THE SMARTEST GUY “He’s so smart, I didn’t understand a word he said.”

Editor’s Note: Due to my ability to type really fast, one of my first jobs was to use the Dictaphone at my dad’s office to type information dictated by the psychiatrists. I would use my foot to press the peddle that played the tape and type along as they spoke. I typed letters to consulting physicians and articles they wrote for publications. I remember being surprised at my dad’s vast vocabulary. He certainly didn’t use those fancy words in the office or at home. When I discussed this perplexing issue with my dad, I learned two lessons that have stuck with me my entire life. 1) Don’t use a dollar word when a dime one will do. 2) Know your audience and communicate in the language they speak. One of our running family quotes is part of this blog post: “Doc, he was so smart I didn’t understand a word he said.”

THE SMARTEST GUY 
My Grandson gave me an interesting book for Christmas. This is not a book review so the title is not important. Suffice it to say, it has to do with some theological issues which he and I had discussed in the past, and in particular a “doubting Thomas” streak owned by me. There was much food for thought, some of which was not very digestible.
The author was obviously well read as there were 53 pages of references cited. It was well written; although I found some of the reasoning a bit convoluted. It was a tedious read for me, but I must confess that I also have trouble deciphering the Bible. All of the quotes the author offered throughout the book often added to my confusion. I am sure those guys are all very famous; however I had never heard of most of them. The author would make his point then throw in a “in the words of……….” which was not nearly as coherent as his original statement. Perhaps he was only paying homage to the experts in his field, but I was impressed that he must be a speed reader to have read all that stuff. I was also surprised to learn that Christianity could be so complicated. 
As I read the book, I was reminded of an experience from many years ago. I was seeing a patient for the first time. His was a chronic, although not disabling condition, which had been exacerbated by the unexpected death of his psychiatrist. He talked warmly of his feelings for the deceased, and shared that he missed his counsel. He also spoke of his respect for the man’s intelligence with: “Dr………. was the smartest man I ever knew. He was so smart that when he said something I couldn’t understand a word he said.”
Now all these years later, I can identify with this patient’s assessment of the good doctor’s intelligence for some of the guys quoted in the aforementioned book were much too smart for me to understand. You may be thinking that the alternate explanation might be that I am too stupid to understand, a conclusion that I am loath to accept. After all, I did manage to limp through 24 years of school even though my scholastic career was admittedly undistinguished. My mother proudly said that I knew my ABCs, and could count to 100 by the time I entered the first grade. I have a vivid memory of my father showing my third grade report card to everyone in Varner’s store who would look. Even though this was the first and last time he would be able to exhibit a report card with all A’s, I feel it should count for something. 
There is the possibility of another less flattering explanation, which could help explain the comprehension problem. I have a friend whom I have always admired for his scholarship. His writings demonstrate a vast knowledge of classical literature, history, philosophy and classical music. He is also a veritable expert in psychoanalytic theory. His writings make use of metaphor and relevant quotes. Imagine my surprise when in my confessions of envy for his use of all this knowledge in his writings, his wife responded, “I think it is just showing off.” Perhaps she was having a bad day or he had forgotten to take out the trash, for she has shown her love for him in many ways during the many years they have been together.
The comment by my friend’s spouse does raise the question as to whether our writings are often more about ourselves than the subject about which we are writing. Could it be that sometimes the message intended may be corrupted by our ego needs? How much of the motivation of this author’s writings were motivated by a need to “show off”? For that matter does that same dynamic have anything to do with my writing of this paper. I have often said in jest that I would like to be rich and famous. Since the former has escaped me, perhaps I am still holding out for the latter. But then I have also had fantasies of winning the $1.5 billion power ball thing; even though I have never bought a ticket. 

