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Robin and Patch

August 19th, 2014

I learned of Robin Williams’ death while I was with Patch Adams MD on our annual clown trip to the Peruvian Amazon. We are here with supporting the Belen Project a community health initiative that’s been going on here for the last 10 years.

Clowns from all over the world have been coming to this impoverished community in the middle of the Amazon floodplain to work with children, collaborate with community service organizations, conduct street clinics, paint homes, and create murals… all promoting community health.

As soon as the news of Robin’s suicide came out reporters appeared at the door of Patch’s hotel asking for his response. Patch, in his usual style, told them he was here working with the Belen Project and wanted to talk about that. The media had no interest in pursuing that, and Patch told them that he lamented this tragic loss of Robin’s genius talent, and was grateful for his extraordinary gifts that reminded people of our shared humanity.

There is no question that the movie made Patch the most recognized humanitarian clown in the world, but the fact is Patch hadn’t spoken or corresponded with Robin (or anybody else involved in the movie) after the first year of its release.

The movie is not what Patch Adams MD is all about, that’s a Hollywood version, and the story ends when Patch graduates from medical school at age 25. Patch is now 69 years old, and for the last 40+ years still trying to build his hospital in West Virginia. He has committed his life to supporting his prophetic vision that love can heal individuals, communities, and planet.

The reporters weren’t interested in his tireless work for peace and social justice; they only wanted his thoughts on Robin Williams The problems in Belen (gut wrenching poverty, disease, violence, sexual exploitation, political disenfranchisement) were not reported because the worship of celebrity and sensationalism seems to be more real.

Robin could make us laugh until we couldn’t catch our breath, but he extinguished his own because of his suffering. I lament the loss of this comic genius, and am pained that no drug or doctor could save him from himself.

Patch said, “ I wish we could have become pals… I could have loved him in his loneliness.

Patch wanted to add his own commentary, so I encourage those of you who only read my Schlagbytes, to also watch this one.

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Losing it and Finding it

August 3rd, 2014

During my recent trip to the Pacific Northwest, I was out was asked to assess a woman who’d been diagnosed with early onset dementia and subsequent Parkinsonism when she was 60.

Dee is a former physical education teacher and fitness expert whose escalating lapses in memory, thinking, and judgment were making her anxious and depressed. Doctors prescribed medications for all her symptoms, but some of their side effects left her tired and more forgetful.

We talked on a back porch, on the cool evening while watching the sun set. Dee was well dressed, engaging, conversational, with a sense of humor, in short, seemed quite together. She was oriented in every arena; she knew where she was, whom she was with, and events in the world. Then in a flash, she’d suddenly stop in mid sentence, and have no idea what she’d been talking about. She acknowledged the lapse, asked me where she was in the conversation, and when I reminded her, continued on without hesitation.

These lapses escalated her anxiety, and she was unforgiving of herself for these new limitations. Her husband was devoted to her care, and always by her side. He was clearly wearing down, the stress escalating the frequency of his cardiac arrhythmias.

Dee and I sat on rockers, both under blankets watching the sunset. It’s farewell glow created a halo over the distant snowcapped peaks as we talked intimately about the things that were important to us.

My six year-old Grandson was playing nearby, and the scene was so breathtakingly beautiful that I felt my voice quiver when I spoke. I told Dee that Native people looking at the setting sun and say…thank you for this day and for the one that will come tomorrow. I told her everything changes, the way it was is not the way it is, and it’s up to us to find a way to be happy in this moment. Look how beautiful this is, and as I watched my Grandson I felt my eyes moisten. I told Dee to visit with an animal loving, tree hugging, sage burning friend of mine who had faced some serious losses herself and could help her create more moments just like this.

An estimated 15% of the population over 65 is diagnosed with a dementia, and 33% will be affected by the time they are 85. As a culture we’re getting older, and it’s imposing an enormous burden on families and caregivers. We don’t need to be over-medicating our elderly, we do need to be making more personal connections…(support groups for patients and caregivers, chaplains, friends and relatives, people who will walk the dog with you, see the flowers, hear the music, listen to each others stories), these are all the things that stimulate our physical, sensory and cognitive abilities.

We cannot cure dementia but a community coming together can make the path a healing journey.

