Says Who??

Verstehen, through shared perspectives


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BREAKING THE CYCLE OF PAIN: THE CHRONIC PAIN SUPPORT GROUP

cpsg flyer 4.11                  Last year, as you might have read in previous blogs, I worked in a Pain Management Center. My favorite times at the Center were when I was calling the patients between their appointments, to make sure they were doing OK and find out if there was anything they needed from us before their next appointment. Some were not doing well for various life experience reasons and needed an earlier appointment. Others were having trouble with obtaining their medications from their pharmacy and needed us to work with them to locate a more reliable place to obtain their medications. Still others had questions about various issues of living with chronic pain in a less than supportive political environment and a health insurance economy that does not guarantee that a patient will be able to afford the medication that they need.

But the patients that stay in my heart the most are those who lived alone, those who were themselves their only caretakers, and those who struggled the most with their pain. Their misery resulted from the entire gamut of problems from cancer to rheumatoid arthritis, from low back pain to pain in every joint in their bodies, and more. But that was only the pain. There was, added to this insult to the body and mind, the trauma to the soul. I heard how they were not believed when they tried to relate their stories; how no one wanted to listen to how they felt because “They heard it so many times already.” I heard how they missed doing the things we all took for granted, such as; going out to eat or to a party or a concert, cleaning their homes the way they liked for them to be, or working full time and earning a living that included enough money to pay for the extra needs in life. Even worse was the fear associated with brain fog and confusion and the ultimate threat of not being able to stay in their own homes. The increasing loss of choices in their lives was worst of all.

I, of course, could relate. This week I read an article from KevinMD, entitled “Seven Reasons Why Being in Pain is a Pain,” by Franklin Warsh, MD, MPH. It was not so much an eye-opener for me as it was a message to my soul. Here, finally, I heard a medical professional unburden himself of the true awfulness of chronic pain, how it takes over every facet of one’s life, and how it makes the patient fight for every ounce of joy they may be able to experience. Some of what he said echoed the voices of patients who had shared their stories with me. Much of what he said was also about things I knew our Pain Center patients would not necessarily voice to anyone. Some were things I also often experience, but would never tell anyone because I was not sure they were not the result of some flaw of my own—some insufficiency of my DNA, or my character, or my failure to be a better person in some way. Dr. Warsh was able to take the shame out of chronic pain. By sharing (naming) the common symptoms and losses accompanying chronic pain, he defused the stigma we assign to ourselves for having pain.

I am not saying everyone suffers all of these things he mentions, because all chronic pain patients are unique in their experience of pain, their response to pain, and what works for them to ease that pain. Some can take medications with a lot of success; others cannot tolerate medications and have to seek other means to alleviate their pain. And there are many other ways—ways that, like medication, may be more or less effective for any given patient. But that extended discussion is for another blog. This blog post is about a means of dealing with chronic pain that I believe to be one of the most important, based on my own experience and the experiences that of some of our patients have related to me. The experience is that of  Joining a chronic pain support group.

Recently some of my professional friends and I agreed that a Pain Support Group that was open to all chronic pain patients was a necessity for our area. We decided it should be free to the public, approved by relevant medical and psychological professionals, and not intended for political advocacy but rather would be a community of accepting, active listeners who are willing to care for one another and meet together for learning and sharing. That group has begun to take shape, and the next meeting will be on April 11th of 2018 at 4:00 pm. We meet in St. Paul’s Episcopal Church Education Wing at the corner of Market and Walnut Streets in Jeffersonville IN.

This group is intentionally meant to be a means of healing through our sharing, rather than advocacy. We are definitely not opposed to advocacy and know that it has its own role in healing. But it is often difficult for people in severe pain to commit themselves to such active work. As one patient has said very poignantly, “Why, when I finally have something I really need and want to advocate for, am I least able to do it?” On the other hand, if you already belong to an advocacy group and would like to join us as well, you would be very welcome.

I have the privilege of being the facilitator, or moderator, of this group. My professional life as a nurse/sociologist has been based on working with groups to facilitate the process or goals of the specific group. We do not work on what my personal agenda might be, but what we all agree we want the agenda to be. The caveats I have mentioned above concerning advocacy and sharing are the basics agreed upon by the professionals who participated in our discussions when we formulated the group, along with the co-pastors of the church who have donated the space for us to meet each month. From that opening point, we worked together to create the process of finding healing within ourselves and each other.

The links for the article by Dr. Warsh, as well as an article written by Dr. James P. Murphy about the group, are below. I invite you to read them and to think about what we might be able to accomplish together for and with others, and please meet with us on April 11th or any second Wednesday of the month at St. Paul’s. We need you, and if you are seriously considering this, you probably need us.

      breaking cycle of pain

 The Family of Pain is a Club Nobody wants to join, 

But Isolation is Worse.   –Lynn Webster, MD

  

Resources

Murphy, James P. “A Letter in Support of a Support Group” March 25, 2018 https://jamespmurphymd.com/2018/03/25/a-letter-in-support-of-a-support-group/

Warsh, Franklin “Seven Reasons Why Being in Pain is a Pain” in KevinMD, Dec. 27, 2017 https://www.kevinmd.com/blog/2017/12/7-reasons-pain-pain.html

Webster, Lynn “Family of Pain is a Club Nobody Wants to Join, but Isolation is Worse.” http://thepainfultruthbook.com/2018/03/family-of-pain/

 


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AN URGENT PLEA TO END THE WAR AGAINST PHYSICIANS AND PATIENTS

UPDATE 12/5/17:  A revised (shorter)version of this blog has been posted in KevinMD, at the following location.  Thanks, KevinMD!

https://www.kevinmd.com/blog/2017/12/stop-opioid-crisis-war-physicians-must-end.html

 

 

Crimes against humanity are widespread on this planet, and too many to count.  Over the past decade diligent researchers (by diligent I mean those who verify sources and results) have uncovered the roots of some of our more persistent and frightening social problems, and published reputable accounts thereof.  Many such problems are actually the result of conspiracies set decades ago, like the rise of private prisons for the purpose of incarcerating a specific race of young people because of socioeconomic issues (read racism), and calling it a War Against Drugs.  But the drugs continued to take over our nation—not just because of those young people, but because of the greed for money and power in the pharmaceutical companies, insurance companies, and politicians that has grown exponentially, unchecked.  Nixon’s intended outcome—that of getting minorities off the streets and severely impacting their ability to live normal lives outside of prison—also suited well the baser needs of other groups in our society.

