Friday, January 22, 2016

Label Things, Not People



I'm a doctor.  I should label a disease, Schizophrenia.  I should not label a person.  A schizophrenic.

We put people into groups, classes, designations.
I try to follow the advice of the Arbinger Institute when they said “Don’t lump the people you’re thinking about into an impersonal mass. Think of individuals…Think of the people.”

It’s a problem I have every day.  I’m a psychiatrist, and every day I am asked to label people.  I am asked to diagnose them and treat them.  Patient #1 has Schizophrenia, #2 has Borderline Personality Disorder, etc…  It’s very easy to change and say Patient #1 IS Schizophrenic, #2 IS Borderline. 

It’s easy to “stop seeing them as people and just see them as a diagnosis.  If I can do that then I can stop worrying about them, and their lives, and their feelings.  I can treat their stated symptoms and go home.  I don’t have to worry about their visitors, their comfort, their real needs or anything. This way is easier.  It’s simpler.  I could just slap a label on them and go home.

Some therapists would tell me to never use the word “patient” but rather “client.”

I still use the term patient because I think mental illness is an illness.  I don’t think my patients are illnesses, I think they have illnesses,

I once read a book called Crucial Conversations”

The author said “Labeling is putting a label on people or ideas so we can dismiss them under a general stereotype or category… By employing a handy label, we are now dealing not with a complex human being, but with a bonehead.”

I still make this mistake with people every day.  I am a conservative independent, which means I usually agree with the republicans and disagree with the democrats – I’m just sick of political parties so I refuse to be a republican.

When one of my facebook friends wrote a post about “Plan B” for birth control, my autopilot conservative mind kicked – yep, that’s abortion, that’s murder, that’s wrong.  The friend posting must be a bleeding heart liberal.  She probably has never stopped to consider any opinion other than her own.  She must be blinded by her partisan and left wing ideation.  To quote the book – she must be “a bonehead.”

I labeled her.  I discounted her as a “liberal” and that meant I no longer had to consider anything she said as “valid.”  She was part of an “extreme” group, and everything about her must be wrong, tainted, misled, etc…  Forget the fact that she is one of the smartest people I knew in High school, she is now an OB/GYN, she is well read and stays current, and one of the most caring people I know. Luckily she did not instantly label me as a bonehead conservative.  She took time, assumed I was an intelligent human being, and she explained her views, and the reasoning behind it.  My viewpoint changed.  Not only did my view of the subject change, but my view of her changed.  She was once again a person, not a “bonehead liberal.”



It goes beyond politics.  This labeling and dismissing happens everywhere

In the book The Anatomy of Peace, the authors state:  "Lumping everyone of a particular race or culture or faith into a single stereotype is a way of failing to see them as people…we have a propensity to demonize others.  One way we do this is by lumping others into lifeless categories – bigoted whites, lazy blacks, crass Americans, arrogant Europeans, violent Arabs, manipulative Jews, and so on.  When we do this we make masses of unknown people into objects and many of them into our enemies."

Do those labels sound like presidential politics to anyone else?  I hear labels like: Socialist, Rich snob, Flip-Flopper, Baby-killer, Flaming Liberal, fascist, Tax-evader, Communist, Right Wing Hack, etc…

"Let's tell people he's not American."  "Let's tell people she's not Christian." -  It seems all the political parties want to do is find a label that scares people, then make it stick to the other side’s candidate.

Labels and stereotypes are killing us.   They allow us to ignore people, to write them off.  They allow us to dehumanize everyone who doesn’t agree with us.

We must see people as people, anything less is just plain wrong.
Start with language.  Stop defining people by some small aspect of their life.

I was born male, I was born white, and 75 years after I was born, I’ll be Old.

Suddenly, by being born, I just became the enemy of some of my democratic friends: and Old White Man.  The evil overlord of politics and business and religion, an old white male.

It is true that I will be an old white man.  But I will not JUST be an old white man.  I will be so much more, in every possible way.  You cannot know who I am by knowing my race, my religion, my birthplace, or even my diagnosis.

Ever heard people say “She’s so Bipolar, He’s ADD, She’s Borderline, He’s Schizophrenic, She’s Anorexic, He’s OCD, she’s an addict?

That doesn’t sound like labeling problems to be fixed.  That sounds like labeling people, because they ARE the problem, so we can dismiss them.

What did President Obama see when campaigning across the country 8 years ago?
He said: “Spend time actually talking to Americans, and you discover that most evangelicals are more tolerant than the media would have us believe, most secularists are more spiritual. Most rich people want the poor to succeed, and most of the poor are both more self-critical and hold higher aspirations than the popular culture allows.”