Fluorescent Stories

July 22nd, 2014

For the first time in at least a year and a half, I left my computer and all wireless contact behind for five days. I say this with some chagrin because I have railed endlessly about how imprisoned we are becoming by the instruments that were intended to free us but end up chaining us. But this is the time of year we celebrate our annual family reunion at Oregon Country Fair, this place we ceremonially separate ourselves from our ordinary reality to live in the community that celebrates the art, science and spirit of living together in harmony with people and planet.

I love coming here, although it’s not easy living. This is the only place I still tent camp, use portable toilets and washbasins.  We live side by side, in a multi-generational community of about 20 families, many of whom we only see at this time. The OCF is always an extraordinary experience… music, theater, vaudeville, saunas, clowning as The Truth Fairy, intellectual stimulation, and the camaraderie of friends who live in a spirit of tolerance.

This year’s most personally impactful moment was when I spoke to four boys (aged 5 through 12. We were sitting under a tent canopy illuminated by a fluorescent lamp, and I told the colorful Native American story about two boys who were once sworn enemies but later became brothers.

My grandson fell asleep in my arms not long after I started talking (which happens frequently among my family members), but it still left 75% of my audience staring hypnotically with   mouths open in awe. I can’t remember the last time I have left an audience so entranced.

Native American legends hold that if you can tell the stories you learned from your great-grandfather to your grandchildren then your tribe will survive forever. Stories, myths, ceremonies, that transmit an ethic of morality and teach us something about how to live in the world.

Our future is not ensured through the transmission of our DNA, but through the transmission of our stories. So get away and play, separate yourself from your ordinary reality, leave your wireless instruments behind and remember another way to tell your story .

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What is Clown Therapy?

July 10th, 2014

The Clown/Fool/Jester is a recognizable figure in every culture in recorded history. The clown is an archetype, a human characteristic that’s biologically embedded in the mind, universally present in the human psyche. There are many archetypes; Kings, Warriors, Princesses, Wizards, and Demons, and they are all pieces of ourselves that all reflect unconscious patterns and appear in dreams, myths, fairytales, and wisdom stories.

The Clown archetype is a character that lightens the mood, pokes fun, is irreverent, provides social commentary, flaunts taboos, diffuses anxiety, and embodies healing wisdom. The Clown stands at the threshold between reality and imagination, and in that space allows us to see the world from another perspective.

The literature is filled with both anecdotal and research evidence about the therapeutic efficacy of humor. Laughing in the face of tragedy seems to shield a person from its effects; it even seems to have a buffering effect against physical pain. It’s abundantly clear that the central nervous system, cardiovascular and immune systems are all strengthened by laughter and joyful connections.

The Gesundheit! model of clown therapy is to have clown-clinicians, healthcare practitioners all of whom make their living working with people with problem’s…(doctors, nurses, counselors, social workers, body workers, nutritionists, traditional healers). What distinguishes these clinicians is their willingness to get out of their heads and connect with people at the heart level. Clown therapists trust their intuition, are willing to open channels into their unconscious minds and find something to say or do they might be helpful.

We see people for short periods of time (15-20 minutes), and in public places. We wear clown noses, and are active listeners, which means we are acutely present in every moment. We talk to anyone about anything that’s important to him or her. We do not make diagnoses or prescribe pills. The clown-therapist can acknowledge suffering without becoming consumed by it. In the midst of crises they don’t “awful-ize” or “catastrophe-ize”, instead they can identify what gives their patients meaning in their lives and find a way to reveal to them what they still have inside that his not been lost.

My own journey into clown therapy came late in my career as a psychiatrist. I was middle-aged, and traditionally trained psychiatrist, before I met Patch Adams MD, perhaps the world’s most recognizable humanitarian clown. We were both speaking at a dental convention. I watched him get 40 dentists to dress-up and parade in public. Patch asked them to find things in their rooms to dress up in, and they appeared in bathrobes and lampshades, he gave them a clown nose and led these usually meticulous, exact, measured, detailed, organized doctors through the streets of a Colorado ski resort town. It made such an impression on me that I sought him out afterwards and that led to the start of a close family relationship.