Other groups, in fact, began to see the financial success and knowledge of physicians to be a major threat to their own greedy plans.  They deduced that chronic pain patients, now acknowledged and receiving treatment for their pain, could be both blamed as a source of street drugs and used to help bring down honest physicians (and to support the pill mill “doctors” who supplied the patients with enough medicine  to both use and sell).  Eventually, we begin to see “statistical reports” that “prescription drugs” were the cause of abuse and overdose deaths in specific regions of our country.   For a short time, they may have been.  But when the deaths began to occur in White Middle-Class families, the outcry to increase the efforts of the War on Drugs became deafening.  There had to appear to be some effort to control the drugs, so we see draconian measures being set—in some states by law, in others by regulation—that were targeting the legitimate physicians who prescribed for pain patients, and ultimately the patients who were frequently cut off without warning from their pain treatment.  Despite the outcry against punishing patients and physicians, and the evidence showing the futility of this approach to the War on Drugs, this situation continues to threaten the lives of both patients and their physicians, every day.

Despite scientific proof that Substance Abuse Disorder (being addicted to a substance) is an illness of the brain and can usually be well managed by an addiction specialist, legislators and law enforcement officials alike still only see “drunks and addicts” and still, after DECADES of failure, claim that incarceration/punishment is the only way to fight the war on drugs.

Despite, also, the logic that if you are fighting a War against a crime, you go after the source rather than innocent bystanders.  If we don’t get rid of the sources:  drug cartels, the dealers, and the creators of the drug,  how much good is it going to do to punish the people who use them?  Sadly, these sources have never been the primary targets.  Just as now we see heroin and fentanyl actually being the greater cause of overdose deaths (because they are cheap and much more potent than earlier versions), we still hear and see stories about prescription drugs being the cause of these deaths.  We are still subjected to so-called charts describing dubious statistical proof that prescription drugs are the main cause of overdoses, when more reliable research shows that it is street heroin and fentanyl.

To that, I would ask the reader to please follow the hyperlink below.  The author of this piece has provided a thoughtful and well researched discussion of what is really causing overdose deaths, and why the propaganda we are getting is so dishonest:

https://www.acsh.org/news/2017/10/12/opioid-epidemic-6-charts-designed-deceive-you-11935

Having read this article, consider well the facts that every year more than 400 physicians commit suicide;  that thousands of chronic pain patients suddenly deprived of their medication have either committed suicide or gone to the streets to get their medication; and that many of these have also suffered unintended overdose deaths.

These measures that make practicing good medicine so difficult, and the law enforcement mentality that believes physicians are guilty until proven innocent,  are not the only reasons physicians are either opting out of practicing medicine, or opting out of life altogether.  The War on Physicians and on Patients is real, and it is devastating.  The pharmaceutical houses and insurance companies may actually believe that we can survive without trained doctors; Artificial Intelligence will be just as good if not better, they believe….but check out this article:

https://www.scientificamerican.com/article/the-social-life-of-opioids/.

We read here that there is well-researched, scientific proof that a caring and trusting relationship between patient and doctor is a necessary, (but not sufficient), ingredient for best medical practice—AND for healing!  As one incredible physician has noted:  “They (the patients) don’t care how much you know until they know how much you care.”  Artificial intelligence hasn’t managed the caring part, and even if it does I don’t see much healing effect to be expected from a robotic hug.

The crime against pain patients who are now not only being vilified in news media, in pharmacies, and in social media, is certainly heartbreaking.  If you happen to be one of those pain patients, it is also a return to the terrors of intractable pain, inability to function productively in society, and a potentially horrible death.

If you are a physician who has spent at least half the normal human life span studying and preparing to make life better for those who suffer, life may be  becoming a nightmare.  Insurance companies dictate what treatments are allowable, how often, and how long such treatments will be permitted.  They do not refer to medical societies for their information.  They refer to bottom line profit indexes.  Legislators who pass laws (when medical board regulations would more properly suffice) that limit what physicians can prescribe, and how often—arrange that physician’s offices and lives will be disrupted, the physicians in question treated as guilty before having a chance to be proven innocent.  As usual, those who are charged with the felonies that have been put in place as a weapon in the War on Drugs never quite regain their previous status of innocence, even when proven so.

Does it matter to the insurance companies or the legislators that these laws have only created chaos and confusion, betrayal and mistrust?  Does it matter that physicians are already reeling from finding themselves backed into corners where they have to “sign on” to corporate health care entities that are run by non-medical administrators who decree when and how often they work, how many patients they will see for how long, and determine bonuses based on computer-run quotas and outcomes?  Does it matter that medical students are so disillusioned that they drop out, and that some commit suicide?

And finally, adding to the fears of losing their practices, their licenses, and the meaning attached to their life work, physicians in increasing numbers are being attacked and/or killed by frustrated, angry patients or their relatives.

Why is this ethically, morally, and even logically wrong approach to our drug crisis—which MUST be separated in our minds from medical care for chronic pain patients—continuing to exist as a modus operandi?  Why are physicians who serve our communities targeted as criminals at worst, and problem employees who must be managed at best?  Sociologically, physicians have historically belonged to one of the highest prestige vocations in America.  Their demotion to the present state is not through fault of their own, but through others’ sociopathic greed for money and power, combined with the attitude that allows so many to hate anyone who differs from themselves, to create this totally inhumane situation.

It is not “liberal” or “progressive” to respect and care for others.  It is Christian, and Muslim, and Hindi, and Jewish—it is a basic precept of many world religions and predates organized religion itself by centuries.  Of course, being human and egocentric, we do not always succeed in living up to these standards.

It is my opinion that the proof of our own individual humanity is the maturity, intelligence and self-motivation to care for others as we care for ourselves.

I could go on for pages about why so many people have lost the human characteristic of empathy, but there are enough people who retain it who could help our country become human again.  Who still respect the dignity of other human life, and who realize that “together, we stand; divided, we fall.”

It is definitely in our best interests to respect and protect the lives and experience of our physicians; it is also in our best interests not to stand by and leave them or their patients to live and die in misery when it is all so unnecessary.  And inhuman.

And, a last plea……

 

 

RESOURCES:

Alexander, Michelle.  The New Jim Crow:  Mass Incarceration in the Age of Colorblindness.  2012.  The New Press, NY

Bertram, Eva and Morrris Blachman. Drug War Politics: The Price of Denial.  1996. University of California Press.

Bateman, Dustin.  Neurobiological & Sociological Aspects of Addiction

Levinthal, Charles F.  Messengers of Paradise.  Opiates and the Brain.  The Struggle Over Pain, Rage, Uncertainty and Addiction. 

Meier, Barry.  A World of Hurt:  Fixing Pain Medicine’s Biggest Mistake.  2013.  New York Times Company.

Parsons, Talcott.  “Illness and the Role of the Physician:  A Sociological Perspective.”  American Journal of Orthopsychiatry 24 March 2010.  Copyright © 2010, John Wiley and Sons.

Quinones, Sam.  Dreamland:  The True Tale of America’s Opiate Epidemic.  2015.  Bloomsbury Publishing Plc.

Sternheimer, Karen.  Connecting Social Problems and Popular Culture:   Why Media is not the Answer. 2nd Ed.  2013.  Westview Press, Perseus Books Group.

