I'm sitting here after a cold walk in Ottawa with Gilbert. He three legged it a bit, his little paws chilled by the icy salty street at times. Overall he loved the walk, especially smelling cold preserved dog poops in snow.
In my brother's kitchen at the table, Adell is sewing her son's new stockings for the mantle. The old ones were apparently tasty in the garage to some little critter.
Walking Gilbert I thought of the year in review. Can't even remember where I was last year. I mixed up Christmas with Thanksgiving. That's when I was l here fall last year. I just realized I could consult my blog. There's a record there but that's the 'facts' and what I'm remembering is a whole different calendar of importance.
Adell sorted out that I was here 2 Christmas ago but last year had worked at the Methadone Clinic then taken Gilbert for a couple of nights in a dog friendly luxury hotel in Seattle. I remember how pleasant that break was. Especially loved the fashion in Seatle.
I worked all year. My office in the Old Electric Building had a steady flow of patients with more wins by far than losses. In chronic disease treatment, the aim is to stop deterioration and maintain levels of competence. Occasionally you can actually reverse the process. I like the addiction work, because anyone you can bring into abstinence restores a life and saves the health care systems hundreds of thousands an individual at least. Stopping alcoholism stops heart disease, bowel cancer, liver disease and dementia. Stopping marijuana smokers reduces lung disorders, adolescent psychosis and emotional disorders and work and relationship difficulties commonly.
Getting heroin addicts off street drugs is a joy because without injection there's no further risk of emboli, overdose, infection or spread of diseases like HIV. The cost saving to a community of a methadone clinic is millions of dollars of health care costs and similar millions saving in crime prevention. In contrast the Insite centre, sexy as it is to the liberal media, serves the illicit drug crime industry and because people keep injecting they inject when they're not at the In Site site. Drug trafficking persists and deaths occur off site as does spread of disease. it's good for the drug trade. I love Steppenwolf, the Canadian rock group whose song, "Goddam the Pusherman" still gives me shivers.
So I feel good about my work, with patients, knowing that I'm directly affecting morbidity and mortality and helping individual patients with the quality and quantity of the lives. My psychiatry work focuses on trauma, head injury, addiction and change. A third of my practice comes from the highest walks of society and have the greatest motivation to change for the better. It's often humbling to work with these highly functional individuals who have a glyph in their systems. I sometimes describe my work as 'ferrari human mechanics- sometimes I'm tweaking engines, sometimes I'm overhauling they're all ferrari's." I like my now dead friend who said, "God doesn't make junk'. I've attended funerals this year and heard of more death. The baby born was a joyfulness. We're getting older and more often than not my friends children are having children or dying themselves.
I've been blessed with Hannah as an assistant. She's been so trustworthy, competent and caring. All the patients have appreciated her too. That's been the same for several years thanks to Aim and Joanne before her. Mostly I've been blessed with tremendous assistance.
It's the same with family physicians and specialists, psychologists, counsellors, lawyers, judges and pharmacists I' work with. 99% of my interactions are highly positive with all these people but there's those one or two people with a negative interaction and it's hard to focus on the positive given the damage I've experienced with individuals. The 'system' maximizes the damage potential of social terrorists too. But that's a personal mental process too. The inability to focus on the positive requires exercise and work whereas it's so much easier and lazier to let the negative colour one's experience. Some call that depressive thinking, others alcoholic, others Irish blood, or sour Scottish phlegm. It's a lack of gratitude and I'm thankful for a program and church that remind me that I must always look at the half filled glass rather than see the glass as half empty.
My accountant Anil and my brother Ron made life less confusing when it came to finances and business management. I'm certainly thankful to the the managers at Scotia and TD banks for their sound business advice. So focused on patient care I've lost a million or more because I simply don't focus on finances, sales and all that manner of stuff. So much of the difficulties of practice are the confusion of taxes and books, with clinics and various insurance and private fees. It's become worse every year with higher overhead and less services.
I've never done as well as I did financially as a family physician but I've continued to be able to work in the areas of greatest need while managing overhead and a good life by world standards. I can't afford a house in Vancouver and worry sometimes with all the corruptions and billions made here by crime and drug dealing that my neighbours if I did own a house might likely be a dealer. While others though were suffering because of the financial collapse and younger and older folk were having severe difficulties I was getting by thankful to have work and a modicum of security. Nonetheless I remain a survivalist and enjoyed the full range of zombie movies the year brought. I'm ready. If apocalypse happens or www III then I'll be the go to guys. There's a lot to be learned from zombie movies too.
I was blessed to go to Mexico last year. I attended the Family Practice Trial Lawyers of BC conference, an enjoyable affair, looking at medicine in terms of liability and costs. Then the diagnostic issues in areas of conflict were informative as well. Mostly I enjoyed the good humour of the judges and lawyers in a mock trial as well as the discussions by judges and lawyers of the interface between health and law.
On my own time I went for lunch with a traveller after a meeting in town discussing the value of sober judgement and the conflicts we had personally with the chemically dependent. I'd shared my work and he'd shared his. He went on to show me where they served great chicken locally. I enjoyed the horse back riding, galloping on the beach, and scuba diving the fresh water caves. I enjoyed a root canal there which didn't disrupt my overly busy Vancouver life but took little time out of a vacation. It's like shopping, something I only seem to do travelling these days. I've no time or desire to wander a mall on a weekend back home but enjoy the novelty of this experience elsewhere.
Bear hunting wasn't successful in the spring from a bear kill basis. I was in Princeton before the bear came down from their hibernation. Riding my 250 Honda motorcycle in the backwoods with Gilbert on the back and plinking at targets was fun.
I love how spring comes so quickly on coast. Driving my Honda 250 in town and in the back woods was preparation for getting back my confidence on my Harley Classic 1600 cc motorcycle. After the injury to my knee and foot I'd had doubts about my abilities on a bike but no problem.
I bought a new small boat with a big engine and we had a great time in the spring at Harrison Lake. I do all this fishing and hunting but have little return but good pictures and good times. Gilbert loves the outdoors. So much of life is about the journey. Hunting and fishing and camping is contrast. It's like eating a variety of diet so you appreciate hamburger and steak. All of one is dull. I love the variety in my life and seek to expand it. My friend was sky diving and I could only think, when will I do that. Another friend caught big fish off Mexico and I remembered the thrill of catching big tuna in the ocean and all the great meals.
I was out in my big boat in the summer. I towed the new pontoon boat with 20hp enjoying fishing south of Texada Island. Beautiful country and boating. It was on that trip I cast my cat Angels ashes to the sea.
I enjoyed riding around English Bay in the new little fast boat. Moon, Randy and Tom were all out in it as I learned how to get it up on a plane and get the most speed out of it.
The summer addiction conference in Denver was the wonderful time this conference always is. I was thankful to be asked to speak with friends present. It was great to ride there on my Harley and on to Sturges the Big Harley Davidson festival in South Dakota. Seeing the Dooby Brothers and Kid Rock was great but I liked Steve Bell's music most on that trip. 5000 km on Harley, Washington, Idaho, Wyoming, Colorado, South Dakota and Montana. Loved the antelope and buffalo and hot springs.
The Christian Medical and Dentist conference in Edmonton was amazing as always. I'm delighted to be among people who somehow manage to be the most moral and ethical doctors yet work in such difficult situations. I'm always filled with hope and humbled by their examples.
Then it was a week of hunting just south of Prince George. Mostly I loved camping out in the RV and driving about in the truck with Gilbert. We got out on the motorcycle a couple of times but there was only partridge .The weather was perfect for camping but that's the problem. Hunting is best when conditions are horrible. I did encounter a very big bear face to face when I was bow hunting this year and thought twice about shooting him even though I could have. I worried my arrow might just piss him off. He ran off probably after getting Gilbert's 'dog scent' and not being sophisticated enough to separate cockapoo dog from pit bull.
It was a real privilege to meet Prime Minister Harper. What an amazingly accomplished low key gentleman he was. I was touched with his personal concern and realized what an honour it's been for me to have met 4 sitting prime ministers and known so many amazing political leaders. When CBC especially gets me thinking the country is ruled by only corrupt incompetents I have to remember the great men I've met. I found myself increasing pissed off with CBC news coverage and their supercilious attitude of superiority when the media in Canada is a glass house. People in glass houses shouldn't throw stones .
All year I enjoyed the Canadian Authors Association executive. I also enjoyed the board of the Drug Prevention Network. Ben Nuttall Smith, Jean Kay, Margaret, Margot, Dennis and all the others. I so enjoyed getting to know David Berner and the other executive and Recovery Day and the whole host of folk who worked on that. It's just good to know people doing good for others. I loved St. James Anglicah Church too. It's welcomed me and Gilbert and helped structure my week with guidance and insight.
It was an expedition, driving the truck and RV all that way and back to Prince George and the logging road with the trailer.. Each of these passages is a trial of organization and endurance with lots of new skills to be acquired and steep learning curves but a whole lot of fun.
The real joy was being invited by Dr. Phillip Ney to attend the Hope Alive Conference in Baku Azerbaijan. The counsellors I met there were all so incredibly accomplished and inspirational. I loved that time.
It was a great hunt weekend with Luke, Tom and Sonny, with enough equipment and fire power to take over a small nation and only one partridge raised by Gilbert to show for our hard work up before dawn facing blizzard winds that fell logs that had to be cut before we could carry on. Great camaraderie.
Then Singapore with its international meetings, jungle train trip to Kuala Lumpur, meeting the east Indian and Australian doctors, International Society of Addiction Medicine, folks from ASAM and CSAM, all a real joy. The Batu Caves were a spiritual experience. As was Cambodia's Ankgor Watt. What an amazing time and what a privilege to experience first seeing a part of the old USSR and then Malaysia and Cambodia. It really expanded my sense of the world despite my having been around north america, europe, the middle east, mediterranean, northern africa, the polynesian, India and some of Asia. I think what most amazes me is how intelligent and accomplished my colleagues are in these diverse regions and how little our media or our scientific journals represent their work. I loved the methadone clinic in a mosque with imans doing drug counselling.
Responding to medical emergencies on planes is fun. It's been a year of adventure and now I'm here with family.
Thanks to Hannah and Ben Nuttall-Smith I even got a book done, collected poetry, Love between the Sacred and Profane. The book launch with the help of Mida and Hannah's family went superbly.
It's been a struggle supporting patients to the best of my ability only to be condemned for doing what is normal but seen abnormally. I hated the twisted view of caregiving that the unscrupulous give with cavalier arrogance in their gross ignorance. It's still so typical of me that I allow this devastating attack to distract me from all the incredible work I've seen and done. Again it's the perception that allows the wrongs of others to influence one's own correct and true action. Only arm chair quarterbacks who are rich and above the laws that rule the real world can be so cavalier. I fault them less that those who advise them wrongly due to incompetence or greed. I've seen the destruction and know the faces of the patients whose deaths occurred as much because of the horribly 'fucked' system.
