LIVING SMALLER
(Published in the May 2008 East Bay Psychiatric Newsletter)
Have you noticed that the size of people, houses and cars has increased greatly over the past decade or two? My architect son, who thinks in spatial terms, commented that he sees Americans existing on a scale of 1.2:1 relative to Europeans. But now the recent economic downturn in our country has some pundits talking about a 20% chance of a depression, and others predicting the loss of value of the dollar so great that the U.S. economy will eventually resemble an emerging market country. Maybe it’s time we all started living smaller.
This economic downturn, with the certainty of less buying power for most people, got me thinking about the things that are important in life that money can’t buy. Many of my patients who are under emotional stress can benefit from clarification of their values so that they don’t simply expend all their time on the treadmill of earning money and spending money, with no chance to actually find meaning, purpose, and pleasure in their lives.
How one manages money seems to correlate with stress. One patient of mine who was earning $300,000 a year between himself and his wife, complained, “we can’t make ends meet.” I asked him what kind of car he owned, and he answered, “A Lexus SUV.” I then asked him how often he drove his SUV off road, and he answered, “Why would I take it off road?” I proceeded to point out that he had purchased a $45,000 car that was engineered for off road driving, when he could have bought a car for half that amount to accomplish what he wanted from a vehicle. Regardless of how much money you earn, if you spend beyond your means, you can feel poor.
In an attempt at clarity, I have made a partial list of things that I suggest are important toward fulfillment and satisfaction, followed by a list of things not so essential. When measuring the importance of these, it is helpful to distinguish between what would bring you happiness (a long-term emotional state), versus what simply is fun (a short term emotional state). Some are expensive and need to be budgeted for, others are free of cost.
Important:
1) A lot of laughter
2) Freedom
3) A support system of family, colleagues, and friends
4) Accessibility to the natural world for pleasure, exercise, and spiritual awareness
5) Reasonable quality food, clothing, and shelter
6) An intellectual life, including access to good books
7) A cultural life, including access to good music and the arts
8) A recreational life including exercise
9) A spiritual life
10) Adequate leisure time to reflect, read, and relax
11) Some travel and entertainment
12) Meaningful, satisfying work
13) Good health with access to quality medical care
14) A safe, quiet neighborhood to live in
15) Access to information and knowledge
Not so important:
1) A luxury car
2) An elaborate house
3) Fancy furniture
4) Gourmet food and wine
5) Expensive jewelry
6) An expensive wardrobe of brand name clothes
7) Electrical appliances of all sorts
8) Technological gadgetry
9) Recreational vehicles
A financial counselor, when asked by his client whether he could afford to retire yet, said: “It depends on what you want to do when you retire. If you want to play golf every day you will need more money than if you want to play bridge every day.”
It seems important to go through some clarification of values from time to time. Overworked, heavily indebted people encounter more emotional problems, more marital conflict, more problems with their children who may feel neglected, and a greater sense of frustration and dissatisfaction that can lead to problems with physical health.
One definition of being rich is to feel satisfied with what you have. This may be one of the most important keys to happiness. If you have your values clear and your “head straight’ in this regard, you probably have all the money you need, regardless of what happens to the larger economy as the future unfurls.
Saturday, March 29, 2008
Sunday, March 09, 2008
SCIENCE, FAITH, OR GOOD FORTUNE?
Published in the March 2008 edition of the East Bay Psychiatric Newsletter
I take a bunch of pills every day—ten to be exact. But despite my scientific training and “prove it” attitude when it comes to most things, seven of these ten pills are non-proven, over-the-counter nutritional supplements that I take mostly as a matter of faith. You won’t find me acting this way in other areas of my life, so why do I behave this way is this particular area?
The simple answer is that when it comes to my health, I’ll do just about anything to improve my odds of remaining well and lengthening my life. Scientific evidence seems less important when non-toxic supplements like a high potency multivitamin, glucosamine, folic acid, vitamin C, selenium, omega-3 fatty acids, and vitamin E are concerned. And I haven’t even mentioned the Echinacea tea and other herbal teas I drink routinely to “boost one’s immune system and add anti-oxidants to prevent aging of cells.” I have fallen prey to the poorly documented claims that if I take these remedies I will delay the onset of Alzheimer’s disease, ward off colds, keep my knees and varicose veins from worsening, improve my cardiovascular status, and maybe even live longer.
There is some documentation for these claims from the multi-billion dollar nutritional supplement industry, but for the most part it is anecdotal and has not been subjected to the rigorous double blind studies that I would normally demand. Studies that would definitively demonstrate value or lack thereof for some of these substances could take decades to complete. They may even be too costly or cumbersome to undertake at all. At age 64, I do not have 20 years to learn that it might have been helpful to take some of these supplements for the prior 20 years. By then it will be too late for me, so I have to proceed now on sparse evidence and hope.
I am not looking for the fountain of youth. My hope is an ordinary one--to live to a ripe old age without being afflicted by the physical infirmities or serious decline in cognitive functioning that so many people suffer from in their last years. One of my patients recently told me that her 96-year-old father simply “stopped.” He went to bed one night saying he felt over-tired, woke up the next day not feeling well, held his 94 year old wife’s hand during breakfast, and then died right there sitting at the kitchen table. He had experienced no serious physical decline, no major illness, and no loss of mental acuity. I asked my patient if I could sign up for the same end-of-life contract her father had arranged for himself, and she and I smiled, knowing it doesn’t get any better than that.
Published in the March 2008 edition of the East Bay Psychiatric Newsletter
I take a bunch of pills every day—ten to be exact. But despite my scientific training and “prove it” attitude when it comes to most things, seven of these ten pills are non-proven, over-the-counter nutritional supplements that I take mostly as a matter of faith. You won’t find me acting this way in other areas of my life, so why do I behave this way is this particular area?
The simple answer is that when it comes to my health, I’ll do just about anything to improve my odds of remaining well and lengthening my life. Scientific evidence seems less important when non-toxic supplements like a high potency multivitamin, glucosamine, folic acid, vitamin C, selenium, omega-3 fatty acids, and vitamin E are concerned. And I haven’t even mentioned the Echinacea tea and other herbal teas I drink routinely to “boost one’s immune system and add anti-oxidants to prevent aging of cells.” I have fallen prey to the poorly documented claims that if I take these remedies I will delay the onset of Alzheimer’s disease, ward off colds, keep my knees and varicose veins from worsening, improve my cardiovascular status, and maybe even live longer.
There is some documentation for these claims from the multi-billion dollar nutritional supplement industry, but for the most part it is anecdotal and has not been subjected to the rigorous double blind studies that I would normally demand. Studies that would definitively demonstrate value or lack thereof for some of these substances could take decades to complete. They may even be too costly or cumbersome to undertake at all. At age 64, I do not have 20 years to learn that it might have been helpful to take some of these supplements for the prior 20 years. By then it will be too late for me, so I have to proceed now on sparse evidence and hope.
I am not looking for the fountain of youth. My hope is an ordinary one--to live to a ripe old age without being afflicted by the physical infirmities or serious decline in cognitive functioning that so many people suffer from in their last years. One of my patients recently told me that her 96-year-old father simply “stopped.” He went to bed one night saying he felt over-tired, woke up the next day not feeling well, held his 94 year old wife’s hand during breakfast, and then died right there sitting at the kitchen table. He had experienced no serious physical decline, no major illness, and no loss of mental acuity. I asked my patient if I could sign up for the same end-of-life contract her father had arranged for himself, and she and I smiled, knowing it doesn’t get any better than that.
Thursday, January 31, 2008
To the Editor:
(Published in The New York Times, February 1, 2008)
Re: "The Kennedy Mystique"--op-ed by David Brooks, January 29, 2008
If you were a college student in the early 1960's, as I
was, you know exactly what Mr. Brooks is talking about in
his op-ed regarding the inspirational leadership that Senator
Edward M. Kennedy and so many others have come to recognize
in Barack Obama. I read this essay 3 times before I could read
any other, because it transported me back forty-five years.
It has been that long since I have felt hopeful and energized
about our politicians and about our nation. I hope that
enough people recognize the potential greatness of this
young leader so that he is the one giving the next State of
the Union address.
(Published in The New York Times, February 1, 2008)
Re: "The Kennedy Mystique"--op-ed by David Brooks, January 29, 2008
If you were a college student in the early 1960's, as I
was, you know exactly what Mr. Brooks is talking about in
his op-ed regarding the inspirational leadership that Senator
Edward M. Kennedy and so many others have come to recognize
in Barack Obama. I read this essay 3 times before I could read
any other, because it transported me back forty-five years.
It has been that long since I have felt hopeful and energized
about our politicians and about our nation. I hope that
enough people recognize the potential greatness of this
young leader so that he is the one giving the next State of
the Union address.
Tuesday, January 29, 2008
DIVERSITY
(Published in the East Bay Psychiatric Association Newsletter, February 2008)
When I went to college back in the early 1960’s, my sixteen hundred classmates included only a handful of African-Americans and about the same number of students of Asian ancestry. There was also a sprinkling of foreign students, mostly from prominent, well-to-do families. And, oh yes, there were no women in the class. My college had a sister school which allowed the women to attend the same classes, but the women lived in dormitories at some distance from the men’s living quarters, and they were not allowed to study in our main library or eat in our dining halls.
Almost all of my classmates were white, male, urban, and middle class or above socio-economically. The major points of diversity back then were whether one had gone to public school or to “prep” school, and whether you came from a different part of the country. Beyond that, one didn’t talk much about diversity. In fact, there was some comfort in knowing that most of one’s classmates came from similar backgrounds. Recently, as you will read below, it has become clearer how diversity is advantageous.
Since that era, there has been an enormous amount of effort expended on seeking diversity in universities and in the workplace. Some of this has been driven by the social policy of affirmative action for minorities and disadvantaged populations. Most colleges now also include significant numbers of students from other parts of the globe. And, of course, women not only make up half of the student bodies of what used to be all male colleges, but these gender-equal student bodies now live together and interact in all manners. So much for my college bygone era of homogeneity of the 1960’s!
Now there is new evidence that increasing diversity has been for the good, but for reasons different from what was originally envisioned as simply opening doors for groups previously marginalized. It now appears that there is an inherent advantage that flows from mixing people of different backgrounds when it comes to problem solving.
Professor Scott Page of the University of Michigan has published a book entitled “The Difference: How the Power of Diversity Creates Better Groups, Firms, Schools, and Societies.” His main finding, using mathematical modeling and case studies, is that “diverse groups of people bring to organizations more and different ways of seeing a problem, and thus faster/better ways of solving it.” Professor Page explains that in today’s world of complex problems, organizations where everyone thinks in the same way lead people to get stuck at the same point. But in diverse groups, people get stuck at different points in a problem, and thus collaboratively arrive at better, faster decisions. In fact, Professor Page found that the most diverse companies are the most innovative. Furthermore, breakthroughs in science increasingly come from teams of bright, diverse people, which is why interdisciplinary work is the biggest trend in scientific work today.