Webster, Lynn R.  The Painful Truth:  What Chronic Pain is Really Like and What it Means to Each of Us.  2015.  Webster Media LLC, PO Box 581113, Salt Lake City UT 84158.

WEB ARTICLES, including peer reviewed

Pain Medicine News – How Did We Get Here? http://www.painmedicinenews.com/ViewArticle.aspx?d=Guest%2BEditorial&d_id=351&i=March+2014&i_id=1042&a_id=26043&tab=MostEmailed#.U3PLVV6vdyI.twitter

Report: Chronic, Undertreated Pain Affects 116 Million Americans http://ti.me/AAfT7q  via @TIMEHealth

New Pain Management Rules Leave Patients Hurting http://seattletimes.com/html/localnews/2016035307_pain28m.html#.U2mA77bwJzQ.twitter

Chronic Undertreated pain affects 116 million Americans: http://healthland.time.com/2011/06/29/report-chronic-undertreated-pain-affects-116-million-americans/

Our Fear of Opioids Leaves the world in Pain  http://edsinfo.wordpress.com/2014/10/27/our-fear-of-opioids-leaves-the-world-in-pain/

MT @toni_bernhard: My new piece. It should be of interest to anyone whose illness is questioned: http://www.psychologytoday.com/blog/turning-straw-gold/201410/i-m-sick-what-is-wrong-me …Dr. Paul Christo @DrPaulChristo  ·  Oct 27

California Doctor….    http://paindr.com/california-doctor-unveils-painful-abyss-facing-patients-in-pain/

Physician Suicide:  http://t.co/4vhF63eD6N

Physician Risks:

The damage done by the war on opioids: the pendulum has swung too far http://www.dovepress.com/articles.php?article_id=16781 …

Trial Verdict:  Dr. Baldi Not Guilty on All Charges http://whotv.com/2014/05/01/baldi-trial-not-guilty-on-all-charges/

What are Patients to do when Law Enforcement Closes Clinics?  http://missoulian.com/news/state-and-regional/ravalli-county-health-officer-says-patients-of-raided-florence-clinic/article_cf2e1690-bac0-11e3-848e-001a4bcf887a.html

Killing Pain in Perry county http://www.kentucky.com/2009/12/12/1056711/killing-pain-in-perry-co.html

Patient role in helping physicians:

“Unless patients wake up and fight for the providers of care, we are headed for the sickest system in the world.” http://www.kevinmd.com/blog/2014/03/dissatisfied-doctors-provide-good-patient-care.html …


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REFLECTIONS ON THE EFFICACY OF OPIOID PAIN RELIEF OVER TIME

pain photoBefore addressing the issues of this article, I will need to explain the position from which I write. At the present time I am a 76-year old, semi-retired sociologist and former nurse. As a sociologist, it was natural for me to include the sociology of medicine as one of my major interests. As a nurse, I worked for three years in the county jail nurse’s office, several years in the emergency room, and for six years as a hospital corpsman in the navy reserve.

I was introduced to the whole drug scene while working in the jail, where it was my job to treat substance abusers who were addicted to paint, glue, alcohol, and various drugs. This was in the very early ‘80s, and the majority of the street drugs were amphetamines, Quaaludes, heroin, and marijuana. It was necessary to control withdrawal symptoms from the time the inmates were booked, to keep them alive long enough to go to court, serve whatever time they were given, and be released back into the same environment with virtually no change in their lives except those imposed on felons. The recidivism rate was extremely high—more so than for any other offense. During the time I worked there, the fastest turn-around rate for a released prisoner being picked up drunk and brought back in to Booking was 30 minutes.

Of course, in the ER and even in the Navy reserve I saw evidence of substance abuse. As a corpsman I was also involved with both diagnosis and treatment. The most heartbreaking experiences, however, occurred while I was working at a private college in Appalachia from 1997-2013. I saw firsthand the growth of the OxyContin and heroin epidemic that Sam Quinones documents in Dreamland, followed by Meth and various other prescription drugs, soon followed by the amoral pill mills that so delighted students who were already dependent or in early stages of addiction. At their age, they were the most vulnerable to the brain disorder of addiction, and the main targets of the dealers who would actually supply their first pills free, to encourage a new customer. I saw so many beautiful, bright students succumb to the promise of a pill that would make their life better, more fun, or at least easier. I was able to help some, but not all, by far. They needed experienced and trained medical attention, and I was no longer in that field. I came to despise the very thought of drugs, dealers, and pill mill “doctors”.

But there is another side to my story. In 1968 I suffered the first experience of a bulging spinal disc. Within 3 years I was diagnosed with degenerative disc disease, and with osteoarthritis of the spine, hands, feet, shoulders and hips. By 2013, there was no part of my spine that was not affected; I had major stenosis at various levels, bone spurs, episodes of bulging and decayed discs, a vertebra that had decayed discs on both sides and was standing on edge, resulting in a spinal S-curve from my waist to the upper thoracic region. Unrelenting pain caused muscle spasms in my entire back and neck, adding to the pain. A meningioma would soon be discovered attached to my spinal cord at T3-4; it is benign—the only worry being that it will grow.

During those 45 years living with pain, I never had any medication stronger than NSAIDS. Like many patients, I could not tolerate narcotics or opioids. I had to learn meditation and “mind control” (pushing the awareness of pain to another part of my consciousness). I had a great deal of physical therapy. I played the piano and organ for distraction, until I could not. I walked from 1-3 miles every day, and I worked full time as a nurse, then as a college professor, usually working between 40-60 hours a week. I spent seven years in South Africa in the middle of a revolution. The more I could distract myself with external demands, the longer I could function. Again, until I could not.

In 2014, so disabled by pain I could neither work nor sufficiently care for myself, I was sent to a pain management specialist in Louisville, KY. After I was finally convinced that he was a legitimate pain specialist who would not try to get me addicted, we were able to work together very well. I learned to trust his judgement, and to follow his lead in determining my treatment.   As a result, I have been able to teach at a local university part time for the last two years, and it has been a year since I have had pain greater than 5 on the 0-10 scale. One of the reasons that the pain has not been greater, and has not persisted, is that when it gets to that point I take hydrocodone, at its very lowest dose. My pain doctor realized that I am able to tolerate very low doses of medications for other problems (many of which were caused or exacerbated by long-term use of NSAIDS), so we tried the opiate. The complete pain relief has been astounding to me. I have never before had medication do more than take the edge off the pain. Equally important, my need for the opiate is becoming less and less frequent. My chronic anxiety levels have dropped considerably, and that also is a source of pain relief.

