GREED
(Published in the January 2009 edition of the East Bay Psychiatric Association Newsletter)
Wall Street insiders using unethical practices and awarding themselves multimillion dollar bonuses despite running their institutions into the ground; Detroit automaker CEO’s producing impractical cars because they are profitable only in the short run and then demanding government bailouts to keep their businesses afloat; banking executives soliciting and selling unsustainable loans and then taking government bailout money that they use to pay dividends to their stockholders and bonuses to themselves; average Americans using their houses like ATM machines to take out equity loans and exhausting their entire credit lines on their credit cards to live lavishly; an individual perpetrating a $50 billion Ponzi scheme for over 30 years, devastating individual investors and charitable institutions alike. What do these people all have in common? Their road to happiness is paved with greed!
Individuals who excessively attach themselves to money alone as a means to achieve happiness have a very weak foundation upon which to move forward when hard times come. But people who have built their lives around occupational achievement, cultural, spiritual and intellectual pursuits, and friendships, are no less rich when stock markets collapse and wealth diminishes.
There’s an old saying about Americans: “Shirtsleeves to shirtsleeves in 3 generations.” The immigrant populations and their children work hard to establish themselves and provide security for those that follow them. But by the time the third generation comes along and has been over-indulged by those that came before them, many people no longer feel the need to be productive themselves. In addition, without the family lore that conveys the message of overcoming adversity through hard work, there is no longer even an understanding of what it means to work hard. If you have not had a parent or grandparent who has told stories about what it was like to overcome hardship, you have missed an important source of motivation in your life. For people who have missed that inspiration, it may seem as if money should simply grow on trees, and their avarice often increases.
There has been a shift in this country over the past generation from the brightest minds going into medicine, law, engineering or other professions to many of those people going to Wall Street to figure out how to make money out of money. Seventy-five per cent of the engineers trained in this country now are foreign born. Americans no longer specialize is manufacturing products; they specialize in slicing up the money pie differently with nothing created but profitability for different people. If our country is to succeed, it appears that we had better embrace our immigrant populations who are entrepreneurial and hard working, because without them, our economy is likely to stagnate. Greed alone cannot sustain a society.
With continued tough times ahead financially, it might be well for all of us to remember that the basis of our happiness cannot be found in money alone. A long walk in our natural surroundings, laughter with close friends, reading a good book, or listening to enjoyable music each have a price tag of almost nothing. Perhaps this difficult transition our nation is going through will help us all get a firmer grip on what is truly important; then we can discern more easily what money can and cannot buy, and the amount of greed that now prevails will diminish.
Wednesday, January 14, 2009
Thursday, November 27, 2008
EQUANIMITY
(Published in the December 2008 edition of the East Bay Psychiatric Association Newsletter)
I am one of those political junkies who read hundreds of editorials, opinion pieces, and blogs during the presidential campaign this year. Every day I would find points of view from the entire political spectrum expounding on all conceivable perspectives of the campaign and the personalities involved. It didn’t matter what your opinion was about anything—you could find support for it as well as an argument against it every single day.
After all is said and done, however, I have concluded that there was one factor above all others that led to President-elect Obama’s victory. And that factor had nothing to do with his positions on the economy, the war, his running mate’s personality, or what his racial background is. It was Barack Obama’s equanimity—his calmness and emotional cool—that carried the day. Whether during the debates or when his opponents were throwing political attacks or smears at him on the campaign trail, he never exhibited undue anger. He remained calm in every storm, stepping back and discussing what was happening, rather than reacting emotionally.
It is this precise quality of equanimity that we psychiatrists attempt to instill in our patients. We do this in several ways--by modeling such behavior, by helping our patients cognitively reframe their emotional reactions, and through the use of particular medications such as SSRI’s.
In politics, people have to find you likeable in order to vote for you. If a candidate projects irritability, anger, frustration, or annoyance, people will identify with those feelings (projective identification) and begin to feel emotionally uncomfortable themselves. But if a candidate projects equanimity, then the listener feels calmer and more reassured and is more likely to overlook differences in political positions and trust the candidate.
