“But It’s Just the Way Things Are”

Alice Keys, M.D.

November 29, 2012

My sabattical of last winter has spun off a second one. I remain uncertain of my role as a physician in a society which values pills over personal growth and change.

Last summer, unplugging my life from the “American dream” seemed in order. It’s not easy to make changes with chains and weights in place. It’s not easy to think, decide and move with the financial shackles that are the bones of everyday life.

I sold the long-time family home. I gave away our accumulated possessions. Now I have more freedom to think and work on personal projects. It was a busy and difficult summer. I hope yours was better.

A line from a song I learned in elementary school comes to mind here:

“Freedom isn’t free.”

Now, I get to spend more time watching and walking, thinking and writing. The more I watch and walk, the more I see that things are interconnected, enmeshed together, part of a larger unity.

Please bear with me through another of my rambles. They are connected, as all things and all of us are.

However much I would like to think that the issues in the practice of medicine are isolated to medicine, however much easier the cure if the problem was limited to thoughtless and greedy psychiatrists prescribing cash-cow drugs to innocent patients, I cannot, personally, view the situation as such.

Yesterday, I thanked a bicyclist for riding his bike instead of adding one more car to the polluting mass of cars at the intersection where we met. His panniers and basket were loaded, his backpack filled. He seemed startled when I thanked him for not adding one more car to the pollution. The unending stream of cars coughed out fumes into the five-by-five lane intersection beside us. My husband and I were on foot, one mile into our one-point-two mile walk to a grocery store. Before he rode away, the cyclist thanked us for walking.

We picked this area because it is more walkable than much of America. A lot of our country was intentionally designed to be dependent on the automobile for everyday life. Collusion among industrialists, particularly car manufacturers and fuel producers, led to the destruction of other transportation systems. Over time, our country’s development has continued in this car-dependent fashion. For most Americans, there is no way to get from home to work or to buy food without a car.

I talk to people I meet about global warming, pollution and the financial and health costs of automobiles. According to the CDC, the number one cause of death among all Americans ages 5 to 34 are car crashes. In response, I get a nod of agreement, then a smile and a shrug.

“I know. But it’s just the way things are.”

If anything else were cutting short the lives of so many innocent young people, we would be taking to the streets in protest. Wouldn’t we?

But it’s just the way things are.

Recently, I had a conversation with the medical director of a psychiatric clinic in another town. Since prescribing drugs is now the entire job description of  psychiatrists (and most doctors today), our conversation turned toward the prescribing of drugs.

I expressed my professional concerns about “polypharmacy” (the increasingly common habit of rapidly prescribing multiple drugs to one person), the narrowed role of doctors in the practice of medicine, the loss of other skill sets in psychiatry and my concerns about the toxicities of drugs.

I got agreement, then shrugs and smiles.

“It’s just the way things are. We have to work with it.”

Then I raised my concern about the money issues, how the tactics used in promoting drugs could be leading us doctors astray. I mentioned the drug money that pays for both undergraduate and post-graduate medical education, the drug money funding research, the drug money at the FDA level funding the drug approval process.

His expression became worried.

Because I was trained before the takeover of the psychiatric profession by psychopharmacologists, I’m a practiced observer of human non-verbal communications. I was able to read the thought bubble that hung over his head.

“Suspicious kook. Troublemaker.”

I’ve learned to tame back the rhetoric when I get that “look”. Otherwise, I lose my audience altogether.

The air pollution where I am now is thick along the beach on a sunny weekend. If I walk on those afternoons, I cough for two days after. This can’t be good.

When I mention air pollution to people that get out of their cars to look at the water, I get that look. I’m told that the air is fine here, that American cars run clean, that we’re protected by federal regulations.

Two days ago, I was reminded by a visitor that the U.S. blocks the import of many European-made cars. He would like to buy a German vehicle that is not allowed in this country.

“Of course we do,” I said. “The government blocks imported cars to protect our auto industry.”

I smiled and nodded. I thought we were on mutually agreeable territory.

“We have stricter safety and pollution standards,” he insisted. “Europe has much worse pollution than we do.”

“Funny,” I said. “When I was there last year I didn’t see the orange haze over any town I visited. My eyes didn’t burn. Walking in town didn’t make me cough.”

We had little to say after this. He got back in his big truck and drove away, alone. And he left a swath of diesel fumes behind for me to breathe.

The air is fine, sealed inside the air-conditioned cab of a truck.

I tell people of my concerns about the over-use of psychiatric drugs. I fret aloud about their known and unknown toxicities. I talk about the financial conflicts of interest happening between pharmaceutical companies and government agencies, medical schools and researchers.

Folks nod and agree. Poison drugs are bad. Greed sucks.

But one friend of mine whispered this to me:

“I agree with everything you say. Just don’t take my antidepressants away from me.”

 

Thanks for reading, thinking and writing.

All the best.

Alice

 

 

Alice Keys, M.D.

Necessary Phoenix:  Can one physician help heal the practice of medicine? After  two and a half decades of work as a psychiatrist in private practice, community clinics and inpatient units, Dr. Keys shares her personal perspectives on the devolution of medical care and the needed  resurrection.

