jonathanrosman

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  1. Eating Disorders

    Dear RunningOnEmpty, It sounds like you have had a terrible struggle with a very difficult illness. As a former medical director of an eating disorder program, your story is familiar to me. While I obviously cannot give personal psychiatric advice over the Internet, it is important not to lose hope. Most of the patients I have treated over the years with eating disorders are highly intelligent, with great personalities, and with a huge potential for success. Many went through several bouts of treatment before they found the treatment setting that helped them to concquer their disorders. Although you may have heard these many times before in your treatment, there are some key principles regarding eating disorders that I believe are worth repeating: 1. Severe eating disorders rise to the level of psychoses or quasi-psychotic conditions. Aside from the effects of chronic starvation on the brain, which make it impossible to think rationally until the starvation effects are cleared up, I believe that there is a degree of cognitive distortion involved that prevents a person with an eating disorder from making use of the psychotherapeutic advice they may get, until the thought processes are straightened out. This may even require the judicious use of antipsychotic medication for a period of time. (For instance, one is not in touch with reality if one is anorexic, yet looks in the mirror and sees oneself as fat.) 2. Psychologically, eating disorders represent a defense mechanism in which all psychological problems are reduced to a few numbers: calorie intake and weight. Sometimes the only sense of control a person feels is over these numbers, even when they may feel totally out of control over their lives. A crucial aspect of treatment involves learning how to translate the obsessive focus on food and calories into the real issues that affect one's life. Eating disorders are not really about weight, psychologically speaking. 3. Issues that must be looked for and addressed in the treatment of eating disorders include: problems in the family, often saddled with all kinds of guilt trips, irrational demands and expectations; and a history of molestation or abuse. Support from family that is facilitated and helped along by a therapist, can sometimes mean the difference between success and failure in treatment. 4. Patients with eating disorders express their despair with their bodies, often because they literally do not know how to express themselves emotionally. It is very important to learn how emotions affect one, and how to express one's feelings to others - and how to feel safe enough to do so. Techniques like yoga are frequently helpful, because patients learn a lot more about how their bodies express their level of comfort or discomfort. 5. Values are what fills one up and makes life meaningful. Values, not figures or numbers. The more value-rich your life is, the less you will need to cling to numbers, such as weight. I hope these brief comments are helpful. Jonathan Rosman
  2. Principles of Sleep

    Dear RS3000, There are no "mandatory" principles to get to sleep quickly, but there are well recognized principles of "sleep hygiene." 1. Maintain a regular sleep schedule i.e. go to bed and get up at the same time each day. 2. Reserve your bed for sleep and sex and nothing else. 3. Don't watch tv in bed. 4. Don't exercise late in the evening, and don't eat late at night. 5. Avoid caffeine after 5-6 pm, and avoid alcohol. 6. Maintain a quiet, dark bedroom, that is cool. 7. No pets in the bedroom. 8. Don't sit in front of the computer late at night, as the light from the computer screen will alert your brain. 9. Bright light in the morning, dim light at night. At the age of 25, it is possible that you are having trouble falling asleep is because of what is known as Delayed Sleep Phase Syndrome. This means that your biological clock may only want to switch off later at night, and turn on later in the morning. This is the reason that so many high school and college students have trouble paying attention in early morning classes. If this is the case, melatonin may be helpful, but it is most helpful as a clock-resetter if it is taken early in the evening, i.e. at about 6 p.m. You only need small doses, eg. 0.5 mg for this effect. If you take it at bedtime, you may achieve some sedative effect - although it is not a very good sleeping pill - but you won't achieve the clock-resetting effect. Sleep is a complex phenomenon, and we do not understand it fully. There is therefore no one theory of sleep yet. There are many things that could explain a difficulty falling asleep and daytime fatigue, and my best recommendation would be to get a professional evaluation by a sleep specialist to sort out your symptoms. Jonathan Rosman
  3. Psychiatry as a medical specialty

