Emotional Problem Solving

I always wondered why my parents talked about the weather so much but now I know.  Grandad was a rancher and dad was an engineer.  Grandmother was a farm woman and mom was a journalist home maker.  They had a whole lot of experience between them.  They paid attention to the world around them and people.  They drew on this  vast wealth of ‘traditional’ and ‘conventional wisdom’ .

When something wasn’t right with them they first considered the WEATHER.  They didn’t think that they should kill themselves, divorce or change their jobs.  They just knew that commonly people are affected by the Weather.  It’s even been shown that on Wall Street trading increases on sunny days and decreases on rainy days.  It’s really not rocket science.
Next thing the old people talked about was the GOVERNMENT. Whenever anyone felt badly and were uncertain of the cause they considered the influence of Government on the overall well being of people.  Government decisions can make or break a country and can destroy individuals lives with their wars, tax programs, corruption, graft and deceit.  Throughout history next to the natural catastrophes caused by Weather, Government is the greatest source of catastrophe and illness.  That said we all know that if the Government is good and respectable and responsible there really can be peace and love in the valley.  When Governments are mature and thoughtful and productive not wasteful the society as a whole improves with general well being spreading through the land.
Old people also realized that FINANCES were a major source of anxiety and depression.  Not only research but common sense tell us that the poorer one is the more one is at risk for negative events and the more negative events one encounters.  This was truer before the social ‘net’ of modern societies which ‘catch’ people when they fall.  There’s loans, disability, welfare, food lines and charity, all manner of resources that protect one from the ravages of starvation and ‘debtors prisons’.  In some Moslem countries slavery still persists so it’s really not in some distant past that financial problems lead to really bad outcomes.  We really take this granted often simply because our education has been basically shoddy and substandard.
Naturally most of these social security developments in the First world are not present in the Third World. Their development also did not occur in a variety of cultures and historical societies but are increasingly taken for granted in the present day democratic societies most of which began in the enlightened Christian cultures which believed in ‘second chances’.  By contrast this was not a part of the ‘law of the jungle’ or ‘social darwinism’.  It’s a whole separate history to follow the rise of ‘charity’ for ‘strangers’ not just family and tribe but ‘outsiders’ and consider this by culture and religion because again it’s something most simply take for granted not realizing how unique and extraordinary this is.
That said there’s a serious issue of ‘relative wealth’ in that people adapt to certain ‘incomes’ and ‘financial capacities’ and experience loss of ‘status’ with any reduction in FINANCIAL SECURITY.  So old people had savings and made sound investments and recognized that ‘bad times’ could come. Farmers had to save for bad weather years, the droughts, and families ‘saved’ for sickness as sickness was commonly associate with loss of work capacity.  When a person felt badly they commonly recognized that they were fundamentally anxious because of FINANCES and set about remedying this by reducing unnecessary spending and looking for ‘extra work’ to increase savings and security.
HEALTH is commonly discussed by middle aged and older people. Young people are generally healthy unless they have chronic illness from childhood. Most take their ‘good health’ and lots of energy and ability to go without sleep or meals for granted yet as they get older commonly they don’t realize that their well being is directly related to their overall physical HEALTH.  When a person sees a psychiatrist the first thing the psychiatrist considers in investigating a person’s anxiety or depression is whether there is a physical cause for negative change, how long that negative change has been developing and if this might not just be a product of a temporary illness, like a flu or ‘something that’s going around’.  Old people with a variety of chronic illness, arthritis, diabetes, heart disease, bowel diseases, lung diseases will simply consider that a bad day or week or month may be because their physical illness is worse. Chronic physical illness, like all psychosomatic illness responds to external stresses but can be it’s own source of stress.  When I’m well a hemorrhoid might not bother me but when I’m already anxious or depressed the bleeding hemorrhoid, a really minor health problem, may be the straw that breaks the camel’s back. It’s because of this that people faced with general malaise, anxiety or depression, or just a lack of well being and a sense they’re not happy as they might be, commonly go to their general practitioner and discuss their health concerns with them or talk about their HEALTH with their friends and family.  Maybe an antibiotics which cures a urinary tract infection is all that is necessary to right the problem. Maybe a change in diet or exercise or an increase in an anti inflammatory medications is sufficient.
Successful people faced with lack of happiness, a sense of feeling that they are not enjoying life, feelings of emptiness, or too much anxiety and maybe a sense of depression consider early their RECREATIONS.  All work and no play makes Jack a dull boy. The World Health Organization took Freud’s simple definition of Mental Health, ‘the ability to work and love’ and extended it over two full pages but really only added that Mental Health is the ‘ability to work, love and play”.  A lot of people have really barren personal lives yet somehow expect they should be happy. The adage is ‘Misery Loves Company’ and as we are ‘herd animals’ we need social outlets. Maybe our work is not that social or our family just not enough. A major proportion of todays’ divorces occur because young people want their partners to be their ‘all’, (friend, parent, therapist, lover, cook, parent, cheerleader, etc ,etc).  We all come from a tribal society where everyone was interconnected and all had close to dozens, a hundred or more people to turn to.  Today often people’s lives are sterile.  They work and eat and sleep and wonder why they suffer anxiety or depression.  Really , they need to get involved, take up some ‘sport’ even if it’s just, walking with a group.  There are countless clubs, activities, ‘MEET UPS’ on the Internet, and community organizations, and schools, churches and temples.  Really, commonly a person’s life is ‘boring’ because they are ‘boring’ and don’t have any activities in their life because of their narcissism and selfishness and unwillingness to ‘SHARE THEIR TIME”.  These people are time hoarders but like most entitleed people want something for nothing.  Yet a problem shared is a problem halved and loneliness in modern society is so often described as ‘anxiety’ or ‘depression’.