“But It’s Just the Way Things Are” Comments RSS

35 thoughts on ““But It’s Just the Way Things Are”

  1. “I got agreement, then shrugs and smiles.

    “It’s just the way things are. We have to work with it.””

    That is what I call a lack of Liberty. People, especially the employed, will not “do” anything unless a law tells them to (or NOT to).

    Liberty is an aspect of freedom. Liberty seeks no permission, approval or acceptance. Liberty is the *self-empowered* motivation to act.

    A good question would be: How can psychiatrists utilize Liberty in caring for people? The prerequisite to treating a person is caring about them. When we care about a person, the person becomes important and significant. When a person is important and significant, there is a greater motivation to want to honor and protect that important person’s rights (and well-being). To achieve even this much would be transformative to the point of miraculous, but this isn’t the way things are.

    Laws must be obeyed. Protocols and procedures must be followed. There are no exceptions. Rigid, inflexible, skeletal infrastructures. Concrete. Masonic.

    I have personal issues with the Statue of Liberty.

    • MJK,
      What a lovely response you’ve written today. Very thoughtful.

      I have additional thoughts about liberty. Buying anything on credit makes a person less free. Any time you’re obligated to make payments, it influences your decision-making. No one is immune to this.

      Every doctor I know leaves school with a lot of debt. There is no other way for a person of less than independent means to become a physician. Medical schools accept a lot of fundng from pharmaceautical companies. This doesn’t prevent the schools from demanding enormous sums from the trainees as well. Banks are out there, ready to loan money to earnest young people who want to help. These loans can no longer be discharged through bancruptcy.

      Back to my recent re-read of “Grapes of Wrath”. People lost their family farms after accepting bank loans against them that they couldn’t pay. Steinbeck mentions that the people who worked for the banks didn’t want to do what they did (ie take away the homes and farms) but that they had no choice in the matter. Disobeying would mean job loss to those workers and loss of livelihood.

      Everything’s connected.
      Thanks for reading, writing and thinking.
      Alice

      • Alice,

        In France medical school is almost tution free ( I would say a few hundred dollars a year)and gives right to social benefits.(There is a very selective exam to enter the second year of medical school.)

        No hudge students loans to repay for MD in France.

        Still, prescribing too many drugs from antibiotics to psychiatric drugs is a main issue for our health system.

        The main difference with the USA might be that many MDs are chosing nowadays not to practice medicine

        Also in France, women are making nowadays around 70% of the medical schools students’ force so to speak. It is becoming like nursing schools.

        • Dr.Fulli,

          Thank you very much for offering a French perspective. I am honored that you would take the time to read what I write here. Thank you.

          I meet doctors in this country (besides myself) who have also decided to stop the practice of medicine. I suspect that more would stop if they were economically able. The numbers of women practicing medicine here has been on the increase as well. The highest numbers of women work in the lowest paid specialties (pediatrics, primary care, psychiatry).

          We have also been licensing nurses in the USA to practice medicine here for many years. The “nurse practitioner” profession is a field dominated by females as it is a a graduate nursing degree. They work as independent practitioners and are used as a low-pay doctor equivalent for the same work.

          I have heard that private insurance companies are making inroads in France, as in England. I have heard of a push to “privatize” medical care in France. I would like to hear your thoughts about the impact this will have.

          What are the costs for a routine medical check up there? My Primary care doctor’s fees for an annual check up (about 45 minutes) runs around $500. This does not include any lab tests, xrays or medicines. An uninsured person could not afford this.

          Thanks so much. I would like to hear more from your perspective when you have the time.

          Alice

          • Dear Alice,

            Thanks you so much for your kind words and for asking about the French system;

            Unfortunately, to explain it, I would need a “foreigh correspondant blog” on MIA and my English is not up to it- not to mention the fact that I am not MIA politically correct in my defense of psychiatrists…

            Anyway, as much as the costs and organization of health care in the USA – compared to France- might explain a huge gap in health between poor and wealthy people in the USA compared to France , in social psychiatry there is much more than poverty at stake- seems to me.

            Just think about the fact that some of the poorest people emigrating in GB from the Far-Est seem to suffer less frequently from psychosis than the general GB population when they belong to the Buddhist religion when non Buddhist people emigrating from other places have a much higher rate of psychosis than the general UK population.

            NB: I think psychiatrists and doctors in general have their faults for sure but the clients do not deserve to pay for it by being prescribed dangerous psychiatric drugs by non MDs or to have no other choice than to be put under the care of people believing that their own story applies to anybody or that any interesting causal theory or FRMI study is sound science when it is not, etc…

            I wish you a very nice holiday seasons and a happy new year for 2013.

            Ivana

          • Ivana,

            Sorry to be slow responding here.

            I think that the differing structure of our medical system does explain a lot of the differences in health care between the US and France. Our system is made of a changing web of profit making organizations all battling for market share. Units of health care are sold to those that have money. No money, no health care.

