THE ANTISOCIAL QUOTIENT

Tags

Mankind should be our business, The antisocial quotient, The show NUMB3RS defines the antisocial element

This is a post I have been thinking of for weeks, but it has come to fruition due to the combination of a few events and experiences I have had in the past last 5-6 days, as it started with my watching a couple of NUMB3RS episodes of season 2, and then watching the ongoing BS of Hillary Clinton’s announcing her candidacy for President, and finally just listening to some of the crap from various colleagues and reading more BS from the APA in their recent Newsletter I continue to get without any effort on my part to request.  Oh, and the shooting of the man in South Carolina, that had an impact too.

So, the following scan is a summation of what I deem THE ANTISOCIAL QUOTIENT, and while it is a bit rough, I think it hits the highlights, or better to term the lowlights that are the antisocial.  The three groups in our society that prompted me to compose this are our politicians, our health care system, and our police force.  I think it is applicable to others in America, but, let’s start with those who seem to impact on us with a regularity that may redefine obscene and disruptive.

Oh, and you might note the theme of words with the letter “D” in there, and that is not a coincidence.  I like to look for patterns and similarities, and I think the letter “D” for deviant, disaster,and plain Demon or Devil seems to fit, eh?

So, here is my “Charley Epps” moment, hope it is entertaining, if not provocative and just plain presumptuous?

I  can’t enlarge it too much for the post and risk the type becoming more illegible, so if you want to read it, you have to click it as a separate page and enlarge it as able per your device.  I want readers to know, I really did spend a good deal of time composing this in my travels and thoughts.  I will be adding addendums to this post in the coming next few days to clarify and postulate further, so if interested, please come back and read up.

But, let’s end this post now with something that hit me while lying in bed last weekend, while not related to this season, I think the scene transcends the Christmas holidays and is applicable to any time, any moment, and any real point of what our culture has lost in it’s meaning and intent these last couple of decades, to me since Reagan was President…

Go to minute 5:30 for the classic line, “Mankind was my business!”

Not what you hear from the usual suspects in the Democrat Party these days, not that the Republicans as a group fare much better anyway.

Just think of Obama when you consider an example to fit the Quotient, I think the scoring might just frighten you…

________________________________________________

Addendum April 16 8PM:

Good work always needs to be cleaned up, and I will start with noting I had just 6 immature defenses listed, not 7, so I am not going to reprint the scanned sheet above, I ask readers to note it is an equal number of immature to mature defenses.

It shouldn’t mess up the quotient significantly at the end of the day.

Next, I found this today in my search for other scales for antisocial PD, and will link it for those interested, although it is moreso about psychopathy:

http://vistriai.com/psychopathtest/

It does overlap a bit of what I list in my scale, er, attempt at quantification of human deterioration of values and boundaries.

Anyway, I hope readers note this is just my simplification at documenting the depths that people can degenerate to in being disgusting at the end of the day.  Like the ongoing use of “D” words there?

I do declare, the dogma is daunting…

Feel free to offer your declarations.

______________________________________________

Addendum #2 April 16th:

Oh hell, let’s have some fun, I want to apply the quotient to Hillary:

Section A:  1.  Dishonest: can we give her a 6?  Ok, a 5.  2.  Disingenuous: easily a 4, I would give a 5 but people think this is a 5 across the board.  Maybe…  3.  Disdain:  she is a poster child, 5.  4.  Disruptive: a 3, only because so many Democrats are willing to suspend reality and believe her.  5.  Divisive: again, a poster child like her predecessor Barry, a 5.  6.  Disinhibitive:  a 3, she has some boundaries, just not around people like you and me.  7.  Destructive:  again, a 3.

So, 5+ 4+ 5+ 3+ 5+ 3+ 3 = 25.  Divided by 7 = 3.6 (average up)

Section B:  potential to destabilize, let’s use that phrase so well associate with her, “what difference does it make?!” = 8.  So, the denominator of negating factors, well, she has Republicans, but business opponents, who?  And influential family members not allied with her, again a fat 0!  Community groups as outlets, I guess some to count as 1.  Responsible media outlets, outside Fox News, I mean, how big is this woman’s butt to have all those media outlets with lips affixed to her cheeks?  Total a kind 2!

