The rating scales beyond physical pain: optimism/pessimism, energy, mental clarity

Optimism flooded through me—optimism, my great weakness or my great strength (depending on whom you asked and on my own mood as well). In Voltaire’s Candide (whose full title is Candide, ou l’Optimisme), the hero’s positivity in the face of the world’s horrors is close to idiotic. (If this is the best of all possible worlds, then those parallel universes must be hellish indeed.) When I wrote my novel Quichotte I lampooned my own nature by making my title character an optimist of the Candidean kind. And now, bedridden and gravely injured as I was, I began to believe that the worst was past, that Milan’s arrival was a sign that a corner had been turned, and happy days would soon be here again.

Rushdie, Salman. Knife: Meditations After an Attempted Murder (p. 81). Random House Publishing Group. Kindle Edition.

Salman writes about his experience in rehab which I found interesting because I have spent five months in orthopedic rehab from September of 2023 to February of 2024. One of the things I noticed was how the nurses would frequently ask me to rate my pain on a scale of 0 - 10. Luckily my pain was usually minimal. However there were three other things that were very noticeable and troubling to me and I constructed my own scales to rate them daily and sometimes hourly.

After pain, my second scale was “mental clarity.” I often experienced a fogginess and lack of concentration.

The third scale was “energy level.” There were many times when I just didn’t have the energy to engage in minimal things like talking with visitors. There were many days when my energy level was at 2 and 3.

The fourth scale is “optimism/pessimism” which Rushdie describes in the passage above. There were days when my optimism was 0 and I wanted to die. Had MAID, medical assistance in dying, been available in New York State as it is in 17 other states and Canada I might have killed myself. I was that despondent and pessimistic. That’s when you need someone to love you. I am blessed by three good friends when my family abandoned me and I obviously got through that desolate period to write this post.

The turning point for me was finding an apartment I could be discharged to. Finding the apartment, a place to go, gave me something to live for. Also, the PTs and OTs were very helpful and encouraging. Without them I couldn’t have recovered to the extent I have.

Yesterday, August 23, will be one year since I tore the quadriceps tendon in my right leg, and tomorrow, August 25th will be one year since I tore the quadriceps tendon in my left leg. On the 29th of August it will be one year since I had the surgery on both legs to repair the tendons and I woke up from the surgery in two leg braces from my upper thighs to my ankles at full extension with no flexibility for 6 weeks. I was a beached whale, totally bedridden, and totally dependent on others for even the smallest things like picking up things I dropped on the floor from my bed.

Optimism when a person’s life has been totally turned upside down is a huge thing. I am filled with joy to learn that Salman got his optimism back. Been there, done that as they say.

Editor’s note: I am a member of the online Allnonfiction book discussion group which discusses a different nonfiction book every month.

During August, 2024, we have been discussing Salman Rushdie’s book, Knife, which describes his attack by a man wielding a knife at the Chautauqua Conference Center in August of 2022 as a result of the fatwa proclaimed in 1989 by the Ayatollah Khomeini for what the Ayatollah said was blasphemy in Rushdie’s novel Satanic Verses 33 years prior to the attack in 2022.

The book being read and discussed by the Allnonfiction book discussion group in September, 2024 is Being Mortal by Atul Gawande. 

The Best Way to Stall Dementia: Quit Smoking

 From Cornell University

While the number of smokers is at a historical low, data demonstrates that smoking still affects public health. Smoking increases the risk of heart and lung disease, affects bone health, and increases the risk of birth defects. A growing body of research demonstrates that smoking also affects neurological health, specifically cognitive decline.

A longitudinal study published this fall in the journal Nature Communications tracked data from 32,000 adults between ages 50 and 104 for 15 years to identify lifestyle factors linked to cognitive decline. The surveys, conducted in 14 European countries, asked about a broad range of lifestyle factors including smoking, alcohol consumption, physical activity, and social contact. The surveys also measured episodic memory and verbal fluency, two domains affected by dementia.

Researchers found that most participants showed some signs of cognitive decline over the course of the study, but current smokers demonstrated the largest and most significant levels. The only exception were current smokers who had other healthy habits including avoiding or limiting alcohol, moderate to vigorous physical activity, and regular social contact; those participants showed less cognitive decline, similar to that of nonsmokers.

Editor's note: I have spent many decades of my 56 year career as a Psychiatric Social Worker helping people quit smoking. The interesting finding is that a person who is a long time smoker makes, on average, 5 quit attempts before they finally quit for good. So, I encourage people by telling them "Don't quit trying to quit."

