Tao


‎"Health is the greatest possession. Contentment is the greatest treasure. Confidence is the greatest friend. Non-being is the greatest joy." Lao Tzu

Definition:


Sojourner comes from the Old French, séjourner, meaning "to stay for a time."

Saturday, September 28, 2013

Robbie Burns: To A Mouse

A sculpture of a mouse in the garden of the Robert Burns Birthplace Museum, Alloway
 
 
TO A MOUSE
ON TURNING HER UP IN HER NEST WITH THE PLOUGH, NOVEMBER, 1785
by: Robert Burns (1759-1796)
      I
       
      EE, sleekit, cowrin, tim'rous beastie,
      Oh, what a panic's in thy breastie!
      Thou need na start awa sae hasty,
      Wi' bickering brattle!
      I was be laith to rin an' chase thee,
      Wi' murd'ring pattle!
       
      II
       
      I'm truly sorry man's dominion
      Has broken Nature's social union,
      An' justifies that ill opinion
      Which makes thee startle
      At me, thy poor, earth-born companion
      An' fellow-mortal!
       
      III
       
      I doubt na, whyles, but thou may thieve;
      What then? poor beastie, thou maun live!
      A daimen-icker in a thrave
      'S a sma' request;
      I'll get a blessin wi' the lave,
      And never miss't!
       
      IV
       
      Thy wee-bit housie, too, in ruin!
      Its silly wa's the win's are strewin!
      An' naething, now, to big a new ane,
      O' foggage green!
      An' bleak December's winds ensuin,
      Baith snell an' keen!
       
      V
       
      Thou saw the fields laid bare an' waste,
      An' weary winter comin fast,
      An' cozie here, beneath the blast,
      Thou thought to dwell,
      Till crash! the cruel coulter past
      Out thro' thy cell.
       
      VI
       
      That wee bit heap o' leaves an stibble,
      Has cost thee mony a weary nibble!
      Now thou's turn'd out, for a' thy trouble,
      But house or hald,
      To thole the winter's sleety dribble,
      An' cranreuch cauld!
       
      VII
       
      But, Mousie, thou art no thy lane,
      In proving foresight may be vain:
      The best-laid schemes o' mice an' men
      Gang aft a-gley,
      An' lea'e us nought but grief an' pain,
      For promis'd joy!
       
      VIII
       
      Still thou art blest, compared wi' me!
      The present only toucheth thee:
      But och! I backward cast my e'e,
      On prospects drear!
      An' forward, tho' I cannot see,
      I guess an' fear!
"To a Mouse" is reprinted from English Poems. Ed. Edward Chauncey Baldwin & Harry G. Paul. New York: American Book Company, 1908.

 Source:
 http://www.poetry-archive.com/b/to_a_mouse.html



 Portrait of Robert Burns 
 Robert Burns by Alexander Nasmyth
(By permission of the National Galleries of Scotland) 


Embrace Change




The world hates change, yet it is the only thing that has brought progress
– Charles F. Kettering



The secret of change is to focus all of your energy, not on fighting the old, but on building the new.
- Socrates


What saves a man is to take a step. Then another step.
- C. S. Lewis



An investment in life is an investment in change... When you are changing all the time, you've got to continue to keep adjusting to change, which means that you are going to be constantly facing new obstacles. That's the joy of living. And once you're involved in the process of becoming, there is no stopping.
- Leo F. Buscaglia



All changes, even the most longed for, have their melancholy, for what we leave behind us is a part of ourselves; we must die to one life before we can enter into another.
- Anatole France




Become a student of change. It is the only thing that will remain constant.
- Anthony D'Angelo'









Sunday, September 22, 2013

Addiction and Recovery

 
Home » Substance-Related Disorders

Psychiatric Times. Vol. 28 No. 6

SUBSTANCE ABUSE: ADDICTION and RECOVERY

Novel Therapies for Cognitive Dysfunction Secondary to Substance Abuse
Brief Screening, Referral, and Cognitive Rehabilitation


*By Antonio Verdejo-García, PhD | June 8, 2011


The prevalence and durability of cognitive deficits in patients with substance use disorders raises the need to develop specific assessment and rehabilitation strategies. This is pertinent because general deficits in cognitive function and specific deficits in executive functions are robustly associated with worse drug treatment outcomes, including poorer adherence, shorter retention, and greater risk of relapse.14-16

In this article, I propose the use of a brief screening instrument for frontal-executive deficits in patients with substance use disorders and provide examples of novel treatment interventions aimed at addressing these deficits.

