Sunday, October 24, 2010

The Narcissistic person.

All patients are narcissistic. In fact, we all are. People care about themselves more than anything else. This is normal human behavior and a necessity for survival. If we did not care for ourselves, we would not be able to survive as a species. Think about this, in a moment of survival, the human being will try to safe itself instinctively.  If there is an airplane crash, all survivors will push each other to get out of the aircraft first. Its survival of the fittest. There is nothing wrong with this behavior. However, when it regresses to more immature behavior, it causes problems with others. That is when a person turns into a “patient”.
I make a living of listening and treating people. Sometimes I am appalled at the expectation of people.  If you try to point it out to them, they get defensive and angry. We psychiatrist use a lot of terms to describes these people. However, I’ve learned that the best way to understand what I am trying to say is to be descriptive of their behaviors.
On the hit show “Monk” from USA network, they make mockery of one such type of patient. Adrian Monk is an obsessive-compulsive detective, i.e. OCD that solves crimes in spite of his mental handicap. The first time I watched the show, I did not find it funny since I know many patients that are like this and are so sick. However, the more I watched it, the more I enjoyed it and laughed. If you watch closely at the show, you will see how narcissistic the character “Monk” is. He never cares about his assistant, Natalie or her needs, it is all about him. In the episode, “Monk goes to group therapy”, is the best example of how he did not like group therapy because everyone else was talking about their own problems and not listening to his. This brings me to our real world. Every patient that walks into my office has several degree of narcissism.
Narcissism is defined by the English Assistance; US as “an extreme interest in your own life and problems that prevents you from caring about other people”.
People that are depressed wallow in their own self pity. They talk about it, rehearses it, repeat it to anyone that is willing to listen but don’t make any attempt to change their situation. A good example is the alcoholic person. This lady came into my office extremely depressed. Her husband left her, she had no job, she had no money and she had her neighbor paying her rent, food, utilities, taking her to the doctor and paying her doctors visits plus her medication. He is helping her get back on her feet with the condition that she stops drinking booze. The lady is drinking daily 2-3 bottles of liquor a day. She cried during the interview because she had “all these problems”.  When I told her that she needed to stop drinking, her answer was, “I stop yesterday but you need to give me a pill so I won’t drink”.  Every suggestion on rehabilitation, detoxification or AA, (alcoholic anonymous) brought out a new excuse of why she couldn’t do that. By the end of the interview, I gave up. She was in the position she got herself into. I had no pity for her. The neighbor seemed upset when she confessed she had continued drinking even though she denied it to him so he would continue paying her bills. I heard him tell her that he was cutting her off if she did not stop drinking. Having worked with addicts for years, I knew that it would take much longer before he gave up on her. The lady was so into herself, i.e. narcissistic, that she couldn’t see how she had created her own situation.

Teenagers and young adults tend to be more narcissistic since they have very little life experiences. Most of us grow out of this since life has the ability to humble us. Losing a spouse through a divorce or a job makes us look into ourselves and reflect if we did something wrong to merit our loss. However, not everyone is so insightful. People tend to blame others for their misfortunes. “It was that bad boss I had that made me lose my job”. Or, “my spouse was a jerk and that is why the marriage did not work”. Even if some of this may be true, have you looked into yourself and figure out what did you do to contribute to the problem?  If you do, you may make yourself a better person. 

Saturday, October 16, 2010

The FMLA; don't abuse it or you will lose your job.

