Tuesday, October 20, 2020

Sympathy vs. Empathy






Today's post was written by my current attending, Steven Berger, MD. He wrote it for the residents to discuss. Something to ponder. (Goodness I am blessed to work with such wonderful compassionate attendings!)


Sympathy vs Empathy

Sympathy means similar. It consists of being similar to another person. For example, at a funeral, you express sympathy and say things such as: "You must feel awful," "I’m sorry for your loss," or "I can’t imagine what it’s like for you to lose a child." In a funeral setting, you are saying that you are supportive of the person in his sadness and that you stand beside him in his time of need. A friend feels and expresses sympathy.

Empathy means same. It consists of having the same feelings as the other person and being one with the other person. As a psychiatrist, you are the authority of thoughts and feelings. With the patient, you identify the thoughts and feelings the patient is having. You bestow credibility and acceptability to the person’s thoughts and feeling. You endure those thoughts and feelings with the patient. You become one (same) with the patient in his thoughts and feelings. Instead of saying sympathetic things, you say empathic things, for example: "You feel awful," "The loss of your child is unfair," or "I know you feel unconsolably grieved. I will endure that inconsolable grief with you."

In being sympathetic, you act as a friend standing beside the person. In being empathic, you act as a holy spirit co-existing with the patient in his experiencing his thoughts and feelings. You experience the patient’s thoughts and feelings with him. You demonstrate to him that he is not alone, that you are with him, that you are bearing his burden with him, you are on his side to deal against his struggles with him. You are more than just a team with him. You are one with him.

As a psychiatrist, you side with the patient against whatever devils he is fighting. Instead of opposing the patient by saying, “Those voices you hear are not real”, you side with the patient by saying, “How are you and I (together) going to deal with those voices?”


Personally, one of my favorite pieces on the difference between empathy and sympathy is a short, two minute cartoon by Dr. Brene' Brown. I first saw it during medical school orientation at Wake Forest. The images from this short clip have stayed with me since. It's definitely worth watching (click HERE to view), but in a nutshell Dr. Brown proposes that empathy consists of four key steps:

1. Perspective Taking, or putting yourself in someone else's shoes.

2. Staying out of judgement and listening.

3. Recognizing emotion in another person that you have maybe felt before.

4. Communicating that you can recognize emotion.

A way to understand empathy is one that I carried with me throughout my active ordained ministry and still use today. When I express empathy towards another who is hurting (whether spiritually, physically, or mentally) I picture the person who is hurting in a deep dark well (kind of like the one in the Brown cartoon above). I picture myself empathetically entering the well with the person to sit with them in their pain, but I also always picture the rope that maintains a connection to the outside. I picture that rope tied securely outside the well, and I hold onto while in the well. If you as the helper/healer do not maintain the grounding lifeline, the way out of the well, you will both just be wallowing in the darkness.

Thank you Dr. Berger for the thought provoking writing!

Saturday, October 3, 2020

Is it time for the house church to re-emerge?

 




Is it time for the re-emergence of the house church in mainline denominations?

Despite not being able to worship in person during the COVID pandemic, I’ve really enjoyed attending different churches virtually—from the grandeur of Easter morning, morning prayer, and even a weekly Covid-19 memorial service at the Washington Cathedral (click here to visit), to the familiar faces at Sunday worship at my mom’s congregation, St. Peter’s Del Mar (click here to visit), to the memories sparked by Sunday services at my sponsoring parish, St. James Paso Robles (click here to visit)--all with out leaving my office.

I have loved this and applaud the creativity of these big and small worshipping communities to find new and innovative ways to proclaim God’s never ceasing love in a time when we need it so desperately. As my congregation in New Zealand used to say, “Good on ‘ya.”

As I’ve thought about where we are, and where we are going, I wonder if we might need to push ourselves even further outside of the mold of what we know. While these virtual experiences work, there will always be something missing from not being able to gather in person as a community. And after COVID is over (yes, that will happen one day) I worry about the financial state of congregations and their ability to continue to afford “church” the way we’ve always done it--aging buildings and full time, seminary trained clergy in a society with declining interest in mainline Christian denominations are all  concerns. My fear is that COVID has accelerated the unsustainable nature of our current model.  

