climate or things outside of us, it’s just all happening to me, but we become an upstander. Tell me more what you mean by that in relationship to emotional inflammation? How does making that move in our lives change, actually, our physiology and our emotional condition?

LVS: It’s a fascinating, really, story. Because first, we have observed that when people take action, collective action, that they feel better. We know that from personal experience. We know it from the stories of people who helped throw sandbags to stop a rising river. But now what we have seen is that with neuroscientific studies, a functional MRI, which means that you can see where the blood flowing in the brain, when we go from thinking about ourselves—which is a bystander state of mind, we’re just here focusing inward on what is happening to us at a particular moment, which tends to make us ruminate and even become depressed. There’s a certain side—it’s actually the right side of the brain of what’s called the parietal lobe that lights up when you do a functional MRI.

When in contrast, a person says, “Enough. I am going to take a leadership role here. I’m going to be involved in collective action. I am going to put myself in a situation where I am working with others.” It goes to the absolute opposite side of the brain, which looks outward. That opposite side of the brain activated, gives us this transcendent feeling of being a part of something bigger. We get away from the narrow specifics of ourselves. And it allows us to feel gratitude. We have a certain sense of humility. It brings about compassion.

Most of all, it gives us a sense of awe, of that we have forgotten about our narrow—it makes us more generous. It gives us a feeling of reducing the sense of our own personal needs and importance in favor of the group. Boy, is that a magic sauce for the spirit. That’s what happens when we go from thinking narrowly of ourselves, going from being a bystander to an upstander that takes action, that leads the way. Emotions are contagious. We lead best by example. When we do something—there’s a great line, I think it was Gandhi said that when the people lead, the leaders will follow. Boy, does that give us a reason to be agents of change.

TS: OK. You’re a psychiatrist. You’ve dealt with all kinds of people walking into your office, day after day, year after year. I’m sure there are people who walk in and intellectually they follow what you’re saying, but there’s a river they need to cross to get there. They’re not there. They can’t make that leap from the place that they’re in. They’re inspired by it, but they can’t get there. What would you recommend to that person who right now they don’t have that kind of sense of empowered agency? They may care, but they’re just sort of flattened right now.

LVS: Yes. What you mean—at this very moment, you and I are talking about a time when there are thousands of people around the world dying every day from coronavirus. We hear that news—even if we put ourselves on a diet, we hear that news. This is a very, very difficult time, obviously. I would say to most people, you know what, don’t expect a heck of a lot from yourself right now. If you are of a mind to sew masks or to share food, obviously, respecting the physical distancing and all the rest of it is recommended, go ahead and do it. But I would say don’t expect a lot of real high-level thinking. If your behaviors are consistent with being a good citizen and a loving person, then that’s great, but I wouldn’t— obviously, but I wouldn’t expect a lot.

If a person walked into my office—although I’m only seeing patients remotely—the first thing we have to now is really try to heal. People heal in different ways. A one-size-fits all approach will never work. People have different coping strategies—for some it’s busily going about sewing masks and sharing other things. For someone else, it might be a time to kind of retreat into a more thoughtful period of time, reflecting on what’s important in life, and what changes one wants to make, or how to get through the day, if you’re in a place where there’s a great density of people around you and you have to deal with new things.

The first thing we have to do is really get through this especially fraught, inflamed time. But you’re right, to get to a point where we can go to a place where we exercise our power. Of course, it was the last chapter, not the first chapter in the book. There are many steps that can bring us there. One of the major steps, I think, is really recognizing that we’re products of nature and we’ve forgotten that. In our attention, devotion to the wizardry of technology—which has only really, I think, augmented our feeling that things have to happen really quickly and at the touch of a button—we’ve lost a lot of the cardinal virtues of patience and temperance and wisdom. We’re not thinking much. We’re really just acting and we’re expecting—our frustration tolerance has dropped. We’re expecting things to happen immediately.