Which brings me, finally, to the point of this article. I hope I have sufficiently established the experience and credentials that give me the foundation for writing it. I must write it, because for too long I have been reading articles by people who have based their judgement about the dangers and/or efficacy of opiate treatment for pain on short-term, inadequate research. In A World of Hurt, by Barry Meier, he quotes Dr. Jayne Ballantyne as saying that her studies, and those of others, show that after a short term of therapy, there is little to no efficacy (5% of patients) of opiates for pain. I have seen and heard these figures often; yet pain management physicians also have records of people who have been carefully managed on opiates and other pain relieving measures for at least twenty years, who are functioning without severe pain. None of these studies satisfy me that they meet the natural science or sociological requirements of longitudinal studies. The former studies fall far short of twenty years, and the latter are a matter of record but no sufficiently rigorous scientific research has been done to establish credibility.

Additionally, our understanding of the prevalence and range of chronic pain issues, and the new brain studies that have completely revised our knowledge of addiction, have rendered those studies irrelevant. But the continued widespread references to them has created a situation that is clearly morally and ethically bankrupt: Patients with persistent, severe pain—including, in many states, terminal cancer patients—are being deliberately, systematically deprived of relief and therefore from the ability to lead potentially productive lives, or at least to spend their final days in peace, without pain. This, while other substances that are addictive are legal and can be consumed by any adult, regardless of their risk factors for addiction, whether or not there is a “need” for the substance.

What would make opiate efficacy studies reliable and verifiable? First, to acknowledge that all pain patients are unique in their tolerance to pain, their response to pain, and their response to treatment. Not everyone can metabolize medications the same way. Not everyone responds equally to physical therapy, or to psychological counselling. Not everyone has the personality to effectively meditate, or to suppress awareness of moderate pain. But all of these treatments, as well as known risk factors, are variables that must be accounted for if you are judging the efficacy of pain treatment.

Then there is the issue of the selection of participants. When I read the studies done in past years, I found they were limited to a single practice, or a hospital, or other small group of patients with no concern for variables like age, risk factors, history of abuse, previous treatment and other illnesses. The participants were not chosen scientifically in order to be representative, so results are inevitably skewed. I am reminded of early anthropological ethnographic studies where small, isolated villages were researched, then the results extrapolated to all such groups: “from the particular to the general”. We now realize that you can’t do this and arrive at accurate conclusions. Yet, on the basis of these flawed opiate efficacy studies, people’s lives are being damaged, their families are suffering needlessly, and many patients who are cut off from their medication either take to street drugs with the risk of overdose, or just commit suicide in the first place.

We do need more research about the safety and efficacy of drugs. But it must be longitudinal and scientifically designed and the results assessed to be reliable and verifiable. We also need politicians to stop enacting laws and policies based on moral definitions of issues, which we can never come to consensus about, and work on the actual economic and environmental issues that they can actually improve.

Addiction is a disease, not a moral issue. Pain is a disease, not a moral issue. And we are not speaking of just a few people affected by the neglect resulting from ill-informed laws and regulations designed more to punish the innocent along with the guilty rather than to end the War on Drugs. We speak of hundreds of thousands, even millions of sufferers. When properly identified as scientific (medical) problems instead of moral issues, we can see the potential to improve conditions. People could be adding to the economy, rather than being forced to either live off of it, or to live in poverty while their pain continues to worsen.

Big Pharma—for example, Purdue Pharma– are far from innocent in this War. Additionally, the FDA is no longer as concerned with protecting potential patients as they are in protecting corporate rights to profit; witness the countless lawsuits for drugs improperly researched, improperly advertised, and improperly presented to physicians who must rely on that information in order to prescribe successfully. And the DEA is still, regardless of evidence that they are often destroying the lives of the innocent while failing to halt the spread of illegal drugs, using pain patients and their physicians as cannon fodder in their failed war on drugs.

A significant paradigm shift is required here. Educationally, culturally, legally and morally we must illuminate the darkness of our willful ignorance about the suffering of the innocent who have become scapegoats in the failed War on Drugs due to tunnel vision about the relationships between drugs, physicians, and pain; a tunnel vision that cannot see the greed and political will that perpetuates the drug problem. Every institution of our society has failed our physicians and their patients who are in pain, or addicted. Those institutions have either failed to adjust a false worldview that blames patients for their illnesses, or have just failed to assume responsibility for their role in finding solutions to the need for a collaborative approach to these widespread diseases, and to the devastation that has resulted from long term beliefs that they are moral issues that must be punished.

For over a century, that approach has not worked. And as the saying goes, insanity is defined as continuing to do the same thing over and over again (or doing even more of it), expecting different results. From family, to education, to religion, culture, economics and government we need a major overhaul of outdated and inaccurate beliefs, and development of procedures that decriminalize the treatment of chronic pain and addiction, as well as the afflictions themselves. Medical decisions need to be made by medical experts and their appropriate medical agencies, and the Criminal Justice system could concentrate on ridding our nation of illegal drugs by putting the same time and effort into stopping the dealers who daily increase the supply of drugs available on our streets. We might even look to the successes of other countries, and determine if their methods are importable.

I cannot bear the thought of more bright and beautiful college students ruining or ending their lives before they have even begun. The data suggests that it is not stopping with college students, but that high school and even middle school students are being targeted as “customers” of the illegal drug trade. I also cannot live with the knowledge that caring and dedicated physicians, who have spent nearly half of an average 70 year lifetime studying and working for the privilege of becoming practicing physicians, have lost everything they have worked for because they have tried to help their patients. (I am quite ok with pill mill “doctors” being brought to justice for their crimes, however!)

It is Christmas Eve as I write this. A time of hope, a time of expectation that the promises of life can be fulfilled. I am a sociologist because I believe in the amazing capability of human beings to solve the problems of life, separately and together. I am also all too well aware of our capability to create and maintain cultural and social institutions and structures that protect certain groups of humans at the expense of huge numbers of their fellow humans. I believe that most of us are better than this; that we can do better, and that bit by bit we can learn to adapt to change, to each other, and to the requirements of living in our world safely, together.

Please—let’s make 2017 the year we begin to deal with chronic pain and addiction as the disease processes they are, and begin to structure our corporate life accordingly, so that together we can end the war on drugs, and on patients and their physicians, and restore the rationality of the Enlightenment without killing the compassion of empathy.

enlifghtened being

RESOURCES: Books & Peer Reviewed Articles

Alexander, Michelle. The New Jim Crow: Mass Incarceration in the Age of Colorblindness. 2012. The New Press, NY

Bateman, Dustin. Neurological & Sociological Aspects of Addiction.

Bertram, Eva and Morrris Blachman. Drug War Politics: The Price of Denial. 1996. University of California Press.

Levinthal, Charles F. Messengers of Paradise. Opiates and the Brain. The Struggle Over Pain, Rage, Uncertainty and Addiction.

Meier, Barry. A World of Hurt: Fixing Pain Medicine’s Biggest Mistake. 2013. New York Times Company.