I think of the man dead in the emergency of Winnipeg General 36 hours without medical or nursing attention. I've three white patients dead this year because of failure of the system to hear their cries and the steam roller Gorgon destruction. I've no children and can't stand the abuse of children anymore. All the thousands disenfranchised children and broken families I've treated have left me raw. Adults are easier to deal with. When the system fails them it's easier to be accepting.
I'm blessed though. My friends George and John touch me to the core with their generosity of spirit. I've enjoyed blogging and all the friends in blogging world and Facebook and Twitter. It's been a good experience truly. I am so thankful to Jesus, the Holy Spirt, God of Gods. Creator, omniscient, omnipotent, present and loving.
Here I am. Thank you. Another good and full year. Christmas Eve. And the Hagmanny not here yet.
Tuesday, December 24, 2013
Personality Disorder and Personality Traits
First and foremost a diagnosis of a disorder means illness, and dysfunction. Mental health has best been described first by Freud and later adapted by the WHO as roughly, the ability love, work and play.
We consider a person's ability to love by the quantity and quality of relationships. A person might have many 'superficial' 'short term' relationships best described as acquaintances without any long term deeper relationships, better described as friends. It is unlikely that at any time a person has so many deep and personal relationships as they do acquaintances.
This friendship pattern and the years of relationships and how a person's voice changes in the mentioning of friends is indicative of the nature and depth of relationships. Psychopaths may describe relationships without a tonal differentiation which can deeply reflect the depth of the relationships. A patient with Aspergers may similarly lack the ability to indicate emotionally the difference between their mother's name and the person who they just met today.
Dr. C. Jung did research on significance of delays in response but similarly one of the cues emotionally to the 'meaningfulness' of relationships is in the non verbal communication which simply tells a sensitive examiner that a person's reference to a friend is a 'felt' friendship and not merely an 'acquaintance' relationship.
The love life of an individual starts with family and how a person speaks of family is inherent in the nature of the communication given when one asks about family and family history. Some people maintain long term positive relationships with family members indicating healthy maintenance of relationship compared to those who have not seen or communicated with a parent in decades. The latter indicates all manner of potential area of conflict and/or deficit.
After family relationships, friendships begin in school era, and hometowns then progress to workplace and associated institutions such as church and club and recreational associations.
Finally the length and depth of primary relationships is an indication of presence or absence of disorder.
People who have maintained relationships with family, have friends and acquaintances, can name them and speak about them, and those who have maintained intimate relationships for 5 years or longer have clearly a highly developed personality regarding the 'capacity' to form and maintain relationships. I say '5' years for the latter because our 'western society' has been described as 'serial monogamy' with a 50% divorce rate and average length of relationship at 5 years.
Clearly in a previous generation the role of the marriage was a more significant indicator of personality development but considering an arranged marriage with limited choice for alternatives this might well reflect societal development over individual development. The greater the 'free choice' the greater the development of a trait since, as with morality, lack of opportunity for vice, doesn't necessarily reflect "virtue'. Virtue requires the potential for 'test'. Similarly an isolated individual might well not have the opportunity to make friends whereas a person in a healthy community's isolation might well reflect intrinsic deficits.
A disorder of relationships is not only seen with personality disorder but is at it's worst with thought disorder (e.g. schizophrenia) and mood disorders (e.g. bipolar, depression).
The ability to work and maintain work reflects a person of strong personality because the character traits of survival and success are related intimately to work. This is reflected first in schooling, the higher the education, the greater the learning, the greater the diversity and buffering and the greater the successful network. A university education is like a 'white collar' or 'officer class' development whereas a trade school or skills specific learning may be likened to a 'blue collar' or sergeant class development relative to society or military hierarchies. The success of an individual may reflect to a large degree his family of origins wealth and privilege, the area of community they are from and their associations. The advantages and disadvantages sociologically and geographically are well documented.
Cultural factors are intrinsically an important aspect of diagnosing and understanding a personality disorder. One example I recall from practice was an obsessive compulsive upper class asian psychiatrist describing a Jamaican reggae star as having a 'personality disorder'. The Jamaican millionaire's later highly accentuated description of my colleague left me in doubt as to who most like had the personality disorder but clearly understanding that the cultural values of each individual differed by work and place of origen.
As for play one considers diversity of activities. Does one merely 'watch' an event or are they a higher developed 'participant' in sports,arts, or social and recreational communities. Fat academics don't notice the higher development of a person who coaches and participates in community hockey for instance but will think a 'wine connoisseur' is somehow 'refined' and 'tasteful'.
One is considered to have a 'disorder' when ones' educations, work, and social life and relational world are below an arbitrary standard set roughly for a similar person of similar background and age and culture. A ghetto child who achieves the first Phd in their family is more 'successful' than a Bachelor of Social Work from a family of PhD's in classics and mathematics. Though both have achieved an educational development it must be considered in 'context' of the individual family and community.
Naturally everyone wants to 'dumb' down 'classifications and the KISS , "keep it simple, stupid" competes with the KISS, "keep it stupid, simpleton" proponents.
Obviously classical music is beyond the ken of the average country and western musician or rapper just as quantum physics is beyond the ken of the average or even above average arts student.
The traits of personality are in all of us. All of us have antisocial traits, grandiose traits, narcissistic traits, dependent traits, paranoid traits, obsessive compulsive traits and histrionic traits etc. The absence of the traits at particular developmental stages is the indication of a more serious disorder than the presence. Traits are also seen to be in balance. A trait is further 'contextual'.
To understand this is to reflect on the person who 'talks shop' at a part, clearly 'overly dependent on rationality' and 'lacking in capacity for emotionality and relaxation and 'fun', as opposed to the opposite 'workplace 'jokester' who can't 'settle down' and 'pay attention' in the workplace and disrupts the serious flow of work. One's a party pooper and old before their years while the other is immature and disruptive.
The presence of personality traits in excess however is indicative of a disorder. Hence a person who is narcissistic in their workplace ( a leader apparently in war does best if they don't share their inner doubt and fear and resists waffling) but may be very loving in the home. The American Generals I've met had good friends and were considered good friends. Hitler, obviously a severely disturbed personality in the area of eugenics, had a powerful friendship network, and was admirable as a leader before the war and at times quite brilliant in other areas as well as maintaining a love relationship with Eva Brawn for much longer than most North Americans can sustain sexual relationships today. Prime Minister Mackenzie King, long thought an excellent Canadian leader, frequented prostitutes, held seances to speak with his dead mother and had most peculiar relationship with his dog, Spot. I don't think it would be right, by mental health standards, to describe him as 'disordered' but I have colleagues who wish to walk on the snow shoes of their betters, so claim that Jesus was Manic Depressive and a masochist and that PresidentGeorge Bush was a narcissistic personality disorder or that President Clinton was a histrionic personality disorder. To this I respond, some of colleagues are 'nut bars'.
Most great individuals, despite the criticisms found in excellent texts like Paul Johnson's "Intellectuals', would not be called 'personality disorders' even though Marx for one had distinctly narcissistic traits and St. Paul could well be described as having greater than normal obsessive compulsive traits.
The personality disorders of the DSM - the classification of the American Psychiatric Association - are derived from Carl Jung's classification of personality as Cluster A - Odd , Cluster B - extrovert and Cluster C - introvert.
Personality is developed in late teen years, though Thomas and Chess saw that the temperament of children as calm, or irritable or in between could be seen in infancies. Over the years the 'context' of the environment in which a personality exists will cause their personality be 'compensated' so that an introvert who gets a job as a television host might well appear an extrovert in later years though actually prefer solitude and quiet time outside of work situations and vice versa for an extrovert who works in an introverted area of endeavour. Odd individuals left alone will accentuate their differences but when involved in a community the association will polish these diamonds in the rough.
We might call a judge 'narcissistic ' or a psychiatrist 'paranoid' but neither would necessarily have a 'disorder' as these statements may reflect a situational context. As stated earlier the burden of abnormality must itself be 'abnormal' and their outcome cause significant clinical difficulties for the individual or society and be a long standing 'pattern' of behaviour. Freud indeed said 'maybe the paranoids were right' when he was escaping Germany because of the Nazi's. Obviously a judge whose interested in 'pleasing everyone' as the histrionic would be, couldn't possibly maintain a 'moral compass' apparently important in such a position where 'objectivity' is demanded by 'justice'.
If a person's personality is 'successful' in that it progresses the individual through life in the main stream of their community then something 'changes' dramatically so that a person's behaviour is 'out of the norm' for that individual, one considers that possibly situational events have impacted on the individual, such as a change in personality from drugs and alcohol or medical disease, such as a brain tumor, or social events, such as war or poverty which might require a wholly different 'adaptive' stately. Adaptive diversity is what' personality' is also about, its a collection of 'coping strategies' which have 'worked' to date and began to work in adolescence.
The antisocial personality disorder might have been a bully physically in high school who continued on as a bully through excessive litigation and abuse of women and co workers so that they might overtly succeed' in work, play and relationships overall, for a time. But if they are a 'disorder' versus having 'trait's then these early coping strategies won't carry them well in more complex situations which come with maturity.
A person without a full blown 'disorder' per se' may nonetheless be described as 'narcissistic' and 'manipulative'. They might even be 'pathological liars' but not be considered a 'personality disorder' because clearly some work and relationships succeed with lies versus 'text book truth'. I might not think well of a tobacco executive for instance, the lowest of scum in my opinion frankly, worse than rapists, whores, pedophiles and thieves, but I can't say that a tobacco company executive has a 'personality disorder, he's obviously 'successful' in work, love and play - assuming his golf handicap is adequate - but in my mind, his characterological deficits are strongly 'anti social'. In contrast a petty thief in and out of jail is clearly an 'anti social personality disorder'.
Now there are those who consider anyone 'different' from them and 'not politically correct' by their standards as being 'ill' or disordered. In an earlier era these defilers would have called someone a 'goat fucker' but today due to political correctness and deceit,they attempt to use less 'delicious' terminology by 'pseudoscienfically pigeonholing people they don't approve of. To say a person is a personality disorder in this day and era is to perhaps imply that they are a goat fucker but in a 'nice way'. The poet ee cummings made much fun of those people who described these people thus. Inclusivity and exclusivity is a central facet of a society where the leadership is 'generous' or 'not generous' as a reflection of whether you're 'useful' or 'not'. It's a bit of a 'paranoid' analysis. You are either 'with us' or agin us, a 'team player or not'. To be 'acceptable in England you had to have an Eton accent, in French society, a Parisian accent.
