Welcome to our wikizine called "Thoughtz fromda HEADoc"

Quest 4 Sanity
 
            A Perspective From Within the Intriguing World of Psychiatry

 DREAMS 2

Much can be learned from dreams. . .

Freud once wrote a book entitled The Interpretation of Dreams. Actually I've never read it but have stumbled on many of its principles through different encounters along the way. Our dream life is much like the vacation home of the mind. Some philosophers have pondered whether the reverse is true or not. If you've ever seen Ashton Kuchner in The Butter Fly Effect it becomes easier to entertain this idea. This movie I consider the horror version of Ground Hog Day.

In real life our dreams are believed to possibly serve the practical purpose of allowing us a place where we are allowed to be completely insane in a way that is unacceptable during the waking hours. Most of our repressed drives and suppressed thoughts are free to express themselves while we dream. It is really the emotion felt during the dream that has value and not so much the plot occurring, as many are tempted to become more enthralled by. One can dream of war and kill thousands then wake up and go to work as if nothing happened as that repressed aggressiveness returns to the abyss of forgotten memories. Having such a dream doesn't mean the person is a violent killer in the least. More likely it represents an opportunity to let off steam from repressed emotions of anger internally or from an external stimuli such as the unacceptable thought of wanting to punch the boss or other individual causing conflict in the persons life.

Everyone dreams whether the dreams are recalled or not. This has been pretty much proved through studying the rapid eye movement stage of sleep in research and clinical labs. In essence, many of the bad dreams are representative of taking out the garbage of the subconscious mind. Without the existence of dreaming we would probably act out those emotions in the waking world which would not be a good thing. If you don't accept that idea then try stressing out someone who has been sleep deprived for several days and see if that person isn't more likely to react in a more irritable and hostile manner than a person who has received their nightly eight hours of sleep. I work with many Post-traumatic Stress people who characteristically have nightmares to the point they sometimes resist or avoid going to sleep at night. It is my belief that if the patient can ever reach a point where they are willing to endure the fear and discomfort and challenge those dreams they can, in theory, conquer the dreams and realize the therapeutic value of purging their subconscious mind of these toxic emotions and fearful drives. This of course is a process that takes time and is best done while in psychotherapy. People in bereavement often have pleasantly euphoric dreams of the loved one being alive. In this case awakening is when the trauma is felt as they re-aclimate and realize the loved one is no longer a physical part of their life.

I have found that no dream can be considered too crazy. In fact, the crazier the dream the more creative the dreamer for dreams are not meant to have boundaries or make sense. I have had some repulsive and repugnant dreams but learn to throw them back just as a fisherman returning an undesirable catch to the water. Those bad dreams actually make us thankful to be finally awake. Like everything else in our reality dreaming relies on balance. If 100% of our dreams were good who would want to ever get out of bed and much productivity would be lost. So bad dreams may have value from an evolutionary standpoint just as certain positive envisionary dreams. Someone had to dream certain things for them to ever have been developed. The initial dreamers of the airplane, the telephone, and the television were likely looked at as being totally insane the first time they spoke of such ideas but had they not had the courage to dream of such things these luxuries would not be a part of our waking reality today.

This entry was inspired by an intense recurring dream that visited me last night involving being in a play. Drama played a major part of my younger life and helped me to develop and  explore many different characteristics within myself and among others. By nature, I'm introverted and tend to live inside my head majority of the time. But as most introverts are aware of we are more creative than our extroverted counterparts because they rely on having to hear themselves talk and participating in an active way to maintain their self esteem and productivity. We introverts tend to work on stuff inside our heads until a brilliant idea is born and it isn't until that idea is presented to others that we are given credit for having much intelligence. Okay, maybe that's an over simplification but I think the point was made. Without further digression, I dreamed this dream of being in a play at a whole 'nother level of chaos last night. The play had no name, the auditorium was unfamiliar, I knew no lines, knew none of the characters, the plot was not known, the setting continuously changed, I was always on stage at the wrong time, the cues were always off, retreating to the backstage area was useless because the drapes would always reveal me to the packed auditorium. Early in the dream I felt confident I could improvise and wing it. My unknown fellow actors would or could not respond and I continued to look increasingly like a complete idiot. This dream may have lasted ten minutes in reality but to me the perception was that it was going on for hour after hour. I tried so hard to awaken myself after entering that state of awareness of it being a dream. The inability to awaken myself seemed to intensify the helplessness and sense of embarrassment.

