Transcript:

Hi, my name is Dr. Uejin Kim. I'm a dual board-certified psychiatrist in Texas. And this is a presentation that I gave to a local church. Just because I'm very passionate about bringing the world of church and spirituality and mental health together. I don't think they're adverse, or in disagreement with each other. I think they're very synchronous, and synergistic. And I hope you did enjoy your presentation. And if you have any questions, please email me at restorepsychiatrymd@gmail.com.

So, when I was thinking about possible topics, to talk about mental health, one reason why I wanted to start with private practice, and put my Christian faith on my website, which is kind of a taboo, and possibly an ethical issue for a psychiatrist to do, was because I knew that there's a lot of people in church with mental health, and there was a division to seek help, you know. There's a lot of obstacles and stigmas that I knew that believers have to go to seek help. And that's why I put the Christian faith out there just to kind of ease that, you know, access to care. So, I'm going to be sharing what I learned in training, and what I learned in my life, with my personal relationship with God. And how it's not different. It's very much the same, and I wanted to kind of portray that.

So today, in our objectives, we're going to be discussing the definition and components of mental health. And understand the difference between mental health issues and mental health disorders. And at the end, we're going to discuss the presence of mental health in the Bible. And how God addresses our mental health or emotional issues. So, this is a disclaimer. Denise did a really good job saying that I'm not your personal psychiatrist today. But I'm available to answer any questions. And I know that this presentation alone is not a start of a patient-physician relationship. A patient-physician relationship is very intimate. And this is not the time or place for that. So, whenever we go to the question-and-answer portion, whenever you're asking a question, try to refrain from like giving specifics like ‘Oh, my son’ or ‘my cousin,’ because those are technically patient health information. So just kind of ground rules there. Okay?

So, what is mental health? I think COVID did a great job of bringing up the issue of mental health crisis in the world. And now depression is one of the top reasons of morbidity and mortality in the world. And financially, I think I picked the right career. Because there will always be a job for me. But what is mental health? So, let's define that. So ‘mental’ is relating to the mind and relating to the disorders of the mind. And ‘health’ is the state of being free from illness or injury, related to being whole. So, the emphasis here is ‘mental’ is related to the mind, and ‘health’ is being free from illness or being whole. And the reason why I emphasize that is sometimes the word ‘mental’ is used like an adjective. Like in British slang, like, ‘Oh, that was mental,’ that means kind of like that was crazy, or like that's off the charts. So, I'm gonna be using these definitions to kind of describe what does it mean in reality and clinically. So, which organ controls the mind? So, my background is being a medical doctor, MD. So, we have to study all different kinds of organ systems. And these are the pictures of roughly, not all, but some of the organ systems. And the organ that we studied the most as a psychiatrist is the brain. And brain has two functions. It has neurologic functions and mental functions. And neurologic is kind of like sensing, moving, you know, kind of more functional. And mental is more emotional.

So how does brain decide and think and feel? So, what happens is different organs, even your internal organs have a lot of input of data that they gather, you know. Pain or you know, what we see, and hear, and they relay it to the brain. And brain does amazing stuff in the organ, and processes it an organizes all the sensory input. And then relays the same message to all the different organs. Okay, so this is a very simplistic explanation of how the brain works.

So how much of the mental health is due to biochemical imbalance? There was a recent study, that's called meta systemic studies, which is like, you kind of step back and you look at all the different studies and say, ‘what is the conclusion of all these different types of things?’ And it came out saying, there's no relation between depression and serotonin. So, I kind of want to bring that up. As of, you know, does that mean that I have to take anti-depressant? You know, I don't have chemical imbalance. And we'll definitely address that later. But this is a good question to kind of explain to you another way of looking at mental health. So, we looked at the organ system, right, the clinical medical part. Now, this is more of a conceptual diagram that we use in psychiatry and mental health. This is called Biopsychosocial Model. And this is what we go off of to assess and treat, you know, the patients. So, ample of biological components of mental health contribute to your health of your mind. There’s like general medical condition. So, dementia, you know, sometimes if you have hepatitis, it can affect how you think and feel, IQ, genetics, biochemical imbalance. So that’s a component of biological factors. Intra-utero exposure. That's like, when you're in the womb of your biological mother, was she exposed to any trauma or medications or substance. But this is what I mean by intra-utero exposure, and substance abuse. So, you know that there’s a biological component that is feeding our mind.