When I was a kid we sometimes perpetrated cruel party jokes designed to humiliate and embarrass. One such stunt involved telling a joke with a nonsense punch line. The group who was in on the joke would laugh loudly, and the butt of the joke would join in the laughter even though there was nothing remotely funny. We called such tactics “shaggy dog stories.” I must admit there are times when I feel I have nodded in agreement with someone when I had no idea what they were talking about, much as the patient who idolized his dead psychiatrist must have done. 
There are times when reading something that is clearly beyond my abilities to grasp, I wonder if I am the victim of a shaggy dog story, and that the author is having a good laugh at my expense. The most recent example is my attempt to wade through a book on quantum mechanics. I was humbled by my inability to make any sense of that stuff. Upon learning that the book was written for ordinary people like myself left my ego was left in shreds. This was not Greek to me. It was more like a mixture of Mandarin Chinese, Arabic and Apache indian. What I could decipher was so implausible that I found myself thinking “can this person be serious?” and again wondering if this was not a variation on the shaggy dog theme. 
It has been said the best defense against Alzheimer’s and similar dementias is to make liberal use one’s brain. All intellectual pursuits are encouraged, but I have noted that this can clearly be overdone. I submit that a brain can also become fatigued; consequently, I will now put down my book on particle physics, fire up my kindle, and escape to a mindless mystery novel. 

SUCCESS

carterThe other morning I awakened to a pleasant surprise. CNN had someone on the screen other than Donald Trump. Jimmy Carter was holding a news conference about his illness and plans for the future, a future that one could safely assume was rather limited since he acknowledged that he was about to undergo treatment for a melanoma with cerebral metastases.

As a cancer survivor myself (see: THE BIG C AND ME) I felt my admiration grow even more for this man who had always been my hero. This 91-year-old man of unshakable faith, showed no bitterness or self- pity, but was determined to carry on with his life’s work as long as he could function. His response to questions about how he felt about his illness was typical Jimmy Carter: “I will hope for the best and accept what comes.”
As I considered the accomplishments of this person who had come from inauspicious beginnings as a peanut farmer in a small town in Georgia, a feeling of awe came over me. As a young man he left the small town of his childhood to attend Annapolis, bent on a career in the Navy. Subsequent to that, he attained an engineering degree and was involved with Admiral Rickover in the development of nuclear submarines. After returning home, he not only was elected governor of his state and then to the highest office in the land, but won a Nobel Peace Prize after negotiating a treaty between Israel and Egypt that may have saved thousands of lives. It would also seem unlikely that a son of the deep south would become an outspoken foe of bigotry and a strong supporter of human rights throughout the world, but he did. A failed attempt to rescue American hostages in Iran is said to be responsible for his defeat for a second term as president.

Mr. Carter’s presidency was labeled by many as a failure, and his many achievements in economic and foreign policies have been largely ignored. His integrity however has never been challenged. His fulfillment of his promises to “never tell a lie” and to “never avoid a controversial issue” did not enhance his popularity, for as any successful politician will admit, truth telling is not a winning strategy in the political arena. His successor however could have used the tune “don’t worry, be happy” as his theme song.

The loss of his presidency would prove to be the beginning of even greater exploits. Most ex-presidents build libraries which are more like monuments to themselves. They seem to be very concerned about their legacy, which shouldn’t surprise us, after all those with weak egos are unlikely to ever make it to the top spot. Mr. Carter; however, used his monument as a platform on which to establish a center to “wage peace, fight disease, and build hope.” He did confess in his news conference that he has cut back his schedule somewhat, but still plans to remain involved in The Carter Center’s operation. When asked about his most fervent wish, he replied “to outlive the last guinea worm.” For those not familiar, the guinea worm has been a prevalent cause of much suffering throughout many parts of the world and has been almost totally eliminated through the efforts of the Carter Center.

Not only was I impressed with his vigor and enthusiasm, but by his abiding concern for issues he obviously considered more important than his own. Now I ask you, how could you not love a guy like that? For me, listening to him was very emotional. I experienced an intense feeling* of respect. A few days later, a grandson happened to be visiting and we were discussing my blog. As reigning patriarch, I have issued a hard and fast rule that all family members must read this stuff whether they like it or not. Accolades are appreciated, but not required. On the other hand, those who are critical should expect to move down a notch or two on the Christmas gift list. After successfully passing the quiz on the contents of my last blog (although not a fan of Ronald Reagan, I do subscribe to the trust but verify policy) he went on to suggest that I do an essay on success.
Since both my grandsons are beginning their senior year in college, I could understand why such a topic might be on their minds. I also felt the topic particularly serendipitous due to my recent encounter with Jimmy Carter. An analysis of his career brings up the problem of defining exactly what we mean by the word success, and how do we make that judgment? What do we mean when we say a person is a success or a failure? Does it make any sense to make such all encompassing judgments about people since the inconsistent conclusions arrived at by those who are judging would seem to prove that such distinctions are quite subjective. Is success like many other things in life in the eye of the beholder?