Instruments to assess substance use–related cognitive deficits

Key manifestations of cognitive/executive dysfunction among patients with substance use disorders are:

• Difficulties in understanding complex instructions

• Distractibility

• Premature or disinhibited responses

• Thought and behavioral inflexibility


  • Some other symptoms may be neglected by the patient but stressed by significant collaterals, including:

- problems with initiating and planning novel activities, 

- disorganized behavior, 

- lack of insight into his or her mistakes, and 

- lack of concern about the consequences.
Insight is often lacking in the patient, which underscores the need for the clinician to effectively screen for cognitive dysfunction.

If cognitive impairment is suspected in light of clinical observations and interviews, I recommend the use of a brief screening instrument to detect frontostriatal systems–derived cognitive, behavioral, and emotional deficits. For example, the Frontal Systems Behavior Scale (FrSBe) is a sensitive instrument used to detect frontostriatal-related deficits in patients with substance use disorders.17-19

The FrSBe is composed of 46 items (rated on a 1 to 5 Likert scale) that yield 3 scores for:

-symptoms of apathy, 

- disinhibition, and executive dysfunction (working memory, planning, or awareness deficits), as well as

- an overall score of frontostriatal-systems dysfunction.

The scale includes a self-report and a collateral report. Both reports have shown adequate reliability indices, but the use of the latter is especially recommended when the patient’s insight deficits are overtly manifest.17

The scale also possesses norms extracted from the healthy population of the United States, which provides easy classification of patients as impaired or nonimpaired in comparison with demographically adjusted norms.

If the information from the clinical interviews and the scale’s scores converges to suggest at least mild cognitive impairment (below 1.5 standard deviations [SDs] in some of the FrSBe scales), the clinician can complement the assessment by administering a brief battery of neuropsychological tests focused on those cognitive abilities with well-known implications for addiction treatment prognosis (Table). Response inhibition is measured with the Stroop test, the Wisconsin Card Sorting Test (WCST) is used to measure flexibility/perseveration, decision-making capacity is measured using the Iowa Gambling Task (IGT).14-16

The Stroop test measures response inhibition, and it is based on the interference effect driven by the demand of naming the color of a word that is printed in a color incongruent with the name (eg, the word blue printed in red).20

The test consists of 3 conditions.

1. The first condition (W) presents the words red, blue, and green printed in black ink, and patients are requested to read aloud these words.

2. The second condition (C) presents strings of XXX printed in the same 3 colors, and patients have to name the colors as quickly and accurately as possible.

3. The third condition (WC) introduces the interference effect: the words red, blue, and green are printed in incongruent colors and patients have to name the color and ignore the word.

The interference score (IS) is calculated by subtracting a weighted mean of the first 2 conditions from the third condition [IS = WC 2 (C 3 W)/(C + W)]; then results are compared with normative values to evaluate the degree of impairment.

The WCST21 is a measure of flexibility to change. It measures response patterns in the face of changing schedules of reinforcement. The clinician presents 4 stimulus cards; the shapes on the cards differ in color, quantity, and design. 

The patient is given a stack of 64 cards that he has to sort according to initially unknown criteria. However, the examiner knows the criteria (the first sorting criterion is the color of the shapes, the second is the design of the shapes, and the third is the number of shapes) and provides trial-by-trial feedback of the correctness or incorrectness of each card sorted.

Patients try to sort the cards correctly by adjusting their performance to the ongoing feedback. Critically, the sorting criteria change across the test (without any overt warning from the examiner): after 10 consecutive hits in sorting by color, the criterion changes to shape, and then to number.





*Dr Verdejo-García is Researcher and Lecturer at the Department of Clinical Psychology and Institute of Neuroscience, Universidad de Granada, Spain. He reports no conflicts of interest concerning the subject matter of this article.



