On Line reviews:

Are on line reviews, like Yelp, of service providers the same as on-line reviews of products? Are they reliable? Not in the least. First let’s look at how to read product reviews. The prevailing wisdom is start from the bottom as the top 5 at least are often fake reviews from people who have received free products or been company hired. Look for poor English and if they are glowing but non-detailed.  The verified buyer thing doesn’t really mean much.

For service providers the onion had an article recently that summarizes the issues. Regarding doctors “Oh my on line reviews are down I have to give out more Adderall!” says the DR.  The only people who generally write reviews of service providers are those that have had issues. In my experience it is people you have said no to their agenda.  Like in the article no you can’t have klonopin or Adderall.  A friend and fellow service provider gives this example.  He has an eight year old. “If I gave my eight year old candy, chocolate, and a steady diet of junk food I would be the best parent in the world according to him; But am I?”  The fact that it made it to a political parody web site must mean it is a universal Doctor experience.

Using myself as an example regarding on line reviews, my on-line reviews really suck; 1 out of 5 possible stars, the worst! In all but 1 of about 16 on line reviews over about a 3-year period.   If you would go just by these you would run for the hills before seeing me but let’s look at the bigger statistical picture. In this period of 3 years I have seen about 9,000 people.  16 bad reviews are a .18% bad review rating. That’s a tad under for every thousand patients 2 go out of their way to complain on line which is consistent with another statistic.  1-2% of the American population has a completely miserable personality with a diagnosed severe personality disorder. They are not only unhappy no matter what you do but the mere fact that you saw them pisses them off.       In a psychiatric practice the concentration due to selection (people send their unresponsive to treatment patients to psychiatrists) is higher.  In a psychiatric practice severe personality disorders are found in about 20%.  So, 16 awful reviews, .18% is statistically normal background noise for the general population.  It is about nothing for a psychiatric practice.  In fact anything less than this would indicate the reviews are fake, manufactured.

Doctors with all glowing reviews, 100% are often of large practices that hire companies that generate good reviews. This is an expensive service so usually found in larger practices but anyone can do this. Again, if there are no negative reviews for any service provider the reviews are fake.   It is improbable if not impossible to satisfy every customer.

So how to evaluate useless reviews, look to what the person disagreed like their diagnosis or was said no to.  Look for ranting and raving, defensiveness, self-righteousness, childish or exaggerated bizarre statements.

Overall subjective opinions about people just aren’t very useful.  A product has a specific purpose and either does it or does not. Service especially medical service is a lot more ambiguous despite what insurance companies or pharmaceutical sell as expectations.

 

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How to make people happy:

In order to make someone happy you have to act within the role they have ascribed to you. That’s why you can’t make everyone happy as its impossible to act with multiple different roles at the same time. Therefor don’t try to make people happy. Just be consistent to the role you ascribe for yourself and over time that is what people with expect from you. That has the potential to make people happy.

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You are being manipulated:

The onion had a great article the other day where it showed  two photo’s of the same teenage woman. In one she was just herself as is, pleasantly normal, Average. In the other she was photo shopped, glamoured and looked like a supermodel.  The point is that for this teens whole life whenever she looked at or saw any media depiction of women she saw an untruth that doesn’t exist in nature and she thinks that is the mean, or average that she compares herself to.  This is a recipe for forever unhappiness and discontent and a large product bill which is the purpose of the untruth in the first place.

Last night I saw the movie Dean and in it there was a unsavory male character that picked up women by first saying something demeaning, like your hair is unruly, I like that you don’t care about that.  Then he would follow by some rescue positive statements.  The purpose is making the woman feel vulnerable and insecure then bolstering her up. This was in fact a very successful technique perpetuated by social media that men actually used successfully to get woman to sleep with them. It worked as it is the same technique used to get woman to buy make up and other feminine products.

It is also the same technique used to elect public officials. You advertise something that makes you feel vulnerable or fearful then offer the solution. Like there are rapists crossing our borders and I will build a wall to protect you.  These are all classic advertising human behavior manipulating techniques.