            Also poorer people have less access to healthy food here. There are areas of towns and cities that have no access to food unless it comes from fast food chains. Our small corner groceries sell snack food and beer, not produce or good bread.

            It is interesting to me that the Buddhist immegrants have a lower incidence of psychosis. Do you suppose social support and family support is stronger?

            HAve a good holiday season and new year as well.

            All the best.
            Alice

  2. Our society and economy are not sustainable. Global wwarming is a reality; the temperature will most likely rise 4 to 6 degrees by 2050. Mammalian life any larger than a shrew will be dead and gone before then. We are moving towards a massive die-off of humanity. We may be able to stave off the total destruction of the human race if we begin doing radical measures to lower CO2 emmissions but there will still be massive die-offs.

    We’ve made the projections and we know the end results and what is the response? Exactly what you describe here. It’s like an inertia has set in which will not allow people to deal with reality and work to change things. Talk about a huge helping of DENIAL! Then of course, you have huge groups of politicians who deny all of this and tell people not to worry. Big Business keeps going right on down the same old road and will not allow changes to be made. Look at how it’s trying to dismantle the Environmental Protection Agency. Our government seems to be held hostage by the robber barons who only value makeing profit hand over fist. Capitalism is cannibalizing itself and all of us along with it.

    Frankly, I’m not optomistic about how it’s all going to end. “It’s just the way it is; we have to work with it.”

  3. Alice

    I have found your posts to be very educational and interesting critiques of modern medicine and psychiatry. I have also admired and appreciated your courage and willingness to openly process very personal thoughts about your career crises as well as dialogue with psychiatric survivors about your previous role as a psychiatrist working in locked units in hospitals prescribing medications. Some of these were very tough discussions and you hung in there with great honesty and humility.

    In your current journey I would like to take your pulse on a few questions regarding the state of the psychiatric profession and the movement for the total transformation of mental health care? This would help me and perhaps others to understand what role doctors can play in this movement.

    Do you now consider yourself anti-Biological Psychiatry (as opposed to anti-psychiatry)?

    Would you be in favor of totally dismantling modern psychiatry and and the current mental health system and replacing it with something more humane and progressive?

    Have you thought about joining with a minority of other doctors who share your alienation and criticisms of the current system in order to build organization and struggle that might eventually lead to the overthrow of the current paradigm of treatment?

    Richard

    • Richard,
      Thanks for your support of my writing and processes. As a writer, I enjoy being read.

      Although I do feel professionally alienated by the current system of profit driven, mass-marketed and drug-based “health care”, I’m not the “overthrowing” and “dismantling” kind. That takes an outwardly aggressive edge I was not born with.

      And I honestly cannot say that I’m “anti-” psychiatry or even “anti-” biologic psychiatry on the whole.

      I am a physician. I am a psychiatrist. I have prescribed drugs to people and found that there were times that the drugs were useful to specific people.

      Before going much further, please notice the quotation marks around the word fragment “anti”. This is the pivot point of my thoughts on the matter.

      In my experience, any time I’ve focused on what I “didn’t” want, that very thing came into my life. When I spend a lot of time thinking about anything, it becomes more apparent in my life. When I proudly proclaimed that I’d “never” do something, I invariably came to the point of doing just that. I learned not to say “never”. Focusing on “fat loss”, for example, has ones eyes glued to “fat” and “loss” rather than health and vigor. “Mad” in America, draws anger like a lightening rod. “Pain” management draws the focus to what hurts.

      How I use words directs how I think and feel and how I live.

      I certainly encourage every physician I talk to to re-evaluate their notions about medicines, their relationships with their patients and their relationships with their employers, the medical corporations.

      I’m very much in support of finding and developing more humane ways to take care of one another.

      I hope this addresses your questions.

      Thanks for reading, thinking and writing.

      Alice

      • One of the things I’ve decided is tht it’s not only the biopsychiatrists, or psychiatrists in general, that have to answer some difficult questions and be held to accountability. All of modern medicine must be called into question and held accountable. Medicine is one of thsoe systems I was talking about in my earlier post that has morphed into something that is unsustainable. This isn’t totally the fault of doctors but too few of them struggled to change the paradime(sp.) and are now finding themselves bogged down in situations that they don’t really like. They got caught in the mess that was the brainstorm of insurance companies and managed care and Big Business. It seems like far too many people become doctors these days, not becasue they truly care about people and the pain we suffer, but about profits and the dollar bill. People are the “cattle” in the medical industry. Doctors’ waiting rooms are filled to capacity because appointments are scheduled for every fifteen minutes. This is not enough time to interact with your doctor and get your problems sufficiently examined but “that’s the way it is” and we either accept it or lump it. Even to use the words medical and industry seems like a contradiction to me but this is where everything is at.

        I’m old enough to remember the days when our family doctor made house calls when one of us kids was sick so that my mother, who was poor, didn’t have to get a cab and drag all of us out of the house to go to his office. I also knew a doctor whose father was also a doctor in a small country town of the state where I live and in the 1990′s was still accepting eggs, chickens, venison, etc. in the place of cash payment. He didn’t own a palatial house and he obviously didn’t become a doctor in order to amass a fortune. He’s dead now and we will never see the likes of him ever again in this system of medicine.

