Dr. K's Tiips

Avant Garde Psychiatry

I see my early life as divided into distinct stages: the first decade was a time of innocence and wonderment, the second decade a grand rehearsal for adulthood. Young adulthood had not begun until I turned 20. That order of my early life seems quaint today. In our 21st century Western society, we have a “cultural growth spurt”: innocence gives way at 6, adulthood rehearsal occurs in preteens, which turns into “adulthood” in middle and late teenage years. Consequently, many arrive at their actual young adulthood jaded, wizened and bored. While young people experience maturity at an accelerated pace, our instincts cannot be pushed to match the rapid social and cultural changes. Thus, the juxtaposition of contemporary experience and ancient instincts is more a collision course than a harmonious shared journey. This interplay between nature and nurture is made even more discordant by the breakneck, exponential progress of modern technology. This is a very...read more

Hunger, Diet and Lies – the problem with losing weight in societies of plenty

Some years ago, a colleague told me that he is embarking on a new weight loss program.  It was purportedly based on cutting edge metabolic concepts, thus, producing a high rate of success without really eating less. It is about “boosting the metabolism”: It was easy, it made you thin a long while - for life!

My colleague was very excited. The following week I saw him and asked how it was going.  He was crushed: “it’s a diet!...” he exclaimed with profound disappointment. He stopped dieting a few days later. Therein lies a major problem for those who struggle for years with the desire for weight loss. We hope that we could lose weight without feeling hungry. We find the feeling of hunger intolerable - we must vanquish it before it even starts!  Our relationship with hunger has changed in modern times. What those of us in the society...read more

Closure and other unhelpful memes

Definition of Meme: an idea, behavior, style, or usage that spreads from person to person within a culture. Memes (discrete units of knowledge, gossip, jokes and so on) are to culture what genes are to life. Just as biological evolution is driven by the survival of the fittest genes in the gene pool, cultural evolution may be driven by the most successful memes. — Richard Dawkins In my time as unit chief at Mount Sinai Medical Center in New York, I sat in many team meetings. Those were comprised of different disciplines typically present on a psychiatric in-patient unit. One day in discussing a certain patient on the team I asked a colleague how she intended to go about treating him. Her answer, given with firm certitude, was: “We have to strengthen his ego”.  I looked around me, earnest intelligent faces of dedicated professionals, all beamed with a certain satisfaction: We have a strategy for...read more

Planning for your Past

It’s springtime, and as nature flares with abundance in my garden, the squirrels are roaming happily, anticipating the prosperity of the coming months. But every fall, as they become busy collecting acorns from the old oak tree and stashing them in their winter pantry, I wonder if they are saying to themselves: “very soon the air will freeze, there will be no food available and the ground would be covered with snow - better collect acorns now and prepare for the winter.” Who knows? But for us, humans, planning ahead is constantly on our mind. We fantasize the future ahead of us: we prepare clothes for tomorrow, we plan our vacation, and we even brush our teeth so they would not decay years from now. The past seems to us, well, in the past… The past is over, immutable, forever frozen in our personal and communal history. But is it...read more

The fanciful alternative

“When a dream comes true, you lose a dream”  Dr. K.   The future provides an endless parade of fanciful alternatives. “Wouldn’t it be nice if…” - you say to yourself and suddenly that thought becomes, well, a possibility. We are immersed in figments of our imagination that add false trajectories, existences, and memories. Some imaginings like nostalgia and daydreaming sweeten the memories, and upgrade the present. Other, painful imaginings e.g. anticipatory anxiety, pessimism, bitterness, and vengeance mar our happiness. Enduring fantasies can feel very real. So real, in fact, that we often experience them as an alternative to our actual life. That alternate “reality” is a cause of many bad decisions and wrong turns into second-rate life trajectories. We can assume therefore that decisions based on reality vs. fantasy are bound to produce choices more beneficial to your life. Unfortunately, you are by definition totally subjective and biased about your own life. Moreover,...read more

The Hunting Ground

Last week I watched the documentary “ The Hunting Ground”. Ostensibly it deals with rape on American college campuses, but the real accusatory focus is on the shameful behavior of the Universities’ government. Briefly, the documentary claims that when a female student chooses to complain - all too many do not – there is a bias against siding with her. In one segment, an interviewed male student felt the furor is exaggerated: “so there was a sexual act, he said, and she said no. Does that constitute a rape?” One wants to shout at the screen: Yes!! This is exactly what rape is: a sexual act imposed on an unwilling person. Hopefully, the interviewed student, so flippant about rape, would come to reevaluate his position when he himself has a daughter. But perhaps in that inane statement he betrayed the mindset leading to the discrimination against students who are sexually attacked. While college administrations...read more

Your personal life – the virtue of self-centeredness

Recent terrorist attacks in Europe highlighted the distinction between personal life and life in general. Those closest to the horror: the wounded, the family members, friends, coworkers, experienced a personal sense of loss. The rest have been touched by degrees of distance. In millennia of human life a small, very present circle was all a person knew. Hunters/gatherers roamed in groups of 100 people. Most have not ventured more than 30 miles radius from the place they were born. The low density of human population made it unlikely for one group to meet another. It seems safe to conclude that early humans knew everyone in their life and that each individual, especially an adult, was quite important. In our modern world, despite a huge growth in population, social media, swift transportation etc. we seem unable to broaden our circle beyond a relatively handful of people. Research shows that today the average person...read more

“…when you dared not go to sleep for fear of your dreams.” Terry Prachett

Once, many years ago I was rowing in a small French lake with a young Swiss woman I had met on the bus going there. I was twenty, in medical school, and used the summer break to backpack across Western Europe. The day was spectacular, the young woman was lovely, and I was very happy. It struck me however, that this is it. Even if we returned here tomorrow, it would not be the same: I will never be 20 again, on this lake in this boat with this young woman whose name I still remember. Faintly, a poem formed in my mind: A simple, inelegant lament for time lost. The following day, or was it several days later, on the train to Amsterdam, I wrote it down.   I still have it somewhere,...read more

Usefulness – Surfing the River of Time

I prefer the present to the future: the current moment offers a possibility for course correction, just before it slips back into the immutable past. Surfing on the river of time, requires an appreciation of immediacy; a perpetual closeness to your own self. Conversely, distant aims provide no quarter – your life - inexorably drifting off course. Inattention to the present robs you of the only slice of time where you truly exist. Focusing on the past or the future gets you to bypass your actual life, miss instant opportunities, and slowly relegate your life into forgettable smokescreens. It is very hard to focus on the train of todays, made blurry by the rush of all tomorrows into the waiting yesterday. An eye blink, yet another present is forever lost in the black hole of yore. Start by paying attention to what is happening now, together with you. I like to think about it...read more

Success and the taunting choir of the soul

Being disposed to the others’ perceptions of oneself is natural for social beings. When people speak to me about peace of mind they usually mean freedom from imaginary onlookers - the taunting choir of the soul. Never is this torment as difficult as during adolescence. Teenage years, when all aspects of life are experienced under the magnifying glass of one’s peers, leave us exhausted and determined to stop caring about what the others are thinking. Luckily, except in some specific conditions, we are mostly able to ignore this internal reproach. However, the natural yearning for others’ perceived approval continues to flicker inside. Living with mock tribunal is a price we pay for our consciousness. But life is strewn with insecurity landmines. Trigger one, and you are instantly mired with teenage- like angst, all over again. The demons are not gone, just dormant. “Success” is an explosive trigger, which instantly awakens the...read more
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