INTIMACY
(To be published in the September 2010 edition of the East Bay Psychiatric Association Newsletter)
Human nature is pretty clear in some areas. Our species seeks affiliation with other human beings, we desire closeness, warmth, physical attention, touching, sex, communication, understanding, and relationships. We need to share our most intimate feelings and thoughts and we need to feel understood. In short, people need people.
Our modern technological society appears to be conspiring to interfere with these basic needs. There’s e-mail, Facebook, Twitter, Skype, cell phones, and i-phones to help us communicate with people instantly and from afar, but what about the actual face-to-face “intimacy” that real relationships provide?
I read recently that nearly half of the teen-age girls in this country are turning to alcohol to help them cope. This suggests that they don’t have others to help them with all of the complex issues that they are flooded with at this juncture in their lives. Where are their mothers, sisters, friends, counselors, and other confidants? Apparently they are nowhere to be found. So the next best thing is to find some solace in getting high or drunk on booze—it’s legal, it’s available, and it works—but only for the briefest of time, at which point the exact same concerns continue to trouble them.
A friend of mine who has been active in AA for over 30 years still puzzles over why this institution works so well, but recently we hit upon an explanation: AA provides “fellowship”. Go to an AA meeting and you are with people who support you, listen to you, call you by name, and make themselves available to you when you are down and out. Where else can you find that? Fellowship is just another aspect of intimacy. It’s not just recovering alcoholics who need an AA model. It’s just about anyone.
People cannot survive well emotionally when they are treated anonymously all the time. The increasing anonymity that characterizes human-to-human interactions in our modern society, including with one’s physician, is unappealing and unpleasant. It recently took my wife 20 minutes to make an appointment for a yearly examination, and when she had finally completed the task through anonymous phone mail and then a nameless person filling in a computerized form for her, that nameless person gave her a “confirmation number” for her appointment. Mind you, she wasn’t making an airline reservation, she was making an appointment for a mammogram!
This abhorrence for anonymity is the same reason, I believe, that people are shopping increasingly at farmer’s markets where they get personal attention, social interaction, and food that is grown by someone they actually meet, and they get to visit with friends and neighbors who may also be at the market. The reasons go well beyond the desire to buy fresh, locally grown food. It’s the same reason that people may prefer to frequent small local banks whose tellers know your name rather than national mega-banks who find creative new ways to charge you suspicious fees. People would rather interact with someone who actually speaks to them as an individual, than with someone who seems to have his hand in your pocket.
Most of us lead excessively hectic lives which can drive us to try to shorten our conversations with others, to communicate as efficiently and remotely as possible with others, and to actually “digitalize” much of the commerce, interactions, and relationships that we engage in. But this lack of intimacy is wearing thin, and I predict we will experience a return to simpler ways sooner than later as people figure out that being anonymous is far less appealing than the closeness and intimacy that is possible with a minimum of effort.
Monday, August 23, 2010
Wednesday, April 07, 2010
CHANGE
(Published in the April 2010 edition of the East Bay Psychiatric Association Newsletter)
Two articles about psychiatry recently caught my eye. Each questioned long-standing tenets of psychiatric diagnosis. The February 2010 edition of Psychiatric Annals was devoted entirely to the rethinking of the dichotomy between schizophrenia and bipolar disorder, positing that the two illnesses are on a single continuum of psychosis—not distinct entities after all. The second was an article in the New Yorker magazine, entitled “Head Case: Can Psychiatry be a Science?” (March 1, 2010). This article questioned psychiatric diagnoses altogether, suggesting inaccurate identification of much of normal human behavior as pathological, often encouraged by pharmaceutical companies as a way to sell their products.
Regardless of the accuracy of each of these striking revisions of thinking, what is implicit is the importance of questioning long-held beliefs and teachings as a means of moving any field of knowledge forward. The fact is that psychiatry is only in an early stage of its understanding of mental illnesses.
Current clinical descriptions of psychiatric disorders are vague and non-specific, yet are presented as if they are scientifically determined and clear-cut diagnostic entities. A hundred years ago physicians talked about “fever” and “infection” as terms for specific medical conditions. It was not until the science of microbiology was developed that differing causes of fever and infection were understood. So it is with psychiatry because brain imaging techniques and genome mapping are being rapidly developed, which will allow for the more precise definition of specific mental illnesses. Psychiatrists will then, with greater certainty, be able to modify their understanding of the two major psychotic conditions, as well as most other current diagnostic entities. Older thinking will fall away, just as has the word “neurotic” in psychiatric nomenclature, even though in the past this term was used freely as if it described some scientifically determined entity.
