“The fact that we don't trust the word of a physician with mental illness the same way we do one with a chronic physical health condition speaks volumes about embedded stigma.”
— Dr. Devika Bhushan
Today, on “The Things Not Named,” I speak with Dr. Devika Bhushan, former Acting Surgeon General of California, pediatrician, and author on a mission to drive greater health innovation and equity. You can subscribe to her Substack at Spread the Light with Dr. Devika B.
Below is an edited transcript of our conversation on Substack Live.
Transcript:
Joshua Dolezal:
Welcome back to The Things Not Named. I’m Joshua Dolezal. Willa Cather said that the presence of the thing not named gives high quality to literature. This year, I’m applying that idea to medicine, asking how we might be more attentive to what goes unsaid in the clinic and popular culture and in the experience of illness from the patient’s side.
My guest today is Dr. Devika Bhushan. Dr. Bhushan is a pediatrician, public health leader, and author who served as California’s acting surgeon general in 2022 after three years as the office’s inaugural chief health officer. In that role, she advised the governor on public health and helped build the ACEs Aware initiative, which focuses on healing from childhood trauma.
She now teaches as adjunct faculty at Stanford, serves on the national board of the National Alliance on Mental Illness (NAMI), and advises organizations working at the intersection of mental health and innovation. She’s also writing a children’s book series on stress and resilience with Dr. Bruce Perry. Dr. Bhushan trained at Harvard Medical School and Johns Hopkins and has spoken publicly about her own experience of bipolar disorder, work that has made her an award-winning mental health advocate. She lives in the Bay Area with her husband and child.
Welcome, Dr. Bhushan. So nice to talk to you today.
Devika Bhushan:
Thanks so much for having me, Josh. It’s really good to be here.
Joshua Dolezal:
So you’re in the Bay Area, and you were telling me it’s foggy there. What do you like about San Francisco? Because I know you’re from the East Coast originally.
Devika Bhushan:
Yeah. I spent a lot of years on the East Coast and actually grew up all over the world, so India and the Philippines mostly.
What drew us here to the Bay Area is that both my husband and I have had really good fortune, in a way, because a lot of our friends from different parts of our lives have ended up in and around the Bay for different reasons. So from a community perspective, it felt like the best place for us to land, and we came here almost a decade ago now.
It’s also just very rich with cultural experiences, nature, a lot of incredible communities and neighborhoods. So it’s been a really nice place for us to land.
Joshua Dolezal:
I was an academic for 16 years, 20 years counting grad school, and one of the things professors say is they can’t pick where they live. So it seems like that’s one of the benefits of medicine, that you can make that choice to move closer to your friends, your people. Is that fairly consistent, or do doctors also get boxed into certain places?
Devika Bhushan:
I would say that in the early phases of training, where you go to medical school, where you go to graduate school, and where you go to residency are largely outside your own control. You can apply to the places that you’d be willing to go, but especially for residency, you are given one option through this arcane system known as the Match, where each applicant and each program are optimally matched by an algorithm, and you end up with a letter that says where you’re going to be living for three, six, seven, eight years.
So in the early phases of my career, no, there wasn’t very much choice. But once there was, this is where we came to be. And you’re in Pennsylvania, right?
Joshua Dolezal:
Yeah, Central PA. I’m from Montana originally and did my grad work at Nebraska, and I think my whole adult life I’ve been trying to get back out West. Academic life is just different in that regard.
Devika Bhushan:
And you bill yourself as a recovering academic, right?
Joshua Dolezal:
I do. I left higher ed in 2021, so I built a coaching practice and started this Substack in 2022. So four years strong, I guess, fifth year total on Substack, but it’s definitely a second chapter for me.
Devika Bhushan:
Nice.
Joshua Dolezal:
Thanks for asking. I want to get into your mental health work shortly, but first, can we go back to your desire to become a doctor? Because for some people, that’s a childhood dream. I’m wondering when that started for you. Did you always know you wanted to go into medicine, or is that something that happened later for you?