Parsons, Talcott. “Illness and the Role of the Physician: A Sociological Perspective.” American Journal of Orthopsychiatry 24 March 2010. Copyright © 2010, John Wiley and Sons.

Quinones, Sam. Dreamland: The True Tale of America’s Opiate Epidemic. 2015. Bloomsbury Publishing Plc.

Sternheimer, Karen. Connecting Social Problems and Popular Culture:   Why Media is not the Answer.  2nd Ed. 2013. Westview Press, Perseus Books Group.

Webster, Lynn R. The Painful Truth: What Chronic Pain is Really Like and Why it Matters to Each of Us.  2015  Webster Media, LLC.

Hyperlinks to articles on Web:

Addiction is a Brain Disease http://www.attcnetwork.org/explore/priorityareas/science/disease/

Pain Medicine News – How Did We Get Here? http://www.painmedicinenews.com/ViewArticle.aspx?d=Guest%2BEditorial&d_id=351&i=March+2014&i_id=1042&a_id=26043&tab=MostEmailed#.U3PLVV6vdyI.twitter 

Report: Chronic, Undertreated Pain Affects 116 Million Americans http://ti.me/AAfT7q  via @TIMEHealth

New Pain Management Rules Leave Patients Hurting http://seattletimes.com/html/localnews/2016035307_pain28m.html#.U2mA77bwJzQ.twitter 

Chronic Undertreated pain affects 116 million Americans: http://healthland.time.com/2011/06/29/report-chronic-undertreated-pain-affects-116-million-americans/

Our Fear of Opioids Leaves the world in Pain http://edsinfo.wordpress.com/2014/10/27/our-fear-of-opioids-leaves-the-world-in-pain/

MT @toni_bernhard: My new piece. It should be of interest to anyone whose illness is questioned: http://www.psychologytoday.com/blog/turning-straw-gold/201410/i-m-sick-what-is-wrong-me …Dr. Paul Christo @DrPaulChristo  ·  Oct 27

California Doctor….   http://paindr.com/california-doctor-unveils-painful-abyss-facing-patients-in-pain/

Physician Suicide http://t.co/4vhF63eD6N

References from this article:

  1. Gagné P, Moamai J, Bourget D. Psychopathology and suicide among Quebec physicians: a nested case control study. Depress Res Treat. 2011;2011:936327. [Medline]. [Full Text].
  2. Adams D. Physician suicide: searching for answers. American Medical News [serial online]. April 25, 2005;Available at http://www.ama-assn.org/amednews/2005/04/25/prsa0425.htm.
  3. Center C, Davis M, Detre T, et al. Confronting depression and suicide in physicians: a consensus statement. JAMA. Jun 18 2003;289(23):3161-6. [Medline].
  4. Hawton K, Malmberg A, Simkin S. Suicide in doctors. A psychological autopsy study. J Psychosom Res. Jul 2004;57(1):1-4. [Medline].
  5. Holmes VF, Rich CL. Suicide Among Physicians. In: Blumenthal SJ, Kupfer DJ, eds. Suicide Over the Life Cycle. Washington, DC: American Psychiatric Press; 2004:599-618.
  6. Middleton JL. Today I’m grieving a physician suicide. Ann Fam Med. May-Jun 2008;6(3):267-9. [Medline].
  7. Noonan D. Doctors who kill themselves. Newsweek. Apr 28 2008;151(17):16. [Medline].
  8. Petersen MR, Burnett CA. The suicide mortality of working physicians and dentists. Occup Med (Lond). Jan 2008;58(1):25-9. [Medline]. [Full Text].
  9. Worley LL. Our fallen peers: a mandate for change. Acad Psychiatry. Jan-Feb 2008;32(1):8-12. [Medline].
  10. Frank E, Dingle AD. Self-reported depression and suicide attempts among U.S. women physicians. Am J Psychiatry. Dec 1999;156(12):1887-94. [Medline].
  11. Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry. Dec 2004;161(12):2295-302. [Medline].
  12. Gross CP, Mead LA, Ford DE, et al. Physician, heal thyself? Regular source of care and use of preventive health services among physicians. Arch Intern Med. Nov 27 2000;160(21):3209-14. [Medline].
  13. Myers M, Fine C. Suicide in physicians: toward prevention. MedGenMed. Oct 21 2003;5(4):11. [Medline].
  14. Myers M. Doctors’ Marriages: A Look at the Problems and Their Solutions. 2nd ed. New York: Springer; 1994.
  15. Charles SC, Frisch PR. Adverse Events, Stress, and Litigation: A Physician’s Guide. New York: Oxford University Press; 2005.
  16. Balch CM, Oreskovich MR, Dyrbye LN, et al. Personal consequences of malpractice lawsuits on American surgeons. J Am Coll Surg. Nov 2011;213(5):657-67. [Medline].
  17. Sessions S. Dr. Ticktin and the Expert Witness Industry. 2005;[Full Text].
  18. Myers M, Gabbard G. The Physician as Patient: A Clinical Handbook for Mental Health Professionals. American Psychiatric Publishing; 2008.
  19. Lehmann C. Aggressive Intervention Urged for Depression in Physicians. Psychiatric News. November 17, 2000.
  20. Miles SH. A piece of my mind. A challenge to licensing boards: the stigma of mental illness. JAMA. Sep 9 1998;280(10):865. [Medline].
  21. Hendin H, Maltsberger JT, Haas AP. A physician’s suicide. Am J Psychiatry. Dec 2003;160(12):2094-7. [Medline].
  22. Hendin H, Reynolds C, Fox D, et al. Licensing and Physician Mental Health: Problems and Possibilities. Journal of Medical Licensure and Discipline. 2007;93:6-11.
  23. Schwenk TL, Gorenflo DW, Leja LM. A survey on the impact of being depressed on the professional status and mental health care of physicians. J Clin Psychiatry. Apr 2008;69(4):617-20. [Medline].
  24. Polfliet SR. A National Analysis of Medical Licensure Applications. J Am Acad Psychiatry Law. 2008;36:369-74. [Full Text].
  25. Altchuler SI. Commentary: Granting medical licensure, honoring the Americans with disabilities act, and protecting the public: can we do all three?. Acad Med. Jun 2009;84(6):689-91. [Medline]. [Full Text].
  26. Schroeder R, Brazeau CM, Zackin F, Rovi S, Dickey J, Johnson MS, et al. Do state medical board applications violate the Americans With Disabilities Act?. Acad Med. Jun 2009;84(6):776-81. [Medline]. [Full Text].
  27. Andrew LB. Survey Says: Many EPs Suffer in Silence. Emergency Physicians Monthly Online [serial online]. March 2006;13:3:1-7. Available at http://www.epmonthly.com/index.php?option=com_content&task=view&id=226&Itemid=15.
  28. Shaw DL, Wedding D, Zeldow PB. Suicide among medical students and physicians, special problems of medical students. In: Wedding D, ed. Behavior and Medicine. 3rd ed. Hogrefe and Huber: 2001:78-9 (chap 6).
  29. Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. Mar 1 2008;336(7642):488-91. [Medline]. [Full Text].
  30. West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of resident fatigue and distress with perceived medical errors. JAMA. Sep 23 2009;302(12):1294-300. [Medline].
  31. Frank E, Carrera JS, Stratton T, Bickel J, Nora LM. Experiences of belittlement and harassment and their correlates among medical students in the United States: longitudinal survey. BMJ. Sep 30 2006;333(7570):682. [Medline]. [Full Text].
  32. Moutier C, Norcross W, Jong P, et al. The Suicide Prevention and Depression Awareness Program at the University of California, San Diego School of Medicine. Acad Med. Mar 2012;87(3):320-6. [Medline].
  33. American Foundation for Suicide Prevention Physician Depression and Suicide Prevention Project. American Foundation for Suicide Prevention. Available at http://www.afsp.org/index.cfm?page_id=05804002-E8F4-13AB-2D4B97A0815A2744. Accessed 10 March 2010.
  34. Goldsmith SK, Pellmar TC, Kleinman AM. Reducing Suicide: A National Imperative. Institute of Medicine Monograph. National Academies Press; 2002:[Full Text].
  35. Andrew LB. PHPs Are in Your Corner. Emergency Physician Monthly Online. 2006;13:6:[Full Text].