So that’s Step One: Label Things, Not People. That’s our job.  To notice how many times we label people, even if it’s only in our heads.  Then work to see them as a complex individuals, not a stereotype.

Thursday, September 17, 2015

Why Less Than 1/3 of Your Life is Happy

Most Psychologists agree that we have 9 basic feelings:
  1. Joy
  2. Fear
  3. Anger
  4. Shock
  5. Love
  6. Disgust
  7. Sadness
  8. Guilt
  9. Curiosity
Go back through the list and count how many of those are "good" feelings.

Most people pick 2 or 3: Joy and Love, and sometimes Curiosity.

Most people consider Fear, Anger, Shock, Disgust, Sadness and Guilt to be negative or "bad" feelings.

Well, let's assume you're a normal person and in an average day you feel most of these emotions, and in about equal amounts.  If 6/9 or 7/9 of them are BAD then you can only spend 1/3 of your life feeling GOOD.  

If you live 75 years like most Americans, then you are going to spend every moment of an entire 50 years feeling BAD.

That leaves what, 25 good years?  Most people think of their childhood as pretty good, and sometimes up to their mid-twenties, so that means most of the good times are behind you.   So I guess most of you can look forward to the next 50 years of constantly feeling BAD, and then you'll die.

(I really should end this blog post here, just leave everything BAD)

What if there were no "good emotions" and no "bad emotions."  What if emotions were just, well, emotions?  They were something to be felt.  That's it.  

What if none of them were bad, what if they were all just meant to serve a purpose and move us forward, all in their own time.

The writers of the Disney movie "Inside Out" understood this. They chose 5 emotions for the movie, Joy, Sadness, Fear, Anger and Disgust.  

Joy was the only "good" emotion. She tried to control the mind all the time.  She thought that if JOY could be the only emotion ever felt, then life would be perfect.  She worked really really REALLY hard to make sure sadness never took control.  Sadness couldn't touch the mind, or the memories.

In fact, in the movie, Joy eventually made Sadness promise never to do anything or affect anything by staying inside a circle she drew on the ground.

Joy was caught in the happiness trap. She thought that sadness was BAD, and anger was BAD.

She didn't realize until the end of the film, that sadness is necessary.  Sadness helps us apologize and fix relationships. Anger helps us protect what's important in our lives when it is threatened.

Emotions aren't good or bad.  The only way we should measure good v. bad is "Are we doing what matters to us?  Are we living according to our beliefs, our values?"  If we value family, are we doing what matters to make our family succeed?  If anger and sadness and love and joy and guilt and fear all help us live our values, then they are all worth it.  

We don't WANT to feel them all.  We are instead, willing to feel them all because we WANT to make our family succeed.  

If you keep labeling emotions as "good and bad" or "acceptable and unacceptable" then you are guaranteed to have a BAD and UNACCEPTABLE life at least 2/3rds of the time.

Let yourself out of the box.  Don't be chained to a life of misery by thinking you have to feel joy all the time for life to be "good."  Statistically, almost 90% of your life will not be "joy"ful.  

When you accept all 9 emotions, and make them all useful, then 100% of your life can be worthwhile, and push you further down the path you want to go, living the life you want to live.

That is TRUE Happiness.

Wednesday, August 12, 2015

Book Review: The Martian


Grade: A+

This book is a genius thriller.  Pair excellent science with a hilarious astronaut, and it's irresistible. 

I mean it.  You can't believe how realistic the book is, and how the main character is always saying and thinking exactly what you would be.

This is not a spoiler, because you find this out on the first page - the book is about an American astronaut, Mark Watney, who gets stranded on Mars.

How do you survive on a planet in a research dome meant to last 30 days, when no one will be back for 4 years?

The twists and turns are unexpected and realistic.  The author didn't make up crazy things, he just studied mars really REALLY well to know what would naturally happen. 

There is a caveat to my recommendation.  There is a good amount of language in this book.  When a man thinks he's gonna die alone on another planet - he swears!  Mark Watney is the guy you want to be best friends with and invite over to BBQs at your house.  He is smart, funny, creative, down to earth, and just irreverent enough to make you laugh out loud over and over again.

You've been warned, and you've been also been teased with the promise of an amazingly awesome, fast paced, believable thriller.

Enjoy!

(and read it before the movie with Matt Damon comes out)

Saturday, August 1, 2015

Book Review: Go Set a Watchman




Grade: A-

I have not read “To Kill a Mockingbird” in 20 years, and I remember very little about the book.
I refrained from reading it again because I wanted to see: can this book stand on it’s own?

