Monday, November 29, 2010


A news item in the NY Times ( reported that “Narcissistic personality disorder” is going to be deleted from the upcoming revision of the Diagnostic and Statistical Manual of Mental Disorders, due out in 2013.

NPD isn’t the first entity to get bumped from the DSM. In 1973, homosexuality was deleted after years of debate. It finally happened when enough gay psychiatrists came out, causing their straight colleagues to observe, “Gee, I know those people and they seem fine. So maybe they’re normal.”

Psychiatric diagnoses rise and fall from a show of hands: it's no more scientific than that.

If you wonder why NPD, of all behaviors, no longer looks abnormal, take a look at Facebook, where hundreds of your “friends” can’t wait to tell you they bought a jar of Skippy this morning. Take a look at television, where people ache so much for their fifteen minutes of attention that they wait in line to make fools or felons of themselves. Notice that we gaze into one another's eyes less than at our cell phone screen’s display of messages, messages to US. 

Yup, narcissism’s getting relieved of its “disorder” burden because a significant number of psychiatrists have had the courage to admit that they, too, have become navel-gazers. Narcissism is now officially normal. What gets rehabilitated next, greed?

Friday, November 26, 2010


Thanks to our interminable wars, we hear regularly about returned veterans suffering Post-Traumatic Stress Disorder. PTSD is characterized by hypervigilance, nightmares, mood swings, and inexplicable emotions, including emotional numbness. In sum, PTSD is a frightening derangement of feelings.

We’re beginning to realize, though, that PTSD isn’t limited to war veterans. It’s shared by people who, having been through any situation that threatens their sense of self and who didn’t consciously process their consequent feelings. For example, one study found the rate of PTSD in adults who were in foster care for one teenage year was higher than that of combat veterans.

Is it any surprise, then, that PTSD is common in people with cancer? If you haven’t been through cancer yourself, then imagine that your doctor just spoke the C word. Your hearing failed immediately after that, but later you remember the doctor saying you need some diagnostic studies, and the sooner the better, since cancer cells are anything but patient. You undergo a variety of mystifying scans and other tests, learn about the stage and intensity of your cancer, and are encouraged to begin treatment, chemotherapy, say, immediately. The treatment is no picnic. It fatigues and nauseates you, and changes your body image. Meanwhile, your relatives and friends conduct their own confusingly mixed choreography. A few separate from you, a few infantilize you, and conversely, many show you loved you’d never dreamed of.

In other words, your life as you knew it is utterly gone, and at this point there’s no reliable replacement. Is that a bit unsettling? Would that all these changes had occurred more leisurely, with enough time for you to emotionally digest each, but that’s a rarity. New cancer can demand an urgency that leaves emotional health in the dust. Yet as one member of a cancer support group advised, “Buried emotions are always buried alive.”

Sooner or later, like stones in a farm field, they surface, and can do so in distorted, baffling ways: PTSD. Part of my work in facilitating cancer support is to convey two items of hope to new patients and their families:
    1. The emotional roller coaster they’re riding does NOT mean they’ve gone nuts. It’s not abnormal. It’s a common, even expected aspect of cancer.
    2. It’s transient. The emotions patients had to stuff temporarily in order to survive are now finally accessible, and can be gently drained away.

Wednesday, November 17, 2010


Finnish researchers recently found that exercise doesn't carry predictably results. Some people benefit, some don't, some decay a little more.
That finding parallels experience with diet, too, and with personal response to medication.“…the actual mechanisms involved are complex,” says the article. Indeed: maybe we aren’t as knowledgeable as we claim. In a story that may be apocryphal, a medical school dean told his graduating class, “I’m sorry, but about a third of what you’ve learned here is incorrect. We just don’t know which third.”

When we view any human being, we need to know that this flesh we see is only the tip of something invisible and far larger. Each of us is a universe of perception, emotion and meaning, which inevitably informs our every activity. 

The mornings I run, I of course observe others running. Some look blissed out, some look as though The Reaper’s chasing them. My fantasy—though not yet borne out by science—is that we squirt out hormones specific to our emotions: some runners bathe themselves in cortisol, others in endorphins. That is, consider that it’s not about exercise, but the meaning that exercise holds for us.

One can postulate similarly about diet (and any other function, as a matter of fact). Imagine gobbling a half-pound of bacon. Tastes good, right? But it might also generate a guilt pang, meaning certain as-yet-undiscovered brain cells emit guiltotonin, a hormone with nasty cardiovascular consequences.

As long as we wish to see ourselves primarily as physical beings, we’ll attend just to that aspect. We won’t learn much about who we really are until we significantly appreciate our subjective elegance.

Tuesday, November 16, 2010


As I pay attention to developments in the world of cancer, I see a particular aspect gaining justified prominence: caregivers.

Just a couple of years ago, caregiver issues were considered almost ancillary, a sideline to the major phenomenon, the patient and his or her tumor. It’s increasingly apparent, though, that the quality of care patients receive is inevitably dependent on the condition of their caregivers.

In my experience, caregivers (usually spouses, but sometimes other relatives or friends) often suffer more than the patient does, beset by anxiety, depression, sleep deprivation, fatigue, and underappreciation.
And if you’ve ever been a patient, you know that at times you can be a real pain in the butt.

A scientist friend is currently caring for his wife. Normally easygoing and pleasant, she’s on a steroid, Decadron, that leaves her wired, sleepless, tired, and uncharacteristically irritable and demanding.

My friend says, “Her intensity around being sure I have done obvious things gets annoying, but I am trying to find words to convey my position without getting upset. It gives new meaning to the idea of your spouse acting like a ‘princess.’ Get me this, do that, do it THIS way, and do it NOW. Weird. But it is something I need to be tolerant of, especially because it is clearly not due to a previously un-manifest personality flaw, but is a pharmacologic side effect of euphoria. We have had to develop a sense of humor about it, so I came up with the idea of a a quantitative measurement, the ‘Princess Index.’” 


So if you’re sick and it seems your caregivers regard you as Mr. Hyde, consider that there's nothing wrong with you. It's just that your Princess (or Prince) Index is temporarily elevated.