SCHLAG BYTES
Health

Schlag Byte 12/30/2002 - "No Stress in the New Year"

I'm at the Rancho la Puerta in Tecate, Mexico one of the great destination health spas in the world, where I am conducting a workshop entitled "Creating Healing Ceremonies". When I am not working I'm playing, sitting in hot tubs and getting massaged with warm hands, hot rocks and dribbling oil.

I'm getting better at reveling in such self-indulgence but can still feel a twinge of guilt at such pleasures when I think about the pain and suffering in the world. This week I'm trying to work through my neurosis.

The Gerontological Society of America reported at their recent annual meeting that low levels of neuroticism (anxiety, guilt, shame, obsessions and phobias) kept people psychologically and physically healthy. The study said that seniors who were still working, reading, exercising, relaxing, going to lectures and concerts, meeting friends and socializing, stayed vigorous. The old people acknowledged that genetics and keeping active were important but they said the key to their longevity was not getting too stressed out. They agreed life was filled with grief and joy, evil and goodness, darkness and light, but that to live long you had to be able to roll with the punches.

So here I am sitting in this hot tub waiting for Cesario, a world-class masseur, to rub out my kinks and soreness. In this moment the world is not on the brink of war and recession, rather it is a place of blessing and thanksgiving.

May this be a year in which we all learn to roll with the punches better. Lets smile more, touch each other lovingly, live long and in good health, Happy New Year!

To All My Relations

Mi Takuye Oyacin

For photos that accompany this Schlag Byte please visit http://www.healingdoc.com/bytephotos/123002.html

Schlag Byte 11/04/2002 - "Pinker's No Stinker"

It's already clear that as a species we are hard-wired to perform in certain ways. Our muscular ability, musical talents, intelligence and interdependence on one another are all genetically inherited. Now comes another book bashing sociobiology, telling us that life is all nature and not nurture.

Stephen Pinker, a language and cognition researcher at MIT, has written a new book "The Blank Slate: The Modern Denial of Human Nature" (Viking, 2002). This is another in a series of works that say we are who we are because our brains are programmed conception. Human nature is determined by our DNA and not by culture, learning or experience. Girls play with dolls, boys play war because we are programmed to do so by our genetics.

Some religious thinkers and scholars think Pinker’s a stinker; for them the idea that humans are preprogrammed prisoners of their biology does not sit well. It doesn't sit well with me either but it's not because I have a problem with the fact that human nature exists. I just think that the idea we are solely driven by our biology too simplistic a view. I don’t believe that social hierarchies, economic inequalities, taste, music, jealousy, taboos, violence are so rooted in our biology that we can’t influence our genetic inheritance. The idea that the whole of the human experience is preprogrammed and that we have little influence on personality seems to me shortsighted.

We are all the same and yet we're all different. There are genetically programmed human traits but that's different than saying its all genetics. It would be equally ridiculous to say it's all environment, we are both. We are not a blank slate and are also influenced by our experience, culture and connections. We have the capacity to manipulate our programs for good or evil. Pinker’s no stinker, genes are important but we must not become slaves to them.

Schlag Byte 10/28/2002 - "MCI's No Phone Company"

A couple of weeks ago I was getting ready to open my locker and for the moment couldn't remember the combination sequence on the lock and I have been using this lock for years. That day I also heard Charlton Heston announce that his memory had been slipping and that "his doctors diagnosed his condition as consistent with signs of Alzheimer's disease". I know that all memory loss is not Alzheimer's but it did get my attention. I say that just because I can't remember names or where I put the car keys doesn't imply encroaching senility.

We can test for Alzheimer's Disease with 90 percent accuracy nowadays but, what we cannot do is diagnose Mild Cognitive Impairment (MCI). MCI describes changes in memory that also affect your daily routine. How badly does it have to affect your daily routine before you ought to start getting worried? Nobody knows, what is known is that 80 to 90 percent of people who are diagnosed with MCI do progress on to Alzheimer's disease within ten years. There is no diagnostic test to confirm MCI. Lots of people have lapses in memory and it's nothing to worry about. It's when you can't remember what the keys are for or what your own name is that you might worry!

I can't just forget something without my sons-in law promoting the event as further evidence that the old man is losing it. It could be anything that they think smacks of inexorable decline, emitting unusual sounds, an ache or going pee-pee too often. Such an event results in my getting another notch on the "crab-pot" belt. At some time they determine, when I have accumulated enough notches, they will call "crab pot" which means kiss me goodbye and "pull the plug".

I have dodged these assaults with occasional flashes of brilliance but their scrutiny is unabating. I am grateful therefore that groups such as the National Institutes of Health (NIH), Alzheimer's Foundation and National Council on Aging are spending $500 million on Alzheimer's research -- much of it aimed at early-stage disease.

In the meantime, I take vitamin E every day and keep quiet around my sons-in-law.

Schlag Byte 10/21/2002 - "Diseasing Our Civilization"

Doctors are developing a new disease; leading psychiatrists are advocating at the American Psychiatric Association to create a new mental illness called "relational disorder". This is a new concept of disease which identifies as sick those people who are having problems in their relationships.

Is there anybody out there who hasn't had a relationship problem? Let's face it, it's not possible to be in a relationship and not have some struggle; there is no intimacy without struggle. By expanding our definition of a disease to include relationship struggles it now enables you see a doctor who will give you a DSM IV diagnostic code and prescribe pills for it. We don't need to be diseasing our civilization and prescribing more pills in order for us to deal with the ordinariness of the human experience.

We already have too expansive a definition of the diseases in an attempt to explain our social problems. For example, if your child is inattentive, overactive and hard to control nowadays he/she is thought to be suffering from an Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder for which we now have pills. We have seen an epidemic rise in those diagnoses since the advent and promulgation of pills that treat those symptoms. The fact is we have an army of neuropharmacologists racing to formulate new pills that will boost positive emotions and mask unpleasant ones.

Here is the latest attempt at expanding the disease model. On television this week I have seen this repetetive, direct-to-consumer pitch. You may be depressed and taking something for it but it may not be enough because you may have been hiding some other facts from your doctor. For example, if you're having trouble sleeping through the night, over-energized and painting your bedroom at three in the morning; or if you are talking too rapidly or having grandiose ideas because then you might be suffering from a manic-depressive psychosis. In the TV commercial they also use the term bipolar disorder which they seem to prefer because I think it sounds less debilitating.

Manic-Depressive illness affects less than one percent of the population and usually begins in adolescence or early adulthood (generally a period when people go through intensely difficult times) By urging the public to see their doctors if they have ever felt this way we are going to see an epidemic rise in this disease too. Every teenager who has ever experienced ups or downs, been impulsive, insomniac and grandiose (all of which could have described me and lots of other teenaged friends) will now be seen as incipient manic–depressives rather than just being impossible shmucks.

I am not saying it's not good to treat people with Manic-Depression, ADD or ADHD , only that most of what we see are not diseases and we'll get through them without pills.

We don't need to be prescribing more pills which often don't work for diseases that don't exist. We do however need to be talking to somebody when we're in trouble. We do need to have relationships with people we respect, love and trust. We do need to be living in communities of support where there are people we can count on. As parents of young people we need to be setting better examples than those they see in the media headlines. We need to be setting limits , making it clear what behavior is acceptable and what's not.

We need to stop expanding the disease model to deal with our social problems and human frailties and instead find more connections to one another and the universe that help us through the hard times and allows our wounded spirit to heal.

Schlag Byte 8/19/2002 - "Protecting Patient Privacy, Poppycock"

Patients in the American healthcare system are monitored more closely then sex offenders and are now being threatened with greater invasions of privacy. The Bush Administration formally rolled back some major protections for the privacy of medical records. The new rules abandon the requirement that hospitals, HMO's, and doctors obtain written consent from patients before using or disclosing medical information. Instead all they have to do is make "a good faith effort to get a written acknowledgment." These new rules will affect every doctor, patient, hospital, drug store, and health insurer in the U.S. Health corporations and insurers say it will result in better healthcare by removing obstacles to referrals and promoting better communication between providers but everybody knows what it really does is abolish the control patients once had over their medical records. The results of these standards will be that patients will no longer reveal information to their doctors for fear of its potential disclosure and doctors will no longer record important information that might potentially embarras or compromise patients. The new rules do prohibit pharmacies from selling information on their patients to a drug company but nothing about pharmacists and doctors making recommendations on products. We will see new marketing strategies that will escalate the billions of dollars currently expended on marketing to healthcare providers including the lobbying, wining, dining and travel perks to get them to prescribe their products. It will come at the expense of patient privacy and it's already happening. Prozac sales have plummeted because Eli Lillys patent has just expired. Now that 80% of patients are taking it at a generic equivalent . Lilly came up with a new patented pill "Prozac Weekly". A sales rep in Florida got doctors to write a cover letter and provide names of patients already taking Prozac and send them unsolicited samples of the new drug. The cover letter read "Dear Patient, Enclosed you will find a free one month trial of 'Prozac Weekly'. Congratulations on being one step to full recovery." A 59 yr. old Floridian filed a class-action suit because it infuriated her "to think that somebody could give out my medical records and start sending me dangerous medications." We are a decade into the healthcare crisis, costs are soaring, the uninsured are rising and prescription drugs prohibitively expensive. There is no easy fix but invading privacy certainly isn't one.

Schlag Byte 7/29/2002 - "Gesundheit!"

I'm in Hillsboro, West Virginia , sitting on the back porch of my bedroom which is actually the loading dock for a woodworking shop. My home this week is a foam rubber mattress on the floor of the workshop where I am surrounded by an an assortment of power tools, work benches and sawhorses that serve as drawers and dressing tables. From the porch I can see a fish-filled pond that is also home to turtles, beaver and migrating water fowl. In the meadow in front of me are thousands of "Mourning Cloak" butterflies whose black wings flecked with turquoise and orange polka dots make a fluttering magic carpet. Not far away, in the overgrown forest, are picturesque waterfalls and an abundance of wildlife.