There generally seems to be a consensus that Carter was the most successful ex-president in our history, but the agreement ends there. As to the rest of his life, there are those who applaud and those who consider him a failure in many ways. One could say that his political career was a mixed bag. He lost his first bid for governor of Georgia, and his Camp-David_wareelection for president. His presidency was mired by so called “stagflation” for which he was blamed by some while others gave him credit for initiating policies that got the economy back on track. I believe most historians would agree that the negotiated peace treaty between Israel and Egypt was his most laudable success. In spite of this, he was accused of anti-Semitism for his book on Israeli politics: “Palestine Peace not Apartheid” in which he presented the Palestinian side of the story.

With this in mind one must conclude that the distinction between success and failure very much depends upon one’s values. Those of us of a more liberal position are more likely to judge Mr. Carter as a successful person than those of a different political persuasion. Our success in competitive activities such as sports can be more easily determined by winning. We also have developed tools, even though crude, to help us measure academic success. In business, success is generally measured in terms of profits generated, but we have no way to assess the most important facets of life such as honor, compassion, fidelity, fairness, integrity, parenting, and citizenship to mention a few.

The term success is usually viewed favorably by society, but can also have negative connotations. The most succinct definition I could find was “the accomplishment of an aim or purpose”. Obviously if that goal is nefarious in nature the accomplishment will not be viewed in a positive light. For example there are successful criminals, con-artists, and other asocial people. There may also be an issue with the means of accomplishing the desired goal. There may be not only illegal but unethical factors contributing to an individual’s success. Unfortunately such behaviors are many times ignored as successful people are often idealized.

Is the Key to Success Linked to the Courage to Fail?

With all this in mind I have come to the conclusion that each individual is the only one who can judge his success. Of course we need to set goals if we want to be successful in reaching them, but if the goal is to leap tall buildings in a single bound our chances of success are diminished. I have known people who are reluctant to set goals for themselves presumably due to fear of failure. I can only assume their life must be very boring. Success requires risk, and one must be prepared to accept failure for in spite of our best efforts we will not always succeed. It is said that many of the most successful people throughout history have had multiple failures prior to achieving their goals. In my own case, although I have never aspired to lofty goals, I figure my success rate to be about one success for every 10 failures. It is therefore logical that success usually requires a certain amount of determination, and the ability to not be dissuaded by failure. It also lends credence to the age old admonition: “If at first you don’t succeed, try try again.”

Flexibility in interpreting results may also be helpful. At times it may be necessary to revise or reframe one’s expectations. There may be unintended consequences of reaching one’s goal which may exceed or diminish expectations. If a goal is not attainable, it may be possible to modify it in such a manner that one can still enjoy the feeling of success. I have a brilliant close friend and colleague who has written much about psychiatry both for lay and scientific consumption, most of which has remained unpublished. I sense that he thus feels as if he is a failure even when I point out to him that he has been successful in producing thoughtful extremely well written material, and further remind him that his judgment is at least as good as the editors who reject his writings. It is always dangerous to allow someone else to be in charge of one’s self-esteem.
Most successes go unnoticed so it is important that we acknowledge our successes to ourselves. Patting oneself on the back does not necessarily denote arrogance, and will help us develop the confidence needed to pursue more successes. Failure sucks, but even an occasional success will rid us of that feeling. Mankind has undoubtedly been motivated by the search for that feeling one associates with reaching a goal.
At this point in my blogging career, I find it necessary to modify my goals for success. I have come to accept that my writings will not be appearing in the New York times, be going viral or be considered for a Pulitzer Prize; consequently my quest for fame and fortune must end. To that end, I will reread this thing and convince myself that it is worth reading, and crown myself a success.

*One of my friends who reads this stuff has questioned my definition of respect as a “feeling” in my last blog . The highlighted word is for her.

Separation Anxiety + Mental Health

LincolnLincoln is a very large black Labrador retriever, who has bonded to my son-in-law. Bonded does not adequately describe this relationship for it is as if Lincoln is attached to Jim by a very short invisible rope. Recently, during a visit to my daughter’s home I had the opportunity to witness a hilarious demonstration of this attachment. Jim was mowing his yard with Lincoln at his heels, and when he turned to push the mower in the opposite direction Lincoln followed. This continued with Lincoln following back and forth until the job was done. In a similar manner, he is rarely separated by more than a few feet from his master. When Jim leaves he is frantic, constantly watching the door, pacing back and forth, obviously quite agitated. Lincoln would seem to be the poster child (excuse me, poster dog) for the diagnosis of separation anxiety.

