Working Remotely,Part Deux

Working Remotely, Part Deux

Last week I discussed some of the more personal issues I’ve noticed in remote workers, aka digital nomads, and made some suggestions (lectured?) on some things they should be doing for themselves in order to help ensure a better, more fulfilling life. As a global workforce, ‘rona allowed us, or forced us, depending on your point of view, to embrace the remote work concept. So much so, that many companies are progressively implementing it into their current strategies, and/ or incorporating it into their expansion plans. But given my profession, I have to ask, how psychologically healthy is it? It seems to me that as it stands in some companies now, not very. But certain personality types are somewhat uniquely suited to remote work, and thrive in the independence associated with it. Even if you aren’t necessarily one of them, humans are supremely adaptable beings. The questions then become, are you a person that could be happy working remotely, or could you make it work for you? 

Many of my patients say remote work has been an answer to their most ardent prayers. But a disturbing proportion of them say it through a mouth of unbrushed teeth, from a face covered with scraggly unshaven beard, and topped with a head of tangled unkempt hair, so I’m just not buying what they’re selling. So what’s up with that? Why are some digital nomads, who are usually neat and tidy, suddenly messy and… messy?! The answer is deceptively simple: they’re SAD. Stressed, Anxious, and Depressed. But why, when most people’s greatest wish, to 🙌👼🏼work from home👼🏼🙌 has suddenly been granted? Can you hear the angels sing? Visual sound effects! I’m absolutely positive that it might become a thing. 

Well, as with so many things in life, the remote work format is like an equation, with positives and negatives to take into account. In order to know if it works for you or not, you have to know the factors involved in order to effectively evaluate them. Today will basically focus on the more negative side of that equation, and some of the reasons why some people might feel SAD, even though they 🙌👼🏼work from home👼🏼🙌 Just wanted to test them to make sure they still worked. 

I know I make a lot of jokes, maybe as the result of a coping mechanism that morphed into a habit, but there can be real and unanticipated mental health consequences as a result of the stresses associated with working remotely, and it is important to be aware of this fact. I should also note that it’s equally important to remain aware of it, as sometimes it can seemingly sneak up on you, or can even be a building phenomenon. While they can have a serious impact on mental health, these effects can also be very subtle, or happen within a dynamic and fluctuating range. The best idea if you start to notice that working from home is bumming you out, is to make some changes to improve your situation right away, because you don’t get extra points for spending more time miserable. Toward that end, next week’s blog will discuss some solutions to the issues I’ll be posing here today, along with the positive side of the remote work equation.

The Work Experience

Clearly, the actual experience of working from home is very different from doing so in a public office. But it also differs amongst each person who works remotely as well. On a basic level, the work experience is vastly different, because the quality of the home working experience largely depends on the home. Captain Obvious says it’s a much better experience for people that have dedicated rooms within their homes than it is for people in small apartments, or those who share homes, and therefore have to work in their bedrooms. Please note the five extra letters denoting the compound word- bedrooms– not beds, people. At any rate, companies must consider what they can do to help even that playing field a bit, if they want to improve productivity in a remote work situation for all of their employees. 

Tech No!

Another huge difference in the remote work experience comes into play when we talk about technology. When it doesn’t work at home, it’s a bigger problem than when that happens at the office.  One specific concern focuses on the speed of technology- or lack thereof- when working remotely. Most organizations demonstrated great agility in switching to remote working nearly overnight, but it’s common knowledge that technology never works as well remotely as it does in an office, where it’s laced together with high-tech cabling and hardware. Here in the good ole US of A, if our wi-fi drops out, we feel pretty indignant, but in some places on the planet, just getting a good enough signal to even access the internet can be challenging enough. It may not sound like a big deal, but internet connectivity is important, because it’s how technology talks. As a human, if you’re speaking with someone, and they choose not to respond for ten or fifteen minutes, or not at all, that would be frustrating, no? Especially if it happened all. the. time! All. day. everyday! That’s why connectivity is a big deal when working remotely; because the lack of it is very frustrating to humans, especially when we’re working. 

If you’re working from home and faced with problems with wi-fi or getting a decent signal, it’s usually a persistent and pervasive issue. Because it can extend timelines and destroy deadlines, it affects your everyday business, and sometimes can even affect your employment. All of that of course impacts your stress levels, so you can’t really afford to underestimate it. The short answer solution is that you have to do whatever you can to mitigate the issue. Communicate with your supervisor, if you have one, and call whomever you need to call to have the issue resolved. Captain Obvious says your supervisor has a vested interest in making sure you’re adequately equipped, because they want you to get your projects done too. Or build an office entirely out of wi-fi hotspots and boosters, and maybe wear a tin foil hat. You decide. 

No Ball

No matter where you are, if your computer decides it doesn’t want to play ball, forget feeling indignant, we feel screwed. If you’re from a conventional office environment, and now working from home, any tech problems you may have probably won’t get resolved as quickly off site as they would in the office, and unfortunately, that can make it difficult- even impossible at times- to work remotely. The time it takes the IT software and people to diagnose and fix any issues further disrupts processes and extends timelines, adding to everyone’s frustrations. That’s if you even have IT people, people. If you’re the IT department, president, and janitor, that makes it a little more frustrating, and time consuming, to solve tech issues. Because bringing the office home depends so much on remote technology, when you multiply networking issues by slow running apps and software, working from home can equal big tech stress. 

MicroManagement

But it’s not just IT that has a long road to hoe in the remote work equation. Management also has to make big changes if the remote work equation is going to balance, because you can’t manage people the same way if you’re not with them. If nothing else, ‘rona proved to management that most employees do have the capability to adapt to remote work, and fairly productively and effectively, to boot. But in reality, management and supervisors themselves have to adapt as well. For it to work effectively, they have to learn to trust and enable their staff, rather than interrogate and demand. One of the biggest complaints I hear from employees is that while working remotely, they sense an implied, or sometimes more direct, mistrust from supervisors and management. They feel like every minute must be accounted for, like they have to prove they were working during the day, not just watching television or doing their nails. That said, one of the biggest complaints I hear from supervisors and management types about working remotely, is that they suspect that their employees are taking advantage of a remote work arrangement. I wonder if maybe they suspect they’re watching television or doing their nails instead of working?

This dichotomy would be funny, if it didn’t have the capacity to be so inherently stressful and anxiety producing in all parties involved in the equation. I think the concept of how to manage a person you’re not watching poses interesting psychological questions. When you feel like you’re “losing control” over something, or someone, a natural human response is to grip it tighter; evolution has built that into our brains. In a remote work environment, when a supervisor can’t see what an employee is doing for eight plus hours every day, that equates to the dreaded micromanagement. And in the minds of the employees or people being supervised, that often comes across as suspicion, and can feel accusatory. Taken together, this tends to breed mistrust; and so the problem begins. If the problem sounds complicated, imagine the solution. Personally, I can easily see both sides of this issue, but I know that traditional management methods aren’t the answer to a modern remote work problem, and that for the equation to balance long term, we have to take big strides on the road toward improving the remote work experience for everyone.

Isolation and Loneliness

As I mentioned briefly last week, isolation and feelings of loneliness are among the most commonly reported issues that remote workers face. While working remotely has some benefits, like allowing you to effectively bypass distracting and/ or annoying coworkers, it also prevents you from sharing pleasantries with your boss, clients, and the coworkers you doenjoy camaraderie with. You miss out on the more social aspects of traditional work life, like water cooler venting, office gossip, and bouncing ideas off of one another. These interactions simply don’t translate to tech like Zoom very well, and this lack of interaction between coworkers can be a detriment to team building and corporate culture. In a prolonged state, such as occurs in a remote work environment, this disconnectivity contributes to isolation and loneliness in individuals, and is associated with higher rates of anxiety and depression, as well as somatic symptoms, such as headache and generalized body pain.

If you’re a person who is already accustomed to, and appreciative of, conventional office life, and the steady rate of social interactions at work, the effects of switching to remote work might have a surprising effect, because our daily interactions help us reinforce our sense of well-being and belonging in a community. Researchers have demonstrated that loneliness as a result of isolation is actually twice as harmful to physical and mental health as obesity. One study I read found that 19 percent of people who work remotely report loneliness; and as with many such conditions or feelings, this poses a bigger risk when it becomes chronic. As you can imagine, people who not only work remotely, but also live alone, are especially at risk for feeling lonely, though I certainly see a fair amount of it in digital nomads who live with others. 

