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Dr. Darrell White's Personal Blog

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Posts Tagged ‘depression’

Emotional Well-Being: Mental Health Deserves Equal Footing

Some time ago I wrote about creating a way to measure health. Real health. Health that encompasses every aspect of what it means to be alive and well. As a CrossFitter I definitely included Coach Glassman’s Disease -> Health -> Wellness continuum, and I also acknowledged the critical importance of his concept of “Fitness over Time”. As a classically trained physician/scientist there is clearly a place for more traditional metrics like blood pressure, serum lipids and the like, although they may, indeed, be an variable that is ultimately tied to fitness.

Where my thoughts on defining and measuring health seem to depart from most current trends is in the recognition that mental health–emotional wellbeing—is as much a part of being healthy as any other thing we might examine.

Think about it for just a moment. Most of what we would classify as mental illness has as many outward signs that we can see as diabetes and hypertension. Which is to say, none. Yet we—all of us, not just CrossFitters—see nothing but the good in treating diseases like diabetes openly and aggressively. There is no stigma attached to seeking care for your hypertension or your elevated LDL. To the contrary, if someone who loves you discovers you quit measuring your glucose before you bolus your insulin, they are for sure gonna get in your grill.

For whatever reason, mental illnesses, including addiction, are looked at quite differently. No one is asking the person with chronic depression whether she is taking her life-saving medication, for example. We might notice an insulin pump on a friend or family member, but then it’s quickly forgotten. Everyone seems to be very uncomfortable around the young man who has very obvious hand tremors from the life-saving medication he takes for his Bipolar disease. We all seem to be so much more understanding when we have to wait for a response from someone suffering from Parkinson’s Disease than from the young women who has the same symptoms as a side-effect from the medicine that quiets the dangerous thoughts in her head from Schizophrenia.

It’s not even necessary to look only at these kinds of severe mental illnesses when we are examining the importance of mental or emotional wellbeing as an integral part of being healthy. What good does it do to have a 5:00 mile, a 500 lb. deadlift, and a 1:59 “Fran” if it was self-loathing that drove you in the gym to get there? You may be quite accomplished, the envy of your peers, at the peak of whatever life mountain you wished to climb, and yet you cannot feel joy. How is it possible to be healthy without joy? I look at Usain Bolt and what I see is quite possibly the healthiest man alive. My friend Tim, the writer, tells me that Justin Gatlin has nearly everything that Bolt has—youth, fitness, wealth—but the combination of failure to knock off Bolt, and the public disapproval reigned on him as boos from the Rio stands has left him emotionally broken. It’s subtle, but if you look at his face in the blocks of the 100M Final it’s there.

Our complex and conflicted attitudes and feelings about mental illness are especially evident when the topic of suicide comes up. Just typing the word makes me uncomfortable. Even how we describe suicide is fraught with hidden meaning that reflects our discomfort: someone has “committed suicide”. Right? Someone committed an act that we simply cannot fathom, one that leaves the survivors completely without any understanding whatsoever. How could someone DO that? It’s as if every suicide is the same as the suicide of the crooked prison warden in The Shawshank Redemption when he looks out the window and sees his fate arrive in the front seat of a State Trooper’s car.

In reality most of the time it’s simply not like that at all. Nothing about it is simple at all.

The outer walls at the periphery of my world have been breeched by suicide twice in the last couple of months. One of them actually does feel a bit like that prison warden. Frankly, I am too conflicted, too aware of the external circumstances and not enough aware of the internal life of the deceased to offer much right now. The other one, however, just stopped me in my tracks when I heard. The loss was profound.It has also introduced to me a new vocabulary that I truly believe provides a starting line from which we can change how we think about not only suicide, but all of mental illness. A friendly acquaintance lost his wife when she was killed by suicide.

We don’t need to know all of the details of the story. Suffice it to say that in the face of a child’s illness she suffered quietly. Too quietly to be noticed. Perhaps she didn’t realize how badly she was suffering, or maybe she was like so many of us and couldn’t bring herself to see her illness for the life-threatening entity that it was. No one will ever know. What is clear, though, is that this was not anything about commitment. Kidney failure may be cause of death in a diabetic, but it is diabetes that kills him. There is no difference here. The cause of death was suicide. Her disease, her depression is what killed this young woman.

