Medical Professionals Quotes

Stigma against mental illness is a scourge with many faces, and the medical community wears a number of those faces.

The problem with medicine and the institutions it has spawned for the care of the sick and the old is not that they have had an incorrect view of what makes life significant. The problem is that they have had almost no view at all. Medicine’s focus is narrow. Medical professionals concentrate on repair of health, not sustenance of the soul. Yet—and this is the painful paradox—we have decided that they should be the ones who largely define how we live in our waning days.

I am rather disturbed by the fact that so many people—who are neither medical professionals nor trans themselves—would want to hear all of the gory details regarding transsexual physical transformations, or would feel that they have any right to ask us about the state of our genitals.

The problem was that there was no treatment. No cure. There was nothing that...any medical professional could do. If I'd been fully human, I would have been a dead girl walking....

I am afraid of reduction. After a lifetime's independence- yes, selfish independence- I am terrified of being reduced to childhood once more, to helplessness, to seas of confusion from which the cruel lucid intervals poke up like rock shoals. I don't want to sit in my chair and be fed, much less do I want to be handed over to medical professionals.

A Palestinian man cannot just die. For him to be mourned, he must be in a wheelchair or developmentally delayed, a medical professional, or noticeably elderly at the very least. Even then, there are questions about the validity of his victimhood.

For every ten pounds of fat lost in our bodies, eight and a half pounds of it comes out through the lungs; most of it is carbon dioxide mixed with a bit of water vapor. The rest is sweated or urinated out. This is a fact that most doctors, nutritionists, and other medical professionals have historically gotten wrong. The lungs are the weight-regulating system of the body.

Several medical professional organizations acknowledge the utility of opioid therapy and many case series and large surveys report satisfactory reductions in pain, improvement in function and minimal risk of addiction.

Our society assigns us a tiny number of roles: We're producers of one thing at work, consumers of a great many things all the rest of the time, and then, once a year or so, we take on the temporary role of citizen and cast a vote. Virtually all our needs and desires we delegate to specialists of one kind or another - our meals to the food industry, our health to the medical profession, entertainment to Hollywood and the media, mental health to the therapist or the drug company, caring for nature to the environmentalist, political action to the politician, and on and on it goes. Before long it becomes hard to imagine doing much of anything for ourselves - anything, that is, except the work we do "to make a living." For everything else, we feel like we've lost the skills, or that there's someone who can do it better... it seems as though we can no longer imagine anyone but a professional or an institution or a product supplying our daily needs or solving our problems.

The difference between "active" and "busy" is that the former includes reflection and is directed, whereas the busy life feels out of control and does not seem purposeful or meaningful.

We are increasingly pushed to see more patients in less time.”27 It’s a trend he fears is contributing to a loss of empathy among medical professionals (and in turn to scary rates of depression and burnout).

For me, hands are hard." She looks up from what she's doing. "Because you're holding this disconnected hand, and it's holding you back." Cadavers occasionally effect a sort of accidental humanness that catches the medical professional off guard. I once spoke to an anatomy student who described a moment in the lab when she realized that the cadaver's arm was around her waist. It becomes difficult, under circumstances such as these, to retain one's clinical remove.

The study of medicine consists on the one hand in storing up in the mind an enormous number of facts, which are simply memorized without any real knowledge of their foundations, and on the other hand in learning practical skills, which have to be acquired on the principle “Don’t think, act!” Thus it is that, of all the professionals, the medical man has the least opportunity of developing the function of thinking.

Nine out of ten deaf kids had hearing parents, and those parents held Deaf fate in their hands—the fate of their own children, of course, and the future of the Deaf community at large. Problem being, most parents understood deafness only as explained to them by medical professionals: as a treachery of their genes, something to be drilled out.

impossible for two attractive medical professionals to take a simple elevator ride that doesn’t end in a make-out session.

The bike would be finished this summer and Papi would be fine, and Janice and all the other concerned medical professionals could take their long-term care facility and shove it, while the rest of us ate empanadas and laughed about that one summer Papi almost lost his mind.

Doctors love unsolicited stool samples. Next time, shit in a to-go box and leave it in your favorite medical professional’s fridge. Or just order some duck poop and have it delivered.

Although it is important to be able to recognise and disclose symptom of physical illnesses or injury, you need to be more careful about revealing psychiatric symptoms. Unless you know that your doctor understands trauma symptoms, including dissociation, you are wise not to reveal too much. Too many medical professionals, including psychiatrists, believe that hearing voices is a sign of schizophrenia, that mood swings mean bipolar disorder which has to be medicated, and that depression requires electro-convulsive therapy if medication does not relieve it sufficiently. The “medical model” simply does not work for dissociation, and many treatments can do more harm than good... You do not have to tell someone everything just because he is she is a doctor. However, if you have a therapist, even a psychiatrist, who does understand, you need to encourage your parts to be honest with that person. Then you can get appropriate help.

The two Baudelaires, of course, had no idea what the hospital’s policy was concerning surgical paperwork, but they were beginning to see that the crowd would believe just about anything if they thought it was being said by a medical professional.

As a result of its investigation, the NIH said that to qualify for funding, all proposals for research on human subjects had to be approved by review boards—independent bodies made up of professionals and laypeople of diverse races, classes, and backgrounds—to ensure that they met the NIH’s ethics requirements, including detailed informed consent. Scientists said medical research was doomed. In a letter to the editor of Science, one of them warned, “When we are prevented from attempting seemingly innocuous studies of cancer behavior in humans … we may mark 1966 as the year in which all medical progress ceased.

I feel like every medical professional I talk to is two degrees from saying “you’re too fat” no matter what you’ve made an appointment for them to check. I don’t know the correlation between gummy ears and weight, but if you give a doctor enough latitude, they will find one.

As she began rattling off a number of multi-syllabic Latin-derived medical terms, he had to rearrange himself in his leathers. Something about her getting all professional made him want to get all up in her. Probably had to do with the bonding thing—he wanted to mark this spectacular person as his, so the whole world knew they needed to back the fuck off. Jane was the only female who had ever gotten his attention and held it. And yeah, if he had to wax psychological on the situation, it was probably because her single-minded passion for her job, shit, her relentless commitment to excellence, made him feel a little like he was always chasing her just to keep up. On so many levels he was a typical predator: The chase was more electric than the capture and consumption. And with Jane, there was always something to pursue. “Hello? V?” When their eyes met, he frowned. “Sorry. Distracted.

How did we forget these lessons from the past? How did we go from knowing that the best athletes in the ancient Greek Olympics must consume a plant-based diet to fearing that vegetarians don’t get enough protein? How did we get to a place where the healers of our society, our doctors, know little, if anything, about nutrition; where our medical institutions denigrate the subject; where using prescription drugs and going to hospitals is the third leading cause of death? How did we get to a place where advocating a plant-based diet can jeopardize a professional career, where scientists spend more time mastering nature than respecting it? How did we get to a place where the companies that profit from our sickness are the ones telling us how to be healthy; where the companies that profit from our food choices are the ones telling us what to eat; where the public’s hard-earned money is being spent by the government to boost the drug industry’s profits; and where there is more distrust than trust of our government’s policies on foods, drugs and health? How did we get to a place where Americans are so confused about what is healthy that they no longer care?

Doctors and health care institutions are complicit in the medicalization of poverty that encourages the creation of professional patients.

The medical professionals should fight PTSD at every cost for those living in pain and the battles they've lost.

those with mental health issues and problem families. Perhaps most controversially, he said medical professionals should share information about women suffering from domestic abuse, even against

Enslavement could not have existed and certainly could not have persisted without medical science. However, physicians were also dependent upon slavery, both for economic security and for the enslaved “clinical material” that fed the American medical research and medical training that bolstered physicians’ professional advancement.