Physician Risks

The damage done by the war on opioids: the pendulum has swung too far http://www.dovepress.com/articles.php?article_id=16781 …

Trial Verdict: Dr. Baldi Not Guilty on All Charges http://whotv.com/2014/05/01/baldi-trial-not-guilty-on-all-charges/

What are Patients to do when Law Enforcement Closes Clinics? http://missoulian.com/news/state-and-regional/ravalli-county-health-officer-says-patients-of-raided-florence-clinic/article_cf2e1690-bac0-11e3-848e-001a4bcf887a.html

Killing Pain in Perry county http://www.kentucky.com/2009/12/12/1056711/killing-pain-in-perry-co.html

Patient role in helping physicians

“Unless patients wake up and fight for the providers of care, we are headed for the sickest system in the world.” http://www.kevinmd.com/blog/2014/03/dissatisfied-doctors-provide-good-patient-care.html …

 

dr-murphyFrom James P. Murphy, MD, MMM;

Practicing Pain Management Physician

Board Certified in Pain Management & Addiction Management

https://jamespmurphymd.com/2014/04/25/the-dream-of-pain-care-enough-to-cope-the-seventeenth-r-dietz-wolfe-memorial-lecture/

https://jamespmurphymd.com/2016/07/24/comparing-apples-to-apples-the-morphine-equivalent-daily-dose/

https://jamespmurphymd.com/2016/06/21/prescribing-controlled-substances-in-kentucky-cme-presentation-for-flaget-memorial-hospital-in-bardstown-ky-june-21-2016/

https://jamespmurphymd.com/2015/02/13/pathway-to-partnership/

https://jamespmurphymd.com/2015/09/a-stellar-time-at-bellarmine

 


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COLLEGE STUDENTS GIVE MY LIFE MEANING

bare tree

The university academic year begins for me this week, and—not for the first time—my thoughts are heavy with the implications of the grave responsibility of educating the young. This year, though, seems to weigh heavy on my heart more than any such year in the past, with the possible exception of the years in South Africa during the end of apartheid and the first years of democracy. It could even be because of those years, and the comparisons that can be made between South Africa then, and the United States now, that my concern is great.

Of course, no comparative study would find a perfect correlation between the two countries. But there are many similarities, especially when observing the issues of race, intolerance, social injustice, disenfranchisement, rule of a power elite—I could go on, but already it become obvious that there are points to be made, as well as huge differences in the two situations. Can anything be learned from the past in another country, that would shed light on a way forward for us in the present?

My course load this semester consists of Intro to Cultural Anthropology, Social Theory, and Political Anthropology. All three courses contain a great deal of material that directly relates to August 2016 in the United States. Some of these situations, like the failed war on drugs and its ongoing, devastating aftermath, do not appear to be related to anything that occurred in South Africa. But when you look deeper at the combinations of political misinformation, low intensity violence incited deliberately by the government, and antipathy between police and the often innocent subjects of their brutality, a shared trend appears.

In fact, one can see that the troubles in both nations were not caused by failed societal structures so much as by a shared failed personal accountability for human actions. I always try to find an opportunity to explain to my students why it is true that to the extent we dehumanize others, we dehumanize ourselves. And the more often that we do that, the less human we become. At some point, it no longer matters who we hurt, or how much we hurt them. Having reached that point, nothing is sacred—we can lie to each other, cheat in personal and public relationships, and shame our religious traditions by turning them inside out and using them against each other, rather than in enjoyment of the sacredness of our existence. Some people blame this on the capitalist profit motive; I blame it on unrestrained greed grown to inhumane size, however you want to rationalize it.

Our inhumane behavior is seen in social media pages, day after day. Many posts are deliberate lies, some are propagated by people and organizations who make a great deal of money developing the ways and means of destroying political opponents, or spreading ideas in order to challenge inconvenient truths about how we should live. Our youth often do not trust our government, our news media, or our religious leaders. We have an entire generation of youth who have grown up in the midst of uncontrolled verbal and media bile, day after day. Yet many parents and teachers are still able to reflect the values of integrity and community to their children; too many others have failed.

I don’t want to be one of those who fail those precious young people. It would be safe for me to just present the information in the texts as is, and avoid controversy. Unfortunately, sociology and anthropology are not calculus. They exist to provide a learning situation whereby we may study, compare, theorize, and determine the state of our world, and consider possible ways to improve our situation and that of others. If we learn anything at all from these disciplines, it is that humans are not meant to live just for themselves. We are psychologically and mentally geared to living in community, from whence we learn our sameness as well as our beautiful uniqueness; where we learn to share, to care for others, and to be cared for. It is where we discover the meaning of our lives, as Victor Frankl explains so beautifully.

On the surface, our country is in what Durkheim would call a state of anomie; of “normlessness.” There are too many who live by disregarding the norms of human interactions, of human responsibility. The rest of us are not free of responsibility for this state of affairs. The rapidity of progress has allowed us all to enjoy an unprecedented mobility, separation from family and old friends, from the norms that defined our lives when we were young people. The sense of normlessness that has grown has produced political and religious apathy, as our values as a nation have withered into weapons for some groups to hurl at others in hatred.

It could appear that all is lost. It is not. We can, and must, regain our humanity by treating others as the precious human beings they were meant to be. We cannot separate ourselves from community, especially from communities of meaning. We can look to the examples of those around us who are good people, who live honestly and compassionately. We can seek justice for those whose lives have been broken by injustice.