Each of us has a very few moments in our lifetimes that forever change us. On the second Tuesday of July in 2006, unbeknownst to me, one of those moments was transpiring in a lonely, dark corner. Joyfully, the moment was a beginning, not an ending. Regardless, once learning of the moment I was changed forever. Now I knew. You cannot see any marks from mental illness, no swollen appendage or insulin pump. But it is there all the same, and it must be acknowledged and accorded the same degree of care as any other disease that may take our loved ones from us. Mental illnesses are real, and they can be deadly. There ought not be any conflict or discomfort in treating them.

We may stop losing so many of our loved ones when start to see emotional wellbeing as part of being healthy.

 

Wellbeing Is Part of Being Healthy

Some time ago I wrote about creating a way to measure health. Real health. Health that encompasses every aspect of what it means to be alive and well. As a CrossFitter I definitely included Coach Glassman’s Disease -> Health -> Wellness continuum, and I also acknowledged the critical importance of his concept of “Fitness over Time”. As a classically trained physician/scientist there is clearly a place for more traditional metrics like blood pressure, serum lipids and the like, although they may, indeed, be a variable that is ultimately tied to fitness.

Where my thoughts on defining and measuring health seem to depart from most current trends is in the recognition that mental health–emotional wellbeing—is as much a part of being healthy as anything else we might examine.

Think about it for just a moment. Most of what we would classify as mental illness has as many outward signs that we can see as diabetes and hypertension. Which is to say, none. Yet we see nothing but the good in treating diseases like diabetes openly and aggressively. There is no stigma attached to seeking care for your hypertension or your elevated LDL. To the contrary, if someone who loves you discovers that you stopped measuring your glucose before you bolus your insulin, they are for sure gonna get in your grill.

For whatever reason, mental illnesses are looked at quite differently. No one is asking the person with chronic depression whether she is taking her life-saving medication, for example. We might notice an insulin pump on a friend or family member, but then it’s quickly forgotten. Everyone seems to be very uncomfortable around the young man who has very obvious hand tremors from the life-saving medication he takes for his Bipolar disease. We all seem to be so much more understanding when we have to wait for a response from someone suffering from Parkinson’s Disease than from the young women who has those same symptoms as a side-effect from the medicine that quiets the dangerous thoughts in her head from Schizophrenia.

It’s not necessary to look only at these kinds of severe mental illnesses when we are examining the importance of mental or emotional wellbeing as an integral part of being healthy. What good does it do to have a 5:00 mile, a 500 lb. deadlift, and a 1:59 “Fran” if it was self-loathing that drove you in the gym to get there? You may be quite accomplished, the envy of your peers, at the peak of whatever life mountain you wished to climb, and yet you cannot feel joy. How is it possible to be healthy without joy? I look at Usain Bolt and what I see is quite possibly the healthiest man alive. My friend Tim, the writer, tells me that Justin Gatlin has nearly everything that Bolt has—youth, fitness, wealth—but the combination of failure to knock off Bolt, and the public disapproval reigned on him as boos from the Rio stands has left him emotionally broken. It’s subtle, but if you look at his face in the blocks of the 100M Olympic Final it’s there.

Our complex and conflicted attitudes and feelings about mental illness are especially evident when the topic of suicide comes up. Just typing the word makes me uncomfortable. Even how we describe suicide is fraught with hidden meaning that reflects our discomfort: someone has “committed suicide”. Right? Someone committed an act that we simply cannot fathom, one that leaves the survivors completely without any understanding whatsoever. How could someone DO that? It’s as if every suicide is the same as the suicide of the crooked prison warden in The Shawshank Redemption. He looks out the window and sees his fate arrive in the front seat of a State Trooper’s car, and swallows his revolver.

In reality most of the time it’s simply not like that at all. Nothing about it is simple at all.

The outer walls at the periphery of my world have been breeched by suicide twice in the last couple of weeks. One of them, close to my age, actually does feel a bit like that prison warden. Frankly, I am too conflicted, too aware of the external circumstances involved and not enough aware of the internal life of the deceased to offer much right now. The other one, however, stopped me in my tracks when I heard. The loss was profound. It has also introduced to me a new vocabulary that I truly believe provides a starting line from which we can change how we think about not only suicide, but all of mental illness. A friendly acquaintance lost his wife when she was “killed by suicide”.

