WillSpirit!

Where Will meets Spirit
∞ Love, Clarity, Balance, Peace, & Bliss ∞

A science, mental health and spirituality blog written by a physician.








  • Red_Exclamation_DotDisclaimer
    • Dear Visitors:
      Although I trained and practiced as a physician, my background does not include formal instruction in psychiatry beyond basic medical education. This journal presents ideas about treatment philosophy, but must not be considered therapeutic advice. Abrupt changes in one's psychiatric medications can trigger profound cognitive, emotional, and physical symptoms, including suicidal thoughts and actions. Consequently, pharmaceutical agents should not be increased or decreased without supervision by a mental health clinician.

    • ON THE OTHER HAND, your brain belongs to you, and your opinion counts. If you decide that changing your medication regimen will serve your best interest, then I believe your providers have an obligation to help you try to achieve your goals. I want everyone to be educated about their options, and do what will be most helpful for themselves. No one should feel pushed around by dogmatic and/or limited viewpoints, whether those of psychiatrists, anti-psychiatry advocates, or myself.


The Teaching of Survival

It’s funny how just when Western healthcare had almost completely alienated me, it saved my life. Having studied a holistic tradition (Chinese medicine) to a certain depth, my portrayals of conventional medicine had become dominated by the shortcomings of its clinical care: overly technological, narrowly focused, insufficiently personal. It seemed obvious that healing requires more human touch and less electronic gadgetry. Just six days ago I railed against modern inpatient treatment (see Hospital, Heal Thyself).

And then…

It turns out a ligament occluded my celiac artery, which supplies many abdominal organs. This led to enlargement of vessels around my pancreas, one of which became so thin and weakened that it bled. During a four-hour procedure, an interventional radiologist embolized this aneurysm to prevent further bleeding. But the hematoma remains in place, where it has totally blocked my small intestine. Since no food can get through my digestive tract, the doctors ordered a semi-permanent venous access and started IV feedings two nights ago. Without nutrients dripping directly into my bloodstream, I probably wouldn’t survive long enough to permit my intestine to reopen. And if the problem doesn’t correct itself with time, I’ll need surgery. My life is likely to continue, but only because of modern medical techniques.

So it appears I need to soften my stance against contemporary biomedicine. To remain contemptuous would be hypocritical and ungrateful.

I still see problems, of course. More artwork, nicer paint jobs, some soothing music, fewer computer screens, and more patient contact would all be nice. On the other hand, technology does demand we tolerate a bit of depersonalization and indignity.

This became clearest as I rested on a rigid radiology table during my procedure. After the third hour my bladder was so full that the discomfort made it difficult for me to remain still. The team members, who had already shaved my groin to my slight embarrassment, now placed a plastic urinal between my legs and dropped my appendage into it. While five people watched impatiently (four of them women) I was commanded to pee into the bottle. Can you imagine how difficult that felt? I tried very hard, which was of course the wrong approach. A nurse placed my fingers in a cup of warm water, but nothing flowed. Finally, I had to endure the dreaded Foley catheter, the fear of which was a large part of the reason I was so desperate to urinate on my own. As they inserted the tube, it hurt just about exactly as much as I’d expected. I felt mortified by the entire experience, though at least I managed to lighten the mood with a small joke about my situation.

Although the process involved pain and a dose of humiliation, the angiographic procedure clarified a confusing clinical problem. It cured me of my aneurysm. Yes, attempting to micturate publicly under duress felt embarrassing, but I don’t see how the awkwardness could have been avoided. Three of the staff were scrubbed and gowned, so they couldn’t leave the bedside. One was monitoring the equipment and the other dealt with positioning the bottle relative to my anatomy. It was dehumanizing but unavoidable.

There are trade-offs in life. Although I resist viewing the body as a device, it does have mechanisms that can fail, and which can be corrected by technological procedures. This requires a team of health care workers, lots of machinery, and sometimes compromise of modesty. But if the alternative is death, why complain?

Over and over in the course of writing this blog I’ve found myself modifying earlier narrow views with later expanded ones. These days a popular buzzword is integrative healthcare. It suggests that we can combine the best of technological and traditional healing. I suppose it’s our most promising option, as difficult as it might be to achieve. It would also be the equivalent of clinical medicine maximally enlarging its range and acceptance.

