Early Diagnosis Quotes

The greatest barrier I have met is the almost total absence from the minds of my audience of any sense of sin... The early Christian preachers could assume in their hearers, whether Jews, Metuentes, or Pagans, a sense of guilt. (That this was common among Pagans is shown by the fact that both Epicureanism and the mystery religions both claimed, though in different ways, to assuage it.) Thus the Christian message was in those days unmistakably the Evangelium, the Good News. It promised healing to those who knew they were sick. We have to convince our hearers of the unwelcome diagnosis before we can expect them to welcome the news of the remedy. The ancient man approached God (or even the gods) as the accused person approaches his judge. For the modern man, the roles are quite reversed. He is the judge: God is in the dock. He is quite a kindly judge; if God should have a reasonable defense for being the god who permits war, poverty, and disease, he is ready to listen to it. The trial may even end in God’s acquittal. But the important thing is that man is on the bench and God is in the dock.

Elizabeth incorporated the company as Real-Time Cures, which an unfortunate typo turned into “Real-Time Curses” on early employees’ paychecks. She later changed the name to Theranos, a combination of the words “therapy” and “diagnosis.

Modern researchers have identified one or more major mood disorders in John Quincy Adams, Charles Darwin, Emily Dickinson, Benjamin Disraeli, William James, William Tecumseh Sherman, Robert Schumann, Leo Tolstoy, Queen Victoria, and many others. We may accurately call these luminaries “mentally ill,” a label that has some use—as did our early diagnosis of Lincoln—insofar as it indicates the depth, severity, and quality of their trouble. However, if we get stuck on the label, we may miss the core fascination, which is how illness can coexist with marvelous well-being. In

A survey taken by the association found that 45 percent of patients with autoimmune disease were labeled as chronic complainers early in their diagnostic journeys, with the resulting delay in diagnosis often leading to organ damage from lack of appropriate treatment.

Fortunately, the clinical diagnosis “ADD” didn’t exist when I was a child, and restless children were not medicated, or I might have been narcotized at an early age, and my brain affected. (No one can tell me that dosing young children with such powerful drugs will have no long-term effect upon them.)

Having worked as a clinician for almost 40 years, I have seen some young adults, who had the classic, clear and conspicuous signs of Asperger’s syndrome in early childhood, achieve over decades a range of social abilities and improvements in behaviour such that the diagnostic characteristics became sub-clinical; that is, the person no longer has a clinically significant impairment in social, occupational, or other important area of functioning. There may still be very subtle signs of Asperger’s syndrome, but when the diagnostic tests are re-administered, the person achieves a score below the threshold to maintain the diagnosis. There is now longitudinal research that is starting to confirm clinical experience that about 10 per cent of those who originally had an accurate diagnosis of Asperger’s syndrome in childhood no longer have sufficient impairments to justify the diagnosis (Cederlund et al. 2008; Farley et al. 2009).

ADHD is spreading like wildfire. It used to be confined to a small percentage of kids who had clear-cut problems that started at a very early age and caused them unmistakable difficulties in many situations. Then all manner of classroom disruption was medicalized and ADHD was applied so promiscuously that an amazing 10 percent of kids now qualify.

I do believe that we (autistic individuals such as myself) are very susceptible to suicidal thinking for multiple reasons that include: chronic high levels of anxiety, tendency to fixate on or get stuck on negative disturbing thoughts, low self-worth, inability to have significant or intimate relationships with others, replaying over and over again negative statements that others have said to us, feeling unable to be understood, lack [of] a solid self-identity, difficulty with expressing self to others, feelings of great isolation, feeling that you are or may be a burden to others, feeling unable to contribute to society or the greater good, etc […] I do believe that the most important thing that someone else can do for a struggling autistic individual is to affirm their self-worth, recognise and validate their struggles and affirm the things that they do that are greatly valued by others. The worst thing to do for an autistic individual, or any struggling individual for that matter, is to not believe them or to deny the validity of their struggles. My greatest and deepest hurt is that doctors, family members and important others did not believe me in my struggles, particularly when I was younger, before my diagnosis at the age of 35 years. This has been the strongest impetus for my feelings of unworthiness and suicidal thoughts. (Woman with autism)

For a while, every smart and shy eccentric from Bobby Fischer to Bill Gate was hastily fitted with this label, and many were more or less believably retrofitted, including Isaac Newton, Edgar Allen Pie, Michelangelo, and Virginia Woolf. Newton had great trouble forming friendships and probably remained celibate. In Poe's poem Alone, he wrote that "All I lov'd - I lov'd alone." Michelangelo is said to have written "I have no friends of any sort and I don't want any." Woolf killed herself. Asperger's disorder, once considered a sub-type of autism, was named after the Austrian pediatrician Hans Asperger, a pioneer, in the 1940s, in identifying and describing autism. Unlike other early researchers, according to the neurologist and author Oliver Sacks, Asperger felt that autistic people could have beneficial talents, especially what he called a "particular originality of thought" that was often beautiful and pure, unfiltered by culture of discretion, unafraid to grasp at extremely unconventional ideas. Nearly every autistic person that Sacks observed appeard happiest when alone. The word "autism" is derived from autos, the Greek word for "self." "The cure for Asperger's syndrome is very simple," wrote Tony Attwood, a psychologist and Asperger's expert who lives in Australia. The solution is to leave the person alone. "You cannot have a social deficit when you are alone. You cannot have a communication problem when you are alone. All the diagnostic criteria dissolve in solitude." Officially, Asperger's disorder no longer exists as a diagnostic category. The diagnosis, having been inconsistently applied, was replaced, with clarified criteria, in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders; Asperger's is now grouped under the umbrella term Autism Spectrum Disorder, or ASD.