Recently many people have turn towards the Family Medical Leave Act, i.e. FMLA, as a method to miss work whenever they don't feel like working. I mention this in my previous blog but I think  this subject deserves more attention. The FMLA was created for people who had a serious medical condition, or a loved one that needed care, so they could use time off from work to care for themselves or others and not lose their jobs due to absences. After 9-11, I noticed an increase in people requesting doctors excuses to use the FMLA. In the beginning it was mostly flight attendants that had anxiety relating to flying after 9-11. This made sense to me so I would fill out the necessary paperwork for them to take time off. However, as the years went by, many people are requesting it due to increased work demands in a slow economy. Since many companies have decreased the amount of employees, the work has to be distributed to the employees left behind. This means higher demands on workload and more productivity expected on the remaining  people. People get stressed out and develop anxiety and depressive symptoms. Instead of searching for coping mechanisms. They go to their doctors and request time off. Some ask for a "block" of weeks to months off while others request intermittent time off. The intermittent time off is tricky. They request days off whenever they feel anxious. Some ask for 2-3 times a week, if they "need" it, to several times a month. I know people that take the day off if they happen to oversleep. Others have had the audacity to travel to Las Vegas or New York, on a brief vacation, while using the FMLA. Two people that I know where caught on these mini vacations while on the FMLA and were fired immediately. I know this other woman that has been applying for the FMLA for years now because she has to start work at 9:00 AM and she oversleeps a lot. So every time she oversleeps, she just calls in "sick", i.e. "anxious", and gets the day off. She has been accommodated at work with special hours so she could start work at a later hour than her coworkers. Even with these accommodations, she still misses work every Sunday, (she works weekend shift), because she is too tired to get out of bed. The last time she applied for the FMLA, she told me that she had to continue applying every year since she knew she would be fired if she was not "protected" by the FMLA. She said that other coworkers had not renewed their FMLA and once it expired, they would lose their jobs. I wonder how people put themselves on these predicaments. In a slow economy where jobs are scarce, wouldn't you want to keep your job? Isn't it better to stress out at work than stress out because you have no money to pay your bills? The way I look at work is time I put in to be productive. Staying at home with nothing to do won't do you any good. They call it "work" because you get paid for doing it, otherwise they would call it "fun".

Thursday, October 14, 2010

"Earth" a must read book!

I just finished reading the book "Earth" written by the writers of "The nightly show with Jon Steward". Even though it's supposed to be funny, I found it to be more of a satire of human race. They start the book addressed to aliens in the presumption that the human race is extinct. The book tries to give us an historical view of mankind from the beginning of the Universe. It talks about religion, wars, science, marriage, sex, children, birth and death, in addition to many other topics. It certainly gave me "food for thought" . As I read the book, I realized how small and insignificant we are as people. It also made me think of how narcissistic we are as a species. From the beginning of the book, the writers, try to put in perspective how huge the universe is compared to our so small planet. It also enlightens  how blessed we are to be living in such a beautiful planet and how little respect we have towards it, in the sense that we do not take care of our natural resources and how little we respect our fellow human beings. When it talks about Wars, it rehearses most of the major wars fought throughout our time and what propelled us to fight for. For example, many wars were started due to religion, like The Crusades. Bringing this to modern times, how we still have terrorism based on religious difference between us. People that kill in the name of God. The book also talks about God or Gods, depending on the religion people practice. It also empathizes how people force their religious beliefs on others, many through violence. The more I read, the less funny it seemed to me. It gave me some insight on how petty we humans are. I extrapolate this to the type of job I do. I am a psychiatrist. I listen to peoples pain and suffering all day long. I medicate them, if needed, to help them cope with life's normal stress-ors. The more I think about this, I quite don't understand why they let themselves be consumed by life. Don't get me wrong. I do believe there are mental illnesses that need to be treated, but many people that seek therapy or medications, are consumed by life. For example, they get upset because they have to work for a living. Instead of enjoying the fact that they do have a job, they complain of their supervisors, their duties, the hours they have to put in, why they do more "work" then the other person, etc. They seek "doctors excuses", like the FMLA, ( Family Medical Leave Act), to be able to "call in sick" whenever they don't feel like working. When they are fired, they are so surprised that this would happen to them. They think that after all the "work" they have done and dedication to the company, they get fired. How dare they! On the other hand, they could look at their job as a blessing where they can contribute to our planet in a small way, but added to the efforts of others, they may make a difference. Either way, we all die the same. That was one of the points the book made. We can guarantee you will die. So, fellow earthlings, you are here for a short time, make it a heck of a "ride" on your journey through Earth!

Friday, September 24, 2010

Is sex medically necessary?

As a physician, I encounter many times when a medical treatment or medication is denied by an insurance company saying that it is not medically necessary. Patients get upset since it is hard to understand what this means. By medically necessary, it means that the patient cannot do without the specific treatment. Since insurance companies are for profit, they will try to save money and search for cheaper alternatives for treatments. This brings me to the topic of sex. Many male patients have ED, i.e. erectile dysfunction. Many of them benefit from Viagra or Ciales, medications that treat ED. Most insurance don’t cover these medicines, however, Medicaid, the governments insurance for the poor, covers one pill a month. Other insurances cover up to six pills a month. Every time I prescribe it, I wonder, how did the government come up with having one erection a month, medically necessary? 

Being born must have hurt!