The temperamental quality of equanimity is not only optimal for politicians, but for almost anyone else as well. People with equanimity tolerate disagreement, personal criticism, and conflict without becoming unglued. In Obama’s case, now in this post election period, he even seems comfortable appointing people who were at odds with him during the campaign. He doesn’t appear to hold grudges or be vindictive—he seems to be able to keep his eye on the bigger picture of what he wants to accomplish politically.
If as an employer or manager you want someone to work hard for you and be loyal, then you praise that person when he succeeds, and you moderate and contain your anger toward him when he errs. That is the way to obtain devotion and hard work from your subordinates in any of life’s endeavors.
Developing increased equanimity may be the best investment any of us can make in these difficult economic times. It’s a no risk venture, won’t lose value over time, and will likely pay increased dividends for the rest of one’s life.
(Published in the December 2008 edition of the East Bay Psychiatric Association Newsletter)
I am one of those political junkies who read hundreds of editorials, opinion pieces, and blogs during the presidential campaign this year. Every day I would find points of view from the entire political spectrum expounding on all conceivable perspectives of the campaign and the personalities involved. It didn’t matter what your opinion was about anything—you could find support for it as well as an argument against it every single day.
After all is said and done, however, I have concluded that there was one factor above all others that led to President-elect Obama’s victory. And that factor had nothing to do with his positions on the economy, the war, his running mate’s personality, or what his racial background is. It was Barack Obama’s equanimity—his calmness and emotional cool—that carried the day. Whether during the debates or when his opponents were throwing political attacks or smears at him on the campaign trail, he never exhibited undue anger. He remained calm in every storm, stepping back and discussing what was happening, rather than reacting emotionally.
It is this precise quality of equanimity that we psychiatrists attempt to instill in our patients. We do this in several ways--by modeling such behavior, by helping our patients cognitively reframe their emotional reactions, and through the use of particular medications such as SSRI’s.
In politics, people have to find you likeable in order to vote for you. If a candidate projects irritability, anger, frustration, or annoyance, people will identify with those feelings (projective identification) and begin to feel emotionally uncomfortable themselves. But if a candidate projects equanimity, then the listener feels calmer and more reassured and is more likely to overlook differences in political positions and trust the candidate.
The temperamental quality of equanimity is not only optimal for politicians, but for almost anyone else as well. People with equanimity tolerate disagreement, personal criticism, and conflict without becoming unglued. In Obama’s case, now in this post election period, he even seems comfortable appointing people who were at odds with him during the campaign. He doesn’t appear to hold grudges or be vindictive—he seems to be able to keep his eye on the bigger picture of what he wants to accomplish politically.
If as an employer or manager you want someone to work hard for you and be loyal, then you praise that person when he succeeds, and you moderate and contain your anger toward him when he errs. That is the way to obtain devotion and hard work from your subordinates in any of life’s endeavors.
Developing increased equanimity may be the best investment any of us can make in these difficult economic times. It’s a no risk venture, won’t lose value over time, and will likely pay increased dividends for the rest of one’s life.
Monday, November 24, 2008
MIND FIELDS: Stories From the Other Side of the Couch
(ISBN 978-0-9745540-2-0)
Published by Big Hat Press, Lafayette, California, 2008
(Below is the Forward from the above entitled book of 9 psychiatric short stories):
The short story is a literary genre that has always appealed to me. I suppose this is so because in a single sitting I can complete the reading and feel the satisfaction of coming to the conclusion. I remember as a schoolboy reading O. Henry or Hans Christian Andersen or Grimm’s Fairy Tales and enjoying what I had read because of their brevity and quick resolution. I can remember also the appeal of certain novelists like Thomas Hardy, who held my interest over a longer period of time, and feeling disappointed when my relationship with his characters had ended. But Hardy was the exception for me, and too often I would find myself growing impatient with novelists and their protracted stories, and my interest would wane before I had completed the book.