Addiction to smoking is one of toughest addictions to overcome.

80% of people for whom alcohol is a significant problem also smoke. The outcome research shows that quitting both smoking and alcohol at the same time gets better outcomes than quitting these chemicals one at a time.

Cinematherapy can be useful in mental health treatment and recovery.

 

Do you use movies, TV shows, YouTube videos, etc. in your therapeutic work. If so, can you name such a film or video and how you use it?

Yesterday, I finished the Netflix TV series, (8 episodes) of Escape at Dannemora. I remember when this happened in 2015. This is a soap operish kind of story with a narrative that is predictable. What might be interesting is how manipulable people can be in institutional settings and how creative people can be in totalizing circumstances. 

I am not sure how I might use this series in therapy but Tilly demonstrates some of the signs and symptoms of what might be called "inadequate personality disorder." Her insecurities contribute to compulsive sexual behavior which gets her into criminal behavior with two of the inmates.

At any rate, do you have movies or TV shows that you refer to for therapeutic purposes in your work with clients?

If you have been a mental health patient, are there movies, novels, TV shows that have helped you resolve and transcend the mental health problems which have challenged you/

Does Narcissism Fade With Age?

If you’re hoping the narcissist in your life will make sweeping behavioral changes, you are likely to be disappointed, according to a systematic review published in the journal Psychological Bulletin.

For more click here.

Editor's note: As a Licensed Clinical Social Work Psychotherapist with 56 years in the field of mental health I have observed that some people with personality disorders do change in positive directions or at least "mellow" in their older age. However, I also have observed that some people, as this study finds about people with Narcissistic Personality Disorder, not only don't change but the symptoms even become worse.

Another sad observation is that people tend to die the way they have lived their lives. The old expression "you make your bed and you lie in it' is pretty accurate. Death bed conversions make great stories and movies but are exceedingly rare that's why they are so valued and appreciated if and when they do occur.

However a good story about end of life change is told in Dr. Irvin Yalom's book; "Love's Executioner: and Other Tales Of Psychotherapy" in the second chapter "If rape were legal..."

Trust in a benevolent universe is a key to spiritual health.

Even if your spirituality does not include a Supreme Being, children need to feel that the universe smiles on them. Einstein said that the most important decision each person makes is deciding whether or not this is a friendly universe.

Dr. Laura Markham, Great Spiritual Lessons Every Child Should Learn, 

Laura Markham is no relation to me and I don’t know her. However, I admire her work.

As I read and think about this quote, it seemed to me that this is an important decision for adults as well as children. To what extent is one of the foundational purposes of psychotherapy to help people shift their perception from a world of malevolence to one of friendliness? How do we help our clients shift their perception from a malevolent universe in which they feel victimized to a benevolent universe in which they are loved unconditionally?

One of the most important contributions to this mind shift from the negative, fear based perspective to a positive, optimistic perspective is the cultivation and expression of gratitude. Before bed, it is suggested by the positive psychologists that we reflect on the three good things that have happened to us during out day. What have we been blessed by? Identifying these things fosters an appreciation that allows us to become aware that we are loved by the Universe. 

At any age we can intentionally choose to recognize and acknowledge the blessings in our life. What greater gift could a parent give a child that to facilitate the child's awareness and expression of gratitude?

Lethal drug overdoses in the year 2021 killed 100,000 people.

 

Lethal drug overdoses in the year in  2021 killed 100,000 people. After fentanyl, methamphetamine is the largest killer.

In my practice I know far more people who have died from drug overdoses than from Covid-19 and suicide.

 

The interesting observation is that people have much more control over lethal drug overdoses than they do of Covid-19 in the sense that the exposure to the agent of death is under the individual's control.

 

What are the factors that contribute to the high level of substance misuse in the United States?

What can we do as psychotherapists do to ameliorate the suffering that contributes to this phenomenon?

Mental health of populations should be an indicator in measuring a countries gross domestic productivity, GDP

 Here is an interesting short article on Conversation.com about the addition of "mental health" as an indicator of well being in a country's GDP.

While Indonesia’s economic prospects seems promising, an essential factor of productivity needed to sustain growth is often overlooked: mental health.

How mental health affects the economy

People with moderate to high distress levels typically demonstrate reduced productivity and need higher levels of healthcare. This increases the societal economic burden.

The World Health Organization (WHO) found a 25% increase in the prevalence of anxiety and depression worldwide in 2020, the first year of the pandemic.