Total here = 4

Section C:  Determined by past, present and future, I give her 3’s for every one!  Yeah, I know I am accused as not being impartial!  Shit, and she is?!

Total = 3

Section D:  Drugs, I think not, a 0.  Debauchery?  I give her a 0.5, as I think she is not a healthy heterosexual, and married to Bill after all his BS cheating, that counts at least for something against her.  Duplicitous, again, can I go above 1?

1.5 divided by 3 = 0.5

Section E: Defense mechanisms, this will be fun!  Denial, projection, minimizing, deflecting, false rationalizing, and acting out, textbook on all counts from her!

+6!  Then, let’s here from the back about any mature defenses by her.  Displacement, really?  Intellectualizing, only in her mind.  Undoing, not the way the definition is for a defense, but if it happens in her campaign, hell yeah!  Realistic rationalization, maybe at times, a kind 1 here!  Sublimation, really a stretch to give her that one.  Assertiveness, well, not in a healthy way, but I am trying to be a kind guy and not give her every negative..

+6 for immature and -2 for mature, = 4

Section F, the Quotient Denominator, I can’t keep a straight face reading them and applying them in any fashion to her, well, maybe take out an enemy of the country, oh, Ambassador Stevens was on our side, shit!  Accepting of punishment, yeah, get back to me when the email fiasco plays out in the end!!!

SO the ending:

3.6 + 4 + 3 + 0.5 + 4 / 1 (and a kind one, note that if it is 0 it does not negate the quotient, but nice try out there Hillary defenders!  = a big ass 14!

Frightening if you agree with me to some level, eh!!??

______________________________________________

Addendum April 21 9PM:

First this, from the most recent issue of Psychiatric Annals, Vol 45 Issue 4 (Ironically dedicated to Psychopathy versus Sociopathy, are they catching up to me in meaningful topics?), article by Michael Brook PhD, The Role of Psychopathic and Antisocial Traits in Violence Risk Assessment:  Implications for Forensic Practice:

Interesting how they show the progression of antisocial PD into pure psychopathy intent, hmm?  I feel the overlaps into my Quotient give it some validity?

Anyway, I ask readers to do their own assessment of Obama from my Antisocial Quotient, I think the scoring would be at least 10 if not even higher than what I scored Clinton a few days ago.

And I think my addendums for this post are done now.

After 5 days, I watched with my family Robin Williams best performance!

Tags

Robin Williams on "Inside the Actor's Studio"

If you can’t find it, look harder.  “inside the Actor’s Studio”, around 2001, Robin Williams was on, and I was lucky to find the DVD of it about 5 years ago, and watched it tonight after my family debated what was the best R.W. movie to showcase his talents.  After watching him be himself on this show, the laughs alone were hands down!

If this does not make you cry from laughing hysterically, you are dead!

Robin Williams, you are funny beyond belief, and I hope if there is an afterlife, they will give you an exception and let you be around those who did not make painful choices.  And if there is a God, he is lying on the floor like I have been in my life going “Oh man, you are hurtin’ me!!!”

The scarf routine is beyond priceless!

Robin Williams was a damn funny man!

Tags

Robin Williams is gone, Suicide is never a happy ending

I saw Robin Williams here in Baltimore for this tour he finished in New York in 2002, funny, I mean, so funny I was wiping my eyes for 5 minutes!

Yet, he probably had Bipolar Disorder, I don’t know he ever admitted to that definitively, but, his death today is certainly sad.  I just wanted to post about it after watching a couple of cable shows that had some guests, CNN had Drew Pinsky on just 5-10 minutes ago and I think Pinsky hit in directly on the head, the combo of a mood disorder, being in rehab recently, and possibly the fatigue of keeping it going as a celebrity, all equally too much at some point.

I leave you with a montage from “Good Morning Vietnam”, one of his best to me:

“Turn it up”, by Alan Parsons, seems to fit the dialogue of late, eh?