If we go back to the way we were evolved—and I mean evolved meaning over millions of years, from ancestors to certainly quarter million years ago since we dropped down on the savanna as our recent ancestors did. Our bodies were designed by nature, research and development, over thousands, tens of thousands of years, to live in accordance with the rules of nature. And we’re breaking them—again, just like the teenagers when their parents are out of town throwing a wild party. We’ve got lights going until midnight, and we’ve got moving images across our screens. We’re walking around, running around doing all sorts of stuff which really do not respond to our native biorhythms.

We’re eating food that is not natural to this incredible, what’s now referred to as the second brain, the gut microbiome. We’re not giving this incredible factory that lies within our gut the products that it needs to keep us in optimal health. The air that we breathe is not clean.

What we are seeing even as we are sick and dying is that nature is healing. Our skies are cleaner, they’re bluer. Water is cleaner. We’re seeing swans on the canals in Venice. You can see fish now. And while, what a terrible price to pay, what we can say to ourselves is that as we learn about some of the mistakes that we’ve been making, that have meant that rather than living in harmony with nature, we have thought somehow we were the masters of the universe and we could defy all of this exquisite balance that nature has delivered over the millions of years. This is our salvation.

Once we learn those lessons, we can pour all the energy of the—sometimes the despair, the outrage, the fear, and turn that into effective action. That’s the last chapter of the book and that’s the most important place we can be, which is to take all that we have learned about being respectful of how our bodies and how our spirits live or must live in harmony with the rest of nature, that we learned that lesson, we’re good to go. And we will have a planet that healed.

TS: I do have to say that I think your book, Emotional Inflammation, is a guidebook for our times. It’s a guidebook to help us take responsibility for what we can impact, our health, our mental health, and come forward. It’s really gorgeous. There’s a couple things that I want to talk to you about that I thought were truly unique about the contribution you’re making in this book. One of them is that you identify what you call “reactor types,” different ways that people suffer with emotional inflammation. and I’d love to know how you came up with this typology, if you will, of reactor types; and then if you could explain to our listeners, the four reactor types you’ve identified and why does it help us to know what kind of reactor we are?

LVS: First of all, thanks so much for saying a typology because that’s exactly what it is. People don’t often use that word. You’re absolutely right. Typology, the core is well described, but the periphery is a little bit more blurred. So we can bleed into one typology or another. The four types that we identified come from experience looking at people, and noting the various defense mechanisms that we use to deal with the challenges of everyday life. It really was based on an empirical evidence, my experiences of dealing with people. These are the survival strategies, and they can be determined by the particular place we live, by our temperament, as we all have temperaments, by the people that we were exposed to growing up, the experiences that we’ve had over life.

It’s exceedingly important to look at these different styles, and the reason is that if we can name what it is that we’re doing that is a survival strategy, we can see both the benefits and the downsides, and there are benefits and downsides to both. It also has been so incredibly helpful, even for me,—you know, I was at a board meeting not long ago, and I pointed out these different coping styles, and the tension that was experienced among a couple of different people immediately began to resolve when we could give it a name. Certainly, we’ve all heard of or had the experience of having an illness or something like that and not having a diagnosis, not having a diagnosis. Finally, you get the diagnosis, and though you’re not happy about it, you’ll hear a person say, “Well, at least now it has a name.”

When we look at these various coping styles, we can see who we are, how we are. We can see how we could rub other people the wrong way with our style, even though it’s “not intentional.” So what? If you’re a frantic type, and you’re with a person who’s retreating, that’s not going to work well. The retreating person has certain contributions to make and how to deal with the world, so does the frantic person. But you can still rub each other the wrong way. But if you understand that these are just stylistic differences, ways to cope, then all of the judgmental stuff recedes. The tolerance rises. And once you know what’s going into the soup, so to speak, you can try to adjust the ingredients. So if you’ve got somebody that’s wants low salt, don’t get salty about what you’re doing. Have a moment where you want to talk peacefully to the person. Seek a time, maybe when you’re on a walk, don’t just barge in and start saying stuff. Other people love that high intensity.

You got to know your audience. Anybody who has ever done a presentation or talk to anybody knows that if you know the person and know their upside, downsides, and what sets them off, or what calms them down, you’re at a huge advantage. So these types are exceedingly and have been exceedingly useful in my being able to order my own inclinations and figuring out how to get along with others.

