D e e p Thoughts

   The procrastination shall stop here. . .

There has been a lot on my mind lately but little that I haven't written about before. In the past I have usually been inspired by things that tended to incite anger from deep within. I feel like I'm at a point in my life where I don't care to entertain thoughts and emotions about things for which I have little or no control over. My 50th birthday will come in three days despite the feelings of denial I have experienced. I just cannot believe that I am actually 50 years old. I remember quite well when I thought 28 was old. I remember how fast the past 20 years flew by and to think that should I live 20 more years I will be 70 years old when it happens again. I don't know if I can grow old gracefully. I suppose growing old does beat the alternative, however.

I'm quite pleased with the outcome of the election. Strangely, there is a part deep within myself that rings of grief. The cold reality that there really is a limit to how good things will ever get has started to set in. I think I realize for the first time that there really is no one to blame for the bad things that happen in life. I gave George Bush and Dick Cheney far too much credit in the past. The whole political arena is actually just an illusion enhanced by the mass media that helps influence one's world view but I'm starting to realize more clearly that the real power lay within the grass roots of society. That is what truly makes America have the potential to be the greatest civilization ever possible. Emphasis must be placed on the word potential, for that is quite the key word. There also exists a potential for America to fail. I feel we have surpassed that threshold but have exposed where we really are as a country. There is an enormous amount of work to be done both individually and collectively if true greatness ever becomes a reality.

I'm an idealist in my thinking.It took me years to stifle the competitiveness within my personality, even though I'm aware that I would have accomplished very little in life were it not for that very trait. I never became the professional athlete or actor that I dreamed of for years. That doesn't really matter. What is important is that America gave me the opportunity to have those dreams. Without such dreams I probably would have never become The HEADoc. The problem with the competiveness is that one can never reach a point where one is truly satisfied and in harmony. There always has to be more. Someone must always win and there must be a loser. Thank God I no longer think that way. It really has been a process of adapting. Adapting to diminishing physical limitations over time and compensating through other means. I know that if I could regenerate my 18 year old body and keep the wisdom gained over time, I would somehow figure out a way to have been successful in a professional sport or as an actor. But... after achieving such an accomplishment I truly believe that I would have regrets about not knowing whether or not I could have become a doctor. There still would have been a lack of total satisfaction because the accomplishment would have been achieved through competing instead of being a gift and a natural calling. It took some competing (and luck) to get into and out of Med School but becoming a Psychiatrist was totally by choice. I believe it to be my true calling.

So what is the point I'm trying to make here??? Maybe it is that our free will in an atmosphere of freedom is an awesome thing. Each day I exert great effort in hopes of shining some light on the source of the emotional pain that brought a given patient into my office. I know that if the individual can ever gain the insight to understand some of why they feel the hurt it then becomes possible for them to move beyond it. One prototype is the sexually abused child who is betrayed in the worst possible way by an adult who was charged with the responsibility of protecting and nurturing. After repeated assaults that child understands on a gut level that something is terribly wrong and seeks protection from another adult where there still remains some trust. More often than not, that adult may not be up to the task and either blames the child or refuses to believe the child's story. Thus the child is emotionally traumatized again and perhaps scarred for life. Who in this world can this child trust? From their young and restricted point of view they conclude that no one can be trusted. That child then retreats within themself and develops whatever coping mechanisms that will allow them to survive, or in many cases to self destruct over time. Another prototype that really bothers me is the case of the dead beat dad. I see no excuse for such behavior. The only thing a child cannot forgive a parent for is voluntary abandonment. This is so difficult because it forces that child to question and explore themselves for answers that do not exist. Such a child may conclude subconsciously and erroneously that he left me because I am defective or I am bad or was not worthy. A child without a healthy self esteem has little chance of success and happiness. Children, by nature,  have no means of expressing frustrations and emotions other than acting them out. A child who is hurt and angry may know only one recourse, to make others feel the same as them. Often that other person is their single mother who already has issues from the disappointing relationship with the child's father. Those closest to us are capable of causing the deepest pain.

