Courage is not not being afraid. Courage is being afraid and doing it anyway. Ask James Bond.  Here is a great interview that can be a lesson in reality. Click on read more and share it if you like it.

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 Sorry I am a little late with this blog posting. I just got home from a trip to Long Island where I grew up. In a small beach town on the south shore of Suffolk county I spent 4 days reminiscing and experiencing many bittersweet memories.

This visit I saw some friends I had not seen in 50 years; it was amazing how the memories came rushing back in a group setting with everyone talking of their personal remembrances. We each had something to share about that time so long ago.

I got to thinking about reminiscing and wondering why it has such a strong draw.

 I know that reminiscing is something that the older we get the more we enjoy. Based on this, a magazine called Reminisce has gained a large following and made lots of money with a very simple format. We also use reminiscence with older folks as a talk treatment to help those who are sad and confused. Try it yourself with an elderly relative who is agitated or unhappy. Just ask them a simple question about their past.

 This adventure “home again” got me to thinking about the meaning and importance of reminiscing and nostalgia and trying to figure out why they are so irresistible at times.

 Here are some of my questions and thoughts.

 Ø     Is it the sweet memories and pleasure of remembering that attracts us?

 I don’t think so; many of the memories are not sweet and actually sad or painful, but these also can have a strong pull.

Ø     Is it the wish to be young and innocent again?

Being young was often not the best time of our lives, and sometimes I wonder if we were ever truly innocent. As youngsters we picked up on and experienced anxieties and worries from our environment. Even though we may not have recognized or understood these feelings we often had a vague  discomfort that we used all kinds of psychological maneuvers to avoid.

I believe that these trips down memory lane are more for self-understanding, acceptance and sometimes even personal change.

Every time I make one of these visits I realize something else that has affected me all my life, and made me who I am. This can be something I view as positive or not.

  I am a person with a desire (? need) to understand and that need drives me to search the past. It can lead to forgiveness of others, self-healing and self-acceptance that is priceless.

I also notice that the bitter in bittersweet gets less with each visit, I think I will go “home” again next year.

 Send me your stories or ideas about reminiscence in the comments so we all can enjoy and learn.

I realize I am a little late posting on this story, but I have been struggling with what to say. I decided to tell my own experience around this issue. I read the story on Harvard MDs and drug company money with a mixture of guilty pleasure (I was right!!!) and disgust.  The guilty pleasure comes from the I told you so feeling that I couldn’t help.  I had been complaining about the Harvard view for a long time (but nobody had listened.)

As a psychiaric nurse practitioner I have been prescribing medication for years. I can tell you  that MOST NPs  have a different perspective from MOST physicians.  I don’t see every psychological problem as a diagnosis or a disease to be treated or cured. I see many problems as social, enviornmental and learned. I firmly believe they shouldn’t be given a label or diagnosis ( did you know insurance companies require a diagnosis in order to make payment) and can’t be fixed with pills .

 Having said that, I also know that clinical depression, and other legitimate mental illnesses often MUST be treated with medication. The problem is often figuring out which is which. It seems that many people who really need medications don’t get them, and so many who don’t need them are taking them ( and thus the medicine “doesn’t help”.)

 Any way, back to the “I told you so” part. As a concientious prescriber I have always feel it is critical to keep up on the latest in medication information. To do this for a number of years I went to what I thought was the “best”, Harvard .I attended quite a few of Harvard’s well known and respected psychopharmacology conferences. More then once I listened to the physicians who are now identified as not reporting their drug company income. After a few times I got tired of the same old message: more medications, higher doses, polypharmacy and  a drug for each symptom. I stopped going.

I have to say many of the physicians in the audience seemed to be swallowing these ideas whole. This is in part because of the traditional viewpoint taught in medical schools, the “disease and cure model”.  

Now comes the  hard part. We all need to take some responsibility for fostering this as this is ALSO the public expectation of medical care That is, we expect providers to be able to “fix it”, no matter what it is.  We often want, no insist on a pill. This is a big part of the reason for the overuse of antibiotics.

Dr. Biederman’s push for the diagnosis of Bi-Polar disorder in kids was particularly disturbing to me. Of course if we give them this diagnosis, it will naturally follow that we can give them a drug (or two) and FIX them. Few seem willing/able to look at social or environmental facts. Or if they do, they realize how difficult it is to change these things; pills are so much easier!  By the way pills are all most insurance companies will pay for (with higher and higher copays of course) and pills are what many of the public wants instead of dealing with all the other factors.

