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It takes a high-profile celebrity death — the most recent example is Prince — to highlight problems with legally-prescribed medications such as opioids.

Pain is a horrible thing, and those who suffer any level of pain from mild to extreme are deserving of relief.  A doctor is trained to give relief and is trained to do so safely and responsibly. Read more on Doctors Have Been Brainwashed By Pain Medicine Guidelines…

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Prince’s death was less original than his music. When Prince died of a self-administered dose of Fentanyl, he was far from the first celebrity to succumb to the use of addictive prescription drugs, and far from the first to succumb to the most dangerous of legal pharmaceutical opioids. Fame has long conferred a sense of entitlement.  The rich and famous who are powerful enough to have things they want have wanted freedom from both physical and emotional discomfort.  The list of them is long.  Their scandals nourish their admirers, often helping them feel superior to their idols. The list is long. The best news is that at least some, like Jamie Lee Curtis CITED HERE, have managed to vanquish addiction and continue with their lives. I applaud them, for I believe their public admissions inspire many.

Read more on Prince’s Death, Unlike His Music, Was All Too Familiar…

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I idolized the American medical establishment. When I was a mere Blue Cross number-collecting lackey working at the front desk of the Emergency Room of Massachusetts General Hospital, I sometimes saw, slipping into the doctors’ lounge, notable people — doctors whose surname in footnotes graced the basic core medical textbooks I was using as parallel reading in France, to prepare myself for my American examinations in medicine. I never wanted to penetrate more than the lowest echelons of the American medical establishment when I returned from France.  I mean I doubted the Harvard-types would open their world to me easily, no matter how clever I was. I proved to be right.  At a Harvard-associated residency program, I was actually asked at the interview if anyone in my family was a Harvard University trained physician. I still remember the program chairman’s barely muffled laughter when I told him my father held a graduate degree from the Harvard University School of music. Read more on Drug Misuse in American Medicine Leads to Possible Catastrophe…

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I heard it long ago, when I was early in my training, at some big international psychopharmacology meeting so I reproduce it here. “What people really want is an on-off switch.” Most people seem to get through life pushing the envelope only minimally.  A few cups of coffee in the morning helps promote “alertness.” A drink or two with the guys after work helps to “wind down” on the way home. Neither of these decisions is harmless. Although there are indeed some beneficial compounds in some forms of alcohol, I have come to believe that civilization has taken a poor turn in validating its use for a very long time.

Read more on Addictive Drugs and Questions They Raise…

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When I was little, I relished trips to my aunt Sadie and uncle Irving’s farm.  There were many reasons, including the freedom to run free with my brother in the sweet-smelling grass, in the country air.

The best reasons, however, were the chickens. Read more on I Have Always Loved Chickens…

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Every honest and complete psychiatric evaluation includes screening for delusions. A delusion is a strongly held belief that is totally without basis in the factual reality that we all use to live our daily lives. I have taken care of several people, institutionalized and not, who have had such beliefs.  Medications known as “antipsychotics” can be very effective on the hallucinations — the hearing voices and seeing things and such — that are the hallmark of a lack of mental “normalcy” as is generally expected and accepted in the community. The same medications may be less effective on these delusions, these beliefs.  Sometimes, in a particular kind of delusion, a kind that hits folks somewhere between 18 and 90 (average age 40) where there are no hallucinations, just beliefs.  They are less frequent.  They are also hard to treat, with antipsychotic medicines working maybe about half the time — in those who can actually be convinced to take them. Read more on Screening For Delusions…

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My struggles with obesity are well known and well publicized.  Although my web page regarding weight loss hasn’t been updated lately, that will be changing soon, as I have some new focus on obesity — causes and treatment.

