Sunday, October 31, 2010

Virtual Book Tour, Guest Blogging/ Author Interviews, Writer and Book Blogs

Here is a List of Writer and Book Blogs, (really cool blogs) where I will be guest blogging or interviewed  for Virtual Book Tour for "When Can I Go Home?"

1.       October 25 -
(Virtual Book Tour Cafe Feature Spotlight) Book Tour Cafe

2.       October 27 - Guest Blogging at
(Rhodes Review)

3.       November 2 - Guest Blogging at
(A Moment With Mystee)

4.       November 4 - Guest Blogging at
(Cindy Vine)

5.      November 6 - Author Interviewed at
(Written In Blood)

6.       November 8 - Author Interviewed at
(Brummet's Conscious Blog)

7.       November 10 - Guest Blogging at
(Writers Movement)

8.      November 16 - Guest Blogging at
(Ginger Simpson's "Dishin' It Out")

9.      November 18 - Guest Blogging at
(Arms of A Sister)

10.    November 22 - Author Interviewed at
(O'Neal Media Group Publicity News)

11.    November 24 - Guest Blogging at
(The writings & ramblings of a Philadelphian)

12.   November 26 - Author Interviewed at
(BK Walker's Musing of the Mind)

13.   November 30- Guest Blogging at
(Changing Face of Publishing)

14. December 2 - Guest Blogging at
(Ashley's Bookshelf)

Friday, October 29, 2010

Human Communication- Part 2 Cyber bullying, social media FB Twit Narcissist Haven?

The concept of anonymity was discussed. The lack of identity etc. You get to be whoever you want. The next major issue is how communication has changed, or lack of communication more precisely. Think about it, regardless of you religious affiliation, oh sorry Spirituality and beliefs I mean, you still have to consider human beings are mammals evolved animals. What sets us different? Opposable thumbs, of course and hence cutlery, and big old evolved brains. Huge brains with massive overgrown cerebral hemispheres, relative to everybody else in the animal kingdom. so what comes with that? Well verbal communication, It started out as eye contact then grunts and it evolved into words. Yeah we lost all the other cool senses and non-verbal communication that other animals still have with each other, instinct etc. (See "New Age Spirituality" of  the last 25 years Metaphysical or whatever it is called in 2010. you can work to get some of it back it is actually not a special gift for all the clairvoyants out there, it is actually something old humans lost hold of.)
Anyway so humans evolve, we loose our old instinctual communication, we grunt, we speak we make up languages, lots of them, based on where we are geographically, sort of still around, global neighborhood etc, based on who invaded who, I mean why don't the British speak French as primary language. (Rhetorical).
Then you throw in the opposable thumbs, and we start drawing on Cave walls and we get symbols and signs. We can draw. We start to draw lots of symbols and make up symbols for those grunts that are now words. Verbal and now written language. We communicate through it.
The original verbal language of humans was very intimate. It was all about eye contact and gestures, just slightly beyond the other animals.  you had to be in the same cave or vicinity to communicate. you knew where you stood.
The written stone tablets changed everything, you did not need to be in the vicinity of the person to communicate. Throw in ink and paper over the centuries, and finally the printing press. Communication became more massive, and less intimate. And nothing much went on for a few hundred years.
Then very recently, (relatively speaking to how long humans have been on earth)  just the last two centuries or so, all hell broke loose. The telegraph, early 1800's really brought out the immediacy of remote communication. Then of course the phone, TV and radio, in only the last century.
The telegraph brought in immediacy but not intimacy. no eye contact, no inflection. soon the phone brought even more immediacy and a strange new  pseudo-intimacy. Inflection, and voice but remoreness. No facial expression, no smells, no gestures. But lots of auditory.
TV really revolutionized the pseudo-intimacy. Now lots of one way communication, with two dimensional visual. and lots of sound. in your home no less, but still not real communication at least in a truly intimated two way human form. You can't bully someone through the TV, but you sure can demonstrate lots of it, even in high def now.
interestingly, people used to harass and beat the hell out of people over the phone, crank calls, etc. Just as the Internet, was taking off, some genius thought of caller ID and *69, and all of a sudden no more anonymous terroristic threats, people stopped playing games and harassing each other in that way.
Then emerged the Internet and simultaneously cell phones they sort of became the same thing as far as cyberbullying is concerned.
It was great we got rid of those clunky typewriters. Printers got better. We all learned how to type, if we hadn't in high school, except, the darn keyboard lingered as a remnant of the old typewriter. Now emerges the touch screens.  Smart boards etc. Thank God for modern technology right.
The anonymity is back with the Internet, you really have no idea whom you are talking to or listening to. Sorry but you don't. Of course now we have the crude innovation of skype, That of course will only get more perfected, but it will still only be two dimensional, no smell, no touch, until we can do molecular transport like Star Trek.
So now we communicate with the Internet. At work we email somebody across the hall. Parents and kids text each other in the next room. Why is that? Because it is a lot of work to communicate with someone face to face, and we as a society have started to develop a distinct anxiety about it.
Probably as a society the only thing we are more phobic about than direct face to face communication and intimacy. We are probably lazier than ever as a society. Think about it video-conferencing has taken off V-tel and all that, but it will never take off as it could have by now at least in the workplace.
We will always go for real life face to face meeting, if it involves excessive travel, why my God we can't do a video conference for that, we have to go for London for  five days for that one hour meeting. Because when you are traveling you get to get out of doing actual work, and still get to do all the self-aggrandizing- you know the type, always busy, gotta be somewhere. Check any airport.