This is as close to camping as my wife gets nowadays (says she's been there and done that). We are fortunate to have a communal bathroom on our floor. Everything here is communal: eating, cooking, dishwashing and learning. I am at the "Gesundheit! Institute". This is the place where Dr. Patch Adams wants to build his visionary hospital. Here patients will be seen free of charge and the institution sustained by "love offerings". So far it has six buildings that include bunkhouses, workshops, theatrical spaces, music rooms, mechanical shops and barns.

Every summer, in late July, Patch gathers an assortment of healthcare professionals, architects, gardeners, teachers, actors, musicians, clowns, and volunteers -- all of whom are committed to building a vision of health based on loving service and respect for all living things. Although Patch and I have been close friends for well over a decade, I've never come to his sacred place and it was time. This year he has again brought together an incredible assortment of bright, passionate activists all doing innovative work in healing the planet. We talked together, shared ideas, sang, clowned, worked the land, and reveled in this special place where dreams and possibilities are commonplace and encouraged. I love being here even though I think that building another hospital is the last thing we need. Patch reminds me that the healing journey is a sacred undertaking and whose practitioners must come to it from a place of loving and compassionate joy. In today's environment of growing mistrust he is the embodiment of our noblest selves.

Two classical musicians, the Lehnert Duo from the University of Colorado, perform a spectacular concert one evening. A pre-eminent permaculturist, David Blume, is consulting on how to create a sustainable, recyclable environment here. David convinced my wife that she could reduce her air-conditioning bill by half if she planted butternut squash and pumpkins on the roof of our Phoenix house. It turns out a simple sprinkling system hooked up to half of a 55 gal. plastic drum and hung from the roof will , if planted in the spring, cover the roof by midsummer . The broad leaves will shield it from the sun ensuring considerable energy savings, the vegetables are an additional dividend. David estimates that if people utilize such a system it would result in a 50 percent reduction in the cities' energy consumption and feed the homeless.

I spend an afternoon with him in a treehouse, 30 feet up in ancient White Oak tree where he tells me that the planet has enough natural resources and renewable energy sources to eliminate world hunger and tame hostile climates. He says however that as a civilization we have to committ ourselves to it. That's when he reminds me that part of changing the culture has to be my willingness to hang the plastic drums from our roof, prepare the soil and install the sprinklers . That's when I knew how hard it would be to change the world.

See photos that accompany this Byte at http://www.healingdoc.com/bytephotos/072902.html.

Schlag Byte 7/1/2002 - "The Fountain of Youth"

I have been deluged in recent weeks with advertisements selling Human Growth Hormone (HGH) . Banner headlines announce that growing old is not inevitable and that HGH is the new "fountain of youth". Advertisers promise that within 4 weeks your stamina will improve, you’ll sleep better and be more optimistic. By the end of 8 weeks you’ll have improved muscle tone, enhanced sexual function, improved skin tone, better digestion, and will lose weight. By the end of the third month your mental processes will have improved, muscle size increased, hair will grow and sexual desire explode. By the end of 6 months you will be emotionally stable, resistant to illness, your old wounds healed, gray hair will return to its natural color and cholesterol and triglycerides will be reduced. Tell me this is not irresistible; the fountain of youth can be had in our lifetime.

This is what we know about HGH: its production declines precipitously after age 20. Also the body becomes increasingly insensitive to the hormone as we age and nobody knows whether flooding the body with this stuff will cause problems in the future. We live in a culture that worships youthfulness and we have seen over the last 50 years a steady increase in lifespan. Aging experts now tell us there is no scientific basis for believing there is a fixed upper limits on age. Our bodies, they say, are not programmed to die by some unavoidable "sell- by" date.

Everybody wants to stay youthful and healthy but the human body has some basic design flaws. For example we walk on two legs so gravity is continually crushing our spines. Also, our cellular structure does not appear to be immortal, senescence seems to be a built in limitation of aliveness.

I think staying young is not about ingesting rocket fuel to make your old banger car go faster , it’s about living your life as if eternity is in every moment. What makes the fountain bubble……

• working at something that makes you happy
• excercising
• eating a low fat diet and occasionally splurging
• giving love, getting love, making love
• dancing
• laughing
• volunteering
• hanging out with kids
• listening to music
• getting unstressed
• experiencing awe
• lightening up and not taking ourselves too seriously

Drink up!

Schlag Byte 6/24/2002 - "Marketplace Medicine"

There was a time, not so long ago, that if you read something in a prestigious medical journal you could count on its accuracy and conclusions -- not anymore. The Journal of the American Medical Association (JAMA) recently put itself under the microscope and devoted an entire issue to examining the results of their published articles and found them to be often misleading and frequently failed to mention weaknesses in their methodology. JAMA believed that published conclusions were biased by conflicts of interest. Most researchers were now funded by drug manufacturers so they all had a stake in study outcomes.

In the past, to guard against conflicts of interest, journals asked outside experts to review potential articles, a process called "peer review". Peer-reviewers had no financial stake in the outcome. Today you can’t find a researcher or reviewer who does not have some conflict of interest, so JAMA called for changes and ethical review. In response, the New England Journal of Medicine (NEJM), one of the world's most respected periodicals, said that it was relaxing its "conflict of interest" rules because they could not find original articles whose authors did not have financial ties to a drug company. Jeffrey M. Drazen, M.D., the NEJM’s Editor-in-Chief, said that most of the seminal work in new treatments were done by investigators whose work was supported by the industry: "They are the ones who know about the new stuff." He added that the journal would continue its custom of informing readers about those who sponsored the author’s research and whether or not the author had a financial stake in it. The business of healthcare is compromising the practice of and research in medicine.

Now it's not only patients who don’t trust their doctors, who no longer believe they are making clinical decisions based solely on what they need, but rather on what their insurance will cover or what the doctor can get away with. Now it’s doctors who aren't sure of the credibility of the research results they read.

We live in a culture in which we don’t believe in much anymore, and healthcare is joining the ranks of other unbelievable institutions compromised by the pornography of bottom-line considerations. When such pursuits become our primary task, it not only robs us of our objectivity and judgment, it steals our spirit as healers.

Schlag Byte 6/3/2002 - "Wake Up to Life"

The Federal Drug Administration (FDA) approved the drug Modafinil to treat a rare neurological disorder called narcolepsy. This is a disease in which people suddenly fall asleep. They can be in mid-sentence, walking or playing a game when they suddenly drop off into sleep.

The pharmaceutical company spent an enormous amount of money developing this drug. Do you think they made this investment to treat this rare disease? Of course not! Last year Americans spend $150 million on Modafinil. Most of these people didn't have narcolepsy, or for that matter, any other kind of disorder.

People are taking this drug because they want to sleep less and stay awake more. Its manufacturer touts it as an improvement over amphetamines because it is not addictive. But nobody has a clue about what happens to people who use it for long periods of time.

Even though the FDA restricted its use for narcolepsy , its manufacturer has been promoting it as effective for lots of other conditions. In the April 2002 issue of Psychiatric Times was a two-page spread touting Modafinil. The first page said "Wake Up To Life"; the next page announced it as :

- a unique wake-promoting agent that keeps patients Alert, Aware, Awake.

- Promotes daytime wakefulness with no effect on nighttime sleep

- Improves patient's ability to participate in daily activities

- Long-term safety profile has been demonstrated for up to 136 weeks.

Sounds like something everybody ought to take.

The FDA recently told the manufacturer that their promotional materials were "faulty, lacking in fair balance and otherwise misleading". The company responded that it would present the FDA with proof that would expand the drug's approval for more than just narcolepsy. Studies are now underway to see whether Modafinil can help healthy truck drivers drive through the night and get safely to their destinations by dawn. The military is investigating whether it can keep healthy soldiers awake for long periods of time during combat. There is a study underway that is looking at its effect on shift workers.

We are becoming a culture that seeks well-being through medication. We're spending billions in research for medicines that do not treat diseases but that are adjuncts designed to support a lifestyle. The elderly can’t afford to treat their heart disease, arthritis and indigestion because we support the production of pills to keep us awake, slim, sociable and happy.

Lets wake up to life by getting one that is not in pill form.

Schlag Byte 4/8/2002 - "Animal Farm"

The January issue of Scientific American announced the creation of the first cloned human embryo. You have heard me rail on endlessly on this subject, and already know that I am terrified about the implications of changing what it means to be human. Cloning research is just a skip, jump, and slide down the slippery slope into the new "eugenics". Soon we will be able to alter our biology to create "new and better" people, even redefine what a healthy kid is. We can choose to find unacceptable, for example, those who are genetically blind, have Down’s Syndrome, or carry the genetic marker for Huntington’s disease? We will also be able to selectively enhance those genetic markers responsible for musical ability, mathematical genius or muscular development? Does this sound like an Orwellian "Animal Farm" to you? You know that if we develop this technology, somebody is going to sell it to the highest bidder, and it will happen.

I have supported the cloning ban in this country but it’s become clear that such a ban on research is not preventing its pursuit. Now I am more concerned with unsupervised research. When the profit motive determines what’s moral, we're in trouble, so I'm rethinking the total cloning ban. There is a difference between reproductive cloning and therapeutic cloning. Cloned early-stage human embryos, as described in the Scientific American article, can create needed new stem-cell lines. These cells hold the promise for curing diseases from diabetes, cystic fibrosis, leukemia, and melanoma to spinal cord injuries. We are obligated to help those who suffer which is, I think, fundamentally different than creating new people.

Just last week Dr. Severino Antinori, director of a human reproduction research center in Rome, said that a woman in his human cloning program was eight weeks pregnant. As a community of nations, the time has come for us to establish the limits on how far we are willing to go in redefining our humanity.