Read More:
Source:  http://www.psychiatrictimes.com/substance-use-disorder







ANIMAL FRIENDS IN PICTURES

 

 
A Really Good Read by Laurie Rubin on 500px 

 

 




 
 




 



Tuesday, August 20, 2013

A Simple Philosophy


“To ensure good health: eat lightly, breathe deeply, live moderately, cultivate cheerfulness, and maintain an interest in life.”


-William Londen



Tuesday, July 16, 2013

Cannabis

 Although medical cannabis is now legal, it is hazy as to how it will be dispensed in Canada --- probably by your GP.  

Surveys like this one show how reactionary this profession is SO you must wonder how easy it will be to obtain from your local doctor.




The Dope on Medical Cannabis: Results of a Survey of Psychiatrists : 


- See more at: http://www.psychiatrictimes.com/psychopharmacology/dope-medical-cannabis-results-survey-psychiatrists/page/0/8#sthash.Ab7kzUZP.dpuf


If our survey on medical cannabis is any indication, psychiatrists are widely—and deeply—divided on whether and how marijuana should be used in clinical practice. You can read the results here.
- See more at: http://www.psychiatrictimes.com/substance-use-disorder#sthash.BWIzXKUh.dpuf


The Dope on Medical Cannabis: Results of a Survey of Psychiatrists

If our survey on medical cannabis is any indication, psychiatrists are widely—and deeply—divided on whether and how marijuana should be used in clinical practice. Feelings are running, well . . . high, about whether, when, or in what circumstances this drug might be prescribed for patients with psychiatric disorders.
- See more at: http://www.psychiatrictimes.com/psychopharmacology/dope-medical-cannabis-results-survey-psychiatrists#sthash.iZ1uVy71.dpuf


We invited psychiatrists to complete a survey about medicinal marijuana and didn’t expect nearly 2200 people to complete that survey in a just a few days. We heard from 1138 psychiatrists, 930 of whom practice in the US. We also heard from 109 psychologists, 163 nurse practitioners, and 22 physician assistants. About 30% of the respondents were 51 - 60 years old; 20% were 41 - 50; and 22% were 61 - 71. The minority (40%) live in a state where medical cannabis is legal.

The graphs you see on the following pages summarize survey results.

What is your opinion of medical marijuana?

We got 922 answers and 112 comments: 37% would never prescribe; 40% would consider prescribing in some circumstances; and 11% would consider, but only in pill form. Here’s a sampling of the widely divergent opinions.

“Marijuana should be legal for all and should not require a prescription."

“There is no medical necessity to legalize or prescribe something as addictive or toxic as smoked marijuana.”

“I am offended at the use of the term 'medical.' I am a physician and it is up to physicians to decide what is medical, not politicians. It is recreational or political, not medical until we as a profession say otherwise."

“Marijuana is NOT medicine. It happens to be effective for chemotherapy-related side effects, but not all the time, and not for everyone. Let’s get real. People want ‘medical marijuana’ because they feel less discomfort WHEN THEY ARE HIGH. When people are facing terminal illness, I give them whatever they want. Welldocumented, intractable pain—almost anything they want, with careful monitoring. Short of this, they want the buzz. There is nothing inherently wrong with wanting this. I, however, do not need to support it in my practice.”

“I would not prescribe marijuana because it has no psychiatric indication.”

“I work in a state facility where it is not an option to prescribe marijuana. However, some of my elder patients may benefit from prescribed pills of its synthetic derivatives like Marinol.”

“When I see good double blind studies that demonstrate effective long-term uses in psychiatric conditions, I would consider prescribing regulated medical marijuana.”

“I have a 49 year old patient with rapid deterioration of multiple sclerosis. Marijuana helps her with mood swings and discomfort. If legal, I would prescribe it without hesitation . . . ”

“I would prescribe for terminally ill cancer patients. I consider it to be a toxic, dangerous drug under most circumstances.”

“I would legalize all drugs of abuse as the war on drugs is a failure, wastes money, is a threat to civil liberties, and funds narco-terrorism.”