In India there were the 'untouchables' and the jobs associated with them. The gypsies of Europe carried a stigma, as once the gays and blacks and their activities carried a stigma. A white 'cotton picker' was unlikely to be invited to the local southern country club for instance especially in the 19th century. Today even as Mandella is being buried the Africans are insisting that the blacker one's skin colour the more African (inside, top of the heap) one is. Clearly a white man is 'personality disordered' by the new leadership standards, i.e. he's the new goat fucker.
The attempt at the development of a diagnosis of personality disorder and 'traits' was to be as objective scientifically as possible. There is a variety of 'personality' assessment tools. These are developed from a variety of ways of looking at personality. There is a complex sophisticated qualitative and quantitatively multi dimensional personality inventory favoured by Europeans and researchers and likely superior in many ways to the DSM working system. It's a bit like the 'miles' versus 'km' debate. Despite a lot of lobbying this complicated system wasn't accepted for the latest DSMV which continued to use the 'traditional' Axis II approach. As an older clinician whose studied personality disorder extensively I was frankly thankful because I know the present system backwards and am glad to let the next DSM come of age in the understanding of personality and change and disorder as modern research is changing.
Character and personality are multidimensional and change over time with core features usually constant. Yet even a group of 'psychopaths' , (psychopaths being thought to absolutely lack a capacity for empathy unteachable and incapable of learning) appeared in their late 50's or early 60's to change in the relationship with a strong maternal loving constant in their lives. Various theories about 're parenting' and 'holding environments' were developed for these 'exceptions'. New theories are even being required to incorporate understanding of 'spontaneous remissions' which are being discussed in terms of 'quantum change' research.
In contrast' countless studies going back to Kohut and Kernberg and Masterson have shown that Borderline Personality Disorders can be 'cured' in a combination of group and individual therapy. Cameron et al have studied extensively the cost effective and scientific evidence based outcomes of various psychotherapies relative to diagnosis. While few psychologists were trained in the 'curative' treatment of Borderline Personality Disorder, psychiatric psychoanalytic therapy maintained 'public payment' for this 'evidence based therapy'. A noted psychologist recommends treatment for borderline personality disorder that have long been established by solid evidence based research as wholly ineffective but are interestingly exorbitantly and exclusively expensive.
Alternatively 'group therapies' have been found by psychologists and psychiatrists alike to 'cure' borderline personality disorder when combined with standardized individual therapies. 12 step support groups have had high success with borderline personality disorders because of the group holding environment and tolerance for deviation. Indeed many previously diagnosed with a personality disorder who abstain from chemical addiction have a 'spontaneous' cure' of their 'concurrent diagnosis' of personality disorder. As addiction psychiatry has long demonstrated, remove the on going chemical brain damage, and the true personality, not the 'disorder' shines forth.
Similiarly the Elizabeth Fry society has provided 'community' based treatments that have succeeded with antisocial individuals where many psychologists would be 'ignorant' of the success of these modalities while known to sociologists and psychiatric psychotherapists.
A presentation of the successes of the 'community based treatment' modalities developed first in New York for the worst of the marginal, homeless and drug addicted personality disordered was a major topic at the International Society of Addiction Medicine. In face of the high cost of individual psychological therapy modalities for this poorly responsive often non compliant group, the community models were being adopted internationally not only because of their clinical success but mostly these days, their cost effectiveness coupled with their high outcome success.
Unfortunately, 'give a little boy a hammer and everything is a nail' couples with everything that isn't a nail, isn't interesting to a little boy with a hammer. Personality disorders don't respond to 'medication treatment' so are by nature the 'bane' of the reductionist psychopharmacologist psychiatrist. Indeed the 'cluster b' personality disorders are commonly excluded or actively discriminated against by 'individual psychologists' or by psychopharmacologists psychiatrists' because they don't respond to "their' treatments". That they respond extremely well to personality disorder specific treatments is widely ignored.
A colleague who was captured by the Pol Pot made an interesting observation of the schizophrenics during his ordeal. "They didn't get shot. The Communists withheld food and the schizophrenics were happy to work for food so they didn't get shot like the doctors, lawyers and professors. I followed their lead or I'd have been shot….I think this is a key to understanding why the cluster a 'trait' survive in our society". What this brilliant cultural psychiatrist, today, was referring to ,was the genetic research work which shows a trait apparently counterproductive is maintained in society because of it's benefit in aberrant situations. The sickle cell anemia genetic trait is thought to be maintained in a community because it 'protects' against falciparum malaria'.
Similiarly 'antisocial personality disorder' traits are often what make successful soldiers and the 'protectiveness' of borderline personality disorder 'mothers' is what is commonly described in stories of 'mothers' who defend their children against wild animals and terrorists. In quieter days in better times these same people are often called 'rebells without a cause'.
To understand personality disorder fully one must appreciate that most of those who are 'successful by today's society's standards' would not have been successful a hundred years ago and may not be successful in a hundred years. Histrionic traits might well be successful in media dominated America but to date hasn't been a particularly successful survival trait in obsessive compulsive paranoid communist China, if one speaks generally.
Whereas schizophrenia appears present in 1% of individuals regardless of culture, country, or political regimen, personality disorders are defined as 'coping' and coping is affected by sociological, psychological and biological and even spiritual factors which fluctuate by country and culture. Cluster C individuals are more likely to succeed in traditional Japanese society whereas Cluster B individuals succeed more freely in Los Angeles or New York. There are even divisions to be made by gender with 75% of antisocial personality disorders being male whereas 75% of borderline personality disorders are female. Further rural and urban communities differ in regards to areas where a person might more likely be diagnosed a 'personality disorder' as opposed to an eccentric if they were 'cluster a'. Cluster A personalities generally do more poorly in the city , despite their creativity and uniqueness, but often thrive as 'eccentrics' in the country and especially Britain. Older cultures, as opposed to new cultures like the Canadian frontier, appreciate more wisely the contribution of the eccentrics like Turing.
Of course, stupidity trumps personality every day and very stupid people have been saying all manner of offensive and inconsiderate and downright stupid things about personality and character, reflecting by their statements their own lack of character. The more a person is a 'media personality' the less 'character' they might indeed have as superficial consumer societies dominated by power and money tend to be the least diverse and lack all depth.
They tend to view 'difference' which is what 'personality and character traits' is all about as abnormal and wrong. The more primitive a society the more demand for conformity. Indeed in the most primitive society decisions are made according to power and all discussion is simply to support the a priori decision.
The arrogance of the ignorant is never to be underestimated because they commonly solve arguments about quantum physics, theology and psychiatry with guns. Might is right in their realm. That said, they are frequently wrong, even when they do their best to rewrite history and populate the world with people just like them. Yes, men , to their negativity.
When a society is anthropological limited to development by the 'strong man' , pre democracy state, then every on is by nature their' bitch'. Anyone who has true 'character' is a 'threat'. In Shakespeare, only the 'fool' or 'jester 'is allowed to tell the truth in court which might explain the rise of Comedy today. King Lear ends with him saying, 'we'll talk of courtly things, whose in, whose out." Only the 'fool' can tell the truth, which is why the cluster b 'histrionics' and the cluster a 'odd' may well have have have survived considering the above genetic hypothesis. .
Personality is about character and character is about successful 'coping'. That said, tools to assess personality however have not been able to separate high class call girls , from successful business women and lawyers. An artist like Joni Mitchell, one of the greatest genius of music and words, would not be considered as successful financially as a stripper singer marketing millions in music as oral pornography. In this case 'all art is sales' is only offensive to those who question the financial system and consumer context of society which equates the death of a baby as a 'fixed' dollar value. These aspects of 'success' are probably not the realm of 'personality' and 'character analysis' in the context of a 'materialistic' society who argue that success is solely defined by "those with the most toys when they die 'wins'. What really is the different between love and lust?
Given the limitations of traditional psychology in face of modern research the American Society for education of psychiatrists requires residents be trained in 'spirituality' and the British Society of Psychiatry has a speciality 'division' for ''Psychiatry and Spirituality'. Apparently when the reductionists threw out the bath water they lost the baby and everyone is now scampering to find this lost infant.
Perhaps that's why reflecting on Personality and Personality Disorder on Christmas Eve isn't so difficulty.
We consider a person's ability to love by the quantity and quality of relationships. A person might have many 'superficial' 'short term' relationships best described as acquaintances without any long term deeper relationships, better described as friends. It is unlikely that at any time a person has so many deep and personal relationships as they do acquaintances.
This friendship pattern and the years of relationships and how a person's voice changes in the mentioning of friends is indicative of the nature and depth of relationships. Psychopaths may describe relationships without a tonal differentiation which can deeply reflect the depth of the relationships. A patient with Aspergers may similarly lack the ability to indicate emotionally the difference between their mother's name and the person who they just met today.
Dr. C. Jung did research on significance of delays in response but similarly one of the cues emotionally to the 'meaningfulness' of relationships is in the non verbal communication which simply tells a sensitive examiner that a person's reference to a friend is a 'felt' friendship and not merely an 'acquaintance' relationship.
The love life of an individual starts with family and how a person speaks of family is inherent in the nature of the communication given when one asks about family and family history. Some people maintain long term positive relationships with family members indicating healthy maintenance of relationship compared to those who have not seen or communicated with a parent in decades. The latter indicates all manner of potential area of conflict and/or deficit.
After family relationships, friendships begin in school era, and hometowns then progress to workplace and associated institutions such as church and club and recreational associations.
Finally the length and depth of primary relationships is an indication of presence or absence of disorder.
People who have maintained relationships with family, have friends and acquaintances, can name them and speak about them, and those who have maintained intimate relationships for 5 years or longer have clearly a highly developed personality regarding the 'capacity' to form and maintain relationships. I say '5' years for the latter because our 'western society' has been described as 'serial monogamy' with a 50% divorce rate and average length of relationship at 5 years.
Clearly in a previous generation the role of the marriage was a more significant indicator of personality development but considering an arranged marriage with limited choice for alternatives this might well reflect societal development over individual development. The greater the 'free choice' the greater the development of a trait since, as with morality, lack of opportunity for vice, doesn't necessarily reflect "virtue'. Virtue requires the potential for 'test'. Similarly an isolated individual might well not have the opportunity to make friends whereas a person in a healthy community's isolation might well reflect intrinsic deficits.
A disorder of relationships is not only seen with personality disorder but is at it's worst with thought disorder (e.g. schizophrenia) and mood disorders (e.g. bipolar, depression).
The ability to work and maintain work reflects a person of strong personality because the character traits of survival and success are related intimately to work. This is reflected first in schooling, the higher the education, the greater the learning, the greater the diversity and buffering and the greater the successful network. A university education is like a 'white collar' or 'officer class' development whereas a trade school or skills specific learning may be likened to a 'blue collar' or sergeant class development relative to society or military hierarchies. The success of an individual may reflect to a large degree his family of origins wealth and privilege, the area of community they are from and their associations. The advantages and disadvantages sociologically and geographically are well documented.