One of my favorite bands of all time, Alan Parsons Project, and this song, “Turn it Up”, the lyrics really hit home for what I think defines what someone should be adhering to for motivation:

It’s no good believing in somebody else
If you can’t believe in yourself
You give them the reason to take all the power and wealth
It’s no good you trying to sit on the fence
And hope that the trouble will pass
‘Cause sittin’ on fences can make you a pain in the ass

If there’s something you find to believe in
Then the message must get through
So don’t just sit in silence
When you know what to do
Turn it up
Turn it up, make it louder
Turn it up
Turn it up, make it louder

There’s no conversation if nobody speaks
And nothing gets done in the end
There’s no confrontation when fantasy makes you its friend
So much injustice, too many lies
We don’t have to look very far
But nothing will change if we leave things the way that they are

If there’s something you find to believe in
Then the message must get through
So don’t just sit in silence
When you know what to do
Turn it up
Turn it up, make it louder
Turn it up
Turn it up, make it louder
Ohh

[Inaudible]
[Inaudible]

If there’s something you find to believe in
Then the message must get through
So don’t just sit in silence
When you know what to do
Turn it up
Turn it up, make it louder
Turn it up
Turn it up, make it louder

Turn it up
(Turn it up)
(Turn it up)
Turn it up, make it louder
(Turn it up)
(Turn it up)
Turn it up
(Turn it up)
(Turn it up)
Turn, turn it up, make it louder
(Turn it up)
(Turn it up)

hope you enjoy the song, a bit of an abbreviated version, but, it works for me!

By the way, never saw that video until just now, but, that is Alan Parsons for ya!

Seven Questions a patient should ask of a psychiatrist when beginning treatment.

Tags

Questions to ask a psychiatrist when beginning care

These are valid, appropriate, and necessary questions I would be happy to accept from a new patient, and I would offer that any doctor who would be unwilling to answer them to some degree at least, well, good luck with care!

1.  How long have you been practicing as a board certified psychiatrist?

2.  Do you provide any other treatment interventions besides prescribing medication?

3.  Do you have admitting privileges to any hospital that provides psychiatric care?

4.  Can I (the patient) ask for other medication options besides what you offer?

5.  What is your standard of prescribing medication, do you prefer to prescribe one medication at a time and do you believe in titrating and tapering medications?

6.  What is your position on second opinions about my diagnosis and treatment options?

7.  Do you belong to the APA?

For the sake of consistency and transparency, I’ll answer them all here if anyone is interested to see how they would be handled by a psychiatrist still practicing:

1.  I have been board certified since 1997, recertified in 2008, maintain licenses in Maryland, Pennsylvania, and Delaware.  Not that you asked, but I have never had any disciplinary actions lodged against me, legal problems involving being a physician, nor any issues maintaining my licenses to this point in time of my life.

2.  I would love to provide therapy as able, and believe there are plenty of adjunctive interventions for treating psychiatric illnesses, most probably best provided by other professionals.  Treatment is multifactorial as much as the development of an illness is as well.

3.  At this point in my career I have no admitting privileges, as I do not practice at a set site for more than 3-4 months working as a Temp Doc.  My advice to you if you need to be hospitalized, go to places X,Y, or Z as able, and make sure you or your trusted collateral contacts tell treating staff at the hospital you are seeing me for outpatient care ongoing, and I would appreciate knowing what is going on with your inpatient care to ensure continuity of care after discharge.

4.  Patients can always ask for other medication options, but, if such meds don’t match the standards of care for what I see as the provisional diagnosis at this point of time in treatment, I have the right to decline writing for them.  Just to be clear about concerns regarding some medications out there, I do not write for certain controlled substances like Xanax, Valium, and Adderall, and am wary to write for high dosages of medications other colleagues feel are safe to prescribe but seem to go beyond what I feel is a ceiling dose for some medications.

5.  I prefer to prescribe as few and at as low a dose I hope will impact on the needs at hand.  I have no problem if you want to research further before beginning a medication, but I do advise you stick with the prescription as written, especially if I advise you titrate the dose from low to high per the times written.  Medications take time to impact, and side effects are minimal when titrating meds.  If it seems best to stop a medication, I advise tapering per the length of time on the medication.

6.  I have no problem with a patient seeking out a second opinion.  However, if the person providing another diagnostic or treatment opinion to care is not willing to provide it, I would hope this colleague would contact me or give you something in writing to bring back to me to clarify their differing perspective.  I am not obligated to provide services that someone else is advising without documenting and reviewing another provider’s opinion.

7.  No, I do not belong to the APA, I do not feel this organization represents both mine and the public’s best interests in care as they advocate today.