We don’t need to know all of the details of the story. Suffice it to say that in the face of a child’s illness she suffered quietly. Too quietly to be noticed. Perhaps she didn’t realize how badly she was suffering, or maybe she was like so many of us and couldn’t bring herself to see her illness for the life-threatening entity that it was. No one will ever know. What is clear, though, is that this was not anything about commitment. Kidney failure may be the cause of death in a diabetic, but it is diabetes that kills him. There is no difference here. The cause of her death was suicide. Her disease, her depression is what killed this young woman.

Each of us has a very few moments in our lifetimes that forever change us. On the second Tuesday of July in 2006, unbeknownst to me, one of those moments was transpiring in a lonely, dark corner. Joyfully, the moment was a hopeful beginning, not a tragic ending. Regardless, once learning of the moment I was changed forever. Now I knew. You cannot see any marks from mental illness, no swollen appendage or insulin pump to clue you in. But it is there all the same, and it must be acknowledged and accorded the same degree of care as any other disease that may take our loved ones from us. Mental illnesses are real, and they can be deadly. There ought not be any conflict or discomfort in treating them. There ought not be any conflict or discomfort in seeking treatment.

We may stop losing so many of our loved ones when start to see emotional wellbeing as part of being healthy. When treating mental illness is as much of a non-event as injecting insulin for diabetes.

Measuring Health Part 3: Emotional Well-Being “W”

2016 is an Olympic year. We will hear stories, as we do in every Olympic cycle, of the extraordinary physical accomplishments of Olympians in sports which require otherworldly amounts of what we in the CrossFit world would consider “Fitness”. Strength, speed, and agility. Uncanny feats of coordination and accuracy, some performed over distances and times that are so far beyond the reach of the average human as to defy credulity. Many of these athletes, certainly the ones we will meet through the intercession of NBC, will match our expectations of the happiness that must certainly accompany such outsized achievements. Mary Lou Retton, anyone? Indeed, what we will see on our screens will fairly scream “Healthy”.

But there will be others, too. And for all of their physical fitness, expressed so dramatically for our viewing pleasure and patriotic zeal, the lack of emotional health will make it obvious to anyone that they are not healthy. Bruce Jenner, anyone?

Remember our proposed definition of “Healthy”: Able to perform in all ways at the farthest limits of one’s potential capabilities. Health is therefore the state in which no infirmity is, or can in the future, impede this ability to fulfill a potential. It takes but a moment to think of how mental illnesses such as depression, bi-polar disease, and schizophrenia can be hidden from view when examining only physical metrics. There are examples all around us. The woman who partners with a 1400 pound horse in the rigorous, physical tasks required to compete in the three-part test that is eventing, so poised and accomplished in the arena, who retreats to solitude outside the barn because she is incapable of overcoming her anxiety around people. The outdoorsman who in his manic phase performs feats of strength and endurance others can only marvel at, and then plunges into the depths of depression from which he cannot see the noon-day sun. Much more prosaic and much more common is the individual who continually increases his or her fitness by any and all measurements due to a deeply held sense of low self-worth, perhaps even self-loathing, pursuing an unreachable ideal and always falling short.

A truly universal measurement of health must include some element of emotional well-being. Let’s call it “W”. You could certainly call it the “Happiness Factor”, and some undoubtedly will. I imagine criticism directed toward this to take the form of “Happy Face” mockery. No matter. Well-Being is a better term for this part of our equation because it encompasses more than whether or not you are happy, whatever happy may mean to you, when you are measured. Are you content with your circumstances at the moment? Do you have the ability to persevere under duress?  What is the state of your relationships? A recent study of Harvard men carried out over decades found that both happiness and longevity were tied quite closely to the quantity and quality of your relationships with family and friends. Where are you in your pursuit of your goals, your dreams, and how do you feel about that? How much stress do you perceive in your life and how are you managing that? All of these make up what one might think of when we consider Well-Being.

How, then, should we go about measuring ‘W’? Remember, all of our tests should meet the dual imperatives of being accessible to pretty much everyone, and as inexpensive as possible. We could certainly use something like the classic anesthesia “smily face” pain scale, relabeling the figures, but this feels too simplistic and too momentary to be truly applicable. Our measurement should require a bit more thought than that. I have to admit here to countless hours of internet crawling trying to find a validated test of emotional well-being that has a track record in a heterogenous group that mirrors our population; most have been utilized in very specialized populations (e.g. soldiers) with a very specific research interest. Those that might apply must typically be purchased.

