She spends her days at one edge of human experience and her time off at another, and both of them taught her the same lesson.
Dr. Adjoa Smalls-Mantey works as an emergency psychiatrist in New York City. That means she sits with people at the absolute edge, the ones who arrive in crisis, in psychosis, after a suicide attempt, on what may be the worst day of their life. Depression and suicidal thinking are a quarter to a third of what she sees, every day.
Then she goes off the clock and drives to a different edge. She’s a mountaineer. She led the first all-Black team to attempt Everest. She’s climbed Denali. She goes looking for altitudes where the air itself can hurt you.
Two edges of survival, one person. And when Will and I asked what the mountain taught her that she carries back into the ER, she didn’t reach for something grand. She reached for the least heroic sentence imaginable.
Ask for a little help before you need a lot.
The most expensive words a high performer won’t say
Adjoa is exactly the kind of person who could get away with never asking. Physician-scientist trained at Oxford and Columbia, a PhD in immunology, a summit résumé most people will never touch. And she’ll tell you the people who wait longest to ask for help in the mountains are the inexperienced ones, the ones still trying to prove they belong, because asking feels like admitting you don’t.
She named the exact fears, and every one of them lives in me too. I’ve always figured it out on my own, so I should figure this out. I’m the expert here, I can’t be the one who doesn’t know. And the quiet one underneath, if I ask and they say no, now I look weak and I’ve been rejected, so I just won’t ask.
The mountain punishes that math. Wait too long and your small problem becomes everyone’s emergency, and now the whole team is hauling you down instead of climbing. On Denali she felt her toes going cold on a training day and told her guide right then, I can’t do this practice climb, I’ve had an injury, I’m not going to push it into something you have to rescue. That’s the most experienced person in the group knowing the difference between a little help now and a helicopter later. Twenty years in the SEAL teams taught me the same thing, and I still forget it at home, where asking feels hardest.
The self-care that actually keeps you alive
Somewhere around COVID, self-care turned into candles and scented lotion and a nice coffee. Adjoa enjoys that version too. But the mountain taught her the real one, and it’s not soft at all.
Up there, self-care is the stuff your life literally depends on. Are you sleeping. Are you hydrating. Are you eating enough to keep moving. Are you protecting your hands and feet so you don’t lose them. She learned this the hard way, a cold-weather injury that started as feet slipped off an air mattress onto frozen ground and turned, days later, into weeks on crutches and a neuropathy that six specialists had to puzzle out. Your body sends the early signal. The skill is catching it before it becomes the emergency.
She brings that same attention into the ER. Yesterday, she said, she made herself stop and eat for 10 minutes with a patient waiting, because she was getting dizzy and the last thing that room needed was a second person going down. Will’s version is the one every parent on a plane has heard. Put your own mask on first. It sounds selfish until you understand it’s the only way you stay useful to anyone else.
Who’s showing up now, and the turn worth holding onto
Here’s the part that should get all of our attention. The faces in Adjoa’s ER are changing. It used to be, mostly, people without stable housing. Now she’s seeing middle-class people in their late 30s and 40s, holding a career while raising kids and caring for aging parents, buckling under finances that won’t add up, and some of them arriving after a suicide attempt that would have been rare a few years ago. And she’s seeing young people from stable homes who did everything right, went to school, and still can’t find work after 3 or 4 years, ashamed to be living at home, nowhere near the life they were promised. The stress of the economy is landing on people’s nervous systems, and it’s landing hard.
If that’s near where you or someone you love is, hold onto the turn she offered, because it’s a hopeful one. Psychiatry itself is changing. Adjoa is certified in lifestyle medicine, and she says the field is re-emphasizing the pillars that actually hold a mind up, nutrition, sleep, movement, easing off the risky substances, connection, and stress management. The medications matter and they’re getting better. And so does the daily, unglamorous work of taking care of the machine. You can do a lot of good by doing a little, every day...
What to do about it
Make one small ask this week. Not the big vulnerable one. A small, specific, time-limited one, to the right person. “Can you take this off my plate just for today?” Adjoa’s whole method is that the little ask early prevents the big rescue later. Reply and tell me the ask you’ve been avoiding; I read every one.
Do the self-care that isn’t soft. Sleep, water, food, movement. The mountain version, the stuff your body actually runs on, before the candles. Pick the one you’ve been skipping and treat it like your life depends on it, because over a long enough timeline it does.
Catch your own early signal. Learn the tell your body sends before you crash- the dizziness, the short fuse, the 4 p.m. fog and respond to it then instead of pushing through. Start by knowing your baseline with our free Awareness Self-Assessment; it's just 24 questions, and it's free. Start now —> focusnowtraining.com/focus-score. Paid subscribers, Resource 2 makes this a full practice.
If you or someone you love is in crisis, 988 is there. You can call or text it anytime, and the people answering are trained to triage and point you to help near you. Reaching for it early is the same move as telling your guide your toes are cold. It’s not weakness. It’s survival.
Reply with the name of someone you’re going to actually check on. Not “let me know if you need anything.” A real call. Adjoa’s whole world is people who waited too long and people who got reached in time. Tell me who you’re reaching, and I’ll build a follow-up on how we actually show up for each other.
This week on Men Talking Mindfulness
Dr. Adjoa Smalls-Mantey is an emergency psychiatrist in New York City and a physician-scientist trained at Oxford and Columbia, with a PhD in immunology. She’s a mountaineer who led the first all-Black team to attempt Everest and has climbed Denali, an award-winning author, and a voice shaping national mental health policy through the New York County Psychiatric Society and the new New York Mental Health Foundation. Will and I both took this one, on the ER, the mountain, and why asking for a little help early is the strongest move there is.
Watch on YouTube | Listen here
One more thing before the paywall…
Awareness to Action has been open a couple of months now. Text A2A to 33777 or go to FocusNowTraining.com/A2A-course. It’s built around the lifestyle pillars Adjoa says the whole field is coming back to, the daily awareness and small resets that hold a mind up. On the fence? Reply with the word A2A and I’ll tell you straight whether it’s for you.
Until next time,
Jon Macaskill and Will Schneider
Focus Now Training and Men Talking Mindfulness
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