Schlag Byte 3/18/2002 - "Healing Chants"

Modern science continues to provide us with new biological explanations for the ways we think and behave. We can now visualize the deep structures of the brain and map out exactly where the brain responds to states of anger, sexual excitement, jealousy, as well as meditative states, love and tenderness. We have sufficient data to prove that the human immune response is modulated by psychological events. Negative emotions and stress can cause cardiovascular disease, endocrine disorders, and autoimmune disorders. Scientists have discovered that in states of fear and panic the body produces chemicals called protoinflammatory cytokines, which cause immune system dysregulation. I believe these kinds of stressors will prove to be the core mechanism behind a whole lot of diseases. On the other hand emotions like love, joy, humor, faith and meditative states enhance immune system function. Here is the latest study (British Medical Journal, December 2001) about the measurable health benefits of meditation and prayer. Dr. Luciano Bernardi measured heart-lung functions in volunteers who agreed to be poked, measured, and analyzed while reciting a prayer or mantra. Participants either recited the Ave Maria Prayer (which was spoken by one participant and finished by another, in the style of the Rosary in which the priest says part of the prayer and the congregation completes it). Or they recited a Sanskrit mantra used in many Eastern traditions, "om mani padme om," which is loosely translated as "harmony is the core of our being". Both recitations took time and slowed the subjects breathing rates to about six breaths per minute. Professor Bernardi discovered that slow rhythmic breathing improves blood oxygen levels, changes heart rhythms and increases cardiovascular responsivity. Another demonstration of ancient healing wisdom……slow down and smell the roses, find a way to be where you are, focus on something other than yourself and you will stay healthier.

Schlag Byte 2/11/2002 - "Farewell My Friend"

Betty, my beloved friend, died last week, less than five months after being diagnosed with metastatic cancer. Told it was incurable and living with pain, she decided she didn’t want to fight. She never wanted to get old and suffering with a disease whose outcome was a foregone conclusion she made a choice for herself. In the beginning I was angry with her, I didn’t want her to abandon her life force but it was right for her and I came to honor it.

Together in these last months we’ve gone to dinner, movies, played bridge -- until these last few weeks when her mind began to drift. The week before she died she was in and out of consciousness and finally admitted to a hospice. The day before she died I called her and she roused from her stupor and said, "It's good to hear your voice." "Shall I come over?" I asked. "No," she said, "hearing your voice is enough." I told her it was good to hear hers too and then asked me, "Who are you going to talk to tomorrow?" I said, "Of course I’d speak to you tomorrow and the day after that too." "Good," she said, "keep talking to me." This was our last conversation.

Betty was also my wife Elaine’s closest friend and she was with her when she died. She felt such an urgency to see her that she arrived 20 minutes before Betty took her last breath. Elaine cradled her head and told her that they were all with her, her boys were all there, everything was going to be all right. She said to her, We have laughed and cried together, been furious with one another but we’ve always been together. "We have nothing to forgive each other for," Elaine said to her.

What an incredible thing to say to someone you love before they die. My beloved friend, I treasure everything we have been together; we have nothing to forgive each other for.

And Betty, I’m still talking to you.

Schlag Byte 12/17/2001 - "Make Music"

I have two beloved friends both of whom have recently been diagnosed with metastatic cancer. One of them is virtually bedridden, requiring lots of pain medication, complaining and angry. It fills me with sorrow. The other is going to work with an oxygen tube in his nose, wearing a pain patch and saying that as long as he can do good work he's going to keep on. He is living whatever time he has left.

Reminds me of a story I received a while back through the E-mail grapevine about how important it is to keep making music with the instrument you have left.

"On Nov. 18, 1995, Itzhak Perlman, the violinist, came on stage to give a concert at Avery Fisher Hall at Lincoln Center in New York City. If you have ever been to a Perlman concert, you know that getting on stage is no small achievement for him. He was stricken with polio as a child, and so he has braces on both legs and walks with the aid of two crutches.

To see him walk across the stage one step at a time, painfully and slowly, is an unforgettable sight. He walks painfully yet majestically, until he reaches his chair. Then he sits down, slowly puts his crutches on the floor, undoes the clasps on his legs, tucks one foot behind and the other forward. Then he bends down and picks up the violin, puts it under his chin, nods to the conductor and proceeds to play.

But this time something went wrong. Just as he finished the first few bars, one of the strings on his violin broke. You could hear it snap — it went off like gunfire across the room. There was no mistaking what that sound meant. There was no mistaking what he had to do.

People who were there that night thought to themselves: "We figured that he would have to get up, put on his clasps again, pick up the crutches and limp his way off stage — to either find another violin or find another string for this one."

But he didn't, instead, he waited a moment, closed his eyes and then signaled the conductor to begin again. The orchestra began, and he played where he left off. And he played with such passion and such power and such purity as they had never heard before. Of course anyone knows it is impossible to play a symphonic work with just three strings. I know that, and you know that, but that night Itzhak Perlman refused to know that. You could see him modulating, changing, recomposing the piece in his head. At one point, it sounded like he was de-tuning the strings to get the new sounds from them that they never made before.

When he finished, there was an awesome silence in the room. And then people rose and cheered. There was an extraordinary outburst of applause from every corner of the auditorium. We were all on our feet, screaming and cheering, doing everything we could to show how much we appreciated what he had done.

He smiled, wiped the sweat from his brow, raised his bow to quiet us, and then he said, not boastfully, but in a quiet, pensive, reverent tone, 'You know, sometimes the task is to find out how much music you can still make with what you have left'."

Schlag Byte 12/03/2001 - "One Flew Over the Cuckoo's Nest"

Ken Kesey, the great novelist and counterculture icon of the Sixties died from liver cancer a couple of weeks ago at age 66. Kesey's fame rocketed when his blockbuster novel "One Flew Over the Cuckoo's Nest," was made into an Academy Award-winning movie. It is the story of a prisoner who fakes insanity to escape from a prison farm. At the mental institution he has an enormously beneficial effect on seriously disturbed patients but because he challenges the hospital authorities he is labeled antisocial, non-compliant, aggressive and ultimately incorrigible. After being medicated, isolated and straitjacketed, the staff is still unable to alter his behavior and he is lobotomized.

Kesey made you wonder about what was crazy. He loved to poke fun (he called it pranking) about the ridiculousness of things. In 1964, Kesey organized a bus tour across America, with his "Merry Pranksters", which was chronicled in Tom Wolfe's 1968 book, "The Electric Kool Aid Acid Test" and came to symbolize the psychedelic '60s. Kesey’s bus came through Phoenix during the Presidential campaign that year. It was wrapped in American flags and flew a banner that read, "a vote for Barry is a vote for fun".

The psychiatric profession no longer advocates prefrontal lobotomies to change unacceptable behaviors. We have become much more sophisticated in mapping the brain and pinpointing those areas responsible for aggression, distractibility, and hyperactivity. Now we treat those symptoms chemically with tailor-made medications that act on specific areas of the brain like the hippocampus and amygdala or we do microsurgery with cryoprobes to freeze specific sites.

With these techniques we are trying to promote quick fixes to our social and behavioral problems. Kesey’s warning in "Cuckoo's Nest" is about what excesses are possible in a culture that uses chemical and surgical manipulation to alter human behavior and it is still relevant.

For example a new surgical procedure had been developed to cure blushing which is hardly a life-threatening disease. Most of us have blushed and also experienced somebody pointing us out saying, "she/he is blushing", which usually draws a giggle. It embarrasses us but we get on with our lives. Some people are chronic blushers and really don't like it, 80 percent of them can be cured by a surgical procedure called "endoscopic thoracic sympathetomy". This is a 15-minute operation that is performed under general anesthesia. Two or three small incisions are made between the ribs, just below the armpit. The endoscope is poked into the chest cavity and through it, you can see inside. The surgeon isolates and then cuts the sympathetic nerve fibers. The sympathetic nervous system controls unconscious involuntary functions like breathing, heart rate, digestion, sweating and blushing.

Cutting those sympathetic nerves also comes with lots of side effects. Fifty percent of the people who have the procedure notice an increase in lower body sweating. Thirty percent salivate excessively when exposed to certain smells or tastes. A small percentage develop "Horners Syndrome", a condition in which the eyelid droops and the pupil is permanently constricted. In spite of these complications there are people going for the quick fix. The operation costs about $6,500 excluding hospital expenses, and medical insurance usually covers it. Blushing is not a disabling disease it’s usually the fear of blushing that is far more disabling. That fear can be dealt with by psychotherapy, biofeedback, behavior modification, hypnosis, even changes in diet. We have got to stop promoting surgical "cures" for alleviating our social anxieties.

Kesey's dead but his cuckoo is still flying over the nest.

Schlag Byte 10/15/2001 - "The Last of the Mohicans"

I am speaking at a health conference that's taking place at an exquisite retreat on Lake George, in New York's Adirondack Mountains. On this "Queen of Lakes" the tribes of the Eastern woodlands canoed, the Revolutionary War was fought and what remains is the pristine forest it always was. I went a couple of days early so I could kayak into "The Narrows" and spend a day in its heavily wooded islands.

I disembarked on one called Mohegan Island to sit and eat my lunch. There are squirrels chattering, chipmunks share my food, and I dropped a line into the water. While reading I became aware that a single spruce needle was dangling from a single spider thread in front of my eyes. It was dancing in the breeze. Looking up I saw a spider slowly cross her web. Whenever she moved the needle danced and I was entranced by this ballet. I tried to go back to reading but was invariably drawn back to the dancing needle which never fell. I didn't make much of it until later that evening when I finished the article. It is a story about a man who lets surgeons place a plastic heart into his dying heart to save him. Mr. Robert Tools is 59-years-old who five years ago was forced to leave his job because he could hardly breathe. Now he is too sick to qualify for a donor heart. He was sent home to spend his last weeks with his family.

The makers of a new mechanical heart were ready to try it on humans. All the things that made Mr. Tools ineligible for a heart transplant made him eligible for the mechanical one. This was his last thread to life. Eight weeks later Mr. Tools is walking around. He says he’s eager to get back to fishing. He knows his future is uncertain, but says, "it feels great just to be able to look around, see people and thank God".

That's what the dancing spruce needle is all about. The Hopi say that Spiderwoman is the weaver of the web of life. On her strands we move through our earthly existence. Sometimes our web breaks and we are close to falling and she reminds us, we can be saved by a single strand of hope.

Schlag Byte 07/23/2001 - "No Time for Questions"

My morning newspaper recently announced that some physicians in Phoenix have adopted a new policy with their patients. Patients are limited to asking two questions per visit. A woman with questions about her cholesterol, the bump on her hand, and her allergies had to make another appointment. One family doctor was quoted as saying, "it wasn’t unusual", he knew a physician who allowed only one question.