Regardless of one’s political persuasion, socio-economic background, nationality, place of residence, or gender, this new information can help one shape conclusions about social policies as varied as affirmative action, immigration, hiring practices, and college admissions.
No one person can design a rocket ship to get people into outer space, or construct a silicon microchip to run computers. People have to work as teams to accomplish such complex feats, and diversity in groups offers advantages in solving complex problems. It’s a big, interesting, globally diverse world out there, and if our schools, companies, and nation are to continue to be at the forefront of innovation, we had better heed this knowledge while going forward.
(Published in the East Bay Psychiatric Association Newsletter, February 2008)
When I went to college back in the early 1960’s, my sixteen hundred classmates included only a handful of African-Americans and about the same number of students of Asian ancestry. There was also a sprinkling of foreign students, mostly from prominent, well-to-do families. And, oh yes, there were no women in the class. My college had a sister school which allowed the women to attend the same classes, but the women lived in dormitories at some distance from the men’s living quarters, and they were not allowed to study in our main library or eat in our dining halls.
Almost all of my classmates were white, male, urban, and middle class or above socio-economically. The major points of diversity back then were whether one had gone to public school or to “prep” school, and whether you came from a different part of the country. Beyond that, one didn’t talk much about diversity. In fact, there was some comfort in knowing that most of one’s classmates came from similar backgrounds. Recently, as you will read below, it has become clearer how diversity is advantageous.
Since that era, there has been an enormous amount of effort expended on seeking diversity in universities and in the workplace. Some of this has been driven by the social policy of affirmative action for minorities and disadvantaged populations. Most colleges now also include significant numbers of students from other parts of the globe. And, of course, women not only make up half of the student bodies of what used to be all male colleges, but these gender-equal student bodies now live together and interact in all manners. So much for my college bygone era of homogeneity of the 1960’s!
Now there is new evidence that increasing diversity has been for the good, but for reasons different from what was originally envisioned as simply opening doors for groups previously marginalized. It now appears that there is an inherent advantage that flows from mixing people of different backgrounds when it comes to problem solving.
Professor Scott Page of the University of Michigan has published a book entitled “The Difference: How the Power of Diversity Creates Better Groups, Firms, Schools, and Societies.” His main finding, using mathematical modeling and case studies, is that “diverse groups of people bring to organizations more and different ways of seeing a problem, and thus faster/better ways of solving it.” Professor Page explains that in today’s world of complex problems, organizations where everyone thinks in the same way lead people to get stuck at the same point. But in diverse groups, people get stuck at different points in a problem, and thus collaboratively arrive at better, faster decisions. In fact, Professor Page found that the most diverse companies are the most innovative. Furthermore, breakthroughs in science increasingly come from teams of bright, diverse people, which is why interdisciplinary work is the biggest trend in scientific work today.
Regardless of one’s political persuasion, socio-economic background, nationality, place of residence, or gender, this new information can help one shape conclusions about social policies as varied as affirmative action, immigration, hiring practices, and college admissions.
No one person can design a rocket ship to get people into outer space, or construct a silicon microchip to run computers. People have to work as teams to accomplish such complex feats, and diversity in groups offers advantages in solving complex problems. It’s a big, interesting, globally diverse world out there, and if our schools, companies, and nation are to continue to be at the forefront of innovation, we had better heed this knowledge while going forward.
Tuesday, December 25, 2007
SQUASHED
(Published in the East Bay Psychiatric Association Newsletter, January 2008)
I read an article in the New York Times recently that parents are encouraging their youngsters to take up the game of squash. Kids as young as 8 years old are enrolling in squash classes. The reason for this is that elite eastern colleges have squash teams, and according to one parent who was interviewed for the article, “it could give my son a leg up on his Harvard application some day.” There are now so many kids playing squash for this reason, yet so few students needed to fill a squash team, that such an effort is doomed from the start, not to mention the misguided nature of the effort.
I’ll tell you that when I read articles like this, I get the feeling that we psychiatrists will never run out of work. When parents are programming their children as tightly as this article suggests, there will be no shortage of neurotic, anxious, and insecure adults in the future to fill our schedules.
It is a failure of awareness of normal childhood development for parents to direct their children to have a primary focus on building a resume rather than enjoying their childhoods. It’s a good way to have a child lose out on much of the spontaneous friendships, fun, and laughter that characterize youthfulness. I am concerned when I learn of parents scheduling their young children for every kind of lesson and activity, leaving no time for “free play”. Optimal childhoods allow time for youngsters to explore the world they live in, become curious about life, and feel carefree.
When you understand that children on average laugh over 300 times a day, while adults laugh fewer than 10 times a day, you have to ask yourself what the rush is to get children out of childhood and acting more like adults. This parenting approach of excessive scheduling of children to be involved in structured activities is called “green housing”--a way to ripen and prematurely age something artificially. Have you ever compared the taste of a tomato ripened in a green house to one ripened naturally on the vine?
Another common childrearing style today is called “helicopter parenting” because these parents hover over their children excessively. These folks do not allow their children to play outdoors unsupervised, do not ever leave their children with baby sitters, do everything for their children (often including their homework), and think of their children in such idealized ways that they cannot accept imperfection in them. If that’s not a breeding ground for neurosis, I don’t know what is.
So much of life is serendipitous and not really under our control. When parents exert such “over control” of their children, either by “green housing” them or by being “helicopter parents”, they interfere with the normal development of a youngster. The only reason to play the game of squash is because a person finds it enjoyable to play. As a resume builder, it’s a loser. And can you imagine the child dragged off to “squash class” at age 8 because the parents have Harvard in mind for that child’s future? All I can imagine coming from such an effort is not the cost of a Harvard education but the cost of the likely future psychotherapy sessions.
(Published in the East Bay Psychiatric Association Newsletter, January 2008)
I read an article in the New York Times recently that parents are encouraging their youngsters to take up the game of squash. Kids as young as 8 years old are enrolling in squash classes. The reason for this is that elite eastern colleges have squash teams, and according to one parent who was interviewed for the article, “it could give my son a leg up on his Harvard application some day.” There are now so many kids playing squash for this reason, yet so few students needed to fill a squash team, that such an effort is doomed from the start, not to mention the misguided nature of the effort.
I’ll tell you that when I read articles like this, I get the feeling that we psychiatrists will never run out of work. When parents are programming their children as tightly as this article suggests, there will be no shortage of neurotic, anxious, and insecure adults in the future to fill our schedules.
It is a failure of awareness of normal childhood development for parents to direct their children to have a primary focus on building a resume rather than enjoying their childhoods. It’s a good way to have a child lose out on much of the spontaneous friendships, fun, and laughter that characterize youthfulness. I am concerned when I learn of parents scheduling their young children for every kind of lesson and activity, leaving no time for “free play”. Optimal childhoods allow time for youngsters to explore the world they live in, become curious about life, and feel carefree.
When you understand that children on average laugh over 300 times a day, while adults laugh fewer than 10 times a day, you have to ask yourself what the rush is to get children out of childhood and acting more like adults. This parenting approach of excessive scheduling of children to be involved in structured activities is called “green housing”--a way to ripen and prematurely age something artificially. Have you ever compared the taste of a tomato ripened in a green house to one ripened naturally on the vine?
Another common childrearing style today is called “helicopter parenting” because these parents hover over their children excessively. These folks do not allow their children to play outdoors unsupervised, do not ever leave their children with baby sitters, do everything for their children (often including their homework), and think of their children in such idealized ways that they cannot accept imperfection in them. If that’s not a breeding ground for neurosis, I don’t know what is.
So much of life is serendipitous and not really under our control. When parents exert such “over control” of their children, either by “green housing” them or by being “helicopter parents”, they interfere with the normal development of a youngster. The only reason to play the game of squash is because a person finds it enjoyable to play. As a resume builder, it’s a loser. And can you imagine the child dragged off to “squash class” at age 8 because the parents have Harvard in mind for that child’s future? All I can imagine coming from such an effort is not the cost of a Harvard education but the cost of the likely future psychotherapy sessions.
Sunday, November 18, 2007
WALKING
(Published in the December 2007 edition of The East Bay Psychiatric Newsletter)
Recently I learned of a study comparing the average walking speed of people from different countries. The people with the fastest pace are in Japan. The U.S. is in the top five, which also includes other industrialized nations. At the bottom of the list—the slowest pace—are people from Malawi.
Now that I am semi-retired and have more leisure time, I have decided to do more errands by foot rather than by car. I have always done a lot of hiking and walking recreationally, but this is something different. When I need a haircut or have to go the post office, I go out my front door and hit the pavement. There are many destinations within a mile and a half of my home, and I truly enjoy walking the three-mile roundtrip. Because of this behavioral change, there is quite a difference in how I feel, and I’ve noticed that my pace is probably getting closer to the folks in Malawi than to those in Japan.
Walking provides an opportunity to see things that I would not observe if traveling by car. It is interesting to see the variety of plant life along the path, and how houses have such interesting designs. There are scores of things I see now that before were just a blur as I hurried in my auto to get to the next place. It’s also far more civil when one walks. We fellow walkers generally greet each pleasantly, as opposed to the tension and disregard that typifies interactions between fellow drivers competing for position. Sometimes even a conversation develops with others, or if you see someone you know, there’s an opportunity to get reacquainted. I expect all this has reduced my blood pressure, pulse rate, and irritability quotient, as it feels to me like the rat race is occurring on some track that I am not on.
On the negative side, there’s the smell of gas fumes and the sight of litter that one would not be aware of if not walking. But the worst observation is how hurried and harried people seem to be while driving. No one appears to have enough time to get where they are going as they speed along, using up fossil fuel, not getting any exercise, and feeling tense on the roadway. Believe me, I know from where I speak, as that was surely a picture of me for a very long time, and occasionally still is.
I suppose in an ideal world we would all live about a 10-minute walk to our jobs and we would have enough discretionary time to feel unhurried. It’s difficult in a metropolitan area to slow down our pace, observe the world that surrounds us, and interact pleasantly with others. There are times that nothing but our automobiles will do, but there are times when we probably do not need a car, yet are just in the bad habit of using one.
Similar to starting a diet, developing new, healthier habits can take time. But depending on your living situation, walking more to do errands may be a habit worth considering. It might even make your life more interesting and pleasant, and perhaps lengthen it as well because of the cardiovascular health benefits. Just think, if the worldwide supply of oil continues to be less available and more expensive, you could be well ahead of your friends and neighbors if you get started right now on this new 21st century essential behavior called walking.
(Published in the December 2007 edition of The East Bay Psychiatric Newsletter)
Recently I learned of a study comparing the average walking speed of people from different countries. The people with the fastest pace are in Japan. The U.S. is in the top five, which also includes other industrialized nations. At the bottom of the list—the slowest pace—are people from Malawi.
