“REMEMBERANCE OF THINGS PAST” ... AND HONORING THE PRESENT!

No matter what political party we support, and no matter what our position may be on the wars being fought by our young men and women in the service today or in the past, I think it’s a sad statement of our times that we take such insufficient care of those who return home severely injured physically or mentally. The monetary compensation awarded to them and to their families as well as the medical care given them is often all too little and all too inadequate. For those who have lost their lives fighting in the name of democracy and in defense of our nation, even the traditional observance of this one day of the year, Memorial Day, is no longer what it once was. And I do feel it’s regrettable that for so many it has become just another long weekend (originally it was just this one day, May 30th) to take advantage of sales and to barbeque, with little, if any attention paid to those who died in too many wars fighting for our country.

Some of you may not even know the history of Memorial Day. Perhaps you’re too young to remember the pomp and ceremony afforded it years ago. Perhaps you’ve never read about it in your history classes.

Yet, I can recall being taught – from the earliest days of attending elementary school – that Memorial Day was originally called Decoration Day in memory of all the southern women who decorated the graves of soldiers killed in battle even before the Civil War ended. In fact, when I was a child Memorial Day and Decoration Day were referred to interchangeably.

There are still cities which host yearly parades. Politicians and family members are afforded the opportunity to speak, thereby remembering and honoring their loved ones. However, it is also true that there are many today who have either forgotten or never actually knew the meaning of this day. I’ve read that several even believe that the day is for honoring all who are dead and not just those who have died in battle.
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When I was growing up in the 1940s and 50s (at least in the 5 boroughs of New York) there was a yearly assembly program which the entire student body of every public school was required to attend. We would stand, sing the national anthem, and then lower our heads respectfully – as we were told we must – to honor all who had died fighting for our democracy, the greatest nation on earth, the United States of America.

It was a meaningful though somber and dramatic day.

For me, though, it was a day in which I wasn't able to truly celebrate my birthday. Just as today is officially Memorial Day, it is also my birthday ... and, though I know myself to be a patriotic American, I also remember a childhood deprived of experiencing the joy one likes to associate with happy occasions.

In fact, had this day fallen on any other day than the day of my birthday, I undoubtedly would have appreciated it with the appropriateness it deserved. But, because my mother was sick so often – suffering as she did from bouts of severe depression – she was unable to host parties for me, and the best I could hope for was to celebrate with my friends in school. Yet, even there, in the one place where I so longed to experience happiness outside our “four rooms,” the one place where I sought safety and solace as a child, even there my birthday was diminished by a gray cloud of national mourning.

I stood - as everyone else did - and participated in the school assembly, wearing the birthday corsage my friends had made for me. As was the custom then, we girls made one another corsages every year. Each was intertwined with pretty ribbons and pinned to the shoulder of the birthday girl’s dress. When I was ten, my corsage was made of lollipops. Other years it was gum drops, tootsie rolls, bubble gum, life savers, and sugar cubes – always sugar cubes – for one’s Sweet Sixteen. So, yes, the good news is that I did have my corsages and I did have my friends. But, instead of being able to feel carefree and able to smile and laugh, I wore the face of sorrow as I honored the dead.

I am not sharing this so to evoke any degree of pity. I’m writing this to reassure anyone who grew up in a family such as mine - where chaos and confusion were the norm - that it is natural to seek comfort outside one’s family.

Those fortunate enough to live in healthier families where children are celebrated daily and where there is time and energy for fun and laughter would probably not have felt as deprived as I did or as conflicted about having to share Memorial Day with anyone, let alone people whom I did not know, and who were, furthermore, dead. Illness and the possible loss of my mother was an ever present and frightening threat hovering over me during the day when I was awake and in the nightmares of my sleep. It was a threat of which I did not need to be reminded, especially on my birthday.

