Thoughtz fromda HEADoc - Articles - Zimbio

Welcome to our wikizine called "Thoughtz fromda HEADoc"

Sun, 14 May 2007 05:01:45 GMT

posted by 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

Dope to Cope Kills Hope: Update

Sun, 7 May 2007 23:28:55 GMT

posted by headoc

Suffering from a bad case of writer's block for the past few days...

All I know to do is keep hitting the keys in hopes that some inspiration will come. Today was not a bad day as far as the types of cases seen. The only drug addict to enter the building today was not allowed access to me after reporting the theft of medications prescribed 3 days prior. It's hard to believe they try the same old tricks over and over. It is usually a good day when there are no addicts to see. I don't dislike dealing with all people that abuse drugs but if I had to choose one group to avoid this would definitely be it.

Sometimes in the next few months the 100th dismissal mark for the past year and a half for non-compliant substance abusers should be reached. I wish this meant that something great was due to happen but it is just another reminder of a limit for helping people. Three out of ten serious substance abusers have a realistic chance of a complete and productive recovery, no matter what approach is taken at treating them. Though genetic factors are significant, environmental conditioning seems to be the greatest barrier to overcome. When dope is used to cope their is little hope.

I'm trying to accept that the drug culture has always been among us and expected to always be. The U.S. is the greatest consumer of cocaine, opioid products, and alcohol on the planet. This really bothers me sometimes. I find that the real truth boils down to "who really cares?" There is no War on Drugs and never has been and I doubt there ever will be an effective one. I also find there to be two separate societies and economies. One is legitimate and the other more of a syndicate nature. Tons of drugs enter our country daily without much consequence. With all of the emphasis and modern technology available to fight the so called War on Terror it baffles me as to why the transporting of illegal drugs is not given some type of priority. This makes me more suspicious and likely to question whether economic gains are not at the root of both wars. Several political analysts have suggested evidence that naming a cause a war is primarily a means of legitimizing something to be milked financially. There is never any intent of winning from day one. Those of us in the legitimate branch of society must be extra careful to follow all of the rules because we can be regulated or punished with such ease if necessary since all of our demographic data is readily available via computer. This may not be so for big time criminals and what frightens me most about corruption in government.

Having a DEA license is really the only reason these matters have been introduced to me. Small time criminals are constantly on the hunt for doctors they may be able to extort drugs from since prescription drugs are currency for illegal drugs. At the bottom of the food chain are abusers of crack cocaine and crystal methamphetamine. These are the ultimate losers in society. Many are incorrigable and absolutely hopeless, in my opinion. I have found this addiction to be more devastating than terminal cancer or AIDs. These drugs attack the soul in a way that is unprecidented, stripping the individual of basic personality traits and eventually all values and morals. Biochemically, the nervous system is wrecked leaving the individual with the template for a paranoid schizophrenic in the untreated state. They become a hollow shell, caring about nothing but the next rock. They will steal the rent money, the food money, the money to care for the baby, the money in grandmother's purse; there are no limits at this stage of addiction. I know of mothers giving their children away and selling their bodies. The words from their mouths are worthless. Their urine drug screen will be positive though they will swear they do not use. Even seeing the evidence on the paper and being confronted with a 50 lb weight loss will not break through the denial and the lying. The death of friends also does not register in many for they truly believe death happens to someone else but not them. Everyone this person comes in contact with is affected negatively. Those who care are viewed as prey by the individual. This illustration represents the spiral downward of the crack addict. I am convinced that this particular drug stands alone in the havock it wreaks.

Opioid dependent people usually have a physiological dependence that can be safely managed. The social deterioration seen with cocaine is not always present with opioid dependence. Although I find that the patients who snort Tylox through a straw are often equivalent to crack addicts in behaviors and have few limits to what they might do. Many opioid dependent individuals can be maintained on methadone or bupenorphrine and are able to lead relatively normal lives. With the proper treatment the focus of their lives is no longer on obtaining drugs and the problem of involvement with a detrimental social circle can be eliminated. I find that many people self medicating with pain pills actually have underlying conditions that are treatable such as ADHD, PTSD, or a depressive or anxiety disorder. With addition of the proper treatment they can be tapered off the opioid medication sooner. Learning that the primary problem is not addiction sometimes can be a motivating factor for the patient.

