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Mudslide Not an Act of God

April 7th, 2014

The massive landslide that killed 30 people two weeks ago came without warning; happened so quickly that there was no chance for people to run for safety. It swallowed homes, businesses, cars, all holding lifeless bodies. The oozing mud continues to bubble forth artifacts; wallets, paintings, uniforms, toys, all the remnants of lives well lived.

The insurance companies call this an “act of God”, that’s the legal term to describe an event outside of human control for which no one can be held responsible. This was not an act of God, it was an act of irresponsible over logging and there were warnings for decades, the last report 15 years ago outlined, “the potential for a large, catastrophic failure” on the very hillside that just collapsed.

Oso, WA. lies in a stunningly beautiful, picture postcard valley on the banks of the Stillaguamish River. The Stilly as locals call it is world-famous for its fly-fishing whose crystal clear waters I waded almost 50 years ago. I was an intern in Seattle Washington at the time, and then these mountains were thick forests of old-growth trees. There is a powerful lumber industry here, and over the last 30 years these woods been excessively logged until no tree has been left standing.

The Stillaguamish Indians, who have lived there forever, have also issued warnings. They always knew that such large-scale manipulation of their natural world would yield serious consequences. They warned us, scientists warned us, but they were not heeded. Native Americans are still praying and warning us; the Bad River Band of Chippewa (Anishinabe) are fighting against the powerful mining industry in Wisconsin, The Anishinabe live just down river from a proposed iron ore mine that will be the world’s largest open pit mine; 4 miles long, a half-mile wide, and nearly 1000 feet deep (but it could be extended as long as 21 miles). The industrial waste from this mine will pollute the waters of this pristine wilderness because there are sulfides in the iron bearing rocks, and when exposed to air and water the sulfides oxidize and make the water acidic. The fish will die here just like they did in Kentucky and West Virginia.

The Anishinabe want to leave this land to their great grandchildren at least as well as they found it. They make all decisions on the basis of how it will impact the seventh generation. They are fighting to save their tribe, they are also fighting for the State of Wisconsin and our soul as a nation; we ought to be praying and fighting along with them.

These catastrophic disasters are not Acts of God, they are not outside of human control, and they are a tribute to our arrogance and greed.


Walking in Darwin’s Footsteps

March 23rd, 2014

I celebrated my birthday a little early this year with a bucket list gift to myself of a trip to the Galapagos. It has long been my dream to walk in Darwin’s footsteps, in that exotic place that launched our understanding of our evolution as species.

The Galapagos are a World Heritage Site that is well maintained by the Galapagos National Park Service, but it is not the barren volcanic landscape that Darwin landed on in 1835. The archipelago is now a verdant, equatorial paradise with lots of new plants and species (bananas, grapes, melons, insects, Norwegian rats, and domestic animals). There is a major airport here, and the port town of Puerto Ayora is a bustling tourist mecca with 12,000 residents. It is also the home of the Charles Darwin Research Center. who I think would roll over in his grave if he saw the nightly appearance of the Disneyland-like trolley that carries tourists through its streets.

Whatever the changes, the birds and animals that bring people to this equatorial paradise are still well preserved. The birds, sea lions, iguanas, tortoises, have no fear of human’s you can almost get close enough to touch them. The protected waters teem with marine life, and I wanted to see them too.

I am a certified open water scuba diver for over 30 years, and been entranced by the undersea life in the waters of the Caribbean, South China Sea, Gulf of Thailand, Red Sea, and the Great Barrier Reef. It’s been at least 3 years since I last dived and Gordon Rocks in the Galapagos is a hard dive; strong currents, cold waters, and big sharks. This was an opportunity I didn’t want to miss. I went out on a large schooner that rolled in the choppy waters, I’m not a good sailor and got a little wobbly. We changed into our full-body wet suits, a process that left me short of breath, sweating profusely, and having to ask for help pulling it up.

By the time I climbed down into the inflatable Zodiac, which would take us to the exact dive site, sat down and got strapped up, I found I couldn’t reach down far enough to strap on my fins. I’m sitting there thinking maybe I bit off more than I can chew and I’m too old to be doing this.