Burnout

Working from home can also feel like never leaving work, and another commonly reported cause for concern is burnout. I read a 2019 US study that polled remote tech workers. It found that 82 percent reported feeling burned out, 52 percent reported that they believed they work longer hours than their in-office counterparts, and 40 percent reported feeling as though they were required to contribute more than their in-office counterparts. These points are very common themes that people considering remote work, and new to remote work, should definitely keep in mind. In my experience with patients, this near compulsion to work longer hours is almost universal. I assume it’s the result of attempts to prove their ability to be productive from home, despite the presence of distractions and the availability of “extracurricular” activities that can accompany working from home. 

For many people, it’s already difficult to maintain a healthy work-life balance when working from an office, and it seems that this is also the first thing to go when work goes remote. The lines start to blur, and every hour in a day becomes a work hour. If you’re behind on a project, you figure you can afford to spend the “extra” hours in your day on completing it. But not for long. After a much shorter period of time than you’d think, that becomes a dangerous practice. Five minutes for one more email becomes hours, and when you stop to look up, you’ve spent far too long working, and you haven’t moved for 13 hours. My response to burned out, remote workers is to remember that home is also your office now, so you’re not really leaving work unless you turn off all communication platforms. You have to make a concerted effort to leave work, just as you would if you worked in an office. So just as you would walk out the office door about nine hours after you walked in, when you’re working from home, you turn off the devices after about the same amount of time…or else risk the ravages of burnout. Besides, when you’re mentally and physically exhausted, you’re not at your sharpest, not doing your best work, and you’re bound to make mistakes. 

Focus, Motivation, Distraction

Any number of factors in a remote work situation can make you lose focus and motivation, and chief among them are distractions. These are the things, intended or not, that distance you from your work. But the reverse is also true. When you’re not focused and motivated, it’s easy to fall prey to the siren’s call of distraction. Remember last week, I said that just because the refrigerator is a short distance away, that doesn’t mean you should constantly make the trip? Eating can be a distraction you act on when you’re bored. If snack o’clock happens every hour, or you’re having multiple versions of lunch, you’re distracted, or maybe looking for something- anything- to do, other than work. When you’re working remotely, you have a lot of freedom, which is generally a good thing in life. But understand that distraction is really the blacksheep cousin to burnout, and it’s all too easy to get sidetracked by it. 

Some other favorite classic distractions include wanting to sleep in, kids, myriad chores, online surfing and social media, calling friends or vice versa, pets thinking playtime is whenever you’re breathing, and good weather tempting you to ditch work and go to the beach, mall, spa, movies, etc. It’s easier to become distracted because you may be the only one managing your time, and this is one of the big reasons why people may not be as productive at home as they would be in a traditional work setting. It’s also the biggest reason why employers and management don’t generally like the idea of working remotely. While it might seem that the only way to be a successful remote worker is to be a self starter with superhuman focus who is impervious to distraction, there are ways to manage distraction, focus, and motivation. I’ll get into all of that next week, but here’s a hint until then: having a door to shut is an incredibly helpful head start. 

Inconsistent Pay

Working remotely can also be stressful because of the inconsistent wages that may be associated with it. The term freelancing is the one most commonly used for positions of this type, though you may better recognize the alternative terminology of independent contractors. It essentially means that they are self-employed, rather than being directly supervised or employed by someone else; as a result, they typically follow a remote arrangement. No matter what you call it, when you compare freelance work to a regular full-time job, there are some important distinctions. In a regular job, you know that no matter what happens, you’ll be paid (at least) the same amount each month; and since you took the job, I can only assume it’s sufficient to cover whatever bills it’s supposed to. But with freelance positions, because getting paid is typically based on contracts and invoices, payments can be pretty variable, and you don’t have any guarantees that your invoices will be paid on time. If the payor is unreliable, or decides to dispute, you have to expend time, and sometimes even money, to collect. Understandably, these variables and unforeseen complexities can result in cash flow concerns, and we all know that can lead straight to stressville. Not only is income variable, but workload is too. The temporary, variable, too much or too little nature of freelance assignments is intensely anxiety producing, and can wreak havoc with your sense of well-being.  

Communication

Communication with coworkers, supervisors, and clients can be a minefield, as things can easily be misconstrued under the best of circumstances. In a remote work arrangement, when you often keep in touch through non-visual methods like email and instant messaging, communication is further complicated, and this can have some very unwanted effects. Fortunately or unfortunately, depending on how you look at it, the amount of damage that can result from ineffective communication falls along a spectrum, from “uh oh” to “oh no!” One big problem in general, not just in a work setting, that may serve you well to remember, is that you can’t really get a sense of a person’s tone via typed electronic communication, because they can’t read facial expressions or hear your tone of voice. To the recipient, words read the same way regardless of whether you were smiling or yelling when you typed them. I can’t tell you how many times I’ve heard a complaint from a patient start with, ‘And then he texted…’ because instant messaging, while convenient, can also be a recipe for instant miscommunication.  

In a work setting, most tone concerns have to do with accuracy; that the words you’re using are literally sending the right message. Do you have a tendency to be very lighthearted and positive, and therefore potentially at risk for sounding like perhaps you’re not serious enough about a certain topic with a client? Or maybe you have a tendency to be sarcastic and risk that same issue? You might be most vulnerable to this when the person doesn’t really know you, or in circumstances where you may be sending an instant message you don’t give as much thought to as you would a more formal email. As you might imagine, these are situations where the smiley face in cool shades emoji doesn’t really cut it. 😎

Probably the most common communication issue I hear about is the lack of communication. Just as with the tech issue I mentioned previously, when a coworker is unresponsive, humans get frustrated. And understandably so. When you need an answer, but the person you need it from is uncommunicative via whatever digital channels you try, it can pose a problem. In the office, you could simply visit that individual’s desk and see them in person, but in a remote setting, that’s not an option. Since it’s work, you may have a deadline to complete a project, so not having that answer might make it late, and that may have a negative impact on your reputation. It can be a gnarly domino effect, I get it. But I can tell you that the answer is not to sendthem a message you may regret later, because chances are very good that’ll have an even bigger impact on your reputation, than the original lack of communication on their part would’ve had. 

Another thing to keep in mind when communicating electronically is not to set yourself- or anyone else for that matter- up for disappointment, by asking questions that really can’t be answered satisfactorily via these methods. If you’re seeking appreciation or other “feelings” on job performance in a text, you’re nearly bound to read disappointment in the reply, whether it was intended or not. Save the sticky wickets for more personal communication methods, even if they’re not necessarily the easiest choice. While some sarcasm or jokes may be funny, some people may not think so, and that can lead to all sorts of misunderstandings that can have a serious effect on company culture, productivity, team dynamics, and relationships with coworkers, supervisors, and/ or clients. Remember that nothing dies on the net, and everything leaves a digital trail, especially in a remote work setting, so things can come back to bite you later. Lastly, I would suggest that you always think twice whenever you instant message someone in order to avoid instant embarrassment and instant regret, proofread messages to make sure nothing’s getting in the way of what you’re trying to say, and save the complicated stuff for face to face when possible, or at least for video chat when it’s not.

Next week, the working remotely blog continues- I’ll address some solutions to all of the issues I mentioned today, and then I’ll tell you about the positive side of the remote work equation.

I hope you enjoyed today’s blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!

Please feel free to share the love and send blogs and YouTube videos to family and friends. 

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And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them! 

As always, my book Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon. 

Thank you and be well people!

MGA

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The 15 Scariest Mental Disorders of All Time

The 15 Scariest Mental Disorders of All Time

Imagine having a mental disorder that makes you believe that you are a cow; or another that you’ve somehow become the walking dead. Pretty freaking scary, eh? Well, while relatively rare, these disorders are all too real.