Devika Bhushan:
I think through grade school, middle school, and high school, I always really enjoyed learning about how things work, so all of the sciences really called to me. Once I started to take biology and psychology, I was really hooked, because how we do what we do in the world, how we think about ourselves and about the people around us, and how the cellular and molecular processes in our bodies and brains work to either set us up for risk or resilience were really fascinating topics for me.
In undergrad I was a neuroscience major, and my undergrad thesis was about how women who were majoring in the STEM fields were either differentially susceptible to or resilient to something called stereotype threat.
You may know what that is, and many of our viewers and listeners may too, but for those who haven’t heard the term before, it’s essentially the concept that when you belong to a group about which there’s some kind of negative stereotype in a specific domain, that identity can be activated for you as you’re doing something within that domain.
For example, you’re a woman taking a standardized math test, and you’re asked to check off your sex at the beginning of the experience. That will actually activate implicitly all of the negative stereotypes that abound about women’s abilities in math, and women will underperform relative to men when their sex or gender identity has been activated before the task.
However, if you don’t ask that question, women persist as individuals rather than as members of their group, and you don’t see a difference in scores. I was really interested in this concept because we know that there is a leaky pipeline effect, right? At every stage, whether undergrad, graduate school, medical school, or different levels of professorship, women are falling out of the pipeline at disproportionate rates, and this is true across all kinds of underrepresented groups.
But I was really interested in which women are specifically susceptible to stereotype threat, so we designed a paradigm to study that. That’s a long way of saying that what called me to medicine was a deep interest in understanding how the brain works and how our social context influences our health and health outcomes, as well as our achievement and opportunities.
Joshua Dolezal:
So you were a researcher first and then a doctor after that?
Devika Bhushan:
I would say so, yeah. I’ve always had a research bent to my career.
Joshua Dolezal:
Part of your journey has included public advocacy for mental health, and this came after or alongside your diagnosis with bipolar disorder. Now, diagnosis is tricky, because sometimes it can be a label or a box, and it can be wrong. A lot of friends of mine, people I’ve had on the show even, have talked about how they were misdiagnosed for years before they got the autism diagnosis or the one that fits, and then that’s a game changer. So what was that like for you when you were first diagnosed with bipolar disorder? Was it liberating? Was it limiting? How did you respond to it?
Devika Bhushan:
You’re absolutely right. In the mental health field, going from having symptoms of any kind to getting the right diagnosis and then the right treatment plan often spans decades. In my case, I was relatively lucky: my diagnosis and the start of the right kind of treatment for bipolar disorder took only about three and a half years.
I was a medical student at the time. My experience of mental illness only started in my 22nd or 23rd year, and before that I’d had a relatively unblemished early life, at least from a mental health perspective. But the summer after my first year of medical school, going into my second year, I had a very difficult experience. I was living in a remote village, setting up a program from scratch with very little outside contact or support from anybody on the ground or outside of it.
It was a remote village, no running water, very little electricity and connectivity, so even being able to send a quick email to somebody back home was a challenge. That, coupled with all of the pressure I was putting on myself to make this program run a very certain way, and working in Spanish, which is my third language, meant there were a lot of contextual factors that made that summer a breaking point.
Through the eight or nine weeks I was there, I found it increasingly difficult to fall asleep and stay asleep, just very creeping mental health symptoms, if you will. By the end of that summer, I was not feeling like myself at all. I had started having symptoms of my first episode of depression, where I could not come up with the right words to say in response when somebody asked me things like “How was your summer? How are you doing?” when I got back to school. It was the first time my now husband, then boyfriend, and I had moved in together, and it was supposed to be this very warm, cozy homecoming. But I didn’t feel like myself. I felt completely out of sorts and emotionally numb, and I couldn’t feel the things I knew I was supposed to be feeling in various aspects of my life.
