May 17, 2022

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Mitch: Now, mental health is something more people than ever are struggling with according to a bunch of different articles. And I can tell you from personal experience that it's just as important as your physical health. And that's why we made it one of our Core Fore.

But as guys, as people who may not have been raised with the most positive approach to mental health, it can seem a bit overwhelming to get started. And finding the right mental health specialists can be everything.

Today, let's see if we can't learn how to find the right mental health specialist for you. This is "Who Cares about Men's Health," where we aim to give you some motivation, inspiration, and maybe a different interpretation of health.

I'm Producer Mitch, and I bring a little bit more than the mics, I'd like to think. And as always, we have Scot Singpiel, manager of The Scope Radio and one of the best BSers that I know.

Scot: I can't wait to start shoving some feelings down. I'm really excited for that.

Mitch: Perfect, I'm excited for that. And bringing the MD and maybe a touch of validity to the show, it's ER physician Dr. Troy Madsen.

Troy: I don't know about the validity. Maybe the MD. Thanks though, Mitch.

Mitch: And joining us today is Dr. Scott Langenecker. He is a clinical neuropsychologist and professor of psychiatry at University of Utah Health.

Now, before we get into the kind of nitty-gritty, I just want to do a quick check. Scot and Troy, let's start with Scot, what would you say your relationship with mental health is? I mean, it's the Core Four. We talk about it a lot. Have you ever taken the steps to actually talk to someone?

Scot: What's my relationship with mental health? It's kind of like the person that's across the street that you think you know and maybe you wave at them just in case you do.

Mitch: There's a casual nod every now and then, yeah?

Scot: Yeah, I don't like to get to intimate or too close with it. No, I'm kidding. I don't know. That's a tough question to answer, Mitch. It's something that I consider. It's something that I've become more aware of. I think just realizing and acknowledging sometimes when I'm stressed, or when I'm anxious, or when I'm not feeling well. What was the question again?

Troy: Have you ever talked to anyone?

Mitch: Yeah, have you ever actually had help?

Scot: Yeah, I did. A lot of workplaces have those programs where you can have an appointment. And there was a particular time in my life where things were really, really difficult and I just wanted some insight and maybe some tools to help me work through it. So I had two or three meetings with a professional in that respect.

Mitch: And how was it? Was it good? Did it feel weird to be there?

Scot: I'm looking forward to this topic because while it was good, I don't know that I necessarily felt that I had a connection with that individual. And if I was to continue that, I think I would want to try to find somebody that I had more of a connection with. So I'm really looking forward to finding out more about that today.

Mitch: Perfect. And how about you, Troy?

Troy: Mitch, mental health is something I absolutely think about. Sometimes I worry that I think about it too much, and I'm like, "Am I overthinking mental health?" Is that kind of a paradox? I don't know.

Self-diagnosis is something I often struggle with. And I've said before I sometimes take the approach where I either diagnose myself physical ailments with cancer, or I just tell myself, "Don't worry about it. Don't think about it." So sometimes, maybe I do that with mental health as well. But I absolutely think about it.

In terms of speaking with people, I think it's been more of an informal thing for me. I've had a number of conversations recently with several of my colleagues that have been really productive and very helpful as a lot of us have struggled with wellness and mental health, I think coming out of the pandemic in particular, but maybe just general job stressors and those sorts of things.

So it's kind of a relationship. Maybe I'd describe it as an on-again, off-again relationship. Maybe that's the best way to put it.

Mitch: Casual. It's complicated. Yeah.

Troy: It's complicated. Yeah.

Mitch: So with me, I think I've had probably the most interaction with a mental health professional myself. When I was growing up, mental health was definitely kind of treated as a sign of weakness, right? This idea that if you have "big emotions," then it's some sort of moral failing, and to buck up, "This is how men are," etc.

But during COVID and during the last couple years of my life, I knew something was kind of off and something was really wrong. I was feeling stressed, anxious, couldn't sleep. Work was really tough. Feeling good about things was bad. Relationships took a nosedive. And it got to the point where I felt I finally needed to talk to someone, and it was really tough.