Worldwide, 450 million people suffer from mental illness, with one in four families affected in the United States alone. While some mental disorders, like depression and anxiety, can occur organically, others are the result of brain trauma or other degenerative neurological or mental processes. Look, having any mental illness can be scary, but there are some disorders that are especially terrifying. Below, I’ve described the 15 scariest mental disorders of all time.

‘Alice in Wonderland’ Syndrome

In 1865, English author Lewis Carroll wrote the novel Alice’s Adventures in Wonderland, commonly shortened to ‘Alice in Wonderland.’ Considered to be one of the best examples of the literary nonsense genre, (seriously, who knew they even had a nonsense genre?) it is the tale of an unfortunate young girl named Alice, who falls through a rabbit hole into a subterranean fantasy world populated by odd, anthropomorphic creatures. That’s your vocabulary word for the week… anthropormorphic. Popular belief is that Carroll was tripping when he penned it. Regardless if that’s true or not, what is true is that one of Alice’s more bizarre experiences shares its characteristics with a very scary mental disorder. Also known as Todd Syndrome, ‘Alice in Wonderland’ Syndrome causes one’s surroundings to appear distorted. Remember when Alice suddenly grows taller and then finds she’s too tall for the house she’s standing in? In an eerily similar fashion, people with ‘Alice in Wonderland’ Syndrome will hear sounds either quieter or louder than they actually are, see objects larger or smaller than what they are in reality, and even lose sense of accurate velocity or textures they touch. Described as an LSD trip without the euphoria, this terrifying disorder alters one’s perception of their own body image and proportions. Fortunately, this syndrome is extremely rare, and in most cases affects people in their 20’s who have a brain tumor or history of drug use. If you need yet another reason to not do drugs… well, there ya go. 

Alien Hand Syndrome

While most likely familiar from cheesy horror flicks, Alien Hand Syndrome isn’t limited to the fictional world of drive-in B movies. Those with this very scary, but equally rare mental disorder experience a complete loss of control of a hand or limb. The uncontrollable body part takes on a mind and will of its own, causing sufferers’ “alien” limbs to choke themselves or others, rip clothing off, or to viciously scratch themselves, to the point of drawing blood. Alien Hand Syndrome most often appears in patients suffering from Alzheimer’s Disease or Creutzfeldt-Jakob Disease, a degenerative brain disorder that leads to dementia and death, or as a result of brain surgery separating the brain’s two hemispheres. Unfortunately, no cure exists for Alien Hand Syndrome, and those affected by it are often left to keep their hands constantly occupied or use their other hand to control the alien hand. That last one actually sounds even worse- one unaffected arm fighting against the affected arm that’s trying to tear into the person’s own flesh. Yikes. 

Apotemnophilia

Also known as Body Integrity Disorder and Amputee Identity Disorder, Apotemnophilia is a neurological disorder characterized by the overwhelming desire to amputate or damage healthy parts of the body. I recall a woman with Apotemnophilia making worldwide news ages ago when she fought with her HMO to cover the amputation of one of her otherwise healthy legs. Good luck; they don’t even cover flu shots. I remember I was pretty shocked that she found a surgeon to agree to do the amputation in the first place, as it seemed to me that might violate that little thing called the Hippocratic Oath us docs took when we got our medical degrees, specifically that part about ‘do no harm’… and sparked a debate about the ethical dilemma of treating or “curing” a psychiatric disorder by creating what is essentially a physical disability. Though not a whole heck of a lot is known about this strangely terrifying disorder, it is believed to be associated with damage to the right parietal lobe of the brain. Because the vast majority of surgeons will not amputate healthy limbs based purely upon patient request, some sufferers of Apotemnophilia feel forced to amputate on their own, which of course is a horrifying scenario. Of those who have convinced a surgeon to amputate the affected limb, most say they are quite happy with their decision even after the fact.

Boanthropy

Those who suffer from the very rare- but very scary- mental disorder Boanthropy believe they are cows, and usually even go so far as to behave as such. Sometimes people with Boanthropy are even found in fields with cows, walking on all fours and chewing grass as if they were a true member of the herd. When found in the company of real cows, and doing what real cows do, people with Boanthropy don’t seem to know what they’re doing when they’re doing it. This apparently universal finding has led researchers in the know to believe that this odd mental disorder is brought on by possible post-hypnotic suggestion, or that it is a consequence of dreaming or a sleep disturbance, sort of kin to somnambulism, aka sleepwalking. I can buy the sleepwalking thing. I have a patient that is a lifelong sleepwalker who sleep-eats, sleep-cleans, sleep-cooks, sleep-destroys, sleep-online-shops, sleep-everythings. Some mornings she wakes up to very unpleasant findings of the house in total disarray, electronics dismantled and improperly and ridiculously fashioned together, every piece of furniture moved or a sink full of dishes and pots and pans with dried up food in them. Before setting up prevention measures, she even had single episodes of adult sleep-driving, and even sleep-biking at (eek!) age 9. In the middle of the night, her mother awoke to what she thought was the big garage door opening, and when she went to check, she saw her coasting out of the driveway on her bright yellow bike, heading right toward a very busy highway. She always has zero recall of the events afterwards. If she can do all of that while essentially sleeping, it would be comparatively easy to wander out to a pasture on all fours and stick around to munch on some grass. Curiously, it is believed that Boanthropy is even referred to in the Bible, as King Nebuchadnezzar is described as being “driven from men and did eat grass as oxen.” Or was it King Nemoochadnezzar? No? Okay, moooving on…

Capgras Delusion

Named after Joseph Capgras, a French psychiatrist who was fascinated by the effective illusion of doubles, Capras Delusion is a debilitating mental disorder in which a person believes that the people around them have been replaced by imposters. As if that’s not bad enough, these imposters are usually thought to be planning to harm the sufferer. It really sounds like a bad Tom Cruise movie. Oh, wait; that’s redundant. Anyhoo, in one case, a 74-year-old woman with Capgras Delusion began to believe that her husband had been replaced with an identical looking imposter who was out to hurt her. Fortunately, Capgras Delusion is relatively rare, and is most often seen after trauma to the brain, or in those who have been diagnosed with dementia, schizophrenia, or severe epilepsy.

Clinical Lycanthropy

Like people with Boanthropy, people suffering from Clinical Lycanthropy also believe they are able to turn into animals; but in this case, cows are typically replaced with wolves and werewolves, though occasionally other types of animals are also included. Along with the belief that they can become wolves and werewolves, people with Clinical Lycanthropy also begin to act like the animal, and are often found living or hiding in forests and other wooded areas. Didn’t Tom Cruise play a werewolf in one of his many (vapid) movies? Or was it a vampire? Werewolf, vampire – tomato, potato.

Cotard Delusion

In a case of life imitating art, or life inspiring art, we have Cotard Delusion. In this case, the ‘art’ is zombies, a la The Walking Dead. Oooh, scary! For ages, people have been fascinated by the walking dead. Cotard Delusion is a frightening mental disorder that causes the sufferer to believe that they are literally the walking dead, or in some cases, that they are a ghost, and that their body is decaying and/or they’ve lost all of their internal organs and blood. The feeling of having a rotting body is generally the most prevalent part of the delusion, so it doesn’t come as much of a surprise that most patients with Cotard Delusion also experience severe depression. In some cases, the delusion actually causes sufferers to starve themselves to death. This terrifying disorder was first described in 1880 by neurologist Jules Cotard, but fortunately, Cotard’s Delusion, like good zombie movies, has proven to be extremely rare. The most well-known case of Cotard Delusion actually occurred in Haiti, circa 1980’s, where a man was absolutely convinced that he had previously died of AIDS and was actually sent to hell, and was then damned to forever walk the earth as a zombie in a sort of pennance to atone for his sins. 

Diogenes Syndrome

Diogenes Syndrome is a very exotic name for the mental disorder commonly referred to as simply “hoarding,” and it is one of the most misunderstood mental disorders. Named after the Greek philosopher Diogenes of Sinope (who was, ironically, a minimalist), this syndrome is usually characterized by the overwhelming desire to collect seemingly random items, to which an emotional attachment is rapidly formed. In addition to uncontrollable hoarding, those with Diogenes Syndrome often exhibit extreme self neglect, apathy towards themselves or others, social withdrawal, and no shame for their habits. It is very common among the elderly, those with dementia, and people who have at some point in their lives been abandoned or who have lacked a stable home environment. This is likely because ‘stuff’ never hurts you or leaves you, though most people with the disorder are unlikely to be able to make that connection. Fortunately or unfortunately, depending on how you look at it, this disorder is much more common than some of the others I’ve mentioned here.