But the hardest part came when I was not able to process information cognitively in school for the very first time in my life, and that really scared me. I would be sitting up trying to make sense of the words on the page, the facts, the mechanisms we were learning. I remember we were learning about the autonomic nervous system, the parasympathetic and sympathetic nervous systems, which govern so much of our physiology moment to moment, and I knew it was really important. I just could not get it into my brain, and it was my turn to present that information to the class the next day. I remember the sheer panic of “What is happening? Why can’t I make heads or tails of this?” I’d never struggled in school before that point.
Joshua Dolezal:
Can I ask? For some people, when they get a diagnosis like this, it’s like, “Oh, now everything makes sense.” They look back to childhood memories where they felt out of place, or didn’t know how to respond, or always knew that something was not quite right, but they were told it was up to them to adapt, that they were the problem, or that they needed to fix something or try harder. So a diagnosis can be liberating in that way. But it sounds like you had never carried that with you. It was this particular breaking point, as you described it, when a bunch of things happened at once. A new thing for you at that point. That’s fair to say?
Devika Bhushan:
Yeah, it was a new thing for me. Looking back at my childhood, I was always a very shy kid, which was exacerbated a lot by the fact that I moved around three different countries by the time I was 10. I was in my seventh school by fifth grade, so there was a lot of change. Outside of being really shy and unsure of who I was at my core because of all these contextual factors shifting around me so quickly and so frequently, I really don’t think, as I look back, that there were frank mental illness episodes or even early symptoms.
But coming back to that episode of depression, what ended up happening was that within a couple of weeks of being back at school at Harvard, I went to seek help. I was supported in that by my family, who said, “This is not you. What you’re experiencing sounds like something really serious, and we should sort it out.”
I was diagnosed with fairly severe depression and started on an antidepressant, an SSRI. For folks who know about the bipolar spectrum, you may know that SSRIs are fairly activating medications, and in people who have underlying bipolar disorder they can actually unmask experiences of hypomania; a mixed episode, where you have agitation, irritability, and anxiety, i.e. hypomania, overlaid with depression; or frank mania.
So in my case, I was on a cocktail with an SSRI backbone for about three years, and the whole time I was a little bit revved up. I was having what we would call in retrospect mixed symptoms, where I was hypomanic on top of depression.
When that happens, it can be really hard to understand that what you’re dealing with is a hypomanic picture. Often it just looks like anxiety and irritability, right? In my case, I didn’t have a family history of bipolar illness at the time, and they looked at me and said, “This is depression and anxiety,” two fairly common, straightforward experiences that people manage fairly well, right? But for me, the medications, the treatment plan, and all of the demands of medical school together meant I just wasn’t in a well place for at least those three years. My meds kept changing throughout that whole time, and I was finally on three different activating medications and had a frank manic episode, where both I and my treatment team finally understood that this was bipolar illness. That really saved me. I was only manic for about 36 hours, and unlike some people who experience mania, mine was, I don’t want to say mild, but it was something where I was still in touch with some rational part of myself that recognized that what was going on was mania.
When I got the diagnosis of bipolar disorder, I felt a lot of conflicting emotions, to answer your question. One part of me was deeply relieved and vindicated, because I finally had a name for this really terrible set of experiences I had been walking through. Frankly, it felt to me at times that my treatment team may have been frustrated by my lack of progress, right? If it was anxiety and depression, we’d been treating it as such for almost three years, and I’d failed to get better. At least that was my internal voice about it. And finally it was like, okay, there’s something different going on with my brain that we hadn’t been understanding or addressing, and now we can finally have a way forward.
Simultaneously, there was self-stigma, internalized shame, and self-doubt about who I would be with this disorder, whether I would be able to be successful as a person, as a family member, as a long-term partner, as a professional. The reason for those fears is that we have so few examples of people with serious mental illness who are openly in recovery.
We see many more ready examples, both in culture and in real life, of people who are at their most ill with bipolar illness or schizophrenia or schizoaffective disorder. There are a lot of negative stereotypes that we as a society heap onto people who have these illnesses. When you grow up in this society, you already have those immediate associations at the ready, and then you apply them to yourself when you get a diagnosis like this, and you think, “I don’t know what’s going to happen in my life. I don’t know what’s going to be possible for me.” So there was a lot.
