Making sense of world events and struggling to stay hopeful!
Baha'i House of Worship, Wilmette, IL
I am frequently asked about my personal compass that keeps me motivated to go on and to stay hopeful. Many of my more sensitive patients, friends, and colleagues feel paralyzed by all the bad news in the world. The stories of wars, economic hardships, injustice towards the vulnerable, racism, child abuse, animal cruelty and the many other ills of our current world can lead to a sense of desperation and emotional numbness. The suicide rate, especially among our service men and women, is at all time high.
Some want to distract themselves from all this bad news by rationalizations or diversions of all kinds. I approach the clinical aspects of my patients in the office from a both a medical and a psychological perspective. Yet from a broader view, our world is thirsty for a fresh global perspective.
The metaphor that guides me in understanding these macro trends and applying them to my micro life comes from the writings of the 19th century Luminary, Baha’u'llah. He was a Persian prince who gave up a life of luxury and was opposed by two despots of His time, in Persia and the Ottoman empire, for His Divinely inspired teachings. He was chained in prison, then exiled for forty years, but despite these conditions his writing sheds light on our collective social evolution.
His teachings describe two processes at work: One is leading to a gradual dissolution of outdated and nonfunctional patterns of behavior, and the other is building a society founded on the recognition of the oneness of humanity, its spiritual traditions, and its Creator. Internally, each of us can also witness these two fundamental forces. We are either pulled towards our lower instinct-based nature that only seeks self gratification, or towards a higher nature attracting unity, harmony, transcendence, service to others, and peace making. These are not hopeless times but actually a very exciting step in human evolution.
For more information on Baha’u'llah and His spiritual teachings, go to www.bahai.org The following powerful quote is from the Shoghi Effendi, Guardian of the Baha’i Faith, and is inspired by the writings of Baha’u'llah:
Life coaching: Is it renaming psychotherapy?
The answer is yes and no! Life coaching seminars and institutes seem to be popping up everywhere. Some have raised concerns that the concept is a backdoor entry into psychotherapy without proper training or credentialing. Some life coaching advocates differentiate the process from psychotherapy in that its emphasis is on results, here and now, and not the past.
Although in some situations ‘coaching’ might be helpful, it should not replace proper clinical evaluation of a situation. It is similar to resolving a headache with cold compresses and tension reduction. If the headache is caused by a tumor, however, it needs to be properly evaluated, diagnosed and treated. Similarly, if a person is stuck in a career path because of minor faulty habits or assumptions, a bit of skill training and encouragement can be quite helpful. If however the issue is chronic depression, anxiety, ADHD, or more severe psychiatric conditions, a sophisticated and involved analysis is needed, preferably by team of skilled professionals with years of training and experience.
Internal glass ceiling in career advancement
External forces that keep people from career advancement are well documented. Fortunately, some of the barriers in the work place emanating from prejudices of all kinds are improving. Although there is no doubt that we still have a long way to go to eliminate discrimination based on race, gender, nationality, sexual orientation, religion, age, etc, there is a more subtle barrier to career advancement that I see daily: Our own internal dysfunctional dialogue. Moreover many sub-clinical conditions such as undiagnosed ADHD, depression, anxiety, and other psychiatric conditions inhibit people from leading optimum and productive lives. An assessment is well worth the time and effort.
IBS, brain structure, and the stigma of labeling
I was surprised at the headline news a few days ago when the results of some new research were highlighted pointing to structural differences in the brains of the women who have Irritable Bowel syndrome accompanied by pain. What struck me was the conclusion that everyone was reaching regarding the validity of these patients’ suffering, now that a brain link has been found.
Are we still distinguishing psychological from brain-based conditions? Do we hold some diagnoses more valid because of our inherent bias towards what has been referred to as mental illness in the past? The obvious answer to these still remains a sad ‘yes’. A lot more education is needed to remove these barriers.
Is ADHD becoming a metaphor for being different?