In such a dream, over time, I have developed the ability to try and influence the outcome, so I tried to see and interact with some of the people in the audience. I also made the curtains close so the act could be restarted. The restart was more chaotic than the initial take. I waited for the audience to start heckling and booing which surprisingly didn't happen, at least not before I finally awakened. I'm not going to make any interpretive attempts of this dream here but I wanted to document it before it vanishes from my memory. I know it will return at some later night as it has for years. I feel fear while experiencing the dream but I don't fear experiencing the dream because I recognize it has value in helping me sort out fears in my waking life. 

Posted on Fri, June 1, 2007 at 05:34AM by HEADoc in Weekly Entry | 1 Comment | Email | Print

Failure to Communicate

 The essence of effective communication. . . 

requires a complete exchange of thought and feeling between at least two individuals. Having a mutual understanding is the key to communication. Ron Paul received criticism and applause during the last GOP debate between the candidates for President in 2008. The controversy was created because he chose to break rank and interject some basic common sense and truth into the debate.That is something the country has been deprived of for quite some time from many in leadership positions. Ron Paul was able to take this move because he lacks the multi-millions in campaign contributions the front runners will receive. He knows he cannot win because nice guys do usually finish last in American politics. The real irony is that he was making a proposal to return to traditional conservative values of staying out of the affairs of other countries, spending at home first, and considering communication before bombing the heck out of countries that haven't attacked us.

The comment most objected to involved him suggesting that the U.S.'s  assumption that they hate us for our freedom may not be totally correct. Maybe they are telling the truth about hating us because we occupy their land and support their enemies. Those of course, are complex issues with no simple solutions but totally ignoring the validity, understandably, could breed resentment and hostility toward us. Violence will always beget more violence. We do have bigger weapons but they clearly are more willing to die for their cause as evidenced by repeated kamikaze acts.

I have lived my life as a minority person of color within the southern U.S. which I believe provides a unique perspective. I have conditioned myself over time to control the rage I sometimes feel when things have happened to me that are obviously racially motivated. I pretend the race card doesn't exist but sometimes that becomes impossible. As for my last entry, I know that technically I broke the rules and the Bank operated within their self anointed rights to make every dime they could and make me out to be the crook. I see this type thing happen to patients through their encounters with health insurance companies, pharmaceutical companies, and disability agencies. The corporations are always protected and always right. Fortunately, I can get my act together and eventually things may be normal for me because I make enough money to bounce back. For the average citizen this isn't so.

I believe, as Americans, we should take the time to imagine what it might feel like to be a poor inhabitant of a Middle Eastern Country or other Third World place. After doing so, it may become more obvious how the average American can be perceived as inconsiderate, ignorant, arrogant, or lazy. Our freedoms and privileges are often taken for granted. That may be the reason they are being threatened now from within our own government through legislation such as the Patriot Act. At some point the polarization of politics must end or we will be forced to do away with the current political parties and start all over from scratch. At this time neither party seems to care about the people that voted them into office. No matter who wins the Presidency in '08 it can only be an improvement from the status quo. Our current system makes traditional conservatives look like bleeding heart liberals of old. I will be careful not to ask what else could go wrong? I don't want to know the answer again.

Posted on Sun, May 27, 2007 at 04:13PM by HEADoc in Political Commentary | 1 Comment | Email | Print

Emergency Vent: Real Life Stories

 Have you ever been so angry that you didn't know what to do?

That's' how I'm feeling today. I don't even know if I can hit these keys correctly. I'm trying to follow my own advice about managing anger that I give to patients. I have enough containment that I'm sure I won't do anything to get myself into trouble. But I do have fleeting thoughts of homicide without any plan or intent or specific target. I know that eventually I will calm down and feel some remorse and resume conduct as a reasonable person.

Why am I so mad? One of the few entities that can take me here are financial institutions when they throw their muscle around. Several weeks ago I transferred a substantial amount of money from one bank to another for the purpose of paying monthly bills as usual. The check didn't clear because the deposit was late that week. After the deposit was made I wrote another check for the same amount. Because of the previous check not clearing this check was placed on hold for several days. Meanwhile the bank raked in hundreds in insufficient fund fees. To add insult to injury they placed me under investigation for bank fraud but unbeknownst to me. I'm going on with my life as usual until the next months transaction where the same thing occurs to me. No one in the bank can tell me exactly what is happening. They give me a number to call where I can only speak to an answering machine. They continue to collect hundreds of dollars in insufficient fund fees (because they put a hold on the account for the investigation) and my bills go unpaid plus I have to pay late fees. I have never been good at balancing my check book nor have I been the greatest book keeper but I am not a criminal and have never been charged with a crime.