John Pinto is a well-regarded consultant in the world of my day job, ophthalmology. He has long had a list of clients that spans the gamut of pretty much every measurement you could think of in a group of doctors. Men and women. Young and old. Fantastically successful doctors and those that could only be described as spectacular (if unexpected) failures. As part of his quest to better understand his clients in order to better serve them, John used a questionnaire that measured emotional well-being. He found that external measurements of success such as volume of surgeries, income, and professional acclaim did not always coincide with his clients sense of success, their emotional valuation of their professional lives. These were certainly variables that mattered, but his happiest clients were not always his wealthiest, and his least happy not always those who had less. The assessment he used is the best one that I’ve been able to find, notwithstanding the fact that it is not free.

(http://psychcorp.pearsonassessments.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=PAg511 ).

I am not wedded to the Psychcorp assessment and would happily review any alternatives. Especially if they are free! As is the case with ‘M’, our traditional health metrics like blood pressure and serum lipids, I expect a vigorous debate as to the relative weight of ‘W’ in our final Health Index. My bias is that ‘W’ is a current factor with a greater impact on health, and it should have a correspondingly greater weight in our formula. Let me start the “bidding” with double; however the final formula shakes out ‘W’ should have twice the value of ‘M’.

Mental health is an inextricable part of health. It must be included in any serious definition and measurement of health. Our variable is “Well-Being” or ‘W’.

 

It’s (Still) All About Jobs

Lots of noise in the business world about the economy. What’s the Fed gonna do? Is the Recession over? Will rising interest rates pull us back into the despair of 2008-10? What about the blah blah blah?  That’s all this noise is, really. Blah blah blah. It’s all about jobs. Still. Jobs, jobs, jobs. Jobs and work. There aren’t enough jobs out there. People have stopped looking for jobs. Unemployment is stagnant, but even those numbers don’t tell the story because hundreds of thousands of people have just given up the search.

But wait, there’s another side to the coin. It seems that there are hundreds of thousands of jobs out there, but businesses can’t find people with the skills, or even the desire to learn the skills necessary to fill those jobs. Gone is the willingness to take an entry-level job of whatever sort at whatever pay in order to start the journey to “get ahead”. Some would go so far as to say that NOT taking that low-pay starter job is a rational decision. The cumulative value of various and sundry government programs add up to a “salary” that far exceeds most entry level jobs, benefits which would go away if one took such a position.

So which is it? Come on…you can’t have it both ways now. Either there are no jobs, employers are withholding jobs to avoid this or that (Obamacare, yadda yadda), or employable adults are simply unwilling to work. Which is it? Are there no jobs, or has there been a paradigm shift in the collective sense of what it is that must be present in a job before it is worth taking?

I call BS on the no jobs thing. There are jobs out there to be had. Good jobs. Jobs that will add up to $20, $30, $40 or more per hour jobs. The problem with all of those jobs, and the reason that employers are having a tough time filling them is two-fold: you don’t start at $20, $30, or $40 per hour, and in order to have those jobs you have to do actual work. It’s Life, Liberty, and the PURSUIT of Happiness, not Happiness.

Pursuit is another word for work.

Say what you will about government policies that discourage hiring (30 hour work week = full time, mandatory provision of health “insurance” for companies with >50 employees), gnash as many teeth as you please about the inability to house a family on a single minimum wage income (what household has only one worker now, anyhow?), mount as much hew and cry all you wish about income disparity, in the end it all comes down to a very simple, very common denominator: in order to have a job you must be willing to go to work.

All work has value; there is honor is any job. That is not to say that all jobs and all work are equal, or have equal value, or even that there is any justice in the valuation of one job relative to another (why is someone who sells municipal bonds a millionaire while the plumber who drains the basement that was supposed to be kept dry by the pipes purchased with those bonds is not?). No, the point is that having a job, going to work, doing the work has an intrinsic value in and of itself, and that all jobs intersect in society in order that society can function, much like the 11 men on a football team must each do his job in order to move the ball down field.

It’s been offered many times by many people that the best social program for a society is a job. The job you start with, or the job you may have at the moment is not necessarily the job you want to end up with, but each job provides you with a sense of participating, of producing, of contributing, while at the same time perhaps providing a stepping stone to something better. The “Pursuit” in Pursuit of Happiness.

