drmargaret

Things get misinterpreted. You say something innocuous and it gets taken as malicious. You say something intended to be supportive and it gets taken as crass. What in the world is going on in these interchanges?

I had three of them today. These things have to do with ambiguity. When people don’t know how to interpret something they put in place a series of filters to determine how to think about the things they see, think and perceive. Some of the filters have to do with personal experience. If the person has been in an experience, they apply that experience to the situation and determine that their situation is the appropriate way to percieve what is happening. Some filters have to do with personal opinion. If you think something, you think most people will think that way too and believe that’s what most people will do in the situation and it forms your opinions and motives for your behaviors. Some of the filters have to do with how you want to be thought of and the idea that other people may be watching you. People behave and think differently if they think they are under observation or if they think they are noticed or if they are cared about even in a small way than if they are anonymous.

Now my job is to provide psychological evaluations of people who indicate they are disabled in some fashion. It would be nice if people just acted normally and let me evaluate them. The process of evaluation changes some people. Some people change as a result of wanting to do better or worse on the evaluation. Some people just don’t like being evaluated. Added to that is the problem that I have to talk to people, show them things and understand them when they respond. Furthermore, the people I evaluate are upset, anxious and have some idea that I’m the enemy at the time of the evaluation. That just makes everything worse.

Lately, people have been coming in angry. I ask for a Picture ID. People should expect this. They are told on the appointment letter to expect to be asked for this when they arrive. It helps us get their chart. It maintains their privacy by not saying their name outloud. We are polite. We say please. We smile. It starts. “What do you want an ID for?” “Don’t you trust me?” “I’m who I say I am, who the hell are you?”

Then there are forms. Everyone fills out forms when they go to a doctor. I saw a doctor today. I filled out seven pages of forms. Most people know to expect the forms. I hand people the forms. “What are these for?” “Don’t you have my records?” “I’m not filling out your forms.” “Forms make me sick.”

I’m still stuck in helping mode. Lots of the psychologists I work with are stuck in this mode. We really have this idea of helping. The concept of duck and cover hasn’t caught on and I’m not sure it really should.

Psychologists where I work have all taken classes on ethnic diversity. We’ve all taken classes on ethics and assessment. Many of us have published professionally on psychological treatment, racism, sexual abuse, and law and psychology. So having someone scream racial comments is offensive. Having someone swear is offensive. Further, it gets old. It gets old being told we don’t like these people. It gets old being told we are going to judge them and not approve their claim. We can explain we have nothing to do with the approval or denial process. We have tried having them sign statements in writing to that effect. We have tried telling them that the tests are the same kinds of tests for everyone, that we are not singling them out for some imagined form of mistreatment. If we take the tests, (and we’ve taken them all), they make us anxious too. This statement gets misinterpreted as “the examiner even said she was anxious.”

Parents with children are a specific group which causes problems. All parents worry that they will be found responsible for the problems their kids have. I have the parent present with the child in most cases unless there is too much disruption. The child knows if there are things they can’t do as well as other children. The child knows the behavior problems the parent yells at them day in and day out for. I knew before preschool I had motor problems. All the kids told me on my block. Some of the nice kids helped me. Some of the mean kids teased me. By Kindergarten I got speech classes. Some parents worry that talking about these things openly in front of the child are going to cause harm to the children. There is actually much more harm that is caused by acting ashamed. Lots of children have learning disabilities. It doesn’t mean they are stupid or can’t achieve in life, or need to be treated as fragile.

I’ve raised six step-children. I worked with the developmentally disabled. I have a couple of dogs currently. I spent my early behavior work training cats. You spend any time watching any of the televisions programs showing the “Nanny’s” that are so popular and you are watching a behavior specialist. When I talk with people about behavior work I try to make two points. There is a difference between psychology and behavior work. In psychology the individual is considered responsible for their behavior and is taught to manage and control their behavior. In behavior work there is an identified “owner” who controls an individual. The “owner” is responsible for managing, supervising and controling the individual. These are different systems. In psychology people are given choices. In behavior work, individuals are given commands. The legal system uses a behavior system. Parents are held responsible for the management, control and supervision of their children. The school system uses a combination of psychology and behavior work. Frequently, parents are not aware that there is a behavior system they can access at their school. If psychological counseling isn’t working, then behavior work may prove useful. Behavior work is also available through the Regional Center system. When I make this suggestion it can be misunderstood. I’ve been told I’ve compared children to dogs. I’ve been told I’ve said a specific child was just like my dalmation who can’t pay attention. I’ve said no such thing.
I’ve said there is this thing called behavior work. You might want to give it a try. I’ve also said to give clear commands. Use few words. People have children who can’t pay attention and they tell them several sentences and the child is lost after word two. Tell them no more than a word or two. Don’t defend your decisions. Let your yes mean yes and your no mean no. It’s clear. Some parents think this is mean. It’s not. Clarity is not mean. Mean is a voice tone. Mean is hitting. Mean is asking the child to do something they are not capable of doing and understanding they are not able to do it and getting upset at the child when they are not able to perform.