The short story developed as a distinct literary genre in the 19th century beginning with Edgar Allan Poe. It is defined as a brief fictional narrative, usually between 500 and 10,000 words. For me, a short story connotes something akin to a bedtime story or perhaps a tale or fable briefly related orally from one person to another. The climax lurks right around the corner. There is some suspense, but that suspense is short lived. The conclusion is often ironic, leading to a sense of surprise. Typically, the central character has a problem that must be resolved quickly. A good short story stakes out its territory promptly, peaks the reader’s curiosity and colors in its characters swiftly, and then strikes with the climax, which often catches the reader off guard. Like a good joke, timing is crucial to the success of a short story.
Perhaps the most famous twentieth century short story writer was Nobel Laureate Isaac Bashevis Singer, whose prolific tales are published in collections that take up several volumes. Singer’s works focused primarily on Yiddish themes and were enormously popular. More recent day short story writers have also shown a knack for picking a theme and then developing a number of separate tales connected to that theme. Jhumpa Lahira, in Interpreter of Maladies, writes stories about people of Bengali heritage who have immigrated to the United States. Similarly, Joseph Epstein, in his collection Fabulous Small Jews, writes about conflicts as seen through the eyes of people who have a shared ethnicity. And Thomas McGuane (Gallatin Canyon), Annie Proulx (Close Range), and Thomas Steinbeck (Down to a Soundless Sea) each write their stories centered around a geographic local—Montana/Idaho, Wyoming, and the Big Sur areas respectively. In Steinbeck’s case, the focus that envelops his stories is not just a particular locale, but also a specific time period different from the one in which the author is living. These authors have all mastered the short story genre and were inspirational to me in writing this collection, which is my first book.
The theme that unites the stories in my collection is psychiatry. Most of the characters struggle with psychiatric conditions or defense mechanisms that shape their lives and the story. As a psychiatrist myself with 37 years of experience in the field, I have drawn on a range of specific examples from patients who have confided their struggles in me over the years. However, all of the characters in the book are entirely fictional. They are composites of many different patients’ symptoms or circumstances, as well as figments of my imagination.
While writing these stories, I found that if I allowed my characters to speak for themselves, that they went in directions that I had not anticipated and which at times surprised me. In essence, I found myself experiencing what other writers have reported, that is, I was simply “holding the pen” as the characters lived out their own lives. Nonetheless, the psychiatric problems portrayed in my stories are meant to be realistic, and in that sense I hope that they contain instructive elements as well as provide entertainment. Toward that end, I have provided a study guide in an appendix.
Hugh R. Winig, M.D.
Walnut Creek, California
May 2008
(ISBN 978-0-9745540-2-0)
Published by Big Hat Press, Lafayette, California, 2008
(Below is the Forward from the above entitled book of 9 psychiatric short stories):
The short story is a literary genre that has always appealed to me. I suppose this is so because in a single sitting I can complete the reading and feel the satisfaction of coming to the conclusion. I remember as a schoolboy reading O. Henry or Hans Christian Andersen or Grimm’s Fairy Tales and enjoying what I had read because of their brevity and quick resolution. I can remember also the appeal of certain novelists like Thomas Hardy, who held my interest over a longer period of time, and feeling disappointed when my relationship with his characters had ended. But Hardy was the exception for me, and too often I would find myself growing impatient with novelists and their protracted stories, and my interest would wane before I had completed the book.
The short story developed as a distinct literary genre in the 19th century beginning with Edgar Allan Poe. It is defined as a brief fictional narrative, usually between 500 and 10,000 words. For me, a short story connotes something akin to a bedtime story or perhaps a tale or fable briefly related orally from one person to another. The climax lurks right around the corner. There is some suspense, but that suspense is short lived. The conclusion is often ironic, leading to a sense of surprise. Typically, the central character has a problem that must be resolved quickly. A good short story stakes out its territory promptly, peaks the reader’s curiosity and colors in its characters swiftly, and then strikes with the climax, which often catches the reader off guard. Like a good joke, timing is crucial to the success of a short story.