TS: All right. So you identified these four types. The first is the nervous reactor, that person who’s anxious, worried, fearful—and, OK, confessional moment. Not that it was hard for our listeners of Insights at the Edge to know, I’m a nervous reactor. OK. Then the second one you referred to here as the frantic. In the book, you talk about this revved-up reactor, the person who has to do a lot, and then the molten reactor, that person who responds—their coping strategies to get angry and irritated and outraged. Then you also referred here in our conversation to the retreating reactor, that person who withdraws, numbs out, detaches, OK, Lise, what kind of reactor are you?

LVS: All right, drum roll. I am revved up, and I get sometimes totally exhausted. I get myself into so many tight spots because I agree to everything because one of the things that I try to do as a defense mechanism is to not hear the sounds of anguish sometimes, or fear that I might have. By keeping my life so crammed full of activities, you don’t have a chance to fully experience or explore what you’re feeling.

It is a coping strategy for me to agree to every talk, every article, every this, every that—just say yes, yes, yes, yes, yes. Then like a kid in a candy store because I think, “Oh, good, good. Yes, that sounds really fun. I’ll do that,” I eat it all and I’m sick with a feeling that I’m overwhelmed. Then I pivot into this feeling of, “Oh, God, I should just withdraw.” It doesn’t last long, but what it does tell us is that we may have a very central, sort of core way of acting, but we all engage in some of these other types at various times and in various proportions.

Certainly, my family would laugh if I would say, “Oh, I’m not very short fused.” I don’t think I am the molten type. I don’t think I usually . . .” I mean, that’s not true. No, I swear at the television and things like that. I get angry and use vulgar words and things like that. But I don’t do it interpersonally, because I guess 30 years of being a psychiatrist has taught me that it doesn’t work very well. But I think we all have these capacities, but we use these techniques, defense mechanisms that we have seen work well for us, or so we think, based on our particular experiences.

TS: Now, you mentioned that there are benefits and downsides to each of the reactor types. When it comes to thinking of a revved-up reactor, it’s kind of easy, you get a lot done. That’s a benefit of that type. What’s the benefit of being a nervous reactor?

LVS: Well, the nervous reactor—and there is a huge benefit to the nervous reactor. The nervous reactors are the ones who are warning that there is a problem. They are the ones that are saying. “We’ve got to be careful of this. We’ve got to be aware of this. We must do this. We must do that. Don’t just sit idly by.” They may not be the ones that are getting arrested at a barricade, but they are the ones that are warning that there are the pipeline—the first thing I can think of is that the pipeline is going to be [inaudible]. We’ve got to get in the way of it. We got to stop it. This is fossil fuels that will be assured of having delivered. We got to stop it.” They’re nervous. They’re running the numbers. They see it.

Did you say downside or positive—oh, positive, you said positive. Yes. There are many positive sides to the nervous ones. They’re the ones that—the vigilant. They’re trying to address the dangers by bringing up, by making the noise about them.

TS: And the positives for the molten reactor?

LVS: OK. We should be angry. When I look at youth today and the special standing, in a sense, that they have being at the tip of the spear, boy, do they have legitimate reason to go into an elected official to office and say, “How dare you?” This is what of course Greta Thunberg had said, famously addressing—it was either at Davos or the UN. “How dare you?” Her outrage and her anger is searing on the ears of people who are not used to being talked to like that. Outrage has a very, very important role to play, especially if you have not contributed the problem. Obviously, if you’re a titan of industry and now you’re outraged at our greenhouse gas emissions, yes, you can be outraged. But people will say, “Well, wait a minute. That’s how you made your money. This is pretty—isn’t this hypocritical? How disingenuous is this?”

But if you are a young person—especially you have that moral ground to say, “How dare you,” and that anger is exceedingly effective, exceedingly powerful.

TS: OK. The benefits of the retreating reactor, that person who under stress withdraws and detaches?