“Because I am an addiction psychiatrist, I do not prescribe medical marijuana. Like all drugs, it has its place in the medical armamentarium, and I approve of its medical use when appropriate. There should be more funded research and less ‘religious opinion’ so we can know what the proper use of marijuana is. Currently it has become a political football and the medical- correctional industry has a financial stake in not acknowledging the abject failure of the War on Drugs.”



Cannabis—Take the Survey
For what psychiatric conditions would you prescribe medical cannabis?


531 respondents left comments. Aside from “none,” these were among the responses:

“Anorexia”

“Agitated dementia”

“Severe anxiety disorders”

“Chronic pain”

“None, well, perhaps chemotherapy nausea”

“Weight loss in dementia”

“PTSD”

“Pain management, glaucoma, migraine, cancer, AIDS, and a number of other conditions”

“Anxiety, insomnia, appetite stimulation”

“Geriatric depression, geriatric anxiety”

“Bipolar I & PTSD & disability level inability to have social encounters or even to venture out when a neighbor can view them. If it significantly eases paranoid delusional obsessions. Those I feel comfortable in trying out.”

“Terminal patients who qualify for Hospice”

“Comorbid oncology and severe pain”


If your patient was receiving medical marijuana from another prescriber for PTSD, would you continue to treat his/ her psychiatric illness?

The majority (48%) answered “yes” to the question. Among the 182 comments were these: “

What hasn’t been addressed is the liability of mixing psych meds with cannabis when there is no way to determine the cannabis dose. If we Rx cannabis and the patient has a MVA are we liable?”

“My patients have a ‘one prescriber’ contract with me.”

“Would attempt to replace the MJ ultimately via the treatment; would not accede to patient continuing to take as part of a lifeplan.”

“Most likely, but only if I felt it was being used appropriately and not hindering treatment progress or adherence to evidence-based treatments.”

“I would not treat with psychopharmacology. I would assume that person is the prescriber. I might treat with psychotherapy if it was a collaborative approach and therapeutic.”


We would like to extend a special thank-you to our Editorial Board Member, Dr Helen Lavretsky, who wrote our cover story about medical cannabis and who helped us develop this survey. And thank you to all who took the time to complete this survey. We would also call your attention to a survey recently conducted by The New England Journal of Medicine in which physicians across various specialties were asked their views about medicinal use of marijuana.1





The Dope on Medical Cannabis: Results of a Survey of Psychiatrists
The Haze Surrounding Medical Cannabis—Take the Survey


























addiction



PsychiatricTimes SearchMedica Medline Drugs


Psychiatric Times. Vol. 28 No. 6


SUBSTANCE ABUSE: ADDICTION & RECOVERY
Novel Therapies for Cognitive Dysfunction Secondary to Substance Abuse
Brief Screening, Referral, and Cognitive Rehabilitation



By Antonio Verdejo-García, PhD | June 8, 2011



Dr Verdejo-García is Researcher and Lecturer at the Department of Clinical Psychology and Institute of Neuroscience, Universidad de Granada, Spain. He reports no conflicts of interest concerning the subject matter of this article.


The prevalence and durability of cognitive deficits in patients with substance use disorders raises the need to develop specific assessment and rehabilitation strategies. This is pertinent because general deficits in cognitive function and specific deficits in executive functions are robustly associated with worse drug treatment outcomes, including poorer adherence, shorter retention, and greater risk of relapse.14-16

In this article, I propose the use of a brief screening instrument for frontal-executive deficits in patients with substance use disorders and provide examples of novel treatment interventions aimed at addressing these deficits.

Instruments to assess substance use–related cognitive deficits

Key manifestations of cognitive/executive dysfunction among patients with substance use disorders are:


• Difficulties in understanding complex instructions


• Distractibility


• Premature or disinhibited responses


• Thought and behavioral inflexibility

Some other symptoms may be neglected by the patient but stressed by significant collaterals, including problems with initiating and planning novel activities, disorganized behavior, lack of insight into his or her mistakes, and lack of concern about the consequences.