I do not understand how they can legally do this to anyone and I am so mad that I cannot think straight. I know it may be time to seek legal counsel. If there is any way these people can be sued I plan to give it all I have. They have not charged me with a crime because no crime has been committed except what they are doing to me without even informing me what they are doing. This is the kind of thing that makes people go postal. Any Lawyer out there willing to take my case?

Posted on Fri, May 25, 2007 at 06:34PM by HEADoc in Real Life Story | Post a Comment | Email | Print

A Look at Chronic Pain

 is an unavoidable part of the human experience...

Pain is a sign that something has gone wrong and itself is not a disease or necessarily a bad thing. Pain has been a crucial ingredient of human evolution and without it we would not exist in our current form of existence. One suffering from the neuropathic anesthesia of advanced diabetes can testify to the disadvantage of losing the sensation of pain in the limbs when they suffer from burns or cuts that may have been avoided had the sensation of pain been intact to warn them of the danger of tissue damage at the time of injury. Pain triggered by sensors in the skin signal us to remove our hand from a hot object or sharp object. In the diabetic, sometimes the nerves are damaged and rendered useless by an excess of the sugar glucose in places where it doesn't belong.

My work involves the diagnosis and treatment of depressive illness which often is associated with the symptom of pain, both physical and emotional. My experiences have led me to believe that many times the two can be almost one and the same. When a depressed patient presents with chronic physical pain, no amount of morphine or other pain killers provide satisfactory relief. Many have visited several other medical specialists with unsatisfactory results. Those of weaker character often end up strung out on large doses of opioid medications that they are eventually required to obtain by any means necessary. True fighters usually won't allow themselves to be controlled by a chemical substance and will not accept their life being controlled and dictated to by intractable pain. They will do whatever it takes to find an answer.

I have found that a patient who is capable of developing insight can usually accept the concept of psychosomatic illness which basically entails the nervous system being overwhelmed by environmental stressors and no effective outlet. When this occurs this excess of emotional energy may be converted to a neurological or medical condition. Prime examples include, migraines, fibromyalgia, irritable bowel symptoms, chronic fatigue, and even loss of consciousness. When the brain is overwhelmed by stress it ceases to make endorphins in sufficient amounts to allow natural pain control. Artificial endorphin effect can be provided through opioid pain medications. Often these meds can provide an irresistible sense of euphoria. Certain individuals are susceptible to attempting to maintain such a pleasurable feeling indefinitely. This is unnatural in the balance of nature for we aren't meant to live in endless bliss while on earth. Chasing such a feeling via chemical means will damage the normal chemical balance within the brain and nervous system. After a while large amounts of a chemical substance is required just to be able to function at the minimal level and the initial euphoria can never be reached again. At this point the individual is a slave to the chemical and most of their waking life is centered around getting more of their drug of choice.

The main principle of successfully treating chronic pain involves not quickly eradicating all of the pain which is the unrealistic expectation of many sufferers. It is better to convey the fact that there will always be some pain but eventually it may become irrelevant in the big scheme. The sufferer must accept and understand the fact that the brain cannot sense both severe pain and happiness at the same time any more than it can feel heat and cold at the same time. If a person is depressed, sad, anxious, and experiencing severe somatic pain there are certain nerves transmitting these sensations to the brain. The brain cells and nerves that transmit the sensations of pleasure, joy, happiness, and euphoria are inactive. All of the brains' attention goes to to the former set of sensations. In a healthy individual both sets of sensations can be excited with little difficulty. The positive sensations will over ride the negatives when the individual feels in control and there is not the sense of hopelessness and negativity often present in the negative mental state of the depressed individual. This feeling of hopelessness is a real motivation killer and often is a key in a depressed person choosing to stop fighting.

Anti depressants and certain medications such as gabapentin help to turn off the negative nerves and effect the positive fibers favorably. When the individual has adequate support and a life to re plug into their chances for recovering from the pits of depression and chronic pain are favorable if they comply with treatment. Majority of the time chronic pain is accompanied by depressive illness and or severe anxiety symptoms. Interestingly, a severe panic attack often mimics the pain of a heart attack. After a negative EKG and cardiac work up many will again experience the same chest pain with their panic attacks. The analogy I frequently use to explain the emotional and chronic pain overlap speaks of the small child with a newly skinned knee running to mother crying loudly. With simple blowing on the painful spot and a few loving words the crying instantly ceases and soon laughter and happiness are restored. What does that mother's breath possess that relieves pain so effectively? You guessed it. It is the love and affection that cancel out the pain. The breath trick is a clever distraction. Sometimes the pain meds function as the breath and the real effect is due to the doctor's attention and caring.