Yes.

This book is not what I expected.  I expected a somewhat entertaining story that eventually told us, “don’t be racist” and did it in a very convincing and poignant way. 
Lee did much more than that.  She let us love the people around us without jumping to crazy conclusions. 

She let us be good people without being perfect people.  She let us be heroes, who have real lives, and live in the real world.
Though the book was written in 1957, it feels as though it was written for our day.  It was written to teach us that Paula Deen is not a racist monster, and we can have heroes and role models who don’t meet the current public criteria of “appropriate.”
This is a fairly quick read, even though the book is not fast paced.  Lee did a wonderful job of developing characters and relationships so that the climax of the book is real.  The emotions and interactions are real and heartfelt because we know the back story of each character.

Lee took the time to teach vital life lessons, and through this book she taught them wonderfully.

Thursday, March 26, 2015

"Negative Reinforcement" is like "Inconceivable" - I do not think it means what you think it means.

When I ask most people what the term "Negative Reinforcement"  means most of them say something like:

"It's when you want someone to stop doing something so you do something negative so they'll stop. Like yelling at them or grounding them or insulting them."

That is actually the EXACT OPPOSITE of Negative Reinforcement.  That example is actually : Positive Punishment.

Let me explain. (no there is too much, let me sum up):

POSITIVE: Do Something or Give Something
NEGATIVE: Stop Doing Something or Take Something Away

REINFORCEMENT: Increases a behavior
PUNISHMENT: Decreases a behavior

SO:

EXAMPLE: You want your kid to take out the trash

POSITIVE REINFORCEMENT:
When they take out the trash, you praise them or give them a reward, and then they take it out more often

NEGATIVE REINFORCEMENT:
When they take out the trash, you stop nagging them, and then they take it out more often

POSITIVE PUNISHMENT:
Your kid refuses to take out the trash, you spank them, they stop refusing.
OR your kid refuses to take out the trash, you give them $5, they stop refusing.


NEGATIVE PUNISHMENT:
Your kid refuses to take out the trash, you stop giving them allowance, they stop refusing.


The important thing to remember is that NONE OF THESE TERMS refer to moral judgments or preferences.

Punishment, by definition, decreases a behavior.  It could be very enjoyable and nice, if it decreases the behavior it is a punishment.  You could give someone ice cream, and if it stopped them from cussing you out, then it is by definition a punishment of cussing.  (if it made them cuss you out more so they'd get ice cream then it became reinforcing...oops)


Positive means "you do something" so spanking and cussing out your kids is in this sense "positive" because are DOING something.
Negative means "take something away or stop doing something."  It doesn't mean it's aversive or unpleasant

THIS is positive punishment:



ie: Sunscreen works through negative reinforcement.  When you put on sunscreen, you decrease or take away a sunburn, and then sunscreen is put on more often.  The behavior is done more often, because something was taken away.

Parents often think that if something is unpleasant it is a punishment.  Well, if your kid is smoking marijuana and coming home late, and you take away their cell phone - then they smoke more and come home late more often - THEN you have reinforced them.
You used NEGATIVE REINFORCEMENT.  You took something away, and it increased the behavior (smoking and staying out late).

If they were smoking and coming home late and you took them to a minor league baseball game and spent more time with them, and they stopped smoking and staying out late, THEN you have POSITIVELY PUNISHED them.  You did something, and the behavior decreased. 


Clear as mud?

Friday, March 20, 2015

Book Review: Food, A Love Story


Grade: D+

I really wanted to love this book.  Jim Gaffigan is one of the funniest comedians I have ever heard.  I bust up when I watch his videos: Mr. Universe, Beyond the Pale, and Obsessed.  I watch YouTube clips and I constantly quote his material.

He is a comedic genius.  He is hilariously self deprecating and he knows what the audience is thinking.  His timing is precise and his delivery is practiced and polished and perfect.

And his book is a re-run.

I listened to the audio tape.  It is 7 hours of rehashed material I have heard before - with boring descriptions of the food across America mixed in.

I loved "Hot Pockets" the first time I heard it.  I also loved "Kale" and so many others... and I heard them all again.  ALL.  Repeated.  Slower, and much less funny.

This book is a sad money grab.  It is not original.  It is not new.  It is not worth the time or money. 

Go on Netflix and watch his specials.  Laugh so hard you cry - and then skip this book.  You'll thank me.