By listening to the “unspoken voice” of my body and allowing it to do what it needed to do; by not stopping the shaking, by “tracking” my inner sensations, while also allowing the completion of the defensive and orienting responses; and by feeling the “survival emotions” of rage and terror without becoming overwhelmed, I came through mercifully unscathed, both physically and emotionally. I was not only thankful; I was humbled and grateful to find that I could use my method for my own salvation. While some people are able to recover from such trauma on their own, many individuals do not. Tens of thousands of soldiers are experiencing the extreme stress and horror of war. Then too, there are the devastating occurrences of rape, sexual abuse and assault. Many of us, however, have been overwhelmed by much more “ordinary” events such as surgeries or invasive medical procedures. Orthopedic patients in a recent study, for example, showed a 52% occurrence of being diagnosed with full-on PTSD following surgery. Other traumas include falls, serious illnesses, abandonment, receiving shocking or tragic news, witnessing violence and getting into an auto accident; all can lead to PTSD. These and many other fairly common experiences are all potentially traumatizing. The inability to rebound from such events, or to be helped adequately to recover by professionals, can subject us to PTSD—along with a myriad of physical and emotional symptoms.

Opening Yulia Koroleva's uterus was the most heartbreaking thing I'd ever done. When I saw that perfect fetus, when I took it in my hands, my vision clouded over with tears and my professional reserve fell away...[he] had fully formed organs each in its correct location, without any abnormalities. The foot length told me he had been nineteen weeks old, exactly halfway through gestation. I returned him to his mother's body, to be buried with her.

Maternal/child attachment is mostly eroded in increments. The separation begins in hospitals, where mothers are not only made to feel inferior to medical professionals in relation to their infants, but regularly separated from their infants.

Did my dad fool the medical professionals or were we involved with a system that avoided end-of-life discussions? Those conversations might have given my dad the opportunity to focus on last wishes, meaningful conversations, and clarify his needs.

Mammograms are in fact fuzzy things. Reading them accurately is a challenging task—much more challenging than even many medical professionals realize. As Timothy J. Jorgensen has noted, when 160 gynecologists were asked to assess the likelihood of a fifty-year-old woman having breast cancer if her mammogram was positive, 60 percent of them thought the chances were 8 or 9 out of 10. “The truth is that the odds the woman actually has cancer are only 1 in 10,” writes Jorgensen. Remarkably, radiologists do little better.

hierarchies of diseases exist among patients and healthcare professionals...and when it comes to hierarchies of illness, evidence shows that chronic fatigue syndrome (CFS) /myalgic encephalomyelitis (ME), features at the bottommost end of the medical “favoured” list

It is unsettling to find how little it takes to defeat success in medicine. You come as a professional equipped with expertise and technology. You do not imagine that a mere matter of etiquette could foil you. But the social dimension turns out to be as essential as the scientific--matters of how casual you should be, how formal, how reticent, how forthright. Also: how apologetic, how self-confident, how money-minded. In this work against sickness, we begin not with genetic or cellular interactions, but with human ones. They are what make medicine so complex and fascinating. How each interaction is negotiated can determine whether a doctor is trusted, whether a patient is heard, whether the right diagnosis is made, the right treatment given. But in this realm there are no perfect formulas.

President Barack Obama The White House 1600 Pennsylvania Avenue NW Washington, DC 20500 November 29, 2016 Dear President Obama, We are writing to express our grave concern regarding the mental stability of our President-Elect. Professional standards do not permit us to venture a diagnosis for a public figure whom we have not evaluated personally. Nevertheless, his widely reported symptoms of mental instability — including grandiosity, impulsivity, hypersensitivity to slights or criticism, and an apparent inability to distinguish between fantasy and reality — lead us to question his fitness for the immense responsibilities of the office. We strongly recommend that, in preparation for assuming these responsibilities, he receive a full medical and neuropsychiatric evaluation by an impartial team of investigators. Sincerely, Judith Herman, M.D. Professor of Psychiatry Harvard Medical School Nanette Gartrell, M.D. Dee Mosbacher, M.D.

I enjoyed the intellectual rigor and scientific challenge of death investigation. Everyone there, from new students to the most senior doctors, seemed happy, eager to learn, and professionally challenged. None of the medical examiners had cots in their offices. “There are no emergency autopsies,” another resident pointed out to me. “Your patients never complain. They don’t page you during dinner. And they’ll still be dead tomorrow.

We also knew that empathic resonance with pain can lead, when it is repeated many times, to emotional exhaustion and distress. It affects people who emotionally collapse when the worry, stress, or pressure they have to face in their professional lives affect them so much that they become unable to continue their activities. Burnout affects people confronted daily with others’ sufferings, especially health care and social workers. In the United States, a study has shown that 60% of the medical profession suffers or has suffered from burnout, and that a third has been affected to the point of having to suspend their activities temporarily.3

Diagnoses—labels—also help connect people with resources that may often be useful. My caveats are reserved for those all-too-common situations in which parents, teachers, and medical professionals are quick to label someone as “disordered” (whatever that means) when the real problem is a mismatch between a child and a given environment.

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Many survivors of relational and other forms of early life trauma are deeply troubled and often struggle with feelings of anger, grief, alienation, distrust, confusion, low self-esteem, loneliness, shame, and self-loathing. They seem to be prisoners of their emotions, alternating between being flooded by intense emotional and physiological distress related to the trauma or its consequences and being detached and unable to express or feel any emotion at all - alternations that are the signature posttraumatic pattern. These occur alongside or in conjunction with other common reactions and symptoms (e.g., depression, anxiety, and low self-esteem) and their secondary manifestations. Those with complex trauma histories often have diffuse identity issues and feel like outsiders, different from other people, whom they somehow can't seem to get along with, fit in with, or get close to, even when they try. Moreover, they often feel a sense of personal contamination and that no one understands or can help them. Quite frequently and unfortunately, both they and other people (including the professionals they turn to for help) do misunderstand them, devalue their strengths, or view their survival adaptations through a lens of pathology (e.g., seeing them as "demanding", "overdependent and needy", "aggressive", or as having borderline personality). Yet, despite all, many individuals with these histories display a remarkable capacity for resilience, a sense of morality and empathy for others, spirituality, and perseverance that are highly admirable under the circumstances and that create a strong capacity for survival. Three broad categories of survivorship, with much overlap between them, can be discerned: 1. Those who have successfully overcome their past and whose lives are healthy and satisfying. Often, individuals in this group have had reparative experiences within relationships that helped them to cope successfully. 2. Those whose lives are interrupted by recurring posttraumatic reactions (often in response to life events and experiences) that periodically hijack them and their functioning for various periods of time. 3. Those whose lives are impaired on an ongoing basis and who live in a condition of posttraumatic decline, even to the point of death, due to compromised medical and mental health status or as victims of suicide of community violence, including homicide.

Similarly, consider the relationship between how society handles cigarettes and marijuana. Most medical professionals agree that smoking cigarettes is more damaging to one’s health overall than smoking marijuana. Despite its intensely addictive qualities, however, the consumption of tobacco has been legalized in this country, while marijuana is considered a “drug” and is banned.

The bottom line: friends don’t let friends rely on any form of placebo-based faith healing when they require real medical treatment. If you keep someone from seeing a medical professional in favor of prayer or homeopathy or any other so-called alternative medicine, you aren’t “doing it the natural way” or “leaving it in God’s hands.” You’re causing real harm and putting lives at risk.

The incredible benefits of practising and applying mindfulness and self-compassion in the workplace are being increasingly recognised by human resource professionals as well as the medical profession, as the stresses of competing in today’s global economy take their toll on the mental health and emotional wellbeing of many otherwise talented and enthusiastic individuals in the workplace.

Considerable research, however, links the notorious inefficiency of state spending in America to the tendency of professionals to 'medicalize' problems, making them a matter of individual ignorance or family pathology that only 'experts' can resolve. This means that federal funding often creates new career paths for professionals rather than gives poor families the resources to help themselves.

