A Loss Is A Loss Or Is It?


Due to the recent death of Philip Seymour Hoffman a ground swell has once again starting growing about the tragedy that is addiction. People are weighing in about the loss of such an unbelievable talent who died so young.

And what seems to be the undercurrent of the discussion is whether a death due to addiction is equal in sadness or tragedy as a death caused by “natural means”.  Death due to addiction for many implies an unnatural death, or death “by your own hand”. Why is that not a tragedy?

Others are discussing whether we glorify drug addiction when we spend so much time talking about those in the public eye fighting this insidious disease and whether we are lessening the impact of the death of millions of other mothers, father, sisters, brothers, sons, daughters, lovers, friends, etc. who may not be famous but who like Mr. Hoffman, have lost their battle against this demon.

We do need to be reminded about the numbers of individuals everywhere who are trying to fight this all too powerful enemy.

But how do we judge what is a truly “sad” loss?  I’m sure we can all agree that the loss of a child at any time is horrific; that the pain of the loss of a life taken by accident or violence is unspeakably life altering. The loss of millions of lives due to environmental catastrophes or at times, the wrath of mother-nature causes unbelievable amounts of shock and grief, and so on.

But when someone loses his/her life to addiction, why do we get so angry?

Because, all too many people still believe that this death was a matter of choice; that somehow the person chose to disregard their life and loved ones and instead chose their addiction outlet.

I think we need to clear one thing up.  Addiction is not a moral failing . . . it is not a conscious choice . . . and most definitively, not a death wish!

What it is is a way for someone in pain to numb. What it is is the push of the desire to get away from the pain, and the pull to go to another feeling state that seems like it will be a whole lot better.  And for a time it is.

Yes, initially it is thought that someone makes a conscious, mindful decision to start using drugs/alcohol (fill in the blank here) the first time “they pick up”.  Even that is not so black and white. So much of addiction is connected with trauma that it becomes challenging to see whether or not it is ever a conscious choice.  But no one starts out thinking I want to become an addict; I want to lose everything I have, everyone I love, my home, my job, my children, my freedom, my health and eventually my life.  It’s not that simple.

I have known individuals who struggle with the disease of addiction. It is an ongoing battle. I have worked with and continue to help individuals challenged by this demon in my career as a social worker and my work as a teacher allows me to present to many up and coming social workers some of the issues behind various addictions so they can begin to question and challenge their own belief systems to better help their clients.

Whatever your thoughts are as to the etiology of addiction, it is a tragedy that someone (anyone) loses his/her life so young, that someone with such amazing gifts and talents is gone (they don’t have to be famous), that someone was in a thousand kinds of pain that initially he/she turned to that mechanism to self-soothe, and most of all, that young children/other family members and loved ones will no longer have that special person in their lives other than through memories, etc.

So let’s let people express their emotions about addiction, feel free. Let’s keep talking about it. It is a discussion worth having and hopefully one that will begin to change how we see this condition (hey, US Government, I am talking to you as well).

But a loss is a loss, and pain is pain and a father, mother, sister, brother, friend, partner and loved one are gone.

Who are we to judge?

How Well Does Your Doctor Communicate?

I am so glad that this discussion is underway. Too many individuals are intimidated by their medical professionals and are afraid to ask questions or to even schedule an appointment or follow-ups. Consumers need to be empowered.

Through my personal experience and working as a medical social worker in a major NYC hospital and as a speaker and psychotherapist in private practice, I learned just how pervasive this lack of communication and understanding between patients and medical practitioners is at this time. A number of my clients suffer from chronic/life altering illnesses and report that they would rather not ask certain questions of their medical professionals. I see how little time the clinicians actually have to spend with each patient and how uncomfortable or unskilled they are in addressing certain issues or even connecting with their patients.

To that end, I developed and conduct workshops to train new physicians on how to talk with their patients and other workshops for consumers to empower them on communicating their needs and how best to talk with their physicians.

These workshops discuss both sides of the communication process; including active listening, how to ask the right questions, delivering and receiving diagnoses, treatment planning and even sex (the most difficult and most avoided of all), among other topics. Whether it’s 5 or 50 minutes (I know, a fantasy at best), the connection can be formed.
If consumers continue to be dismissed and/or intimidated by the medical profession, and clinicians are so busy that they cannot take the time to listen or don’t know how to, then all sense of communication and connection needed will be impossible. This is sure to result in misdiagnosis, self-diagnosis, needless worsening of medical conditions, avoidance of health care altogether and other serious consequences. (Don’t even get me started on insurance issues.)

Keep talking and listening!