Campaign to destigmatize so-called "mental illness" often take a wrong turning here. They try to demonstrate how suffers of some condition have made amazing contributions to the science or the arts. Trying to destigmatize the diagnosis of autism, for example, we read how Einstein and Newton would have received that diagnosis today, and yet made fabulous discoveries in the field of physics. Even if they are acknowledged to have been "different", their worth is still reckoned in terms of how their work has impacted on the world of others. However well-intentioned, such perspectives are hardly judicious, as they make an implicit equation between value and social utility. Taking this step is dangerous, as the moment that human life is defined in terms of utility, the door to stigmatization and segregation is opened. If someone was found to be not useful, what value, then, would their life have? This was in fact exactly the argument of the early-twentieth-century eugenicists who complained for the extermination of the mentally ill. Although no one would admit such aspirations today, we cannot ignore the resurfacing in recent years of a remarkably similar discourse, with its emphasis on social utility, hereditary and genetic vulnerability.

In 1996, when Senator Bob Dole runs against President Clinton, it’s a historic moment for people with disabilities. No one with a visible disability has run for the high office since Franklin Roosevelt—and unlike Roosevelt, Dole is forthcoming about his impairment (an arm injured in wartime). It sets a political conundrum for some in the movement: Dole may be one of us, and may have been an early supporter of the ADA, but aren’t Democrats better for disenfranchised minorities? That same year, a woman with Down syndrome becomes the first person with that diagnosis to receive a heart and lung transplant. She’d been turned down at first, but hospital administrators cave to activists. These and other

I for many years after my initial diagnosis was reluctant to take my medications as prescribed. Why was I so unwilling? Why did it take having to go through more episodes of mania, followed by long suicidal depressions, before I would take lithium in a medically sensible way? Some of my reluctance, no doubt, stemmed from a fundamental denial that what I had was a real disease. This is a common reaction that follows, rather counter-intuitively, in the wake of early episodes of manic-depressive illness. Moods are such an essential part of the substance of life, of one’s notion of oneself, that even psychotic extremes in mood and behavior somehow can be seen as temporary, even understandable, reactions to what life has dealt.

Women receiving late diagnosis often share the same sense of relief and self-acceptance as men, but perhaps to an even greater degree, due to the way in which they have needed to manage their autism – often through bending to fit to what’s expected of them in terms of gender expectations through camouflaging (which autistic men are seen as less prone to and/or able to do). Feeling justified or vindicated by diagnosis is the strong response of many of the women I have spoken to: a sense of having the right to be yourself established – for the first time – in a world that doesn’t always welcome or appreciate that self. These are women who are exhausted and angry at having tried so hard to make everything make sense, while presuming that they were to blame for not getting it in the first place: women who feel they have had to put on a persona of social acceptability in order to be tolerated.

The case of a patient with dissociative identity disorder follows: Cindy, a 24-year-old woman, was transferred to the psychiatry service to facilitate community placement. Over the years, she had received many different diagnoses, including schizophrenia, borderline personality disorder, schizoaffective disorder, and bipolar disorder. Dissociative identity disorder was her current diagnosis. Cindy had been well until 3 years before admission, when she developed depression, "voices," multiple somatic complaints, periods of amnesia, and wrist cutting. Her family and friends considered her a pathological liar because she would do or say things that she would later deny. Chronic depression and recurrent suicidal behavior led to frequent hospitalizations. Cindy had trials of antipsychotics, antidepressants, mood stabilizers, and anxiolytics, all without benefit. Her condition continued to worsen. Cindy was a petite, neatly groomed woman who cooperated well with the treatment team. She reported having nine distinct alters that ranged in age from 2 to 48 years; two were masculine. Cindy’s main concern was her inability to control the switches among her alters, which made her feel out of control. She reported having been sexually abused by her father as a child and described visual hallucinations of him threatening her with a knife. We were unable to confirm the history of sexual abuse but thought it likely, based on what we knew of her chaotic early home life. Nursing staff observed several episodes in which Cindy switched to a troublesome alter. Her voice would change in inflection and tone, becoming childlike as ]oy, an 8-year-old alter, took control. Arrangements were made for individual psychotherapy and Cindy was discharged. At a follow-up 3 years later, Cindy still had many alters but was functioning better, had fewer switches, and lived independently. She continued to see a therapist weekly and hoped to one day integrate her many alters.