When you have an enforced lack of mobility, if you don’t deliberately lower your caloric intake, you are going to gain weight. Read more on When Life Lowers Your Physical Activity, You Don’t Have To Get Obese…

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In my previous blog post, I talked about “Keeping Up With The Kardashians” — and asked some fans for advice for aspiring reality TV stars. If you got drawn in by that, I continued the topic in my private opt-in newsletter.  If you haven’t followed that, you can register for free by filling in that little form up in the top right-hand corner.  It’s a no-spam non-commercial commentary blog and you can opt-out at any time. But there is more to say — and this time, I’m reaching deep into the psychology of those who are in the spotlight and want to be in the spotlight.

The tie between the popularity of reality TV shows and celebrity worship was not immediately evident. But it is obvious that our American society is clearly increasing in — Narcissism. In Greek mythology, Narcissus was a handsome young man who was sitting on a stone precipice, admiring his own reflection in the water, when he fell in and drowned.  The spot where this happened was allegedly marked by the first Narcissus flower. In modern times — like at dinner last night — the narcissus is a wonderful edible flower that is often served as garnish with sushi. Go figure. The queen of the current American psychology of narcissism in unquestionably Jean Twenge, PhD., a professor at the University of California San Diego, who has written a couple of books and lots of articles on the phenomenon of modern narcissism, and has been much interviewed in the public media. In a recent article, she is defending her own research and findings. Frankly, my non-systematic review of clinical data suggest she is right on. She has been criticized — a badge of boldness and popularity, think I — for attributing narcissism somehow to children having been brought up to believe they are special. Once again, I personalize.  My parents filled my head with feelings of being special.  Comparing me to Wonder Woman” and, when I was very young, telling me that I was “smarter than the average bear” like Yogi.

But they also told me this gave me a terribly heavy responsibility,  They impressed this on me mainly through religion — most especially, making sure that I read parts of the (Jewish) prayer book before the service at all holidays and Sabbath.  And we got to temple early, long before services started, because my father of blessed memory had to “warm up” the organ. (He also directed the choir) They never failed to remind me that I was named after Queen Esther, the woman who saved the Hebrew people. In the Book of Esther, she did this by winning a (Royal) beauty contest.  I can’t have been older than 6 or so when I explained to her that if we were waiting for me to save the people by winning a beauty contest, then the people are in trouble. She told me I could maybe do this by working hard in school. I guess the rest is history.  Many have told me I must have been “raised right.”