I'll kind of fill in as the conversation goes, but it took me a while to find someone that I could talk to with my situation and actually get a connection that could help me. I actually went through three or four mental health specialists until I found the person that I did.

And the reason I even came up with this idea for this episode is I wish I had known that it's okay to find the right person, to try a couple. It's not you. You're not the one that's screwed up. But that's kind of why I wanted to make sure we talked about this.

So I've been with my current therapist for over a year now, and we're making tons of great work. I wouldn't have been able to do that had I not found the right person.

So let's turn to the professional a little bit to talk about this process and a little bit about maybe some strategies and kind of how we can approach this. Scott, Dr. Langenecker.

Dr. Langenecker: Yeah, call me Scott.

Mitch: Call you Scott?

Dr. Langenecker: Call me Scott.

Mitch: We've got two Scotts.

Dr. Langenecker: I know that's confusing. We've got Scott squared here.

Mitch: Maybe I'll call you Dr. Scott, I guess.

Dr. Langenecker: That's a groaner. That's a groaner when you're talking about mental health, but we'll work with it.

Mitch: Gotcha. So what kind of person needs mental health help? I guess that's kind of where I wanted to start. Who can mental health assistance help the most?

Dr. Langenecker: That's a fabulous question. I think about it this way: What's the most complicated system you have in your body? The obvious answer is your brain. If your brain is not working the way you want it to, that's the time to find somebody to talk it out and figure it out and see if you can optimize what's going on.

It's not always about things are terrible. I feel awful. Sometimes it's,"I just feel off," or, "That didn't go the way I wanted it to," or, "I got angry there and I really don't like it when I get angry." There could be all sorts of reasons why it might be a good idea just to chat with somebody and check it out.

Mitch: Is there something that men kind of deal with more than, say, anyone else that maybe that's a sign you should probably go talk to someone?

Dr. Langenecker: Well, the big one for most men is anger, and even acknowledging that sometimes anger gets the best of you. It may be that you've got it under control. It maybe that it doesn't really affect anybody else except for you. But if you walk around, and you get home from work at night, and you just feel off or irritable or angry, that's kind of a good sign that maybe it's a good idea to talk to somebody.

Mitch: So let's go to that next step. You need to talk to somebody. And I've heard that exact phrase far too many times. "Go talk to somebody. Go find a professional." What am I looking for? Are there different types of specialists? Is there some place that I should start? Who is that "somebody" in that statement?

Scot: I mean, that's a great question because there are licensed clinical social workers, there are psychologists, there are psychiatrists. There are probably 16 other titles as well.

Mitch: I was actually sent to my primary care physician first. And I was like, "What? Why would I talk to them about this?"

Dr. Langenecker: Yeah, most people are actually sent to a religious person first, which can be a little bit complicated.

Mitch: What?

Dr. Langenecker: Yeah, the most common person that somebody talks to first would be a pastor or a priest or a bishop. And that can be helpful. But if you think about the first question you asked, "How do I know that things aren't really going the way I want them to?" if the answer to that is, "I don't feel like things are in my control," or, "I feel like there's too much weight on my shoulders," or, "I feel like I can't quite keep all the pieces together," that's a good example of when to say, "Hey, let's maybe talk this out with somebody else."

And then the next step is really to say, "Well, what is it that I think is going on? Is it my emotions? Is it my sleep? Is it my sex drive? Is it my body falling apart as I'm getting older?" That might sort of dictate where you go.

And what am I looking for? Do I want somebody who's just going to listen to me as a real human and care about me? That's pretty powerful all by itself. Or do I have some work to do? Maybe I've got this thing where I come home and I'm angry, and I drink and maybe I drink a little bit too much, and that causes trouble in my relationships or maybe it messes up my sleep. If I've got to do some work, if I've got to make some changes, then the kind of professional I'm going to look for is going to be different. Does that make any sense?