Irony in postwar art and culture started out the same way youthful rebellion did. It was difficult and painful, and productive—a grim diagnosis of a long-denied disease. The assumptions behind early postmodern irony, on the other hand, were still frankly idealistic: it was assumed that etiology and diagnosis pointed toward cure, that a revelation of imprisonment led to freedom. So then how have irony, irreverence, and rebellion come to be not liberating but enfeebling in the culture today’s avant-garde tries to write about? One clue’s to be found in the fact that irony is still around, bigger than ever after 30 long years as the dominant mode of hip expression. It’s not a rhetorical mode that wears well. As Hyde (whom I pretty obviously like) puts it, “Irony has only emergency use. Carried over time, it is the voice of the trapped who have come to enjoy their cage.” 32 This is because irony, entertaining as it is, serves an almost exclusively negative function. It’s critical and destructive, a ground-clearing. Surely this is the way our postmodern fathers saw it. But irony’s singularly unuseful when it comes to constructing anything to replace the hypocrisies it debunks. This is why Hyde seems right about persistent irony being tiresome. It is unmeaty. Even gifted ironists work best in sound bites. I find gifted ironists sort of wickedly fun to listen to at parties, but I always walk away feeling like I’ve had several radical surgical procedures. And as for actually driving cross-country with a gifted ironist, or sitting through a 300 page novel full of nothing but trendy sardonic exhaustion, one ends up feeling not only empty but somehow… oppressed. Think, for a moment, of Third World rebels and coups. Third World rebels are great at exposing and overthrowing corrupt hypocritical regimes, but they seem noticeably less great at the mundane, non-negative task of then establishing a superior governing alternative. Victorious rebels, in fact, seem best at using their tough, cynical rebel-skills to avoid being rebelled against themselves—in other words, they just become better tyrants. And make no mistake: irony tyrannizes us. The reason why our pervasive cultural irony is at once so powerful and so unsatisfying is that an ironist is impossible to pin down. All U.S. irony is based on an implicit “I don’t really mean what I’m saying.” So what does irony as a cultural norm mean to say? That it’s impossible to mean what you say? That maybe it’s too bad it’s impossible, but wake up and smell the coffee already? Most likely, I think, today’s irony ends up saying: “How totally banal of you to ask what I really mean.” Anyone with the heretical gall to ask an ironist what he actually stands for ends up looking like an hysteric or a prig. And herein lies the oppressiveness of institutionalized irony, the too-successful rebel: the ability to interdict the question without attending to its subject is, when exercised, tyranny. It is the new junta, using the very tool that exposed its enemy to insulate itself.

When the time comes, & I hope it comes soon, to bury this era of moral rot & the defiling of our communal, social, & democratic norms, the perfect epitaph for the gravestone of this age of unreason should be Iowa Senator Chuck Grassley's already infamous quote: "I think not having the estate tax recognizes the people that are investing... as opposed to those that are just spending every darn penny they have, whether it’s on booze or women or movies.” Grassley's vision of America, quite frankly, is one I do not recognize. I thought the heart of this great nation was not limited to the ranks of the plutocrats who are whisked through life in chauffeured cars & private jets, whose often inherited riches are passed along to children, many of whom no sacrifice or service is asked. I do not begrudge wealth, but it must come with a humility that money never is completely free of luck. And more importantly, wealth can never be a measure of worth. I have seen the waitress working the overnight shift at a diner to give her children a better life, & yes maybe even take them to a movie once in awhile - and in her, I see America. I have seen the public school teachers spending extra time with students who need help & who get no extra pay for their efforts, & in them I see America. I have seen parents sitting around kitchen tables with stacks of pressing bills & wondering if they can afford a Christmas gift for their children, & in them I see America. I have seen the young diplomat in a distant foreign capital & the young soldier in a battlefield foxhole, & in them I see America. I have seen the brilliant graduates of the best law schools who forgo the riches of a corporate firm for the often thankless slog of a district attorney or public defender's office, & in them I see America. I have seen the librarian reshelving books, the firefighter, police officer, & paramedic in service in trying times, the social worker helping the elderly & infirm, the youth sports coaches, the PTA presidents, & in them I see America. I have seen the immigrants working a cash register at a gas station or trimming hedges in the frost of an early fall morning, or driving a cab through rush hour traffic to make better lives for their families, & in them I see America. I have seen the science students unlocking the mysteries of life late at night in university laboratories for little or no pay, & in them I see America. I have seen the families struggling with a cancer diagnosis, or dementia in a parent or spouse. Amid the struggles of mortality & dignity, in them I see America. These, & so many other Americans, have every bit as much claim to a government working for them as the lobbyists & moneyed classes. And yet, the power brokers in Washington today seem deaf to these voices. It is a national disgrace of historic proportions. And finally, what is so wrong about those who must worry about the cost of a drink with friends, or a date, or a little entertainment, to rephrase Senator Grassley's demeaning phrasings? Those who can't afford not to worry about food, shelter, healthcare, education for their children, & all the other costs of modern life, surely they too deserve to be able to spend some of their “darn pennies” on the simple joys of life. Never mind that almost every reputable economist has called this tax bill a sham of handouts for the rich at the expense of the vast majority of Americans & the future economic health of this nation. Never mind that it is filled with loopholes written by lobbyists. Never mind that the wealthiest already speak with the loudest voices in Washington, & always have. Grassley’s comments open a window to the soul of the current national Republican Party & it it is not pretty. This is not a view of America that I think President Ronald Reagan let alone President Dwight Eisenhower or Teddy Roosevelt would have recognized. This is unadulterated cynicism & a version of top-down class warfare run amok. ~Facebook 12/4/17

