My psychiatry professor asked our Death and Dying class “at what age do you expect to die?” This question was met with a variety of responses:  Furtive glances at others, hyperventilation, sweating, a quick search for the exit door, anger and disbelief.  We thought he was kidding.

“No, really”, he said, “I think I’ll die in my late 70s.  What about the rest of you?”

This was a tough question to spring on us and I wondered what it had to do with patient care.

As scientists, some of us began discussing the predictive value of genetics with the addition of future medical advances minus high risk sports and unhealthy habits.  One of my classmates began to feverishly construct mathematical formulas.  Others stared blankly out the window.

I raised my hand.

“Why do you ask?”

“So you’ll have greater empathy for your dying patients.”

He seemed to think it was time to shake our denial; to teach us some humility; to open our minds.

I thought he was unreasonably provocative.

I said, “I don’t want to think about when I will die.  Maybe it will jinx me.  Maybe I’ll have a subconscious deadline.”

I wondered if he were casting a spell.  Maybe I was just being rebellious.

“All right then.  At least 100 years old!  Are you satisfied?”

“Do you mean it?”

“What?  That I expect to make it to 100 or more?  Well yes.  God willing of course.”

He thought I was resisting his question.

If I could avoid the issue of mortality I would not have to fear it.  I would not have to consider loss of function or the loss of possibilities.

Naturally I knew none of us would live forever but I didn’t want to feel it.

The denial of death and the illusion of immortality helps people go into combat, engage in high risk behaviors, and delay important decisions like where to go with a career, whether to have a family, and how to plan for retirement.

The awareness my professor was inducing had drawbacks.  Some of my classmates stopped taking public transportation late at night.  My lab partner cancelled his sky-diving lessons.  I stopped riding my bicycle to class through a rough part of town.  Our rugby team lost some members.

I asked my professor “Why do you think we should increase our awareness of our own death?”

“Because it will increase your awareness of the death and dying of your patients and make you better doctors.”

“Is there something you want us to learn about ourselves?”

“I just want you to have compassion for your patients.”

I decided there had to be more that he wasn’t saying. I thought I had plenty of compassion but it was clear that I did not want to confront my mortality, at least not in front of him and my classmates.

Years later my professor’s question began to make sense to me.  My best friend Jake died in a freak midair collision just after medical school.  He left behind two young children and a loving wife.  My next best friend Kevin endured a losing battle with brain cancer.  A brilliant psychologist, he was well aware of life and death.  We talked and cried together.  One evening as the sun was setting outside his hospital window, he raised his arm weakly so the rays of sunlight would rest on his skin.  “Pretty” was all he said. I finally understood another lesson my professor was teaching:  Life is delicate and temporary and it’s meant to be savored, even during the hardest times.

Acknowledging mortality, although it can be sad and scary, is liberating.  Awareness of death can help us savor the big events and notice the little moments of life; to honor the people who we care about and who care about us; to do the things that are important, meaningful and enjoyable rather than delay them; and to feel grateful for what we have.

My psychiatry professor became my mentor.  Through him, I met numerous famous people and became aware of a world I never imagined in my small rural childhood town.

One of my professor’s houseguests, Elizabeth Kubler-Ross, wrote the book On Death and Dying.  She was a delightful free thinker who later in life lived communally and took an interest in mysticism.  I hoped she found the answer to what happens after death before she went there.

Being aware of mortality is less painful for me now.  I don’t fight the notion of dying as much as I used to and I am more grateful for being alive.

Death teaches us about life – not only how precious life is but also how important it is to live it meaningfully and responsibly.  Awareness of death highlights the value of life.

I learned about my professor’s death on a National Public Radio show honoring his life.  John Fryer did not make it to his late 70s.  Sadly, perhaps because of his genetics and how intensely he lived, he died at age 64.  During his life he lived fully with few regrets and much gratitude.  Maybe that was part of his lesson.

The post Are You Still Immortal? appeared first on Bick Wanck MD & Associates.

The gene pool has a lifeguard called epigenetics.

Using healing enhancers will help it come to your rescue.

You can influence which of your genes are switched on and which are switched off with what you eat, how much you exercise, and how much stress you allow in your life. The science of epigenetics explains how that works.

As a human, you have approximately 21,000 genes. But you also have 50 to 100 “marks” for each of your genes. Your marks are switches that turn on and off your genes. These marks or switches are what you can control by what you eat, how much you exercise, and how much stress you experience.

