May 2020

“Quarantine fatigue”; fear and Law of Attraction; use it or lose it.

Welcome to the May edition of Tips and Topics. We’re not ready to move on from COVID-19 yet, as much as it would be wonderful to get back to “business as usual”.

In SAVVY, the focus is on “quarantine fatigue”. The HIV epidemic has lessons that can help shape where we go with COVID-19.

In SKILLS, fear attracts more fear.  Daily stress and worry plagues a majority of Americans (60%). Shifting our focus away from what pulls us down, can help us get through COVID-19.  But don’t forget to wash your hands.

In SOUL, the blinds in my lakeview room reminded me to use it or lose it.

savvy

It has felt like this whole COVID-19 (C-19) experience is unprecedented. There are so many aspects that the world, the USA and I personally have never experienced before. But earlier in the month on the “Here & Now” news program, I heard Julia Marcus, PhD, MPH, an infectious disease epidemiologist and assistant professor at Harvard Medical School. She made a lot of sense to me on what we can learn from the HIV epidemic and what to do with what we are all experiencing – quarantine fatigue.

TIP 1

Quarantine Fatigue is Real” and learning from the HIV epidemic

Julia Marcus wrote an article about quarantine fatigue in The Atlantic and astutely makes the case that instead of an all-or-nothing approach to risk prevention like long stay-at-home orders and economic shutdown, Americans need a manual on how to have a life in a pandemic.

Dr. Marcus pointed to parallels with the HIV epidemic that had not occurred to me:

  • “In the earliest years of the HIV epidemic, confusion and fear reigned.” –

That sure sounds like C-19.

  • She said “AIDS was still known as the “gay plague.” – Sounds like names used early in this pandemic, like the “Chinese virus” or the “Wuhan virus”.
  • Gay men received the health advice to avoid sex. – We were all ordered to stay at home, social distancing, avoid going out, and abstaining from all social interaction.
  • “In 1983, the activists Richard Berkowitz and Michael Callen, with guidance from the virologist Joseph Sonnabend, published a foundational document for their community, called “How to Have Sex in an Epidemic.” – This is what we need now, a document on how to have a life in the C-19 pandemic.
  • “Recognizing the need for pleasure in people’s lives, the pamphlet rejected abstinence as the sole approach and provided some of the earliest guidance on safer sex for gay men, including recommendations about condoms and which sex acts had a lower or higher risk for disease transmission.” – Recognizing “quarantine fatigue” and the need for pleasure and social interaction, we need recommendations about what activities have a lower or higher risk for C-19 transmission.

TIP 2

Why abstinence-only messages and mandates don’t work and what to do about it

Dr. Marcus goes on to say: “Public-health experts have known for decades that an abstinence-only message doesn’t work for sex. It doesn’t work for substance use, either. Likewise, asking Americans to abstain from nearly all in-person social contact will not hold the coronavirus at bay-at least not forever.”

  • The protests over stay-at-home orders have emphasized that abstaining from all in-person social contact doesn’t work. Even the President tweets for governors to “liberate” their states and people.

Dr. Marcus makes these points about abstinence-only messages:

  • “Public-health campaigns that promote the total elimination of risk, such as abstinence-only sex education, are a missed opportunity to support lower-risk behaviors that are more sustainable in the long term.
  • Abstinence-only education is not just ineffective, but it’s been associated with worse health outcomes, in part because it deprives people of an understanding of how to reduce their risk if they do choose to have sex.
  • And without a nuanced approach to risk, abstinence-only messaging can inadvertently stigmatize anything less than 100 percent risk reduction.”

What to do?

  • Some people are going to take risks, whether public-health experts want them to or not. Instead of condemnation, offer them strategies to reduce any potential harms. –

With C-19, we have seen many people defy public health advice and congregate on the beach or in church or refuse to wear masks, including President Trump.

  • Offering them strategies meets people where they are and acknowledges that individual-level decisions happen in a broader context, which may include factors that are out of people’s control. – Instead of arresting people, shaming them and inflaming political tribalism that fuels the protests and rejection of public health recommendations, how can we engage people in solutions to increase individual freedom, while caring about others who could be infected?
  • “Policy makers and health experts can help the public differentiate between lower-risk and higher-risk activities; these authorities can also offer support for the lower-risk ones when sustained abstinence isn’t an option.
  • Enclosed and crowded settings, especially with prolonged and close contact, have the highest risk of transmission, while casual interaction in outdoor settings seems to be much lower risk.”

Bio:

JULIA MARCUS is an infectious disease epidemiologist and an assistant professor in the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute. Her article was in The Atlantic May 11, 2020.
https://www.theatlantic.com/ideas/archive/2020/05/quarantine-fatigue-real-and-shaming-people-wont-help/611482/

skills

Linda Searing reported in The Washington Post that “Daily stress and worry plague a majority of American adults – 60 percent, according to a new nationwide Gallup poll, conducted from March 21 to April 5.” The result “represents what Gallup describes as an ‘unprecedented’ increase in the number of anxious Americans. It is believed that “economic and health fears brought on by the novel coronavirus pandemic…have sparked the spike in anxious Americans.”

TIP 1

We have nothing to fear but fear itself

“Nothing to fear but fear itself” may refer to a phrase from the 1933 inaugural address of Franklin D. Roosevelt.” When your focus is on fear, you attract more fear.  

Have you noticed that if you are focused on buying a new car, you start seeing the brand you want all over the place? The cars were there before, but they weren’t attracted into your view and reality until you focused on them. I have become increasingly attracted to The Law of Attraction to understand such phenomena.

