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>> Dr. Rosemarie Tong: Welcome to another segment of our Medicine
and Society series co-sponsored by the Mecklenburg County Medical Society and by the Ethics Center
at UNC Charlotte. We have three great guests today and you all
have come up with the title for the program From S.A.D. to G.L.A.D. and to let our audience
in on the story I'll tell them what S.A.D. to G.L.A.D. means.
It means Stress, Anxiety and Depression to Gratitude, Love, Awareness and Drive.
It sounds great, you know, hey sign me up. And our guests are Mr. Peter Popovich from
Popovich Associates. Doctor John Hall who is a psychiatrist.
He specializes or has the subspecialty in addiction psychiatry and in psychosomatic
medication. And Doctor *** Blackwell he's, Doctor Hall
is an M.D., Doctor *** Blackwell is a Ph.D. and he is a counseling psychologist which
is I've been informed, is different from a clinical psychologist.
A little bit, well we'll talk about that later, okay?
I've been looking forward to this show because I thought I'd get a lot of free advice, you
know what I mean? You know, at the present rate of services
I thought that would be a good deal. And I was wondering, with you *** in particular,
we just got off the holiday season you know November, Thanksgiving, Christmas, New Year's,
I guess Super Bowl counts or whatever. And we're heading into Valentine's, Mother's
Day, graduations, weddings, all these wonderful, supposedly wonderful, events and I frequently
have the experience as experiencing these days that I sort of visualize them as they
are going to be great and wonderful and feel so good.
And what happens is everybody starts yelling at each other, people are pouting, old news
bubbles to the surface and at the end I can't wait to go home.
And I feel depressed and sorry and sad really sad and just wondering what it is about the
kind of expectations we create not only about special days but about goals we're going to
achieve or who we're going to be when we grow up, which I still don't know, and what actually
one experiences because it happens to me all of the time a discrepancy between expectation
and experience and I was wondering, ***, if you could explain that to me what's, how
can I get over that?
>> Richard “***” Blackwell: Well I don't know that I can explain to you
how to get over it but I'll sort of lead in to the other two guys with some of the sort
of the bad news about that. What's the bad news?
Well S.A.D. can also stand for Seasonal Affective Disorder.
We make up a name to cover up everything in therapy and then we categorize it and we give
it a number and then we decide how much we're going to reimburse for it so we have this
thing called Seasonal Affective Disorder. I have a hunch that that probably is a sort
of a catch all term. What it says to me is for most of us we learn
on the basis of our childhood experiences, on the basis of our life experiences, and
on the basis of social media, television shows, movies, everything we've learned to expect
certain outcomes. Yeah.
And from that, we kind of develop a belief that says, if anything doesn't go the way
I expect it to, it's awful. And and we probably even add to that it's
awful and it's got to be somebody's fault. And and so that sort of sets us up for not
really good vacations and Christmas and Thanksgiving but if you think about Valentine's Day, I
was driving up here today to do the show and I think eighty percent of the ads on the radio
were talking about what candy I should buy for Valentine's or what gift I should buy
for Valentine's and and you know my experience with Valentine's is if I buy the wrong candy
or I failed to buy candy or I don't buy the right card bad things happen to good people
mainly me and and the person to whom I give the card is disappointed because it doesn't
meet his or her expectation, and I'm disappointed because he or she is not acting reacting the
way I want them to and then I get sad. So so my sense is that it's kind of a disconnect
between our memory of what was which before the show the three of us were talking about
the fact that how accurate is my memory of what was anyway if you talk to the other thing
I was thinking about is I was born in the summer and growing up in the summer means
that your birthday is in the summer and you know what that means?
No. Nobody comes to your birthday party.
If born during the school year, your mother brings cupcakes and everybody goes "yay" and
sings Happy Birthday to you. In the summer so that's my memory.
Now, probably the reality is that my parents had birthday parties and invited my school
friends and my non-school friends and they probably came so my memory is probably not
accurate but my memory is it was awful having a summer birthday.
So that's just an example of how what I think happened may not really be what happened but
what I think happened has become my truth and my truth then defines my expectations.
So, Valentine's, birthdays the year is littered with expectations that are created for us
by our families, created for us buy our ad campaigns to make money and almost never do
they live up to the expectation. So that's kind of the bad news.
The other piece of the bad news is that people, who are kind of around all the darn time,
they don't live up to my expectations either. You know?
When I was in training, one of my wise teachers said the definition of resistance, big psychological
word. The definition of resistance is anytime your
client doesn't do what you want them to I thought about that.
I think that's kind of the way that all human relations are.