But when I finally rolled backwards into the water, and the sea opened herself up, I was again enveloped and my world transformed. There were millions of schooling fish, and suddenly out of the darkness 2 Hammerhead sharks that cruised by not more than 2 arms lengths away; my heart pounding and breathing real fast.

In this awesome place I feel Darwin’s seminal discovery in a very personal way. Everything in nature is in a constant state of transformation and those who survive are not the fittest, rather those who are the most adaptable. I’m not as fit as I once was and I will adapt to my growing limitations (shallow dives, warmer waters). I’m letting go, life is about the experiences we’ve had, not the things we hang onto

Clinical Dinosaurs

March 3rd, 2014

The February issue of Current Psychiatry featured an editorial by Dr. Henry Nasrallah; he is Professor and Chairman of the Department of Psychiatry and Neurology at St. Louis University, and said that psychiatrists who were not speaking the new language of the “neuroscientification” of psychiatry would soon be rendered obsolete.

Henry says that we are at the tipping point in psychiatry, giving up the primitive notions that have guided the profession for the past century. We are moving toward explaining our successes and failures in terms of microglial activation, inflammatory markers, aproptosis, S100B, and NOTCH 3. Those who talk about ego strengths, defense mechanisms, resilience,, the unconscious mind, and the human spirit are “clinical dinosaurs”.

Henry speaks for most psychiatric academicians today, who believe the best way to understand the complexity of the human condition is to explain it in terms of neurotransmitters, genomics, and MRI’s. But the truth is that no matter how much we know about the brain, the mind will always have a mind of its own. The language of science can’t adequately explain the mystery and awesomeness that are an essential part of the human experience.

I was introduced to an old Hopi medicine man many years ago who, upon learning that I was a psychiatrist, asked me what I knew about the mind (The Dancing Healers, 1988). At the moment, I couldn’t come up with a brief, pithy, summation so I said that what I knew about the mind I couldn’t tell him in a short time. He responded that if I couldn’t explain what I knew about the mind in a short time, that I didn’t know it. I asked him what he knew about the mind, and he said he could tell me in one word; it was he said “mysterious”.

Brain researchers tell us that the brain is hardwired for mystical experience. We are biologically programmed to experience awe, transcendent states that allow us to see the familiar from a new perspective, to experience the awesome. It matters less how we explain the mechanics of the mysterious, than it does to know it’s important.

To all my academic colleagues who herald in the ‘neuroscientification’ of psychiatry, I say let’s not take ourselves too seriously. Awe is the mechanism by which we tame the ego, and lift our spirits.

P.S. I wrote to Henry and told him I would be in St. Louis in late April and would come free of charge to present to his Department the memoirs of a clinical dinosaur, perhaps entitle it, The Magic and Mystery of Mind Healing.

Angelina’s Breasts and DNA Screening

February 17th, 2014

It’s only been in the last decade that we’ve been able to decode the human genome. Today genomics is a multibillion-dollar industry and growing daily. We have discovered a genetic mutation that predisposes women to breast cancer, but finding it doesn’t mean you are certain to get the disease. Angelina Jolie made headlines when she decided to have a preemptive double mastectomy because she carried the BRCA1 mutation. Her mother died from ovarian cancer, an aunt from breast cancer, and her doctors told Angelina she had an 87% risk of developing breast cancer. She went public with her story because she hoped all the women who might be living under the shadow of cancer would also get tested.

But Angelina’s genetic predisposition may not be the loaded gun as her doctors led her to believe. The Oxford University Cancer Epidemiology Unit says that women with one close relative with breast cancer have an 8% risk of developing it and it goes up to 13% with two close relatives. The Cochrane Breast Cancer Group carried out one of the largest reviews of preemptive mastectomies. In 7000 women, some of whom had healthy breasts and others who had cancer in one, researchers found that there was no survival advantage. Furthermore, half the women suffered surgical complications that required repeated operations.

I find no fault with Angelina’s decision but it’s one thing to make those decisions for yourself as an adult and quite another making them for your child at birth. The genomics industry soon we will be able to do comprehensive DNA tests on infants at birth. Parents will be sold a comprehensive genomic screening program that promises to reveal a child’s susceptibility to getting a disease. What is going to happen is that we will find lots of variations in the genetic code (because all of us have them), but have no idea of their significance. Most of the mutations we’ll find will pose no problem for the people who carry them.