Perhaps the most famous twentieth century short story writer was Nobel Laureate Isaac Bashevis Singer, whose prolific tales are published in collections that take up several volumes. Singer’s works focused primarily on Yiddish themes and were enormously popular. More recent day short story writers have also shown a knack for picking a theme and then developing a number of separate tales connected to that theme. Jhumpa Lahira, in Interpreter of Maladies, writes stories about people of Bengali heritage who have immigrated to the United States. Similarly, Joseph Epstein, in his collection Fabulous Small Jews, writes about conflicts as seen through the eyes of people who have a shared ethnicity. And Thomas McGuane (Gallatin Canyon), Annie Proulx (Close Range), and Thomas Steinbeck (Down to a Soundless Sea) each write their stories centered around a geographic local—Montana/Idaho, Wyoming, and the Big Sur areas respectively. In Steinbeck’s case, the focus that envelops his stories is not just a particular locale, but also a specific time period different from the one in which the author is living. These authors have all mastered the short story genre and were inspirational to me in writing this collection, which is my first book.
The theme that unites the stories in my collection is psychiatry. Most of the characters struggle with psychiatric conditions or defense mechanisms that shape their lives and the story. As a psychiatrist myself with 37 years of experience in the field, I have drawn on a range of specific examples from patients who have confided their struggles in me over the years. However, all of the characters in the book are entirely fictional. They are composites of many different patients’ symptoms or circumstances, as well as figments of my imagination.
While writing these stories, I found that if I allowed my characters to speak for themselves, that they went in directions that I had not anticipated and which at times surprised me. In essence, I found myself experiencing what other writers have reported, that is, I was simply “holding the pen” as the characters lived out their own lives. Nonetheless, the psychiatric problems portrayed in my stories are meant to be realistic, and in that sense I hope that they contain instructive elements as well as provide entertainment. Toward that end, I have provided a study guide in an appendix.
Hugh R. Winig, M.D.
Walnut Creek, California
May 2008
Sunday, October 19, 2008
MULTIPLE LIVES
(Published in the October 2008 edition of the East Bay Psychiatric Association Newsletter)
Despite my ongoing classes in Buddhism, I do not buy the idea of “bad karma” coming from bad things one did in a past life, or “good karma” coming from good deeds one performed in a past life. This concept of “past lives” makes no connection to my rational mind and requires too great a leap of faith to appeal to me. But what I do believe is that in the course of one’s natural life span, one does experience multiple lives in the figurative, if not literal, sense.
Twenty-five years from now, assuming you are still alive, your life will be filled with memories of the next 25 years—events that have not yet happened, so you cannot possibly know them. And your current memories of the things that are now fresh in your mind will have faded. One’s psyche will be extremely different 25 years hence from what it is now, and you may discover that your future self will be somewhat unrecognizable to you. Similarly, think back 25 years, or 50 years, and imagine the child you once were, or the developing young adult you may have been. Surely you see yourself today as someone vastly different.
So regardless of any religious bent, it might be fair to say that in the course of a normal lifetime, one experiences multiple lives—not discreet in nature, but vastly different nonetheless. The youngster, the teenager, the young adult, the mid-lifer, the retiree, and the very aged individual may have existed in the same body and have had the same brain, but all of the molecules in that body have turned over and been renewed many times, and the new experiences one has had during a lifetime have changed that person in many ways.
These multiple lives that we experience blend imperceptively into each other and do not occur in quantum leaps. Hormonal and other physiologic factors play a role in the normal aging process. But as psychiatrists, we know also of the psychological impact of traumas and losses on the one hand, or healthy relationships that provide for corrective emotional experiences on the other—it is not just physical change that is part of growing older.