The bottom line in communication is that it isn't what you say,  it's how you say it. Or at least that is 50% of human communication. At least that is what I have told students and anyone else who wants to know the art of developing an empathic connection with a patient.
Eye contact, inflection, volume, gestures, body posture that is 50% of human communication.pauses, facial expression. We call these non-verbal forms of communication but in reality human communication is one entity, and those are all components of it. Anything less than that is slightly less than human, say something like the Internet and social media for example.  We don't call it less than human communication though we call it virtual. But face it, when something is slightly less human isn't it easy to behave in a less than decent human fashion say cyberbullying?

Monday, October 18, 2010

Guest Blogger from Isabel at Enduring Care

Here is a post from my fellow blogger and Caregiver Isabel. She has a great blog called Enduring Care and knows firsthand about caring for a family member with AD. She is a excellent writer and captures the essence of all this stuff, you will see what I mean......

Living in the Age of Instant (Non)Medical Diagnoses
In the millennium, televised medicine is all the rage. Colonoscopies are performed before a live, gasping audience, staged for national television. Patients are being encouraged to second-guess our physicians. Everyone, it seems, is a wannabe physician.
The old, “everyone wants to be a comedian” should be updated in the millennium to: “Everyone is an unlicensed medical diagnostician.”
Even in the days of “Dr. Ben Casey’s” fictional character on television, tv “medicine” realistically took longer than today’s “Hollywood-style” camera-ready medical practice. Plastic surgery? No problem! Aging? “Fuhgged-about-it,” as my New York City Italian friends love to say.
Our millennial medical madness trend is evident to me in a number of areas, including Alzheimer’s and dementia lay-diagnoses. Lost your keys? Alzheimer’s! Tired and at a loss for words? Dementia! “Ask your doctor about Aricept” for the treatment of Alzheimer’s disease “symptoms,” is the overarching message of one long-running millennial tv commercial. Piece of cake diagnoses and medical treatment await you and me, should we be so na├»vely inclined.
In my younger years, I believe we called such thinking hypochondria. Back then, no reasonable person ever dared mention or conjure up chronic diseases, lest the individual were to tempt the universe to rain down illness in one’s life. Back then, hypochondriac thinking was frowned upon, or laughed out of town. In the millennium, we encourage and celebrate hypochondriac tendencies, more so about perceived or imagined Alzheimer’s and dementia symptoms. Some folks see Alzheimer’s at every turn – more so in the lives of others!
Dr. Sivak’s blog, Differences Between Delirium, Depression, Dementia, Delusions, Alzheimer’s, is a good read if any layperson feels a sudden urge to non-medically diagnose another individual’s “symptoms” as Alzheimer’s and/or dementia.
Cultural Perspectives on Alzheimer’s
I am part of the (Baby Boomer) generation that grew up accepting the generic use of the word “senility.” Back then, the word “senility” was used regularly by adults to define perceived “symptoms” of aging in some elders who displayed episodic or persistent memory loss, wandering behaviors, and, mental confusion such as currently associated with Alzheimer’s and dementia.
Oddly, although we were less medically enlightened in the 1960’s and 1970’s than we are today, many “senile” elders were not socially hidden by their families. Many families with “senile” elders revered their elders and taught their boomer offspring to do the same.
One of my childhood friend’s grandfather was “senile.” “Gramps” once walked half-mile, got on a bus, and wandered off – albeit in a kinder, gentler world. An entire community was on the lookout for “Gramps.”
“Gramps” was given a ride back home near dusk, when someone spotted him at the end of the bus line, confused, in a city more than 15 miles away. When “Gramps” was safely back at home, my friends and I asked him where he’d been. We listened to his sharing and laughed when he laughed. “Gramps” was physically fit, cheerful, otherwise seemed to be in good health, albeit cognitively lost quite often. Gramps died in his 90’s, in his adult daughter’s home, surrounded by his grandchildren, neighbors who’d looked out for him, and, other loved ones.
Medical Advances in Alzheimer’s Treatment and the Great Social Divide
Social progress is a funny thing. Are individuals who have been medically diagnosed with Alzheimer’s in the millennium, more, or less, socially visible than those in Gramps’ generation? You decide.
How far have we come in our public perceptions of Alzheimer’s?
·        Public education and awareness may be at all-time highs, yet, there are some communities that have yet to realize that Alzheimer’s disease is fatal. Might some individuals be in social denial?
·        Whether due to social over-simplification of symptoms or over-use of medical terminology by laypersons, there is some tunnel-vision in recognizing possible symptoms of Alzheimer’s and related brain diseases. Some individuals pounce at “senior moments” of lost keys or forgetting the day of the week as “evidence” of Alzheimer’s or dementia, while missing the medical forest for the laypersons’ trees.
·        Some may view the lack of a cure for Alzheimer’s as the final word. “Senility” happens, and there is no cure, so why bother, may be the prevailing thought for some individuals.
Regardless of how far we may have come, some individuals may still be circling the wagons.  Dr. Sivak’s blog says it all for me: “Lots of D’s to differentiate.” While we’re at the letter d, please talk to your doctor. This is not your grandfather’s generation. It’s the millennium.
There are medical treatments that have been proven to slow the progress of cognitive decline. Aren’t you the least bit interested in hearing?


