Wednesday, June 1, 2022

To Appreciate or Not

In typing my journal each morning, I review the previous day’s events and my thoughts, reaction and responses to them. This morning happens to be Memorial Day, the day on which we remember and appreciate those who died in active military service, defending our country.  

Today, I become aware that I have to work to appreciate what I have rather than focus on what I may not have. In other words, I realize that depreciation comes more easily than appreciation. I don’t know why this is so. Curious, I explore the topic.

I think that appreciation is a more active process than depreciation, that unfortunately, emanates more naturally to many of us. We often seem to need some hardship to put us in touch with what we had, have, may have before we perceive both sides of the equation: to have, or to have not. 

As we emerge from the pandemic, we recognize the many ways we may have changed. Sometimes for the better; sometimes for the worse. If we’ve been spared physical illness or even worse, ongoing medical issues/problems as a result of covid, we might come out of the pandemic with a heightened appreciation for intimacy and social engagement. 

What we took for granted, we now embrace as an almost new-found privilege.

We were deprived of social get-togethers so now, the chance to see friends and relatives holds greater pleasure than ever. Dining in restaurants imparts a heightened sense of pleasure and appreciation. For me, attending gym classes, especially Nia dance, has imbued appreciation as well as patience. In pre-covid days, I was more often late to class than not. And I glanced at the clock impatiently wanting it to end. Now I arrive on time and delight in every minute and I’m more in touch with which muscles are called into action. I appreciate the togetherness of fellow dance mates, and it goes without saying that the instructor, Caroline, whom I always loved, I perceive with renewed gratitude for her dedication, passion and spirit that she exudes to all of us.  

Let’s consider this photo that I include in this blog. What do you see? 


For me, I view a masterpiece—the various shades of greens and browns and the variegated shapes, hills and valleys of its diverse patterns. But when you hear what it is you may experience disgust because it is mold. I call it Mold Masterpiece, which nature grew and imposed on old, cream cheese pushed to the back shelf of my refrigerator, where of course, I forgot it. Well, my point is that here is that this is an opportunity to note the dual reality, to appreciate or depreciate something in a harmless situation that implies no consequences in our daily lives.

How our choice to appreciate or depreciate impacts us on many aspects of our being—mind, body and feelings/soul—is a topic for another blog.

Dear Readers, I invite you to share your thoughts and feelings and look forward to your responses.

Gratefully,

Jsimon145@gmail.com

Jane Simon, M.D.


Monday, February 7, 2022

ASSUMPTIONS and the Power They Play in our Lives

 


 

Assumptions both keep us alive and lead to our demise.

 

When we board a jet plane to go on vacation, we do well to assume 

we’ll arrive safely. If we are afraid the jet will crash, we suffer from anxiety.

 

When we cross the street in the walkway with the light, we naturally 

assume we will get to the other side. And chances are in our favor that we will. 

 

What is an assumption? An assumption is something that we accept as true or as certain to happen without proof. Assumptions are ubiquitous. We can’t avoid making

hundreds of them every day!

 

Some work out well; some are disastrous. When an assumption increases

anxiety, we do well to explore its underpinnings. On the other hand, when

an assumption decreases anxiety it is helping us function. For example, 

in this difficult time of the pandemic, assuming that we will emerge 

from it with greater knowledge of viral diseases, can help to decrease

anxiety. 

 

Dynamics of Assumptions

 

More than 40 years ago, my first psychoanalyst taught me about assumptions 

presumably in response to an unhelpful assumption that I’d introduced. He related a 

graphic “lawnmower story,” as follows: 

 

A man wants to borrow his neighbor’s lawn mower and heads across the lawn to his neighbor’s house several blocks away. During his walk he assumes that the neighbor most likely will veto his request. He repeats the negative scenario in his head over and over again.  By the time he arrives at his neighbor’s door, he’s in a rage. When the neighbor opens the door, he punches him in the face. “You can keep your darn lawn mower anyway,” he says leaving the baffled man with a black eye. 

 

The wallop of this message demonstrates the power of assumptions.

Sorting out what goes on in our heads as opposed to what is happening in the world outside ourselves is a never-ending conundrum. Those who are accurate most of the time, function better in life.