Troy: I was going to say that makes so much sense. And I love, Scott, how you said, "It's one of those things where the mind is the most complex system in the body." The brain is the most complex system, and I look at some of the advice that I hear people's family members giving them about the heart or the digestive system, and it is not good advice.

And then you think we need these supportive people. We need them in our lives, but oftentimes, we're going to them with very complex mental issues and really internalizing that advice when we probably need something more than that and a much higher level of expertise.

Mitch: It makes me think of my cousin and her mother. She was having heart palpitations and she was like, "Mom, I have heart palpitations." "Oh, I have those. They're the flutters. Don't worry about them."

Troy: Exactly.

Mitch: I'm just like, "Maybe you should go talk to a specialist, not just somebody."

Troy: Exactly.

Dr. Langenecker: Yeah, let's get that bit out of the way right away, because the first thing that you're going to get from people who care about you is, "I want to come to a solution for you." And how that's going to be heard in your mind might be, "I don't really care about your problem. Let's talk about something else."

Mitch: Yeah. That struck a chord.

Troy: Yeah. I mean, certainly as men as we talk to other men, I know that that is often a complaint about men, hearing people talking about issues that are of importance to them. We certainly are solution-focused. We want to find answers. And I am as guilty of that as anyone. But again, like you said, that may not or probably is not the best approach.

Dr. Langenecker: Yeah, that's going to come across as, "You're making me uncomfortable right now. Please talk about something else."

Troy: Yeah, like, "Let's put a bow on this. Let's move on. Let's talk about something else."

Dr. Langenecker: "Let's go play basketball."

Mitch: "Cool. Yeah."

Troy: Yeah. Exactly. "Cool. Okay."

Mitch: So your loved one is good for a lot of things. That's important. Those relationships are important, but maybe not the most helpful person to go to with some of these issues.

Dr. Langenecker: Well, it may be that the relationship with a loved one may be the thing that you're struggling with. Your loved one may be struggling, or you may be struggling and your loved one doesn't want to hear about it, or they don't know how to how to support you. That's a good time to go seek out a mental health professional.

Mitch: All right. Let's go to that next term then -- mental health professional. What am I looking for? If I type in "mental health professional," am I going to get what I need, or do I need to go in with a little bit more know how?

Dr. Langenecker: Well, to be completely frankly honest, this is a daunting thing for me, and I've actually been doing this for 25 years. So I do want to be completely honest with your listeners.

Your example, Mitch, is a perfect one, which is sometimes it takes a bit to find the right person. And so when you start out, you might be entering something into Google. "I've got anger issues, and I want to find somebody to talk to." And that may send you to a place that you don't ultimately ended up going, but it may send you to somebody who can actually give you some advice on where you need to go next.

So one of the things that I say in the first meeting when I meet with any patient is I say, "You know what? I'm a 51-year-old white male from rural Wisconsin. That may or may not jive with who you are and what you think of the world. And we're going to talk for a bit and hopefully you feel comfortable working with me. But if you don't, I want you to feel comfortable saying, 'Hey, Scott. I need to talk to somebody else. Can you help me find someone else?'" And then I do.

That's where we get to some movement, get to the place where you actually find somebody who you can jam with and jive with and feel comfortable with and do some meaningful work.

Troy: And you don't take offense at that, if someone is just like, "Hey, this is not working. I've got to find someone else"?

Mitch: It's not you. It's me.

Dr. Langenecker: Yeah, to be completely honest, as a therapist, I feel it too, if things aren't quite going. I'm working my tail off to try and make it work, but if it's not, and you're just being polite and saying, "Hey, let's work on this thing today," and it's kind of nails on the chalkboard, let's not do that. Tell me so we can find somebody who will work with you and you get a good experience out of it.

Troy: So I wish I could do that as a healthcare professional. "This isn't working. I'm going to go find someone else to take care."

Scot: "I'm going to go find another arm to fix."

Troy: I'm just joking.