Conrad Hall Waddington (1905–1975) proposed the term epigenotype in his 1939 book, An Introduction to Modern Genetics and in 1942, in an article called “The Epigenotype.” He described epigenetics as the means by which your genetic expression is affected by how you interact with your environment.

The most noticeable effect of epigenetics is seen in how tissues differentiate. Your brain cells and your bone cells share the same genes, yet they look and behave very differently from one another. The difference is because of which genes are switched on and which ones are switched off. The switches are determined by epigenetics—in this case, by the effects of chemicals from surrounding cells.

Just as epigenetics determines where you have brain cells and where you have bone cells, it also determines whether to switch on genes of wellness and whether to suppress genes of illness. It’s been shown that childhood abuse results in changes in epigenetic effects on gene expression. Researchers at McGill University showed that genes were switched on and off differently in people who suffered childhood abuse than in those who did not. They theorized that this could explain higher rates of illness in those who suffered childhood trauma.

Epigenetics Can Protect Future Generations

We already know about epigenetic defense mechanisms. Disease-causing genes can be silenced when epigenetic effects prevent their expression. This explains why one identical twin can develop bipolar disorder (manic depression) while the other does not. They were affected by different experiences and by different sets of behaviors. Those differences affected gene expression epigenetically.

What you  experience and how you behave can even affect future generations in two ways:

1. If you model healthy behaviors and resilient attitudes for your children or for other children, they may adopt those behaviors themselves. Those healthy attitudes and actions can change their genetic expression. They may be less likely to express an inherited case of anxiety, depression, or physical illness. Their epigenetics might overrule their undesired genes by not allowing them to switch on.
2. Sometimes epigenetic influences may be transmitted to subsequent generations. In a landmark study published in 2014, researcher Lars Olov Bygren and his team[CJ1] [BW2]  found that the children and grandchildren of people who suffered through a famine lived longer than expected. They lived longer because they did not develop obesity. It was the first time an epigenetic trait was shown to be inherited by subsequent generations.

Hopefully one day we will be able to show what effects specific types of diets, exercises, meditations, and social interactions may have on genetic expression. If we know what genes need to be suppressed and what behaviors will do that, we may be able to tailor a particular type of exercise or diet or meditation to prevent a particular type of illness in someone who might be inclined to inherit it.

Enhancing one’s healing with positive attitudes, healthy behaviors, and compassionate love has been shown in studies to be so strong that it can rival the effectiveness of some medications. When well timed, healing enhancements can, in some cases, prevent the need for medication. When medication is needed, they can strengthen its effect.

Be sure to discuss your plan for exercise, diet, and other healing enhancements with your health care providers. It is especially important to discuss medication decisions with your prescriber. Healing enhancements can help you get well and stay well, but they should not be undertaken until you have discussed them with a qualified professional.

I hope science will convince you that adopting a set of healthy attitudes and behaviors will be worth the effort. If you go to the trouble of practicing healing enhancement in your daily life, you’re likely to see payoffs. You’re likely to feel better and have more energy, and you may have less need for medication.

The genetic lottery is not so risky when you work with your epigenetics. By influencing which genes are switched on and which genes are switched off, you may be able to prevent (or at least mitigate) some illnesses and enhance your wellness.

The post How to Change Your Genes appeared first on Bick Wanck MD & Associates.

Mindfulness

I recommend a daily three-minute gratitude ritual.  This starts with quieting your mind by paying attention to your breathing to help you become aware of the moment.  Here’s my favorite ritual.

With each slow breath, I say:

Thank you God for this moment,

Thank you God for this place,

Thank you God for the water,

Thank you God for the air,

Thank you God for the light,

Thank you God for this life.

Thank you God, Thank you God, Thank you God.

In place of God you can thank the Great Spirit, the Great Mother, Allah or whatever force you believe has given you these gifts.

Exercise

I recommend at least three minutes of daily exertion.  Exertion means you are breathing so hard you can’t have a conversation.  This may involve running up and down stairs, doing push-ups, crunches, and squats (modified as needed), or running in place.  You don’t need to change your clothes (sweat from exercise doesn’t stink like sweat from anxiety), and you can do your exercise of choice before lunch, between meetings, or when you first get home.  No one will miss you for three minutes (okay, maybe a crying baby or puppy).  And whatever exercise you enjoy or do routinely, but ALWAYS do at least three minutes of exertional exercise daily.  You’ll be amazed and pleased by the results – within weeks you’re likely to feel stronger, more toned, and more energetic.  Exercise is one of the best MEDs you can take!