To land and then to keep a job is really not all that difficult. I worked for others as a younger man, and for some 25 years now I have been an employer. Really, as someone who gives people a job I’m here to tell you it’s not that tough to get one. You need three things, only, to get a job. You must WANT a job. Once you have a job must be willing to DO the job, to work hard. You must have integrity–you must be honest.

Seriously, that’s all it takes.

Ideally you would add a fourth component; you would be ambitious. People who have jobs to fill also have businesses to grow, and growing businesses have room for ambitious workers to grow into much larger jobs. Hard workers who are honest, who put in an honest day’s work who have any ambition whatsoever move up, either with the company that gave them that first job or with another company that is competing for the skills they acquired because they took that “entry-level” job. The managing editor of Time Magazine started there in a sub-minimum wage job as a fact-checker. She is the epitome of the axiom that all you need is a foot in the door and the willingness to work hard.

Sure, sure, I know, it’s not always that cut and dried, and people get rooked, and bad stuff happens. I know. That’s life. Life happens. Life can be hard. In life, though, the reality is that rarely, if ever, is anything handed to you. You earn it. You don’t sit back because something unfortunate might happen because the odds are really stacked in your favor that they won’t, go against you that is, if you simply go out and demonstrate your willingness to get a job, even an entry-level job, work hard, and be honest. The work/life balance thing is all well and good, as long as you remember that work is part of the equation, too.

Indeed, work comes first.

 

Three Friends

Every couple or three years comes a slew of articles on friendship, specifically friendships in adults. Thus it is that I find myself returning to the topic for the first time in awhile, having been bombarded of late with articles, books, and movies on the subject (“Of Mice and Men” is being staged on Broadway, for example). That, and my brother’s rather humorous story of having bumped into a fellow Eph with whom I was friendly in college (more on that in a bit). Much has been written on the subject, almost all of it a re-hash except one little gem, a tiny bit of research that suggests that friendship in mid-life is the strongest predictor of longevity of all.

Weird, huh? And not too positive a finding either, what with my oft-told and hard-earned experiences with how difficult it is for men to create new friendships after the age of 30. The magic number is 3. Three close friends predicts a longer life, especially for men. Sadly this usually does NOT include your wife; the overwhelming percentage of wives drifted AWAY from the men in favor of younger women, usually daughters, as they moved through adulthood. As an aside I’m now desperately hoping that Beth will have some room left over from “Lovely Daughter” Megan. (Actually, getting Beth hooked on CrossFit might be my ace in the hole)

Interesting, huh? Three close friends and you live longer. Very few folks had more than 4 or 5, an incredibly tight range when you think about it.

It’s become a kind of psychological dogma that men and women make friends in very different ways. Women, it is said, make friends through the sharing of feelings. In person two women who are friends are said to be most often facing one another, talking. Maintaining this kind of friendship is structurally rather easy in our modern age of communication. Feelings can be shared in any number of ways that do not require the friends to actually be in the same room together. Phone, text, Facebook and Twitter are but a few of the tactical and mechanical advantages to a friendship built on an exchange of feelings, and the currency required for the ongoing investment is simply time.

Men on the other hand make friendship a much more arduous affair. Many women would opine that this could actually describe many, if not most things that men do, but that’s a topic for a different Sunday. The picture most often used to illustrate men in the company of friends has them standing shoulder to shoulder, in the act of sharing an experience but not necessarily sharing any internal reaction to that experience. It makes me chuckle to think that a video of the same scene would probably also look like a portrait, nothing moving, certainly not their lips. For men the basis of friendship is the experience and the fact that both were physically present for it. Whether sitting at a Bulls game in Row J seats 11 and 12 , or working up a sweat at the Loyola Prep gym playing pick-up hoops, the friendship blooms only from the seed of the experience which is fertilized by proximity. At some point the memories of those experiences, stories re-told dozens, hundreds of times, fail to prompt growth in the friendship without the Miracle-Gro of presence. Eventually even shared “experiences by proxy”, raising similar aged children for example, fails to prevent slack from growing in those friendship ties if you aren’t physically there to tighten them.

