5 Minutes With Adam Brown

This week we interviewed Adam Brown, author of “Bright Spots & Landmines” and former diaTribe writer, about the importance of mental health in diabetes care and his new journey as a licensed therapist. 

Brown has lived with type 1 diabetes for over 20 years and is a staunch advocate for people with diabetes. He worked at diaTribe until 2019, where he wrote countless articles including the acclaimed column "Adam's Corner." In his book, Brown shares hundreds of practical tips on food, exercise, sleep, and mindset that have helped him the most with managing his diabetes. 

Along with bringing a valuable patient perspective to public venues, industry events, and scientific conferences, Brown's goal for himself and other people with diabetes is to live a healthier, happier, and more hopeful life. Brown earned a master's degree in Counseling Psychology from The Wright Institute in 2021 and now runs a private practice in San Francisco.

Anna Brooks: What type of work are you currently doing in the diabetes space?

Adam Brown: I’m just getting back into the diabetes world now that I’m a licensed therapist. It has been a deeply fulfilling – and quite challenging – five-year journey. After completing graduate school in 2021, I worked as a therapist for three years in intensive teenage eating disorders. I was part of an incredible team and learned so much about integrating physical and mental health.

I’m excited to open my own therapy practice this summer in San Francisco, allowing me to work with a wider variety of people. Diabetes, of course, will be a main focus of mine. I’ll be offering some creative ways to engage in therapy, including ACT, Sandtray, and spending time in nature. I’ve also been working on a new diabetes book and look forward to speaking more about that soon.

Brooks: Can you share a few mental health challenges people with diabetes face and why access to mental health care is so critical for those living with a chronic health condition?

Brown: People often discuss “mental health” as something different from “physical health” or “diabetes health.” In reality, mental health and physical health are inseparable; they are made of each other. To illustrate this very vividly, I’ll share a personal example from my life.

Last year, I began struggling with insomnia. I’d lie down in bed at night and feel wired, jumpy, and unable to be still. My heart seemed to be pounding and I’d feel an overwhelming urge to get up and out of bed. Sometimes I’d doze off and then wake up startled, hypervigilant, and on-guard. 

The onset seemed to be work stress. I’d ruminate on client sessions I’d had earlier in the day or worry about what was coming up the next day. I’d carry the emotional stress of my day home. I’d worry if I was making the right decisions and if I was cut out to be a therapist. I’d feel so jumpy that I began taking walks outside at midnight, breathing deep and appreciating the cool air. It felt nice, but it would wake me up further and make it harder to fall asleep. 

My intellectual knowledge about sleep only added more stress. I’d look at the clock (3:45 am!) and feel worse, thinking “How am I going to function tomorrow?” I remember breaking down crying on more than one night, feeling scared that this was going to last forever and my life was ruined. My stress would wake my partner, which made me feel guilty and even worse about the situation. “Why me? I wrote a whole chapter on sleep in my first book. I know my stuff! How could this be happening to me?” 

Of course, this struggle massively impacted both my physical and mental health. I had higher blood sugars the next day from inadequate sleep, which made me more irritable. Feeling physically exhausted, I was less inclined to do things I enjoyed like riding my bike and going for a walk. I reached for more caffeine to get through the day, which kept my body in a state of hyperarousal and made it harder to fall asleep that night. When bedtime approached, I’d worry and stress and the cycle would repeat. What a mess!

In this example, where is the dividing line between “physical health” and “mental health”? Does it even matter? 

Thoughts, feelings, sensations, behaviors, biology, relationships, and life context are all interconnected. They all influence each other in complex feedback loops. This is precisely why as therapists we are trained to look through a “biopsychosocial” lens – biological, psychological, and social. While this is true for humans in general, it is magnified for those of us with diabetes. 

Right from diabetes diagnosis, we learn that the stakes are high. We are lectured about what out-of-range blood glucose can do to our body over the long term. Hence, we often start in a place of fear and must directly confront our own mortality – and that’s just the beginning. 

I don’t have direct control over everything that affects my blood sugar; there are at least 42 factors in play. Often, we must give up or make radical changes in our lives, which prompts big feelings like grief, anger, bitterness, guilt, and beyond. My blood glucose influences my emotions, and my emotions influence my diabetes choices and actions. It’s a tangled mess. 

