A Thousand Acts of Compassion

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars
credit: 10tv

By Mary O’Brien, M.D.

Millions of people around the world were stunned by the horror of the Las Vegas massacre.  The magnitude of the attack was staggering.  However, it was the cold, cruel, calculating mindset of the shooter that left us speechless.  Normal, decent human beings are not capable of grasping that degree of unmitigated evil.  And yet, as the days passed, stories of stunning courage, heroism, and compassion emerged.

Police officers stood up amidst crouching civilians trying to discern the shooter’s location, making themselves targets. At least two men were shot while performing cardiopulmonary resuscitation (CPR).  Scores of people used their own bodies as shields to protect loved ones and even strangers.  And quick-thinking, brave people fashioned splits, tourniquets, and stretchers from anything these people could find.

Several victims survived, in part, because combat veterans inserted their fingers into bullet wounds to slow blood loss.

Many individuals demonstrated compassion, courage, and creative thinking, transporting victims to hospitals.  An Iraq war veteran “borrowed” a truck with the key in the ignition and shuttled 30 people to the emergency room (ER).  A cab driver passing by scooped up a young woman with severe wounds.  In the back seat, his passengers cradled her as they raced to the nearest hospital.  In a moving demonstration of selflessness, many of those injured or wounded declined ambulance transport or emergency care in deference to those in even more serious condition.  As one of the ER triage physicians said, “I’ve never had such wonderful patients!”

All of these stories are remarkably reminiscent of the kindness and heroism displayed by people in the aftermath of the Boston Marathon bombing.  Countless people donated blood, water, food, accommodations, time, and money to assist victims, family members, first responders, and medical personnel.

Truly evil people always want to aggrandize themselves, often through unspeakable violence.  But violence has always been the last refuge of the coward.  And, as we’ve witnessed in Las Vegas, one cowardly act by a monster inspired a thousand acts of compassion and courage.  May God heal and protect all the good people who endured so much and helped so many.

Anger, News and The Brain

Posted on Posted in Brain Science, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Have you reached the point where you’re afraid to watch the news?  I have.  The sight of one human being kicking another sickens me and every other sane person. However, anger, hatred, and violence are not new.  They are as old as mankind because they stem from primitive, tribal, and “us versus them” thinking.  And lest we think we’re above it all, primitive, tribal thinking occurs daily in neighborhoods, businesses, offices, universities, and political and religious entities around the globe.  No one starts out that way. As a poignant lyric from the World War II musical “South Pacific” reminds us, “You’ve got to be taught to hate and fear, you’ve got to be carefully taught.”

Perhaps more people in the under-50 crowd can relate to a line spoken by Yoda in the “Star Wars” saga.  Cautioning Luke Skywalker about the true enemy, Yoda warns against fear:  “Fear leads to anger, anger leads to hatred, and hatred leads to the dark side.”

That’s not merely a memorable line from a movie.  That is profound.  Wherever we see evil, darkness, or violence, there is almost always some measure of fear.  People fear the loss of their money, their power, their identities, their rights, their beliefs, and their version of “truth.”  All of this sounds like a philosophical discussion until we consider the underlying physiology.

Appropriate fear, as part of the fight-or-flight response, is a survival mechanism.  It has helped humans and other species to endure for many millennia.  Learned fear originates in the amygdala.  Repeated, fearful stimuli, if unchecked by higher centers in the frontal and pre-frontal cortices, can rapidly lead to anger and aggression.  Simply put, a person can literally develop an angry brain.*  The result is an individual who becomes angry too easily and too often.  These people overreact to angry feelings, become aggressive whenever upset, and have great difficulty calming down.  Allowing oneself to simmer in a sea of angry thoughts, feelings, hormones, and neurotransmitters can rapidly lead to some horrible behavior.  We see it every night on the news.