Cultural factors are intrinsically an important aspect of diagnosing and understanding a personality disorder. One example I recall from practice was an obsessive compulsive upper class asian psychiatrist describing a Jamaican reggae star as having a 'personality disorder'. The Jamaican millionaire's later highly accentuated description of my colleague left me in doubt as to who most like had the personality disorder but clearly understanding that the cultural values of each individual differed by work and place of origen.
As for play one considers diversity of activities. Does one merely 'watch' an event or are they a higher developed 'participant' in sports,arts, or social and recreational communities. Fat academics don't notice the higher development of a person who coaches and participates in community hockey for instance but will think a 'wine connoisseur' is somehow 'refined' and 'tasteful'.
One is considered to have a 'disorder' when ones' educations, work, and social life and relational world are below an arbitrary standard set roughly for a similar person of similar background and age and culture. A ghetto child who achieves the first Phd in their family is more 'successful' than a Bachelor of Social Work from a family of PhD's in classics and mathematics. Though both have achieved an educational development it must be considered in 'context' of the individual family and community.
Naturally everyone wants to 'dumb' down 'classifications and the KISS , "keep it simple, stupid" competes with the KISS, "keep it stupid, simpleton" proponents.
Obviously classical music is beyond the ken of the average country and western musician or rapper just as quantum physics is beyond the ken of the average or even above average arts student.
The traits of personality are in all of us. All of us have antisocial traits, grandiose traits, narcissistic traits, dependent traits, paranoid traits, obsessive compulsive traits and histrionic traits etc. The absence of the traits at particular developmental stages is the indication of a more serious disorder than the presence. Traits are also seen to be in balance. A trait is further 'contextual'.
To understand this is to reflect on the person who 'talks shop' at a part, clearly 'overly dependent on rationality' and 'lacking in capacity for emotionality and relaxation and 'fun', as opposed to the opposite 'workplace 'jokester' who can't 'settle down' and 'pay attention' in the workplace and disrupts the serious flow of work. One's a party pooper and old before their years while the other is immature and disruptive.
The presence of personality traits in excess however is indicative of a disorder. Hence a person who is narcissistic in their workplace ( a leader apparently in war does best if they don't share their inner doubt and fear and resists waffling) but may be very loving in the home. The American Generals I've met had good friends and were considered good friends. Hitler, obviously a severely disturbed personality in the area of eugenics, had a powerful friendship network, and was admirable as a leader before the war and at times quite brilliant in other areas as well as maintaining a love relationship with Eva Brawn for much longer than most North Americans can sustain sexual relationships today. Prime Minister Mackenzie King, long thought an excellent Canadian leader, frequented prostitutes, held seances to speak with his dead mother and had most peculiar relationship with his dog, Spot. I don't think it would be right, by mental health standards, to describe him as 'disordered' but I have colleagues who wish to walk on the snow shoes of their betters, so claim that Jesus was Manic Depressive and a masochist and that PresidentGeorge Bush was a narcissistic personality disorder or that President Clinton was a histrionic personality disorder. To this I respond, some of colleagues are 'nut bars'.
Most great individuals, despite the criticisms found in excellent texts like Paul Johnson's "Intellectuals', would not be called 'personality disorders' even though Marx for one had distinctly narcissistic traits and St. Paul could well be described as having greater than normal obsessive compulsive traits.
The personality disorders of the DSM - the classification of the American Psychiatric Association - are derived from Carl Jung's classification of personality as Cluster A - Odd , Cluster B - extrovert and Cluster C - introvert.
Personality is developed in late teen years, though Thomas and Chess saw that the temperament of children as calm, or irritable or in between could be seen in infancies. Over the years the 'context' of the environment in which a personality exists will cause their personality be 'compensated' so that an introvert who gets a job as a television host might well appear an extrovert in later years though actually prefer solitude and quiet time outside of work situations and vice versa for an extrovert who works in an introverted area of endeavour. Odd individuals left alone will accentuate their differences but when involved in a community the association will polish these diamonds in the rough.
We might call a judge 'narcissistic ' or a psychiatrist 'paranoid' but neither would necessarily have a 'disorder' as these statements may reflect a situational context. As stated earlier the burden of abnormality must itself be 'abnormal' and their outcome cause significant clinical difficulties for the individual or society and be a long standing 'pattern' of behaviour. Freud indeed said 'maybe the paranoids were right' when he was escaping Germany because of the Nazi's. Obviously a judge whose interested in 'pleasing everyone' as the histrionic would be, couldn't possibly maintain a 'moral compass' apparently important in such a position where 'objectivity' is demanded by 'justice'.
If a person's personality is 'successful' in that it progresses the individual through life in the main stream of their community then something 'changes' dramatically so that a person's behaviour is 'out of the norm' for that individual, one considers that possibly situational events have impacted on the individual, such as a change in personality from drugs and alcohol or medical disease, such as a brain tumor, or social events, such as war or poverty which might require a wholly different 'adaptive' stately. Adaptive diversity is what' personality' is also about, its a collection of 'coping strategies' which have 'worked' to date and began to work in adolescence.
The antisocial personality disorder might have been a bully physically in high school who continued on as a bully through excessive litigation and abuse of women and co workers so that they might overtly succeed' in work, play and relationships overall, for a time. But if they are a 'disorder' versus having 'trait's then these early coping strategies won't carry them well in more complex situations which come with maturity.
A person without a full blown 'disorder' per se' may nonetheless be described as 'narcissistic' and 'manipulative'. They might even be 'pathological liars' but not be considered a 'personality disorder' because clearly some work and relationships succeed with lies versus 'text book truth'. I might not think well of a tobacco executive for instance, the lowest of scum in my opinion frankly, worse than rapists, whores, pedophiles and thieves, but I can't say that a tobacco company executive has a 'personality disorder, he's obviously 'successful' in work, love and play - assuming his golf handicap is adequate - but in my mind, his characterological deficits are strongly 'anti social'. In contrast a petty thief in and out of jail is clearly an 'anti social personality disorder'.
Now there are those who consider anyone 'different' from them and 'not politically correct' by their standards as being 'ill' or disordered. In an earlier era these defilers would have called someone a 'goat fucker' but today due to political correctness and deceit,they attempt to use less 'delicious' terminology by 'pseudoscienfically pigeonholing people they don't approve of. To say a person is a personality disorder in this day and era is to perhaps imply that they are a goat fucker but in a 'nice way'. The poet ee cummings made much fun of those people who described these people thus. Inclusivity and exclusivity is a central facet of a society where the leadership is 'generous' or 'not generous' as a reflection of whether you're 'useful' or 'not'. It's a bit of a 'paranoid' analysis. You are either 'with us' or agin us, a 'team player or not'. To be 'acceptable in England you had to have an Eton accent, in French society, a Parisian accent.
In India there were the 'untouchables' and the jobs associated with them. The gypsies of Europe carried a stigma, as once the gays and blacks and their activities carried a stigma. A white 'cotton picker' was unlikely to be invited to the local southern country club for instance especially in the 19th century. Today even as Mandella is being buried the Africans are insisting that the blacker one's skin colour the more African (inside, top of the heap) one is. Clearly a white man is 'personality disordered' by the new leadership standards, i.e. he's the new goat fucker.
The attempt at the development of a diagnosis of personality disorder and 'traits' was to be as objective scientifically as possible. There is a variety of 'personality' assessment tools. These are developed from a variety of ways of looking at personality. There is a complex sophisticated qualitative and quantitatively multi dimensional personality inventory favoured by Europeans and researchers and likely superior in many ways to the DSM working system. It's a bit like the 'miles' versus 'km' debate. Despite a lot of lobbying this complicated system wasn't accepted for the latest DSMV which continued to use the 'traditional' Axis II approach. As an older clinician whose studied personality disorder extensively I was frankly thankful because I know the present system backwards and am glad to let the next DSM come of age in the understanding of personality and change and disorder as modern research is changing.
Character and personality are multidimensional and change over time with core features usually constant. Yet even a group of 'psychopaths' , (psychopaths being thought to absolutely lack a capacity for empathy unteachable and incapable of learning) appeared in their late 50's or early 60's to change in the relationship with a strong maternal loving constant in their lives. Various theories about 're parenting' and 'holding environments' were developed for these 'exceptions'. New theories are even being required to incorporate understanding of 'spontaneous remissions' which are being discussed in terms of 'quantum change' research.
In contrast' countless studies going back to Kohut and Kernberg and Masterson have shown that Borderline Personality Disorders can be 'cured' in a combination of group and individual therapy. Cameron et al have studied extensively the cost effective and scientific evidence based outcomes of various psychotherapies relative to diagnosis. While few psychologists were trained in the 'curative' treatment of Borderline Personality Disorder, psychiatric psychoanalytic therapy maintained 'public payment' for this 'evidence based therapy'. A noted psychologist recommends treatment for borderline personality disorder that have long been established by solid evidence based research as wholly ineffective but are interestingly exorbitantly and exclusively expensive.
Alternatively 'group therapies' have been found by psychologists and psychiatrists alike to 'cure' borderline personality disorder when combined with standardized individual therapies. 12 step support groups have had high success with borderline personality disorders because of the group holding environment and tolerance for deviation. Indeed many previously diagnosed with a personality disorder who abstain from chemical addiction have a 'spontaneous' cure' of their 'concurrent diagnosis' of personality disorder. As addiction psychiatry has long demonstrated, remove the on going chemical brain damage, and the true personality, not the 'disorder' shines forth.
Similiarly the Elizabeth Fry society has provided 'community' based treatments that have succeeded with antisocial individuals where many psychologists would be 'ignorant' of the success of these modalities while known to sociologists and psychiatric psychotherapists.
A presentation of the successes of the 'community based treatment' modalities developed first in New York for the worst of the marginal, homeless and drug addicted personality disordered was a major topic at the International Society of Addiction Medicine. In face of the high cost of individual psychological therapy modalities for this poorly responsive often non compliant group, the community models were being adopted internationally not only because of their clinical success but mostly these days, their cost effectiveness coupled with their high outcome success.
Unfortunately, 'give a little boy a hammer and everything is a nail' couples with everything that isn't a nail, isn't interesting to a little boy with a hammer. Personality disorders don't respond to 'medication treatment' so are by nature the 'bane' of the reductionist psychopharmacologist psychiatrist. Indeed the 'cluster b' personality disorders are commonly excluded or actively discriminated against by 'individual psychologists' or by psychopharmacologists psychiatrists' because they don't respond to "their' treatments". That they respond extremely well to personality disorder specific treatments is widely ignored.