In order to make things better there are many pieces that need to be looked at. The first is regulation, but also I recommend the following:

• Patients need to stop expecting doctors to know everything and fix everything, and ask more questions. Even when they are afraid of the answers! If they don’t get their questions answered in a way they understand (not necessarily like),  they should  get a second opinion.
• Doctors and all health care providers start excepting there own limitations and the limitations of our medical knowledge
• We also need more self oversite by medical professionals. This is not a closed private club, its a public trust. Persons who break that trust should be given fair treatment but severe consequences.
• The broken health care system in this country needs to be seriously overhauled.

Ok lets get to work.

Question and Answer

I am a new nurse on a psychiatric inpatient unit. I was told that I was allowing a patient to “split.”  The person who said this to me seemed annoyed. Can you tell me what it means? What did I do wrong? I didn’t want to ask her.

 You may have heard the expression “splitting” as a description of the way that persons with personality disorders  relate to others.  Splitting is a coping mechanism (also called a defense mechanism) that is used by both persons with and without Borderline Personality Disorder.  It is a mechanism that is considered immature and is an unhealthy way to deal with disappointment in relationships.

• How does Splitting Work?  

  Splitting is defined as the inability to reconcile the presence of both positive and negative aspects in another. Splitting allows the person who uses it  to see others as either all good or all bad. Of course no human being is either “all good or all bad” but a combination of strengths and weakness. Splitting and Relationships  Although being the “all good” person may initially feel flattering, be aware that it will not last! When the person who is seen as all good disappoints (which of course is inevitable when expectations are unrealistic) they quickly become “all bad”. It is often this change in perception that will make someone struggling with BPD enraged. Persons who use splitting have unrealistic and unobtainable expectations of others, chaotic relationships, and are inevitably disappointed.

• Splitting and Relationships.
  
  Although being the “all good” person may initially feel flattering, be aware that it will not last! When the person who is seen as all good disappoints (which of course is inevitable when expectations are unrealistic) they quickly become “all bad”. It is often this change in perception that will make someone struggling with BPD enraged. Persons who use splitting have unrealistic and unobtainable expectations of others, chaotic relationships, and are inevitably disappointed. In order to grow and heal, a person who uses splitting as a way of  coping must somehow come to terms with the limitations of other human beings (and of themselves).
  
• Dealing with Splitting.

  In order to grow and heal, a person who uses splitting as a way of  coping must somehow come to terms with the limitations of other human beings (and of themselves). On an inpatient unit the best way to deal with splitting is not to engage in conversations about other staff with patients. Refer them to the person themselves or if necessay the nurse leader.  It is critical that all  staff are clear and in agreement  about the treatment and approaches to be used with the patient . This is also the same way to deal with difficult people in work or social groups who try to get people to take sides on an issue. an open discussion with everyone involved is the best strategy to avoid splitting. 

   

   

John Nash, Nobel prize winner, genius mathematician had Schizophrenia. He was played by

Russell Crowe in  the movie about his life  ” A Beautiful Mind”.

Question & Answer Post

Question

My whole family is very upset. My 19 year old brother is in the hospital. He can home from his freshman year at college and was acting very strange. He talks to himself and makes weird movements with his hands. My mother and I met with his psychiatrist who said my brother has schizophrenia and both positive and negative symptoms. Can you explain the difference between these? He gave some examples but I still don’t understand.

Answer

This is one of the problems with using Jargon, non-medical people don’t understand and often don’t ask. They become more confused and worried. Schizophrenia actually can have many types of symptoms.

Schizophrenia usually develops slowly over months or even years. At first, the symptoms may not be noticed. For example, people may feel tense, may have trouble sleeping, or have trouble concentrating. They become isolated and withdrawn, and they do not make or keep friends. As the illness progresses symptoms develop.

Schizophenia cannot be cured but can be controlled. Acute episodes of schizophrenia look different then a person in remission (period with no symptoms). In remission persons with schizophrenia often can not be identified as mentally ill. Persons in an acute state are obviously mentally ill.

Symptoms are often describes as three types, positive, negative or cognitive.

“Positive Symptoms“

Positive symptoms must be present (or have been present at one time) to make a diagnosis of schizophrenia. Positive symptoms refers to the presence of a symptom that is psychotic (out of touch with reality). These are the symptoms of delusions, hallucinations, and thought disorder.

• Delusion are false beliefs that are held despite solid evidence to the contrary. An example of a delusion might be a belief that the CIA is watching you.
• Hallucinations are false perceptions, such as hearing things that are not really there. Hallucinations can be auditory (hearing), visual (seeing) olfactory (smelling) or tactile (feeling).
• Thought Disorder is a commonsymptom of schizophrenia . This is a disturbance in the process of thought. Symptoms may include the inablility to think clearly or stay on topic. Sometimes a person with schizophrenia may believe their thoughts are being broadcast so others can here them. Thought disorder may be identified by confused speech, and behavior that does not make sense. Thought disorder makes it difficult for persons with schizophrenia to express themselves, and to understand and communicate with others.