Yeah. It's kind of the way we look at life.
You know, is I want you to be a certain way, I want this show to go a certain way, I want
me to appear a certain way and if I have the fortune or misfortune of watching this show
I'll probably look at it and go "that's not what I wanted to do with my hands," "that's
not what I wanted to say," and to a greater or lesser extent I will have to figure out
what to do with that disappointment because I am a person.
The other side of persons is the persons that we interact with they are sort of our family.
Have you ever noticed that family don't ever act exactly the way we expect them to, but
they always act the way they're going to act? >> Dr. Rosemarie Tong:
You can’t change them. >> Richard “***” Blackwell:
Well not very successfully. We can wish that they would be different.
So that’s another thing that happens all throughout the year is that I come home from
work after a long day at work and I have not had much decompression time in the car so
I get to my house and I come in the door and because I’m tired and cranky and I’ve
used up whatever extraversion I had during the day so my introversion wants me to be
by myself and I kick the dog and I ignore the children and I grouse at my wife.
And now all of those people are disappointed in me and I am disappointed in myself.
Hmm, I wonder what I could have done differently. So with the clients that I see, I would say
to you that a significant percentage of them, what brings them to see me in the first place
can be boiled down to a sense of profound disappointment and disconnect between what
they thought was going to happen and what actually happened and how their life unfolded
and how they wished it to unfold. >> Dr. Rosemarie Tong:
I think that’s a very useful distinction and it sort of synchs with my experience.
Peter, our audience has probably less familiarity with what a coach consultant does and how
a coach consultant might differentiate himself or herself from let’s say a clinical psychologist
or a psychiatrist. Could you tell us some more of that?
I mean what do you actually do for people? >> Peter Popovich:
Maybe the way to frame it is to explain why I got in to coaching.
The whole purpose for me was that I wanted to be a better manager and a better leader
and I had heard about this coaching piece and being a jock and a competitive athlete
and having great experiences with past coaches and sports, I thought wouldn’t it be cool
to take this element and add it to my professional side, my corporate side.
So, I went through a one year training certification program to be a coach, in order to be a better
manager. During the process I became a better husband,
a better parent, overall better human being because coaching is a very specific and bracketed
responsibility. When you look at the medical community, when
you look at the doctor and the doctor, the medical doctor and the Ph.D., that is a broader
capacity a broader capability. Coaching is very specific from my perspective.
It’s all about helping people move forward. It’s all about establishing goals, having
visions, defining vision purpose and the coach helps an individual define a future, helps
them understand what their present condition is, which then defines the gap, the difference,
the things that are still needing some work and then develops a follow up program of activities
to help the person go from the present state condition to the desired state.
Now therapy, I clearly know when that area comes in to play and it’s when my clients
are stuck in the past. So, for example, I was working with a client
recently that was going through transition, looking to get a new job at a very successful
career at a particular financial institution and got let go.
A lot of baggage associated with that experience. A lot of anger and frustration.
So, I was hired to help this individual to define the path they needed to take to get
new employment. What happened throughout our coaching sessions
is that we kept getting back to the bad experience they had and even though I tried real hard
to release that, I couldn’t do it. I wasn’t qualified to do that and that’s
when I turn over to a therapist, to say here’s something that’s deeper, here’s something
that has some roots that I’m not aware of, certainly the individual is not aware of that
I need the professional help of a therapist to release the person from that peace so that
then I can maximize my time with them to experience with them to move them forward a little bit
more quickly, a little bit more clearly. So when I think about differentiating therapy
and coaching, I think of coaching as moving someone from the present toward the future
and when I think of therapy, it’s about the past, about the why about the place where
they’re stuck that they need absolutely need professional help to get them to the
present and move them into the future. So coaching from my perspective is present
oriented, moving to the future, whereas therapy is the past, to the present and can be moving
into the future. It depends upon the charge that the therapist
has for the particular individual. >> Dr. Rosemarie Tong:
That’s really useful Peter. I think I now have a good understanding of
what a coaching consultant does. John, if you thought you were going to escape,
you knew this was coming. I can see going to ***, a psychologist you
know counseling psychologist. I can see asking Peter to help me along, but
you know when it comes to psychiatrists, I sort of carry the burden of our whole society,
that you only go to psychiatrists if you’re really in trouble and something is really
wrong with you and you are operating outside the boundaries of “normal people,” but
the truth of the matter is, you know, there’s a big difference between feeling the blues
and something like clinical depression and I was wondering how you can help people understand
when they should come see you instead of Peter, instead of ***.
>> John Hall: Excellent question.
