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.

The Truth Is The Light

  Very little is as it seems in our reality. . .

I have found that to be one of the greatest truths, yet sometimes The Headoc forgets that. There may be times when a myth or parable actually contain much greater truths than perceived reality. All great orators and teachers are gifted in using metaphorical illustration  as a means of enhancing their transfer of information. Most of the greatest humans to live were actually misunderstood during their time. Jesus was brutally nailed to a tree. Joan of Arc was burned at the stake. Galileo was imprisoned for years as a heretic just for suggesting the world was round instead of flat. I won't even mention the 1960's in America. I believe in seeking out the truth in any situation and confronting that truth. By nature I have always been a risk taker which has sometimes paid off in various ways and at other times made my life more difficult. I am highly intuitive and spiritual at times. I don't care much for religious dogma, however. Most people in the world rely on what their eyes see and ears hear but are unaware of the realm of intuition and balancing emotion and reason as part of the equation. But in America alone there are over 250,000,000 individuals who biologically are 99% alike yet vary greatly in individual experiences that have contributed to their psychological develpment.

On the Internet, I sometimes enjoy a game of Poker at The Full Tilt Site. My play is more unorthodox and undisciplined than most which often infuriates players of the opposite playing style. I believe myself to be unusually lucky for brief windows of time, yet extremely unlucky most of the time. Players such as myself are often referred to as donkeys, donks, retards, tards, or idiots when we win a hand against the so called good players. Sometimes it's hard to not take it personal and I must remind myself to put things in perspective and consider the source of the insults. Usually I find it amusing to observe how some players believe that by following their system of probabilities and statistical laws that they should win the hands they think they should. In reality, if I could ever just learn when to quit I would win just as much as they do through my intuitive and luck based approach.

A flood was produced by the hurricane via the dried creek bed on my property last week. Most of the washout damage was due to blockage from debris left by the dozer during the land clearing process. While attempting to clear out some of the debris I came across my friend the terrapin I had rescued from the highway a few weeks ago. I picked him up to have a look to find his body limp and lifeless. He had drowned from being trapped by the water pressure of the stream. I felt hurt, angry, and defeated and asked myself why? Maybe he would have been better off with his chances of crossing the road that Saturday morning. I thought I had done a noble deed yet in the long run ended up contributing to the creature's demise.

The turtle story is symbolic of how the practice of psychiatry in the public sector sometimes seems. Those who work with this population can usually, at best, just try and do what they feel to be the right thing. This must be performed within the confines of greatly limited resources for the desired objectives to be met. As with the poker, sometimes I feel I continue to do what I do knowing that in the end it might not make any difference. Still I find creating hope and comforting people to be a worthwhile venture. The Medical Board represents that angry player who refers to me as a retard. I am not a retard and far from an idiot. I do sometimes make choices motivated by feeling and conviction. Irrational fear is my enemy.

A colleague suggested I write something to clarify my status with the Medical Board since there are rumors abroad about the situation with me and treating chronic pain. Sometimes when there lacks clear information people tend to think the worst. First of all, I have no criminal charges against me and I have committed no crime. I have never been placed in handcuffs and taken off to jail as some pharmacists have been telling my patients. Nothing has changed with my medical license or my DEA license. Nothing has happened with my practice except that I am phasing out any treatment for management  of medications prescribed for the treatment of chronic pain. Thats it! There is no juicy story. This involves a fraction of the patients I treat. I want to focus on just psychiatry and as few substance abuse patients as possible. The Board is a govermental agency which by nature incorporates some degree of political agenda. As with the IRS, DEA, SBI, or even the SHP (State Highway Patrol) you do not want them in your life, and most do all they can to prevent encounters. In my case there is so much irony. I have worked with detox patients at Residential Treatment Services of Burlington for about 12 years now. Yesterday, 100% of the patients I saw were opioid dependent, taking large doses, yet none of them had ever received a prescription from me. The Board investigator assured me that my case is not a witch hunt and I should not take things personally.  I still beg to differ when they have facilitated such a hostile public attack on my reputation and I am the one who treats the problem. My special DEA # to use Buprenorphine is on hold until my case is settled even though I have completed the training. I have completed the CME training requested by them to prescribe controlled medications. I have done everything asked of me but because my documentation records of a few charts were not to their satisfaction they have continued to drag this situation on. They are doing their part to fight the war on drugs during an election year by dealing with me. The true function of the Medical Board is to identify doctors who may pose danger to the public and remediate such a problem. I am no more a bad doctor than I am a tard or a donk. I think that time will prove this point. If it becomes too difficult for me to practice how I want to practice I may just have to find another way to make a living. Some things just aren't worth tolerating because life is to short.

psychiatry