Today, however, as I am being feted by family and am most grateful to my daughter Keren who is hosting the festivities and my daughter Mia who has kept me laughing throughout the days leading up to today, I am more than able and very proud to share my birthday with all those families who unfortunately are recalling those whom they have lost in war.

My hope is that we who continue to advocate for mental health will live to see a time when services are readily available to those suffering the wounds – physical or mental – of war, as well as those born with predispositions for mental illness. All of us (children, in particular) deserve to feel cared for. All of us deserve to feel safe and have the capacity to be spontaneous and to enjoy all that there is to enjoy in simply being alive.

I need to have that as my goal, just as I need to advocate for my patients when I feel they need me to do so. I’ve been where so many of them are, and I’m here to say the road traveled hasn’t always been easy. Yet, I’ve fought hard at every turn to interrupt the cycle of dysfunction, to offer unconditional love – as imperfect as I am and as incomplete as it may be – in the hope that my mother’s suffering will never be experienced by the generations that follow mine. And I encourage others, like myself, to find ways to do the same.

Today then is, as it should be, an official day of remembrance, a day we call Memorial Day. It is also happens to be my birthday and the birthday of all who were born on May 30th.

We all deserve to be remembered and honored, and our fallen soldiers deserve no less.

So, with thoughts of all those who are remembering loved ones, I also send birthday wishes to those who share this day as their birthday. May you celebrate in whatever way gives you the most pleasure and may the year ahead be filled with good health and much love.

Yours,
Linda

A GLOBAL CRISIS AFFECTING BOTH PATIENTS and HEALTH CARE PROVIDERS: THE RISK OF HEALTH-CARE ASSOCIATED INFECTIONS

Individual physicians and the medical staff at hospitals help save lives every day. In any community, in every state, people of every age who are sick (from newborns to the elderly) rely on hospitals to be places where they will be cared for, their illnesses treated and their pain relieved.

Fortunately, that IS exactly what happens ... for those who are lucky.

But, according to the World Health Organization (WHO), “at any point in time, 1.4 million people worldwide suffer from infections acquired in hospitals ... and the risk of acquiring health-associated infections in developing countries is 2-20 times higher than in developed countries.” As its initials imply, HAI refers to any acquired infection developed in a hospital or health care facility.

These are staggering statistics which affect staggering numbers of people! Therefore, when I was recently contacted by Barbara Dunn at www.haiwatchnews.com asking if I would help inform my readers about how they could learn more about HAI (Health Associated Infections), I agreed without a moment's hesitation. I felt compelled to do so, especially after logging onto NOT ON MY WATCH at www.haiwatch.com, which educates both patients and health care professionals about ways to eliminate preventable illnesses and their often tragic consequences. I urge you to do the same, for among the many things you will learn is that: “Afflicting thousands of patients every year, HAI often leads to lengthening hospitalization, increasing the likelihood of readmission, and adding sizably to the cost of health care per patient.” Then, too, you will learn that the most common problem with the highest morbidity and mortality of all Healthcare Associated Infections is Ventilator-Associated Pneumonia (VAP), Surgical Site Infections (SSIs), and Cross Contamination (Contact Transfer) to name but a few.

Lest you think that I am simply attempting to champion a cause which, in any case, deserves attention, I will tell you that Barbara Dunn’s finding my blog on the web and asking me to help spread the word is more meaningful than she could have ever guessed, for she would have no way of knowing that I was a victim of one such hospital induced infection. The surgery for which I entered the hospital some years ago went very well. I healed from it in record time. But, I was one of the unlucky patients affected and infected by Clostridium Difficile, more commonly referred to today as the C-Diff bacterial infection. It took my body an entire year to recover from its debilitating symptoms and their intrusion upon my daily life. Since I have first-hand knowledge about this very real problem, I wish to spare anyone from suffering unnecessarily!

The good news according to HAI-Watch is that “growing public anxiety regarding the issue and resulting in legislation on state and local levels demanding accountability, is serving to accelerate initiatives to combat HAI’s."