For me, psychiatry can handle the whole spectrum of mental health disorders from the life transition,
the loss and to the more severe mental health conditions like schizophrenia, bipolar disorder,
clinical severe depression. And psychiatrists, we are medically trained,
so most of us went through med school or what’s called DO school there’s two different paths,
but most go to medical school so we have experience through, you know, all areas of medicine and
most areas of medicine. And so we more with and part of anyway the
medical end of the person in addition to the psychological or the life situation and we
try to incorporate what’s called a bio-psycho-social model, biologic components, the psychological
components, why someone came to me from the past and then the social, you know, where
are they now, how were they raised, what expectations did they learn as a child.
So, we try to incorporate all of that into the picture and come up with plan to best
help that person. And so if someone needs medication for a psychiatric
reason, that’s obviously a reason for a psychiatrist for most of the time.
It can be separated to some degree in a matter of spectrum from low degrees of suffering
but needing some help getting unstuck to high degrees of suffering where they’re stuck.
And I like to use analogies, sometimes people fall into a hole, they can climb out themselves.
Sometimes the hole is too deep and they need help and someone to reach down and help them
up. And that’s kind of like therapy, sometimes
the hole is so deep that you need a ladder and that can be the medicine.
>> Dr. Rosemarie Tong: I have a quick question to ask, really quick.
How do you feel about family physicians prescribing medication as opposed to using the route of
a psychiatrist? >> John Hall:
I don’t think we have enough time, completely, for that.
>> Dr. Rosemarie Tong: Really brief.
>> John Hall: The truth is, there are too many people that
need the help from medications for psychiatry. There are not enough psychiatrists to be able
to address all of it. And so the family practitioner, the family
care physician is trained in the general mental health condition, kind of the bread and butter
to depression and anxiety and they are knowledgeable of the basic medications for that.
So, out of practicality we kind of have to because there are just not enough of us to
do it. But if something gets too severe, or if they’ve
tried and failed maybe one or two different medications, then it’s time to move on.
>> Dr. Rosemarie Tong: I agree with you about that.
That was very useful. I have a big question for all of you, we have
about, and we can chat about it for about eight minutes or so.
My big issue right now is making a major transition in life, you know, from being active, really
active and maybe in a couple of years, I’m retiring and that seems like a major challenge.
And also not only kind of transitions that are expected but transitions that aren’t
expected and before we got here we were talking about the fact that both you and I had the
experience of sudden death of a spouse at a relatively young age, basically changing
our life trajectory and all of those kinds of things.
And as I face these transitions and let’s say the expected one, I feel a lot of anxiety
and stress, how am I going to fill my days, what am I going to do, am I going to drive
my husband crazy, is he going to drive me crazy.
>> Richard “***” Blackwell: Probably.
>> Dr. Rosemarie Tong:
I figured there was bad news. So, I want to ask all three of you, what can
you do with a normal bread and butter kind of situation?
I mean I can see myself really getting freaked out, you know, over it, you know, the move
from just kind of finding my way and all of that, to basically being so anxious and stressed
out that I might doing something bad like start self-medicating myself, you know what
I mean, and that’s how many people get into trouble.
>> Richard “***” Blackwell: Well you know, there’s a sort of a normal
even flow of life and we all follow that normal even flow of life.
And it used to be that the model that we grew up with was, overly simplified, you grow up,
you go to school, you graduate from school, you get a job, you get married, you have children,
you work, you stay married, you work some more, your children grow up, your children
leave the house, stay gone and then you retire and you have the golden years of retirement
and that was the model. >> Dr. Rosemarie Tong:
The expectation. >> Richard “***” Blackwell:
And the expectation. And of course that is not the reality that
we live in today. The reality that we live in today is the average
young person, age 20 or so, can be expected to have seven distinct careers in their working
lifetime. Seven careers?
We were supposed to have one, get a gold watch. And so normalizing that for a person graduating
from college who’s struggling to find a job, normalizing it for their parents who
are having a boomerang child move back in the house to say, you know, worse things could
happen. You know, your child as opposed to moving
back in to your house could be out self-medicating or selling drugs or stealing cars, well okay.
