mindfulness – Go Retire Psychiatrist

What Questions Should We Ask on MLK Day?

I ran across this quote from Dr. Martin Luther King, Jr. in my notes:

“Human progress is neither automatic nor inevitable… Every step toward the goal of justice requires sacrifice, suffering, and struggle; the tireless exertions and passionate concern of dedicated individuals.”

― Martin Luther King Jr.

This week we’ll be getting the two biographies of Martin Luther King, Jr. One of them is a biography published a couple of years ago by Jonathan Eig, titled “King: A Life.” The other is an autobiography, “The Autobiography of Martin Luther King, Jr.”

This morning, I was focused on puzzling over Eig’s book, in which there is a focus of how depression affected Dr. King. Gradually, I found out more about his struggles with mental health than I ever knew, and people were aware of them many years before Eig.

Dr. King never shared his emotional problems with anyone while he was alive in order to avoid the stigma in those times. Initially I asked “Why?” type questions. Why does anyone dig into a person’s private health information? That’s called PHI for short and it’s not supposed to be readily available to just anybody. Health professionals know that.

And then I remembered something I learned gradually over the course of my career as a psychiatrist. It’s hard to frame useful answers to “Why?” questions. It’s often more helpful to ask “What?” questions, mainly because they lead to actionable replies about things we might need to change.

What did I do as a teacher before I retired from consultation-liaison psychiatry in order to train those who would improve on what I did?

I shared with my students what I thought would be most helpful to them in their careers going forward:

The shortage of psychiatrists in general, and of C-L psychiatrists specifically, still leads me to believe that George Henry was right when he said:

“Relegating this work entirely to specialists is futile for it is doubtful whether there will ever be a sufficient number of psychiatrists to respond to all the requests for consultations. There is, therefore, no alternative to educating other physicians in the elements of psychiatric methods.”– George W. Henry, MD, 1929 (Henry, G.W., SOME MODERN ASPECTS OF PSYCHIATRY IN GENERAL HOSPITAL PRACTICE. Am J Psychiatry, 1929. 86(3): p.481-499.)

There was so much in Henry’s paper published in 1929 that still sounds current today. I can paraphrase the high points:

Practice humility and patience
Avoid psychiatric jargon
Stick close to facts; don’t get bogged down in theories
Prevent harm to patients from unnecessary medical and surgical treatment, e.g. somatization
“The psychiatrist deals with a larger field of medical practice and he must consider all of the facts.”

The psychiatrist should “…make regular visits to the wards…continue the instruction and organize the psychiatric work of internes…attend staff conferences so that there might be a mutual exchange of medical experience”
Focus on “…the less obvious disorders which so frequently complicate general medical and surgical practice…” rather than chronic, severe mental illness

The advantages of an integrated C-L Psychiatrist service (here I mean integrating medicine and psychiatry; mind and body) are that it increases detection of all mental disorders although that requires increasing the manpower on the service because of the consequent higher volume demand in addition to other requests, including but not limited to unnecessary consultation requests.

Further, what still astonishes me is the study which found that among consultee top priorities was an understanding of the core question (Lavakumar, M. et al Parameters of Consultee Satisfaction With Inpatient Academic Psychiatric Consultation Services: A Multicenter Study. Psychosomatics (2015). The irony is that the consultees frequently do not frame specific questions (Zigun, J.R. The psychiatric consultation checklist: A structured form to improve the clarity of psychiatric consultation requests. General Hospital Psychiatry 12(1), 36-44; (1990).

Moreover, it is sometimes necessary to give consultees bad news. A consultant should be able to tell a colleague what he or she may not what to hear. This principle is applicable across many disciplines and contexts. And it is best delivered with civility.

A former president of the ACLP said:

“A consultation service is a rescue squad. At worst, consultation work is nothing more than a brief foray into the territory of another service…the actual intervention is left to the consultee. Like a volunteer firefighter, a consultant puts out the blaze and then returns home… (However), a liaison service requires manpower, money, and motivation. Sufficient personnel are necessary to allow the psychiatric consultant time to perform services other than simply interviewing troublesome patients in the area assigned to him.”—Dr. Thomas Hackett.

I don’t think it’s too much to expect things to improve. Speaking of improvement, Stephen Covey called it “sharpening the saw,” one of the 7 habits of highly effective people. For this, The University of Iowa Hospitals and Clinics C-L Psychiatry has the Clinical Problems in Consultation Psychiatry or CPCP. This was started by Dr. Bill Yates in the 1990s, and it was originally called Problem-based Learning. “PBL…emphasis on the development of problem-solving skills, small group dynamics, and self-directed methods of education…most common types of problem categories identified for the conference were pharmacology of psychiatric and medical drugs (28%), mental status effects of medical illnesses (28%), consultation psychiatry process issues (20%), and diagnostic issues (13%) …PBL conference was ranked the highest of all the psychiatry resident educational formats.”