 

Take, for instance, the event that served as the inspiration for this blog. During a Sunday breakfast of lox and bagels, my partner  began reviewing the bill from our Saturday evening’s dinner at a neighborhood restaurant. Before he even glanced at the bill, he remarked that it had cost him over $200! I was immediately taken aback. First of all, I thought he was off the mark by $20-$30. Second of all, I I felt insulted because I assumed that he resented paying for our dinner and perhaps expected me to pay or share the bill.

 

He claimed he didn’t mean what I assumed.  He simply wanted to know what he’d paid for dinner. Then he raised a question: Did I prefer that he review the bill at the restaurant before plunking down his credit card?

 

“Of course,” I answered. “Then you’d catch an error if there were one.”

 

But he objected, “I assumed that doing so would be impolite.”

 

“No,” I assured him_“that wasn’t my understanding at all.”

 

Both of us had made assumptions based on our past experiences. Taking responsibility for our mis-assumptions had a positive outcome that advanced our relationship and benefitted our pocketbooks. The next time we dined out, he reviewed the tab and found that he’d been charged for two bottles of wine instead of one. As a result, he saved $50.

 

We are locked inside the realm of our own experience so can’t help but

to make assumptions on the basis of our past experience. But circumstances

are constantly changing! Therefore, it is inevitable that we’ll encounter 

instances in which the past impinges on the present to cause problems. 

 

Books could be written about the occurrence of assumptions and mis-assumptions—those that have paid off and those that have fizzled-throughout the course of history, literature and science—as well as throughout our personal lives. But I’ll limit this blog to everyday assumptions with a slant toward the psychological. 

 

A negative assumption can put us in a bad mood and a positive assumption can lift our 

spirits. But we learn from both the negative and the positive ones.

 

Tragically an assumption turned negative in January 2022 for a 15-year-old girl killed by a school bus in the Bronx when crossing with the light in the walkway. (To make matters worse, instead of coming to her aid, the bus driver drove away, unaware that he’d struck and killed a human being.)

 

From this tragedy, we can take away the concept of caution. This positive strategy can help us reset our anxious thinking to cautious action

 

Patterns of our assumptions are often identified in psychotherapy. For example, a patient I’ll call Mr. Q.  assumed that his friends should give him more attention. He didn’t realize that his demands of them drove them away. Identifying the pattern allowed him step to outside his needs and to see people apart from himself. Paradoxically, when he demanded less, he received more from others. 

 

Conclusion: The exploration of our personal assumptions gives us a deeper understanding of ourselves, our intricate psychological make-up, and the world in which we live, in both the present and the past.

 

Please feel free to share your comments: jsimon145@gmail.com

Thursday, August 19, 2021

Days

 

Days

    (Philip Larkin,  Poet Librarian (1922-1985)

What are days for?
Days are where we live
They come, they wake us
Time and time over
They are to be happy in:
Where can we live but days?

Ah, solving that question
Brings the priest and the doctor
In their long coats
Running over the fields.


Days

    (Jane Simon, Psychiatrist Poet, after Philip Larkin and the Fall of Afghanistan and 
                                                        the Earthquake and Storm in Haiti)

Days what are they for?
They come and go like earthquakes
Nay, not so, more somber
Like a tomb, not so either
More like hope against sorrow
Tomorrow may be better
But no one promises

Tragedy forever mixed with joy
We can't escape the ins and outs
The seriousness of it all
Few toys, a few games and toil
Toil forever mixed with joy.

Wednesday, July 7, 2021

OUTSIDE THE BOX OF THE BRAIN

At the risk of spouting cliches, I shall say that the human is a most complex being/entity. We are divided into so many parts that I’ve always wondered how we can unify this panoply of organs, tissues, cells, thoughts and feelings. 

Now comes another fascinating take on the problem at hand: the great connection among our tissues, our minds, bodies, feelings as expounded in Annie Murphy Paul’s The Extended Mind, the Power of Thinking Outside the Brain (Houghton Mifflin Harcourt). According to the review by Susan Pinker in The New York Times Book Review (June 27,2021) this volume lives up to its tantalizing title. For me, it evokes an abundance of thought. 