Scot: Hey, Mitch, I've got a question for you. So what was the process for you? What was going through your mind as you were meeting with different professionals and you were trying to find that right fit? How did you know? What were the considerations?

Mitch: So I first went through the company work assistance program, and I'm just like, "Hey, I'm feeling off. I think I need to talk to someone." They're like, "Well, we'll connect you with someone." And they first asked me, "Do I have a preferred gender of specialists?" I'm like, "I don't know. No. I don't think so." And so the process, I think, was a little lacking as to . . . I just was given who I was assigned.

And what was interesting is I came in, I was at a really kind of downplays, I was suffering with severe anxiety, severe depression. I was trying to decide whether or not to get on medication for it. I was in a really dark place. And so I'm suddenly just on a Skype call with some random soft-spoken individual and there was something that felt off very early in the conversation with this person.

And what was interesting is that I think it's partially myself, but there's something that's . . . I just assumed that maybe mental health work was not for me, right? The fact that I wasn't jiving with this person, the fact that I felt the vibe was just wrong. I'm like, "Hey, I'm feeling really depressed, and I can't seem to get rid of it." And it's like, "Well, have you tried a gratitude journal?" And I'm like, "Okay. Cool. Yeah, I have. I think there might be something else that I would like to try." "Well, why don't we try that first? I think that's always a great place to start."

Nothing against the guy, but for me, that was just like, "Dude, I've read the self-help books. I've done this stuff. Please listen to what I'm trying to say." And rather than just saying, "Hey, this isn't working for me," I was very sheepish and I was like, "Okay. Yeah, sure. I'll trust the process. I'll trust the person."

And so it took me three or four weeks with this person. And finally deciding, "No, this isn't going to work for me. This isn't the person."

I actually had to talk to a friend who happens to be a mental health specialist for her to remind me, "You don't need to stick with it. You can keep trying people out until you find the person that works for you."

Troy: I was going to say, Mitch, hearing about that, it sounds a whole lot like dating. And I guess with that in mind, Scott, my question for you is how long do you give it? Do you have to go on a second date?

Scot: How many times?

Troy: Can you just walk out on the first date? Can you get 15 minutes into and just be like, "This is not working. I'm not wasting my time"?

Dr. Langenecker: That's a great analogy. And let me take that analogy one step further. "This date is not working, but do you have any close friends that are hot?"

Mitch: Yeah.

Troy: Can I go with your roommate?

Dr. Langenecker: I mean, that's kind of what it's like. The person that you're talking to, you may not jive with, but they're probably in the best position to point you to the next stop. So one, maybe two visits. If you're not feeling it then, then it's time to move on.

Let's be honest. We're all human beings. When somebody says, "Hey, you know what? It's you," we can be hurt by that. And so somebody might say, "I've got to take a minute to think about what you just said before I can be effective in giving you good advice." I hope for a day when that doesn't happen, but I think that's where we are right now.

Scot: I want to jump in with a quick question for you, Scott. I was listening to Mitch's story and just thinking what that would be like to go in and start revealing some of these very personal feelings, right? For some people, maybe that's going to happen on the first time. But for a lot of people, it's going to take time with an individual before you can really start getting at it. Is there any research or anything that shows how many times you have to go before you start developing a trust?

Dr. Langenecker: It's really tricky to answer that question. So some people feel comfortable with a person, and it's like opening the floodgates. It all comes out.

And then sometimes as a therapist, you're like, "Oh, man. We're just scratching the surface. We're scratching the surface." We're on the third session and I'm like, "There's something else here." And as a therapist, then you kind of just try and bring the warmth and bring in the energy and just say, "Hey, it seems like there might be something else on your mind."

And the funny joke we have as therapists is if it comes up in the last two minutes of a session, it's probably super important.

Scot: I have people in my life, that's their strategy. It's the "one more thing" strategy, I like to call it, where the one more thing is the thing.

Dr. Langenecker: "And by the way, my house is burning."