In 2009, Kahneman and Klein took the unusual step of coauthoring a paper in which they laid out their views and sought common ground. And they found it. Whether or not experience inevitably led to expertise, they agreed, depended entirely on the domain in question. Narrow experience made for better chess and poker players and firefighters, but not for better predictors of financial or political trends, or of how employees or patients would perform. The domains Klein studied, in which instinctive pattern recognition worked powerfully, are what psychologist Robin Hogarth termed “kind” learning environments. Patterns repeat over and over, and feedback is extremely accurate and usually very rapid. In golf or chess, a ball or piece is moved according to rules and within defined boundaries, a consequence is quickly apparent, and similar challenges occur repeatedly. Drive a golf ball, and it either goes too far or not far enough; it slices, hooks, or flies straight. The player observes what happened, attempts to correct the error, tries again, and repeats for years. That is the very definition of deliberate practice, the type identified with both the ten-thousand-hours rule and the rush to early specialization in technical training. The learning environment is kind because a learner improves simply by engaging in the activity and trying to do better. Kahneman was focused on the flip side of kind learning environments; Hogarth called them “wicked.” In wicked domains, the rules of the game are often unclear or incomplete, there may or may not be repetitive patterns and they may not be obvious, and feedback is often delayed, inaccurate, or both. In the most devilishly wicked learning environments, experience will reinforce the exact wrong lessons. Hogarth noted a famous New York City physician renowned for his skill as a diagnostician. The man’s particular specialty was typhoid fever, and he examined patients for it by feeling around their tongues with his hands. Again and again, his testing yielded a positive diagnosis before the patient displayed a single symptom. And over and over, his diagnosis turned out to be correct. As another physician later pointed out, “He was a more productive carrier, using only his hands, than Typhoid Mary.” Repetitive success, it turned out, taught him the worst possible lesson. Few learning environments are that wicked, but it doesn’t take much to throw experienced pros off course. Expert firefighters, when faced with a new situation, like a fire in a skyscraper, can find themselves suddenly deprived of the intuition formed in years of house fires, and prone to poor decisions. With a change of the status quo, chess masters too can find that the skill they took years to build is suddenly obsolete.

Nocebo effect” refers to the unintended negative effect of a medical diagnosis or treatment. It is particularly relevant to maternity care, because the mother’s emotional well-being is so often neglected, as we have discussed. Michel Odent comments, “The nocebo effect is inherent in conventional prenatal care, which is constantly focusing on potential problems. Every visit is an opportunity to be reminded of all the risks associated with pregnancy and delivery.”12

In fact, because this antibiotic regime starts early, far too many of us have always lived with compromised intestinal flora and have never been truly healthy. I see more and more of this in my practice every year. It is my experience that chronically ill people, who often present with an elusive diagnosis, have a long history of consuming antibiotics. The earlier they started, the more complicated their symptoms are later in their lives and the harder it is for doctors to find a diagnosis.

Early identification of patients who suffer from dissociative symptoms and disorders is essential for successful treatment, because these disorders do not resolve spontaneously. In addition, dissociative disorders are not alleviated by treatment directed toward an intercurrent disorder. However, because the dissociative disorders are among the few psychiatric syndromes that appear to respond favorably to appropriate treatment (Spiegel, 1993), improved accuracy in differential diagnosis is critical.

Early identification of patients who suffer from dissociative symptoms and disorders is essential for successful treatment, because these disorders do not resolve spontaneously.

Addiction is a human problem that resides in people, not in the drug or in the drug’s capacity to produce physical effects,” writes Lance Dodes, a psychiatrist at the Harvard Medical School Division on Addictions. It is true that some people will become hooked on substances after only a few times of using, with potentially tragic consequences, but to understand why, we have to know what about those individuals makes them vulnerable to addiction. Mere exposure to a stimulant or narcotic or to any other mood-altering chemical does not make a person susceptible. If she becomes an addict, it’s because she’s already at risk. Heroin is considered to be a highly addictive drug — and it is, but only for a small minority of people, as the following example illustrates. It’s well known that many American soldiers serving in the Vietnam War in the late 1960s and early 1970s were regular users. Along with heroin, most of these soldier addicts also used barbiturates or amphetamines or both. According to a study published in the Archives of General Psychiatry in 1975, 20 per cent of the returning enlisted men met the criteria for the diagnosis of addiction while they were in Southeast Asia, whereas before they were shipped overseas fewer than 1 per cent had been opiate addicts. The researchers were astonished to find that “after Vietnam, use of particular drugs and combinations of drugs decreased to near or even below preservice levels.” The remission rate was 95 per cent, “unheard of among narcotics addicts treated in the U.S.” “The high rates of narcotic use and addiction there were truly unlike anything prior in the American experience,” the researchers concluded. “Equally dramatic was the surprisingly high remission rate after return to the United States.” These results suggested that the addiction did not arise from the heroin itself but from the needs of the men who used the drug. Otherwise, most of them would have remained addicts. As with opiates so, too, with the other commonly abused drugs. Most people who try them, even repeatedly, will not become addicted. According to a U.S. national survey, the highest rate of dependence after any use is for tobacco: 32 per cent of people who used nicotine even once went on to long-term habitual use. For alcohol, marijuana and cocaine the rate is about 15 per cent and for heroin the rate is 23 per cent. Taken together, American and Canadian population surveys indicate that merely having used cocaine a number of times is associated with an addiction risk of less than 10 per cent. This doesn’t prove, of course, that nicotine is “more” addictive than, say, cocaine. We cannot know, since tobacco — unlike cocaine — is legally available, commercially promoted and remains, more or less, a socially tolerated object of addiction. What such statistics do show is that whatever a drug’s physical effects and powers, they cannot be the sole cause of addiction.

presence of a gait disturbance makes Alzheimer disease less likely (especially if the gait disturbance appears early during the patient’s course;

Ashish Bhatt answered, “Often those persons who live successfully with schizophrenia are ones who have positive prognostic factors, which include good premorbid functioning, later age of symptom onset, sudden symptom onset, higher education, good support system, early diagnosis and treatment, medication adherence, and longer periods of minimal or absent symptoms between episodes.

