Longevity and Healthy Aging: Two Competing Visions (Part 5 of 5)

Emotional Health, Dialectical Behavior Therapy and Adverse Childhood Experiences, and a Conclusion to Our Series

Emotional Health

Previously, in the first four posts of this series on Longevity and Healthy Aging, we covered the major concerns of Healthspan, Exercise, Metabolic Health and Diet, and Bio-Hacking (with supplements, off-label prescription drugs, and technology) as discussed by our four medical doctors, Sullivan (2016), Luks (2022), Hyman (2023), and Attia (2023), and as confirmed or challenged by other qualified experts and peer-reviewed sources. 

We had a largely shared path by our experts on Healthspan, Exercise, and even generally on Metabolic Health and Diet. But when it came to Bio-Hacking, this shared path noticeably forked off into two separate routes. From this, two (or more) competing and substantively different visions of longevity and healthy aging have emerged. Our final concern, Emotional Health, seems part of both visions.

All four of our medical doctors writing on longevity — Sullivan (2016), Luks (2022), Hyman (2023), and Attia (2023) offer some discussion of the importance of emotional health to one’s general well-being.

Sullivan (2016) has the least to say. Not from a lack of compassion, but from a fear of overstepping his mandate as any thorough discussion of such matters “is far beyond the scope of this text.” Acknowledging that "overwhelming stress, worry, and despair are threats to health and even to life, and may indicate serious underlying endocrine or neuropsychiatric derangements,” Sullivan (2016) implores anyone “confronted by these difficulties to bring them promptly to the attention of medical or mental health professionals.” Fair enough.

Action Steps for Emotional Health

But many people will want actionable steps to maintain and improve their emotion health, to create wellness and not just treat sickness. So how do we create emotional well-being? Or, at the least, the conditions which allow it to flourish?  At engaging these concerns, Luks (2022), Hyman (2023), and Attia (2023) all have a go.

Defining Emotional Health, to Start

We will start and largely end with Attia (2023), who based upon his own experience now believes:

Emotional health may represent the most important component of healthspan. Nothing else about longevity is really worth much without some degree of happiness, fulfillment, and connection to others. And misery and unhappiness can also destroy your physical health, just as surely as cancer, heart disease, neurodegenerative disease, and orthopedic injury.

Attia (2023) holds that “mental health and emotional health are not the same thing,” but “Medicine 2.0 is set up to treat mental and emotional health in pretty much the same way that it treats everything else: diagnose, prescribe, and, of course, bill.” So what is emotional health?

Emotional health, Attia (2023) argues “has more to do with the way we regulate our emotions and manage our interpersonal relationships.” Speaking about his own experience, Attia (2023) reports:

I did not have a mental illness, per se, but I did have serious issues with my emotional health that impaired my ability to live a happy, well-adjusted life — and potentially did put my life in danger.

We will return to his discussion. In the earlier section on Metabolic Health and Diet, we covered the self-admitted failure of American Mental Healthcare. Attia (2023) clearly believes we are failing also at Emotional Healthcare. But two key take-aways for now: (1) we have a rough definition of emotional health as “the way we regulate our emotions and manage our interpersonal relationships;” and (2), emotional health is vitally important both to extending Healthspan and to making any additions to Lifespan worth having.

Luks: “Straightforward, Easy Strategies”

With his focus on better years but not necessarily more, Luks (2022) emphasizes “evidence-based strategies [which] have been shown to improve your metabolic health, lessen the chances of suffering from many chronic diseases and early demise, and therefore increase your longevity.” The last two of his seven “straightforward, easy strategies” concern emotional health [numbers mine]:

1. Create a caloric deficit, then stay lean.

2. Get sleep.

3. Eat real food.

4. Move often, throughout the day.

5. Push and pull heavy things.

6. Socialize.

7. Have a sense of purpose.

Aware that “loneliness is a grave health issue these days,” Luks (2022) asserts that “stress management, optimism, laughing, being socially connected, and feeling a sense of purpose and community” all contribute vitally to “maintaining a long healthspan.” His Longevity … Simplified (2022) has useful insights scattered throughout, and makes numerous connections between emotional health, exercise, and metabolic health, but offers no systematic treatment of emotional health.

Hyman: Social Practice, Individual Purpose, and Spiritual Nourishment

Although his general position is similar to Luks (2022), Hyman (2023) offers a considerable and generally excellent discussion of emotional health in chapter 5, subsection “Social Diseases: Our Social Environment and Health,” and in chapter 9, subsections "Healing Our Minds, Hearts, and Spirit" and "Meaning and Purpose."