Human physiology is such that anger and empathy are mutually exclusive.  Empathy, being a far more highly-evolved emotion, tends to inhibit anger and aggression.  And calmness is a pre-requisite for empathy.  Long, long ago, in our very own galaxy, someone even wiser than Yoda said, “Perfect love casts out fear.”  Perhaps someday the human race will catch on.  Until then, don’t go overboard watching the news.

After The Storm

Posted on Posted in Brain Science, Elder Care, Homestudy, Psychology

By Mary O’Brien, M.D

A week of frightening forecasts.  Days of hectic, worried preparations.  Hours of terrifying wind and torrential rain.  Now nearly seven million Floridians are without power.  They, along with millions of other people, will begin the long process of recovery.  Despite their exhaustion and stress, they will follow in the footsteps of so many Texans and help one another.  People in Florida are not strangers to disasters.  They know how to re-build.

And who, among the rest of us, does not know someone in Texas or Florida?  Nearly every individual I know has family members, friends, colleagues, or acquaintances in one of these disaster-ravaged areas.  We are all interconnected whether we realize it or not.  Those of us in health care who are well-acquainted with suffering have an opportunity to set a good example for others.  Whatever each of us can do to help, now would be a good time.

Why Humans Need to Cry

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

“Stop that crying, young lady, or I’ll give you something to cry about!”  Most of us heard something similar growing up.  Certainly, there is a time and a place for tears.  However, what most of our parents, teachers, or coaches did not understand was how complex and profound crying can be.  The neurophysiology of crying is far more intricate than most of us realize.

Crying, to oversimplify greatly, involves the autonomic nervous system, the frontal and prefrontal cortices, the brainstem, hypothalamus, basal ganglia, amygdalae, vagus and trigeminal nerves, heart, lungs, facial muscles, larynx, pharynx, eyes, nose, and throat — as well as a host of neurotransmitters.  Anthropologists believe that, in humans, crying developed long before speech.  As tears begin to flow, we become choked up and speechless.  This may explain why crying reveals emotional states that are nearly impossible to express in words.

Clearly, tears can be shed in response to pain and physical distress, as well as to fear and anger.  All mammals experience fear largely as the result of having a limbic system.  Given certain circumstances, most mammals can express anger.  Grief, mourning, and bereavement can move people to tears at any age and in every culture.  Some animals such as dogs, elephants, and primates can manifest behaviors suggestive of loss or grief, but these animals’ ability to shed tears in response to grief has not been scientifically verified.  Grief and mourning have a cognitive component.

Human beings are social creatures.  Barring neurologic anomalies, humans can cry from the moment of birth onward.  The tears, vocalizations, and facial expressions of crying signal a universal plea for help and empathy.  Tears elicit a change in the mindset and behavior of the person who cries and in those who witness the crying.  It’s not rare for someone to “feel better” after a “good cry.”

The ability of humans to feel empathy and compassion for others has had a profound effect on culture and civilization.  Without these emotions, there would be no such thing as hospitals, orphanages, disaster relief, or volunteers of any sort.  The capacity for compassion is not present to the same extent in everyone.  Some individuals have no empathy or compassion at all.  Others are veritable saints.  The next time you feel moved to tears, don’t fight it.  It may just mean your humanity is still intact.


Trimble, Michael, Why Humans Like to Cry, Tragedy, Evolution, and the Brian.  Oxford, UK, University Press, 2012.

To Our Friends And Colleagues In Texas

Posted on Posted in Elder Care, Psychology
credit CNN

How do you cope with a year’s worth of rain in a few hours? It’s like anything else in life: Until you’ve been through it yourself, you don’t know. Some of us scattered across the country have vivid memories of Superstorm Sandy or hurricanes like Andrew, Hugo, or Katrina. I remember all too well what Hurricane Floyd, in the late 1990’s, did to my house in coastal North Carolina. Water poured into my kitchen and living room, ruining my furniture and morale. I was on call at the time. At one point, all I could do was cry. That was a result of 22 inches of rain in 24 hours. How anyone copes with 50 inches of rain is beyond my comprehension.