There are probably several other questions you as a patient might feel are critical to clarify at the beginning of care with a psychiatrist, and I welcome comments offering such other opinions/perspectives of how to enhance beginning a strong alliance.  One I will not agree should be asked outright is if you the physician have been sued.  Being sued and losing a lawsuit have several endpoints, and some mean absolutely nothing about the character or skills of the provider.  And with Malpractice insurers looking to settle lawsuits more often than actually provide legal representation for providers who are being frivolously sued, being sued and settling a case is not an admission of guilt or wrongdoing.  But, the simple mention of it infers guilt these days, eh?

And no, as of now, I have never been sued or named in a lawsuit about my professional care.  Hopefully never until I retire.

As I was trained, stay within the standards of care, never compromise your work to become a physician for a short term gain or simple gratification, and never do something that could put you in jail.

So, hope this post is enlightening to readers.  What will be interesting is if any colleagues read this and have a reply.

A nice article about Adult ADD that promotes skills, not pills

Tags

Adult ADD article in Scientific American Mind 2014, need for pills and skills in ADD, opiate abuse consequences

This was the cover picture for the article “ADHD Grows Up” by Tim Bilkey, Craig Surman, and Karen Weintraub, in the Jan/Feb 2014 issue of Scientific American Mind.  It is a good read, and I include a cut and paste I did from the middle of the article that stresses medication alone won’t impact fully on legitimate ADD in adults.

Here it is:

It seems readable to me, so I hope you read it!  Again, if you have read here with any regularity, I am an outspoken advocate for patients being in therapy as much as any use of ADD meds, and I am equally an outspoken critic of the “Gimme drugs as I tell you I have ADD” crap that is prevalent these days, but even moreso in the counties around Washington DC.  I worked a year in Montgomery County in a private practice, and quit when 20% of the new referrals in the last 6 months there were for ADD seeking medication patients.  Now I am at a CMHC in Frederick County, a definite bedroom community for DC, and is nothing less than pathetic having picked up a colleague’s patient load that over 33% are on stimulants, mostly Adderall, and on dosages I am waiting for patients to drop dead from cardiovascular collapse, with many of them over 45 years old!  Why do I say it that way?  These patients don’t want to hear I am not happy being asked to continue these absurd prescriptions, much less dosages.

Below is the link to the article, but realize they at Sci Am MInd only give you a preview, but, check it out, there are other good articles in there too about women and men can’t be just friends, role of chronic traumatic encephalopathy from head injuries in sports, and the role of talking to yourself.

the link:  http://www.scientificamerican.com/article.cfm?id=adults-can-have-adhd-too

Oh, I’ll end with this from the issue too, not surprised I note it, eh?

Enjoy, and don’t be afraid to seek out treatment from various sources, including yourself!  Change starts from within, so want it, do it, be it!

An open letter to Premed Students in the USA

Tags

how Obamacare will impact Medical education in the US, Open letter to PreMed students

Undergraduate Students in American Universities

PreMed Programs, Medicine Aspirations

Any State in the USA

Dear PreMed Student:

Greetings to you during this Holiday Season of 2013, my name is Joel Hassman,  I am a graduate from the University of Maryland Medical School class of 1989, and have been a clinical psychiatrist for the past 20 plus years, practicing mostly in Maryland for my career.

I write to you now offering an unsolicited opinion to whether it is worth the commitments and expenses you will make these next 8 or more years, expenses not only in money but equally in time and energy, to earn a Medical Doctorate degree.  I respect I am just one opinion in a sea of a million or so colleagues who have already traveled the path you now face, and many may not agree with what I will opine below.  But, I feel I have a duty to advise, and more so caution any who are interested to weigh what are my observations, experiences, and expectations what physicians have been able to provide as health care professionals, and how those skills and efforts will be impacted hereon.

My concerns I want to impart from those years of observations, experiences, expectations, and collected discussions with colleagues during my career are simple:  with the likelihood that PPACA, also dubbed “Obamacare”, is going to be a legislative intrusion of sizeable magnitude as envisioned now,  medicine as practiced to this point in time will be forever negatively altered in ways that will not be appreciated until the consequences play out for all who participate in the health care system.  And those participants include many players,  be them patients, providers, associated supports to patients and providers, affiliated allied health supports, hospitals,  outside medical technology and pharmaceutical industries, and even insurers in place as of now.  I am sure I am forgetting others, so my apologies for not naming them all.