So I think normalizing the fact that there is a developmental flow which is different
from what we were told was going to be. And probably as Gail Sheehy writes in her
wonderful anthropological works, about every 20 years, we need to redefine our goals, because
about every 20 years the goals that we set, we either have achieved them or we’re never
going to achieve them and we probably would sit down and say okay, as opposed to oh I
failed at this, what are the new opportunities. If you’re looking at retirement as an end,
I remember when my mother was anticipating my father retiring, she was terrified that
the man was going to be home for lunch every day and he was and she kept saying “find
something to do with your time.” >> Dr. Rosemarie Tong:
Yeah, I’ve got to think of a way to find something for me to do for lunch so that we
don’t have to have breakfast, lunch, dinner. >> Richard “***” Blackwell:
So we know that the sixties now, is the fifties, you know and seventies is sixties so I think
the transition to, if you view them as life transitions as opposed to life crises, that
is a start. >> Dr. Rosemarie Tong:
That makes sense. Peter, you’re a big I just want to make
sure that our audience knows that we’re talking about Gail Sheehy who wrote a very
famous book called “Passages” which is about transitions in life and I heard Peter
before we got here talking about her too. >> Peter Popovich:
I still have the paper that I wrote around that book about the transitions that happen
predictable and that happen on a regular basis so I’m all in and all on board about the
transitions. To your question, what I love about your question,
that’s the kind of juicy, coaching question that we just love, because it’s all about
determining and developing a vision for the future.
How do we do that? Because we all have concerns and fears and
maybe some bad experiences, but when we start goal setting and planning and thinking about
what pieces to put in place to create a vision of future that we want to be proactive rather
than reactive, man, I think you and I need to have some breakfast.
>> Dr. Rosemarie Tong: I think so too.
John, how would you help someone like me if I did get really stressed out, really anxious,
not be able to take it and found myself going the way of addiction, you know, addiction
in this case to prescription. >> John Hall:
I was going to say, what we’re talking about is transitions, and most of them are expected
transitions, but then what happens when things don’t go as planned and no one as a child
go “gosh I wish I were an addict.” You know, no one says that, no one’s planning
for that or no one plans for you know “I’m going to be so depressed that I can’t get
out of bed today.” And first off, don’t be afraid to ask for
help. Everybody needs helps we’re not idols unto
ourselves. Don’t be afraid to reach out to family,
loved ones or you know a professional. And from my prospective again, I would look
and talk with you, evaluate and see, would a medicine be helpful, is it necessary in
this situation. And to me, I say when someone is so stuck
that the symptoms, either the anxiety or depression prevents them from doing what they need to
do to continue to do healthy things for themselves, that can be a trigger or a flag that medication
may be helpful. But with addiction, no, the mainstay is group
therapy, you know, group support, AA or NA, there are certain medicines for certain addictions.
So it is truly a kind of a group effort for all of that.
>> Dr. Rosemarie Tong: You three were talking about collaboration and referrals between,
you know, coach consultants, psychologists and psychiatrists.
You know, we have just very, very brief time. If you each could give a, I don’t know,
a sentence or two, I know, I know, I’m first to write abstracts of papers and you know,
I hate writing the abstract, but what would you like the audience to hear in particular
about what you’ve said or what you still would like to say, you get one or two sentences.
So, I’m going to start out with, I’m going to mix it up.
I’m going to start with Peter just one or two.
>> Peter Popovich: Straight As.
Anticipate a positive outcome, acknowledge whatever happens, accept it, appreciate it,
take action, and then follow it with an accountability or a support system.
>> Dr. Rosemarie Tong: Well that’s a good A A A A plan, you know.
John? >> John Hall:
First off, be realistic, know your strengths, and know your weaknesses.
Not everyone has strength in every area. Be flexible, if something doesn’t happen
the way you anticipate or expect learn to reframe it, put it in a way that can be helpful.
And again, if you’re truly suffering or if a loved one is truly suffering, don’t
be afraid to ask for help. >> Dr. Rosemarie Tong:
I think we need to learn to ask for help. And ***, you get to be the last, very quick.
>> Richard “***” Blackwell: First one is, we may not have control over
the things that happen to us. We do have control of our reaction to the
things that happen to us. That’s my first thing.
My second thought, is there are four things we have absolute control over.
>> Dr. Rosemarie Tong: I’d like to know them.
>> Richard “***” Blackwell: And they are the same things that I recommend
to all of the clients I work with. The first is, you can control what you eat.
The second is you control sleep. The third is you can control exercising and
the fourth is you can control play. Eat, sleep, exercise, and play.
>> Dr. Rosemarie Tong: Well, you know, I think that’s great advice.
All of you have given me some great advice. There is a possibility of being glad and not
being sad. I think the control piece is very hard.
>> Richard “***” Blackwell: Letting go
>> Dr. Rosemarie Tong: Oh, well letting go of control is the most
difficult thing or trying to mold people, our expectations or all of those bad kinds
of things. I really want to think the three of you for
coming here today and I wish we could continue this conversation for another hour or maybe
two, but I know you’re all busy and so thank you, you did a great service.