However, the only way to protect patients from such risks is also to educate the medical community. That is precisely what NOT ON MY WATCH is attempting to do, and the way in which they’re doing it seems to make a lot of sense. They provide facilities with a toolkit that contains information, flyers, patient safety tips and posters.

The NOT ON MY WATCH campaign provides information and understands all too well that "busy doctors and nurses on the front lines of delivering care can find it difficult to find the time to take advantage of scheduled programs within their hospitals.” That is why – in their commitment to quality care and infection prevention - nationwide doctors and hospitals are partnering with Kimberly-Clark to provide educational programs to staff and management. Accredited (CE) programs based on best practices and guidelines as well as research on reducing the incidence of healthcare-associated infections are provided and up-dated as often as possible.

The HAI education bus seen above is a mobile classroom that brings accredited CE Education right to your door. They encourage everyone – as I do – to look for this tour bus, “as it makes its way across the country, delivering education about healthcare-associated infections and other critical healthcare issues from the Plains of Texas to the California coast to New York City and places in between." Also, remember that just by logging onto www.haiwatch.com you will be able to follow information regarding how to keep yourself best informed about any/all health associated infections.

Educated consumers – especially where health is concerned – can only lead to a healthier nation. Become a part of those who continue to press for more research and who spread the word about the need for PREVENTION.

Support those who advocate for us, do the research and provide the education necessary to help us all!

Yours,
Linda

WE ARE MORE THAN JUST OUR ACHING PARTS!

By the time one reaches middle age and beyond, it’s not unusual to need the services of a variety of physicians with numerous specialties, each of whose name and phone number take up a page or more in one’s phone book. At least, that’s true for me and most of my peers.

It’s also true that both medicine and the roles of physicians are drastically different from when I was a child in the 1940s and 50s.  In many respects, the changes have been for the better, certainly with regard to all the high tech advances.

However, where once a family doctor made house calls (for which, I might add, there was never an extra fee), today most doctors are so burdened they seldom have enough time to spend with their patients, many of whom are kept waiting long past their scheduled appointment time. Private practitioners are also deciding to join large group practices in order to get coverage for their patients and to stay financially solvent themselves.

That being said, doctors have been rigorously trained to diagnose and to treat not just a disease or injured anatomical part, but also to do no harm to a patient. And, since by definition, a patient is someone who is already vulnerable and compromised, common sense tells us that it’s the physician’s obligation to treat the whole person, to take into consideration a patient’s probable fears and concerns, while at the same time evaluating the presenting problem and determining the best course of action.

In general, I consider myself to be fortunate. The physicians I’ve chosen for myself are all exemplary: intelligent, respectful, thoughtful, caring people who have given me every reason to trust their expertise as well as their concern for my well-being.

I can’t say that I haven’t bumped into a few whose offices I wished I had never entered, but that’s true in any profession. Not everyone is talented. Not everyone is caring.  But, I can also tell you that throughout the years I've been in practice, my patients have often talked about doctors whose manners were so insulting and whose care so questionable, that I've had to spend their session time helping them to feel empowered, to know that they had a right to be their own advocates, and to believe that they never had to suffer from anyone’s emotional abuse - doctors included.

This brings me to why I am writing this particular blog this particular week.  Some say that we teach what we need to learn.  That may be true, but as my blood started to boil when I was in the office of a highly successful physician this past week, I was reminded of all that I’ve been teaching these many years.  I won’t lie and say that I had not been forewarned.  I won’t leave out the part where the referring doctor told me that the man he was recommending had NO bedside manner and could even be abrasive.  I knew all that but my priority was to be provided with an excellent treatment plan.  I didn't particularly need someone who would also be “warm and fuzzy.”

However, when the physician had me in his office and quickly scanned the lengthy medical history forms I'd been asked to complete, he began to offer a plan of action without even looking at me.  He left no time nor did he have any desire to hear anything I, the patient, might need to say.  He touched my knees, did some range of motion maneuvers, had a technician do some x-rays, and then asked if I wished to think about his plan of attack or wanted to begin receiving his protocol, a series of injections.