Parents of the developmentally disabled adults have some of the same problems. I have to evaluate adults independently. This really bothers some of these parents. I understand that. My oldest step child had some developmental delays. It’s hard to let them go off with a stranger even for a few minutes. The evaluation process can be upsetting to some people with developmental delays. It can be upsetting to normal people. As a psychologist I try to limit how upsetting the evaluation is while maintaining the integrity of the evaluation, but some people are just going to get upset. People who get upset during the evaluation process are likely to get upset in other settings as well so it shouldn’t be a surprise, but I’ve had parents act like it was a surprise that their adult child was upset. I even got assaulted by a parent whose adult child got upset. When she calmed down evough to think rationally she could recall he got upset at school, at work and even at family gatherings when he didn’t quite understand what was going on. She apologized and realized she would need to talk with him about what happened and might need to get him some treatment.

Getting people the help they need is the point of all this after all.

A pandemic is an epidemic that spreads around the world. There is a current infection which is killing off a lot of different kinds of birds in several countries now. A lot of people are worried about it. The main people that should be worried about it are the people who raise birds.

There are some rules about sanitation that don’t get followed everywhere. If you have a sick bird, don’t eat it. If you have a lot of sick birds wear a mask when you clean them up and dispose of their waste products. Wash your hands when you come into contact with animals.

These rules are hard to follow if your birds live in your house. Lots of people in Asia have their birds live very close to them. My mother lived in Hunan for a time. She had a pet bird. No, she didn’t get bird flu. She got the anticipated heart attack. But people get to live in fairly close quarters with chickens, pigs, ducks, geese and turkeys. They live on rural farms. They know their animals. They are poor. They sell their animals in open markets in large groups. People are in close contact with animals all the time. As a result people catch viral infections that migrate from animals to humans.

This is the case with the H5N1 virus. Mainly is goes from 1 bird to another and causes the bird to become sick. Lots of people who regularly live among birds are appaarently immune to the infection. Young people and some older people who come into contact with sick birds become sick. So far there have been no cases of any people transmitting the virus to other people.

But what people are worried about is that if someone with the flu catches H5N1 then it might be possible to transmit this virus to another person. It will take up to 36 hours for that peron to know they are sick. By that time the first person may have infected many other people. Computer models of H5N1 with influenza A make it look like it might have up to a 50% mortality rate. About half of the people who contract the disease may die. That figure may be erroneously high. It’s based on the people who get sick from H5N1 now and from the flu now.

The regular flu kills somewhere around 10,000 people a year in the US. Most of these are the elderly, the very sick, and children. It’s a complication of diseases already present and weakened immune systems. No one pays much attention to “flu season.” People get a fever, chills, a sore throat, and are miserable for several days. The flu is caused by a virus. There are preventive flu shots for at risk groups to lessen the risk of getting into that 10,000 or so group that dies from the illness. A year or so ago it was predicted that there was going to be a very bad flu season and few flu shots. Lots of elderly people lined up to be vaccinated. There were shortages. The one major lab had it’s license pulled and vaccines had to be imported. There was a big outcry. As it turned out, the “flu season” that year was relatively mild.

So now people are trying to think about what to do for a pandemic. By and large this is an intellectual exercise. What would you do if you were the last person alive? What would you do if a tire came off your car while driving? What would you do if your house was on fire? What would you do if someone approached you with a gun? What would you do if you saw a lost child crying? What would you do if a virus to which few people had immunity was going around the globe? These are all things people can think about. A government needs to think about the last one. They should have some sort of basic plan in place.