Narcissism is a concept that originated with Freudian psychiatry.  It was believed to originate in a man when his relationship with his mother was overly close.  Other theorists have suggested in may be related to excessive closeness or neglect from either parent. Here is a good summary of the evolution of the concept, as well as the currently accepted diagnostic criteria. There seem to be biological and/or genetic factors, as well as psychological reasons that people can end up diagnosed as the full blown “Narcissistic Personality Disorder.” A personality disorder is a way of dealing with the world that a human “develops” during adolescence that is dysfunctional, causing pain to the individual and/or to the people in the world who deal with this person. Estimates of prevalence (frequency) of this disorder in the general population is estimated at about 6%.  If you know more than 20 people (you do), chances are you know at least one. They come across as egotistical, to put it mildly.  They are not particularly empathic, blame other people for their problems.  Their self-esteem is inflated. Their attitude toward themselves fluctuates between feeling “omnipotent” and feeling “devalued.” Curiously enough, I seem to be more likely to meet people with this disorder as colleagues or associates than I am to see them as patients.  I believe that to be because when they have troubles in life, they invariably believe the difficulties that caused them are other people’s problems, and not theirs. So it is no surprise that folks with these problems don’t usually show up in a psychiatrist’s office seeking treatment. I can think immediately of a couple of technically excellent surgeons who would meet criteria, as well as a couple of psychologists and psychotherapists.  Especially one who believes herself so gifted in application of a certain psychotherapeutic method that nobody else should perform psychotherapy in any other way.  Of course, it just ain’t so. I shall avoid discussing narcissism in presidential candidates for now, although it is not hard to imagine another posting about that one. When people note there is an increase in narcissism, they do not usually mean the same full-blown personality disorder we are discussing above.  Very often we diagnose narcissistic “traits” for people who have some aspects of narcissism in their personality. There is a fair amount out there. In case you are curious, there is an online test (with a bunch of disclaimers that it should not be used for a clinical diagnosis) to see if you are in any way a little narcissistic. Narcissism seemed historically to be just a little more frequent in men than in women.  However, most of the followers of the Kardashians known to me are women. Some statistics suggest that the growth in narcissism that has taken place in our generation comes mainly from women. Remember, they want to be admired, but may also feel “devalued.” While all these changes in the world have been going on, I have been aging.  I do look at objective research findings to confirm observations whenever I can. Still, I think the page indexed below is correct when it infers more people will look at a woman’s physical appearance than at her character development. Put this into the context of the age of the internet and most particularly, Facebook.  It is possible for a woman who craves more admiration and self-esteem than she has got, to vicariously live the life of someone with the ascribed status that comes with wealth, fame, and physical attraction. This page adopts Twenge’s work and associated studies into a set of directions to help men avoid “hooking up” with narcissistic women. By this time, I have pretty much made up my mind that I am not terribly likely to get a Kardashian-type status in any social context known to me. But I am still wondering — what do I really know about the people, the women who make up a non-negligible amount of people I know either casually or as folks on a professional staff? What do I know about them if they like and follow the Kardashians? Yes, the obligatory formal academic type psychological studies do exist, and have been reviewed. Note that this article focuses on “celebrity worshipers,” who have taken a scale relevant to that entity, which seems to be far from having 100% consistency with the designation of “narcissist,” although I suspect there may be more than a little overlap. This paper specifically cites a fairly large study (343 folks) where 4 of 5 scales on the inventory for narcissism correlate with the Celebrity Attitudes scale for “celebrity worship.” Aspects of psychopathology (that is, mental illness) that are found in the population of celebrity worshipers more frequently than in the population at large include a “proneness” to fantasy and a “tendency” toward addiction, and criminality, depression and anxiety. This particular combination sounds like more than a few of my “dual-diagnosis” patients — that is, folks being treated simultaneously for addictions and mental illness. As for me, I have at least decided that I am not suited for Kardashian-type celebrity worship.  Given the above psychopathology, I am very glad I do not encourage such psychopathology, for I was imprinted with the notion that with great power comes great responsibility (many years before the popular Spiderman movies picked up this slogan). Somehow, I still want to believe that every human has the capability of elevating the entire human race by elevating individuals to higher moral situations. I will cling to these beliefs of my childhood, as anachronistic as they may seem. I feel somehow noble that I have put this effort into explaining what is going on.

The End

 

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Why people are obsessed with the Kardashians? I have not followed them in the slightest. I am obsessed about knowledge — how to apply it to helping humans (my favorite species) have happier lives through scientific knowledge. I was very surprised when I heard two professionals — a man and a woman whose knowledge I respect — gushing about how much they loved the Kardashians. I wanted to know why. I admitted to them that I was, perhaps, just a little bit, well, jealous. My patients mostly seem to like me well enough, and some even say the love me.  But I did not understand how or why people could “gush” about loving the Kardashians. My friends came to the rescue.  They told me, step by step, the things that the Kardashians had done to make them so “lovable.”  They thought I could replicate the process. Of course, me being me, I tried to find all that I could in the neuroscience and (more) the psychological literature, to figure out what worked, and why — and what they may have forgotten to tell me. Read more on Cashing In On The Kardashians…

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Congratulations are in order for Senator John McCain,a Vietnam veteran, and his Arizona colleague Senator Flake (I refuse to comment on HIS name) for pointing out to America that the Department of Defense is paying the NFL for demonstrations of patriotism. Here is the Washington Post article that my ever vigilant (and unabashedly patriotic) husband used to notify me of this wildly newsworthy knowledge.

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