This is a direct outgrowth of managed care in America. Doctors need to see a certain number of patients per day in order to meet their overhead. Since they get paid the same if they see a patient for five minutes or 20 minutes, economics dictates that if you see a patient for more than five minutes you're losing money.

This policy compromises healing relationships, but medicine has become just like every other industry: time is money. A spokesperson for the AMA says it " encourages patients to ask questions," however they’re also recommending that office managers inform patients that they have a "limited question policy" so that patients will be prepared for it and accept it.

Don’t accept it! Find a physician who doesn't have his finger on a stop -watch. Find doctors you respect, trust, and who will spend time answering all your questions, then pay them what they are worth.

Don’t let the economics of health-care steal our healing spirit!

Schlag Byte 07/02/2001 - "No More Placebo Effect"

It is part of mainstream medical thinking that one-third of patients get better if you prescribe an inert pill or sham treatment, this is called "the placebo effect." In last months prestigious, New England Journal of Medicine, two Danish researchers reviewed the worlds literature on the placebo effect and concluded that it was a myth. It didn’t matter whether patients were given something or nothing at all, both groups showed the same improvement. The doctors concluded that if you did nothing and people got better it meant that whatever you did would improve the outcome, it’s not the pill or treatment.

The problem here is the assumption that if nothing is done nothing is happening. This is ridiculous, something is always happening. You get up in the morning and may say a prayer, stroll in the park, look at birds, see a rainbow, hold your grandchild. Something is always happening even when we’re not consciously aware of it. The unconscious mind responds to smells, touch, faith and family. The unconscious mind influences healing even if it cannot be statistically measured. For scientists whose only truths are measurable by official binary analyses they transform science into "scientism." Scientisms’ sacred credos are if it can’t be reliably measured it doesn’t exist and that material things are the foundation of everything.

Every doctor and every patient knows that health outcomes have as much to do with those things that can’t be measured as those that can. Just as spiritual truth can exist without historical fact so can healing exist without scientific explanation. The great danger in the New England Journal article is its readers might conclude that it doesn’t matter if you spend time talking to patients, touching them, consoling them or even holding them. Every doctor must know these are all ways that intensify their healing power.

The Wizard of Oz gave the Tin Man, Scarecrow and Lion gifts of enormous value; heart, brain and courage. Even when Toto the dog, unimpressed by all the magical trappings, ran behind the curtain to reveal who the Wizard really was, it changed nothing. The Travelers got what they came to find. The wizards of healing are everywhere, even when nothing measurable is being done.

Schlag Byte 06/11/2001 - "Rosita Visits Superman"

Rosita is a beloved friend, I call her sister. She is a mental health professional, wife, mother, grandmother and one of the most inspiring speakers I have ever heard. Eight years ago Rosita was diagnosed with Multiple Sclerosis. She’s up and around, sometimes uses a cane or rides a scooter around shopping malls. Recently Rosita decided not to continue with the rigors of professional speaking. No more year-in-advance scheduling, cancelled flights and no anxiety on the platform for fear of losing control.

We just spent a weekend together at her beach house on Anna Marie Island, near Sarasota. This is a gorgeous place with silken sand and a glorious sunset where the last light illuminates the sea like a lightning bolt. This is an easy place to talk about life.

Rosita told us about her visit with Superman. Christopher Reeves, who played Superman in the movies spoke in Gainesville recently. Reeves broke his neck six years ago in a horseback riding accident and was instantly rendered quadriplegic. Rosita described his impact on the platform. Leaning back in his wheelchair, connected to a breathing device he speaks audibly and tells his audiences that it is possible to choose to live no matter what your condition is. He currently lectures all over the country to disabled groups and able bodied audiences, to students and business executives. He tells them he did not always feel this way. It took a long time not to want to die. But his wife and children wouldn’t let him see himself only as some tragic cripple. They made him look at another reality; they saw a man inside they loved and believed in. They helped him see the light at the end of this tunnel.

I asked Rosie what she remembered most about his lecture and she said, "He kept repeating the phrase, when I get up. He never doubts that he will get up and move. That’s what it’s all about, if you want to live you have to keep moving. I’m going to keep walking, sometimes I may even be talking."

These are my heroes, the real Supermen and Superwomen who are never so afraid they stop moving. The light at the end of the tunnel is not an illusion, the tunnel is.

To see the image for this Schlag Byte, please visit http://www.healingdoc.com/bytephotos/061101.html

Schlag Byte 02/26/2001 - "Winnie the Pooh has A.D.D."

I’ve dribbled on endlessly about the over-diagnosis and over-medication of younger and younger children diagnosed with learning and behavioral disorders. We have in the current lexicon even created disorders previously unknown.

The current bible of psychiatric conditions is the DSM-IV, which now includes a disorder called "Oppositional Defiant Disorder". What is that? It’s a pattern of negative, hostile and defiant behaviors in children and adolescents that lasts at least six months. Oppositional Defiant Disorder children demonstrate at least four of the following characteristics: losing temper, arguing with adults, refusing to comply with requests, deliberately annoying people, blaming others for their mistakes, and are angry and resentful. Do these behaviors sound at all familiar to you? Do your own teenagers fit this profile? Are we going to psychopathologize the whole of human experience? We have got to lighten up!

The annual Winter Lampoon issue of the Canadian Medical Association Journal included this article submitted by the Department of Pediatrics as Dalhousie Medical School entitled "Pathology in the Hundred Acre Wood." The authors say Pooh, the bear with very little brain, could be suffering from microcephaly and A.D.D., inattentive subtype. Pooh is obsessional (he can’t focus on anything but honey), he is impulsive and, doesn’t think things out. Even though he seems bright, he can’t stay on track, obviously he needs Ritalin.

Piglet has a Generalized Anxiety Disorder for which he might need Paxil. Eeyore is a chronic dysthymic (mild depressive) for which Prozac could be helpful (maybe just nibbling on St. John’s wart). Tigger, the affectionate tiger, is impulsive and displays a recurrent pattern of risk-taking behaviors. Christopher Robin they couldn’t find a diagnosable condition for but clearly there is a problem here with his parental supervision. They allow this kid to spend a lot of unsupervised time talking to animals. I loved this piece although lots of people wrote critically that the authors should be ashamed of making fun of mental illness.

It’s hard raising children, and it’s hard growing up but wandering through the enchanted forest isn’t always pathological. If we’d spend more time playing with our kids and talking to bears in the woods I think we’d need less medications.

Schlag Byte 02/19/2001 - "What's a Heart without a Mind?"

The response to last weeks Schlag Byte has been overwhelming. I want to thank all of you who sent me your blessings and thoughts. It seems to strike a universal chord in all of us when we become aware of our parents' mortality. It leaves us heavy as we watch the irrevocable decline in what once was indestructible. One of the respondents raised the important unanswered question. How do we balance the awesome power of our technology with its potential negative impact on the quality of our lives? This is Janet’s letter:

"My father (age 82) had triple by pass surgery 2 weeks ago. I am not sure he will live long enough to realize the benefits (and I've felt guilty for these thoughts). The surgeon said he would have more energy to do the things he used to be able to do (like what?). My dad's daily level of "fully functioning" (his entire life) consisted of walking the dog 100 yards a few times a day. As he got older (and the blockage got more severe) he reduced this to 50 yds once a day. He was content. He was doing everything he wanted to do - his mind was (is?) incredibly sharp; he was still working daily on craft projects and active with church. But when he had a stress test and then an angiogram and THEN was told he had 95% blockage in two main arteries - no one questioned the recommendation for surgery and everyone decided that dad's level of "fully functioning" wasn't enough.

I never told my dad I didn't think he should have the surgery. He will never know that. I only support him as fully and as totally as I can because this is what he wanted. My prayers for him are that he lives to walk the dog again 100 yards twice a day and he will believe this was all worth it.

Thank you for your words this week. I applaud your mother's courage as I do my father's. You and I are both realizing we will love our parents and the choices they make."

Last weeks New England Journal of Medicine reported forty percent of patients who were placed on a heart-lung machine showed a 20 percent drop in their mental ability five years after heart surgery. Doctors have always known that people lose their mental sharpness immediately after such operations. We thought however that they recovered fairly quickly; that is not the case. Think about it, in the United States alone an estimated 400,000 people a year are put on the heart-lung machines for coronary bypass operations. This means that 160,000 will lose a significant amount of their mental ability.

Our technology has made it possible to do surgery that lengthens lives, now the task is deciding whether it’s a quality life.

Look at all the options and then "love our parents and the choices they make."

Schlag Byte 02/12/2001 - "My Indestructible Mother"

My mother has been getting shorter and shorter of breath of late. It’s gotten to the point where she now has to rest after taking a shower or getting dressed. Her doctor says she has a leaking mitral valve so every time her right ventricle pumps blood into the pulmonary artery and into lungs, only half gets there, the rest gets pushed backwards. He recommended she consider surgery because she is still in good shape and he thought the chance of operative success about 90%.

She goes to a heart surgeon, who spends a lot of time with her and after the exam, tells her he can fix the valve, but she ought to think seriously about it. At 87 years of age there are more risks no matter how good of shape you’re in. It’s a long time to be under anesthesia and brain circulation isn’t always great. The surgery could be a success but she might not. Your mind is sharp, you’re playing bridge every day, you go to concerts and take care of your own house. Even if surgery gives you several more years you ought to know it’s going to take eight months to a year to recover fully from this major operation. There are also medicines that will help you breathe better for a long time.

My mother asked him what he would recommend if she were his mother. He said, "First of all, I’d tell her the odds are more like 60% and if she were as fully functioning as you, I’d tell her not to do it." It didn’t take my mother a millisecond to decide. She said she felt as if a weight had been lifted from her chest. "What’s the point?" she said, "for couple of more years, I could also end up sitting in a wheelchair with my tongue hanging out, that’s not me."

She had been scheduled for an angiogram for which I made arrangements to be there. The test was now unnecessary so I said maybe I wouldn’t come out. "Come anyway," she said, "you have a ticket, you made the time, let’s have a party and celebrate life." It didn’t take me long to decide a party might be a good idea.

