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Hope is the Opiate of Humanity

December 8th, 2014

I’ve railed endlessly about the epidemic rise in psychiatric illness in this country that has resulted in one out of every four Americans being diagnosed with a mental illness. With the publication of the new Diagnostic and Statistical Manual of Mental Illnesses (DSM V) my guess is it will soon be one out of every two. These are not really diseases as we understand them (we don’t know what causes them, how they’re transmitted, and why treatment is so often ineffective), they are just symptom clusters we have labeled as diseases.

This epidemic is in no small part the result of direct to consumer advertising by pharmaceutical companies in collusion with the psychiatric profession, to convince people that if they are feeling anything other than wonderful in every moment, that they could be suffering from a disease. These diseases can of course be treated with pills (usually more than one, they often don’t work, and come with potentially serious side-effects).

We must stop ‘psychopathologizing’ the symptomatic manifestations that are the expectable ups and downs of life, and perpetuating the myth that there is a pill for whatever ails you. Instead we need to make it easier to talk to someone who is credible, will listen to you, maybe even offer some new perspectives or help you see a new ending to your story.

I spoke in Aspen a few weeks ago at the invitation of the Aspen Hope Center (http://www.aspenhopecenter.org), where they are actualizing a community-based mental health program. Aspen is a spectacularly scenic venue in the Colorado Rockies whose 5,000 permanent residents become 25,000 at the height of their tourist seasons. The Aspen Valley has a high suicide rate; last year they had four such deaths. Two years ago the Hope Center began as a volunteer suicide hotline, now it has clinicians available 24/7, and the staff has integrated their work with police and sheriff departments, ambulances, lawyers, business leaders and local nonprofits. The Center has added outpatient follow-up in addition to crisis intervention services, and are teaching prevention programs in schools, churches and local agencies.

This is the future of healthcare, we heal better in community with lots of people working toward the same goal, and it actually makes a good outcome more likely. Our connections remind us that we are not alone in the world, they inspire our hope, and hope is the opiate of humanity.

P.S. If you’d like to watch the Aspen presentation in it’s entirety go to http://www.grassrootstv.org/view?showID=12854

A Thanksgiving Story

November 23rd, 2014

At the recent National Caring Awards we watched Gabby Giffords and Mark Kelly get honored for their work against gun violence. Whenever they get introduced they are invariably introduced as former US Representative and the former Astronaut/Navy Captain; which seems to me to dramatically overemphasize who they once were, rather than who they are now; it’s as if their most significant accomplishments are behind them.

At this event they were honored not for who they were, but for who they now are. Since Gabby survived a near fatal gunshot wound to the head in 2011, and over these last 4 years, she and her husband Mark have become National spokespersons against gun violence, and strong advocates for Congressional enactment of responsible gun laws.

Gabby still has a partial paralysis on her right side, but her physical, cognitive, and language ability are in the top 5% of patients recovering from similar injuries. When they walked to the podium to accept their award, their presence lit up the room. They told us their lives dramatically changed in the flash of a second, and the road to recovery has not been easy. The biggest lesson they learned was to be thankful for wherever you are in your life; for all the positive things you have, your health, your family, your career; and if you can make a contribution that helps others… that makes us very happy.

The former US Representative Gabby Giffords, and the former Navy Captain/ Astronaut Mark Kelly worked hard earlier in their lives and made great contributions to America. They are still working hard every day; Gabby works every day to overcome the residual of her gunshot wound. On Saturday she completed the El Tour de Tucson bicycling event funride for which she trained for 6 months. Every day she and Mark remind us to get serious about gun legislation.

They inspire me, these two “Former’s” walking arm in arm, still making contributions to leave this Nation a safer and healthier place.

During this Thanksgiving week Relatives, say thank you for everything that you have in your life.

I say this for all my relations, Mi Takuye Oyacin

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Depressing Politics and Flamingos

November 10th, 2014

This mid-term political campaign has left me feeling depleted, bludgeoned, and unhappy. The deluge of e-mail solicitations, the mud slinging, and the growing influence of outside ‘dark’ money on elections, depressed me.

The US Supreme Courts decision to eliminate dollar limits and disclosure requirements has made getting elected in this country, an auction to the highest silent bidder. There was a time when my outrage was translated into action, and I believed we could create systemic change; now I’m not sure anymore, and it leaves me feeling demoralized.

When I get this way, I adhere to my mother’s advice, when you despair, feel helpless or hopeless; find something to celebrate and laugh about (my survivor Mother knew something about adversity). I’m a believer in this principle.