Now that I am semi-retired and have more leisure time, I have decided to do more errands by foot rather than by car. I have always done a lot of hiking and walking recreationally, but this is something different. When I need a haircut or have to go the post office, I go out my front door and hit the pavement. There are many destinations within a mile and a half of my home, and I truly enjoy walking the three-mile roundtrip. Because of this behavioral change, there is quite a difference in how I feel, and I’ve noticed that my pace is probably getting closer to the folks in Malawi than to those in Japan.
Walking provides an opportunity to see things that I would not observe if traveling by car. It is interesting to see the variety of plant life along the path, and how houses have such interesting designs. There are scores of things I see now that before were just a blur as I hurried in my auto to get to the next place. It’s also far more civil when one walks. We fellow walkers generally greet each pleasantly, as opposed to the tension and disregard that typifies interactions between fellow drivers competing for position. Sometimes even a conversation develops with others, or if you see someone you know, there’s an opportunity to get reacquainted. I expect all this has reduced my blood pressure, pulse rate, and irritability quotient, as it feels to me like the rat race is occurring on some track that I am not on.
On the negative side, there’s the smell of gas fumes and the sight of litter that one would not be aware of if not walking. But the worst observation is how hurried and harried people seem to be while driving. No one appears to have enough time to get where they are going as they speed along, using up fossil fuel, not getting any exercise, and feeling tense on the roadway. Believe me, I know from where I speak, as that was surely a picture of me for a very long time, and occasionally still is.
I suppose in an ideal world we would all live about a 10-minute walk to our jobs and we would have enough discretionary time to feel unhurried. It’s difficult in a metropolitan area to slow down our pace, observe the world that surrounds us, and interact pleasantly with others. There are times that nothing but our automobiles will do, but there are times when we probably do not need a car, yet are just in the bad habit of using one.
Similar to starting a diet, developing new, healthier habits can take time. But depending on your living situation, walking more to do errands may be a habit worth considering. It might even make your life more interesting and pleasant, and perhaps lengthen it as well because of the cardiovascular health benefits. Just think, if the worldwide supply of oil continues to be less available and more expensive, you could be well ahead of your friends and neighbors if you get started right now on this new 21st century essential behavior called walking.
Sunday, October 14, 2007
COMMERCIALISM RUN AMOK
(Published in the East Bay Psychiatric Association Newsletter, October 2007
Excessive advertising has always been a pet peeve of mine. It is difficult to watch a ballgame on TV these days without being inundated with ads for cars and trucks, and more recently even for medications for erectile dysfunction. You’d think people watching these games had nothing else to purchase but another gas guzzling vehicle, or for that matter, care to have it suggested to them that they might need an erection-enhancing medication.
Our economy depends on people purchasing things, and commercials are the engines that propel those purchases. There comes a time, however, when people have to realize that things are either “bought” or they are “sold.” You “buy” something when you have a need or desire to make a particular purchase, and go out make that purchase. You are “sold” something, when no such need or desire exists within you until enough glossy ads, store models, or media commercials seduce you into thinking that purchasing that product is in your interest. One’s long term financial stability may actually be based on how well one is able to make this distinction.
It is one thing when cars and trucks, fancy clothing, or high-tech gadgets are pushed on us by commercials. But it is quite another when prescription pharmaceutical agents become the daily grist of advertisers. This morning my computer’s home page had an ad for a “Seven day free trial of Ambien-CR.” In just one click you can be connected to a “health care provider” who will send you this free sample, become registered to get a free monthly newsletter on sleep problems, and get to be part of a group of people who will be nurtured along and encouraged to take this medication. Imagine that. You go onto your computer for some routine e-mail, and you get a message to take a sleeping pill free for seven nights—perhaps just long enough to get you accustomed to it so that you become a long-term customer.
This direct-to-consumer advertising for prescription pharmaceutical agents is a good example of commercialism run amok. We physicians must speak up about this intrusive and inappropriate behavior on the part of drug manufacturers. If you think Madison Avenue should determine diagnoses and enlist physicians to get people started on controlled substances, then perhaps you are in the wrong field. We physicians have a fiduciary responsibility to tell our patients what is in their interest—not in the interest of some corporate entity. If one wants to be a salesperson, fine, but that should not be confused with the art and science of practicing medicine.
Don’t get me wrong. I use the fancy pens drug companies give me, find it handy to put the free boxes of tissues out in my office which contain the drug company’s logo, and enjoy the free dinners that these companies sometimes provide. But after seeing that ad on my computer this morning for a free sample of Ambien-CR, I have made a vow to stop enabling these companies’ improper behavior. I will no longer accept or use any of these free offers and will tell the drug reps that visit my office just how I feel about this behavior of advertising directly to the consumer. I hope you will consider doing the same. After all, if someone needs Ambien-CR because they have a serious problem with insomnia, the treating physician is the proper one to make that judgment, not someone in a pharmaceutical company’s sales or marketing department, or worse yet, an anonymous physician employed by that company to write a prescription for such a product.
(Published in the East Bay Psychiatric Association Newsletter, October 2007
Excessive advertising has always been a pet peeve of mine. It is difficult to watch a ballgame on TV these days without being inundated with ads for cars and trucks, and more recently even for medications for erectile dysfunction. You’d think people watching these games had nothing else to purchase but another gas guzzling vehicle, or for that matter, care to have it suggested to them that they might need an erection-enhancing medication.
Our economy depends on people purchasing things, and commercials are the engines that propel those purchases. There comes a time, however, when people have to realize that things are either “bought” or they are “sold.” You “buy” something when you have a need or desire to make a particular purchase, and go out make that purchase. You are “sold” something, when no such need or desire exists within you until enough glossy ads, store models, or media commercials seduce you into thinking that purchasing that product is in your interest. One’s long term financial stability may actually be based on how well one is able to make this distinction.
It is one thing when cars and trucks, fancy clothing, or high-tech gadgets are pushed on us by commercials. But it is quite another when prescription pharmaceutical agents become the daily grist of advertisers. This morning my computer’s home page had an ad for a “Seven day free trial of Ambien-CR.” In just one click you can be connected to a “health care provider” who will send you this free sample, become registered to get a free monthly newsletter on sleep problems, and get to be part of a group of people who will be nurtured along and encouraged to take this medication. Imagine that. You go onto your computer for some routine e-mail, and you get a message to take a sleeping pill free for seven nights—perhaps just long enough to get you accustomed to it so that you become a long-term customer.
This direct-to-consumer advertising for prescription pharmaceutical agents is a good example of commercialism run amok. We physicians must speak up about this intrusive and inappropriate behavior on the part of drug manufacturers. If you think Madison Avenue should determine diagnoses and enlist physicians to get people started on controlled substances, then perhaps you are in the wrong field. We physicians have a fiduciary responsibility to tell our patients what is in their interest—not in the interest of some corporate entity. If one wants to be a salesperson, fine, but that should not be confused with the art and science of practicing medicine.
Don’t get me wrong. I use the fancy pens drug companies give me, find it handy to put the free boxes of tissues out in my office which contain the drug company’s logo, and enjoy the free dinners that these companies sometimes provide. But after seeing that ad on my computer this morning for a free sample of Ambien-CR, I have made a vow to stop enabling these companies’ improper behavior. I will no longer accept or use any of these free offers and will tell the drug reps that visit my office just how I feel about this behavior of advertising directly to the consumer. I hope you will consider doing the same. After all, if someone needs Ambien-CR because they have a serious problem with insomnia, the treating physician is the proper one to make that judgment, not someone in a pharmaceutical company’s sales or marketing department, or worse yet, an anonymous physician employed by that company to write a prescription for such a product.
Friday, September 21, 2007
IMMIGRANT WORKERS
(Published in the East Bay Psychiatric Association Newsletter, August 2007)
Looking at my checkbook recently, I noticed that the last three checks I had written were to people named Javier, Geronimo, and Lupe. They are, respectively, a gardener, a house painter, and a domestic. They all speak some English, certainly better than I speak Spanish, and they all are dependable, honest, hardworking, and nice people. I have relied on them to do tasks for me that I no longer am able to do, or no longer want to do.
A lot of the current fuss about immigration escapes me, as I’m not sure where I would find the kind of help that these folks have provided for me of late if they were not living here. Some days when I drive off to work, the block I live on is half lined with cars and trucks of Latino workers who are mowing lawns, installing roofs, laying cement, or providing a myriad of other services for people who have the good fortune to be able to afford to hire help. I have never once heard a complaint or learned of any difficulty that anyone in my neighborhood has experienced from an immigrant worker.
Some Latino workers charge very little for their services. There are probably many reasons for this, but one is that they are more motivated simply to have work than they are to get rich. Making a marginal living is better than making no living at all. But if I sense that someone is vastly undercharging me for his or her services, I make sure to provide additional funds for those services when they are completed satisfactorily.
I don’t ask these workers if they have a “green card” or what their immigration status is, or how they came to be here. But if they are working on my property, I do ask them if they need to use the bathroom, or if they need something to eat or something to drink. I don’t ask if they have health insurance or what kind of a place they live in when they are home, but I do try to make small talk as much as I can, sometimes using my newly acquired basic Spanish: “De donde eres? En qual ciudad vivia?” “Le gustaria algun comer o beber?” My struggle with Spanish brings a smile to their faces, at which point they become the teacher and I the student, and the playing field is somewhat evened. Then we have a chance to experience a more co-equal relationship, and friendliness comes more easily.
If I lived in a country with little economic opportunity, and I needed a way to support my family, I would find some way, any way, to do just that. If I needed to escape my country and find a place somewhere else where I could make money and send some of it home, I would do it. All of us have raw survival skills—we just don’t have a desperate need to use them given our circumstances.
I have had the good fortune to be born in a land of opportunity, but this is only so because my great-grandparents left their countries of origin where they were persecuted, oppressed, and had no opportunity. Taking care of the stranger in one’s midst, which is how I see my role in interacting with immigrant workers, is exactly what I would hope for if I were that stranger, as my ancestors in fact had been.
There are many ways to behave in a community. One is to feel entitled. Another is to feel grateful. I don’t know what it is like to be uneducated, impoverished, and highly dependent on the good auspices of others. But I do know how I should behave if I interact with someone with such a background. Being considerate, thoughtful, and helpful to people is, after all, simply a matter of being a decent human being—nothing more and nothing less.
(Published in the East Bay Psychiatric Association Newsletter, August 2007)
Looking at my checkbook recently, I noticed that the last three checks I had written were to people named Javier, Geronimo, and Lupe. They are, respectively, a gardener, a house painter, and a domestic. They all speak some English, certainly better than I speak Spanish, and they all are dependable, honest, hardworking, and nice people. I have relied on them to do tasks for me that I no longer am able to do, or no longer want to do.
