Hit Me

Hit Me

 

 

If you have ever gambled (and who among us has not gambled in some fashion, whether with dice, chips, cards, or love) then you know that feeling that you get when you hit twenty one, you roll sevens, or she says yes. It is unmatched. It is intense, pleasurable beyond anything else you’ve ever felt, and a feeling that by its very fleeting nature begs you to chase it again and again. So you do, and what happens? Inevitably, you lose. The cards are not there, the house wins, she moves on to someone else, and you are left poorer in pocketbook and spirit, and one more very important thing. Dopamine. Yes, your poor brain, once so full of brightness and light and possibilities, is now devoid of that thing that was making it feel invincible before. The neurotransmitter dopamine.

 

If you haven’t figured out from reading my column, and dozens of others, we are (still) in the middle of a worldwide pandemic, a gripping medical drama so intense that it sucks the pleasure out of our lives, takes the mundane and makes it unbearable, and strips us of our hopes, dreams, and reasons to strive for more. It is literally making us bad, mad and sad. It is leveling the daily playing field so much that we have a hard time finding joy in anything anymore, even the things that used to make us so very happy. So what do we do? Lots of things, of course, but in this day and age the one thing that binds us together is our collective use of technology, and the one piece of technology that all of us above the age of five seem to have in our fingers or our purses or the pockets of our jeans is the cell phone. The video phone. The smart phone. The gaming device. What Steve Jobs called as he unveiled that first iPhone  “a phone, an iPod, and an internet communicator”. I would venture to call these shiny, expensive gadgets that we love so much dopamine generators. “Are you getting it?”

 

We wake up and our hands instinctively reach for the bedside table, where our precious has been patiently charging overnight, readying itself for the hundreds or even thousands of times we will touch it throughout this new day. We will ask it about the weather this morning, use it to schedule our workday, order lunch on it, entertain ourselves with music in the afternoon, use it to search for mindfulness in the evening, and take in a Monday Night Football game to cap the day. We play games on it, tweet with it, send emails, take pictures, share pictures, manage our money and express our political views on it. We get instant feedback on what we say, how we say it and how it makes others feel. We are in search for the likes, the checks, the hearts. Why? Dopamine. Lots of little squirts of that lovely little chemical that makes us look up and say WOW, many many times per day.

 

In her August 14-15, 2021 article in the Wall Street Journal titled Digital Addictions are Drowning Us in Dopamine, psychiatrist Anna Lembke tells us that the brain likes to keep itself in a state of balance called homeostasis. This means that every time a little hit of dopamine comes along, the brain downregulates the receptors that recognize it, trying to restore balance in the Force. She says that “there is a natural tendency to counteract it by going back to the source of the pleasure for another dose”. Another tweet. Another email. Another like. Another heart. If we keep this up for weeks or months, she tells us, “the brain’s set point for pleasure changes. Now we need to keep playing games not to feel pleasure but just to feel normal.” If we decide to stop, what happens? We feel irritable, anxious, don’t sleep, get depressed and crave the activity that made us feel good. Addiction? Yes sir, you betcha. Hit me.

 

Dr. Lembke tells us that there is now a whole new class of electronic addictions that did not even exist twenty years ago, and they are primed to keep us coming back with their “flashing lights, celebratory sounds and likes to promise ever greater rewards just a click away”. Funny thing is, even though we all have ready access to these addictive devices and processes, “we are more miserable than ever before”. “Rates of depression, anxiety, physical pain and suicide are increasing all over the world, especially in rich nations.” It’s hard to take an objective look at all this when we are still “chasing the dragon”, as it were. Dr. Lembke says “It’s only after we’ve taken a break from our drug of choice that we’re able to se the true impact of our consumption on our lives.”

 

So, the answer to this whole dopamine dysregulation question might be to ease up on the addictive devices, games, social media and other aspects of modern life that are in fact making us less happy than we were ten years ago. Avoid high potency stimuli. Regulate how much time you spend in the presence of the little glass god. Dr. Lembke calls the smartphone “the equivalent of the hypodermic needle for a wired generation”. Ouch. Reducing phone time is hard, as it makes us feel deprived, irritable and cranky at first. “If we keep it up long enough, the benefits of a healthier dopamine balance are worth it. Our minds are less preoccupied with craving, we are more able to be present in the moment, and life’s little unexpected joys are rewarding again.

 

Sounds like a very good prescription for happiness. I’ll take it. Hit me.

 

 

Tools of the Trade

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I have had some of you ask me what I use day-to-day to get my job done. In other words, what are the tools of the trade for a psychiatrist as he goes about the business of seeing patients in the clinic and the emergency room?

Although the personal interview and personal attention to patients is my stock-in-trade, I could not survive nowadays without technology.

I use a new twenty-one inch iMac in my home office, the machine I use to do most of these posts. I have two 4 TB hard drives attached to it for extra storage of music, video, and other items, as well as to back up my data. Everything is backed up three times, twice on my desktop on two different drives and once in a cloud service off site.

I have a set of harman-kardon speakers as well as a DVD drive attached to this machine for enjoyment of music, as well as for viewing videos, doing continuing medical education and the like.

There is a copier/scanner, a stand alone printer and a Fujitsu ScanSnap iX 500 on another desk adjacent to my main workspace. A shredder lets me securely get rid of paper that needs to be destroyed. I am transitioning to a completely paperless home office, so the last two remaining piles of charts and supporting documents on the floor will find their way into the ScanSnap and from there to my iMac as soon as time permits. 