I think wholesale screening of infants is dangerous.

Let Death Have Its Day

February 3rd, 2014

We’re being reminded with some frequency that we can keep people alive with machines even when they’re dead. Recently life support was turned off on a brain-dead 33 year old who was 18 weeks pregnant. Marlise Munoz was a paramedic who had made clear that she would not have wanted to be kept alive by a machine. But Texas state law prohibited withdrawing or withholding life-sustaining treatment from a pregnant patient, regardless of her wishes, or those of her husband and parents. Ultimately the family went to court and prevailed.

The accepted medical standard defining death is when you are brain dead; but what happens if someone is deemed brain-dead, and the family insists that their loved one be kept alive?

That’s exactly what happened to Jahi McMath, a 13-year-old girl who suffered complications from a tonsillectomy at Oakland Children’s Hospital in December 2013, and was subsequently declared brain-dead. Her mother said her religious beliefs say that as long as her child’s heart is beating then she’s alive.

This is the darkest tragedy any parent should ever have to endure, but keeping somebody’s heart pumping on the machine is not going to bring them back. We’re not talking about someone in a coma; no one deemed fully brain-dead has ever recovered.

We live in an age in which machines can keep any body operating indefinitely. Does that mean everybody gets to define death for themselves? There will always be people/families who say “please make more efforts for my loved ones”.

Never mind the economics of chronic life-support; what is the morality of it? Nature does not design things forever; every generation makes room for the next (some a little longer others shorter) but we all move on. It’s getting harder and harder for us to let go, and now we can manipulate our genetics so that we will live longer and longer. I say, let’s stop pursuing immortality and let death have its day.

Holy Shirt!

January 20th, 2014

In April of last year, the French auction house Daouot’s, sold many Native American artifacts that included dozens of sacred Hopi masks and kachina’s that were stolen from the reservation in the late19th and early 20th century. The Hopi Tribe and the U.S. government pleaded to halt the sale, and it went to court.

To the Hopi, the idea that these “objects” are commercial art is an insult. They see them as the living embodiment of their ancestors, that need to be nurtured and fed. In the end they were put up for sale that brought hundreds of thousands of dollars. The Crow Mother mask alone sold for $136,000.

Just 8 weeks ago, Skinner, an auction house in Boston, Massachusetts listed a “Sioux Beaded and Quilled Hide Shirt” that belonged to the Lakota Chief, “Little Thunder”. The shirt was estimated to fetch between $150,000-$300,000 when Skinner put it up for sale on November 9. But minutes before the auction began, Skinner withdrew the item in response to pressure from the Little Thunder family and Sioux tribal officials.

This is not just a shirt for the Little Thunder family or the Lakota people. Little Thunder’s shirt is a symbolic representation of a culture’s history and values. Karen Little Thunder, the great, great granddaughter of the Chief, says that the shirt is special in a way that white people can’t understand (NY Times, 12/28/13). “As a nation, we once stretched from Montana to eastern Wisconsin, and from the Canadian border to Nebraska…this shirt brings the greatness of our tribe within reach of every tribal member”.

Since our earliest ancestors, every culture has developed its own myths, rituals, ceremonies, and created sacred objects to bind its people together. Those sacred objects give stories their power. Chief Little Thunders shirt reminds the Lakota people who they are and their unique place in the world.

As a culture, we need more “holy shirts” and better stories that remind us of our best selves and sustaining values, instead of the daily feed of stories that dramatize our basest selves. Our survival as a species is not transmitted through our DNA, but through our stories.

Wireless Medicine

January 5th, 2014

I’ve said that wireless technology was reprogramming human behavior. That we were becoming so dependent on the instruments which were intended to free us, are actually captivating us by their incessant demands. It is so hard for us to get away from our cell phones that there is no longer a life between the pings (http://www.healingdoc.com/blogs/2013/11/life-between-the-pings/. I also want to tell you that the cell phone will change the practice of medicine in wonderful ways.

We are in the midst of a culture shift in healthcare delivery, moving from an interventional model to one that focuses on prediction and prevention. The new technology will help patients manage their health problems; they’ll be able to purchase applications for their phones to monitor their heart problems (take an EKG, perform an ultrasound, echocardiogram), or check blood glucose and manage their diabetes at home, while having a phone appointment with their doctor.