We had a bad flu when I was a child. It was in the late 1950’s. Both I and my brother caught it. Lots of people were sick. We recovered. But people have the memory of the stories of the Spanish Flu pandemic. It killed lots of people. People get scared about something like that coming back.

Right now there’s no need for people to be afraid. Birds, on the other hand, should be awfully worried. There is a current bird pandemic. Birds have been reported to be sick in Mongolia,Vietnam, Indonesia, Romania, Tibet, and a sick bird was stopped from entering the country at customs in England. Birds will continue to spread the virus along normal wild bird migratory paths and along the routes used for smuggling exotic birds and poultry. As long as the virus stays with birds, with a few cases of birds to people, there is no problem. The US has good surveilance on sick birds. Sick birds in most places are killed and the flocks are killed. In small family farms, especially in Asia and in other third world countries, what people do is eat sick animals after they kill them. Not a bright idea. So, predictably, those people seem to be getting sick. To stop sick birds from possibly entering the food supply some countries like Canada have proposed a ban on poultry from China or all of Asia. It’s a proposal. In most cases it’s not needed. Good, safe food handling is needed. Most viruses are killed with proper food cooking and freezing. If you undercook meat or poultry you get sick. Poultry needs to be done to an internal temperature of 180F. The juice should run clear when the bird is punctured with a knife when taken out of the oven.

If you own birds try to keep them separate from your home. Don’t let them wander in and out of your house. Give them their own space. Make them their own small house and keep it enclosed to keep away migratory birds. If you have a sick bird, keep it away from the rest of the birds and get it tested by your vet for bird flu. Most birds are dying of Newcastle disease and not H5N1. It’s a different type of bird virus, and doesn’t transmit readily to humans. It’s common this time of year. If your sick bird dies, don’t eat it. If your sick bird dies don’t feed it to other animals. If your sick bird dies don’t compost it. Have your bird examined and necropsied. Governments are looking to contain H5N1 virus. It can wipe out large bird manufacturers. Contact your vet for assistance. Yes they may quarantine your farm, but you may save a lot of other livestock and you may ultimately save some lives.

As for antivirals, there are currently several on the market. Tamiflu is the one getting the most press. Flumadine and Symmetrel are othera. Acyclovir is an antiviral for herpes type viruses. Epivir-HBV is effective against hepatitis B. Repitol is effective against hepatitis C. Combivir, Crixivan, Emtriva, Hivid, Viracept, Viramune, Zerit, are AIDS medications. Synagis is effective against the RSV virus. There are other antivirals on the market as well. My list here was designed to cover the manufactures of antivirals, all of whom have the capability to produce anti-influenza drugs.

So what stops the big pharmaceutical companies from producing anti-flu drugs? Several things. There’s a limit on the profit the drug companies can make from producing vaccines for children. The US has a low cost vaccination program for children which limits profit. Second, there’s a limit on how the SEC wants the profit documented for shareholders. Lastly, since all drugs have side effects and some people get sick from vaccines, people sue the manufacturer making it a problem to produce vaccines for very large numbers of people. So big business will want to either limit the number of people who will get their vaccines or limit litigation or both.

So here is the worst case of a pandemic of H5N1 in the hypothetical. Remember this is an intellectual exercise. There is no human to human transmission of the virus in existance. But if there is, then the US is planning to develop 20 million doses of vaccine. The H5N1 in computer models (and remember the computer model is believed to be overestimating mortality) is 50% and the majority of death is for victims at age 49 years and younger. The average is 14. If you develop the vaccine then at least 1% of the people vaccinated will develop some side effect to the vaccine itself. Side effects will range from mild to severe. The severe side effects may include the possibility of death. 50% of the people who get sick who are not vaccinated may die. There are around 6.5 billion people in the world. If a flu pandemic occurs, everyone will consider whether or not to be vaccinated. There will not be enough vaccine to vaccinate everyone. Some people will not want to be vaccinated. Some people will not be able to be vaccinated based on how the vaccine is developed. It’s likely that concern over who will get the vaccine may be worse than the pandemic itself. If you recall what happened last year with the flu vaccine, that’s what happened.

At some point in our future there will be some illness which travels around the globe. It’s likely to be some type of virus. We have global travel and a global economy. It’s important to put safeguards in place and to plan now for things that might happen. It’s also important to keep in mind that for the most part these are intellectual exercises and there is no need for panic.