A colleague who was captured by the Pol Pot made an interesting observation of the schizophrenics during his ordeal. "They didn't get shot. The Communists withheld food and the schizophrenics were happy to work for food so they didn't get shot like the doctors, lawyers and professors. I followed their lead or I'd have been shot….I think this is a key to understanding why the cluster a 'trait' survive in our society". What this brilliant cultural psychiatrist, today, was referring to ,was the genetic research work which shows a trait apparently counterproductive is maintained in society because of it's benefit in aberrant situations. The sickle cell anemia genetic trait is thought to be maintained in a community because it 'protects' against falciparum malaria'.
Similiarly 'antisocial personality disorder' traits are often what make successful soldiers and the 'protectiveness' of borderline personality disorder 'mothers' is what is commonly described in stories of 'mothers' who defend their children against wild animals and terrorists. In quieter days in better times these same people are often called 'rebells without a cause'.
To understand personality disorder fully one must appreciate that most of those who are 'successful by today's society's standards' would not have been successful a hundred years ago and may not be successful in a hundred years. Histrionic traits might well be successful in media dominated America but to date hasn't been a particularly successful survival trait in obsessive compulsive paranoid communist China, if one speaks generally.
Whereas schizophrenia appears present in 1% of individuals regardless of culture, country, or political regimen, personality disorders are defined as 'coping' and coping is affected by sociological, psychological and biological and even spiritual factors which fluctuate by country and culture. Cluster C individuals are more likely to succeed in traditional Japanese society whereas Cluster B individuals succeed more freely in Los Angeles or New York. There are even divisions to be made by gender with 75% of antisocial personality disorders being male whereas 75% of borderline personality disorders are female. Further rural and urban communities differ in regards to areas where a person might more likely be diagnosed a 'personality disorder' as opposed to an eccentric if they were 'cluster a'. Cluster A personalities generally do more poorly in the city , despite their creativity and uniqueness, but often thrive as 'eccentrics' in the country and especially Britain. Older cultures, as opposed to new cultures like the Canadian frontier, appreciate more wisely the contribution of the eccentrics like Turing.
Of course, stupidity trumps personality every day and very stupid people have been saying all manner of offensive and inconsiderate and downright stupid things about personality and character, reflecting by their statements their own lack of character. The more a person is a 'media personality' the less 'character' they might indeed have as superficial consumer societies dominated by power and money tend to be the least diverse and lack all depth.
They tend to view 'difference' which is what 'personality and character traits' is all about as abnormal and wrong. The more primitive a society the more demand for conformity. Indeed in the most primitive society decisions are made according to power and all discussion is simply to support the a priori decision.
The arrogance of the ignorant is never to be underestimated because they commonly solve arguments about quantum physics, theology and psychiatry with guns. Might is right in their realm. That said, they are frequently wrong, even when they do their best to rewrite history and populate the world with people just like them. Yes, men , to their negativity.
When a society is anthropological limited to development by the 'strong man' , pre democracy state, then every on is by nature their' bitch'. Anyone who has true 'character' is a 'threat'. In Shakespeare, only the 'fool' or 'jester 'is allowed to tell the truth in court which might explain the rise of Comedy today. King Lear ends with him saying, 'we'll talk of courtly things, whose in, whose out." Only the 'fool' can tell the truth, which is why the cluster b 'histrionics' and the cluster a 'odd' may well have have have survived considering the above genetic hypothesis. .
Personality is about character and character is about successful 'coping'. That said, tools to assess personality however have not been able to separate high class call girls , from successful business women and lawyers. An artist like Joni Mitchell, one of the greatest genius of music and words, would not be considered as successful financially as a stripper singer marketing millions in music as oral pornography. In this case 'all art is sales' is only offensive to those who question the financial system and consumer context of society which equates the death of a baby as a 'fixed' dollar value. These aspects of 'success' are probably not the realm of 'personality' and 'character analysis' in the context of a 'materialistic' society who argue that success is solely defined by "those with the most toys when they die 'wins'. What really is the different between love and lust?
Given the limitations of traditional psychology in face of modern research the American Society for education of psychiatrists requires residents be trained in 'spirituality' and the British Society of Psychiatry has a speciality 'division' for ''Psychiatry and Spirituality'. Apparently when the reductionists threw out the bath water they lost the baby and everyone is now scampering to find this lost infant.
Perhaps that's why reflecting on Personality and Personality Disorder on Christmas Eve isn't so difficulty.
Jet Cockapoo - Gilbert
We've made another flight with Gilbert under the seat. He's become a really good traveller. Rides fine in the carry on then sleeps through most of the plane flight. Taking off and landing are stressful. I worry about his ear equalization. Does he know to swallow. He's usually panting at the end of those parts but no apparent pain. I figure it must be anxiety. It's also just hot at times in the plane and given his fur coat that might well be sufficient explanation. He's happy to be with me, that's for sure.
In the airport he's fine. I worry he'll pee on something after a 5 hour flight. However, he's a good boy, patient as we wait for baggage. Then he sled dogs us out the door where he really does let go a stream. Here in Ottawa with all the snow the yellow puddle was evident. More dogs are travelling and the evidence was apparent in the yellow snow patches of the dog walk zone.
My sister in law, Adell, arrived to pick us up. He's ecstatic with family, jumping all over humans and licking their ears. His memory for those who love and play with him is incredible. Looking forward to his seeing my nephews and their partners. There's a young folk love fest he really gets into. Three guys and almost as many girls willing to throw ball. Lots of great festive holiday cooking smells and treats. How can life get better for a dog!
Thank you Air Canada and Westjet for understanding pet owners and making it more and more convenient for us to travel with our family.
In the airport he's fine. I worry he'll pee on something after a 5 hour flight. However, he's a good boy, patient as we wait for baggage. Then he sled dogs us out the door where he really does let go a stream. Here in Ottawa with all the snow the yellow puddle was evident. More dogs are travelling and the evidence was apparent in the yellow snow patches of the dog walk zone.
My sister in law, Adell, arrived to pick us up. He's ecstatic with family, jumping all over humans and licking their ears. His memory for those who love and play with him is incredible. Looking forward to his seeing my nephews and their partners. There's a young folk love fest he really gets into. Three guys and almost as many girls willing to throw ball. Lots of great festive holiday cooking smells and treats. How can life get better for a dog!
Thank you Air Canada and Westjet for understanding pet owners and making it more and more convenient for us to travel with our family.
Sunday, December 22, 2013
Attack the Block - the movie
Attack the Block - the movie. Just watched this 2011 British movie on Netflix and loved it. So very original. The story line is a teen age gang is at the scene of an alien attack on earth. They fight the alien only this attracts more. They're involved with a marijuana grow op and the business men who run this and a nurse who lives in the block along with a parallel group of teen agers. It's England today so white, black, east indian. There's two children as well. The show is amazingly well done with these alien gorilla like believable creatures having vulnerabilities but being ferocious as well. It's a great show for character development, with the teens going from thieves to socially conscious. A truly funny moment at times with lots of action and weird twists. Well done English film. This is a great sci fi unlike any other I've seen with lots of modernity and depth surrounding a Hitchcock like horror sic fi. Loved it.
Director: Joe Cornish
Stars - Moses - John Boyega
- Sam - Jodie Whittaker
- Pest - Alex Esmail
- Jerome - Leeon Jones
- Dennis - Franz Drameh
Writer - Joe Cornish - great directing and great writing!!!!
Director: Joe Cornish
Stars - Moses - John Boyega
- Sam - Jodie Whittaker
- Pest - Alex Esmail
- Jerome - Leeon Jones
- Dennis - Franz Drameh
Writer - Joe Cornish - great directing and great writing!!!!
Saturday, December 21, 2013
Winter River Walk
The snow has made the winter real. Walking is a slippery sliding squishing affair. The leaves of trees are gone and great open spaces appear where memory says there never was. I can see the train passing now. I couldn't see this in spring. I love the ducks in the winter and can see them fly further without the foliage in the trees.
Gilbert runs about joyfully. It's a long walk but maybe only an hour or so. I remember when injuries didn't let me walk for 15 minutes. I'm thankful for healing. I'm glad I'm still in some semblance of shape.
Talked with a couple in their 60's. They'd liquidated and were travelling the world, living in hostels, not eating out, going on the cheap, hiking. Europeans. Adventurous. Not something I associate so much with Canadians or Americans. Yet friends winter in asia and some others are in Mexico.
Maybe the mainstream is sedentary but the outliers aren't. My friend George gave me the latest book by the author of Outliers. I look forward to a good read. Now I'd just like to lie on the couch and watch a detective show. I'd like to hike along the old pilgrimage paths in England. I don't think they take dogs in hostels. Gilbert is a luxury consideration.
I like my Keystone RV. There's a lot of places I'd like to go with this. Canadian lakes and parks are a wonderful world of outdoors and fine people. I'll have a motorcycle in the back of this toy hauler and a canoe at very least. Just wish I could take the boat and motor along. Now I wonder if I could get a rack in the truck? I certainly have everything I could want right here. And I like the idea of a moveable home.
My dream was always to arrange my life so I'd be three months in the south in winter and the rest of the year in Canada's wilderness. Don't know if I'll ever achieve that or I'll just come to enjoy winter again. I'm not minding the snow so much this year, even thinking of skiing, something I've not even considered for several years. The idea of going to the cold was simply unappealing but now with friends in Whistler I'm thinking maybe. Mostly though, ski areas don't accept dogs so as always I must consider my pal first. I like best people and places who like dogs.
This winter river dog walk is just that sort of place.
Gilbert runs about joyfully. It's a long walk but maybe only an hour or so. I remember when injuries didn't let me walk for 15 minutes. I'm thankful for healing. I'm glad I'm still in some semblance of shape.
Talked with a couple in their 60's. They'd liquidated and were travelling the world, living in hostels, not eating out, going on the cheap, hiking. Europeans. Adventurous. Not something I associate so much with Canadians or Americans. Yet friends winter in asia and some others are in Mexico.
Maybe the mainstream is sedentary but the outliers aren't. My friend George gave me the latest book by the author of Outliers. I look forward to a good read. Now I'd just like to lie on the couch and watch a detective show. I'd like to hike along the old pilgrimage paths in England. I don't think they take dogs in hostels. Gilbert is a luxury consideration.
I like my Keystone RV. There's a lot of places I'd like to go with this. Canadian lakes and parks are a wonderful world of outdoors and fine people. I'll have a motorcycle in the back of this toy hauler and a canoe at very least. Just wish I could take the boat and motor along. Now I wonder if I could get a rack in the truck? I certainly have everything I could want right here. And I like the idea of a moveable home.
My dream was always to arrange my life so I'd be three months in the south in winter and the rest of the year in Canada's wilderness. Don't know if I'll ever achieve that or I'll just come to enjoy winter again. I'm not minding the snow so much this year, even thinking of skiing, something I've not even considered for several years. The idea of going to the cold was simply unappealing but now with friends in Whistler I'm thinking maybe. Mostly though, ski areas don't accept dogs so as always I must consider my pal first. I like best people and places who like dogs.