Healthy aging is the subject for another essay, but the reality of change itself, both good and bad, is inevitable, relentless, and universal. We do what we can to transition from stage to stage successfully, but change will occur no matter what. When one looks back on life from the vantage point of 8 or 9 decades, one will view a life cycle that consisted of multiple lives that you may not have been mindful of while living them. It is then that people opine such things as “I should have had more fun,” or “I should have invested differently.”
I have learned through Buddhist meditative techniques to be as mindful as I can be of the moment I am living in and to take advantage of the present to absorb the wonder of simply being alive. While I do not know what my future will bring, I do know that if I live long enough, I will be very different than I am now. The awareness and wonder of that alone is part of the mystery of life that makes us human beings.
(Published in the October 2008 edition of the East Bay Psychiatric Association Newsletter)
Despite my ongoing classes in Buddhism, I do not buy the idea of “bad karma” coming from bad things one did in a past life, or “good karma” coming from good deeds one performed in a past life. This concept of “past lives” makes no connection to my rational mind and requires too great a leap of faith to appeal to me. But what I do believe is that in the course of one’s natural life span, one does experience multiple lives in the figurative, if not literal, sense.
Twenty-five years from now, assuming you are still alive, your life will be filled with memories of the next 25 years—events that have not yet happened, so you cannot possibly know them. And your current memories of the things that are now fresh in your mind will have faded. One’s psyche will be extremely different 25 years hence from what it is now, and you may discover that your future self will be somewhat unrecognizable to you. Similarly, think back 25 years, or 50 years, and imagine the child you once were, or the developing young adult you may have been. Surely you see yourself today as someone vastly different.
So regardless of any religious bent, it might be fair to say that in the course of a normal lifetime, one experiences multiple lives—not discreet in nature, but vastly different nonetheless. The youngster, the teenager, the young adult, the mid-lifer, the retiree, and the very aged individual may have existed in the same body and have had the same brain, but all of the molecules in that body have turned over and been renewed many times, and the new experiences one has had during a lifetime have changed that person in many ways.
These multiple lives that we experience blend imperceptively into each other and do not occur in quantum leaps. Hormonal and other physiologic factors play a role in the normal aging process. But as psychiatrists, we know also of the psychological impact of traumas and losses on the one hand, or healthy relationships that provide for corrective emotional experiences on the other—it is not just physical change that is part of growing older.
Healthy aging is the subject for another essay, but the reality of change itself, both good and bad, is inevitable, relentless, and universal. We do what we can to transition from stage to stage successfully, but change will occur no matter what. When one looks back on life from the vantage point of 8 or 9 decades, one will view a life cycle that consisted of multiple lives that you may not have been mindful of while living them. It is then that people opine such things as “I should have had more fun,” or “I should have invested differently.”
I have learned through Buddhist meditative techniques to be as mindful as I can be of the moment I am living in and to take advantage of the present to absorb the wonder of simply being alive. While I do not know what my future will bring, I do know that if I live long enough, I will be very different than I am now. The awareness and wonder of that alone is part of the mystery of life that makes us human beings.
Sunday, September 28, 2008
POLITICS and RELIGION
(Published in the September 2008 edition of the East Bay Psychiatric Newsletter)
A few years ago I took a class taught by fellow psychiatrist Thomas Lewis entitled “The Neurobiology of Emotions.” It was a fascinating look at how biology regulates our feelings. One of Dr. Lewis’s insights was “it doesn’t do any good to discuss politics because people’s positions are usually hard-wired and not subject to revision. Any such discussion will likely lead nowhere.” This advice is similar to the adage: “Discuss politics and religion, but only with great caution.”
Unfortunately, two of the most critical and important issues for people to talk about are politics and religion. These subjects encompass a mass of theory, thought, and understanding about how societies function. But if one cannot alter one’s notions within these two areas of thought, we are doomed simply to follow our hard-wired beliefs over a cliff, regardless of what new facts may arise. For example, history is replete with examples of those willing to kill themselves and others because of fundamentalist political or religious beliefs. Similarly, despite the enormous volume of modern scientific data explaining the mystery of evolution, the religious belief in creationism persists.