FRIENDS are either as source of joy or a drain. Some are down right ‘soul suckers’ and others are chronic ‘kafetches’.  Many are ‘takers’ and ultimately one has to seriously consider how much time one has to be an emotional cheer leader of those who haven’t a minor or occasional problem but have a chronic recurrent unrellenting series of crisis.  In life saving the lifeguard is taught to swim out to help but not let the drowning person pull them down with them.  Whole communities are alcoholic or drug addicted and frankly some people need to get right out of these hell holes to get away from those who would drag themdown.  In Canada and in communist countries in general there is a phenomena called the ‘tall poppy’ syndrome which means that the ‘group’  because of some ideology actively stop those around them progressing.  They chop down the ‘tall poppy’ or ‘chop off the heads of others to make themselves look taller’.  In some tribal communities those who are doing well will have their homes broken into and wealth stolen or even have their house burnt down.  Many communities of ‘friends’ are gang like where the expectations of the ‘group ‘ is for the ‘individual’ who succeeds to ‘share ‘ his success yet this ideology destroys initiative.  Why should one person ‘work’ at an extra job and then share the reward with those who didn’t put out the effort.  A lot of individual lack of success is associated with ‘friends’ who are negative and ‘belittling’.  Being around people who say ‘nothing is going to change’, ‘life suck’s’ and various other ‘depressive statements’ is Depressing.  By contrast those who succeed and are happy commonly are surrounded by positive people. People who are enlightened are generally encouraging and supportive of those who wish to learn and excel but shy away from those who live by stealing and fawning relationships.  It’s often that we don’t have to  ‘end’ a relationship but rathe that we need to ‘distance’ ourselves or ‘spend less time’ with people who are ‘wallowing’ in their negativity
WORK is often a source of anxiety and depression but few throughout history had the LUXURY of NOT WORKING or even CHANGING THEIR JOBS.  So many accepting that work is principally to pay for the physiological needs, and provide fundamental food, clothing, and shelter simply accept their work.  They stay in less than perfect jobs because they see that those who jump around from job to job commonly ‘take their own selves ‘ with them.  PERSONALITY DISORDERS are primarily identified by the inability of an individual to stay at one job for a year. A red flag goes up with those who are workers when a person can’t last a year in the ‘class’.  Our school system was supposed to provide this basic capacity.  4 seasons, one job.  Admittedly there’s many factors to be considered but there is a direct correlation of “success’ and ‘happiness’ and ‘general well being’ for those who ‘stay’ at a position. There’s even a thing called ‘position authority’ which gives status to even a bull frog in one pond that stays rather than jumping from pond to pond.  Work is not only associated with activity which by itself is healthy but its a place of socialization which is also healthy. Buddhists even designate ‘RIGHT LIVELIHOOD” as essential to enlightenment recognizing that a lot of jobs intrinsically are depressing, risky, unhealthy or simply dehumanizing.  Prostitutes collectively are unhappy even though many ‘chose’ the job for quick wealth  It just doesn’t have the long term benefits that teaching children has.  Survey a hundred prostitutes and a hundred school teachers and the evidence is overwhelming that prostitution isn’t a very ‘high quality’ job.  The whole job world is laid out in terms of education, financial reward, risk, and effort.  Entrance level jobs have the real advantage they need low education but they commonly lack security and rarely have long term financial reward.  One has to seriously consider their work in light of what they want and what their present and future desires and needs are. All too often people have been satisfied with a particular job and had a whole lot of short term benefits from that job only to find that one day the job didn’t have longevity. This occurs with athletes and commonly with dancers.  If one doesn’t have a fall back plan or a plan to progress then it’s not uncommon for crisis to arise which could well have been foreseen and prepared for.  In today’s world it is expect that people will have three careers minimum in a lifetime and those who are “coasting’ will likely encounter job problems. While the ‘coasters’ are blaming everyone and everything for their loss of work, the rest have been upgrading their skills and taking extra training at night anticipating that their job as a ‘steam engineer’ is less than permanent.
FAMILY is a fixed ingredient. Those who are fortunate are born in loving families and learn the ART OF LOVING (see Erickson) and know that LOVE Is not something that just “HAPPENS” but needs to be nurtured and maintained.  Successful happy families pass on the SKILLS for happiness to their children and commonly this learning leads to generations of success whereas the poor believe the success is only a product of the individuals in this segment of society starting with a ‘financial nest egg’.  If this were true then those who won LOTTERIES would be similar examples of personal and societal success.   However,  commonly those who ‘win lotteries’ lose them just as quickly.  One of the reasons AID works so poorly is that it doesn’t ‘teach’ people how to produce more successfully but only cares for their needs that one day. Often what a family teaches is the cornerstone to the success of the members whereas equally so a family can be perpetrating ‘self defeating’ ideologies.  It is important to remember if we had sent Einstein to a tribe of Cannibals they would have thought him a tough rooster at best and learned nothing about energy and relativity because they were simply not capable of appreciating the genius of the man.