Yates, W. R. and T. T. Gerdes (1996). “Problem-based learning in consultation psychiatry.” Gen Hosp Psychiatry 18(3): 139-144.Yates, W. R. and T. T. Gerdes (1996). “Problem-based learning in consultation psychiatry.” Gen Hosp Psychiatry 18(3): 139-144.
- Covey, S. R. (1990). The seven habits of highly effective people: restoring the character ethic. New York, Simon and Schuster.

What did I do when burnout made me a less effective teacher? In 2012 I started getting feedback from colleagues and trainees indicating they noticed I was edgy, even angry, and it was time for a change.

After reflecting on the feedback from my colleagues and students, I enrolled in our university’s 8 week group Mindfulness-Based Stress Reduction (MBSR) program. Our teacher debunked myths about mindfulness, one of which is that it involves tuning out stress by relaxing. In reality, mindfulness actually entails tuning in to what hurts as well as what soothes.

Maybe we should ask what helped Dr. Martin Luther King, Jr. persevere in spite of the inner turmoil and external pressure.

Glue Myself to My Biography

There’s a reason for why I so often tell Dad jokes. In keeping with my post from yesterday about Dr. Martin Luther King, Jr’s biographies:

I glued myself to my autobiography. You may not believe it, but that’s my story and I’m sticking to it.

We’ve ordered a couple of biographies about Dr. King. One of them is his autobiography and the other is Jonathan Eig’s book, “King: A Life.”

I’m getting to be too old to write my own autobiography—guess it’ll have to be done by autopen. Sorry about that one (no I’m not).

I’m a psychiatrist so I know when I’m using humor as a defense mechanism. A lot of good that does.

I’ve never seriously considered writing my autobiography. I could have it tattooed on my back—it would be my backstory.

Seriously—no, I guess that’s impossible. On the other hand, every year about MLK Day, I think about the blog I wrote that the Iowa City Press Citizen published in 2015 on January 19th. It’s becoming almost something like a tradition. I think I need to repost it annually around this time. The title is “Remembering our calling: MLK Day 2015.”

“Faith is taking the first step, even when you don’t see the whole staircase.”

-Martin Luther King, Jr.

That quote is interesting because Jonathan Eig’s biography of MLK can be said to reveal more of the staircase, so to speak, at least from the standpoint of his flaws as well as his strengths. But I stray from the tradition:

As the 2015 Martin Luther King Jr. Day approached, I wondered: What’s the best way for the average person to contribute to lifting this nation to a higher destiny? What’s my role and how do I respond to that call?

I find myself reflecting more about my role as a teacher to our residents and medical students. I wonder every day how I can improve as a role model and, at the same time, let trainees practice both what I preach and listen to their own inner calling. After all, they are the next generation of doctors.

But for now, they are under my tutelage. What do I hope for them?

I hope medicine doesn’t destroy itself with empty and dishonest calls for “competence” and “quality,” when excellence is called for.

I hope that when they are on call, they’ll mindfully acknowledge their fatigue and frustration…and sit down when they go and listen to the patient.

I hope they listen inwardly as well, and learn to know the difference between a call for action, and a cautionary whisper to wait and see.

I hope they won’t be paralyzed by doubt when their patients are not able to speak for themselves, and that they’ll call the families who have a stake in whatever doctors do for their loved ones.

And most of all I hope leaders in medicine and psychiatry remember that we chose medicine because we thought it was a calling. Let’s try to keep it that way.

You know, I’m on call at the hospital today and I tried to give my trainees the day off. They came in anyway.

I used to joke that they would erect a playdoh statue of me in the Quad (Quadrangle Hall was there) on the University of Iowa campus someday. Unfortunately, the Quad was demolished in 2016, so I guess I can’t put that in my autobiography.

Since I retired in 2020, I keep meaning to write my memoirs, but I never get around to it. I guess that makes it my oughta biography.

Working on a Simple Plan to Stay Fit?

I saw a couple of web resources about staying healthy and fit that seem to make sense to me. One of them was actually a YouTube video by a personal trainer advising people to stop doing certain kinds of workouts that could be unhealthy. He recommended avoiding certain kinds of weight lifting exercises, especially for those over 40. I’m way over 40 and I agreed with him.

The video was posted about 2 months ago and there are so far 725,000 view and well over 2,000 comments, both for and against the trainer’s advice. Many of the older commenters disagreed with slowing down after the age of 40.

I’m 70 and I’m a minimalist when it comes to exercising. I’ve slowed down from daily exercise, but I still enjoy juggling, riding an exercise bicycle, limited use of dumbbells, body weight squats, a step platform routine, planks, stretching and wrestling grizzly bears. I occasionally go for walks when the weather permits.