The free will exercized in a dangerous manner by the adult examples mentioned above is capable of catastrophic emotional damage to the most innocent of victims. It is extremely difficult for a victim to break free from the bondage created by such situations. I suppose my work sometimes causes me to feel that hypocrisy is pervasive throughout our society. We often pretend that certain atrocities within our culture don't really exist or they may be minimized or dismissed as though fictitious. We tend to only acknowledge what we are fed through the media and accept that as an accurate portrayal of our social reality. Unfortunately, the media is limited in the ability to reflect an accurate and precise reality of human life. This too happens concerning the problem of drug addiction. Those higher up are charged with protecting the metaphorical child. In reality, they essentially look the other way or allow our attention to be diverted as literally tons of poison are dumped on our streets. An occasional bust or arrest is publicized to reassure the public that the war on drugs is being fought and progress is being made. It is total B.S. in reality. There is absolutely no intention of ever winning a war on drugs. That is what really hurts me most about the way I have been treated by the State Medical Board and the local media. I know the real truth so it doesn't really matter how they choose to portray me. I know that it all is political in nature. I understand on a street level how their approach is ultimately part of the problem and not the solution. The unfortunate irony and cold reality of the big picture is that there is a need for misery in our society, due to its profitability and economical importance. There is a need for prisons. There is a need for crime. Could you really imagine a world without those things? What would all the lawyers, judges, and prison guards do? Bush vowed to stamp out evil in the world at one point and was greatly criticized. I don't think he was altogether wrong with the idea. I think we just need to start at home.

It's All In the Mind

Nihilistic thinking means anticipating the absolute worst for the immediate future... Those suffering from depression are most vulnerable to this form of thought content. As a therapist my strong suit turned out to be a gift for interpreting. At the commencement of numerous sessions, patients have voiced feelings of despair and hopelessness and somehow end up leaving with a better outlook for their future. The process for this to happen usual starts by allowing the patient to express the laundry list of everything not going well in their life then pose the simple question: Well, what good is happening? The automatic response to that question is "nothing." I challenge them to rethink that answer and almost without fail, at least one positive thing can be identified. This single positive is used as a foundation to help make associations with the considerable number of worthwhile aspects of that person's life. There have to be reasons they even chose to keep their appointment. If their situation were truly that hopeless, they would likely have offed themselves or drowned their sorrows with alcohol or other mind altering substances. I point out that the fact they have kept the appointment and chosen to not entertain the thoughts or temptations of self harm is an important asset and that hope remains alive. Prioritizing is crucial. Freud wrote that true happiness is based on the quality of personal relationships and the status and degree of satisfaction with ones career or occupation. Any person who has lost their job and has a marriage on the rocks simply must feel grief emotions and depression at least for a period of time. If they do not, that person is truly out of their mind. The question is whether or not the person has sufficient coping mechanisms and an adequate support system to endure the storm. There are only two scores to be made on this crucial test; 100 or 0. One who choses to take their life and succesfully do so receive the zero. Even the person botching the suicide attempt receives a score of 100. Those who choose substance abuse as their primary means of coping are rapidly headed toward the zero mark. One who has children or grand children will be less likely to engage in the selfish act of suicide for they more than anything don't wish to transfer their pain to others that they love. Given enough time every storm eventually passes. Suicide can become a legacy since the number one risk factor for a succesful suicide is to have had a close relative commit suicide. It must be taken into consideration as well that severe substance abuse is no less than a masked wish to die and suicide in slow motion. The trigger has been pulled but the bullet just hasn't struck yet. Nature provides a simple guide that it doesn't take a rocket scientist to figure out for how to stay focused and make the best decisions. The answer is children. Almost every mammalian species has it encoded in their DNA to rear their young to at least some degree. Parents who consciously do their best to meet the needs of their young tend to have better mental health. This does not mean giving the child every material object they themselves never had or sparing the rod. Kids actually want to be disciplined and failing to meet this need will result in more acting out of undesirable behaviors. Kids with special behavioral needs associated with conditions such as ADHD or ODD need to be treated professionally as part of their parents involvement with being responsible and effective in the parenting role. Yes, you the mother or father of the child experiencing problems likely may carry an adult version of what your child has. It's nothing to hide or be ashamed of but be thankful we understand these conditions better today and can offer safe and effective treatments. Stop reading the internet and package inserts so much. It still amazes me how some people can learn more in an hour of Googling than I learned in 8 years of training and 12 years of practice. When this happens, as it often does, it gives me a pretty good clue of the origins of the problem at hand. My months of labor at my Chatham County retreat are starting to pay off. Out of what appeared to be random forest with major over growth, i have been able to restore a piece of history. Observers don't see me as a nut so much now. It is therapeutic for me, though at times it feels like PTSD without the trauma. Over forty years ago comes back to me as if it still lives. Practically all the adults I knew at that time are dead and long gone from a physical perspective but the memories are priceless. I see the pedal car, the tricycle, and remains of the little red wagon I once pulled lying in a pile of junk. I know its just rusted metal that should be hauled away to the random observer. The freight train passing by twice a day is undesirable noise to the random observer. It brings back memories to me of leaping from bed to run and wave to the engineers and count the cars. The dogs howling and owls hooting in the distance are not frightening to me but reminders of a simpler time in my life. I've spent 90% of my time working around the spring and the branch because they were my favorite places as a child. I know how to appreciate those simple structures. I think of how my ancestors relied on this source of water for their very lives. I think of the time and effort they must have put in so many years ago. Now it's up to me to not let that be forgotten. I am honored.