According to Jonathan Haidt, we are not a tabula rasa when we are born. Rather we have a “first draft” of moral intuitions already inborn within our minds. For liberal thinkers this means having moral values that relate more so to concern for doing no harm and for fairness. For conservative political thinkers, this means being biologically predisposed to valuing authority, purity, and group loyalty. Liberals value change and different points of view; conservatives prefer sameness and uniformity of thought within the group. While some cultural learning can modify these inherent moral intuitions, most people’s political and moral beliefs are too hard-wired to be easily influenced by facts that don’t support their preconceived views.
When I was actively practicing forensic psychiatry, I discovered that the outcome of a criminal trial was often determined at the time the jury was selected. The reason for this is that if the legal issues are subsequently argued equally forcefully on both sides, jurors will hear enough of an argument to support their inherent biases and vote for conviction or acquittal based of their preconceptions. Their view of right and wrong is something they carry with them into the jury room before the trial starts.
While it is true that educated people can honestly differ in their subjective assessment of the same facts, there is a limit to subjectivity. The gender of a mouse whose external genitalia are not visible might be ambiguous, but the accurate gender cannot be determined by a simple majority vote of casual observers. A scientific inquiry must be undertaken to determine the facts. Believing is one thing but factual data is quite another or we would simply have the “tyranny of the majority.”
It seems that during this current political campaign that people selectively hear what they want to hear. People believe what they believe based on their genetically determined moral intuitions, regardless of the facts. It is the wise man or woman, indeed, who can step out of his intuitive moral framework and see the other person’s point of view as also valid, but in the meantime it would seem important to “discuss politics and religion, but only with great caution.”
(Published in the September 2008 edition of the East Bay Psychiatric Newsletter)
A few years ago I took a class taught by fellow psychiatrist Thomas Lewis entitled “The Neurobiology of Emotions.” It was a fascinating look at how biology regulates our feelings. One of Dr. Lewis’s insights was “it doesn’t do any good to discuss politics because people’s positions are usually hard-wired and not subject to revision. Any such discussion will likely lead nowhere.” This advice is similar to the adage: “Discuss politics and religion, but only with great caution.”
Unfortunately, two of the most critical and important issues for people to talk about are politics and religion. These subjects encompass a mass of theory, thought, and understanding about how societies function. But if one cannot alter one’s notions within these two areas of thought, we are doomed simply to follow our hard-wired beliefs over a cliff, regardless of what new facts may arise. For example, history is replete with examples of those willing to kill themselves and others because of fundamentalist political or religious beliefs. Similarly, despite the enormous volume of modern scientific data explaining the mystery of evolution, the religious belief in creationism persists.
According to Jonathan Haidt, we are not a tabula rasa when we are born. Rather we have a “first draft” of moral intuitions already inborn within our minds. For liberal thinkers this means having moral values that relate more so to concern for doing no harm and for fairness. For conservative political thinkers, this means being biologically predisposed to valuing authority, purity, and group loyalty. Liberals value change and different points of view; conservatives prefer sameness and uniformity of thought within the group. While some cultural learning can modify these inherent moral intuitions, most people’s political and moral beliefs are too hard-wired to be easily influenced by facts that don’t support their preconceived views.
When I was actively practicing forensic psychiatry, I discovered that the outcome of a criminal trial was often determined at the time the jury was selected. The reason for this is that if the legal issues are subsequently argued equally forcefully on both sides, jurors will hear enough of an argument to support their inherent biases and vote for conviction or acquittal based of their preconceptions. Their view of right and wrong is something they carry with them into the jury room before the trial starts.
While it is true that educated people can honestly differ in their subjective assessment of the same facts, there is a limit to subjectivity. The gender of a mouse whose external genitalia are not visible might be ambiguous, but the accurate gender cannot be determined by a simple majority vote of casual observers. A scientific inquiry must be undertaken to determine the facts. Believing is one thing but factual data is quite another or we would simply have the “tyranny of the majority.”