For those of you interested in becoming doctors for the simple, yet valuable reason to be a provider who can impact on peoples’ lives for the better, in efforts to heal, comfort, advise, and support, well, those were key reasons that drove me to choose medicine as a career.  And an equally important part to my choice was to maintain a level of autonomy and independence that for me, at least, was a driving force in formulating such a career pursuit.   While making a decent income also had some bearing in the decision, money was never a primary driving force to my choices throughout my career.  You receive a decent income as a doctor overall, so money should not be a primary consideration to decisions what to do as a health care provider.  If you are not already aware, the for-profit drive that has consumed much of the health care profession has wrought enough damage before what PPACA will surely do further.

Unfortunately, in my opinion, money, profit, financial gain, these are the driving forces to health care of late, until proven otherwise, and you need to be aware at least what some providers are offering as advice and direction in your contacts in formulating your plans to become a doctor will NOT likely be what you experience once you complete your training within the next decade.  No, you will most likely not be asked to make decisions that are in the best interests of patient care, comfort, and resumption of health and function.  Instead, you may risk being  forced to practice to provide what is popular, easy, convenient, and for the system what is inherently cheap and redirects income streams to select peoples’ personal pockets.   As for any interest in maintaining autonomy and independence, forget it, you won’t have it unless you are fortunate to be in a care setting outside the system being forged into stone now.

My intent in forwarding this open letter to those of you interested in becoming doctors now is simply this:  I do not want to deter people who want to be a doctor for what the profession inherently intends;  I want people to succeed me to provide future care that helps people the way medicine was and still should intend to be practiced.  But, I want people to be well aware of what potential intrusions and disruptions await you in your developing education not only within the didactic settings, but encourage you be attentive to what are dubbed the “street smarts” no professor, mentor, or advisor will be able to provide within the system.  Medicine has to be practiced with both mind and heart.  I hope you won’t lose track of this simple expectation.

Become a doctor because you want to help people be healthy, or to regain health, offer further  supports beyond what the patient’s own support systems can provide, and most importantly, advocate and defend what are the principles and necessary boundaries of what the needs and expectations medicine has to maintain to work and succeed.  I feel the last part of that last sentence needs to be magnified:  medicine needs people to be strong advocates and defenders from those looking to alter the system in inappropriate, irresponsible, and disruptive ways.

I think health care, and the practice of medicine more specifically, has now passed the proverbial “cross roads” of adhering to principles and needs for the society we commit to when accepting that “MD” title.  But, passing this point does not mean health care is lost or forever tarnished.  You just have to want and need to care and focus on doing what is right and responsible.  If you listen to those who don’t understand or even don’t respect that basic premise, well, then good luck in your pursuits.  I hope what drives you to want to be a doctor will guide you well and see you be successful and appreciated by most you work with, be them patients or colleagues.

I hope your journey will be enlightening and inspiring, as much as safe and valuable.  Thank you for taking the time to read this open letter, share it as you see fit with others.

Sincerely,

Joel Hassman, MD

When they call it “Classic Peanuts”, on the mark!

Tags

Classic Peanuts with Psychiatrist Lucy

Oops, your 60 minutes are up! We’ll deal with that break through revelation next week!

Timeless, man this stuff is just timeless!!!

“How am I driving, man? I think you’re parked, man!”

Tags

consequences of legalizing marijuana, Legalization of marijuana

So, the federal government is going to stop going after marijuana use as a felony.  Hey, maybe that is a good idea.  But wait, there is more, as the substance abuse (SA) lobby will never be satisfied once one illicit substance gets a pseudo free pass.  How long do you think it will take for the SA lobby to start pushing for the decriminalization of cocaine, or hallucinogens, hell, they’ll get bold and push for opiates as a class to be taken out of the Class 2 category of prescription meds.

Here is the link I read tonight to prompt this post:

http://news.yahoo.com/marijuana-ruling-could-signal-end-prohibition-pot-151612677–abc-news-topstories.html

WHEN we start seeing and reading of multiple consequences of pot smokers in society, be it on the road, at jobs, in your neighborhoods, when will it become obvious that legalization was NOT a good idea.  Decriminalization, that I have never had a problem with.  But, addicts and abusers, they will rationalize, minimize, deflect, and just deny away that pot use is nothing less than what alcohol is to society.

