Psyhrink (Shrink) Fit - Doctor Mike's thoughts on life fitness

Your Majesty and Other Honorifics

2024-08-31T12:43:00.000-06:00

It was many years ago. I was just a young pup of about 15 years of age. Working at the local zoo was a fun job for me. I was permitted to go behind the locked gates to mow the lawn and pick up trash. Not a particularly glamourous job, but it came with some privileges and a name tag that made me look official. I distinctly remember an occasion when an even younger young man approached me to ask a question about one of the animals. He began his inquiry by addressing me as "Sir." I thought that was an odd way to address a 15 year old lawn mowing trash collecting young man, but it was nice to feel respected.

Now fast forward with me to more current times.  Last night I attended an event where I bumped into one of my colleagues, another physician that I hadn't seen for many years.  It was fun to catch up a little bit.  In the course of our brief conversation I noted that I am rarely called "doctor" anymore since I retired from active psychiatric practice.  The title of distinction that I hear most often nowadays is "grandpa," and that is a prized title.  

I've learned that with different titles there are different levels of authority.  As a physician, when I issue "Doctor's orders" I expect that there will be some change of behavior on the part of the person receiving those orders (although I realize that that may not always happen).  If I order a specific medication or a specific test I have much confidence that those things will actually happen.  However, when issuing "grandpa's orders" I've learned that things may not always go as hoped.  Same is true when issuing "dad's orders" or "husband's orders."  Uh, yea, I suggest much caution and hesitation before issuing "husband's orders" if ever, and understand that the outcome of such orders may not be to your liking.   Anyway, the point is that things are different as a retired physician, and that's ok. 

This exchange with my physician colleague got me thinking about all of the various titles of distinction or honorifics that folks reach for.  Titles such as "your honor," "counselor," "doctor," "professor," "ambassador," "commissioner," "chief," "pilot in command," "captain,"  "chairman," "boss," "foreman," "sir"  - these are all significant titles of distinction and they generally are accompanied by respect and authority, rightfully so.  

There are other titles of distinction which have a different character.  These titles are more enduring, even permanent, and they are deserving of respect as well.  The authority that accompanies these titles is the byproduct of love, loyalty, and kindness rather than compulsion.  And that authority must be accompanied by patience and devotion.  I've already referred to one such title of distinction - "Grandpa."  Other similar titles include grandma, mom, dad, sister, brother, husband, wife, son, daughter, grandson, and granddaughter, cousin, and friend.  There may be more I skipped over.   These are titles that come to us in the course of life. Some of them are automatic, such as being part of a family.  Others are pursued (e.g. pursuing your spouse), and others happen in the course of time, such as grandpa.  

I have some vague memories of the first time someone called me "Doctor."  That was satisfying even though I didn't feel quite ready to accept all of the responsibility that goes with that title. I have a more clear memory of the first time I was called "grandpa" since it was more recent, and more impactful. I didn't feel quite ready to accept all the responsibility that goes with that title either, but it did feel good.  Even though I didn't feel quite ready to be a grandfather, when my grandson first uttered the word "grandpa" (or something close to it) I was hooked.  That title resonated deeply within me, and I had a sense that that title, unlike so many other titles, would never be obsolete or retired. 

In life we strive for things - we strive for accomplishments, we strive for comfort, we strive for recognition, and we may strive for titles of distinction.  I think these are worthy and worthwhile endeavors.  However, there are other milestones in life that ultimately are more enduring and more satisfying to our souls than the transient titles and accomplishments of life. Those other milestones include titles such as wife, husband, mom, dad, grandpa, and grandma.  Please don't forget or neglect  the far reaching and enduring opportunities that come with these titles.

Words and Politics

2024-02-13T20:05:00.002-07:00

So, another presidential election is just around the corner. And with that you and I get to look forward to another season of political football - including all the bad calls, cheap shots, taunting, inappropriate celebrations, dropped passes, fumbles and injuries that seem to be part of the game (of football as well as politics). The stakes in football are high, including things such as bragging rights and financial windfalls. However serious the game of football is, the stakes in the game of politics are much higher - I hope people can appreciate that.

I believe (hope) there are people of good conscience with noble intentions on both (all) sides of the political playing field. Sometimes that belief is seriously challenged. I'm fairly confident that there are those with nefarious intentions as well.

In an earlier blog post I discussed what I referred to as "Brain Games and Politics" and discussed psychological concepts including cognitive distortions and defense mechanisms. You might refer to that post for a brief discussion of those topics and how they influence political discourse.

In this post I'd like to consider some words that might be added to your vocabulary and mine. These words may come in handy during this politically charged season. Dictionary.com helped with these definitions, and I refer you to that resource if you want more information on the history of these words and definitions. As you read down this list, it is likely that you will associate some of these words with specific politicians. It is not my intention to direct these words one way or the other, but to simply arm you with words that may be useful even if not commonly used.

Kakistocracy: government by the worst people

Pornocracy: government by harlots

Empleomania: a mania for holding public office.

Throttlebottom: an innocuously inept and futile person in public office.

Politicaster: an unstatesmanlike practitioner of politics, a petty or contemptible politician

Mugwump: one that withdraws his or her support from a political group or organization, a regular member who bolts a party and adopts an independent position.

Gerrymander: the act or method of dividing a territorial unit into election districts in an unnatural and unfair way with the purpose of giving one political party an electoral majority in a large number of districts while concentrating the voting strength of the opposition in as few districts as possible

Embusqué: a person seeking to avoid military service (as by working in a government office)

Obstructionist: one that hinders progress: one that deliberately and often by indirect or delaying tactics obstructs business (as in a legislative body)

Carpetbagger: a nonresident who meddles in politics

Highbinder: a person who engages in fraudulent or shady activities; specifically. a corrupt or scheming politician

Misprision: neglect or wrong performance of official duty, misconduct, or maladministration by a public official

Obviously, this list is not complete. You may come up with your own list of vocabulary words that are useful in a political discussion. My hope during this politically charged season (is there a time when things aren't politically charged?) is that we can participate in an informed manner.

And I really hope that we can be civil and peaceful throughout the process. I know it is hard to believe, but there are well meaning and intelligent people who may see things a little differently than you or me - a little bit of courtesy can go a long ways toward dispelling the hostility that is so abundant.

Thanks for reading. Your thoughts and comments are welcome (especially if you follow the suggestions listed above). As mentioned, the blog entitled "Brain Games and Politics" has some related ideas. Also, dictionary.com is a great resource for more information on these and other words.

Pickleball, People, and Politics

2024-01-24T20:28:00.001-07:00

Among things I do, when not in my doctor mode, I participate in a limited way in the politics in my community. In that capacity pickleball, of all things, has become an unexpected topic of heated discussion.

I'll admit to not being much of a pickleball aficionado. I've played the game a few times and have enjoyed it, but I've not yet caught pickleball fever. However, unlike me, some folks are passionate about pickleball - so much so that they are constructing pickleball courts on their own property. Some of these persistent pickleball players play pickleball in the morning, in the afternoon, and in the evening. They may invite their friends over to enjoy a pickleball party, and they may rent out their pickleball court - assuring that even though they may take a pickleball pause, other pickleball playing people promptly pickup pickleball paddles in persistent pursuit of pickleball dominance, and the pickleball court remains in use.

I recently did a quick review of medical journal articles relating to pickleball. As I scanned several articles from various medical journals, I learned several things about pickleball that are worth noting.

Pickleball is a healthy activity.
It does not require a high level of skill to be played and enjoyed (although it can become a highly intense and competitive activity if pursued).
It is an activity that people can enjoy in their youth as well as in later years.
The population is aging (not just in the USA).
As we age continued physical activity is important for physical wellbeing.
And, as most psychiatrists will tell you, physical activity is important for mental wellbeing.

