Welcome to the middle path

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Sporadic photos and notes from a Psyche-midwife, cheerleader, anthropologist--aka clinical social worker in therapy practice. Photos are usually mine except for those of historical events/famous people. Music relevant to the daily topic is often included in a web video embedded below the blog. Click on highlighted links in the copy to get to source or supplemental material. For contact information, see my website @ janasvoboda.com or click on the button to the right below. Join in the conversation.

Sunday, March 25, 2012

Hearts Stopped by Fear: With Sadness for Trayvon

I don't even know how to begin this one.  

Two Sundays running, I have had heartbreaking conversations with two friends, both women who raise(d) and love their African American boys.  Their sadness about Trayvon was not universal.  It was personal.  It was about living with the knowledge that a son's mortality risk is raised just by the darkness of his skin.

I have a son.  I know something about the worry I had when he was out late.  It did not include a worry about him being harassed by police or "neighborhood watchmen". I did not have to explain to him that some people might lock their car doors if he drove up next to them at a stop light, or follow him in a store, or hold a wallet or purse tighter just because he walked by.

I watched one of these women in tears and anger today say "It's as if we have made no progress in all these years".

And there is truth to this.  Author and speaker Tim Wise addresses the statistics in a recent essay.  A portion is reprinted below; click the title to read the rest of the article.

How do we as a community begin to change this?  First, by acknowledging racism exists, in our country and in our own (sometimes sub) consciousness.  We can't resist what we refuse to see.   Educating ourselves about the effects is a start.  Calling it out when we see it is another. 

The national outrage over the shooting of an unarmed boy by a grown man who followed him, chased him down after deciding based on the color of his skin-- that is justified outrage.  While his killer will have his day in court-- if, indeed, he is ever arrested-- Trayvon will not even get a hour in adulthood.

We cannot save Trayvon Martin.  I hope we can begin to save our country, our communities.  In the past few weeks I have been blessed with the opportunity to begin to know dozens of "others" through a world-wide community photo project .  There are Muslims, Christians, Jews, Hindus, Buddhists and the unchurched.  Artists from Germany, Findland, India, Korea, Iran and Serbia, to name a few, post a picture from their day.  That project has done more to shrink my world in three weeks than I could possibly imagine.  I get to know these "foreigners" a little and suddenly, they are not the Other.   These are my brothers and sisters.  I wish them love, freedom from fear, enough for their needs.  Empathy is the answer to fear, but there can't be empathy without resonance.  And for that, we have to get closer to the Other.

I read a story on the website of one of the project participants.  It was written by author Paulo Coehlo.
A master asked his disciples:
‘Why do we shout in anger? Why do people shout at each other when they are upset?’

the disciples thought for a while, and one of them said
‘Because we lose our calm, we shout for that.’
‘But, why to shout when the other person is just next to you? ‘Isn’t it possible to speak to him or her with a soft voice? Why do you shout at a person when you’re angry?’
The disciples gave him some other answers but none satisfied the master.

Finally he explained:
‘When two people are angry at each other, their hearts distance a lot. To cover that distance they must shout to be able to hear each other. The angrier they are, the stronger they will have to shout to hear each other through that great distance.’

Then the master asked:
‘What happens when two people fall in love? They don’t shout at each other but talk softly, why? Because their hearts are very close. The distance between them is very small…’

Let's start a conversation.  If you live in the Willamette Valley and would like to be a part of it, e me for details.  We will meet this week to think of how to shorten the distance between our hearts. 


Elizabeth Lesser inspires us to Take The Other to Lunch

...and here's that except from Tim Wise's essay.

"What is Post-Racial?  Reflections on Denial and Reality."
To believe that the United States is post-racial requires an almost incomprehensible inability or unwillingness to stare truth in the face.
How can we be post-racial, after all, when the typical white family has 20 times the net worth of the typical black family, and 18 times that of the typical Latino family?
How can we be post-racial when studies find that even white men with criminal records are more likely to be called back for job interviews than black men without them, even when all other credentials and personal characteristics are indistinguishable?
How can we be post-racial when evidence suggests that the lightest-skinned immigrants earn roughly 17% more than the darkest-skinned immigrants, even when qualifications and levels of productivity are the same?
How can we be post-racial when Asian Americans, Latinos and blacks with college degrees are anywhere from one-third more likely to nearly twice as likely to be unemployed as their white counterparts? When schools serving mostly students of color are more than ten times as likely to be places of concentrated poverty, and far more likely to have the least experienced teachers?