WE and our children are constantly being manipulated and it is imperative that we recognize it and learn, teach, and roll model skills in order to see through the mist. Allowing oneself to be lied to and manipulated cannot bring happiness. It caters to and reinforces our lowest self, shame, fear, and vulnerabilities.

The fact that advertising works reinforces its use. But the more it is used the worse the human living situation becomes as it is all based on lies, exaggeration and false hope. If you are promised the Garden of Eden and Heaven, you will accept no less and it diminishes what you have here and now.

What you have here and now whatever they be are tools that if used wisely can bring happiness and success. Learn the art of limitations on you tube Embrace the Shake | Phil Hansen | TED Talks.

What you do not have as a self comparison can bring envy, emptiness, and shame,  leading to anxiety, depression, migraine, auto immune disorders via the slow demise of your immune system. All of which get you to buy, buy, buy, and consume. The purpose of our culture as it has evolved to be currently.

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Too big to fail:

Most of human life is determined by social convention. We believe what we believe because we were taught these things are true and the way it is and we look at the world through this lens from then on.  Reality self-perpetuates via tradition.  Because so much of life revolves around social convention or tradition these traditions become in of themselves self-sustaining entities that resist change.

 

In medicine this is called a facilitated segment. An injury causes a change, the area around that change adapts to protect it or compensates for it then the rest of the body adapts around this adaption. When the injury heals the changes can’t resolve on their own as the whole body has adapted and sustains the changes as if the injury is still there. The body doesn’t know it is healed and can’t function as healed. Because the adaptive change self-perpetuates itself.

 

An example in culture recently was the banking collapse. Banking as the system functions currently supports the system as it is currently.  Even though banking took a huge hit, the system had to support it despite the injury in order for the whole system not to collapse. Thus, the system self-sustained the system for no other reason but because it is the system despite it clearly being a dysfunctional injured system.

 

Another example in my field is the DSM5, our classification of disease entities in psychiatry. It was created to be able to allow psychiatrists to talk to each other and do consistent research but when that research which it now has shown the whole thing to be malarkey misguided it is too late. The system is as it is based on this book and it is now too big a system to be able to change easily. Insurance reimbursement is based on the system as it has been created so despite it being shown to be malarkey we have to force people to fit into it because the system is the system, self-perpetuating.

 

Religion, economics, medicine, marriage, sexuality, how we define ourselves, our groups, and nearly everything else follows these same phenomena. Once created then defining our lives it becomes tradition i.e. social convention and too big to fail or change.  This creates the phenomena of most of what we think we know and how we live our lives and base our feelings on is just not true. It just is social convention.  Anyone challenging the system becomes an outcast to the system and a threat to it. The system as a self-perpetuating entity resists change and sees these reformers not as good but misguided or evil.

 

Although it can be done, it is very difficult to create enough energy or support to break a facilitated segment and reintroduce adaption and change and create a new norm.  People see the world the way they were trained to see the world. They don’t realize they have these glasses on.  Tradition often flies in the face of common sense but again that doesn’t matter as reality as we know it is social convention not facts that readjust moment to moment and day by day.   Social convention even if is bad for us or unhealthy is often just too big to fail.

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SHAME

Shame/demoralization can manifest as anxiety, depression, or in hypervigilance (ADHD) and is not respondent to medications.  

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Dreaming :

I was woken up mid dream last night and upon falling back to sleep I couldn’t fall back to the dream as my left brain started picking out all the impossibilities; that doesn’t work, how could, that makes no sense… Also although the dream while in it seemed whole and complete, upon falling back into sleep the details just were not there. I realized the dream was just a feeling, right brain. No left brain detail and no left brain sense of self. I wonder if like some birds, we rest our brains one half at a time? and isn’t it interesting that a feeling can form a whole picture, a whole reality, that appears fully made and detailed but really is not. I have clients who’s whole realities are this way.