So, what is the problem? and why the heated discussion? Well, it turns out that if you happen to live next to (or nearby) one of those pickleball playing people you may well experience persistent pickleball pinging and ponging throughout the day. It may interfere with your work (especially if working from home), It may interfere with your rest. And it may interfere with your enjoyment of your own property. In addition, it may create unnecessary resentment or contention with your neighbors - and that is quite regrettable. Great neighbors make for a much more favorable experience than the alternative.

So, what are some of the other issues? On the one hand there are many reasons to play and enjoy pickleball. On the other hand, there are reasons to consider giving it a rest once in a while. Among the concerns I'm aware of is the issue of sound. Pickleball games are often loud (and that loudness often accompanies having fun). In addition, the pitch (i.e., frequency) of the sound has been found to be particularly irritating to those neighbors who are involuntarily exposed to that sound.

One of the fundamental issues boils down to property rights - what can I do with my own property? and does my neighbor or my government have any right to limit my right to use my own property as I see fit?

So now what? My initial reaction to this is to hope that people can learn to get along. I'd love to see neighbors talk about the pros and cons of pickleball and find some common ground and a workable arrangement. That hope may be a little optimistic, but possible. Another option is to find ways to voluntarily diminish the impact of the noise on neighbors. There are ways of dampening the sound (e.g. sound barriers, distance from property lines, etc.). And there is the option of involving the police powers of the government. To me this is the least appealing option, although sometimes necessary. This could lead to the creation of new laws and new penalties.

So, what does this psychiatrist think about this issue? As mentioned, I would love to see individuals on both sides of this issue be considerate and civil. I've worried that civility in society is fading, so expecting civility to resolve this may be disappointing. Also, I recognize that there are personality styles and personality disorders (e.g narcissistic, antisocial, and others) that lead some folks to feel that the rules don't apply to them, and that may lead to conflict. It would be well to keep those personality issues in check if possible. I am eager to see physical activities such as pickleball be encouraged. Physical activity is a very important component of mental health. I have encouraged physical activity in pretty much all of my patients and have been encouraged by the results. And if government is to be involved, I would prefer to see an approach that might first remind people of the shared responsibility we have in creating a desirable community. This might take the form of public service announcements through various media (radio, internet, city website, etc.) encouraging neighborliness and cooperation. And if the problem persists then involvement of the government may be necessary to diminish the nuisance.

So, there you have it, a few of my thoughts on Pickleball, People, and Politics.

Thanks for reading. I hope a few thoughts have been stirred. Tell your family and friends about this site, if you don't mind, and please feel free to reply.

Doctor Mike

POLITICS - BE CIVIL AND INFORMED

2020-02-08T11:44:00.000-07:00

A few years back I was the chairman of a grassroots political organization – Republicans for Civil and Informed Participation (aka RCIP). The goal of the organization was to promote both civil and informed participation. We sponsored a few “meet the candidates” nights, and I think we were successful in accomplishing our goal of civil and informed participation. As I recall there were a few disagreements, maybe even frustration, but never name calling or insults.

I wonder if it would be helpful to reemphasize both civil and informed participation in the political process. I believe it is important for us to be involved – there is a lot at stake. Winston Churchill said, “The hottest place in hell must be reserved for those who, in the face of great moral crisis, maintain their neutrality.” So, according to Mr. Churchill, we ought to be involved. I think that involvement should be civil and well informed. To be well informed will take some time and effort. To be civil will certainly require discipline and practice. And at the outset I acknowledge that leaders of the two major political parties (both Republicans and Democrats) don’t set a great example of civility.

I have a few questions to further this discussion –

Can good people disagree?

When you disagree with someone politically do you have solid support for your position?

Are you consistent? – If names were changed or party alliances changed would you feel the same?

Are your interests truly self-interests (i.e. selfish) or are you looking for answers that serve others and the country well?

Have you read the constitution?

Do you resort to name calling, pejorative labels, and insults rather than considering the merits of the issue?

Are you able to consider the possibility, slight as it may be, that you may not be correct?

I have additional questions on specific issues –

What is the proper role of government?

What about abortion?

Do you have opportunities?

Who is responsible for you and your life?

Where does the money come from to pay for government services and interventions?

Do we need a strong military?

Do we need a space force (as an independent branch of the military)?

Should we have an embassy in Jerusalem?

Is our country built on the foundation of correct principles (even if the implementation has been flawed)?

Is there room for improvement?

Should we (the USA) be a beacon of hope to the world?

Should we have a “political class” that is immune to the requirements and challenges that are faced by the average citizen?

Should politicians become wealthy as a result of their political activities and connections?

As Rodney King said, “Can’t we all just get along?”

My hope, for myself and everyone, is that we can acknowledge differences and learn from each other in a civil manner. Also, there is no shortage of information but not all information is well supported or of equal value.

Be civil and informed, and if that doesn’t work, be nice and smart.

(PS – you might consider looking at an old blog post – Mind Games and Politics (https://doctor-mike.blogspot.com/2012/04/brain-games-and-politics.html?view=flipcard ) for some additional thoughts on this topic. )

Brain Games and Politics

2019-09-13T10:00:00.000-06:00

BRAIN GAMES AND POLITICS

I shared these thoughts a while back, but once again we are in the midst of another wild political season. I thought it might be well to revisit these topics. - please enjoy and please comment if you feel so inclined.

Winston Churchill said, “The hottest place in hell must be reserved for those who, in the face of great moral crisis, maintain their neutrality.”

Considering that statement, I’m risking my postmortem well-being by attempting to maintain (at least for now) a politically neutral position as I write this blog.

I’ve heard it said that those who run for president (and other political offices) ought to have their head examined. I agree with that thought - not that it is a bad idea to run for office, but it is a good idea for the rest of us to be better informed about those who want to be in positions of authority. With that thought in mind, I offer the following -

As I’ve watched the political season move forward, I believe I’ve seen evidence of various psychological forces at work.    Candidates certainly provide good examples of these psychological processes, and so do their constituents.   I would like to briefly discuss two broad areas that are of interest to psychiatrists and psychologists as they interact with their patients. This will not be a lengthy discussion of these topics, but hopefully will stir some interest.

The two general areas of interest include:

1) defense mechanisms

2) cognitive distortions.

So let me first introduce the concept of defense mechanisms. A defense mechanism is a mental maneuver that allows a person to defend and reinforce their own self image. That explanation may be a little awkward, but perhaps a simpler definition is as follows - a defense mechanism is the technique we use to keep feeling ok about ourselves. These techniques have been broadly classified into primitive, less primitive, and mature mechanisms. The primitive defenses include: denial, regression, acting out, dissociation, compartmentalization, projection, and reaction formation. Less primitive defenses include: repression, displacement, intellectualization, rationalization, and undoing. More mature defenses include: sublimation, compensation, and assertiveness.

The second concept to be introduced is that of cognitive distortions. Cognitive distortions are similar to defense mechanisms in that they are mental maneuvers, but in the case of cognitive distortions, the maneuvers are aimed at helping us make sense of the world around us.   Included here are distortions like: filtering (seeing only what we are looking for), polarizing (aka black and white thinking), overgeneralization (using too few facts to draw a conclusion), jumping to conclusions, catastrophizing, personalization, control fallacies, fallacy of fairness, blaming, emotional reasoning, global labeling, etc..

You might think of it like this - defense mechanisms help us to make sense of ourselves, cognitive distortions help us make sense of the world around us. Neither technique is necessarily linked to reality.