It seems that during this current political campaign that people selectively hear what they want to hear. People believe what they believe based on their genetically determined moral intuitions, regardless of the facts. It is the wise man or woman, indeed, who can step out of his intuitive moral framework and see the other person’s point of view as also valid, but in the meantime it would seem important to “discuss politics and religion, but only with great caution.”
Monday, June 23, 2008
CHAN (ZEN) BUDDHISM and NIRVANA
(Published in the August 2008 edition of the Easy Bay Psychiatric Association Newsletter)
Back in 1970 when I was starting my psychiatric residency, our department chairman, Albert Stunkard, mentioned that he thought that Zen Buddhism was a powerful psychotherapeutic tool. My group of eleven fellow residents looked at each other quizzically and gave the comment little attention. We were far more focused on learning about the established schools of psychotherapy and the basics of psychopharmacology. Why would a psychiatric resident be interested in some Eastern religion? It wasn’t until this year when I began studying Zen that I thought about Dr. Stunkard’s past comment—and now I know what he was talking about.
Chan Buddhism and Zen Buddhism are the same thing—the former is the original Chinese sect, and the latter the word used by the Japanese who studied under the Chinese Chan masters. There is a Chan monastery nearby in Lafayette named Buddha Gate Monastery where I am taking a beginner’s class. This monastery is the only one in the country run exclusively by nuns without the help of monks.
Chan Buddhism’s religious teachings are called Dharmas, which are themselves very meaningful. But more relevant here is that Chan teaches individuals to become enlightened and self aware through meditative techniques that quiet the mind of past, present and future concerns that occupy our thoughts constantly. When our mind is quiet, we become aware of our own intrinsic nature and are more in touch with peaceful thoughts. In neurophysiologic terms, these meditative techniques attempt to quiet the left side of the brain and allow the right brain to dominate one’s perceptions. It is in the right brain where people can experience an epiphany and come to feel at one with the natural world and empathic with other sentient living beings.
Over the years, many people have argued for the legalization of various drugs that enhance these peaceful right-brained perceptions. But the drug culture has led to many casualties--people who have lost their psychological equilibrium. One needs left-brain activity as well to bring balance to our perceptions or we can lose touch with what it means to be human, live in a society, and behave appropriately.
Recently, there was a well-publicized case of a Harvard brain researcher, Jill Bolte Taylor, Ph.D., who suffered a massive left sided stroke in 1996 at age 37. She experienced what she called nirvana (a supremely tranquil state of mind) as she temporarily experienced only right-sided brain activity. She perceived herself as a living membrane filled with fluid that contained molecules and atoms that were connected to all the other molecules and atoms in the universe. She saw herself in the form of a living body that could reach out and affect the world she lived in but only during her temporary state as a human being. She felt entirely at peace, empathic, and euphoric, and could see the meaning of life and her oneness with the universe. As her stroke resolved and her left-brain healed, she returned to a state of psycho-physiological equilibrium that she understood to be her normal self that could function in the real world.
Dr. Taylor now speaks about her experience nationally (see the New York Times article about her entitled “A Superhighway to Bliss,” her You Tube interview on the Oprah show, or her memoir entitled “My Stroke of Insight”). The most fascinating aspect of Dr. Taylor’s experience is that as a result of her stroke, she achieved what the Zen Masters seek to accomplish through decades of meditation practice. They want to hold onto that blissful state of nirvana during which they transcend mundane existence and are unperturbed by anything. This is what Dr. Taylor describes more scientifically as the “deep inner peace circuitry of our right hemisphere.”
Many of the answers to the mysteries and intangible dimensions of the universe —the mystical, spiritual, or cosmic—possibly are already encoded information concealed in parts of our right brain. All religions and philosophies struggle to gain more insight into this seemingly unknowable information. Chan Buddhism appears to have some techniques to give us greater access to this realm. Most people, at a minimum, could benefit from Chan’s ability to enhance equanimity, blissful feelings, insight, and inner directedness.