An EKG app costs $199 that records and transmits to your doctor’s phone your cardiac status. A microscopic chip the size of a grain of sand is being developed that will circulate in your bloodstream and can pick up the warning signs of an impending heart attack. The new technology actually allows doctors and patients to transmit data while talking to each other; even if it’s only 5 minutes they’ll focus on each other, it’s a relationship.

The healthcare of the future is not about intervention, but prediction and prevention. People will be monitoring their own bodies, listening to what it’s telling them, and making some intelligent choices about how they come to whatever they are facing. We will heal ourselves at home, and in supportive communities, that’s cheaper and will leave us healthier.

May this year find you making healthy choices,…a very Happy New Year to you all relatives, I say this For All My Relations…Mi Takuye Oyasin…

Happiness Formula

December 23rd, 2013

This is the season to be jolly…so what is it that makes you happiest in this season of joy? Social scientists who study things like what it means to be happy say that happiness derives from three major sources; genes, events and values.

Half of our happiness is hardwired in our genetic makeup (we inherit a lot of our capacity for happiness).  About 40% of people who are happy attribute it to a one-time event (like winning the lottery or getting an inheritance). However the happiness from such one-time events are short-lived, they tend to dissipate after a while so you don’t want to bet your well-being on a one time event.

That leaves a lot of happiness being that is under under our control. Researchers say the pursuit of 4 basic values is the surest way to happiness; they are faith, family, community/friendships, and work. Faith, family and friendships are pretty self-explanatory, but work is also critically important. 80% of the people who say they are happy are the ones who say they are completely or very satisfied with what they do.

Tis the season to be jolly, and what that means is, love the ones you’re with, and love the work you do. Our forefathers set before us some unalienable rights among which are life, liberty and the pursuit of happiness. This is the New Year, it’s the time to make choices about being and doing the things that give you the most joy.

Much happiness in the New Year to you all, may it be a year of joy and blessing.
I say this For All My Relations, Mi Takuye Oyasin

Trust the Season and Mandela

December 8th, 2013

This is the season we say thank you for all the gifts in our lives, and restore our belief that dreams and miracles happen, and peace and good will prevail.

This is not a good time to be reaching out to each other. As a culture we have grown cynical and mistrustful of the institutions that once sustained us (government, judiciary, police, religious institutions, Big Five accounting firms), and now it turns out we don’t trust each other.

A recently published Associated Press (AP/GfK ) Survey found that only 1/3 of all Americans believe that most people can be trusted.

One of the basic ingredients of a democracy, is a trust in the other fellow to make decisions based on the common good, not just our own. The current political gridlock is another reflection of what happens to a society when its members no longer trust in the common good and pursue only their own.  When that happens we no longer behave civilly toward each other.

Mistrust escalates fears, if you can’t trust 2/3 of the people you meet then it makes every stranger you encounter a potential trespasser. If you don’t trust the institutions to protect you, then you have to protect yourself. We are becoming a gun-toting, armed citizenry intensifying the boundaries between people.

The Survey also suggested that by the time we reach our mid-20s our attitudes about trust are pretty much set.  I found myself fretting about how our growing mistrust is becoming so deeply embedded that maybe it’s already too late to spread this season’s message. In the midst of these musings I learned the Nelson Mandela died. I loved him, the man and the symbol. I loved that after 27 years of imprisonment and torture for his stand against apartheid he did not emerge as someone seeking retribution and revenge. Instead he built a community based on reconciliation and compromise.

Nelson Mandela restored my flagging spirit, another gift from this remarkable man whose life and work are living testimony that we are capable of moving beyond our mistrust and isolation, to find a way to live together in shared humanity. In this season of thanks and miracles, thank you for reminding us to live the dream.

Rest in peace Madiba.

Global outreach project is not your ordinary mental health clinic

December 4th, 2013

We are in the midst of enormous changes in health care delivery. Implementation of the 2010 Patient Protection and Affordable Care Act will make health care accessible to more people than ever before, and ushers in a cultural shift from a prohibitively expensive interventional health care model to one based on prediction and prevention.