A lot of the current fuss about immigration escapes me, as I’m not sure where I would find the kind of help that these folks have provided for me of late if they were not living here. Some days when I drive off to work, the block I live on is half lined with cars and trucks of Latino workers who are mowing lawns, installing roofs, laying cement, or providing a myriad of other services for people who have the good fortune to be able to afford to hire help. I have never once heard a complaint or learned of any difficulty that anyone in my neighborhood has experienced from an immigrant worker.
Some Latino workers charge very little for their services. There are probably many reasons for this, but one is that they are more motivated simply to have work than they are to get rich. Making a marginal living is better than making no living at all. But if I sense that someone is vastly undercharging me for his or her services, I make sure to provide additional funds for those services when they are completed satisfactorily.
I don’t ask these workers if they have a “green card” or what their immigration status is, or how they came to be here. But if they are working on my property, I do ask them if they need to use the bathroom, or if they need something to eat or something to drink. I don’t ask if they have health insurance or what kind of a place they live in when they are home, but I do try to make small talk as much as I can, sometimes using my newly acquired basic Spanish: “De donde eres? En qual ciudad vivia?” “Le gustaria algun comer o beber?” My struggle with Spanish brings a smile to their faces, at which point they become the teacher and I the student, and the playing field is somewhat evened. Then we have a chance to experience a more co-equal relationship, and friendliness comes more easily.
If I lived in a country with little economic opportunity, and I needed a way to support my family, I would find some way, any way, to do just that. If I needed to escape my country and find a place somewhere else where I could make money and send some of it home, I would do it. All of us have raw survival skills—we just don’t have a desperate need to use them given our circumstances.
I have had the good fortune to be born in a land of opportunity, but this is only so because my great-grandparents left their countries of origin where they were persecuted, oppressed, and had no opportunity. Taking care of the stranger in one’s midst, which is how I see my role in interacting with immigrant workers, is exactly what I would hope for if I were that stranger, as my ancestors in fact had been.
There are many ways to behave in a community. One is to feel entitled. Another is to feel grateful. I don’t know what it is like to be uneducated, impoverished, and highly dependent on the good auspices of others. But I do know how I should behave if I interact with someone with such a background. Being considerate, thoughtful, and helpful to people is, after all, simply a matter of being a decent human being—nothing more and nothing less.
Friday, July 27, 2007
SIBLINGS AT THE MOMENT OF TRUTH
(To be published in the East Bay Psychiatric Association Newsletter, August 2007)
One of the least well-studied subjects in human psychology is the relationship between siblings. There are plenty of twin studies related to genetic factors of inherited illnesses, but ordinary sibling relationships take up very little space in the catalog of human inquiry. Sibling relationships are the longest ones that occur during one’s lifetime—longer than for spouses, parent and child, or for friends. We psychiatrists tend to minimize the importance of sibling relationships--I know that when I take a psychiatric history, I make relatively short shrift of this subject including the order of birth of my patients in their family, even though I recognize these issues as crucial aspects of anyone’s development.
One critical time in the history of sibling relations is when the last parent dies. It is at this juncture that I have witnessed major problems in a number of my patients’ relationships with their siblings. In fact, I have seen several patients through the years who sought my psychiatric assistance solely because of problems they encountered with their siblings during the time their parents’ estate was being settled. The problems encountered are often very ugly, with siblings battling each other for advantages in inheritance matters. Often the problems can be traced to parents not making the hard decisions before they die as to whom will receive what. Leaving too many decisions to the surviving children to sort out can lead to trouble more often than not.
Most parents have the fantasy that all of their children are level headed, fair-minded, and free of excessively competitive impulses. The parents want to believe that their children will matter-of-factly execute their will and never encounter a bit of conflict. But attorneys who specialize in estate matters will tell you that siblings only agree about 30% of the time on how to execute a will equitably. The larger the inheritance and the more illiquid the assets, the more opportunity there is for trouble to arise. The Clark brothers, heirs to the Singer Sewing Machine fortune, are but one example of siblings who never spoke to each other again after their wealthy parents’ estate was divided because of the resentment they experienced due to their perceived inequities in the division of the assets they inherited.
Siblings in this modern age of mobility often spend their adult lives in communities far apart, may have spouses with very different needs and personalities, and may often have very different financial circumstances. Mix these factors with some unresolved sibling rivalry, and you have the ingredients for a toxic brew. It is unrealistic to expect that several siblings with differing life-styles and ethical standards will agree on all significant matters. Parents may leave their children better off financially after they die, but worse off in more important matters if they do not address these matters preemptively. Some siblings, of course, have never been close or care much for each other, and in those cases, regardless of advanced planning, things may fall apart after the last parent dies.
Proper legal advice is essential in estate related matters, but sometimes attorneys are not so astute about psychological issues. Whether your patient is an aging parent or an adult child with aging parents, common-sense advice would be to encourage an open family discussion of estate matters, assuming they are deemed appropriate issues in the context of your patient’s therapy. It may prove helpful to have the family decide together which child should be trusted to be the sole executor, as having multiple siblings appointed as co-executors often leads to unnecessary complexities. Parents may also be wise to decide on the disposition of most of their assets during their lifetime, so as to minimize the possibility of excessive avarice, competition, and jealously arising in the surviving children. Failure on the part of your patients to address such estate matters within the family when it is still possible to do so may cause you to witness some of the more difficult and unpleasant family dynamics that one can encounter.
(To be published in the East Bay Psychiatric Association Newsletter, August 2007)
One of the least well-studied subjects in human psychology is the relationship between siblings. There are plenty of twin studies related to genetic factors of inherited illnesses, but ordinary sibling relationships take up very little space in the catalog of human inquiry. Sibling relationships are the longest ones that occur during one’s lifetime—longer than for spouses, parent and child, or for friends. We psychiatrists tend to minimize the importance of sibling relationships--I know that when I take a psychiatric history, I make relatively short shrift of this subject including the order of birth of my patients in their family, even though I recognize these issues as crucial aspects of anyone’s development.
One critical time in the history of sibling relations is when the last parent dies. It is at this juncture that I have witnessed major problems in a number of my patients’ relationships with their siblings. In fact, I have seen several patients through the years who sought my psychiatric assistance solely because of problems they encountered with their siblings during the time their parents’ estate was being settled. The problems encountered are often very ugly, with siblings battling each other for advantages in inheritance matters. Often the problems can be traced to parents not making the hard decisions before they die as to whom will receive what. Leaving too many decisions to the surviving children to sort out can lead to trouble more often than not.
Most parents have the fantasy that all of their children are level headed, fair-minded, and free of excessively competitive impulses. The parents want to believe that their children will matter-of-factly execute their will and never encounter a bit of conflict. But attorneys who specialize in estate matters will tell you that siblings only agree about 30% of the time on how to execute a will equitably. The larger the inheritance and the more illiquid the assets, the more opportunity there is for trouble to arise. The Clark brothers, heirs to the Singer Sewing Machine fortune, are but one example of siblings who never spoke to each other again after their wealthy parents’ estate was divided because of the resentment they experienced due to their perceived inequities in the division of the assets they inherited.
Siblings in this modern age of mobility often spend their adult lives in communities far apart, may have spouses with very different needs and personalities, and may often have very different financial circumstances. Mix these factors with some unresolved sibling rivalry, and you have the ingredients for a toxic brew. It is unrealistic to expect that several siblings with differing life-styles and ethical standards will agree on all significant matters. Parents may leave their children better off financially after they die, but worse off in more important matters if they do not address these matters preemptively. Some siblings, of course, have never been close or care much for each other, and in those cases, regardless of advanced planning, things may fall apart after the last parent dies.
Proper legal advice is essential in estate related matters, but sometimes attorneys are not so astute about psychological issues. Whether your patient is an aging parent or an adult child with aging parents, common-sense advice would be to encourage an open family discussion of estate matters, assuming they are deemed appropriate issues in the context of your patient’s therapy. It may prove helpful to have the family decide together which child should be trusted to be the sole executor, as having multiple siblings appointed as co-executors often leads to unnecessary complexities. Parents may also be wise to decide on the disposition of most of their assets during their lifetime, so as to minimize the possibility of excessive avarice, competition, and jealously arising in the surviving children. Failure on the part of your patients to address such estate matters within the family when it is still possible to do so may cause you to witness some of the more difficult and unpleasant family dynamics that one can encounter.
Wednesday, July 18, 2007
A BEAUTIFUL MIND
(Published in the East Bay Psychiatric Association Newsletter, January 2002)
Hollywood had not been too kind to the mentally ill or to psychiatrists in the past. Portrayals of emotionally disturbed individuals has often been stereotypical and demeaning, and psychiatrists have often been portrayed as eccentric, emotionally detached, or sadistic. All this has changed with the recent movie, "A Beautiful Mind" , where paranoid schizophrenia is presented in a most dramatic and sympathetic fashion.
This is not a movie that psychiatrists should try to see. This is a movie that psychiatrists must see! As more and more people see this film, more and more are asking me, “Is this what schizophrenia is really like?” This provides an opportunity to discuss the nature of severe mental illness. More importantly, the population at large should come to be far more empathic with the plight of the mentally ill. This movie could do more to advance the cause of psychiatric treatment than any educational program the American Psychiatric Association could dream up to create support for our work.
The movie has certain flaws. It is about a real individual, John Nash, who is still living today, who was such a brilliant mathematician as a graduate student that he eventually won the Nobel Prize for his work. But subsequent to his graduate school years, he became schizophrenic. The movie leaves out certain less than pleasant details of Nash's life to create a more sympathetic character. And there is a note of unreality in the depiction of a remission of the illness that might give families false hope for an ill loved one. The implicit message is that sufficient community support, an enormously loving relationship, and proper medication can cure the illness.
Nonetheless, the overall dramatic impact of the film is enormous. It was so great on me that I left the theater shaken. It took me a long time to feel composed enough to express my thoughts, as the reality of the portrayal overwhelmed me as it reminded me of all those broken minds in patients of mine through the years that I have toiled to mend.
"A Beautiful Mind" is a beautiful movie, with stellar acting on the part of Russell Crowe who plays John Nash, and Jennifer Connelly who plays his wife, and whose talent appears equal to her substantial beauty. The movie is based on the book by the same name written by Sylvia Nasar, and while I have not read the book, others who have, rate the book as superior to the movie, which is indeed a great compliment.
(Published in the East Bay Psychiatric Association Newsletter, January 2002)
Hollywood had not been too kind to the mentally ill or to psychiatrists in the past. Portrayals of emotionally disturbed individuals has often been stereotypical and demeaning, and psychiatrists have often been portrayed as eccentric, emotionally detached, or sadistic. All this has changed with the recent movie, "A Beautiful Mind" , where paranoid schizophrenia is presented in a most dramatic and sympathetic fashion.
This is not a movie that psychiatrists should try to see. This is a movie that psychiatrists must see! As more and more people see this film, more and more are asking me, “Is this what schizophrenia is really like?” This provides an opportunity to discuss the nature of severe mental illness. More importantly, the population at large should come to be far more empathic with the plight of the mentally ill. This movie could do more to advance the cause of psychiatric treatment than any educational program the American Psychiatric Association could dream up to create support for our work.