It will be interesting during this political season, as the temperature of the rhetoric rises, to watch for these mental manipulations among the candidates, as well as among the commentators and constituents. We will be provided with a great opportunity to watch defense mechanisms and cognitive distortions in action. I don’t at all mean to imply that the political discourse can be reduced to these two broad concepts (defense mechanisms and cognitive distortions), but I suspect that these things do play a role.

If you’d like more information on these interesting concepts, please consider following the links:
Defense Mechanisms and Common Cognitive Distortions, I think you will find the information thought provoking.

Thanks for taking a look at the blog. Tell your friends about it. Please leave a comment if you’d like.

Doctor Mike

Responsibility in the age of Rights

2012-09-17T22:34:00.002-06:00

Responsibility in the age of Rights

Recently there has been tragedy and commotion in the middle east, ostensibly because of some film maker's irreverent treatment of topics dear to the heart of Muslims. The fact that the violence and murderous acts that occurred in the middle east took place on September 11 suggests to me that plans for mayhem were already in the works. The film, that I have not seen, and that purportedly will not receive much in the way of critical acclaim, serves as a convenient justification for the throngs of misguided middle-easterners who have now taken up flag burning and worse.

The behavior of the looters and murderous thugs who stormed the embassies in Egypt and Libya is beyond the pale, it is outrageous, indefensible, and unjustified. It is the behavior of the corrupt and uncivilized. The response of the US ought to be a clear condemnation of those who perpetrate such behavior, and the governments that apparently (as indicated by their ineffectual response) condone such behavior. The US response should not apologize for the rights, including the right to free speech, that are enjoyed by its citizens.

Having said that, however, I do believe it is time to begin the process of reconnecting two primal principles - Rights, and Responsibilities.

My early years were in the 1960's, a time of great societal upheaval and unrest, a time when rights were emphasized, and injustices (at least some of them) acknowledged. The half century since then has been a time of clamoring about various rights. We have constitutionally guaranteed rights - such as the right to free speech and the right to bear arms. We have rights recognized in the Declaration of Independence, including the right to life, liberty, and the pursuit of happiness. We expect many other rights, such as the right to privacy, the right to a good education, the right to marry, and more recently, the right to health care. I am not arguing the merits of these various rights, but I do understand that people of my generation appear to have more "rights" than did people of prior generations in this country, and there seems to be an inverse relationship between the discussion of rights and the discussion of responsibilities.

The angst that I have has to do with the other side of the coin. A discussion of rights is incomplete without a discussion of responsibilities. It is my belief and contention that along with God given rights, we have God given responsibilities associated with those rights. And whether or not you believe your rights come from God, I hope that you acknowledge that a discussion of responsibilities is germane to a discussion of rights. As I reflect on the news of the past half century I am impressed that a lot of ink (and cyberspace) has been dedicated to a discussion of rights, but rarely have I read in newspapers or heard on the news a discussion of responsibility. I believe that such a discussion is way overdue.

I am not at all arguing that the rights to which we have become accustomed need to be altered or abridged. But I am hoping that those rights will be considered along with the responsibilities that I believe we all have to try to be good citizens, to try to be good neighbors, to try not to be jerks.

So how does all this relate to recent events involving the middle east, and a certain low budget video. Having the right to be offensive doesn't mean you should exercise that right. What is to be gained by insulting Muslims, or any other group of people? The right to speak freely certainly does not guarantee that there will not be consequences to that speech. Please understand that even though our rights are not always legally contingent upon behaving responsibly, there is a hope among most members of our US society that people will exercise their rights in a responsible manner, and perhaps exercise a modicum of good judgement (yes, I realize I may be disappointed in this).

I haven't yet seen the video, and likely will not, but the news reports indicate that it is not really a great work of art. I hope the next time someone considers exercising their right to offend someone else, they will reconsider. And as for you middle-easterners who are so angry (Libya, Egypt, Yemen, et al), perhaps there are some of you who will take a look at this blog - you do yourselves no favor by behaving so poorly.

Perhaps there should have been a "bill of responsibilities" to accompany the bill of rights. I suspect our forefathers may have overestimated our ability to govern our ourselves, and thought that such a "bill of responsibilities"unnecessary.

One of the nice things about psychiatry is that it encompasses so much, including examining individual behaviors, as well as the behavior of masses. I'll get back to more typical psychiatric topics in the next blog (unless something else catches my interest first).

Thanks for reading. Please leave a comment if you'd like.

Hi Friends

2012-07-30T22:42:00.000-06:00

"Hi Friends" - So began my four year old grandson's first talk in church. That innocent salutation is rich in so many ways. I've very much enjoyed watching this little boy over the last several years. Lucky grandparents have a wonderful opportunity to love and teach their grandchildren. I've learned, however, that the teaching goes in both directions. One lesson I've learned from this little boy is to see the world a little differently. When he finds himself around other kids that he doesn't know (or adults for that matter), he quickly becomes acquainted with them by saying, "hi friend." It seems that he sees pretty much everyone as friends, or as potential friends. What a nice way to view the world!

His refreshing and innocent view of the world reminds me of the psychological concept known as unconditional positive regard. This is a term made popular by the psychologist Carl Rogers, and it refers to the attitude that mental health practitioners are encouraged to develop (somewhat depending on their style of practice and school of thought). It makes sense to me that in order to help my patients, it is important to maintain an attitude of unconditional positive regard. Of course this doesn't mean that I accept or approve of their poor behaviors, but it does encourage me, like other practitioners, to provide the emotionally safe environment that will facilitate the patient "working through" their stuff. I believe this emotionally safe environment is useful in hard core psychotherapy, and it is also useful even in situations where the doc is mostly doing "medication management." And beyond the clinical setting, I think that the concept of unconditional positive regard has great potential to improve our day to day interactions.

Imagine how pleasant it would be to see potential friends in everyone you meet. And consider how nice it would be for all of us to possess the attitude of unconditional positive regard as we interact with each
other.

I'm thinking of writing a song, something like, "what the world needs now is unconditional positive regard, sweet unconditional positive regard, it's the only thing that there's just too little of . . ." (apoligies to Jackie DeShannon, Hal David, and Burt Bacharach)

Thanks for reading, friend
Comments are welcome and encouraged,

Doctor Mike

IATROGENIC aka UNINTENDED CONSEQUENCES

2012-07-02T22:16:00.000-06:00

"Remember, there is no condition that surgery cannot make worse." Such was the sage insight offered to me by my former anatomy lab partner who went on to become an orthopedic surgeon. I don't recall what prompted him to say such a thing, and I don't know if he had given it much thought, but I've thought about that comment several times since, and I think it is a quite insightful comment.

The medical profession has done an excellent job of promoting high expectations. And that is not necessarily a bad thing. Physicians have so many more tools at their disposal now than in the past, and many maladies that have tormented people in the past are dealt with much more effectively in today's world. It is a great time to be a doctor (if you can avoid thinking about insurance companies, lawyers, politicians, and bureaucrats). And it's not a bad time to be a patient.

However, medicine remains an imperfect art. Even with the great tools and expanding knowledge base, sometimes things do not go as hoped. There remains an element of risk in all medical or surgical interventions. Sometimes good intentions lead to poor outcomes. There are times when the cure is worse than the illness. This was true in the days of George Washington (whose demise was unintentionally facilitated by the common practice of blood letting), and it remains true today. In medicine a well intended cure may leave the patient worse off.