The days, weeks, and months ahead of you will be brutal. At some point, nearly everyone will feel overwhelmed with exhaustion, anguish, anger, and frustration. Many of you will wear yourselves out while helping others. That’s what good people do in a crisis.

Throughout the U.S. and Canada, there are many good people who frequent INR (Institute for Natural Resources) and Biomed seminars. Perhaps it will give you a miniscule measure of comfort to know that you are in our thoughts and hearts and prayers. Across the country, the number of people in schools, businesses, religious groups, and civic organizations contributing to relief efforts is growing. One day all of this will be behind you. Until then, may you all be blessed with the safety of your loved ones, compassion for one another, and Texas-sized resolve.

Random Acts Of Coolness

Posted on Posted in Continuing Education, Homestudy, Psychology, Seminars, Webinars

by Mary O’Brien, M.D.

I live in Myrtle Beach, South Carolina.  In the dead of winter, I’m grateful for that.  Right now (during mid-summer), however, it’s the dead of “awful.”  The temperature has been in the mid to high nineties for several weeks, and I suspect there may be lower humidity in a steam shower.  For that added touch, traffic is terrible.  Tourists are tripping over one another, and everyone is cranky.  I’ve thought about moving to Alaska.

Yesterday, on the way home from the grocery store, I drove by a utility crew digging a huge ditch.  For a split second, I caught the glance of a very large, burly man crawling out of a hole.  He was covered with dirt and sweat.  I thought he was about to collapse.  In a heartbeat, the “do something” physician-part of me began to debate with the shy, introverted, aging woman part of me:

“This man is on the verge of heat exhaustion.  I should stop and offer help.  But with what?   A trunk full of cereal, paper towels, and cat food?  It’s really none of my business.  This is their job.  Besides, it’s probably not safe to pull over. Blah, blah, blah…”  Perhaps you know the routine.  I can debate myself for hours.

A mile down the road, I turned into my driveway — still conflicted.  Then it dawned on me. “I am an idiot.  This is not a difficult decision.”  I dumped my groceries in the kitchen and grabbed what I could from the fridge:  bottles of water; Coke; lemonade; and Hawaiian Punch.  I know, I know — I have the taste buds of a ten-year old.  Then, I raided my stash of ice cream bars from the freezer and headed back out.  As I pulled up to the work site and got out, the crew looked baffled.  I suspect the crew thought some fussy woman was about to start complaining about the mess or the congestion.  It happens.

I explained I had driven by ten minutes earlier and was worried about them.  When I pulled out the cold drinks and ice cream bars, their jaws dropped.  They still looked as if they were about to fall over, but this time it was from shock.  By the way, I’m not the only one with the taste buds of a ten-year old.

If you’re ever in a similar situation and you feel conflicted, choose the “random act of coolness.”  You’ll feel better about everything all day long.

Anxiety

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Barbara Sternberg, Ph.D.

A basic human emotion, anxiety is the sensation of worry, fear, apprehension, panic, tension, or unease that occurs in response to situations that seem overwhelming, dangerous, threatening, or distressing.  Manifesting in such forms as worry prior to a major test, nervous anticipation of a social occasion or business event, or heightened alertness in the face of apparent peril, anxiety is an intuitive recognition that action of some kind should be taken.

Anxiety that prompts appropriate action is a normal, adaptive response to temporary stress or uncertainty.  Detrimental anxiety overwhelms the individual experiencing it, preventing appropriate action or producing counterproductive responses.  Prolonged, intense, or inappropriate worry that interferes with normal function or that is a source of significant emotional or physical distress may signal the presence of an anxiety disorder.  Free-floating anxiety that occurs in the absence of an external threat and is pronounced enough to impair daily function may also be symptomatic of an anxiety disorder.