Saturday, October 16, 2010

cyberbullying, social media, facebook, twitter, a haven for narcissists? part 1

So what is all this cyberbullying really about? Has it always been there, the concept of bullying that is and now there is just another really convenient outlet in social media? Is it getting worse? Have teenagers always been attempting and committing suicide because of the vile ways they are treated by other young adults? Are we just more aware of it? Is it just in our faces more because of the instantaneous virtual connection and immediacy of the Internet?
There are so many frameworks to understand it, yet it is still not understood well, we know it is bad, but we don't know how to really stop it as a society. There are maybe three things to think about in terms of this whole problem. The concept of anonymity, communication, and narcissism.
Think about it, you really have no idea on social media outlets,  on the Internet for that matter exactly whom you are communication with through the concept of electronic printed word, that's why it is called VIRTUAL. With the concept of true anonymity, anyone can be anything and anyone they want. It is amazing how many people lie about who they are and what they are, but that was happening long before the Internet, but I think it is safe to say the Internet really propelled that pathology forward by light years in just a couple decades. Why would someone do that?
Well we like to think a person just feels bad about themselves, low self-esteem, etc etc, yes that is true, that why people brag and boast. But it is deeper than the everpresent low self esteem. The reason the self esteem is low and the person is constantly lying trying to reinvent themselves, it isn't low self esteem, it is more that there is really nothing there on the inside at all, a big hole of emptiness in ones sense of self. The sense of self is a big lofty concept, but it also sounds quite simple. It is our sense of reality of ourselves and the world around us. It is our sense of who and how and what we are in the world and how the rest of the world (people) relates to us. That is our so called "ego-strength". The more developed ones ego strength the better they can cope relate and navigate through the world. Now when someones ego is developed in a healthy way, it gets really sophisticated in that when that is developed the next thing that develops is a sense of right and wrong, in reference to the world and others. Unless you have a true sense of self, a sense of right and wrong the so called "super-ego" can't really develop. How we relate to others in the world is our so called "object relations". Pretty much all these things start to develop and build upon one another from the time a person is coming out of the womb. an infant has no sense of self, they pretty much think the mother and they are the same thing for the first few months of life. no separation, no boundary. Pretty much everyone figures out they are a separate entity, right. To psychologically separate is a lot harder and a longer process through the early years.
What does all this have to do with the anonymity of the Internet and social media and cyberbullying and teens? Well the teenager struggles with their identity, their ego there sensee of self. They learn to think abstractly,  they have to figure out how to go from childhood to adulthood. The have to figure out how to use their super-ego (The sense of right and wrong) if they ever developed it ( comes FROM the PARENTS) to get through the world. Every teen struggles with identity and sense of self, it is a growing period. It is all based upon how things went in those first ten or twelve years of life.
We hear the old adage"he is she is basically a good kid- he or she just got into the wrong crowd" Well hears news, Every kid is basically a good kid, no one ever asked to be born right?
so since every teen struggle with their sense of self and identify, isn't it cool to have the Internet and facebook and YouTube and myspace and this and that and the other thing to help facilitate that? You can be whoever you want, who cares, it's really right? Well virtually anyway.
you could see how the anonymity and the flip side of the coin VIRTUAL INTIMACY and connection really helps the old psychological developmental process along in the teenage years.  Oh and it is really immediate and convenient too. But it is just you and your computer, or laptop of iPhone or whatever, and you are pretty much cut of from developing and sense of object relations or really how to get along or connect with other people when it is so important to refine in those developmentally turbulent adolescent years. Just the kid and his keyboard hmmm, sounds pretty powerful and omnipotent doesn't it. Well at least virtually. Hmm with that in place why would there not be cyberbullying? Throw in the communication issue, (the only form of human connection be it physical, spiritual, intellectual, or virtual communication it is connection, but what about virtual?