The next is psychological. So, your mood, how you feel, sensory comprehension, as of how are you comprehending the inputs, you know, that different organs kind of pick-up: personality, emotional resilience, ability to focus, ability to relate to other people. These are kind of components of the psychological components that feed into our mental health. And then there are social components, like your friends, community, upbringing, bullying, hobbies, trauma. So, these are social components. Now, when we are trained in a secular training, there is not a sphere of spiritual components. It’s mainly a Biopsychosocial Model. But the more that I kind of, learned from the training and kind of incorporating my spiritual kind of background, what I think fits the best is spiritual components kind of feed all of this. So spiritual, when I say spiritual, I don't necessarily mean Christian, you know. Spiritual is like a sense of belonging, and a sense of purpose, or a calling, or sense of worth, you know. And you can kind of see that that kind of spiritual component is like the river that runs underneath all these biopsychosocial components, you know. It will kind of send the direction. So, this is how I conceptualize spiritual components when I'm assessing the patient.

So, what can we control and change? Because when you look at all these different components, you can see how each component contributes to your mental health, right? And our first question is, is like, how can we improve our own mental health, right? But actually, only the ones that are highlighted are dynamic. Dynamic, not even saying that you can control it, or if it is something that can change. So, if you look under biological, we can't control our IQ, we can't control our genes. And we can't control a lot of our medical conditions. But only thing we can really choose in a way is amount of substance that we use. And under psychological, you know, we can't really control how you feel, we can't control how we comprehend all the sensory inputs. But the things that can change over time are emotional resilience, ability to focus, and ability to relate. And sometimes those are not really in, “in our control.” And social, we can't really change how we were brought up. We can't really change what kind of trauma or bullying happens to us and not happen to us. But we can choose our friends, community and hobbies. And spiritual, is a sense of purpose and belonging and meaning. I highlighted it because it’s dynamic and it can change over time. But we all know that it's a journey, you know. And there's a lot of components in our spiritual journey that we can control, right?

So, I want to highlight this because there's a lot of stigma of, ‘Oh, you're depressed because you choose to be depressed,’ or ‘you're depressed because you're lazy,’ or ‘you're tired, because you just don't put yourself,’ you know. And this chart clearly states that there are a lot of things that are not in our control in our mental health. And I just wanted to emphasize that. So, I mentioned emotional resiliency as part of one thing that we can control. And this is what I focus on, whenever I see my patients over a long period of time. So, I want to explain that. And is everybody kind of following through? It is pretty big. So mental emotional resiliency, what is that? So, this is another conceptual diagram of how our mind processes sensory input. And we'll definitely go into the examples of it. So, this is called Cognitive Triad. And this is something that cognitive behavior therapy is based on. And this is a relationship between thoughts, emotions, and behaviors. And I put the arrows only on one direction, but it can go the other way too. They are bi-directional arrows. And this explains how we process our life events. And I'll give you some examples. Okay?

So, scenario #1. I don’t know if you’ve been in my shoes, but there are some times where I will text my husband or you know. And he doesn’t respond to it right away. Can anyone relate? Yes. So, I put pictures there that I'm texting, and I'm seeing the lack of response, and I'm hearing lack of, you know, notification. And that's the situation. That's a life event. Right? And what's my first step? ‘Is he cheating on me?’ ‘Is he dead?’ ‘What is he doing?’ ‘What is more important than my text?’ Right? That's my thought. Can anyone relate? So, then it leads to emotions of anxiety, and fear, right? Insecurity? It brings up a lot of emotions. And then what would be my behavior if I'm feeling that way? Hammer texting? ‘Are you okay? Are you dead? Are you cheating on me? Or leaving the call?’ Yes, leaving a thousand voicemails of anger, maybe yelling at him. Right? And what does my behavior do? It creates another situation that just takes it and runs with it, right? So, I'm talking incessantly, we get into fights. I'm hammer texting. This creates another situation that will repeat the cycle in that direction. Okay.