Tuesday, March 20, 2012

Using Others' Eyes to See

Ansel, about 14
Today's quotes: “A ship is safe in harbor, but that's not what ships are for.”  --William Shedd

“Life shrinks or expands in proportion to one's courage.”  --Anais Nin

This week marked the sixth year since Ansel Reed (poet, reader, social rights activist, hiker) left his too short life on this planet.  He'd only gotten 20 years in.  Born with a rare immune deficiency, he'd had more medical interventions than most octogenarians see in a lifetime.  He packed a lot of adventure into his days.  Sadly, there were many he just didn't have time to get to before his liver failed while he waited for a donor.

I think of Ansel at least once or twice a week.  When I hear poetry recited, I remember the time, not long before he left us, that I visited him in New York as he waited for that liver we all promised was coming.  He'd be feeling cold, or poorly, and would ask me to rub his back.  While I did he would sing to me-- hymns, usually; or recite wonderful odes--Keats, Yeats, Dylan Thomas and Shakespeare.  He had an amazing memory.  He knew his time was short and By God He Was Going To Pay Good Attention.  His eye for detail was astounding, and he had stories to tell. 

When I told him I was coming for a visit and asked what he needed, he said : "Kelp.  Seaweed.   I want to bathe in it and pretend I am in the ocean."  Thanks to a very kind co-op worker I was out the door and on that plane smelling just a bit fishy.  He also requested and received Japanese rice crackers, and he wanted baking soda, coffee filters and a blender, for various Grande Schemes he was craftsying up.   He spent a hundred days at a NY apartment, fighting off bugs when there were livers ready, and trying to be hopeful when he was healthy but there were no livers to be found.  Sadly those two worlds would not collide, and after a time, he called it a day. He seemed much more at peace with it than we were.

I still vacillate between my own peace in knowing he found his, and fury he isn't here to keep stirring up the creativity pot.  What can be done?  We have to accept that he's really gone from this physical life on this place.  We don't have to like it.  But that don't change the facts, Ma'am.

So what to do?  I look for him in others, sometimes-- if I see a particularly high spirited sweet joke-cracking 6 year old, or hear of someone undertaking a physical challenge when they already have one (mountain climbing blind, skiing with Parkinson's, that sort of thing).  Ansel never seemed to let his health stop him, whether he was running a marathon or fighting for social justice.   When I see that spirit in others, his own spirit is very present to me. 

And I use his eyes to view the world.  I see something beautiful and think, "Ansel would have liked that."  Knowing him changed me some, and changed what I see in the world.  He gave me a bit of his vision.

That's one way others live in us.  They give us new eyes and perspectives.  And we honor their short visits when we notice what they might have noticed.  It's not enough, but it's a lot.


Monday, March 19, 2012

Smells Like Baby Spirit

Thoughts that keep an info junkie up at night:

I read a very short article today in Utne reader about the positive health implications of our genetic ancestry being mixed with a little Neanderthal.  Researchers  reported a couple of years ago that due to a little inter-species hanky-panky way back in the day, lots of humans carry some Neanderthal DNA-- 1-4% of Asians and Europeans.  Late last year, new research supported a finding that there's a good evolutionary benefit to this mixing:  a strengthened immune system through the contribution of different human leukocyte antigens (HLA).  That's something dog owners have known for years.  Mutts are healthier than those inbreed pedigrees.  My gorgeous lab, for example, missed out on the hip malformations common to her breed, but did get the eyelid defects that led to her blindness in late life (despite two corrective surgeries).

The article went on to state that immune gene mixing, critical to species survival, shows up in our mate selection.   Says Stanford, "people are attracted to the scents of prospective sexual partners with disparate HLA types."  That's another bit we've known for a while (as mentioned in an earlier post, "You May Sniff The Bride").  But it got me wondering.  If we consider that this scent attraction is a positive indication of procreative success, does that mean that persons with more similar HLA are more prone to miscarriage?  A quick Google and Pub Med search confirmed that I'm not the only one curious about that.  The research would indicate it's true-- and that it will make IVF more difficult as well.

I wonder what this means for people with anosmia.  Are they more likely to mate unsuccessfully, at least from a procreative standpoint?  It does suggest strongly that marrying outside of your genetic lottery is sensible.  Here's to the mixing of the pool!

Wednesday, March 14, 2012

Tuesday, March 13, 2012

Zebra Hunting: Medical Mysteries and When It's Not All in Your Head

name this disease:
Fair warning:  Hypochondriacs should skip this post.