If I had been more open minded and more aware of Eastern religious traditions as a first year psychiatric resident, it might not have taken me until the near end of my career to appreciate this.
(Published in the August 2008 edition of the Easy Bay Psychiatric Association Newsletter)
Back in 1970 when I was starting my psychiatric residency, our department chairman, Albert Stunkard, mentioned that he thought that Zen Buddhism was a powerful psychotherapeutic tool. My group of eleven fellow residents looked at each other quizzically and gave the comment little attention. We were far more focused on learning about the established schools of psychotherapy and the basics of psychopharmacology. Why would a psychiatric resident be interested in some Eastern religion? It wasn’t until this year when I began studying Zen that I thought about Dr. Stunkard’s past comment—and now I know what he was talking about.
Chan Buddhism and Zen Buddhism are the same thing—the former is the original Chinese sect, and the latter the word used by the Japanese who studied under the Chinese Chan masters. There is a Chan monastery nearby in Lafayette named Buddha Gate Monastery where I am taking a beginner’s class. This monastery is the only one in the country run exclusively by nuns without the help of monks.
Chan Buddhism’s religious teachings are called Dharmas, which are themselves very meaningful. But more relevant here is that Chan teaches individuals to become enlightened and self aware through meditative techniques that quiet the mind of past, present and future concerns that occupy our thoughts constantly. When our mind is quiet, we become aware of our own intrinsic nature and are more in touch with peaceful thoughts. In neurophysiologic terms, these meditative techniques attempt to quiet the left side of the brain and allow the right brain to dominate one’s perceptions. It is in the right brain where people can experience an epiphany and come to feel at one with the natural world and empathic with other sentient living beings.
Over the years, many people have argued for the legalization of various drugs that enhance these peaceful right-brained perceptions. But the drug culture has led to many casualties--people who have lost their psychological equilibrium. One needs left-brain activity as well to bring balance to our perceptions or we can lose touch with what it means to be human, live in a society, and behave appropriately.
Recently, there was a well-publicized case of a Harvard brain researcher, Jill Bolte Taylor, Ph.D., who suffered a massive left sided stroke in 1996 at age 37. She experienced what she called nirvana (a supremely tranquil state of mind) as she temporarily experienced only right-sided brain activity. She perceived herself as a living membrane filled with fluid that contained molecules and atoms that were connected to all the other molecules and atoms in the universe. She saw herself in the form of a living body that could reach out and affect the world she lived in but only during her temporary state as a human being. She felt entirely at peace, empathic, and euphoric, and could see the meaning of life and her oneness with the universe. As her stroke resolved and her left-brain healed, she returned to a state of psycho-physiological equilibrium that she understood to be her normal self that could function in the real world.
Dr. Taylor now speaks about her experience nationally (see the New York Times article about her entitled “A Superhighway to Bliss,” her You Tube interview on the Oprah show, or her memoir entitled “My Stroke of Insight”). The most fascinating aspect of Dr. Taylor’s experience is that as a result of her stroke, she achieved what the Zen Masters seek to accomplish through decades of meditation practice. They want to hold onto that blissful state of nirvana during which they transcend mundane existence and are unperturbed by anything. This is what Dr. Taylor describes more scientifically as the “deep inner peace circuitry of our right hemisphere.”
Many of the answers to the mysteries and intangible dimensions of the universe —the mystical, spiritual, or cosmic—possibly are already encoded information concealed in parts of our right brain. All religions and philosophies struggle to gain more insight into this seemingly unknowable information. Chan Buddhism appears to have some techniques to give us greater access to this realm. Most people, at a minimum, could benefit from Chan’s ability to enhance equanimity, blissful feelings, insight, and inner directedness.
If I had been more open minded and more aware of Eastern religious traditions as a first year psychiatric resident, it might not have taken me until the near end of my career to appreciate this.
Saturday, March 29, 2008
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.
(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.
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.
Subscribe to:
Posts (Atom)