2016

 

We turn over the calendar with hopes and dreams of turning over into a new and better self. We promise to exercise and eat better, pay more attention to our friends and family, and we hope to work either more or less, depending on our self-perception of the role that work should play in our lives. Inevitably, by mid-January, old habits return and the glow of new year’s resolutions dim. This return to ourselves, the part of ourselves which we find troublesome, or self-sabotaging, is so disturbing and yet so predictable because fundamental change requires a fundamental overhaul of the psyche. Hoping that a change in the calendar will somehow undo the bad habits that we have accumulated over decades is naïve, at best, and misguided, at worst. We can’t tell our addict loved ones to stop using drugs, nor can we tell our obese loved ones to eat less, since they both already know this. On the other hand, we can be sympathetic to how hard change is, any change for that matter. Most of us bumble along by inertia, doing what we did yesterday, not creating a lot of surprising behaviors. That is because habits are hard to break, even bad habits, because the familiarity of the habit may override the desire to stop it. The hope for a new beginning is endless. Each new week, each new month, and each new year can give us the notion that things can be different, because, after all, the calendar changed. Can we use the calendar change to cause internal change? Sure, but the effort is monumental, and without being braced for the intensity of change, relapse is bound to happen. We are creatures of habit, and with age, habits are more deeply entrenched. So we return to the importance of childhood, the importance of setting up good habits, both in terms of behaviors like diet and exercise, but also in terms of expectations for a relationship, the expectation of giving and taking and treating others with respect. The sooner we can lay down these neural pathways, the better each individual, and hence society will be. There is a critical period for the developing brain to learn how to take care of himself. As a society, nothing is more important than respecting that. Happy 2016! May all your wishes come true, with the associated effort required, of course.

Can Depression Be Taught?

Depression Class: check! I just had a wonderful and stimulating time teaching depression at the psychoanalytic institute and yet I am left feeling that this is a class which should not be taught. The word is simply meaningless. Psychic pain is my replacement. Pain is a symptom. Depression is a diagnosis. We need to be clear about the distinction. Symptoms trigger deep inquiry into the origin, the pathophysiology and the underlying issue. A diagnosis closes the discussion, as if there is nothing more to be said. “He is depressed,” the physician says, as if the next step is clear, when in fact, so much more needs to be done to investigate what that means. So, maybe I do need to teach this class to convey this point of view, spread the word, as they say. Yet, I am left feeling part of the problem and not part of the solution. I will lobby to rename this class “Psychic Pain” because this gets at the issue of how people suffer, and as with all of psychiatry, there are more differences than similarities between patients, making this the most interesting field in medicine from my point of view. Pattern recognition, the job of a good internist, to determine how symptoms present the clue to disease processes, gets old and routine, whereas the individuality of psychiatry, the unique stories of the patient, create an atmosphere of intense curiosity and openness to new perspectives. Looking at suffering as the end-product of years of life experience helps the patient understand how the past influences the present. It is not that the patient is “depressed,” but rather that the patient has hit a time in his life, both because of current and historical issues, along with their biology, making the patient lose the joy, the happiness, the fulfillment, in his life. There are contributing factors, but never a “good explanation” for why the patient is suffering. The quest of understanding is infinite and hence digging into suffering is a deep and moving experience. “Thank you for making me think about something I did not want to think about,” my patient expressed today, causing me to laugh and feel her gratitude, at the same time. That is what I want to teach. The way in which suffering has a language, which, when shared, creates an intimacy, a healing feeling, which cannot be quantified or predicted, and yet, is very meaningful when it happens. Psychic pain, that is what I am going to propose. That sounds right.

UCLA Medical Alumni Highlights Yours Truly

 

 

 

 

https://alumni.ucla.edu/email/maa/2015/bruin-md/summer/default.htm