Facing One’s Own Fears Following An Event Like A School Shooting – A How To…

The Parkland, Florida shooting brings up two themes. First is how to prevent, as much as possible, these types of multifaceted, tragic events from occurring. Secondly, the focus must be on mitigating and softening the damages that these events leaves on the surviving victims and all those around them. This later group can reach far into the wider community. 

It is critical that parents, the schools, clergy, the media, and whomever else has a voice that people will hear, need to reemphasize in a clear and nonjudgmental manner, that there is absolutely no shame in feeling frightened, distressed, or deeply unsettled by the events. Various advocacy groups loudly purport that we need to break the silence that is fueled by shame that if one has these sufferings, and that they must not hold back from asking for help. To hold these feelings inside, or to hide them because they fear it will reflect a “weakness” in them, is to risk adding a treacherous additional layer of damage, be it in a child or an adult. Everyone has feelings.

It must be done gently but affirmatively, that there is no weakness nor is there shame in being unable to manage feelings following the shooting. Of course, the same philosophy applies to wider events in life as well, but for we wo live nearby, it is now so poignant and pressing. It should also be pointed out that not everyone needs professional counseling, per se, but the process should start with having an open access to family and comforting people. If the symptoms are too tenacious or intense, then professional counseling may be indicated.

Another pressing reality comes to me from three of my patients who are now afraid that because they have been labeled as having a mental illness, that they will be segregated or pointed out in public, that people may misinterpret or blame them inappropriately for something, and they will be somehow punished. All are afraid of an over reactive and uninformed, impulsive backlash. Their points are well taken, so we as a community need to fully understand that the vast and clear majority of those with mental illnesses are not violent. In fact, they are more likely to be the victims of violence.

The challenge too is if anyone develops, realizes, or reveals a mental illness because of the shooting, that they be reassured that their condition will not be deduced to be of a similar caliber or pathology as what it being reported to be in the shooter. We cannot drive mental illness, because of fear and shame, further back into the dark caves of so many lives.

Please also go to the Florida Psychiatric Society’s podcast at www.interviewlibary.info to hear Danny Brom, PhD, an Israeli psychologist who specializes in such managing such situations. 


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The next step must be to use the same science that is now protecting me from Irma to also protect the world.

The next step must be to use the same science that is now protecting me from Irma to also protect the world.  


Hurricane Irma is on top of me. I see trees bend and hear the rain hit the window. In fact, a tornado warning exists for another 30 minutes; I should take shelter.


But picture me, sitting in an air-conditioned room, working on this essay, merging my ideas and nature’s ferocity, captivatingly, enthrallingly, utterly amazed at my well-being. For I, a person in such a monstrous storm, do not feel it.


Think about how uniquely sophisticated it is that our science has mastered techniques to avoid, at my level, nature’s customary means to ecologically clean, remove, and inspire new growth. These techniques allow me to watch it, but not be a part of it. I’m not controlled by, and remain unclenched, by the storm.  Is this a naïveté that misdirects me into ridiculous cockiness?


These tools make me both voyeuristic and apathetic to the wind. This science, the human artifact, with its standing up to the hurricanes’ oblivious fury, imparts a ration of extended permanence and durability upon the thresholds of mortal life and time.  These inventions free me from nature!


The best news, after the safety issues are broadcast, are the discussions about the birth, feeding, and demise of hurricanes. Newscasters bring it up, but many political guests talk of needing to first prepare for the storm. Ok, fair enough. But let’s ask them again during a budget debate when the storm is only a memory.


The ironic truth is that the tools which now insulate me are related to the tools which add to the problem. How improbable that I am comforted and protected from the storm that I helped feed. I did not parent the storm – that is nature’s doing. But I certainly added to its unhealthy diet. The ocean’s temperature, for the percentage that is from human global warming, comes from me, and that makes fatter storms. Obese storms.


Let’s proportion the man-made versus nature made global climate change, and then promptly and earnestly reduce what we can.


