If you ask most people they would say they are healthy. If you ask them to define what is Health they would start to say, вЂњThe absence of diseaseвЂќ and then pause. Our medical system can find a disease label to apply to almost anyone. How many Americans are overweight, wear glasses for вЂњMyopiaвЂќ or some other condition that affects their life in very minor ways?
I still consider myself healthy, even though I can no longer do many of the things I once did. When my eyesight failed I had to give up clinical medicine. I learned that people with far less or no eyesight lived full and seemingly normal lives. I learned how they do it. Armed with those skills I found ways to help in the aftermath of hurricane Katrina.
I No longer see health as a set of standards. Standards that say you have such and such ability, but as functioning in ways similar to your peers. Thus health is relative and varies throughout life. A healthy infant cannot do what an adult does. An elderly person can no longer do what they did in their вЂњPrimeвЂќ.
What are the Aspects of Health?
We can break this functioning into four parts of our lives physical, mental spiritual and social. Most of us find the physical easy to understand. Mental is also fairly easy to grasp. The Spiritual is harder to understand. I see it as how we relate to the universe and the essence of others. Western Science has no way to describe or measure this. People throughout time have recognized this. Non-western societies experience this more too.
The vitality that results from living in a functioning community became all too apparent after hurricane Katrina. The illness I saw in Biloxi in the aftermath of that storm was appalling. In those who came to work and those who lived there developed physical illnesses that we do not see elsewhere. The emotional toll was apparent in the depression and suicide. Spiritually many asked, вЂњWhere is God?вЂќ As help poured in and over time the community came back together. The illnesses disappeared. We do not live alone. We are dependent on each other in ways we can hardly fathom.
Is this social health the outgrowth of our need for Love? I recently came across a study where baby monkeys were separated from their mothers. These infants were offered two surrogates. One a wire mesh structure with a feeding bottle and the second a soft, warm and fur covered one. The infants clung to the fur covered one and avoided the food. The Spiritual and social aspects of health might be ways for us to get the Love we desire, much like the infant monkeys.
So what makes you healthy?
Coach Dr. Dave (MD disabled)
Last week I invited you on a journey beyond disability. When we are young we do not expect to be disabled. When we see or hear of others becoming disabled, we think it cannot happen to us. Yet, one in five working aged Americans says they have a disability. Yet we do not prepare ourselves or our children for the possibility of becoming disabled. In raising our children do we prepare them for becoming disabled without knowing it?
When I was raising my children, I sought to make them competent adults capable of living in the world that they inherited from me. Even though I had been diagnosed with the disease that will eventually take my eyesight I did not contemplate my own disability or that my kids might become disabled. Instead I tried to instill in them those values skills and ethics that I thought would serve them best. It turns out that many of those skills are what we need to successfully journey through the storm of disability.
It seems that no sooner than we are aware of past and present, we become aware of the future. We also become aware that some events in life are pleasant and others unpleasant, good or bad. It is human nature to be optimistic. Psychological studies have shown this to be true even for pessimists. Yet, we donвЂ™t prepare ourselves for the bad.
How often do you see bicyclists not wearing helmets? We all know stories of bicyclists getting severe Head injuries. All cyclists know it is easy to take a spill. Usually we just get a good scrape sometimes a broken bone. Those injuries heal, and we return to cycling. Serious head injuries are another story. So why donвЂ™t more cyclists wear helmets? Those cyclists I have asked usually talk about comfort. I know people confined to wheelchairs and the like because of head injuries. Would a cyclist think that was comfortable?
I used to cycle and still hope to return. After my eyesight became poor I continued to cycle. One day while cycling, I swerved to allow a car to pass. My front tire went off the road into a ditch. I was thrown forward onto my shoulder and probably my head. I was wearing a helmet, so the worst I received was a separated shoulder. As I look back on it I am sure the helmet saved me from a more permanent injury…
On that occasion I had prepared for a bad outcome. But do we go through life preparing ourselves for possible bad things? Early in our lives we assume bad things will not occur. Later when we focus on bad things we find ourselves depressed. Are there ways to prepare ourselves for bad events that make us happy?
In recent yearвЂ™s psychologist have found many ways to do just that. In fact a whole field of psychology has developed around that. It is called positive psychology. It is exactly what life coaches have been seeking to do. These techniques have been shown to be effective when taught in schools. They reduce bullying, truancy, teen suicides and criminal behaviors.
Studies have shown that people with better social and emotional skills handle adversity better. These skills can be learned and thus our ability to whether bad events can be improved. Adults can learn these as well.
The terms emotional intelligence and social intelligence are not well defined. Emotional intelligence generally refers to the ability to sense our own and othersвЂ™ emotions, to use those emotions to express ourselves and understand the emotions of others. Social intelligence goes beyond that to understand the roles and norms of the social situation. Many authors have attempted to develop tools to measure these intelligences and to teach them.
I would love to know what social and emotional skills you would like to have in your toolkit. I am It is collecting as many of these tools as possible for the book I hope to write. The book will appear in early May.
Coach Dr. Dave [MD [
PS, most cats I know would have as little as possible to do with a dust buster.
Author of the upcoming book, вЂњRecipes for Lemonade: Dr. DaveвЂ™s Recipe for Thriving through DisabilityвЂќ.