This winter river dog walk is just that sort of place.
Loss at Christmas
It's coming up Christmas.
I was woken from sleep at 3 am. Nightmares. Again. Wet pillow. Tears.
I was reminded today of a woman who had the courage to refuse an abortion and how she was hounded for years after and abused terribly till she was no more. Everyone who tried to support her was attacked viciously. I feel I've come close to pure evil again and was strongly reminded of this today.
I found myself missing a lawyer friend, Dugald Christie. We sat in church and talked about God, love, ethics, morality, society on drives to the jail where he got me doing pro bono work. I was blessed to know him. He was killed.
I learned of another patient who died today. HIV and drug addiction. I talked with him of his whole life. So many fine chapters in that blessed book. These last few pages were miserable and his death is a kind of blessing. I'll miss him. Another patient hung himself earlier this fall. He'd been turned away from the hospital and refused services. We did our best in the community but it wasn't good enough. We have no resources and we are punished for caring. Our thinkings is wrong because we're not looking at things from the perspective of profit and these people simply aren't profitable.
There's more talk of euthanasia for the elderly. Legalize marijauna, give them cake, have everyone stoned and it's Matrix and the Holocaust all over again but now we'll all be 'high' so it will be okay.
I feel so alone at times.
I miss my mother and father and aunt and grandparents. They're dead and I'm old and it sometimes seems so sad. I pick myself up and pray and pray. I meditate and I try to exercise. The pain gets to me more some days. I'm blessed beyond belief but I grieve.
Loss is loss. There's no getting around it. I miss people who have gone.
I miss Jesus. I think of him being killed by Herod and Pontius Pilate and Peter being crucified upside down by Nero and stupidly I'm reading about William Wallace tortured and quartered by Edward Plantanget. These are the real morality tales.
I should be reading about birds and flowers. I think adults who have children have a buffer, they get to read all the fairytales over and over. I miss the fairytales.
I don't have answers or solutions. Mostly questions. I dare not ask why anymore. Mostly I just ask, where? 'Where are you Jesus?'
The great lie of the secular world is that atheists are foisting the notion that theists are killers but the only religion of atheism is communism. Russian Communists killed 80 million people in very few years. Chinese Communists killed 120 million people. And I just came from Cambodia where Cambodian communists, the latest generation of atheist government, killed 3 million in record time, 4 years, more than a third of the countries population of 8 million.
I swore on a Bible today. I liked that, It felt good under my hand. In a break I read psalms. They were comforting as they always are. Still I'm sad. So very very very sad. But this too will pass. It's just a hiccup. I could take a drug, smoke some grass, have some wine, not 'feel', 'numb' myself out. I tried that years ago after the divorce, after being held hostage, the life threats and the deaths, so many, back then. HIV and suicide. "Man up!!!" "Shake yourself out of it."
I remember the shame and embarrassment I felt kneeling and crying in the hospital corridor when the boy died despite all I did to save his life. He died because he stopped taking the medication that was keeping him alive and here I am years later, still crazy after all these years, trying to stop people from taking drugs that are killing them. Will I ever float down stream?
I sat with a colleague and felt his fear at the threat of being hounded in retirement. He's scared about the babies he delivered. He did his best. I know. He's the best doctor I know but we're not perfect and now there's so much money to be made by destruction. No one's into creation. It's out of vogue. Bankers even bid on insurance against collective suicides they've engineered for power and greed and we're pawns in the insanity of politics.
I'd rather be in a storm at sea alone than in the crush of media hype hysteria. First they built enough bombs to kill us all a hundred times over then they were supposed to stop that and needed a whole bunch more money to clean up the mess they made and then some of that clean up didn't work and Syria has gassed its people and it's no long global but regional and we're supposed to make sense of it with all the false prophets and misinformation.
Trust me I'm a politician. Trust me I'm a reporter. Trust me I'm a government representative. Trust me I'm a lawyer. But if I say 'trust me, I'm a doctor', everyone thinks that's funny. Weird and twisted humour this planet earth has.
I probably should walk the dog more along the river where I take pictures of the beautiful birds that live there year round. I could lie on the beach. I could sit a lot longer in Rome churches with the smell of incense and the place of worship.
I'm an ecumenicalist. I believe that all spiritual seekers are on the same path. I pray to the 'saints of all religion' and believe that Buddha, Mohammed, Moses, Jesus all were further along the path than their followers. I see these spiritual men walking out at the front where God is calling to his son and all his children, to come home. And death is that home for me but I can't get there till I love this gift of life to it's fullest. And I don't feel I'm living life as lovingly or as meaningfully, gratefully or graciously as God would have me.
The irony is I'm as likely to meet Spongebob in the afterlife. Divine Comedy is what it is.
I'm kind of slouching towards Bethlehem. I've got way too much attitude. I'm dragging a whole lot of luggage that's negative and resentful and poor me. I'm so full of lust, sloth, gluttony, greed, and downright stupidity that I can't feel the wings of eagles or be lifted up to my Lord in Heaven. I'm a slug wallowing in the dirt, hiding in fear a lot when I should be a kid in sandbox throwing the dirt in the sky.
I want to dance without pain, sing without hoarseness, laugh till tears stream down my cheeks.
I want Jesus.
The basic story is God was born man and killed by man. What could be simpler as metaphor. Now I have to believe that God resurrects. There is life after life and life after death and my family who have died, my friends who have died and my patients who have died are still alive, not just in my memory but where I can meet them again, like long lost friends, like high school reunions and comings home from distant lands.
Mary was like my mom, like every mom and Jesus was like me, like every baby. And they had friends and they suffered governments and taxes and intolerance and greed and the powers of this world. I've lived twice as long as Jesus and my mom lived longer than Mary and all of us have been living this metaphor myth story in our own lives as the cosmic Christ is within all of us. God is born. God died. God will come again. The trinity of father, son and holy spirit. The beginning middle and end, Parent, child, holy spirit. But it's not linear. It's stellar
Contemplating the Christmas story. Advent and the coming of the king. The servant king. The message that God is a lover.
I have no children but my brother shares the men he and his wife created with me. They're fine men. I was with a friend and his sons. They're fine men too. They're all moving into marriage and having families.
The cycles go on.
I delivered a hundred babies, stopped an epidemic or two on Indian villages, saved a dozen infants with meningitis from brain damage. All those nights without sleep. All those terrible unknown diseases. Being held hostage. Being attacked, The deliriums and dementias and the teams of people, teachers and friends. I've been blessed to be a healer among healers.
When I studied buddhism and was a disciple and yogi in my 20's I learned about right living. I figured that what Jesus did was right living. So becoming a healer was okay and it's been okay. It's been good.
I'm not allowed to do that so much anymore. I feel I've been hi jacked for other purposes. I keep thinking of missionary work. But then I like my things. I 'm a fat cat yuppie who lacks any real compassion, self centered, self serving, complaining, whining, twittering and face booking with my luxury computer and luxury I phone communication devices, and designer clothes and glorious motorcycle and fast sports car. I worry about losing this hard won hard earned bit of the Canadian dream.
But I've not had heat secure for weeks and the water hasn't been sure. Basics like electricity are never things I can take for granted in my world. This cold snap caught me off guard, fighting beurocrats with too much tax dollars and not enough real work and no real life experience to learn humility. I've no house and the really rich think I'm rich but my riches are my dog and a fishing rod and rifle. I 'm a survivalist.
I can live off the sea or off the land. I haven't had much faith in governments and stupid people in groups not to crucify the citizenry collectively and have us all nuked and having to defend ourselves individually from zombie groups of marauder gangs. I fear the break down of civilization and yet I've prepared for just that eventuality. Boy Scout motto, always be prepared.
The core fear is what Pascal described as the God shaped hole inside me. I can't find the architect God in the wall of the building. I have to find the light within that is the source of the light without. Easy enough to say and easy enough to talk about.
But
But
I pray and meditate and meditating am distracted by a myriad of 'things' in that quiet time when I listen for the wee small voice of God.
I would know you more fully, more surely more really. Let me be like you Jesus. Let me know you but lets accept you did the cross bit and that was for all of us so I can get down off the cross, take the nails out of my hands and feet that I keep putting there and use the wood to build a house.
I loved the 150 year old St. Thomas church where Steven Bell sang and played guitar last month. Now there was some mighty fine wood.
Maybe I can sleep again. The little dog is sleeping beside me. I pray I'll be with God in my dreams. I love when I dream of family and dogs and friends who have gone before. I love the dreams of meetings and especially love the old ladies. I'm walking towards the light, Jonah like, stumbling and twirling and back stepping , getting swallowed by whales, staggering, side stepping, sashaying, skipping, hopping and crawling. Sometimes it's so slow and other times its way too fast.
Thank you God for hope. Still my fear and comfort me in the loss. Thank you for these days to come and Christmas. Hi Jesus, baby God.
I was woken from sleep at 3 am. Nightmares. Again. Wet pillow. Tears.
I was reminded today of a woman who had the courage to refuse an abortion and how she was hounded for years after and abused terribly till she was no more. Everyone who tried to support her was attacked viciously. I feel I've come close to pure evil again and was strongly reminded of this today.
I found myself missing a lawyer friend, Dugald Christie. We sat in church and talked about God, love, ethics, morality, society on drives to the jail where he got me doing pro bono work. I was blessed to know him. He was killed.
I learned of another patient who died today. HIV and drug addiction. I talked with him of his whole life. So many fine chapters in that blessed book. These last few pages were miserable and his death is a kind of blessing. I'll miss him. Another patient hung himself earlier this fall. He'd been turned away from the hospital and refused services. We did our best in the community but it wasn't good enough. We have no resources and we are punished for caring. Our thinkings is wrong because we're not looking at things from the perspective of profit and these people simply aren't profitable.
There's more talk of euthanasia for the elderly. Legalize marijauna, give them cake, have everyone stoned and it's Matrix and the Holocaust all over again but now we'll all be 'high' so it will be okay.
I feel so alone at times.
I miss my mother and father and aunt and grandparents. They're dead and I'm old and it sometimes seems so sad. I pick myself up and pray and pray. I meditate and I try to exercise. The pain gets to me more some days. I'm blessed beyond belief but I grieve.
Loss is loss. There's no getting around it. I miss people who have gone.
I miss Jesus. I think of him being killed by Herod and Pontius Pilate and Peter being crucified upside down by Nero and stupidly I'm reading about William Wallace tortured and quartered by Edward Plantanget. These are the real morality tales.
I should be reading about birds and flowers. I think adults who have children have a buffer, they get to read all the fairytales over and over. I miss the fairytales.
I don't have answers or solutions. Mostly questions. I dare not ask why anymore. Mostly I just ask, where? 'Where are you Jesus?'