A decade ago, at our annual family reunion at the Oregon Country Fair, I emerged as The Truth Fairy (see pictures), a pink ballerina in tights and tutu who invited people to talk with him for 3 minutes about an important question/issue/problem that they wanted answered…if they were ready to hear the truth. I sat in the middle of a meadow filled with hundreds of people, in a 10 x 10 roped off enclosure, with an empty chair facing me. People stood in line to spend… 3’ With The Truth Fairy; it turns out people will share the most intimate things because it’s completely anonymous, and you can choose to ignore whatever you hear. It gave me the opportunity to listen intently and trust my intuition to see something that was often funny and helpful.

We’ve expanded upon this model in the streets of Iquitos, Peru at the Belen Project where clown-clinicians from a dozen countries invite people to come and talk to them for 20 minutes about whatever concerns they might be having. In soccer fields, storefronts, and schoolyards, and marketplaces we have set up chairs, and seen people who want to talk. Often speaking through interpreters, we find these encounters have been profoundly impactful on both the people and the clinicians. They remind us that in the presence of traumas and disasters people can connect in ways that remind us of our shared humanity.

We have repeated these street clinics again and again, and find that making the heartfelt connections, and actively listening is an intimate therapeutic connection…and those are moments that make suffering bearable.

Carl A. Hammerschlag M.D.

Chief of Community Mental Health, Gesundheit! Institute

 

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References:

Psychiatry and the Art of Listening, Clinical Psychiatry News, Nov. 2012

Global Outreach Project, Clinical Psychiatry News, Nov. 2013

3” With the Truth Fairy, Schlagbyte, Aug. 29, 21011

Fireworks and Farewell

July 7th, 2014

Amidst the celebration and fireworks of Independence Day, I mourned the death of my holy mentor, guide, and friend Rabbi Zalman Schachter-Shalomi who was buried that morning. We met almost 30 years ago, at a time in my life when I had pretty much abandoned the organized Judaism of my past and expressed my spiritual life through participation in Native American ceremonies and rituals.

I was introduced to Zalman by another Rabbi, Aryeh Hirschfield  whom I met during a sweat lodge at a Lakota Sundance ceremony in the mid 1980’s. (I have written about that meeting and the intense friendship it created, in my book The Dancing Healers). Reb Aryeh, who was also a Yeshiva boy, had been ordained by Zalman, and he said his entire view of about Jewishness and how it could be expressed, was the result of  R. Zalman’s influence…we had to meet he said.

It just happened to come at the perfect time, because the first gathering of the Jewish Renewal movement was about to take place outside Philadelphia; and my wife was making more and more noise about wanting to find a Jewish spiritual path we might walk together.

When I first saw him, he was of average height but looked taller than he was; had a shaggy, white-flecked beard, was dressed in a long caftan, colorful yarmulke (skullcap), rainbow colored tallis (prayer shawl), and a smile that was heart melting.

Reb Zalman was born in Poland in 1924, escaped from the Nazi’s, and came to the US in 1941. He was ordained as an Orthodox rabbi in the Lubavitch Hassidic community, became a Hillel Rabbi on college campuses and slowly his ideas about how Judaism could be practiced with absolute kosher legitimacy, began to be expressed. He moved away from his ultra-orthodox Hasidic roots and founded the Jewish Renewal Movement. Jewish Renewal was about the transformation of spiritual expression. Like my Native relatives, he said you could pray in any language and sing any song because he saw the Great Spirit in everything and everyone, and everyone had a direct link to that energetic source. Zalman pioneered interfaith dialogue (hobnobbed with Ram Dass and the Dalai Lama); he was a passionate activist for women, LGBT community, and explored the sacramental value of hallucinogens.

He was one of a tiny handful of spiritual teachers I have ever known, who grabbed me by the throat and dragged me to face the power of Awe. After that first Kallah in Radnor, Pennsylvania, we saw one another and spoke periodically for the next 30 years. He was an anchor in my struggles, and the bridge to restoring my Jewish soul.

On July 4th , this day that we remember the visionary gifts’ of our founding fathers, I’m looking at the fireworks and seeing my Lubavitcher Rebbe. The death of a Tzaddik (a great teacher) does not extinguish his light, it only reminds us that what’s most important in life, is what you leave behind.

I feel your smile sweet Z, farewell, and I’m smiling with you.

