Saturday, May 8, 2010

Psychosomatic Medicine

The head bone is connected to the toe bone. E=MC2, Energy and matter are related. Physicists describe matter as frozen energy. The spiritual world of unseen forces is connected to the physical world. Not so long ago what we know of today as electricity was the domain of cults and religion. Science is not solely about 'physical' phenomena. We can't see atoms. Spiritual-Soma may one day be the term that supplants 'psycho' in psychosomatic. There is a relationship between vapour, liquid and solid. The universe is in movement. Nothing is fixed. The permanent for lack of better word, has been called God, the impermanent, all else.

Cognitive therapy has demonstrated what hypnosis had already proven that our feelings and behavior are connected to our thoughts. Change the thoughts and the feelings follow. All the great religions and the ancients knew this. It's not rocket science. Just as it's not rocket science that caring for others makes one feel better. L'Arche Movement of Jean Vanier has proven the following but so did Florence Nightingale and Albert Schweitzer.

The difficulty with such change is that people 'resist change'. The adolescent sees the flaws in the world but cannot make their own bed. Same with adults. Jesus said 'take the timber out of your eye before you take the sliver our of your neighbour's eye'. So we feel depressed and anxious and have all manner of negative emotions but the fact is we, not anyone else, hold onto these.

Today surgeons have done variations on the old frowned on lobotomies but the fact remains that neurosurgery can make people happy. The latest in this somatic treatment is the brain pacemakers that work. ECT, electroconvulsive therapy, works too. Yet people usually refuse these therapies and prefer to take medications. Medications are a somatic therapy with equal psychological component. Psychiatric medication is a psychosomatic treatment. The pharmaceutical companies advertise excessively and put as much money into marketing and "hype" as they do into basic science. This marketing direct to the public is coupled with marketing to the prescribers. Medications given and recommended by physicians literally double the success rate of the psychiatric prescriptions.

30% is the golden key to research because it's the 'placebo effect" common denominator. Roughly 30% of illness 'spontaneously remits' so that when a therapy is developed the main question is whether it does better than 'placebo'. In research this is the 'sugar pill' in the blind and double blind studies. The 'halo effect' is the people who get better from illness while in a study taking a 'placebo' (they don't know) but believing they're part of new research and are going to get better.

I hypnotized people and did surgery on them. I hypnotized children and their warts disappeared. I later did hypnotherapy but found that while I could cause an illness to remit under hypnotherapy when I stopped the hypnosis the illness spontaneously returned because the person 'needed' it or wasn't yet 'ready to let go of it.'

Freud was the first to articulate this "resistance to change" and concluded that there were two forces at work, Eros, life wish, and 'thanatos' or death wish. Since studies of 'resistance to change' have come under the heading of "non-compliance' , 'non-adherrence to medical regimen' and most recently 'motivational therapy'.

I was forever changed as a clinician by watching a young man die who had not taken a life saving medication prescribed to him by three doctors and who lied to me about this as his family equally feared telling me the truth about his deteriorating condition. No matter what I did I could not save his life and in the end I was slumped in a hospital hallway crying in impotence and asking God 'why'. Later I talked with an older doctor and an older nurse and we grieved our personal limitations and the limitations of medicine.

I chose psychiatry over immunology while doing research on non compliance to medical regimen. "Why don't people do what is good for them." "Why do people suffer when they don't need to." "Why do people resist change". "Why do people like to complain but don't take action to change."

All these were the questions that psychiatry was addressing before it got dumbed down and the only psychiatrist promoted and rewarded were drug detail men and pseudoneurologists therafter. I've often considered I should have done immunology. Immunology studies the 'host' and 'disease' interface as once psychiatry did.

Addiction Psychiatry, however, was where I ended because it went beyond a 'stronger pill'. The play of personality, psychology, sociology, environment, community and choice as well as spirituality are core to Addiction Psychiatry. The back bone of successful treatment for addiction is the group therapy and community. Medication is adjunctive to this process. Individual psychotherapy and drug counseling is adjunctive to the therapeutic community process. Even the use of methadone replacement therapy is used as an aim to moving a person from their toxic community to a therapeutic community.

Emotions Anonymous is the 12 step organization that encourages the chronically depressed and chronically anxious to see their negative emotions as 'addictions'. This variation on cognitive therapy is not surprisingly hugely successful especially where other treatments have failed.

The old term "mental hygiene" is considered the basis of happiness. I know personally that listening to the news can produce in me depression, disillusionment and cynicism if I don't 'titrate' the dosage. Even an hour a day will produce in me a verbal diarrhea called 'tirades' and 'rants'. Yet if I limit my 'news' intake to small dosages of a reputable source I'm fine. My brain doesn't get 'gas'.