Diet

I recommend you avoid sugar to reduce mood fluctuation.  By curtailing your intake of sugar, you’ll have more consistent energy, and you’ll lower your risk for diabetes, hypertension, and heart disease.  You’ll feel better and live longer!  No matter what diet you follow, whether it’s gluten-free, Mediterranean, vegetarian, vegan, or Paleo, you’ll feel better and you’ll be healthier if you eliminate sugary sweets.

Stress Management

I recommend saying NO!  Say no to unnecessary activities.  Say no to unnecessary work and relationship drama.  Say no to requests for your time when it’s not crucial.  Say no to unhealthy urges.  But say YES to getting enough sleep, spending less than you earn, and surrounding yourself with kind and loving people and animals as much as you can.

By consistently practicing these daily M.E.D.S., you’ll reduce your stress, feel good about yourself, and live longer!

Before you begin your “M.E.D.S.” be sure to discuss them with your healthcare provider.  It’s necessary to be sure that the activities you chose, particularly diet and exercise, do not cause you any harm.

The post The Best M.E.D.S. for Stress Management appeared first on Bick Wanck MD & Associates.

One of the most meaningful aspects of your life may be providing service to others. This could involve raising a child, caring for a parent or a pet, helping a friend or sibling, or performing service for your community or for an organization. Helping others may be a calling or an enjoyable sideline activity. Helping others can help you to feel connected and worthwhile.

Sometimes helping others goes too far. You might have an overdeveloped sense of responsibility or you might feel obligated and trapped. It’s easy to get out of balance when you help others. If you give too much, you can deplete yourself. If you don’t get enough back, you can feel resentful. If you feel you must shoulder someone else’s load, you can overwhelm yourself. If you do so much for others that you have little time for yourself, you can feel like you are suffocating.

Here are three things to keep in mind as you provide service to others. Practicing them will help keep you from feeling depleted:

          1.  Maintain a quid pro quo
          2.  Stream rather than contain the suffering of others
          3.  Take time to recharge

     Maintain a quid pro quo

Quid pro quo means “something for something.” It means that if you do something for someone, you receive something in return. When you do something for someone as a family member or friend, the usual expectation is that you are doing it altruistically and that you expect nothing in return. This is okay for a while, but eventually it will feel unfair and you will grow resentful.

Perhaps what you receive in return is a feeling of satisfaction, or that by “paying it forward” you are doing the right thing. Maybe you believe your payback will come later from some other person’s good deed, or that your service will pave your way to heaven.

Most generous acts are performed with no expectation of a return. The giver feels good about giving, especially if the receiver appears to benefit or voices gratitude. That’s adequate payment if you have a generous heart and if you feel you have more than you need.

If you give consistently more than you receive and if you have no source of spiritual nourishment for it, eventually your emotional health could suffer. That is why it is important to try to maintain a balance. If you consistently give more than someone else and you feel drained by it, you may need to give less or ask for more in return. Over the long run, a balanced quid pro quo will help you maintain balance in your relationships and balance in your mind.

     Stream the suffering of others rather than trying to contain it.

Suffering usually comes down to a question of ownership. Can you really own someone else’s suffering? The simple and obvious answer is no … but letting go of the urge to help can be difficult. Witnessing someone’s suffering with compassion and constructive concern is not easy. It requires clarity and usually quite a bit of practice.

If your words and/or your actions are the cause of someone’s pain, it is right to take responsibility. If apologizing  does not add to the hurt, doing so will probably help. Taking action to repair damage you may have done is also a good idea if it does not compound the problem or place you in an overly compromised position.

If you are not responsible for someone else’s suffering, it is not yours to mend.  Becoming a witness to someone else’s suffering and offering observations and suggestions, however, can be extraordinarily helpful and healing for both parties. Having compassion for the suffering of someone you love or care about is right and good. Going about it in a way that does not harm you is necessary.

It might help for you to visualize yourself as a rock in a stream. As someone’s suffering comes into your awareness, witness it with compassion and loving-kindness. Remarking on it and reflecting observations about it as it flows around you can give great comfort to the sufferer without taking too much from you. Give as much as you feel is right for you, and sustain your own presence as their distress flows around you. Know that they own their discomfort or suffering, and wish for them a deepening of awareness and a resolution.