I was so delighted to learn that what he was offering could stave off surgery for years that I agreed to have that first injection.  His hand was heavy, the pain significant.  But, still, it was not surgery. I could, I convinced myself, deal with his unpleasant manner and inability to communicate respectfully.

When I returned the following week for my second and final injection, which was to hold me over for four months, the noted doctor was on vacation and the injection was administered by a gentler soul. The actual pain was minimal.  My mood upon leaving had not been darkened, and my personhood had not felt threatened.

So, what’s my beef?  Why am I about to rant?  I hope it’s because I want to process what happened to me and, at the same time, help any of you who may encounter similar situations. You see, the story hasn’t ended yet!

When I came to his office the following week to review my progress, as scheduled, the doctor was in a foul mood.  I knew that because I could hear him shouting in the hallway.  He was having a phone conversation with someone concerning an uncle he clearly believed wasn’t getting the home care he paid for and deserved. My problem was that he then brought all the anger and frustration at whomever he’d been speaking with into the examination room, and immediately began to ram a series of questions down my throat.  I’ll spare you the details of what ensued.  Suffice it to say, I think I eventually found my voice and did let him know what I thought of his behavior ... and that I resented not being treated as a whole person but only as two injured anatomical parts, namely my two knees.

My husband, who had been able to accompany me, also helped by telling the doctor – most respectfully, I might add – that it appeared as if it were burdensome for him to listen to his patients and asked him to please allow me to speak.

Did said doctor eventually apologize and offer to shake my hand? Yes!  But the grief he had caused me until that point, the insinuated insults and implied knowledge of who he assumed I was, reminded me of all my patients over the years who had been treated similarly but who had no voice with which to challenge their doctor’s so-called authority.

White coat or no coat, highly recommended or found in the yellow pages, doctors do not have license to abuse their patients.  We are the consumer.  We can choose to suffer the slings and arrows of any "professional" or we can leave and never return.  The choice is ours!  We mustn't allow anyone to bully us into believing otherwise.

So, remember this, if ever you find the need to do so:  Part of the modern Hippocratic oath sworn to by all physicians upon graduation includes this statement:  “I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.”

Here’s to health, excellent medical care, and good decisions on our part to assist ourselves in maintaining our physical and emotional well-being!

Have a great week!

Yours,
Linda

MOTHER'S DAY AND MENTAL HEALTH MONTH!
On this Mother’s Day, as I find myself feeling more sentimental than usual, I wish that my mother was still alive to meet the grandchildren who were born years after her death and to know the young women, our daughters, whom she only knew as children. I wish, too, that she could have lived to benefit from all the advances in psychiatry and psychiatric medications.

In the first chapter of my memoir, FOUR ROOMS, UPSTAIRS, I write: “Mother didn’t read to me. She told me stories.” Though some of her stories were colorful and amusing, the majority were sad and filled with the tragedy of her earliest memories and the loss of both her parents before she entered adolescence. It’s also true that my mother’s behavior – due to her frequent bouts with major depression - often lacked consistency, ranging from being loving and rational to the times when “she was not herself” and when she and all our family suffered. Yet, despite what we were denied due to her mental illness, I was never left feeling un-loved. That is the one loss I never suffered, though I know many people who have.

My mother’s love for me was always unconditional, and it is a gift I will always cherish. So, while our lives were far from ideal, I welcomed her love and continue to welcome LOVE every day of my life.

Since today is Mother’s Day, I naturally find myself thinking about her. But, May is also Mental Health Month, and I wish to honor her memory by focusing, as well, on the issues of mental health.

What still astounds me is the fact that though early detection and treatment is always stressed when referring to physical illnesses, the stigma of mental illness and emotional problems still exists today, often silencing those who are suffering and those who witness the suffering: parents, siblings, colleagues, or closest friends.