Likewise I see daily in my work that patients are addicted to computer activies, pornography, or television or just plain sloth and negative thinking, or in several cases, lying in bed all day and yet they are immensely angry at me and all others for not 'helping' them and 'blame' me and the 'government' and 'God' for their 'ill health' in the same way as 'alcoholics' blamed everyone for their misery. Yet alcohol is a chemical depressant and taken in a dosage of more than 2 to 3 drinks causes mental and physical illness, mood disorder and heart disease. More and more I have also seen that people who claim that they can't get jobs or haven't money are doing the classic 'yes-but' in that they have so many demands and entitlements and want often to be the big boss without ever working in the basement.

Just recently a friend told me that they wanted the government to pay them more for doing what they were doing but didn't think they should have to be accountable for their actions, ie they didn't want to go to work or demonstrate that what they were doing was beneficial to anyone but themselves. They actually said "people should just trust me." Clearly they wanted money for free but couldn't themselves see the grandiosity in this not uncommon desire. And I told them that when they figured out how to do this let me know as I'd be next in line.

Most days I'm thankful I've trained in psychiatry. It's a hard slog addressing the resistance and confronting the anger. Nothing makes a person hate a physician more than that that physician try to encourage them to do healthy activities. I've had dozens of complaints to the college because I told incredibly powerful angry people that their 'depression' was a product of the 26 ounce a day alcohol habit. There is no 'right' way to tell a person to stop drinking. Most people get ahead by not rocking the boat. Any time you tell a person to stop an addiction in any way you are likely to be loathed. Most physicians, and especially government and administration 'enable' and 'deny' and are indeed part of the problem rather than part of the solution.

Thankfully, "motivation therapy' has provided a scale for 'readiness to change' and frankly encourages doctors to let the sickest remain sick given that they will only try to destroy the caregiver if the doctor does anything more than suggest considering change. However, this 'scale' is itself idealistic because working in many populations even 'suggesting' consideration of change can get a physician's head chewed off and complaints to the college and in fact death threats.

I have many 'hypersensitive' patients with tattoos who when I tell them that beating their wives is probably related to their poor sex life, which they think I should fix by telling the old lady to put out more, leads to them literally threatening me with their fists when I suggest the connection between the physical violence and verbal threats and poor sex life. I've become a very ginger and fast moving therapist and often make my best suggestions with a lot of running room.

Not only that I've discussed and trained in length in how to do it and know those who are 'holier than thou' in these regards haven't even stepped into the kitchen. The frontlines make people humble.

Canada's foremost forensic pscyhiatrist a brilliant experienced gentleman of the first order is alive today only because his secretary investigated an unusual noise and found his patient strangling him to death. Beaurocrats have all the answers though and tell everyone how to do their job from the safety and certainty of their desks. Some of them are so burnt out and so out of touch with reality that they're literally dead but no one has told them so for fear they'll poltergeist.

I've admired my colleagues who have ignored the wife battering, alcoholism and sexual abuse of children and all manner of things and said, "take this pill and everything will be better". Naturally I've thought these colleagues either psychotic or clever sociopaths but they've been promoted and now are teaching courses on 'boundaries' saying that psychiatrists shouldn't ask about sex or violence in the home but focus on the medication and limit questions to the side effects of the medication.

I practice psychopharmacology but I did take an oath to 'do no harm'. Ignoring work place bullying, discrimination, child hood abuse, and all manner of things and just giving a pill as if the problem of life is to be solved by a 'magic potion' makes the psychiatrist little better than the street drug pusher who claims that heroin is the answer to life. Psychiatrists are first physicians and just because 'cherry picking' and "putting on blinkers' is highly lucrative and rewarded by colleges and universities, doesn't make it right or even good medicine.

I watch my colleagues in a methadone clinic doing the most basic 'drug therapy' yet always encouraging sobriety, work, asking about relationships and literally doing daily 'unpaid' and much 'maligned' psychotherapy. They're really good and yet they're only paid for the 'prescription' but are 'faulted' if they don't do everything. Doctors today are punished for everything but only rewarded for the least. Psychiatric medications work but they work best if they're prescribed in context wisely and humanly by good physicians. The present pharmaceutical stats only reward the doctors with the most sales and don't really concern themselves with any other measures of well being.

Every time I've exposed the pedophiles , male and female, I've found that there were dozens of professionals who knew but turned a 'blind eye' to the problem. The whole political legal system today hangs on the evil of 'deniability'. Everyone knows of the drunken drivers which judges, who aren't held accountable, have in the past allowed to drive over and over again until they have a child show up on their car grill. Suddenly it's a 'surprise' and a terrible thing and eventually today after countless deaths we have the amazing advance called 'drug court'. I can only assume that there were judges like myself who grew weary of their colleagues and the system that supported lethal drivers.