Unfortunately, we are in an era of diminishing resources, so integral approaches will need to be developed on the cheap. Yet that may be a good thing. It might force us to trim the waste of natural resources that is so rampant in hospitals. It might reduce the use of expensive and ineffective medications. It might result in fewer unnecessary procedures.

As always, life is teaching me to extend my awareness, soften my criticisms, and increase my thankfulness. This illness has been painful, frustrating, and discouraging, but it has aided my maturation. I now remember the tremendous power of a health system I’d nearly rejected. I recognize that although there are many insensitive hospital workers, there are also legions who are dedicated and compassionate. I better understand that you sometimes need to sacrifice dignity and comfort in service of survival. It’s been a tutorial, finally, in letting go of rigid demands.

I’m seeing, once again, that learning to be flexible and open-hearted in the face of fate’s trials is the ultimate lesson and reward of living. Adopting levity helps too, as in joking while trying to ‘produce’ under trying circumstances. It never hurts to milk a little humor from humiliation. Life is, after all, at turns both sublime and ridiculous.

Thanks to modern medicine, my life will go on despite this setback, and perhaps I will be wiser, jollier, and suppler from here on out.

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The Teaching of Survival was published on February 3rd, 2012 . 11 comments






Hospital, Heal Thyself

The Face of Modern Care

Two hospitalizations in the past ten days have updated my views on modern medical treatment. As a physician who used to practice a standard (albeit obscure) specialty and now provides acupuncture services, I interpret events during my inpatient stays from a unique perspective. As you read the following critique of inpatient care, keep in mind my past sufferings with awful medication side effects, and the fact that I’m currently sitting in a cramped and ugly hospital room.

Skeptics dismiss acupuncture as a ‘mere’ placebo. Although reams of research demonstrate that people improve after treatments, the mechanism remains uncertain. Relevant neural pathways seem to be altered, but these changes can be subtle and may not suffice to explain acupuncture’s effects. Bodily energy (Chi) remains a possible agent, but since it has not yet been proven to exist, it cannot be invoked in a Western context. In short, the data establish that people feel better after acupuncture, but there remains much mystery. It may well be true that much of the improvement is due to placebo action.

Here is my preferred definition of the placebo effect: the triggering of the body-mind’s innate healing response by an external signal. This description is broad enough to encompass sugar pills, hypnotic suggestions, and hugs. The unifying factors are trust, intention, and expectation. If a respected physician prescribes a pill and calls it potent medicine, the chance of improvement is high. This is true whether the pill contains a sophisticated drug or only sugar. (Pharmaceutical researchers often find it difficult to prove that a medication works better than sugar.) Recent work shows that patients may even feel better after knowingly taking inert pills, if they are assured that healing will follow.

Notice that context matters, and that trust is a big part of it. Hugs make us feel good, but not if offered insincerely or by those who abuse us. In a hospital, trust gets fostered by personal attention, smiles, and small acts of kindness. As a patient, you’d like the staff to ask how you feel while looking you in the eyes with genuine interest. You’d like to see a warm smile on the face of the person checking your vital signs. You’d like your nurse to notice if the room feels chilly and bring you a warm blanket.

Although I experienced each of these gestures during my hospitalization, I regret to report that they were rare. Usually, questions about my status were asked as the nurse faced his or her mobile computer cart. Blood was often drawn grimly by technicians who said few words and hardly looked at me. I had to ask for blankets repeatedly, even when being wheeled through drafty public corridors, where the need for coverage seemed obvious.

On a clinical pod of ten rooms containing fourteen beds, I counted two dozen computer screens. At any given time, nearly all the nurses and aides were working on computers rather than caring for patients. Even when they visited my room, which happened rarely, they spent most of their time entering data and asked only those questions mandated by the online forms. I was treated like a mechanical device in a repair shop rather than a flesh and blood human in a center for healing.

In my acupuncture office I keep the surroundings comforting and calm. Meditative music plays in the background and art adorns the walls and shelves. In the hospital the corridors were painted institutional green. There was no music and only a few token photographs. The background noise consisted of a near-constant cacophony of beeps and alarms emitted by all the technology. I didn’t see a single houseplant.