Garden variety alcohol dependence is welcomed for treatment as opposed to treating cocaine addiction. Today there are clinically proven treatments that can greatly curb alcohol intake and essentially cure the disease in a highly motivated individual willing to participate in a reasonably comprehensive treatment program. Support groups and spiritual support are crucial components of a successful recovery. A monthly injectable form of naltrexone is available and proven to be effective in treating alcohol consumption. Campral and oral naltrexone also work if the patient can adhere to treatment. These drugs offer hope where there once was little hope for some with alcohol dependence.

Crack and Antisocial behavior are deadly in combination. There is no effective treatment to offer them. No one is safe around them. Our world has never before seen a chemical compound so ruthless and predictable in its effect. I have never been a judgmental individual but have developed a strong personal belief that a person choosing to smoke this drug repeatedly has signed their own death warrant and have sunk to the level of a common felon even before they start to regularly commit crimes. The drug seems to activate a gene of self destruction. I know of nothing more devastating than crack and crystal meth. Do you?

Brief Look at Partner Abuse (and Battered Bloggers)

Fri, 24 Mar 2007 03:14:18 GMT

posted by headoc

For the regular readers, I'm sure you notice the change in layout and graphics on the site...

Nothing is really meant by the change except an opportunity for me to play around with something I really know very little about. Much like a kid with a new toy I sometimes get caught up with the creative potential of my computer. The finished product here was reached by trial and error of things I've learned to do and things I'm clueless about and just happen to stumble upon. A reader visiting the first time might get the wrong idea by some of the images, colors, and hidden humor and think that I'm either crazy or out of sync with mainstream. I usually make an effort to write about things that curious minds will find of interest. I'm aware that perhaps 75% of people will have no idea of what I'm trying to say and 15 to 20% of people wouldn't find it interesting anyway. I know that my blog journal is not appropriate for all but I do appreciate those who find it worth reading. I really didn't care much about the appearance at first because I really just wanted to say what I had to say just for the therapeutic benefit. I never really expected it would be read as much as it has.

I've written about Battle of the Blogs at the Blog Explosion Web Site a couple of times before. Involvement there probably motivated me more than anything to explore and learn more about graphics and word processing. If you aren't familiar with how it works; A blogger accepts the challenge from another member for a battle by matching the credits wagered under the thumbnail image of the blog. 15 other volunteer members spend 20 seconds looking at each blog then vote on which is the best by clicking a button. The blog with the most votes then splits the credits wagered with the voters and chalks up another in the Win column. When I first started competing I thought that the voters actually read what was in the blog and thought about what they read before they voted. About 80 losses later I finally accepted that it wasn't that type of party. I understood that winning more than an occasional battle was all that I could expect regardless of the quality of the writing. I always thought that if I picked up just one serious reader out of the 15 voters that I had actually met my objective. Yeah, right. Even though Battle of the Blogs was clearly not the place to promote my blog, or my self esteem, I was bitten by the competition bug and just had to know what it felt like to be able to be a little more competitive. I started seeing nothing wrong with trying to make a good first impression with readers through a little cosmetic augmentation. So I decided to upgrade and even though I still don't know what the hell I'm doing half the time, my site certainly looks better than it once did. I still lose most of the battles but I'm able to compete with most of the mediocre blogs. To me that's an accomplishment and I hope to continue learning more about computer graphics and such.

Enough of that. My intention initially was to write a little about something that has been on my mind quite a bit lately. That something is one of those things often overlooked but that happens much more frequently than one cares to think about. What I speak of is domestic violence. It's not always the man who is the perpetrator but most battered husbands seem to avoid seeking help, probably due to embarrassment. Next to crack addicts who also have sociopathic traits and sexual predators, I would have to say that next on the despicable list fall the wife beaters. Usually they are lurking somewhere in the wings like in a Greek Tragedy where an actor runs onto the stage to dramatically report to the principle characters what is happening somewhere offstage. The viewers imagination is crucial to really understand the plot of the story completely. In practicing psychotherapy, the old cliche' of believing half of what you see and none of what you hear is often quite accurate. When there is conflict between two individuals I find it unreal how the versions of the identical same story are almost always totally different. Over the years I have found it crucial to never draw any conclusions with just one version of a story. That is usually a big mistake if you desire to really help the patient.