    Dear Medical Student, Your question contains several misconceptions, which I believe explains, at least in part, your concern: First, psychiatry does not involve violations of human rights. The involuntary hospitalization of severely ill patients is a small part, and a marginal issue when you consider the entire field of psychiatry. Your statement that doctors are allowed "and expected" to hospitalize patients against their will is not true. For instance, I do not practice inpatient psychiatry, there is no expectation on me to do so, and, in fact, I am NOT allowed to hospitalize patients against their will (since in the county I practice in, one is required to obtain a special credential to do so), whereas police officers ARE authorized to take certain patients to a psychiatric facility against their will for an evaluation. The authority to hospitalize patients against their will is delegated to mental health professionals in most jursdictions only in very narrowly defined situations, all involving emergencies, and all involving situations in which there is objective evidence that a patient is incapable of making rational decisions on his or her own behalf. There are very well defined legal safeguards and legal review to protect the rights of patients in these circumstances. Ethically, these civil commitment laws should be considered under the ethics of emergencies. Even if you disagree with the civil commitment process, it is not reasonable to define the whole profession of psychiatry by the ethics of psychiatric emergencies. Second, while there is much deterministic theory in psychiatry, the worst of it actually comes from the NON-biological psychiatrists, especially those who have a Freudian basis. The biological psychiatry movement, which is responsible for the fantastically positive development of modern psychiatric medications, while it may have started off very deterministic, appears to be much more "evidence-based" and empiricist, rather than relying on deterministic theory. Excessive use of medication is bad in medicine in general. However, in modern psychiatry, just as in modern medicine, the concept of "rational polypharmacy" has emerged, which is the idea that it is irrational to expect one medication to do everything, and very often, a combination of different medications will produce a better effect, with less side-effects than a single medication can. Third, the parity laws of which you speak are bad - they are a misguided attempt to raise the reimbursement for mental health up to what the reimbursement for other specialties has been. Psychiatric illnesses, for some reason, have historically gotten the short end of the stick when it comes to insurance coverage. However, the parity laws do not require any clinician to act immorally, and I do not understand the connection. However, what concerns me more than the misconceptions contained in your question is your apparent willingness to seize on these issues out of context, and then deduce that psychiatry would be a profession that forces one into immorality. I believe this to be a rationalistic way of thinking, and if this is representative of how you analyze things, I would recommend you obtain some help to correct your method of thinking before considering entering the field of psychiatry. Good luck. Jonathan Rosman
  4. Hypnosis

    Dear Brin, I don't believe that there is any situation that actually requires hypnosis. Hypnosis may be helpful for people who want to quit smoking, or to curb their dietary intake, i.e. to lose weight. Thus, it has been shown helpful for certain compulsive habits. And it has been used for anesthesia. Beyond those uses, I do not think it is of much value. Hypnosis is basically a state of heightened focus, with suspension of one's critical faculty, making one hyper-suggestible. This can lead to false convictions and dependence, which have negative consequences of their own. Jonthan Rosman
  5. Thomas Szasz

    Dear Betsy, It's been many years since I read Szasz' books (such as "Ideology and Insanity"). As I recall, Szasz has been a well respected psychiatrist. However, it is my understanding that as a libertarian he has always been critical of Objectivism. I do not believe he has been very influential on the field of psychiatry in general, because of his libertarianism, which represents a non-principled, or anti-principled part-philosophy. Jonathan Rosman
  6. Monogamy

    Dear Mrocktor, "Mutually accepted non-monogamous relationships" basically means casual dating, in which no relationship is important enough for you to commit yourself to fully. This is fine as a transitional state, for example if you are young and you are just learning about dating and relationships, and you haven't yet defined for yourself what kind of partner is your soulmate. However, health and happiness requires a full commitment to values in all spheres of life. Something as important as romantic love cannot be properly enjoyed if you go about it casually, and you will suffer the consequences of a chronic sense of a lack of fulfilment. Such a course of action also sets up a very bad psychological habit, in that you chronically undercut your enjoyment of one partner by swapping her for another whenever you feel like it. You develop the habit of treating your top values as interchangeable instead of precious. This will negatively impact your self-esteem. An analogous situation would be trying to have several careers at once. You can't be an architect and a lawyer and a doctor and a carpenter, and give full commitment and passion to all of them. You have to choose. This is not a curse, it is a fact. However, the analogy is not perfect, because in romantic love, the degree of intimacy and intensity of commitment required means that there is only space for two in the same bed. Jonathan Rosman
  7. Dear Jordan, Yes, hypnopompia is a real occurrence. It occurs when the boundaries between sleep and wakefulness are blurred, and results because of an intrusion of an aspect of dream sleep into the wake state, upon waking up from sleep. It is not related to any of the conditions you mentioned, and can occur entirely normally. It also occurs as part of the narcolepsy syndrome. Jonathan Rosman
  8. Polyphasic Sleep