LVS: The retreating a person is helpful in the following way. First of all, in the midst of all—and it’s not just young people who can be angry, older people can be angry too and there’s a place. But I don’t mean to say that it’s just the problems of young people because it’s not. In a million years, it’s not, and I can think of many examples, but that was the one that I think is the most effective, or representative. But again, I could talk about these for hours.

But the retreating person, first of all, is often a thoughtful person. A thoughtful person oftentimes teaches us a sense of humility. They can teach us the value of compassion. They can teach us the sense of the patience that we need. The work of finding and creating and making a world that is just, is a marathon. It’s not a sprint. People who are sometimes retreating can teach us that the Rome wasn’t built in a day. We can start by building our own vegetable garden, making sure that our lives speak for the values that we hold dear. They’re not looking for a big stage. They’re not looking for a lot of noise. They’re looking to do the right thing.

As we had said earlier, we lead by example. This is the power of social norms that I really see, that people who are involved and taking action in themselves that are withdrawing perhaps from the play, but these are the ones buying seeds. These are the ones that are potentially planting community gardens. They have gone into a world that is in sync and is in harmony with the speed and the pace of nature.

Feelings, emotions, behaviors are very contagious. One thing the world really, really needs now, just as there are climate and other tipping points, there are cultural tipping points. We need people who are doing the right thing, just in a quiet, but persistent way. Sometimes those retreating, thoughtful people are the ones that create change by creating social norms. And I’ve said this before, and people say, “Oh, well, what one person does doesn’t matter.” Are you kidding? Why do we all vote in November? It’s—yes, you can say every once in a while one vote make the difference. Most of the time, it doesn’t. But our votes are counted as a collective, or they’re counted together. So what each one of us does, in a thoughtful way, is counted as a collective, and that’s how the world changes. When you get a certain percentage of the world taking action, then it becomes a social norm. That’s what changes the world quickly.

TS: It’s interesting hearing about the upsides, the benefits, the strengths of each one of these different reactor types. Because of course, how we react, this is our form of emotional inflammation. This is our personal expression of emotional inflammation. What it shows me is that our emotional inflammation is intelligent in a certain way. I wonder if you can address that, that this response we’re having is actually a form of intelligence.

LVS: Oh, this is so nice. Yes. Thank you for asking that question. I wouldn’t have thought to say it, but I think you’re spot on. What we have to understand is that when we think about emotional intelligence, which you can—you know, stress, anxiety and whatever other words, you want to think of. If we’re smart and we can see this, and this is why I think it’s so important to be able to name it that we can say to ourselves, “OK, what can I do with the energy that’s embedded in this particular state of mind, take that energy—” and it is a response to the world. Boy, the day we stop—I think, it was Martin Luther King, “The day we stop caring is the day we die.” People within these groups with these—people with emotional inflammation feel this way because they care. They have, we call it a sensory processing sensitivity. They feel what’s going on, and that’s an elevated state. That’s a place we want people to be in. We want them to be responding to what’s happening in the world around them and to take that energy and redirect it in to empowering action.

The intelligence of each one of these types is really up to the bearer to turn into something constructive. That’s the middle ground between being so panicked you can’t do anything, and being so far in denial that nothing matters to you except yourself. Somewhere in the middle, that’s that sweet spot where we take the energy and turn it into constructive action that makes us feel like agents of change, and honestly is the best antidote to the condition that is taking so many of us and putting so many of us on edge.

TS: Just one last topic I want to talk about, Lise. The subtitle of the book is Discover your Triggers and Reclaim your Equilibrium during Anxious Times, and this notion that there’s value in identifying what triggers us. I think a lot of people are, “What do you mean, what triggers me? I’m triggered! I mean, there’s a global pandemic. People are wearing masks in the grocery store. Do I really need to get any more specific than that?” But there’s a way in the book on emotional inflammation that you direct people to a self-investigation about what triggers them that I thought was really helpful. I wonder if you can talk a bit about that.