Now, let's look at scenario #2. So, the first situation is the same. I'm not getting the response in a timely manner from my husband. And I'm seeing and hearing the still same lack of response. But another way to look about it in this scenario is my thought is, ‘Hmm, okay. He's not responding. I remember he told me that he had a lot of meetings today. Maybe he convened a meeting, or maybe he is just ignoring my texts.’ It leads to emotions of not freaking out, right, based on that. But more cautious, right? Exploring options. I'm calm. And then at least a behavior of maybe waiting for him to text or sending one text, ‘Hey! I tried to text you. I didn't get a text back. Let me know when you're out of the meeting,’ is less reactive, and is more thoughtful. So, then it creates a situation that's a little bit calmer, where I'm texting, you know, very calmly once or twice. And then I'm just waiting for, you know, the next situation to occur, right?

And these two scenarios are the difference between mind that is fragile, and mind that is resilient. And the picture here of the muscle is that this is a skill that grows over time. And it has to have practice. We don't all wake up one day and become mentally resilient. You know, sometimes, that's what we want, you know. But can you imagine from first-scenario-me, overnight, turning into second-scenario-me. That's impossible. So, this is an element that needs patience and practice. And these are the differences though. And this is a journey that I want to focus on, whether you're mentally fragile or have disorders or not, you know? Being mentally and emotionally resilient is a skill. It is a muscle strength. It is something that we can all work on. And the results are drastic. Like a mentally fragile mind is reactive. It reacts immediately. It misfires the cognitive triad. And it lacks the in-real-life processing. It lacks insight. And lack in boundaries. And it's very insecure. But a mentally resilient mind, they thought through multiple scenarios, and multiple perspectives, is slow to react, is a controlled fire of cognitive triad, and it can process things immediately. Right? Not in hindsight. Hindsight is always 20/20. But a resilient mind can process things in real life, is very insightful, and has balanced perspectives, has boundaries, and is very secure as much as possible. So just to kind of take away is that mental and emotional resiliency is a component of mental health. And that's something that we can work on. We can't control a lot of things but this is something that we can work on.

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Okay, so what's the difference between mental health issues and mental health disorders, right? I want to answer this question because a lot of times people have a meltdown, let's say. And they say, ‘Oh, I think I have generalized anxiety disorder.’ Or they watch TikTok and they say, ‘I think I have ADHD,’ you know? So, what is the cutoff between having mental health issues? And what are the diagnosable clinical symptoms of mental health disorder? Okay?

So, this is a diagram called Normal Bell Curve. And this is used in a lot of medicine, but also economics. But it basically is a curve that represents a population. If you think the population is big enough, everybody will fit under that curve somewhere, okay? So, I'm going to use high blood pressure for an example. Because that's a very common medical condition that we're all familiar with. So, when we're diagnosing high blood pressure, in that normal curve, we draw a line. It is kind of arbitrary, but based on evidence that if you're on the left of the curve, then you don't have high blood pressure. But if you're on the right of the curve, you do, okay? So, based on evidence, we say the stage 1 hypertension systolic is 130 to 139. And diastolic is 80 to 89. Everybody kind of familiar with that? So it’s just a number. It is a range and kind of draws a line in the sand and then defines a diagnosis. And then there's stage 2 hypertension, where there's a higher number, right? And how we, in medical research, reached these numbers is based on a lot of factors that we might not consider all the time. So, drawing the line, we have to calculate what's the risk of diagnosing, right? And leading to unnecessary treatments. And what is the risk of not diagnosing and leading to consequence of untreated hypertension. Okay? So, those are the things that we have to balance when you are drawing a line in the sand.

And another thing that we have to look at is like public health burdens. So, if we draw the line in the sand, and a lot of people need blood pressure medication, can the nation afford that? You know, so there's a lot of kind of economical and material, you know, kind of concerns, when we're drawing the line in the sand. And public health burden, you know, access to care. This is all kind of under the access to care, the materialistic economic factors. Quality of care, stigma, destigmatizing, and specificity, which is like if we draw the line in the sand, how much of the people who qualify really have hypertension? Do you guys kind of get that, right? So, it's like when you're kind of like scooping up the sand, how much is our real hypertension, right? And not the ones who have a really bad hypertension a day three times? Right? Like, what is the cutoff?