Yeah, just wait until you listen to the abusers claim driving high is NOT a problem.

I truly hope the loudest advocates for legalizing pot have the gravest consequences happen to them or their family and await their reaction once the calamity occurs.  And you know what, they will still rationalize and minimize the role of the drug, because to the user, the drug is more important than the people.

Good luck America.  Are ya parked, yet?!

When do we as a culture stop glamorizing addiction?

Tags

Corey Monteith death, role of codependency and enabling

My daughter is a big fan of “Glee”, so the recent death of actor Corey Monteith was very sad for her and all the fans.  But, fans weren’t so close to this man as his family, loved ones, show peers, and others who knew him, so how does the pain really transition into a real response for change?.  And  frankly, for me as someone who has dealt with addiction personally (thru family issues), professionally, and throughout travels in our society, I still don’t see the consistent reaction that addiction deserves.

Which is, zero tolerance once the addict is not accepting true, honest, and consistent change.  Relapse is part of recovery, I get that, but how many failures do participants in the addict’s life put up with?  That is the message this recent death illustrates to me!

There recently was a blog post at a mental health site that notes alleged myths about addiction, and I link to it to ask readers to read and digest some of these “myths” that I don’t think are myths, just more ways to minimize and diminish what addiction is in its pure forms:

http://psychcentral.com/blog/archives/2013/07/17/they-could-stop-if-they-wanted-to-common-myths-about-addicts-addiction/

Now also today there was another post which I just read as I was writing this very post, and will link it also as it relates well, I hope:

http://psychcentral.com/blog/archives/2013/07/20/cory-monteith-a-wake-up-call-about-relapse/

While I am not a big fan of opiate substitutions like Suboxone, which the author promotes at the end, nor Methadone that is still prevalent out there, I do fully agree with this comment in the middle of the latter post above:

“Brain chemistry has a lot to do with why relapse is so common. Opiates have an intense effect on the brain. They are engineered to make you feel really good and they do this so well that within a short time of using, it becomes very difficult to feel “normal” without the drug. Even after months or years of being clean people struggle with withdrawal symptoms of depression, anxiety and insomnia.”

And that is why I am so burnt out dealing with the opiate addicts, heroin and Prescription Opiates alike, who just continue to minimize and deflect the long term complications such chemical abuse creates and stays in place for months, if not a year or longer depending on the duration of use before starting abstinence.

How many more celebrities and other well know people in society have to die before society finally says in sizeable majority “enough, recovery is not easy nor convenient to gain, and we respect addicts efforts, but, it is solely about abstinence, and if that is going to be negotiated or trivialized by an addict’s circle of alleged supports, then good luck and enjoy the hole in the ground you are headed to in weeks, months ahead!”

The enabling, codependency, and just sheer ignorance or denial by family, significant others, or benefactors to someone’s abuse/dependency has to be called out!  Stop accepting continued relapse is par for the course.  If people don’t learn from triggers and need for pervasive change in lifestyle and choices, then they are going to resume misery until they die.  Unless a true moment of change occurs, which to me with addicts probably is a miracle.

You really think seeing this actor’s picture on all those magazine covers is going to create a tsunami of change and effective education in substance abuse recovery?  Good luck thinking yes to that!  And sorry to any reading this who was close to Mr Monteith, I do feel for your loss.  Channel it to make it the last, as best you can do!!!

addendum July 20:  via my wife, this link which I think notes additional comments of value to what opiates do:

http://www.thedailybeast.com/articles/2013/07/17/how-a-mix-of-heroin-and-alcohol-killed-cory-monteith.html

Addendum July 21:  via Fox news opinion piece, maybe we could use the show to give the fans a teachable moment:

http://www.foxnews.com/opinion/2013/07/19/glee-should-use-cory-monteith-death-as-teaching-moment/?intcmp=HPBucket

as she wrote at the end:  “Hollywood writers are experts at making us think by making us feel. Perhaps, if Finn suffered a similar fate as the actor who flawlessly portrayed the guy we love to love, the lives of some of our real-life loved ones can be saved.”

Amen to that thought!