Joshua Dolezal:
Did you worry, if I can ask, about your existing relationship, that it would change your partner’s view of you? Some people, if they weren’t in a relationship, would think this would be something they would have to carry forward, and it would bring uncertainty. Was it something he was able to absorb, or did you feel like that was another one of these “what’s the future look like” kind of things?
Devika Bhushan:
It’s a really good question, and I think that would’ve been a concern of mine had I not been in a relationship at the time, or been in a new relationship. At the point of my diagnosis, my partner and I had been together almost four and a half or five years, and we’d really grown up together in a lot of ways. We met when we were 18. We started dating when we were 20. Now we’re 40. We’ve lived more than half of our lives in communion with each other. So for me, he and my parents were actually a really large source of support as I was coming to terms with the diagnosis. They knew who I really was, both before I was symptomatic and through that early part of the diagnosis and the restabilization on mood stabilizers, which are the standard of care for bipolar illness.
My husband did something really powerful at that phase of our journey. You mentioned I’m on the national board for NAMI, the National Alliance on Mental Illness. NAMI offers support through mental illness journeys, both to the people who are walking through them and, crucially, to their family members.
So my husband took a local class with our local NAMI group, and he heard from other family members: How do you support a loved one through an experience like this? What do you say and do that’s really helpful? And what do you not say and not do that can be harmful or unhelpful in ways you might not know?
I think that was a really powerful experience for him and for me, to have a playbook and a way to access the recovery journey not on our own.
Joshua Dolezal:
That’s great. So that’s something you’re trying to contribute more through your advocacy and make available to others.
I think you’ve answered one of the questions I wanted to ask you. As an advocate, you celebrate what we call mental illness Coming Out Days. Recently we’ve been restacking and sharing the anniversary of Simone Biles’s Coming Out Day. It’s not really a question. It’s clearly a way of breaking stigma, right? You’d be showing solidarity with others who are telling their stories without shame, without stigma, and normalizing that for other people.
So I’m curious. When you’re doing that, and when you learn how to live with your own mental health, there is a kind of Western medical training that teaches you to be superhuman. You have to be capable of these completely unreasonable work shifts. You go through a kind of hazing that’s like a boot camp. It’s the opposite of a shamanic tradition, where a shaman is broken and brought near the threshold of death, and that’s the qualification or credential for being a healer. In the Western tradition, you try to make yourself unbreakable. In the Patch Adams film, the dean of medical education says, basically, “We’re here to train the humanity out of you.” So was there a conflict for you between learning how to live with bipolar disorder and learning how to think like the doctor you’ve been trained to be? Do you have to unlearn any of that?
Devika Bhushan:
It’s a really good question, and there are many layers to this. First, I will say that there is a deeply held stigma and culture of perfectionism in medicine that makes it difficult for anybody to own any kind of imperfect experience. I say that because in the first few years of my career, especially when I was in training, I kept this part of myself tightly hidden.
The facts support the experiences I had in training. There is this fear of breaking rank and crossing over from that us-versus-them relationship with patients. There are ways in which people are punished and penalized for doing that, or for having a mental health condition.
We have to be licensed state by state in the health workforce, and most states used to ask very intrusive and stigmatizing questions about mental illness, as opposed to physical health. That’s starting to improve through the work of an organization called the Dr. Lorna Breen Heroes’ Foundation. But they would require doctors with mental illness to jump through exceedingly difficult hoops to get our licenses. For example, when I applied for my California state license, I was asked to submit a list of every single provider I had seen to date.
Joshua Dolezal:
Wow.
Devika Bhushan:
On the therapy side, on the psychiatry side, and so on. And then I had to submit letters from every single provider I had ever seen in my adult life.
Joshua Dolezal:
So this wasn’t just a mindset thing. It was an actual credentialing obstacle.
