Evolution--Courtesy of Dove

For related posts, please see: Ankle Cellulite

Who is Fighting for Her Feminine? and Lisa's Story.

Who Do You Want to Be When You Grow Up?

I remember a moment, suspended in time, when I was eighteen. I lay in bed daydreaming…or so I thought. I was imagining the perfect life of me, at about the age of thirty. I visualized my physical life, my mental life, and my emotional life. Physically, I would have a decent job by societal standards, something important, accomplished. I would make a decent amount of money, enough to work part-time, perhaps a three-day week, and still have all of my needs met. I would be living in my own place, an apartment. My location would be my hometown, close to my family. I was single, no children. I valued my independence too much to be married just yet, and would have worked hard for my career-related accomplishments.

Mentally, I would feel a calmness, a security, that comes with such hard-earned accomplishments. My focus would be on my work, on my place in the world. I had a pride in the work that I did, because I was helping others. I felt respected. I was confident. Others looked up to me without putting me on a pedestal. I didn’t stand out, because I accomplished my work quietly, not drawing the attention of others. My thoughts were mostly involved in intellectual linear matters. My mind, attitude and way of being was, in fact, quite masculine.

Emotionally, I was pleased with my life and accomplishments. Emotionally, I didn’t feel highs or lows, because I had everything that I wanted. No, security was the most important quality. That and respect. I was not invested in a relationship with a significant other. I didn’t need another person to be happy or fulfilled in my life. I eventually saw myself with a partner, with children, but not just yet.

I don’t recall contemplating the spiritual part of my life. It was a given…or an afterthought.

I also remember another moment, suspended in time; this time I was thirty. This was the moment that I realized the enormous power we hold to create our own destiny.

During this moment I was also lay in my bed, daydreaming. I had just finished my eight years of medical training. I lived alone in an apartment in my hometown. I was working three days a week, making enough money to cover my expenses and begin to pay back my medical student loans. My parents lived within walking distance. I was single. I had no children. I valued my independence. It was too early for me to marry. After all, I had worked so very hard to get to this point, and, frankly, there wasn’t room yet for someone else in my life.

I felt calm, a sense of security that comes with a hard-earned accomplishment. I had completed my training in a respected field. Even though I was doing things my own way and choosing a path slightly different from my colleagues I was confident. Even though I was in a respected field, I didn’t stand out. Even though my choices differed from others, I went about my life quietly, not wanting to draw attention to ways in which I was different. My mind was occupied by linear, rational things. The only place where my mind was free to wander to the feminine was during my annual trips to Greece.

Emotionally, I was please with my life and accomplishments. I seldom felt highs or lows, because I had everything that I wanted…or so I thought. Security and my standing in the world were the most important aspects of my life, and I had these. Although I had several relationships, none were long-term, because I was not ready or willing to share my life with another person, to leave my career to become a mother. I soon would turn down my first offer of marriage, and much later, my second.

At that moment, I remember the first moment, and, like a lightning bolt realized that the life I had was exactly the one that I had envisioned at eighteen. Exactly. As a matter of fact, not only was my physical life exactly as I had envisioned, but my intellectual and emotional lives as well. I was blown away. I got it.

We have tremendous power in creating our reality.

I would like to say that the story ended here, but life does not end at the age of thirty, and because I’m a late-bloomer, I had quite a ways to go. The next ten years were spent defining myself, discovering my tribe, identifying the way in which I wanted to practice my work, having amazing synchronistic experiences that lead me to the right people and gave me a vision of where my life was heading.

But at the age of forty, something happened. It was as if I felt that I had already been there, done that, and, as many of us do, I went into remote control. Instead of my forties being a time of growth and expansion, they actually ended up stagnating and eventually imploding. By the time I hit forty-nine, my ignored soul declared itself. It gave me an ultimatum. It would not allow me to continue down that same path, the life that I had envisioned at eighteen and achieved by the age of thirty. I had pressed the pause button and placed myself in cruise-control for nineteen years. I realized that I hadn’t envisioned my life at forty or fifty or sixty or at one hundred.

What followed was a year of catch-up.