Less than a hundred years ago psychiatry had a very limited understanding of the human psyche. Even 45 years ago, rudimentary behavioral terms like “stimulus,” “response,” “extinction,” and “reinforcement” were being taught as major tenets of psychology in college courses.
The science of human behavior and brain function has come a long way and is evolving rapidly. It is crucial to be open to new ways of perceiving psychiatric illness. Labeling a patient diagnostically today may give one a false sense of security in terms of what really ails the patient. No two human beings look exactly alike, and no two psychiatric patients completely resemble each other, regardless of their diagnosis.
As the adage states: “Change is the only thing that is constant.” How true!
(Published in the April 2010 edition of the East Bay Psychiatric Association Newsletter)
Two articles about psychiatry recently caught my eye. Each questioned long-standing tenets of psychiatric diagnosis. The February 2010 edition of Psychiatric Annals was devoted entirely to the rethinking of the dichotomy between schizophrenia and bipolar disorder, positing that the two illnesses are on a single continuum of psychosis—not distinct entities after all. The second was an article in the New Yorker magazine, entitled “Head Case: Can Psychiatry be a Science?” (March 1, 2010). This article questioned psychiatric diagnoses altogether, suggesting inaccurate identification of much of normal human behavior as pathological, often encouraged by pharmaceutical companies as a way to sell their products.
Regardless of the accuracy of each of these striking revisions of thinking, what is implicit is the importance of questioning long-held beliefs and teachings as a means of moving any field of knowledge forward. The fact is that psychiatry is only in an early stage of its understanding of mental illnesses.
Current clinical descriptions of psychiatric disorders are vague and non-specific, yet are presented as if they are scientifically determined and clear-cut diagnostic entities. A hundred years ago physicians talked about “fever” and “infection” as terms for specific medical conditions. It was not until the science of microbiology was developed that differing causes of fever and infection were understood. So it is with psychiatry because brain imaging techniques and genome mapping are being rapidly developed, which will allow for the more precise definition of specific mental illnesses. Psychiatrists will then, with greater certainty, be able to modify their understanding of the two major psychotic conditions, as well as most other current diagnostic entities. Older thinking will fall away, just as has the word “neurotic” in psychiatric nomenclature, even though in the past this term was used freely as if it described some scientifically determined entity.
Less than a hundred years ago psychiatry had a very limited understanding of the human psyche. Even 45 years ago, rudimentary behavioral terms like “stimulus,” “response,” “extinction,” and “reinforcement” were being taught as major tenets of psychology in college courses.
The science of human behavior and brain function has come a long way and is evolving rapidly. It is crucial to be open to new ways of perceiving psychiatric illness. Labeling a patient diagnostically today may give one a false sense of security in terms of what really ails the patient. No two human beings look exactly alike, and no two psychiatric patients completely resemble each other, regardless of their diagnosis.
As the adage states: “Change is the only thing that is constant.” How true!
Sunday, March 07, 2010
PLUGGED IN
(Published in the March 2010 edition of The East Bay Psychiatric Association Newsletter)
A recent report indicated that today’s youth spend about 50 hours a week plugged in to high tech products—I Pods, cell phones, video games, computers and a multitude of other electronic devices. Some teens listen to their I Pods while texting on their I Phones while looking at Facebook while “twittering” and sending e-mails. They are often consumed with the stimulation of high tech gadgets to the exclusion of having any time to reflect, ponder, or actually think about anything else.
What has this new age of technology brought us? I suppose like anything else, too much of a good thing is no longer a good thing. Humans can overdose on just about anything: bread, salt, fat, sugar, TV, alcohol, drugs, sex--you name it. Some technology is great, like the access to the universe of information at our fingertips on Google. But how much is too much?
When I was a teenager, I worked in a snack bar for a couple of summers. The day I started work there I asked the manager if I would have to pay for the food I ate or could eat the food for free. “Eat all you want for free,” he said, knowingly. So after about a week of gorging on greasy hamburgers, hot dogs and all the cokes, ice cream sandwiches and candy that my enormous appetite could tolerate, I began to bring my own lunches consisting of anything but those foods that I had quickly come to abhor. It is for this reason, I presume, that people who work in candy shops, ice cream parlors, or bakeries can actually keep their figures. They smell, taste and ingest more than they care to of the sweet products they are selling, and pretty soon the person no longer finds such treats a treat at all, but something to avoid.