My heart is heavy. Her decision is irrevocable; her leaky valve is not going to get better. I have always had a sense my mother was indestructible. My mother has survived Nazis, two husbands, and spent a lifetime working. Now she plays bridge (sometimes twice a day), gives luncheons, bakes, e-mails her grandkids and does exercises to a videotape every morning. Yeh, let’s party and celebrate life.

She greeted me with homemade pea soup loaded with kosher knockwurst, one of my all time favorites followed by cheesecake and coffee. Then she invited friends and we played bridge until I pleaded mercy and went to bed.

In the morning she said she wanted to go over some things and sat me down with a pad and pencil. She wanted me to write down her lawyer’s name, what bank her CD was in, the address in Germany to send a copy of her death certificate to discontinue her reparation payments. "There is always five thousand dollars in my checking account to cover my funeral expenses," she said and I raised my hands and said, "Enough Ma." She said, "Hey, this is my party and it’s not over yet. I just want you to know what to do with my stuff when the party’s over." We laughed and cried.

I’m thinking your mother always has something to teach you. It doesn’t matter if she is here or not, she is indestructible. I’m hoping I can party with my kids when we have this discussion. Sit around together, listen to some Jerry Garcia, open a bottle of vintage port, light some sage and talk about what happens when the party’s over.

Schlag Byte 01/15/2001 - "The Power of the Human Spirit"

In November 1999, Nicole Barrett, a 27 year old Texan moved to New York City to start a new job and life. Weeks after her arrival those dreams were shattered. A stranger, on a midtown Manhattan Street corner smashed a 6 lb. paving stone over her head breaking her skull and leaving her near dead. Weeks later she amazed everyone at Bellevue Hospital when she woke up.

This small town Texas girl was a bareback horse rider, an excellent shot and a student pilot. The assault left her unable to remember, read, make sense of stories or numbers, and emotionally unstable. After several brain operations nobody really believed she would ever lead a normal life.

In her debilitated condition she returned to Texas where her parents and therapists nurtured her recovery. Her garbled speech slowly became understandable. The many manifestations of her organic brain syndrome improved dramatically.

She just celebrated the first anniversary of her survival and is thinking clearly, reading, walking, and considering riding again. She has never been depressed.

Nicole says, "I’m not going to spend my life agonizing over the bad things that happen. I will always think positive and look forward. A lot of people say, how can you be so positive. I don't understand how so many people accept defeat. Who is going to try to tell me that I cannot live?"

Nicole Barrett refused to be categorized; she refused to believe that she had to live her life as a victim or a half-dead person. She hopes to return to college soon and complete a degree in interior design.

When I read Nicole’s story, I felt my spirit soar. She reminded me that it’s possible to live your life in every moment; to seek out the positive; to be lovingly connected; and to be balanced in your life.

Thank you Nicole.

Schlag Byte 10/23/2000 - "Fat's Out in Fiji"

I was recently in Minneapolis to address the Aveda Corporation, perhaps the world's premier purveyor of high-quality beauty products.

The event took place at Northrup Auditorium at the University of Minnesota and was filled with 4,000 well coifed, chic, beautiful people. The backstage prep rooms were a three-ring circus with hairdressers, makeup artists and dozens of drop-dead gorgeous models being prepared for a Hollywood production number. I was bombarded with beauty and paraded around with a perpetual grin. Later, I felt guilty about the seduction of such loveliness as I read this piece from the Journal of the American Medical Association (JAMA, 2000, 283) on my return flight. In the five years since television broadcasting began in Fiji, symptoms of eating disorders have increased five-fold; teenage girls in Fiji who watch television at least three times a week are 50 percent more likely to see themselves as fat and diet. This is a Polynesian culture in which thin has never been in. Now that Fiji has broadcast programs, mostly from the United States, Australia and Britain, this culture has changed its perception of what it means to be beautiful.

It scares me when the power of media, models and entertainers can sell our perception of idealized beauty and other cultures choose to buy them.

Schlag Byte 6/26/2000 - "Can't Pay? Die."

A recent front-page feature article in our local paper was about the elderly streaming over the border to get drugs. By the chartered busload, the elderly from Arizona (California and Texas too) go to Mexican pharmacies to get their prescriptions filled because they are significantly cheaper there.

Why are prescription drug prices so prohibitively high in this country? Drug companies say it's because their research and development costs are astronomical. There's no question that pharmacotherapy advances in treating serious illnesses have been impressive and laudable. However, lots of research dollars are focused on drugs intended for the appetites of customers who are already reasonably healthy. Research for blockbuster drugs that grow hair, remove blemishes, and curb appetites earn companies billions of dollars each year.

Let's use some of those profits to make existing drugs cheaper for the old and the poor. There are lots of drugs that are cheap to produce that could cure people in impoverished nations and would reap a windfall of good publicity for the companies.

For example, African Sleeping Sickness still infects 300,000 people a year. It can be cured by a drug invented 70 years ago. The production of Melasoprol was discontinued last year when the company found out it was ineffective against cancer so its only use was in countries that couldn't afford to buy it. These are the same countries plagued by malaria, tuberculosis, and leishmaniasis, for which cheap curative drugs also exist.

As a "civilized" nation we cannot in good conscience continue to declare people in unprofitable markets as expendable. Nor can we abandon 44 million uninsured Americans, and the tens of millions of other marginally insured elderly whose coverage does not include prescription drugs. Otherwise we're getting closer and closer to a system in which those who can, pay . . . and those who can't, die.

Schlag Byte 5/8/2000 - "Uganda and Urbana"

The prestigious New England Journal of Medicine recently reported the results of an epidemiological study performed in Uganda on 415 heterosexual couples. In the study, one of the partners had AIDS, but the uninfected spouse wasn't told. Instead, the couples received intensive instruction as to how to prevent the transmission of the disease and were provided with free condoms. For the next two years they were monitored, but anti-viral drugs were withheld. When the study was completed, ninety more people were HIV-infected. The conclusion to this study was that the more virus a person carried the more likely he or she was to infect their sexual partner.

Does this research leave you feeling a little disquieted? Are there shades of the famous Tuskegee study where penicillin was withheld from Black Americans with syphilis to learn about the natural course of the disease. You know that this study could never have been done in America because we have access to sophisticated laboratory tests that can provide viral counts and T-cell data, which would reveal early exposure and prompt anti-viral treatment. The researchers said they violated no ethical standard because in Uganda what they provided was the best medical care the country had to offer. Since Ugandans didn't have laboratory capacity or other treatment options they were actually exceeding the local standards.

Is anyone going to buy that? We all know that the people with the most to gain from this kind of research live in "developed" countries where the best medical care is available and where we continue to elevate ourselves on the remains of the "underdeveloped."

Drug companies can afford to build laboratories in Uganda and make anti-viral agents available. How long can we keep up our moral pretense, mouthing concerns about human rights while also participating in this kind of exploitation?

Schlag Byte 4/3/2000 - "'Fill-Er-Up' For Health"

The price of oil is going up, up, up and we are bitching and moaning about it with little cause, I think. We are reaping the rewards of our pathetic attempts to create alternative sources of fuel. OPEC is not to blame, they are in business selling a product only they have and that the rest of the industrialized world needs.

OPEC will certainly realize gargantuan profits. What do they do with it all? The January issue of Worth magazine reported a Kuwaiti potentate who has his own exquisitely outfitted Boeing 747, complete with a prayer room that gyroscopically rotates to Mecca at all times. He suffers from a weak heart, so the top deck has been converted into a state-of-the-art cardiac intensive care unit. The most lavish appointment, however, is human. On-board is a living heart donor. A poor man, who is a perfect tissue match, has offered his heart if a transplant is needed. In exchange for this gesture, he and his family reap handsome rewards.

The selling of human organs is a flourishing black market; there are lots of poor people willing to sell them and a growing number of very rich people who can buy them. The genius of modern medicine is available to those who can afford it.

The rich and poor are growing further and further apart in terms of the availability of healthcare options. By the end of this year, the human genome will be fully mapped out. We will now be able to alter the biology of what it means to be human. We can make "designer" babies that are resistant to disease and abnormality and genetically endow traits like musical ability or math talent. These amenities will only be within the financial reach of the extremely affluent, thus separating even further the healthier rich from the sicker poor.

Jonathan Wiener is a Pulitzer Prize winning author. His latest book Time, Love, Memory, which examines the genetic roots of behavior, just received a National Book Critic's Award. Wiener delivered the Centennial Lecture at ASU last week, and told the audience that the two classes could even evolve into different species, prevented from interbreeding by creating genetically induced chemical incompatibility. The egg of one class would reject the sperm of another.

So when the price of gas goes up, and your hard earned cash is guzzled at the pump, find solace in the thought that you are making a contribution to the healthcare of a few and paving the way into the Brave New World.

Schlag Byte 12/13/99 - "Medical Errors"

Like many people, I woke up to my morning paper to discover that an estimated 98,000 Americans are dying unnecessarily every year because of their doctor's mistakes. Medical errors made by physicians, pharmacists and other healthcare professionals cause more Americans to die than do breast cancer, highway accidents or AIDS. This is an appalling statistic.

How does a profession that is sworn to the oath that says "primum non nocere, above all cause no harm", get into a situation like this? For one thing we have not done a good job at policing ourselves and getting rid of harmful practitioners. But it's not just bad practitioners that are responsible for these mistakes; in fact, the vast majority are human errors not committed by bad apples but by good docs, with good hearts who are trying to do the right thing under very difficult circumstances.

It's hard for docs to make a mistake in an atmosphere that is brutally litigious. We are terrified to acknowledge our human shortcomings because we think if we tell anybody we'll be sued. Health-care delivery is more complicated than ever before, and machines, computers and providers sometimes fail. We must train healthcare professionals to understand that error is not a moral failing, but silence is. We must be able to talk about our mistakes, but in today's market the instinct is to point the finger of blame whenever something untoward happens. This intensifies a culture of silence among healthcare professionals.