Of course, different people will have different approaches to life. And individuals may feel differently about different diseases—particularly if some specific disease runs in the family.7 Adding to that variability is the fact that people may feel differently at different points in life. When we have major responsibilities to others, such as young children, we are likely to place more value on the “staying alive” side of the equation. But later in life, we may place more value on “staying well.” So we should expect that people will make different decisions about early diagnosis and that individuals’ decisions may change over time. In short, there is no single right answer.

There is no simple way to determine when and where to get help. Many factors come into play, including the child’s age, family’s financial status, insurance, knowledge of resources, religious affiliation, availability of services in community, and so on. Parents may seek outside assistance for their adopted child when other factors such as a divorce, job loss, or other stresses compound the family needs. Parents are generally in the best position to determine when to get help, but advice from relatives, family physicians, teachers, and others in a position to know the family should be carefully considered. Services for children with special needs are provided by a variety of professionals. A physician—pediatrician or the family practitioner—is usually the place to begin. Families may be referred to a neurologist for a thorough assessment and diagnosis of neurological functioning (related to cognitive or learning disabilities, seizure disorders or other central nervous system problems). For specific communication difficulties, families may consult with a speech and language therapist, while a physical therapist would develop a treatment plan to enhance motor development. A rehabilitation technologist or an occupational therapist prescribes adaptive aids or activities of daily living. Early childhood educators specializing in working with children with special needs may be called a variety of titles, including Head Start teachers, early childhood special education teacher, or early childhood specialist.

The situational diagnosis conversation. In this conversation, you seek to understand how your new boss sees the STARS portfolio you have inherited. Are there elements of start-up, turnaround, accelerated growth, realignment, and sustaining success? How did the organization reach this point? What factors—both soft and hard—make this situation a challenge? What resources within the organization can you draw on? Your view may differ from your boss’s, but it is essential to grasp how she sees the situation. The expectations conversation. Your goal in this conversation is to understand and negotiate expectations. What does your new boss need you to do in the short term and in the medium term? What will constitute success? Critically, how will your performance be measured? When? You might conclude that your boss’s expectations are unrealistic and that you need to work to reset them. Also, as part of your broader campaign to secure early wins, discussed in the next chapter, keep in mind that it’s better to underpromise and overdeliver. The resource conversation. This conversation is essentially a negotiation for critical resources. What do you need to be successful? What do you need your boss to do? The resources need not be limited to funding or personnel. In a realignment, for example, you may need help from your boss to persuade the organization to confront the need for change. Key here is to focus your boss on the benefits and costs of what you can accomplish with different amounts of resources. The style conversation. This conversation is about how you and your new boss can best interact on an ongoing basis. What forms of communication does he prefer, and for what? Face-to-face? Voice, electronic? How often? What kinds of decisions does he want to be consulted on, and when can you make the call on your own? How do your styles differ, and what are the implications for the ways you should interact? The personal development conversation. Once you’re a few months into your new role, you can begin to discuss how you’re doing and what your developmental priorities should be. Where are you doing well? In what areas do you need to improve or do things differently? Are there projects or special assignments you could undertake (without sacrificing focus)? In practice, your

Twenty years prior to my birth, Marie Curie advocated the use of Radiography in the diagnosis of injuries and treatment of wounded soldiers during World War I. The advances in X-ray machines were rapid and by the 1920’s they were everywhere. Shoe-fitting, fluoroscope machines, known in England as Pedoscopes, which displayed a continuous X-ray image on a monitor, were outside most of the better shoe stores and were a great toy to play with. I thought that it was fun to hop onto a Pedoscope, when the clerk wasn’t looking, and stick my feet into its openings. Looking down through the scope, I could see the bones in my toes wiggle around. My family doctor, Dr. Kooperstein, and his colleague, Dr. Franklin, bought an upright fluoroscope machine, giving me a chance to see my insides moving around in real time. Wow, what impressed me was how complicated everything was inside of me! Modern medicine was making great advances and I was there to witness them. Penicillin came into use in the early 1940’s and perhaps could have saved my sister’s life, if only it had been developed fifteen years earlier. The twenty-second bursts of radiation from the shoe machines and that of the fluoroscope machine used by my doctors were many times greater than the X-ray machines in use now. Even at these elevated bursts of radiation, I doubt that I was in any great danger, but shoe clerks fitting shoes have been known to receive radiation burns requiring the amputation of their hands and arms. Doctors and nurses were also in danger of the effects of being over-radiated, but at that time radiation poisoning wasn’t known and was of little concern to anyone.

Early-onset dysphagia in PD is atypical and usually alerts the clinician to an alternate diagnosis such as PSP or MSA.