 I haven’t been inspired to write a blog in quite a while, but this book does tickle my brain cells. “I knew it,” I say to myself gleefully about my obsessive habit of waking, sipping my strong morning coffee and opening my computer to the word document that records the date followed by odd tidbits of thoughts and dreams that roll into my sluggish mind. 

I have thought of the time spent in this process that can last up to 45 minutes as rather a colossal waste of time, but occasionally some insight occurs that I can apply to my work as a psychiatrist with one of my patients or the beginnings of a poem. 

Annie Murphy Paul’s book provides information that I conclude justifies my time journal-writing and likely contributes to my good health. Paul speaks about interoception which is an awareness of “an SOS signal from body to brain.” “Though we typically think of the brain as telling the body what to do, just as much does the body guide the brain with an array of subtle nudges and prods. One psychologist has called this guide our ‘somatic rudder,’” Paul writes. 

Paul notes that looking out on grassy expanses near loose clumps of tress and a source of water helps up solve problems: “passive attention is effortless: diffuse and unfocused, it floats from object to object, topic to topic. This is the kind of attention evoked by nature. Psychologists who follow in the footsteps of William James, deemed the father of psychology, call this state of mind ‘soft fascination.’” 

I think the connection that Paul notes between diffuse and unfocused thinking and problem-solving helps to explain what happens during journal writing. From the comfort of my bed or couch I allow my mind-brain to enter the state of soft fascination. 

From my scattered thoughts of a few days ago, I jotted down the words therapist-journal. I realized my journal is my therapist. For years I have acknowledged that writing is a form of therapy and urge any patient who is open to exploring the process to try this technique to help them identify a conundrum and possible solutions to it. If one could prescribe a pill to overcome the resistance to the process, I would write a lot of prescriptions. The resistance to the process to problem-solve is another wide avenue to explore. 

Dear Reader, Kindly, send your thoughts about the above to jsimon145@gmail.com.

Tuesday, August 18, 2020

10 Sure Paths to Unhappiness:

 

 

1.      Expect more than can ever be delivered.

 

2.      Allow your mind to erase all your accomplishments.

(It is amazing how many minds I’ve seen accomplish

 this senseless, undermining task.)

 

3.      Focus on the negative and allow doom, gloom,

 and hopelessness to overrun and take over your neuronal pathways.

 

4.      Eat a lot of rich HD ice cream, instead of training your taste buds

to relish TJ’s delicious vanilla organic yogurt. (This is just one example

 of how you might wreck your health by failing to make disciplined choices).

 

5.      Failing to recognize how your creative brain is capable of manufacturing endless numbers

 of saboteurs that flummox your brain and obstruct your personal progress.

 

6.      Indulging in hours of “bad” news (fires, earthquakes, hurricanes, corrupt politicians)

 on the TV, iPad, iPhone, etc. especially immediately before bedtime.

 

7.      Forgetting to employ the great tool of curiosity to the world and everything and

anything in it.

 

8.      Putting all your hopes and dreams on the back burner.

 

9.      Forgetting that play and hard work go hand in hand.  Whether you express and/or appreciate humor

or farce or music, the visual arts, or great theatre, forgoing enjoyment can make you miserable.

 

10.    Forgetting that you must always attempt to rebound from setbacks. 

Each of us has our own hurdles; no one is immune from them, including royalty.

 

 

Tuesday, May 19, 2020

On Pondering the New Normal




A May 3 New York Times article quotes Jon Grinspan pointing out that “democracy” and “pandemic” share the same root— “demos,” Greek for people. What affects us all should reflect us all.  

Although we’re all in this pandemic together that potentially affects every aspect of our lives, the impact and ramifications of the disruption vary greatly among us.

Unemployment claims have zoomed into the headlines. Clearly those who’ve lost their jobs are worse off than the employed. In April the highest rate of unemployment was recorded since jobless tracking began in 1948, the highest since the Great Depression.

Furthermore, the inequities in the workforce are fully exposed: those who serve with their hands and bodies are more likely to come in contact with the virus than the computer-technically savvy who work with fingers and brains in virtual offices.

Families with small children and two working parents experience much more stress than a grandmother who has to take care of only her pets and plants.

Many teachers experience stress from online teaching and students from online learning and the loss of peer interaction.