Dissociative Identity Disorder

Dissociative Identity Disorder (DID), is the mental disorder that used to be called Multiple Personality Disorder. Another disorder that has inspired a myriad of novels, movies, and television shows, DID is extremely misunderstood. Generally, people who suffer from DID often have 2-3 different identities, but there are more extreme cases where they have double digit numbers of identities. There was a “reality” show a few years ago that centered on a young mother of two that supposedly had like 32 distinct personalities. All of them had names and ranged from a five-year-old child to an old grandpa; and according to her, a few of them were homosexual while the rest were not, so she was required to be bisexual. She claimed that many of the personalities knew everything about all of the others, and they would get mad at or make fun of the others at various times. What’s more, she would “ask” other personalities to come forward so that producers could ask them questions for the camera’s sake, and her voice and mannerisms changed, depending on the different characteristics of the personalities. It was all pretty difficult to buy to be honest, because I’ve seen a lot of people with DID, and none seemed like they were having as much fun with their illness as she did. In true DID cases, sufferers routinely cycle through their personalities, and can remain as one identity for a matter of hours or for as long as multiple years at a time. They can switch identities at any time and without warning, and it’s often nearly impossible to convince someone with DID that they actually have the disorder, and that they need to take medications for it. For all of these reasons, people with Dissociative Identity Disorder are often unable to function appropriately in society or live typical lives, and therefore, many commonly live in psychiatric institutions, where their condition and their requisite medications can be closely monitored. 

Factitious Disorder

Most people cringe at the first sniffle indicating a potential cold or illness, especially these days, but not those with Factitious Disorder. This scary mental disorder is characterized by an obsession with being sick. In fact, most people with Factitious Disorder intentionally make themselves ill in order to receive treatment; and this is what makes it different than hypochondria, a condition where people blow mild symptoms into something they aren’t, kind of like if you cough once and automatically think you have covid-19. Sometimes in Factitious Disorder, people will simply pretend to be ill, a ruse which includes elaborate stories, long lists of symptoms, doctor shopping, and jumping from hospital to hospital. Such an obsession with sickness often stems from past trauma or a previous genuinely serious illness. It affects less than .5% of the general population, and while there’s no cure, psychotherapy is often helpful in limiting the disorder. 

Kluver-Bucy Syndrome

Imagine craving the taste of a book or wanting to have sex with a car. That’s reality for those affected by Kluver-Bucy Syndrome, a mental disorder typically characterized by memory loss, the desire to eat inedible objects, and sexual attraction to inanimate objects such as automobiles. I’ve seen a television documentary that featured people with strange fetishes, and they had two British guys that were sexually attracted to their cars. They gave them names and described their curves in the same manner that some men describe women. While one guy (supposedly) limited it to “just” caressing his car, the other actually also made out with his car; I’m talking about tongue and everything. Talk about different strokes! Because of the memory loss, not surprisingly, people with Kluver-Bucy Syndrome often have trouble recognizing objects or people that should be familiar. They also exhibit symptoms of Pica, which is the compulsion to eat inedible objects. The same wierd fetish documentary featured two young women that were “addicted” to eating weird stuff; one routinely ate her sofa cushions. She actually pulled the foam apart into bite sized pieces and ate them, many times a day. She became so used to doing so that she would get anxious if she went too long without eating it, so she started having to bring pieces of her sofa with her to work. I’m guessing she didn’t have to worry about co-workers stealing her food. She had started eating the cusions so long ago that she was actually on her second couch. Her family was so concerned about the potential medical ramifications of eating couch cushions that they made her see a gastro doc, who thought he was being punked when he asked why she was there. After imaging studies, she was in fact diagnosed with some intestinal issues and told to stop eating couch cushions, but the desire was too great for her to cease. She’s probably on her fourth couch by now. The other girl actually loved eating powder laundry detergent. She described the taste in the same dreamily excited way a foodie describes a chef’s special dish du jour. This terrifyingly odd mental disorder is difficult to diagnose, and seems to be the result of severe injury to the brain’s temporal lobe. Unfortunately, there is not a cure for Kluver-Bucy Syndrome and sufferers are typically affected for the rest of their lives.

Obsessive Compulsive Disorder

Though it’s widely heard of and often mocked, Obsessive Compulsive Disorder (OCD) is rarely well understood. OCD manifests itself in a variety of ways, but is most often characterized by immense fear and anxiety, which is accompanied by recurring thoughts of worry. It’s only through the repetition of tasks, including the well-known obsession with cleanliness, that sufferers of OCD are able to find relief from such overwhelming feelings. To make matters worse, those with OCD are often entirely aware that their fears are irrational, but that realization alone actually brings about a new cycle of anxiety. OCD affects approximately 1% of the population, and though scientists are unsure of the exact cause, it is thought that chemicals in the brain are a major contributing factor. I’ve discussed OCD and recounted OCD patient stories many times in this blog and in my book, Tales from the Couch.

Paris Syndrome

Paris Syndrome is an extremely odd but temporary mental disorder that causes one to become completely overwhelmed while visiting the city of Paris. Stranger still, it seems to be most common among Japanese travelers. Of the approximately 6 million Japanese visitors to Paris each year, one to two dozen of them experience the overwhelming anxiety, depersonalization, derealization, persecutory ideas, hallucinations, and acute delusions that characterize Paris Syndrome. Despite the seriousness of the symptoms, doctors can only guess as to what causes this rare and temporary affliction. Because most people who experience Paris Syndrome do not have a history of mental illness, the leading thought is that this scary neurological disorder is triggered by the language barrier, physical and mental exhaustion, and the reality of Paris as compared to the idealized version. Slam! I’ll bet the Paris Tourism Board hates to hear about this one! Huh houn, wee wee monsieur.

Reduplicative Amnesia

The Reduplicative Amnesia diagnosis was first used in 1903 by neurologist Arnold Pick, when he described a patient with a diagnosis of what we know today as Alzheimer’s Disease. It is actually very similar to Capgras Syndrome, in that it involves duplicates, but instead of believing that people are duplicates, people with Reduplicative Amnesia believe that a location has been duplicated. This belief manifests itself in many ways, but always includes the sufferer being convinced that a location exists in two places at the same time. Today, it is most often seen in patients with tumors, dementia, brain injury, or other psychiatric disorders.

Stendahl Syndrome

Stendahl Syndrome is a very unusual psychosomatic illness; but fortunately, it appears to be only temporary. The syndrome occurs when the sufferer is exposed to a large amount of art in one place, or is spending time immersed in another environment characterized by extreme beauty; probably one of those places that “takes your breath away.” Those who experience this scarily weird mental disorder report sudden onset of rapid heartbeat, overwhelming anxiety, confusion, dizziness, and even hallucinations. It actually sounds a lot like a panic attack to moi. Stendahl Syndrome is named after the 19th century French author who described in detail his experience after an 1817 trip to Florence, which is evidently a beautiful place. I have it on good authority that Stendahl Syndrome has never happened to any visitor to Paris, which, oddly enough is Stendahl’s country of origin. 

So, we’ve learned a lot today: that there is a nonsense literary genre, that there are a bunch of freaky and frightening mental disorders out there, that some people might need to look up the word anthropormorphic, that illicit drugs are bad for yet another reason, that a lot of terrible B movies are actually based on some pretty obscure mental disorders, that people with Boanthropy probably get a lot of fiber in their diet, that the lives of people with Capras Delusion sound a lot like a bad Tom Cruise movie, that the term “bad Tom Cruise movie” is redundant, that Tom Cruise probably has Clinical Lycanthropy, that Tom Cruise is a tool, oops, sorry, everyone already knew that. We also learned that there is no longer such thing as Multiple Personality Disorder; it is now called Dissociative Identity Disorder, that Kluver-Bucy Syndrome is threatening to couches, and that if you have Kluver-Bucy Syndrome, co-workers will never steal your lunch. We learned that Japanese tourists hate Paris, and that Stendahl Syndrome never happens there. And we learned lots of other cool stuff, but that if you have so much stuff that you can’t walk through your house you likely have Diogenes Syndrome, probably because you have a deep seated knowledge that stuff never hurts you or leaves you. 