“Negative symptoms”

Negative symptoms are the absence of a “normal” behavior or ability. Such symptoms include: lack of emotion, slow speech with little spontaneity or detail, and little interest, motivation or pleasure in life. Low energy, social isolation and lack of interest in relationships, and flat affect (the lack of emotion) are also negative symptoms.

Schizophrenia can also affect mood. Depression is a problem for many with schizophrenia who become depressed. Some individuals have mood swings. which may indicate a schizoaffective disorder

“Cognitive Symptoms”

Cognitive symptoms include difficulty with memory and concentration. It may be difficult to remember dates and appointments. Reading can also be a task. Persons with schizophrenia can have a hard time understanding what another is saying. They may also have and have slowed thinking and expression of their thoughts and ideas.

I know this must be very upsetting for you and your family. However let me reassure you that we have many very good medications that can help your brother. In the best responses cases all symptoms go away and their is no obvious indication of the illness as long as the person takes his medication.

I am a great believer in the power of empathy, and view it as number one communication skill.

I really enjoyed this article that theorizes (not proves) that empathy can make people look alike, especially those that love one another.

I wanted to share it with you because it is an uplifting fun to read piece, take a look.

It makes sense to me, any opinions or comments?

Helping Professionals Especially Women, Must Learn to Take Care of Themselves.

This is much easier to say then do! Although there are more men in the helping professions today, in nursing and social work the vast majority are still women.

Womens’ Sense of self is Often One of Caretaker and Nurturer, and Society Enforces This View.

Nurturing and care taking have long been associated with women in general, and nurses and social workers in particular. Empathy is a mainstay of the helping professions, particularly the “women’s professions” such as nursing and social work. Nurturance has historically been intertwined with, and seen as a major function of nursing. Nursing has been called the “practice of professional nurturing”.

Who Comes First You or Me?

When a woman must choose between caring for herself and caring for another, social pressure fosters the choice of nurturing of others. Women often experiences conflict when faced with what may seem like the continual choice of caring for others or caring for themselves. It is not unusual for women to have difficulty saying no or setting limits, thus ending up doing more than they really want to. Women frequently nurture everyone but themselves and end up feeling conflicted, unappreciated, resentful, and burned out. Women already struggle with these issues, but this is much worse for those in the professional role of nurturer/helper.

Some Important Reminders for Women in the Helping Professions

• Take care of yourself, it will relieve some of your stress and allow you to better take care of others
• Learn and use self-empathy and self-nurturing techniques.
• Try understanding and treating yourself with the same care you give your patients or clients.
• Allow yourself to say no, offer alternatives, or even avoid situations if you feel unable to say no.
• Increase your self-awareness
• Plan for a routine to help ease the transition from work to home. (Do not use alcohol to unwind)
• Do not expect all your feelings of self-esteem to come from your profession or your nurturing.
• Develop outside interests that have nothing to do with helping others!
• Try to avoid over-identification with patients.
• Recognize and allow your own feelings
• Develop relationships outside of work where you can talk about your feelings.
• Practice stress reduction techniques (exercise, relaxation, meditation, distraction)
• Plan for regular breaks, days off, conferences, and vacations.
• Talk with colleagues to not only complain, but also to also make plans for burnout prevention, take charge where you can.
• Know when to say “enough”, consider transfer or another area of work if necessary.

Burnout Can and Must be Prevented.

Recognition of your own level of stress and self-care are the keys to stress reduction and burnout prevention. When self-care is a priority, helping others can be the rewarding successful career it is meant to be.

Ironically, beginning signs of burnout can have an unexpected positive influence in your life; if you don’t let it go too long. These signs can act as a catalyst for you to make a much-needed change. They can be the impetus to move on to different areas of your profession or even more rewarding careers. Caregivers in search of something more have become entrepreneurs (the writer included). They have developed many ways of working as a helper that allow them more reward both financial and personal, and more control over their careers and their lives.

Take Care of Yourself!

Vincent Van Gogh, believed to have Bipolar I Disorder

Questions by Readers.

Dear Dr Duffy,

I am confused about my daughters illness. She is in a residential treatment facility and we have had a terrible time trying to control her. She has been given a number of different diagnoses including Oppositional Defiant Disorder, Schizophrenia and Bipolar disorder. My question is, is Bipolar and Schizophrenia the same. She seem to have many symptoms that could be either. How do the doctors know the difference between these illnesses? She is on many medications and although she is calmer I am still not able to control her at home. I don’t know what to do.

Any insight would be appreciated.

Worried Mother

Dear Worried,

I am sorry for the you and your daughters distress . This is a very difficult situation to deal with.

For the diagnosis of Schizophrenia to be made, certain symptoms must be present, such as hallucinations and/or delusions. These are not necessary for a diagnosis of Bipolar disorder although may be present in severe cases. I do not know how old your daughter is but Bipolar is a controversal diagnosis in children.