Three days before the election, the Arizona Ballet was performing Swan Lake at Symphony Hall, it was Halloween and if you wore a costume you were eligible for special seating and prizes. I don’t need much provocation to dress up and clown. My wife was fully into it and came as an elegant butterfly winged ballerina, and I went as my clown character, a giant flamingo ballerina in pink tights and tutu. As many times as I have seen this ballet (my absolute favorite), this was the first time I ever went as a clown.

We valet parked across the street and strolled arm in arm into the most elegant venue in the city, accompanied by enthusiastic hoots and hollers from street performers and Pedi-cab drivers. The Box Office found us great seats and we entered the lobby to be greeted by titters, outright hysteria, and wide mouthed disbelief.

I love getting into this persona; it gets me out of my headspace, and into my spontaneous, intuitive heart space. I tune into my uninhibited, unconscious mind, and see the familiar landscape from a new perspective. This place always lightens me up, and affects those around me.

The ballet was great, and the scene hilarious, and I won first prize. In the midst of despair find something to celebrate, lighten up, laugh more…it really is the best medicine.

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Using clown therapy to deliver mental health care

November 4th, 2014


The clown/fool/jester is a recognizable fgure in every culture. The clown is an archetype, a universal image that’s embedded in the brain. These images dwell in the unconscious mind. They can be animals, people, gods/goddesses, or objects (a tree, a house, a cross, or mandala) that are a staple in many myths and legends.

The clown lightens the mood; encourages us to laugh at ourselves (and the ridiculousness of life), pokes fun at convention, provides social commentary, and can get away with revealing that the emperor has no clothes. The clown is irreverent, faunts taboos, and difuses anxiety; in many cultures, the clown is a sacred healer, wisdom keeper, and serves as the community’s psychotherapist.

This also is the purpose of psychotherapy; we psychiatrists help patients look at their In many cultures, the clown is a sacred healer, wisdom keeper, and serves as the community’s psychotherapist. The clown’s purpose is to help us look at the familiar from another perspective. old landscape with new eyes, and in so doing help them create new endings to their old stories.
It took me until midlife to embrace myself as clown healer, and I took this step only after many years of working with Native Americans as chief of psychiatry at the Phoenix Indian Medical Center. I went fnally went public after meeting Dr. Patch Adams, perhaps the world’s most recognized humanitarian clown, more than 20 years ago.

This is the third year we have been conducting mental health clinics in the streets of Iquitos, Peru, which I have described before, most recently last year. These street clinics are stafed by clowns who also happen to be health professionals representing many disciplines (doctors, nurses, psychologists, social workers, counselors, body workers, chaplains). They’re also part of a humanitarian clown trip that I make every year with Dr. Patch Adams and the Gesundheit! Institute in Hillsboro, W.Va., along with more than 100 clowns from around the world.

The impact of the clinics and on both ”patients “ and “therapists” has been profound. These encounters remind us that even in the presence of unimaginable sufering, connecting in this heartfelt way and remaining actively present in every moment makes sufering more bearable. They also remind us of the value of incorporating culture into treatment plans.

What is clown therapy?
Our clown-therapists will talk to people about anything that’s troubling them and work with them in open spaces (football felds, storefronts, loading docks, markets), sitting in a tight circle (with an interpreter for non–Spanish-speaking therapists) wearing a clown nose. We listen intently and are acutely present in every moment. We see people for 20 minutes and do not make diagnoses or prescribe pills, although we sometimes hand out amulets and give blessings.

As clown-therapists, we welcome the opportunity to get out of their heads and connect with people at the heart level. We delight in spontaneity, which facilitates opening channels into our unconscious minds, trusting that we will come up with something to say or do that will be helpful.

These clinicians can acknowledge sufering without becoming consumed by it … in the midst of crisis and/or pain they don’t “awful-ize” or “catastrophe-ize”; instead they have the capacity to identify people’s strengths and resilience and get a sense of what gives meaning to their lives. In a short time, such heartfelt connection can have a profound impact on not only the recipient but also the provider.

A case study
As a rule, we see people only once, but this year, I saw Maria, a 42-yearold woman twice. She was acutely suicidal, and after her morning prayers, decided today was the day she was going to kill herself. After 6 months of unbearable torment, she’d reached the end of her rope; she told me that her 20-year-old daughter had been raped 6 months earlier and was now pregnant. Maria’s family blamed her, saying that if she hadn’t divorced her husband 15 years earlier, this would not have happened. Maria knew she was not to blame, in which I concurred, but alas, she could not (as her family suggested) get over it and move on.