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Sexual communication

Sexual communication isn’t a subject that is taught in this country but the “Me Too” movement has started many interesting conversations and Sexual dogma is one of them i.e. the do’s and don’ts , the how to’s, and sexual expectations. Sexual dogma forms mostly in High School. In our country currently Boys figure it all out primarily from porn and woman end up complying with boy’s expectations for women have been brought up to suppress their own needs and wants. Thus no one has any realistic or working knowledge, techniques, or expectations and everyone is mostly out of sync with each other. There of recently have been articles describing this phenomena and how it ends up creating a lot of the me too problems. Porn offers poor role modeling for equal, healthy, and in sync relationships. There are growing conversations and blogs about re education and trying to get male and female’s more in sync with each other and reality. This is important as what other experiences do males have unless someone shares what is in these articles.

A good blog started by a woman to help women have a forum to talk about their sexuality and for men to get more in realistic sync with women’s needs is :

http://howtomakemecome.tumblr.com/

I don’t know if in the long run it will make a difference as it has to compete with things like the 50 shades of gray which is miseducating yet another whole new generation.  Until someone figures out how healthy relationships can make money this information will not enter the mainstream.

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Today’s Truisms:

1) good to be a weatherman. It will do something wet today!!!!

2) Empathy is not listening. They are different skill sets and too much empathy actually blocks listening.

3) smart is not synonymous with rich and vice versa.

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Love is great except when it is not:

This time of year, it is all about love. So many facebook posts are touting the beneficial and healing effect of love.  Only love is Heroin, endogenous (body made) endorphins. Endorphins certainly can boost the immune system causing seemingly miraculous recovery from everything from cancer to depression. This is also true for laughing yoga as laughing also releases endorphins.

But so as is up must be as well down. What no one is talking about is Love’s dark side. Jealousy , obsession, Domestic violence, Hate, can all be part of love. Adultery, religious zealots, nationalism, the crusades, All Love. 

And as Love is heroin the removal of love, heroin withdrawal.  The loss of love can exhibit the exact symptomology as heroin withdrawal or worse, Grief in some is fatal.

So just as Santa has his Krampus, God his devil, Love has its dark side.

Happy Valentine’s day?

Dr. B.C.

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Adderall as a gate way Drug:

A patient of mine said today “Marijuana isn’t a gate way drug Adderall is!” This client was diagnosed adhd as a child and started on Adderall which made him by his words “tweak.” He lost his appetite became irritable and agitated but his Doctors continued the medications as his grades did improve. By the time he was 14 he started self-treating with marijuana to according to him get rid of these side effects. He continued on Adderall for 7 years until I stopped it. The next difficult task will be getting him off the marijuana.

My favorite saying, I heard at work ,was when one therapist in describing a local practice that does testing for ADHD said, “if they tested a horse it would be diagnosed with ADHD.”

That is the problem. All ADHD has a lack of attention but not all lack of attention is ADHD. Most “Neuropsy testing” done these days is superficial as it is expensive with poor insurance coverage to get thorough testing. A lot of insurances no longer cover Neuropsy testing at all and it can cost $3000.00 for an exam that really means anything. Most people just get school testing for their IEP and this testing is extremely superfluous. It is not real Neuropsy testing.

This client had processing delays, Learning disorders and, low average IQ . All of which will test as ADHD on superficial testing but giving him stimulants is like overdriving a computer. Sure, it works but at a cost. The computer heats up when overdriven and, in a way, so does the brain. You can get aggression, agitation, anxiety, mood lability and secondary self-treatment all as can be seen in this client.

There are many more effective interventions that could have helped him in school but Medication is the default intervention in this country. Other countries that do not believe in adhd create effective individual education plans for each child using behavioral interventions. I have seen some creative schools use service animals, aerobic exercise, standing desks, bouncy bands, kinetic learning, and other interventions that successfully manage kids without medications.

In this client Adderall wasn’t a gateway drug, it was a drug in itself. If you don’t have ADHD Adderall is just cocaine. Another area of concern in medicine is in eating disorders. Back in the 1950’s many housewives got addicted to amphetamines as Dr’s were giving them out like candy for weight loss. Although this never really entirely went away it had receded a bit (mainly because many of the diet pills were killing women by causing heart attacks.) Now returning to the past Vyvanse (long acting Adderall) got the indication for binging. Once again, we are addicting a large portion of women to amphetamines. But now they have medical marijuana to take with it to help them stop them from Tweaking or with their subsequent Anxiety diagnosis. Sound familiar!

Dr. B.C.

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