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Monthly Archives: October 2011


There was evening and there was morning……

In its description of the story of Creation, the book of Genesis, or B’rashit describes each day as beginning in the evening.  Is there some message in this about how we should conduct ourselves as human beings? As a Jew I believe that while, indeed, there is a G-d and that She created us in Her image, that Creation was not simply a historic event that occurred at sometime in the past. To the contrary, our Creator, being infinitely creative, created the Universe much like the playwright created Tony & Tina’s Wedding; we are never mere observers (a passive audience) of the events that occur all around us. We play as much a part in how the show ends as our Creator, Herself. In Yiddishkeit, this  is called Tikun Olam or repairing the Universe. Tikun Olam reconciles the seemingly paradoxical concepts of an omniscient Creator while each of Her creations have free will. While we mere mortals do not have the power to change the past, we can, by exerting our will, change the outcome of anything that has already occurred. An unfortunate but powerful example of Tikun Olam in action is the Holocaust. Two out of every 3 Jews living in Europe in the 1930s and 40s were systematically exterminated by the Nazis and their collaborators and, try as some may, there is nothing anyone can do to change this fact. However, within 3 years of being liberated by the Allied Forces (including the former Soviet Union), many of the survivors of the Holocaust garnered their collective will and not allow Hitler to reign triumphant they instead repatriated with their ancient Homeland in the newly formed modern State of Israel!

So you may ask, what does this have to do with whether our day starts at midnight versus when we decide to wake up in the morning or at sundown? The answer is that to live a life where we effect the world in which we live and not it affecting us, we better bring our A Game every day.Modern neuroscience teaches us that we can only function (perform) optimally when our Circadian Rhythm (our internal clock) is aligned with the rhythm of our planet, such as night and day (Diurnal Rhythm). After all, Hashem created us here, on the 3rd rock from the sun. If our Creator wanted us to be angels perhaps we would have wings and be floating somewhere up in the atmosphere but, instead She planted us firmly here on the ground otherwise known as the planet Earth; and us Earthlings must begin today with some preparation this evening. Rabbi Tarfon taught: “It is not your responsibility to finish the work [of perfecting the world], but you are not free to desist from it either” (Pirkei Avot-2:16). That being said, each day must have a beginning and an end. Just as we know that if we want our beloved Personal Computers (PCs) to function optimally each day when we turn them on, we need to close down each open Window, one at a time before we shut it off, we Earthlings share this same need.  Our G-d given human effectiveness runs on the same set of tracks as our sense of wakefulness, which peaks soon after awakening and gradually degrades as the day progresses into evening, when we become drowsy and the cycle starts anew. While feeling drowsy is something with which we all can identify, diminished effectiveness or our executive function (the neuroscience equivalent of Tikun Olam) is not as noticeable. Never the less, executive function is the first of our brain’s functions to decline when we are sleep deprived or drowsy. A major review conducted in 1996 suggested that the oil spill of the Exxon Valdez, the destruction of the space shuttle Challenger, the nuclear accident at Chernobyl (costing over 4,000 lives) and the near nuclear accidents at the Three Mile Island and Peach Bottom reactors were all associated with sleep deprivation of the people involved. Sleepy driving causes as many car crashes as driving under the influence.

During the course of our hectic days, there are multiple Windows open in our brains, as it should be when we are putting our signatures on the world. However, just as our PCs, our brains cannot switch from having multiple open Windows to off without some untoward effects upon reopening these same Windows come morning time. In order for it to be fully restorative, we must not only get the proper measure of sleep, we must get the proper quality of sleep, as well. Many people, under the incorrect assumption that work time and sleep time is a zero sum game, will continue to attempt to problem solve up to the minute they fall asleep. In reality, their productivity is reduced by this habit. Just as with our PCs, to keep our performance of Tikun Olam at an optimal level, we need to start the process of closing down some of our open Windows well before it is time for sleep. The 90 minutes we spend chilling out and relaxing in the evening is a mandatory pre-requisite for restoring our ability to do Tikun Olam come morning time; it was evening and it was morning.

End

Mitchell R. Weisberg, MD. MP

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Below is an excerpt from a letter my patient, KP received from The Trustees of the Plumbers’ Welfare Fund in September 2010:

Elimination of Mental Health Benefits

Effective October 1, 2010, no amount is payable under the Welfare Plan for claims connected with the treatment of a Mental Health Condition. A Mental Health Condition is generally defined as a condition or illness that affects an individual’s emotional or psychological well-being. Mental Health Conditions include, but are not limited to, dementia, delirium, anxiety disorder, schizophrenia, depression, bipolar disorder, delusions, obsessive-compulsive behavior, Anorexia, Bulimia, attention deficit disorder, mental retardation and autism.”