    Dear Bryan, I am not familiar with this term, but as you describe it, it appears to be an attempt to circumvent the normal physiological requirements for sleep. (If I am wrong, please correct me.) Such an attempt would fly in the face of what we know of what is called "sleep homeostasis." Basically, there is a set amount of sleep that each person seems to need. Some people are fortunate enough to be "short sleepers" -- I believe Donald Trump may be one such individual -- and can function very well on, say, 4 hours of sleep a night. But generally, if you get less sleep (assuming normal quality of sleep) than you require, you incur a "sleep debt," which grows each night that you get suboptimal amounts of sleep. The normal sleep cycle itself is phasic. For example, you have REM sleep periods approximately every 90 minutes, and your deep, non-REM sleep periods are concentrated in the early part of the night, while your REM sleep periods are more concentrated at the end of the night. If you sleep deprive yourself to the degree of only getting 3 hours sleep in each 24 hour period, you will be horribly sleep deprived. I don't care how you try to do it. You will accrue an enormous amount of sleep debt, and you will not be able to function very well. You are not going to be able to "catch up" the restorative and REM sleep that you require by means of six 25-minute naps. When you initially deprive yourself of sleep, you may feel pretty good, or even euphoric, because sleep deprivation can precipitate an emotional high. But eventually you will crash. (Try it at your own risk if you like!!) Scheduled naps, even of 10 minutes in duration, CAN be very helpful to people who are sleep deprived for other reasons, to lessen the sleep debt that they already have. For example, this is a recommended procedure for people who suffer from narcolepsy. However, I would not recommend scheduled naps as a replacement for a normal sleep cycle. Jonathan Rosman
  9. DiSC Profiling

    Dear Steve, I am not familiar with the particular test you mentioned, but I have the same reservations that you do about personality tests for employment. Unfortunately, the most validated of tests, the MMPI-2, is not used for business purposes because it was not developed to be sensitive to things relevant to business, and also, as I understand it, because of legal problems with labor laws in asking some of the questions therein. There are several other personality tests used either by businesses, or else by companies consulting to businesses, but these tests, in my opinion, are pretty useless. The reason is that they assume the existence of artificial categories and subdivisions of personality types based on definition by non-essentials. Thus, you may find that you fit quite well into all of the categories they describe, or else you fit into none of them -- and that is just if you are healthy (i.e. rational)! Typically, the test results are then used by the management consulting people to justify whatever direction they were intending to direct you in in the first place, which is not a very honest process. A few years ago, I had the opportunity of evaluating the program of a company (which shall remain anonymous) devoted to consulting to executives from large companies around the country, with the aim of improving the executives' management skills. The entire program turned out to be thoroughly Kantian in its underlying premises and methodology. A personality test was one of the methods used to seduce one into accepting their premises, very analogous to astrology, in that a lot of it seems to fit. Unfortunately, many of these executive or management consulting programs are quite useless, and they are usually very expensive. I have had a plan for some time now to develop a rational program as an alternative to what is being offered, but due to the priority of other projects, this has not yet materialized. I would very much like to know from readers involved in the business or corporate world if they think there would be an interest in such a program. Jonathan Rosman
  10. Monogamy

    Dear Mhn, It is not merely "realistic," it is ESSENTIAL for both a man and a woman to remain monogamous in order to remain psychologically healthy. Now, just because you are in a committed relationship with a woman does not mean that you become blind. You can still appreciate the beauty and sexiness of other women and find them attractive and stimulating. But if you are in the right relationship, you should not feel tempted to flirt or to cheat on your partner. If you do, you are not fully committed to the relationship you are in. There is a huge difference between loving someone and being "in love" with someone. If you are in love, your partner consumes you, and you are passionate towards her and 100% committed to her. If she is indeed your top value in life, in order to make that value objective and real, and in order to sustain a relationship, you have to, as Ayn Rand said, act to gain and/or keep it. That action, in the context of a romantic relationship, means that you have to really commit yourself to the relationship. If this is a top romantic value, that commitment should be 100% or more -- otherwise what you have is not the kind of relationship you are trying to convince yourself that you have. If you love your partner, but find yourself wanting to be with other women, something is wrong. Maybe your partner is close to, but not the right fit for you. (In other words, maybe you have never really been in love.) Maybe there are some conflicts between you and your partner that need to be resolved. Or, if this is a pattern in your relationships, maybe you have a problem with commitment (which really means a problem with achieving and sustaining values), or some other problem that causes you to connect with women who are not quite right for you. Whatever the case may be, I do not believe that it is healthy to try to have your cake and eat it too. If a relationship is not satisfying one's needs, one should understand what the reason is: is it something in you, something in your partner, or that the fit is not right? If the problem is fixable, fix it. If not, why stay in it? If, however, you try to split your commitment on such an important value as a romantic partner between two or more people, you will end up keeping none of them and destroying your capacity to enjoy your most important values. Jonathan Rosman
  11. Chronic Insomnia