 Therapy was not about ‘rejecting family’ or dishing parents but about sorting out the useful teaching from the commonly once useful but now outdated ideas.  A mother might teach her daughter to avoid black men because when she grew up black men were migrant and poor but today that very statement might be a limiting ideology if the majority of black men in the community were hard working successful individuals.  If a person is a live today it’s thanks to the parents simply not killing them when they were vulnerable.  Since life if fundamental and without it all else is nothing all parents are 50% good.  Fish eat their eggs and reptiles leave them to fend for themselves.  Therapy isn’t supposed to be about ‘blaming’ but rather about understanding and learning from the past to make the present and future better.  Therefore each individual must recognize the contribution of history and not dish it outright.  Further today people commonly judge the past by the yardstick of their own limited understanding.  Dickens said, “it was the best of times and worst of times’ and this is true for all times. The trick is to be selective, learn from and make valuable alliances. Family are the main stay of society and the STATE is threatened most by family. Alone individuals are likely to perish but the capacity to form networks and communities is central to the happiness of individuals. This begins with the family.  When I worked with the most mentally ill they commonly had the worst family relationships and least social skills.  If the family can be strengthened most commonly success for individuals follows.
The LOVED ONE, the PARTNER, the most intimate sexual partner has through all cultures and classes been associated with the greatest joy and happiness at some time.    Many a person has said that their life is made by the finding and nurturing of their soulmate.  This is the person they marry. This is the person we have sex with. Sexual relationships are limited to those who we are willing to be most intimate with, most vulnerable with, closest too.  A ‘casual relationship’ is never truly casual but marriages and long term sexual relationships define emotional landscapes for all.  The Loved One is the most important person in a person’s network of relationships. That person is commonly the father or mother of the children, the most important person in the family, and the one who can most affect a person’s emotional life positively or negatively.
IF mental health is the ability to love, work and play, then it follows that a person without work or school, without a Loved One or Family or Friends would at most register ’30’% generally on a happiness scale. Those who lack that most important cherry on the happiness cake , the loved and loving one, at best might only approach a “B” grade  in the overall likelihood of general well being. There are clearly exceptions, saints, heroes, hermits but generally speaking our sense of well being follows from this simple analysis.
Now the must successful and mature people do not ‘change’ their ‘loved one’ or their ‘job’ first but progress through an analysis of what is lacking in their lives by starting at the outside.  Maybe it’s just a bad hair lousy weather day and that one could consider buying and umbrella or taking a vacation to the hot spot or improving the use of sunscreen.  There’s a whole lot of solutions to the ‘weather’ problems. I took up cross country skiing when the ‘weather’ was forcing me to curtail outside activities and I felt a prisoner in the winter city.  My general well being improved immensely. My friend has made a point of cycling and winter swimming at Wreck beach at least twice a week ‘getting outside’ and ‘facing the elements’ and their sense of well being and decrease in anxiety is amazing to see.
Recently a whole group of people rioted because they didn’t like the government but studies showed that 70% hadn’t voted.  Most of these government activist complainer types commonly don’t even join a political party.  A friend is a professor of political sciences and I watched her acquire her wisdom and generally amazing calmness around matters political by gaining in depth knowledge about the mechanisms of government, anthropology, sociology and the misinformation of media and propaganda.  When she was a student government most upset her but today she’s probably the least ‘upset’ person I know in this regard because she is actively participating in government, making things better for herself and other individuals.
Countless times I’ve seen people’s general malaise and depression a product of something so simple medically as hypothyroidism.  Depression and anxiety are commonly the presenting symptoms of countless treatable illnesses. Increasingly most depression and anxiety I see has it’s roots in addictions, substance abuse, alcoholism, pornography, eating disorders.
Work problems arise in every job and in every life but rather the ‘take this job and shove it’ over the years mature individuals have formed unions, discussed the negatives of their job with co workers, counsellors and even the boss.  These minor changes in a person’s life can reap amazing results in solving emotional problems
Obviously spending less time with a ‘soul sucker’ , that constantly ‘needy’ , person always bitter and always complaining, will lead to less stress and more room for positive relationships.  Maintaining contact with family but modulating the time and distance of the relationships is a sure fire way of improving one’s happiness simply because these are the template of all relationships that follow and the source of so much joy for those whose lives are most successful.
Finally the most mentally ill commonly admit to having their longest intimate relationship as under a year, under five years, or under 10 years.  Relationships are like vehicles and if you keep crashing or trading in your primary vehicle for relational happiness then you really would benefit from seeing a psychiatrist not to discuss what the partner is doing wrong but to learn what others do right and what you are doing wrong.  The Gottman Institute “love labs’ studies successful happy couples and unhappy couples and scientifically came up with a set of rules that are simply not rocket science but really do give a decent basis for  setting up or repairing broken relationships before they get trashed by this ‘throwaway unhappy society’
The main reason I wrote this though was to simply encourage people to consider problem solving from the weather inward to work and loved one rather than dumping the job and life partner only to find it El Nino was all that was wrong and if you’d waited a year the weather would have improved and you could have saved the cost and pain of trashing work and love.
Finally spirituality is associated with the greatest happiness and joy for most people.  Research shows that spiritual people are overall happier and more prosperous with greater security and success. This doesn’t mean any one religion or any one moral prescription is right but it does tend to challenge atheist political idealogies that reject the spiritual community lives of the most successful individuals in society.  Perhaps when all else fails or earlier ,one might consider, as Victor Frankl, the psychiatrist who survived Auswitch, encouraged, asking yourself "what is the meaning of life”.  What is your relationship to God   Or  perhaps change the word, God, to  the GOOD.  What is the Good to you or what is the GOOD LIFE.  Often emotional problems solving follows ‘reframing’ the question'.
In the end it’s your life.  Enjoy.

