A Different Tradition

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

By Mary O’Brien, M.D.

Has your home returned to a relative state of post-holiday normality?  I’m almost there.  The boxes and bags and bows and ribbons have been put away until next year.  The “thank you” notes are in the mail.  And my kitchen table has been restored to an acceptable state of neatness.

Many people will start to focus on new year’s resolutions now, knowing full well the resolutions are unlikely to last.  I have a different tradition at the end of December.  It goes back quite a few years.  In a reflective state of blissful solitude, I write down my own little “year in review.”  It takes some time, thought, and effort, but it’s an exercise that can generate some profound insights.

  • What were the best or most positive events of 2017 — personally, nationally, and globally?
  • What were the worst or most tragic events of 2017 — personally, nationally, and globally? How did I cope or respond?
  • What event or situation made me feel most grateful?
  • What was the most beautiful, unusual, or remarkable sight I saw in 2017? (Personally, it would be difficult to top the perfect, unobstructed view of the total solar eclipse I had from my own backyard in August 2017.)
  • What was the biggest mistake I made in 2017? This one can be tough and sobering.
  • What was the most important lesson I learned in 2017? It’s often related to the biggest mistake I made.
  • What experience or moment touched me the most deeply?
  • What was the most noble, courageous, or generous thing I did in the past year? Coming up short on this one is not a good sign.
  • And finally, what could I do in 2018 to become a better person — physically, mentally, emotionally, and spiritually?

The little, personal “year in review” may not be as fascinating as a list of the year’s top news stories, viral videos, or celebrities who have passed.  It will, however, become profoundly revealing to you 10 or 20 years from now.

Have a happy new year.

 

Something Feels Different

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

By Mary O’Brien, M.D.

Are we there yet? I wonder as I stare at my kitchen table covered with gift bags, wrapping paper, bows, ribbon, tape, and scissors. Every year, I tell myself I’ll cut back a bit next year. It never happens. The pressure starts with Christmas-in-July sales on shopping channels. I confess I find it difficult to resist. I love buying and wrapping presents for people. It truly makes me happy, especially when someone is genuinely surprised and delighted. It’s a constructive way to take the focus off myself.

This year however, something feels different. It’s been a tough year with historic, natural disasters. Devastating hurricanes, floods, tornadoes, earthquakes, wildfires, and blizzards have wreaked havoc on tens of millions of people. Mass shootings, riots, and appalling, vicious acts of violence have left most of us stunned and horrified. My heart breaks for all of those who have lost loved ones and homes. How I wish I could ease their anguish.

I cannot restore lost loved ones, homes, and treasured possessions for people in California, Texas, Florida, and Puerto Rico. I can write a few checks and say a few prayers. Those are good things to do, but they never seem to be enough.

Then it dawned on me. There are lots of people suffering all around us every day. They just don’t appear on the evening news. Here, in Myrtle Beach, South Carolina, there are nearly 2,500 homeless teenagers. That seems ironic in a town that’s largely focused on tourism and fun. I decided to give some money to my almost-adult niece and nephew. I gave them instructions to go buy clothes for homeless teenagers. I have no clue what teenagers would want or need, but my niece and nephew do, and they did well. Unloading their bags full of jackets, hoodies, sweaters, socks, underwear, scarves, and hats, they announced they “had a blast” doing it. Surprise! Thinking of other people can be fun.

My kitchen table is still a mess. But this year, I realize how blessed I am to have a kitchen, messy table and all.

 

Let It Go!

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

By Mary O’Brien, M.D.

Did you survive Thanksgiving without major family stress or tension? If the answer is “no,” you’re not alone. Holiday gatherings don’t always bring out the best in everyone. Some folks are already frazzled by travel nightmares. Those hosting the feast are tense and worn down by days of planning, preparation, and cooking. No one ever has quite enough room in her kitchen for all the food, much less the guests who congregate in the middle of the mess. There’s nearly always one culinary mishap and someone is sure to announce she has a life-threatening allergy to gravy.

But wait! We haven’t even begun to address deeply ingrained differences in political perspectives, religious beliefs, and good, old-fashioned feuds and grudges. Was all of this supposed to be fun? Fortunately or not, many of us will have another crack at family festivity soon as we try to celebrate Christmas or Hanukkah. I have a few time-tested thoughts that might help—at least a bit.