Then the next step must be to use the same science that is now protecting me to also protect the world.  Maybe votes will change because this storm because will get people who do not feel the global changes to begin to do. This a public health and social crisis of the highest order. It will be costly, and paying for it will not be always fair.


 (Power lost and returned…so this was not posted until post-Irma.)


Time for additional thought: The normal we are returning to today is our normal, not the earths. Our normal is not as securely and fundamentally unfailing for us as we would like it to be. It’s an exploitive normal in which we suppress and raze earth’s nature. 


Let’s close with this: how different did life became for both the earth and us when we learned how to use gasoline to do much of our work for us.














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The Opioid Crisis — Looking At One Part Of It’s Real Origin


The mental health needs of the addicted are rarely given the real energy-drink they need. Yes, it’s necessary to stop the overdoses, but the focus needs to be on what triggers the drift and movement into such behaviors. I disagree with the notion that the problem is so much the result of doctors being too liberal with prescriptions – though this is true in part, but I suspect that many people who are prone to substance abuse go to doctors because the supply is ‘legal’, it is with a safe product as opposed to a street product, insurance may pay for some of it, it is given the cloak of legitimacy, etc. Where lies the real issue for the attraction and need for the narcotic — is it anxiety, depression, genetics, personality issues, irresistible peer pressure,  immature impulsivity, etc.? 

Successful treatment is really possible. But it takes time, truly skilled diagnosticians and therapists, learning new social skills, developing a healthy passion, admitting to one’s limitations but finding ones’ real strengths, learning patience, developing spiritual or philosophical grounding, and the  proper use of psychiatric medications.

It’s important but too easy and less expensive to only point to the doctors. The key question is “why do these people go to the doctor in the first place?” Any good psychiatrist must make this differential in all patients. If  and when people can’t get the opioids from the doctors, they go to streets to get it. 

The wheel need not be re-invented for this problem. Use the one we already have.  But one question hangs over us — why was this wheel put in the closet in the first place?  It’s worthy of thought and a look at our choices, and to whom we give treatment power and authority, etc.  Don’t just blame the addicts, don’t just blame the doctors, but blame all of this for allowing it to happen. If it hit you or your family, or you are in the health care, political, educational, religious, or legal or any other industry for that matter, do a ‘selfie’ and taste the bitter bullet of your portion of the problem that you induced or let happen.

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Remember the Precautionary Principle? The hurricanes suggest we should.

The Precautionary Principle states that “When an activity raises threats of harm to the environment or human health, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically.”  1998 Wingspread Statement

“President Trump’s Homeland Security adviser, Tom Bossert, declined on Monday to say whether climate change is fueling powerful hurricanes like Harvey and Irma but suggested the federal government will eventually look into a possible connection.” (Yahoo News, Sept 12, 2017) During the news conference he suggested that the government will have to do a ‘trend analysis.’


One need not be a scientist or philosopher to trip over this dangerous illogic. The duty of science is to wisely study observations so to be able to apply their labor to protect both our planet and we, its tenants. Thousands of scientists are presently convinced such that we don’t need another ‘trend analysis.’

Have those in power not been reading the news for the last 50 years? Do they also reject that good diet, exercise, clear air, and non-polluted water make for healthier and heartier lives? How do they sleep after they deny the human contributions to climate change as real and needing straightaway change?  Yes, natural cycles and contributions do exist, but it’s chancy, irresponsible, and conceited if we fail to lessen the earth’s burden by reducing our inputs.

Why do they do deny? Will taking on these massive projects will disrupt their life styles? How do they contort themselves around the fact that even the large carbon fuel companies concur with global warming? (These companies also know that not saving the world will destroy their markets, so their survival also rests in finding less climate changing energy products.)