Leading Motion

I had my first session with Derek Baker of Leading Motion fitness.  He had ideas of having me roll around on the offfice. He had fitness gear and was really keen to see me accomplish my goal of pushing back the fat.
 I've been sliding. Sloth and gluttony have taken their toll this winter.  I've used the excuse of  my injuries to take my self pity weekly to my favourite East Vancouver Bakery.
Then my staff have been very good at walking Gilbert, my cockapoo, who despite his best efforts has had limitted effect on my tendency to return home, lie on the couch, and watch tv rather than going for walks with him in the dark and rain of winter.
Derek has worked in physiotherapy for years and has motivational training and personal trainer credentialing.  He came highly recommended.
My first day was amazing if only for his walking Gilbert and I all over the hills of the nearby Coal Harbour coast at a clip faster than Gilbert and I might go.  He monitored my heart rate, complemented me on my 'power' but said my 'cardio' was a little slack.  For a slackard I wasn't surprised. 
At the end of the hour because of the advice he gave me I was pain free, limber, my back and armpits soaked in sweat and generally thinking and feeling brighter. I realized I'd not 'worked up a sweat' except out hunting in the fall a bit, because post injury I'd been timid about putting out the effort and rather than working through the initial joint soreneess had been coddling myself. 
With Derek's help I saw this and have set a higher level of exercise potential.  I realized too that I'd used to climb the stairs at the office but haven't in months.
So much of the process was psychological and the 'buddy system' at this level was worth its weight in gold for my learning and insight despite all my medical and athletic training. I couldn't see what I was doing myself and was thankful for Derek's kind observations and gentle direction. 
I"m actually looking forward to future sessions and have renewed hope that before long I'll be at least back to the pant size I was in November, and hopefully another couple of inches more and I'll be able to wear those almost unused new pants I got in a moment of radical optimism a year or two back. 
This all can only help my heart and joints so fashion aside I'm very thankful for the investment I've made in health and wellness.  I'm actually taking the advice I so often give and really it's fun and enjoyable.
 