The most important rule is that violence is unacceptable under all circumstances. Both parties must conform to this rule. A woman must accept the principle of hit me once shame on you, hit me twice shame on me. There should never be a second time but it isn't outside of reason for this to occur. By the third time it becomes clear that the situation is critical and dangerous. The battered partner has committed to being an enabler to a sick criminal. The battered wife often accepts the myth that she is somehow to blame for this fool"s anger. She also believes she has the duty and where-with-all to change this person. She often finds herself apologizing for his out of control anger and covering up for him. At this stage of the game the dynamic is much like a dance with one party's behavior being totally dependent on the other's. Usually, it only gets worse from here. Adding alcohol abuse to the mix is like pouring gasoline on the fire. The outcome will not be a desirable one.

The police and battered women's shelters usually are first to deal with situations that escalate to physical violence, if it's not too late before it is learned that intervention is required. In my practice there are many women who suffer mental and emotional abuse which can be just as damaging as physical abuse because such wounds are much harder to heal. I find that most women that find the courage to see a therapist usually have the potential to eventually develop the skills to empower themselves and put a stop to the abuse. Often they know they need to leave this man but he usually has warned her that if she were to do so he would have to kill himself or her. Unless impaired by drugs or alcohol most of them are too cowardly to kill anyone but the woman usually isn't ready to call his bluff at this point. When there are children involved the situation can get even more complex. Sometimes it is the love of the children that motivates the mother to do what she has to do. Statistically, 75% of wife beaters also abuse their children. I would estimate that about 25% of wife beaters have plans of beating their wife's therapist. I say that as a joke but it is probably true, which makes sense if one understands the basic psychological make up of many abusers. All the abuser is really interested in is control and possessing which makes the behaviors associated with insecurity and jealousy typical. This is most often served up with a side order of blaming the victim. As I often find myself explaining to the abused subject, the abuser is a master projectionist and really the opposite of everything he professes to be. Deep within he is a fearful and insecure boy child who has a need to control his external environment to have any self esteem at all. He also is aware that his mate in many ways is much stronger than he could ever hope to be. He goes to great lengths to keep a lid on this valuable secret. His most important weapon is to constantly attack her self esteem which he will fight desperately to do if she shows any signs of proclaiming what he perceives to be independence or control of her own circumstances.

I find it satisfying to observe a woman regain her self esteem and control of her life after an extended period of being manipulated and brainwashed into psychological oppression. Most of the time I feel very little empathy for the abuser because he has usually scoffed at every invitation and opportunity to save the relationship. With such an individual the only intervention having any hope of working is for him to be left by the object of his control and abuse. Usually this type individual finds it easier to find a next partner who is like his wife used to be before that horrible therapist ruined his life. It is a fact that some people are not capable of making significant behavioral changes despite the cost to them.

Fight or Flight

Thu, 30 Mar 2007 02:12:05 GMT

posted by headoc

I saw a patient a short while ago who had seen ten doctors and scheduled to see the twelfth tomorrow...

We had a good first meeting and I was glad to hear her say she didn't think it would be necessary to keep that next appointment. Her primary care doctor realized he was in over his head and that it might be time for a mental health consult. She had been diagnosed with a common but challenging to treat syndrome Known as fibromyalgia. People afflicted by this condition frequently may also show signs and symptoms of Irritable Bowel, Chronic Fatigue, and frequent migraine headaches. This middle aged married woman was starting to lose hope that the medical profession could offer any help for her symptoms of constant burning, aching, sore muscles and joints. Unlike the drug seekers that often find their way to my office, she was clearly anti-medication and wanted to get by on the bare minimum of drugs. The history collected from her showed that she had not had an adequate trial of an antidepressant or one of the medications designed for neuropathic pain such as neurontin. My greatest challenge would be to overcome her fear and reluctance to take adequate doses of medications to achieve the desired effect. It also became clear that she would need psychotherapy to address several recent losses she was trying to cope with. I learned that she was a woman of faith which gave me another avenue to connect. I don't hesitate to remind appropriate patients that even Jesus Christ could not heal one without their belief in his connection to the power. Without faith Simon Peter began to sink into the sea, Daniel would not have survived the lions den, and Job could not have endured his ordeal. I don't know how I ended up going there but it was effective and I was able to form an alliance and prescribe her medications that I trust will benefit her.