And sensitivity is how much of that will be, how much of the people who fall away really don't have it. So, these are the public health epidemiology terms that we have to consider when we're drawing the line in the sand. So, it kind of seems a little bit not clinical, you know. There's a lot of external factors that we have to do. We have to consider all these different things to draw the line in the sand. So, let's look at ADHD, right. As a mental health disorder. We don't really have numbers for ADHD, right? So how do we draw the line in the sand for mental health disorders. So, everybody's under the curve, but we do draw the line based on evidence as much as possible. And we use the big thick book of DSM V. And every time there's a new edition. And they have different criteria, like seven out of nine impulsive symptoms, seven out of nine hyperactivity symptoms. So, we tried to quantify as much as possible to make that cut. But depending on the severity, so remember how there was like a stage 1, hypertension and stage 2. So, in the diagnosis, we draw the line in the sand as much as possible, as accurate as possible. But just because you have ADHD tendencies, doesn't mean that you need medication. There's also therapy options. There's different treatment options. But if you look like, let's say stage 2 ADHD, that's when we would recommend medication. So just because you have a diagnosis doesn't mean an automatic ‘I have to be on medication,’ okay?

And how we differentiate from stage 1 and stage 2 is we have to look at over a long period of time, and the burden of the mental health issues in you being, you know, a father, mother, son, daughter, a civil citizen paying bills on time, you know. All these things will kind of play a factor to divide the criteria. Now, one point that I wanted to mention in this slide is, imagine if you had a patient who is consistently 129 over 79, right? Do they have hypertension? No, not based on this criteria. But just because they don't have hypertension criteria, are they that much healthier than the person who is 130 over 80? No. So, the reason why I wanted to show that is we draw a line because we have to. But it's all a spectrum. So, you see kind of what I'm saying? So, a lot of times people, and this is how I want to destigmatize mental health. Just because you have a diagnosis doesn't mean that you're that much sicker, you know. It's all a spectrum. It is the shades of grey. So, you might fall somewhere, and you might meet the criteria for diagnosis. But that doesn't mean that you're less than, you know. Alright, so this is the last component.

So, what does God think about mental health? So, this was not in His plan. So mental health, I think, is just like any other illness, that's medical, you know. We all believe that medical illness is due to sin entering the world, right? And then it kind of has a ricochet of effects. I think mental health is exactly the same. I don't think it was His intention to create mental health in His original design. But I believe that His response to mental health is drastically different from how the Church has answered mental health. So, if you look at the Bible, there's so many examples of prophets and people who are after God, really expressing their mental and emotional burden, right? There's Elijah who is suicidal. There's Jonah who is angry. There's David who is depressed and anxious. And also, Moses has a social anxiety disorder, you know. He had a public speaking anxiety, right? And even with God pleading like, ‘You need to go,’ I think Moses fought with God, like four or five times, right? He's like, ‘I don't think I'm the right person,’ right? Yes. So, there's so many examples of this. And I think you guys know if you know the Bible, there's so many examples of real-life mental health crisis in the Bible, right? But He hears it. And I think a lot of people with mental health, and they comes to me. And they might have Christian background, or their parents might be culturally not as accepting as, you know, other cultures. And they will say things like, you know, ‘No, you don't. You're not depressed. You're not anxious. Just get over it. This will pass,’ right?