It’s possible for you to remain comfortable and within your own place as you offer kindness and support to someone you love. If you do this by streaming and not by containing, you will have room in your heart to continue to be present for them. In this way, you can be present for someone without losing yourself.

     Take time to recharge

Whether you do so alone or with others, taking time to recharge your batteries is vitally important. Consider this a quid pro quo for yourself. When you have expended a great deal of energy in helping others, it is only reasonable that you take some time to resupply your energy reserves. The emotional labor required in many interactions can be extraordinarily depleting. You will need some time to reconstitute yourself with enjoyable time on your own or with people who expect little or nothing of you.

When you take the time to take care of yourself with these three simple steps, you’ll be able to show up for those in need without draining yourself and without resenting others for it. You’ll be able to find meaning and fulfillment as you provide service for others.

HOW TO HELP OTHERS

WITHOUT DEPLETING YOURSELF

MAINTAIN A QUID PRO QUO

Keep a balance of giving and getting in your relationships.

It is important to get back as much as you give out.

STREAM RATHER THAN CONTAIN

THE SUFFERING OF OTHERS

Witness with compassion and loving kindness the suffering of others

without trying to take it for them.

Take responsibility for any pain you may cause but do not try to own

someone else’s misery.

TAKE TIME TO RECHARGE

Whether it be alone or with others, find ways to recharge your

batteries when you feel depleted.

The post How to Help Others Without Depleting Yourself appeared first on Bick Wanck MD & Associates.

The 3 A’s of successful coping are:

1. Accept
2. Act
3. Adapt

Anything you would rather not know about or comes as a shock can overwhelm your system with dread.  It’s natural to protect yourself with denial.  News that’s too big or too unwanted requires an adjustment.  You may not be ready to handle it.  You may prefer to run from it or to ignore it but the 3 A’s of successful coping will give you a way to manage it.

ACCEPT

            The first A is Acceptance.  It requires you to shake off your denial and grasp the reality of a situation you may not have wanted.  Once you accept the fact that there’s no escaping your situation, you are ready for the next step.

 ACT

Once you’ve fully acknowledged the fact that there is a situation you must deal with, it’s time to act.  Action involves two components:  gathering information and making a decision if one is needed.  There’s no turning back.  There’s no reversing course.  It is now time to incorporate your action into your life.  Take action despite fear but don’t let fear dictate the action.

ADAPT

Once you have taken action to gather information or to make a change of direction, it sets awarenesses and events into action.  These awarenesses and events then become inescapable.  When you take action, an entire sequence of events may unfold.  Now it’s time for you to adapt to the realizations you’ve made and the actions you’ve taken.  Adapting to the action you’ve taken may seem overwhelming or scary but you can do it by taking one step at a time.

Imagine that you’re running late for an important meeting and that you’ve just come upon a traffic jam.  Now is a good time to put triple A coping into effect.  Acceptance is easy; you may not want to believe it but it’s true:  You will be late for your meeting.  Next comes action.  Perhaps you’ll try calling someone but the most important action in this case is likely to be no action.  As long as you are safe, you could manage better by slowing your breathing and calming yourself.  That’s part of Adaptation:  You’ll need to adapt to your situation by breathing through it, adjusting your schedule and contending with whatever you’ve missed.

Here’s a tougher one.  Your latest medical tests indicate you might have cancer but you’ll need more tests to know for sure.  Acceptance here is tricky:  You have to accept that something scary might happen but you don’t know if it will.  Acceptance means not jumping to premature conclusions but also not ignoring a possible danger.  Action, something you probably would rather not have to do, means collecting information and making a decision to either delay the tests or move ahead with them.  Adaptation then means finding ways to avoid to either decision involves adjusting to how your decision changes how you see your world and what you need to do to manage it, such as who to tell and how to manage your schedule.

You can use the 3 A’s of successful coping for anything that happens in your life.  By practicing it with minor events, you’ll be ready if you need it for a major event.

THE THREE As

OF SUCCESSFUL COPING

ACCEPT

Shake off your denial and accept the fact that

there is a situation you need to address.

ACT

Take action by gathering more information and by

making a decision if one is needed.

ADAPT

Adjust yourself to what you know and deal with the

Consequences of your decisions.

No matter what has happened, you can manage it.

The post The 3 A’s of Successful Coping appeared first on Bick Wanck MD & Associates.