Mitch: Well, it's interesting that you said that because it took me three or four people and I actually started to talk to friends. And that was a really weird place myself, to be like, "Hey, do you go to therapy? Do you have someone that you could recommend?"

And it eventually got to the point where I had been working with some mental health specialists up at The U for another project, and I was talking to the person I was working with and she was just like, "I have the perfect person for you. Reach out, see if they have any openings, whatever." I got in.

If we're going to keep saying that it's like dating, there was just an instant connection. There's something about being able to find a mental health person that approaches your problems in the way that you need, who can talk to you the way that you need to be talked to. There's something about being able to just like . . . I curse like a sailor, and just to be able to curse freely and not feel inhibited by that and have the same energy brought right back and just . . . I don't know. There was something that very quickly I was able to really . . .

We talked about Kung Fu movies. There was just something instantly about this person and this connection, and all of a sudden he's making references to TV series as how they can be applied to my life. And I'm like, "I've seen that series. I love that series. Yes." And that's when the mental health work actually started.

Dr. Langenecker: As you're talking Mitch, it just makes me think of . . . Imagine you're going on a journey to a place you've never been before and you have to go on this journey with a blind date. This is kind of how hard it is. And so if you're not feeling that chemistry right away, it's probably time to find a different blind date.

Troy: And would you recommend you go into that search kind of with that mindset, like, "Hey, I've got to go on a long road"? Let's say it's a 24-hour train ride or something. Is that the kind of person you're looking for, the person you want to take that train ride with? Someone you enjoy that much that you would enjoy spending that much time with them?

Scot: I don't know what kind of problems Troy has, but 24 hours is your idea of long?

Mitch: That's long. That's terrible.

Scot: I thing we're talking like a summer backpack across Central America, perhaps?

Dr. Langenecker: Yeah, I was thinking more like a trip to the Lonely Mountain with Bilbo.

Mitch: Sure. Yeah.

Troy: Okay.

Mitch: You need a Samwise.

Troy: Twenty-four hours is the starting point.

Dr. Langenecker: Yeah. I mean, it could be. It could be 24 hours. Just to share a bit of my own experiences with mental health, I've been in sessions for other people who have needed support. I've obviously been on the other side providing the support. I've gotten support myself. Sometimes it's literally like I need to talk to somebody about this problem, it's going to take about 30 minutes, and that's it. And that sounds like such a male thing to say.

But sometimes it takes more. Sometimes it takes quite a bit more. And so you don't necessarily know. But it's fair to say, "If I got I trapped in a capsule on the mission to Mars with this person, could we make it? Could we do it?"

Troy: And not just do it, but enjoy the conversation, I guess.

Dr. Langenecker: Well, maybe.

Troy: Maybe.

Dr. Langenecker: This is hard work. So it's kind of like cleaning a bathroom. You know you've got to do it. You know if you don't do it, you're going to get germs all over, and it's going to be gross, and you're going to get sick. But it's not like somebody says, "I want to do this today."

Troy: One thing Mitch mentioned, too, kind of looking at this process, he started with the Employee Assistance Program. Do you find those programs are helpful? Is that a good starting point if someone is just like, "I don't know where to go. I don't know where to start"? Or do you recommend a different route?

Dr. Langenecker: That's such an important question. In our culture, right now, in the space we live in, most people don't seek help because they're afraid that it will affect their job. And so going to an EAP, that's the hardest thing in the world. If you feel comfortable with that, great. I mean, those folks are there to help you, and they're good at it, and they're in touch with being confidential about things. But if that's going to be a hesitation or a hitch for you, then let your fingers do the talking. Go to Google or talk to somebody who might know somebody.

Troy: Yeah, I think from a personal standpoint, it's a good point you make and it's interesting to hear that. I feel like if I went there, they would know my job title, they would know what I do for work. I would just worry that there would be so many assumptions based on that, and I would almost feel obligated to play that role. For me, personally, be the doctor role. "I'm the guy who sucks it up, and I deal with it, and I'm going to get through this." My doctor persona.