How do we walk that line? The President has ordered federal agencies to take steps to reduce medical errors and a new agency may be established to oversee the problem. However, we must at the same time create a climate of openness. For example, no lawsuits if there is no criminal negligence and the mistake is reported immediately. We have got to foster a better environment that allows us to acknowledge our humanness without being sentenced to a lifetime of punishment.

Schlag Byte 2/28/2000 - "Cider House Rules"

If you haven't seen the movie "The Cider House Rules," don't miss it. It's a poignant tale whose underlying theme is that those who make the rules are not the ones who have to live by them.

Michael Caine plays a caring, beloved obstetrician who is the guiding force in a rural New England orphanage. He sees the suffering of women burdened by unwanted children, and also the suffering of orphans desperate for families. He performs abortions, and his job is being threatened by the Board of Directors who object to how he breaks some of their rules.

One of his orphans, Homer, has spent his whole life in the institution and decides to see the world. He gets a job with migrant workers who are harvesting apples. The workers live in a dilapidated cider house, communal style, with a curtain being the only attempt to create a separate space for the only woman among them. Posted on the wall are rules, which no one ever noticed or was able to read. When the orphan arrived, he read them aloud, "Don't smoke, sleep on the roof, eat on the porch," etc, etc. When they heard them they laughed incredulously. Nobody in their right mind could make up such stupid rules, they thought, not if they'd ever lived in this cider house.

You don't have to live in a cider house to be subjected to cider house rules. This is the cider house rule in today's healthcare industry, "Come join our HMO and we will take care of you". What is not added is that they don't play by the rules. If you cost them too much money the HMO leaves. Only weeks ago, people living in rural Arizona counties were abandoned by their HMO's. These people, many of whom are elderly and have lived in these towns since Arizona was a territory, were told to move someplace else where they could find coverage.

Welcome to the age of cider house healthcare rules. We will take care of you as long as we want to, which may not be as long as you need to be taken care of. So the way you thought it was is not the way it is. Is it any wonder that people everywhere are rising up and demanding the right to sue their health plans? The elections are soon approaching. Let's vote to eliminate cider house rules. Schlag Byte 8/9/99 - "In pursuit of sacred space and the sauna"

My wife and I were back in Massachusetts recently where, among other things she attended her nursing school reunion. They met on a Saturday afternoon at a classmate's home in Marshfield, and I planned to find some little pond and write for the afternoon. It turned out that the reunion was right next to a Finnish summer camp which was on a lake and opened its sauna to guests (on the weekends). It was an irresistible offer.

The Uljas Koitto Temperance Society is one of three such organizations left in America. It turns out that at the turn-of-the-century there were lots of Finns in this area. They worked in the granite mines. You can't have a lot of Finns without having a sauna. For the Finnish a sauna is not just a hot room, it's a place of birth and death and many of the happiest hours in between. Ninety percent of the population of Finland goes was to the sauna at least once a week. It is so important that it was the first structure the Finnish peacekeeping forces built when they established their base camp.

In their frigid homeland, the sauna was the warmest and cleanest place on Homesteads so it was used for giving birth and for breathing one's last breath. Dr. Lasse Viinikka who heads the Finnish Sauna Society describes it this way, "everything is blank and soft there, it affects your mind. We respect the sauna, it's a holy place. We try to keep silent, we don't argue in it."

I'm sitting in the Uljas Koitto sauna with two old timers who are really heating it up. I like saunas, steam rooms and sweat lodges, so I can bear a little heat, but these guys are smoking me out. my face is hugging the ground. " You're not a Finn," one of them offers laughingly. "I'm not even sure I'm alive," I answer. They help drag me out, and we plunge into the ice-cold lake. When we return for another round they tell me about the Temperance Society. "It was the Italians," they said. "We worked with them in the mines. They drank with every meal, but we weren't used to it. We only drank at celebrations so we got hooked." The Society was formed as a defense against the problem of alcoholism among Finnish men when they came to the New World. The wood burning sauna was built when the summer camp was found 75 years ago. It saved a lot of individuals and families.

My companions told me mostly old people come. They've opened up to guests who don't have to take a vow of abstinence to participate. Afterwards we sat around, ate Finnish delicacies and gabbed. They teased me, suggesting that if Americans had more saunas, they would need fewer psychiatrists. The sauna restores the soul, they say. I agree, we need more saunas, more sacred places where one can empty the mind and see things clearly.

Schlag Byte 5/3/99 - "My Last Afternoon with Tim"

On the afternoon of March 25 I met Tim Fleming in the parking lot of Tomicita's Restaurant in Santa Fe. I saw him from far away. He walked with an occasional stumble. His face and neck were distorted and scarred from his repeated surgeries. His 6' frame down to 132 pounds. I waved. Then we hugged and we walked together to a park on Don Gaspar Street where we sat on a park bench.

"You notice my two margarita shuffle? Sometimes I stumble. It's some kind of dystonia from tumor invasion in the spinal cord. I still get out, though."

He told me about his recent book opening for Rendezvous with Clouds, his life story that ends with living and dying with cancer. Lots of friends came to the event, including the governor, colleagues, and patients. To each of them, Tim wrote a personal inscription. The whole event sounded like an incredible gift for both the giver and the receiver.

Then he went on, "Do you remember that story I told you about my vision quest and the Oryx?"

Oh, I remembered it all right. It took place after Tim's third operation and radiation therapy. He decided to participate in a charity bike race across New Mexico. He called it his "vision quest" but it sounded more like a self-prescribed test of endurance. Tim was hurting badly after the first day but he didn't want to quit. The second day was worse. And, by the morning of the third day, Tim knew he would never finish. The question was, how long could he bear it? He was pedaling laboriously, breathing heavily when he looked up. Running beside him, not more than twenty yards away, he saw a wild Arabian Oryx. These creatures were brought to New Mexico as a wildlife rehabilitation project in an attempt to save the species. The Oryx ran beside him, stride for stride, for what seemed minutes. Tim could see the animal breathing heavily. Then, as quickly as it appeared, the Oryx disappeared, which is when Tim received his vision. He was also breathing as hard as he could and could not keep up the pace. He understood that he too could stop running whenever he was ready, now and in the future. He finished his race after the next downhill coast and, to his support crew he announced that his quest was completed.

"Since my vision quest, I get up every morning and the first thing I say is, Thank you for breathing. But, hey, enough about me. What's happening with you?"

We schmoozed for about an hour about kids and grandkids, books, and lectures and then he said, "I'm getting a little cold. Not much body fat any more. Let's walk back to the car." As we strolled, Tim said, "I was thinking about seeing my daughter in Tucson again. It's a long ride, but I'd like to see her and it would give me a chance to see you in Phoenix."

After Tim drove away, I walked over to the St. Francis Hotel for their afternoon tea service. I jotted down some notes on Tim's profound teaching. If you can say thank you for breathing, you'll appreciate everything in your life a lot more. I will be saying thank you more.

He never came to Tucson. On April 19 Tim Fleming died. I want to thank you, Brother, for your presence in my life. Your light still shines.

If you're interested in reading Tim's book, it can be purchased by sending an e-mail to: bdeaux@aol.com.

Schlag Byte 4/19/99 - "Brain Surgery to Adjust Your Attitude"

Brain surgery is now being advocated for people with the common psychiatric problem Obsessive Compulsive Disorder (OCD). A surgeon destroys a tiny area of the brain found by researchers to be responsible for the disorder. In the March issue of the journal, Neurosurgery, researchers at Stockholm's distinguished Karolinska Institute analyzed 35 people who had undergone surgery to treat their OCD after they had failed to respond to drug treatment. Fifty five percent of the patients showed sustained improvement. Dr. Eric Hollander, a professor of psychiatry at the Mount Sinai school of medicine in New York, said, "finding the target area represents a real advance." Doesn't seem like much of an advance to me to be advocating psy-surgery for obsessive-compulsives when almost half the people are unimproved and left walking around with a piece of their brains obliterated. This sounds more like phrenology in new packaging.

There is no question that we're getting closer to mapping the anatomy, biochemistry and neurotransmitters in the brain. We can even visualize the central brain connections responsible for lots of behaviors. Using MRIs and PET scans, (which illuminate brain activity while it's happening) we have now localized the anatomic point responsible for the anxiety disorders. It's an area no bigger than the head of a pin called the central nucleus of the amygdala. Are we now ready to operate on people with crippling fears?

We are fine tuning our biological understanding of the human experience but will we improve the human condition by surgically eliminating behaviors? Do you believe the pursuit of our humanity is likely to be improved by advances in our technology? We will never obliterate our fears with scalpels. There is no quick-fix surgical remedy to improve the human condition and hoping to find one only keeps us from finding simpler ways to behave more cordially to each another.

Schlag Byte 3/22/99 - "A Rendezvous with Clouds"

After a decade in Indian Health, he became an emergency room doc and Assistant Professor of Emergency Medicine at the University of New Mexico. In 1994 he was diagnosed with a rare and progressive malignancy. In his just released book, A Rendezvous With Clouds (Chamisa Press, Santa Fe, 1999), Tim tells us about his extraordinary life's journey from Doctor to healer, to patient and now teacher. Tim has been operated upon, been irradiated and given chemotherapy. He is doing all he can, including participating in Native ceremonies. His cancer is doing all it can and so it keeps coming back.

This book is Tim's legacy. A distillation of his life story and his current transformation from caregiver to care-receiver. Tim shares his journey from a place so deep inside, it forces you to touch a place inside yourself that will force you to confront your own mortality.

A Rendezvous with Clouds made me realize again how precious every moment is and how much I take for granted. I want to spend as much time fishing as I do talking and I will say thank you more.

In the book's closing lines Tim concludes, "the days ahead will be spent collecting moments and closing the sacred loops. I will write, take long mountain walks, listen to loud, loud music, and remember how blessed I am for having had the opportunity to be a caregiver."

So, I want to say to you, my brother, "Thank you for walking with me on this healing journey. We have been kindred spirit in this life and you will never be far away from me. In beauty may you walk, my brother, knowing the beauty you leave behind."

