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.

A Real Hero to Honor

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

By Mary O’Brien, M.D.

Gary Michael Rose is a devoted 69-year-old husband, father, and grandfather.  Many people in Huntsville, Alabama, know him from his commitment to multiple volunteer projects.  For decades he has served as a Knight of Columbus, helped at a soup kitchen, and repaired broken appliances for the sick and elderly.  That’s only a partial list.

Only a handful of people knew that Gary Michael Rose was a war hero of the highest caliber because for 40 years he never said one word about it.  Not one word.  On October 23, 2017, Captain Rose received the Congressional Medal of Honor.  Now the whole world has a real hero to emulate and honor.

“Mike,” as people call him, trained as a Special Forces medic during the Vietnam War.  His second assignment involved a top secret mission into Laos to stem the flow of weapons to enemy fighters.  It wasn’t long before all hell broke loose.

The men in Mike’s unit sustained heavy casualties.  Desperate to save them, Mike raced into small-weapons and machine-gun fire, tending to the wounded as he shielded them with his own body.  One by one, Mike used one hand to hoist a wounded soldier over his back and held a gun in his other hand to return enemy fire.

Eventually, Mike sustained multiple wounds himself, but that didn’t deter him. When a chopper finally arrived to evacuate the wounded, it was unable to land and was forced to hover above the ground.  Mike lifted and pushed his wounded buddies into the helicopter in the midst of gunfire.  As the chopper began to lift up, the gunner was struck in the neck by a bullet.  Mike fashioned a pressure dressing with several bandanas to contain the bleeding.  But the helicopter was badly damaged and crash- landed.  In an unbelievable display of courage and fortitude, Mike raced in and out of the smoldering chopper to save the wounded before everything exploded.

After four days and nights of constant combat, no food or sleep, and nonstop efforts to save others despite his own injuries, Mike and his men were evacuated.  The Army believed that Captain Gary Michael Rose saved between 60 to 70 men, including the man who was shot in the neck.

All of this happened in 1970.  Mike never discussed it with anyone because the mission was classified.  His men talked about it though — through channels at the Pentagon.  For 47 years his men campaigned to get Mike the medal he deserved.  Mike finally received his medal, and many of men witnessed the ceremony at the White House.

If someone had written a screenplay detailing the heroism of Gary Michael Rose in combat, it would have been rejected as “unrealistic.”  Fortunately for the world, Captain Rose is very realistic.  After a ceremony at the Pentagon, he’s going home to Alabama with his family.  He still has people to help.

 

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.

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.

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.

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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.