If you live in the valley and are fascinated by medical detective stories, you're in luck this week.  Dr. Lisa Sanders, author of the NYTime's "Diagnosis" column, is speaking as part of the OSU's Program in Medical Humanities lecture series on Tuesday, March 13th, 7:00 p.m. at the LaSell Stewart Center.  Her column inspired the popular TV series "House"; Sanders continues as its medical consultant.  She'll be selling and signing her new book at a reception prior to the lecture.  You can hear an interview with Dr. Sanders and see snippets from her book on NPR at this link:  http://www.npr.org/templates/story/story.php?storyId=111844063

Later this week, I'll be lecturing (in a very loose sense of the word, and without the crowd or book signing) on differential diagnosis at my therapist's continuing education group.  Although most of us aren't doctors, it's important that mental health clinicians have at least a rudimentary understanding of the many diseases and conditions that can present "psychiatrically".   I use the distancing quotes for emphasis.  It's a strange notion to me that so many want to separate disorders of the mind from those of the body.  Where, exactly, do these people think the mind is located?  The brain is an organ.  All organs can have imbalances or diseases.  Furthermore, the problems that affect what we experience as the mind-- eg, those that cause anxiety and depression-- can originate in many other areas of the body.  For example, persons with mitral valve prolapse (a common and usually benign heart condition in which a heart valve does not close properly) may have palpitations and shortness of breath misdiagnosed as panic attacks.   Thyroid irregularities can present as either depression or anxiety, depending on whether there is too little or too much of the related hormones circulating in the system.  Starting (or abruptly stopping) some medications can cause problems in thinking, memory, sleep and certainly in mood.

For many years stomach ulcers were thought of as a psychosomatic illness, caused by the mismanagement of stress.  No one thought bacteria could live in the highly acidic environment of the stomach.  It wasn't until 1982 that two Australian doctors made the connection of between stomach distress and high colony numbers of the heliobacter pylori strain.  Epilepsy is another disorder with a roller-coaster history of (mis)understanding.  Although Hippocrates (400 BC) saw it as a physical ailment, it was considered a sign of demon possession in the New Testament Bible, and a positive symptom of being a witch during the persecutions in the 15th century.  The classic tonic-clonic seizures (also known as "grand mal"--major electrical storms in the brain) were the first to be recognized as clearly organic in origin, though those suffering were still seen as in the grips of a mental illness for at least half of the 20th century.  More subtle electrical brainstorms can cause such varying symptoms as hypersexuality, religious preoccupation, olfactory hallucinations and more.  

Manic, or just immature?
And that lousy memory of yours.  Is it early onset Alzheimer's?  A brain tumor?  That allergy medicine you take year round in our sweet little Valley Of Runny Noses?  Or your Ambien, menopause, seasonal affective depression?  Maybe it's something rarer and more sinister--  that parasite you picked up rafting down the Amazon, or those infiltrating prions from Uncle Bubba's tasty breakfast offering of scrambled squirrel brains.  Even as I type perhaps holes are popping up like yeast bubbles in your gray matter.  But probably not.  Really.  The fact that you can't remember is more likely one of two factors:  those constant electronic interruptions (and training from all that manic transitioning in those Sesame Street shows you weaned on) has whittled your attention span down to the tensile strength of a wet strip of cheap paper napkin, or you are just too tired and/or preoccupied with you busy-ness to be present and attending to the Here and Now. 
Yes, there are lots of possibilities.  But a diagnosis over-stimulation and lack of rest will pretty much trump the likelihood of Mad Cow (or squirrel, for that matter) Disease.  It's not likely you'll be featured on the next episode of "House."

I'm not a doctor, and can't give you medical advice or treatment.  But if you come to see me with complaints of forgetfulness, anxiety, depression and fatigue, I'm going to be using all my senses to help you figure out what's going on.  I'll notice your gait and movements (slowed ones can mean depression, or early symptoms of Parkinson's).  I'll pay attention to the rate and fluency of your speech, and the clarity of your thinking.  Back before my anosmia, I would have noticed distinct smells, if you had them-- too much perfume might mean you're covering up your substance abuse habits, or that you too have lost your sense of smell.  I'll  be asking you when you last saw a doc and what she said; what meds you are on, and what for, whether you have a  history of traumatic injury (especially the old noggin'), how you are sleeping, your drug and alcohol and other significant medical history.  I'll want to know if you see or hear things others don't-- sure, it could be schizophrenia or another serious psychotic disorder, or it could be a detaching cornea, a migraine aura (shimmering changes in the visual field), your carotid artery pulsing loudly in your ear (ear wax blockage?  something more important?).  I'll wonder if your symptoms came on suddenly, and if you had any illnesses or trauma preceding the problem, and if you've felt that way before.  I'll want to know your theory about what is happening to you.
Not Mad, just Cranky

I may also ask you what you eat and how often.  Fluctuating blood sugars can wreak havoc on mood, making you flaky and cranky and shaky.  If you're actually diabetic, that requires vigorous changes in diet and lifestyle because you're going to want those feet, those eyes and that heart later in your life.