Today I am fifty. Once every fifteen years Saturn appears to lose its rings, the rings that are made of debris the size of SUVs. Today, Saturn loses its weighted middle, and SO DO I!

Ankle Cellulite

Believe me, this is so much prettier than the picture you were expecting…

First, I would like to take this opportunity to apologize to every single woman who has ever come to see me complaining of weight issues at midlife. Everything each one of you claimed is indeed true. One day, suddenly, your body goes out of control—like a teen over whom you have absolutely no influence—and also like a teen, wants desperately for you to love her just the same, even though she’s completely out of control and refuses to listen to you.

Every month, heck, every week, she’s changing right before your very eyes. Nothing you do makes a difference. As a matter of fact, the more you try to control her, the worse she gets. You increase your exercise one extra day a week, then two, then double—then you add other routines. Now you’re exercising eight hours a day, and you still don’t look like Madonna (but, boy, are you happy about that!). So you go on strike and starve yourself. Your “menopot/menopudge” reacts by drooping further over your pubis; your belly button has turned into one big smile, laughing its pants off at you.

Nothing works, no matter what you do.

The last straw for me came today, when I was at the beach in my bikini. Yes! Bikini! It’s nothing but strings that stretch, the least amount of material that miraculously still fits—and hasn’t yet snapped in two, although I’m waiting…

No. That wasn’t the last straw. I was casually wiping off the sand from my feet when…What the…?! Cellulite on my ankles? Come on! Is that even possible? No one told me this could happen, and I’m a doctor. Certainly, I should have been informed.

So for all of the women out there with my twin ankles—I have supreme empathy for you.

As I was trying to explain to my fifteen-year-old nephew today, sometimes it sucks to get old—I mean, this is almost as bad as (one of my Tweeps came up with this diagnosis) “Broken Brain Syndrome.”

But, if you haven’t yet realized it, menopause gives us multiple creative opportunities to learn its main lesson:

Let go of what no longer serves you and appreciate what you already have.

I will gladly accept my body of cellulite; I am so thankful that despite all of the abuse suffered by my poor body it still manages to give its all every day of my life. As a matter of fact, I am so thankful for all of the tremendous gifts and blessings in my life that these cellulite ankles are doing a happy dance right now!

For a related post see Lisa's Story.

“Just Go With the Flow”

The Elia family on the infamous red retro shag carpet

Are you, like me, tired of hearing "just go with the flow?"How many times have I heard that? And what does it really mean? I’ve seen so many people insist on doing so, and then use it as an excuse to so completely let go, that they lose all sense of direction. Suddenly, all responsibility is relinquished into the cosmos, playing into the belief that we are truly empty vessels, without will, at the whim of the first force that comes our way.

Don't get me wrong. I'm all for "letting go," and, being an incredibly stubborn human myself, know how difficult that can be. But “letting go” and “just go with the flow” are not always prescriptives to relinquish all will. Unless it is your intention to stop completely, then “just go with the flow” does not imply lack of direction. Actually, it usually implies exactly the opposite.

I was reminded of this today when I made my second attempt to use a very old (and heavy) upright vacuum cleaner to clean our carpeted cabin floor. I had tried once before, several weeks ago, but abandoned my efforts when—for the life of me—I couldn’t find the “on” switch. Where the heck was it? There were all kinds of potential switches on the thing, but none of them panned out. Even a call to the parents didn’t solve the mystery. So instead, I pulled out an even older vacuum cleaner from under the benches and practically broke my back, hunched over the darn thing. The latch was broken and was (not) held closed by duct tape. It was a nightmare.

Today, I dragged the original enigma out of the closet and, determined this time, found the magic button. But when I attempted to use it on our red retro shag rug, my back immediately screamed protest. It was like dragging a boulder over tree branches. Surely there was another latch on it somewhere for carpeted surfaces. It glided over the puny one foot uncarpeted slate square. But you know how successful I am with finding buttons…so instead, I, by sheer willpower and unknown force, accomplished the task to the detriment of my back. When I was finally finished, I wrapped up the cord, popped it back on its hind legs and directed it to its parking place in the bedroom closet. Again, it glided (with glee, mind you!).