Insight is often lacking in the patient, which underscores the need for the clinician to effectively screen for cognitive dysfunction. If cognitive impairment is suspected in light of clinical observations and interviews, I recommend the use of a brief screening instrument to detect frontostriatal systems–derived cognitive, behavioral, and emotional deficits. For example, the Frontal Systems Behavior Scale (FrSBe) is a sensitive instrument used to detect frontostriatal-related deficits in patients with substance use disorders.17-19

The FrSBe is composed of 46 items (rated on a 1 to 5 Likert scale) that yield 3 scores for symptoms of apathy, disinhibition, and executive dysfunction (working memory, planning, or awareness deficits), as well as an overall score of frontostriatal-systems dysfunction. The scale includes a self-report and a collateral report. Both reports have shown adequate reliability indices, but the use of the latter is especially recommended when the patient’s insight deficits are overtly manifest.17 The scale also possesses norms extracted from the healthy population of the United States, which provides easy classification of patients as impaired or nonimpaired in comparison with demographically adjusted norms.

If the information from the clinical interviews and the scale’s scores converges to suggest at least mild cognitive impairment (below 1.5 standard deviations [SDs] in some of the FrSBe scales), the clinician can complement the assessment by administering a brief battery of neuropsychological tests focused on those cognitive abilities with well-known implications for addiction treatment prognosis (Table). Response inhibition is measured with the Stroop test, the Wisconsin Card Sorting Test (WCST) is used to measure flexibility/perseveration, decision-making capacity is measured using the Iowa Gambling Task (IGT).14-16



The Stroop test measures response inhibition, and it is based on the interference effect driven by the demand of naming the color of a word that is printed in a color incongruent with the name (eg, the word blue printed in red).20 The test consists of 3 conditions. The first condition (W) presents the words red, blue, and green printed in black ink, and patients are requested to read aloud these words. The second condition (C) presents strings of XXX printed in the same 3 colors, and patients have to name the colors as quickly and accurately as possible. The third condition (WC) introduces the interference effect: the words red, blue, and green are printed in incongruent colors and patients have to name the color and ignore the word. The interference score (IS) is calculated by subtracting a weighted mean of the first 2 conditions from the third condition [IS = WC 2 (C 3 W)/(C + W)]; then results are compared with normative values to evaluate the degree of impairment.

The WCST21 is a measure of flexibility to change. It measures response patterns in the face of changing schedules of reinforcement. The clinician presents 4 stimulus cards; the sh apes on the cards differ in color, quantity, and design. The patient is given a stack of 64 cards that he has to sort according to initially unknown criteria. However, the examiner knows the criteria (the fi










Frank Lloyd Wright’s famous house: A River Runs Through It



Society and Culture - A River Runs Through It



A River Runs Through It

One of the most famous and beloved houses in the country has not survived without a struggle.
BY: Renee Valois 
June 09, 2009

From the very beginning, Fallingwater made a huge splash in the world of architecture. In 2000 the American Institute of Architects voted it the Building of the Century. But Frank Lloyd Wright’s famous house did not always look like it would last through the century.

The house remains as unique today as when it was designed in 1935. But the very originality that made Fallingwater so beloved has also endangered it.

When department store magnate Edgar J. Kaufmann commissioned Wright to design a country house for him on the Bear Run stream on forested mountain property in western Pennsylvania, he expected Wright to build a retreat with a view of the waterfall his family loved. He did not anticipate a house built right on top of the river—incorporating the very boulders upon which the family enjoyed basking.

Legend has it that the design for Fallingwater spewed out of Wright in one frantic session. It started one morning in September 1935, when Kaufmann called Wright to inform him that he was in Milwaukee, about to drive up to Taliesin (Wright’s home and studio in his childhood town of Spring Green, Wis.) to see Wright’s designs. Kaufmann had been waiting impatiently for months. Wright replied “Come along, E.J. We’re ready for you,” implying that the plans were finished. In reality, Wright had not even begun to work on the designs—at least on paper.

