In the course of an evaluation, a patient asked me if she might be a candidate for an “SSRI.” These are potent drugs she has seen advertised on TV as effective in treating symptoms like hers.

Such requests are becoming routine in the direct-to-consumer, “ask your doctor” promotional blitz. Most of the knowledge that guides today’s medical care comes from pharmaceutical companies through the media. Patients are introduced to drugs that purportedly cure everything from shyness to tiredness, anxiety, lack of focus, and sadness. It’s an education designed to sell pills, and it is predicated on “psychopathologizing” the human condition. We have pills for kids who are too active, are sad, or can’t stay focused. There are pills for couples who argue, for people who can’t sleep, and for those who can’t stay awake. Patients are requesting pills and doctors are prescribing them. This is not the answer to living a life of joy. If you’re not feeling good in every moment, it doesn’t mean you have a disease. It does not mean you need powerful medicines to elevate your mood or minimize your anxiety.

There may even be something to be learned from the experience of your suffering that will last you in good stead in the future. Some valuable things are being lost in the contemporary practice of medicine when patients come to believe that the ordinary ups and downs of life are chemically treatable diseases. As a culture, we become increasingly dependent on drugs and are popping pills because it’s so much easier than taking the time to make the emotional investment required for personal growth.

The doctor-patient relationship is the core of a sacred profession. Dr. William Osler, the first Professor at the Johns Hopkins Medical School, and the greatest clinician of his time, said, “It is much more important to know what sort of patient has a disease than what sort of disease the patient has.”

Seek out someone you trust whose commitment has not been dulled by the commercialization of medicine, a doctor who prescribes pearls not pills.

P.S. Interested in reading more about the pill-pushing in America? Read Dr. John Abramson’s new book, Overdosed America: The Broken Promise of American Medicine (HarperCollins, 2004)

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I recently spoke at a healthcare conference in an exquisite tennis and golf resort outside of Tampa. On Sunday morning, I was lounging on the porch of a lovely condo, reading the New York Times delivered to my doorstep.

A fresh pot of coffee, uninterrupted hours . . . this is my kind of Sunday morning treat. When I took a break to sip my coffee, I looked out onto a Florida Everglades scene with turtles swimming and heron and egrets wading and moving harmoniously in a graceful, feathered ballet.

A front-page story captured my attention (NYT, 11/7/04). It was about two middle-aged professional men with Amyotrophic Lateral Sclerosis (ALS, or Lou Gehrig’s Disease), a progressive, paralyzing disorder that quiets every muscle in the body. Your mind stays intact but your body is totally paralyzed. From the time of diagnosis, the average life span is 3 to 5 years.

Dr. Jules Lodish, a hematologist and oncologist, has been living with ALS for 10 years. The only muscles he can still move are slight twitches of his cheek. In this condition, he has helped develop a computer program that electronically converts his twitches via a sensor attached to his glasses. The computer translates the twitches into words that allow him to communicate. In this “locked-in state,” he has managed to write a 30-page manual that sets the standards for how to create sterile environments for ALS patients. He now advises ALS patients and their families about how to organize their own care and use the communication device he has mastered.

Dr. Lodish says he communicates with more people now, than he did when he was able-bodied. He sits strapped to a wheelchair while a machine breathes for him through a tracheostomy tube in his throat. He still looks forward to every day and says, “I still have quality in my life….quintessentially, I have found that ambulation, movement, swallowing, eating, talking, breathing, and self-care, are not me. They are substantial physical losses; but they are not me….Who I am, is what I have always been, a father, a husband, a friend.”

Not everybody with the disease makes the same choices as Dr. Lodish. At least 90% of patients with ALS decide to die when they can no longer breathe on their own. Even though it’s clear that commitment and medical science can extend their lives much longer, the tracheostomy surgery and going on the lung machine, marks the dividing line between living naturally and being kept alive artificially. I think Dr. Lodish is a hero on his life’s journey. He provides living testimony that if what you are is still something you want to hang on to, then you can do it. I also think those who choose the other path are heroes too.

You don’t have to wait until your last muscle twitches to ask if your life has meaning. Make your life a hero’s journey by knowing that the quality of your life is acceptable and meaningful, and you will look forward to every day.