We’ve had to rate essential services and cut out (like diseased organs) those considered non-essential—theatre, concerts, operas and museums and restaurants that add enormously to the quality of our lives—leaving thousands of actors and musicians and restaurant workers without jobs.

One of my clients bemoaned the reality that our nation is no longer a first world-power highlighted by the government’s response to the pandemic.  What has become blatantly apparent, is that we are now a third world power in light of the president’s response and anti-scientific attitude.  

Everything changed after 9/11, as prize-winning journalist Laurie Garrett points out. She is referred to as the pandemic Cassandra, after the Greek prophetess who issued dire warnings. She sees part of our current predicament as stemming from the fact that America has never been sufficiently invested in public health. Even so, she is shocked that America “isn’t in a position to lead the global response to this crisis, in part because science and scientists have been so degraded under Trump.”

The pandemic has underscored the inadequacies of our health system, and the relationship of health insurance which depends on one’s state of employment.

Siddhartha Mukherjee, physician and author of the best seller, The Emperor of All Maladies, comments that the medical infrastructure of one of the world’s wealthiest nations fell apart, “like a slapdash house built by one of the three little pigs.”

Andrew Cuomo suspended usual record-keeping requirements, which suggests that the EHR can be an obstacle to care. It focuses on obtaining reimbursement for services rather than transmitting vital information about patients. Nor do we have a standardized digital database of patient-care records, searchable across hospital and medical-care systems.

In the May 4th New Yorker, Dr. Mukherjee credits the clinicians, who in spite of having to “wade through the muddy slop of fake news” during this crisis, have made good use of twitter and Facebook, to cobble together an informal medical bulletin board for the pandemic.

Elisabeth Rosenthal, author of An American Sickness: How Healthcare Became Big Business and How You Can Take It Back agrees with Mukherjee. Summarized in a New York Times article, her opinion is that whether it’s run by government or motivated by new incentives, the system we need is one that responds more to illness and less to profits.

The pandemic has caused us to question the value of a college education. According to journalist Masha Gessen, the pandemic has shattered “the myth of college in America.” She points out that college education does not necessarily guarantee a clear path to the future.

On a more personal level, I’ve spoken to people now working remotely from the comfort of their homes who, in spite of fears about being infected, have felt relief since liberated from oppressive bosses and work environments.

On the other hand, I’ve worked with people who are more oppressed than ever, as the virtual work load has increased and the expectation that they will devote well over 50 hours a week to meet the demands. Grateful to have their jobs, and afraid of losing them, they comply.

I’ve spoken to mothers now juggling child care and turning out the same quality and quantity of work. (Daycare centers aren’t an option now, and they dare not allow the nannies to come into their homes.)

In addition, working parents have to be more involved in their children’s education as classes move online.

Instead of experiencing relief from their commute, the teachers are embroiled in phone conversations with students and parents and feel impotent to help the 30% of the students who remain unengaged in their schoolwork.

Some clients have temporarily dropped out of treatment because their lives have become monotonous and they decide they have nothing to talk about.

Others flock to therapy because they are anxious and depressed by the radical changes and uncertainty about where they’ll be, fearing they will be left stranded high and dry on an alien beach after the dangers of the pandemic recede like ocean waves.

What Should We Expect?
The April 3 issue of Boston Review quotes Alex de Waal: “Epidemics are inflection points in evolution across different scales, from the microbial to the planetary. The post-pandemic world is a changed ecosystem.”

At best, the outcome on many fronts is nebulous. How health, environment, and politics will intersect is unpredictable and renders the outcome unknowable. If Trump and his opinions prevail, the devastation will be greater.

Most of agree, however, that the pandemic is going to affect how we think about all kinds of things, and that life after we emerge is going to be different. The territory is wide open for speculation on many fronts. What changes will persist for years after COVID19? Which will be integrated to make up the new normal? Which will vanish entirely?

Although much about the new normal is now as unsettled as a muddy puddle, some major changes are apparent on the horizon.

Quite likely, some of us will continue to Zoom and work remotely from home at least some of the time.

How will the arts fare? Will theatre, concerts, opera ever recover their pre-pandemic grandeur?