As his apprentices Edgar Tafel and Bob Mosher later recalled, Wright talked to himself as he laid out plans for the house. “Liliane and E.J. will have tea on the balcony . . . The rock on which E.J. sits will be the hearth, coming right out of the floor, the fire burning just behind it . . .” He kept his two assistants sharpening the colored pencils he rapidly used up. The plans, elevations, and sections were finished just in time for Kaufmann’s arrival.

Fallingwater comprises a series of concrete levels anchored in rock. It is so integrated into the landscape that the huge boulder Wright envisioned actually protrudes through the floor of the living room. Multilevel platforms and balconies mimic the natural ledges of the falls, and stone quarried from the area enhances the organic look. The cantilevered house projects over the river, and steps from the living room lead right down to the water.

The spectacle of breathtaking architecture enfolded in a beautiful forest stream has drawn visitors from around the world. In 1963 Edgar Kaufmann Jr., who was instrumental in his father’s original decision to hire Wright, gave Fallingwater and its acreage to the public in care of the Western Pennsylvania Conservancy as a memorial to his parents. Today, 135,000 people visit annually.

But peaceful surroundings belie the danger Fallingwater has endured through the decades. In 1956 a tornado hit, and Edgar Jr. wrote, “The house was being racked . . . The main stairs . . . carried a cascade from the hillside behind the house. Ankle deep in water, we looked over an alien lake obliterating the glen and shoving restlessly against glass doors, while the wind howled and the rain poured down in wild sheets . . . The next morning we awoke to a house thick with sludge. The banks of Bear Run were ravaged . . . smaller boulders were swept away, trees were down . . . Two bronze statues, set outdoors near the house, had disappeared.”

Fallingwater came through the terrible storm structurally intact, and the mud and drowned snakes were cleaned out, but nagging problems have resurfaced through the years.

When the house was built, many engineers feared the cantilevers that supported the floors would eventually collapse—or the river would cause the house to disintegrate. Indeed, the cantilevers sagged so much over time, and moisture damage was so pervasive, that in 1999 a plan was formulated to resolve both issues. In 2002 the cantilevers were stabilized with post-tensioning, using high-strength steel cables buried inside the floors.

Lynda Waggoner, director of Fallingwater, says water damage had warped doors, peeled paint, and caused stains and cracks in walls, creating problems that rivaled the sagging cantilevers in importance. Fortunately, advances in modern technology have made it possible to completely waterproof the building.

However, Waggoner says that, just as with any home, one might put a new roof on, but then something else needs to be replaced—there are always new issues. She says that although the original glass was replaced with UV-filtering laminate glass in 1987, it’s beginning to fail. Also, it has always been difficult to get paint to adhere to the building because Fallingwater has a lot of horizontal surfaces.
Waggoner says it’s difficult to ask fans of preservation for more money after the big capital campaign that recently funded the extensive structural and waterproofing work.

But the physical poetry of Fallingwater will surely ensure its preservation. As Waggoner says, “It’s one of our national treasures. It’s the most famous modern house museum on the planet. Few houses speak to a whole host of people. But you don’t have to be an architectural aficionado to love Fallingwater.”

Renee Valois wrote about Civil War battle relics in the September/October 2006 issue of the magazine.


File:FallingwaterWright.jpg







Tuesday, July 9, 2013

BE MINDFUL NOW




LOST

Stand still.
The trees ahead and the bushes beside you Are not lost.
Wherever you are is called Here,
And you must treat it as a powerful stranger,
Must ask permission to know it and be known.
The forest breathes. Listen. It answers,
I have made this place around you,
If you leave it you may come back again, saying Here.

No two trees are the same to Raven.
No two branches are the same to Wren.
If what a tree or a bush does is lost on you,
You are surely lost. Stand still.
The forest knows Where you are.
You must let it find you.




An old Native American elder story rendered into modern English by David Wagoner, in The Heart Aroused - Poetry and the Preservation of the Soul in Corporate America by David Whyte, Currency Doubleday, New York, 1996.



AWAKEN TO THIS DAY

Detail of an illustration prepared for the print version of this story.




SANSKRIT PROVERB

Look at this day, for it is life, the very life of life.

In its brief course lie all the realities and verities of existence, the bliss of growth, the splendor of action, the glory of power.