Please check out my videos on YouTube- better yet, hit that subscribe button, and share them with folks. And as always, my book, Tales from the Couch has lots more information and patient stories on various psychiatric diagnoses and is available on Amazon and in the office. Be well, everyone!

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24/7 news Is Stressing Us Out

THIS JUST IN!

24/7 NEWS CAUSES ANXIETY! 

READ ALL ABOUT IT!

I remember when I was a kid, my family used to eat dinner after the news. The news used to be thirty minutes. People tuned in and heard about the church bake sale, the plumbing problem being fixed at the elementary school, road closings, and the weather for the next day, and then they moved on with their lives. In this modern age, we are instead constantly inundated with information. We are bombarded with news, 24/7 – 365. News from CNN, ABC, NBC, CBS, MSNBC, FOX, CNBC, Facebook, Twitter, Instagram, on and on. Even when you go to your email inbox it’s in your face. And it’s mainly negative. Why is this? Because negative gets a reaction. Positive news does not get a lot of attention, but negative news does. People react to it, so the news organizations push negative news. They sensationalize the negative, make it bigger, more fearful, more imposing. Until it raises the hairs at the backs of our necks. News that offends, insults, and shocks our sensabilities…that’s sensationalism.  This kind of news- sensationalism- lures viewers. This sensationalism sells. That equals ratings, which then equals advertisers. It’s a big circle. And you, the watchers, the viewers, you’re the target smack dab at the center of that circle. 

Today, when you turn on the news, you hear about more gun violence, another act of terrorism, a missing child, or a scary health epidemic, and it seems as if the world is getting smaller, but growing ever more frightening at the same time. I’m hearing more and more people tell me they’re finding it harder to feel calm in their day-to-day lives. They feel beleaguered by the never-ending cycle of bad news, and this changes them, changes how they feel about life; these changes range from having a constant low level sense of uneasiness all the way to having full-blown anxiety disorders. The persistent sense of worry is joy-robbing at the very least, and debilitating at worst. This news cycle-related anxiety has become particularly obvious in the 21st century, a time that has been packed with global events that live and breathe on the news cycle, the internet, and social media. 

There have been studies on who is at risk for negative impacts from the news cycle. These show that women are more at risk, because they are better than men at remembering negative news for longer periods, and they also have more persistent physiological reactions to the stress caused by such news. The news makes many women feel personally devalued, unseen, unheard, and unsafe, resulting in them having a sense of dread and mistrust about the future. Age is also a big factor: millennials are the age group most upset by the news cycle, with 3 in 5 millennials saying that they want to stay informed, but that following the news causes them undue stress. That’s compared with 1 in 3 older adults saying the same. But these older adults are more apt to deal with this issue by avoiding the news, with 2 in 5 adults reporting that they have taken steps over the past year to reduce their news consumption in response to the stress and anxiety caused by it. 

Our highly connected culture can exacerbate these feelings of anxiety. The internet and social media add to the illusion that the whole world is right outside your door, ready to get you. It used to be that danger from man-made or natural disasters seemed far away. In some cases, you never heard about it in the first place. Today, we have headlines in the 24-hour news cycle that detail the most horrendous crimes and tragedies, from those that touch a few individuals to those that affect thousands. The saying goes “there’s nothing new under the sun” but in fact, now in the last week of February 2020, there is a new thing under the sun: ‘coronavirus anxiety.’ It’s now a real thing in the psych world. The response to the coronavirus illustrates a point about response to the constant news cycle and the fear it breeds. In the last week of February 2020, the global coronavirus outbreak dominated headlines as it entered the political debate and sent stock markets tumbling. In response, Americans did what they always do when confronted with something new and scary: they hit the internet search bar…and the bar bar, and not necessarily in that order. Aside from “coronavirus,” among the most popular topics searched over the past week was “Lysol,” “dog coronavirus,” and “social isolation.” 

Don’t misunderstand me, some anxiety is a good thing. Low levels of it enables awareness and proactive problem-solving. It motivates you to take sensible steps to protect yourself and your loved ones. News serves to inform us about things that are important to us, and at times to warn us about possible health dangers and empower us to avoid them. But too much news and some types of news content, especially when sensationalized, may lead to worry and anxiety. And when anxiety becomes more than a constructive concern, that’s when we need to slow down, when things need to change. So what can you do if what seems like a constant cycle of negative news throughout every media outlet is getting you down and interfering with your well-being? There are some measures you can take to control how much the news negativity affects your everyday routine and outlook. I have ten suggestions below. 

1. When the news is first reported- there has been a bombing, there has been a shooting, war has been declared, there is a new coronavirus outbreak- turn it off, blow it off immediately. This may seem counter intuitive, but initial news, the first news to be reported, is notoriously inaccurate. Numbers are over-inflated. So wait until the news is organized, fully formulated, until they have multiple sources and they can accurately assess the situation. You’ll typically find that, no, it was not 500 people killed, it was 50. It was not 50 people shot, it was 15 people wounded. So just take a step back. When you hear breaking news, put it down, wait, and look at it in a few hours or the next morning, when the news organizations have multiple accurate reports.  

2. Look for good news. Bad news comes your way free and easy, while you have to look for good news. So look for good news. Dig for it. If you look for positive things, you will find them. The whole world isn’t all bad, there are good things happening, positive things. Look for positive things things that interest you, on social media, on YouTube, on television, on the internet. Literally put ‘positive news’ in the search bar and read what you find. 

3. Don’t leave a news channel on all day long, TV or radio, even if it is just for background noise. Some is bound to permeate your brain. Limit the amount of news you watch each day: 20 to 30 minutes a day is enough. You don’t need to be getting news all day long. Be strategic about news exposure. Maybe check the most recent headlines first thing in the morning and then disconnect for the rest of the day. It may be tempting to read every update of a breaking news story throughout the day, but your mind has a way of thinking that the longer a story goes on, the more you are actually involved in the event, even though it may not even directly affect you. And you don’t need to be checking texts, Facebook, Twitter, YouTube, etc multiple times each day either.  

4. I recommend not getting your news from Facebook, Twitter, Instagram, etc because what they say doesn’t have to be true, and what you see will often be a raw emotional response to something that they just saw, which may or may not even be accurate. Get your news from newspapers, either online or in actual print format. News in newspapers, the printed word, tends to be more accurate. The information has been digested and scrutinized by multiple people, so it is a little more fair and presents a more well-rounded perspective.  

5. Prioritize your sleep. Worry often interrupts sleep, and sleep deprivation increases worry. Short-circuit the vicious cycle by avoiding your television, iPad, laptop, and cell phone for at least an hour before bedtime. That means no more late-night scrolling through Instagram or Facebook, where you might find reminders of heavy topics. Pick a before-bed pastime that doesn’t involve a screen, like reading a book. Get your news dose in the morning or maybe a little bit when you first come home from work. Do not do it before bed, because you will not sleep. Murder, treachery, and deceit make for bad bedtime stories.

6. If you find that social media affects you negatively in any way, delete it. Facebook, Twitter, Pinterest, you really don’t need it, especially if it causes you stress or anxiety. Contrary to popular belief, you can live without it…likely better than you can with it. So just delete it.

7. Give yourself a minimum of two hours per day where you are cut off from text messaging, emails, posting, TV, and radio. Spend that time doing something body-positive, like exercise. Physical activity reduces stress and anxiety in the moment and long-term. Practice mindfulness while you exercise by tuning in to your breathing and the physical movement your body is experiencing. This way you’ll have a conscious train of thought that doesn’t involve worry. Or distract yourself some other way. You can preoccupy your brain with relaxing activities: take a warm bath, listen to music, or meditate. If these low-key methods don’t block out the anxiety, try something more engaging, like playing a card game, or catching up with a friend. Whatever you choose, the idea is to give your mind a break.