I remember trying to lift really old barbells in the free weight room at the YMCA when I was a kid. I dropped them once and the director directed me out of the room. After they got a weight machine, a guy bet me and a friend a dollar that he could jump over a broom handle (in another variant of this stunt you try to jump over a dollar bill, I think) while bent over and grasping his toes. He did it but we couldn’t. We didn’t pay him any money. I still can’t do that trick. Nobody recommends doing this as a regular fitness exercise.

On the other hand, patient YMCA teachers taught me how to swim and helped me get over my severe headaches related to my initial fear of the water.

The other web source is an article that actually recommends we stop focusing on working out. In fact, the title is “Stop focusing on working out”—a professor says you should follow these five science-backed steps to improve your wellness instead.”

There are so far no comments on it. The authors have five suggestions:

Make movement fun

Be socially active

Use mindfulness as a stress buster

Be kind to yourself and others

Prioritize quality sleep

The last one usually is difficult for me. Ever since kindergarten, when the teacher wanted the class to take a nap, I’ve had trouble sleeping. The teacher never understood that. I also tend to be shy. I like playing cribbage, though my wife is my only partner. I still practice mindfulness meditation. Juggling is a fun movement activity and it’s also beneficial exercise.

I think it might be a little safer to try to jump over a dollar bill while squatting and grabbing your toes than squatting with barbells if you’re 70. You’re welcome. That’ll be one dollar, please.

Sit and Rise Exercise Related to Longevity?

I just read a few news articles and saw a couple of videos on something called the sit and rise or sitting rising exercise. It’s not the same as the sit to stand exercise, which is how many times you stand up from a chair without falling down after drinking several beers. The sit and rise exercise is sitting down and then standing back up in a cross-legged position.

Just to let you know, there are dozens of news stories that claim if you can’t do the sit and rise exercise without using one or both hands or a crane to get back up, you’re marked for death within hours. Make sure your last will and testament is notarized.

OK, I also saw a Snopes fact-check story about the sit and rise thing and it’s a myth that the inability to do it predicts mortality within a few years. It does indicate you have problems with mobility and that could be from a number of factors, including previous joint injuries and not having legs. Check a full-length mirror.

Apparently, there was a study done in Brazil in 2012 that got this story going about imminent mortality if you can’t do the sit and rise cross-legged routine. It looks like there have been news stories about it every year or so since then just to scare old people.

I can’t do the sit and rise cross-legged and wondered if there’s some kind of trick to it. There isn’t and the main problem according to experts are weak glutes. And I’m able to stand on one leg for 30 seconds and I can do 3-4 reps of the single sit to stand exercise on both legs. I also have no problem getting up from a chair from a sitting position without pulling myself up using grab bars or having somebody haul me up with a tow chain.

I can’t remember a time when I could even sit cross-legged, although I guess I did when I was in kindergarten. When I took a Mindfulness Based Stress Reduction (MBSR) course, I had to try to sit cross legged to meditate and I was numb in my hips and knees within a couple of minutes. When I got up, I usually fell over, sustained a minor head injury and was rushed to the ER about 1,200 times (“It’s Dr. Amos again; he’s been trying to sit in that lotus position” “OK, put him in the rack.”).

There’s a web page that gives advice on how to fix a problem with not being able to sit in a crossed leg position for longer than a minute. The author provides a short list of exercises without instructions for how to do them:

Child Pose: I imagine this resembles standing pigeon-toed, holding your crotch and dancing around a little about an hour after drinking a half-gallon of Kool-Aid.

Pigeon Pose: This is kind of like the Child Pose only it’s done while pooping on the head of a statue.

Toe Touch: Self-explanatory but apparently you can touch anything with your toe as long as it’s not something recently expelled from a pigeon.

Vajrasana: It involves contacting extraterrestrials who will assist you by inserting various probes in several orifices while you remain very still to allow the tracking device to be correctly installed.

Lung Pose: I’m not sure how this strengthens your glutes but obviously it involves surgery. Check your insurance.

Bridge Pose: This might tone your glutes if you dive off a bridge without a parachute. Make sure your life insurance policy is up-to-date.

That about does it for the sit and rise cross-legged issue. Remember, it’s only when you do it while cross-eyed that all the trouble starts. Glad I could clear that up.

This essay is satirical.

Three Photos to Share for Mental Health Awareness Month

So, I have to hurry up and get these 3 photos posted for today because it’s getting pretty late. Recall the Iowa Healthiest State Initiative calendar along with my photos to share:

The images are important features of events in my life or my sense of humor.

I’m a birdwatcher and many different species of birds visited the fountain. The fountain attracted bluebirds who splashed and even swam in it. That fountain was very heavy. We couldn’t leave it out all winter. In the fall I had to lift the bowls off and move them somewhere else. Moving them entailed lifting them onto bags of mulch so as to reduce the work of hefting them a small distance at a time. The birds were beautiful to watch.