Devika Bhushan:
It was to get my medical license in the state of California. The state has since revamped its question structure to have parity between mental health and physical health. Uncontrolled diabetes or uncontrolled arthritis also lead to cognitive and other changes that influence how you can perform your job. But the fact that we don’t trust the word of a physician with mental illness the same way we do one with a chronic physical health condition speaks volumes about that embedded stigma.
But to come back to your question of what it actually looks like to break that stigma and break that fourth wall: I didn’t know anybody in my personal life who was living in recovery with bipolar disorder. I knew of two people. One was Kurt Vonnegut’s son, Mark Vonnegut, who is a pediatrician in the greater Massachusetts area and has written a memoir about his experiences. The other was Kay Jamison, a therapist with a great research base who has also been public about her own experiences.
I knew of them. They were my glimmers of hope as I was walking through this. But in medicine, up to one in three students has depressive symptoms. Of everybody who is symptomatic, only one in six seeks formal help, because they’re afraid of what’s going to happen at subsequent junctures of their career ladder and what’s going to be allowed to happen.
So there’s a great need for physicians, especially in early to mid-career phases, to build networks of peer support and to feel comfortable, to the extent that we have that privilege, sharing our experiences, not necessarily publicly, but in our communities and circles of influence. We know that peer support is the one piece that starts to unravel self-stigma, public stigma, and also the institutionalized or embedded stigma that we see a lot of in medicine. So that was part of my impetus to share my story.
Joshua Dolezal:
Well, it’s all fascinating. So you’re not advocating now as much for adults living with mental illness or adults seeking these resources. Your work as acting surgeon general was focused on kids, and you’re a pediatrician, so you’re thinking more about kids.
Devika Bhushan:
Actually, I would amend that. I’m thinking about mental health, health, and resilience through the life course. Our work at the state level setting up ACEs Aware applied to everyone from prenatal through adults up to the age of 64.
Joshua Dolezal:
Okay. Can we pivot to your work with kids? Because that’s been a really important part of your career. With your work in California as acting surgeon general, two of the phrases you used to describe that work were adverse childhood experiences and toxic stress. These are two things that typically wouldn’t be named with those phrases in clinical settings.
So I’m curious how you distinguish between what previous generations might have just called hardship and adverse childhood experiences. And do you have a position in the debate between owning and processing feelings, what some might see as gentle parenting and safetyism, and the Jonathan Haidt idea that it’s good for kids to experience hardship, and that overcoming obstacles is one of the sources of building resilience? Do you have a position on that spectrum or in that conversation?
Devika Bhushan:
Yes, 1,000 percent. I’ll start by grounding us in a couple of the terms we just used. Adverse childhood experiences, often referred to as ACEs, is a term first used in the 1990s in a very famous study, since replicated a number of times with different populations, which showed that ten specific childhood experiences before the age of 18 were associated in a dose-response way, meaning the more you have, the greater the impact, with what is now 60-plus different health conditions in childhood as well as adulthood.
So what are these experiences? ACEs refers to experiences that really destabilize your sense of security and attachment: child abuse, neglect, growing up in a household where somebody was truly struggling, for example with untreated mental illness or substance use disorder, a key family member being in jail or prison for a number of years, or a separation or divorce that was traumatic.
Obviously, there’s a whole spectrum in terms of the impact and severity of experiences like these. But in general, at the population level, folks were finding this dose-response relationship between the number of ACEs and the number of health outcomes that came on earlier than typical, more severely than typical, or both.
And those health impacts were all kinds of things: behavioral and mental health concerns, of course, but also early-onset cancer, diabetes, heart disease, and so on. The key understanding over the subsequent 20 years was that adverse childhood experiences reset our stress biology. That influences all kinds of biological cascades: our hormonal systems, our immune system, our inflammatory cascade, our epigenetics, and even genetics. Adverse childhood experiences have been known to affect telomeres, which are the caps on the ends of chromosomes that protect them.
Joshua Dolezal:
So this is part of what becomes inherited trauma later, right?
Devika Bhushan:
Correct. Yes, absolutely. ACEs are associated not just with health conditions that are harder to treat than typical, but also with early mortality. I say all that to say that this is all very real and very serious, and we know that ACEs are not destiny.