That’s when I was reminded of the phrase “just go with the flow.” If only I had found that magic button, would it not have glided over the shag carpet too? I mean, the task of cleansing had to be done; it wasn’t a directionless task. Without the magic button I was faced with “going with the flow” and leaving the darn thing in the closet, or expending a tremendous amount of energy in order to enjoy a newly vacuumed cabin floor. But, oh, if I had only found that button, then that vacuum cleaner would have glided itself—with very little steering effort on my part.

Bingo! I got it! That’s what it really means to go with the flow. We’re still doing the steering, but we’re not the power behind it. The task is practically accomplishing itself, because we’re moving with the bigger flow, the bigger power. Yes, that cabin floor needed to be cleaned, and yes, it was my job to do so, but I had help available. Instead of old, heavy, backbreaking help, there was a magic button somewhere. All I had to do was find it, and we’d both be gliding across that carpet!

Confessions of Yet Another Writer

Ancient Dedication to Hygieia, Delphi

***

Do you know a writer? Perhaps, you're a writer? If so, then I'm sure nothing I say here will be a surprise. For you self-proclaimed non-writers out there, hopefully, at the very least, this will help you understand writers better.

Writers have the best profession on the face of this earth.

1. We have no problem choosing our career since it chooses us. We aren’t plagued by doubts about our chosen profession. Thoughts of other career choices don’t wreak havoc with our thoughts. Why? Because writing chooses us. How many hundreds of writers have said this? They are telling the truth. We aren’t burdened with low job satisfaction. We love to write, and we are compelled to write. No other outlet will suffice.

2. We are allowed to create daily. Furthermore, creativity is encouraged and valued. The more unusual our perspective, the more our efforts are valued. One would think that this would be true of most professions, but it is not. The status quo is not of particular value to readers or writers.

3. Writing is cathartic. This is one of the best kept secrets of our profession. If the word got out, it would probably drive psychotherapists out of business. On an antidepressant or anxiolytic? Try journaling! Notice I didn’t mention anti-psychotics. This is because if you’re on an anti-psychotic, there’s a good chance that you’re already a prolific writer. Which leads to the next and, perhaps, most useful point:

4. Being a writer allows us all kinds of excuses. We have much more squiggle room than most. Because unique perspectives are encouraged, we are able to voice all kinds of opinions in all kinds of ways, ways that would be thoroughly unacceptable through other channels. We can use bad language and slang. We can rip apart people, systems, ideas, and beliefs. We discuss deep dark secrets and express the unthinkable. Freedom of expression is grand!

5. We also have numerous excuses for our behaviors and lifestyle choices. Everyone knows that writers are introverts so I can, for example, disappear for months at a time without anyone taking offense. It’s also common knowledge that we write best at odd times of the day or night. So it’s perfectly acceptable for me to stay up all night, go to sleep at 5am and wake at 12 noon. It also means that I will not be disturbed by my friends or family, who would never think to interrupt me. After all, I might finally be constructing that most perfect sentence. (Doubtful, since it hasn’t happened yet.)

6. I also have a wonderful excuse for my sluggish nature, lack of exercise, and poor food and snack choices. One of the absolute greatest excuses is that of just sitting there and doing nothing at all. Everyone knows that writers need the open space of nothing in order to create. Who else gets to justify doing nothing in our present society? Add to this that I can eat anything I want. If that means cereal and peanut butter for fifteen days straight, so be it! Tack onto this the added benefit of escaping an expensive dinner that would otherwise use up my entire monthly food budget. Oh, and that fifteen pound weight gain? No big deal. Everyone knows that all writers become alcoholics or fat or both. Heck, some of my friends are even trying to comfort me, convinced that I was too thin before. They couldn’t respond more perfectly if I had trained them.

7. One of the best excuses of all—it allows me justification for traveling anywhere, anytime. Need two weeks of uninterrupted time at the family mountain cabin to write? No problem. Writing about Greece? Must go again! Obviously, the previous nineteen trips weren’t enough. And of course, I must be at Delphi to produce superior prose.

Writers have the worst profession on the face of the earth. (Yes, I know. I just said the opposite in the paragraph above. I haven’t lost my faculties yet.)