After listening, I told her I thought today was a miracle; this morning, she was ready to die, and this afternoon, we happened to show up on her street. I also said I believed the seriousness of her suicidal intent and told her she had two choices; I could hospitalize her, although I had no idea if that was even possible, or she could make me a promise – at least for today – that she would not kill herself.

I gave her an amulet that had been blessed by Navajo and Huichol shaman and said I wanted her to hold onto it during tomorrow’s morning prayers; she would feel our blessings and remember this miraculous day that we found one another. Perhaps tomorrow she could promise herself to also live for another day.

After the clinic, I couldn’t get her out of my mind, so after dinner I asked my clinic coordinator to check in on her the next day. We were going to be conducting another clinic not far from her home in a few days, and I asked her to invite Maria to the next clinic and to please bring her daughter, too.

Maria showed up not only with her 6 months’ pregnant daughter, but also with her younger 18-year-old daughter. Together, they told me the rest of the story. Both girls had been raped (the younger more than a year ago), and both by diferent maternal uncles. They had never spoken about it to anyone outside of their family, and although Maria had confronted her brothers, she refused to press charges. This is not a culture in which women prosecute their rapists.

Before we ended, I gave both girls an amulet and blessed the family; whatever they faced, they would face it better together; their love for one another would be showered on this new baby, and they would carry our blessings with them and those of many relatives all over the world.

In most Latin cultures, there is a strong belief in the power of spells, curses, and witchcraft, as well as in traditional healing practices and the power of faith. A critical element for successful healing in all cultures is the patient’s belief in the practice and in the practitioner.

As mental health professionals, we magnify our power not only with the pills we prescribe, but also with the blessings and amulets we may bestow. And it doesn’t take a long time to connect at the soul level if you are actively in the moment, and it is in those miraculous moments that we are reminded of our shared humanity. Imagine if we used our 15-minute medication reviews to actually connect with people at this heartfelt level and talked about what’s really important to them. I’m thinking we could reduce our prescription writing by half and be reminded of the joys of psychotherapy.

Dr. Hammerschlag is chief of community mental health at the Gesundheit! Institute. He is also the author of several books on healing and spirituality, including Kindling Spirit: Healing from Within (New York: Turtle Island Press, 2012) and The Dancing Healers: A Doctor’s Journey of Healing With Native Americans (San Francisco: Harper, 1988). Scan the QR code to read more commentaries at clinicalpsychiatrynews. com.

Meet Me in the Lobby, Bobbi

October 27th, 2014

Once every few years I go to my local Psychiatric Society meeting, it’s a chance to socialize with my colleagues (and remind them I’m still alive). This month’s annual Fall Social event was sponsored by a major pharmaceutical manufacturer (which always means good food and drink).

The program was entitled “Why Advocacy Matters” and featured local politicians, the Society’s lobbyist, and “Bobbi” the company’s spokesperson encouraged us to speak up and let our voices be heard on important legislative issues that affect us and our patients. “It’s the squeaky wheel that gets the oil” and doctors are notoriously poor advocates as compared to lawyers for example who contribute 10 times more money to ensure their influence.

During the Q & A, I asked Bobbi how much her company had contributed to advocacy last year. She took a step back, paused a moment and said, “I’ve heard this before and I’m not going there. No! No! I’m not going there”, and took another question.

Where Bobbie didn’t want to go was that when it comes to a squeaky wheel influencing policy in Washington, no industry games the system better than the pharmaceutical industry. Between 2009-2011 Big Pharma spent more than $700 million on lobbying efforts, to encourage Congress to pass bills that encourage price fixing, and create a culture that has resulted in criminal negligence for false advertising. When the industry gets caught they pay hundreds of millions in fines (but what’s $100 million when your making $100 billion).

The $700 million that Big Pharma pays for lobbying pales in comparison to the $4 billion they spend on direct to consumer marketing. Big Pharma has sold the idea to the public, that if you are feeling anything other than wonderful in every moment, you could be suffering from a disease. For any symptom of distress you should call your doctor who can prescribe pills that can relieve your pain. This media barrage has resulted in one in every four Americans being diagnosed with a “mental illness”.

I agree that all psychiatrists should lobby on behalf of our patients, but lets lobby for the elimination of direct-to-consumer marketing. Pharmaceutical companies with enormous psychiatric support are creating a nation of mentally ill.

A Good Day To Die

October 12th, 2014

I loved that scene in the movie “Little Big Man” where Chief Dan George is preparing to depart for the spirit world and tells Dustin Hoffman ‘today is a good day to die”. The Native American concept that you can decide how, when, or where you choose to abandon your life force, has always appealed to me.