Today I was talking with one of my patients who is in her seventies. She was very preoccupied with death. She was having anticipatory anxiety of the thought of dying. “Will it hurt?” she wondered.  I honestly don’t know. As far as I am concerned, I have not been dead yet. But this made me think of what I’ve experienced in the past. As far as we know, everyone on this Earth has been born, and for sure, we will all die someday. I’ve never seen a corpse in pain. However, I’ve seen hundreds of people that are alive in pain. This made me think of the miracle of birth. Think about this for a second. Fetuses feel pain intrauterine. This has been proven by sonogram studies. Pinch a fetus intrauterine, and it will react to pain. Then imagine an eight pound baby coming through the birth canal. The cervix can dilate up to ten centimeters. Go get a ruler and see how small ten centimeters is. Can you visualize all the squeezing this baby has to go through to poke its head out to the World? Once it does get out, the baby starts screaming his heart out. People surrounding the baby are full of joy, but have you ever thought how the baby feels? I bet if you started pinching the baby, he would react to pain. After thinking about this for awhile, I thought that no one I know ever remembers the day they were born or recalls any pain associated with this. Some can argue that the under developed brain of the baby cannot make an association of the feeling of pain since it has not felt pain before. Most of our emotions are learned throughout our lives. Pain must have been the first one!

Saturday, September 18, 2010

Golden Handcuffs.

I've met many women that have gone through a divorce after many years of marriage. They had supported their husbands in their careers, raised their children and grown old by their side. Then one day, the husband announces that he is confused, needs his space and eventually, needs to move on. This takes many women by surprise because this was not expected. They go through a long, and sometimes, nasty divorce. At the end, they may get permanent alimony plus half of the marital asserts. This is when it gets tricky. These women think they have "won" because their ex husband has to "pay" for leaving them. Even if they get a "lump sum" alimony, they tend to go back asking for more money, feeling that they have been cheated. I call these the golden handcuffs. Let me tell you about "Laura". Laura is a fictitious name that encompasses some of these women. Laura was 52. She had been married to Bill for 20 years and had a 18 year old daughter. She was looking forward to when her daughter would leave for college since Bill and her could start enjoying more traveling together. One day Bill told her that he didn't want to stay in the marriage. After several months of marital therapy, he moved out and eventually divorced her. She was awarded with the house, and a mortgage attached to it, and $5,000.00 of alimony a month to support herself. This seemed like a sweet deal but she  quickly realized that the amount of money she got a month, barely covered the mortgage and house expenses. She started growing bitter because she felt cheated of what she felt she deserved. Laura was a very attractive woman that looked younger than her age. However, she was unable to let go of her anger. She started to isolate herself from others and would not date in fear of having the same fate happen to her again. She would also say that she was not willing to get married again since she was not about to lose her alimony. Years passed, and her ex husband remarried and had a child, starting a new family. Laura continued alone. She would go to social parties of old friends who were still married. She went to their children's, weddings, birthday parties and grandchildren christenings.Every time any one suggested she go on with her life she would say that she was not going to lose her alimony. Going on with her life did not necessary mean lose the alimony. It meant let go and move on. Ten years gave gone by and Laura continues alone. She has lost some of her looks and the opportunities to find a decent partner had decreased. Every time a decent man approaches her, she finds something wrong with him. Most of her friends have moved on with their own lives and she is very lonely.

About this Blog.

This is the first blog of Arlene MD; thoughts and reflexions. The goal is to inspire others to see the beauty and positive in every situation they may encounter. Every day of my professional career is working with people who do not know how to see that the glass is half full and not half empty. No matter how bad things may seem, there is always something worse that can happen. Your specific situation could be worse so lets be happy that it's not. Having said that, lets try to change the things you can and accept the ones you can not change. If you are caught in a bad relationship, realize that you can not change an other persons behavior but you can change yours. If you are unhappy, don't waste your time trying to change the other person, just change your own. Either stay or leave, but do what is in your control and live with your decision in peace with yourself. This applies to all areas of life: work, family, friends, spouses, children, parents and so on. Another thing I will write about in future blogs is how people tend to hold on to grudges. It amazes me how people live in the past. Sometimes people are bitter and angry about past life events while the other person involved doesn't seem to care or even know that they have caused hurt or damage to them. Who is wasting their time? You are! Feel free to comment about your own positive experiences. If you don't have anything positive to say, don't say it.There is a saying, "If you spit upward, you will get wet". So read and enjoy!