On this topic, I’d rather be wrong on the side of over-care than under-care.  This is the breath in the precautionary principle. If you aren’t familiar with it, then link here for a scientific piece to read or here for a less ‘scientific’ explanation, but approach each with the imminent and unapologetic goals of sharing it as a basic concept of lesser damaging activity.  Make people read it and talk about it!  Make it akin to a good education, going above giving a ‘just enough education to hold a job,’ but to insist that we take extra courses to better understand the core and nuances of the topic.

Then let’s next study the psychology of the denier.


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The Fort Lauderdale Airport Violence

On January 9, 2017, the US House of Representatives stood in a moment of silence following the Ft Lauderdale Airport shootings. (http://www.sun-sentinel.com/news/fort-lauderdale-hollywood-airport-shooting/sfl-us-house-of-representatives-holds-moment-of-silence-for-airport-shooting-victims-20170109-story.html)

I concur with the thoughts and concerns for the families of those who were killed or for those who were injured, either physically or emotionally, or both. Words do not reverse the pain and the losses.

But let’s take an ‘etiological’ look. So far, all the dominate evidence seems to point to a shooter who was acting in response to dreadfully malevolent psychiatric spirits, over which he had no rational veto.  Therefore, it seems this shooting is from a psychiatrically allied event.

As for the US House standing in respect to the victims: yes, it is nice…it honored the victims…. which as a community is very needed and crucial, and very fitting to the collective craving we need to assemble a means to resolve and endure the event. But did they realize they stood up in response to a psychiatric event?

I doubt most of them thought of it that way. I will loudly apologize if I am wrong.

The reason I ask is because I need to add to this event our country’s statistics of 44,192 suicides per year. That’s 121 per day. (https://afsp.org/about-suicide/suicide-statistics/)  This circadian carnage does not capture the countless daily domestic assaults, mental cruelty acts, reckless or inebriation based motor accidents, or other acts of violence which equivalently stem from inadequately treated mental illnesses.

I wonder if the authorities in Alaska would have addressed the shooter with more concern for public safety if he had spoken of a core political/religious fanaticism that would have been graded as dangerous, as opposed to a mental illness, which, shall we say, was not categorized as frightful and uncontrollably destructive? Is being mentally ill without a political component more of a community nuisance than a community danger? Do agencies choose to move the person elsewhere so the problem will belong to another agency? Or was the decision to release him and return the gun yet another case of the typical, all-too-common, errors in judging future dangers?

We must discuss the notion of violence and mental illness. The clear and immense majority of mental illnesses do not threaten others in the manner of a Ft Lauderdale like shooting. Rather it is the opposite, and those who suffer a mental illness tend to harm themselves more than others. The etiology of a mental illness is a drifting mixture of bad genetic/toxic biological exposures and processes interspersed with psychosocial stressors.

But there are some troubling realities. For example, a non-mentally ill victim of domestic abuse may develop a mental illness in response to the actions of other people’s mental illnesses – the victim may need medications to relieve some of the pain, but the real treatment is cognitive and behavioral therapy; this may at times also require geographical separation that is financially or legally impossible. It gets very complex and sticky.

Mental illness eats at our society in horrific, massive, and often non-public ways. At times, it finds venues for those whose thinking is distorted by mental illness to find expression and solace in political/religious extremism.

The inside core is mental illness. The outside scaffolding is extremism that, to the person, feels nutritious and wholesome.

The US House of Representatives should daily stand up to think about the so many whose lives, and deaths, are controlled by mental illness.  They would never sit down if they memorialized every suffering event produced by mental illness.

We, too, should stand up. Yes, stand up, and use the augmented height to look beyond our usual landscapes, and see the world a bit more to what it really is.



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Is the MTHFR enzyme the next Prozac? Not exactly…

Note: Many thanks to Catherine Passariello, Ph.D., for being a co-author. Follow her as she speaks about genetic testing and psychopharmacology at www.interviewlibrary.info  – a podcast interview.

Fifty percent or more of depressed people fail to respond to their first trial of an antidepressant, and the percentage only decreases as numbers of antidepressant trials increase.