1. “Writer,” by definition, implies, in many cases, jobless state. Oh, I have a job. I’m a writer. But I, like many other writers, am unpublished and, currently, unpaid. Being jobless, penniless and living off the goodwill of others becomes old really fast!

2. Writers hate to write. Yes, once again, I know this is the opposite of what I wrote above, but it is true. We do hate to write. We love it and we hate it—sort of like many important things and people in our lives. We write because we are compelled to. Have you ever thought about exactly what we are compelled to write and how painful writing about this “what” is? It’s worse than visiting the dentist and the gynecologist in the same day. Really. And we’re not talking a simple dental cleaning and pap smear. No, we’re talking teeth extractions, root canals and endometrial biopsies.

3. We must pay the price of our free use of the English language. This can get us into a heap of trouble (and I’m not talking grammar police), not just with the general public, but with our friends and loved ones. What writer hasn’t had a falling out with a friend or family member after they wrote something “incriminating?” And our warning of “know a writer, become the content” doesn’t go very far when they actually see it in print.

4. We’re reminded on a daily basis of our inadequacies and the miserable nature of our existence. This is one consequence of deep observation, contemplation, and feeling. Fortunately, the flip side is also true; otherwise, we’d all commit suicide, which leads to #5:

5. High rates of addiction, depression and suicide. Fortunately, this is of no consequence to me since my original profession of physician also holds these same high risks.

6. Warped sense of reality. Most writers live in a different reality than those who surround them. Early on, we question which is the true reality. This can get us into an even bigger heap of trouble. If we’re really unfortunate, we may win a room in Boston’s McLean Hospital next to Sylvia Plath. (Yes, I know she is no longer alive. What’s that about 5150? Please put that phone down!)

7. We lose track of styles, fashion, news, the date…

8. Even Grecian travel has its problems. See http://www.itsallgreecetome.com/ for detailed explanation.

So-yes-I did notice that there are more items in the second list than in the first, but it doesn’t matter, because, if you were paying attention, I have no choice. I must write. Furthermore, there are oodles of repressed writers reading this. You know who you are. It’s time to admit it and join the infamous lot. Suffer the consequences, and enjoy the wonderful benefits.

Happy writing, everyone!

When Not to Follow the Signs

My Fave Sign

Are you someone who pays attention, who follows the signs? Do you see the signs but ignore them? Do you miss the signs completely? Or do you see them and follow them, but they turn out to be wrong?

Yesterday, I paid close attention to the signs--traffic signs, that is. I was making the 180 mile drive up to our mountain cabin, the temperature in the valley was 101°, I was driving the last air-condition-less car in California, and roads were being repaved. As my pre-iced water bottle turned tepid and the back of my seat grew stickier I thanked God that the usual bottlenecks were flowing freely. Extra bonus: the highway patrol car that had joined us five miles back moved onto the off-ramp. Only thirty-five more intolerable miles to go. I might actually escape the usual nausea and migraine this time. What a treat!

When I made it up to a high enough elevation for the inside temperature to drop to a tolerable 90°, I thought I was cabin-home free. That is, until I started seeing “Left Lane Closed Ahead” signs. The first such sign forced me to pull over behind a 100,000 pound truck going 35mph up a steep grade. Take one of those slow deep-I-hate-yoga-and-there’s-nothing-calming-about-this-breaths. Problem was that the left lane was still open…still open…still open. A couple miles later, finally convinced, I pulled back out into the faster lane.

The next “Left Lane Closed Ahead” sign appeared five miles later. Huh! I thought, I’m a quick learner. No sir-ee, you’re not going to fool me this time. I’m not going to let the next fifty cars pass me by while I’m stuck behind 100,000 pound truck’s twin brother. So I continued on my merry 75mph trek up the mountain. Cars started moving over, and I kept thinking Suckers! As far as I could see, my left lane was still open—no signs—no orange cones—no construction trucks—no nothing…oops! Until NOW! Suddenly the left lane was-yes-closed. Fortunately, I was able to move over without endangering myself or others.