For yesterday is but a dream, and tomorrow is only a vision, but today, well lived, makes every day a dream, a dream of happiness and every tomorrow a vision of hope.

Look well, therefore, to this day








*PICTURE: Detail of an illustration prepared for the print version of this story.



Tuesday, February 26, 2013

Bully get the message: To This Day Project - Be mindful that actions have consequences


Published on Feb 19, 2013



Shane Koyczan "To This Day" http://www.tothisdayproject.com Help this message have a far reaching and long lasting effect in confronting bullying. Please share generously.

Find Shane on Facebook - http://on.fb.me/Vwdi65
or on Twitter - http://www.twitter.com/koyczan

I send out one new poem each month via email. You might like to join us. http://www.shanekoyczan.com

"My experiences with violence in schools still echo throughout my life but standing to face the problem has helped me in immeasurable ways.

Schools and families are in desperate need of proper tools to confront this problem. This piece is a starting point." - Shane

Find anti-bullying resources at http://www.bullying.org

Dozens of collaborators from around the world helped to bring this piece to life. Learn more about them and the project at http://www.tothisdayproject.com

Buy "To This Day" on BandCamp http://bit.ly/VKGjgU

or iTunes http://bit.ly/W47QK2








Source:
To This Day Project - Shane Koyczan - YouTube

 https://www.youtube.com/watch?feature=player_embedded&v=ltun92DfnPY#!





Sunday, January 27, 2013

Successful and Schizophrenic: Every person wants to work and to love

 I'm always looking for examples of people who beat the odds by overcoming adversity and go on to build a good life for themselves...

.............





January 25, 2013

Successful and Schizophrenic

LOS ANGELES
THIRTY years ago, I was given a diagnosis of schizophrenia. 

My prognosis was “grave”: I would never live independently, hold a job, find a loving partner, get married. My home would be a board-and-care facility, my days spent watching TV in a day room with other people debilitated by mental illness. I would work at menial jobs when my symptoms were quiet.

Following my last psychiatric hospitalization at the age of 28, I was encouraged by a doctor to work as a cashier making change. 
If I could handle that, I was told, we would reassess my ability to hold a more demanding position, perhaps even something full-time. 
Then I made a decision. I would write the narrative of my life. 

Today I am a chaired professor at the University of Southern California Gould School of Law. I have an adjunct appointment in the department of psychiatry at the medical school of the University of California, San Diego, and am on the faculty of the New Center for Psychoanalysis. The MacArthur Foundation gave me a genius grant.
Although I fought my diagnosis for many years, I came to accept that I have schizophrenia and will be in treatment the rest of my life.

Indeed, excellent psychoanalytic treatment and medication have been critical to my success. What I refused to accept was my prognosis.
Conventional psychiatric thinking and its diagnostic categories say that people like me don’t exist.

Either I don’t have schizophrenia (please tell that to the delusions crowding my mind), or I couldn’t have accomplished what I have (please tell that to U.S.C.’s committee on faculty affairs). 

But I do, and I have. And I have undertaken research with colleagues at U.S.C. and U.C.L.A. to show that I am not alone. 

There are others with schizophrenia and such active symptoms as delusions and hallucinations who have significant academic and professional achievements. 
Over the last few years, my colleagues, including Stephen Marder, Alison Hamilton and Amy Cohen, and I have gathered 20 research subjects with high-functioning schizophrenia in Los Angeles. 

They suffered from symptoms like mild delusions or hallucinatory behavior.

Their average age was 40. Half were male, half female, and more than half were minorities. All had high school diplomas, and a majority either had or were working toward college or graduate degrees. 

They were graduate students, managers, technicians and professionals, including a doctor, lawyer, psychologist and chief executive of a nonprofit group. 
At the same time, most were unmarried and childless, which is consistent with their diagnoses. (My colleagues and I intend to do another study on people with schizophrenia who are high-functioning in terms of their relationships. 

Marrying in my mid-40s — the best thing that ever happened to me — was against all odds, following almost 18 years of not dating.) 