I'm Back

   I had started to grow tired of writing about the same old old depressing topics. . .

therefore, I haven't made an entry in several weeks. It seems that recent references to partisan politics made my Blog unattractive to the national market just as I thought things were about to take off. The AOL Journals site has announced it will shut down for good this month. That is where Thoughts From The HEADoc began over four years ago. I'll need to find a way to save the archives on this site or another.

Traditionally, October seems to be a bad month when everything that can go wrong usually tends to do so for me. I learned of the death of a resident at the 1/2 way house where I work this morning who apparently died in his sleep possibly from an accidental overdose from opioids bought off the street. I had helped him through his detox period and seen him several times where I resisted his drug seeking and refused him what his body craved from years of dependence from family doctors, emergency rooms, and off the street purchases. He had a couple months abstinence from his drug of choice. His addiction, it seems, still ended up taking his life. Had I been able to start him on Buprenorphine at the commencement of treatment he may have resisted those cravings and not have resorted to desperate measures. The next witch hunt may look at me as the primary villian in this tragedy though I may in all actuality be the one who could have prevented it. Despite completing the training to use Buprenorphine, there is a strong possibility the Medical Board will restrict me from prescribing it for its intended use because of their need to discipline me for prescribing opioids to treat chronic pain patients in the past and not having the documentation to suit their satisfaction. There is an abundance of opioid pain medications on the streets today that addicts have access to. Where it all comes from I do not know. It does make me quite angry to think of what I have been put through for what I find to be politically motivated. Not only do I find my past involvement to not be a significant part of the problem, I have been one of the few foolish enough to try and help those in need with prescription drug addictions. For that my reputation was attacked and my name dragged through the mud. At my last meeting with their people and my lawyer, I was told that if I had hired a lawyer from the very begining, none of what has happened would have happened. Thanks for the belated advice. I found that it is dangerous to assume that because you think you have done nothing wrong that you will necessarily be treated that way. It's not that difficult for the system to make a decent person look like a criminal if that becomes the intent. It's not personal they say. Live and learn I guess.

I have never been more sick of anything than I have of this whole Medical Board thing. I want so much for it to be over. The Consent Order is expected to be finalized this month. At the very least, I expect to be restricted from writing Schedule 2 Narcotics. As long as I can continue to write ADHD medications such as Ritalin and Adderall I have no problems with this. I think it is fair for them to order me not to treat chronic pain patients if that is what they feel they must do. I don't believe it will have any impact on the problem that exists with opioid dependence/abuse in North Carolina. I know it is no more than a gesture that may make them feel they are doing a good job. I will find it unfair and difficult to accept not being able to prescribe Buprenorphine, which is a Schedule 3 medication approved last year for the purpose of helping people get off of pain medications and heroin. It is the first medication ever that will allow doctors to treat patients safely in the office setting. It is more effective than methadone but more importantly much safer to use. Physicians must complete 8 hours of training to be certified to prescribe this medication. Each certified physician can manage up to 30 patients the first year, monitored by the DEA. I'm hoping The Board will not see it necessary to deprive me of such a useful tool. If they really want to hurt me they could also not allow me to prescribe Schedule 4 medications such as Ativan, Klonopin and Xanax. I see no reason for them to take such a stance, but they hold all the cards. They could take my license to practice if they wanted to.

Enough of that. I cannot even find a way to joke about such thoughts as that. My cat was spayed. It's finally over. I don't have to worry about any more kittens. Squeaky had to go due to some major sanitary issues. I truly believe her to have some major emotional developmental issues as well. It's amazing how easy it becomes to detach from them emotionally once they are no longer a cute cuddly kitten.