Below is KP’s Résumé:

  • Current Position: (held for the past 18 months): Field Superintendent/ Project Manager with a 35 man Plumbing Company. He began as an entry-level plumber and within 3 months was promoted to his current position; second in command only to the company’s owner. A company with $3M annual revenues at the time of his promotion it has since grown to revenues of $15M the year following KP’s promotion. Every member of the company, including its owner, would attribute this explosive growth in the face of a down economy to KP’s performance as their Superintendent. They would tell you about his innate leadership abilities, his ability to command respect while being perceived as a genuinely nice guy who cares about the people he works with. This quality, combined with the treasure-trove of plumbing wisdom KP absorbed in his quarter century in the field, has made this explosion in his company’s growth seem effortless. Not being one for accolades, I do know that KP takes pride in the fact that he is the first one there in the morning and the last to leave; this is just who he is and this is just the way he does things.
  • October 2006 to Present: With his sheer willpower and the support of his family and his physician (yours truly), KP became a Recovering Cocaine Addict.
  • October 2006KP in another failed suicide attempt took an overdose of medicine which I prescribed to treat his Mood Disorder.
  • From 1967 to October 2006: KP, like 25% of the American population, was functionally impaired due to  a Mental Health Disorder and, as is the case for two-thirds of the members of this population, KP went unrecognized and untreated in spite of his frequent use of the healthcare system. (1)
  • Career PathAs are nearly 10% of persons in this country, KP was born with Attention Deficit Hyperactivity Disorder (ADHD). (2) By the age of 14, KP went on to acquire Bipolar Disorder when he effortlessly met the stringent requirements for achieving his first full-blown Major Depressive Episode.  It was at about this time PK began dabbling in something in which he fortunately never became very proficient; suicide. A novice in the skill of snorting cocaine at 17, he rapidly ascended to become a full fledged functional Cocaine Addict by the age of 21. No surprise really, since most 17 year olds with PK’s diagnoses that do not receive treatment become substance abusers and addicts by the time they turn 21, with cocaine being the usual drug of choice. (3) Until 2005, KP continued to self medicate with an addictive, deadly and illegal substance in his futile attempt to treat the agonizing symptoms of mental illness. Miraculously, due to his strong faith, his will to live and his having family and friends that loved and believed in him, he is now the 12 Million Dollar Man; twice as good as any TV superhero.

While KP is, indeed, a rare person his diagnoses are all too common. He came to me in 2005 to find out why he was experiencing severe pain from a relatively minor back injury, he had gained about 60 pounds and was having digestive problems. Had I not done 2 minutes worth of screenings for Depression, Bipolar Disorder and ADHD, as I do on every new patient to my practice, these symptoms never would have come out from KP’s spontaneously elicited complaints. (4) (5) (6) Fortunately, when I reviewed the Mental Health Screeners with KP he was open, honest and quite frankly, relived to share with me the details of the symptoms from which he suffered  silently for the previous quarter century; and his silence was not due to his fear of being stigmatized. KP, as intelligent a person as he is, simply never even considered that these symptoms were relevant to any physician.  You can imagine his surprise when I told him that he was suffering from a medical condition as treatable as Congestive Heart Failure but, more common and with a far better prognosis. He trusted me enough to commit to taking 4 medications per day for the rest of his life.

I am recounting the case of KP the Plumber, not to show my readers what a great physician I am. What I accomplished with KP does not require the skills of a great physician, just a good one. The treatment of mental illness is as straight forward as the treatment of Asthma, Hypertension or any other common disorder physicians treat on a daily basis. Yet, two-thirds of persons suffering with mental illness are simply not recognized; and this is not due to their not accessing the healthcare system. (7) Persons with undiagnosed mental illness use the healthcare system more than those persons without mental illness. (7)They most commonly do so for the evaluation of the physical symptoms that are actually a common component of mental illness. (7) Recognizing mental illness is as simple as asking every patient if they have it or not; this is simply not being done and until it is there will continue to be needless human suffering and an excessive waste of healthcare dollars.

In the 18 months during which KP increased his company’s annual revenues by $12M, the total expenditure on his health care, including my treatment and his medications, was a grand total of $13,500.  Stated another way, for every $1 invested in KP’s mental health his company realized a return of nearly $900. Any venture capitalist would gladly have purchased as many shares as possible of KP Inc. Unfortunately for KP he is not a publicly traded company on the NASDAQ and unfortunately for The Trustees of the Plumbers’ Union Welfare Fund they only consider cost and not return on investment when they make healthcare decisions. This gives me cause to seriously question their sanity.

END

Mitchell R. Weisberg, MD. MP