Failure can occur even with a correct diagnosis and good medications. But now a genetic mutation may help explain why this is so.

This can all be a bit technical, so read it slowly. Maybe even read it twice. It is not thorny or impossible to understand.

It is now accepted that inadequate folic acid intake or a deficiency in its conversion is associated with high homocysteine levels and an inadequate monoamine production. This effectively is a lessening of norepinephrine, dopamine, and serotonin levels Knowing this information makes for a significant paradigm shift in understanding biological depression. It moves the traditional focus away from primarily blocking the re-update of neurohormonal entities to now actually increasing hormone production. This is done by reducing homocysteine levels. And this, in turn, is partially done by an enzyme which converts folic acid into its active form.

That enzyme is the MTHFR – the initials stand for MethyleneTetraHydroFolateReductase. It converts folic acid, which is vitamin B9, into l-methylfolate. Unconverted (the fancy term is ‘not reduced’) folic acid is not active, but l-methylfolate is quite active. This active form induces a cascade of biochemical actions affecting many of our body systems.  We now know that many people have a ‘sluggish’ enzyme insofar as being able to make that folic acid conversion.

The question exists about taking extra regular B9 to override the compromised MTHFR.  No, it does not, but taking more B9 may help if there is a primary B9 deficiency.

MTHFR was discovered in 2003 as part of the Human Genome Project. The MTHFR gene produces the MTHFR enzyme, which changes dietary folic acid (also known as 5,10- MethyleneTetraHydroFolate, into 5-MTHF; this is also called l-methylfolate.  The problem lies in that there is a single point variation (C677T) of the MTHFR gene that directly effects how well the enzyme works: the gene can either have the C or the T variant.  We all inherit two copies of every gene, one from our biological mother and one from our biological father, each copy is called an allele. Two C copies (C/C) makes for a normally functioning enzyme, two T copies (T/T) for a severely reduced functioning enzyme, and a mixed combination (T/C) is for a less diminished function enzyme. So, if a T/T or T/C form exists, the enzyme owner could suffer.  The T/T or T/C forms are still compatible with life; they can, however, result in a host of biological limitations.  About 40% of people have the C/C,  40% have the C/T, and this leaves 20% with a T/T variation.

Getting past the hurdle of a less than optimal MTHFR improves a host of biochemical events, often including a reduction of depression. Indeed, the relation of depression to elevated homocysteine has been referred to as the Homocysteine Theory of Depression.

This is the biochemical cascade: the 5-MTHF is necessary to convert homocysteine (an amino acid) into methionine (another amino acid). Methionine later changes into SAMe (s-adenosylmethionine) which supports the immune system, helps with anti-inflammation, and makes and breakdowns neurotransmitters. It also helps to grow and maintain cells. Your doctor will say that SAMe is a methyl donor, and that the SAMe donated methyl group goes directly into the production of norepinephrine, dopamine, serotonin and melatonin.

Without SAMe, which comes from methionine, which in turn comes from the breakdown of homocysteine because of the l-methylfolate, the neurotransmitters will be produced in short supply.

Here is a quick summary of the downstream effects of a poorly functioning MTHFR enzyme:

  1. When homocysteine is not sufficiently broken down into methionine, there is a build-up of homocysteine in the system, a condition termed as hyperhomocysteinenemia. This is associated with cardiac and vascular problems, inflammation, some cancers, IBS, possible pregnancy issues, migraines, and even some dementias.
  2. Low SAMe leads to a decrease in its products which is associated with depression. Taking extra SAMe offers mixed results as an antidepressant.

Too much homocysteine is toxic. It can interfere with the synthesis and repair of DNA and worsen inflammatory responses.  An oxidized homocysteine can also stimulate the NMDA (N-methyl-D-aspartate) receptor which will let calcium enter a cell. This then releases a substance known as proteases, and the process can result in cell death and hasten dementia. Homocysteine can also damage cells that line arteries and contribute to the atherosclerotic processes.