So I wondered if that's the best route just because maybe you are in more of that work mindset and that work role that you play, and if that would carry into those sessions.

Scot: I'm getting the feeling that you think that the person would know your job title. I don't know that that's the case.

Troy: I would think so. Maybe they don't. Yeah, I don't know.

Dr. Langenecker: Let's explore this from the headspace, the headspace of the person who's looking for some help. There might be some shame. There might be some shame about, "Oh, gosh, I've got to ask for help." First of all, men don't ask for help. And second of all, we do it while playing basketball, not in some cushy office. So that could be a really hard thing to start out with.

I just try and clear the air, right? Clear the air and be like, "Let's go to a place where you feel comfortable walking into the building, and that shame thing isn't going off in the back of your head."

Troy: Yeah, and maybe that's the EAP program, maybe it's not. Maybe it's somewhere else.

Dr. Langenecker: Yeah, it's not a one-stop shop and it's not a one size fits all.

I was sharing with Mitch before when we were chatting, finding a good therapist is kind of like finding a good pair of shoes. You've kind of got to know what you're looking for. Do I want running shoes? Do I want hiking shoes? Do I want dress shoes? But they've got to be super comfortable. You've got to be comfortable working with a therapist.

And the reason why I like using the analogy of shoes is once you put them on, you're going to go somewhere. If you're going to be successful, you're going to make some moves. You're going to make some changes.

Troy: See, that's a great analogy. There's nothing worse than a long walk or hike or run with a little rock in your shoe. And you think, "Oh, I can deal with this." But just that little thing in there just becomes intolerable. So I would imagine same with these relationships. If things just are not quite right, it's just not going to work.

Dr. Langenecker: Yeah, we've all been on that walk with that pebble in our shoe or we don't have the right kind of shoes, and we're not enjoying the scenery. We're thinking about the blister we're about to have.

Mitch: That reminds me of the time I wore cowboy boots on the Vegas strip. And that was the worst decision I have ever made. I think I could not walk the next day. My feet were so broken.

Troy: Let me guess that was probably the first time you'd ever worn cowboy boots.

Mitch: Absolutely. I bought them for the Vegas trip.

Troy: That's what people wear in Vegas. They wear cowboy boots.

Dr. Langenecker: I bet you they looked good, though.

Mitch: Oh, they were banging. But no, after walking up and down the strip all night, the next morning I was limping to a Walgreens to get some flip-flops.

Troy: That sounds so horrible.

Mitch: It was.

Dr. Langenecker: If I could carry the analogy further, there are some times where a person just needs somebody to talk to and they just need a super comfortable pair of loafers. They're not going anywhere. They just want somebody to hear them as a human and to feel the connection.

Scot: Scott, talk about for somebody that maybe does not have EAP assistance or doesn't have very good insurance, what are their options?

Dr. Langenecker: Yeah, that's a great question. So here in Utah, at the Huntsman Mental Health Institute, we have something called the Warm Line. And I hope it's every bit as warm as it sounds. You can call them and say, "Hey, this is the thing that's going on with me right now. Do you have any advice for me on where I could go next?" They're there 24/7.

And it could be like we were talking about before. It could be like, "I've got this blister on my foot." It's probably not a blister on your foot, but that's just sort of me giving you space to say if you think it's a minor thing, it may be, or it may be something bigger. Just call the Warm Line and they can help you out.

Mitch: Scott, thank you for being here so much. If there was one piece of advice when it comes to finding the right specialist, if someone is curious, if they're feeling the things you're saying, something is off, you need to talk to someone, what is the one piece of advice you'd give our listeners?

Dr. Langenecker: My best advice is don't delay. In your mind, especially for men, it's like, "Oh, I can deal with that later." I know you've covered this in other health topics on this podcast, which is, "Sure, it can wait, but it doesn't have to." Things can get better, and they can get better sooner.

Mitch: Well, thank you so much for joining us, and thank you for caring about men's health.

Dr. Langenecker: Thank you.


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