Vol. #15, No. 5
Welcome to the August edition of Tips & Topics (TNT). If you are in the Northern Hemisphere, I hope you are enjoying summer. If you are Down Under, may your winter be not too cold.
David Mee-Lee M.D.
- To be emotionally present: how incredibly hard is for the service person returning from a tour of duty, to try to live a regular life after the terror and trauma of war.
- To simply hear ordinary sounds and experiences: These can so easily trigger rage, fear, and automatic aggressive reactions – e.g. the sound of the car mechanic’s drill triggering the memory of the terrorist’s drill torturing a child; a convoy of commercial trucks sounds like the beginning of a military operation; playful wrestling between the family dog with a child at a barbeque looks like the child is under attack.
- The pain for loved ones to understand what is going on: It is so hard for the serviceperson to talk about what has happened to them and what is changing in their thoughts, feelings and behavior.
- The partner’s pain: How painful it can be to love and be with the person who is not now the one you loved and married.
The courage and sheer will it takes to be on the frontline is remarkable. In addition, there are so many others giving so much to save the lives of the wounded. For returning veterans, especially those with PTSD, they need easy access to all the services necessary to reintegrate back to “normal” life – housing, jobs, mental health services, physical health care and rehabilitation. Veterans Health and the Veterans Administration (VA) have such an important role.
- White and black; white supremacists and multiculturalists
- The different colors of race, religion and ideology
- Climate change deniers and believers
- Republicans and Democrats
- Factions in Congress
- The President and many of the citizens he serves
- Spouses and intimate partners in daily physical, mental and emotional battles
- Siblings who don’t talk
- Parents and estranged children
- Grandparents separated from their grandchildren
- The lonely, isolated and abandoned people at war with their depression and pain.
I have written before about understanding that behind violent words, behaviors and thoughts are universal feelings and needs to be recognized addressed and satisfied.
How aware are you of other treatment models and strategies different from your own training and experience? Do you fervently defend your approach out of ignorance, fear of feeling incompetent in other methods, or because this is what worked for you in recovery? In addiction and mental health, we have the battles between:
Medication in addiction treatment and abstinence-based treatment:“We don’t believe in medications here – it is just substituting one drug for the other.”
- Harm reduction and abstinence-mandated services:
“Harm reduction is a last resort for people who fail abstinence.” Do you think harm reduction is a good thing or bad?
- 12 Step approaches and Moderation Management or behavioral therapy to teach controlled use.
- A focus on psychotropic medication versus psychosocial and community-based interventions:
Why is Pharma called “Big Pharma”?
- Treatment and prevention:
Where do the majority of funds go to: treatment or prevention? How much does lifestyle affect chronic disease development and healing?
I have not personally worked with refugees of war-torn countries and immigrants settling into the United States. We have so much to learn from those who work in this arena. In the current political climate, it is disturbing to me how little empathy we have for these victims of war. What can our country, rich in resources and opportunities, do for so many people whose lives have been devastated by the guns, bullets and bombs of us and the terrorists?
- Increasing case-loads
- Decreasing funding
- A rapidly changing healthcare system with performance measures, electronic health records, strict managed care, productivity expectations and population management
- Compassion fatigue and burnout
Treatment isn’t just about abstinence, faithful support group attendance, medication adherence, psychosis stabilization and staying out of the hospital. Just as important is paying attention to the following:
- Does your client have a safe place to live? – maybe a Housing First service takes priority over getting abstinent and sober first.
- Do they have transportation, money to buy food, a drop-in center to feel a sense of community?
- Can they access physical health care for their blood pressure which hasn’t been checked for years or for teeth unattended to in decades?
- Will the person be bounced between addiction, mental and physical health systems when they need integrated co-occurring or complexity capable services?
- Eating an Aussie meat pie – so much better than an American pot pie
- Eating a lamington – even a lot of bakeries in Australia have stopped making them: sponge cake covered in cocoa or chocolate topped off with desiccated coconut, cut up into little rectangles or squares of about 3 by 4 inches. But the size varies, so that’s also part of the fun.
- Aussie hamburgers – Of course McDonalds and Burger King’s equivalent called Hungry Jacks are everywhere. But a real old-time hamburger has handmade hamburger with lettuce, tomato, beetroot and a fried egg between a mouth-widening bun.
- Vegemite in both my “home” countries – we always bring back some jars so we can have toast spread with Vegemite and avocado in both Australia and the USA.
- Aussie beaches – wide, long expanses of sparsely trafficked, fine
Brunswick Heads, New South Wales
sandy beaches. No pebbly, rocky, narrow, coarse sand beaches for me!
- Australian currency – besides an exchange rate with the US dollar favorable to the US visitor, the actual notes and coins are both attractive and practical. There’s a one and two dollar coin – no $1 or
$2 dollar notes. All the Aussie notes are brightly colorful, easy to distinguish. Somehow they’re manufactured with material that’s always so smooth, durable and new-looking. They don’t crinkle up as they get old; they stay flat and compact in your wallet. Take a look at your US dollars and see if they meet the same criteria.
Well that is surely enough of what I look forward to. Thanks for indulging my nostalgic experiences. They are certainly not enough for me to up and leave all the stimulating and gratifying experiences of my adopted home.
In this world of ours, so torn by conflicts and wars and pain and suffering, how could we all become citizens of the world? What would it take to be proud of our country while also shunning intolerance, isolationism, hate and bigotry? How might we embrace empathy, inclusion, community and the fulfillment of universal human feelings and needs?
I know I am naïve and idealistic.