Ralph Wittenberg's New Life Blog

Prejudice and Labels

Dr. W — Sun, 30 Oct 2011 18:32:34 +0000

Labeling is useful in that it’s sort of a time saver. Labels are often used in our dealings with other people. There are two instances in which they’re over use is very dangerous; in medicine and politics.
Children call each other names with the idea of putting someone else down for being part of the disrespected category. so by using labels such as “Sissy”, “fatty”,”Nigger”, “nerd” orhim “bitch”, you’re supposed to know all that you need to know about to target of the label from the label and who the person actually is, is irrelevant. In these instances the intention to hurt is conscious. But many times labels are used that are hurtful without the person being conscious all of that intent.
We often hear the term “stigma” in relation to people who have serious emotional difficulties. I believe much of that is the result of the fact that psychiatric diagnoses, in contrast to the specific diagnoses in other branches of medicine, are insulting labels. In fact, in the vernacular, the new way to put somebody down is to say that he or she is obsessive,” he or she is a maniac,” or he or she is psychotic. Anyone who reads about so-called psychopathology gets the feeling that whatever it is they may be talking about might refer to them as the labels are so vague. That is because the categories are so vague that just about all of us will fall into one or two of them. Are labels themselves actually dangerous? In the United States if you get labeled “depressed” you can be denied health insurance, life insurance, promotion in the military, and even being hired for new job. One of the appeals of labeling is the illusion that you know something important, such as what medication to prescribe. But an examination of the use of medication for the treatment of severe emotional problems reveals that the same medication will treat a number of supposedly disparate disorders. For example, antidepressants which reduce the symptoms of depression (and don’t necessarily make you happy) are also of the drug of choice for the long-term treatment of so-called “anxiety disorders.”
As a psychiatrist and psychoanalyst, over the years I have protected my patients in two major ways. I helped draft confidentiality laws of the District of Columbia back in the 1970s which have been considered some of the best in the country because it severely limits information being sent to insurance companies. In my experience, the only purpose that insurance companies have for patient information is to find a pretext to deny them benefits. for that reason in my private practice I refuse to have any direct dealings with insurance companies where I have to report about my patients so-called progress and I himhimfill out billing statements in such a way that my patients are never compromised but always reimbursed. As a psychoanalyst in practice for almost 50 years I know that no two patients are alike . What matters is each of their unique individual stories. But then you have to spend a lot of time listening and allowing an intrinsic healing power to take place.
Over the years I have been struck by the extreme danger of labels in the political sphere. Words which have complex meanings are converted into insults, such as Liberal, lefty, progressive, socialist, “tax and spender”, Nigger lover, himor conservative, right wing, Tea Partier, banker, terrorist, Zionist and on and on and on.
himThe Occupy Wall Street (OWS) movement brings these issues into high relief. There is a great frustration expressed in the media about the fact that what these people stand for are hundreds of individual grievances; lack of jobs, poverty, social justice, corruption of the political process by the use of corporate money used to lobby, student debt, lack of affordable available healthcare, attacks an individual women’s rights, racial and cultural prejudice, the over use of natural resources by the military industrial complex, police brutality rather than policing are just a few of the items. The various Occupy encampments around the country are distinctive but also built on the Democratic principle of complete equality. Nobody is more important than anybody else. Nobody is inferior to anybody else. Great pains are taken in the conduct of the various meetings that are held to discuss and plan the direction of the organization to ensure that everyone is included as an equal and no one is left out. I am personally a member of just such a group. The group was facilitated rather than led. A different facilitator volunteers each time. The job entails going around to ask members what they want to have on the agenda, how long they want the meeting to last, how much time on any agenda item. The facilitator invites him another member of the committee to maintain what is called “the stack.”him This is a list of who wants to talk in order of their raising their hands and making sure that that order is maintained. In my group of a dozen people alone, there was an array of people from their mid-20s to myself at age 77. There was almost an equal number of men and women. One person was an amputee, another had a severe neurological problem, another had a very hard time keeping it there anger under control, some consider themselves revolutionaries and anarchists (with pride) and others like myself, were people who lived in the community that had conventional occupations, but a particular expertise to contribute.. Everyone at the meeting had to indicate their ongoing involvement, moment to moment, through the use of hand gestures to indicate whether they were or were not in agreement with what was getting discussed. There are no bosses.
I see the desire to simplify this movement, even to the point of wishing it away, almost every day in the major media. What I find most amazing is that this OWS only began on September 10 of this year. The self-identity of “We Are The 99%” of OWS is now used routinely as though it was a part of everyday language.
Parallels can be drawn between OWS and other great social movements, such as the overthrow of British colonialism in India to the civil rights movement. the conventional media are dying to find some simple way to characterize it as such as how many participants are, how they dress, the fact that they use drugs, singing and dancing, what kind of scruffy, and on, and on. Yesterday, on 29 October, Washington DC had freezing weather with snow for the first time in 50 years. The pundits keep saying that cold weather will make these people go away. While I was visiting yesterday a group of 100 protesters began a march, full of enthusiastiasmhim. Local unions have provided cold-weather survival techniques, especially since the local authorities have forbidden the use of various heating devices. There are no bathroom facilities in the park, the only water comes from a small public drinking fountain, through what looks like a Vietnamese bamboo irrigation system into large carboyshim and the local merchants, such as Starbucks allow free use of their restrooms.
I feel I am privileged to be both a witness to it participant in historic change, and I don’t know the next move that will unfold will beas this is an evolutionary process. It can’t be lumped together in a word, characterized by any one label other than its own name, which is the same for people.