The letter was a class assignment our Mindfulness Based Stress Reduction (MBSR) teacher had us write at the beginning of the class. After we graduated, she mailed us those letters shortly thereafter. We were to write something connected with what we thought we had gained or what we thought might happen after taking the MBSR class. The book might seem out of place, and while I can’t talk much about Gordon Strayer, I did meet him and read his book (which is now long gone; probably lost in a move). I admired him. I don’t think he feared death.

The Chrysler Building reminds me of the Men in Black (MIB) 3 movie, and I included it because my sense of humor is very important to me. In the movie, Agent J and Jeffrey Price have this funny conversation about time travel back to an era that was not the greatest for black people. I know because I lived through it. Agent J is about to use the time travel device which involves jumping off a tall building (it’s a “time jump!”). Agent J is preparing to travel back in time to M.I.B.’s early days in 1969 to stop an alien from assassinating his friend Agent K and changing history. They have this short conversation:

Jeffrey Price: Do not lose that time device or you will be stuck in 1969! It wasn’t the best time for your people. I’m just saying. It’s like a lot cooler now.

Agent J: How will I know if it works?

Jeffrey Price: You’ll either know…or you won’t.

Juggling Concentration Meditation

I haven’t done a juggling YouTube video in a while, and lucky you I made one. When the daily news gripes me or gets me down, juggling forces me to concentrate on just that—juggling. If I break my concentration for any reason, I literally drop the ball.

I’m limited a little in our new house because of the lower ceiling height, risking a throw into the ceiling lights. And I’m still prone to flinging and dropping balls, depending on the trick I’m practicing. So, I go downstairs to practice more difficult juggling tricks.

So, if you need a special kind of focused attention meditation, try the 100-throw cascade.

Thoughts as Train Cars Visualization in Mindfulness Meditation

The Iowa Interstate Railroad train rumbles past our hotel a few times a day and it reminds me of the Mindfulness Based Stress Reduction (MBSR) course I took 10 years ago. One of the exercises the instructor mentioned was the train visualization mindfulness exercise. I don’t know if I remember what our instructor actually said about it, probably something like what the instructor says in a mindfulness video.

One thing I do remember is that it’s OK to notice my thoughts as train cars running through my head. The other thing is the train cars can sort of hijack me and off I go on a tangent, like a hobo hopping a freight car. And, what if also I notice the spaces between the train cars? What would that be like?

The side of my nose itches.

My left eye is tearing up.

What can I do about anything?

Are we all alone in the universe?

Why is David Attenborough’s voice so calming?

Why do I joke around so much?

Even after 10 years of mindfulness practice, I still notice my thoughts jumping around. I’m still hopping from box car to box car.

Mindfulness Video

Great mindfulness video below. Millions of views.

Is it About the Nail or Not?

I saw this essay about getting your hamster off the treadmill and being in the moment. It’s not just for University of Iowa employees. I do the mindfulness thing, I juggle, I make dumb YouTube videos. And for a little over a month now, I have not scrolled past the first few headlines at the top of the on-line news outlets. It’s a little easier than I thought to give up FOMO zombie-scrolling news habit, if you can even call it the news.

And the nail video is a hoot.

Jim Updates His Workout and Adds a Step Counter!

Since we added the step platform, I’ve been wondering how to count steps when I use it because for some reason my smartphone step counter won’t count steps when I try to use it on the platform.

Sena got a handy step counter and it works! It works if you have it in your pocket or wear it on neck with a lanyard.

I usually practice juggling patterns as a warm up to exercising. I’m still working on the shower pattern. Progress is slow.

My exercise routine takes a half hour. Following that I sit for mindfulness meditation for 30 minutes. We are still using our anti-Peloton exercise bike. I do one leg stands for a minute on each leg. I still do floor yoga, body weight squats, planks, and dumbbells. I still count my own steps on the platform: 50 steps alternating right and left leg four times (200 steps). The counter number varies between 170-200 or so.

As a review, a recently published study found that climbing 5 flights of stairs (approximately 50 steps) was associated with a lower risk of ASCVD types independent of disease susceptibility (Song et al, see reference below). There was a threshold effect of stair climbing in the study, meaning the benefit was lost if you went over a certain number of “floors.” Going over 15 or 20 didn’t gain much for subjects. A flight was 10 stair steps.

Step up!

Reference:

Song Z, Wan L, Wang W, Li Y, Zhao Y, Zhuang Z, Dong X, Xiao W, Huang N, Xu M, Clarke R, Qi L, Huang T, Daily stair climbing, disease susceptibility, and risk of atherosclerotic cardiovascular disease: A prospective cohort study, Atherosclerosis (2023)