In the current healthcare climate we rarely get to make those decisions because they are made for us. Our culture celebrates the denial of death; we encourage interventional medicine that pursues life at all costs; even when the outlook is terminal. Doctors don’t ask patients what their priorities are, what’s important to them, or how they want to spend their last days.

Things are changing though, I just saw a YouTube video that went viral about a 29-year-old woman with an inoperable brain tumor, who has decided when she wants to leave this world. Brittany Maynard’s story is that soon after she got married, on New Year’s Day of 2014, she experienced severe headaches. A thorough workup revealed an aggressive brain cancer, and doctors told her she had less than a year to live.

In her video (http://youtu.be/yPfe3rCcUeQ), Brittany says that she wants to spend the rest of her life traveling around the world. In these last nine months she has traveled to Yellowstone National Park with her husband, been to Alaska with her best friend and mother, and says she is still setting goals for herself. Brittany wants to use this time to raise awareness and advocate for more death with dignity laws. So far only Oregon, Washington, Montana, Vermont, and New Mexico allow terminally ill residents to end their lives using lethal medications prescribed by a doctor and administered by the patients themselves.

Brittany has left her California home and moved to Oregon with her husband in order to qualify for the States, Death With Dignity Act; she has received the drugs to end her life. I applaud Brittany’s efforts in bringing to the forefront this critically important conversation in healthcare. We need to be asking terminal patients what they want, what’s most important to them at this time in their lives; sharing their memories, passing on wisdom and keepsakes, connecting with loved ones, maybe even make some lasting contribution to the world, and then help them achieve those goals. These closing moments are among lifes most important, not only for those dying but for those who are left behind.

Brittany still wants to go to the Grand Canyon, I’d like to take her there myself (maybe introduce her to some Native American ceremonies). In the meantime I’m supporting her at (www.thebrittanyfund.org).

Brittany Maynard may live a short life but she will leave a lasting imprint in the history of our humanity.

My love and blessings go with you Brittany, thank you for the gift of your life, I say this for all my relations. Mi Takuye Oyacin.

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Reunion Nostalgia

September 28th, 2014

I’ve never gone to a reunion before; not high school, college, or until now to medical school. This was my 50th medical school reunion from SUNY Upstate Medical University in Syracuse, and I really wanted to go.

My adult life began in Syracuse; I got married during the Christmas break of my first year in medical school, and had two children by the time I graduated. We were a small class of 82 people and I knew them all. The last time I saw or spoke with any of them was 50 years ago, when we were freshly minted MD’s. We had survived the fiery baptism that is medical education, with its emotionally and physically exhausting workload, intense pressure, and horrendous hours. This is why physicians are more than twice as likely as non-physicians to kill themselves; some 400 doctors commit suicide in the United States every year, and many during their training years.

Before going to our reunion I wondered…would we recognize each other, could we reconnect with the intimacy of those initiation years. It turned out to be an amazing experience, and the reconnections were easy and intimate (after an initial delay in recognition, since the people we revealed on our nametags were taken at our graduation). About 1/3 of the class showed up (most still married to their first wives); we had become professors, researchers, and practitioners of every specialty.

We talked late into the night at receptions, outings, dinners and bars, where we laughed, cried, and reveled in nostalgia. I was surprised at the intensity of our bonding; perhaps it was the acute awareness of how much everything had changed… from our bodies to the neighborhoods. At the soul level we were still the same characters we always were, and seeing them all reminded me of how important it is to stay connected. Those people and places remind you of what you like best about yourself and that your story is not over; the final chapter has not been written, we are still writing new endings to our stories.
Go with joy on the journey and with my blessings in the Jewish New Year 5775.





Ebola Healing

September 17th, 2014

The Ebola virus is epidemic in Liberia, with people left dying in the streets. If a family member has died or if you have symptoms nobody talks about it, because the government has been singularly non-supportive and/or punitive.

Unfortunately, anyone who has been in contact with an Ebola victim and walks away is a ticking time bomb. There are 1.5 million people in Monrovia, the capital city where the infection and death rates are escalating daily. There are critical shortages of all treatment resources from hospital beds to health workers, and vehicles to remove the dead.

Into this lethal outbreak walks Dr. Mosoka Fallah, a 44-year-old epidemiologist/immunologist with extensive experience working in humanitarian crisis with Doctors Without Borders. Dr. Fallah, who now lives in the U.S., grew up in Monrovia’s poorest neighborhood before getting a doctorate in microbiology and immunology at the University of Kentucky, an MPH from Harvard.