As we continue to struggle with the stigma surrounding most psychiatric conditions, I have noticed a very interesting trend when it comes to ADD. Different personality traits such as proneness to boredom, procrastination, shyness, creativity, novelty-seeking, dislike of one’s job, etc. are now collectively labeled as ADD! The cultural reference has crept into our jokes, comedy clubs and movies. People don’t even identify ADD as a clinical condition but nonchalantly use it as an adjective to describe many of these styles. The problem comes when the overapplication of a label eventually leads to diffusion of meaning and eventual rejection of a valid clinical condition. The pseudo-scientific aura surrounding a label such as Adult ADHD should never replace clearer and more descriptive words that describe our human condition, our similarities, and our differences.
Where are the new treatments?
The current economic downtrend and all the deserved and undeserved criticisms of the drug companies seem to have slowed down the pace of new therapies dramatically. The high cost of research as well as the development of a subtle bias against medications and biological therapies seem to be discouraging innovation and pioneering work. We see a lot of repackaging and slow-release preparation of old treatments with brand name costs.
What is needed is support of research centers that does not come from industry, and a concerted effort not to relinquish our quest to find better prevention and treatment for these devastating conditions. I do hope the break-through revolution in the treatment of these brain illnesses is not stillborn!
Hooked on Apps: A trap for the ADHDer!
” I have not read any books since I got my smart phone.” Thus announced a patient with ADHD and a propensity for compulsive behavior and addictions. With the advent of smart phones, we are all fascinated by finding interesting references, games and applications just a touch away.
The trouble comes when the time spent with the device goes unchecked and the person looks for the next ‘high’ in searching for a more interesting and engaging application. Many compulsively check the weather condition or the stock market fluctuations. Others endlessly search for things to buy and pay for useless applications.
Like any novelty-producing product, one must observe moderation and treat such useful technology as also potentially harmful and addictive. As my patient later acknowledged, she doesn’t really need to know the weather condition every ten minutes!
Shame on ADHD!
I have been struck by the predominance of shame in ADDer adults. This is a different kind of shame than, let’s say, someone who has PTSD symptoms. It is not related to one or a series of catastrophic events. It is more related to feeling different and inadequate in day to day tasks.
Many feel exhausted and embarrassed after social interactions. They believe they say the wrong thing at the wrong time. Blurting out responses and forming complete thoughts only after starting to talk is a hallmark of ADD! Paying close attention to this phenomenon is crucial to the psychological health of the ADDer.
The first step is the recognition of this deep sense of shame that has formed throughout the years and with millions of interactions. The second step is to manage the insidious and all-pervasive anxiety that comes with it through psychotherapy and SSRI or SNRI antidepressants. The third step is balancing self-acceptance and cultivating a sense of compassion for self and others.
Saying the wrong thing might not be as bad as one thinks. Besides, who really cares?! In the larger scheme of things, an off-hand remark is inconsequential. That’s a good ADDitude!
Anxiety and serotonin-based antidepressants
Unrealistic expectations set people up for treatment failures, especially when it comes to treatment for anxiety disorders. The changes that take place with the initiation of therapy are gradual and subtle. I conceptualize these changes as palliative as opposed to curative.
For example: If you have been prone to constant states of worry or irritability , you’ll notice a gradual loosening of the grip of these problems with the initiation of therapy. The dose of the medicine obviously needs to be adjusted and monitored under the supervision of your Physician. If you expect a magical transformation from symptoms to no symptoms, you will be disappointed; but if you look for subtle signs of easier transition from uncomfortable states of mind to more mastery of your thoughts and behavior you will be amply rewarded.
Alcohol abuse in teens and young adults
I am baffled by our cultural permissiveness towards alcohol use in the young. Many assume its use as a right of passage and bring up their own experiences of people who ‘grew out of it’. Reality points elsewhere: Many of the young abusers face catastrophic consequences and develop lifelong addictions.
Alcohol intoxication melts away the essence of what means to be a decision-making human. The executive functions of the brain’s frontal cortex are suspended under the influence of alcohol. How can we consider this effect to be harmless precisely at the juncture of life when critical thinking is needed most?
Tobacco use was accepted not too long ago. Let’s take action to send alcohol and other mind-altering substances the same way. Pay attention to popular art and the not-so-subtle message it gives to our youth, glorifying addictive behaviors. These ‘prophets of immorality’ are talking to our kids more than we do!