NB: when I use the term omnipotence or all powerful, (sitting at the keyboard), it may be derived from then anonymity, or that bubble or shell around the person, it is the same concept as why some people are outrageously aggressive people when they drive, Road rage etc. There is a false sense of power and security being in a car and as such the keyboard and the Internet.

Wednesday, October 13, 2010

antidepressants and suicide

Popular hype. do they increase risk of suicide? Not a new concept, been around since antidepressants were around. Yet some seem to find antidepressants more sinister than depression, schizophrenia, ptsd, hmmm they all have an increased risk of suicide right. Generally untreated mental illness can have a fatal outcome. Sometimes it is just really debilitating, and causes a lot of suffering.
so we have mixed reviews on antidepressants, some studies showing a slight increase in suicidal risk when on these meds.
Here is a fact, meds are not there to hurt people or make them worse or make somebody kill themselves.
There is very little data on if and how many lives antidepressants save. I mean think about it, how can we really research that.
Not to mention the fact that there is more media hype on the dangers of antidepressants than on the fact that alcohol is associated with most completed suicides.
So the meds prescribed by doctors to actually prevent suicide may increase the risk, even a little bit?
First of all if they were truly dangerous, would not your wonderful Federal Government that we all know love and trust pull them from the market??
Lets say you are a liberal and you love big government, you have a nice 401k and cheap or free health insurance, you have enough money to afford to be liberal, generally speaking, you by default hate doctors, are suspicious and mistrusting of them and perceived authority and you really groove on the concept of these meds being dangerous prescribed by mean non-caring doctors, okay fine, but you love government, and generally vote in the direction of bigger government. If that was the case, think about it, WOULDN'T THE GOVERNMENT PULL THESE MEDS OFF THE MARKET IF THEY WERE TRULY DANGEROUS???? oh sorry I forgot it is the big bad drug companies that are out of control, and the government just has to control them better?
Well you see all the political issues involved here.
Anyways, since the government put out stern warnings on suicide risk of these meds in people under say 24 years old, it scared the hell out of doctors and the teen suicide rate has been climbing ever since. SAD. Doctors afraid to treat, afraid of getting blamed and sued? Maybe who knows.
What is known clinically and generally still accepted is this, when you start and antidepressant the vegetative signs of depression improve before the cognitive signs. Generally in the first couple weeks.
This means a person with depression responding to antidepressants gets their energy back before there sad hopeless suicidal thinking improves. So they actually get enough energy in those first few weeks,  to kill themselves. A risky time. Not new, been around and clinically known like forever, The patient must be monitored closely in those first few weeks. Something your health care reform does not like much. The suicidal thinking does improve for many, if not most people that are depressed and get adequately treated. That is assuming you have the CORRECT diagnosis of major depression , the person is sober, and actually following a treatment plan prescribed, hopefully by a physician. It also helps for the person suffering to have a decent psychotherapist,  that does not have a chip on their shoulder about meds and psychiatry, and actually some understanding of the expectations and limitations of meds, and not just what they read on the internet or heard on TV. See my earlier blogs.
What if these meds really were meant to help people, actually saved some lives, and were prescribed by doctors who knew how to diagnose and treat and had their patients best interest at heart and were trying to help them because that was their profession and their vocation and that's what they do all day? That is just no fun to believe? Or we actually know better than that, cause we do.
I just wish we did not want to have are cake and eat it too. If we could just take these medications seriously for a minute, we devalue them, yet evetrybody wants to prescribe them with a minimal amount of training. So which is it? And yes we all know many terrible stories, of the bad med and the bad doctor and the terrible things that happened because of the meds. There are 100 of those stories to one, wear somone actually is allowed to speak out on how medicaiton actually helped them.
And no meds are not the panacea. no one is saying that. Frankly they have profound limitations but they actually do save lives whether we want to admit that part or not.