Instead of waiting to get sick and seeking expensive urgent care, we are moving toward identifying vulnerable patient populations early and encouraging them to become active participants in maintaining their health. Whether you like it or not, the Affordable Care Act (or some modification of it) is here to stay, because we simply can’t afford the 20% of our gross domestic product that health care costs us, and it’s not making us any healthier. Psychiatry is not well positioned to respond to this cultural shift, because as a specialty, we are moving in the opposite direction, creating more illnesses and prescribing more drugs. Patients only come to see us now as a last resort because they know we will label them with a disease and prescribe drugs.

Twenty-five percent of all Americans are now diagnosed with a mental illness, and with the recent publication of the DSM-5 and its record-breaking number of mental illnesses, soon 50% of the population might have a diagnosable mental illness. We are perpetuating the myth that if you are feeling anything other than wonderful in every moment, you might be suffering from a mental illness. We are “psychopathologizing” the ordinary ups and downs of the human experience and promoting pills for whatever ails the patient. I believe we would reduce the incidence of mental illness in this country by 90% if we prohibited direct-to-consumer advertising by pharmaceutical companies.

The message to the patient: Are you anxious, shy, sad? Can’t stay focused or can’t stay awake? If so, you could have a disease for which there is a drug (nowadays often more than one). Such messages are good for business, because we’re reimbursed better if we see four patients an hour for 15-minute medication checks than we do for an hour-long psychotherapy session. We are spending less time listening and establishing an intimate rapport, even though this is what most of us like best about what we do and understand as an important aspect of our healing power. Can we do both? Is it possible to make a soulful, human connection in a short time, and could this reduce an epidemic of overprescribing? I believe we can if we expand the ways in which we engage people – and in doing so, move into the new prevention paradigm.

In addition to my degreed credentials, I also am a clown and proudly serve as chief of community mental health at Gesundheit! Institute in Hillsboro, W.Va. The clown/fool/jester/trickster is an archetypal human characteristic that has served the purpose of lightening mood, diffusing anxiety, helping patients look at the familiar from a new perspective. The character can serve as a sacred healer. I clown all over the world with Dr. Patch Adams, perhaps the world’s most recognized humanitarian clown and founder of Gesundheit! Last year, I discussed a 20-minute mental health clinic in which I participated on the streets of Iquitos, Peru.

We did it again this year in Iquitos, and people lined up to see the clown-clinicians; they sat in an open space and talked for 20 minutes to someone they knew was listening to them. Clinicians heard gut-wrenching stories of suffering and challenges, helped people identify their strengths, applauded their resilience, gave advice, and blessed them. Patients felt better, and the clinicians felt better, because it doesn’t take long to make an intimate connection if you are truly present. It is in those moments that we are reminded of our shared humanity and that dreams are possible.

I’m thinking of bringing the Gesundheit! Global Outreach or (GO!) clowns to a mall in America and conducting such mental health clinics. Clowns would play, perform, sit in silence, and talk to anybody who wanted to right out in the open without charge. There would be neither signing of HIPAA compliance forms, nor making diagnoses, nor prescribing drugs. The idea would be to provide clown healers who might inspire people to see their lives from a different perspective.

This would be a community-based, mental health promotion program in which clowns would be supported by local community health agencies; self-help groups of every description (from survivors of violence, burns, and addictions, to parents with attention-deficit/hyperactivity disorder kids who found a way to help them without drugs). There are many untapped resources in communities, and these “clinics” can mobilize them to connect people. By doing this work publicly, we would destigmatize the concept that having ordinary problems of living is the equivalent of being mentally ill, or disabled, and needing only drugs.

You don’t have to be a clown and do this in the street (although you are welcome to join us). Try this approach in your office; use 15-20 minutes to make a heartfelt, therapeutic connection with patients; and remind yourself why you do this work. It will make you feel good and intensify your healing power.

Dr. Hammerschlag is affiliated with the Arizona Health Sciences Center at the University of Arizona, Phoenix, in addition to his role at the Gesundheit! Institute. He also is author of several books on healing, spirituality, and other topics. To get in touch with him, e-mail him at info@healingdoc.com. Those interested in the work of Gesundheit! and clown trips should go to patchadams.org.

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.