The idea that a good intention may lead to a bad outcome is true not only in medicine, but is true in other areas of life and society as well. During this politically charged season, I hope that those who find themselves charged with the task (and privilege) of leadership will pause and consider the possibility that the cure, in some cases, may be worse than the illness; I hope they will consider "the law of unintentional consequences," and I hope they will consider that "there is no condition that surgery cannot make worse." Sometimes it is best to leave well enough alone.

Thanks for reading, your comments are welcomed and encouraged.

By the way, the definition of "Iatrogenic" is - iatrogenic /iat·ro·gen·ic/ (i-ă´tro-jen´ik) resulting from the activity of physicians; said of any adverse condition in a patient resulting from treatment by a physician or surgeon.

Doctor Mike

Dollars and Sense

2012-05-23T17:41:00.000-06:00

It's been said that having money is a poor way to be rich.

I very much agree with that sentiment (point of clarification - in my view money is fine, but if it cankers your soul you're losing out).

Narcissistic Personality Disorder is defined by the DSM IV TR as follows: "A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

has a grandiose sense of self -importance,
is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love,
believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions),
requires excessive admiration,
has a sense of entitlement,
is inter-personally exploitative,
lacks empathy,
is often envious of others, or believes that others are envious of him or her, and
shows arrogant, haughty behaviors or attitudes.

The DSM does a nice job of defining Narcissistic personality disorder, but it seems a bit cumbersome to me. In order to grasp the essence of a mental disorder such as Narcissistic Personality Disorder (or other things for that matter), I think it is useful to create a mental picture that captures the features of whatever it is you are trying to remember. In the case of Narcissistic personality disorder, I imagine someone driving a car they probably can't afford, parking it at a restaurant they probably can't afford, taking up two parking places at that restaurant (even though it is obviously crowded and parking is in short supply), and then "blowing a gasket" when some undeserving person has the audacity to squeeze into a single parking spot nearby.

This describes fairly well a situation encountered by my son and his wife. Recently he and his wife went out to dinner at a fairly nice restaurant. Unfortunately parking was scarce, but they did manage to squeeze into a parking place next to an expensive car. The driver of the expensive car parked so as to occupy two parking spots, even though the parking, as already mentioned, was in short supply. Following dinner my son and his wife returned to their car and found waiting for them a fairly irate woman and several of her somewhat inebriated associates. This woman proceeded to lash out verbally in a way that embarrassed her friends - and certainly should have embarrassed her, as she quite effectively demonstrated all nine of the criteria listed above for a diagnosis of Narcissistic Personality Disorder.

When I learned of this I felt sympathy for my son and his wife, and I felt something approaching sympathy for the unfortunate woman who is so full of herself that there is nothing left.

If you are interested in an interesting and detailed discussion of this disorder you might consider getting a copy of Doctor M. Scott Peck's book entitled "People of the Lie." In that book Dr. Peck discusses many examples of evil, and finds that evil is often associated with narcissistic personality disorder. I understand that scientists and scholars don't often discuss things in terms of good and evil, but perhaps it may help to do so at times. M. Scott Peck is also the author of "The Road Less Traveled," you've probably heard of that book.

I understand that diagnosing from afar can be tricky, and I could be off the mark. However, the circumstances lend themselves quite well to a discussion of this disorder. Hopefully you don't have too many people around you with this problem, it can be pretty tedious.

One other thing, diagnostic labels, such as Narcissistic Personality Disorder, serve to describe patterns of behavior, but do not alter the issue of culpability or responsibility. A person guilty of obnoxious behavior, regardless of the diagnostic label that might be attached, still has the opportunity to improve that behavior. A diagnosis generally is not sufficient to excuse bad behavior.

Thanks for reading. Please leave a comment if you'd like

Doctor Mike

Place the mask on yourself first

2012-04-14T21:55:00.001-06:00

In the course of my work I occasionally come across someone who is doing all they can to be helpful to someone else. These helpers may do things such as drive patients to their appointments, shop for them, sort their mail, pay their bills, clean up after them, walk their dog, and listen to them complain. They do this not really expecting anything in return (although they certainly appreciate an occasional thank you). Often these helpers feel guilty if they are not able to complete all of the tasks given to them by the patient.
I appreciate those good souls who are willing to forego their own comfort and leisure in the interest of helping someone else. It seems to me, when I am in one of my more cranky moods, that the world has an ample supply of people who are selfishly focused on their own "needs." So with that awareness, I am especially grateful for those charitable souls who are able to look beyond their own comfort as they consider the discomfort and pains of others. I sometimes worry that some of these caregivers may take on too much. As I see it, it is not really my role to tell caregivers when they have taken on too big of a load (there may be a few Mother Theresas around who can carry a huge load), but I do feel good about acknowledging the burden, and suggesting that it is appropriate, and perhaps necessary, that they care for themselves along the way as well.

When on an airplane, it is the usual practice for the flight attendant to remind us that if the cabin decompresses we need to put the oxygen mask on ourselves first, I think that there is a message there for caregivers. The message to me is that if you don't maintain your own well-being you won't be much good to anyone else. Patients get the attention they need, hopefully. Caregivers sometimes do not.

Thanks for reading,
Leave a comment if you'd like,

Doctor Mike

Pets and PTSD

2012-04-07T08:38:00.001-06:00

In the world of science there are concepts that defy common expectations, such as quantum entanglement, gravitational time distortions, and black holes. Occasionally, however, there are scientific findings that fit comfortably with our expectations. One such finding is that pets make us feel better. Actually quite a bit of information exists regarding the mental and physical benefits associated with pets. A quick review of some recent headlines in Medscape (www.medscape.com) includes things like, "Dog Therapy in Waiting Rooms Calms and Eases Pain", "Animal assisted Therapy Can Decrease Anxiety Before an MRI", and "Therapy dogs, integrated with more traditional forms of treatment, can improve therapeutic results"

I recently completed a review focused on the various treatment options for Post Traumatic Stress Disorder (aka PTSD). The speaker was Elspeth Cameron Ritchie, MD, MPH, Chief Clinical Officer, Department of Mental Health, Washington, DC, (audio digest psychiatry volume 40 issue #13). PTSD is an important topic, important because it can be quite debilitating, and because if affects so many people. PTSD is a condition that may occur in people who have been exposed to a severe or life threatening event. Such an event might occur in battle, or in a violent crime, or a serious accident. Symptoms of PTSD include re-experiencing the trauma in some way, such as with flashbacks, or with disturbing nightmares. In addition, the person with PTSD experiences an alteration in their level of psychological and physiological arousal. This results in hyper-vigilance, increased startle reaction, poor sleep, increased anxiety, and other distressing symptoms. In the review I recently completed Dr. Ritchie spoke about various counseling techniques and medications that might be helpful in treating folks with PTSD. In addition, Dr. Ritchie underscored recent observations suggesting that pairing a recently returned veteran who suffers with PTSD with a dog results in a clear reduction of some PTSD symptoms. The magnitude of the benefit may be equal to or greater than medications. Dogs may promote the social and emotional wellbeing of PTSD sufferers.

As I noted above, there are additional studies looking at the role of pets in maintaining and promoting mental health, and I believe that there is good evidence supporting the positive impact of pets on our lives.

Thanks for reading, please leave a comment if you'd like.

Doctor Mike

Chimps Day Off

2012-03-23T18:35:00.001-06:00

Ok, so my last blog entry was on the serious side, maybe it's time for something a little lighter. I had in mind to entitle this blog "Low Tech Accidental Study Of Primate Gender Behavioral Differences," but I'm afraid that might not have caught your attention, even though it sums up pretty well what happened many years ago at one of my many different jobs.