        There are no simple solutions to the problems and we ourselves are as much a part of the problem as the doctors are. There is nothing simplistic about any of this. You are partially responsible for my understanding this crucial point. If we are going to find answers and solutions to these things it’s going to have to come from all of us working together. And it’s not just medicine where there are things that must be dealt with. It’s in all of our systems from government on down.

        As psychiatric survivors I sometimes think that we become so focused on this particular medical system that we miss the broader and larger picture of what is happening. And on top of all of this I always run around looking for simplistic answers because I don’t like the complcated and involved and convoluted ones!

        • Stephen,
          Thanks for taking the time, enegy and thought that have obviously gone into your post here. Wow. It’s a blog in itself.

          So I’ll follow it with what should probably be yet another blog.

          The fifteen minute (or less!) appointments are a contruct of the insurance/medical corporations and have nothing to do with providing care. Personally, there is nothing I can get done in fifteen minutes outside of hello, goodbye, typing a progress note and data entering prescriptions. This is not care. It’s a payment pump.

          Even patients have come to believe in the fifteen minute appointment as a stadard of care. For the last two years of my private practice (2002-2004), I kept my rates down so low that I could only pay the overhead of a low overhead private practice. I had 30 and 50 minute appointments for the price of the usual “med checks” at the medical school clinic. I was still trying to practice medicine in a way that made sense to me.

          9 of 10 calls that came to me were from people only wanted a fraction of an hour every six months or a year so they could obtain prescriptions with endless refills. They looked for the cheapest, easiest access to the brand and type of drugs they wanted. Period.

          Physicians did not invent the “managed care” companies. Physicians do not run medical corporations. Physicians do not make policies for these corporations. At times, to add an air of legitimacy or as a liability foil, physicians are hired as figurehead “medical directors” or “advisory panels”. These docs still have to pump “billable units of care” as fast as they can to keep their jobs. Lower paid providers (nurses or social workers) are put in the position of directly “managing” care (limiting access and expenditures). But they must follow the corporate rules. It gives an air of validity to be turned down by a licensed professional even if they are following a corporate script.

          Doctors are employees of corporations these days. Nothing more. They’re not allowed unions. The days of a “private practice” of medicine in this country has been dead and gone for over a decade.

          “Medical system” means “for-profit medical services corporation”. Don’t be fooled by a “non-profit” label. This is a tax designation. They are not working for free. They still pay their top management very well. These medical services corporations have every bit of the medical field tied up tight. They will not simply roll over and play dead. There’s way too much money involved.

          The largest third-party (insurance) payor in our country is the US government. Money is paid from tax coffers through medicare and medicaid entitlements. This is a big pool of dollars. This is the reason for the big push in the past twenty years to get everyone possible on disability. Each disabled person is another cash cow.

          Medicare prescription coverage was a great win for the pharmaceutical companies. This additional “benefit” for the disabled and retired make each one into another lucrative place to stick a straw.

          If I (or any other physician) decides not to play ball by corporate rules, we are out of a job, out of the game. Period. For me, there was no union, no benefits, no unemployment, no retirement. I’ve spent my life training and paying off loans for training and working as a doctor.

          What was my backup plan to earn a living? I don’t have a back up plan. Neither does your doctor.

          I think you are right when you say we are all to blame for this mess. We all must work together. It is, indeed, very complicated.

          I’m sorry. I really, really wish it were simpler.

          All the best.

          Alice

          • “9 of 10 calls that came to me were from people only wanted a fraction of an hour every six months or a year so they could obtain prescriptions with endless refills. They looked for the cheapest, easiest access to the brand and type of drugs they wanted. Period. ”

            Amazing. As the case would be with me, I always complained that one hour a week of “counseling” was not enough. I always knew, and would acknowledge, that I needed much, much more. And I was always fed the same semi-sympathetic apologies of how utterly defeated we all were (impossible circumstances). But then “out-patient day hospitalization” programs became part of the equation. Even THAT was not helpful to me.

            I don’t dream too much but if I could ever get my hands on a major lottery jackpot, my first priority would be hiring a team of no less than two dozen people to support me in all of my mental, intellectual, psychological, spiritual, sexual, religious, emotional, physical, historic and personal issues. In my own grandiose opinion of myself, I’d say I’m worth no less than a few million dollars. But as it is right now, the price tag on my head is a whopping $20,000 per year. I’m cheap and next to worthless.

            And I don’t even use my medicaid or medicare cards (aside of a reduced bus fare). No joke, my medicare *health insurance card* is actually a BUS PASS.

          • Thanks for your response. I think you’ve pinpointed how all of this mess developed. How do we begin getting outselves out of it?

            I have a nurse practitioner instead of a doctor because I don’t have insurance and go to a clinic that bases it’s charges on a sliding scale. She’s better than any male doctors I’ve dealt with; she actually looks at me and listens to me when I need to tell her something important. And I get as much time with her as I need which is a real plus.