To quote one or more key passage from each subsection, from “Our Social Environment and Health:”

Our social determinants of health, including community, relationships, stress, trauma, and sense of purpose and belonging, are just as important for our health as what we eat and how we move. If you’re feeling lonely, stressed, isolated, or powerless, your biology, your cells, your microbiome, literally “hear” your thoughts and feelings, driving inflammation and disease. Working with a trained professional to heal from trauma, serious life events, or struggles like chronic depression is important, but there are simple daily practices that help improve your social and emotional well-being, including practicing gratitude, prioritizing self-care, being of service to others, joining a community, and starting meditation. Whatever strategy you develop for health and longevity, it must include nurturing and developing your own social fabric of belonging, meaning, and purpose. (Hyman, 2023)

From “Healing Our Minds, Hearts, and Spirit:”

The truth is you cannot live a healthy, happy, fulfilled, and long life while neglecting to nourish your mind and spirit. … If your emotions are inflamed, so is your biology. … Nourishing your spirit includes cultivating a positive mindset (optimists live longer even if they are wrong!), developing self-love and self-worth, prioritizing self-care, cultivating community and meaningful relationships, practicing healthy stress-management techniques, finding support, and practicing religion or spirituality if that speaks to you. (Hyman, 2023)

And from “Meaning and Purpose:”

[Research found] that people who have a clear sense of purpose, a reason to get up in the morning, lived up to seven years longer than those who didn’t have a clear purpose. … [Having purpose] is as essential as eating well and exercising for your longevity. It is no accident that the risk of death goes way up after retirement — and it’s not just because of chronological age. … The foundations of health and longevity — diet, exercise, sleep, learning to manage stress and rest our nervous system, building meaningful relationships and community, and finding purpose and meaning in your life — are available to all of us at little or no extra cost in our lives. Just getting these habits and practices embedded in your daily life will make profound changes in your health and extend your life span. (Hyman, 2023)

Beautifully stated: so much we can do now which is “available to all of us at little or no extra cost in our lives” (Hyman, 2023). But what if you are not good — as in you have poor emotional health to start?

Attia: Sharing an Ongoing Personal Journey

With no small amount of self-righteousness, Henry David Thoreau famously declared: “The mass of men lead lives of quiet desperation.” Attia (2023) agrees with the general sentiment, but takes a different approach:

Countless people are in desperate need of help with their emotional health, yet fail to recognize the signs and symptoms of their condition. I was the poster child for this group.

In chapter 17, “Work in Progress: The High Price of Ignoring Emotional Health,” Attia (2023) describes a breakdown he had in 2020, what he now understands as the root causes, and the steps — learned by trial and error — he now takes for improving and maintaining his emotional health.

Deaths of Despair, of Substance Abuse and Mental Illness

Back to Thoreau’s take just for a moment, but updating it: the deaths of despair. “Not all suicides jump from bridges,” Attia (2023) observes:

Many more people sort of slow-roll into misery and early death via various roundabout routes, letting stress and anger erode their health, or falling into self-medicating addictions to alcohol and drugs, or engaging in other reckless, life-endangering behaviors that mental health professionals call parasuicide. It’s not a surprise that deaths related to alcohol and drug abuse have surged over the last two decades, especially among people ages thirty to sixty-five.

In the USA, we have two deeply connected public health crises: poor metabolic health and deteriorating mental health. Moreover, the “substance-abuse crisis,” which is also lowering the average American life expectancy, is according to Attia (2023) “really a mental health crisis in disguise.”

The Trauma Tree: Mapping Childhood Roots of Emotional Disturbance

Attia (2023) understands his recent breakdown in 2020 as ultimately resulting from both unresolved trauma from Adverse Childhood Experiences and the consequences of his subsequent coping strategies, which had survival value at the time but which were now proving maladaptive. A key model which helped him is the Trauma Tree:

The idea behind it is that certain undesirable behaviors that we manifest as adults, such as addiction and uncontrolled anger, are actually adaptations to the various types of trauma we suffered in childhood. So while we only see the manifestation of the tree above the ground, the trunk and branches, we need to look underground, at the roots, to understand the tree completely. But the roots are often very well hidden, as they were with me. (Attia, 2023)

Attia (2023) frankly and bravely recounts his struggles to recover from his breakdown and to improve his emotional health. Meaningful change, he now believes, requires:

[That] we are equipped with a set of effective tools and sensors with which to monitor, maintain, and restore our emotional equilibrium. These tools and sensors are not innate; for most of us, they must be learned, and refined, and practiced daily. And neither are they quick fixes. (Attia, 2023)

