Civilian Intelligence, Mental Health, and Revenge Bedtime Procrastination: my interview with psychiatrist Dr. Gene Yang
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In this post, I interview Dr. Gene Yang, a practicing psychiatrist who works with children, adolescents, and adults. Dr. Yang provides us input and guidance from a clinical perspective, so that we can build mindora to help people understand and improve their mental health.
From Civilian intelligence to Psychiatry
Kerry: Your background as a psychiatrist is fascinating. You were in civilian intelligence before you went to medical school! Can you share more about your journey?
Dr. Yang: I didn’t believe mental health was a thing before I went to medical school. I thought mental health was something you could just work through. Going to medical school and getting into psychiatry completely changed my perspective. Now I’m really passionate about raising mental health awareness.
Kerry: What do you say to people who feel uncomfortable trying to understand or manage their mental health?
Dr. Yang: What I hear commonly, especially from high achieving people, is their perception that discomfort or being unhappy is normal. People often think that feeling desperation every single night or needing to go through a 100+ item checklist every night in your head before you can fall asleep is normal.
Having focus and determination to achieve your goals is obviously important and how a lot of these people have achieved their goals but what I try to help my patients realize is that you can be successful while also feeling good, and most importantly, feeling good about yourself.
Kerry: Any similarities or differences between your experiences in civilian intelligence and psychiatry?
Dr. Yang: Yes actually! In both disciplines there’s a focus on gaining information and learning about motivation. You want to get a better understanding of someone and where they’re coming from. In psychiatry the goal is to help the individual that you’re working with by better understanding them and what’s going on with them.
Why destigmatizing mental health is important
Kerry: There’s a lot of media attention about the current mental health crisis. Why do you think we’re in such a mental health crisis right now?
Dr. Yang: A few things have happened over the past few years. In particular, COVID played a big role in increasing awareness of mental health. In 2020 a lot of people who didn’t previously experience mental health issues, experienced them for the first time or directly knew someone who did. I think we’re also seeing older generations of people who are open to and receiving treatment.
And for younger people, like those in Gen Z, they’ve really destigmatized seeking mental health help. So we’re a lot more aware of these issues than we might have been before. Destigmatizing mental health is really important since these medical conditions impact a lot of people and have pretty devastating effects on people’s lives, their families, and society in general. The more access, support, and tools people have for their mental health, the better.
Mood and cognition
Kerry: Science shows there is a clear link between mood and cognition (e.g. memory, focus). As a psychiatrist, what are the most common questions you hear from patients about mood and cognition?
Dr. Yang: Well the questions I hear definitely depend on the age of the patient. For older patients the kinds of questions I get range from “Is cognitive decline inevitable”, “I’m forgetting things, what’s wrong with me?”, or “My parents both had dementia, what should I be aware of?”. Younger patients might ask things like “how does my mood impact my cognition”, “what’s cognitive depression?”, or “will my cognition get better if I treat my mood?”.
Kerry: What leads people to realize they’re experiencing a change in mood or cognition? If your weight changes you can tell, your clothing fits differently, but with mood and cognition it seems like you often realize it after the fact. It’s much more subtle.
Dr. Yang: Changes in mood and cognition are often gradual. In some conditions, we might see gradual changes in what we refer to as “activities of daily living”, things like taking showers or eating meals. Or people realize there are changes in their phone activity. Normally they’re social and texting their friends a lot and then they start to realize they haven’t really been using their phone as much. If they’re working or in school they’ll notice differences in how long it takes them to get their work done or how hard it is to do things.
This is where mental health tracking can be helpful and informative. From a clinical standpoint, we ask patients to answer questionnaires about their mood, like the GAD-7 for anxiety or PHQ-9 for depression. These standardized scales are helpful to measure clinical changes in mood over time. However these scales are administered on a less frequent basis and can be quite in depth. We also want to enable patients to track their moods on a more frequent basis. Having easy to use mood tracking that patients will stick with can not only help patients better understand their emotions but it is also valuable from a clinical perspective.
Sleep and mental health
Kerry: I know a really important factor in improving both mood and cognition is sleep. Can you share more about the link between sleep and mental health?
Dr. Yang: Sleep is so important. There are both psychological and biological components of sleep deprivation and mental health. We’ve seen research in the last few years showing how important the glymphatic system is for mental health. The glymphatic system is a more recently researched part of our brains that is responsible for processing toxins and waste in the brain and clearing them from the central nervous system. When you don’t sleep as much, the glymphatic system isn’t able to do its job as effectively and research suggests this may play a role in neurodegenerative disease.
Kerry: What are the reasons people give you for trouble getting to sleep?
Dr. Yang: Well, there are many medical reasons for insomnia, but one behavioral component that’s really common is this thing called “revenge bedtime procrastination”. That means that before bed you’re doing fun things like watching a show that you weren’t able to watch earlier in the day because you were busy and now you’re “procrastinating” getting sleep in order to do those things.
Kerry: Revenge bedtime procrastination! So my mind is taking revenge on me for not getting to watch TikTok videos earlier when I was busy doing work? It’s like,” I want to do this now and it’s more fun than sleeping!”
Dr. Yang: Yeah, exactly! A big part of encouraging people to sleep for their mental health is finding a way for them to turn sleep into something they enjoy doing. If they enjoy sleep or find it pleasurable then it becomes easier to sleep.
Kerry: Is that generally true? Should you find activities that are both good for your mental health and more enjoyable, fun, and easier to do?
Dr. Yang: Absolutely. We often think about finding ways for you to be motivated to do something good for yourself. You can always have someone else like a parent or significant other driving certain things but that’s often less effective and causes conflict as opposed to it being internally motivated.
One activity that’s really valuable to do but can be a challenge for people, because a lot of the tools available can be quite tedious, is monitoring changes in yourself over time. Journaling is an option, recording your mood every night before you go to bed is an option, monitoring your sleep is helpful.
While practices like morning writing are getting pretty popular, for the broader population I think it’s important to find a way that’s enjoyable to keep track of how you’re feeling so that you can detect any changes. That way you can find out what makes things good or bad for you and increase your knowledge about yourself. Increased self awareness and understanding what helps or hurts you is an important part of managing and improving your mental health.
