It’s been a while since I’ve mentioned my book project, but rest assured it’s still percolating along in good form. My former colleague Lynn Grogan and I had fun sharing some of the key concepts from it on her podcast Courageously Unconventional. I thought it would be fun to do a deeper dive into some of the topics that we talked about in How To Live Vibrantly to 100 with Dr Em Wong.
How I came to write a book
So it’s funny to think that I would never have considered myself an author four years ago. Of course I did publish many scholarly articles and book chapters during my years in academic medicine, but I struggled mightily with that particular aspect of my work. To be honest, I never appreciated the pressure to publish anything that wasn’t particularly relevant or original - I had trouble buying into the currency of the academic promotion system of grants and publications. What mattered more to me were the patients themselves and the people teaching and delivering their care.
I didn’t realize then that I had been writing for the wrong audience. It wasn’t until I learned about empowering others through coaching that I found my true voice. I had started the University of Arizona Integrative Health and Wellness Coach training program in 2019, just before the global pandemic disrupted every aspect of our lives. I gradually shifted from in-person clinical work to online coaching shortly thereafter, and to begin to write about preventive health.
At first it wasn’t clear what aspect of prevention I should focus on. Women’s health and integrative medicine were natural considerations given my training, but as an internist I also wanted to talk about heart health and the epidemic of diabetes.
I had an interest in brain science at that point, but I convinced myself that it was beyond my specific expertise and so I had no business writing about it. In retrospect, I was making any excuse possible to avoid dementia because I was convinced that there was nothing I could do to mitigate against my personal and family risk.
Imagine my disbelief when I first learned that up to 40% of dementia cases can be prevented through lifestyle measures, I dug into the research with that incisive skepticism that had been bred into me over decades in academic medicine, but the science held up repeatedly.
Stress impacts both current performance and future brain health
It seemed hard to believe that I hadn’t learned about this literature as a practicing primary care doctor. But of course I had maintained a huge blind spot about brain health because I’d been actively avoiding it. It took a lot more coaching and research to begin to break through all the fear, denial and avoidance that had become a consistent habit over the years.
At first I considered iHeal Mag to be a somewhat random collection of musings about brain health and my life as a doctor, but then some repeated themes began to emerge. And as I began to consolidate my writing into a masterclass, I realized that I had enough material for a book.
What’s different about our book?
When Emma and I first started writing this book together, we had envisioned something along the lines of “80 Healthy Brain Tips.” While that book may still come, it became clear as we went along that something bigger and broader needed to emerge.
We wanted our readers to learn about WHAT evidence-based practices could help them to develop better brain health. And we also wanted to teach them HOW to coach themselves on shifting from unhelpful to more helpful habits.
My definition of brain health has two components to it:
Cognitive ability or performance - i.e. day-to-day focus, problem solving, memory, processing speed and language;
Preventive health - i.e. how we take care of our brains and protect them from harm to prevent future conditions like stroke or dementia.
Our experience of brain performance can be affected by myriad factors, including sleep quality and alcohol intake. Even minor health conditions like allergies or the common cold can and do interfere with brain function either through symptoms or medication side effects.
I’m constantly finding more layers of ageism in myself
Stress has the capacity to impact both current performance and future brain health. Immediate or acute stress triggers emotions and biological signaling through molecules like cortisol and adrenaline that can create a sense of urgency. When we are under stress, our limbic system (or creature brain) tends to be focused on survival and we have limited (if any) access to our prefrontal cortex (human brain).
Our new book discusses the definition of stress, how stress impacts our brain both acutely and over the long term, and what can be done about it.
Passing through the 3 gates to brain health freedom
My own experience of getting to this place of teaching about brain health has required me to pass through what I’m calling the 3 Gates to Brain Health Freedom
The first gate was Denial about how important brain health was for me specifically. I was so scared about my personal risk for dementia that I was going out of my way to avoid learning about the new science. And in so doing, I had ironically denied myself the knowledge and ability to take action to protect myself.
The second gate was Ageism, which meant confronting my negative beliefs about ageing. I must admit that I wasn’t even aware of how many cultural and generational ageist beliefs I had internalized and developed over my lifetime. It still feels like I’m constantly finding more layers to that particular onion, but at least I’m somewhat on to my inner ageism at this point.
The third gate was Self-bullying, which was understanding that there was a way to turn the volume and intensity down on my inner critic voice, thereby reducing the level of stress that my own brain was causing me.
The coaching term for self-bullying is the “second arrow”, and refers to this phenomenon where our thoughts are complicit in adding more stress to an already stressful situation. So for example, we feel stressed by a “first arrow” situation that is out of our control like our mother having a stroke, but then our inner critic adds a “second arrow” by blaming us. The inner critic may berate us for inadequately controlling her blood pressure or shame us for not having been with her when it happened. But the reality is that sometimes bad things happen to our loved ones and there was nothing we could have done to prevent it.
I have written about my inner critic or gremlin Milly, whose images used to be as big as the video screens in Times Square and whose voice was as loud and deafening as a full-on rock concert inside my head. Milly will never go away but I don’t let her bully me any more. I know that she is a part of my childhood that helped me survive, but her words are usually no longer relevant so I get to shrink her to a smartphone-sized screen and dial down the volume so that she can have a balanced conversation with my inner coach.
Up to 40% of dementia can be prevented through lifestyle
Turns out that we all have both inner critic and inner coach voices inside our heads. In fact there is a parable about two wolves that has been attributed to the Cherokee tradition. The story goes that a grandfather is telling his granddaughter about the two wolves inside a man’s head. There is a bad wolf who is angry, mean and harshly critical of everything, and also a good wolf is kind, forgiving and encouraging. The little girl asks which wolf is stronger, and the grandpa answers that it’s one that gets fed more.
Lynn asked me when I think that book may be published, and the answer is “when it’s ready.” I did guess perhaps early next year, but no promises because I’ve learned to surrender to the creative process, because it has a life and timeline of its own. The book is writing me at this point, more so than the other way around, and it’s turning out to be so much better when we can allow it to evolve.
My co-author Emma Carronna was my coach and teacher, and our working title is “Vibrant to 100: Extend Your Brainspan and Shape How You Age.”
Dr Em coaching tips
Fear and avoidance are often an excellent indicator for future growth opportunities - and there is no shame in hanging out in the sanctuary of denial. See if you can approach your fears by growing gentle awareness and curiosity over time.
See if you can begin to notice any ageist language or actions in yourself, your family or coworkers. How do you feel when you observe ageism?
Do you have a name for your inner critic when they are in self-bullying mode? Have you noticed what their specific favourite approaches are to making you feel bad?
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