Now that the pathogen has been identified and antidotes/vaccines developed, everyone must be informed about how to protect him or herself. Dr. Fallah has plunged into the slums to search for any information about dead or sick people, and remove bodies before the disease spreads. But spreading the word requires a community who believe in what you are saying and doing, who trust that you will deliver, and be there with them.

Dr. Fallah recruited leaders in the community to spread the word, they believed in him, knew he was one of them, and trusted that he would be there with them. Dr. Fallah said (NYT Sept. 14. 2014) if they don’t trust you they’ll hide the body and you’ll never know who has been exposed and the virus will keep spreading. The surveillance teams instruct the community on the use of bleach and water to wash their hands; the youth have raised money to print an eight-page informational pamphlet.

Dr  Mosoka Fallah inspires me, he provides living testimony of a compassionate healer,  restores my faith in the healing profession, and in our humanity.  We treat the sick in hospitals, but we heal and prevent disease ain communities. I made a contribution to their Ebola program in Dr. Fallah’s honor @  www.doctorswithoutborders.org.

P.S. For those of you out there who want to magnify your power to heal come join Mona Polacca and me Dec. 7-9, 2014 in Phoenix, AZ. for our Turtle Island Project retreat entitled Rituals and Ceremonies of Healing. Early bird discounts still apply.

A Miraculous Day

September 1st, 2014

Just back from my annual clown trip to Iquitos, Peru with Patch Adams M.D., and 130 clowns from all over the world, where we participate in the Belen Project. It is a community preventative health initiative that’s been going on for 10 years; that in addition to our clowning work (visiting hospitals, children’s workshops, street theater, painting murals), we also conduct mental health clinics in the streets which I’ve described in detail before ( http://www.healingdoc.com/blogs/category/articles/ )

The professionals who staff these clinics are all clowns, who in addition are healthcare professionals from many disciplines (doctors, social workers, nurses, psychologists, counselors, chaplain/ministers, body workers), all work with people and their problems.

The Gesundheit! model features a one time, 20 minute, intense heartfelt encounter, intently listening and focusing less on the trauma, and more on the patients strengths and resilience. We don’t make diagnoses or prescribe medication, but we sometimes give away amulets and blessings. In the 3 years I’ve been doing this, we find that in this short time one can make a heartfelt connection that can inspire hope. This year I broke the rule and saw someone a second time.

Maria is a 42-year-old woman who was acutely suicidal. She woke up, and after her morning prayers, decided today was the day she was going to kill herself. After 6 months of unbearable suffering she’d had enough; told me her 20-year-old daughter had been raped 6 months ago and was now pregnant. Maria’s family blamed her, saying if she hadn’t divorced her husband 15 years earlier, this would not have happened. Maria knew she was not to blame, in which I concurred, but alas she could not, as her family suggested, get over it and move on.

I told her I thought today was a miracle; this morning she was ready to die, and this afternoon we showed up on her street. What are the odds of that happening? I also said I believed her and that she could kill herself so she had two choices; she could be hospitalized, or she could make me a promise at least for today and tonight she would not kill herself. I would give her an amulet that had been blessed by Navajo and Huichol Shaman, and I wanted her to hold it during tomorrows morning prayers; she would feel our blessings and remember this miraculous day that we found one another. Perhaps tomorrow she could make a promise to herself to live for another day.

After the clinic, I couldn’t get her out of my mind, so I asked my clinic coordinator to check in on her the next day. We were going to be conducting another clinic not far from her home, and to invite her to the next clinic we would be conducting in a few days and to please bring her daughter as well.

Maria showed up not only with her six-months pregnant daughter, but also her younger 18-year-old daughter. Together they told me the rest of the story. Both girls had been raped (the younger over a year ago), and both by different maternal uncles. They had never spoken about it to anyone outside the family, and although Maria confronted her brothers she refused to press charges (this is not a culture in which women seek legal redress and prosecute their rapists).

At the end, I gave both the girls an amulet and blessed the family; whatever they faced they would face it better together. Their love for each other would be showered on this new baby, along with blessings of many relatives all over the world.

It doesn’t take a long time to connect at the soul level if you are actively in the moment, and it is in those miraculous moments that we are reminded of our shared humanity.

PS: If you want to connect with your own healing power check out the only workshop I will be doing with Mona Polacca this year entitled Rituals and Ceremonies of Healing (http://healingdoc.com/rituals-and-ceremonies-of-healing.php )

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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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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.