As a result of its investigation, the NIH said that to qualify for funding, all proposals for research on human subjects had to be approved by review boards—independent bodies made up of professionals and laypeople of diverse races, classes, and backgrounds—to ensure that they met the NIH’s ethics requirements, including detailed informed consent. Scientists said medical research was doomed. In a letter to the editor of Science, one of them warned, “When we are prevented from attempting seemingly innocuous studies of cancer behavior in humans … we may mark 1966 as the year in which all medical progress ceased.” Later that year, a Harvard anesthesiologist named Henry Beecher published a study in the New England Journal of Medicine showing that Southam’s research was only one of hundreds of similarly unethical studies. Beecher published a detailed list of the twenty-two worst offenders, including researchers who’d injected children with hepatitis and others who’d poisoned patients under anesthesia using carbon dioxide. Southam’s study was included as example number 17. Despite scientists’ fears, the ethical crackdown didn’t slow scientific progress. In fact, research flourished. And much of it involved HeLa. 18

These US doctors are trained to cut you and write prescriptions. That is all. They don't know a thing about healing you. They treat symptoms, not causes. Like other professionals, they're working to buy their homes and send their kids to Harvard. That doesn't mean they don't care about your wellness, or that they're not good at diagnosing, and some of their treatments are excellent and should be followed. But before you let anyone go sticking a knife or needle in you, you've got to investigate. You've got to be sure you know what's happening with your body. You've got to advocate for yourself and your loved ones.

The 1930s brought what is known as the “medicalization” of death. The rise of the hospital removed from view all the gruesome sights, smells, and sounds of death. Whereas before a religious leader might preside over a dying person and guide the family in grief, now it was doctors who attended to a patient’s final moments. Medicine addressed life-and-death issues, not appeals to heaven. The dying process became hygienic and heavily regulated in the hospital. Medical professionals deemed unfit for public consumption what death historian Philippe Ariès called the “nauseating spectacle” of mortality. It became taboo to “come into a room that smells of urine, sweat, and gangrene, and where the sheets are soiled.” The hospital was a place where the dying could undergo the indignities of death without offending the sensibilities of the living.

Of course that diagnosis was never made official because my mother refused to get professional help. Instead, she lived her life with her fingers in her ears, as though the truth would not exist if she never heard the words spoken aloud. Add to that cauldron an ever increasing measure of cheap vodka—a form of self-medication that quelled the inner scream but amplified the outer crazy—and you get a picture of the mother I left behind. She

Today, our view of genuine reality is increasingly clouded by professionals whose technical expertise often introduces a superficial and soulless model of the person that denies moral significance. Perhaps the most devastating example for human values is the process of medicalization through which ordinary unhappiness and normal bereavement have been transformed into clinical depression, existential angst turned into anxiety disorders, and the moral consequences of political violence recast as post-traumatic stress disorder. That is, suffering is redefined as mental illness and treated by professional experts, typically with medication. I believe that this diminishes the person,

Esmé Weijun Wang writes in The Collected Schizophrenias about speaking to medical professionals about her experiences with schizophrenia. A doctor approached her to thank her afterward, but what she said shows how many able-bodied people don’t treat or see disabled people as human: She said that she was grateful for this reminder that her patients are human too. She starts out with such hope, she said, every time a new patient comes—and then they relapse and return, relapse and return. The clients, or patients, exhibit their illness in ways that prevent them from seeming like people who can dream, or like people who can have others dream for them. Disabled voices like Wang’s and others are needed to change the narratives around disability—to insist on disabled people’s humanity and complexity, to resist inspiration porn, to challenge the binary that says disabled bodies and lives are less important or tragic or that they have value only if they can be fixed or be cured or be made productive.

Medicine’s focus is narrow. Medical professionals concentrate on repair of health, not sustenance of the soul. Yet—and this is the painful paradox—we have decided that they should be the ones who largely define how we live in our waning days. For more than half a century now, we have treated the trials of sickness, aging, and mortality as medical concerns. It’s been an experiment in social engineering, putting our fates in the hands of people valued more for their technical prowess than for their understanding of human needs.

Here you had the top professional soldier in Japan, and to think he didn’t know how to kill himself with a gun! They took him straight to the hospital, he got the best care the American medical team could give him, recovered, then was tried and hanged. It’s a terrible way to die.

Tiffy: So … in your professional opinion … Me: As a palliative care nurse? Tiffy: As a vaguely medical person … Oh, no. These conversations never go well. People always assume they teach us all the medicine in the world at nursing school, and that we remember it five years later.

On one occasion a medical colleague chastised Dr. Nelson for failing to separate his professional knowledge from his religious convictions. “That startled me,” he admitted, “because I did not feel that truth should be fractionalized. Truth is indivisible” (Hafen, Disciple’s Life, 165).

Also, the high standard held up to the public mind by the College of which which gave its peculiar sanction to the expensive and highly rarefied medical instruction obtained by graduates of Oxford and Cambridge, did not hinder quackery from having an excellent time of it; for since professional practice chiefly consisted in giving a great many drugs, the public inferred that it might be better off with more drugs still, if they could only be got cheaply, and hence swallowed large cubic measures of physic prescribed by unscrupulous ignorance which had taken no degrees.

However, taking action based on what a given study recommends would require personal initiative on the part of individual healthcare providers. But as corporate culture goes, so goes medical culture. We live in the age of consensus and groupthink, where otherwise curious and capable professionals avoid being singled out by huddling in the center of the herd. The herd, in turn, waits for an authority figure to lead the way. So if there is no authority figure acknowledging the importance of a given article’s findings, nothing happens. It’s as though it were never written.

The Tree of Life was an ancient symbol of interconnection, fertility, and eternal life—precisely because of this legendary tree’s fruit. Fruit is part of our essence, a basic element of who we are. We cannot survive without fruit on this planet. It outweighs the nutrition of any other food. Yet the current “health” movement toward low-carb diets has put fruit on the endangered species list, with the goal of making it extinct. Is this denial? Ignorance? Foolishness? We’re not talking about uneducated people who are driving the trend. We’re talking about smart, highly intelligent professionals with advanced degrees in medicine and nutrition. If they’re advising patients to shun fruit, it must be because of their training, the misinformation out there, or their own selective interests. Have you heard of book burning? If the anti-sugar war keeps up its momentum, fruit trees will be next to go up in flames.

Addiction to internet pornography is a very real phenomenon with a very real impact on well-being. It is a phenomenon which has grown exponentially in the last decade, even though it has remained largely invisible and undetected by society. Tragically, its risks continue to be ignored or actively denied by all but a few enlightened medical professionals. It is a phenomenon that is not just here to stay, but also likely to increase. It is almost certainly the cause of the widespread sexual dysfunction found in recent studies of late adolescence.[1] It is a problem that is most likely impacting you, or your loved ones, without you even being aware of it.

can't speak to what it's like to abuse a child: I've never done it. I can speak to what it's like to have mental health issues that require professional help. It's scary, it's overwhelming, and it makes some people (like me) feel like less of a person sometimes. But getting that help is better than the alternative. Much as I hate the idea that I need help to run something as basic and intimate as my own brain, and much as I hate the fact that I have to take medication every day to keep my sanity train from derailing, I vastly prefer it (when I'm thinking rationally) to the idea of hurting myself (and through that action, hurting the ones I love), or completely losing control of my life.

...[S]o many people look only to their bank balance for peace or to fellow human beings for models to follow. Clinicians, academicians, and politicians are often put to a test of faith. In pursuit of their goals, will their religion show or will it be hidden? Are they tied back to God or to man? I had such a test decades ago when one of my medical faculty colleagues chastised me for failing to separate my professional knowledge from my religious convictions. He demanded that I not combine the two. How could I do that? Truth is truth! It is not divisible, and any part of it cannot be set aside. Whether truth emerges from a scientific laboratory or through revelation, all truth emanates from God.

MODERN SCIENTIFIC CAPABILITY has profoundly altered the course of human life. People live longer and better than at any other time in history. But scientific advances have turned the processes of aging and dying into medical experiences, matters to be managed by health care professionals. And we in the medical world have proved alarmingly unprepared for it.

Alcohol, the drug of choice in professional life, puts us to sleep, but then we wake and can't get back to sleep. 'Do you take a nip of whisky or not? Or do you put up with it? There are penalty clauses to all of these sleep-inducers,' [Former Australian Greens Leader Bob Brown] says. I knew this from medical school. It turns on you in the middle of the night.'