Cannibis Addicted Fetus

"It's so sad to hear their wee high pitches cries," when they're born addicted to marijuana, he told me.  They're shaking and go into withdrawal.  He was a pediatrician at a conference I was attending.  We knew smoking was harmful to the fetus. Nicotine is a teratogen but now it was evident that marijuana was causing fetal distress.
Child abuse by drug addiction is a concern with 12 to 24% of mothers using drugs and alcohol in pregnancy.  With marijuana though the 'withdrawal phase' post delivery is particularly unnerving. The babies shake just like opiate withdrawing infants, an obstetrician described.
I am on a plane right now and hope when I've time to investigate this more.  The difficulty I recently had with searching information regarding the increasing dangers to physical and mental health associated with marijuana use was that a very poor small number unsupported outdated research on marijuana was dominating the servers. Clearly there are reputable studies documenting the dangers and risks which are well known to us in the medical community who observe the problems and show more caution than the mercantile business and political interests.  The spam in favour of marijuana simply swamps the google servers so that I am forced to use medical and university sites to find research that is not of the most spurious kind.  Given the influx of pharmaceutical marijuania too there is less interest in the industry which has hopped on board big money marijuana.
http://emedicine.medscape.com/article/978492-overview
 

Lying and Health

Research by Anita Kelly of University of Notre Dame showed that the more people lied the more unhealthy they were. She did her study by coupling lie detection with a lie detector to periodic health surveys.
Linda Stroll strudied trust and health find that those who were least trustworthy had more stress due to increased conflict in their lives.
Outwardly sociopaths and psychopaths appear at least for awhile to have success but all the while their 'insides' are 'putrifying.  It was apparent that the relationships of liars lacked substance and depth. Possibly Fathers who lied couldn't 'love' their children with depth or their families as such  because lying is associated with an unhealthy environment.  Mothers who lie are prone to excessive conflict as well.
http://www.suntimes.com/news/metro/14285134-418/avoiding-lies-can-help-your-health-study-finds.html