Queer contagion, including the anxiety triggered by gender nonnormativity, found its viral materiality in the early 1980s. The diagnosis of gay cancer, or GRID (gay-related immune disorder), the original name for AIDS, was a vengeful nomenclature for the perversion of existing in a world held together, at least in part, by trans/queer undoing. Found by chance, queers began showing symptoms of unexplainable illnesses such as Kaposi's sarcoma (KS) and Pneumocystis carinii pneumonia (PCP). Unresponsive to the most aggressive treatments, otherwise healthy, often well-resourced and white, young men were deteriorating and dying with genocidal speed. Without remedy, normative culture celebrated its triumph in knowing the tragic ends they always imagined queers would meet. This, while the deaths of Black, Brown, and Indigenous trans and cis women (queer or otherwise) were unthought beyond the communities directly around them. These women, along with many others, were stripped of any claim to tragedy under the conditions of trans/misogyny. Among the architects of this silence was then-President Ronald Reagan, who infamously refused to mention HIV/AIDS in public until 1986. By then, at least 16,000 had died in the U.S. alone. Collective fantasies of mass disappearance through the pulsing death of trans/queer people, Haitians, and drug users - the wish fulfillment of a nightmare world concertized the rhetoric that had always been spoken from the lips of power. The true terror of this response to HIV/AIDS was not only its methodological denial but its joyful humor. In Scott Calonico's experimental short film, "When AIDS Was Funny", a voice-over of Reagan's press secretary Larry Speakes is accompanied by iconic still images of people close to death in hospital beds. LESTER KINSOLVING: "Over a third of them have died. It's known as a 'gay plague.' [Press pool laughter.] No, it is. It's a pretty serious thing. One in every three people that get this have died. And I wonder if the president was aware of this." LARRY SPEAKES: "I don't have it. [Press pool laughter.] Do you?" LESTER KINSOLVING: "You don't have it? Well, I'm relieved to hear that, Larry!" [Press pool laughter.] LARRY SPEAKES: "Do you?" LESTER KINSOLVING: "No, I don't.

As you’ll read in Chapter 11, when colic was first described in the 1950s it was the hot new thing. And throughout the latter twentieth century whenever a baby cried, she was diagnosed with colic. It was a constellation of symptoms positioned as a diagnosis that had no clear treatment. For better or worse, colic was the label that kept pediatricians free and clear from fixing the problem. There was no fix. Fast-forward to the early twenty-first century. Reflux is the new colic. Unfortunately, some of my colleagues have fallen into the habit of labeling every inexplicably fussy baby with reflux. What’s worse, some act on the impulse and prescribe medications when they’re not indicated. Some of this is a function of a new label. Part of this may be a consequence of doctors seeing more and more babies in the same eight-hour clinic day. A label and the promise of a pill have a certain appeal when facing a desperate, tired mom in a six-minute follow-up visit. So proceed with caution if your doctor hears crying, sees a dirty burp cloth, and immediately wants to start medication. Remember that you are your baby’s lead advocate. Take the time to consider all that we’ve talked about over the past few pages before assuming medication is the only and best solution.

10 Things You Should Always Discuss with Your Gynecologist – Motherhood Chaitanya Hospital Your gynecologist is your partner in women’s health, and open communication is key to receiving the best care. From reproductive health to general well-being, here are 10 crucial topics you should always discuss with your gynecologist. If you’re in Chandigarh, consider reaching out to the Best Female Gynecologist in Chandigarh through Motherhood Chaitanya for expert care. 1. Menstrual Irregularities Don’t dismiss irregular periods as a minor issue. They could be indicative of underlying conditions like polycystic ovary syndrome (PCOS), thyroid disorders, or hormonal imbalances. 2. Contraception Discuss your contraception options to find the one that best suits your needs and lifestyle. Your gynecologist can provide guidance on various birth control methods, from pills to intrauterine devices (IUDs). 3. Pregnancy Planning If you’re planning to start a family, consult your gynecologist for preconception advice. This can help you prepare your body and address any potential risks or concerns. 4. Sexual Health Openly discuss any concerns related to sexual health, including pain during intercourse, sexually transmitted infections (STIs), or changes in sexual desire. Your gynecologist can provide guidance and offer solutions. 5. Menopause and Perimenopause If you’re in your 40s or approaching menopause, discuss perimenopausal symptoms like hot flashes, mood swings, and changes in menstrual patterns. Your gynecologist can recommend treatments to manage these changes. 6. Family History Share your family’s medical history, especially if there are instances of gynecological conditions, such as ovarian or breast cancer. This information is vital for early detection and prevention. 7. Breast Health Talk to your gynecologist about breast health, including breast self-exams and recommended mammograms. Regular breast checks are essential for early detection of breast cancer. 8. Pelvic Pain Don’t ignore persistent pelvic pain. It can signal a range of issues, including endometriosis, fibroids, or ovarian cysts. Early diagnosis and treatment are crucial. 9. Urinary Issues Frequent urination, urinary incontinence, or pain during urination should be discussed. These symptoms can be linked to urinary tract infections or pelvic floor disorders. 10. Mental Health Your gynecologist is there to address your overall well-being. If you’re experiencing mood swings, anxiety, or depression, it’s important to discuss these mental health concerns. Your gynecologist can offer guidance or refer you to specialists if needed. In conclusion, your gynecologist is your go-to resource for women’s health, addressing a wide spectrum of issues. Open and honest communication is essential to ensure you receive the best care and support. If you’re in Chandigarh, consider consulting the Best Gynecologist Obstetricians in Chandigarh through Motherhood Chaitanya for expert guidance. Your health is a priority, and discussing these important topics with your gynecologist is a proactive step toward a healthier, happier you

Anna O.'s real name was Bertha Pappenheim. Bertha Pappenheim became one of the first social workers in Europe. Her work was recognized in a commemorative German stamp issued in 1954. She was also an early feminist. Her work involved the establishing of homes for prostitutes and unwed mothers. It is possible that, and psychoanalytic terms, this career was on undoing of her own childhood sexual trauma and of the failure of any person in authority to validate its reality or offer comfort.