As part of his emotional health toolkit, Attia (2023) uses dialectical behavior therapy, or DBT, which [boldface his] is “predicated on learning to execute concrete skills, repetitively, under stress, that aim to break the chain reaction of negative stimulus → negative emotion → negative thought → negative action.” DBT, which emphasizes mindfulness, has according to Attia (2023) four pillars [italics his]:

emotional regulation (getting control over our emotions), distress tolerance (our ability to handle emotional stressors), interpersonal effectiveness (how well we make our needs and feelings known to others), and self-management (taking care of ourselves, beginning with basic tasks like getting up in time to go to work or school).

Additionally, Attia (2023) has continued working with a DBT therapist. All good.

Attia (2023) understands that Adverse Childhood Experiences, and some of his were quite awful, contributed significantly to his later dysfunctionality as an adult. He does acknowledge that “there is no bright line between trauma and adversity,” and that he is “not suggesting that it is ideal for children to grow up without experiencing any adversity at all, which sometimes seems to be a primary goal of modern parenting.”

By “Adverse Childhood Experiences,” What Do We Mean ?

Once again, we have a pronounced socio-economic divide in terms of how certain people think about Adverse Childhood Experiences, and about emotional, mental, and general health. This divide is revealed neatly by a recent Washington Post report (yes, your author is surprised as well) by Donna St. George (Apr 28, 2023): “One school’s solution to the mental health crisis: Try everything.” 

St. George (Apr 28, 2023) describes the efforts of an elementary school in Ohio, within the greater Appalachia corridor. To her credit, St. George (Apr 28, 2023) is not Hill-Billy slumming or engaging in poverty porn: Oh, pity the poor white trash! She is respectful, considerate, and aware.

Mental and Emotional Health Problems — Or Even More Basic?

But here’s the rub. It makes limited sense to claim that many of these children are having emotional and mental health problems — they are having basic resource and even survival problems.

Let’s hear a sample of the stressors or challenges these K-12 students face (St. George, Apr 28, 2023):

• “Our water got turned off, and my mommy doesn’t want to tell you.”

• “My dad died … and I’m sad"

• Missing family members, parents, and grandparents, in part because of increased number of alcohol and drug related deaths in the county (i.e., “deaths of despair”).

• Food and housing insecurity because of the high levels of unemployment with few viable prospects for this former blue-collar community.

• Multiple generations of family crammed into small houses or trailer homes.

• Adult caregivers — and the occasional lack thereof — who themselves suffer from emotional, mental, and general health issues.

Another way to put this: these children don’t have first world problems. They have third world problems. Their emotional reactions seem entirely appropriate — and in that sense, healthy — given their circumstances. They should feel angry, sad, confused, and even at times hopeless.

Questioning the Chemical Imbalance Model — The Status Quo

Would putting these children on prescription medications — the standard anti-depressants and anti-psychotics, for example — make things better? Why and how? These children are reacting to their social environments and material circumstances: exactly what our brains are supposed to help us do. Respond to external stimuli because the real world does matter.

If we have a child suffering from severe depression, for example, does it make sense to treat this as a chemical imbalance? Or, does it make more sense to ask what might be provoking that chemical imbalance? What do we gain — and equally vital, what do we lose — by treating these Adverse Childhood Experiences as mental health challenges? An adult reflecting back on their childhood is one scenario; a child going through it in real time is another.

Balyee Bently, the WashPo Poster Child

St. George (Apr 28, 2023) offers the case study of Baylee Bently, a high school sophomore whose father died suddenly. Baylee went to live with her grandparents, who had a house fire, and then suffered an eviction. After which her grandfather was hospitalized. Baylee, in her own words, "wasn’t getting any school work done."

Baylee believes that her therapy is helping her to cope — along with the support of other family members and friends. Please note that in Baylee’s case, she needs more than someone to speak with. She needs a place to live and food to eat. Nor is it reasonable to expect an unskilled high school sophomore to support herself. What does Baylee need more: DBT (or some other talk therapy) and anti-depressants, or some basic stability in her life?

Peter Attia, the Alpha-Male Poster Child

On the one hand, your author admires the willingness of Peter Attia, MD, millionaire celebrity, to openly discuss his emotional health issues and his ongoing efforts to be better a human being, and a truly loving and considerate husband and father. On the other hand, your author wonders if Attia’s presentation isn’t at times just a bit self-indulgent or even narcissistic. Italics his: “If you take nothing else from my story, take this: If I can change, you can change.” Got it. So you are THE role model for alpha-male high-achievers who wake up one day and realize they’ve been behaving like assholes for years. Inspiring.