Don’t get me wrong. Sterility of equipment and surfaces is vital in a hospital. But does that require a sterile ambiance? Professionalism is important too, but does it rule out humanism?

Once after midnight I rang the call button. A young man barged into my darkened room and immediately turned on the brightest overhead light. When I told him I had abdominal pain he asked sarcastically, “so you’re having gas?” Worse, he didn’t seem phased by my response: “No, I have internal bleeding.” He simply stalked out of the room to summon the medication (and would have left the light glaring if I hadn’t stopped him).

This wasn’t an isolated incident. To cite one other example: when I was in the ICU I needed the nurse’s help to reach the nifty toilet that rotates out of a cabinet next to the bed. When I asked for assistance onto the commode, she suggested: “can’t you use a urinal?”, which forced me to spell out my bodily need so she’d see that her solution wouldn’t work. After I was in place and she left me to my business, she failed to close the curtain across the glass wall separating my room from the corridor. She expected me to defecate in full view of all the staff and visitors walking by.

I could go on, but you get the picture. This experience wasn’t healing, it was exasperating. At least the doctors seemed highly competent, though they failed to communicate a unified message and often contradicted one another. On the one hand, I was glad of my medical training, since it helped me sort out my options in a confusing situation. On the other, I was saddened to see how hospital care has deteriorated. Apparently, many young people entering health fields have neither empathy nor sense of mission. Computers win more attention than patients.

We hear a lot about evidence-based medicine. It is a good idea, but let’s add in a little placebo-based healing, too.

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Hospital, Heal Thyself was published on January 28th, 2012 . 15 comments






‘Progress, not Perfection”

(Click image to go to the 'Vintage Calculator Museum')

(Click image to go to the 'Vintage Calculator Museum')

Although no posts came out of it, I have actually been working quite a bit on WillSpirit. In the first step, I found software that would allow me to run Internet Explorer on my Mac. I had tried this before with a product or two that did not work, but at a local ‘Mac’ store I came across a sale copy of ‘Crossover’. I am now able to run IE6 and IE7. Crossover won’t run IE8, however. Despite that, I was able to move on to figuring out what the problems were when I saw my blog behaving so shabbily at the library. Just being able to use IE7 and IE6 puts enough in hand for me to feel comfortable putting the old WillSpirit theme back up. It appears the problem was limited to IE6. For instance, the pernicious gray box around the ‘roots’ photo only shows up there, not in IE7, or Firefox, or Safari. Also, the ‘disclaimer’ did not work in IE6, but did in everything else. (Actually, the footer is way too long with Opera, but so few people use opera on home computers I’m not going to worry about it.) Something got fixed between IE6 and IE7 so that it complies with the standards better. I’m assuming Microsoft would not have gone backwards and made IE8 noncompliant, so I put the old theme back in place. (If you are using IE8 and see problems, however, you would win my eternal thanks if you told me about them.) I am also grateful to anon, who pointed out that many of the glitches I saw at the library may have just been one-time loading errors. I believe that to be the case now, since they have never reappeared. Sadly, I was forced to set things up so that IE6 users no longer get to see the awe-inspiring ‘roots’ graphic, and might have to suffer with a small but always-visible disclaimer (that will probably be temporary). In case these awful losses prompt some people to upgrade their browsers, I am providing the link to the free download for Internet Explorer 7 and/or 8. That’s the technical update.

As for a personal update. My mood has lifted. I had a session with a therapist (and to tell you the truth, I’ve just about given up on therapy), that really made a difference. The experience could have been out of a movie: deep seated wounds, fears and anxieties that I’ve repressed since childhood came roaring to the surface. I wept with a mixture of sorrow about the past, and relief that I can finally let it go. The therapist validated the trauma I suffered and guided me through the pain. I actually feel freer today. It’s only taken about a thousand (literally, a thousand) therapy appointments over thirty years to finally have a session that made a decisive difference. There are a number of reasons why this happened, one being that coming off Cymbalta has released my emotions. Silly things, like cheesy inspirational emails, right now have the power to spur a rivulet of tears. I don’t want this to be my emotional condition for the rest of my life, so that my eyes well up at the slightest suggestion of something sad. But it is nice being able to let down my guard and experience some deep emotions. For years my feelings have been limited to little more than an oppressive fist of depression on my chest. I am tired of watching the angry teeth of cynicism bite the flesh off my experience, in service of guarding my most sensitive wounds. Yes, without flesh there is less pain, but there is also neither movement, nor passion, nor embrace.