We live in an environmental context that often makes it very difficult to manage diabetes, and we are schooled in a paradigm of “control, control, control” that can make people feel like failures. Diabetes technology is game-changing and can easily become its own source of stress. Diabetes often defies problem-solving logic – for example, the obvious solution to a problem can make the problem worse, as I experienced with insomnia (eventually I did get it sorted out, thanks to the book “Hello Sleep” as well as going to therapy). And since diabetes is intimately connected to the rest of my life, any disruption in my life is likely to impact my diabetes (and vice versa).

So when you put it all together, diabetes is a combination of high stakes, uncertainty, imperfect tools, profound complexity, and a deeply challenging context. That makes for a very demanding biopsychosocial health condition.  

Brooks: As a therapist living with diabetes, what do you do to take care of your mental health?

Brown: My tendency is to go, go, go – to do more, add more, produce more, lean into the future, plan ahead, and problem-solve. These tendencies have their limits, especially as a therapist. I’ve had to build very intentional practices to slow down. What I do changes over time, so this is what I’m up to currently.

Stillness in nature: I go somewhere beautiful and take it in with my senses. I’m not trying to do anything or get anywhere; in fact, I’m mostly not doing. I’m not on my phone. I’m not talking. I’m listening, looking, noticing, and appreciating. These books have all been awesome guides on this front: “A Walk in the Wood,” “Forest Bathing,” “Healing Trees,” and “A Field Guide to Nature Meditation.”

Mindfulness: I love the app Waking Up for training in the crucial mental skill set of presence/attention without judgment. I’ve also come to love Qigong as a mindful movement practice; I highly recommend this YouTube channel for a beginner-friendly intro. The Calm app's Daily Move is also great.

A hobby: It has always been easy for work to consume most of my life, including in my free time. I’ve long needed an activity that is non-professional. I’ve taken up juggling in the past 18 months, and it’s been a wonderful outlet to learn and play. A juggling club here in San Francisco has become a weekly source of connection, community, and fun. 

I still take care of my diabetes in line with most of “Bright Spots & Landmines.” In general, I’m less obsessive about data and running experiments. I’m kinder to myself and more flexible. I focus more on “joyful movement” than on “exercise.” All of the skills I teach clients in sessions are things I use constantly, particularly connecting with my values, noticing thoughts, and engaging in the present moment. I spend far less time on my phone and on screens.  

Brooks: What do you see as a main challenge in diabetes care right now and what can we do to address it?

Brown: I think the paradigm of “control” is a major challenge, particularly as technology has gotten better. This is a topic I attempt to tackle in my new book. Here’s a draft excerpt:

I don't "control" my diabetes;
I influence it,
I manage it,
I balance it,
I hold it,
I carry it.

This is not merely a synonym game. It’s about something far more important: the story I tell about the complexity behind every blood sugar. From that story flows expectations, judgments, and evaluations from myself and others about how I am doing as a person with a complex, multidimensional, ever-changing chronic illness. 

If diabetes is "simple" (three factors – food, medication, and exercise) and things aren't going well, that sounds like my fault. It readily leads to judgments like "unmotivated," "lazy," "not educated enough," “non-compliant,” “poorly controlled,” etc. It leads to people offering unsolicited advice, trying to "fix," searching for magic solutions, and me feeling disappointed and self-blaming when they don’t work.

If diabetes is "complex" (42+ factors) and things aren't going well, that makes a hell of a lot more sense. An appropriate response is curiosity, kindness, self-compassion, acceptance, and slowing down to enable skillful actions. 

The difference between these frames is vast, and I think it’s central to the psychological experience of living with diabetes. 

Brooks: I’d love to hear about the upcoming Sequoia Slipstream retreat in August. Can you tell us more about it and the workshops you’re running there?

Brown: I’m so excited about it. We’ll spend a weekend in the gorgeous Sequoia National Forest here in California. I’m doing a talk on “Bright Spots & Landmines” and on “Diabetes During Difficult Times” (a preview of the new book). Connected in Motion runs incredible outdoor events for people with diabetes. I’d love to see you in person in August! Sign up here.

As I return to the diabetes world, I’d love to hear from you. diaTribe readers are deeply important to me. How can I best serve and contribute to the diabetes community? Please write and let me know!

Read more about diabetes and mental health here:

• How to Find the Right Therapist When You Have Diabetes
• 5 Diabetes Myths and How They Harm Mental Health
• How to Build Resilience as a Person With Diabetes