Friday, October 8, 2010

Some things you may not know about antidepressants.

Antidepressants have been around for fifty years. The first one was imipramine. How they work on the brain and central nervous system has not really evolved  much over the last fifty years. Our understanding of why and how they work has evolved, and the bottom line is we still don't know exactly why or how they work. They tend to effect neurotransmitters in the brain, that is the chemical connections between nerves. The three big neurotransmitter we know the most about are serotonin, norepinepherine and dopamine. The old and most of the newer antidepressants inhibit reuptake of these neurotransmitters into the pre-synaptic nerve. The original theory on why they work was related to the fact that you kept more serotonin or norepi around and this somehow helped treat depression.
Then in the 80's, 90's and into this century more attention was paid to the area on the nerve cell where these chemicals bind to. The so-called synaptic neuroreceptor.
For a long time it was felt that because you kept more of the neurochemcial around and it moved forward from the presynaptic to post synaptic nerve site, that somehow the neurorepceptors got desensitized or "downregulated".
Over the last 10 years the theory has evolved even more as to why these things work to treat depression and many anxiety disorders.
Now the science has led us to believe that the binding of the neurochemical (caused by keeping more of the chemical around) cause changes within nerve cell and somehow this affects the genetic coding of proteins within the cell, (remember RNA and DNA?) and somehow this causes an uptick or a positive swing in encoding for proteins within the cell that help protect the cell and treat the depression or anxiety problem.
The theory continues to evolve.
Some other facts- most antidepressants are prescribed by primary care physicians, internists, obgyns, and even pediatricians. Yes psychiatrists prescribe them all the time, but there are a lot less psychiatrists, and in terms of total volume of scripts, more come from primary care.
For many reasons, culturally speaking, it is much more socially acceptable to be depressed now. We are more open to talking about it and being aware of it. Depression is still debilitating and potentially fatal and we have a long way to go. Primary cares screen for it better now.
Within the demise and so called restructuring of the health care system in this country, there is much buzz and initiatives to screen earlier, treat and be aware of depression and its consequences.
The problem is now in screening for it, there is a tendancy to diagnose most mental health problems and simplify them simply into depression. The screenings will pick up symptoms of depression, but often not the specific and primary mental health problem. for examply Bipolar disorder (horribly misdiagnosed) and often missed and PTSD or post traumatic stress disorder, to name just a couple.
There are a whole host of antidepressants out there, the SSRI's which were developed back starting in the 80's with prozac, then in the 90's and into this century. Zoloft, Paxil, Luvox, Celexa and Lexapro.
The SNRI's which stands for selective noradrenergic serotinergic reuptak inhibitors, Effexor, Cymbalta, Pristiq. Basically these work pretty similarly to the old imipramines and elavils of the 60's and 70's, with a couple huge differences. The newer ones have way less side effects, and they are not so lethal alone in overdose. They are also felt to be more effective by many, compared to the old ones, -which may be a product of the fact that they are eaiser to take and tolerate and stay on since the side effects are better. The key to antidepressants working, is staying on the meds. They don't work if you don't take them.
Antidepressants have been used to treat chronic pain almost for thirty years. It was generally off label meaning the FDA did not approve or recognize these things in use for chronic pain. Then the popular media campaign came that "depression hurts" and cymbalta being approved for various pain problems a few years ago. Sometimes they really work well and sometimes not for chronic pain.
You do get more physical aches and pains and such if you are depressed. That is not new and has been known like forever in the medical world, well at least the psychiatric medical world.