The history of the tobacco industry with the cooperation of the Ministry of Health and Attorney General's office and all the doctors who at one time said things like 'smoking is good for your health" and 'smoking will make your delivery easier because smokers have smaller babies' should not be quickly forgotten because the same thing goes on today but only in a different arena. Just consider those promoting 'smoking' marijuania while firemen are en mass getting compensation as any smoke is unhealthy. There are no easy answers and I've found the political doctors who are rich and powerful have a habit of saying 'you have to crack a few eggs to make an omelette'.

The fact remains that doing the right thing will be resisted and persecuted because of systemic factors not disimiliar to the very issues at the 'microcosm" of "host and disease". A study of the waste and horror of the 'cold war' and later the 'war on drugs' will enlighten anyone to the insaneity that can rage like hysteria outside the limits of the cranium.

When I specialized in suicide as the most obvious 'resistance' and 'non compliance' issue in psychiatry, I had no 'suicides' on my hospital watch and reduced attempts by two thirds. This would result in medical awards and academic chairs in any other area of medicine. However I achieved this "therapeutic breakthrough" by denying cigarettes to suicidal patients telling them they could only slowly kill themselves if they convinced me they wanted to live in the immediate future. This resulted in suicidal patients desperate for a cigarette devoting their minds to writing reasons to live and telling me all the reasons for living and frankly convincing themselves that living with cigarettes beat dying without cigarettes. Naturally I was told I was cruel and inhumane and soundly abused for stopping these highly suicidal patients from killing themselves.

The highest offices of medicine, the appointees, have declared that only 'politically correct' medicine is allowed and sadly more and more people will die because these people are themselves not accountable. Such ideologues who live furthest from the front lines are usually recognizable by their pompousness.

I found that increasingly 'society' and especially the 'legal' system wasn't interested in 'outcome' but solely "rights' and "appearances" and "technicalities". Increasingly just as obstetricians could make the best money by doing abortions so today the highest paid and most promoted doctors are those now lobbying for euthanasia. The doctors who recommended marijuania when it was illegal were similiarly eulogized while doctors such as myself who encouraged people to stop marijuania as it caused lung disease, poor school performance as well as emotional disorders continue to be vilified.

Today I think the answers to these bigger questions are more often spiritual. I still chop wood and draw water but mostly we know the answers and have the solutions. We don't want to be responsible and we want license more than freedom. The research in psychosomatic medicine is still exciting. However so much of what I learned and was proven 25 years ago I've not been able to practice because it's 'politically incorrect'.

I watched the debate about 'food dispenser' in schools which were little better than 'cigarette dispensers' giving candy, salt and toxins when parents wanted these illness disposing devices banned or improved. There was no shortage of knowledge. Yet it took years for change. If ex President Bush had been involved as a school trustee he would have explained the reason as the forces of the Axis of Evil. I really would have loved to see him organze divisions of good elementary students armed with pea shooters and water guns to storm the lowest of school dispenser potato chip factories. The weapons of mass destruction aren't in Iraq but in the 'fast food' industry. Americans who didn't succomb to McCarthy's communist conspiracies have finally succumbed to obesity. Too late American generals find that they simply can't get the obese Americans to rally to the flag or answer the call of the nation because it takes too much effort to get off the couch.

Yet today I'm as equally delighted to see the salads in MacDonalds and love the new angus burgers. Just when I feel there's no cause for hope I look up and see that everywhere change is occurring and frankly it's amazing. Really. Psychiatry is still exciting. Especially Addiction Psychiatry and Psychomatic Medicine.

The sun is shining today. I'm at the Pemberton Valley Lodge enjoying the utter luxury of a place that sits on the edge of the most amazing wilderness. A lodge with swimming pool and hot tub and Starbuck latte was not to be found north of Whistler. When I came here 25 years ago the only accommodation was a hotel room above a rock and roll band and drunken barroom . I'm an hour and half from Vancouver.

I'm almost an old man (I am but people try to convince me I'm still young – the life expectance of doctors was less than my age when I began in country practice) and my generation didn't think we'd live past 30. Some of us actually thought people over 30 should be killed or at very least locked up to 'save the planet'.

I'm alive today and that is a miracle. It's time to put psychosomatic medicine into effect. So I'm off to exercise, enjoy good food, share good company and have a little recreation that makes work so enjoyable. I feel sorry for people without work because only with work does 'leisure' become 'leisure'. I'm thankful for work if only it makes the weekend so pleasurable. My puppy makes me really appreciate quiet. The person who invented 'squeaky toys' for dogs must have had a death wish.

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