In my mind the universe is divided into a very few groups of varying sizes. Think of your life as kind of like a bulls-eye floating through a vast space. The center of that bulls-eye comprises that small group of true friends, men and women who would drop everything should you have need, and for whom you would do the same. Friends are people you miss if you haven’t had contact for a matter of days, people whose company you actively seek. These are people you go out of your way to see and never try to avoid. Man or woman, they know how you feel. Again, an aside, happy is the couple who have overlap in this innermost circle of the bulls-eye.

The next circle is filled with friendly acquaintances, people who make you smile. When you have an opportunity to be with them in person or in spirit it makes you happy. There’s no limit on these, and a reasonably friendly character could have dozens of friendly acquaintances scattered throughout a life. This is the group from which most friends are created, and if you are fortunate someone who is no longer really in that bulls-eye drifts no further out from center than this inner ring. Just outside the circle of friendly acquaintances is the ring containing acquaintances, people you’ve met and remember but either don’t ever really spend time with or never have the chance to explore a move toward the center. My brother met a someone who has always been here, the humor in wistful remembrance notwithstanding. Your circles of friends and acquaintances drifts through a vast space filled with folks yet unmet, a (hopefully) few enemies orbiting in there somewhere as well.

We float through the universe in our circles, people drifting in toward the center (perhaps my Brother’s encounter will drive my acquaintance inward) and sadly on occasion out and away. In CrossFit we know both a definition of fitness and a way to measure it. Indeed, Coach Glassman has opined that not only is fitness the most important part of health, but in his opinion it is a precise measurement of the same. He and I disagree around the margins of that position, at least in part because of friendship and what it does for us. We may not be able to define friendship in quite as absolute terms as those we use for fitness, but I’m reasonably sure we all know what it means to be and to have a real friend. Read or watch “Of Mice and Men” if you are unsure. It’s likely that friendship itself, unlike fitness, does not have a precise metric, a measurement of volume or degree. No “friendship across broad time and modal domains” if you will. Though I continue to hold this truth, that you can never have enough friends, there is apparently a number that does have some significance. Three. Three friends, real friends, lead to a longer life. Side by side or face to face, the tipping point is 3.

No amount of time spent or distance traveled is too much for them.

 

 

 

 

The Value of Work

All work has value. Well, all legal work of course. Every job has value. There is a certain dignity that can be found in every job. Mop the floors? Someone’s gotta do it, and the rest of us should be thankful that someone did it. Digging up coal? Man, that’s a dangerous job. I think I read that 90% of Ohio’s electricity comes from coal. I’m warm today because someone went deep and came up with that coal.

Heck, even used car salesmen perform a job that has value. Seriously.

More to the point, especially at this time of year, is the value that is conferred on the person who has the job. Almost any job. You’ve got a reason to get up in the morning (or evening if you work graveyard). You have folks you are responsible for, and you are taking care of them. You are taking care of yourself. Taking responsibility. FWIW I would go to work on Wednesday if I had the magic lottery ticket on Tuesday.

In the Great Depression what everyone asked for was a job. Will work for food. I truly believe that this is still true for the most part today. People feel deep down that they need to work. When they have a job by and large most people work as hard as they can to do a good job. I live and work in the second most highly regulated industry in the U.S. (bonus points for knowing the first), and my income has been halved over the last 10 years or so. I still go to work, though, and I still work for the people who “buy” my services just as hard and in the same good faith that I did 10, 15, 20 years ago.

That’s my job.

Which brings me to the point: if you have a job for Heaven’s sake do your best. Work hard. If someone has given you a job work hard for her. Don’t’ let any resentments interfere with doing your best work. Everyone is underpaid; your boss thinks he’s underpaid, too. It may or may not be true, but when you are on the job it doesn’t matter. When you are at work is not the time to harbor or act on anything other than the job at hand. If you work for someone, WORK for him. Do whatever it takes to do the work well, to get the job done.

It’s not just that you owe it to her, you owe it to yourself.

 

Does “MD” = Manic Depression?

“Manic depression is touching my soul.”

You’re up;  you’re down. You’re happy; you’re sad. You have the best job in the world; thinking about going to work makes you sick to your stomach. You’re so good at what you do, everybody loves you; everyone is out to get you.

You are an American physician.