Life-style can also increase homocysteine levels, such as smoking, obesity, some medications, insufficient exercise, and psychosocial stresses. Excessive alcohol use and poor diet may cause a multiple B vitamin depletions. Exercise distributes the homocysteine more evenly throughout the body. Some lipid lowering medications, as well as lithium, methotrexate, birth control pills, L-dopa, and some anticonvulsants also increase homocysteine levels.

All this is fascinating. For a long time, the strategy to address this gamut of problems was simply to add folic acid. But too often this did not work well enough. The reason was the  sluggish MTHFR enzyme.  With a sluggish enzyme, the ingested folic acid never became ‘active.’

Fortunately, l-methylfolate formulations now exist that can bypass the sluggish enzyme. It would seem that getting around the sluggish MTHFR would therefore solve so many problems. The effect of these l-methylfolate formulations can sometimes be positively dramatic.

But, and medicine is replete with the ‘buts’, the real-time practice of medicine is not always so uncomplicated as is the draw to this charismatic concept.  Each case needs a rigorous consideration because other processes can cause these same medical problems.

Many folks remember when the antidepressant Prozac had the reputation that it could fix so many things.  In time, however, Prozac’s ranking was re-measured in step with its reality – it was good but not magic.  The same is happening for the MTHFR. Too many people speak of it as the present-day Prozac. It’s not.  But it is a great new tool.

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What happened? The downside of growing up.

‘Tis the season.

For all it’s a New Year.

Some of us celebrate a freedom after a war – Chanukah.

Others celebrate a birthday – Christ.

The United States celebrates a living democracy.

But equally, for all of us, it’s another time – not a first time – to think about who we are and what is important to our lives.

Here’s what I am thinking about: I have never reconciled the need for war. Especially if it is born of singular religious or political convictions. Please don’t tell me to change, or fear me, because I connect to God or live differently than you. I hold you dangerous only if you first hold me dangerous. How can a common God allow one set of humans to be less worthy of life than others? Surely God knows we all relate to Him in many ways. My son vigorously and eloquently teaches me that there are many roads to God.

In the purity of those roads is also a purity of all life. Would it not be better to blend our views and not punish if we elect one road to God than another? Is there a sense that one path gets us a seat closer to God than another road? I’m certain that every religion can find practitioners in other religions who are charitable, caring people, with family and community love, and who work honest jobs. It would be nice to see people realize that we all seek the same endpoint.  I would like to see people this year think about how the differences between us came about and who perpetuates them to continue. Why do we compete for something that needs no competition?

Disappointingly, every religion or political group has its extremists who tolerate violence to reach their end-points. Do they do the violence for themselves or for God? We need to carefully study that question. The best life work is usually done by the noiseless, unsung teacher. Let’s all think about and proportion those in life who loved us, who taught us, who scared us, who hurt us, or who misguided us for their own gains.

Chanukah’s toy is a small square top called a dreidel. Each of the dreidel’s four sides is inscribed with a Hebrew letter—nun, gimel, he, shin. They mean “A great miracle happened there”

Nothing grows from knowing I have killed in war. It is not a sign of a progressive human civilization. But, and it is so painful to have so say ‘but,’ it is part of the current human experience that thus far we have no developed skills to often remove danger by other humans but for with violence. War breaks or exhausts the violence, which then seeds a peace. What an all too common, laughable and wretched decorum and etiquette.

There are many roads to God.  These roads do not last if blood and retribution is used in the pavement.

The how-to prophecy comes with children playing together. They don’t know of political or religious differences – they only know curiosity, healthy competitions and games teaching respect and self-confidence, and that their Muslim friend’s mother can cook tasty and interesting, but different, foods.

Listen to the kids. What joy.  Nun, gimel, he, shin. But let’s change it to ‘A great miracle happened today.”

And as an aside, how interesting it is that Chanukah and Christmas are now both festivals of lights?

What happened? Why are we all so similar until we grow up?





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