          • Stephen,

            I would really like to hear about small individual steps anyone has made as well.

            My own efforts have been focused on myself and my own family. I have stepped away from the prescription pad for now to give myself time to think. I have simplified my life in many ways.

            Your NP must be allowed more time with you. You are fortunate to have found a place you can afford medical care that works for you.

            Thanks for you contributions here.

            Alice

  4. Alice

    Thanks for answering my questions above. Your answer to Stephen is another devastating critique of our current medical system; it screams out that this system is truly broken beyond repair. You better be careful because you are sounding more and more like a radical who just might end up next to some of us at the barricades. You could play a very valuable role in educating people about what really goes on in the belly of the beast, as well as advocating for drastic changes to this system. I look forward to learning more from you and witnessing your growth in our movement.

    Richard

    • Richard,

      Thanks for your support of my work here. Thanks for your comments.

      The conversations in the comment section give me an opportunity to explore the issues we will all have to work with if things are to get better.

      I learned long ago, in biology 101, that a “radical” is the central core root without which the plant is unlikely to thrive or survive. The meaning of the word “radical” has changed so far that it now means its opposite: an extreme view that can be pruned away to relieve distress of the core group.

      Those I talk to about my “radical” views (neighbors, friends, doctors, nurses, social workers, administrators, patients, the insured and the uninsured), agree that things have gone very wrong with medical care. The current “medical system” is not meeting needs on many levels. I guess this means that I and my radical views are closer to the core of things and more in line with the old biology 101 definition.

      Yup. Our medical system is pretty broken, indeed.

      I have always taken seriously the doctor’s's mandate toward education of patients, co-workers, the public and the medical community. I was taught in medical school that one aspect of the word “doctor” is “teacher”. I took this lesson to heart that day and still do. As a doctor today, I am left with this role: doctor as teacher.

      I’m glad to meet you in the “movement”. My hope is that the energy invested in “barricades” can be instead used find ways to better meet the needs of everyone.

      Thanks for reading, thinking and writing.

      Best regards.
      Alice

  5. THE “SYSTEM” IS STUCK IN CAUSE & EFFECT THINKING! AREN’T WE ALL?

    Great post Alice, brave and thoughtful as usual, provoking others to go beyond the usual “us vs them” cause and effect logic which so limits our sense of self and others. I guess its hard for us to adopt a systems thinking approach, even those we may be “intellectually” aware that this is the way of the future, as the brightest minds now tell and show us. Yet it seems just too painful to give up the ““It’s just the way things are,” “reaction” rationalized as intelligent reasoning and acceptance of reality, while remaining unconscious to the thought’s self soothing impulse?

    Perhaps its just the great circle of life and way progress into a meant to be future finds truth in the middle path. Sounds a bit convoluted, I know, yet consider fearless thoughts from the 1950′s which are echoed in new research findings across all science fields, and which a better educated, younger generation may be more willing to embrace than their post world war two great Grandparents were not?

    “Systems thinking?

    Systems thinking, which this research has tried to implement in human relationships, is directed at getting beyond cause-and-effect thinking and into a systems view of the human phenomenon. In the coarse of trying to implement systems theory and systems therapy, we have encountered the intensity and rigidity of cause and effect thinking in the medical sciences and in all our social systems. Man is deeply fixed in cause-and-effect thinking in all areas that have to do with himself and society.

    Systems thinking is not new to man. He first began using it in theories of the Universe. Much later he started thinking systems in the natural sciences, and also in the physical sciences. There was a rapid increase in systems thinking with the beginning of the computer age, until now we hear about efforts to implement systems thinking in many new areas of the applied sciences. The medical model has been one of the proven cornerstones of good medical practice. It is based on cause and effect thinking and the principles of careful examination, the establishment of etiology (cause), making an accurate diagnosis, and specific treatment directed at the etiology.

    The medical model has served medicine and society well for all diseases within the person of the patient. The theory and practice of psychiatry also employs the medical model, and cause and effect thinking. The theory based on the study of the individual, postulates an illness in the patient developed in relationship with the parents or other close family members. It requires a diagnosis and treatment is directed to the patient. The model “blames” the parents for the illness, even though the psychiatrist may deny that he blames the parents, and the model excludes other family members from the treatment process. And so, the medical model created a dilemma when applied to emotional (functional) illness.

    Emotional reactiveness in a family, or other group that lives or works together, goes from one family member to another in a chain reaction pattern. The total pattern is similar to electronic circuits in which each person is “wired” or connected by “radio,” to all other people with whom he has relationships. Each person becomes a nodal point or an electronic center through which impulses pass in rapid succession, or even multiple impulses at the same time.

    One important variable has to do with different kinds of impulses, and each kind exists in a wide spectrum of intensity, and in degrees of importance. A more important set of variables as to do with the way each nodal point, or person, functions within the system. Each person is programmed from birth to serve a certain set of functions and each “senses” what is required or expected, more from the way the system functions around him than from verbal messages that he is free to function as he pleases.