The right amount of stress is a moving target between emptiness and overwhelm. Too much stress can cause you to exceed your stress threshold—the point at which stress causes your Achilles heel (your point of vulnerability) to flare up, and this can cause both physical and mental distress.

Too much cortisol can cause anxiety and depression, and it can activate or worsen a physical illness like acid reflux, migraine, or back pain.

Some people know when this is going to happen because of past experience. They know that a problem is likely to surface when they are pushing too hard. They can feel extreme overwhelm or a feeling of entrapment, or that desperate feeling that comes with feeling you have to do more than you can handle. These feelings could be due to changes at work, unexpected relationship demands, or self-imposed pressure to accomplish something important.

The state caused by stress that exists before stress results in the manifestation of illness is something I now call Pre-Illness Stress Syndrome. Actually, my wife, Ramona, coined the term during a conversation we were having about stress.

Pre-Illness Stress Syndrome

“Pre-Illness Stress Syndrome is like PMS,” she said, “the way you know you’re about to get your period—or like the way you feel when you’re coming down with a viral infection before you get a runny nose, cough, or upset stomach. It feels different from your usual state, and you know by experience and by timing that it’s about to come.

“But with stress,” she continued, “there’s a different kind of sensation—part physical, part emotional—that lets you know you’ve pushed yourself too far.”

Most people would call the solution for Pre-Illness Stress Syndrome taking a mental health day. But that term is too often associated with irresponsible fun seeking . . . and the manifestations of stress are anything but fun. Panic attacks, despair, insomnia, back pain, GERD, and IBS don’t go away just because you take a day off from your responsibilities. Taking a P.I.S.S. (Pre-Illness Stress Syndrome)-off day means taking a day of deliberate healing.

How Your P.I.S.S.-off Day Brings Stress Relief

When you are beyond your limit, try taking a day away from the source of your stress and treat yourself to a health-promoting day of decompression. Your P.I.S.S.-off Day helps you relieve stress by:

1.      helping you become aware of the triggers for your stress and the illnesses it can cause.

What causes your stress? Is it caused by trying to do too much in not enough time?  Is it related to too much work place or home life conflict or drama? Is it because of spending more than you earn, or trying too hard to please the people you love? Pay   attention to how your mind and body respond to the sources of your stress. What kind of emotional or physical upset does it cause? Could it contribute to the worsening of a chronic condition like hypertension, diabetes, IBS, or depression? Or, could it be causing a new case of acid reflux or anxiety? If you know that you are stressed and not feeling well but you don’t know why, taking a P.I.S.S.-off day could help you gain some perspective.

2.      creating a day of healing.

Do some things you know are good for you, such as meditating, preparing a healthy meal, exercising, spending time with nature, or reaching out to someone you know to be kind and loving. Take time to be a better friend to yourself by treating yourself with kindness and compassion.

3.      helping you learn new coping strategies.

On your P.I.S.S.- off Day, take time to decompress. Do nothing, or do something you enjoy. If you do something you enjoy, be sure it is safe for you and for those around you and does not include an addictive drug or behavior. Then, before you return to your stressful life, think of ways you could do things differently. Maybe you’ll need to pace yourself better, or unplug from unnecessary workplace drama, or speak up more for what you need at work or at home. Maybe you’ll need to schedule another P.I.S.S.-off day!

For the Long Term

Remember every day to practice some of the healthy activities you tried on your P.I.S.S.-off Day. Remember to breathe and return to the moment when you get too caught up with life’s pressures. Remember to exercise and eat better—even if you don’t want to. Try to minimize relationship drama and maximize time you spend with kind people. Try to dial down your inner pressure when you find yourself expecting too much of yourself. Turn everyday into a day of healthy behaviors so you don’t need as many P.I.S.S.-off Days!

The post Have you scheduled a P.I.S.S-off Day? appeared first on Bick Wanck MD & Associates.

Careers, families and health are too often needlessly destroyed.  Craving and denial can be so powerful that alcoholism’s victims become locked in its embrace with little hope for escape unless they find help.

It’s easy to be fooled by alcoholism.  This great imposter can mimic mild to severe states of anxiety and depression, confusing even the most discerning observer.  Two weeks without a drop are often needed to know if there’s more going on than simple alcohol overuse.  On its own, simple alcohol overuse can result in symptoms of panic and despair rivaling the most severe cases of genetically driven mental illness.