Schlag Byte 1/25/99 - "Older and bolder not colder"

My young granddaughter stood on a chair and introduced my daughters and together my mother's grandchildren and great-grandchildren sang an original composition. It was hysterical. Her friends at Leisure World range in age from 75 to 95 and many of them spoke. These are vibrant, talented people - dancers, doctors, ministers, entrepreneurs, sea captains, and soldiers who still work at things. There was an 88 year old man who just had gotten married to his 85 year old wife the previous week at a ceremony attended by 185 guests. They were leaving the following morning on their Hawaii honeymoon.

These are old people who are looking forward to things. They know they are old but they lead vibrant lives. They are all getting up, getting on and getting older. They visit, discuss books, play bridge, cook and bake for each other, grow vegetables in a community farm, create furniture in workshops and encourage each other in water aerobics every morning.

I gave a final toast to them - a community lovingly connected that sustains them during their ups and downs. I thanked them for providing me, and those of us who follow, a model of what's possible. I want to become such an old person whose memories do not exceed his dreams.

Schlag Byte 1/18/99 - "Scientism is the new religion"

What is this all about? It's a power struggle between Cartesian dualists who say that if things can't be measured they don't exist and the pragmatists who hold that if it works don't knock it. Alternative medicine threatens the established order of things. The same thing happened when the church was in power and was threatened by science. For Relman, science has been elevated to "scientism," believing only what's provable. Andy Weil threatens him because he is a fellow Harvard man and, therefore, can't be cavalierly dismissed. In Relman's article, he said he finally discovered what led this Harvard scholar to such softheaded thinking. In reviewing Weil's books, Relman discovered Andy did research with marijuana, psychedelics and altered states of consciousness. Now he understood Weil's teachings are simply the result of a once great mind turned to toast by drugs.

The bottom line is that alternative medicine is a threat to the medical establishment's exclusive entry into the healing mystery. Relman and other critics have confused science with scientism, clinging to the belief that there is only one path to truth. Arnold, lighten up, your intolerance will lead to bad humours.

Schlag Byte 1/11/99 - "Patch Adams"

For the last three weeks Patch Adams, the movie, has been the #1 box office success and it has received two Golden Globe nominations. Audiences love it but the critics have panned it. This is a movie about a young man who is institutionalized in adolescence for a mental breakdown and subsequently decides to become a doctor. He graduates from medical school, not without some difficulties. This is a story about ten years of a young man's life and how he becomes a loving healer.

What is it the critics don't like? Here is Bob Fenster's review from the Arizona Republic: "This couldn't be a story about a real person...he is smarmy and self-righteous...he couldn't heal anybody." Let me tell you about my friend Patch Adams, Bob. He is a real medical doctor who, since medical school graduation, has spent his life living his message. He clowns with doctors and patients all over the world. In orphanages and old age homes, in schools and hospices, he has healed the sick even when they could not be cured. With compassion and humor he has helped people find an inner peace that eases their journeys.

Patch Adams is now 53 years old. After a lifetime of loving service he is finally seeing his dream come true -The Gesundheit Institute - a hospital in West Virginia that will provide free healthcare to all comers. No payment of any form will be accepted, not even insurance payments. Patch Adams says this hospital will be sustained by "love offerings." He already has physicians, therapists of every kind, gardeners, musicians, chefs, and poets who have donated their services.

This "smarmy and self-righteous clown" that Fenster described is a real doctor, who has received the Templeton Award for Creative Altruism and who walks his talk.

The public feels the movie's underlying sincerity even if the critics can't. I hope Patch makes his dream a reality. Patch ennobles my profession. He reminds me of the doctor I would most like to be, a loving healer.

Schlag Byte 11/23/98 - "Wendell Todd"

Wendell Todd is an old friend--an ear, nose and throat surgeon. We worked together for many years in the Indian Health Service. Wendell has probably done more radical mastoid operations than anybody in the world and was beloved by his patients. Nowadays he does a lot of cochlear implants which are electronic devices that can help some congenitally deaf kids hear. It's an expensive operation and it has to be done before the age of four because after that age the learning pattern becomes so ingrained that the procedure is not effective. Treating congenital deafness requires early detection which means screening newborns. Who is going to pay for this? Do healthcare providers have an interest in this kind of screening when the results will cost them fifty thousand dollars? Most insurance companies and HMO's resist such procedures even though they espouse preventative health screening. When Wendell finds a congenitally deaf child who is a great surgical candidate with a committed family, he fights with their insurers to pay for the procedure.

Tonight at dinner he tells me, "I'm thinking about retiring. This struggle is stealing my joy. Yet, when I see those kids hearing, it keeps me coming back." I worry about the future of healthcare when the paperwork and struggle force the "Wendells" from their profession. During this holiday season, let's say thank you to all the healers who sustain us in this world.

Schlag Byte 10/12/98 - "Prozac on TV"

The first TV commercials promoting Prozac, this country's leading antidepressant medication, have just been released. TV watchers are encouraged to call a toll-free number to learn more about depression and an unnamed prescription medication that will cure you.

This will lead to lots of people calling in for advice because nowadays nobody can talk to a doctor. Doctors don't have time anymore. Managed-care, with its emphasis on numbers, does not reward practitioners for having relationships with their patients, so people have to diagnose themselves. Nowadays the marketplace determines the quality of healing relationships so it makes sense for drug companies to talk directly to the consumer. It has got to be clear that the drug company is disseminating information with the hope of selling Prozac. Prozac sales worldwide earned Eli Lily a cool 2.6 billion dollars last year - up 8.5 percent over the previous year. Pharmaceutical giants are becoming the health educators of the world. Promoting drugs has become a cultural lifestyle.

This is not a good idea. Most of us will have ups and downs in our lives and we can find ways other than drugs to deal with them. Chemicals are not the only things that can restore us to balance. Better living through chemistry is not the only way to feel good. There are ways other than drug connections to recover from your depression. Find people to talk to, find something or someone to believe in, build community and reach out.

Does anyone really believe that a drug company is the best public health vehicle we have to help people understand and deal with their depressions?

Schlag Byte 9/14/97 - "Doctors' skills"

If there's any way to be sure that someone is a doctor it's by seeing that stethoscope draped around their necks. Unfortunately, the ability of doctors to use that instrument may be becoming a dying art.

Just this week, the Journal of the American Medical Association, reported a study of 453 recent medical school graduates. These new doctors were in training programs in internal medicine and family practice and were asked to listen to the recordings of patient's pathologic heart beats. Only 20 percent of them could do it.

Our clinical skills today are less than they were a generation ago while at the same time, we have become more skilled in the corporate applications of medical practice. Yet we can learn more from a patient by talking to them for 15 minutes and doing a physical exam than we can by filling out questionnaires and doing lab work.

In this age of managing health care, we are losing the core skills of what it means to be a doctor, like learning to listen, putting your hands-on, and establishing healing relationships.

Schlag Byte 8/11/97 - "Medical costs"

Everybody knows that the tail of cost control is wagging the dog of medical care. Managing costs means reducing operating expenses to ensure profitability. This means doctors are having to ask themselves questions that they never asked themselves before, like "can I get away without doing this" rather than is it in the best interest of my patient.

Doctors at the Thomas-Davis Medical Centers in Tucson and Phoenix say they won't do that anymore and are resigning in droves because cost-cutting measures are hurting patients. Out of 129 doctors, 52 have resigned from the Thomas-Davis Medical Centers in Tucson and Green Valley since September 1996 and about 30 more have resigned from clinics in the Phoenix area where 85 physicians were employed a year ago.

Dr. Donald Speer, the President of the Pima County Medical Society, said the number of physicians leaving Thomas-Davis is alarming. "It's not an economic issue" Speer said. "It's physicians who are concerned about the quality of care they provide. Many of these doctors are quitting with no known alternative professionally and that certainly reflects the intensity of their feelings." One cautionary note however, these doctors sold their practices to the clinic for a substantial up front payment thus setting the stage for subsequent commercialization and the current crisis.

If we ask ourselves today who is directing healthcare, it's got to be clear that it's the wrong people. We must stand up as 2,000 physicians in Massachusetts just did, representing many of the preeminent institutions in our country, and say no the corporatizing of healthcare delivery. Our profession a ministry not an industry.

Schlag Byte 7/27/97 - "Community psychiatry"

People browsing my Web site see my description as a community psychiatrist and ask me "what is that". This saddens me, it makes me reflect on the rise and decline of the community mental health movement in the United States.

Community psychiatry was in its heyday when Congress passed the Mental Health Systems Act during the Carter Administration. Psychiatrists had learned that mental illness did not just result from some "infantile traumatic neurosis", and understood that symptomatic behavior could be the expression of such things as racism, poverty and enforced dependency. Clearly there were things outside of peoples control that had some influence in determining their destinies. Community psychiatrists believed that effective mental health consultation needed to address such issues in addition to examining the intrapsychic determinants of behavior.

Community psychiatrists looked at cultures and neighborhoods and provided multi-dimensional interventions (like helping people educationally and vocationally). Community psychiatrists advocated a continuum of services that included crisis intervention, inpatient care, and aftercare in the community. The whole idea was that services should be community-based and every effort made to keep people close to their support systems, their social networks, their families and churches. Community psychiatrists understood that services needed to be affordable and could be delivered at homes, schools, even in barber shops.

This community-based approach gradually changed in the 1980's when the Nation was facing an exploding national debt and rise in defense appropriations. To save money, the Reagan Administration began whittling away at the human services infrastructure.

In the 1980's, the White House Conference on Children, which had been held annually since the early 1900's, was canceled. That was the first step in the Federal Government's decision that gave to the individual States "block grants" and the responsibility for implementing social service and mental health programs. This decision led to the delivery of inadequate services everywhere. Arizona recently ran out of money for services to the chronically mentally ill and eliminated those patients from receiving health care.

Where is psychiatry's voice in all of this? Since todays psychiatrists have become enamored of biological explanations for disease, we prescribe more pills. We believe that through genetics and biochemistry we will be able to manipulate the physiology of the brain and thus eliminate severe mental illness. If only we could find the right medications to rewire the right pathways then we could then biologically eliminate the problem. Today, financial support for psychiatric research, is genetic and drug centered which really doesn't help us much in treating the societal problems of disintegrating values, hunger, violence, addictions and homelessness.