During a staff debriefing, doctors and doctors-to-be explored the Hippocratic Oath, again, the one about not doing harm. Supporters apparently argue, “What’s the point of causing more suffering in this situation, when soothing is so readily available (for the survivors, that is)?” Of course, this is a personal opinion, a value judgement not necessarily shared by all medical professionals. For the record, I personally doubted the doctor’s choice, despite the circumstances, and wonder whether it was right to lie to the survivors, in the Grandest Scheme of the Cosmos. I can imagine myself responding to an order like “Tell me he died peacefully” with something more akin to “I’m so sorry, but I can’t,” and cross the subsequent bridges accordingly.

Because now mental health disorders have gone “mainstream”. And for all the good it’s brought people like me who have been given therapy and stuff, there’s a lot of bad it’s brought too. Because now people use the phrase OCD to describe minor personality quirks. “Oooh, I like my pens in a line, I’m so OCD.” NO YOU’RE FUCKING NOT. “Oh my God, I was so nervous about that presentation, I literally had a panic attack.” NO YOU FUCKING DIDN’T. “I’m so hormonal today. I just feel totally bipolar.” SHUT UP, YOU IGNORANT BUMFACE. Told you I got angry. These words – words like OCD and bipolar – are not words to use lightly. And yet now they’re everywhere. There are TV programmes that actually pun on them. People smile and use them, proud of themselves for learning them, like they should get a sticker or something. Not realizing that if those words are said to you by a medical health professional, as a diagnosis of something you’ll probably have for ever, they’re words you don’t appreciate being misused every single day by someone who likes to keep their house quite clean. People actually die of bipolar, you know? They jump in front of trains and tip down bottles of paracetamol and leave letters behind to their devastated families because their bullying brains just won’t let them be for five minutes and they can’t bear to live with that any more. People also die of cancer. You don’t hear people going around saying: “Oh my God, my headache is so, like, tumoury today.” Yet it’s apparently okay to make light of the language of people’s internal hell

Participatory Medicine is a model of cooperative health care that seeks to achieve active involvement by patients, professionals, caregivers, and others across the continuum of care on all issues related to an individual’s health. Participatory medicine is an ethical approach to care that also holds promise to improve outcomes, reduce medical errors, increase patient satisfaction and improve the cost of care.

Antidepression medication is temperamental. Somewhere around fifty-nine or sixty I noticed the drug I’d been taking seemed to have stopped working. This is not unusual. The drugs interact with your body chemistry in different ways over time and often need to be tweaked. After the death of Dr. Myers, my therapist of twenty-five years, I’d been seeing a new doctor whom I’d been having great success with. Together we decided to stop the medication I’d been on for five years and see what would happen... DEATH TO MY HOMETOWN!! I nose-dived like the diving horse at the old Atlantic City steel pier into a sloshing tub of grief and tears the likes of which I’d never experienced before. Even when this happens to me, not wanting to look too needy, I can be pretty good at hiding the severity of my feelings from most of the folks around me, even my doctor. I was succeeding well with this for a while except for one strange thing: TEARS! Buckets of ’em, oceans of ’em, cold, black tears pouring down my face like tidewater rushing over Niagara during any and all hours of the day. What was this about? It was like somebody opened the floodgates and ran off with the key. There was NO stopping it. 'Bambi' tears... 'Old Yeller' tears... 'Fried Green Tomatoes' tears... rain... tears... sun... tears... I can’t find my keys... tears. Every mundane daily event, any bump in the sentimental road, became a cause to let it all hang out. It would’ve been funny except it wasn’t. Every meaningless thing became the subject of a world-shattering existential crisis filling me with an awful profound foreboding and sadness. All was lost. All... everything... the future was grim... and the only thing that would lift the burden was one-hundred-plus on two wheels or other distressing things. I would be reckless with myself. Extreme physical exertion was the order of the day and one of the few things that helped. I hit the weights harder than ever and paddleboarded the equivalent of the Atlantic, all for a few moments of respite. I would do anything to get Churchill’s black dog’s teeth out of my ass. Through much of this I wasn’t touring. I’d taken off the last year and a half of my youngest son’s high school years to stay close to family and home. It worked and we became closer than ever. But that meant my trustiest form of self-medication, touring, was not at hand. I remember one September day paddleboarding from Sea Bright to Long Branch and back in choppy Atlantic seas. I called Jon and said, “Mr. Landau, book me anywhere, please.” I then of course broke down in tears. Whaaaaaaaaaa. I’m surprised they didn’t hear me in lower Manhattan. A kindly elderly woman walking her dog along the beach on this beautiful fall day saw my distress and came up to see if there was anything she could do. Whaaaaaaaaaa. How kind. I offered her tickets to the show. I’d seen this symptom before in my father after he had a stroke. He’d often mist up. The old man was usually as cool as Robert Mitchum his whole life, so his crying was something I loved and welcomed. He’d cry when I’d arrive. He’d cry when I left. He’d cry when I mentioned our old dog. I thought, “Now it’s me.” I told my doc I could not live like this. I earned my living doing shows, giving interviews and being closely observed. And as soon as someone said “Clarence,” it was going to be all over. So, wisely, off to the psychopharmacologist he sent me. Patti and I walked in and met a vibrant, white-haired, welcoming but professional gentleman in his sixties or so. I sat down and of course, I broke into tears. I motioned to him with my hand; this is it. This is why I’m here. I can’t stop crying! He looked at me and said, “We can fix this.” Three days and a pill later the waterworks stopped, on a dime. Unbelievable. I returned to myself. I no longer needed to paddle, pump, play or challenge fate. I didn’t need to tour. I felt normal.

Women struggled to enter the all-male professional schools. Dr. Harriot Hunt, a woman physician who began to practice in 1835, was twice refused admission to Harvard Medical School. But she carried on her practice, mostly among women and children. She believed strongly in diet, exercise, hygiene, and mental health. She organized a Ladies Physiological Society in 1843 where she gave monthly talks. She remained single, defying convention here too.

We are healthy, we think, if we do not feel any pain or too much pain, and if we are strong enough to do our work. If we become unhealthy, then we go to a doctor who we hope will “cure” us and restore us to health. By health, in other words, we mean merely the absence of disease. Our health professionals are interested almost exclusively in preventing disease (mainly by destroying germs) and in curing disease (mainly by surgery and by destroying germs). But the concept of health is rooted in the concept of wholeness. To be healthy is to be whole. The word health belongs to a family of words, a listing of which will suggest how far the consideration of health must carry us: heal, whole, wholesome, hale, hallow, holy. And so it is possible to give a definition to health that is positive and far more elaborate than that given to it by most medical doctors and the officers of public health.

The conceptual problem at the center of contemporary healthcare is the confusion between disease processes and disease origins. Instead of asking why an illness occurs and trying to remove the conditions that led to it, medical researchers try to understand the mechanisms through which the disease operates, so that they can then interfere with them. These mechanisms, rather than the true origins, are seen as the causes of disease in current medical thinking. In the process of reducing illness to disease, the attention of physicians has moved away from the patient as a whole person. By concentrating on smaller and smaller fragments of the body – shifting its perspective from the study of bodily organs and their functions to that of cells and, finally, to the study of molecules – modern medicine often loses sight of the human being, and having reduced health to mechanical functioning, it is no longer able to deal with the phenomenon of healing. Over the past four decades, the dissatisfaction with the mechanistic approach to health and healthcare has grown rapidly both among healthcare professionals and the general public. At the same time, the emerging systems view of life has given rise to a corresponding systems view of health, as we discuss in Chapter 15, while health consciousness among the general population has increased dramatically in many countries. The

Many doctors (and medical students) display uncertainty about whether or not CFS/ME is real…Patients with CFS/ME often experience suspicion by health professionals…The (often unintentional) marginalization of many CFS/ME patients represents a failure in medical professionalism, one that may lead to further ethical and practical consequences both for progressive research into CFS/ME and for ethical care... With one exception, doctors attending the seminar were either defensive or silent. In their eyes, the ME patients present were conforming to stereotype (angry, unscientific, unreasonable) and therefore they – the doctors – would not engage with them. Paradoxically, these doctors were themselves conforming to another stereotype, as described by the speaker: ‘Knowledge-formation is also influenced by social and cultural factors. Such encounters have an inherent power differential; there is significant potential…to be unjust from an epistemic point of view.