Whether someone suffers with alcohol overuse alone or if it’s accompanied by another type of distress, the first step is conceptually simple but not easy – to stop drinking and to stay stopped.  Abstinence is the only sure way to be free of alcohol’s cunning and determined grasp.

Some people become aware that their drinking has gotten out of hand, while others need firm encouragement to realize they have a problem and to find a way out.  Most people start by trying to control their drinking.  If they don’t have genetic alcoholism or if they haven’t set the machinery of alcoholism in motion, they sometimes succeed.  By lowering stress and working through relationship drama, they sometimes manage to reduce their urge and curtail their use.  Many people, however, go through several attempts to restrict their drinking before realizing their drinking pattern is beyond their control.

Then what?

Some people turn to sober friends and go to AA for support.  Others seek counseling.  Some, who drink large amounts, must go for detox.  Medical detoxification may be needed for someone who drinks more than a pint of spirits, a liter of wine or a 6 pack of beer per day.  Without medically supervised detoxification, the risk of seizures or more severe complications of withdrawal may be too great.  Anyone unsure of their detox status should seek professional advice.

Repetitive efforts to abstain from alcohol and achieve sobriety sometimes results in success.  Too many times, however, tragedy strikes before the person has managed to establish a solid foothold in sobriety.  Automobile accidents, suicide, job firings and relationship unraveling can happen before some people manage to achieve sobriety.

There’s a path to sobriety often forgotten by harried clinicians or their patients:  disulfiram.  For many years and for many people, disulfiram (brand name Antabuse) has offered a quick way to become abstinent, the first step in the path to sobriety.

Within the context of a Three-Layered Healing Plan, disulfiram (Antabuse) is a Layer Three (Restoration with Medicine) decision.  I recommend you not rush this decision but consider it carefully.  In most cases, people are able to achieve a sober lifestyle with AA and, as needed, counseling.  Sometimes, however, particularly with stubborn cases of genetic alcoholism, people cycle through detox, counseling, and rehab numerous times.  They and their families can feel frustrated, desperate and scared.  Although there’s no guarantee that it will work, disulfiram (Antabuse) sometimes helps to create a period of abstinence long enough for the healing assists of healthy lifestyle, counseling guidance and spiritual AA guidance to take effect.

Disulfiram works by blocking aldehyde dehydrogenase, the enzyme that clears away acetyladehyde, a product of first stage of alcohol metabolism.  Acetyladehyde is a toxic molecule that, when not metabolized away, results in a severe reaction of facial flushing, accelerated heart rate, projectile vomiting and panic.  Anyone who drinks alcohol while under the influence of disulfiram, is unlikely to repeat the behavior because the disulfiram reaction is so severe.

Disulfiram mimics a genetic state called Asian flushing syndrome.  Although not restricted to Asians, a significant percentage (36%) of East Asians lack the gene that manufactures the enzyme that gets rid of acetyladehyde.  Because they can’t get rid of acetyladehyde, anyone with this genetic trait cannot tolerate alcohol.  If they were to develop an addiction, it would not be alcoholism.

Mimicing this genetic state by blocking the metabolism of acetyladehyde, disulfiram (Antabuse) leads to a nonnegotiable abstinence from alcohol.  This crude but very effective solution ensures abstinence for as long as disulfiram (Antabuse) is taken.  Plus, there’s a bonus:  the effect of disulfiram (Antabuse) lasts at least one week and often up to two weeks after the last dose of disulfiram is taken.  Even if someone thinks they want to return to drinking, this gives them time to reconsider their decision.

The disulfiram/alcohol reaction was first observed in an American tire factory in 1937.  Disulfiram, a sulfa compound, was used in the vulcanization (rubber manufacturing) process.  Factory workers inhaling disulfiram during their shifts were unpleasantly surprised they could not enjoy a drink after work because the disulfiram they inhaled on the job caused an unpleasant (and embarrassing) reaction at the bar.  This observation was reported by the occupational physician at the factory.  Later, in 1949, the molecule, was finally understood and isolated and was sold as Antabuse.

The dose of disulfiram (Antabuse) that works for most people is 250 mg taken at any time with or without food.  Occasionally people discover after taking alcohol, intentionally or not, that 250 mg is not sufficient to cause the full reaction.  In such cases, increasing the dose to 500 mg almost always works.