There are 2 types of Bipolar disorder, Bipolar I and 2. Bipolar I is the most serious type and may have psychotic features (out of touch with reality) . Bipolar 2 is often more closely related to personality disorders.

Yes, it is possible to have both a Bipolar and Schizophrenia diagnoses. In fact there are some in the field who think they Schizophrenia and Bipolar are just different presentations of the same underlying illness. Usually persons with Schizophrenia who have severe cycles of mood (depression and mania or hypo-mania (less severe)) are diagnosed with Schizoaffective disorder.

Certainly behavioral problems can also be caused by personality disorder, such as oppositional defiant disorder. When this is the case, medications usually have little success.

Psychotic disorders, including both Schizophrenia and Bipolar disorder are  usually helped by antipsychotic medication. (Risperdal, Seroquel, Zyprexa, Geodon, Abilify, Haldol). Often mood stabilizers are necessary with Bipolar I disorder (Lithium, Depakote, Tegretol, Lamictal)

This is a  complicated situation, and you may want to get a second opinion. Make sure the Psychiatrist or Psychiatric NP you see listens to you and explains what they are thinking in terms of diagnosis and treatment.

Remember Psychiatry is not an exact science.

Good Luck,

Dr. Duffy PhD, NPP

Today The World Lost a Caring Man Way Too Soon.

Michael White formalized and introduced the idea of using storytelling as healing in psychotherapy. He introduced the idea of Narrative Therapy to many professionals who needed to be reminded of the power of stories and the importance of helping patients tell their stories in a therapeutic way. Of course people have also been telling their stories to therapists for a long time. The stories of their lives, of their pain and joys and of their healing.

Story telling has a long history.

Stories are used to teach lessons in all Easten and Western religions. In Christianity Jesus used stories to teach, in Buddism Buddha, Lao-Tse in Taoism, Confucius in Confucianism. Native Americans told many beautiful stories as does the Tora in Judasm. There are many more traditions that use stories because stories are powerful !

How We Tell Our Stories

Today we tell our stories in books, articles, blogs, journals and many other avenues. If you haven’t heard about Storycorps check it out, It is fascinating , touching and a learning experience. Why do so many people want to tell their stories? We tell out stories because they affirm our life, leave a legacy and also because telling our stories brings healing to us and others.

How to Tell your Story!

Is it time for you to start to tell your story for yourself, for the next generation, and for for those you wish to share it with who may need to hear it ? Remember you do not have to share this with anyone you don’t want to, this is for your personal well being. As time goes on you may find some things you really want to share.

You don’t have to be a professional writer to tell your story, in fact, you don’t even need to write, you can use one of many ways of recording. Speak just as if you were talking to someone you completely trust. When you start to tell a story it might help to be specific, especially if you have a particular issues to deal with. Your life is a book of many chapters (stories).

It may be easier to start off by asking yourself about how you learned certain lessons in life.

• How I learned to love?
• How did I learn about anger and how to deal with it.
• Where did I learn about how to be in intimate relationships, what did I learn?

Your stories are not fairy tales and will probable bring up sad feelings, unfulfilled dreams, and pain that lingers on. However, in your stories you will also find self understanding, forgiveness of self and others, triumphs, and strength. The real benefit is in understanding how and why you learned to do things that you may want to change today. Recognition is always the first step in letting go.

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The old saying goes that money can’t buy happiness.

Some don’t seem to agree. Some recent work from the Brookings Institute and from Harvard seem to question this old addage. An article in the NY Times recently discussed this issue and gives links to research that is beginning to question this old addage. There is also some recent research telling us that giving your money away makes you happy

What give your money away! Well…. wait a minute, giving really does feel good, and that feel good sensation could be like happiness. Some people think it’s wrong to give in order to feel good. I say, Baloney, its fine to feel good from giving. Boasting is tasteless, (but you can subtlely let people know. That warm glow inside is certainly allowed!

Money also can buy freedom to do the things you want, such as:

1. Work when you want
2. Play when you want
3. Travel
4. Give It Away

On its own however its just paper. Spent well and wisely it can buy things that may make you happy, but there is no guarentee. It may buy you healthcare but not health, nor true love, nor loyal family, nor true friends.

Here are some quotes about giving that I would like to share.

• ” …who dies rich dies disgraced. Carnegie, Andrew
• You can have everything in life that you want if you will just help enough other people get what they want. Zig Ziglar
• If you think of life as like a big pie, you can try to hold the whole pie and kill yourself trying to keep it, or you can slice it up and give some to the people around you, and you still have plenty left for yourself. Jay Leno

And my favorite:

• We make a living by what we get, we make a life by what we give. Sir Winston Churchill