8. Do not catastrophize, meaning thinking that because one thing is wrong, the whole world is falling apart. Just because there is a terrible stabbing of a little girl in another state does not mean that everyone is unsafe. If there is a shooting in a church in Georgia, that does not mean that all churches are unsafe. Just because there is a strike by the NY City subway workers does not mean that all subway systems across the country are falling apart. Just because there is a viral outbreak in one country does not mean that the whole world is unsafe and that we should shut ourselves in our homes.   

9. Stop querying fear. When fear first strikes, ask yourself once, “What can I do to solve this problem?” If you have an answer, make a plan and implement that plan as best you can. But if you can’t think of a plan or solution that is logical and realistic, then move on. If you continue to worry and rack your brain, resist those thoughts. Distract yourself. See my #7 above. Eventually, the questions will lose their power, and your mind will stop asking them. 

10. Practice eternal optimism. When you start the day in a positive way, the rest of the day will fall in line. And continuing to go about your life with some degree of positivity and optimism is an important cue to your family and friends, reinforcing the message that you- and they- are okay.

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How Cocaine kills You

How Cocaine Kills

Cocaine is a potent, illegal stimulant that affects the body’s central nervous system. It is extracted from the green leaves of the coca plant, and people in South and Central America have chewed these leaves and used them in teas medicinally and as a mild stimulant for thousands of years. But somewhere along the line, these people learned that this humble leaf could be processed in a way that extracted and concentrated its active components to create a substance called cocaine, a white powder stimulant that is anything but mild. 

Cocaine goes by a lot of different slang terms and street names, mostly based on its appearance, effects, or drug culture: C, blow, coke, base, flake, nose candy, and snow are some examples. At the peak of its use here in the 1970’s and 1980’s, cocaine began to influence many aspects of American culture. Glamorized in songs, movies, and throughout the disco music culture, cocaine became a very popular recreational drug. It seemed everyone was using it, from celebrities to college students to suburban moms looking to turn up at the disco on Saturday night. It was so popular in the disco scene that people openly snorted it on the dance floor at Studio 54. But powder cocaine would soon take a back seat to its trashy cousin from the wrong side of the tracks: crack cocaine, or crack. Crack is an off-white crystalline rock made by cooking down powder cocaine with God knows what else for bulk, and the crack rock is then smoked in a pipe. This form of cocaine created a scourge of epidemic proportions and ruled the streets throughout the 1980’s and early 1990’s. Crack is whack and crack was king then, and it’s still around today. It’s actually named for the cracking sound the crack rock makes when it’s smoked. While it’s the same drug as powder cocaine and has the same effects, smoking crack gives a more immediate high than snorting powder cocaine. But it doesn’t last long, so to stay high, crack users have to “hit” the pipe over and over, constantly, 24/7, for hours and ultimately days on end. Crack also has street names: rock, gravel, sleet, and nuggets to name a few. And combined drugs also have street terms, like speedballs, which are a mixture of cocaine with heroin or other opiate. Every illegal drug and drug combination you can imagine has a list of street names…Cocoa Puffs, Bolivian Marching Powder, Devil’s Dandruff…Every time I think I’ve heard them all, a patient uses one that’s new to me.

So, what’s the attraction? What does cocaine do for you? Captain Obvious says… it gets you high. Cocaine creates a strong sense of exhilaration. You feel invincible, carefree, alert, and euphoric, and have seemingly endless energy. It makes you more sensitive to light, sound, and touch. It makes you feel confident, competent, and increases performance and output. For intense Type A individuals, cocaine is a requirement, on par with oxygen. These individuals want maximum performance, maximum fun, maximum sales…maximum everything. Period. And cocaine delivers. It works by increasing the  feel good neurotransmitters dopamine, serotonin, and norepinephrine by blocking their reuptake. No reuptake equals more feel good neurotransmitters equals more feeling good. To be candid, when just starting to use, and in small amounts, people can actually do fairly well using cocaine. They feel great and are more productive, and that’s how smart people get involved with it. At first, it seems there’s no down side, it’s up up up….on top of the world. But as they say, what goes up must come down. Whether you snort, smoke, shoot, or suck on it, using cocaine is a very sharp double-edged sword. I’ve seen people go six, eight months, using every day, and for a short time, for all appearances it works for them; they feel great, they’re focused, performing well. But then without warning, they’re not. They crash, their performance sinks into the abyss. They go into an impaired state, a mental fog, and their neurotransmitters betray them. They become paranoid, confused, disorganized, hopeless, and lost. 

Using cocaine even once can lead to addiction. As with many drugs, the more you use it, the more your body gets used to it, and that creates the need for a larger dose and/or using the drug more often in order to get the same effect. Cocaine is a potent chemical, and both the short-term and long-term effects of using are dangerous to physical and mental health. Riddle me this: how many old crack addicts are out there? I can tell you, not too many. Why? Because they’re all dead of heart attack, stroke, arrhythmia, respiratory failure, seizures, and sudden death. Whether you use cocaine once, use on occasion, or you’re a habitual user, the risk of seizure, stroke, cardiac arrest, respiratory failure, and even sudden death, is equal. Equal. No matter how little you use or how rarely you use. And the first time you use can also be your last chance.

So exactly how can you kill yourself with cocaine? Let us count the ways….cocaine’s potency and molecular makeup causes serious physiological consequences. No matter what form you use it in, it increases your blood pressure, increases your heart rate (aka your pulse), and it constricts the arteries that supply blood to your heart, all at the same time. So now, you’re asking the heart to pump faster and harder (because it has to pump against your increased blood pressure), and without as much blood flow (and therefore not as much oxygen and energy) as it was getting before the cocaine was in your system, and tah-dah! What can you get? Arrhythmias. Simply put, that’s when your heart can’t keep good time, it beats erratically and sporadically. Without conversion, you have a heart attack. Your heart basically stops beating and you die. And just remember, as you get older, your body is not as resilient. You may or may not have a lethal heart attack at 20, but you sure will at 50. How else can you kill yourself with cocaine? Using can cause you to go into a state where you’re unable to control your temperature, so it gets very high, you get restless, have tremors, dilated pupils, nausea, vomiting, complete disorientation, and mental confusion. If the fever gets too high, you can have seizures, which can lead to death. It happens every day. You also have to take into account potential accidents resulting just from being high, without your normal faculties, and being unable to take care of yourself. Freak accidents while high can be deadly. Remember too that cocaine is cut with crazy stuff- ground glass can cause internal bleeding, and diuretics and laxatives can cause electrolyte imbalance, both of which can kill you. And these days, cocaine is often cut with fentanyl- an opiate 50 times more powerful than pure heroin- which causes hundreds of overdose deaths each day. If you freebase cocaine or smoke crack, the chemicals used to cut it can cause sudden acute respiratory failure where you stop breathing and die, or they can damage the lungs over time and cause respiratory failure and the same result- death. If you use IV (intravenous needle injection) and share needles, you expose yourself to all sorts of potentially lethal infections, including Hepatitis, HIV and AIDS. If you choose to suck on crack, the chemicals used to cut it may be caustic and potentially damage the throat and/ or stomach and cause bleeding, or they may cause intestinal death and decay; these can potentially lead to death. 