The key motivation for the ACEs Aware initiative, which we put into place in California in 2020, just before the pandemic hit, was that you can re-regulate somebody’s stress biology in key ways that help protect them against the risk they have for these health conditions. Or, once those health conditions are in place, you can re-regulate stress biology to decrease their severity.
These are somewhat simple things, but the work was really systematizing the way healthcare providers were both assessing for the risk of what we call toxic stress, which is this dysregulated stress biology, and then also addressing it. So things like anti-inflammatory nutrition, exercise, boosting your relational health, meaning the important relationships in your life or establishing new ones, spending time in nature, and mindfulness practices. And making a program where each person or each family can choose for themselves the stress-buffering experiences that build on strengths they already have, or things they’re already doing that they could increase the dose of.
So we made stress reduction and regulation a scientifically backed, new, and crucial aspect of treatment planning with patients.
Joshua Dolezal:
Well, I asked the question in a misleading way, then, because what you’re describing are very extreme circumstances.
Devika Bhushan:
Oh, yeah.
Joshua Dolezal:
So it’s quite removed from the garden-variety hardship that your kids might experience.
Devika Bhushan:
Yes. And to come back to your question, I do believe that resilience is built through walking through challenges in a supported way. What’s different about ACEs is that your core sense of self, your attachment, and your sense of safety and security, that if I fall, somebody’s going to be here to help me move forward, is totally disrupted. So it’s a very different scenario.
Say you have a three-year-old, and you let them struggle for a little while putting on a shirt or putting on pants and figuring it out, while a parent is potentially available if they literally get stuck and can’t get their head through. That’s a very different situation, right? And that is what I advocate for. You should let your kids struggle through the things that are developmentally hard for them at that phase, because getting to the other side with your support builds the sense of “I can do hard things. I can rise to the challenge. I have it within me to do things I didn’t even know I could do.” Those kinds of experiences build confidence and a lasting sense of resilience to subsequent stressors. But that’s a very different bucket of things.
Joshua Dolezal:
Well, partly why I was asking is that our culture is so saturated with the word trauma, and some of the language you’re using can be a bigger umbrella that’s not describing extreme situations like the ones the research is actually designed to address.
So in your practice, there are two parts to this question. When you’re listening to a child’s story about their health or their illness, they’re not always well equipped to tell the story with familiar terminology, or they don’t know the right words for diseases or categories of things. So I assume as a pediatrician it requires a different listening skill set. But also with families, as you’re listening to their children narrate their own illness narrative or health narrative, how do you distinguish between trauma that’s on that scale and trauma that’s a misuse of the term?
Devika Bhushan:
In general, when people are telling their stories, whether in a health context or outside of it, it’s important to take their lead in the ways they’re using words, as long as the diagnostic process isn’t thereby obscured. So if somebody says, “I’m feeling the symptoms of appendicitis coming on,” you might investigate with them exactly what kind of nausea and stomachache and other symptoms they mean. In the end, it may or may not be due to appendicitis. But at the outset, you have to take somebody’s word for their experience.
I think it’s really important for patients to be able to tell stories in their own words, and for physicians and other clinicians to seek to understand that first-person narrative in a way that doesn’t diminish or gaslight that experience.
Joshua Dolezal:
So you start with belief, even as a scientist knowing that there’s some usefulness to doubt or questioning. What I hear you saying is that a first step in listening carefully to a child’s story, or anyone’s story of health or illness, is just believing the story you hear.
Devika Bhushan:
That’s right. And sometimes we don’t have data to understand certain kinds of clinical narratives. Some of that has to do with who’s been studied, and therefore which diagnostic entities we have clearly defined understandings and protocols for, and which ones we don’t.
For example, women were not included in clinical trials until the ‘90s, right? So many of the conditions that uniquely affect women, like heart disease, or that largely or only affect women, we don’t understand well because they haven’t been studied. What happens as a result is that people come in with symptoms of, say, endometriosis, which takes years to correctly diagnose even though it is so common.