If you're female, I may ask about your menstrual history.   Perimenopause (the years leading up to cessation of the cycle) can trigger severe PMS-like symptoms of irritability, anxiety and weepiness for some women.  Premenstrual Dysphoric Disorder can look like Bipolar, with mood swings so severe that some women with it are suicidal several days a month.  While CBT is helpful, sometimes hormonal or other medication therapy is needed.

If you have pre-existing conditions-- diabetes, hormone issues, head injuries, autoimmune disorders-- I will want to know about those too.  Their effects may be causing your mood issues; certainly their stresses will be a factor.  Are you following the medical treatment prescribed?  Many people fail to connect the dots between their poor physical health management and the brain fog, anxiety or other issues that can result.  And as noted, sometimes it is the medication itself that's causing the problem.  For example, steroids can cause mania (and occasionally psychosis).  It's not typical, but it happens. 

Brain tumors and other serious illnesses are the Zebras in our herds of horses at the counseling office.  They happen, and they typically don't get found out until they've started making a ruckus.  Chances of accurate and early diagnosis seem very dependent on who you see, how clearly you can present your symptoms and their progression , and what sort of bureaucracy you run into trying to get adequate testing.  These tests are expensive, and it's hard to convince a strapped system to check out a herd of horses because there may be one very horsey-looking zebra hiding there.  It can help to get back up history from others who have observed and been concerned about the changes in your behavior or pain.  Bring them with you as a second pair of eyes and ears and an advocate if you are really concerned and don't feel you are being heard.  Be nice to the doc, though. Advocacy does not need to be rude.  Listen hard.  You may hear things you don't like or understand,.  Have your questions at the ready but be prepared to accept they may not all get answered.  Get second opinions if your insurance will provide that and you feel uncertain or dismissed.

Many years ago in SE Texas I had a patient who was very country, not very educated but quite organized in her life and thinking.  She seemed perfectly fine except she had an obsession that invisible bugs were crawling on her arm.  She couldn't stop itching.  Her arms were covered with bloody scratches.  She was driving her family crazy trying to get them to see her tormentors with magnifying glasses. She developed lots of obsessive-compulsive symptoms trying to treat the infestation.  But there were no bugs.  I sent her for a physical, telling the doctor things weren't adding up. There was a lesion in her brain; sure enough, when it was resolved the "bugs" disappeared. 

Another woman I saw with fatigue, weight gain, high blood pressure and a long onset depression found relief after she was finally diagnosed with Cushings and treated for her metabolic issue.  The weeks of talk therapy I provided didn't do much at all, though we both enjoyed it.  It was the strange distribution of weight, and facial hair, that clued me to refer her.

Years before that, also in Texas, a man with no previous violent history (family man, former eagle scout) killed his wife, then climbed a tower at the University in Austin and killed several strangers. In his diary, Charles Whitman spoke of having spent two hours with a doctor trying to explain his sudden and overwhelming violent impulses.  It apparently didn't go well, and he never went back.  Writing again, he requested that doctors examine his brain after his death.  He had been convinced for some time that it was changing and these violent impulses were outside of his control.  He was right.  A glioblastoma (tumor) had insinuated itself into his thalamus, hypothalamus and amygdala, hijacking his previous personality. 
The Case of the Collapsed Kelp:  Not drunk, just dehydrated and sun-stroked

The thing is, these are exceptions.  There is so much overlap in cause and disease, and the same symptom of a rushing sound in your ear that could be an aneurysm forming is much more likely to be some flake of ear wax floating around. Neither I nor any other clinician, including your doctor, is going to be hunting for Zebras when it's looking so horse-y out there.  Don't blame us if we forget to ask you something you are worried about' let us know what you are worrying about.   Listen to what we know, and to what we don't.  We will refer you for care if we have suspicions that your chronic fatigue, aches, rapid heart beats or what have you need a doc or a test.  We don't practice medicine.  But we should know enough to point you in the right direction if our expertise and intuition suggest the need for medical consultation.