LVS: Yes. This is certainly culled from a lot of personal experience, certainly, and from listening to other people. I’m going to just give you a very personal example. About a week ago, this is—where are we, 2020 April. Unfortunately, a very tragically, one of the Kennedy, Robert F. Kennedy’s grandchild and great-grandchild drowned not far from where I live. Yesterday, which would be exactly a week before, was just around the time that the accident must have occurred. I’d been outside, it was a beautiful day, but relatively good mood despite what was going on around me. But all of a sudden, I realized I walked into the house and this huge darkness—I glanced at my watch, this huge darkness came over me. I thought, “What just happened?”

So what I did was what I advise my patients often and what I advise people generally, backtrack a little bit. What happened? You were in a good mood before. Was there a random thought that came to mind? Did you associate with something? Stop. As we said in the book, hit the pause button. Ask yourself what the heck just happened? We’ve got a list of various examples of the kinds of emotions that you might have that you were—that someone shamed you or you felt belittled or something else.

For me, it was this profound sense of sadness that was the Kennedy family, all that, sure, they’ve gotten a lot in life, but all they have endured. I realized that it was just about the moment, yesterday, and that that thought, just in a fleeting second, came to my mind that it was about that time and my mood just went dark, a light went out. I was able to grasp it and I was able to say to myself, to process it and to understand what happened so that I could begin to let go of it. Certainly not easy because it remains such a great tragedy to what sounded like a wonderful mother and son and family.

But the idea of knowing your triggers, going back, saying to yourself, “Are there early life connections? Did a boss say something to me that reminded me of what someone had said to me as a child when I was bullied, or criticized by a parent? Was there an experience, public experience that I had that now came to mind when I saw or had this particular event come to fruition? Was I made to feel less than in some other way, that I feel stupid, or some other frustrated, demeaned in some way?”

By understanding the emotion that we have, what we can do is rewind and say, “Well, what events in my life may have predisposed me to feel this way?” Once we can name that upstream—either might have been many experiences like that, maybe it was just one cataclysmic event, it really does help us to bring it to conscious thought, where with our conscious thinking, our cognitive sense, we can bring rational thinking into play. We can say, “Well, that’s no longer the way—I don’t have to feel like a victim anymore. I don’t have to feel like all is lost. I don’t have to feel demeaned.”

You can talk yourself through with a rational dialogue. Once it becomes conscious and you can solicit your own good judgment, your own world experiences since that event, and use that to heal.

TS: As I mentioned, I really do believe that Emotional Inflammation: Discover Your Triggers and Reclaim Your Equilibrium During Anxious Times could be for many people a guidebook for our times. I know I’m recommending to all of the Sounds True staff to actually read and study and practice what’s in the book.

I’ll tell you why, Lise: one of my goals is through this difficult period of the pandemic, to give the 120 or so people who work at Sounds True something specific that they can do to contribute to the ability of the company to weather the economic storms of our time. I think for people to understand their reactor type, to know what’s triggering them, and then to engage in your seven-part RESTORE program that we haven’t had a chance to talk about here, but it really goes through seven different steps that you can take where you can have an influence directly on your own mental health. It’s just so powerful because as you’ve been describing this conversation, you then become capable of creating a positive impact, and I think it will help our staff create a positive impact. So I want to thank you for the book. It has so much wisdom in it. Thank you so much.

LVS: Well, on behalf of Stacey and of course of me, we can’t thank you enough, first of all, for this opportunity. Because I must say that this is one of the most joyful activities that I have engaged in, in my professional life, to be thinking of providing opportunities for people to think of ways that they can heal and get on a road that makes them feel as if they’re agents of change in the driver’s seat of their lives. That is just a thrill. Thank you.

TS: I’ve been speaking with Dr. Lise Van Susteren. Along with her co-writer, Stacey Colino, they’ve created the book Emotional Inflammation: Discover Your Triggers and Reclaim Your Equilibrium During Anxious Times.

Thank you for listening to Insights at the Edge. You can read a full transcript with today’s interview at SoundsTrue.com/podcast. If you’re interested, hit the subscribe button in your podcast app. Also, if you feel inspired, head to iTunes and leave Insights at the Edge a review. I love getting your feedback, being in connection with you, and learning how we can continue to evolve and improve our program. Working together, I believe we can create a kinder and wiser world. SoundsTrue.com: waking up the world.

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