Letter to the Editor of the New York Times

Dr. W — Tue, 11 Oct 2011 04:35:03 +0000

October 10, 2011
To the Editor
The New York Times

One of the most common criticisms leveled at the Occupy Wall Street movement is that they don’t have a coherent message. There is also an implication that they are an anti-American, inchoate mob, uncivilized, and unpatriotic. But if you take a step back it can be seen that the message is the motto of the United States, E Pluribus Unum; Of Many One. No matter what the particular problem of any participant, what they all say is, “We Are the 99.”
Ralph Wittenberg M.D

Mental Health

Dr. W — Mon, 19 Sep 2011 19:22:22 +0000

I get my messages from the universe everywhere.
Today on Oprah’s website there was a quote about how the universe is sending us messages all the time, in many different ways. I received an email today from the Director of the United Nations Foundation saying that NCDs are to be the lead item on the agenda of the Annual Meeting of the UN going on in New York this week. It focuses on the leading causes of mortality, as usual. There is another measure of what is called the “Burden of Disease”, a figure tracked by the World Bank for over 30 years. Morbidity is what cripples but does not kill. Of the ten leading causes of medical morbidity worldwide, at least five are related to mental health. Depression in women is the second leading cause.The latest estimate is that 17% of the worlds population is affected.
I have developed a program in conjunction with the National Naval Medical Center that actually provides primary prevention for newborns. It was so successful that it is now the standard of care throughout the Navy by Act of Congress. I also have a treatment modality, facilitated peer group support therapy that not only works without the need for trained professionals but is adaptable across cultural and linguistic barriers.
These health care efforts that are based on the care of individual patients are ultimately the most successful. One of the major problems that more ambitious top down efforts, such as immunization, run into is the fact that as many as 40% refuse to accept it. 40% of patients who are given a prescription for an antidepressant never fill it.
This is labeled “patient non-compliance.” by the drug industry and conventional medical practitioners. I also have a method for overcoming this difficulty by training health care professionals in a different approach that recognizes that the patient is only person who decides what they want to do with their health.
I have requested a meeting with the United Nations Foundation to create the possibility of my being able top present my ideas at a policy making level.

Mental Illness

Dr. W — Mon, 19 Sep 2011 04:20:32 +0000

The latest comment I have seen about the UN conference on NCDs is that mental illnesses comprise 17 percent of them. On the one hand I am very happy to see someone draw attention to the issue, but on the other I am worried that the same old ineffectual ways of dealing with it will be invoked. Much is made of the ‘stigma”of mental illness. A large patient advocacy organization tries to combat that by saying that these are “brain” diseases, namely they are physical. Psychiatric diagnoses are labels, as are file drawers in a library. The table tells you something but the contents are what counts. You can prescribe medications by using labels. Unfortunately the labels are insults to the patients and are used as such in common parlance. That’s why patients don’t seek out psychiatrists.
Medication has a place in the treatment of people with severe emotional disorders when their functioning is severely impaired. There are other far more effective methods that do not require diagnosis, or medication and are by far the best the vast bulk of problems. More to come.

United Nations Health Care Campaign

Dr. W — Fri, 16 Sep 2011 03:56:33 +0000

The United Nations is opening a conference on what are called non-contagious diseases (NCDs.) These include the most common deadly and crippling illnesses of mankind, i.e. heart disease, cancer, respiratory disease, and diabetes. These are the four that the UN plans to target.

These days there is almost no mention of emotional, psychological, or psychiatric illnesses as being extremely serious problems. a study of medical morbidity worldwide (conditions which cripple but don’t kill you) was conducted by the Harvard School of Public Health sponsored by the World Bank. Five of the top ten were psychiatric conditions or behavioral problems,such as alcoholism, depression, schizophrenia etc. nor is there any discussion of the impact of severe emotional conditions that are not only a couple severe in their own right, but lead to and complicate physical illness as well.