More than three-quarters had been hospitalized between two and five times because of their illness, while three had never been admitted. 
How had these people with schizophrenia managed to succeed in their studies and at such high-level jobs? 

We learned that, in addition to medication and therapy, all the participants had developed techniques to keep their schizophrenia at bay. 

For some, these techniques were cognitive. An educator with a master’s degree said he had learned to face his hallucinations and ask, “What’s the evidence for that? Or is it just a perception problem?” Another participant said, “I hear derogatory voices all the time. ... You just gotta blow them off.” 
Part of vigilance about symptoms was “identifying triggers” to “prevent a fuller blown experience of symptoms,” said a participant who works as a coordinator at a nonprofit group. For instance, if being with people in close quarters for too long can set off symptoms, build in some alone time when you travel with friends.
Other techniques that our participants cited included controlling sensory inputs.

For some, this meant keeping their living space simple (bare walls, no TV, only quiet music), while for others, it meant distracting music. “I’ll listen to loud music if I don’t want to hear things,” said a participant who is a certified nurse’s assistant. 

Still others mentioned exercise, a healthy diet, avoiding alcohol and getting enough sleep. A belief in God and prayer also played a role for some. 
One of the most frequently mentioned techniques that helped our research participants manage their symptoms was work. 

“Work has been an important part of who I am,” said an educator in our group. “When you become useful to an organization and feel respected in that organization, there’s a certain value in belonging there.” This person works on the weekends too because of “the distraction factor.” 

In other words, by engaging in work, the crazy stuff often recedes to the sidelines. 
Personally, I reach out to my doctors, friends and family whenever I start slipping, and I get great support from them. 

I eat comfort food (for me, cereal) and listen to quiet music. I minimize all stimulation. 

Usually these techniques, combined with more medication and therapy, will make the symptoms pass. 

But the work piece — using my mind — is my best defense. It keeps me focused, it keeps the demons at bay. 
My mind, I have come to say, is both my worst enemy and my best friend. 
THAT is why it is so distressing when doctors tell their patients not to expect or pursue fulfilling careers. 

Far too often, the conventional psychiatric approach to mental illness is to see clusters of symptoms that characterize people. 

Accordingly, many psychiatrists hold the view that treating symptoms with medication is treating mental illness. 

But this fails to take into account individuals’ strengths and capabilities, leading mental health professionals to underestimate what their patients can hope to achieve in the world. 
It’s not just schizophrenia: earlier this month, The Journal of Child Psychology and Psychiatry posted a study showing that a small group of people who were given diagnoses of autism, a developmental disorder, later stopped exhibiting symptoms. They seemed to have recovered — though after years of behavioral therapy and treatment. 

A recent New York Times Magazine article described a new company that hires high-functioning adults with autism, taking advantage of their unusual memory skills and attention to detail. 
I don’t want to sound like a Pollyanna about schizophrenia; mental illness imposes real limitations, and it’s important not to romanticize it. 

We can’t all be Nobel laureates like John Nash of the movie “A Beautiful Mind.” 

But the seeds of creative thinking may sometimes be found in mental illness, and people underestimate the power of the human brain to adapt and to create. 
An approach that looks for individual strengths, in addition to considering symptoms, could help dispel the pessimism surrounding mental illness. 

Finding “the wellness within the illness,” as one person with schizophrenia said, should be a therapeutic goal. Doctors should urge their patients to develop relationships and engage in meaningful work. 

They should encourage patients to find their own repertory of techniques to manage their symptoms and aim for a quality of life as they define it. And they should provide patients with the resources — therapy, medication and support — to make these things happen. 
“Every person has a unique gift or unique self to bring to the world,” said one of our study’s participants. 

She expressed( in the words of Sigmund Freud)  the reality that those of us who have schizophrenia and other mental illnesses want what -

 everyone wants to work and to love. 









Elyn R. Saks is a law professor at the University of Southern California and the author of the memoir “The Center Cannot Hold: My Journey Through Madness.”


 Source:
Successful and Schizophrenic - NYTimes.com

http://www.nytimes.com/2013/01/27/opinion/sunday/schizophrenic-not-stupid.html?_r=0&pagewanted=print