The disulfiram/alcohol reaction is unforgettable.  Within minutes skin flushing is accompanied by an accelerated pulse.  This is followed by intense vomiting and a sensation of panic.  It can be so bad that many people believe they are going to die and go to an Emergency Department for help.  Death is rare but disulfiram should not be used or should be used with caution for someone with a heart condition.

Although rare, if someone has an allergic reaction (rash, hives, and especially if trouble breathing), they should go to an Emergency Department for IV antihistamines and an anaphylactic reaction protocol.   Although there have been reports of liver toxicity, it appears that in most cases, the toxicity was caused by alcohol.  I have safely given disulfiram to people with cirrhosis but insist they be under the watchful eye of a gastroenterologist.

I caution people to not have a drink at least 12 hours before their first dose of Antabuse and then to avoid alcohol completely.  I write on a card or on a blank prescription that I have prescribed disulfiram for them and tell them to keep it with their health insurance card.   In case they have a severe reaction and pass out, Emergency Room staff will know the combination of disulfiram and alcohol may be a factor.

I caution people not to have rum cake (sometimes the rum is added after the cake is removed from the oven), to avoid ice cream cordials (liquor added), chocolates that may have liquor inside and never drink from the punch bowl at a party.  Some people who take disulfiram spray perfume or cologne on their hair rather than on their skin to avoid absorbing the alcohol in liquid fragrances.  They also ask for betadine rather than alcohol swabs when giving blood.  Those precautions I feel are unnecessary but some people feel safer by following them.  Please consult with your prescriber or pharmacist for additional information about the safe use of disulfiram.  Anyone considering using disulfiram (Antabuse) should do so only with the guidance of a prescriber knowledgeable about its use.

Disulfiram (Antabuse) can be a useful tool for ensuring abstinence until a program of recovery is undertaken and a state of sobriety established.  Some people use disulfiram only when they think a big event might lead them to drink.  They start it one week before the event (birthday, wedding, holiday gathering) and stop it after their urge has diminished and the immediate risk of relapse has passed.

Abstaining from alcohol with the help of disulfiram (Antabuse) should not be confused with sobriety.  Sobriety is a state of acceptance of the condition of alcoholism and surrender to a higher power to help maintain abstinence.  This is most often achieved by a recovery-oriented lifestyle, including active AA participation and the development of a daily ritual of reflection and renewed commitment to not drink.  Working with a “sponsor” (mentor) in AA, provides the guidance most people need to fully benefit from what AA has to offer.  Unfortunately, alcoholism has no cure and its management requires a lifetime of vigilance.

The spiritual guidance of AA harmonizes well with the emotional and cognitive guidance provided by psychotherapy.  In fact, it’s a good idea to add therapy to whatever efforts are being used to ensure abstinence and sobriety.  The top priority however, for anyone afflicted with alcoholism, must be abstinence.  Without it, any accomplishments, made in therapy are too easily thwarted by alcoholism’s relentless potential for relapse.  For someone who has trouble sustaining abstinence long enough to establish sobriety and a daily program of recovery, disulfiram (Antabuse) can be a useful tool.

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If you spend too much time above your stress threshold, you are likely to suffer symptoms of anxiety, panic, and even despair. If the stress lasts too long, you run the risk of having those symptoms harden into an anxiety or depressive illness. You also run the risk of developing a medical condition like ulcers, hypertension, diabetes, or chronic back pain.

Although there’s no way to determine the exact level of your stress threshold, you’re likely to find out where it is as you are confronted with challenges in your life.

Your capacity to handle stress may not be the same as your friend’s or even your relatives. Although your stress threshold level is influenced by your genes, it is also influenced by your childhood adversity, medical problems, your age, and certainly your life events. The more problems you have, the more likely it is that your threshold for stress is low and that you have less tolerance for stress.

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1. Would a medication help me heal or would it interfere with my healing process?

2. Are my symptoms so severe that they block my capacity to make good use of psychotherapy or other forms of healing guidance?

3. Might I have a hard-wired condition for which medication may be needed?

4. Is there a safe way to monitor my progress if I don’t take medication?

5. Would side effects and brain blunting caused by medication, outweigh its benefits?

These questions may not have easy answers but they are important to consider.  If medication is likely to help you heal, then it may make good sense to use it.  If it’s likely to interfere with your healing or cause dangerous side effects, then you may be better off without it.