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Commencement Address

June 22nd, 2014

I watched proudly as my eldest granddaughter graduated with honors from the University of Oregon. It was a deliriously joyful weekend, filled with parties, parades, and the usual commencement ceremonial rituals.

The commencement address is today’s secular sermon, and usually addresses themes like, endings and new beginnings, or what determines success in life. I was sitting in a huge arena, far from the stage, the marginal sound system, and found myself thinking about Steve Job’s’ moving commencement address at Stanford in 2005.

Jobs, the legendary founder of Apple and Pixar told the graduating class that speaking to them that day was the closest he’d ever been to a college graduation. He said he dropped out of college because he wasn’t learning what he wanted to know, and that experience taught him three most important things he believed were necessary to be happy and successful in life: 1. Trust your intuition 2. Love what you do 3. Live as if today was the last day of your life.

He told the graduates that last in the last year he’d been diagnosed with pancreatic cancer. Initially he was told he’d live 3-6 months, but after the tumor was biopsied and analyzed it turned out to be a rare type that was curable with surgery. It didn’t matter how much time he had left, the diagnosis woke him up to a new appreciation of the biological truth that our time on earth is limited. Don’t let other peoples opinions/predictions stop you from trusting your intuition and pursuing what brings you joy and meaning. Steve Jobs was not cured, he lived 6 more years after delivering that address and loved what he did every day.

I found myself reminiscing that 50 years ago, right about this time I graduated from medical school, and wondered am I doing what I love doing, Surely I love being surrounded by love in these families celebrations, and I want to bring the Clown Town Healing Fest to a city in America before my last breath. A city that understands the future of healthcare is shifting our focus from a model based on the intervention (diagnosing and treating diseases) to one based on predicting and preventing them.

This Fest is about how we heal better in community, by integrating a communities healing resources, and inspiring people to taking the necessary steps to live healthier lives. Gesundheit! Global Outreach (GO!) Clowns will soon launch a campaign to make this happen and I’m hoping you will help me spread the word.

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Washington Foreskins

June 8th, 2014

Harry Reid, the Senate majority leader has finally been able to galvanize his colleagues into bipartisan action. He wrote to Roger Goodell, the Commissioner of the National Football League telling him to change the name of the Washington Redskins because it was clearly racist.

Dan Snyder, the franchise owner has vowed never to change the name, and had Bruce Allen, the President of the organization write to the Commissioner. He said the team was a positive, unifying force for the community; adding that it was one of the NFL’s flagship franchises, played in 11 NFL championship games, been world champions five times, and that the Redskins team name carried “ a deep and purposeful meaning for millions”.

Allen exhorted Redskin fans, to ” show your pride and tell Senator Reid what this team means to you”. This strategy backfired badly, lots of people said they loved the team, but not the name. Allen, responded that the term Redskin actually originated as a Native American expression of solidarity”. Not really, when a Native American speaks of his or her red skin with pride and strong identity, that’s different than when white man says it. When white man used Redskins it has a hint of derogation. When that term was first used it was invariably preceded by an adjective like damn, heathen, dirty, or murdering.

Bruce Allen said that the overwhelming majority of Native Americans did not find the name offensive. I don’t know who did this survey nor, who was interviewed, how the questions were asked, but I personally doubt the surveys conclusions. The truth is most of my Native friends think it’s a well- orchestrated PR campaign to promote product sales; and the Redskins Original Americans Foundation which has contributed 1,000 tablet computers to Native American students, a laughable pittance.

What I find most interesting is that our government, which has been paralyzed by partisanship for the last 7 years, was able to mobilize so much passion and purpose about the name Washington Redskins. Proves that you have to be a bit of a putz to be a politician which is why I suggest the team be renamed the Washington Foreskins to remind us of what the business of politics is all about.

Big Money Bleeds Healthcare

May 26th, 2014

More headlines in the news blaring that yet another doctor is bilking insurers out of millions of dollars. This fraudulence disgusts me, but let’s all be clear… a doctors’ income is not the big cost in our healthcare delivery system.