But how God answers these prophets, and his children are eye opening. So, He answers you. He doesn't just hear you, but He answers you. And sometimes He answers angrily. But He still answers you, right? He's there with you. And this is something that I didn't personally see in my personal life growing up. I always perceive that God was like, ‘Just do it.’ You know, like, ‘Just get over and figure it out.’ And I'll do it. But the more that I get to know God, He answers, you know. So, in a way, Jonah is complaining, but He doesn't answer like, ‘How dare you?’ You know, like, ‘Do you know who I am?’ Right? He's like, ‘Do you think it is right for you, to get angry? Like, how's that serving you?’ You know, it's a very understanding tone. And when Elijah was suicidal, and depressed, and all burned out, He didn't say, ‘Get over it.’ You know, ‘You're my prophet. You're gonna do my job,’ right? He sent the angel to make him sleep and eat and nourish his body. He took care of Elijah. And David, you know, we know the psalms of, you know, the help comes from God. And whenever I believe for Him, He listens. And He always ends up in praise. And this is a relationship that God offered to anyone who's willing to come to Him. And Moses, this is an interesting one, that Moses was not willing to do what God wanted him to do. And God knew that Moses was the guy to do, right? But He angrily responded, ‘Okay, I’ll get you help.’ Right. He didn’t say, ‘Get over it. You're still the man.’ He said, ‘I'll get you the help that you need. If anxiety is that overwhelming, I will provide a helper for you,’ right? He never makes us do things just because we’re by ourselves.

So, the reason why I think God responds and God is able to respond this tenderly to our mental health and emotional struggles is because He knows that it's bigger than you. And this is a timeline, a very simple drawing that I did. And, you know, if this is a timeline of the world, the smiley face is where we are, okay? And the sun represents the creation of the world, okay? When the creation started. And this triangle is the effect of sin in our world. So, imagine the smiley face is me and let's say that I got bullied or have trauma or relationship trauma. I know that that person was hurt and abused probably, right? From before. And if so, imagine, at the smiley face, I’m going up, right? The previous generation had trauma, and the previous generation had trauma. It all starts from how sin entered the world and created this brokenness, right? And it’s a chain reaction, but also that triangle shows you that the effect of sin is exponential. Over time, it’s going to affect more and more people. And it’s going to multiply its effects, right? So here we are at the middle of the timeline. But what I think is, Jesus came in the middle of that. To show us something different. Doesn't mean that sin is gonna stop hurting us, right? Doesn't mean that we'll be completely all mentally free from illnesses in this world. The effect will continue to happen. But I think Jesus came to show us that there's something else. Even in our mental health struggles.

I have a thing or two about how historically Church and Christians have responded to mental health. And I'm biased, because I'm a psychiatrist. But this is the difference between us and God, and how we see mental health. So, He doesn't dismiss it. He sees the reality of it. He doesn't dismiss that, if I don't see it, it doesn't happen. Right? He knows, and He expects it. He's not surprised by it. He expects it right. So, the end of the world, He knows how it's gonna go down. He doesn't hide it. He reveals it. He doesn't turn, you know, His eyes away when Elijah is suicidal. He reveals what's going on in our mind and our hearts. He doesn't judge it. He sees beyond it. Right? The burnout, the suicidal thoughts. He doesn't, you know, assess you by it. He sees you beyond your complaints. He doesn't ignore it. He is aware of it. He doesn't blame it. He blames sin. And He doesn't give up on it. He deals with it.

So, at the end of the day, he sees you apart from it. And this is something that I wanted to kind of share is that, you know. If I have mental health disorder, a lot of times the stigma is ‘my faith is not strong enough.’ You know, or like, ‘I'm not believing the right stuff,’ you know, and ‘God wanted me to be free from mental health,’ right? But it's almost like, not that He doesn't care, but He sees you apart from it. Like it's a different issue, you know. He sees you as a person who's made in His image. Who's struggling with the effects of sin in the world. He doesn't define you by him. So, this is a normal bell curve that represents the whole population. And as we talked about, all of us fall somewhere in that curve. But what I think is that you're more than the place of the spectrum. Right now, you could be on one end of the line in the sand, or you could be on the other side. It will all change. But I think Jesus Christ died for everybody under that curve. And whoever believes in Him will carry you to the other side to Ultimate Health. But you're more than the place in the curve. So, this is just kind of like promotion. So, on the left is my podcast. So, if you liked the material, how I presented it, I want to teach mental health in these terms. And on the right is my private practice website. In case wherever you are on your journey, I would love to kind of help you understand, you know, how to explain it. And I think the next slide is just a ‘thank you’ slide. So that was a very short presentation, but I think you guys are kind of tracking, right? So, I will open up the floor for some questions.

I hope you really enjoyed the video. And if you want more information, please email me at restorepsychiatrymd@gmail.com or put a comment below. And I'll have more videos following in the future so hit subscribe. Thank you!