And that’s only because of the incompleteness of the medical knowledge base around conditions like this. It’s not just women’s health, but the health of many people with stigmatized identities within medicine that is overlooked and often gaslit.
Joshua Dolezal:
So I’m curious about this children’s book series you’re working on. I’ve got three kids, and I don’t know how many hundreds of hours I’ve spent reading to them over the years, which I love to do. We all went through a divorce about three years ago, and I remember it being useful to have books that were explicitly about that.
Devika Bhushan:
Right.
Joshua Dolezal:
Two homes, and a character who’s navigating the same transition. I know this isn’t out yet, and you’re still working on it with Bruce Perry. Can you tell us a little about him, and then how you’re translating abstract themes like stress and resilience into stories that kids would not just want to read but learn something from?
Devika Bhushan:
Absolutely. The concept for this series came out of the idea that in our era of parenting, Josh, there are so many incredible resources out there: books, courses, coaches. But frankly, they are extremely difficult for the average parent to access, largely because of time, but also because of expense.
If we don’t have, let’s say, the ten hours it would require to walk through a course, or the twenty hours it would require to read one of these amazing parenting books cover to cover, then you end up feeling like you are in this flood. We’re in a very difficult era in which to parent, where we have way less time than in previous eras, and we’ve taken on much more of the work of intensive parenting. But many of us, as you said, have the time and the capacity to spend ten minutes a day reading to a kid.
So the idea was: wouldn’t it be amazing if we could make this experience really fun and interesting, in a fiction world that is engaging first and foremost, but then secondarily embed ideas for parents, caregivers, and educators about how to respond to a tantrum in a way that promotes resilience in the long run and doesn’t make things worse in the short run? And how do you do that in a way that’s fun?
So we have this magical world of dragons. There are six books. The first three are for a preschool audience, and the subsequent three are for about six- to nine-year-olds, so it grows with the family. Each one helps unlock a set of stress and resilience tools for parents and caregivers. I won’t say more than that.
But a word on my co-author. Bruce Perry is an MD-PhD, a neuroscientist and child psychiatrist who has become one of the world’s leading experts on trauma, and specifically childhood trauma. His expertise has been accessed for international relief work and a number of high-profile trauma cases. He’s written a lot of books in this field. A few years ago he wrote a book with Oprah called What Happened to You?, which I think is one of the best lay explanations of what trauma actually looks like in the brain, and what healthy development or resilience looks like at a brain level. I very highly recommend that book for anyone who’s interested. He has never written any children’s books, although he has a number of courses for educators, caregivers, and therapists about how you approach a kid who has been through something really challenging, and how you optimally engage with children of all stripes. That’s some of the work we’ve started to embed into the takeaways of this series.
Joshua Dolezal:
Well, it’s a tricky thing to balance. The Roman poet Horace said that literature should both delight and instruct, and I think the best children’s books do that. The Berenstain Bears teach all kinds of life lessons about money or about bad habits. It’s a character-driven story, it’s enjoyable, it’s funny, but there’s a takeaway that’s valuable, an insight as well. But some of those books can be a little too didactic, in my opinion.
There’s one, What Would Danny Do?, I don’t know if you’ve seen it, that’s like a choose-your-own-adventure. Danny goes through a series of things where his little brother steals his plate at breakfast, and then he’s got a choice: is he going to kick him under the table, or is he going to do the right thing? But I sympathize with Danny, because sometimes you just want to kick your little brother under the table, right? Why does that always have to be the bad choice that leads to this horrible outcome?
That kind of book feels a little heavy-handed at times. Kids obviously know what the correct answer is, but they know life is messier than that. It’s not as tidy as it’s made out to be.
Devika Bhushan:
And there’s a reason why the messaging or lessons mostly sit in a little note at the end of the story, a note to readers and caregivers. We try for the story proper to be really fun and engaging and not feel pedantic or heavy-handed for the folks walking through it, but to give people who are looking for the tools enough of them in a separate place.