Years ago I had the opportunity to participate in an accidental study of primate behavior. At the time I had a job at the local zoo. My primary responsibilities were to keep the grass green and the garbage picked up. I enjoyed interacting with many co-workers and animals in the course of my daily routine. As I recall, I was being paid less than a dollar an hour, which was fine because it was a fun job (but certainly not easy). I got free food from the girls at the concession stands (please don't let the bosses know), I played with a lot of exotic animals, and there were a lot of cute 15 and 16 year old girls working there - what a great gig.

One bright morning, prior to the gates being opened to the public, I heard the announcement over the PA system for all keepers to report immediately to the great apes building. I was more of a grounds keeper than an animal keeper, but I thought I'd go anyway to see what was going on. Four adult chimpanzees were on the loose. Apparently the holding cage had not been properly secured - the chimps hit the cage door, it flung open, the stunned keeper hit the floor, and the chimps headed out the back door. So here we have four chimps on the loose - 2 females, and 2 males. I sprinted off hoping to find the escapees. As I circled around the giraffe enclosure I came face to face with the two adult male chimpanzees.

They appeared intent on making it to the golf course adjacent to the zoo grounds. They were only about one good tee shot away from the fairway when they found me standing in their way. Fortunately they stopped in their tracks, as did I. I felt no fear - after all I was 15, male, and a high school football player, consequently I didn't have the sense at the time to see any danger. We stood there for a little while, just me and two big chimps. Soon several other keepers caught up to us. The chimps recognized their usual keeper and the zoo director, and the chimps cautiously approached them. Eventually they made it back to their enclosure and things got back to normal.
I found it interesting at the time that the two male chimps headed straight to the golf course, as if instinctively knowing where to go, while the two female chimps went "shopping" in an uninhabited part of the zoo where they could find berries and other things.
The event fortunately had a happy ending. The chimps were returned to their usual residence, and no one (human or otherwise) was harmed. And I was left with a fun story about chasing wild chimpanzees. How many city slicker kids have a chance to have such an experience?

I don't believe there has been any attempt to replicate this accidental study, but it might be interesting to see if there is indeed a golf instinct built into male primates, or a shopping instinct built into female primates.

Thanks for reading - please leave a comment if you feel so inclined.

Doctor Mike

What's it all about?

2012-03-14T21:43:00.000-06:00

Too many of my friends are suffering with serious or life threatening illnesses. These serious circumstances are very difficult, but do serve to refocus priorities. And they have caused me to reflect on events in my life that have helped me clarify my own priorities.

I remember a time as a young father. My first born infant son had a little bit of a croupy cough that quickly became much worse. Soon we found ourselves in the emergency room with a child barely breathing, too fatigued to do much more than whimper, whose lips and fingernails turned blue with even the slightest extra exertion. Clearly he was not doing well. Before the night was over he had experienced a respiratory arrest even as he was held on my lap while receiving a respiratory therapy treatment. During that arrest he was unresponsive, even during the painful procedure of an arterial blood gas (requiring obtaining a blood sample from his radial artery). He was subsequently admitted to the intensive care unit.
At the time I was an undergraduate college student, and was becoming more serious about my studies. I had hopes of improving my grades and doing well enough that I might eventually be considered for admission to medical school. As I recall, I had a couple of major papers due and a couple of major tests within a day or two of my son being admitted to the ICU. My infant son's experience in the hospital brought a few things into focus for me. It became very clear to me that even though school was important, it was trivial compared to the life and well-being of my son. It became clear to me that in life some things really are important, and some things really are not. Those papers and tests that were due in the next few days suddenly became so much less important than they had been just a few days earlier. I had been given a new understanding of what is important and what isn't. I'm not arguing against doing well in school, and I think it is important to do a good job of whatever it is you are doing - but it is nice to have some perspective regarding the relative importance of things.

In the big scheme of things, some things are not really big things. Of course it is important that we pay attention to the mundane details of life, but it is also important that we not confuse the mundane details of life for the fundamental principles of our life. Let us not lose sight of the forest for the trees. Some of those core issues that ought not be overlooked include things such as family, faith, friends, purpose, meaning, integrity, charity, service,and fidelity to values. Sometimes it takes a near death experience, either your own or someone close to you, to be reminded of the things that matter most.
It has now been quite a few years since that long and difficult night in the ICU. I remember that night like it was just a few days ago. I am grateful for the lessons of that night, even though those lessons were very painful. By the way, my son survived that difficult night, and has thrived since. Many times since then we have wrestled together, as dads and sons sometimes do, and for many years I could overpower him. However, in recent years it really hasn't been much of a contest - now he quickly overpowers me, and I have slowly learned not to provoke those wrestling matches. Even though I don't compete very well anymore when we wrestle, it is still a sweet victory when I consider how things might have been.

Just of few thoughts on life, perspective, what really is important, and what really isn't. Thanks for reading and feel free to leave a comment if you'd like.

Doctor Mike

Ex-spouses, kids, and personality.

2012-03-05T16:58:00.004-07:00

So I'm dealing with a patient today who asks me if her daughter is going to inherit her father's obnoxious personality. This prompted a discussion about personality, behavior, environment, genetics, and choice. I explained that certainly genetics plays a role in determining personality characteristics, but is not the only factor. Other factors include learned behaviors, social environment, psychological issues, and other biologic factors. This discussion led to consideration of "personality disorders" and what may falsely appear as a personality disorder. We agreed that ongoing physical illness and chronic pain syndromes can contribute to what appears to be personality disorders. I recognize that in some cases people who have been diagnosed with personality disorders lose that diagnosis after their chronic physical problems are cleared up. By the way, there are several different personality disorders, according to the latest edition of the DSM-IV (the diagnostic manual used in psychiatry and related fields).

Each of those disorders has in common "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas:

cognition (ways of perceiving and interpreting self, others, and events),
affectivity (i.e. the range, intensity, lability, and appropriateness of emotional response),
interpersonal functioning, and
impulse control.

The enduring pattern is inflexible across a broad range of personal and social situations.The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning. The pattern is stable and of long duration and its onset can be traced back to adolescence or early adulthood." The DSM includes a couple of disclaimers addressing possibility of other psychiatric or physical problems that may cause or contribute to the clinical presentation. So the short answer is that the daughter most likely will inherit some potential to develop a personality similar to her father's. She will also inherit some potential to develop a personality similar to her mother's. Anyone with more than one child will likely recognize that each child comes with their own set of personality traits. The genetics of personality are complex, polygenic (i.e. many genes working in concert), and beyond the scope of this paragraph. The actual outcome will be a reflection of at least several factors in addition to her genetic predisposition, including: environmental influences (e.g. school quality, friends, financial issues), psychological issues (e.g. motivations, values, learned behaviors, etc.), and choice. Choice, or willfulness, is the variable that trumps others, in my estimation, and is also the variable most difficult to get a handle on.

OK, so that really wasn't such a short answer - but please understand that the answer to why we behave as we do could be much much longer than this comment.

Thanks again for reading, please leave a comment if you'd like.

Doctor Mike

Where did the pictures go?

2012-03-03T08:29:00.000-07:00

Just a quick update - Those of you who are familiar with this blog will realize that the interesting images have been removed. I've realized that, as stated by Google, "images may be subject to copyright." So in order to avoid misuse of someone else's work I have decided to remove the images and look for a hassle free source of similar images. I hope you enjoy reading the blog anyway.

Thanks,

Doctor Mike

Healing - Some Thoughts on Doctors

2012-03-02T15:25:00.003-07:00

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Some patients, though conscious that their condition is perilous, recover their health simply through their contentment with the goodness of the physician. Hippocrates 460 – 400 B.C.E.