Will the subway system still be shut down to allow the trains, stations and equipment to be disinfected? How will the resurgence of infection be prevented if we’re once again, packed like sardines in the subway cars? And how will these changes impact the homeless?

Nature has had a resurgence since fewer of us clog the streets,  sidewalks and parks. I see some brilliant-colored birds frolicking and singing loudly from their perches in the trees of Central Park. Some animals have dared to show themselves during lockdowns—
a fox in the middle of a London street. Will wildlife go into lockdown after we re-emerge?

Regarding the economy, few experts are willing to predict with much certainty the current behavior of the stock market. With GDP down on a par with the Great Depression of the 1930’s, what will a recovery look like? Will it be long or short? Some businesses are closing their doors forever. Will jobs be available for the unemployed?

Warren Buffet, one of the greatest investors of all time, assures us that our future is not all downhill as some of us fear during this Covid19 time. His viewpoint is unusual for an 89 year-old, since older people tend to be more pessimistic than younger ones.

We’re in the middle of a tunnel, he says, and gratefully, he is one who sees the light at its end. He believes that we will emerge from the darkness for the better. 

We’ll evaluate our use of mass transportation including the pros and cons of travel for work and for pleasure. (The thought of even a short ride on the subway arouses my anxiety).

We’ll attend business meetings with masks or perched behind plexiglass. We’ll question whether college Is a necessary and natural step for our high school graduates as well as question whether our kids should go out of state?

If the rich get richer by benefitting from this debacle, and neglect the welfare of everyone else, Garrett suggests that we could have massive political disruption. Massive unemployment may evoke collective rage.

Now the people celebrated as heroes are “essential workers”—doctors and nurses, grocery store clerks, bus drivers, mail carriers. But will we continue to recognize their importance and reward them accordingly?

(Tragically, after 9/11 the heroes of the day, the firemen and policemen suffered years of serious physical illnesses /cancers, chronic lung and digestive disorders. Those in power denied that their illnesses were directly related to exposure to the noxious chemicals that spewed into the atmosphere and inhaled into the lungs of the heroes who pulled the victims from the burning rubble.)

A New Era for Labor
Political commentator Andrew Yang says that we are going to be faced with a national rebuilding project at a scale that has never existed in our lifetimes. The biggest battle in politics now is over who will control that project, and who it will prioritize.

Writing this blog has helped me understand why many younger people rallied behind Bernie Sanders. Some of his points have special relevance now. Perhaps he failed because he wasn’t able to combine a style with his content that would appeal to the majority of Americans.

The time is critical for the essential workers and the unemployed to band with the young people, among whom are the Sanders’ supporters, to usurp some political power to bring about a more equitable political system: to guarantee accessible health care, childcare, and college or relevant job preparation, and environmental protection  (for the ecology, our water, our climate, our oceans and our animals). Andrew Cuomo has proved himself as savvy, sane and scientific, a savior in this time of turmoil. Hopefully, he’ll pursue and impose justice in the face of rampant political corruption and overt racism.

Conclusion: With many of our assumptions about the way our country works collapsing around us, we are going to be faced with a national rebuilding project that has never existed in our lifetimes, as Yang has said. The biggest battle in politics now is over who will control that project and whom will it prioritize.

Dear Reader, Please, feel free to send your comments. Jsimon145@gmail.com

Friday, May 1, 2020

Telemedicine (and me)





Telemedicine and telehealth have been with us for decades, but with the onset of the pandemic, it has become a vital tool, catapulting to the forefront of medicine. With the continued requirement for social distance, its use and acceptability are expanding at unprecedented rate. The availability of electronic equipment and reliable broadband, along with our ability to use them, are also contributing to increase. Long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions are now possible.

Before this recent acceleration, telehealth/telemedicine had provided treatment to offset costs in rural settings, in situations where sufficient staff wasn’t available, or where transportation or immobility made in person treatment untenable. Now, NYU Langone books an average of 4000 telemedicine appointments a day.

Some organizations and countries distinguish between telehealth and telemedicine; Telemedicine specifically focuses on diagnosis and treatment; whereas telehealth includes communication between clinicians, and between facilities, home monitoring of patients through the transmission of health data as well as non-clinical applications like administration and provider education.