An estimated 40 million Americans over 18 years of age — about 18 percent of the adult population of the United States — experience anxiety disorders.  In contrast to relatively mild transient anxiety induced by a stressful event like public speaking or a first date, anxiety disorders persist for six months or longer and can worsen without treatment (NIMH). According to the National Comorbidity Survey Replication, overall lifetime prevalence of anxiety disorders in the U.S. is 28.8 percent, meaning that more than one out of every four adults experiences at least one anxiety disorder during his or her lifetime. Anxiety disorders are approximately twice as common in women as in men. Most people who are affected by anxiety disorder have more than one, and nearly 75 percent of those who have an anxiety disorder experience their first episode by the time they reach 21.5 years of age.

Although anxiety disorders are highly treatable, only about one third of those with these disorders receive treatment.

Coping with Anxiety

Although evidence indicates that early treatment of anxiety disorders can prevent such complications as depression and severe phobic avoidance, only about one victim in four ever seeks medical help. Recommended self-help strategies for anxiety management include:

  • maintaining perspective.
  • being informed.
  • having a positive outlook.
  • building resilience.
  • creating a social network.
  • seeking help when necessary.

When personal anxiety management proves ineffective, a family physician can help determine if symptoms are caused by an anxiety disorder, another medical condition, or combined factors.  Coexisting medical conditions may have to be treated or brought under control before the anxiety disorder can be addressed, by a psychologist, psychiatrist, social worker, or counselor. Some people with anxiety disorders must try several treatments or combinations of treatments before finding one that relieves their distress.  Medications do not cure anxiety disorders, but antidepressants, anti-anxiety drugs, and beta-blockers may control some physical symptoms while the patient receives psychotherapy.

Little Charlie

Posted on Posted in Brain Science, Continuing Education, Pain, Psychology

By Mary O’Brien, M.D.

Do you know what “Mitochondrial Deficiency Syndrome” is?  Most people don’t.  Unfortunately, that doesn’t stop them from weighing in on the case of little Charlie Gard.  Charlie is an 11-month old baby with a rare and devastating genetic disorder that precludes normal functioning of mitochondria.  Mitochondria are intracellular organelles that generate ATP (adenosine triphosphate).  In essence, ATP represents energy at the cellular level.  Without ATP, cells, especially brain and muscle cells, cannot function.  The most sensitive and vulnerable cells in the body are those of the cerebral cortex.  Little Charlie cannot see or hear or move or swallow or vocalize or think.  No one can know with absolute certainty, but he probably cannot “feel” anything at this point.  The word tragic is utterly inadequate.

The global media frenzy surrounding this heartbreaking situation is revealing and deeply disturbing.  Controversy sells, and unfortunately, the less people know, the more adamant and emotional they often become.  Those of us who have dealt with life and death situations for decades can help by elevating the level of conversation.  Some timeless principles are useful:

  • Embrace humility.  Never be afraid to say “I don’t know enough about this situation to have a well-informed opinion.” That would be refreshing.
  • Exercise the intellectual discipline to learn the facts involved.  In medicine, every patient is unique.  Arguments for or against life support or experimental treatments are pointless absent actual knowledge.
  • Resist the temptation to become emotional.  Unbridled emotions cause far more problems than they solve.  Try to be the voice of reason.
  • Try not to confuse or conflate the issues.  People in nearly every media outlet have tried to make the case about socialized medicine, cost control, parental rights, the British court system, the European Union, or theology.  The case of Charles Gard is about medical ethics.
  • Focus on principles, not personalities.  There is a colossal difference between saving life and prolonging death.  Remember, there is never a moral imperative to render futile care.

Primum non nocere.  (First, do no harm.)  There’s a reason that Solomon prayed for wisdom.

Photo Source

Minimizing Summertime Maladies

Posted on Posted in Continuing Education, Homestudy, Psychology, Webinars

By Mary O’Brien, M.D.

Triple-digit temperatures.  Devastating storms.  Disease-carrying insects.  Rip currents.  Shark attacks.  Jelly fish stings.  Fireworks accidents.  Food poisoning.