My iPhone has been my primary go-to computing device on the road since 2007. When I leave home, the iPhone goes with me. Everywhere. Everything that I do on the iMac syncs wirelessly at home and through the cloud without me thinking about it. When I pick up the phone, I can get right back to a post, a project or anything else I was doing on the main machine at home before I walked out the door. Believe me, I have tried more configurations of more machines than you can shake a stick at, including desktops, laptops, phones and tablets. For me, having one main machine at home and one device to take with me just works better overall. 

Of course, you have seen me post about the setup at work, including the Polycom system, an HP laptop, a Dell desktop, fax machine, printers and the like. This is in my telepsychiatry office and is a static configuration that I leave on and operational all the time. As you know, I am an Apple guy, I use PCs and supporting peripherals to do my day job by default, trying not to whine too much about it! Another Dell desktop lives at the clinic office and is tied into the department network, so I can access all databases and notes for either job from either site. 

So tech is cool, but what about analog tools? Is there still a place for them in the twenty-first century? Of course there is! I also love paper, notebooks, pens and other analog tools almost as much as I do my tech toys. In the home office, I always have a couple of Field Notes notebooks and a large cup full of pens around for jotting down ideas as they come to me, later to be captured in my electronic devices for processing. I have a large whiteboard on an easel right behind my desk, so that I can stand up, think about projects on my feet and jot down outlines or notes as I go. On this board I also note books that I’m reading, places I want to visit, and a working budget for my daughter’s upcoming wedding! There’s something about having a large  white space like that that promotes brainstorming and planning for me, which can be very helpful in a way that a blinking cursor or mouse pointer cannot. 

When interviewing patients, especially new patients I meet for the first time, I’m still a clipboard and template sheet kind of dinosaur. I have an interview template that I’ve used on and off, with multiple modifications, for over twenty-five years. It keeps me on track, helps me to remember overall areas that I want to cover, and is sprinkled with mnemonics for various assessment tools that I might want to use. When I get to the bottom of the stack of papers on that clipboard, I make fifty more copies and keep going. 

I also have Field Notes notebooks in my bag for on the go, plus an assortment of charging cables, batteries, pens, paperwork and other goodies that I grab as I go out the door. I keep this bag stocked all the time, so that I never have to remember whether or not I have a USB cable or a uni ball Vision Elite pen or some other equipment that I might need when I’m away from home. 

Prescription pads, printed schedules, paper projects that need to be top-of-mind and various other stuff take up the remainder of the room in my bag. There is always something to send to someone, process, respond to or to read. 

I haven’t covered absolutely everything, but you get the gist of what I grab and go with almost every day as I go about the business of working, writing, reading, seeing patients and living. 

One day soon, I’ll share with you the applications that I use on my iPhone every day. That little device connects me with the world and keeps me organized and productive in ways that I would never have imagined even five years ago. 

What do you use as you go about your day? Are you a digital or analog person, or do you rely on both to keep you productive? 

I’d love to hear from you. 

Different Strokes

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We sat there yesterday morning, all partaking of the proffered breakfast at the hotel that was being remodeled and so was a little more disorganized on this Sunday morning than would be expected. I sat at one end of the long straight row of wooden tables, sampling my oatmeal and fruit. They sat at the other, enjoying the eggs and muffins and coffee. I was headed out for a day of walking up and down grassy slopes and taking pictures. I’m not sure where they were going. 

I couldn’t help overhearing the conversation being lead by a fellow who looked to be in his mid sixties, maybe older. 

“Yeah, he told me he was getting one of those phones, you know, they call ’em smart phones or something like that.”

Murmurs of agreement, slurps of coffee, another bite of egg, another piece of muffin buttered and disposed of. 

“I don’t know why he would need that. I have a phone, and it works fine I guess. But you know,  he says it has this new virtual keyboard, I think he called it.”

Mumble mumble, virtual, mumble mumble, typing on a phone?, mumble mumble. 

“Yeah. Really. Blackberry or something like that. Yeah. Blackberry I think he called it.”

“I don’t know why they like those tiny little keyboards,” piped up another man around slurps of orange juice.

“Remember that Olivetti you used to type on?” brought up one man.

“And the IBM Selectric?” the woman asked, her first foray into the discussion.

They reminisced a minute about the old days of typewriters and correction fluid and ribbons and reams of paper. 

Then the conversation turned to Hawaii and which beaches were best and the last trip each of them had taken there.

We can’t assume that what gets us excited and drives our exploration and jump starts our curiosity does that for everyone else in the world around us. Those of us who love technology anxiously await the fall and the next release of the latest smart phone with near field communication (NFC), fingerprint recognition on the lock screen and multi-layered, parallax driven home screens that move as the viewing angle is changed. 

Others of us look forward to the next trip to beaches with black sand and sunsets that are to die for.

The take home for you on this Monday morning?

The next generation iPhone will have a gorgeous retina display, a virtual keyboard and do things that we never even thought about doing on a phone ten years ago.

If you want sun, fun, and gorgeous sunsets, and you don’t mind a significantly higher cost of living for a little while, head to Hawaii. Skip the big island. The smaller, out of the way places are best. 

Different strokes for different folks. 

I hope you all have an excellent week.