Those who oversee the business of medicine, not the hands-on caregivers are the ones who earn the big bucks. The average base pay of an insurance company executive is $584,000 a year, for a hospital CEO $386,000, compared to a family doctor who earns $156,000. As an industry, healthcare is staffed by some of the lowest paid professionals. The average staff nurse earns $61,000 a year; an Emergency Medical Technician (EMT) earns $27,000 a year (about minimum wage) if they have a families they work three jobs to make ends meet.

The U.S. spends almost 20% of its Gross Domestic Product (GDP) on health care, which is more than any other country in the world by sevenfold, and yet we are not the healthiest country in the world (not even in the top 20). The administrative costs in healthcare make up to 30% of the US healthcare bill, which is twice as much as any other developed country.

We will lower the cost of healthcare in this country if we reduce the administrative costs. The current reimbursement system is so complex it requires specialists in everything other than hands-on care. The jobs in healthcare now feature specialists in coding, claims adjusting, medical device brokers, drug purchasers, and navigators.

Put healthcare back into the hands of those who actually care for patients, and want to do well by them. If we can’t get a single-payor system, let’s at least elect legislators who are not bought by industry lobbyists (pharmaceutical, device manufacturers and other suppliers), to pass laws requiring insurers to spend 95% of insurance premiums for actual medical care.

Most doctors want to do well by their patients, they still come to their work as if it’s a ministry, not an industry.

 

Native Americans: A Story of Transgenerational Resilience

May 19th, 2014

Arizona Psychiatric Society Newsletter, Vol. 5, No. 1, 2014

I appreciate the invitation to address my Arizona colleagues on the psychiatric care of Native Americans. Generally, when we hear the words psychiatric care and Native Americans, it immediately conjures up a symptomatic population rife with substance abuse, domestic violence, high suicide rates among the young, and educational underachievement; because the literature focuses on these aberrations. The underlying psychological explanations for these problems are attributed to internalized anger, and the powerlessness resulting from their subjugation and political disenfranchisement. These ongoing symptomatic manifestations are attributed to the transgenerational transmission of their historical trauma.

There is not much in the literature about the transgenerational transmission of resilience among Native Americans; how did some tribes survive the assaults on their culture while others fade away? I have spent much of my professional life working with Native Americans, and would like to tell you their story from that perspective. The tribes who thrived were the ones who maintained a connection to the values and cultural systems (language, myths, rituals and ceremonies) handed down from generation to generation. Resilience is rooted in the nurturing soil of knowing who you are in the world. If you have a sense of yourself as unique in a positive way when you are young you greet the world as equal when you become an adult.

First, a brief history of how I came to work in Indian Country. It was the mid-60′s, and I didn’t want to go to Viet Nam; so after completing my internship I served my military obligation in the Indian Health Service. I thought it would be a 2-year experience but it turned into more than 20. Shortly after my arrival at the Santa Fe Indian Hospital in 1965 I was introduced to an old man on morning rounds who would be my patient because I provided the aftercare in his village. He was admitted in acute congestive heart failure, and was resting comfortably since he’d been digitalized, given a diuretic and oxygen.  I introduced myself, and then he asked me “where did you learn how to heal?” I assumed he was asking for my academic credentials so I tell him where I went to medical school and completed my internship, and when I finished he looked at me smilingly and asked “do you know how to dance?”

I was touched by his whimsy, thought I’d humor him, and said I knew how to dance and shuffled my feet at his bedside. The old man laughed, so I asked him if he knew how to dance, not knowing at the time he was a renowned medicine man. So he got out of bed the oxygen running and did the steps to a Corn Dance at the bedside, When he got back into bed he said to me “you must be able to dance if you are going to heal people” so I asked him if he would teach me those steps and he said “I can teach you my steps, but you have to hear your own music”.

I learned from Native healers that there were many ways to do the healing dance and what it meant to be healthy. Health was never defined in medical school, other than if you weren’t sick then you were healthy). And I learned about how many ways there were for people to get sick and how many ways to do the healing dance.

Most of us in Western medicine (especially in psychiatry), learn to do our healing dance one way; we become proficient in whatever our preferred methodology (psychopharmacology, neurobiology, psychotherapy, behavioral therapy, cognitive therapies, psychoanalysis), and then spend most of our professional lives refining the steps to that familiar tune.