Unfortunately, for those believing there is magic in the percocet or vicodin, they will madly seek more and more until they wake up or until they die. These are the patients roaming from one doctor's office to another week in and week out pursuing one more bottle of pills. For them, one pill is too many and a thousand is not enough. I have found that many suffer from severe and persistent emotional pain since childhood, usually because they never received that breath on the knee from mother. Their life becomes basically a quest for analgesia. As adults they still receive little genuine love because they never learned to give love. Chemical abuse has become the preferred coping mechanism. Many such patients are diagnosed with personality disorders and the potential to develop insight into their condition is often lacking. Sometimes the pain they feel can never be relieved. Many doctors and therapists would rather not treat them because they remind us of our very finite limits as healers.

Posted on Thu, May 24, 2007 at 08:17PM by HEADoc in Weekly Entry | Comments Off | Email | Print

Mid Week Ramble: Advanced Psychotherapy 102

  My last two entries have been total losses. . . 

battling at Battle of the Blogs, essentially losing every battle to every genre. I'm not really sure how to take that but probably best with a grain of salt. I suppose in the blogosphere every author, self included, feels their topics are of the utmost importance. Often I recall my youth when I was totally oblivious to current world events or any topic outside of popular media culture of Hollywood tabloids and the sports world. With age my interests have changed 180 degrees and the space in my brain reserved for starting line up rosters and stats of my favorite teams have been replaced by the Democratic and Republican Candidates for the next Presidential election. I've taken interest in 9/11 conspiracy theories and have even tried the stock market and reached a point where I could care less for the Super Bowl or the Final Four. I find myself turned on by excerpts from Jon Stewart, Stephen Colbert, and Bill Mauer. I've learned to love to hate O'Rielly, Ann Coulter, and Sean Hannity. Maybe such changes are normal for the fifth decade of life. I believe the ability to change or evolve is one thing that makes life more interesting.

I think I have the most interesting job in the world but also am aware that others may beg to disagree. It's probably the fact that I have the privilege of actually intervening, where appropriate, into the lives of others that makes it more interesting for me. What I have found to be most fascinating is observing people change over time and resolve problems once seen as unsolvable by that individual. Milton Erickson was a gifted psychologist that possessed super human insight and interpretive abilities. I learned of him from a former colleague. My potential and abilities pale in comparison to such a great professional but I have found my own gift of making accurate psychodynamic interpretations. There is a certain pleasure in the experience of seeing a persons' face light up when they understand their situation in a more hopeful light for the first time. Providing even a modest degree of clarity to what was once viewed as chaos can be exhilarating as a part of psychotherapy. Confronting a patient still anchored in denial is the most crucial phase of effective psychotherapy but also the part where I do not feel gifted at all. There is often no pleasurable way of doing denial demolition. Sometimes if the countertransference is negative toward the person, presenting a little painful truth may not be as problematic. If a good therapist to patient alliance exists the risk of an undesired or ineffective response to confronting one in need of confrontation has a better chance of success.  

To the average reader this entry may seem senseless or hard to follow. As you may have noticed, sometimes I tend to make these self therapeutic entries that may only have clear meaning to me. By blowing this stuff out of my brain I usually seem to replenish my creativity and passion and produce one or two following entries that may be worth reading to more people. Or at least that's my perception. I know if my narcissism starts to exceed its boundaries I can just visit Battle of the Blogs to have my ego rapidly and thoroughly deflated and return to reality.

This entry is actually premature but my day was filled with so many interesting cases that I felt a need to record something for future reflection. Any information written here will always be in a manner within compliance of HIPAA regulations and with absolute privacy protection of any person mentioned. I never thought working with adolescent patients could be so fascinating but when the proper support system is in place some of them can be amazing to work with. Because the young have limited vocabularies they become masters of the art of acting out most everything. Many times their behavior can be a direct reflection of the inappropriate behavior of parents or other adults they associate with. The mind of many kids can be compared to a lump of clay being molded by experiences and emotions.