Researchers and clinicians study statistics and educate themselves about emerging treatment modalities, including the advances discovered in medications. Yet, all too often, the public at large remains ignorant and consequently powerless about what to do about the dark feelings they experience or the questionable behaviors they witness – all of which are outside the accepted norms.

Many of us, unfortunately, assume that we are capable of handling disturbing and potentially life-threatening problems on our own. Yet, that is the one thing we cannot afford to do. Call it denial, call it a paralysis to take action. It doesn’t matter what label is used, what matters is that we cannot allow emotional cancers to grow. We cannot ignore warning signs and pretend that by ignoring them everything will simply “go away.” We must educate ourselves or allow others to educate us, even though it is easier, at first glance, to think – especially when children are at risk – that abnormal behaviors are but a passing phase that will simply heal with time. In a small percentage of cases that is absolutely true. Yet, it is still wiser to err on the side of having an evaluation by a trained clinician, whether our concern is about a child, an adolescent, or an adult.

The number of suicides, murders and rapes on college campuses, the abuse and then “disappearances” of women with disgruntled partners or husbands, the snatching of children by strangers who are listed as sex offenders or even by their own deranged parents MUST NOT escalate further. Attention must be paid and treatment made available for those who are sick. Every sick person who goes untreated and every person who takes the law into his or her own hands affects the very fabric of our society.

I would not, of course, have continued to practice therapy these past twenty-five years if I did not believe that each of us has the potential to alter and even reverse destructive patterns of behavior. With the exception, perhaps, of sex offenders, I believe that mental illness is, in general, treatable, especially when diagnosed and treated early. Some need and benefit from only brief treatment and others may need to be stabilized throughout their lives; but, first and foremost, we must recognize when help is needed for ourselves or others.

On this day, I encourage all of us to honor the mother in each of us and in our daughters who are mothers. We must also honor the people who get the help they need to live healthy, productive lives, making good choices, learning how to best cope with life’s challenges and how not to hide and feel shamed by their genetic wiring. Getting help to improve whatever predispositions we may have inherited or developed is something each of us deserves.

The most recent statistics from reputable sources claim that there are nearly one in three Americans who suffer from a mental disorder in any given year. That’s more than 75 million people! And we know, too, that mental illness does not discriminate. It affects children and adults of all socio-economic backgrounds and across all races and religions.

The bottom line is that every mentally well-balanced person in our society makes us all that much safer and healthier. Investing in mental health is an investment in our individual future and the future of the world. We cannot afford to turn our backs and pretend it does not exist. We must somehow be a part of the solution and not add to the problem.

Should you or someone you know need help, please get a referral from a trusted physician, a person you know who has benefited from being treated by a particular practitioner, or a mental health clinic or agency in your local area that has a good reputation. Call for a consultation. Interview whoever interviews you and remember that therapy is only as good as the clinician who is treating you. The relationship you have with that person is a microcosm of all relationships outside the therapy room. Therefore, if you learn all that you can learn from a therapist (with or without the added assistance of medication when indicated), you will gain the tools to be your very best person and, as the saying goes, to make lemonade out of what you thought was a lemon.

With all best wishes for a wonderful Mother’s Day to all mothers and in memory of my dear mother, I hope this is truly a month in which we will all be mindful of the need to pay attention to mental health issues.

If I am able to help you directly or to offer you good resources should you live outside the greater New York area, please don’t hesitate to contact me.

Yours,
Linda

THE RISE IN CHILD ABUSE AS ECONOMY FALLS!