This list of problems only scratches the surface of serious summertime challenges.  But an ounce of prevention really is worth a pound of cure.  With that in mind, let’s consider some tips for minimizing summertime maladies:

  • Never leave an infant, child, adult, or pet in an unattended car.  Temperatures can soar past 120 F within minutes, even with the windows cracked.  Within 20 minutes, temperatures can exceed 140 F.  Every summer, mere carelessness leads to terrible tragedies. Please educate the people around you.
  • If a storm is close enough for you to hear thunder, it is close enough for you to be struck by lightning. Get inside a car or building.  Do not seek shelter under a tree that could turn you into a veritable lightning rod.
  • Most hurricane-related deaths occur as a result of drowning. People who are out and about can face dangerous flash floods.  Never attempt to drive through standing water.  It takes only six inches of water to move a vehicle.  Unless you are a first responder, please stay put in the immediate aftermath of a severe storm.
  • These days, mosquitoes are more than a nuisance. The West Nile virus is already active in many states and the Zika virus remains a threat to pregnant women in particular.  Eliminating standing water such as bird baths, planters, or backed up gutters where mosquitoes can breed can help.  Avoiding outside activity at dawn and dusk when mosquitoes are out in full force would also help.  Spraying protocols and insect zappers or traps may be worthwhile.
  • Be prudent at the beach. Warnings about rip currents, sharks, jellyfish, contaminants, or other dangers are not issued to ruin everyone’s fun.  Every summer, needless tragedies occur because people do foolish things.  Be the voice of reason for younger people around you.
  • Drink alcohol sparingly, if at all.  The vast majority of fatal boating accidents involve alcohol.  Even on shore, alcohol and high temperatures can be a disastrous combination.
  • Let professionals handle the fireworks. No one ever imagines they could be horribly burned or blinded by an accident with a firecracker.  Sadly, that is not rare.
  • Keep any meats or side dishes made with mayonnaise at proper temperatures — hot or cold. Food poisoning can have consequences far beyond an upset stomach.  When in doubt, throw it out.

Summertime is supposed to be fun.  With a little prudence and common sense, it can be precisely that.

Obsessive-Compulsive Disorder

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Barbara Sternberg, Ph.D.

Occurring in men and women with comparable frequency, obsessive-compulsive disorder (OCD) affects about 2.2 million Americans 18 years or age and older — one percent of the adult population of the United States.  Initial symptoms usually manifest themselves in childhood, adolescence, or early adulthood, and median symptom onset is 19 years of age.  One third of adults with OCD experience their first symptoms as children.

 OCD is characterized by repetitive, intrusive, unwanted, and disturbing thoughts known as obsessions and by the performance of rituals known as compulsions — in an urgent attempt to control the anxiety that the obsessions generate.

Fear of social embarrassment, for example, could prompt someone with OCD to comb his or her hair so compulsively that the individual becomes unable to look away from the mirror.  Thoughts of engaging in violence, bringing harm to loved ones, and having a persistent preoccupation with performing distasteful sexual acts or violating one’s religious beliefs are common obsessions.  Common rituals include repeated hand-washing, counting, or touching objects (especially in a particular sequence).

People who have OCD may be preoccupied with order and symmetry, have trouble discarding things, and accumulate or hoard things they don’t need.  Healthy people perform such rituals as repeatedly making sure the stove is off before leaving the house.  People with OCD perform rituals that distress them, interfere with daily life, and provide no more than a temporary respite from their obsession-induced anxiety.  Most people who have OCD are eventually enslaved by their own compulsions. 

Research indicates that OCD may be a familial disorder.  Many adults who have OCD recognize the futility of their actions, but children and some adults who have OCD are unaware that their behavior is unusual.  The course of OCD can vary.  Symptoms may emerge and disappear, ease or intensify, or prevent the individual from carrying out his or her responsibilities.  Many people with OCD try to control their disorder by avoiding circumstances that trigger their obsessions or by self-medicating with alcohol or drugs.