I wonder if it is time to think about the house church again, and how the first models we have of the “ecclesia” might inform how we do church. The description of the house church appears multiple times in the bible (Corinthians 16:19, Philemon 1:2, Romans 16 to name a few). The practice in these house churches is best described in Acts 2:42-47, They devoted themselves to the apostles’ teaching and fellowship, to the breaking of bread and the prayers (NRSV).

What if we were to go to a model, maybe even just during COVID, where congregational hubs supplied materials and creative ideas for gathering that could occur in people’s homes with proper social distancing. These could be like the “learning pods” that are springing up for educating children. We could offer “worship pods” or “spiritual growth pods” that focus on authentic and relevant biblical teaching that is applicable to these very difficult times we are living through. These pods could be a way to safely be together, break bread safely, and support one another. And we could pray...

House churches could allow us to reclaim some of the best of the early church in a new, evolved way.

 


Monday, September 21, 2020

When to seek mental health help for your child: Questions to ask before therapy/hospitalization (Part 3 of 3)

 

 

Your children are not your children.

They are the sons and daughters of

life’s longing for itself.

They come through you, but not from you.

And though they are with you,  they belong not to you...

you are the bow from which your children as living

arrows are sent forth.

from Kahlil Gibran,  The Prophet

Previously I’ve shared work from one of the UNR faculty, Tom Lavin, MFT, LADC. He recently wrote a piece for parents about when to seek help if they think their child is struggling.

While all of us are facing increased stress due to COVID-19, children are especially vulnerable. In addition to the worry about their health and the health of their loved ones, there is the disruption to their schedules, having to adjust to a new type of schooling/education, isolation from peers, and more. They are also surrounded by reminders about the fragility of life.

In a three-part series I am sharing Lavin’s advice* on when to seek help. Part one covered when to seek help for children and part two focused on teens. The series concludes with this post, adapted from Lavin’s work and the AACAP website, which focuses on some helpful questions to ask when considering outside help. 

If you are considering therapy for your child on an outpatient basis (i.e. not in a hospital setting), parents are encouraged to ask the following questions:

  • If someone else is suggesting that your child start therapy, why is it being recommended?
  • What type of therapy will my child receive?
  • What are some expected results?
  • How long will therapy last?
  • Will the family also receive therapy?
  • How will the family be included?
  • How will the family be informed about our child’s progress?
  • How can the family be most helpful and supportive?

If inpatient hospitalization is being recommended, the AACAP recommend that parents ask the following questions:   

  • Why is psychiatric inpatient treatment being recommended for our child, and how will it help our child?
  • What are the other treatment alternatives to hospital treatment, and how do they compare?
  • Is a child and adolescent psychiatrist admitting our child to the hospital?
  • What does the inpatient treatment include, and how will our child be able to keep up with schoolwork?
  • What are the responsibilities of the child and adolescent psychiatrist and other people on the treatment team?
  • How long will our child be in the hospital, how much will it cost, and how do we pay for these services?
  • What will happen if we can no longer afford to keep our child in this hospital or if the insurance company denies coverage and inpatient treatment is still necessary?
  • Will our child be on a unit specifically designed for the treatment of children and adolescents and is this hospital accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) as a treatment facility for youngsters of our child's age?
  • How will we as parents be involved in our child's hospital treatment, including the decision for discharge and after-care treatment?
  • How will the decision be made to discharge our child from the hospital?
  • Once our child is discharged, what are the plans for continuing or follow-up treatment?

 The AACAP web site contains much more information and is a reliable and trusted place to learn more. Click HERE for a list of Family Resources.

 

*The following resources were cited by Lavin: 

"Understanding Teen Depression” by Empfield and Bakalar  

“Overcoming Teen Depression: A Guide for Parents” by Miriam Kaufman, M.D.

  American Academy of Child and Adolescent Psychiatry: www.AACP.org

 


Thursday, September 3, 2020

When to seek mental health help for your child: Teens (Part 2 or 3)

  All Children Develop at Their Own Pace – Even an Educator's Child |  Children's Services Council of Broward County                                                    

Your children are not your children.

They are the sons and daughters of

life’s longing for itself.

They come through you, but not from you.

And though they are with you,  they belong not to you...

you are the bow from which your children as living

arrows are sent forth.

from Kahlil Gibran,  The Prophet

Previously I’ve shared work from one of the UNR faculty, Tom Lavin, MFT, LADC. He recently wrote a piece about when to seek help if your child is struggling.