We have created a rhetoric of “gender identity” that is disconnected from biological sexual fact, and we have done so largely in the service of enabling the sexual mutilation of physically healthy men and women (significantly more men) by medical authorities who should be barred by professional convention if not by conscience from the removal of healthy organs (and limbs, more on that later), an act that by any reasonable standard ought to be considered mutilation rather than therapy.

supervisors force professional service people to broadcast the Professional Smile? Am I the only consumer in whom high doses of such a smile produce despair? Am I the only person who’s sure that the growing number of cases in which totally average-looking people suddenly open up with automatic weapons in shopping malls and insurance offices and medical complexes and McDonald’ses is somehow causally related to the fact that these venues are well-known dissemination-loci of the Professional Smile?

Parallel to the idea of the US Constitution as covenant, politicians, journalists, teachers, and even professional historians chant like a mantra that the United States is a “nation of immigrants.” From its beginning, the United States has welcomed—indeed, often solicited, even bribed—immigrants to repopulate conquered territories “cleansed” of their Indigenous inhabitants. From the mid-nineteenth century, immigrants were recruited to work mines, raze forests, construct canals and railroads, and labor in sweatshops, factories, and commercial farm fields. In the late twentieth century, technical and medical workers were recruited. The requirements for their formal citizenship were simple: adhere to the sacred covenant through taking the Citizenship Oath, pledging loyalty to the flag, and regarding those outside the covenant as enemies or potential enemies of the exceptional country that has adopted them, often after they escaped hunger, war, or repression, which in turn were often caused by US militarism or economic sanctions. Yet no matter how much immigrants might strive to prove themselves to be as hardworking and patriotic as descendants of the original settlers, and despite the rhetoric of E pluribus unum, they are suspect. The old stock against which they are judged inferior includes not only those who fought in the fifteen-year war for independence from Britain but also, and perhaps more important, those who fought and shed (Indian) blood, before and after independence, in order to acquire the land. These are the descendants of English Pilgrims, Scots, Scots-Irish, and Huguenot French—Calvinists all—who took the land bequeathed to them in the sacred covenant that predated the creation of the independent United States. These were the settlers who fought their way over the Appalachians into the fertile Ohio Valley region, and it is they who claimed blood sacrifice for their country. Immigrants, to be accepted, must prove their fidelity to the covenant and what it stands for.

A note about me: I do not think stress is a legitimate topic of conversation, in public anyway. No one ever wants to hear how stressed out anyone else is, because most of the time everyone is stressed out. Going on and on in detail about how stressed out I am isn’t conversation. It’ll never lead anywhere. No one is going to say, “Wow, Mindy, you really have it especially bad. I have heard some stories of stress, but this just takes the cake.” This is entirely because my parents are immigrant professionals, and talking about one’s stress level was just totally outlandish to them. When I was three years old my mom was in the middle of her medical residency in Boston. She had been a practicing obstetrician and gynecologist in Nigeria, but in the United States she was required to do her residency all over again. She’d get up at 4:00 a.m. and prepare breakfast, lunch, and dinner for my brother and me, because she knew she wouldn’t be home in time to have dinner with us. Then she’d leave by 5:30 a.m. to start rounds at the hospital. My dad, an architect, had a contract for a building in New Haven, Connecticut, which was two hours and forty-five minutes away. It would’ve been easier for him to move to New Haven for the time of the construction of the building, but then who would have taken care of us when my mom was at the hospital at night? In my parents’ vivid imaginations, lack of at least one parent’s supervision was a gateway to drugs, kidnapping, or at the very minimum, too much television watching. In order to spend time with us and save money for our family, my dad dropped us off at school, commuted the two hours and forty-five minutes every morning, and then returned in time to pick us up from our after-school program. Then he came home and boiled us hot dogs as an after-school snack, even though he was a vegetarian and had never eaten a hot dog before. In my entire life, I never once heard either of my parents say they were stressed. That was just not a phrase I grew up being allowed to say. That, and the concept of “Me time.

The problem with medicine and the institutions it has spawned for the care of the sick and the old is not that they have had an incorrect view of what makes life significant. The problem is that they have had almost no view at all. Medicine’s focus is narrow. Medical professionals concentrate on repair of health, not sustenance of the soul. Yet—and this is the painful paradox—we have decided that they should be the ones who largely define how we live in our waning days. For more than half a century now, we have treated the trials of sickness, aging, and mortality as medical concerns. It’s been an experiment in social engineering, putting our fates in the hands of people valued more for their technical prowess than for their understanding of human needs. That experiment has failed. If safety and protection were all we sought in life, perhaps we could conclude differently. But because we seek a life of worth and purpose, and yet are routinely denied the conditions that might make it possible, there is no other way to see what modern society has done.

Adding social structural analysis to medical and public health education would move toward a more realistic and balanced version of the biopsychosocial model already explicitly claimed in contemporary health-professional training. More important, this would provide future physicians and public health professionals with the lenses to recognize the societal critiques available in sicknesses and their distributions. With such an awareness of the structurally violent social context of disease, health professionals could move effectively toward acknowledging, treating, and preventing suffering.

Health professionals have a formal classification system for the level of function a person has. If you cannot, without assistance, use the toilet, eat, dress, bathe, groom, get out of bed, get out of a chair, and walk—the eight “Activities of Daily Living”—then you lack the capacity for basic physical independence. If you cannot shop for yourself, prepare your own food, maintain your housekeeping, do your laundry, manage your medications, make phone calls, travel on your own, and handle your finances—the eight “Independent Activities of Daily Living”—then you lack the capacity to live safely on your own.

As nurses, we’re supposed to compartmentalize, to be detached, to mentally separate our professional lives from our personal lives, like sorting medication into a pill sorter, clearly divided with thick plastic tabs. We were taught this in nursing school, though it’s not that easy and it’s not something that can be taught—to care for and about our patients, but to not let ourselves get emotionally attached because attachment, they say, leads to burnout, which causes nurses to leave an already hemorrhaging profession. It’s hard because as nurses, it’s in our nature to be compassionate, and these two things—detachment and compassion—are at odds with one another.

Yet, it was precisely our failure to differentiate between work and politics, between reality and illusion; it was precisely our mistake of conceiving of politics as a rational human activity comparable to the sowing of seeds or the construction of buildings that was responsible for the fact that a painter who failed to make the grade was able to plunge the whole world into misery. And I have stressed again and again that the main purpose of this book—which, after all, was not written merely for the fun of it—was to demonstrate these catastrophic errors in human thinking and to eliminate irrationalism from politics. It is an essential part of our social tragedy that the farmer, the industrial worker, the physician, etc., do not influence social existence solely through their social activities, but also and even predominantly through their political ideologies. For political activity hinders objective and professional activity; it splits every profession into inimical ideologic groups; creates a dichotomy in the body of industrial workers; limits the activity of the medical profession and harms the patients. In short, it is precisely political activity that prevents the realization of that which it pretends to fight for: peace, work, security, international cooperation, free objective speech, freedom of religion, etc.

The point is that the fatigue characteristic of such depression reasserts itself every time we repress strong emotions, play down the memories stored in the body, and refuse them the attention they clamor for. Why are such positive developments the exception rather than the rule? Why do most people (including the “experts”) greatly prefer to believe in the power of medication rather than let themselves be guided by the knowledge stored in their own bodies? Our bodies know exactly what we need, what we have been denied, what disagrees with us, what we are allergic to. But many people prefer to seek aid from medication, drugs, or alcohol, which can only block off the path to the understanding of the truth even more completely. Why? Because recognizing the truth is painful? This is certainly the case. But that pain is temporary. With the right kind of therapeutic care it can be endured. I believe that the main problem here is that there are not enough such professional companions to be had. Almost all the representatives of what I’ll call the “caring professions” appear to be prevented by our morality system from siding with the children we once were and recognizing the consequences of the early injuries we have sustained. They are entirely under the influence of the Fourth Commandment, which tells us to honor our parents, “that thy days may be long upon the land the Lord thy God giveth thee.