This campaign is a great opportunity to widen the perspective of conventional, so-called evidence-based medicine. There’s already a proposal to develop a cocktail of medicines to prevent these illnesses. I’m sure this will soon be followed by suggesting the use of high-tech surgical devices or medical apparatus.

The greatest strides in medicine have been made in what is called primary prevention. When it is successful, such as with immunization or water treatment, nobody gets sick. Conventional medicine usually focuses on what is wrong with people and what needs to be done to fix them. Secondary prevention is where there’s early detection and treatment of illnesses that shortens their course and increases the chance of success. The usual care is of people who are already sick and need extensive treatment. The principles of prevention have been most successful in the area of communicable diseases, such as immunization and water treatment.

I plan to write a number of posts discussing a variety of issues that are outside of the conventional discussion. They will examine the fundamental questions about illness versus wellness. It will suggest a variety of unconventional options that could create the conditions for primary prevention that actually work, are relatively inexpensive, and are based on elements that are usually ignored. These will include, for example, such things as psychology, the unconscious, sociology, culture, and issues that could be described as spiritual.

I’m particularly qualified to discuss these matters as I have been a physician for over fifty years, am a Clinical Professor in a medical school, a psychiatrist, psychoanalyst, and the creator of a number of preventive programs that have been very successful. My views on these matters are sharpened by my personal experience over the years as a patient who has had the gamut of serious diseases, including heart disease and cancer. I might not be alive to tell the tale without the miracles of modern medicine. But I might also have been dead because of egregious errors brought on, in many cases, by healthcare personnel, characterized by the lack of caring, respect, empathy, the inability to relate on a personal level or communicate effectively.

Tune in!

A New Health Statistic

Dr. W — Tue, 13 Sep 2011 15:24:02 +0000

GROSS NATIONAL HAPPINESS

Yesterday, President Nicholas Sarkozy of France suggested that a new measure be made of the well-being of the country. Instead of using the gross domestic product (GDP) to measure the state of the country’s economy, he proposed that a completely different set of measures be used. In many ways it is similar to the notion that was developed in the country of Bhutan, called the Gross national happiness. Instead of a very narrow measure of economics, and in which profits from such things as pollution and illness are listed as positives a new system would look at such things as contentment with employment, overall state of health, enjoyment of life and number of dimensions, etc. be used.

There is a parallel to this in the American healthcare system. The focus is on such things as illnesses, pain, and the threat of death. There are many medical interventions that actually improve the quality of life. Improving the patient’s mobility or breathing capacity can open possibilities for both employment and enjoyment. Surgery that repairs serious damage, either from trauma, genetic malformation or birth defect, all making for them a more effective, satisfying and happy life possible. Unfortunately, the majority of focus of American medicine consists of combating symptoms. In these usually require expensive medicines, expensive surgical procedures that are doubtful value, expensive medical devices, which are very effective when they’re called for, but we overused in various strategies to combat death, as though that were intrinsically valuable.

Another way to evaluate a person’s well-being has to do with what are referred to as quality-of-life measures. This takes into account whether the person is happy, has good relationships, feels her life has purpose, feel that they matter personally, that they are able to love and be loved, to feel connected rather than isolated and they’re able to enjoy things from moment to moment. So this really refers to the person’s life as a whole, which is also referred to as holistic health care. Through a combination of elements that alter the fundamental way that people relate to the world this is a state that is achievable for far less money, and in a much more permanent way. So maybe normalcy can be defined by what you might call an index of happiness. This has been demonstrated to be possible again and again through programs that involve only lifestyle changes such as those of Dr. Dean Ornish. While these programs combat identified disease states they are capable of creating a complete new life. They have been shown to save enormous amounts of money.

Burnout prevention

Dr. W — Sun, 11 Sep 2011 18:38:44 +0000

The other day a colleague of mine told me that she was completely overwhelmed by all the demands she was trying to satisfy and that she didn’t know how she was going to get through it having an overseas trip coming in addition. What occurred to me was the warning that is part of every first aid and CPR training. “Before doing anything make sure that you are safe and OK.” Don’t jump into the water to save someone as the chances are they will get you in a paralyzing bear hug and you both drown.
Don’t touch anyone who is in contact with a live wire as you will get electrocuted.
As I am a psychiatrist who trained in a big city emergency hospital I never interview someone who may be dangerous without at least a couple of burly people in the room. In my area there have been three psychiatrist killed by patients they were seeing alone in their home offices,over the past two years, even though they knew they were dangerous.

The idea of protecting ourselves first should be practiced all the times, throughout the field of health care. If you allow yourself to get burned out it is devastating to you, your family, and your patients. I have a sign pasted on my computer that says,”Is my loyalty to other people more important than my loyalty to myself.”