    A predictable pattern is the placing of “blame” for failure to function (cause and effect thinking) and the pattern of either blaming the other or blaming self. Under tension, every person tends either to place the blame outside of self, or within self, or alternate between the two, which is the pattern of cause and effect thinking. If the head of the family unit is calm, the entire family unit can be calm and the system operates smoothly

    When the head goes into panic and transmits panic impulse, the others send panic (mirroring) messages which further panics the head, in a mounting cycle of panic, with poor handling of messages, disorderly and conflicting messages, and increasing paralysis of functioning. There is another variable having to do with the way the family is wired into other families and larger social systems, and into the total system of all society.

    Though man may have gained some knowledge about systems thinking from the sciences, he is still a cause and effect thinker on all things that involve his emotional system.” _Murray Bowen.

    And of coarse I don’t need to remind you and others here what NAMI’s “reaction” was to the fearless thinking of the 1950’s and theories about the human condition, like Bateson’s “double-bind?” “Don’t blame us, screamed……..” in a reasoned-reaction. “That’s just the way it is – in families, don‘t blame us, don‘t you dare “shame” us.” And so the reactive reasoning rolls on, down through the generations, while cause & effect logic looks to the non-shaming-blaming wishful reality of “It must all be genetic – surely?”

    Is it possible that beyond our reasoned-reactions, our sense of “I” & “otherness” which matures into a group sense of “us & them,” that the systemic reality of nature really is cycling its way forward into a meant to be future? Consider this forward to Allan N Schore’s work from the 1990’s “Affect Regulation & The Origin of The Self.”

    “Maturation, with its achievements and failures, is fundamentally determined – and altered – by a vast array of carefully timed neurodevelopment processes that can now be conceived of, thanks to the explosion of new interdisciplinary data, as occupying vaster and more complex, as well as more intricately timed and sequenced scenarios than we could have ever imagined.

    These developmental sequences are determined by a fantastic, almost surrealistically complex choreography that integrates postnatal neural anatomic and neurochemical development so that they unfold in an intricately coordinated series of contacts with the maternal-social-environment.; all in an orcestration of specifically times phases of availability to a holding environment of appropriate, mediating caregiver functions that at first soothe, validate and confirm, and then stimulate, challenge, and encourage , the sequential interventions that appear to be absolutely necessary for neural development – and, as a consequence, the roots of the infant’s emotional development, to occur.

    Upon this depends the unfolding of the neural anatomy of the regulatory centers of the brain, particularly the right hemisphere orbit frontal cortex, which apparently becomes the control center for the regulation and mediation of affect, social relations, and emotional balance, to name just a few of its functions.

    Put another way, if I read Dr. Schore correctly, it is the prefrontal cortex generally – and the right hemispheric orbito-frontal cortex specifically that is most responsible for the establishment and mediation – and even the development of the humanness of the infant.

    What psychoanalytic theory had speculated upon from its very beginnings now turns out to be truer than had been anticipated. As in chaos theory, which states that there occurs an unusual sensitivity to initial conditions, the role of the mothering person with her offspring, which had been all but neglected in the dawn of psychoanalysis. Nobody then anticipated how dependant the infant’s brain was on the mothers care giving.

    In developmental disorder one thinks of psychopathology, insecure attachments and their neuropsychological consequences, affect dysregulation, the onset of personality disorders, and vulnerability to somatization disorders. Developmental psychopathology, which is rapidly becoming a field unto itself, can certainly be understood in no small measure by the concept of the “failed appointment,” that is, failure, whether by chance, trauma, neglect, or inherent genetic programming, for the key neuronal connections to have been evoked at the proper time by the mother-as-appropriate-self object at the appropriate time.

    One certainly must now view such disorders on the anxiety spectrum, such as the disorders of anxiety, panic, phobia, hypochondria, and such trait-state disorders as borderline personality, the obsessive compulsive disorders, affect dysregulation (the manic-depressive-dysthymic spectrum disorders), schizophrenia, and many others as being deeply rooted in one or another form of a neuro-biologically induced disorder of regulation.

    Joseph Palombo, who works with the neuro-perceptual-cognitive aspects of developmental disorders of childhood, including borderline syndrome, calls attention to the presence in these impaired children of a discrepancy between their private, personal selves and their shared selves in terms of a lack of ease in communication. Put another way, these damaged children seem to sense that there is something neurodevelopmentally wrong with them, and they feel a “deep sense of shame” about themselves as a result.”

    Excerpts from “Affect Regulation & The Origin of The Self.” by Allan N Schore.

    And as we cycle forward into the 21st century, is there a new discovery that truly will change everything, in terms of how we understand ourselves, beyond our knee-jerk self-soothing reaction of “that’s just the way it is?” Please consider why ‘The Polyvagal Theory.” really does change everything as we cycle into a meant to be future? Stephen Porges discovery of a third branch to our autonomic nervous system, deepens our understanding of what truly makes us tick, and brings us closer to the systemic reality of nature and beyond.

    Please consider a recent post on my blog;

    “Discovering a Paradigm Shift in Mental Health?