The editors of the first edition of Harrison’s Principles of Internal Medicine, a book that is on the shelf of just about every M.D., noted that “no greater opportunity, responsibility, or obligation can fall to the lot of a human being than to become a physician. In the care of the suffering he needs technical skills, scientific knowledge, and human understanding. He who uses these with courage, with humility, and with wisdom will provide a unique service for his fellow man, and will build an enduring edifice of character within himself. The physician should ask of his destiny no more than this, he should be content with no less. Tact, sympathy, and understanding are expected of the physician, for the patient is no mere collection of symptoms, signs, disordered functions, damaged organs, and disturbed emotions. He is human, fearful, and hopeful, seeking relief, help and reassurance.” Continuing on - “the true physician has a Shakespearean breadth of interest in the wise and in the foolish, the proud and the humble, the stoic hero and the whining rogue – he cares for people.”

On the physician’s role regarding hope, the great physician William Osler noted, referring to physicians, “One thing is certain, it is not for you to don the black cap and assuming the judicial function take hope away from any patient . . . hope that comes to us all.”

Your doctor's primary responsibility, as stated by Hippocrates is “first do no harm”. What this means to me is that your doctor should be conservative in his or her approach, should acknowledge the limits of his or her skills and knowledge, and should recognize the limits of medical knowledge. He or she must then carefully weigh the possible benefits of the treatment being considered against the possible problems related to that treatment. He or she should discuss those possible benefits and risks with you, and together you and the physician should go about making a decision. The patient, if able, should be informed and should fully participate in the decision making process. Patients and doctors need to understand that medical treatment remains very much an art, and that remedies may come with their own set of problems. Medicine cannot solve all ills, and this is probably a good thing (and that may be a topic for a later blog). Sometimes in the practice of psychiatry I feel frustrated because of my inability to fix all of the problems that are presented to me. I remind myself that life is full of challenges, and then I go about trying to reduce the size of some of those challenges for my patients, even while recognizing that other challenges will remain.

Thank you for reading. I hope you recognize your doctor in these comments. I remain impressed by the intellectual and emotional capacities of my physician colleagues. Please leave a comment if you feel so inclined. I'd love to hear what you like about your doc, as well as what concerns you have.

Doctor Mike

Life, Liberty, and the Pursuit of Happiness

2012-02-27T22:25:00.000-07:00

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are Life, Liberty, and the Pursuit of Happiness.

The pursuit of happiness is, as underscored in the American Declaration of Independence, one of the fundamental rights possessed by all people.

I’ve had it on my mind to write a little bit about happiness – what it is, and how to get more of it. That ought to be a simple task. However the more I look into it, the more I am reminded of the many factors that are relevant to a discussion on happiness. And I think it may take more than one blog post to discuss this.

I attended the psychiatric congress a few months ago. It is an annual meeting for psychiatrists to get together and learn from each other. If you can imagine a couple thousand shrinks all hanging out together at your local conference center, you’ll have an idea of what the psychiatric congress is like. At the recent meeting, I attended a wide variety of lectures. A tantalizing lecture on the topic of happiness was presented by Jeff Victoroff, MD, MA. I learned that a simple definition of happiness is, “the degree to which someone evaluates positively the overall quality of his or her life as a whole.”

There are two (at least) types of happiness – Hedonic and Eudaimonic. Hedonic happiness is that type of happiness associated with things such as winning the lottery, getting the date, driving the fast car, enjoying that intimate encounter, etc.. Eudaimonic pleasure has to do with the more long lasting experiences of contentment, peacefulness, and fulfillment. I would argue that it is good to have some of both hedonic and eudaimonic pleasure in our lives.

Other than the obvious benefits of happiness, are there other reasons to cultivate happiness in our lives? It has been recognized people who report being happy at age 18 are more likely to have more prestigious jobs at age 26. Happy people experience higher incomes, longer lives, fewer accidents, and less susceptibility to some viruses. I think it is interesting to note that life satisfaction peaks at around 65 or so – that might seem counter-intuitive with our youth obsessed society. Beauty doesn’t necessarily lead to happiness – fashion models have about the same rate of happiness as non-models. Exercise leads to happiness (causation not clear, perhaps there is an underlying mechanism affecting both). Lottery winners receive temporary boost in happiness, but return to their baseline level of happiness. Happiness (or subjective wellbeing) requires enough money to cover the basics; additional wealth adds little to feelings of wellbeing (although I’m sure many of us would like to challenge that conclusion). Higher education may actually interfere with happiness, by creating higher levels of aspirations. Where you live may affect your happiness. On a World Values Survey, 1997 – 2000, Nigeria achieved the highest happiness rank with a score of 299, USA had a score of 89, and Iraq came in with a score of -127 (that's a negative 127 for Iraq). Why are some countries happier than others? I’m not sure but it appears that there is an association between happiness and freedom. Marriage, social connectedness, and religious observance all promote happiness. Biologic and genetic factors certainly play a large role in happiness. Some of the things that may enhance lasting happiness include; expressing gratitude, meditation, regular aerobic exercise, regularly recording positive events, and pursuing a valued goal (and accomplishing that goal, especially if initially it was felt to be unattainable). Biologic interventions that may help include antidepressant medications, hormone replacement for women, transcranial magnetic stimulation, and vagal nerve stimulation.

Happy people generally have: “happy genes”, extraverted personalities, control of their own destinies, time for leisure, sufficient wealth to match their educational level, good social connections, good health, and valued goals that they are progressing toward.

And now, a few thoughts on happiness from various luminaries –

Benjamin Franklin said, “Money has never made man happy, nor will it; there is nothing in its nature to produce happiness. The more of it one has the more one wants.”

Socrates said, “By all means, marry. If you get a good wife, you'll become happy; if you get a bad one, you'll become a philosopher.”

Mother Teresa said, “The miracle is not that we do this work, but that we are happy to do it.”

Albert Einstein said, “A table, a chair, a bowl of fruit and a violin; what else does a man need to be happy?”

Victor Frankl, M.D. said, "Happiness cannot be pursued, it must ensue, and it only does so as the unintended side effect of one's personal dedication to a cause greater than oneself or as the by-product of one's surrender to a person other than oneself."

These comments serve to underscore some of the earlier points, such as the need for good social relationships, the need for a worthy cause, and the minor contribution of wealth in the “happiness equation.”

One other concept to consider is the “Hedonistic paradox.” Existentialists have made the argument, which I agree with, that a life spent in the pursuit of pleasure results in a soul that is withered and still unsatisfied. John Stuart Mill stated, “Those only are happy who have their minds fixed on some object other than their own happiness … Aiming thus at something else, they find happiness along the way."

Those of you familiar with cats will appreciate the succinct comment made by William Bennett, "Happiness is like a cat, if you try to coax it or call it, it will avoid you; it will never come. But if you pay no attention to it and go about your business, you'll find it rubbing against your legs and jumping into your lap”

The Creator, who endowed us with unalienable rights, including the right to pursue happiness, also gave us some guidance on how we might find that happiness, as stated in the New Testament, "For whosoever will save his life shall lose it: and whosoever will lose his life for my sake shall find it." (Matthew 16:25)

Much more could be written on this topic, and certainly much more has been written. I hope you find much lasting happiness, the kind that comes from not directly pursuing it. Thanks for reading. Please leave a comment if you’d like.

Doctor Mike

Do you have some change?