The movie has certain flaws. It is about a real individual, John Nash, who is still living today, who was such a brilliant mathematician as a graduate student that he eventually won the Nobel Prize for his work. But subsequent to his graduate school years, he became schizophrenic. The movie leaves out certain less than pleasant details of Nash's life to create a more sympathetic character. And there is a note of unreality in the depiction of a remission of the illness that might give families false hope for an ill loved one. The implicit message is that sufficient community support, an enormously loving relationship, and proper medication can cure the illness.
Nonetheless, the overall dramatic impact of the film is enormous. It was so great on me that I left the theater shaken. It took me a long time to feel composed enough to express my thoughts, as the reality of the portrayal overwhelmed me as it reminded me of all those broken minds in patients of mine through the years that I have toiled to mend.
"A Beautiful Mind" is a beautiful movie, with stellar acting on the part of Russell Crowe who plays John Nash, and Jennifer Connelly who plays his wife, and whose talent appears equal to her substantial beauty. The movie is based on the book by the same name written by Sylvia Nasar, and while I have not read the book, others who have, rate the book as superior to the movie, which is indeed a great compliment.
Monday, July 09, 2007
ONLY IN AMERICA
(Published in the East Bay Psychiatric Association Newsletter, April 2002)
This past weekend, my wife and I, along with three other couples, went out to dinner. This was not your ordinary evening out, as you will see. We four couples were joined by our adult sons, now about age 28. Our boys have remained close since childhood, despite having scattered far and wide during their college and graduate school experiences.
For many years, we four families would see each other at our children’s events like soccer games, scout troop meetings, and other school activities. We adults were never really close friends, just very good acquaintances, and we had never before gone out to dinner together as a group.
The idea for this dinner, sadly, was borne out of a tragic situation. Two months earlier, our sons’ other closest friend--my own son’s best friend since fourth grade--committed suicide. The loss was sudden and catastrophic--and nearly unbearable for our boys. As parents, we were also devastated.
What seemed to arise out of our mutual shock and grief, was a greater appreciation for our ongoing relationship with each other, and we felt a need to form closer ties. We wanted to strengthen our previously casual relationship, and somehow consolidate our closeness with each other and with our sons in the face of this tragedy. There were hugs and kisses all around that night in the restaurant--and enough warmth to keep you cozy all next winter. We four families, who previously had been living out our joys as parents together, now had to confront our sorrow together, too.
The diversity of the families who found themselves sharing this moment in their lives was also unusual: one family is Muslim originally from Pakistan, one Armenian Christian, one Catholic, and one Jewish. And we spent the evening sitting around a table in a CHINESE restaurant.
That such a meaningful experience could be shared by such a diverse group of individuals is a strong affirmation of our American democracy and our way of life. In this difficult time in world history, it is good to keep such stories in mind, because only in America is an event like this likely to have occurred.
(Published in the East Bay Psychiatric Association Newsletter, April 2002)
This past weekend, my wife and I, along with three other couples, went out to dinner. This was not your ordinary evening out, as you will see. We four couples were joined by our adult sons, now about age 28. Our boys have remained close since childhood, despite having scattered far and wide during their college and graduate school experiences.
For many years, we four families would see each other at our children’s events like soccer games, scout troop meetings, and other school activities. We adults were never really close friends, just very good acquaintances, and we had never before gone out to dinner together as a group.
The idea for this dinner, sadly, was borne out of a tragic situation. Two months earlier, our sons’ other closest friend--my own son’s best friend since fourth grade--committed suicide. The loss was sudden and catastrophic--and nearly unbearable for our boys. As parents, we were also devastated.
What seemed to arise out of our mutual shock and grief, was a greater appreciation for our ongoing relationship with each other, and we felt a need to form closer ties. We wanted to strengthen our previously casual relationship, and somehow consolidate our closeness with each other and with our sons in the face of this tragedy. There were hugs and kisses all around that night in the restaurant--and enough warmth to keep you cozy all next winter. We four families, who previously had been living out our joys as parents together, now had to confront our sorrow together, too.
The diversity of the families who found themselves sharing this moment in their lives was also unusual: one family is Muslim originally from Pakistan, one Armenian Christian, one Catholic, and one Jewish. And we spent the evening sitting around a table in a CHINESE restaurant.
That such a meaningful experience could be shared by such a diverse group of individuals is a strong affirmation of our American democracy and our way of life. In this difficult time in world history, it is good to keep such stories in mind, because only in America is an event like this likely to have occurred.
WHEN LESS IS MORE
(Published in the East Bay Psychiatric Association Newsletter, January 2000)
We psychiatrists like to use words. We believe that by using language we can explain, clarify, and help resolve emotional problems. Without the use of language, we are helpless. Would you consider me crazy if I told you that absolute silence can also be highly therapeutic?
I saw a documentary movie recently about the use of the Buddhist meditation technique "vipassana." Inmates in prisons in India can elect to participate in a 10 day meditation treatment program which requires absolute silence. After these 10 days, we were shown prisoners who had been transformed from violent, aggressive inmates, to calm, controlled individuals; their behavior and motivation had altered drastically.
The dynamics of what happened to these inmates is complex, as in India one may have to wait for years in prison just to get a trial. Thus, there is a lot of motivation to look inward and use this open-ended amount of time to gain control over one’s frustration and rage. Regardless, what was once a hell-hole of a prison filled with violence and chaos, has been turned into one of relative calm and serenity.
I have two acquaintances who periodically go to “silent retreats.” They spend a number of days in complete silence, and leave the retreat feeling emotionally cleansed and renewed. And it is well known that monks throughout the ages have taken vows of silence to enhance their own state of piety.
There are many studies that show that people do better health-wise when they have outlets to verbally express their feelings to others. Paradoxically, the opposite may also be true--that periods of absolute silence may also be emotionally beneficial. It is thought provoking to realize that saying nothing has more therapeutic impact on some individuals than vast amounts of verbal expression has on others.
(Published in the East Bay Psychiatric Association Newsletter, January 2000)
We psychiatrists like to use words. We believe that by using language we can explain, clarify, and help resolve emotional problems. Without the use of language, we are helpless. Would you consider me crazy if I told you that absolute silence can also be highly therapeutic?
I saw a documentary movie recently about the use of the Buddhist meditation technique "vipassana." Inmates in prisons in India can elect to participate in a 10 day meditation treatment program which requires absolute silence. After these 10 days, we were shown prisoners who had been transformed from violent, aggressive inmates, to calm, controlled individuals; their behavior and motivation had altered drastically.
The dynamics of what happened to these inmates is complex, as in India one may have to wait for years in prison just to get a trial. Thus, there is a lot of motivation to look inward and use this open-ended amount of time to gain control over one’s frustration and rage. Regardless, what was once a hell-hole of a prison filled with violence and chaos, has been turned into one of relative calm and serenity.
I have two acquaintances who periodically go to “silent retreats.” They spend a number of days in complete silence, and leave the retreat feeling emotionally cleansed and renewed. And it is well known that monks throughout the ages have taken vows of silence to enhance their own state of piety.
There are many studies that show that people do better health-wise when they have outlets to verbally express their feelings to others. Paradoxically, the opposite may also be true--that periods of absolute silence may also be emotionally beneficial. It is thought provoking to realize that saying nothing has more therapeutic impact on some individuals than vast amounts of verbal expression has on others.
Saturday, July 07, 2007
WORK
(Published in the East Bay Psychiatric Association Newsletter, September 2006)
I recently heard about a study that found that people who take vacations function better in the work place. The study’s findings revealed what most of us probably already know. But unfortunately, the work force in our country is actually becoming more and more “work addicted,” either out of fear of losing one’s job because one might be seen as a slacker, or because social and economic pressures increasingly communicate to people that their worth as a person is measured in the dollars they earn--and staying on the job longer means more dollars. On average, Europeans get three times more vacation time than Americans. During the 1990’s, The Netherlands, Sweden, and Denmark matched our productivity rate without our over-zealous work ethic. The explanation may well be that working extra hours does not make you more productive, because after a certain point, you are exhausted and burnt out.
How did we get to this place in our society where people have come to believe that they should not take time away from work? Where did our society lose its sense that a balanced life requires intellectual, cultural, spiritual, and recreational activities in addition to one’s job? Is our country’s raison d’etre simply a matter of getting more economic productivity out of its citizenry, rather than also promoting individual well-being and social progress?
Today, parents of newborns compete to gain enrollment in more and more competitive pre-schools for their little scholars-to-be. First graders get homework. Taking the SAT’s in high school is a nightmare for the competitive college-bound senior. And many high school students and their parents believe that not getting into a prestigious college dooms their chances for a successful life. Getting ahead means just that, and if you are not always working, perhaps you will not get ahead. In other words, children don’t get to have a childhood, and adolescents don’t get to have an adolescence. Everyone gets to be a “work addicted” adult right from the start.
I see adults in my practice who are the result of these overly driven and competitive childhoods. They are anxious, fearful, and lacking in the capacity to experience their lives as joyful. They may have panic attacks, high blood pressure, high blood sugars, as well as dysfunctional relationships with their spouse and children. In fact, they unknowingly have become unhappy as a result of following this prescribed course toward happiness, which apparently now includes the belief that taking a vacation might interfere with success.
The ability to step back from our work--whether it is by traveling to some distant shore, or simply by going to the shore--provides us a chance to relax and reflect on the meaning of our existence and to find new meaning in our lives. We become re-awakened by vacations and ready to return to a job with a new sense of vitality. Vacations allow quality time for a family or for an individual. It exposes us to places and activities that we cannot access in our ordinary work world.
Driving to and from work or the grocery store in vehicles with names like Yukon, Serengeti, Outback, or Tahoe, is not anything like being in those actual places. But if a person does take a vacation, he might actually come to understand first hand what all the fuss is about in places with those names, and he might even like his job more, knowing that it’s not an activity that will consume every one of the 52 weeks of a year.
(Published in the East Bay Psychiatric Association Newsletter, September 2006)
I recently heard about a study that found that people who take vacations function better in the work place. The study’s findings revealed what most of us probably already know. But unfortunately, the work force in our country is actually becoming more and more “work addicted,” either out of fear of losing one’s job because one might be seen as a slacker, or because social and economic pressures increasingly communicate to people that their worth as a person is measured in the dollars they earn--and staying on the job longer means more dollars. On average, Europeans get three times more vacation time than Americans. During the 1990’s, The Netherlands, Sweden, and Denmark matched our productivity rate without our over-zealous work ethic. The explanation may well be that working extra hours does not make you more productive, because after a certain point, you are exhausted and burnt out.
How did we get to this place in our society where people have come to believe that they should not take time away from work? Where did our society lose its sense that a balanced life requires intellectual, cultural, spiritual, and recreational activities in addition to one’s job? Is our country’s raison d’etre simply a matter of getting more economic productivity out of its citizenry, rather than also promoting individual well-being and social progress?