    Understanding the Face-Heart connection, and hidden vitality affects, in human health?

    The paradigm shifting discovery of a “polyvagal” control of the heart, explains just how, those of us suffering from unresolved trauma experience, become locked out of the social system of group survival, in our inability to self-regulate unconscious survival reflexes,
    ie, freeze/flight/fight?

    The theory shows just how “unconscious, spontaneous, social reflexes,” are inhibited in those of us struggling to cope with unresolved traumatic experience, so often diagnosed as a mental illness. In a computer analogy, its like having two distinctly different operating systems, (1) survival, (2) social. If our unconscious spontaneous social reflex functioning is “turned off,” by unresolved trauma experience, we cannot form the kind of healthy human relationships, so vital for our physical/emotional/mental health.”

    http://www.bipolarbatesy.blogspot.com.au/2012/11/discovering-paradigm-shift-in-mental.html

    And from a near 3000 year old Buddhist perspective?

    “Seeing the interdependent nature of all things, Siddhartha therefore also saw their empty nature: all things are empty of a separate self (ego).
    He realized that the key to liberation lies in the two principles of interdependence and non-self (ego).
    Illuminating the rivers of perception, Siddhartha understood that impermanence and the absence of (ego) are the conditions that are indispensable to life.
    The cause of suffering is the false notion of permanence and of a separate self (ego).
    When we penetrate the empty nature of things, mental barriers are overcome and we are liberated from the cycle of suffering.
    Right understanding, has been handed down by Buddhist tradition under the name of “enlightenment.”

    But what in concrete terms, is Right Understanding?
    Ignorance of reality – the exact opposite of knowledge – is what the Buddha considers the cause of suffering.

    “Brothers, the cause of suffering is ignorance. Because of ignorance, men do not see the reality of life and allow themselves to be imprisoned in the flames of desire, anger, envy, anxiety, fear and despair.” _Buddha.

    But what is reality?
    The definition traditionally attributed to the Buddha is quite clear.

    Reality is constant change!”

    Excerpts from “How to become a Buddha in 5 Weeks,” by Giulio Cesare Giacobbe. In brackets mine.

    Is there a meant-to-be reason for our current malaise? Economic and moral bankruptcy in the name of “its just business – that’s just the way it is?” Or are we on the brink of a major “phase-shift,” to use a term from systems theory, as we cycle our way into a meant-to-be future, that some physicists suggest has already happened? Reality! Its turning out, is truly stranger than fiction?

    When we do pause to feel the “impulse” beneath our egoic sense of “I,” perhaps we get that deeper sense of Jesus statement “I am,” as a reflection on the Cosmic nature of ALL? The Buddha is said to have discovered “The Way.” And is perhaps reflected in Jesus later, cross-fertilized statement “I am the way?” As we stand on the brink of what seems like a looming disaster, at the beginning of the 21st century, are we perhaps, entering the phase shift to a deeper realization, beneath our daily sense of survival, which we label ego?

    Are we entering the maturing phase of species survival, in the realization of no-separation and the reality of God within?

    I hope your continuing your sabbatical with more trips’s down the rabbit hole Alice:)) On this great self-reflective, journey within?

    Best wishes,

    David Bates.

    • David,
      Thanks for your support of my writing here on MIA.

      I can tell you put a lot of time and thought into your writing here.

      I wonder if “cause and effect thinking”, as you put it, is a natural and built in feature of the human cognitive operating system. For example, if you stub your toe your toe hurts and if you eat rotten food you get sick. “Cause and effect thinking” sounds like a good thing for everyday life.

      I certainly hope we are entering a time of more unity of spirit and understanding.

      All the best,
      Alice

      • Yet is cause and effect thinking to shallow, and far to mechanical to capture the nature of being, Alice?

        Consider the late Teresa Brennan’s thoughts on the contagious nature of affect/emotion, our feeling oriented reactions and responses and our subjective states of mind;

        “The Subjective State:

        Our subjective state, tends to take the definition of itself as the center of all definition and defines all “activity” as having its own character. It labels “passive” everything that is not active in its own way, and which it is able to bend to its will, passive if it does not assert itself against the subject. The active/passive dichotomy, as consciousness understands it, is a product of a sense of self which divides itself of from the rest of the world, on the grounds of its difference. So the distinction between subjectivity and objectivity cannot rest on a distinction between psyche and soma, meaning that it cannot rest on a distinction between ideas and matter. What prohibits the assimilation of the psyche/soma, ideas/matter distinctions to the subject/object distinction is, the fact of feelings and the existence of energetic affects. (p, 93.)

        Both feeling, as a process of sensing energetic affects and the transmission of affects, are physiologically, material processes. We cannot distinguish between them, anymore than we can distinguish between subject and object, by any criteria to do with materiality as opposed to ideality. A distinction can only be drawn on the basis of the nature of the feelings and affects involved. Feelings connect consistently with information provided by the flesh. Yet negative affects divide one person from another, remaking connections inaccurately (dependant on individual history) within the subjective state.