Recently I’ve been asked at least a dozen times why I became a doctor, or why I became an eye doctor. I’m not really sure why this has come up now, because most of the people who are asking have known me in some way for many years. Why I became an eye doctor is really rather simple, and I have written about it HERE. The question “why did you become a doctor” is much more complex, much more involved, and frankly I’m beginning to wonder about that myself.

“Why do you want to be a doctor” was at the same time the easiest and most difficult question for me to answer, especially during medical school interviews. I grew up in a small, dying mill town in Massachusetts. The happiest, most fulfilled, most IMPORTANT people in that town were the doctors, of which there were very few. The busiest surgeon in town, Dr. L., could possibly have been the happiest person in the entire town. Beautiful wife, attractive, intelligent, athletic children, really big house. He was even a decent golfer! I don’t think I ever saw him without a smile on his face.

It was Dr. Roy, though, my pediatrician, who really clinched it for me. There must have been another pediatrician in town–heck, there were 24,000 people there. For the life of me, though, I can’t ever recall any of my friends seeing any doctor other than Dr. Roy. He was confident. Secure. Always with a gentle smile whether in the office or on Main Street. My mom later told me that he was perhaps the most influential politician in town as well. Everybody looked up to Dr. Roy, no matter how young or old they might be. His was a happy, contented, full life, largely because he was a respected physician.

Can you name a single pediatrician now living and practicing in the United States whom you would describe like that?

Nevertheless, that’s mostly why I wanted to be a doctor. I want to be Dr. Roy. I wanted people to look up to me because I was good at doing something that was important, something that was meaningful to their lives. All of the doctors in town were like that.

Now? Well, I’m a 51-year-old eye surgeon and I am just like every other physician in the United States. I swing between the euphoria associated with a good outcome or a happy patient, and the bitter black hole that appears when a disease wins. My world is actually pretty good in this regard: for every defeat there are literally hundreds of victories. For every patient who is dissatisfied or unfulfilled there are hundreds who can’t wait to tell everyone in their lives how good their experience was. It’s just that there seems to be a couple more people who are less satisfied. A couple more each year.

Again, the success rate in my particular specialty is incredibly high, and these people who are less than satisfied have actually had an extraordinary good outcome if you look objectively. I think it all tracks back to the creeping consumerism in health care. It’s not good enough to have an outstanding outcome, it’s only truly even good enough if it meets the expectations of the consumer, the patient, no matter how outlandish or inappropriate those expectations might be.

I’m up. I’m down. The downs seem to hurt more because they are so much more, I don’t know, personal now.

I always got the idea that there was pretty much nothing to the business of being a doctor. All the docs seemed to have enough money, although none of them seemed wealthy. There was only one “girl” in the office and she made the appointments, gave you your bill, and took your payment. No back office or billing department. No special personnel responsible for charting, compliance, insurance communications. My “chart” was a couple of 5×7 cards stapled together.

Now? Oh man…the squeeze is coming from all directions. Private practice or big group practice, it doesn’t matter. You either deal with the external forces conspiring to make it more unpleasant to make a living as a doctor (insurance companies, the government, malpractice attorneys) or you deal with your boss (or more likely your boss’ secretary since you’re just another employee, after all). Your chart is now a legal document littered with land mines meant to ensnare even the most pious and dedicated among us.  Most docs do OK financially, maybe not 1%’ers but pretty well. It just seems like so many folks go so far out of their way to make us feel like we don’t deserve our pay. Any of us. Any of it.

I’m comfortable; you don’t deserve it.

Now, if you are not a doc you could sit back and rightly say “quit yer whinin”. I’d get it. I just can’t shake the feeling that Dr. Roy, and all of the Dr. Roy’s of the day, got and gave more out of what medicine could offer than any of us do now, despite the fact that those of us who practice now have so much more at our disposal on the medical side of the equation. It just doesn’t feel as good. There’s just too much that comes between doctors and that sense of service, of satisfaction in those bygone days. It just seems so much like work now. I don’t think Dr. Roy ever went to work. I believe he would have practiced pretty much the same way if he’d inherited a million dollars.

You’re up; you’re down. You have the best job in the world; you can barely make yourself open the office door. Everybody loves you;  you don’t deserve it.

“Manic depression is a frustrating mess.”

 

 

Shades of Grey

It’s still winter here in northeast Ohio, regardless of what the calendar may be saying. We don’t have weather right now, we just have shades of grey. My son, Randy: “I don’t know, Dad, seems like every day is either light grey or dark grey right now.”