Psychosomatic Medicine

Pscyhosomatic medicine doesn't mean "it's all in my head".  It means rather that the 'head bone is connected to the toe bone'.  Without your head you'd not experience any medical condition. The fact is that all medicine and surgery is 'psychosomatic'.  By convention and the dualism of Greek philosophy and later Descartes people began to think of their 'body' as somehow disconnected from their mind.  Modern "mind-body" medicine tries to overcome this limitation. My hand is truly separate and different from my arm but they share a common nervous system, circulation and lymphatic system. Indeed the more advanced the medicine the more recognition of the interconnectedness of the parts.
I started my career with a surgical internship. I wanted to be an orthopod, to tell the truth.  I got waylaid by family practice in the country and northern medicine. It was in the thick of clinical work I saw the importance of depression, psychosis, drugs and alcohol, attitudes and beliefs to health.  I decided to study psychiatry with the purpose of advancing my understanding of bodily illness in many ways.  I learned a tremendous amount in psychiatry about disease in general and mental health in particular.  At times though the psychiatrists themselves were all too much in their heads.  Just as family practice was revolutionalizing to a greater awareness and understanding of community, family and the individual as those contriubted to physical health psychiatry was fleeing from embracing the whole realm of psychosomatic illness and instaed focusing on 'brain disease as if the brain was somehow floating disconnected from the body.
The Ericksonian Foundation based on the pioneer work of American psychiatrist , Dr. MIlton Erickson along with the Palo Alto School and other key centres of research was a place where I found a home a way from home. At the huge medical and psychological conferences of the Ericksonian Foundation in Phoenix I met others interested in the efrects of faith on healing, how exercise promoted health, nutrition and it's influence on mental health, and all manner of psychosomatic ideas far too advanced to be embraced by the increasingly rigid orthodoxy of psychiatry. I followed cardiologist  Herbert Benson, and Internist Bernie Segal's work with rapt attention. Later I'd love the medical magazine, Psychosomatic Medicine.
I would too often attend a psychiatric confrence and hear more about treating the 'brain disease' without consideration of the human holding the brain and how their mind was altered by disease, their relationships and their community.  Always I thought in 'systems' and interactions but I'd be frustrated by those around me who seemed to think that equations could only flow in one direction as if they had not studied biochemistry as I had.  I found the ecologists and community medicine doctors and more and the addiction medicine docotors were thinking in the broadests sense while not missing the details.
It's not surprising that I've ended up in addiction and trauma psychiatry with an interest in consultation liason neuropsychiatry.  Every organ in the body is affected by alcohol and drug abuse.  Alcohol increases throat and bladder cancer, diabetes, heart disease, depression and community violence as well as poverty.  Drug abuse such as crack causes micro infarcts, causes MRI changes in the frontal lobes, afffects immune systems, marijuania causes early psychosis which can persist as lifelong schizophrenia, as well as causing lung disease and asthma from the smoke inhallation. Heroin is as much a community problem as an individual problem. The opening of a methadone clinic in a community can reduce theft there by 25% or more saving the inhabitants of the community millions of dollars a year.  Yet addiction is a mental illness as well as a physical illness and a matter of public and community health.  I'm delighted to be among colleagues who while working for a 'brain' disease 'cure' don't seem to think in rigid isolation but rather see the issues in the microcosm and the macrocosm.
In consulataion liason and neuropsychiatry the wide ranging effects of head injury or crohn's disease, diabetes, cancer, or multiple sclerosis are not limited to the cellular damage or the initial injury. A head injury commonly becomes a life long disability no different than loss of a finger or limb while often concurrent mental illness affects how a person will recover from surgery.
Psychosomatics is medicine and it's surgery.  The idea that the body exists in isolation is long gone.  People with depression develop physical illness more readily just as the Rahe Holmes studies showed the significance of stress on body illness. Similarly people with bodily illness are more prone to develop mental illness. Patients with chronic pain from arthritis commonly develop depression.  The use of prednisone, a life saving medication, is commonly associated with psychosis and mood disorder.  People with infections commonly develop panic and anxiety.
All teaching hospitals have a consulting psychiatrist as part of the team of physical doctors who work in hospitals, medical and surgical, wards, because psychiatric issues arise so commonly among patients with physical illness. I was the consulting psychiatrist to a hospital and commonly called out every night on call to deal with delirium, dementia, grief and violence.  I enjoyed one old codger who was going into DT's the night before his surgery and my psychiatric intervention was to make sure he had enough alcohol through the night to stop him from seizuring.  The surgeon and anesthetist were very thankful to have a psychiatrist on board.
I'm a medical doctor first, psychiatrist second.  I also had two years of residency in community medicine and public health so I not only see my patient's brain connected to his body but I also see my patient connected to his family and community. Increasingly in my work with addiction and with patients who have been in and out of jail I see that the 'system' is the old fashioned jailhouse punishment mentality that exists outside the shining light of the 'drug court'.  Yet few of my patients are fortunate enough and rarely early enough to take advantage of that breakthrough in the all too often dinosaur thinking of the criminal system.
Just last week I met with a group from the courts who were shining lights but I could see that they had had years of the frustration I'd had working with the entrenched stupidity of people trying to fight today's wars with yesterday's ideas.
I was delighted to work with a judge in Saipan who saw so clearly the need for the New York solution for chronically violent mentally ill to be discharged to the community only on condition of being on long term injectable antipsychotics. Like the drug court which uses urine testing for drugs as a conditon of freedom these 'systems' are working now with psychiatrists who are trained as much in psychosomatics as community to achieve what is best for the patients and society. Often an ethicist and leaders of the patients failth community are brought together to ensure that an individual decision doesn't lead to an abuse of human rights in general.
At times I miss the idea that "Mr. Jones is the 'kidney' in hospital bed 3" or Mrs. Smith is the 'mental case' in hospital bed #4.:  It's always easier to think like administrators and reduce people to nazi numbers but the fact is I like people as people with all their diemensions. Increasingly too it's the spiritual dimension that moves me. That said I'm thankful for enlightened administrators who with great humanity can actually move the ship of state away from the rocks in a storm.
People are not only connected to community but it's been said 'anxiety is a measure of your distance from God".  I don't think of God as the Santa Clause tyrant on the cloud. I rather like Bishop Spong's debunking of the Christian God and the Jesus Convention work on the History of the Bible.  God in a 'spiritual' sense is about all those imponderables.  What do I believe is my 'purpose'. What are my thoughts about the meaning of life. It's not that there's an answer to these questions in general but how I answer them specifically is critical.
Just last week I met a depressed woman who said she thought the world was going to end so there was no reason for her to even think of marriage and children. Yet that's what she had wanted till she'd embraced that pseudoscience of nihilism.  Her noncompliance with medical regimen, refusal to care for herself and refusal to take medications for her illness was tied to the central questions of her life.  I think that's where the 'spiritual' lies.  It's all those questions and sometimes arbitrary working answers that get us through the night. It's not that 'prayer' is right or wrong but it can work quite amazingly. just as confession, asking for help, meditating, doing yoga, chanting, singing hymns, going to a concert, dancing can all contribute to health. It's the wholistic that's God or the Good in life.
I once wrote I didn't want someone to give me a bag of whole grain riice when I needed admission to an intensive care unit but I knew then that eating whole grain rice, as just one example, could help me avoid admission to an ICU. The more we learn about chronic illness the more we learn that they are psychosomatic illness of lifestyle. It's time to embrace the idea that the head bone is connected to the toe bone just as the toe bone is connected to the headbone as we live in relationship with all around us.