Joshua Dolezal:
I’m not judging it, because I haven’t seen it, and it sounds like some of it’s proprietary and you can’t share too much now. But as a parent, what are some of your favorite books? Do you have any models, where if this series hits its target, it’s going to be like this book or that series?
Devika Bhushan:
There are a number of really amazing children’s books in this universe. Some of our favorites are classics like Dr. Seuss. Right now we’re really into The Sleep Book. I have a five-year-old, and every night we have to go through The Sleep Book. If anyone has read that book, you know it’s got a lot of pages, like 75 or 80. At least that’s how it feels going through it. But we love the lyrical, very rich language of the Dr. Seuss universe.
I know there are lots of books with messaging around mental health and health, and I’ve seen a few that are really good. For example, Megan Madison wrote a series of six books that walk kids through different concepts. The one I really like is probably right behind me. Hang on one sec.
Joshua Dolezal:
Our Skin?
Devika Bhushan:
It’s called Yes! No!, and it’s all about consent and boundaries. It’s not a fiction book. It’s a nonfiction book that talks about why consent matters, what it means in different contexts, and how it can be removed even if it’s already been given. So it’s more instructive, at least directly, than our stories aim to be. But I love the way she writes, and I love the way she brings these concepts to a very young audience in ways that are readily understandable. She’s definitely one of my heroes and mentors in the child communication space.
Joshua Dolezal:
This might be a can of worms to open, but are you taking a stance on being totally AI-free? Are you using AI in writing this series? Is that something you’d even want to talk about publicly? I know there’s a stigma with that as well.
Devika Bhushan:
Totally. I don’t judge any authors who use AI in drafting or researching. When I write nonfiction, I do use AI support to identify primary literature, and then I read that primary literature myself and make sure I know what it says and how I would interpret its findings. As someone who’s done research in my career, I find it very important to read that directly and synthesize it myself. But in this series I’m not using AI, because first of all, the writing of it is the part that’s fun. If I were to take that out of the equation, then what am I doing? Why am I doing it?
Joshua Dolezal:
Exactly.
Devika Bhushan:
I adore finding the ideal word in a specific phrase, or figuring out exactly which words will resonate with younger audiences. And I’ve been doing a lot of pilot testing with my son and his friends, so that part is just fun for me. I don’t knock anyone who uses AI for drafting, but I haven’t been using it.
Joshua Dolezal:
Well, you mentioned Dr. Seuss, and I think all of these beloved books are beloved, like most literature, for their distinctive voice. I was celebrating Annie Dillard recently, who passed this last week, and her Pilgrim at Tinker Creek was so influential for me because it was this explosive demonstration of how free voice could be. You could have this fearless lyricism and just lean into that. And Dr. Seuss, of course, does that for kids, with rhymes that are just off-the-charts crazy but still make sense somehow.
AI is a tool that hedges its bets, that aims for the mean, and kids, I think, respond better to things that are novel. That’s how their brains are wired to work. I’m sure we could spend a whole other hour on that. But I’m glad you’re having fun with the writing, because that, to me, is one of the core whys of the practice. If you can’t have fun, then why write to begin with?
Devika Bhushan:
You get into that flow state, and it’s unlike anything else. So if you can’t get to that, then why write, exactly.
Joshua Dolezal:
Well, I can’t wait to see your series when it comes out, so I’ll stay tuned. To learn more about Dr. Bhushan’s writing and speaking, check out devikabhushan.com and Spread the Light with Dr. Devika B.
That’s the thing not named for today. Thanks so much for being with me today, Devika, and see you around Substack.
Devika Bhushan:
Sounds good. Thanks so much for having me here, Josh. I really appreciated our conversation. Thanks for the good questions.
The Recovering Academic explores the messy intersections of medicine, culture, and storytelling. I write three new essays a month, hold live interviews, and produce a podcast about the things medicine leaves unnamed. It’s free to read, and the members who support it help it stay that way. I also give 5% of what I earn here to local charities.
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