Adding to the good feelings brought on by that ‘breakthrough’, I came home to find my email box holding messages from members of Lon Gallagher’s family. Lon was my very good friend during the years after my hospitalization in 2000, until his death a little over a year ago. I posted a tribute to Lon in July, and his daughter came across it. She and some others of Lon’s family wrote nice comments and/or emails to me. It feels good to know they saw my little piece, and so understand how much Lon meant to me, and also what I observed as he deteriorated toward the end of his life. Best of all, it seems to have brought them some comfort, too.

The internet continues to astound me with its power to help people communicate despite the distances that separate us, and the fact that we are lost in an ocean of six billion people. Just to give a sense of how many human animals the planet holds, if you said one person’s name every second, it would take 190 years to say the name of every individual on Earth. The internet helps people with similar interests and concerns find one another in this unfathomable crowd.

Such a thing was unimaginable when I saw my first hand-held calculator in 1971 (or so). It cost almost $400 (US) at a time when you could by a VW bug for $2000. All it did was add, subtract, multiply, and divide. Not long after, I hitchiked over a long distance in the middle part of the US. I got a ride from a man in an unremarkable light blue sedan, covered with dust on the outside, and reeking of tobacco inside. We talked for hours as we rolled through miles and miles of late season cornfields, the stalks froming green walls on either side of the road. The terrain had no hills, and the road had few curves. As we travelled through this monotonous landscape, I told him my grandmother’s story. She had been born in a time of horse-drawn carriages and kerosene lamps. By her ninth decade, she lived in a world of color televisions, jumbo jets, interstate highways, and telephones she could use to call relatives across hundreds of miles of separation. The complexity of all this ‘stuff’ almost overwhelmed her, but she knew she had lived through a landmark epoch of human history: the rise of the technological age. As this man and I zipped along at seventy miles per hour, I related what my grandmother believed: that my own life would not see anything like that much technological progress. I tended to believe her.

My companion disagreed. He told me that before I died, computers would have spread to involve every aspect of human life. Even simple household appliances would be run by computer. Everyone would have a computer at home, and it would be more used more often than the television. Medical technology would be unrecognizable in its advances. He had many predictions along these lines.

I did not disbelieve him, exactly, but it sounded pretty far-fetched. Then, in the early eighties, I watched as magnetic resonance imaging scanners were first deployed in clinical use. Still in medical school, I happened to be at the University of California, San Francisco, which had a lot to do with the technology’s development. The pictures of the brain those machines provided (the brain having always been my major interest), seemed literally miraculous. Without surgery, or (ionizing) radiation, you could see nerves exiting the brainstem that aren’t much thicker than spaghetti strands. This is old news, now, but at the time the advance thrilled anyone involved in the field. Perhaps that marked the time I realized that the anonymous guy who drove me across Indiana had quite likely given me a true picture of the future.

childreninternet

Looking back, it is obvious that he articulated a clear and accurate vision of the world we now inhabit. I don’t know if those ideas were in common parlance among computer specialists in the seventies, or if he was a visionary. Maybe a little of both. I wish I knew his name, so I could look him up and see what his role was in bringing about this computer-run world, where I can make friends with someone in Australia, exchange messages regularly, and have the communication pass instantly and without charge. Or where I can write a note of affection for a deceased friend on my computer one month, and have it reach his family and make a difference to both them and me several months later. Best of all, we have this forum where people affected by the mental health system can interact, share stories, strategize, support one another, and work together to improve a bad situation.

Computers are not always positive forces, of course. They allow our governments to keep tabs on our activities in ways Hitler could only have dreamt of. They tag people with mistakes they made as youths, so that they can never fully remake themselves and leave the past forgotten. They allow corporations and swindlers to shuttle fortunes from one corner of the globe to another with a few keystrokes, thus evading government control and opening whole new universes of expolitation and fraudulence.