Today, parents of newborns compete to gain enrollment in more and more competitive pre-schools for their little scholars-to-be. First graders get homework. Taking the SAT’s in high school is a nightmare for the competitive college-bound senior. And many high school students and their parents believe that not getting into a prestigious college dooms their chances for a successful life. Getting ahead means just that, and if you are not always working, perhaps you will not get ahead. In other words, children don’t get to have a childhood, and adolescents don’t get to have an adolescence. Everyone gets to be a “work addicted” adult right from the start.
I see adults in my practice who are the result of these overly driven and competitive childhoods. They are anxious, fearful, and lacking in the capacity to experience their lives as joyful. They may have panic attacks, high blood pressure, high blood sugars, as well as dysfunctional relationships with their spouse and children. In fact, they unknowingly have become unhappy as a result of following this prescribed course toward happiness, which apparently now includes the belief that taking a vacation might interfere with success.
The ability to step back from our work--whether it is by traveling to some distant shore, or simply by going to the shore--provides us a chance to relax and reflect on the meaning of our existence and to find new meaning in our lives. We become re-awakened by vacations and ready to return to a job with a new sense of vitality. Vacations allow quality time for a family or for an individual. It exposes us to places and activities that we cannot access in our ordinary work world.
Driving to and from work or the grocery store in vehicles with names like Yukon, Serengeti, Outback, or Tahoe, is not anything like being in those actual places. But if a person does take a vacation, he might actually come to understand first hand what all the fuss is about in places with those names, and he might even like his job more, knowing that it’s not an activity that will consume every one of the 52 weeks of a year.
Friday, July 06, 2007
Suicide of a Patient--The Psychiatrist and Grief
(Published in the Northern California Psychiatric Society Newsletter, December 1998)
This week was a difficult one for me. My normal schedule was interrupted by attendance at the memorial service for a patient of mine who leapt from the Golden Gate Bridge the day I returned from a week-long vacation.
I don't remember being so saddened by the loss of a patient. Throughout the course of most of her treatment, she remained suicidal, despite extensive medication, ECT trials, and intensive psychotherapy. But I had come to believe that the power of our close therapeutic relationship would overcome her pain. When I was told of her death, I was not wholly surprised, and actually felt some relief for her. But when I went to her memorial service, I could hardly believe she was gone, and I felt an enormous sense of loss. My disbelief was so great that I had numerous fantasies of her showing up at my office during the following days because she had not really killed herself.
What surprised me most, was how attached I apparently was to my patient, despite the presumed mastery of "detached concern" I thought was so much part of my professional makeup. After the cermony, the patient's sister and I, not ever having met, mutually embraced, instinctively knowing each other's need for comfort. The sister, who looked and sounded so much like my patient, held on to me, and I to her, and for a moment I thought I was embracing my patient, now in death, the way I knew I never could in life. It was a profoundly emotional moment, a "cleansing" moment, and one which I will not soon forget.
I have re-learned many lessons from this tragedy: the limits of my powers as a physician, the extent of some of my patients' dependency on me, and not the least, the magnitude of my own attachment to some of the people who make their weekly trip to my office. I hope that the peace that so eluded this person in life is with her now, as no amount of my understanding or attention to her psychiatric condition was sufficient to bring her that relief in life.
(Published in the Northern California Psychiatric Society Newsletter, December 1998)
This week was a difficult one for me. My normal schedule was interrupted by attendance at the memorial service for a patient of mine who leapt from the Golden Gate Bridge the day I returned from a week-long vacation.
I don't remember being so saddened by the loss of a patient. Throughout the course of most of her treatment, she remained suicidal, despite extensive medication, ECT trials, and intensive psychotherapy. But I had come to believe that the power of our close therapeutic relationship would overcome her pain. When I was told of her death, I was not wholly surprised, and actually felt some relief for her. But when I went to her memorial service, I could hardly believe she was gone, and I felt an enormous sense of loss. My disbelief was so great that I had numerous fantasies of her showing up at my office during the following days because she had not really killed herself.
What surprised me most, was how attached I apparently was to my patient, despite the presumed mastery of "detached concern" I thought was so much part of my professional makeup. After the cermony, the patient's sister and I, not ever having met, mutually embraced, instinctively knowing each other's need for comfort. The sister, who looked and sounded so much like my patient, held on to me, and I to her, and for a moment I thought I was embracing my patient, now in death, the way I knew I never could in life. It was a profoundly emotional moment, a "cleansing" moment, and one which I will not soon forget.
I have re-learned many lessons from this tragedy: the limits of my powers as a physician, the extent of some of my patients' dependency on me, and not the least, the magnitude of my own attachment to some of the people who make their weekly trip to my office. I hope that the peace that so eluded this person in life is with her now, as no amount of my understanding or attention to her psychiatric condition was sufficient to bring her that relief in life.
Wednesday, July 04, 2007
THE FUTURE
(Published in the East Bay Psychiatric Association Newsletter, January 2005)
One thing is certain: no one can predict the future! While this sounds obvious, people behave as if they can foretell what lies ahead. In reality, the world moves forward in accidental, serendipitous, and random ways. If one looks at the contents of “time-capsules” that people left behind with instructions to be opened 100 years in the future, what one finds are predictions that are wildly off base. And many major scientific breakthroughs often occur serendipitously during a search for unrelated scientific truths.
Fifty years ago no one had any notion of the home computer, a technological advancement which influences things we do almost every minute of every day. One small aspect of the computer revolution is how the lives of seniors have been enhanced. The elderly, who often live alone and have limited ability to move around, have enormously enriched lives now because of their in-home access to e-mail and the Internet. Do you think that Dell or Apple had any inkling years ago that the market for personal computers would be so huge for the senior population?
Back in the 1800’s, before recording devices existed, if people went to a concert, they would hear a performance of a piece of music that they would likely never hear again, regardless of how much they enjoyed listening to that piece of music. This week my son bought an I-Pod, which has the capability of holding 5000 songs of his choosing in its memory. In a little mechanism smaller than his wallet where he can listen to music over and over again wherever and whenever he chooses. Find me an article from a couple of decades ago that foretold of such an innovation.
We are even less capable of controlling our future than we are of predicting it. Did you really control how you met the person who is your life partner? Did you really have control over the specific job offer that has led to so much of what you do everyday? Of course the most accidental and unpredictable of all things is whether or not you were even born in the first place. Think about all the couplings of people that had to occur in your ancestors exactly at the right moment, leading up to the existence of your parents, and then the precise egg and sperm that had to unite to form you. Talk about overcoming extreme odds.
Perhaps life is best lived without excessive regard to trying to control what is going to happen in the future. In other words, try to live in the present. Some future planning obviously makes sense, but what you are going to be doing five years from now, let alone what happens to you tomorrow, may be a lot less predictable and a lot less in your control than you think.
(Published in the East Bay Psychiatric Association Newsletter, January 2005)
One thing is certain: no one can predict the future! While this sounds obvious, people behave as if they can foretell what lies ahead. In reality, the world moves forward in accidental, serendipitous, and random ways. If one looks at the contents of “time-capsules” that people left behind with instructions to be opened 100 years in the future, what one finds are predictions that are wildly off base. And many major scientific breakthroughs often occur serendipitously during a search for unrelated scientific truths.
Fifty years ago no one had any notion of the home computer, a technological advancement which influences things we do almost every minute of every day. One small aspect of the computer revolution is how the lives of seniors have been enhanced. The elderly, who often live alone and have limited ability to move around, have enormously enriched lives now because of their in-home access to e-mail and the Internet. Do you think that Dell or Apple had any inkling years ago that the market for personal computers would be so huge for the senior population?
Back in the 1800’s, before recording devices existed, if people went to a concert, they would hear a performance of a piece of music that they would likely never hear again, regardless of how much they enjoyed listening to that piece of music. This week my son bought an I-Pod, which has the capability of holding 5000 songs of his choosing in its memory. In a little mechanism smaller than his wallet where he can listen to music over and over again wherever and whenever he chooses. Find me an article from a couple of decades ago that foretold of such an innovation.
We are even less capable of controlling our future than we are of predicting it. Did you really control how you met the person who is your life partner? Did you really have control over the specific job offer that has led to so much of what you do everyday? Of course the most accidental and unpredictable of all things is whether or not you were even born in the first place. Think about all the couplings of people that had to occur in your ancestors exactly at the right moment, leading up to the existence of your parents, and then the precise egg and sperm that had to unite to form you. Talk about overcoming extreme odds.
Perhaps life is best lived without excessive regard to trying to control what is going to happen in the future. In other words, try to live in the present. Some future planning obviously makes sense, but what you are going to be doing five years from now, let alone what happens to you tomorrow, may be a lot less predictable and a lot less in your control than you think.
Sunday, July 01, 2007
"Brokeback Mountain" and The Art of the Screenplay
(Published in the East Bay Psychiatric Association Newsletter, January 2006)
It is not often when a book and a movie are equally masterful. But within the recent Academy Award nominated best film category is "Brokeback Mountain", adapted from the short story by the same name in Annie Proulx’ book of short stories of the American West entitled "Close Range". The movie and the book are both exceptional artistic achievements, neither to be missed.
According to Ms. Proulx, when asked to discuss “that gay cowboy movie”, she said, “Excuse me, but the story is about two inarticulate Wyoming ranch hands who experience something they don’t understand and can’t put words to.” So much for the romantic fantasy of the hard drinking, gun toting frontier cowboys as heroes who won the West—this story completely explodes that mythology.
The story/movie deals with homosexuality in the pre-AIDS and pre “out of the closet” era of 1963, but it is not so much about sexuality as it is a love story between two people who are lonely and isolated. The full-length movie is amazingly true to the relatively brief, 35 page long short story, as it is virtually identical in dialogue and content. It is a creative tour de force for the screenwriter to be able to flesh in the details of the characters in the movie so well, based on such a brief tale. Yet this is also to the credit of the story’s author, who has been able to create such full and colorful characters in such a brief story.
As much as I liked the movie "Brokeback Mountain", I enjoyed reading that story and the others in "Close Range" even more. The loneliness and emotional impoverishment of Ms. Proux’ characters are so penetrating that one feels transported into the lives of these people in the rural ranch-land of Wyoming.
As a psychiatrist, it was notable to me that this story so effectively conveyed the difficulty that emotionally deprived people have in “making love” as opposed to “having sex”—or in some of the stories “taking sex.” This seems to be an underlying dynamic in the lives of many of the Proulx' characters, as it is in some of my patients as well.
Whether you see the movie, read the story, or do both, I think you will agree, "Brokeback Mountain" represents a breakthrough in cinema and story telling. And it is the screenwriter who can take credit for transforming one media form into the other so masterfully.