I have survived waking up another day

I have survived waking up another day,
The old car with a hard start on a cold winter morning,
The ache and pain of lost youth,
The coughing sputter of engine refusing to turn over,
Choking, gasping, sucking air
Praying, begging, rolling over,
Fighting through the worrying dog and cat,
One wanting food, the other needing to pee,
Toilet pit stop bringing certain relief,
Dressing a chore, especially the shoes,
The overcoat barely breaks the chill wind,
But the dog's ecstacy uplifts.
And walking,
The old car gathers steam,
Takes the corner like a pro,
Follows the lead dog,
Leaning into the wind,
Making the coming home turn,
The dog having done his business discreetly,
Saving me the effort of bending and picking up,
My engine veritably roars in the home stretch,
Imagining the smell the brewing coffee.
After a shower, dressed in work clothes
I'll look like something new and fresh,
No one would believe I barely survived this morning.
How easy it would have been to roll over and gone back to sleep
Hiding in that other world, uninterrupted
Except for the occasional nightmare, these days.
The cat now eats her breakfast
And the dog is looking relieved.

Chinatown Xray and Ultrasound, 180 Keefer Street, Vancouver,BC

I've been sending patients to the Chinatown Xray and Ultrasound on the second floor of the Chinatown Mall on Keefer Street for over a year now. The results have always been excellent and patients have always appreciated the services. There's a lab at the same location.
When I went to my doctor in North Vancouver, unable to convince myself that my post accident pain and suffering was wholly psychosomatic and due to insufficient breast feeding as a child, he actually recommended Chinatown Ultrasound. "I often have to wait weeks more at other locations whereas they often have the best service."
As a doctor I should be immortal and indeed even now am seeking out the kryptonite that has no doubt has been placed somewhere in my proximity. I really am the worst patient I know. Lots of isolation and solo whimpering. Nonetheless limping and sore I staggered over to have the x-rays and ultrasounds. The service was superb. Delightfully pleasant and upbeat staff.
The laughing xray lady must have been a chiropractor in his last incarnation as she forced my neck into all manner of contortions that confirmed that it couldn't possibly be broken and indeed it felt better after she ordered it to 'assume the position'. The ultrasound lady had just finished with a pregnant girl who came out with radiant smile and the 'glow'. I hobbled in and was treated kindly and professionally. The ultrasound specialist was even called in because I had calcification in the tendons of the knee and the technician wanted him to take a peek. He asked me a number of clinical questions and insisted psychotherapy was not the solution for such a traumatized knee. "Looks like it's actually trying to heal itself, though. Might have been a hematoma or some fibers that tore at the insertion." He was really a caring and nice man. I was impressed that he didn't recommend amputation but would never have let on that I thought it was anything 'serious'.
It was reassuring that there wasn't a microscopic alien invasion. Indeed I walked out reassured and felt well cared for. They're 'diagnosticians' but therapeutically I was very impressed. Something about the attitudes and tempo of the place. Lots of healing fen shui probably.
I went down stairs and had some Chinese fish and chow mien in the market buffet, After that I saw the barbershop and got a haircut. "You look a whole lot better, " Al the barber said. I don't think he was just praising his own work. I really did look scruffy and after his ministrations I looked 'cleaned up'. If I'm going to live I might as well look better, I thought.
I actually saw some patients and didn't snap at them. I actually swapped tales of braking as cars came at me when I didn't need to brake and imagining myself going over cliffs when I was driving just normally. She'd had an accident a year ago and despite driving is still traffic shy at times involuntarily drawing back when she sees a big car coming at her.
What amazes me is that I actually feel better having sought help from a family physician, done what he recommended, went to Chinatown Ultrasound and Xray, and actually found out that I'm not going to die yet. Normally I'd just review my will, moan a lot alone, talk to the mirror and tell myself it's all in my head, and say that I deserve this because of my sins and know God is punishing me. I'd suck on my suffering. But then I'm a physician and physicians make the worst patient.
And that's what the kind psychiatrist masquerading as a radiologist and ultrasound doctor said to me, "We all know doctors make the worst patients, don't we". Yea, and that was good psychotherapy. I think the family physician poet said the same thing.