So in the beginning of your cocaine career, you’ll feel great- super powerful, confident and competent. High. But shortly into your cocaine career, you’ll find that the magic is gone. The genie is out of the bottle. The high just isn’t the same, no matter how much you use or how you use it. So you chase that high…and you’ll chase it for the rest of your life, but to no avail. The high is replaced with the craving for the high. I’ve never seen a drug with cravings as powerful as cocaine. They’re just unbearable cravings, and they can last indefinitely. I’ve seen many, many cases where they last for years. I see patients now who have had these horrendous cravings for years, and I expect they’ll have them for the rest of their lives. They were lured in by the shiny bauble that is cocaine, and cocaine showed them a great time. Then cocaine turned on them, closed the door and threw the bolt, leaving them to want/need/crave what they had, likely forever. It’s just not worth it. I treat addictions of all kinds: heroin, alcohol, marijuana, benzodiazepines, you name it. For the most part, people with these addictions comply with treatment and come to their follow-up appointments. But cocaine addicts are a different story. They’ll come to my office once, all committed to stopping the cocaine, but you never see them again. They vanish…poof! They don’t do well in treatment, because the cravings are so strong that they can’t resist, so they take off and use again. The cocaine cravings are bar none the strongest I’ve ever seen. Now, the withdrawal from cocaine isn’t bad at all. It’s not like an alcohol withdrawal or withdrawing from Xanax or heroin. Those are gnarly, even potentially dangerous. With cocaine withdrawal, you can get depressed, you sleep a lot, you get vivid dreams, you want to eat a lot, you can’t think super clearly for let’s say three to seven days, but there is no real treatment needed for it, just comfort measures- keep the person cool, keep them hydrated, keep them fed, and allow them to rest- and they’ll bounce back. Now, one thing that sure does come up is that, because the cravings for cocaine are so intense, as soon as they’ve slept and ate and they’re back on their feet, it’s sayonara sucka! They bolt. They’re out again, they’re using, they’re smoking, they’re shooting, they’re shoving it up their nose, they’re putting it in their mouth, wherever and however they can use it. If they had a decent time period of not using, they may get that first super awesome high; but then they’ll inevitably spend the rest of the binge chasing that high, but they won’t find it.   

Now, you might ask how intelligent, successful, type A people get involved with cocaine when they know it will lead to their eventual mental and physical collapse and  possible death? Because these people know that in the short term it will increase their work performance, their ability to think, their social acumen, and their confidence. I always ask my patients what price they’re willing to pay for this temporary condition. Most don’t have an answer. I think that’s because they think nothing bad will come of their using, but I know different because I’ve seen different.

A true story from when I worked in the emergency department at Roosevelt Hospital: there was some sort of summer festival in Central Park, and evidently a guy locked himself in a portajohn so he could smoke crack. It’s summer, there’s no ventilation in the portajohn, and crack causes an increase in body temperature, so this guy had to be hot. But he was also high, so he was confused as to where he was and how to get out. People reported hearing him freaking out in the portajohn, kicking the walls and pounding on the door, but they couldn’t get past the locked door and he couldn’t follow their instructions to unlock the door and open it. So he was all worked up on top of being overheated, so his muscles heated his body up even more. Eventually, NYFD came and got him out of the portajohn, and he was brought to the ER, where I saw him. He was very hot and very dehydrated and very high. I started cool IV fluids and ordered an alcohol bath, but the damage was done. In short order, he developed something called rhabdomyolysis, where the muscles begin wasting away and all the muscle fibers enter the blood stream and shut the kidneys down. Despite our best efforts, he died. The family was very upset. They knew he was smoking crack, but couldn’t stop them. Every attempt to put him in treatment ended with him running away to use. And he was no slouch, no crack bum; he was a regional manager for Ace Hardware, in charge of like 20 stores. And he wound up basically killing himself in a portajohn. What a waste.

When I think about the stereotypical Type A individual doing cocaine to excel in the workplace, I think of a  Wall Street broker. I had a patient, a broker who worked on the Exchange floor. This guy was 40 when he first came to me, said he was on the fast track, that he wasn’t going to make $700,000K a year for much longer. He said he had to be sharp, had to be quick at all times and at all hours, no complacency, so he’d been using cocaine. I warned him about the potential dangers of piling cocaine on top of such a high stress job, but no matter what I said, he wouldn’t give it up. His motto was “Damn the torpedoes- full speed ahead!” He was getting away with using. Six months, seven, gaining on eight, he worked constantly, but he was the man, top trader, taking home fat 6-figure bonuses. After just over eight months on the cocaine, the piper insisted on his payment. He had a heart attack at 41, and when the ER doctor took his history, he readily admitted to using cocaine for eight months. With further questioning, he also reported having periods of confusion over the previous six months. His solution was to use more cocaine in an attempt to regain the sharpness it had once brought him in the beginning, but it didn’t work. What the cocaine did do was really keep him up at night. His solution for this was to drink four martinis every night in order to come down and get some sleep. He was doing this every day of the week for about seven months: cocaine throughout the day and martinis in the night. The cardiologist ordered a whole bunch of tests and it soon became clear that the heart attack that sent him to the ER was not his first. And unfortunately it wouldn’t be his last. His heart muscle was quite damaged from the ups and downs of the cocaine and alcohol fueled roller coaster he had boarded months before. I suspect that he never totally got off that ride, despite having another three heart attacks. Each one was progressively worse and made more obvious his mental and physical decline. At the age of 43, a massive fourth heart attack punctuated his life with a period. The man that burned the candle at both ends had burned himself out. 

No tales of caution would be complete without mentioning the models and the housewives. They like cocaine because it helps them lose weight and stay thin. And because the cocaine stimulates them, they like to take Xanax and drink alcohol at night to come down. I can spot the cocaine/alcohol/Xanax Barbies at 50 yards, because they actually turn gray. I’m serious- their skin turns gray and they get too thin. The whole program makes them look like victims of concentration camps. And they wind up forgetting normal daily activities- forgetting to pick the kids up, forgetting when dinnertime is, forgetting how to do the homework with the kids, forgetting how to accomplish simple banking transactions- everything gets screwed up. In my career, I have lost count how many husbands have sincerely asked me if I think that their cocaine/alcohol/Xanax Barbie wives are: A. Going crazy, B. Exhibiting symptoms of early onset Alzheimer’s disease or dementia, or C. Showing signs of having a brain tumor.

I’ll tell you this one last quick story about a patient I saw a few days ago. Her name is Julia, and she is a 33-year-old out, loud and proud lesbian. She’s very intelligent, a paralegal, and lives with her girlfriend of several years, Paola. She was introduced to cocaine after coming out and getting involved in the lesbian scene at age 21. She used cocaine daily- and in increasing amounts- for ten years, because she said it stimulated her libido and helped her reach orgasm. She stopped using cocaine when she had a heart attack at age 31. Unfortunately, the heart muscle was significantly damaged, and now she is unable to tolerate even mild exertion, such as that which happens during sex. So…the cocaine she used for ten years to increase her libido and help her reach orgasm has caused her current inability to have passionate sex with her girlfriend. How’s that for cruel irony? 

Cocaine is relentless and seductive…initially it can feel amazing, a ladder that lets you climb to the top of the world. Then cocaine is vicious, it sinks its hooks into you, which very few people manage to completely free themselves from. The perceived benefits aren’t worth the cost, which, as with some of my former patients, can be your life. It’s simply not worth it. I hope you get the take home message of all the many ways that cocaine can kill you, and that you understand how smart people find themselves tangled up in using cocaine, but also how even smarter people manage to stop using cocaine. 

For more details and stories about addictive drugs like cocaine, check out my book, Tales from the Couch, available in my office and on Amazon.com.

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The Dangers Of Alcohol

As an addiction specialist, I see patients abusing substances of all kinds. Today I’d like to talk about alcohol. It is so ingrained and accepted in our society. Pop culture would have you believe that you can’t have any fun or lead a fulfilling life without alcohol. During nearly every commercial break on television, there is an advertisement for alcohol, full of smiling people having the time of their lives like they’re on a permanent vacation. As a matter of fact, as I write this, I have a television on in the background, and there was just a commercial for a Mexican beer. It was a fiesta, with women in bright costumes dancing around and people cheering and cheersing with cold cervezas. The message: you’re clearly missing out if your life doesn’t resemble the lives of these people, but if you drink their beer, your life can be as awesome as theirs.  

Fermented grain, fruit juice and honey have been used to make alcohol for thousands of years. Even early Greek writings warned of the perils of alcohol. In our modern world, the dangers of alcohol are well studied and well known. Despite this fact, alcohol is the most common drug used and abused by people. Here are some sobering facts and figures: an estimated 15 million Americans suffer from alcoholism, and nearly 90,000 people die from alcohol-related causes annually, making alcohol the third leading preventable cause of death in the United States. 40% of all car accident deaths in the United States involve alcohol, claiming approximately 10,000 lives a year. According to the Institute of Alcohol Studies, consuming larger amounts of alcohol can cause more than 60 different health issues and hundreds of physical conditions.