(Published in the East Bay Psychiatric Association Newsletter, January 2006)
It is not often when a book and a movie are equally masterful. But within the recent Academy Award nominated best film category is "Brokeback Mountain", adapted from the short story by the same name in Annie Proulx’ book of short stories of the American West entitled "Close Range". The movie and the book are both exceptional artistic achievements, neither to be missed.
According to Ms. Proulx, when asked to discuss “that gay cowboy movie”, she said, “Excuse me, but the story is about two inarticulate Wyoming ranch hands who experience something they don’t understand and can’t put words to.” So much for the romantic fantasy of the hard drinking, gun toting frontier cowboys as heroes who won the West—this story completely explodes that mythology.
The story/movie deals with homosexuality in the pre-AIDS and pre “out of the closet” era of 1963, but it is not so much about sexuality as it is a love story between two people who are lonely and isolated. The full-length movie is amazingly true to the relatively brief, 35 page long short story, as it is virtually identical in dialogue and content. It is a creative tour de force for the screenwriter to be able to flesh in the details of the characters in the movie so well, based on such a brief tale. Yet this is also to the credit of the story’s author, who has been able to create such full and colorful characters in such a brief story.
As much as I liked the movie "Brokeback Mountain", I enjoyed reading that story and the others in "Close Range" even more. The loneliness and emotional impoverishment of Ms. Proux’ characters are so penetrating that one feels transported into the lives of these people in the rural ranch-land of Wyoming.
As a psychiatrist, it was notable to me that this story so effectively conveyed the difficulty that emotionally deprived people have in “making love” as opposed to “having sex”—or in some of the stories “taking sex.” This seems to be an underlying dynamic in the lives of many of the Proulx' characters, as it is in some of my patients as well.
Whether you see the movie, read the story, or do both, I think you will agree, "Brokeback Mountain" represents a breakthrough in cinema and story telling. And it is the screenwriter who can take credit for transforming one media form into the other so masterfully.
Monday, June 25, 2007
“ALL THE SAME”
(Publshed in the East Bay Psychiatric Association Newsletter, August, 2006)
I recently left my one-half day a week part time job at the Contra Costa County Forensic Mental Health Clinic. My responsibilities there for 14 ½ years had been primarily to provide medication management for some 40 conditionally released offenders who were undergoing mandated treatment in the community after a period of years stabilizing in a state mental hospital. Typically, these patients had committed major felonies while psychotic, had been found “not guilty of reason of insanity”, and were diverted from the prison system to the state mental health system. Their crimes were the worst kind, such as homicide (including infanticide), unprovoked assaults, and arson.
I enjoyed this part time work as a contrast to my own private practice. These two patient populations were about as different as night and day. The forensic patients typically came from minority groups in the inner city, had disadvantaged or abusive backgrounds, and often had psychoses complicated by substance abuse. These were the “throwaways” of the population—the people no one wanted. In contrast, my private patients were drawn mostly from the white, suburban, professional class—the people of privilege.
What surprised me was the impact that my leaving this job had on some of the patients. I had not realized that my relatively brief visit with them monthly for prescriptions and support had had such an impact on many of them. Some simply said polite goodbyes at their last appointment. But others amazingly spoke eloquently about how they felt at a little retirement party. And one of the female patients, with whom I felt very little connection, said something very poignant. She suffered from a major psychosis as well as a personality disorder. At her last visit, she brought me a small bouquet of flowers, an appropriate retirement card, and said, “Dr. Winig, you’re a good doctor. You treat us all the same,” and she started to cry.
I realized then, without having fully appreciated it before, that I was taking care of certain people for whom being taken care of was a very foreign experience. Perhaps no one else in their lives cared very much about them, or certainly never treated them as if they were “the same.” It was natural for me to do this. I was just being their doctor. But for some of these patients, the nature of the human relationship that they had with me may have been qualitatively different from anything else they had ever known.
It is important to keep in mind the powerful impact we may have on our patients. Even brief contacts may bring an individual hope and the sense that they are worth something, in the face of a lifetime of experiences that may have communicated something quite different. Sometimes, what seems so simple may actually be quite profound.
(Publshed in the East Bay Psychiatric Association Newsletter, August, 2006)
I recently left my one-half day a week part time job at the Contra Costa County Forensic Mental Health Clinic. My responsibilities there for 14 ½ years had been primarily to provide medication management for some 40 conditionally released offenders who were undergoing mandated treatment in the community after a period of years stabilizing in a state mental hospital. Typically, these patients had committed major felonies while psychotic, had been found “not guilty of reason of insanity”, and were diverted from the prison system to the state mental health system. Their crimes were the worst kind, such as homicide (including infanticide), unprovoked assaults, and arson.
I enjoyed this part time work as a contrast to my own private practice. These two patient populations were about as different as night and day. The forensic patients typically came from minority groups in the inner city, had disadvantaged or abusive backgrounds, and often had psychoses complicated by substance abuse. These were the “throwaways” of the population—the people no one wanted. In contrast, my private patients were drawn mostly from the white, suburban, professional class—the people of privilege.
What surprised me was the impact that my leaving this job had on some of the patients. I had not realized that my relatively brief visit with them monthly for prescriptions and support had had such an impact on many of them. Some simply said polite goodbyes at their last appointment. But others amazingly spoke eloquently about how they felt at a little retirement party. And one of the female patients, with whom I felt very little connection, said something very poignant. She suffered from a major psychosis as well as a personality disorder. At her last visit, she brought me a small bouquet of flowers, an appropriate retirement card, and said, “Dr. Winig, you’re a good doctor. You treat us all the same,” and she started to cry.
I realized then, without having fully appreciated it before, that I was taking care of certain people for whom being taken care of was a very foreign experience. Perhaps no one else in their lives cared very much about them, or certainly never treated them as if they were “the same.” It was natural for me to do this. I was just being their doctor. But for some of these patients, the nature of the human relationship that they had with me may have been qualitatively different from anything else they had ever known.
It is important to keep in mind the powerful impact we may have on our patients. Even brief contacts may bring an individual hope and the sense that they are worth something, in the face of a lifetime of experiences that may have communicated something quite different. Sometimes, what seems so simple may actually be quite profound.
Friday, June 15, 2007
THE PRICE OF SELF-DECEPTION
(Published as a review of Arthur Miller's play "The Price" in the East Bay Psychiatric Association Newsletter, October, 2005)
I recently saw Arthur Miller’s play "The Price" at the Aurora Theatre in Berkeley. This is another one of Miller’s incisive and insightful dramas, like his Death of a Salesman, that cuts to the quick regarding the failure of families to face their own reality. This play was written in 1968 as a metaphor for our own government’s lack of honesty in facing up to its failed policy in Vietnam. As Miller himself said then, “50,000 Americans and millions of Vietnamese paid with their lives to support a myth and bellicose denial.”
The struggle for many families to deal honestly with their lives probably lies in their attempt to maintain a fragile balance between practicing a certain amount of self-deception versus risking the total breakdown of the family unit. Many families have an “elephant” that sits at the dinner table every night that is never mentioned, so that the family can survive, albeit dysfunctionally.
Sometimes this fragile balance breaks down in unanticipated ways. Recently I saw the mother of a 21 year-old son who had bipolar illness and alcoholism. For years the family had not been strong enough to confront this child’s chaotic, dysfunctional behavior, which escalated at times to physical assaults and death threats on the part of the son within the home. The family remained largely codependent, choosing to avoid confronting the son and practicing self-deception, until one day they finally called the police. The son was then in turn jailed and hospitalized, but tragically took his own life while in confinement—not exactly the kind of resolution the family had wished to accomplish.
Miller’s "The Price" is an attempt to show “that through the mists of denial, the bow of the ancient ship of reality could emerge.” His metaphorical use of family self-deception to reveal the nation’s problem confronting the Vietnam War in 1968 holds true today as well. We as a nation are now facing a similar dilemma as our administration explains its rationale for the war in Iraq in varying ways depending on how events unfold. Most recently we were told that the reason to “stay the course” is not to dishonor those brave soldiers who have already died in the conflict, as if simply sacrificing more troops will do more good. (We were also told that in the Vietnam War era when only 100 soldiers had perished). A more honest approach, a la Arthur Miller, would be to come clean as to why we are in Iraq in the first place—why we are building the biggest American Embassy building that exists anywhere in the world, and why we are establishing Air Force bases around that country. But to do that would risk the already eroding public support for the war, and throw the “family’ into chaos. Better to practice deception, it seems our administration has concluded. But this also robs the nation of a chance to change course correctively.
People (and nations) will pay “the price” in the present for dysfunctional decisions they have made in the past, and then take no corrective action in the present. As an individual, for instance, one may be overly attached to a parent, or manipulated by that parent, to make a choice of a career or spouse that is not really one’s own. The price paid can be a lifetime of unhappiness if self-deception is practiced. Similarly, Miller tells us, we pay a price as a nation when we make choices and then do not deal with the reality of the consequences.
Whether one is running a government, a company, or just helping a family or individual to cope, denial and self-deception can get you only so far. At some point you will pay “the price.”
(Published as a review of Arthur Miller's play "The Price" in the East Bay Psychiatric Association Newsletter, October, 2005)
I recently saw Arthur Miller’s play "The Price" at the Aurora Theatre in Berkeley. This is another one of Miller’s incisive and insightful dramas, like his Death of a Salesman, that cuts to the quick regarding the failure of families to face their own reality. This play was written in 1968 as a metaphor for our own government’s lack of honesty in facing up to its failed policy in Vietnam. As Miller himself said then, “50,000 Americans and millions of Vietnamese paid with their lives to support a myth and bellicose denial.”
The struggle for many families to deal honestly with their lives probably lies in their attempt to maintain a fragile balance between practicing a certain amount of self-deception versus risking the total breakdown of the family unit. Many families have an “elephant” that sits at the dinner table every night that is never mentioned, so that the family can survive, albeit dysfunctionally.
Sometimes this fragile balance breaks down in unanticipated ways. Recently I saw the mother of a 21 year-old son who had bipolar illness and alcoholism. For years the family had not been strong enough to confront this child’s chaotic, dysfunctional behavior, which escalated at times to physical assaults and death threats on the part of the son within the home. The family remained largely codependent, choosing to avoid confronting the son and practicing self-deception, until one day they finally called the police. The son was then in turn jailed and hospitalized, but tragically took his own life while in confinement—not exactly the kind of resolution the family had wished to accomplish.
Miller’s "The Price" is an attempt to show “that through the mists of denial, the bow of the ancient ship of reality could emerge.” His metaphorical use of family self-deception to reveal the nation’s problem confronting the Vietnam War in 1968 holds true today as well. We as a nation are now facing a similar dilemma as our administration explains its rationale for the war in Iraq in varying ways depending on how events unfold. Most recently we were told that the reason to “stay the course” is not to dishonor those brave soldiers who have already died in the conflict, as if simply sacrificing more troops will do more good. (We were also told that in the Vietnam War era when only 100 soldiers had perished). A more honest approach, a la Arthur Miller, would be to come clean as to why we are in Iraq in the first place—why we are building the biggest American Embassy building that exists anywhere in the world, and why we are establishing Air Force bases around that country. But to do that would risk the already eroding public support for the war, and throw the “family’ into chaos. Better to practice deception, it seems our administration has concluded. But this also robs the nation of a chance to change course correctively.