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On this year’s annual “Boys Trip,” my sons-in-law all brought their cell phones. The usual explanations: business demands that required attention and availability in case of emergency. At least one was on the phone taking care of business in the bird sanctuaries, elk preserves, on the beaches, or driving through pristine Point Reyes wilderness to the oyster beds. I pontificated on and on about the price of these intrusions, until one of them said, “Will somebody muzzle that dinosaur.” If ranting about this is justification for stuffing and mounting me as an exhibit in the Museum of Primitive Man, so be it.

The cell phone was intended as a tool to liberate us, to let us get away and be free. Instead they are enslaving us because we take them everywhere. The cell phone has become our culture’s American Express card; nobody leaves home without it. People who carry them invariably respond to its ring, even if it’s only to see who the call is from. The musical seduction of your chosen tune is so irresistible that it always takes you away from wherever you happen to be in the moment (at lunch, watching your kid play volleyball, a walk in the woods, listening to the ocean waves, etc, etc.)

We live in a world of terror and color-coded emergencies. The cell phone has become elevated to an icon of personal safety. However, it is evolving into something that is destroying our ability to feel unafraid. In a culture of escalating paranoia, if you can’t reach somebody on his or her cell phone, you begin to imagine the worst.

Cell phones are also promoting dependency. They create the illusion that availability of others is indispensable for personal survival — that the only way to make an intelligent choice or avoid mistakes in an emergency is to have instantaneous access and consultation with somebody else. Kids can’t change a tire anymore, and they don’t have to, because help is only a phone call away.

The only way we learn to survive on life’s journey is by facing our fears without interruption. The more available we make ourselves, the more it steals our freedom. Do not let the ordinary world intrude upon our sacred time and spaces. Get away to places where the spirit soars and you can hear soul music on something other than a cell phone.

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The federal government contributes over $2 million to scientific institutions to study the effects of prayer on the healing process. There are those who express outrage. Some scientists and statisticians say these studies are a waste of time and money; contending that what ever efficacy might be attributed to prayer could have other explanations. It’s what hard-data scientists call “weakened measures”: collect enough variables and it will give you any answer you want.

It’s absolutely true that doing research on the efficacy of prayer is different from other kinds of scientific inquiry. The interface of science and religion raises lots of boundary issues, because you can’t control all of the variables. The same people don’t do the praying, and we can’t even agree on what constitutes a “therapeutic dose.” Is prayer done by an individual or a congregation; is it a Buddhist ceremony, a dance, a Native American sweat lodge, or New Age healers chanting at holy sites? How do you quantify prayer? In spite of these uncertainties, what these studies reveal is that most people, when asked what they think about the healing influence of prayer, say they believe it’s helpful.

I believe some people get offended by the word “prayer,” because it sounds so religious. So, let’s instead call it “making a connection to some healing energy.” And let’s also agree that it may be less important to understand how it works than the fact that it seems to work.

Connecting to something other than self, something that inspires you, something that fills you with awe and love, they all embolden the healing spirit.

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My daughter arrived in Phoenix early one morning on the redeye flight from Honolulu. She slept on the plane from the moment of take off until they announced preparations for landing. I marvel at her ability to sleep at the hint of any vehicular motion. She says it’s because of her “Kapha” (Earth) energy.

When I asked what that was, she said it is an Ayurvedic medicine concept. It seems every person has a predominant physiological style in which their bodies function. Your biological thermostat is set to react to emotional and physical stressors, in one of three styles. Kapha people are grounded, sedentary, and big-boned; however, she is predominantly a “Pitta” (Fire) and “Vata” (Air) person. People with these qualities are hot-blooded, fiery, easy to arouse, spontaneous, unpredictable, and move around like the wind.

It used to be that if you knew what your zodiac sign was, that explained everything. But in today’s globally sophisticated world, that is no longer sufficient. You have to know your physiological markers and your psychological styles as well.

I was at a dinner table where I heard people introducing themselves as, “I’m an ISTJ,” or an “ENTF.” This psychological shorthand is a Myers-Briggs formula that denotes an introverted, reflective, task-oriented person, or an extroverted, dynamic, risk-taking one. These formulaic classifications supposedly capture a person’s essence. Such assessments always trouble me, because they are simply clues to stimulate discussion. I cringe when I hear people explain away their frustrations at work or in relationships by this global shorthand. Businesses are now using this code to make hiring and promotion decisions.

We cannot objectify personality to the point where we are told someone’s “score” and then think we know what he is all about. These global constructs are intended to provide the words for a vocabulary, they do not write the music. Don’t make final judgments about people based on shorthand — take time to listen to their melodies.

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