So we look at a state of the brain in response to a trigger, and in my personal work, this area, cingulate 25, becomes the nexus of the problem. How the rest of the brain responds to a trigger, as a function of your early life experience, your genes, and your temperament, indicates that what the brain is showing us is not the illness, but what the brain is trying to do to restore balance. We can enhance that through different teachings or different kinds of treatment. Consider the metaphor of heart disease. We all know that you shouldn’t smoke and that high cholesterol is a bad risk factor. You should exercise; you shouldn’t eat too many cheeseburgers. But at the point when you have the heart attack, it’s really easy to make the diagnosis that your heart muscle has died. At that point, you are no longer dealing with probabilities. Instead, a specialized test is done to determine the nature of your problem and to match it to the appropriate treatment. For example, if you have one heart vessel clogged, you need to have that single heart vessel opened. Somebody else, who has five heart vessels blocked, will need a different kind of treatment. The heart itself is telling us how it should be treated. Of course, you would like to promise to exercise more and eat fewer cheeseburgers—but only after you survive and have had whatever surgery you need. In cardiology, there is no problem with doing a test to identify how to optimize the short-term and longer-term return to health. We have to take the same approach to the brain, since we are reaching a point where knowing the signal in the brain is potentially very helpful. The state of the brain is really the response, not the cause. It is giving us a signal as to how we might optimize its return to normality. That’s a set of experiments that we are now trying to do. Jack Kornfield: A similar diagnostic process is needed both in meditation teaching and in insight therapy. When people come in to see a teacher, they present specific and unique difficulties, traumas, problems with circumstances in their life, or struggles with their mind and personality. Skillful teaching requires a subtle evaluative process to sense what particular intervention out of the many practices will be most helpful to a given individual. For example, for people with powerful self-critical and judgmental thoughts, a necessary part of meditation instruction will be teaching them how to work with these thoughts. If we don’t attend to this problem, they can do all kinds of other practices, but those self-critical patterns will keep repeating, “You’re not doing it right,” and as a consequence, the other practices they are engaging in may be quite ineffective. Jan Chozen Bays: I want to suggest that we study an intervention that I call media fasting. As I said, we’re not designed as an organism to take in the suffering of the whole world.

So we look at a state of the brain in response to a trigger, and in my personal work, this area, cingulate 25, becomes the nexus of the problem. How the rest of the brain responds to a trigger, as a function of your early life experience, your genes, and your temperament, indicates that what the brain is showing us is not the illness, but what the brain is trying to do to restore balance. We can enhance that through different teachings or different kinds of treatment. Consider the metaphor of heart disease. We all know that you shouldn’t smoke and that high cholesterol is a bad risk factor. You should exercise; you shouldn’t eat too many cheeseburgers. But at the point when you have the heart attack, it’s really easy to make the diagnosis that your heart muscle has died. At that point, you are no longer dealing with probabilities. Instead, a specialized test is done to determine the nature of your problem and to match it to the appropriate treatment. For example, if you have one heart vessel clogged, you need to have that single heart vessel opened. Somebody else, who has five heart vessels blocked, will need a different kind of treatment. The heart itself is telling us how it should be treated. Of course, you would like to promise to exercise more and eat fewer cheeseburgers—but only after you survive and have had whatever surgery you need. In cardiology, there is no problem with doing a test to identify how to optimize the short-term and longer-term return to health. We have to take the same approach to the brain, since we are reaching a point where knowing the signal in the brain is potentially very helpful. The state of the brain is really the response, not the cause. It is giving us a signal as to how we might optimize its return to normality. That’s a set of experiments that we are now trying to do.

A need to develop innovative strategies for prevention, and early detection of cancer & to develop resources that support cancer care to prevent, treat and control cancer

During our early years of medical school, my classmates and I were given a course in physical diagnosis. Usually, we practiced on one another. Each of us would percuss a classmate’s chest or listen to his heart with a stethoscope. But some procedures were considered too personal to practice on a classmate. For some of these, we were assigned a “model patient”—someone from the community who was “compensated” in exchange for undergoing an examination. This was how I performed my first rectal exam. A large group of us were led into a room where our model patient was bent over an examining table with his pants around his ankles. One by one, we approached him nervously from behind, inserted a gloved, lubricated finger into his rectum, and felt around for the prostate. “Thank you,” we all said politely to the model patient as we removed our index fingers from his anus. The model patient stared straight ahead, saying nothing. What made the experience oddly disturbing was not just the forced, pseudo normality of the instruction or the fact that the exam could have been done more privately, but the instrumentality of the encounter: a pretend patient bending over naked for anonymous strangers in exchange for money. The fact that the model patient had been paid did not make his work seem any less degrading. (Tipping him would have made it even worse.)

THERMOGRAPHY Misinformation abounds as to the true nature of breast cancer and what causes it. With so much public focus on breast cancer awareness, very little attention is given to breast health, which we know is governed by things like clean eating, routine detoxification, energy balance, and stress reduction, among other things. These other things include not blasting radiation at the breasts in the form of mammograms, which only exacerbate breast cancer risk. Dr. Martin Bales, L.Ac., D.A.O.M., a licensed acupuncturist and certified thermologist at the Center for New Medicine in Irvine, California, has for years been administering one of the best-known alternatives to mammograms: thermograms. As its name suggests, thermography utilizes the power of infrared heat—hence the root word “therm”—to detect physiological abnormalities indicative of a possible breast cancer diagnosis. Dr. Bales’s father first pioneered the technology in the late 1970s with the development of the world’s first all-digital infrared camera, which was used for missile detection purposes during wartime. Its capacity to track the heat signature of missiles was applied to the field of medicine in the 1980s, which eventually gave way to thermographic medical devices. Dr. Bales opined during a recent interview: “In the early eighties, a group of doctors approached my father and said, ‘You know, we’ve heard the body—obviously with its (blood) circulation—we can diagnose a lot of diseases by seeing where there’s hot spots and where there’s cold.’ He said, ‘Okay, I’ll make a medical version for you.’” And the rest is history: thermography machines that identify hot spots in the breasts later hit the market, and select doctors and clinics offer it as a safe, side effect–free alternative to mammograms. “The most promising aspect of thermography is its ability to spot anomalies years before mammography,” says women’s health expert Christiane Northrup, M.D., about the merits of thermography. “With thermography as your regular screening tool, it’s likely that you would have the opportunity to make adjustments to your diet, beliefs, and lifestyle to transform your cells before they became cancerous. Talk about true prevention.