There were several more “Left Lane Closed Ahead” signs—far more than one would expect in the twenty or so miles left of my trip. Some were on the road, some on the backs of slow-moving vehicles. Some were real. Some were fiction. My psychology background kicked in, “Intermittent reinforcement is the strongest reinforcement.” Ain’t that the truth. I felt like Pavlov’s dog or Skinner’s duck (He was the one with a duck following, wasn’t he?).

How often are we reminded to pay attention to the signs, both outer and inner? And how proud are we when we actually do pay attention and avoid yet another catastrophe? But it looks like my lesson for the day went beyond following the internal and external signs. That, in itself, is difficult--how often have you disregarded your signs? Nope, it appears that we also must be able to distinguish truth from fiction, and this is not always easy or obvious.

If you would like to take a quick trip into the world of signs, travel to the list below:

1. What signs have you ignored recently? Has your intuition been knocking at your door? How loud does the knock need to be for you to pay attention?

Make a list of your signs. Listen to what your intuition is telling you, to the voice in your head, and write it down.

Look at your list. Are these signs real or fiction? Is it a “crazy” voice talking? Is it your voice?

Is the voice coming from someone or somewhere else?

What would happen if you were to follow them? Have you ever followed them before? What happened?

2. What Signs have steered you wrong? Which have steered you correctly? Were they internal ones or external ones?

Were these signs dependable?

Who made the signs? Were they your own homemade signs or were they composed by someone else?

Which signs can you trust?

3. Have any of the familiar signs changed? Did you notice?

What signs have changed? Did you have a hard time believing and trusting the change?

What is preventing you from taking action?

What would happen if you followed this new sign?

Happy Travels! Here’s to following the real signs!

Are You a Tweetaholic?

Okay, I get it. My post on addiction is overdue. First, there was the not too subtle hint with the controversy over Michael Jackson’s death. I could almost ignore that one, but this one I cannot. I admit it, I am a Tweetaholic. Step 1: I admit that I am powerless over leaving Twitterland. I am powerless over turning on my laptop without logging onto Twitter. I am powerless over controlling the number of Tweets that leave my fingers and arrive on your Tweetdecks.

Twitterholism is such a wonderful addiction, though. It connects me with all of these wonderful Tweeple, all over the world, at all hours of the day and night (essential for an introverted writer). It balances out the enormous depersonalization that is intrinsic to the internet universe. It provides a wonderful excuse for procrastination (I know that I’m not cranking out those book chapters, but I’m building my platform, instead!). It connects me with like-minded crusaders of women’s rights, supporters of women and children, fellow healers, writers, artists, feminists, femininists, fem docs and lovers of Greece.

What a perfect addiction! So much better than my old ones—movies and shopping. Funny. I haven’t spent much time or money on either since I started writing. Oh, and this addiction doesn’t add pounds to my waist (although lack of exercise certainly does!).

I know that I’m not alone. Twitterholism and Tweetholism are sweeping the planet. But even if you have no idea what a twitter, tweet, tweeple or tweetdeck is, don’t despair. Almost everyone has had an addiction at one time or another. Addictions are universal, because we are all human.

For those of you who are ready to face your addiction head on, you may find this simple exercise helpful. Although simple, it is not easy, because it takes an enormous desire or incredible pain to decide to face the underlying problem head-on. But I know that you can do it! So here goes:

1. The most difficult step is the first one. Are you ready and willing to let your addiction go? If not, then stop here and enjoy it as best you can for as long as you can. We’ll keep our fingers crossed that you get away with it for as long as possible with the least amount of damage. ;)

2. Decide what behavior you would like to change

3. Each time you find yourself repeating that behavior, ask these questions:

A) How am I feeling? Identify the “negative” emotion—tired, frightened, bored, sad, depressed, angry, frustrated, agitated, anxious, etc.

B) What do I need in this moment that I am not getting? Or--If I engage in the addictive behavior, how will it make me feel, initially? If you’ve identified the emotion in step A, then answering step B will be easy.

C) Write down every single need that you have identified. Make a list. Everything that you need in each of these moments goes on the list. You do not need to record each need more than once. Continue for at least one to two weeks until there are no new needs on your list. The list will, most likely, be a long one!