But back to technology! When will people get enough of multi tasking, of being constantly “plugged in,” or of being connected to so many people that they don’t have a moment to themselves? When will the normal human desire of wanting to ponder, reflect, and think be restored to some balance so that a person is not just an extension of all the technology that their eyes, ears, and fingers can manage?
Sometimes I wonder if our modern world has become so complex and/or distasteful that people need to escape it through technology or they would go crazy. But life does not need to be so distracting that one cannot respond to the beauty of a sunrise or sunset, the wonder of rain or a rainbow, or the magic of a blossoming flower or a budding tree. When I see people talking on their cell phones or looking at their I- phones when on a nature walk, I wonder why they went on the walk in the first place.
I have a little sign at my front door that says: “Live simply, laugh often, love deeply.” Maybe that’s the reason that my cell phone is about 10 years old, my television 20 years old, and I don’t have an I-phone (yet). I still use a typewriter to do my bills in my office and I still use paper and pencil to schedule my appointments. I have resisted technology when I feel it would make my life more complicated, not less, and I try to live according to that adage at my front door. As I get a little older, I know I’ll add more technology to my life if that helps me simplify things. But I refuse to miss the natural beauty, joy, and wonder of the moment that have absolutely nothing to do with technology, but are simply part of being human.
(Published in the March 2010 edition of The East Bay Psychiatric Association Newsletter)
A recent report indicated that today’s youth spend about 50 hours a week plugged in to high tech products—I Pods, cell phones, video games, computers and a multitude of other electronic devices. Some teens listen to their I Pods while texting on their I Phones while looking at Facebook while “twittering” and sending e-mails. They are often consumed with the stimulation of high tech gadgets to the exclusion of having any time to reflect, ponder, or actually think about anything else.
What has this new age of technology brought us? I suppose like anything else, too much of a good thing is no longer a good thing. Humans can overdose on just about anything: bread, salt, fat, sugar, TV, alcohol, drugs, sex--you name it. Some technology is great, like the access to the universe of information at our fingertips on Google. But how much is too much?
When I was a teenager, I worked in a snack bar for a couple of summers. The day I started work there I asked the manager if I would have to pay for the food I ate or could eat the food for free. “Eat all you want for free,” he said, knowingly. So after about a week of gorging on greasy hamburgers, hot dogs and all the cokes, ice cream sandwiches and candy that my enormous appetite could tolerate, I began to bring my own lunches consisting of anything but those foods that I had quickly come to abhor. It is for this reason, I presume, that people who work in candy shops, ice cream parlors, or bakeries can actually keep their figures. They smell, taste and ingest more than they care to of the sweet products they are selling, and pretty soon the person no longer finds such treats a treat at all, but something to avoid.
But back to technology! When will people get enough of multi tasking, of being constantly “plugged in,” or of being connected to so many people that they don’t have a moment to themselves? When will the normal human desire of wanting to ponder, reflect, and think be restored to some balance so that a person is not just an extension of all the technology that their eyes, ears, and fingers can manage?
Sometimes I wonder if our modern world has become so complex and/or distasteful that people need to escape it through technology or they would go crazy. But life does not need to be so distracting that one cannot respond to the beauty of a sunrise or sunset, the wonder of rain or a rainbow, or the magic of a blossoming flower or a budding tree. When I see people talking on their cell phones or looking at their I- phones when on a nature walk, I wonder why they went on the walk in the first place.
I have a little sign at my front door that says: “Live simply, laugh often, love deeply.” Maybe that’s the reason that my cell phone is about 10 years old, my television 20 years old, and I don’t have an I-phone (yet). I still use a typewriter to do my bills in my office and I still use paper and pencil to schedule my appointments. I have resisted technology when I feel it would make my life more complicated, not less, and I try to live according to that adage at my front door. As I get a little older, I know I’ll add more technology to my life if that helps me simplify things. But I refuse to miss the natural beauty, joy, and wonder of the moment that have absolutely nothing to do with technology, but are simply part of being human.