…..We can demand from our government leaders the same values that we hold for ourselves, and make sure not to repeat errors in judgement on that score.

….. We can bring family life back into vogue, securing the early years of our children with the nuts and bolts of honesty, responsibility, and community.

….. We can demand improvements in our education systems so that our children learn to think, not just to memorize.

And we can treat the people we run into each and every day as though they were human beings like ourselves: imperfect, yet full of potential; sacred to their Creator and therefore sacred to ourselves. Deserving of respect—enough so as to inspire those who have none for themselves to strive for improvement.

 

……Yes, this is indeed a heavy responsibility to owe to the students in my classroom. But why else would I even want to be there? The intergenerational discussions and learning that will take place give my life meaning. My students, who are also my teachers, are the joy of my life. When I meet with them again, that “heavy responsibility” will be rediscovered as a great privilege. So begins another year.

classroom


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WHY I WOULD SUPPORT NEEDLE EXCHANGE PROGRAMS

syringes“I don’t understand. Why would you, with all your experience and training, vote for a needle exchange program that supports the habits of drug users?” Her question was not rhetorical. Her face flushed with emotion, angry tears in her eyes, she radiated the frustration behind her outburst. Though the need for answers was obviously deep, she was too overwhelmed to wait through any discussion and stormed out of the room.

I fully understood her point of view, as well as her expectation that I should know better than to entertain what she saw as a completely irresponsible position, counter to all that I should know. But it was precisely my experience, as well as all my education and training, that over the years had brought me slowly but convincingly toward my present convictions on the subject. Like many of us, she may have had close and painful experiences with the devastating results of drug abuse, and with addiction. She may even have taken courses where professors taught the evils of drug use with passion, hoping to spare their young charges the life changing downward spiral of drug use. Or, she could easily be a social worker, or health care provider, daily living with the emotional draining and burnout of working with abusers and addicts. Who would blame her for her perspective on the subject? As I often tell my students, where we stand on a given issue depends on where we stand in life. Experience is valid; it is real. With social problems, however, it just can’t be generalized to explain the whole issue.

Without comprehending the whole issue, we fail to take other valid points into our understanding. And without those other valid points, we make decisions that are almost guaranteed to produce negative unintended consequences.

What are some of those other valid points?

  1. Drug abusers use and share dirty needles. This leads quickly and devastatingly to increased numbers of diseases, primarily HIV and Hepatitis C. Even if only drug users were to be affected, the incidence of disease could reach epidemic proportions.
  2. When users respond to and comply with the regulations of a needle exchange program, they can be tested for HIV and HepC, and immediate treatment begun. The cost of a needle exchange program is high, and the additional cost of treating one HIV patient could be as high as $100,000. There will be more than one patient. This is a commitment of both financial and emotional proportions that is, and should be, taken seriously by any community.
  3. The cost of not doing it is exponentially higher. First, an untreated HIV victim is likely to progress into full-blown AIDS. THE COST OF TREATING ONE AIDS PATIENT FROM THE TIME OF DIAGNOSIS TO DEATH IS, ON AVERAGE, ONE MILLION DOLLARS. Second, that untreated carrier of HIV and/or HepC is eventually going to infect any number of others in a variety of ways: Family, sex partners, healthcare workers, First Responders, law enforcement officers, good Samaritans…all are at risk. They are not the limit, however. And each one infected is going to generate costs of $100,000 to $1,000,000. The financial costs do not even begin to quantify the emotional and productivity costs to everyone from family to the entire community.

In other words, no matter the cost of the program, the cost of NOT having the program in the presence of a proven epidemic is incredibly higher!

Given #s 1-3, we have only looked at the actual costs of having, or not having, a needle exchange program. But what about the perspective of those who resent what they see as a moral, or an ethical, objection to “helping” drug abusers and addicts?

To this, I would answer first of all that the issue is NOT only about drug addicts. IT IS A PUBLIC HEALTH ISSUE. It is simply not rational to fail to protect our families, neighbors, public servants and health care workers because of our antipathy toward ANY one group of people, no matter how deeply that antipathy is grounded in our being.

Second, I would remind those of us who claim to be Christians, that–all appearances to the contrary–these abusers and addicts are still human beings. Once, many were teenagers or young adults who in the blissful ignorance of their mortality succumbed to the desire for the drug-induced high, the shared forbidden experience with like-minded peers.

Others were veterans, returning with dependencies or addictions already in place as one of the costs of defending our rights to live in freedom. Still others began as patients, some who were denied proper medication and sufficient care by our laws; others who for any number of reasons (rational or irrational) took to the streets when their increased tolerance for drugs failed to meet their need for them.

And finally, the fact is that addiction is not something anyone deliberately chooses for their life. No one looks forward to that relaxing drink after a hard day at work, or even a drug-induced escape from the stresses of life, believing that one day in the future they will be a slave to a substance that no longer provides these things, but instead has become a painful, frightening and life-threatening craving, constantly demanding to be satisfied. Instead, we either say “I can’t handle [the substance]” and leave it alone; or we believe that “I can handle it,” and take our chances.

Many, in fact, may be able to handle it better than others. However, no one is fully immune from potentially developing the disease of addiction. We are learning more about risk factors on almost a daily basis, but we still cannot predict with certainty who will develop addiction.

The disease is one in which the reward center of the brain runs amok, refusing to turn off when the need for the reward is satisfied.  Aside from he repeated use of the “addicting” drug, there are risk factors:

1.  Genetic factors actually account for about half of the likelihood that an individual will develop addiction.

2. Environmental factors (i.e. where and with whom do you live and work) are influential.  Unstable social supports and problems in interpersonal relationships affect the risk.

3.  Individual resiliencies (through parenting or later life experiences) are important.

4.  Culture also plays a role, as does exposure to trauma or stressors.

Also at risk are those who suffer from chronic disease, depression, or who feel themselves alone in the world–that no one cares if they live or die.

We may never eradicate drug abuse. That is no excuse for refusing to accept the personal and financial responsibilities for changing our perspectives about those who become victims of it.

What have we got to lose by changing the ways we think about this issue and working to alleviate it? By helping users and addicts to stay alive long enough to be helped and encouraged onto a pathway out of active addiction? In our thousands of years of civilization, we certainly haven’t accomplished much with our old ways of attempted control of drug abuse. I believe it is worth trying, worth the effort to erase the stigma of addiction and restoring the will to change that must happen before an addict can fight their addiction.

After all, when a person repeats the same ineffective activity over and over, expecting a different and positive result, has this not become one definition of insanity? Haven’t we criminalized the disease of drug addiction long enough? Don’t we need to stop the insanity?  Dealing in a positive manner with addicts early enough has the potential to lower the rate of addiction that eventually leads to serious criminal activity in order to feed the addiction. Must we simply stand by and watch this happen? Programs like needle exchange and early testing in clinics don’t increase the problem. They are the only thing proven useful so far in decreasing the infectious diseases, the illegal drug use, and the consequent costs to the community.