D) Do not proceed to this step until your list is complete. You’ve written nothing new on your list for at least a week. Now, step D takes time. You may want to ask supportive people in your life to help with this step. Your addiction is giving you every single “need” that you’ve placed on your list. Your addictive behavior is a quick and easy way to get all of these needs met. We tend to value others’ needs over our own, placing ourselves last, so don’t distress if your list is long. Take each “need” one by one and ask: “How can I get this in other ways?” Have others help you. Brainstorm all the ways in which you can get each need on your list met, even if some of the ways are crazy, impossible, unrealistic or dangerous.

E) You now have a list of the reasons why you are engaging in your addictive behavior (C: your list of needs) and have brainstormed for possible solutions to having these needs met (D). The last step is to decide what actions you can take from your brainstormed list in D that are helpful healthy solutions to getting your needs met.

You may notice a few discouraging things. First, your list of needs will probably be long. This is okay! We all have personal needs that we place on hold for everyone else—our children, our families, our partners, our work. Second, to get these needs met in a healthy way usually takes more time and effort than resorting to the addictive behavior. That’s okay too; just start with one behavior and slowly add to this. Over time, one change will make the next one easier. Remember, until you have all of your needs met in healthy ways, you will be prone to repeating the addictive behavior.

This is one reason why addictions are so hard to break, because we need to have our needs met! This is why when we stop one addictive behavior we are likely to replace it with another one, like overeating after we’ve stopped smoking. This will happen whenever we are not addressing our underlying needs. I have, too often, watched countless women being told that they must stop smoking or lose weight or exercise more, without their underlying needs being addressed. This is the same as saying, “Quit this behavior; your needs are not important.”

Most of us are not ready to take this step, because it means that we must make ourselves a priority, but it is essential that we do so, especially with an addiction that is interfering with our lives.

Good luck to you all...I must get back to twitterland!

Are You Free Yet?

Did the 4th of July set you free? If not, don’t despair; it’s not too late.

The 4th of July brings a smile to my face, because so many of my Greek acquaintances are quick to point out the many ways in which we, Americans, are not free. They are baffled by our definition of freedom, by the number of restrictions and the amount of control present in our society. Their definition goes something like this: you are free to do anything you want at any time with, perhaps, the exception of killing another human being. The most recent example is the reaction of some Greek smokers (40% of the population) who are enraged by the recent ban on smoking in public places. They insist that they are free to do whatever they want with their bodies, no matter the consequences. When I bring up the effects of second-hand smoke and list my friends who have contracted cancers or died from these effects, they merely become angrier. I remember their reaction to foreign veterinarians who volunteered to neuter the cats in the Sporades for population control. The Islanders were furious that such a practice would violate the cats’ freedom. I’ve noticed a pattern: theirs is a freedom that frees them of social responsibility.

But my Greek friends do have a point. It is easier for them to see what we do not see in ourselves. They are quick to remind us of the many ways in which we are not free. The 4th of July is a great time to contemplate our freedom, not just nationally but personally. It gives me a chance to ask am I free yet? Or, perhaps, more useful, where in my life am I not free?

What is the construction of your own personal prison? There are many forms it can take. Here are a few:

1. Physical: Are you limited by your body, by your physicality? Do you have a handicap? How have you dealt with this? Have you become more limited physically because of an illness, an injury, or conditions associated with aging, such as arthritis, pain, lack of energy, weakness?

2. Emotional: Are you an emotional sponge? Do you sense and feel everything and everyone? Do you find yourself reacting to uncomfortable situations through expressing your emotions? Do you have difficulty controlling your reactions? Do you find yourself crying or shouting? Do you feel controlled by your emotions?

3. Mental: Are you trapped by your mind? Do you have a hard time turning your mind off when you get home from work or when you try to fall alseep? Is meditation impossible for you, because you are unable to “still” your mind? Do your thoughts control you, rather than the other way around? What beliefs do you hold? Are your beliefs causing you pain and suffering? Are your beliefs actually true? Are they controlling your choices and actions? What expectations do you hold of yourself and of others? Are these expectations dictating your choices, dictating your life?