The average doctor may be more likely than the average widow to elect to become an enterprising investor, and he is perhaps more likely to succeed in the undertaking. He has one important handicap, however—the fact that he has less time available to give to his investment education and to the administration of his funds. In fact, medical men have been notoriously unsuccessful in their security dealings. The reason for this is that they usually have an ample confidence in their own intelligence and a strong desire to make a good return on their money, without the realization that to do so successfully requires both considerable attention to the matter and something of a professional approach to security values.

For the attitude of society towards the criminal appears to be that of a community of stark lunatics. In effect, society addresses the professional criminal somewhat thus: "' You wish to practice crime as a profession, to gain a livelihood by appropriating--by violence or otherwise--the earnings of honest and industrious men. Very well, you may do so on certain conditions. If you are skilful and cautious you will not be molested. You may occasion danger, annoyance and great loss to honest men with very little danger to yourself unless you are clumsy and incautious; in which case you may be captured. If you are, we shall take possession of your person and detain you for so many months or years. During that time you will inhabit quarters better than you are accustomed to; your sleeping-room will be kept comfortably warm in all weathers; you will be provided with clothing better than you usually wear; you will have a sufficiency of excellent food; expensive officials will be paid to take charge of you; selected medical men will be retained to attend to your health; a chaplain (of your own persuasion) will minister to your spiritual needs and a librarian will supply you with books. And all this will be paid for by the industrious men whom you live by robbing. In short, from the moment that you adopt crime as a profession, we shall pay all your expenses, whether you are in prison or at large.' Such is the attitude of society; and I repeat it is that of a community of madmen. ~ Humphrey Challoner

It was only when professionals believed that reports on errors and near misses would be treated as learning opportunities rather than a pretext to blame that this crucial information started to flow. Managers were initially worried that reducing the penalties for error would lead to an increase in the number of errors. In fact, the opposite happened. Insurance claims fell by a dramatic 74 percent. Similar results have been found elsewhere. Claims and lawsuits made against the University of Michigan Health System, for example, dropped from 262 in August 2001 to 83 following the introduction of an open disclosure policy in 2007. The number of lawsuits against the University of Illinois Medical Center fell by half in two years after creating a system of open reporting.

In the present state of the world, not only are many people destitute but the majority of those who are not being haunted by a perfectly reasonable fear that they may become so at any moment. Wage-earners have the constant danger of unemployment; salaried employees know that their firm may go bankrupt or find it necessary to cut down its staff; businessmen, even those who are reputed to be very rich, know that the loss of all their money is by no means improbable. Professional men have a very hard struggle. After making great sacrifices for the education of their sons and daughters, they find that there are not the openings that there used to be for those who have the kinds of skills that their children have acquired. If they are lawyers, they find that people can no longer afford to go to law, although serious injustices remain unremedied; if they are doctors, they find that their formerly lucrative hypochondriac patients can no longer afford to be ill, while many genuine sufferers have to forgo much-needed medical treatment. One finds men and women of university education serving behind the counters in shops, which may save them from destitution, but only at the expense of those who would formerly have been so employed. In all classes, from the lowest to almost the highest, economic fear governs men’s thoughts by day and their dreams at night, making their work nerve-wracking and their leisure unrefreshing. This ever-present terror is, I think, the main cause of the mood of madness which has swept over great parts of the civilized world.

question that our system can produce positive results when focused on the right problem. U.S. hospitals today are filled with some of the world’s most dedicated, intelligent, and hardworking professionals. But they are operating in a system that has lost its way, one that now makes money when patients are sick and loses money when they are healthy. The modern medical system has systematically, overwhelmingly, and unequivocally let us down in preventing and reversing chronic disease. In fact, if you pull out deaths from the top eight infectious diseases (which were decreased by antibiotics) from historical data, life expectancy rates haven’t improved much in the past 120 years—despite, of course, the fact that health care is the largest and fastest-growing industry in the United States—with the vast majority of health care dollars going to chronic disease care.

A Final Word Now that you have become familiar with social anxiety, you know that it is a common problem, especially for teenagers. You’ve learned that it affects you physically, mentally, and behaviorally, and that it can have a tremendous impact on all aspects of your life. Most important, you’ve learned ways to cope with social anxiety. Now, make the techniques presented in this book part of your daily life. With practice you will be able to calm anxious feelings and develop self-confidence in social situations. Remember that change does not happen overnight. There will be tough times mixed in with the good. It may be necessary to see a professional therapist or to take medication. There is no reason social anxiety needs to remain a part of your life. If you are committed to lessening your anxiety, you will see great results. With time and hard work, you can become the person you want to be and live a healthy, happy, and productive life.

The History of Social Anxiety The fact that some people are shyer than others has been observed since ancient times. However, the medical community didn’t become interested in this condition until the 1970s, when Philip Zimbardo founded the Stanford Shyness Clinic. At the time, many professionals believed that shyness was a natural state that children eventually outgrew. Zimbardo showed that shyness actually is a widespread psychological problem that has deep and lasting effects on those who suffer from it. This new awareness led to a great deal of research into the causes and treatment of social anxiety. Today, the condition is in the spotlight. Ads in magazines and commercials on television tell about social anxiety and advertise medications to treat it. People are becoming more open about discussing when they feel anxious and feel less ashamed about asking for help. The time has never been better for you to try to overcome your social anxiety.

This is related to the phenomenon of the Professional Smile, a national pandemic in the service industry; and noplace in my experience have I been on the receiving end of as many Professional Smiles as I am on the Nadir, maître d’s, Chief Stewards, Hotel Managers’ minions, Cruise Director—their P.S.’s all come on like switches at my approach. But also back on land at banks, restaurants, airline ticket counters, on and on. You know this smile—the strenuous contraction of circumoral fascia w/ incomplete zygomatic involvement—the smile that doesn’t quite reach the smiler’s eyes and that signifies nothing more than a calculated attempt to advance the smiler’s own interests by pretending to like the smilee. Why do employers and supervisors force professional service people to broadcast the Professional Smile? Am I the only consumer in whom high doses of such a smile produce despair? Am I the only person who’s sure that the growing number of cases in which totally average-looking people suddenly open up with automatic weapons in shopping malls and insurance offices and medical complexes and McDonald’ses is somehow causally related to the fact that these venues are well-known dissemination-loci of the Professional Smile? Who do they think is fooled by the Professional Smile? And yet the Professional Smile’s absence now also causes despair. Anybody who’s ever bought a pack of gum in a Manhattan cigar store or asked for something to be stamped FRAGILE at a Chicago post office or tried to obtain a glass of water from a South Boston waitress knows well the soul-crushing effect of a service worker’s scowl, i.e. the humiliation and resentment of being denied the Professional Smile. And the Professional Smile has by now skewed even my resentment at the dreaded Professional Scowl: I walk away from the Manhattan tobacconist resenting not the counterman’s character or absence of goodwill but his lack of professionalism in denying me the Smile. What a fucking mess.

Lt. Gen. Zinni has distilled his experiences in a talk on “twenty lessons learned”that feels like a modern appendix to the Small Wars Manual. The earlier you go in, the better, he argues. Start planning as early as possible, and coordinate it with organizations like the United Nations and private relief groups. Assess the differences between your views of the situation and theirs. Coordinate everything, but decentralize execution. Know the culture. “Who makes decisions in this culture? What is the power of religious leaders? Of political people? Of professionals?”Zinni argues that this is probably where the American military fails most often, as it unconsciously seeks the levers of power that exist in its own society. “Truly, the decision makers are at the back of the tent. You have to find them.”Restart a key institution, probably the police, as soon as possible. But don’t offer well-intentioned help, such as extensive medical care, that you can’t sustain. Don’t set high expectations. “Don’t make enemies, but if you do, don’t treat them gently.