In todayвЂ™s NY Times columnist Paul Krugman wrote вЂњInsurance and FreedomвЂќ about how Americans are enslaved buy their вЂњneedвЂќ for health insurance.
I would reply that Obama Care will not free Americans, just change the way they are enslaved.
You question if Health Insurance has enslaved Americans. I might suggest that the American Medical system has enslaved Americans. In the past thirty or so years American Medicine has gone from curing ills to вЂњPreventingвЂќ them. It is true that the biggest improvement in health has come not from our ability to cure illnesses but in preventing them in the first place. Yet, doctors myself included has made a good living convincing people that if you lower your blood pressure, cholesterol and exercise you can prevent a heart attack or stroke. We have data showing that. However, heart attacks and strokes are still the leading causes of death for Americans. They just happen at older ages. So why does American Medicine continue the promote prevention?
American Medicine promotes prevention because it sells. It is hard to watch the evening news without seeing an ad for some sort of medication. It is usually a new and more expensive version of a current medication. The drug companies spend millions on studies designed to show that their new drug is more effective than the older one. Doctors make a good living prescribing and monitoring those medications. So why to doctors persist in this charade?
Doctors persist for several reasons not just the economic. We are taught that these drugs prevent deaths, but not in how to find the cost of preventing one death with method a or b. When I started in medicine decades ago, we believed that preventing PVCвЂ™s saved lives. We prescribed drugs that made our patients feel ill and dependent. We enslaved them to our care lest they drop dead of a heart arrhythmia. Then patients took charge and stopped the offending drug and felt better. Finally doc tors had the nerve to study the drugs more carefully and found that the drugs were actually killing more than they helped. The FDA banned one of these drugs completely.
Would medicine better serve America by teaching people how to weather the storms of illness? In the past couple of decades a new approach to psychology, called Positive Psychology has found ways to do just that. Several books are now available that document this. Some of the books have even made the NY Times best seller list. Doctors and others can now teach people how to successfully whether the storms of life, including illness. These techniques have other benefits besides just lowering the risk for heart attacks and strokes; they can help people weather divorce, job loss and other trauma. By promoting social and emotional health we can free America from the slavery of ill-health.
David Moseman, MD, MPH, FACP (disabled)
Neurophysiology of sadness
In my years as a physician, I often had to intervene in the sadness spiral. When one has a stroke, it is sudden and unexpected. Often the first thing one knows is that they wake up in a hospital having difficulty moving. They must depend on strangers to get out of bed and do other things. Being dependent on others makes one feel like a child. One of the markers of being an adult is the ability to care for ourselves and others.
Recovering from a stroke takes time. Time that was not planned for. This unplanned interruption of life is depressing. Depression makes recovering from a stroke harder. The brain recovers its ability to direct the bodyвЂ™s movements over weeks and months. During this time muscles atrophy and joints stiffen. To prevent these complications doctors prescribe exercises. It takes effort to exercise with the therapist. Up to forty percent of stroke suffers will get depressed. Adding an antidepressant medication to the treatment plan can speed recovery.
In our brains different things happen when we are happy or sad. Different parts of our brains are active when we are happy or sad. Our brain cells use chemicals called neurotransmitters to communicate with each other. Many sad or depressed people donвЂ™t make as much serotonin as they do when happy. The most commonly used drugs for depression; SRIвЂ™s increase the amount of serotonin available in the brain.
Images of brain blood flow show that in happy brains blood flows to the cortex or thinking parts of the brain when sad or depressed this does not happen. This partially explains why we think better when happy.
There exists evidence that your immune system also works better when we are happy. Thus happiness can keep us from being ill. Conversely, when we are ill we often feel depressed and that will lead to more illness.
A stress hormone, corticotrophin releasing factor (CTrf) can also be increased in depression. CTrf causes increased levels of adrenalin and other adrenal hormones. Increased levels of adrenal hormones cause increased blood pressure and are associated with more deaths after heart attacks and strokes.
Beside medications what can you do to be happy?
We now know that we can reprogram our brains. Several techniques are known to reverse the changes seen in unhappy brains. These techniques fall into two categories, reversing unhappy changes and strengthening happy parts of the brain. Meditative techniques like mindfulness reverse unhappy changes. Finding ways to enjoy and be happy can reinforce the happy brain.
Such simple things as forcing a smile change our brains. I experienced this many years ago, when I had a very stressful semester in college. I developed a spastic colon. I would get gut cramps for no apparent reason. They might double me up while walking across campus. By just smiling the cramps would stop. Eventually I dropped a troublesome course and the cramps stopped.
Music and other things are known to make our brains behave in happier ways. So when you feel stressed or sad, do something that makes you feel happy?
Joy is more than its own reward.
Happy people are healthier.
Happy bodies fight infections better.
Happy brains think better.
We cannot always be happy. In fact life often makes us sad. Sadness can make life worse. When we are sad our faces droop. When we are sad our bodies droop. We have less interest in life and living. We might even have trouble getting out of bed. When you see a sad person do you want to say hi, or avoid them? When others ignore you does that make you feel happier or sadder? Thus, being sad can bring its own spiral of increasing sadness.