The great lie of the secular world is that atheists are foisting the notion that theists are killers but the only religion of atheism is communism. Russian Communists killed 80 million people in very few years. Chinese Communists killed 120 million people. And I just came from Cambodia where Cambodian communists, the latest generation of atheist government, killed 3 million in record time, 4 years, more than a third of the countries population of 8 million.
I swore on a Bible today. I liked that, It felt good under my hand. In a break I read psalms. They were comforting as they always are. Still I'm sad. So very very very sad. But this too will pass. It's just a hiccup. I could take a drug, smoke some grass, have some wine, not 'feel', 'numb' myself out. I tried that years ago after the divorce, after being held hostage, the life threats and the deaths, so many, back then. HIV and suicide. "Man up!!!" "Shake yourself out of it."
I remember the shame and embarrassment I felt kneeling and crying in the hospital corridor when the boy died despite all I did to save his life. He died because he stopped taking the medication that was keeping him alive and here I am years later, still crazy after all these years, trying to stop people from taking drugs that are killing them. Will I ever float down stream?
I sat with a colleague and felt his fear at the threat of being hounded in retirement. He's scared about the babies he delivered. He did his best. I know. He's the best doctor I know but we're not perfect and now there's so much money to be made by destruction. No one's into creation. It's out of vogue. Bankers even bid on insurance against collective suicides they've engineered for power and greed and we're pawns in the insanity of politics.
I'd rather be in a storm at sea alone than in the crush of media hype hysteria. First they built enough bombs to kill us all a hundred times over then they were supposed to stop that and needed a whole bunch more money to clean up the mess they made and then some of that clean up didn't work and Syria has gassed its people and it's no long global but regional and we're supposed to make sense of it with all the false prophets and misinformation.
Trust me I'm a politician. Trust me I'm a reporter. Trust me I'm a government representative. Trust me I'm a lawyer. But if I say 'trust me, I'm a doctor', everyone thinks that's funny. Weird and twisted humour this planet earth has.
I probably should walk the dog more along the river where I take pictures of the beautiful birds that live there year round. I could lie on the beach. I could sit a lot longer in Rome churches with the smell of incense and the place of worship.
I'm an ecumenicalist. I believe that all spiritual seekers are on the same path. I pray to the 'saints of all religion' and believe that Buddha, Mohammed, Moses, Jesus all were further along the path than their followers. I see these spiritual men walking out at the front where God is calling to his son and all his children, to come home. And death is that home for me but I can't get there till I love this gift of life to it's fullest. And I don't feel I'm living life as lovingly or as meaningfully, gratefully or graciously as God would have me.
The irony is I'm as likely to meet Spongebob in the afterlife. Divine Comedy is what it is.
I'm kind of slouching towards Bethlehem. I've got way too much attitude. I'm dragging a whole lot of luggage that's negative and resentful and poor me. I'm so full of lust, sloth, gluttony, greed, and downright stupidity that I can't feel the wings of eagles or be lifted up to my Lord in Heaven. I'm a slug wallowing in the dirt, hiding in fear a lot when I should be a kid in sandbox throwing the dirt in the sky.
I want to dance without pain, sing without hoarseness, laugh till tears stream down my cheeks.
I want Jesus.
The basic story is God was born man and killed by man. What could be simpler as metaphor. Now I have to believe that God resurrects. There is life after life and life after death and my family who have died, my friends who have died and my patients who have died are still alive, not just in my memory but where I can meet them again, like long lost friends, like high school reunions and comings home from distant lands.
Mary was like my mom, like every mom and Jesus was like me, like every baby. And they had friends and they suffered governments and taxes and intolerance and greed and the powers of this world. I've lived twice as long as Jesus and my mom lived longer than Mary and all of us have been living this metaphor myth story in our own lives as the cosmic Christ is within all of us. God is born. God died. God will come again. The trinity of father, son and holy spirit. The beginning middle and end, Parent, child, holy spirit. But it's not linear. It's stellar
Contemplating the Christmas story. Advent and the coming of the king. The servant king. The message that God is a lover.
I have no children but my brother shares the men he and his wife created with me. They're fine men. I was with a friend and his sons. They're fine men too. They're all moving into marriage and having families.
The cycles go on.
I delivered a hundred babies, stopped an epidemic or two on Indian villages, saved a dozen infants with meningitis from brain damage. All those nights without sleep. All those terrible unknown diseases. Being held hostage. Being attacked, The deliriums and dementias and the teams of people, teachers and friends. I've been blessed to be a healer among healers.
When I studied buddhism and was a disciple and yogi in my 20's I learned about right living. I figured that what Jesus did was right living. So becoming a healer was okay and it's been okay. It's been good.
I'm not allowed to do that so much anymore. I feel I've been hi jacked for other purposes. I keep thinking of missionary work. But then I like my things. I 'm a fat cat yuppie who lacks any real compassion, self centered, self serving, complaining, whining, twittering and face booking with my luxury computer and luxury I phone communication devices, and designer clothes and glorious motorcycle and fast sports car. I worry about losing this hard won hard earned bit of the Canadian dream.
But I've not had heat secure for weeks and the water hasn't been sure. Basics like electricity are never things I can take for granted in my world. This cold snap caught me off guard, fighting beurocrats with too much tax dollars and not enough real work and no real life experience to learn humility. I've no house and the really rich think I'm rich but my riches are my dog and a fishing rod and rifle. I 'm a survivalist.
I can live off the sea or off the land. I haven't had much faith in governments and stupid people in groups not to crucify the citizenry collectively and have us all nuked and having to defend ourselves individually from zombie groups of marauder gangs. I fear the break down of civilization and yet I've prepared for just that eventuality. Boy Scout motto, always be prepared.
The core fear is what Pascal described as the God shaped hole inside me. I can't find the architect God in the wall of the building. I have to find the light within that is the source of the light without. Easy enough to say and easy enough to talk about.
But
But
I pray and meditate and meditating am distracted by a myriad of 'things' in that quiet time when I listen for the wee small voice of God.
I would know you more fully, more surely more really. Let me be like you Jesus. Let me know you but lets accept you did the cross bit and that was for all of us so I can get down off the cross, take the nails out of my hands and feet that I keep putting there and use the wood to build a house.
I loved the 150 year old St. Thomas church where Steven Bell sang and played guitar last month. Now there was some mighty fine wood.
Maybe I can sleep again. The little dog is sleeping beside me. I pray I'll be with God in my dreams. I love when I dream of family and dogs and friends who have gone before. I love the dreams of meetings and especially love the old ladies. I'm walking towards the light, Jonah like, stumbling and twirling and back stepping , getting swallowed by whales, staggering, side stepping, sashaying, skipping, hopping and crawling. Sometimes it's so slow and other times its way too fast.
Thank you God for hope. Still my fear and comfort me in the loss. Thank you for these days to come and Christmas. Hi Jesus, baby God.
Thursday, December 19, 2013
Pharmaceutical Representative Lunch
I was feeling pretty good driving to work this morning, till I turned on CBC radio. I sometimes feel like a crack addict must feel at the moment I press the FM 88.1 button and leave the safety and serenity of classical or inspirational music.
Anna Marie Tremonte in that screechingly judgemental supercilious, out of touch with reality, voice she can adopt was talking to a group of angry men making a living off of attacking doctors.
This weeks condemnation of my profession took the twist that we were unduly influenced by pharmaceutical representatives.
Some doctors, very few, extremely few indeed, apparently make as much as $500,000 working as speakers for pharmaceutical industry. I was once paid $100 to talk to a group of doctors about a drug I was using with patietns and knew to be extremely beneficial so was happy to tell my colleagues. I was not going to do this if someone didn't pay me as I'd rather sit at home and read a good book but when offered a meal in a fine restaurant, time to be with colleagues, I took the $100 and ate the meal and told the family physicians why I, a specialist, recommended this drug.
Because Anna Marie Tremonte doesn't live on this planet but is a bubble girl , she doesn't know that there is somebody doing just this sort of thing in every industry in the world. It's called 'education' and it's done by those who are most knowledgeable.
I listened to a presentation on RV's by an RV owner on which RV's they recommend. I listened to a fellow talk about motorcycles. I know nurses get paid lunches to listen to different representatives discuss uniform clothing materials.
The greatest corruption in hospitals, if they are anything like the military, happens in supplies. CBC did mention that since buying doctors lunch was out the pharmaceutical industry had shifted to buying lunches for the beaurocrats who decide which drugs appear on the hospital pharmacy lists. Pharmacists, we learned last year, were getting 'kickbacks' from industry to the tune of millions of dollars.
So I normally don't have lunch. I'm too busy. As a doctor I am tasked to do 90 minutes of activities in every 15 minutes of time spent with a patient, and I'm only paid for by my time. Even if I do all this right, and am the most perfect doctor, I can lose my license because I'm 'unpopular'. I don't even have kill or maim people, I just have to be politically incorrect. So, like most doctors, who on average work 80 hours (the equivalent of two government jobs, and maybe 3 CBC jobs - senior management in CBC do make half million in perks and benefits at least, don't they? I'm not sure what rock star reporters make but I do know that every band is approached by someone in industry hawking their amps and guitars).
So this person offers to buy me lunch and tell me about the latest product from their company whose products I already use, Eli Lilly, for instance, (think Mother Earth Magazine, Danier Leather, Ford Cars, IBM, Apple, Angelina Jolie). That's what I think when I think Merk, Eli Lilly and such folk because their products have saved the lives of my patients. I've been up in the middle of the night and some scientific wizard in some amazing lab has created a product that has stopped my patient dying in the wee dark hours of the morning and I look and see Hoffman Laroche has made this godsend that has just saved a life. I am a front line worker.
When I listen to Anna Marie Tremonte I think she's somewhere safe dressed in white silk and sitting on a soft sedan looking at her painted nails and berkenstocks sometimes soundly pleasantly sane other times sounding seriously daft. Think of me as a crack addict with CBC, a love hate relationship.
So yes, I'm influenced by someone offering to take me for lunch, or coffee even. It's the lever to get me out of the office. Now when this person makes their pitch, I'm influenced just like I was influenced when I heard this one guy, a motorcycle mechanic, talk about the pros of and cons of synthetic versus natural oils. I ask questions and I reason and I eat lunch. I have noticed that the people that the pharmaceutical industry sends around are bright attractive people. They're in sales.
Only government funded agencies like CBC, sometimes called Communist Broadcasting Corporation, knock sales routinely. Salesmen and sales are not dirty. I 'sell' life. I try to convince my patients daily to give up killing themselves. I'm not laying life out there like an 'option'. I'm not miles from reality in a radio studio talking about it in the abstract. I'm selling my soul out to keep an adolescent girl from killing herself because she's overwhelmed. I love 'sales'. I love 'salesmen'. Sales to me is like any communication system. Hitler was a brilliant media person but used that media for ill.