But for once I would have to say that this particular technology is actually doing more good than harm (though I would not argue strenuously with someone who believed the opposite).

Writing this blog has brightened my life in countless surprising ways. I had hoped to build a platform for an eventual book. I don’t see that happening, but so many other connections and projects have blossomed, that it no longer matters. To tell the truth, I feel like I was born to blog. I’ve always enjoyed writing short essays about controversial, complex, or just interesting subjects (for instance, this was a role I got to play regularly when I served as Editor-in-Chief of the campus paper at UCSF). I’ve always liked to toy with visual imagery. I have a short attention span, but a wide ranging field of interest. I know a little about a lot of subjects (though a lot about almost none). I am not a very private person, and have never been uncomfortable discussing personal issues with groups of people I hardly know (like Alchoholics Anonymous). And I have a strong belief, bordering on a sense of obligation, that I should make my opinions known. I tend to think my ways of seeing things are unique, and that I have something to add to discussions about subjects that matter. (It is perhaps my one and only area of true self-confidence.) All-in-all, it makes me feel like I have at last found my true vocation: blogging. Too bad it isn’t an income, but it’s a good occupation.

Not many people read this blog. But those that do mean the world to me. Because of them, I write many days a week, for hours at a time. I explore other sites, read the opinions of others, and communicate with kind and fascinating people across the globe. I think more deeply and organize my ideas more thoroughly than I would otherwise. In the process, I learn more about the topics that matter to me, and begin to see ways I can use my education and (hopefully not imaginary) talents to further important causes. Most of all, I get to make friends with people who can understand what it’s like to live with a mind that operates differently than the norm. Who know the stigma and shame that mental conditions can bring. But who also share the hope that things can get better, and validate one another that very often, ‘different’ is another word for ‘better’.

I modified this post a bit on 3 September 2009. Mainly, I added the photo of the children learning about communication via computers at the Museum für Kommunikation Berlin (obtained, as usual, from Creative Commons–click on photo to see source.)
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‘Progress, not Perfection” was published on September 2nd, 2009 . 4 comments






TechnoTroubles

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Whew! Finally!

I have a fair amount of computer experience, and have done some (extremely) basic programming. I’ve read the better part of a book about HTML/XHTML/CSS. I think I understand this stuff. Yet I spent hours yesterday trying to add a photo to my post. Had to contact the web hosting support system. They changed the permissions for the photo to what I already had them at (!). With a bit more fussing, and a full night’s sleep, I finally got the darn thing to work this morning. I don’t understand how there can be so many great-looking and elaborate blogs out there when I had to struggle so hard just to post one lousy picture.

Every time I start to get confident, it seems, life comes along and shows me my limitations. Since this has been going on for ten years now, I really don’t think this lesson is needed anymore, but it keeps coming. Imagine that I once had the ability and self-assuredness to operate on eyelids and faces. Now I hesitate to pass slow-moving trucks on a two lane road. Mental illness can do that to you, though I don’t suppose it has to. But getting hospitalized, and then having to give up on projects because of emotional instability deeply affected me. It left me wondering how much I’m capable of anymore.

After the photo debacle, it would be easy to conclude: not much. But hey, that didn’t have anything to do with mental illness, just inexperience. To some extent, even the problems I’ve had that were related to MI may have been due to lack of experience: I needed to learn how to work with the changes in my mind. Not that I could, or would want, to be a surgeon again. But there are many things I can do well, many of them that I could only do poorly before my illness, if at all. One of them, it seems, is laugh at myself. Another is to take it easy and not always push, push, push for success (remember that?) and perfection (say what?).

The good news is, I succeeded in getting the photo uploaded and visible. Now anyone interested can see where Amanda and I stay when in the foothills; thanks to her for taking the lovely picture. It’s very nice there. Quiet. Peaceful. Surrounded by life and nature. People evolved in natural settings, and I find myself returning to those roots. When all else fails: back to basics.

addendum:
I received my first bona fide comment yesterday! Thanks, Freda, for noticing me out here. I’ve gotten so many automated messages, that it is really nice to have an actual person check-in.

addendum #2: there has been a great discussion about childhood schizophrenia going on at The Secret Life of a Manic Depressive.

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TechnoTroubles was published on July 7th, 2009 . 1 comment






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