    Dear Dave, Congratulations on adopting several habits that go towards establishing a routine of good sleep hygiene. Other good sleep hygiene tips are: ensure the room temperature is cool enough, ensure the room is dark enough, no pets in the bedroom, use the bed only for sleep and sex, do not watch tv or a computer screen late at night, and dim the lights when getting ready for bed. However, the problem you describe does sound abnormal, and good sleep hygiene is probably not enough. Although I cannot diagnose your condition over the Internet, you may have something called Delayed Sleep Phase Syndrome, which means that your circadian clock is set to go to sleep later than normal. Sleeping pills can be a helpful component of treatment for this syndrome, but unfortunately, due to the infinite wisdom of the FDA, all the over-the-counter sleeping pills are either not very effective, or else last too long and leave you with a hangover, whereas the prescription sleeping pills, in my experience, work a whole lot better. Since sleep is such an important component of one's life, I would recommend that you seek consultation from a Board Certified sleep specialist in your area. Jonathan Rosman
  12. Long-term recurring dreams

    Dear Steve, I am very glad that your recurring dreams are pleasant! While it is true that the content of many dreams are related to the physiology of sleep -- in the sense of loss of muscle tone, and whereas many dreams are obviously related to one's most recent experiences -- for instance the events or discussions of the previous day, there are many other dreams that appear unrelated to either of these two causes. We do not know too much about the causes of dreams. What is apparent is that any previously stored mental content (memories) may become the subject matter of dreams. Also -- and more pertinent to your situation -- memories that derive from the distant past are more strongly retained than more recent memories, perhaps because they have more contextual connections to the rest of one's mental content. Additionally, dream content appears to be often related to emotional context -- to somewhat oversimplify, if you go to bed happy, you will have happy dreams. In other words, if you are basically a happy person, you shouldn't be plagued with recurring nightmares. The other thing that I am confident in saying about dreams, is that the Freudian theory of dreams is ludicrous, so don't spend too much time analyzing your dreams! Jonathan Rosman
  13. Dear Jordan, Most dreams occur in the phase of sleep known as REM (rapid eye movement) sleep. If you awaken out of REM sleep, you will frequently remember your dream. If you have been sleep deprived, and then you have a better night's sleep, you will have more REM sleep than usual - so-called REM rebound. You are then more likely to remember a dream. The content of dreams comes from your thoughts and experiences while you are awake. So, if you watch horror movies, for example, the content can reflect itself in your dreams, often in bizarre ways, of course, because during sleep your brain juxtaposes disturbing images without any logic or context. Good sleep hygiene can help - for example, turning the thermostat down a degree or two, making sure you get enough sleep on a regular basis, etc. An occasional nightmare, while disturbing, is really nothing at all to worry about. If you have frequent nightmares, which mess you up, that may be a clue to some unresolved conflict that can be sorted out through a brief course of psychotherapy. If you have had a major change in your life situation, that can be the source of some disturbing dream content. For example, for quite some time after I arrived in North America, I frequently had a dream in which I couldn't seem to pass my medical school exams in South Africa, even though I had successfully graduated from medical school a few years earlier. The change in context from living in South Africa to living in North America took quite a while for my subconscious mind to resolve, because I had to develop a new context, that is, a new set of experiences living in North America, before the dreams evaporated. Jonathan Rosman
  14. Dear David, Yes, this phenomenon truly does exist. The fact that you have met such people should confirm this fact. These people deserve some admiration for this quality. No, it is not genetic, because self-esteem has to be earned. Family/upbringing can certainly influence one positively, but basically it is you, acting on your own judgment, who will earn the right to feel proud of yourself and self-confident. Jonathan Rosman
  15. Dear David, Great questions. Yes, the problem is that your thought is way too broad and abstract. You may be, overall, a strong, confident, ambitious person, and yet you may be terribly insecure when it comes to women. It's wrong, for example, to conclude that just because you are an Objectivist, you are well equipped for all aspects of life. In this instance, you have to tie your thoughts down to reality in the specific context of relationships with the opposite sex. Here's an analogy: I am a pretty strong alpine skier, but I would be terrified to strap on a snowboard. The only way to overcome that fear (if I were crazy enough to want to do so!) would be to get some practice on a snowboard, and learn how to "shred." Of course, I could take some lessons so that I learn the right technique and don't kill myself, and this would speed up my learning curve, but I would still need to put in lots of practice -- which could be tremendous fun, by the way, despite the inevitable falls and bruises. If you are shy about talking to the opposite sex, the only way to overcome this is to talk to lots of women. Get advice from your friends and others on how to date, what girls like, what they don't like, and how best to make yourself presentable to the kind of women you might be attracted to. Even then, you will still feel nervous, but that fear can be named and dealt with. With practice, you will become more skillful and consequently more self-confident in that area. Exposure to reality is essential, but not sufficient to build self-confidence. You have to develop a certain degree of skill or mastery of whatever it is you are exposign yourself to. That takes practice and some effort. Good luck! Jonathan Rosman