...even though [my psychiatrist] understood mor than anyone how much I felt I was losing--in energy, vivacity, and originality--by taking medication, he never was seduced into losing sight of the overall perspective of how costly, damaging, and life threatening my illness was. He was at ease with ambiguity, had a comfort with complexity, and was able to be decisive in the midst of chaos and uncertainty. He treated me with respect, a decisive professionalism, wit, and an unshakable belief in my ability to get well, compete, and make a difference. Although I went to him to be treated for an illness, he taught me, by example, for my own patients, the total beholdenness of brain to mind and mind to brain. My temperament, moods, and illness clearly, and deeply, affected the relationships I had with others in the fabric of my work. But my moods were themselves powerfully shaped by the same relationships and work. The challenge was learning to understand the complexity of this mutual beholdenness and in learning to distinguish the roles of lithium, will, and insight in getting well and leading a meaningful life. It was the task and gift of psychotherapy.

Revitalized and healthy, I started dreaming new dreams. I saw ways that I could make a significant contribution by sharing what I’ve learned. I decided to refocus my legal practice on counseling and helping start-up companies avoid liability and protect their intellectual property. To share some of what I know, I started a blog, IP Law for Startups, where I teach basic lessons on trade secrets, trademarks, copyrights, and patents and give tips for avoiding the biggest blunders that destroy the value of intellectual assets. Few start-up companies, especially women-owned companies that rarely get venture capital funding, can afford the expensive hourly rates of a large law firm to the get the critical information they need. I feel deeply rewarded when I help a company create a strategy that protects the value of their company and supports their business dreams. Further, I had a dream to help young women see their career possibilities. In partnership with my sister, Julie Simmons, I created lookilulu.com, a website where women share their insights, career paths, and ways they have integrated motherhood with their professional pursuits. When my sister and I were growing up on a farm, we had a hard time seeing that women could have rewarding careers. With Lookilulu® we want to help young women see what we couldn’t see: that dreams are not linear—they take many twists and unexpected turns. As I’ve learned the hard way, dreams change and shift as life happens. I’ve learned the value of continuing to dream new dreams after other dreams are derailed. I’m sure I’ll have many more dreams in my future. I’ve learned to be open to new and unexpected opportunities. By way of postscript, Jill writes, “I didn’t grow up planning to be lawyer. As a girl growing up in a small rural town, I was afraid to dream. I loved science, but rather than pursuing medical school, I opted for low-paying laboratory jobs, planning to quit when I had children. But then I couldn’t have children. As I awakened to the possibility that dreaming was an inalienable right, even for me, I started law school when I was thirty; intellectual property combines my love of law and science.” As a young girl, Jill’s rightsizing involved mustering the courage to expand her dreams, to dream outside of her box. Once she had children, she again transformed her dreams. In many ways her dreams are bigger and aim to help more people than before the twists and turns in her life’s path.

Addicts should not be coerced into treatment, since in the long term coercion creates more problems than it solves. On the other hand, for those addicts who opt for treatment, there must be a system of publicly funded recovery facilities with clean rooms, nutritious food, and access to outdoors and nature. Well-trained professional staff need to provide medical care, counseling, skills training, and emotional support. Our current nonsystem is utterly inadequate, with its patchwork of recovery homes run on private contracts and, here and there, a few upscale addiction treatment spas for the wealthy. No matter how committed their staff and how helpful their services may be, they are a drop in comparison to the ocean of vast need. In the absence of a coordinated rehabilitation system, the efforts of individual recovery homes are limited and occur in a vacuum, with no follow-up. It may be thought that the cost of such a drug rehabilitation and treatment system would be exorbitant. No doubt the financial expenses would be great — but surely less than the funds now freely squandered on the War on Drugs, to say nothing of the savings from the cessation of drug-related criminal activity and the diminished burden on the health care system.

[Charlie is dying:] After what seemed a long while, but hadn’t been, Marsh gave Paulette’s hand a warm and caring squeeze. “They’re here for him,” she said. But their heavenly visitors didn’t take him right away. They had to make room for the chaos of modern medical urgencies. To get out of the way of well-trained professionals who had dedicated their lives to holding back Heaven. Choppers are just as noisy and turbulent as we imagine them to be. One tore in over the hills and shattered every bit of peace Charlie otherwise could have lost himself into. In an instant the Med-Evac team was all over him. In the midst of that blatant orchestrated chaos Paulette fought to find her peace, and to hold him inside it. “Hang on, buddy,” techs kept telling him. “Don’t go leaving us now. You just hang in there.” But they didn’t understand, Paulette thought. It was his time. The chopper made a horrible racket carrying him off. Marsh, Paulette, and Ailana held their peace as its winds whipped their world into a froth. Harve’s face twisted with something that might conceivably have been rage. Then, all of a sudden, the birds sang, as though someone had given them a cue. “So that’s what it’s like,” Marsha said, very softly. “The afterlife. “My God, it’s so beautiful.

One year later the society claimed victory in another case which again did not fit within the parameters of the syndrome, nor did the court find on the issue. Fiona Reay, a 33 year old care assistant, accused her father of systematic sexual abuse during her childhood. The facts of her childhood were not in dispute: she had run away from home on a number of occasions and there was evidence that she had never been enrolled in secondary school. Her father said it was because she was ‘young and stupid’. He had physically assaulted Fiona on a number of occasions, one of which occurred when she was sixteen. The police had been called to the house by her boyfriend; after he had dropped her home, he heard her screaming as her father beat her with a dog chain. As before there was no evidence of repression of memory in this case. Fiona Reay had been telling the same story to different health professionals for years. Her medical records document her consistent reference to family problems from the age of 14. She finally made a clear statement in 1982 when she asked a gynaecologist if her need for a hysterectomy could be related to the fact that she had been sexually abused by her father. Five years later she was admitted to psychiatric hospital stating that one of the precipitant factors causing her breakdown had been an unexpected visit from her father. She found him stroking her daughter. There had been no therapy, no regression and no hypnosis prior to the allegations being made public. The jury took 27 minutes to find Fiona Reay’s father not guilty of rape and indecent assault. As before, the court did not hear evidence from expert witnesses stating that Fiona was suffering from false memory syndrome. The only suggestion of this was by the defence counsel, Toby Hed­worth. In his closing remarks he referred to the ‘worrying phenomenon of people coming to believe in phantom memories’. The next case which was claimed as a triumph for false memory was heard in March 1995. A father was aquitted of raping his daughter. The claims of the BFMS followed the familiar pattern of not fitting within the parameters of false memory at all. The daughter made the allegations to staff members whom she had befriended during her stay in psychiatric hospital. As before there was no evidence of memory repression or recovery during therapy and again the case failed due to lack of corrobo­rating evidence. Yet the society picked up on the defence solicitor’s statements that the daughter was a prone to ‘fantasise’ about sexual matters and had been sexually promiscuous with other patients in the hospital. ~ Trouble and Strife, Issues 37-43

I got back to the vehicles and spotted Ashley Voss right away. She was standing there waiting with her rucksack, ready to go. I walked up to her, smiled, and said, “Hey, what’s up? I’m Noah.” “Hi. I’m Ashley,” she said without much emotion. “Cool. Are you excited to come to our area?” I flashed her a grin. After a brief pause she said, “Yeah, the medics can use a female.” She was acting like a professional and I was acting more like someone standing at a bar trying to buy her a drink. As if that couldn’t be more awkward, right at that moment my radio squawked loudly, “Hey, can somebody get me that female medic’s roster number? I need it before we head out.” It was Jerry, ruining my game. I leaned over and hit the button and said a little too proudly, “I’ve got the female medic with me now. I will get that for you.” And before I could ask her what it was, Jerry came back over the radio, “Galloway. You’re with the female. Why am I not surprised?” Ashley gave me her roster number, and I sent it back to Jerry. I turned to Ashley and said, “I’m not a player, just wanted to know more about you.” She didn’t look that convinced. We got in the trucks and drove back. At the potato plant all the guys started sniffing this girl out like a bunch of hound dogs. One of the guys ran and grabbed her rucksack for her and carried it into the medic station, like he was a bellhop.