Thank you for that, although your author doubts that Andrew Tate is paying much attention. Thank you also, Dr. Attia, for the reminder that it is NOT “ideal for children to grow up without experiencing any adversity at all, which sometimes seems to be a primary goal of modern parenting” (Attia, 2023).  Your author wonders who are the children and who are the modern parents which Attia has in mind.

By “Modern Parenting,” What Do We Mean?

Perhaps any discussion of Adverse Childhood Experiences, emotional health, and longevity should be more inclusive, to start. According to one credible source, "America has one of the highest levels of single-parent families with children in the world" and  the "share of American families with children living with a single parent has tripled since 1965”  to comprise roughly 30% of all American families with children (The Hill, Mar 19, 2021).

Do Fathers Matter?

Taboo time. Does the rise of single-parent families have any possible correlation or relationship with the rise of metabolic and mental health issues?  Consider the following USA government demographic report on households (graph below):

This could get ugly fast. Let’s not go there in detail — at least not in this discussion. Try “The Fatherless Crisis in America” (Jan 16, 2023) for a deeply informed rant. For our purposes at hand, give Attia the credit he deserves. We all have shit to deal with — but too often we don’t. Or certainly not effectively. Attia highly recommends the work of Terrance Real, author of I Don't Want to Talk About It: Overcoming the Secret Legacy of Male Depression (1997). To cite just the blurb:

Problems that we think of as typically male—difficulty with intimacy, workaholism, alcoholism, abusive behavior, and rage—are really attempts to escape depression. And these escape attempts only hurt the people men love and pass their condition on to their children.

As your author’s father was an alcoholic steelworker who died of lung cancer at age 48, although such a description does your author’s father a great injustice, what Terrance Real claims above seems to have some real merit. What also has merit? A vast body of evidence [ref] which shows that missing fathers generally result in worse outcomes for children than imperfect fathers.

       Infographics for public distribution by the National Fatherhood Initiative, 2023.

Good of Attia (2023), truly, to publicly share the working through of some of his own bullshit — his own trauma, damages, mistakes, and ongoing efforts to improve. Motivated in large part by his desire to be a better father to his children, and a better partner to his spouse.

As Mental Health Problems, What Else Do We Disguise or Medicalize?

But for a teenager like Baylee Bently, or for millions of other American children, we’re missing a vital part of the picture if we focus primarily on emotional and mental health issues — and especially if we do so with our current “chemical imbalance” model. We likewise ignore the many other factors which contribute to or detract from health more generally. Your author doesn’t have the answers.

Your author is also uncertain that the medical doctors cited above have the answers. That said, since what we cited from Attia (2023) earlier is so important, your author will simply repeat it:

Emotional health may represent the most important component of healthspan. Nothing else about longevity is really worth much without some degree of happiness, fulfillment, and connection to others. And misery and unhappiness can also destroy your physical health, just as surely as cancer, heart disease, neurodegenerative disease, and orthopedic injury. (Attia, 2023)

Nearly all of us need to do better with emotional health, including yours truly. And for men above a certain age, Attia (2023) has a viable blueprint. Likewise, Luks (2022), Hyman (2023), and yes, even Sullivan (2016) have useful contributions on the more general topic of emotional health.

Your Life is NOT Determined by Adverse Childhood Experiences

Finally, on this topic, Chris Palmer, MD, does not discuss mush of his personal history in Brain Energy: A Revolutionary Breakthrough in Understanding Mental Health—and Improving Treatment for Anxiety, Depression, OCD, PTSD, and More (2022). He does for some of his interviews. As a child, Palmer experienced a period of homelessness and was living with his mother in their car after she had suffered a psychotic breakdown. He dedicates Brain Energy (2023) to her:

To my mother

My futile attempts to save you from the ravages of mental illness lit a fire in me that burns to this day. I’m sorry I didn’t figure this out in time to help you. May you rest in peace.

If we are in need of an emotional health “poster child” in Attia’s phrase, and your author thinks we all have our own stories to share and so your author feels no such need, then over Peter Attia American Exile recommends either Chris Palmer or Baylee Bently. But even this seems the wrong way to go.

Whatever one’s individual path forward with emotional health might be, when as an adult, it should not begin with privileging one’s own victimhood. Self-care is required, yes. Dealing with what happened, yes. But concern for other people goes hand-in-hand with improving relationships with other people.