Monday, January 25, 2010
F A S
(Published in the February 2010 edition of The East Bay Psychiatric Newsletter)
There is a substance that is legally sold in super markets that most adults ingest regularly, but is extraordinarily toxic to fetuses. Avoiding it during pregnancy is the only known preventable cause of mental retardation. 60% of victims to this toxin eventually wind up incarcerated due to severe behavioral problems. Two children out of every thousand babies born in the United States are afflicted with the teratogenic effects of this substance.
There has been extensive research documenting the nature of the brain damage that is caused by this substance. Some of these effects are well known to many people. But the best that the United States has been able to do to educate the general public about this is to require the following cautionary message in small print on the back label of products that contain this substance: “According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects.”
Fetal alcohol syndrome (FAS) is devastating to the individual afflicted, their family, and the nation at large, yet the birth rate of children with FAS continues to be significant. There is no established safe amount of alcohol that can be drunk during pregnancy. FAS is permanent and irreversible. It impairs a child’s lifetime ability to function mentally, socially, and physically. It affects reasoning, judgment and self-control and can result in crime, delinquency and other anti-social behavior.
Alcohol is responsible for an enormous amount of public health problems in this country. While it is one thing for an adult to willfully impact his or her own health by drinking to excess, it is quite another to voluntarily damage one’s unborn child with use of this substance during pregnancy.
Once a pregnant woman has a binge or two of heavy drinking it may be too late to protect her fetus from the permanent toxic effects characteristic of FAS. Toward that end, as psychiatrists, the least we can do is assertively communicate to our female patients with a history of alcohol abuse who become pregnant, that they should immediately become engaged in substance abuse treatment to help them avoid using alcohol during their pregnancy. AA sponsors and lay counselors are another group that need to be alert to, and forceful about, proper education of FAS.
Substance abuse disorders are characterized by relapses. Anticipating the possibility of a relapse during pregnancy, and proactively establishing treatment before a potential relapse occurs, is simply good medical practice. Adult and adolescent psychiatrists should be clear with their patients about the risks that exist and provide them with appropriate information about treatment. Pediatricians’ ability to identify and diagnose FAS in the newborn is all well and good, but the horse is already out of the barn at that point, so the first line of defense needs to be preemptive medical treatment by the professionals who are seeing the individual with a history of alcohol abuse when she gets pregnant.
(Published in the February 2010 edition of The East Bay Psychiatric Newsletter)
There is a substance that is legally sold in super markets that most adults ingest regularly, but is extraordinarily toxic to fetuses. Avoiding it during pregnancy is the only known preventable cause of mental retardation. 60% of victims to this toxin eventually wind up incarcerated due to severe behavioral problems. Two children out of every thousand babies born in the United States are afflicted with the teratogenic effects of this substance.
There has been extensive research documenting the nature of the brain damage that is caused by this substance. Some of these effects are well known to many people. But the best that the United States has been able to do to educate the general public about this is to require the following cautionary message in small print on the back label of products that contain this substance: “According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects.”
Fetal alcohol syndrome (FAS) is devastating to the individual afflicted, their family, and the nation at large, yet the birth rate of children with FAS continues to be significant. There is no established safe amount of alcohol that can be drunk during pregnancy. FAS is permanent and irreversible. It impairs a child’s lifetime ability to function mentally, socially, and physically. It affects reasoning, judgment and self-control and can result in crime, delinquency and other anti-social behavior.
Alcohol is responsible for an enormous amount of public health problems in this country. While it is one thing for an adult to willfully impact his or her own health by drinking to excess, it is quite another to voluntarily damage one’s unborn child with use of this substance during pregnancy.
Once a pregnant woman has a binge or two of heavy drinking it may be too late to protect her fetus from the permanent toxic effects characteristic of FAS. Toward that end, as psychiatrists, the least we can do is assertively communicate to our female patients with a history of alcohol abuse who become pregnant, that they should immediately become engaged in substance abuse treatment to help them avoid using alcohol during their pregnancy. AA sponsors and lay counselors are another group that need to be alert to, and forceful about, proper education of FAS.
Substance abuse disorders are characterized by relapses. Anticipating the possibility of a relapse during pregnancy, and proactively establishing treatment before a potential relapse occurs, is simply good medical practice. Adult and adolescent psychiatrists should be clear with their patients about the risks that exist and provide them with appropriate information about treatment. Pediatricians’ ability to identify and diagnose FAS in the newborn is all well and good, but the horse is already out of the barn at that point, so the first line of defense needs to be preemptive medical treatment by the professionals who are seeing the individual with a history of alcohol abuse when she gets pregnant.
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