More than twenty years ago -- after practicing psychotherapy for over ten years -- I became certified as an alcohol and substance abuse counselor and was asked to participate in a study regarding the rise in alcohol abuse/addiction during harsh economic times. The findings astounded me then, but they were of no surprise to those who initiated the study. What was discovered was not only a rise in the abuse of alcohol and other substances, but a significant rise in family violence. Then, too, wherever we found an abused woman, there were usually abused children in the same family. All this was not merely an eye opener for me but also, as I was led to see, a no-win situation. The facts were known. The data available. But the very men (and, for the most part, men and not women were the offenders) who were without employment and who could not support their families were the same ones who were most in need of social services that would teach them how to channel their frustration, keep their rage under wraps, and gain skills to protect the women who somehow kept food on their table and birthed their children.

So, the other day when I read an article in HealthDay (a web-based news source)stating that there was a clear rise in head injuries in children since the economic recession that began in 2007, I was no longer shocked, but I did experience, once again, a visceral response.

Reading further, I learned that a research team had looked over the 2004-2009 records of four urban children's hospitals and reported on 511 cases of trauma. Dr. Rachel P. Berger (Pediatrician in the Child Advocacy Center at the Children’s Hospital of Pittsburgh and the study’s author) stated unequivocally that "the ebb and flow of abusive head trauma cases correlated with economic ups and downs” and concluded that “we know that poverty and stress are clearly related to child abuse.”

The average age of the cases studied and reported was a little over nine months, although patients ranged from as young as nine days old to six and a half years old.  Nearly six in tentients were male, and about the same proportion were white as those of color.” Overall, 16 percent of the children reportedly died from their injuries.

HealthDay reporter Alan Mozes also noted that this finding “may ultimately touch upon a broader national trend,” and I agree.

Precarious economic times are closely associated with an increased rate of violence, in general, along with abuse within families, including head trauma (often referred to as "shaken baby syndrome"). According to Dr. Berger: "As the economy tanked, the trend towards an increase in cases was most strongly evidenced in two of the four hospitals studied,” and she and the other authors of the study concluded that while several factors were operative in their findings, it could not be ignored that "social service cuts and psychological stresses propelled by tough times might ultimately get at the precise underpinnings of the problem."

Jay G Silverman, an associate professor of society and human development and health at the Harvard University School of Public Health in Boston, noted: "Abusive head traumas is one of the most observable indicators of child abuse, because they result from the most extreme domestic violence that requires hospitalization. But there are many, many, many more child abuse cases that we wouldn't expect to show up as traumatic brain injuries in the E.R. So an increase seen in head trauma is probably indicative of an even larger problem. And that means that this finding should really be a major public concern."

The irony is that there have been, and unfortunately always will be, a segment of the population that is impoverished or living on the edge of poverty, but most have never resorted to violence, especialy toward innocent children. Yet, it is also true that if those who are poor are also predisposed to anger, are un-medicated or self-medicated for depression or anxiety, and are furthermore unskilled and uneducated to begin with, the loss of any possible employment will leave these people feeling they have no options other than to act out despite the severity of the consequences.  And who suffers the most?  Our innocent children.

That is not to say that abuse does not occur among the rich or the rich and famous, or that it is absent from other cultures and religions. The ugly reality that abuse exists is documented every day and not merely now during economically difficult times. The point, however, is that it is clearly more pervasive during times when help is not available to those who could benefit from having it and who cannot afford to pay for it out of pocket.

How can we allow this to continue? Natural disasters and war will inevitably continue to distract us and deflate our spirits and our economy, but we cannot let it also scar the future generation of Americans. Their right to survive (if not thrive) is a God-given right. When harmed by the very adults who are supposed to protect them, when our states and the federal government continue to cut school programs and social service agency personnel, rest assured that the mental health of our nation will not merely be threatened. It will suffer irreparable damage.

Whatever we can do and however loudly we can shout, we must convince the powers that be that focusing on this problem is not a luxury but an absolute necessity.
It must be attended to NOW!

Do let me know if you agree.

Warm regard to one and all ~ Linda

*Please see amazon.com for reviews of published memoir:
FOUR ROOMS, UPSTAIRS: A Psychotherapist's Journey Into and Beyond Her Mother's Mental Illness