Anna Maria Tremonte and the CBC are too often hack journalists and propagandists rather than unbiased reporters. Where's the 'balance'.
I'm now feeling guilty about having that lunch. I spent a third of my life in free time studying to be the best doctor I could be and out of sheer curiosity, all post graduate, and no body was buying me lunch. I don't have a pension. I think my hourly wage is now about minimum wage but then I started the workforce 12 years after my neighbours who bought a house while I was training and now are retired early and spending their winters in Cancun.
Yes, there are bad doctors. Yes, there are bad media people, but why the broad brush and why the Watergate Scandal over somebody buying me lunch who wants to tell me about something in my field when this is 'normal' business. It's 'normal' Anna Maria Tremonte. Somebody in your CBC got a lunch to discuss which microphone you used today.
And as for free samples, you get them at the cosmetic store. You can't tell me you never ate a 'free sample' of food at Christmas time walking through the shopping mall.
I take free samples of medications I'm going to prescribe. I take these because I can give this sample to my patient. I do this not to 'push' drugs like heroin industry. I don't even do this like the guys at the car mall who let me drive around the block my Miata Sports Car. I love my Miata Sports Car. It's been 35 years of 7 day a week work and today I'm able to affor a car that has heated seats that help my back and I don't want to feel guilty because last I looked doctors individually and collectively weren't the really rich people in this country. Oprah makes 2.6 million dollars. How much does Anna Marie Tremonte make and how many perks is she given.
What's wrong with making money, doing good. To listen to CBC making money is evil, collectively. (except perhaps if you are an athlete and why did it take CBC so long to catch the government officials in Quebec stealing outright millions of dollars and seeing no wrong in in it. And why did that 'Scandal of the Year', get so little play when the Senate red herring that cost us all only $500, 000)
I ask for samples so I can give my patient a sample so if they get a side effect, most likely in the first week of use, they won't fill the prescription which would cost them $100 and they'd lose the money because you can't take back antibiotics or medications for psychosis, or any medications and we counsell everyone not to use their neighbours medications. So rather than have a rash and lose $100 I am so thankful the Pharmaceutical Industry, these greats who have extended the lives of my HIV patients by 30 years and saved my Diabetes and allowed my schizophrenic patients to lead relatively normal lives, well I'm thankful they let me save my patients some money.
My patients usually aren't rich supercilious news casters like Anna Maria Tremonte. Because they're sick their income has been affected and they appreciate any help the doctor can provide.
I liked test driving my luxury sports car. I am by CBC standards a 'dirty capitalist pig' even though I can't remember not working and so much of my activity overlaps with my work and I don't own a house, don't have time to gamble on the stock market and don't have pensions and haven't really given money the thought I've given to 'curing' or 'comforting' the person who has come to me sick and suffering.
And frankly, I'm really thankful for the Pharmaceutical Industry because they've given me the tools that have helped me do my job and I get tired of academics and monday morning quarterbacks hawking their books.
Yes, I know, a department head at a university could be bought for $50,000 and there were those who were unduly influenced just as everyone is in 'big business' and there's a need for accountability. But somehow Anna Marie Tremonte and the CBC do more 'carping' than reporting.
Influence pedalling happens in every nook and cranny of existence and every item in our day to day lives is a product of sales so please, wake up. And I will be more impressed if you first tell me whose paying you off and how influence affected which soft seat you sat in and how you refused to let the car company get you to test drive their car and how you really are 'above' it all. Because you do sound very high and mighty and judgemental in a most obsequious way and I guess I'm returning the same.
So I'll pray and forgive and hope tomorrow I can resist turning on CBC.
Anna Marie Tremonte in that screechingly judgemental supercilious, out of touch with reality, voice she can adopt was talking to a group of angry men making a living off of attacking doctors.
This weeks condemnation of my profession took the twist that we were unduly influenced by pharmaceutical representatives.
Some doctors, very few, extremely few indeed, apparently make as much as $500,000 working as speakers for pharmaceutical industry. I was once paid $100 to talk to a group of doctors about a drug I was using with patietns and knew to be extremely beneficial so was happy to tell my colleagues. I was not going to do this if someone didn't pay me as I'd rather sit at home and read a good book but when offered a meal in a fine restaurant, time to be with colleagues, I took the $100 and ate the meal and told the family physicians why I, a specialist, recommended this drug.
Because Anna Marie Tremonte doesn't live on this planet but is a bubble girl , she doesn't know that there is somebody doing just this sort of thing in every industry in the world. It's called 'education' and it's done by those who are most knowledgeable.
I listened to a presentation on RV's by an RV owner on which RV's they recommend. I listened to a fellow talk about motorcycles. I know nurses get paid lunches to listen to different representatives discuss uniform clothing materials.
The greatest corruption in hospitals, if they are anything like the military, happens in supplies. CBC did mention that since buying doctors lunch was out the pharmaceutical industry had shifted to buying lunches for the beaurocrats who decide which drugs appear on the hospital pharmacy lists. Pharmacists, we learned last year, were getting 'kickbacks' from industry to the tune of millions of dollars.
So I normally don't have lunch. I'm too busy. As a doctor I am tasked to do 90 minutes of activities in every 15 minutes of time spent with a patient, and I'm only paid for by my time. Even if I do all this right, and am the most perfect doctor, I can lose my license because I'm 'unpopular'. I don't even have kill or maim people, I just have to be politically incorrect. So, like most doctors, who on average work 80 hours (the equivalent of two government jobs, and maybe 3 CBC jobs - senior management in CBC do make half million in perks and benefits at least, don't they? I'm not sure what rock star reporters make but I do know that every band is approached by someone in industry hawking their amps and guitars).
So this person offers to buy me lunch and tell me about the latest product from their company whose products I already use, Eli Lilly, for instance, (think Mother Earth Magazine, Danier Leather, Ford Cars, IBM, Apple, Angelina Jolie). That's what I think when I think Merk, Eli Lilly and such folk because their products have saved the lives of my patients. I've been up in the middle of the night and some scientific wizard in some amazing lab has created a product that has stopped my patient dying in the wee dark hours of the morning and I look and see Hoffman Laroche has made this godsend that has just saved a life. I am a front line worker.
When I listen to Anna Marie Tremonte I think she's somewhere safe dressed in white silk and sitting on a soft sedan looking at her painted nails and berkenstocks sometimes soundly pleasantly sane other times sounding seriously daft. Think of me as a crack addict with CBC, a love hate relationship.
So yes, I'm influenced by someone offering to take me for lunch, or coffee even. It's the lever to get me out of the office. Now when this person makes their pitch, I'm influenced just like I was influenced when I heard this one guy, a motorcycle mechanic, talk about the pros of and cons of synthetic versus natural oils. I ask questions and I reason and I eat lunch. I have noticed that the people that the pharmaceutical industry sends around are bright attractive people. They're in sales.
Only government funded agencies like CBC, sometimes called Communist Broadcasting Corporation, knock sales routinely. Salesmen and sales are not dirty. I 'sell' life. I try to convince my patients daily to give up killing themselves. I'm not laying life out there like an 'option'. I'm not miles from reality in a radio studio talking about it in the abstract. I'm selling my soul out to keep an adolescent girl from killing herself because she's overwhelmed. I love 'sales'. I love 'salesmen'. Sales to me is like any communication system. Hitler was a brilliant media person but used that media for ill.
Anna Maria Tremonte and the CBC are too often hack journalists and propagandists rather than unbiased reporters. Where's the 'balance'.
I'm now feeling guilty about having that lunch. I spent a third of my life in free time studying to be the best doctor I could be and out of sheer curiosity, all post graduate, and no body was buying me lunch. I don't have a pension. I think my hourly wage is now about minimum wage but then I started the workforce 12 years after my neighbours who bought a house while I was training and now are retired early and spending their winters in Cancun.
Yes, there are bad doctors. Yes, there are bad media people, but why the broad brush and why the Watergate Scandal over somebody buying me lunch who wants to tell me about something in my field when this is 'normal' business. It's 'normal' Anna Maria Tremonte. Somebody in your CBC got a lunch to discuss which microphone you used today.
And as for free samples, you get them at the cosmetic store. You can't tell me you never ate a 'free sample' of food at Christmas time walking through the shopping mall.
I take free samples of medications I'm going to prescribe. I take these because I can give this sample to my patient. I do this not to 'push' drugs like heroin industry. I don't even do this like the guys at the car mall who let me drive around the block my Miata Sports Car. I love my Miata Sports Car. It's been 35 years of 7 day a week work and today I'm able to affor a car that has heated seats that help my back and I don't want to feel guilty because last I looked doctors individually and collectively weren't the really rich people in this country. Oprah makes 2.6 million dollars. How much does Anna Marie Tremonte make and how many perks is she given.
What's wrong with making money, doing good. To listen to CBC making money is evil, collectively. (except perhaps if you are an athlete and why did it take CBC so long to catch the government officials in Quebec stealing outright millions of dollars and seeing no wrong in in it. And why did that 'Scandal of the Year', get so little play when the Senate red herring that cost us all only $500, 000)
I ask for samples so I can give my patient a sample so if they get a side effect, most likely in the first week of use, they won't fill the prescription which would cost them $100 and they'd lose the money because you can't take back antibiotics or medications for psychosis, or any medications and we counsell everyone not to use their neighbours medications. So rather than have a rash and lose $100 I am so thankful the Pharmaceutical Industry, these greats who have extended the lives of my HIV patients by 30 years and saved my Diabetes and allowed my schizophrenic patients to lead relatively normal lives, well I'm thankful they let me save my patients some money.
My patients usually aren't rich supercilious news casters like Anna Maria Tremonte. Because they're sick their income has been affected and they appreciate any help the doctor can provide.
I liked test driving my luxury sports car. I am by CBC standards a 'dirty capitalist pig' even though I can't remember not working and so much of my activity overlaps with my work and I don't own a house, don't have time to gamble on the stock market and don't have pensions and haven't really given money the thought I've given to 'curing' or 'comforting' the person who has come to me sick and suffering.
And frankly, I'm really thankful for the Pharmaceutical Industry because they've given me the tools that have helped me do my job and I get tired of academics and monday morning quarterbacks hawking their books.
Yes, I know, a department head at a university could be bought for $50,000 and there were those who were unduly influenced just as everyone is in 'big business' and there's a need for accountability. But somehow Anna Marie Tremonte and the CBC do more 'carping' than reporting.
Influence pedalling happens in every nook and cranny of existence and every item in our day to day lives is a product of sales so please, wake up. And I will be more impressed if you first tell me whose paying you off and how influence affected which soft seat you sat in and how you refused to let the car company get you to test drive their car and how you really are 'above' it all. Because you do sound very high and mighty and judgemental in a most obsequious way and I guess I'm returning the same.
So I'll pray and forgive and hope tomorrow I can resist turning on CBC.
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