4. Past: Are you stuck in the past, frustrated by past choices, angry at past events, or missing an earlier happier time?

5. Future: Are you trapped in the future? Are your choices and actions motivated by a possible future point in time? Are you making choices now that are unbearable or harmful to your health in order to “have” or ‘be” something in the future?

This is a sobering exercise. Most of us are much less free than we realize. We are controlled by all kinds of things: limitations of our bodies, our minds, incorrect thoughts, beliefs, expectations. We are often stuck in the past or in the future, rarely present in the present. Look at your list and make yourself a promise that you will free yourself from at least one of your many cells.

Take out that key now and turn the lock. You don’t have any more time to waste. Step out and be free.

Make every day the 4th of July.

Happy Freedom, Everyone!

Who is Responsible for Michael Jackson's Death?

Because Michael Jackson’s death has affected us all, I’m going to deviate from my usual posts to share my thoughts. Many individuals have asked me, in my role as a physician, to comment. His tragic death (and life) has brought up many important controversial issues.

First, let me be clear: I am not condoning any irresponsible or criminal behavior on the part of a physician. If these medications were not prescribed responsibly then, of course, this needs to be addressed, as it should be in any situation in which doctors are prescribing irresponsibly. When a person is addicted, they will use extreme means to obtain the addictive substance, and anyone with power or money will be more successful in obtaining these substances.

1. Michael Jackson was misunderstood by many. He viewed the world differently from others. We need to be very careful when judging another human being whom we do not understand. I would go so far as to say that we probably shouldn’t be judging him at all. But it is clear to me that he suffered from being misunderstood. It is also clear that he was dealing with both emotional and physical problems that were not treated by addressing the underlying causes. Conventional medicine is limited in diagnosing and treating underlying causes. This needs to be acknowledged. Addictions are also extraordinarily difficult to treat, and, when treated, relapses are the rule rather than the exception. Also, perhaps most important, the individual needs to want to heal (or be forced by those around him to seek treatment).

2. This leads me to the next point. Did Michael choose treatment for his addiction? Did those closest to him fail in getting him help? These are loaded questions. It is near impossible for someone who is addicted to “choose” treatment. It is equally difficult for others to enforce treatment, especially with someone so independently powerful and isolated.

3. So who, ultimately, is responsible? The doctors who filled his prescriptions? Michael, himself? Michael’s friends and relatives who were unable to recognize that he needed help, or recognized this need but were unable to intervene? What about those making career-related demands? How about society as a whole? What about all of the people who misunderstood him? And those who may have abused him emotionally or physically?

I feel that the issue of responsibility is too complex to blame any one person. If we look deeper, we will probably find many responsible. I was surprised by the extent of Deepak Chopra's anger. I have no reason to doubt his allegation that this is a common occurrence between celebrities and their doctors, and, as a physician who can’t remember the last time she wrote a prescription for a narcotic, I certainly understand his anger. I can’t help but notice, though, that his anger seems personally charged, and this makes me ask the question of whether or not he personally feels responsible for not being able to help Michael. I heard the same anger in the Jackson family attorney’s voice when he said that he had “warned” the family. I understand this all too well. Patients frequently expect me to take responsibility for their health. We each need to start taking responsibility for our own health and choices, rather than passing off this responsibility to others.

The chronic pain management situation has become almost schizophrenic. As physicians, we, in the past, have been so hesitant to prescribe narcotics that many patients who truly need them have been undertreated, and their chronic conditions have worsened. This has become so common that the State of California now requires all physicians to take a twelve-hour course about chronic pain management and end-of-life care. I hope that the outcome of this “investigation” of Michael Jackson’s death does not have the undesired effect of decreasing access of these medications to those who are in true need. I also hope that his death will bring more attention to finding viable solutions to addiction and chronic pain.

Lastly, I hope that Michael Jackson has finally found peace. We honor him, and we will miss him.

I would love to hear your thoughts about this.

Human Beings are Members of a Whole...

"Human beings are members of a whole,

In creation of one essence and soul.

If one member is afflicted with pain,

Other members uneasy will remain.

If you have no sympathy for human pain,

The name of human you cannot retain."

-Saadi