While all of us are facing increased stress due to COVID-19, children are especially vulnerable. There is the disruption to their schedules, being out of school, isolation from peers, trying to learn in their home environment and more. They are also surrounded by reminders about the fragility of life.

In a three-part series I will share Lavin’s advice* on when to seek help, first for children and then for teens. The series concludes with some helpful suggestions about questions to ask when considering therapy. 

Today’s post focuses on teens. 

Sometimes parents are the first to recognize problems with their teen; sometimes they are the last to know. Parents who are concerned about a teen or pre-teen child can review the following checklist, provided by the American Academy of Child and Adolescent Psychiatry (AACAP). If parents recognize some of the signs below, a thorough evaluation by a mental-health professional may be useful.

  • Marked change in school performance
  • Abuse of alcohol or drugs
  • Inability to cope with problems
  • Inability to cope with daily activities
  • Marked changes in sleeping habits
  • Marked changes in eating habits
  • Many complaints about physical ailments
  • Aggressive behavior or frequent outbursts of anger
  • Violation of others’ rights
  • Opposition to authority
  • Truancy, theft, vandalism
  • Intense fear of becoming obese (with no relationship to actual body weight)
  • Depression (sustained negative mood and attitude, poor appetite, difficulty sleeping)

Teen Suicide Signs

Parents of teens need to be aware of the signs of suicide risk and know when to ask for professional help. Research cited by The American Academy of Child and Adolescent Psychiatry reports that suicide among teens has risen dramatically in recent years. Suicide is the third leading cause of death for people ages 15 to 24 years of age.

Many of the symptoms of suicidal feelings are similar to the signs of depression. The AACAP recommends that if one or more of these signs occur parents talk to the child about their concern and seek professional help if concerns persist.

  • Change in sleeping habits
  • Change in eating habits
  • Withdrawal from friends, family and regular activities
  • Violent behavior
  • Drug or alcohol use
  • Unusual neglect of personal appearance
  • Marked personality change
  •  Decline in schoolwork
  • Difficulty concentrating
  • High level of boredom
  • Physical complaints (often related to emotions): stomachaches, headaches, fatigue
  • According to the AACAP, a teen who is contemplating suicide may also:
  • Complain of being “rotten inside”
  • Give verbal hints (“I won’t be a problem for you much longer”, “Nothing
  • matters”.)
  • Give away favorite possessions; throw away important belongings.

If a child or adolescent says “I want to kill myself”, always take that statement seriously and seek a professional help immediately. A parent can call 911, call the National Suicide Prevention Lifeline at 1-800-273-8255 or visit their site at https://suicidepreventionlifeline.org/, or contact their child’s primary care provider.  

*The following resources were cited by Lavin: 

"Understanding Teen Depression” by Empfield and Bakalar  

“Overcoming Teen Depression: A Guide for Parents” by Miriam Kaufman, M.D.

  American Academy of Child and Adolescent Psychiatry: www.AACP.org


Monday, August 17, 2020

When to seek help for your child: Children (Part 1 of 3)

 

And he said:

Your children are not your children.

They are the sons and daughters of

life’s longing for itself.

They come through you, but not from you.

And though they are with you,  they belong not to you...

you are the bow from which your children as living

arrows are sent forth.

from Kahlil Gibran,  The Prophet

Previously I’ve shared work from one of the UNR faculty, Tom Lavin, MFT, LADC. He recently wrote a piece about when to seek help if your child is struggling.

While all of us are facing increased stress due to COVID-19, children are especially vulnerable. There is the disruption to their schedules, being out of school, isolation from peers, trying to learn in their home environment and more. They are also surrounded by reminders about the fragility of life.

In a three-part series I will share Lavin’s advice* on when to seek help, first for children under the age of 12, and then for adolescents (12 and up). The series concludes with some helpful suggestions about questions to ask when considering therapy. 

Today’s post focuses on children. Specifically, if you see any of the following you in your child you should consider seeking outside help:

·        Fall in school performance

·        Poor grades in school despite trying very hard

·        A lot of worry or anxiety

·        New onset hyperactivity/fidgeting that persists

·        Persistent nightmares

·        Persistent disobedience or aggression

·        Provocative opposition to authority figures

·        Frequent, unexplained temper tantrums

 If you have noticed any of the above signs in your child, it may be time to enlist the help of a professional. The first step is to talk to your child’s pediatrician/primary care provider. They can then guide you in the right direction.