If they’re not practicing deliberately, even experts can see their skills backslide. Ericsson shared with me an incredible example of this. Even though you might be inclined to trust the advice of a silver-haired doctor over one fresh out of medical school, it’s been found that in a few fields of medicine, doctors’ skills don’t improve the longer they’ve been practicing. The diagnostic accuracy of professional mammographers, for example, doesn’t get more accurate over the years. Why would that be? For most mammographers, practicing medicine is not deliberate practice, according to Ericsson. It’s more like putting into a tin cup than working with a coach. That’s because mammographers usually only find out if they missed a tumor months or years later, if at all, at which point they’ve probably forgotten the details of the case and can no longer learn from their successes and mistakes. One field of medicine in which this is definitively not the case is surgery. Unlike mammographers, surgeons tend to get better with time. What makes surgeons different from mammographers, according to Ericsson, is that the outcome of most surgeries is usually immediately apparent—the patient either gets better or doesn’t—which means that surgeons are constantly receiving feedback on their performance. They’re always learning what works and what doesn’t, always getting better. This finding leads to a practical application of expertise theory: Ericsson suggests that mammographers regularly be asked to evaluate old cases for which the outcome is already known. That way they can get immediate feedback on their performance.

Don’t I need to practice firing?” “Well, it’s not as if you’re going to shoot somebody with this. You’re just going to shoot yourself, right?” Aomame nodded. “In that case, you don’t have to practice firing. You just have to learn to load it, release the safety, and get the feel of the trigger. And anyway, where were you planning to practice firing it?” Aomame shook her head. She had no idea. “Also, how were you planning to shoot yourself? Here, give it a try.” Tamaru inserted the loaded magazine, checked to make sure the safety was on, and handed the gun to Aomame. “The safety is on,” he said. Aomame pressed the muzzle against her temple. She felt the chill of the steel. Looking at her, Tamaru slowly shook his head several times. “Trust me, you don’t want to aim at your temple. It’s a lot harder than you think to shoot yourself in the brain that way. People’s hands usually shake, and it throws their aim off. You end up grazing your skull, but not killing yourself. You certainly don’t want that to happen.” Aomame silently shook her head. “Look what happened to General Tojo after the war. When the American military came to arrest him, he tried to shoot himself in the heart by pressing the muzzle against his chest and pulling the trigger, but the bullet missed and hit his stomach without killing him. Here you had the top professional soldier in Japan, and to think he didn’t know how to kill himself with a gun! They took him straight to the hospital, he got the best care the American medical team could give him, recovered, then was tried and hanged. It’s a terrible way to die. A person’s last moments are an important thing. You can’t choose how you’re born, but you can choose how you die.

The psychological impact of trauma in both the military and civilian arenas has been documented for well over 100 years [1], but the validity of the traumatic neuroses and their key symptoms have been continuously questioned. This is particularly true for posttraumatic amnesia and therapeutically recovered traumatic memories. Freud’s [2] abandonment of his seduction theory was followed by decades of denial of sexual trauma in the psychoanalytic and broader sociocultural realms [3]. Concomitant negation of posttraumatic symptomatology was noted in regard to the war neuroses, emanating equally from military, medical and social spheres [4]. Thus, Karon and Widener [5] drew attention to professional abandonment of the literature on posttraumatic amnesia in World War II combatants. They considered this to be due to a collective forgetting, comparable to the repression of soldiers, but instead occurring on account of social prejudices. He further noted that the validity of memories was never challenged at the time since there was ample corroborating evidence. Recent research confirms the findings of earlier investigators such as Janet [6], validating posttraumatic amnesia of both civilian and military origin. Van der Hart and Nijenhuis [7] cited clinical studies reporting total amnesia for combat trauma, experiences in Nazi concentration camps, torture and robbery. There is also increasing evidence for the existence of amnesia for child sexual abuse. Thus, Scheflen and Brown [8] concluded from their analysis of 25 empirical studies that such amnesia is a robust finding. Since then, new studies, for example those of Elliott [9], have appeared supporting their conclusion. This paper examines posttraumatic amnesia in World War I (WWI) combatants. The findings are offered as an historical cross-validation of posttraumatic amnesia in all populations, including those subjected to childhood sexual abuse.

Kathy’s teachers view her as a good student who always does her homework but rarely participates in class. Her close friends see her as a loyal and trustworthy person who is a lot of fun once you get to know her. The other students in school think she is shy and very quiet. None of them realize how much Kathy struggles with everyday life. When teachers call on her in class, her heart races, her face gets red and hot, and she forgets what she wants to say. Kathy believes that people think she is stupid and inadequate. She imagines that classmates and teachers talk behind her back about the silly things she says. She makes excuses not to go to social events because she is terrified she will do something awkward. Staying home while her friends are out having a good time also upsets her. “Why can’t I just act like other people?” she often thinks. Although Kathy feels isolated, she has a very common problem--social anxiety. Literally millions of people are so affected by self-consciousness that they have difficulties in social situations. For some, the anxiety occurs during very specific events, such as giving a speech or eating in public. For others, like Kathy, social anxiety is part of everyday life. Unfortunately, social anxiety is not an easily diagnosed condition. Instead, it is often viewed as the far edge of a continuum of behaviors and feelings that occur during social situations. Although you may not have as much difficulty as Kathy, shyness may still be causing you distress, affecting your relationships, or making you act in ways with which you are not happy. If this is the case, you will benefit from the advice and techniques provided in this book. The good news is that it is possible to change your thinking and behavior. However, there are no easy solutions. It takes strong motivation and time to overcome social anxiety. It might even be necessary to see a professional therapist or take medication. Eventually, becoming free of your anxiety will make the hard work well worth the effort. This book will help you understand social anxiety and the impact it can have on your life, now and in the future. You will find out how the disorder is diagnosed, you will receive information on professional guidance, and you will learn ways to cope with and manage the symptoms. Becoming an extroverted person is probably unlikely, but you can become more confident in social situations and increase your self-esteem.

PATTERNS OF THE “SHY” What else is common among people who identify themselves as “shy?” Below are the results of a survey that was administered to 150 of my program’s participants. The results of this informal survey reveal certain facts and attitudes common among the socially anxious. Let me point out that these are the subjective answers of the clients themselves—not the professional opinions of the therapists. The average length of time in the program for all who responded was eight months. The average age was twenty-eight. (Some of the answers are based on a scale of 1 to 5, 1 being the lowest.) -Most clients considered shyness to be a serious problem at some point in their lives. Almost everyone rated the seriousness of their problem at level 5, which makes sense, considering that all who responded were seeking help for their problem. -60 percent of the respondents said that “shyness” first became enough of a problem that it held them back from things they wanted during adolescence; 35 percent reported the problem began in childhood; and 5 percent said not until adulthood. This answer reveals when clients were first aware of social anxiety as an inhibiting force. -The respondents perceived the average degree of “sociability” of their parents was a 2.7, which translates to “fair”; 60 percent of the respondents reported that no other member of the family had a problem with “shyness”; and 40 percent said there was at least one other family member who had a problem with “shyness.” -50 percent were aware of rejection by their peers during childhood. -66 percent had physical symptoms of discomfort during social interaction that they believed were related to social anxiety. -55 percent reported that they had experienced panic attacks. -85 percent do not use any medication for anxiety; 15 percent do. -90 percent said they avoid opportunities to meet new people; 75 percent acknowledged that they often stay home because of social fears, rather than going out. -80 percent identified feelings of depression that they connected to social fears. -70 percent said they had difficulty with social skills. -75 percent felt that before they started the program it was impossible to control their social fears; 80 percent said they now believed it was possible to control their fears. -50 percent said they believed they might have a learning disability. -70 percent felt that they were “too dependent on their parents”; 75 percent felt their parents were overprotective; 50 percent reported that they would not have sought professional help if not for their parents’ urging. -10 percent of respondents were the only child in their families; 40 percent had one sibling; 30 percent had two siblings; 10 percent had three; and 10 percent had four or more. Experts can play many games with statistics. Of importance here are the general attitudes and patterns of a population of socially anxious individuals who were in a therapy program designed to combat their problem. Of primary significance is the high percentage of people who first thought that “shyness” was uncontrollable, but then later changed their minds, once they realized that anxiety is a habit that can be broken—without medication. Also significant is that 50 percent of the participants recognized that their parents were the catalyst for their seeking help. Consider these statistics and think about where you fit into them. Do you identify with this profile? Look back on it in the coming months and examine the ways in which your sociability changes. Give yourself credit for successful breakthroughs, and keep in mind that you are not alone!