By S. D. Shantinath, DDS, MPH, PhD (Associate Professor of Public Health, A.T. Still University of Health Sciences)
What do you get when you mix a pediatric dentist with a clinical psychologist, and toss in a master’s degree in public health?
Someone who wants to get the whole world brushing – brushing their teeth, and their minds!
Let’s face it. Preventing depression and violence is a hard sell, even harder than preventing dental caries.
Sure, we have lots of data from experts informing us about the extent of these problems, and we even have research-based information on how to prevent them. We know we can often prevent depression and violence, but why haven’t our efforts taken hold?
What I discovered in the course of my public health journey is that most people are not interested in these issues – even though they affect millions of people around the world. Among those who are interested, many are discouraged or unclear about what to do.
I believe, however, that the “Brush Your Mind” concept just might be a useful way forward.
Where we are today
I admire and respect the late George Albee, Howard Markman, and Ricardo Muñoz for their work in prevention science. Although they’re world-renowned experts in their fields, their work has yet to be integrated into the mainstream, the way it deserves to be.
Howard Markman has had best-selling books and he’s even been on Oprah. But some years ago when I asked him about the extent to which his work had diffused within society, he responded “a drop in the bucket.”
Unfortunately, he’s right!
What will be psychology’s Space Program?
Various fields have broken barriers and reached milestones, resulting in a collective shift of imagination. For aviation, it was defying gravity, reaching the moon and going beyond. What might it be for psychology?
I propose that for psychology, the public first needs to know and believe that it is possible to prevent or reduce psychological distress – because people cannot desire something that they don’t even know exists. Then we will be poised to vaccinate (metaphorically) our world against violence and depression – two of the most widespread public health issues of our time.
The behavioral sciences offer us the psychological equivalent of vaccines. These include programs that can prevent violence and depression. Just as vaccines don’t prevent all illnesses, these “psychological vaccines” cannot prevent all problems. Nevertheless, when used in a systematic and ongoing way, they will yield the following benefits to millions of people:
- Improve quality of life
- Reduce health care costs
- Reduce the incidence of depression and violence.
Challenges in translating and communicating psychological research
One of the challenges in improving health through the translation of psychology is that we have a plethora of theories. If we dig around enough in the literature, we find that they all, in some way or another, account for some degree of change.
While this may be a researcher’s dream, it’s also a translator’s nightmare.
Additionally, we’re flooded by masses of data informing us about complex problems with multi-factorial etiologies. This makes it difficult to create tidy sound bites – which are frequently the most that an oversaturated and time-starved public can realistically take in.
What we need is a means of addressing problems in a way that is simple, without being simplistic; and we need to do so in a way that promotes hope and self-efficacy on the part of the public.
Lessons from preventive dentistry
During my search for doctoral programs in psychology, I came across George Albee’s question “What is the mental health equivalent of fluoride?” It was a critical question that strongly influenced my approach to psychology.
In 2002, I immersed myself into the world of depression prevention and violence prevention. The various approaches to understanding behavior were intellectually interesting – but equally frustrating. It was difficult to find clarity and consensus.
In 2005, while leading an international nonprofit organization focused on violence and depression prevention, I attended a program for nonprofit leaders at Stanford. I heard Robert Sutton talk about innovation – and how one way to innovate is to look at advances in one field, and transfer those processes to another.
Sutton’s words empowered me to go to the next level – to go beyond fluoride and look for additional lessons within preventive dentistry that could advance the field of mental health.
Metaphors for self-regulation
I began with the widely-known phrase “mental floss,” to symbolize self-regulation – a construct common to the prevention of depression and violence. But in 2007, I discovered that term was copyrighted by a magazine. After having incubated “mental floss” in my head for some years, I was disappointed and frustrated.
During that time, I was a Visiting Scholar at Stanford University, where Albert Bandura and Philip Zimbardo were my sponsors. My time with them amounted to “marinating my brain” as I deepened my search for cost-effective public health methods to address the global problems of depression and violence.
Now I must confess that I don’t always floss my teeth everyday. I floss often and see its value. But each time I floss, it’s effortful, not automatic like brushing my teeth. My patients brushed daily, even when they didn’t floss regularly. And brushing one’s teeth is much more of a universal activity, as more people in the world brush their teeth than ever floss.
From these insights, I realized that it was no great loss to let go of “mental floss.” Even more important than flossing is brushing – and out of that I arrived at “Brush Your Mind.” And the act of brushing one’s mind meshed harmoniously with Albert Bandura’s writings on agency and self-regulation.
A weird idea that works
Sometimes talking about “Brush Your Mind” was like a flash back to my high school nerd moments, when I spoke out about propellants in underarm sprays that harmed the environment. People were amused – but no one cared enough to let their under-arms stink or even switch to a roll-on. Now, here I was a grown-up talking about a goofy sounding concept to promote mental health and sometimes I got the same looks I got in high school.
So, I took solace in three things:
- Pediatric dentistry gave me poetic license to use humor and silliness – because they are as essential to our profession as drills and needles.
- Robert Sutton’s book, Weird Ideas that Work, gave me hope that “Brush Your Mind” just might be one of those weird ideas that work.
- And most importantly, although other people ridiculed me, Albert Bandura and Philip Zimbardo never did. They took my ideas and idealism seriously.
After my time at Stanford, I continued R & D on my own, working out details of the mental toothbrush. In 2013, I produced an animation video of Brush Your Mind and showed it to Samuel Dworkin (also a dentist-psychologist at the University of Washington), and Donald Meichenbaum.
My peer-reviewed video received two thumbs up.
Emboldened, I submitted an editorial on this topic to the Arizona Republic. The responses I received from the Editor, mental health professionals, and lay readers (from the US, Canada, Europe, Asia and Australia) were gratifying.
Now I know.
As strange as “Brush Your Mind” might sound, it’s a sound idea after all!
Going global to reach the tipping point
The next step is to launch a public health campaign to promote the world-wide adoption of “Brush Your Mind.” For that, I continue to draw upon lessons from Robert Sutton, Philip Zimbardo, and Albert Bandura:
- From Sutton: The lateral transfer of successTranslation: Roll out “Brush Your Mind,” modeled after “Brush Day and Night” – a global public-private partnership that extended to over 25 countries, and which I co-lead in 2010 when I was Head of Public Health at the World Dental Federation in Geneva.
- From Zimbardo: Keep your messages clear, focused and easily understandable.Translation: Stay true to science, and make the content practical and accessible – even to children and adults of varying literacy levels.
- From Bandura: Promote self-efficacy, model the desired behavior, and lots more…Translation: Join me and find out!
If we, as humans, can be so creative and ingenious as to explore the farthest reaches of outer space, surely we can make life here on Earth better for everyone. It doesn’t call for rocket science – we can do it with behavioral science.
S.D. Shantinath, DDS, MPH, PhD is an associate professor of public health at A.T. Still University of Health Sciences, in Mesa, AZ. She is a multi-disciplinary professional who has worked in the academic, governmental, non-governmental, and private sectors.
She specializes in pediatric dentistry and public health dentistry, and is licensed to practice dentistry in the United States and psychology in Switzerland. Her expertise includes oral health, mental health, and the use of technology for health information dissemination and large-scale social change. She holds a joint appointment with the School of Health Management and the Arizona School of Dental and Oral Health, where she teaches full time in the dual-degree MPH-Dental and Public Health certificate programs. In addition to working in oral health, she has been recognized by experts in psychology and public health for her innovative strategies to address the global epidemics of violence and depression. Prior to coming to ATSU, she taught pediatric dentistry and health psychology in the United States and public health and health psychology in Switzerland. She can be reached at email@example.com.