- Posted using BlogPress from my iPad

Be Happy

Happiness is the flip side of Depression. Happy people don't say "I'm depressed. I'm anxious." So naturally wellness involves a movement from depression to happiness.
Modern psychiatry or some might say post modern psychiatry has increasingly focussed it's attention on the study of wellness in addition to the study of sickness or pathology.
Spirituality and Psychiatry, editted by Cook, Powell and Sims, 2009 http://www.amazon.ca/Spirituality-Psychiatry-Chris-Cook/dp/1904671713 is just one of the recent resources looking at just what it is to be happy. Koenig, Co director of the Duke University Centre for Spirituality, and Health http://www.spiritualityandhealth.duke.edu/about/hkoenig/ has long studied the tautological relationship between psychological terms, psychiatric terms, terms of spirituality and religion.
Joy is a term commonly used in religion, for example C.S. Lewis' , foremost Christian theologian of the 20th Century's classic autobiographical work of well being was titled "Surprised by Joy" http://en.wikipedia.org/wiki/C._S._Lewis
Happiness is perhaps the 'lighter' side of the joyful or transcendent equation which has made it also the study of philosophers, a group often known having equal dourness to those described with excessiive 'religiosity'. Happiness hasn't really captured the attention of the obsessively intellectual yet but it still holds it's place in Philosophy as it does in Theology.
Plato,http://www.keithwilson.org.uk/philosophy/essays/Entries/2004/1/25_Platos_Theory_of_Happiness.html and Cicero, "a happy life consists in tranquillity of mind" and Montaigne http://www2.lib.virginia.edu/rmds/portfolio/gordon/literary/montaigne/index.html have all considered its relevance to philosophy. Indeed today Happiness continues to be the study of modern philosophy as evidenced by the title of Prof. Solere's 2005 lecture, Passion, Pleasure and Happiness in Modern Philsophy. http://www2.bc.edu/~solere/docs/Syll_705_passions_sp05.pdf
Indeed happiness, joy, well being, are the subject of study in all the social sciences from anthropology, psychology, sociology to todays functional MRI studies of physiological correlates of positive experience in the Behavioural Scientist laboratory of the likes of Davidson and others, http://ajp.psychiatryonline.org/cgi/content/abstract/154/7/926
Physicians today indeed know without much controversy what is required for happiness or positive well being. Certainly there's exercise, and food, and a relational world such as family or community, and some form of positive identification with purpose or work.
Years back the World Health Organization did a study of what those living over a 100 had in common. It wasn't very profound but it was extremely telling. They were all 'lean'. No fat people, no gluttons, lived long lives. Yet given the qualitative and quantitative analysis, if on a scale of 1-10, happiness was 10, a hundred years of happiness would be more so than merely a night. I think Timothy Leary http://en.wikipedia.org/wiki/Timothy_Leary and especially Richard Alpert http://en.wikipedia.org/wiki/Remember_Be_Here_Now_(book)with their LSD experiments of 'instant happiness' put to rest that a single night of 'high' was worth a life time of low. Indeed the 12 step movement originating with Alcoholics Anonymous http://www.aa.org/?Media=PlayFlash the spiritual group following on the work of Dr. Carl Jhttp://www.aabibliography.com/oxfordsteps.htmlung http://en.wikipedia.org/wiki/Carl_Jung and Rev. Frank Buchman emphasized that spirituality and happiness needed to be seen as a "one day at a time" life long experience.
The "Longevity" studies such as Framingham Studyhttp://www.framinghamheartstudy.org/ and Grant Study http://adultdev.bwh.harvard.edu/research-SAD.html have themselves attempted to look at what is happiness and how it applies to well being, physically, psychologically and socially.
To come back to those living over a hundred, the lean people, what was also noted was that they all worked and they all exercised. These three facts were fundamental to the all those studies. The best example as I remember it at the time was of the oldest man in the study, some East European at the ripe old age of 116 or thereabouts. He was the town post man and daily rode to town to sort the mail. What was so endearing was that he'd saddle his horse and ride the one or two miles to town where the post office served the less than a dozen or so members of his community. After that he'd ride home.
Today my father is in his 90's and I feel 'guilty' because I know he feels like he's in God's waiting room to some extent existing as a 'geriatric' in our primitive western culture where happiness is as often as overlooked as spirituality in the societal equations of power and wealth.
Cicero didn't find much happiness in the wealthy and powerful of the Rome of his day. Walden Pond by Thoreau http://thoreau.eserver.org/walden00.html is indeed a study of living well with emphasis on simplicity and indeed frugality. Ironically happiness is as much a product of less as it is more which of course comes as profound shock to a pac man society of consumer mentality.
So what happens when I as a clinician tell someone to Be Happy. Indeed increasingly when I encounter depression and anxiety in my practice I look to the work of Martin Seligman on Positive Psychology http://www.authentichappiness.sas.upenn.edu/Default.aspx
and increasingly like a psychic physiotherapist encourge 'strenghthing the muscles of well being' rather than focussing on the injured muscles of illness. Encouraging Laughter along the lines of the Norman Cousins, Humor Therapy http://en.wikipedia.org/wiki/Norman_Cousins is not surprisingly as 'hard" as sell as encouraging walking in the obese or abstinence in the alcoholic.