This is one of the things I love most about practicing psychiatry. I was able to reach this patient in a way that 10 other doctors could not. For healing to occur she must be addressed from the perspectives of the physical body, the emotional self, and spiritual aspect. This is what a human being consists of. Her approach of seeking healing from a purely physical approach had failed and left her distraught and hopeless. This approach deals with fixing the problem from the outside in which is much like trying to extinguish the fire of a burning building after it is over half the way burned down. At this point there is not certainty that my treatment will be successful but I believe it will.

The factors directly addressed included a devastating heart attack a few years back, having to give up her career, fear of losing her ability to drive, her grand daughter moving away to another town, being constantly in physical pain and daily symptoms of depression, grief, and anxiety. She had not had the opportunity to really quantify the degree of her loss and stress and had not given herself permission to say it was ok to express anger and guilt as a part of a normal grief response. I was able to facilitate that today and begin working with her to restore hope of recovery and the possibility of future happiness. When I see a patient such as this it reminds me that my work isn't in vain and that God has blessed me with the ability and opportunities to make unique and useful interventions with people who are suffering.

If stress ceased to exist I would no longer have a job. I believe that stress is at the root of all disease. Stress is like fire. It can motivate us to thrive or it can destroy us if not managed. Fire can keep us alive from hypothermia or fire can incinerate us in our sleep if it gets out of control. The basic physiological response from stress in life is activation of the well known "fight or flight" response common to all mammals. Without this reflex man could not have survived for so many thousands of years. Man would have been unable to adapt to hostile threats and may have become extinct. The fight or flight response is triggered by events that occur during daily life and lead to release of adrenalin and several other chemicals and hormones into the bloodstream which instantaneously result in a rise in blood pressure, pulse rate, tension of the muscles, widening of the pupils, increase in breathing rate and other changes that prepare us to fight 'til death or evacuate the premises. Through evolution we have learned that physical violence isn't a good initial choice for solving problems. Running away or avoiding a threatening problem sometimes is the best decision. It can sometimes be the best strategy to live and fight another day. One who attempts to solve every problem through fighting blindly will ultimately fail as will one who avoids every problem. Man is king of the animal world because of the small layer of gray matter in our brains that usually helps us decide whether it is best to fight or run in a given situation.

When the fight or flight response is on constantly, as caused by continuous stress, the nervous system can become depleted of valuable biochemicals and eventually start to malfunction. This is the cause of conditions such as depression and anxiety. This sends the body into emergency conservation mode and forces it to select which functions to keep running and which to shut down. The first system to go is usually the immune system which leaves the body open to attack from microorganisms and even certain cancer cells. Sometimes the immune system revs up too high instead causing conditions such as lupus or arthritis. At some point the brain may shut down the endorphin plant depriving the body of this natural opioid-like substance and causing the body to become supersensitive to pain. Due to the massive supply of nerves in the gastrointestinal region and head region symptoms of nausea, diarrhea, constipation, and headaches are common in the stressed out state.

The bottom line is that too much stress, not effectively managed, throws the whole body out of whack and disrupts the natural biological processes thus setting the stage for disease to occur. Because of stigma sometimes attached to mental illness many people actually develop physical symptoms as the primary problem, often being led on a wild goose chase to find the right doctor to help them. Unfortunately, sometimes the psychiatrist is the last stop. This is not good because psychosomatic illnesses often will respond only to the appropriate combination of medications, psychotherapy, and assuring that the patients spiritual needs are addressed.

Search for a Silver Lining

Fri, 10 Mar 2007 03:08:10 GMT

posted by headoc

The past week was a week of sadness and grief...

Less than twenty four hours after the death of my nurses' husband to cancer, my receptionists' grandmother was taken off of life support and pronounced dead. One of the deceased I knew well and the other I'd never met. My practice partner and I made it through the week without support staff the best that we could. I'm glad the week has finally ended. I wanted to find another topic to write on tonight but nothing seems to inspire me. We all wish we could avoid dealing with death and grief but doing so is the greatest form of denial, for death is fully guaranteed for every living creature. It is interesting that this thing we dread and hate so much is the very thing that gives life such value. Were death not a future certainty we would have no reason to be accountable for the life choices we make. It wouldn't matter if we selected a pathway of pure evil and destruction or if we selected the very same pathway we have chosen in our current life. Without death there would not be a past or a future and life would probably resemble that of Bill Murray in the movie Ground Hog's Day. Every day would be like every other day. In that movie, Bill's character eventually prayed for death but since death was impossible he was trapped in his own private hell where he was the only human with a sense of awareness of his reality. All others were only concerned with their own individual realities.