It’s a hard time for everyone, even the youngest among us.

Check back next Monday for some of the signs that may signal it is time for you to consider outside help for your adolescent.

*The following resources were cited by Lavin: 

"Understanding Teen Depression” by Emmpfield and Bakalar  

“Overcoming Teen Depression: A Guide for Parents” by Miriam Kaufman, M.D.

  American Academy of Child and Adolescent Psychiatry: www.AACP.org

Sunday, July 12, 2020

Psychiatry, Racism and the Census

table taken from page 155 of the October 1851 issue of the American Journal of Insanity


The above table appeared in the October 1851 issue of the American Journal of Insanity

The June 23, 2020 issue of Psychiatry News focuses on Structural Racism in American Psychiatry. In that article I was shocked (and horrified) to find the above table. The article explains that the 1840 census added a new category, "insane and idiotic."

The article states: 

The census reported that in free states, there was one insane or idiotic person for every 144.5 Blacks; the ratio for whites was 1 to 867. However, in slave states, the ratio of insanity for Blacks was 1 to 1,558. Also, the farther north one went, the higher the ratio of insanity in Blacks, and the farther south one went, the lower the ratio. The ratio of insanity among Blacks in Maine was 1 in 14, while in Louisiana the ratio was 1 in 4,310. John McCune Smith, the first Black licensed to practice medicine in the United States, and Edward Jarvis, a physician and father of American biostatistics, wrote scathing rebuttals highlighting fundamental methodological flaws. John C. Calhoun, who had resigned his position as vice president to become a senator from South Carolina, supported the findings of the census, proclaiming, “Here is the proof of the necessity of slavery. The African is incapable of self care and sinks into lunacy under the burden of freedom. It is a mercy to him to give this guardianship and protection from mental death.” John McCune Smith’s conclusion was different: “Freedom has not made us mad; it has strengthened our minds by throwing us upon our own resources.”

It is so heart-wrenching to look back 180 years and see this example of both individual and systemic racism. I wonder how the words that are said today will be viewed by those who will come after us...

To read the entire article click HERE.

Sunday, June 21, 2020

COVID Facts

A Guide to What to Know About COVID-19 | Smart News | Smithsonian ...

This past week I had to complete a "returning to work" module on Covid 19 knowledge for the University of Nevada. While I dreaded completing yet another (boring) on line training, this module actually had some information that I found helpful. I'd like to share a few of these facts as I've found getting good, reliable data about the COVID-19 challenging the past few months.

How many virus particles does it take to become infected with COVID-19? It is estimated it takes approx. 1000 virus particles to become infected with COVID-19.  Here is a list of approx. how long it would take to inhale 1000 particles by different activity:

  • Breathing: an infected person sheds approx. 20 particles per minute, so it would take about 50 minutes to inhale 1000 particles and potentially become infected. 
  • Speaking: an infected person sheds approx. 200 particles per minute, so it would take about 5 minutes  to inhale 1000 particles and potentially become infected. 
  • Cough: One cough contains approx 200,000,000 viral particles, so exposure time to inhale 1000 particles is immediate. 
  • Sneeze: One sneeze contains approx 200,000,000 viral particles, so exposure time to inhale 1000 particles is immediate. 

How long does SARS-CoV2 (the virus that causes COVID-19) last outside the body? (From a study and paper by the New England Journal of Medicine, CDC, UCLA, Princeton)

  • As an aerosol in the air--up to 3 hours*
  • On copper--up to 4 hours
  • On cardboard--up to 24 hours
  • On plastic--2-3 days
  • On stainless steel--2-3 days 
*Researchers used a nebulizer to simulate coughing or sneezing and found that the virus became an aerosol. 


Because the SARS-CoV-2 virus may remain viable on non-porous surfaces for several days, you should disinfect surfaces using a product that meets the EPA criteria for use against the virus. The University of Nevada uses TB-Cide Quat to disinfect. An important note. There is a difference between cleaning (wiping off dirt/grime) and disinfecting a surface. To disinfect, you need to spray the surface from approx 6" away, and allow the disinfectant to sit on the surface for approx. 2 minutes. You can then wipe the surface off, and finish by washing your hands.

So friends, wear your mask, wash your hands, and stay safe.