WHAT ARE MEDICAL FACTS?

Dr. W — Fri, 09 Sep 2011 15:17:08 +0000

Medical facts are a subset of scientific facts. They are abstractions from an unbelievably complex real world. As such, they can appear to be astonishingly different from “reality.” A number of years ago I became aware of the “fact that photography (before digitization) was an abstraction. I was in the “Floating Gardens” of Xochimilco. This was where the Aztecs had developed an ingenious form of agriculture where soil was floated on top of the huge system of lakes that surrounded Tenochtitlan and the other city states of pre-Colombian Mexico I also remembered that in the first grade I had a teacher who had gone there for her summer vacation and came back with glowing pictures, both verbal and photographic. So there I am, in a tourist boat that is dingy, the paint is peeling, there are no flowers in the so-called gardens, the water smells fecal and there are flies galore. But I take pictures with my excellent single lens reflex camera with excellent color film anyway. When I get the pictures back I am astonished how beautiful they are. The colors are vivid against a blue sky background. There are no signs, whatsoever, of the noxious elements. It indeed looks paradisiacal.

So what does this have to do with science and medicine? All scientific research that is based on mathematics and statistics, is abstract, and proud of it. It is a world which has screened out any complexity to prevent there being more that one answer to a very finely proposed question. Not only can this data be misperceived, but it can be used to paint a rosy picture, which, surprisingly, is contradicted, again and again. Or those inconvenient facts, such as the side effects of medicines or treatments seem to get lost, or disrupt what should be a direct shot at the truth. This truth is manipulated by mathematics, which is an abstract way of thinking.

So what are the dangers that these elaborate efforts run into in order to find the truth? Just for starters, you lose the value of intuition, feelings, dreams, fantasies, visions, etc. all of which are relegated to the basements or attics of our comprehension of the world. It ignores the actual complexity of the real world. Knowing what the average height of a woman is, not matter how accurate, won’t tell you anything about the height of the next female patient you see. Science assumes that individuals are not equipped to deal with the complexity of the world. That leaves out the existence of enormous unconscious perception, knowledge, and creativity. In the latest count, if there be such, our brains contain 3 billion neurons that can communicate to 80,000 other neurons each. This means something that approaches ten trillion possibilities at any point in time. Go figure!

I believe that humans have the means of knowing the world, in all its amazing complexity, through the very demeaned processes mentioned above that they have been trained to ignore or suppress, rather than use. The “Elephant in the Living Room”, is our visual unconscious mind. We may tell ourselves we want to know the truth, the Holy Grail, but that may turn out to be a frightening elusive mystery.

Changing Global Health

Dr. W — Fri, 09 Sep 2011 15:13:08 +0000

This blog will be about novel approaches to changing healthcare through the use of clinical medical, psychological, and spiritual points of view.

Speed-Therapy

Dr. W — Fri, 25 Sep 2009 19:31:16 +0000

Last night, a member of the New Life Team, Dr. R. Dallas, called me after seeing a segment on speed shrinking on CBS.

This is about connecting therapists with people. And it’s exactly what I plan to do with my New Life program.

Just by talking to me for a minute or two, my patients get a sense of who I am and what I am.

Speed-therapy, like, speed-dating, is just a short, mini-session. Like a short mini-date — because in just a few minutes, you can tell if you want to go to dinner (or an hour-long therapy session) with someone.

They aren’t talking about doing a whole therapy session, instead, they’re talking about connecting people. Which is what I want to happen at our upcoming, New Life events.

The idea is just to introduce people and see if there’s chemistry between them — to see if they can talk to that person. There’s nothing fancy. If you think that somebody’s some kind of schtunck, you won’t want to talk to them. If you think they’re cold, or reserved, or they’re not genuine, you pick that up in no time at all. The idea isn’t to start therapy it’s to connect people. It’s very hard to find therapists.

In the interview, people said ‘They’re going to think you’re crazy.”

But it isn’t.

It’s a chance to connect with somebody in person and you get a sense of what they’re like — people can’t fake it.

Let’s say you’ve got the greatest therapist in the world — but there’s a certain patient that for some reasons they don’t like. It will come right out.

If you go to one of these sessions — don’t expect to have all your problems solved in eight minutes or less. It’s not like people are just going to dive in and cut to the core of their problem because they don’t have a lot of time — they’re not gonna dive into their problems. they’re going to dive into finding somebody.

You can talk until the cows come home — but nothing will make a difference if you don’t think, this is somebody who will care about you, seem interested and seem competent.

You can pick all that up — I think — in no time at all. That’s not therapy that’s just making the connection for therapy to take place. And that’s what will happen at our New Life events.