I find it harder, and longer, and more of a conscious struggle to soldier on in the face of the obstacles and set-backs of daily life at this time of year. Tiny, insignificant inconveniences take on a wholly unreasonable level of importance (a series of dropped cell calls yesterday, for instance), making whatever shade of grey at least momentarily darker. The medical term for this is “Seasonal Affective Disorder”, and man, I’ve got it in spades. The effect is different on any affect I’m sure, but it makes me dark and edgy, on the verge of eruption, the trigger hair and phasers set on annihilate.

And yet, while my challenges and obstacles may or may not subside as grey FINALLY slides into Spring, I know that for me this is just a seasonal effect, born of geography, and borne as a consequence of geographical choice. With some 5 major moves behind me I have managed to land each time at the same latitude, plus or minus the same relative number of cloud-covered days, covered in mud and shivering.

There live among us souls for whom grey is not a seasonal phenomenon, who struggle each and every day to lighten the internal weather as they soldier on. For them even the lightest days are dark, and the best days are those that have the least pain. The darkest days are down right frightening, unknown and unknowable to the rest of us, where there may be only a speck of light somewhere on the far horizon, with consequences and choices that are more frightening, still. These individuals live in a world not of their choosing, shades of grey surrounding them always and everywhere.

Depression, real depression that descends upon a person and declines to leave of its own accord, is fundamentally different from sadness, from unhappiness. It is organic. It comes from within. While one may be able to pinpoint an event or time that might be a trigger, depression once it sets in is not reactive to any one aspect of a life. It is not present in response to something or someone bad. True depression, as well as its close cousin anxiety, gurgles and bubbles and flows from a toxic well within, a cold weather front that arrives and stays.

We live, or fancy that we live, in a country with “up by your bootstrap” values. “Come ON…get OVER it” is a mantra ingrained in our national psyche. Frankly, that actually works very well, eventually, for the sadness or unhappiness one feels in reaction to unpleasantness. Depression, however, is as unresponsive to platitude as this Cleveland season of Grey, and depression has no calendar to eventually force away the Grey.

People who inhabit this world in which shades of grey are all that exist have a problem which is as serious and life-threatening as any other “invisible” problem. Think diabetes: there is no outward manifestation of diabetes, no stigmata to alert the observer to its presence, and yet without insulin the diabetic will die. So, too, the soul afflicted with depression must be treated for what is organic and internal. Voluminous research has shown that a combination of “Talk Therapy” and medicine is necessary, and that for most it is necessary for the better part of a lifetime. Without this lives are lost. We’d not deprive the diabetic of insulin, would we? And yet…

Various medicines for “depression” are rampantly prescribed for varying degrees of sadness, unhappiness, even ennui. I confess to being conflicted about this. Who am I to deprive anyone of additional happiness, or less sadness, or even less time in the middle of life’s  great Bell Curve of emotion. But these medicines are expensive, and the “market” effects of their broader use affects the conversation about treating organic depression as the medical entity that it is. This is a hard conversation; where is the line?

Smarter people than I have failed to find a bright dividing line, to be sure, but there IS a difference. We lose people we love who live only in a world with shades of grey. At some point, for some, only the grey remains. No light is visible, and only one question exists in that world of grey. Do I live with the pain, or is today the day the pain ends? Grey descends into dark. The weather becomes deadly.

Every now and then, through any number or routes, a light begins to glow in one of these people. Nurtured, caressed, husbanded and encouraged, it grows steadily and slowly. To be sure, it waxes and it wanes; there are setbacks wherein the light may be rendered not more than a tiny ember. But in these fortunate ones it never goes out; it continues to grow, bringing light as surely as Spring lights the grey.

To witness this can be as thrilling and monumental as a sunrise in the mountains, or as subtle and delicate as the opening of an orchid. But oh ho, to be there to SEE this, to be a spectator to this, to see light where there was only dark, brilliant color where there was only grey. One night, in a darkened car on a grey, starless night, I drove home bathed in this light emanating from the back seat, so long in coming but now so bright and so strong. The obstacles and the challenges remain, as they always will, but they will seem so much smaller and more manageable in this light. It was hard to drive, so brilliant was that light as it shone through my tears.

So brilliant is that light as it awakens me each morning, still the father of not two, but three children.