According to the ASPCA web site, the condition is not uncommon among dogs, and is most common among those rescued from kennels, and those who have been moved or have lost their major guardian. In other words, it seems that dogs know when they have a good deal and worry that they might lose it. Lincoln fits that category as he had been given up by his family and given to Jim. Watching Lincoln started me wondering if we humans are all that much different from him.

Most of us can recall at least one incident when we experienced “homesickness.” In my own case I remember vividly very intense feelings when left to stay with my Grandparents.   I never have been able to find words to adequately describe those feelings, but have likened it to a kind of psychological amputation in that a part of one’s self is missing. Those who have experienced it will understand how painful it can be.

Leaving for college is a common precipitant for it represents an abrupt breaking of many of the bonds attached to things familiar and to those upon whom we are dependent. My youngest daughter Maggie (currently my editor and the one who bears total responsibility for talking me into writing all this stuff) was the most memorable example of this phenomenon; although, her siblings also experienced it to some degree. Maggie was eager to fly away from the confines of a boring small town to gain freedom from parents who continued to treat her as if she were a child and to subject her to all kinds of stupid rules. As a matter of fact she was so convinced that geography would be the solution to her discontent that she refused to consider any school within her home state.

The vision of that skinny little girl surrounded by huge limestone buildings gently sobbing and feebly waving a goodbye as we pulled out of that parking lot has never left me. Little did she know the effects her mother and I felt from that poignant scene, for we were heading home to an empty nest. Nothing would ever be the same. Maggie was a prime example of the wisdom of the admonition that one should be careful what he/she wishes. She lost nearly 20 pounds during her first two weeks, and was barely able to function according to her roommate who called us to express her concern. Barb and I resisted our impulse to go save her from this horrible fate, and as one would expect she soon had a spontaneous remission, and went on to excel.

Homesickness vs. Separation Anxiety Disorder

What Lincoln and Maggie have in common is that they have both experienced separation anxiety; although in Maggie’s case the condition was temporary but for Lincoln it became chronic, which qualifies him for a diagnosis of separation anxiety disorder. Although they share the same symptoms, Maggie’s reaction would be viewed as homesickness; therefore, benign in its implications while the same problems if persistent are characterized as mental illness.

In like manner, one could make a case that mental illnesses are largely due to quantitative rather than qualitative variations from the norm. Who among us has never experienced an irrational fear, a fleeting suicidal thought, unwarranted suspiciousness, unreasoned feelings of despondency, or a spontaneous episode of anxiety without obvious cause? Such short lived experiences are usually shrugged off, but the realization that these feelings differ from those of a mentally ill person only in their duration can result in self-doubt and feelings of insecurity about one’s mental stability.

The mechanisms we use to deal with these feelings of mental insecurity and self-doubt are all apt to contribute to the isolation and discrimination so often seen in our relationships with people who are mentally ill.

Denial

Denial is a powerful mental mechanism characterized by statements such as: “pull yourself together, stop worrying, quit being so sad, or stop acting so crazy.” Such statements deny illness and suggest he only needs to “buck up,” thus, perpetuating the time honored tradition of blaming the victim for his troubles. Of course kicking a person while they are down is not very therapeutic, but it may help us feel immune. Some naysayers even insist that the whole idea of mental illness is a fable.

Avoidance

Avoidance is another method of dealing with one’s insecurities. It operates under the out of sight out of mind premise. When I was practicing there were some people would not visit friends or relatives in our psychiatric ward. Many others were obviously uncomfortable in that environment, and would avoid eye contact with patients. The usual response to someone exhibiting bizarre behavior is for observers to look away after a furtive glance. Avoidance in its extreme form is to be shunned, which is guaranteed to exacerbate most any mental illness.

Ridicule

Ridicule is a tried and true method to avoid ownership. It is said that those operated Bedlam (which was actually named Bethlem Royal Hospital), the infamous insane asylum in England that charged admission for visits to the facility where one could make fun of and taunt the patients, felt it was quite progressive because the fees collected helped fund the “hospital’s” operation. I imagine the taunters felt safe since most of the patients would have been chained to a wall. We are of course much more sophisticated than the residents of jolly old England, yet when we joke about mental illness, are we not engaged in a similar coping mechanism? For the patients and their families, there is certainly nothing humorous about mental illness.