I choose, however, to see this not as a dilemma of abandoning a moral issue for a practical one, but rather the blessing of making the right choices, for all the right reasons.

Reference for the risk factors and definition of addiction:

http;//www.asam.org/for-the-public/definition-of-addiction

Other Resources: 

http://www.cdc.gov/IDU/facts/AED_IDU_SYR.pdf

http://hcvadvocate.org/hepatitis/hepC/needle_exchange.html


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EXPECTATIONS: Helpful and Otherwise

OLYMPUS DIGITAL CAMERA

Overheard in a college hallway: “I am who I am! I cannot be responsible for his expectations of me.”

The tone of voice was stressed, angry. The speaker was obviously struggling in some relationship where she felt the pain of believing she was expected to measure up to some standard with which she did not agree, or believed she could not meet. Her anger at not being accepted for that of which she felt capable seemed fed by her guilt that she had not measured up to the standards of someone important to her.

Or, was I projecting? Was I reading too much into a simple declaration, simply because it resonated so deeply? Who among us has not at some time felt the pangs of inadequacy, having somehow failed to be the person that a parent, teacher, friend or spouse thought us to be? More important, who of us is not guilty of verbally projecting our expectations on another in a judgmental fashion, capable of stripping the other of self-confidence and a sense of belonging.

Strange Family

Strange Family

As the Academic Dean of a small college in an rural area where students received a suboptimal education, as both student and faculty advocate I was often called upon to mediate the issues arising when faculty from more cosmopolitan backgrounds failed to recognize the intelligence and potential of their students, judging them only on their failure to have been adequately prepared for college level work. Faculty would often disparage the students publically, claiming they would not work, could not learn, and should not be in college. Their expectations of the students were as low as their claims, and the relationships between those faculty and their students were broken and painful. Neither group expected anything good to come from the other.unhappy 1

Yet my own experience with these students was that on the whole (of course there were exceptions – there always are) the more I expected from my students and the more I recognized their exceptional qualities, the harder they worked and the more they succeeded. Further, they returned my love and respect for them, and for each other. The same was true for my students in Africa, as well as for my students in a large city-based university.

The principle, I believe, crosses cultures and generations. I first heard it stated from a young OB-GYN physician who had been charged with overseeing residents, interns and patients in a central city hospital clinic. I had the privilege of working for him as he changed the appearance, the attitudes, and the quality of care at that clinic. Where it had been said patients were “herded like cattle” into the clinic area itself, and then into exam rooms where they were prodded, talked about over their heads between the teaching and learning physicians as though the patient was a dumb animal, where the environment itself was dirty and depressing—there was change. In an attractive, welcoming environment where every patient was treated as well as paying patients in a private doctor’s office, we were able to observe the change from surly, quarrelsome and often unwashed patients to patients who were no different from those in any doctor’s office, where they trusted their caregivers and returned the respect they were given.

What that young physician believed and lived by, and helped everyone around him to emulate, was the statement he always made: “People will respect themselves and act accordingly if they are treated with respect and dignity.” Most did just that.

What I told my faculty members was “These students will live up to—or DOWN to—your expectations. Either outcome will be elicited by your treatment of them.”

Expectations make us or break us. Expressed in love as realistic possibilities that honor and dignify the humanity of the other, they can inspire. Expressed as a judgment of the failures of the other, or as a goal absolutely not in accord with the dreams and goals of the other, they are destructive. And that includes the expectations we have of ourselves.

self-confidence


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THE SKY IS FALLING

The expressions of a pervasive sense of impending doom are on the increase, whether you read/listen to the armchair experts on social media, or the professional experts in science, economics, philosophy, or religion. Yet as I look around me in the “real-life” portion of my world, people seem to be pretty much absorbed by the joys and/or challenges of daily living rather than wondering whether the world is going to end in a financial meltdown, climate change disasters, the extremes of social anarchy, or World War III. Then, of course, there are others who only argue about who is to blame for any of these terminal disasters, as opposed to those who fatalistically refuse to think about it: “Whatever will be, will be.” Finally we have those who are totally unaware, perhaps desensitized by a lifetime of failed threats of the immanent End of Time.

-Remember the back yard bomb shelters of the Cold War era, complete with supplies to support a family until it was safe to return to the earth’s surface (however long that would be)?

-Remember the End Times and the Space Ship arrival cults? (True, these are not entirely gone).

-Remember Y2K, and the Mayan Calendar date of December 2012?

Or, just pick up the New Testament and read the words of the prophets who followed Jesus, claiming the Rapture would occur just any day, despite the words of Jesus himself, who stressed that the date could not be known. Yet the Second Coming of Christ has been predicted many times in the past 2000 years. It seems that when we are not fearing the end of the world, we are happily anticipating it.

Widespread dissatisfaction with and/or fear of the world as it is, however, have always been accompanied by cries that “the sky is falling.” And sometimes, it does – though not even close to earth-wide since the destruction of the dinosaurs. It happens to us as individuals, too. When everything goes wrong in our lives – economically, health-wise, or in relationships – the suicide rates go up, while others still consider ending it all or pray to die, because their situation is intolerable. The reasons for coming disaster mount up, while our ability to think rationally enough to take action for positive change in our own lives rapidly disappears. If that is our individual coping mode, how can we expect to fare any better in large groups, or as a nation?

Where is the leadership that can put aside their personal fears and aspirations, and show us the way to work together to solve the problems that have solutions, and learn how to prepare for the “new normal” when change is inevitable?

Where are the families and the communities that can help each other to get through the bad times, and show their children how to deal with disaster and failure as well as with success and wealth? I know for a fact that these exist, but perhaps there simply are not enough of them. Or maybe they have forgotten.

Where are the teachers who used to show us how to apply theory and practice to real life situations, and how to think critically in order to separate truth from fiction when possible? I do know of some.

Finally, we can’t blame all these people for our individual and collective feelings of impending doom. I believe that our lives will improve when we stop rushing head-long and helter-skelter into the end of time and stop to get our common sense back.

Yes, indeed, there are threats to our safety and well-being. There are major changes coming to life as we know it. (In fact, there always have been – they just come faster now). We can’t afford either denial or complaisance, and we never could. We have, however, succeeded grandly as a human race when we have cooperatively put our mental and physical resources together to figure out how to meet the challenges of the day, how to be good stewards of our resources, and how to live together in relative peace. This works for nations, for communities, for families, and for individuals.

The sky is not falling yet. It may never fall. But there are definitely some threats. While those who can, work together to see that the potential for damage is lessened as much as possible, the rest of us need to be cooperating – with those who are knowledgeable, as well as with each other — and not giving in to fears of the future or to total denial.

The way to get through a challenge is to work it out, and work it through. Life has always been like that.