Monday, February 23, 2015

Book Review: Deadly Medicines and Organized Crime


Grade: A

Mind Blown! I mean it.  I've been skeptical of the pharmaceutical industry for many years, but I don't know of anything as impressive as this book.
This book is not written by some anti-drug hack.  Dr. Peter Gotzsche co-founded the Cochrane Collaboration in 1993 and established The Nordic Cochrane Centre the same year.
I first heard about the Cochrane Collaboration in my high school debate class when my teacher was discussing the greatest collection and analyses of medical knowledge in the world.
Yeah - the author of this book helped found it and he has worked in medical research and meta-analysis of data for most of his life.  He became Professor of Clinical Research Design and Analysis in 2010 at the University of Copenhagen.
Basically - this guy knows what he is talking about. He is a physician who has prescribed medications, he has been a "drug rep" and helped sell medications, and he has since analyzed more studies than any researcher I've read.
The only reason this book doesn't get an A+ is because it is so amazingly heavy on research and medical terminology that it is unlikely to be read by the general public.

This book meticulously and methodically shows how deeply entrenched the pharmaceutical industry is in EVERY level of medicine.
I knew they offered free lunches, free drug samples, and they paid for speakers at medical conferences.  I knew they used to give out free pens and paper, and toys, and clocks.  I even knew they had some pull at the FDA.  I had no idea about all the rest.
MEDICAL JOURNALS
This was the part that scared me the most. 
The BMJ (British Medical Journal)'s former editor said "medical journals are an extension of the marketing arm of the pharmaceutical companies." - p. 64
WHAT?!  Medical journals are where I get my trustworthy information.  It's where I can find double blind randomized control trials that have been peer-reviewed.  They are the gold standard for research!
Journals are where I proudly hang my hat.  I don't need to listen to drug reps - I read the New England Journal of Medicine.  The best in the world!

It turns out journal editors can be bought off - just like everyone else.  Even the best medical journals in the world - New England Journal of Medicine, Lancet, BMJ, Annals of Internal Medicine and JAMA - have all accepted drug money to publish misleading information or bad studies.
The New England Journal of Medicine (likely the most respected medical journal in the world) is as guilty as the rest.  32% of all trials published in their journal were solely funded by drug companies.
NEJM even changed their policy in 2002 to allow authors to write about products in which they had a financial interest.
Journals make HUGE money from advertisements and reprints.  If they publish a study beneficial to a drug company - that company promises to buy reprints in order to show them to physicians.
The Lancet made over £1.5 million on orders for a reprint of just one of their editions.  - p. 65
The Annals of Internal Medicine lost over $1 million in advertising revenue after it published a study that was critical of industry advertisements. - p. 65
Journals have a financial interest in making their article abstracts sound beneficial for new drugs.  Reprints will be ordered.  The more they allow a study to minimize or hide side effects - the more money they'll make.
Journal corruption is just one small chapter in this book.  Gotzsche also details corruption in clinical trials, seeding trials, TV ads, the FDA, patents, professional organizations, and even CME (Continuing Medical Education.)

Doctors have to stay current.  To keep our board certification we have to log hours of continuing education.
60% of all CME is paid for and provided by drug companies - so guess what most of us are learning?  Exactly what they want us to.
Drug companies are not changing.  They get caught in their fraud and they either say it was "one bad apple" or "mea culpa: we've now changed our ways."
It's all lies.
If you look at the 3 years span from 2010-2012 you'll find these cases:
 

2012: Abbott paid $1.5 Billion for Medicaid fraud

2012: Johnson and Johnson fined $1.1 Billion for hiding side effects
2011: GlaxoSmithKline paid $3 Billion for illegal marketing of off-label drugs.
2010: AstraZeneca paid $520 Million for fraud
2010: Novartis paid $423 Million for illegal marketing
the list goes on...


They aren't changing.  Drug companies know how to make money - and these lawsuits are already factored in to the profit predictions.  They know that these fines are worth it.  The fraud makes them more money than they will ever be fined.

This book made me look at my life.  I'll graduate from fellowship in four months and begin my career as a Child and Adolescent Psychiatrist.

I know there are good medications.  There are caring doctors.  There are honest people working as drug reps.  There are intelligent and ethical researchers at the FDA and at pharmaceutical companies.  There are honest, discerning journal editors who want to publish the truth.

I simply don't trust drug companies to give any of these people accurate information.

Peter Gotzsche's book is heart-breakingly accurate.  I highly recommend it.

(Because of this book, I have started a facebook group for prescribers called "Doctors Without Sponsors" to help increase awareness and encourage others to decrease their reliance on drug companies' information and money.  I also recommend signing this pledge: http://noadvertisingplease.org/sign/)