“Simply put, the Law of Attraction is the ability to attract into our lives whatever we are focusing on. It is believed that regardless of age, nationality or religious belief, we are all susceptible to the laws which govern the Universe, including the Law of Attraction.

  • It is the Law of Attraction which uses the power of the mind to translate whatever is in our thoughts and materialize them into reality.
  • In basic terms, all thoughts turn into things eventually. If you focus on negative doom and gloom you will remain under that cloud. (I added emphasis to expand on “we have nothing to fear but fear itself”).
  • If you focus on positive thoughts and have goals that you aim to achieve you will find a way to achieve them with massive action.”

Focusing on fear, keeps you fearful.

TIP 2

Trust in God but tie your camel and Trust, but verify

So then, are we to simply think positive, trust in God and all will be well?

  • Trust in God but tie your camel: “This saying, as relayed by the scholar Al-Tirmidhi, is an ancient Arab phrase attributed to the prophet Mohammed who, when one day he saw a Bedouin leaving his camel without tethering it, questioned him as to why he was doing this.” (Google).
  • Trust, but verify (Russian: Доверя́й, но проверя́й, tr. Doveryáy, no proveryáy, IPA: [dəvʲɪˈrʲæj no prəvʲɪˈrʲæj]) is a rhyming Russian proverb. The phrase became internationally known in English when used by President Ronald Reagan on several occasions in the context of nuclear disarmament discussions with the Soviet Union.

When it comes to COVID-19, fear will attract more fear; but tie you camel and verify that you have:

  • Washed your hands throughly
  • Worn you mask to minimize the risk of infecting others
  • Avoided crowded places, especially indoors
  • Physically distanced to protect yourself and others

soul

My training skills are a bit rusty. Most of my work is onsite trainings at conferences and workshops. With all conferences canceled or postponed, I have been holed up at home for three months enjoying a much slower pace.

I escaped for a week, to my small manufactured home a mile from the beach in Southern California. In the lakeview room, there are three sets of blinds that are the easy pull down, and easy push up kind…..easy that is, if the mechanism works as advertised. That mechanism is known to be temperamental and the manufacturer has already replaced all three sets of blinds for free when they malfunctioned.

Blinds in the lakeview room

I returned to find one set of blinds broken again. Back to the store I went. They asked me how often I use the blinds.  I expected them to say it was way past the warranty time; and the wear and tear can cause the malfunction.

Actually, I said, this is a second home and since I am not here all the time, the blinds don’t get a lot of use. To my surprise, they said that was exactly the problem. The blinds malfunction when they aren’t being pushed and pulled up and down everyday. But even so, they still promised to replace the blinds again – for free. That’s what standing by your customer and your product really means.

The rust is gradually wearing off as my trainings have transitioned to remote learning events using Zoom and other platforms. But my lakeview room blinds reminded me again to “use it, or lose it”.  That applies to training skills, exercise, brain sharpness and in an era of social distancing, social communication and people skills.

April 2020

Bill Gates on pandemics; smiles and songs; how I read the news now

In SAVVY, Bill Gates’s 8 minutes TED talk could have saved thousands of lives and trillions of dollars if we had listened to him. As we think of opening the USA up again, will we listen now? 

In SKILLS, SMILES, SONGS I share some of my favorite coronavirus related humor and music. 

In SOUL AND SHARING SOLUTIONS, I pass by news items that leave me angry and less empathetic. Is there anyone out there wanting to come together to find solutions to our shared common challenges?

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March 2020

March Problem Gambling Awareness Month; Language of Recovery; No need to panic

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January 2020

Frustrations, frustrations – what kind are they and what to do; visioning a new year and decade

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December 2019

Thinking beyond medication; “Just give me medication”; consumerism and loving yourself

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November 2019

Lessons learned from my journey to India and Japan; travel tips; Laughter Meditation; Sharing Solutions

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October 2019

Two STUMP THE SHRINK questions on passive compliance and substance use while in treatment; customer-focused and friendly

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September 2019

What are social determinants of health? Aging providers and the next generation

Welcome to the September edition of Tips and Topics (TNT). My heartfelt thanks to the many readers who took the time to write and share their support and feelings about the August all-SOUL edition.
This month in SAVVY, the focus is on social determinants of health.
In SKILLS, it is important to assess and include social determinants in treatment planning, not as an afterthought or “discharge planning” task.
In SOUL, a guest contributor asks “how do we capture our faith, skills and experiences in order to share and pass them along to the next generations of professionals?”

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August 2019

All SOUL – grief, loss, and moving forward. Perspectives from my children and me.

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July 2019

Behavior Contracts – the good, the bad and how to move away from them; Surpises about food and the environment

In SAVVY, we focus on the advantages and disadvantages of Behavior Contracts.
In SKILLS, I invite you to delete Behavior Contracts from your clinical toolkit.
In SOUL, I was shocked to learn that that a quarter of the world’s greenhouse gas emissions come from putting food on the table.

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June 2019

What to do about addiction clients with prescribed, potentially addictive medications; Pickleball anyone?

In SAVVY and STUMP THE SHRINK, I respond to a question on what to do about psychiatric prescriptions for benzodiazepines and amphetamines in addiction treatment.
In SKILLS, assessment needs a skilled clinician who is savvy about addiction and mental illness who can evaluate specific diagnostic and treatment questions.
In SOUL, I was introduced to Pickleball and now exercise could actually be fun for me.

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