Practically every specialty can now partake in remote medicine, including surgery with the help of robotic assistants. It has proved useful for post-operative monitoring and care as well as telerehabilitation. (Of course, telemedicine’s limitations become obvious when a hands-on examination is necessary, like a yearly physical or a gynecological exam.)
Telenursing is also growing in many countries to treat the increasing number of aging and chronically ill population, to help with the nursing shortage, save time and costs and keep patients out of the hospital. As a result, nurses have reported greater job satisfaction. 
Telehealth facilitates medical disciplines to merge and improve the level of care. The everyday medical and psychological visits as well as those that extent beyond the quotidian. Trauma specialists can interact with personnel on the scene of a mass casualty or disaster via the internet to provide clinical assessments and determine the severity of injuries, and whether injuries warrant evacuation. Remote trauma specialists provide the same quality of clinical assessment and care as a clinician on-site.

Telemedicine is being used in some ICU’s to reduce the spread of infection and is especially useful in communicating among caretakers to relay information for patients’ care between day and night shifts.
The team of attending, residents, fellows, nurses, nurse practitioners and pharmacists are able to watch live video from a patient’s bedside, see the patient’s vital signs on the monitor, view settings on a ventilator, and assess a patient’s wounds. Video-conferencing allow the remote practitioners two-way communication with clinicians at the bedside.
Telepsychiatry
Perhaps nowhere is telemedicine more effective than in psychiatry. Telepsychiatry has been a valuable tool for several years to deliver care to underserved areas. A few years ago, I attended an APA meeting where a young psychiatrist presented. She had designed markers to support the efficacy of telepsychiatry in treating a rural population. Her results were positive and her enthusiasm was impressive and contagious.

Telepsychiatry has been found to be as effective as face-to-face treatment. Since the pandemic, it has become the major method of treatment for diagnosis and assessment, medication therapy management and in-depth psycho-dynamic psychotherapy. And may be even better than in-person treatment for children, veterans and individuals with agoraphobia.
The change in living situations, necessitated by the pandemic has raised many profound issues and increased anxiety and depression for several of my patients who now require intense treatment. 
Telepsychiatry has another advantage of adding an extra dimension of making a home visit possible via Skype. One session focused on helping a woman-homemaker whose symptoms revolve around disorganization and clutter.
During an interview with a new patient (who was tense and hesitant to relate her history) the ice was broken when her cat wandered across the screen and evoked our mutual amusement.
Another patient, who had selected me as her psychiatrist because of my photo with my dog, was able to see him in my home office. 

The advantages of telemedicine are numerous and include:
1.Greater access to treatment improves patients’ health
2.Decreases time spent traveling
3.Cuts down on office costs 
4.Offers greater access to expert care 
      5.Helps to cut down on hospital time

6.Makes fewer demands on the healthcare system
With the possibility of self-monitoring, patients have a greater sense of control and may be more willing to stay on their treatment plans as they are more invested and included in the process. 
Remote monitoring or self-monitoring has been especially useful for managing chronic diseases or specific conditions like heart disease, diabetes, and asthma. And have been found to provide health outcomes comparable to traditional in-person visits.
But there are still barriers to wide-scale adoption, including:
The regulatory challenge of obtaining licensure across multiple states, malpractice protection and privileges at multiple facilities. (Although this consideration is also experiencing a great deal of flux.)
Resistance by government and insurance carriers to reimburse for the practice of telemedicine. 
The reluctance by physicians to change the way they practice.

FUTURE 
With continued use and research regarding the efficacy of the vast possibilities in each medical specialty, the government and more insurers will cover the vast range of therapies that avail us all now through the ever-increasing availability of technology. 
Although its future in post-pandemic days is uncertain, many experts agree that this valuable tool will be integrated and used more widely than before the onset of social distancing.
N.B. I’ve excerpted some details from a scholarly article. My brief blog is by no means comprehensive in any way. I hope the tidbits of personal experience add to the mix. I’m most fortunate and grateful to be able to continue treating my patients via telepsychiatry without a glitch thanks to Fieve Psychiatry (212-249-1600) and our manager Paula Puia. With her technical skills and know-how, she rapidly set up the system that offers confidentiality via Skype. She and the staff process the paperwork to secure reimbursement from a variety of insurance companies. 

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