2012-02-17T20:24:00.002-07:00

"When you're finished changing, you're finished." - Benjamin Franklin

"Life belongs to the living, and he who lives must be prepared for changes." - Johann Wolfgang von Goethe

"Everyone thinks of changing the world, but no one thinks of changing himself." - Leo Tolstoy

"Lord, where we are wrong, make us willing to change; where we are right, make us easy to live with." Peter Marshall

Recently someone asked me about change. Specifically, the question was something like “Can people really change? And if they can, how do they go about it?” This seems like a fairly simple and straightforward question. No doubt many of us have wondered why those around us have such a tough time making a positive change. Some may have even considered why it is difficult to bring about change in their own lives. A fair amount has been written about change and “change theories”

A framework I am familiar with is the change theory espoused by Prochaska and DiClemente. In this view of change they consider various cognitive states associated with change, including: pre-contemplative (consciously unaware of need for change), contemplative (individual is aware of change opportunity, but not committed to the change). Preparation is the next stage, and occurs when an individual is ready to change and has plans to do so within a short period of time (e.g. 2 weeks). This is followed by the action stage, when change is actually implemented, and finally the maintenance stage. In this final stage the individual adopts a lifestyle that reinforces the change.

There are other (probably many) “change theories.” One of the ideas that makes sense to me is a principle referred to as Le Chatelier’s principle. Le Chatelier was a French chemist and engineer living in the late 1800’s. Le Chatlier’s principle is a succinct statement that I first heard about back in my inorganic chemistry days. It obviously pertains to the physical sciences, and it seems to me that it also pertains to the social and behavioral sciences. Le Chatlier’s principle may be stated as follows - “a chemical system, initially at equilibrium, when subjected to a change in concentration, temperature, volume, or partial pressure, will experience a shift in the equilibrium to counteract the imposed change and a new equilibrium will be established.” I don’t know much about Le Chatlier, but I assume he was more interested in physical sciences (engineering, chemistry, physics, etc.) than he was in social sciences – it seems to me, however, that the principle named after him has application in the social and interpersonal realms as well. Perhaps the social form of Le Chatelier's principle might be written as follows - "a relationship, initially at equilibrium, when subjected to a change in attitude, intensity, physical environment, and external pressures will experience a shift in the relationship to counteract the imposed change and a new relationship equilibrium will be established." That new equilibrium can be a good thing or not, depending on the variables in the equation. The concentration, temperature, volume, partial pressure and equilibrium factors he was interested in may be analogous to interpersonal issues such as: attitude, intensity of the relationship, motivaton , emotional environment, external pressures (work, sleep, finances, etc.), and outside considerations (e.g. cultural and family issues).

So, in answer to the question, "can people really change?" the answer is yes, they can. Change is an essential and inescapable part of life. Perhaps by understanding the variables that influence change, a more positive outcome will occur.

One of the variables not directly referred to above is the most human of variables - free will. Our ability to make a judgment and choose a course of action is a wonderful and sublime aspect of our human natures. Free will is a reality that challenges scientists and philosophers. Free will is a huge topic, and will be considered in a future blog.

Thanks for reading. Please tell your friends and neighbors about this blog, and let me know if you have a topic you're interested in.

Puzzles and Parts

2012-02-08T21:00:00.002-07:00

I often find myself with a patient who wonders why they aren't all the way better. Often they have made some improvement and are doing better than when they started, but they still haven't arrived at that state of optimal functioning - where all 8 cylinders are firing smoothly and effectively. Working together we may have picked out a course of treatment that makes sense, but now they are feeling some frustration, as am I.

Often in such a situation I remind my patient (and myself) that there are many parts of "life fitness." And (please excuse me for switching metaphors) I talk about life being like a puzzle, where maybe most of the parts are in place, but if one or two parts are missing then the puzzle doesn't fit together very well, and the result is less than satisfying. The puzzle includes things like nutrition, exercise, relationships, financial stability, work, sleep, recreation, meaning, and many other things. Sometimes I have patients who are disappointed that the medication they are taking hasn't solved all their problems. I point out that the medication is only one part of the puzzle, and that other things need to be addressed as well. Other patients may be doing a good job of taking care of things generally, but still are not doing well or feeling well (and they may avoid using medications). In some cases the right medication is the missing piece of the puzzle, and when it is put in place then other things come together and the patient does fine. Just to be clear, I don't believe that medications are necessary or appropriate for all people who walk into my office. But just like insulin may be a necessary part of the puzzle when managing diabetes, psychiatric meds can be a very important part of the puzzle when helping people who struggle with psychiatric illness. I also consider counseling to often be an important part of the puzzle for many people.

In medical training doctors get some encouragement to think of psychologic and social factors, as well as biologic factors, that may contribute to (or detract from) a patient's health. In psychiatry training the "bio-psycho-social" mantra is heavily emphasized. Psychiatrists learn to consider how the different and varied parts of the bio-psycho-social puzzle fit together. Each of these broad domains may be considered its own puzzle, with many different pieces. (I may explore each of these domains later on, but this blog has probably gone on long enough for now.) I feel it is useful to consider each of these broad domains in our own lives as we try to make our own puzzle pieces fit together.

Thanks for reading.

Doctor Mike

24 More

2012-02-02T08:17:00.000-07:00

There are times when I think I should be a country western singer, except that I don't sing very well and I can't play the guitar. But I do have a ready supply of sad tales that could make for many heart wrenching country western ballads. I could write lyrics about misbehavin' kids, cheatin men (and women), lousy bosses, broken down pick up trucks, and run away dogs. Some of the stories are truly sad, and I'm left not quite knowing what to say - stories of poverty and pain, stories of grief and heartache, stories of betrayal. Other stories aren't quite as earth shattering - like the time the woman in my office was all teary eyed and weepy because her cat died😢 After I expressed my genuine feelings of sympathy she responded with, "Oh it's ok, I have 24 more at home." I am often impressed with the strength and resiliency that some people demonstrate, and I wonder how I would handle similar problems.

It seems to me that everyone has a few things to work on and to overcome as they travel life's journey. Some of those opportunities for growth are not very subtle, such as come in the form of poverty, and sickness. Other opportunities for growth may be much less obvious. Some people find themselves blessed with power, health, wealth, good friends, and a great family. What are their challenges? I think it was Abraham Lincoln who said something like, "if you really want to test a man's character, give him power." I agree with President Lincoln - character can be revealed by the good things of life, as well as the bad. If you are fortunate enough not to be worried about the day to day challenge of paying the rent, what are your challenges? Is it your focus in life to improve your golf score, or to drive a fancier car (point of clarification - I have nothing against golf or nice cars) - or is there something more substantial you might accomplish? Perhaps there remains a country song to be written about the challenge of having it all.

Just a few of my thoughts. Thanks for reading. Feel free to leave a comment if you'd like.

Life Fitness

2012-02-02T08:10:00.000-07:00

Since I was a young pup I have enjoyed generally good health, and I am grateful for that. My older brother would often entice me to go out at night and run a few laps around the block. That helped to establish a good exercise habit. That habit continues, and I find myself in the local gym occasionally. The gym, of course is often full of very fit folks (and a few of us who are still working at it). I see people who can bench press 400 lbs, others who can run non-stop for hours, a few who can dunk a basketball, and others who can combine exercise, music, and dance in a great workout routine (you won't see me doing that). I think it is great that there are so many who are taking such great care of their health. I frequently "prescribe" exercise to my patients - the physical and mental health benefits of regular exercise are significant, and worth pursuing. I will discuss that in more detail in a later blog.