Where is community psychiatry? Moribund like the rest of our healthcare system, in which lots of people and problems don't get attention. We need to get back to being

healers of humanity and not just dispensers of technical wizardry. Community psychiatrist still need to help people understand something about who they are and how they relate as families, citizens, and even as members of a global community. This is the best way to have influence in making a difference in todays problems.

Schlag Byte 7/13/97 - "Cancer"

The esteemed New England Journal of Medicine recently reported that new treatments for cancer haven't done much to reduce mortality from that disease. The death rate from cancer, even when corrected for people growing older, is about the same now as it was before we "declared war" on cancer, a decade ago. The Journal article argued the battle should shift to another front, that of prevention. The authors contended that cancer researchers spent far too much time chasing elusive breakthroughs and too little time on efforts to eliminate things like smoking or persuading people to live healthier lifestyles. (Of course it's harder to get a Nobel prize for promoting more exercise, eating healthier foods and avoiding excess sun.)

We learned this truth a long time ago in Indian Country where scientists studied diabetes among the Pima. This tribe has an extraordinarily high diabetic population and is probably the most studied Native population anywhere. Multiple generations of families have now been tested by National Institute of Health scientists in an attempt to discover the biochemical and genetic underpinnings of the disease. What they discovered was, that if people stopped eating fast foods, changed their diets and lost weight, then diabetes on the Pima reservation would virtually disappear. Did the government put money into such preventative programs, no, instead it funded more doctors to do more research.

The great advances in medicine have never come from more doctors treating more diseases; they come from eliminating the causes of disease. If we helped smokers quit and changed our diets we'd eliminate half the cancers we see and save a bundle of money besides.

Schlag Byte 5/17/97 - "Patch the Clown"

I have a beautiful friend whose name is Patch Adams. Patch is a family physician and his passionate commitment in life is to be of service.

He is also a clown who travels around the world taking people, who clown with him, to visit orphanages, hospitals and old-age homes. Patches lifes work is the subject of a forthcoming movie, his part will be played by Robin Williams. Patch Adams, M.D. has sustained many of us with his idea that healthcare can be delivered with love and that love could sustain it. He has made this dream a reality by starting to build a hospital in West Virginia where medical services will be performed without charge. The institution will be sustained by contributions, love offerings.

We like to play together and recently the designer, who creates all of his costumes, came up with a new one, a toilet. I loved it, and said to Patch, let's do some spontaneous improv on the Capitol steps and make a statement about where healthcare is going in this country.

Let me describe the costume. It comes in two parts. First you wriggle into a tight fitting white bodysuit. Over your thighs, ankles and wrists you pull on foam rubber, hexagonal fittings, that make you look like toilet plumbing. There are hot and cold faucets on your chest. Now you pull a toilet, replete with a bejeweled toilet lid and water tank, over your head. You strap this contraption around your chest and back. Only your head and eyes peek out through the toilet seat. I am Toilet Man!

Except I only had dark shoes and the costume clearly called for white bucks. So we decided to go to the Tysons Corner Mall (as big as any mall in America). Patch goes as a clown, with a baseball cap that holds a toilet paper roll. I go as his toilet. In the mall we are stared at by thousands.

People looked at me but they couldn't see me. They saw a man whose eyes and head protruded from a toilet. I however could see them completely. Some looked at me directly, some ignored me, one kid came up and touched me while another child cried. Some people wanted to carry on a conversation but I was mute. The only sounds I made were toilet noises; I love doing this in public! This is an unbelievable experience usually. I can't shut up but here I'm just Patchs' toilet. Then I think, this is pretty much what I do for a living as a psychiatrist. People dump all their crap on me and I take it. I am, a professional toilet and in Tysons Corner Mall I finally sound like one. But hey, as a toilet people expect those kinds of sounds. Toilet Man!

One lady asked Patch who he really was and he responded "I'm a doctor". "I would never go to a doctor like you" she rejoined, "Do you have a card?" - Patch showed it to her, asking "don't you think healthcare in this country is going down the toilet?" She agreed and after a while said maybe I could see a doctor like you who is walking his toilet.

Then into Nordstroms shoe department. Patch says to the salesman, "I'd like to get a pair of white bucks for my toilet". And the Nordstroms salesman says, "I think I might be able to find something. Why don't you have your toilet sit down". This is what I call customer service! I don't know how many toilets this Nordstroms salesperson has served but I want to tell you, he dealt with me respectfully.

I just saw my friend Andy Weil in Time Magazine. He is a distinguished physician, ethnobotanist and author and in the magazine he appears naked to the waist covered with mud and holding a bouquet of leaves. I know I can go out in public as "Toilet Man".

Schlag Byte 2/24/97 - "Stuffed animal therapy"

At Saratoga Hospital in northeast Detroit an elderly woman whose grasp on reality is dissipating, is curled up in a fetal position and crying. A nurse gives her a stuffed animal which she clutches instinctively and it quiets her down.

You won't read about stuffed animal therapy in any medical journal but at Saratogas' Seniors ward they apply this unique treatment to their patients. Between two and three thousand stuffed animals have been donated and handed out to people over sixty-five years old who suffer from mental deterioration or loneliness. The hospital finds that these small acts of compassion makes a big difference in the lives of those who have nothing to hold on to.

Stuffed animals do not just work for people with senility, it works with people who are depressed, it works with people who anxious and it works with people who are facing major crises in their lives. It works because donated stuffed animals are not just toys, they have been previously loved. Each comes with its own story and history that people respond to; They remind us that we are connected to something other than ourselves that is loving and lovable. This makes the world seem less empty. Cuddling stuffed animals is a healing ritual that is medication for the soul. This is what it means to reach out and touch someone.

Schlag Byte 2/14/97 - "An Unquiet Mind"

A psychiatric colleague has just written a book called "An Unquiet Mind"; it's a beautifully written memoir. Dr. Jamison says that when she went away to college and left a loving family and was competing with other bright young people, she began to experience mood shifts between exciting highs and destructive lows. She would go on spending sprees that she couldn't afford, took too many classes and at night she'd crash, become angry and irritable, unable to sleep. It took Dr. Jamison eleven years to understand that she had manic-depressive illness. She is now traveling to college campuses telling students who are at an age when serious mental illness such as depression, manic-depression and schizophrenia are likely to begin, how to recognize the signs of mental illness. There is no question that this is important, since depression accounts for more suicides in the United States in this age group than any other medical problem. I also agree this is a time of great vulnerability, a time of enormous change, uncertainty and fear.

My concern however, is about going to college campuses and telling young people who are sleeping less, getting revved-up, drinking more, getting louder, becoming aggressive, spending money, and/or feeling invisible that they are mentally ill. The ages of sixteen to twenty-two are times of explosive change and it's important that young people talk to each other and to others they respect and care about, about their uncertainties and fears. It's a dramatic overstatement to suggest to auditoriums full of students that these symptoms are an indication of mental disease needing powerful medications. Most of these symptomatic manifestations will probably not prove to be a major mental illness. We need to get away from psychopathologizing the ordinariness of life and using diagnoses as a way to justify our helplessness or drug dependence.

Schlag Byte 2/5/97 - "Voluntary euthanasia"

The Northern territory of Australia is the only place in the world that permits voluntary euthanasia. Lots of countries are looking at Australia as a testing ground. In Darwin, in the Northern Territory, a sixty-six year old carpenter had been suffering from prostate cancer for five years. He was in intractable pain and argued that if he were to keep a pet animal in the same condition he was in, he would be prosecuted. He said, "if you don't agree with voluntary euthanasia then don't use it but don't deny me the right to use it.

So a doctor stuck a pump-driven syringe into his vein that was connected to a computer. The syringe was filled with three barbiturates and after the doctor inserted the needle, he switched on the computer and the computer said to the patient, "Are you aware that you will be given a lethal dose of medicine and die"? The computer displayed the options Yes and No. If you pushed the Yes button the screen read, "Are you certain you understand that if you proceed and press the Yes button on the next screen you will die?" and he hit it again. Fifteen seconds he got the lethal injection.

I'm thinking as a physician, if this is somebody I have a relationship with how can I feel anything other than an executioner. I know after I stick the syringe in I'm the only person that's going to be walking out of the room. It would be easier I suppose if I didn't know the person but I wouldn't feel any less the executioner. The Aborigines in Australia are terrified; they think that their lives could be taken when they come to seek medical care. I don't want to keep people alive at all costs and I believe people have a right to die but legalizing voluntary euthanasia even with safeguards makes Doctors something other than what I want to be. I'll make my own deals with my patients and I have lots of colleagues who'll do the same.

Schlag Byte 1/1/97 - "Providers and consumers"

When doctors become "providers" and patients become "consumers", it's like farmers becoming "squatters" and the land becoming "Agribusiness". Todays marketplace mentality is stealing our spirit as caretakers because we come to our work as a job and not as a sacred duty.

Schlag Byte 12/5/96 - "The end of AIDS"

Last weeks cover of Newsweek magazine announced "The End of Aids". This overly optimistic view misses the point. We will always face some new catastrophic illness because micro-organisms have the unique capacity to mutate and produce new forms that are resistant to existing treatment. Disease causing pathogens change faster than we can find ways to destroy them. We eliminate one disease, we create others. Our task, as a species, is to learn the catastrophes we face with a sense of optimism, a belief that we can beat the odds and that dreams are possible.

Schlag Byte 9/25/96 - "Mental health services"

As managed care steamrolls through America mental health services have become increasingly limited. Psychotherapy is now delivered by people with limited training or primary care specialists with little time. A recent Journal of Consulting and Clinical Psychology reported the first empirical study showing the importance of the "therapeutic alliance" in treating 225 depressed outpatients. It turns out that making a relationship with patients is the most important variable in treatment! In a healthcare delivery system in which time is money, there isn't time to establish such therapeutic alliances. The result of which is that, we rely more and more on drugs to foster desired outcomes when it's the relationship that's crucially important. This is a metaphor for our whole culture, we must collaborative relationships between families, communities and nations to guard us against despair and disintegration.

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