Hardly a day goes by that I don't speak with someone having at least passive thoughts of suicide. At this stage of my career I will ask someone if they want to die with similar casualness as I would ask them if they had any trouble finding the office. It is well known that talking about suicide does not increase the risk that a patient will commit suicide. Though impossible to prove it is probably more likely their suicide risk is reduced by you asking about such thoughts. If the examiner doesn't think to question a depressed person about suicidal ideation the examination is flawed and incomplete, not to mention the fact that if the patient just happened to kill themselves later that day you would probably be sued and would most likely lose the case. It is equally important to be aware of the homicidal potential of a patient since you could be held liable for people killed by an individual you may have recently examined. So I don't have a problem routinely asking people if there are thoughts of murder. It is not believed that doing so will contribute in any way to an individual becoming more homicidal toward anyone other than yourself, maybe.

Despite all the efforts of the mental health care community the suicide rate remains steady in the arena of 30,000 per year since records began over 80 years ago. The most predictable indicator of a rise in suicidal deaths epidemiologically has been the economy. The suicide rate tends to rise when the stock market falls. There was a marked rise during the great depression and a slight rise during the recession of the 1970s. Suicide has been described as a permanent solution to a temporary problem. The greatest deterrent to considering suicide I have found to be fear of going to hell. This question creates a theological dilemma for all after a suicide has occurred. I personally believe that if the persons' mental capacity had failed them then God would no more hold that against them than if their heart had failed them. The confounder that exists sometimes rests within the fact that a large amount of successful suicides involve self induced states of intoxication from alcohol or drugs. I think many of those people would have come to a different conclusion were they not under the influence of a mind altering substance. Alcohol is great at causing one to feel disinhibited and to do things they probably would not do in a sober state of mind. Theologically, I believe that what makes man God's greatest creation is our free will. Being equally able to choose evil is really what makes doing what is right so much more valuable. Usually, the pathway of least resistance passes through the temptation of doing that which is harmful or not right. In my humble opinion, I think that choosing to take life when in a state of mind that the individual clearly knows to do so is wrong predisposes that individual to whatever the consequence may be. That said, i believe that the vast majority of those intentionally killing themselves are totally out of their mind at the time. I believe God gives them a pardon.

Sometimes I feel I should go to rehab to address the hostility I sometimes feel toward most of the cocaine addicts I've encountered. Interestingly, when I treated them in the jail setting there was never a problem. Even now when that rare addict presents that admits to having a problem and is genuinely sincere about accepting help, I have no problem with them. But when I discover several weeks after seeing someone that everything they told me in their history was a lie and their whole agenda was to get a controlled drug I start to feel like Mel Gibson in Lethal Weapon. Over time I have learned to accept that they are very sick individuals who literally have damaged their brains so much that the parts responsible for good judgment, truthfulness, and any degree of common sense has usually been destroyed. Dead Man Walking is an appropriate description. It is often as if the trigger has been pulled and the bullet is on the way to their head in extremely super slow motion. It may actually take a few years for the metaphorical bullet to penetrate the skull and inflict the fatal wound. In the mean time they have an obligation to make everyone else's life as uncomfortable as possible. I don't mean to let those off the hook that prefer drugs different from crack but I have found there to be a significant difference. I am actually pleased to find an ordinary alcoholic to treat because I know what to do for them and what to expect from them. Pure opioid dependent patients can sometimes be perfectly normal and functional except for having that problem. I have yet to meet an individual smoking crack every day that has a normal life.

I know I have rambled and meandered a bit here but I think something useful may have been expressed. At the very least I feel that I have vented a little and feel better than when I started this entry. I suppose that's a good thing given that I have chosen to write about such a dark topic today. To me it proves that some humor can be found in the darkest situations even when little or no control is available. Maybe next week will be a better one.