The biased beliefs among medical professionals in many countries—that obese patients are uncooperative, hostile, and dishonest—lead doctors to prescribe weight loss for conditions that have no relationship to body fat. As a consequence, obese people are reluctant to go to the doctor.13 When they do, they get lower-quality care, receiving fewer preventative screenings and less treatment overall. Because early diagnosis and prompt treatment influence health, receiving poor medical care may be part of the reason that obese people are more likely to get sick than their lower-weight peers.

In those early days at the VA, we labeled our veterans with all sorts of diagnoses—alcoholism, substance abuse, depression, mood disorder, even schizophrenia—and we tried every treatment in our textbooks. But for all our efforts it became clear that we were actually accomplishing very little. The powerful drugs we prescribed often left the men in such a fog that they could barely function. When we encouraged them to talk about the precise details of a traumatic event, we often inadvertently triggered a full-blown flashback, rather than helping them resolve the issue. Many of them dropped out of treatment because we were not only failing to help but also sometimes making things worse. A turning point arrived in 1980, when a group of Vietnam veterans, aided by the New York psychoanalysts Chaim Shatan and Robert J. Lifton, successfully lobbied the American Psychiatric Association to create a new diagnosis: posttraumatic stress disorder (PTSD), which described a cluster of symptoms that was common, to a greater or lesser extent, to all of our veterans. Systematically identifying the symptoms and grouping them together into a disorder finally gave a name to the suffering of people who were overwhelmed by horror and helplessness. With the conceptual framework of PTSD in place, the stage was set for a radical change in our understanding of our patients. This eventually led to an explosion of research and attempts at finding effective treatments

3. Paul Enright, “A Homeopathic Remedy for Early COPD,” Respiratory Medicine 105 (2011): 1573–75.

Can Strawberries Reverse the Development of Esophageal Cancer? Esophageal cancer joins pancreatic cancer as one of the gravest diagnoses imaginable. The five-year survival rate is less than 20 percent,124 with most people dying within the first year after diagnosis.125 This underscores the need to prevent, stop, or reverse the disease process as early as possible. Researchers decided to put berries to the test. In a randomized clinical trial of powdered strawberries in patients with precancerous lesions in their esophagus, subjects ate one to two ounces of freeze-dried strawberries every day for six months—that’s the daily equivalent of about a pound of fresh strawberries.126 All of the study participants started out with either mild or moderate precancerous disease, but, amazingly, the progression of the disease was reversed in about 80 percent of the patients in the high-dose strawberry group. Most of these precancerous lesions either regressed from moderate to mild or disappeared entirely. Half of those on the high-dose strawberry treatment walked away disease-free.127

In my early teens, bored out of my wits by the tacky plastic tedium of an American suburban existence, I went looking for something—anything—less dreary than the simulacrum of life that parents, teachers, and the omnipresent mass media insisted I ought to enjoy. Since I was a socially awkward bookworm—the diagnosis “Asperger’s syndrome” wasn’t in wide circulation yet—that search focused on books rather than the drugs, petty crime, and casual promiscuity in which most of my peers took refuge.

The way I think of ASD,” she said, “is this: Most people, as they grow up, assimilate the norms of social behavior naturally, through osmosis, if you will. That was not the case for me or for many with ASD. It was as though I’d been dropped into a complex video game but without a manual. I still am unclear on how neurotypicals pick up on those norms. My brain is wired differently, and fortunately, my parents picked up on it very early. They remember the day they read through a list of Asperger’s symptoms, saying, ‘Yes!’ to each. They took me to a psychologist right away. That early diagnosis gave me a tremendous advantage.

plays a role in his capture. Sociopaths like Francois who do not feel guilt exhibit a rare psychiatric disorder. Such individuals are not listed in the DSM. While sociopathy is acknowledged among psychiatrists as a legitimate mental condition, such individuals come under the “Antisocial Behavior” diagnosis in the DSM. According to the DSM, the essential feature of Antisocial Personality Disorder is violating the rights of others. It is a condition that begins in childhood or early in adolescence and progresses into adulthood. The DSM does point out that this pattern of behavior is often referred to by other names, including “psychopathy” and “sociopathy.” Deceit and manipulation are considered characteristics of this diagnosis. People who exhibit this kind of behavior do not conform to social norms; far from it. They may exhibit unlawful behavior. Repeatedly, they may perform illegal acts, including property destruction. Harassment of individuals, robbery and illegal occupations are also characteristic. Frequently, they lie and cheat to get what they want, especially sex or power. They may act impulsively and fail to plan ahead. Thus, when Francois killed the women in his house, he may

Disturbing truth: Early diagnosis can needlessly turn people into patients

After my diagnosis, one of the first things I did was to start writing down different thoughts about my feelings. I was very depressed and so overwhelmed that journaling my thoughts became an initial form of therapy for me. It was certainly better than talking about it, which would bring me to tears every time.