The Navajo word for health is HOZHO… the same word also means harmony, truth, beauty, balance and the Great Spirit. Being healthy is when what you say with your lips, is the same story you’re telling by your actions, and what you truly believe in your heart; that’s when you are in balance, in truth. In the language of modern medicine this is the science of psychoneuroimmunology.

From Native healers I learned the importance of rituals, ceremonies, and sacred objects in setting the stage in opening ones heart, which is critical in healing; and that people heal better in community because the more people you have helping you/pulling for you, the more likely you’ll have a positive outcome. I was also awakened to many ways of altering human consciousness, and helping people see the familiar with new eyes that included the use of powerful psychoactivating substances has been used to heal the mind/body/spirit for thousands of years. The current explorations in the use of psilocybin mushrooms, and the Schedule III drug Ketamine for use in depression and end-of-life anxiety have been part of the indigenous therapeutic armamentarium for millennia.

I learned that no matter how much we know about the brain (its neurobiology and chemistry), that it will always have a mind of its own and some phenomena can’t be satisfactorily explained.

Those Native people who maintained a credible connection to their psychohistory, to the wisdom stories and ceremonial practices of their tribes, survived the vagaries of assimilation psychically intact, because that’s how we learn who we are in the world. It turns out that our survival as a species is not transmitted through our DNA, but through our stories. The road to resilience is in rediscovering old wisdom…stay connected in community, trust the truth of your heart, and keep your mind open to new ways of seeing, hearing, and doing the healing dance.

References
Hammerschlag, Carl A. The Dancing Healers, Harper/Collins, San Francisco, 1988
Hammerschlag, Carl A. The Theft of the Spirit, Simon and Schuster, New York, 1993
Hammerschlag, Carl A. and Howard Silverman. Healing Ceremonies, Putnam/Perigee, New York, 1998
Hammerschlag, Carl A. Kindling Spirit: Healing From Within, Turtle Island Press, 2013

Love Your Banana

May 11th, 2014

I often lament the fact that as a culture we have come to believe that if you’re feeling anything other than wonderful in every moment, that you could be suffering from the disease, and that there is a pill to help you.

I’ve just finished two important and disturbing books that add to this conversation, Saving Normal by Dr. Allen Frances, former Chairman of the Dept. of Psychiatry at Duke, and responsible for the task force that produced the previous edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-4). He warns that the explosion of mental illnesses in the new DSM-5 have no scientific validity, and that we are experimenting on adults and children with potentially harmful drugs. The other is by author/psychotherapist Gary Greenberg called The Book of Woe, which made me cringe with its disturbing depiction of the abuses that result when we turn suffering into a reimbursable commodity.

Instead of more diagnoses consider this simpler proposal; all mental illnesses are a manifestation of a spectrum disorder called Life, and in this life we are all Bananas.

Most of us are Ordinary Bananas, we have our own unique personalities, styles, characteristics, and whatever our quirks/peculiarities, most of us learn to live with them and hopefully even learn to thrive because of them.

However, in life ‘stuff happens’ that can throw us for a loop and we become symptomatic (angry, depressed, withdrawn, addicted, etc.). We become Smoking Bananas, and we need help. 11% of all Americans take antidepressants, but there are many other ways to feel better. What it requires is reaching out and finding support… in people/ places/ institutions/ groups/ communities on whom you can depend, who remind us that we are not alone on the journey, and inspire our hope.

Some of us can smolder and smoke for a long time; it doesn’t matter how intense the pain, we choose to hang on to our suffering. If you smolder long enough it’s a short jump to becoming a Flaming Banana. You don’t need to be a psychiatrist to tell you who these people are; at this end of the spectrum people are hallucinating and delusional, they can’t tell the difference between what’s real from what’s make-believe…these people need more serious intervention.

Because we suffer on life’s journey doesn’t mean we’re mentally ill. Our suffering is generally time limited, and our potential for joy and blessings unlimited. Lighten up! We are all bananas, and the most important thing in thriving on the journey is to love the banana you are.

Dr. Carl A. Hammerschlag, M.D., CPAE is a psychiatrist, author, and professional keynote speaker. He is an authority in the science of psychoneuroimmunology mind, body, spirit medicine and speaks about health and wellness, healing, leadership and authenticity . He has delivered motivational keynote speeches to corporate and business clients around the world.