All of the things the child cannot say are observed in behaviors. The range of behaviors is very broad. Today brought a child between the age of 9 and 11 years old displacing anger at his sociopathic mother, who abandoned him a few years ago, onto his paternal grandmother who has taken on the mother role. The hostility has progressed to where the child saw it fit to call grandmother a bitch and even physically assault her. The mother who abandoned him and continues to terrorize the family unit on occasion, interestingly, is viewed as a virtual saint by the child. It really is a shame that a kid this age has had to be exposed to such a world but confrontation as to why he is so abusive to the one who has shown him the most love is essential. He will not have a logical answer but part of establishing and enforcing limits and boundaries requires that he give this contradictory behavior some thought. His grades have fallen from A's to F's. Eventually, a diagnosis of PTSD with an overcompensation through displaced hostile aggression had to be considered. His pronounced verbal denial of fear, "I ain't afraid of nobody," later followed by the revelation of being terrified of sleeping alone pretty much confirmed my suspicions. Failed trials of Ritalin and Risperdal by his pediatrician also suggested more than Oppositional Defiant Disorder and ADHD as previously thought. Bipolar Disorder must also be considered. Despite this high degree of anger and hostility this kid was likeable and clearly was suffering severely. His mother continues to radiate pain into his life. All he ever wanted was her love. He possessed the assets of being verbal and able to identify with the misdirected explosive emotions. I'm so glad I could see him at age 10 rather than at age 35 after incarceration and crack addiction. The treatment team and I may or may not succeed at helping him but he has a fighting chance against a world that isn't always fair.

In another story there were two young brothers who really touched me. The younger brother had played with matches and accidentally set the grandparents' house on fire. Everyone had safely escaped from the flames except the elderly grandfather. Heroically, the older brother ran back into the home and helped grandfather through the smoke and blazes to safety. I spoke with their mother several minutes before seeing the boys and was amazed at how well she seemed to be handling things. I felt thankful no one lost their life but felt horrible for the guilt the younger kid was probably feeling. He wasn't given a break from end of grade exams by the school and not surprisingly he did poorly. The mother then told me of how the older brother gave his younger brother much needed encouragement at the lowest point in his short life. They both made the gesture of offering the money from their partially burnt wallets to the grand parents to help them back on their feet during the grief and rebuilding period. Tragedies tend to bring out the best or worst in us. This story was so touching and inspiring, especially how the family accepted the event as an accident and focused on the value of life and the need to maintain love as top priorities. The community did rally to help the grandparents who had always been known for their own generosity throughout the years. There were many silver linings here. After it seemed nothing else could add to the story the mother revealed to me the family lineage connecting to a world renoun breakfast food icon who had left an inheritance in the past to the grandparents but they were deprived of receiving any money by legal maneuvers by a closer relative. The mother spoke of how her father never showed animosity toward the person depriving him of what was willed to him. I suppose it is the forgiving nature of this family that touched me so. Fortunately, the home had fire insurance and will eventually be replaced. More importantly, thank God no life was lost partially due to the bravery of a very modest 12 year old. I am happy to be a part of trying to help put things back together.

Several weeks ago I was somewhat harshly critiqued by a reader on my post Hard Out Here for my handling of a session gone awry with an angry 16 yo. Sometimes we cannot know our response to certain situations until that time actually arises for us personally. I've learned a lot from books and training but find that what is learned is not practical for each and every situation. For this particular case, given the circumstances, I still stand by my response though I am in no way proud of it. About certain things, I am from the old school and always will be. I took into consideration that this young woman was quite street smart. She did push my buttons. She felt she could punk me because that tactic had been successful for her in certain other situations. I carry the title of Psychiatrist but can play a number of roles if necessary. Without that potential, I could have not made it this far in life. No one will ever come into my office and blatantly disrespect and threaten me without a firm and direct response in return. I will give them a pass if they have a psychotic illness or they sincerely don't know any better. But, as far as I am concerned, isolated sociopathic behavior is not a legitimate mental disorder, it is a special behavioral problem that is mostly learned and practiced. Adolescents with certain conduct disorders and normal intelligence are often just sociopaths in training. If they are not forced to change they will not change. In my short run I have met enough sociopaths to know that I do not like the behavior of many. With some I have found myself not liking them period.

I may be a doctor but I am a human and a man first. I make no apologies for my behavior in the situation previously mentioned given that there was a chaperone/witness present for observation. In this business it becomes blatantly obvious that only a percentage of those encountered will have what it takes to benefit from treatment. Each day I try and concentrate what I have to offer on that percentage with reasonable promise. It doesn't bother me if an individual sees me as not having what they seek or need. I love all people. I like all people except sociopaths and sociopathic crack addicts in particular. I draw the line here.

Rest In Peace

Yolanda "Yoki" King

11/17/1955 - 05/15/2007

Posted on Wed, May 16, 2007 at 07:45PM by HEADoc in Weekly Entry | 2 Comments | Email | Print