A lot of these bothersome symptoms will disappear as quickly as they came.  It's tricky to know when to pay attention and when to stop obsessing.  Eye tics, annoying and random but nearly always completely benign, are a good example.  It's POSSIBLE that it's the start of Bell's Palsy, a bran tumor, or hey, demon possession (I don't claim to cover all bases here).  But most likely it's a temporary and meaningless glitch, and it will disappear when you stop attending to it.

If you have a health concern and your doc says "Maybe you should see a therapist", it's not because he or she thinks you're crazy.  It's that the interface between mind and body works both ways, and there are things you may be able to do to heal that are more effective than taking a pill.  Stress-related illnesses are still illnesses, but they can resolve when we get more sleep, nature, sun, exercise and balance and learn to change the panicky way we interpret signals from our body. 

To be continued...and in the meantime, let us reflect on the words inscribed of the guide of famous interplanetary hitchhiker Arthur Dent:  DON'T PANIC!

Tuesday, March 6, 2012

Creating Community: Maker's Space

getting the art on
Imagine a group of people with little in common except a desire to be together and be creative.  Add some free vegan cupcakes, art supplies and cheap drinks and you have Maker's Space:  "Culture as adventure, and we're all Indiana Jones".

i ain't scared of art
Under the encouraging eyes of Corvallis's new Art Center director David Huff and Drawing Board art supply shop owner Mike Wiener, a few dozen locals quaffed and created small works that were promptly displayed on clip hangers in the window of the Majestic Theater.  Curator Josie Zarkovich wasn't on hand for the evening's festivities, but her energy was evident.  There is now something way more compelling than reality TV on the first Tuesday of every month. No pressure and lots of friendly folks in sweet surroundings-- it can't be easier to get artsy.

If you're local, join in on supporting the invigoration of Corvallis creativity and community.  Show up and art on with us at the next Drink and Draw April  3rd. And think about throwing some money into two great organizations that support what heals us:  the local Arts Center, and what promises to be a better than ever venue for music and the arts, our own very Majestic Theater.

a couple of the night's creations
While you're spending,  support a new local business.  Mike Wiener's Drawing Board has recently expanded from a 10X10 foot kiosk at the Starbucks plaza into a new storefront at the same location.  Here six months from Palm Desert, CA, Mike grew up at his parent's art supply store there.  A victim of a poor economy, it closed after 21 years and he relocated here, but was sad to see there was no similar place for good supplies.  He's ready for business, and since he pays for shipping and buys wholesale, you can get your art on for the same or less than from some anonymous mail order place.  He's the guy who provided the free supplies for a great night of local fun. Let's keep him in business.

Sunday, March 4, 2012

The Curious Life of the Nerd

Do you have the enthusiastic curiosity of a child, filtered through an eclectic collective of knowledge?  Lucky you.

I found this poster on a Facebook page.  Wish I knew to whom I could attribute the image (and if you do, tell me) because I do so appreciate the sentiment. 

Here's to all of us unafraid to show love for our interests, who are unabashed in our passions and without apology for our obsessions.  I appreciate this particular human variation, and the variation of interests supported.  Being of limited lifespan, if we want to go wide we're not going to be able to go too deep.  For all  of those of you that do, I offer deep gratitude.  I may not be able to do or be all I want in this lifetime, but thanks to Geeks everywhere I can learn a little about a lot. 

Tonight on Krista Tippetts' On Being, I learned a few things about physics, thanks to string theorist James Gates.  At 61, he says he is having more fun than ever exploring math and science.  In the local Gazette Times, I read about OSU neuroscientist Sarina Saturn, who is providing evidence for what I have long suspected:  that variations in oxytocin levels influence individual's emotional states and levels of altruism and empathic ability.  And Kathleen McAulifee told me how my cat might just be making me crazy (via parasites) in her frightening but fascinating article in this month's Atlantic article. 

Thanks to you nerdy obsessives, I can now identify maybe thirty of the world's 75,000+ species of mushrooms, including three or four I enjoy eating and a dozen or so that would kill me.  I know a little about why certain music makes me anxious (see Radio Lab's Sound As Touch episode) and Why Penguins' Feet Don't Freeze (thanks, Mick O'Hare and readers of New Scientist).

I've been obsessed with information and learning since I was a kid.   I hungrily read the encyclopedia my parents were suckered into buying from a door-to-door salesman, as well as my mother's nursing books (ask me anything about elephantiasis-- that picture of the man with his testicles in a wheelbarrow is burned into my brain).  I may have missed learning how to do my hair and makeup, but I have a lifelong curiosity about the world  I'd never trade for a day on the Best Dressed.

So thank you, Nerds.  I only hope I am worthy of your title.

Off to read,