A topic related to fitness, is what I refer to as "life fitness." Life fitness is more than physical fitness, although physical fitness is part of it. A person who is "life fit" is someone who is able to roll with the punches that life throws at them. This may include actual physical punches, but more likely it involves the punches that come in the form of disappointments, illness, family issues, financial setbacks, relationship challenges, and spiritual distress. I've observed that it is difficult to know of someone's character in the absence of challenge or frustration. It is clear to me that a person's level of "life fitness" is more evident at times of disappointment and stress than at times of peace and ease. Why is it that some people are so good at bouncing back from the hard punches that life throws at them? I'd like to introduce a few concepts that might shed some light on this, but that will follow in a later posting. For now, please consider that being "life fit" is something beyond or in addition to physical fitness.

Thanks for reading, and feel free to enter a comment if so inclined.

Big Gulp

2012-02-02T07:56:00.000-07:00

"Dr. Mike, I need more Ambien" - a common request. Often the person making such a request is sitting in my office with their 32 ounce bottle of cola in hand, the first of several that they will likely consume during the day. That same patient likely is experiencing anxiety, irritability, mood swings, and poor sleep. I think I may have acquired a reputation as the caffeine "Nazi", because when patients request a sleep medication, they often get my discussion about the deleterious effects of caffeine. Too often folks have been inaccurately diagnosed with a serious diagnosis like bipolar disorder when really the problem is too much caffeine. I've been impressed with how often things seem to settle down when patients decrease their caffeine consumption. I've told myself, and a few patients as well, that I will quit saying anything about caffeine when my patients quit telling me that they are doing better after decreasing their caffeine intake.

Now I am not entirely against caffeine. It is a useful drug in some situations. It promotes wakefulness, in some people it may increase athletic abilities (not everyone experiences that same benefit). It may provide a mental boost at times. In some situations it may help with headaches. And it can help to open airways. I have benefitted while on long drives from caffeine's ability to promote alertness. It does other things that may not be intended, such as interfering with the absorption of some drugs (e.g. antipsychotics). The diagnostic manual for psychiatry (DSM-IV-TR) lists several undesirable effects of caffeine under the diagnosis of caffeine intoxication - including: restlessness, nervousness, excitement, insomnia, flushed face, diuresis (e.g. excessive urination), gastrointestinal disturbance, muscle twitching, rambling flow of though and speech, heart racing and heart arrhythmia, periods of inexhaustibly, and psycho-motor agitation. These symptoms do not necessarily require consumption of a large amount of caffeine, two or three cups of coffee may be sufficient to bring about many of these symptoms in susceptible people. Some patients may still get the requested Ambien or similar medication, but only after they have made some behavioral changes, including reducing caffeine consumption first.

Averted tragedy

2012-01-27T22:09:00.001-07:00

Recently there has been a story in the news about a couple of teenagers who, fortunately, have been thwarted in their efforts to commit mass murder and mayhem. Judging from the news reports, these two young men had elaborate plans to detonate a bomb of some sort during a high school assembly. They had carefully done their homework – they had scoped out the school, they knew the location of security cameras, they knew the private exits from the school, they had an elaborate escape plan which involved stealing an airplane, and one of them had even gone to Columbine High School, the site of a previous mass murder, apparently to gain some insight into how to carry out such a crime It sounds like they were serious, and it sounds like they had prepared well to carry out their awful plans. We can all be grateful that their plans did not come to fruition.

Why would they attempt such an atrocity? I don’t know that I can give a simple and short answer to that question. And I don’t know that I can give a long and complicated answer to that question either. However, I was doing a little light reading this evening and happened upon an article entitled “The ‘Pseudocommando’ mass murderer: A blaze of Vainglory (written by James L. Knoll IV MD).” The article is available in the Psychiatric Times (www.psychiatrictimes.com ). You need to register to get access to the article. At this point you may be thinking that I should stick to the sports page, and you’re probably right. I will not try to summarize the article here, other than to say that a combination of factors such as; injured egos, revenge fantasies, narcissistic rage, alienation, perceived injustice, and other variables are often present in these situations. There are efforts ongoing to more quickly identify individuals who might engage in such behavior. It is a difficult area to study because these events are few and far between – for which I am grateful.

I’ll get back to lighter topics soon.

Thanks for reading. Leave a comment if you’d like.

500 TRILLION (not the national debt)

2012-01-24T21:57:00.000-07:00

Thank you for spending a few minutes with my blog site. I appreciate the encouraging comments. I hope you find it useful, and perhaps a little entertaining. The focus of my blog site is "life fitness," and I happen to think that psychiatrists are in a pretty good position to comment on this topic. Some may not know that Psychiatrists are medical doctors. The path to becoming a psychiatrist is similar to the path to becoming an internist, or a pediatrician, or a cardiologist. All medical specialties require 4 years of medical school, followed by residency training (usually 3 - 6 or 7 years in duration). Residency training is where physicians develop expertise in their particular specialty.
Psychiatrists have chosen to focus their attention on the brain and nervous system. I happen to think that the brain is the most fascinating part of our bodies. I recognize that other specialties have their appeal, but the brain is where we live. It is where we perceive the world around us, it is where we synthesize thoughts, it is where we formulate plans, it is where the mind resides. Some may not make a distinction between the brain and the mind, but as I see it, the mind transcends the brain, (and that is a topic for a later discussion). Sir John Eccles, past Nobel Prize winner in Medicine and Physiology, edited a collection of essays entitled "Mind and Brain," and in that series of essays he addresses the mind /brain question. I recommend that book to you if this tickles your fancy. Professor Eccles, himself a religious man, wrote an interesting essay on how it is that the brain might interface with the spiritual domain of reality. So anyway, you might, if you are religiously oriented, also recognize that the brain is the site of interface with the spiritual side of life.

We live in an age of wonderful electronic gadgets. These gadgets have great sophistication, and potentially add greatly to our lives. However, they don't yet compare with the mind boggling complexities of our own minds. Consider a few numbers, just to give you an idea of the complexity. One hundred billion = approximate number of nerve cells in the brain. Ten thousand = the average number of synaptic connections between nerve cells. Five Hundred Trillion= a number larger than our national debt = the number of synaptic connections in the brain. And these numbers are only dealing with neurons. The complexity increases much more when you consider the role of other cell types such as glial cells, and various neurotransmitters, as well as the details of what goes on in the synapse.
Life fitness includes taking care of your amazing and mind boggling brain. I'll discuss ways of doing that in more detail later.
Thanks again for reading - sorry I went a little long. Hopefully you find it interesting. Please comment if you'd like. Your reading and comments reinforce my writing (e.g. operant conditioning).

Getting to the Bottom of things

2012-01-24T20:09:00.000-07:00

I remember sometime back being asked by a physician colleague why I chose psychiatry. I believe the person asking the question was a gastroenterologist doc who spent his professional time looking at the inner workings of his patients through a carefully placed scope.

As interesting as that may be (and I mean no disrespect to my GI colleagues), I do think that those of us in psychiatry have an even better opportunity to really get to the bottom of things. More than other specialties, psychiatry regularly taps into the the realms of the medicine, psychology, sociology, anthropology, philosophy, law, and spirituality (whatever you take that to mean). For me the decision to pursue a career in psychiatry happened in my 4th year of medical school. I considered various other specialties (and there are certainly days when I wonder why I didn't pursue one of those other options), but I eventually decided on psychiatry because I knew it would continue to challenge me over the years. Also, I knew it would help me to better understand this interesting, challenging, amazing, and inspiring journey of life - and that is valuable to me.

I understand that blog posts should not be too long. Short and pithy are desirable descriptors. So, with that in mind, I'll try not to go on too long. However, I do have one psychological principle I'd like to hit on briefly - operant conditioning. Operant conditioning is defined as "a form of learning in which behavioral frequency is altered through the application of positive and negative consequences." This blog site is an exercise in operant conditioning - please reinforce my behavior by returning to this site often, and by inviting friends and family to do the same.