Day in and day out, I witness the ravages of alcoholism, and it’s not pretty. Alcohol in any amount affects every part of a person, inside and out. It’s just a matter of degrees. 

What are these effects? Let’s start with the outward appearance. While drinking moderately may not have immediate disadvantages, over time you’ll start to notice them- especially when you look in the mirror. Drinking alcohol dehydrates you, which makes hair follicles dry and brittle and more likely to cause hair to fall out. What hair you have will look crispy with split ends. Heavy alcohol use can lead to permanent damage to the health of your hair. It can also cause hormonal issues like increased estrogen, which can cause problems with hair growth and loss, particularly in men.   

Drinking too much also dehydrates and deprives the skin of vital vitamins and nutrients. Instead of being soft and hydrated, your skin will begin to look cracked and wrinkled. This will leave others thinking you may be older than you actually are. Excess alcohol also alters blood flow to the skin, leaving an unhealthy appearance for days.Alcohol can also cause your face to look pale, bloated and puffy.Sometimes the blood vessels on your face burst and the capillaries break, causing a chapped look. Not only can your face become red, but the tiny blood vessels in your eyes become irritated and rupture, causing bloodshot eyes. Not cute. 

Over time, drinking heavily can have other, more permanent, detrimental effects on your skin. Rosacea, a skin disorder that starts with a tendency to blush and flush easily is linked to alcohol consumption. Continued alcohol consumption can eventually lead to a condition called rhinophyma, a facial disfigurment that is a subtype of rosacea, where large, red, pus-filled bumps develop on the face, commonly on the cheeks, chin, and especially the nose, where it can cause severe bulbous distortion. If you have rosacea, I strongly urge that you google rhinophyma and that you don’t drink. 

Let’s not forget that alcohol is fattening, high in empty calories. A couple of gin and tonics and a pint of beer equal about the same calories as a big fast food burger. You might be surprised to find out what the junk food calorie equivalents are for your favorite drinks. Alcohol also bloats your stomach. “Beer belly” is real people, but not only caused by beer. And then there’s cellulite; many believe the toxins in alcohol contribute to its build up. 

A less often discussed result of drinking heavily is B.O. Yes, the bad odor emanating from the body after a long night of drinking is directly related to the alcohol seeping from it. According to the Institute of Alcohol Studies, over 10 percent of alcohol consumed leaves the body unused through your sweat, breath, and urine. While pretty much everyone can smell it, non-drinkers are generally especially susceptible to the odor. And it is gross. Keep that in mind the next time you wake up after a bender. Your body odor could leave a lasting impression.

Let’s move from external effects of alcohol and go inside the body, starting with the brain. Obviously, when you’re drunk, your brain is impaired. There is loss of inhibitions, confused or abnormal thinking, and poor decision-making. But I want you to understand the chronic effects of alcohol on the brain and cognition, the long term effects. So, how does alcohol impact cognitive ability? Clearly, the impact is directly related to the frequency and quantity of alcohol consumed. 

Occasional and moderate drinkers:
– Memory impairment
– Blackout
– Recklessness
– Impaired decision-making

Heavy and/or chronic drinkers:
– Diminished gray matter in the brain
– Inability to think abstractly
– Loss of visuospatial abilities

-Memory loss

-Loss of attention span

In general, heavy alcohol use causes the brain to shrink. Any alcohol use causes clouded thinking, slow thought process or delays in cognition. If you drink at night – even two drinks – the next day, your thoughts aren’t as fluid, you’re not as clear, you’re not as creative. Alcohol use changes behavior. You may develop psychological issues,  personality issues. It is well established in the mental health field that alcohol consumption can exacerbate underlying mental health disorders. People become more irritable, anxious, and depressed when they drink. So why do it? People use it as a coping skill. It lowers inhibitions, gives “liquid courage” and allows us to do things we wouldn’t normally do. Some people use it to keep a job they hate, or to stay in a miserable marriage. It numbs pain, it’s an escape hatch for the psyche. It becomes a solution to a problem, or a way to mask the problem. Just as we are all different, the way alcohol affects us all differently. 

The following factors have been shown to influence how alcohol impacts a person’s brain functioning over time:
-The volume a person drinks
-How often a person drinks
-The age at which drinking began
-The number of years a person has been drinking
-The person’s sex, age, and genetic factors
-Whether the person’s family has a history of alcoholism
-Whether the person was exposed to alcohol as a fetus
-The person’s general health 

One of the biggest problems with alcohol that I see is trauma, people getting hurt. When you drink alcohol, your decision making is impaired. The brain that usually protects you is suddenly impaired, so you fall, you fight, you drive a car recklessly, and your coordination is off. You’re going to fall or make a bad decision and get hurt. So many accidents and deaths are attributed to alcohol. It’s especially disturbing because they’re preventable.

There is no bodily system that alcohol does not affect. What are other physical dangers of alcohol? Drinking alcohol increases the risk of cancers of the mouth, esophagus, pharynx, larynx, liver, and breast. The common thing that everyone understands is liver damage with alcohol. It causes fatty liver and cirrhosis of the liver which eventually kills you. There are a host of digestive problems with alcohol consumption: peptic ulcers, bleeding ulcers, diarrhea, pancreatic cysts/disease/failure. Alcohol can lead to diabetes, a compromised immune system, lung infections, stroke, and heart disease. It can be associated with memory issues, learning disorders, and neurological problems, where you have numbness in your arms and legs, lack of coordination, and slurred speech.   

Alcohol plays a role in other issues as well. Family problems, legal problems, and social problems. One of the biggest concerns with drinking frequently is (or should be) dependency, becoming an alcoholic. Right now, I’m sure almost 100% of you are thinking ‘I‘d never become an alcoholic.’ There’s a television show called Intervention that documents the trials, tribulations, lifestyles, and consequences of alcoholics and drug addicts. None of them planned on becoming alcoholics back when they drank socially or just had a few drinks at night. The great news is that if you never make alcohol a part of your life, guess what? You’ll NEVER have to be an alcoholic or deal with all of the issues that come with it. I can’t stress enough how strongly you should take this to heart. 

By now I’m certain that you understand the ravages and damages of alcohol use and abuse. But the dangers are minimized and we’re desensitized to it by pop culture; it’s so ubiquitous that we accept it as a part of life. If you tell someone that you don’t drink, they look at you like you have three heads. It is ingrained in every aspect of our society in terms of weddings, funerals, bars, restaurants, hotels, public events, private events, and clubs.  

Have you ever noticed how glorified alcohol is? They put it in these beautiful bottles. I admire alcohol bottles. The artistry and sculpture of the bottles…they’re just beautiful. They look like there must be something very good inside, so you want to find out. When you go to a restaurant, the first question is always, “Would you like a drink?”  Now, children’s birthday parties even serve drinks to the adults. If it’s so safe, why don’t we serve it to children? It’s because we know it’s poison, we know it’s dangerous, but it’s minimized. It’s socially acceptable. I’m not for prohibition; I think there is a place for alcohol in our society, but it shouldn’t be so glorified and so easily accessible. We need to acknowledge it’s dangers and be more restrictive with it. Take all-you-can drink mimosa or bloody mary brunches or happy hours for example, where drinks are two-for-one. These things encourage drunkenness, and then people leave with alcohol-induced poor decision skills and car keys in hand. These sorts of events need to be seriously restricted. There should be no event where we encourage people to get drunk. We should not condone its overuse or extoll its virtues. 

With all of that said, how does an individual stop drinking alcohol? It’s a simple theory. You make a decision to stop, and then you stop. There is no other way. If you’re not in control of stopping, then who is? I’ve spent more than thirty years medically detoxing and working with people with alcohol and drug addictions, and I assure you that there is no other way to stop other than the person making the decision to stop and living with it. I’m not saying it is easy, especially with alcohol all around us in grocery stores, restaurants, on television, on billboards…it is everywhere. But it can be done. I see it every day, people living fulfilling lives without alcohol. If you want to be one of those people living without alcohol, make an appointment. I can help you. I talk more about this in my books, A Chance to Change and Tales from the Couch, both available on Amazon.

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