Or, in the words of your author’s late father, who recovered from alcoholism and was successfully rebuilding his life before he died of lung cancer at the age of 48: “The greatest mistake I ever made in my life was feeling sorry for myself.”

---

Conclusion to Our Five-Part Series

A ludicrously vast cloud of smoke is now blowing from both longevity research labs and supplement manufacturers across the globe. This smoke has the delirious, hallucinogenic qualities of snake-oil burning. Whiff the fumes and believe at least for the moment that the Foundation of Youth has been unearthed, the Peaches of Immortality are now within reach. But if your author is placing bets, the current estimation (Gavrilova and Gavrilov, 2020) of human longevity capping out at around 120 years will NOT be readily overcome. Yet with all this smoke, there is a hint of fire. Some highly promising lab results, indeed. A greatly improved knowledge of how metabolism contributes to health and hence longevity.

Your author now places a second bet: a significant increase — proportionally, and not just by raw count — in the centenarian population (people who reach the age of 100 and beyond). Although the Grim Reaper at some point will have his due, demographically, we will witness a growing percentage of people aged 100 to 120 years or so. But this increase in longevity will be thoroughly undemocratic, as it were. It will require the finest advanced healthcare, well out of the reach of the majority of the global population. We can gain insight into this divide by comparing Sullivan (2016) and Luks (2022) to Hyman (2023) and Attia (2023) on their approaches to Bio-Hacking with supplements, off-label prescription drugs, and technology.

If longevity is the bad news, healthy aging is possibly the good news. When it comes to Healthspan, our medical doctors Sullivan (2016), Luks (2022), Hyman (2023), and Attia (2023) have strong and considerable agreement on the areas of Exercise and General Nutrition. Their essential and highly cost-effective recommendations, however, both run smack into mainstream American cultural practices and require people to individually and responsibly re-negotiate their relationships with Big Food, Big Pharma, Big Medicine, and Big Tech.

Although many motivated individuals and small networks of people have already done so, and hence this solution is more than theoretically possible, it will (likely) not scale. It has no government or MSM support; in fact, the opposite. No matter.

Still good news. If you wish to be something other than a sickly and indebted serf, you have both the means and opportunity to retain or regain your health and liberty. Otherwise, please embrace your future as a prescription-addicted, subsidy-dependent, bio-medical tracked and certified zombie-drone within the emergent Neo-Feudal caste system now replacing our constitutional republic (and replacing Western democracies more generally).

Enjoy your GMO cricket powder with added psychotropics.

So other news. Unless you have substantial means and travel in the right circles, you likely will not be joining select members of our (often deeply corrupt) power elite in their quest to push up to (or even past?) the 120-year barrier. But their success here in the short-term or even the intermediate term is by no means guaranteed. Even then, knowledge travels. Prometheus stole fire from the gods. His punishment is legendary, but his gift endures. Whatever advances are made in longevity may yet become available by merit to those who have maintained their health and their freedom.

Lastly, if you have time to read only one book of the four (or more) we have discussed in this series, please make it Luks (2022), Longevity…Simplified. Living A Longer, Healthier Life Shouldn’t Be Complicated. Alternatively, if you have already been captivated by Sinclair (2019) or Hyman (2023) — and Hyman does offer much useful information, please consider Brenner (2022), “A Science-Based Review of the World’s Best-Selling Book on Aging” [PMC9669175].

This ends our current series on Longevity and Healthy Aging. Thank you for reading.

---

Necessary Disclaimer: American Exile does not offer medical advice, and none of our five posts in this series on Longevity should be understood as such.

Sources are cited in text. The primary books and essays discussed in this series: Sullivan (2016), The Barbell Prescription: Strength Training for Life After 40; Sinclair and LaPlante (2016), Lifespan: The Revolutionary Science of Why We Age – and Why We Don’t Have To; Taubes (2020), The Case for Keto: Rethinking Weight Control and the Science and Practice of Low-carb/High-fat Eating; Luks (2022), Longevity…Simplified. Living A Longer, Healthier Life Shouldn’t Be Complicated; Palmer (2022), Brain Energy: A Revolutionary Breakthrough in Understanding Mental Health—and Improving Treatment for Anxiety, Depression, OCD, PTSD, and More; Brenner (2022: 10.1016/j.archger.2022.104825), “A Science-Based Review of the World’s Best-Selling Book on Aging”; Hyman (2023), Young Forever: The Secrets to Living Your Longest, Healthiest Life; Attia (2023), Outlive: The Science & Art of Longevity; and St. George (Apr 28, 2023), “One school’s solution to the mental health crisis: Try everything.”