Using these questions may help you and your healing team to decide whether your flow of healing needs to be restored with medication or whether it needs a boost with additional guidance or enhancements.  Questions such as these should be revisited anytime your healing flow seems stalled or blocked.  If you are not finding new awarenesses or some degree of relief, it could be that your healing is stalled.  Your healing may be blocked because your symptoms are too severe or it may be blocked because side effects of a medication are getting in your way.

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I have been on something of a “healing rebellion” for many years now.  When I first started medical school, I thought I would learn how to help people heal.  Instead, I was taught how to treat illness.  Although treating illness is a necessary part of helping people to heal, I felt like focusing only on treatment missed the big picture.  This made my medical education seem lacking, because some days I thought western medicine was missing the whole point.

My frustration about the lack of emphasis on healing in medicine nearly drove me away entirely.  After I graduated from medical school, I wanted to hide the degree.  The last thing I wanted was for someone to call me “doctor”.  Without including the concept of healing, this just didn’t seem to be a helping profession.

Giving myself a year to think this all over, I lived out of a van, built customized furniture, meditated and wrote.  When I ran out of money, I picked up lifeguarding jobs and taught children to swim.  I traveled to Peru, climbed mountains and explored the jungle.  While in the jungle, I found my way to an isolated tribe and met a Shaman.

The Shaman did not trust me.  I had the wrong look, smell and attitude.  I was required to join a ceremonial circle and drink a green frothy liquid from a carved wooden bowl.  I was closely observed as I started hallucinating colorful fish leaping out of the ground.

The Shaman taught me how to sense when it was safe to swim in the river – when the piranha would not attack.  He taught me that all things are united and that energy flows through it all.  He showed me how he could direct the flow of energy to result in healing. His ability to transcend ordinary reality and bring healing energy to a sufferer was fascinating and amazingly effective.

Though his skill was way beyond my ability, he taught me to pay better attention to suffering and to realize that healing comes from within the sufferer.

The Shaman’s lessons complemented stories I was taught as a child, like the Seneca (American Indian) creation myth along and other stories of spirit healing.  I had been taught early on to honor the connection between all things and to understand that all is unified by a great power.  As a young man, I spent time in longhouses, corn festivals and sweat lodges.  I accepted the fact that the fundamental process of healing was not well understood or described by western medicine.  I knew that my calling was to serve the greater power of healing.  I just didn’t know how to get there.

When I had first gone into the jungle, I took along a few medical supplies.  I later disclosed this to the Shaman along with the news that I had gone to medical school.

Seeing that my supplies included some medicine that could eradicate intestinal parasites, the Shaman became excited.  Children were dying from infections that his shamanic healings could not cure.  He gratefully accepted my gift of medicine.

At that moment, everything fell into place.  Medicine could be a healing practice when done and timed properly.  It could be woven into a larger healing plan that could work with the individual’s innate capacity to heal.

I returned from the jungle with a new perspective.  I had ended my very short career as a doctor and began my long career as a healer.

Psychiatry appealed to me because it seeks to help the mind, the most interesting part of being human, though also the source of so much of our pain.  I hoped that in psychiatry I could learn how to help.  I also was hopeful that my healing outlook would be tolerated by what seemed a relatively open-minded field of medicine.

My hopes proved well founded.  In my psychiatry studies, the professors tolerated and even took an interest in my perspective.  I had the green light to move ahead.

I soon realized, however, that if I were to help others to heal their minds, I would have to heal my own.  If I didn’t resolve my own issues, I could pollute and derail the healing of others.  I understood the meaning of the phrase, “Healer, heal thyself”.

There was plenty about me that needed to be healed.  I had scars on my skin from the physical violence I had endured in my youth, and scars on my spirit from childhood adversity.  I took on the project of healing for my own good as well as for the good of those who would come to me for help.

When you read in the pages of this book about the practices of enhancing and guiding healing, know that I have personally experienced most of them.  I have bared my soul to many who have touched me deeply and have helped me immensely.  Although I have not taken medication, I know now that there were times when it would have made my journey safer, easier and faster.

My own healing journey has been painful, comforting, arduous and wonderful.  It has successfully delivered me to a stage of comfort and confidence.  It has shown me that healing is possible.

The many people who have come to see me in my practice over the years have taught me that the human spirit is strong, resilient and capable of finding its way to wellness.  With courage and perseverance, I trust that you will find your way as well.  My deeply held hope is that Mind Easing will make your healing journey safer, more direct and more effective.  I’ve written this book because it matters very much to me that others might find their way out of the darkness and into the light.

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