People (and nations) will pay “the price” in the present for dysfunctional decisions they have made in the past, and then take no corrective action in the present. As an individual, for instance, one may be overly attached to a parent, or manipulated by that parent, to make a choice of a career or spouse that is not really one’s own. The price paid can be a lifetime of unhappiness if self-deception is practiced. Similarly, Miller tells us, we pay a price as a nation when we make choices and then do not deal with the reality of the consequences.
Whether one is running a government, a company, or just helping a family or individual to cope, denial and self-deception can get you only so far. At some point you will pay “the price.”
Monday, June 11, 2007
THE NONEXISTENCE OF RACE
(Published in the East Bay Psychiatric Association Newsletter, September 2000)
When I was a little boy, before the age of 4, I lived in a town in upstate New York. In my neighborhood, there lived a family with two girls close to me in age, the Chu sisters. I would play at their house and they at mine. When we moved away, the Chu family gave my brother and me a copy of Grimm’s Fairy Tales as a present, inscribed with best wishes from them. I did not know that they were Chinese, as I had no concept of race.
A few years later, my parents were told by our extended family who still lived there, that the Chu’s were forced to move--that some of the neighbors had maliciously banded together and pressured them to leave: “No Chinese Allowed!” As a youngster, I did not understand then what had happened, as I still had no real concept of race.
When I was growing up as a schoolboy, race began to be presented simplistically. One was either of the Black, White, or Yellow race, and everyone could see that such differences existed. Then as Native Americans were considered, a Red race was discussed. As time went on, I began to ask questions about people who were not Black, White, Yellow or Red. Few answers were forthcoming, so I turned to the encyclopedia. There the concept of race was enlarged to 9 groups, including such exotic peoples as Micronesians, Melanesians, and Australoids. I felt satisfied, based on encyclopedic information, that I now was beginning to really understand the concept of race. However, later, while in college, I read an article that expanded racial groupings to 21, and now I was beginning to get confused and to question how scientists were coming up with these groupings.
Now that the human genome project is marching forward, some remarkable information is being uncovered. The geneticists at Celera Genomics Corporation, which were the first to unravel the human genome sequence, have drawn some dramatic conclusions. The different physical characteristics that make up different “races” appear to be only “skin deep.” One-hundredth of one percent of our genetic material accounts for these physical differences, such as skin color, lip contour, hair texture, etc. The other 99.99% of our DNA is the same from one ethnic group to another. Genetic endowment of such complex characteristics as intelligence requires at least 1000’s of genes, and cannot be distinguished by looking at the DNA of one ethnic group or another.
In a recent article in the New York Times, the “Out of Africa” theory is outlined. According to this theory, modern Homo Sapiens originated between 200,000 and 100,000 years ago, at which point, a small number of them, perhaps 10,000 or so, began to migrate into the Middle East, Europe, Asia, and across the Bering land mass into the Americas. Since that time, a mere 7000 generations have passed. Because of such a limited founding population and such a short time since dispersal, humans are strikingly homogeneous, differing from one another only once in a thousand subunits of the genome.
Because Homo sapiens have only been around for these 7000 generations, only different ethnicities, with differing physical traits, have become distinguishable. Ethnicity is a broad concept that encompasses both genetics and culture, whereas race only takes genetics into consideration, and therein lies the crucial difference. We seem to be a single human race, as biologically we have the same complex set of human genetic characteristics, as do all our fellow men.
Those obvious physical ethnic differences that do exist are adaptations to the environment, stemming from specific mutations that gave that group living in a certain region an advantage (like pale skinned people in Northern Europe being more able to produce Vitamin D from pale sunlight). Formulating the concept of a single human race, which comes in a variety of “flavors,” should alter our current categorization of each other which falsely places us into several different racial groups.
Learning about race while growing up in American society has misled most of us into believing that somehow we are biologically different from people of other races. What may be true, is that we are significantly different culturally, and that may be the source of distrust or prejudice. Race is very politicized in this country, unlike elsewhere. Here, it may be good to be of a different race, as you represent diversity. (College admissions committees are intensely interested in racial diversity of their student bodies). Or it may be bad to be of a different race, as is the case when people band together to keep away people who are unlike themselves. (Realtors often work hard to keep neighborhoods racially distinct, believing that this keeps property values higher). Whatever the case, race in America is rarely viewed from a neutral perspective.
The elimination of biology from the formulation of race as a result of the human genome project may be a quantum leap forward toward helping us all coexist more compatibly. Unfortunately for the Chinese family in that neighborhood of my early youth, this data comes somewhat late, as it does for all other individuals who have suffered the indignities of racial prejudice. However, just as placing a man on the moon led to a variety of scientific discoveries unrelated to space travel, the human genome project may lead to certain sociological advances unanticipated by this biological research.
(Published in the East Bay Psychiatric Association Newsletter, September 2000)
When I was a little boy, before the age of 4, I lived in a town in upstate New York. In my neighborhood, there lived a family with two girls close to me in age, the Chu sisters. I would play at their house and they at mine. When we moved away, the Chu family gave my brother and me a copy of Grimm’s Fairy Tales as a present, inscribed with best wishes from them. I did not know that they were Chinese, as I had no concept of race.
A few years later, my parents were told by our extended family who still lived there, that the Chu’s were forced to move--that some of the neighbors had maliciously banded together and pressured them to leave: “No Chinese Allowed!” As a youngster, I did not understand then what had happened, as I still had no real concept of race.
When I was growing up as a schoolboy, race began to be presented simplistically. One was either of the Black, White, or Yellow race, and everyone could see that such differences existed. Then as Native Americans were considered, a Red race was discussed. As time went on, I began to ask questions about people who were not Black, White, Yellow or Red. Few answers were forthcoming, so I turned to the encyclopedia. There the concept of race was enlarged to 9 groups, including such exotic peoples as Micronesians, Melanesians, and Australoids. I felt satisfied, based on encyclopedic information, that I now was beginning to really understand the concept of race. However, later, while in college, I read an article that expanded racial groupings to 21, and now I was beginning to get confused and to question how scientists were coming up with these groupings.
Now that the human genome project is marching forward, some remarkable information is being uncovered. The geneticists at Celera Genomics Corporation, which were the first to unravel the human genome sequence, have drawn some dramatic conclusions. The different physical characteristics that make up different “races” appear to be only “skin deep.” One-hundredth of one percent of our genetic material accounts for these physical differences, such as skin color, lip contour, hair texture, etc. The other 99.99% of our DNA is the same from one ethnic group to another. Genetic endowment of such complex characteristics as intelligence requires at least 1000’s of genes, and cannot be distinguished by looking at the DNA of one ethnic group or another.
In a recent article in the New York Times, the “Out of Africa” theory is outlined. According to this theory, modern Homo Sapiens originated between 200,000 and 100,000 years ago, at which point, a small number of them, perhaps 10,000 or so, began to migrate into the Middle East, Europe, Asia, and across the Bering land mass into the Americas. Since that time, a mere 7000 generations have passed. Because of such a limited founding population and such a short time since dispersal, humans are strikingly homogeneous, differing from one another only once in a thousand subunits of the genome.
Because Homo sapiens have only been around for these 7000 generations, only different ethnicities, with differing physical traits, have become distinguishable. Ethnicity is a broad concept that encompasses both genetics and culture, whereas race only takes genetics into consideration, and therein lies the crucial difference. We seem to be a single human race, as biologically we have the same complex set of human genetic characteristics, as do all our fellow men.
Those obvious physical ethnic differences that do exist are adaptations to the environment, stemming from specific mutations that gave that group living in a certain region an advantage (like pale skinned people in Northern Europe being more able to produce Vitamin D from pale sunlight). Formulating the concept of a single human race, which comes in a variety of “flavors,” should alter our current categorization of each other which falsely places us into several different racial groups.
Learning about race while growing up in American society has misled most of us into believing that somehow we are biologically different from people of other races. What may be true, is that we are significantly different culturally, and that may be the source of distrust or prejudice. Race is very politicized in this country, unlike elsewhere. Here, it may be good to be of a different race, as you represent diversity. (College admissions committees are intensely interested in racial diversity of their student bodies). Or it may be bad to be of a different race, as is the case when people band together to keep away people who are unlike themselves. (Realtors often work hard to keep neighborhoods racially distinct, believing that this keeps property values higher). Whatever the case, race in America is rarely viewed from a neutral perspective.
The elimination of biology from the formulation of race as a result of the human genome project may be a quantum leap forward toward helping us all coexist more compatibly. Unfortunately for the Chinese family in that neighborhood of my early youth, this data comes somewhat late, as it does for all other individuals who have suffered the indignities of racial prejudice. However, just as placing a man on the moon led to a variety of scientific discoveries unrelated to space travel, the human genome project may lead to certain sociological advances unanticipated by this biological research.
Saturday, June 02, 2007
G.I.'s Battered by the Trauma of Iraq
( Published as a letter to the Editor in the New York Times, December 17, 2004)
To the Editor:
Re ''A Deluge of Troubled Soldiers Is in the Offing, Experts Predict'' (front page, Dec. 16):
As President Bush cavalierly hands out Medals of Freedom to three people who were central figures in the war in Iraq, it might behoove him to observe what his policies have wrought: tens of thousands of soldiers with psychiatric problems who, you report, ''are going to need help for the next 35 years.''
The president is trying to write the history of the Iraq war as a success despite its uncertain outcome.
Expert predictions of the emotional devastation befalling another generation of young Americans sent to war is one of many reasons Mr. Bush sounds more like a salesman than a statesman.
The psychiatric impact of this war on our troops was as predictable as night following day by those of us who work in the field.
Hugh R. Winig, M.D.
(The writer is a psychiatrist.)
( Published as a letter to the Editor in the New York Times, December 17, 2004)
To the Editor:
Re ''A Deluge of Troubled Soldiers Is in the Offing, Experts Predict'' (front page, Dec. 16):
As President Bush cavalierly hands out Medals of Freedom to three people who were central figures in the war in Iraq, it might behoove him to observe what his policies have wrought: tens of thousands of soldiers with psychiatric problems who, you report, ''are going to need help for the next 35 years.''
The president is trying to write the history of the Iraq war as a success despite its uncertain outcome.
Expert predictions of the emotional devastation befalling another generation of young Americans sent to war is one of many reasons Mr. Bush sounds more like a salesman than a statesman.
The psychiatric impact of this war on our troops was as predictable as night following day by those of us who work in the field.
Hugh R. Winig, M.D.
(The writer is a psychiatrist.)
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