  • Psychologists tell us that it takes 21 days to replace a bad habit with a good one. That means we have just enough time to make a difference. Starting now, try not to criticize, condemn, or complain. It’s not easy, especially in this culture. However, it will make the next family gathering much easier to endure, if not actually enjoy.
  • Remember some basic neurophysiology. The human brain cannot hold onto diametrically opposed emotions simultaneously. We can’t feel love and hatred at the same time. We can’t feel empathy and anger in the same moment. And we can’t experience gratitude and resentment all at once. It may sound simplistic, but gratitude is often the best remedy for resentment, anger, anxiety, and sadness. Those of us who have food, water, shelter, clothes, electricity, a little money, and a few loved ones have more than hundreds of millions of people around the world. Smile and say “thank you” — a lot.
  • Forgive yourself and everyone else. I’ve watched relatives feud for decades. They make themselves and everyone else miserable. None of us is perfect. We’ve all said and done things that were misguided or thoughtless. However, refusing to forgive is like drinking poison. It makes no sense. Forgiveness represents the ultimate act of overcoming ego. Let it go. LET IT GO!

Please don’t make me sing that song from “Frozen.” I have relatives who would never forgive me.

 

When Something’s Not Right

Posted on Posted in Brain Science, Psychology, Seminars, Webinars
(AP Photo/Laura Skelding)

By Mary O’Brien, M.D.

“Anyone who believes in God is stupid.”  This statement was among many posted by the monster who murdered 26 innocent people in November 2017 in a Texas church.  The victims ranged in age from 18 months to 77 years old.  Eight members of one family were killed, 20 people were wounded. No one had a chance to hide or escape.

The man who committed this atrocity had been seething with anger and brutality for years.  There were many red flags.  He had received a dishonorable discharge from the Air Force and served time for assaulting his wife and child.  His attack was so brutal, the baby suffered a skull fracture.  He was known to have beaten and starved his dog. Any man capable of beating a woman, a baby, and a dog does not turn into a decent human being after 12 months in prison.  The many pieces of this puzzle are already coming together.

In the realm of religious thought and theology, anger is considered one of the seven deadly sins.  Unjust anger, if allowed to smolder, can lead anyone down a vicious path of destruction.

In the realm of clinical medicine, anger and hostility are considered the two most deadly and dangerous emotions.  Those of us in health care encounter angry, hostile people almost every day.  In fact, all of us encounter angry, hostile people with increasing frequency.  Anger triggers a flood of potent hormones and neurotransmitters that can literally change brain function and even brain structure if the process lasts long enough.

However, pathologic anger, violence, and evil do not exist in a vacuum.  There are always warning signs.  All too often they go unnoticed or unreported.  Most of us have been well-schooled to “mind our own business.” After all, we don’t want to be called judgmental, and we certainly don’t want to be sued.  But considering the horrific happenings in Columbine, Aurora, Sandy Hook, Fort Hood, San Bernardino, Orlando, Las Vegas, and New York, it’s time to rethink a few things.

Folks in law enforcement have been begging us for years: “If you see something, say something.” That advice sounds painfully simple, but simple things often save lives. Most of us know when something’s not right. We need to trust our instincts.

The good people of Sutherland, Texas, trusted their instincts hours after the massacre.  In response to unfathomable evil and anger, they held a candlelight prayer vigil.  That doesn’t sound “stupid” to me.

Why Mindfulness Matters?

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

By Mary O’Brien, M.D.

Will you exit the same way you entered?

Making that assumption is human nature.  Tragically, as people in London, Manchester, Brussels, and Berlin have witnessed, ordinary assumptions can be deadly.

Survival requires alertness.  It always has.  It always will.  There has never been a shortage of danger in the world.  The nature and complexity of threats have evolved over the millennia, but certain principles of survival endure.  Being mindful of your surroundings is one important principle.

Mindfulness is not new.  Nor is it merely a pleasant pastime. “Being in the moment” is a good way to slow down, enjoy a meal, or notice a full moon.  It may, with practice, help reduce blood pressure and stress.  That’s nice.  However, in an age when deranged fanatics and terrorists can wreak massive devastation in minutes, mindfulness can save lives.

An off-duty police officer is still a police officer.  The same is true for health-care professionals.  The next time you’re out in public, be it in a classroom, a café, or a concert hall, practice some mindfulness that really matters:

  • Be alert, be vigilant — pay attention to people and things around you — not your devices.  Do not “zone out.”
  • Scan the area for possible exits.  It is human nature to leave a place the same way you entered.  This can be a fatal mistake in a fire, a terrorist attack, or any catastrophe.
  • Resist the temptation to follow the crowd.  Panic-stricken people can be exceedingly dangerous.  Be mindful of alternate options for escape.  Being trampled to death is not a good option.
  • Cultivate enough silence in your daily life to foster good instincts and intuition.  When seconds matter, this can save lives.

The principles of mindfulness have been practiced and promoted by some very wise people over the centuries.  It is curious that a step on the path to enlightenment may be the most crucial survival skill of all.

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.

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.

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.

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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.