Antidepressants are not there to hurt a patient or make them worse, and they do save lives. We are taught as a society to be afraid of them, suspicious of them and wary of them. Popular culture and media and the government regulation and subsequent media fiascos make this worse.
Conversely we are also taught and expect that these meds are a panacea, a cure a fix it all for all of our emotional and psyhoclogical pains. That simply isn't true. But with those two polar ends of the spectrum suspicion, fear,  and an attitude of this "should fix everything', you have the perfect storm.
There are many other antidepressants out there I did not mention, so that block certain receptor sites like Remeron and Serzone and Trazedone. They have also been around for years. Wellbitrin tends to block reuptake of dopamine and norepi. Some people generally like Wellbutrin becouse it does not affect weight gain like some of the others can. It sometimes does not work so well for anxiety symtoms often associated with depression.
There is a ton of information on antidepressants on the Internet. We tend to love the devaluation of them, and when we find a negative article on them we like to say "Aha I knew it" as if they are bad and there is some awful conspiracy. Some psychiatrists have even made a cool name for themselves in devaluing them. Very politically correct. We also tend to devalue them in this way:
Think about it: the average family doctor has a few weeks of training in psychiatry but they prescribe the most antidepressants.  Non-physicians prescribe them- nurses practicioners, in most states and also psychologists want to prescribe them and in a couple states they are actually legally allowed to.
 We convince ourselves that is all okay. It is not. This comes from the shortage of psychiatrists. Most doctors don't want to go into psychiatry. For a lot of reasons. It is very little pay compared to most medical specialties, with health care reform that will only get worse. Also people don't always get better, it takes a long time and a lot of psychiatric problems tend to be chronic and recurring.
so you will see more unqualified and marginally qualified people prescribing and treating psych disorders.
The sell-out blogs jump on the politically correct bandwagon of supporting psychologists and the so-called mid-level practitioners, prescribing, as well as non-psychiatric physician. With that comes an underlying devaluation of psychiatry in general. You are not allowed in this day and age to even consider that maybe a specialist in psychiatry should be treating many psych problems out there. That is so politically incorrect, you get lambasted and you are very unpopular, so most doctors can't even speak up any more. It is just the way the world is. But with the sort of disdainful reduced attitude towards psychiatry and mental health issues in general, and the lack of accurate information that is truly disseminated, it is easy to see why we are so wary of psych treatment.
Before I get hate mail yes there are good nurse practicioners out there, just like there are good physicians out there.
Generally the popular buzz is "doctors don't talk to their patients, but nurses do". I am sure that is true in some case, but we like to convince ourselves that this is the norm. It is probably going to get worse with health care reform.
Antidepressants are used in Alzheimer's, People with AD can get depressed, it make the AD worse. They often can't articulate it to us, becouse of the dementia, so it is often overlooked. You generally have to use much smalled doses of antidepressants in the elderly (like any med) sometimes if not carefully prescribed or prescribed wrong they can make things worse, and if diangosed right and carefully monitored they can help tremendously.
There is much more to talk about with antidepressants, the suicide issue (horribly misunderstood) side effects, target effects, (what they are actually supposed to do. All of the natural remedies, (chemicals also like the meds) they are a financial; boom to many and severly unregulated, but as a fairly uninformed society or shall I say misinformed, if we hear the world "Natural" we are profoundly reassured.  Stay tuned.

Talking about the book with the Lake Superior wind....... a calm day