        Discernment by feelings, begins with considered sensing, a process of feeling that seems to operate as the gateway to emotional response. Uneducated, unconscious senses are not aware of any psychical, intelligent connection with the internal and invisible body, and this unconscious extends to the rest of the environment. Senses are structured in such a way as to deny or foreclose on sensing information as a conscious process. But the foreclosure is not absolute; it does not govern perception permanently or fully. It is interspersed with feelings that can lead to different conclusions and other directions. (p, 94-95.)

        The foreclosure of senses and repression seem to coincide with the projection outwards of the negative affects. This projection results from a sense of peril and pain in which the nascent subject is attempting to defend itself, by expelling bad feelings outside itself. In this “projective defense” lies the basis of all errors of judgment. When my eye sees what it expects to see, even though it is not there, I have made the image real, given it a tangible and physical existence by the force of my subjective imagination. This imaginative force is not a metaphor, it helps construct apparent chains of reason from the subjects historical standpoint.

        Understanding the influences to which we are subject in terms of passions and emotions, as well as living attention, means lifting off the burden of the ego’s belief that it is self-contained, in terms of the affect/emotions it experiences. Lifting off this burden liberates the ego scientifically, allowing it to explore interpersonal communication in ways that can heal it. Helping us to understand those moments when we are callous or blinded to facts, when tempers are lost and feelings trampled, when spite dictates the words and envy the vision–all these moments can be revisited in the light of understanding the transmission of affect/emotion.

        These moments are not only self-caused, there are also times when waves of negative affect posses us as surely as anxiety is communicated or love truncated. In understanding the transmission of affect, both anxiety and living attention can be seen in there effects and understood in terms that are the very opposite of the superstition that habitually distorts the interpretation of the invisible. (p, 95.)

        Excerpts from “The Transmission of Affect” by Teresa Brennan, PhD

        Is cause & effect thinking more instinct, than insight?

        Best wishes,

        David.

        • David,

          “Yet is cause and effect thinking to shallow, and far to mechanical to capture the nature of being?”

          I am personally unable to capture the “nature of being” with thoughts. I find words get in the way for me. Of course there are different paths for different folks.

          Thanks for your expositions.

          Alice

  6. I highly recommend the film “Ancient Futures: Learning from Ladakh.” Ladakh is a place very lately influenced by globalism. The older people have seen an entire modernization that took the elite parts of the world centuries happen in one lifetime. Because it happened so quickly, the people of Ladakh were able to identify some causes and effects. This film looks at how our modern way of life has impacted our community life, mental health, power structures and environment, as well as the all-important feelings of purpose in life and happiness. It is modern life that is killing us in body and spirit.

      • Karina,

        Thanks for reading and responding here.

        I watched part one on youtube just now. Thanks for the recommendation. Do you have a link to the entire program you could share?

        This video validates the essence of my concerns about industrialization and “progress”. This is a very big and interconnected issue.

        All the best.
        Alice

      • Alice, I think that if we want to get to what is causing our traumas, dis-ease, un-wellness, and even illness, we can start with what human spirits require in the world. This is not a medical or even an individual process, but a social one. Any work on wellness, recovery, happiness and meaning/purpose is basic and profound – and following this trail has always led me back to the same conclusions, even when I worked in public health looking at exposure to lead, or in environmental policy, looking at the roots of climate change. If illness is not within us, then I understand how overwhelming it is for us to think about what it would take to create a world of communities of relationships that sustain us. But we could start by creating communities of relationships that sustain us. :) See? It’s fractal-like and the means and end are simultaneously at our disposal. It lets us understand we are doing meaningful work in the moment and that allows us to let go of some of the fear and stress that comes with being frustrated about how things are and worrying about how we are going to get to a better future. Engaging in that process of community-building will produce the results we are looking for all along the way and make the journey a satisfying and not-lonely one, even if we don’t solve all the problem’s side effects right away. It’s a living, creative process and we will never be able to see how it will end up because we just can’t imagine that far. Utopian kinds of goals will only lead us into restricting the creative force that can lead us to what I hope is not an end.
        Best to you,
        Karina

        • Karina,
          I, too, think that re-building communities that can sustain us is very important. I wish I knew how to go about doing this in these modern times.

          I think that many of our modern human (and planetary) ills are the result of the ongoing industrialization process and an unrestrained capitalistic economy. These processes have slashed and burned families, farms, forests and communities the world over.

          I know how to “network” with people today (emails, drive to meetings, texts, phones, co-workers and classmates) but I have no idea how to re-build actual communities. I grew up in a small agricultural community. When I think of community, I think of sitting on the front porch to see what’s happening in town, walking across the field to dig potatoes, sharing the extra tomatoes with grandma and sitting outside in the evening with neighbors talking as the night falls. You helped your neighbor, not simply because it’s the “right” thing to do but because next time you’ll need help. You weld my plow and I’ll can your pickles, kind of thing. We lived near the same people for a long time to get there. You didn’t always get along with everyone, but you knew what to expect from them.

          That’s what I think of when I think of community.Can we get there?

          All the best.
          Alice

Leave a Reply