From the Wall Street Journal Health Blog


$100,000 Prize to Design New Condom

Here’s some interesting news . . . Bill Gates – Gates Foundation is offering $100,000 in a competition to design a new condom. All over the news including CNN, NPR, etc. Check out the discussion – Slate, NPR, CNN, CBS, etc. You’ll read some intense reactions (both positive and negative) and in some cases there some snarky comments.
I had to comment: Due to my work, I continue to be appreciative when those with wide platforms, if you will, (as well as good intentions) promote a sex positive discussion that can affect change. Let’s face it, this does just that! Who knows what effect this challenge can have and what will be developed. I continue to hear the protests and disappointment voiced by many at “having to use condoms”; so many that it can be scary to think how many people won’t use them because “they don’t feel as good”, “don’t want to interrupt things”, “they are a pain to use”, “contribute to losing sensation” and “put an end to the interlude” (the saga of deflation due to condoms) among other excuses, so that too many people choose chance over protection.

So I say, let the games begin! Whoever gets there first, terrific! The female condom updated, bring it on! Different styles, etc. we’re waiting. But while you’re at it, please don’t forget to keep in mind your fellow sexually active individuals who are challenged by disabilities. Maybe something new for everyone is in the pipeline. We never know!


Chronicity: Giving Voice to Patients

As a therapist working with chronically ill clients or those facing a life-limiting illness, one of the most important and powerful roles you are assigned is as a facilitator in the journey to “give your client voice”.

Too often clients and their family members, as well as the clinicians around them, do not provide a safe environment from which the client can express their thoughts, feelings, questions and concerns. They don’t feel they can talk about their pain, their fears, ask those most intimate questions, and share their concerns about dying.

As some theorists have posited, the defense mechanism of “denial” is often a very productive one and should be maintained. In the case of a serious illness, it can serve as a very effective survival mechanism, one that may be needed to move forward during treatment or in some cases, enable patients to move on to another day.

Many people mistakenly believe that by talking about things, acknowledging feelings, etc. “it/they become too real to ignore” – can no longer deny what is happening and therefore “if I don’t talk about it, then it does not exist”. Clinicians can inadvertently support this belief with their actions.

As a child, a major factor in the development of self-esteem and a sense of self-worth is the recognition of “being heard”, both literally and metaphorically.
With an unbelievable sense of loss of power manifested by serious illness, by “giving your client voice”, you are empowering them, ressuring them that in fact, they are being heard and re-establishing their sense of self. Through this process, you are symbolically taking the journey with them and together you can confront their fears.


NYT: The Rules of Cancer, Slow Down/Exhale

Great advice and suggestions. And important article for both professionals and patients! When you receive that cancer diagnosis it can be an out of body experience — your ears may ring as you find yourself stuck in a very strange movie– you watch the doctor talking but can barely hear him/her — it’s as if he/she is talking in slow motion. Ironically, this all happens as your heart races and you feel your life changing in front of your eyes.
As Ms. Gurland so aptly stated, SLOW DOWN! Exhale!

Some food for thought: 1)make sure you bring someone to all your visits with medical professionals. You need that extra ear. 2)have that person bring in the questions you have prepared and have he/she take notes and most of all: 3) don’t get trapped in the “white coat syndrome”. The doctor is a human being just like you. Tell the physician how you prefer to receive your information — in small doses, in a language you can understand and of course, empathically.

Take back the power. As you can see from Ms. Gurland’s powerful article, This is ALL ABOUT YOU!

As a medical social worker/psychotherapist working with cancer patients and others challenged by chronic illness, I have developed a series of workshops entitled “Asking the Tough Questions”. I conduct workshops for patients and their loved ones and other seminars for healthcare professionals.

Both sides need help in communicating when it comes to issues such as cancer.

The 20-minute doctor visits do not produce collaborative relationships between patients and their healthcare teams. Information is lost and patients are not sharing information that is essential to living their lives and addressing their illness. Too many patients are intimidated by medical professionals and the medical professionals don’t have the time or are overly committed to maintaining that “professional distance”. What do you do if the questions you have are not only about issues directly related to your illness but also include how your illness affects your daily life – work, parenting, relationships – sexuality and intimacy?

Give yourself voice! It will serve you well.

Read the full post > 


NYT: Mental Healthcare on a Dime

Many of us in the mental health profession are committed to providing services on a sliding scale — after all, our goal is to help people in crisis as well as those who want to affect change in their lives. We are also challenged by rising costs and feel torn in that we want to offer more of those services but are restricted in the number of people we can help at very reduced fees.

Yes, in metropolitan area such as NYC there are many training institutes where you can receive excellent services at very reduced costs, Ackerman was mentioned, in NYC, another excellent choice is the Institute for Contemporary Psychotherapy.

However, outside of the major areas, you can contact your local hospitals and ask to speak to a hospital social worker – ideally someone who works either in the ER or mental health services area. They may be able to direct you to individuals or centers where you can receive services at a reduced cost or if they have an outpatient clinic either on-site or one they are work with at the time of your call.

Support groups are extremely helpful for so many reasons as mentioned in the article and on this blog, not the least of which is that individuals in the group as well as the facilitator may also be able to direct you to resources (lower cost) that can be helfpul.

The challenge for all of this is that when you may be feeling at your worst is the time you need to advocate in finding resources that can help you move forward.

If you can’t do it on your own, reach out and ask a friend/loved one to help you find someone.

Read the full NY Times piece