Words

The way we speak often illuminates thoughts buried so deep that we may lack awareness of them. This appears to be true when we discuss mental illnesses, especially the more serious variety. For example when we say a person is schizophrenic, where schizophrenic is an adjective, we seem to be saying what he is, but when we use the term as a noun as “he is a schizophrenic” we are saying who he is. He is no longer a human with the disease, but he is the disease, and his humanity is diminished.  People with schizophrenia have this in common with those suffering from leprosy, who are usually referred to as “lepers.”

The plight of those who suffer from mental illness

The parallels don’t end there for those afflicted with either diagnosis, leprosy or schizophrenia, have suffered the same punishments including: torture, execution, imprisonment, denigration, ridicule, and shunning. Both have been thought to be caused by demonic possession, curses, divine judgments, witchcraft, etc. They have been with us throughout recorded history and probably longer. You may be thinking, “Yes, but we have become so much more sophisticated, enlightened and compassionate.” Yet, thousands of severely mentally ill people are imprisoned. Only recently has there been a movement to mandate psychiatric care reimbursement by third party payers to be equivalent to that provided for treatment of non-psychiatric illnesses. An estimated 70% of the homeless who live on our streets are mentally ill. Our government has diligently worked to deny benefits to veterans suffering with post-traumatic stress disorder, and the list goes on. Incidentally, the last leper colony in the U.S. was not closed until 1999.

The stigma of mental illness

I contend that ignorance is fertile ground for the development of stigmata. We are often most fearful of those things which are mysterious to us. A diagnosis of separation anxiety does not promote much fear in us. We all have some familiarity with and empathy for that problem, but mention psychosis and there will be a different reaction. There are abundant myths regarding psychotic illnesses, and for many that term belongs in the same category as axe murderer. Since early childhood we have been taught to avoid people who are acting strangely, and what we don’t understand is always strange.

Behavior Health vs. Mental Illness / Patient vs. Client: Renaming and Reframing

Another way of dealing with uncomfortable problems is to reframe them by renaming them as something less threatening. In the mental health field this mechanism is used by mental health advocates in a way that I feel undermines their stated goal of de-stigmatizing mental illnesses. One such term which I find totally repulsive is behavioral health which has found its way into the vocabulary of not only the general public, but those charged with treating the mentally ill. While espousing the need for acceptance, they choose to call the condition by a different and totally inappropriate name. A mental illness is no more a behavior than is cancer, but since there is a type of treatment used for less serious illnesses called behavior therapy, the term has now been co-opted to encompass all psychiatric illnesses.

In their zeal to demedicalize mental illnesses, the powers-that-be have successfully substituted client for the word patient when describing people in treatment. This is an issue which sometimes leaves me wondering if it might be time for some more therapy for myself. I have fought this one unsuccessfully for at least 20 years. The word patient is from the Greek meaning “one who suffers” while the word client has to do with a business relationship. Call me a snob, but I feel a doctor patient relationship is more than a series of business transactions. As I have pointed out repeatedly to all who would listen and even those who would not: Accountants, lawyers, and hookers have clients. Physicians have patients.

Shortly before my retirement, I penned a letter on the subject to all the nurses with whom I worked, expecting them to be a bit more sympathetic since they had been medically trained. When I asked one if she had read my letter, she answered in the affirmative, then said “Your next client is here.”

Sadly, the previously described types of reactions to a diagnosis of mental illness occur at a time in a person’s life when he/she is in most need of support and relatedness. Admittedly there has been some progress in educating us about mental illness, and research is opening doors toward more understanding, but society remains relatively uncommitted to dealing with one of our most pressing problems. Hopefully there will come a time when patients will not fear being seen going into their psychiatrist’s office.

From Eshrink’s Editor: What can you do to help?

Get informed. Volunteer.

(Side note from eshrink’s editor: If you think about it, all of the big issues that face our society are just symptoms of a society that has yet to address mental illness and the plight those who are the caretakers for the mentally ill face. As the election cycle gets in full force, pay attention to how few candidates address mental health and mental illness.)

Below are some resources I found helpful.

http://www.nami.org/Get-Involved/Raise-Awareness/What-You-Can-Do

http://www.nami.org/get-involved/raise-awareness

Helpful Tips for Family and Friends

60 Tips