Category Archives: Counselling

Doctors And Empathy

Have you heard the joke?

When is the time to get empathy from a doctor?

Before they’ve gone to medical school.

Boom. Boom.

Well actually it’s not a joke at all. It’s a researched fact, and not a very funny fact either.

Evidence has been building that shows a steady decline in empathy in doctors as they go through their medical training. The latest one came out just last month…

http://www.ama-assn.org/amednews/2008/03/24/prsb0324.htm

It is quite staggering.

Empathy is the ability to feel and respond to what someone else is experiencing.

Doctors are most empathic when they have first been chosen for medical school.

From this point on their ability to be empathic declines. Even once they become registrars it continues to fall away.

I’m not yet aware of research that shows when this trend stops, or begins to reverse. Perhaps at some point it does.

Not surprisingly females on average have more empathy than males, but it makes little difference in medical school.

The proportional drop during training is the same.

Except for alcoholism, some prescription drug addictions, and completed suicide (presumably they have better knowledge about how to succeed if they attempt it) doctors are generally healthier than the average population.

So for self help, empathy may not be very necessary.

But if you want empathy from a doctor you might have to hunt a bit more than you would expect. No joke.

-Dr Martin Russell

For Adelaideans

This self help website attracts readers worldwide, from the US, Canada, Australia and UK, along with about 30 other countries so far. This is the main value of this site.

A few of my readers come from Adelaide, South Australia, where I have my solo counselling practice.

There are some things I can offer locally that I can’t yet do world-wide, so I would like to invite my Adelaide or South Australia readers to get specific local updates.

I will be able to provide access to other aspects of my self help/counselling work, including…

  • Local Adelaide presentations I’m currently doing on why almost all the weight loss methods around today don’t work in the long-term. [Hint: it’s probably NOT your fault. The methods themselves are flawed.]
  • How I fixed my every backache, knee pain, neck twinge, headache, and more, over the past 5 years… without pills, braces, physiotherapists or chiropractors, and all for less than $100.
  • AND, a special offer for an appointment with me at no cost to you. Currently my standard consulting fee is $206 for a 45-minute session (as I am a GP, Medicare Rebates and Safety Net do apply), but as a reader of this blog I would like to offer you – or someone you know – a complete session on me.

You can get all the details by entering your name and email address here…









Full Name:
Email Address:

NOTE: To keep the disruption of the rest of my practice appointments to a minimum this offer is for April only. Also, with school holidays in Adelaide this month my practice will be closed for one week for time with my family, so I suggest you phone my office as soon as you receive the email after you sign up.

-Dr Martin Russell

The Strange Behavior Of Anorexia – Part 2

I ended Part 1 of this series by asking when someone might WANT to have anorexia.

When might you actually want to be repulsed by the thought of eating food?

Put another way, could anorexia ever be “useful”?

Well it is a standard question that I have asked of every so-called problem that I have been told about or come across over the years.

In what way might the presenting problem or symptom or complaint actually be “useful” to the person?

How might depression be useful, or phobias, grief, alcoholism, self-sabotage, low self-esteem, narcissism, or whatever?

This is where you get the idea of “secondary gain”.

Secondary gain is when there is a second or hidden motive for an action. For example being sick can also be a way of avoiding dealing with an issue, as in a child not wanting to go to school or a worker not wanting to face their boss.

This is often implied as a bad way to deal with things.

We’re meant to be upfront, have no secrets, face our fears, not keep hidden agendas.

However the reality is that humans are complex, and being indirect in going after an outcome is an important choice to have.

Some things are quite well dealt with in a secondary way.

Could there be some useful but secondary gain in having anorexia perhaps as a way of attracting sympathy, gaining attention, getting control of emotions of fear or anger, etc etc?

I suppose yes.

Every problem can have secondary gains.

Personally however I don’t think these questions generally lead to useful therapy. When I have explored secondary gains they have often opened up really fascinating stories with many twists and turns, but in the end the problem is no better for having done so.

Secondary gain inevitably happens, but it almost always remains secondary.

Let’s go back to the question with a different emphasis.

WHEN or WHERE might a particular problem be useful?

In the case of anorexia I have only one suggestion for a context.

If I was drifting on a small life raft in the middle of the ocean for days or weeks, and all I had to eat was food that I knew to be contaminated and fatally poisonous, then in this extremely limited situation I could imagine being much happier to have anorexia.

Instead of wishing I had food or being tempted to eat the poisonous stuff around me, I would be happy that I finally had no one pressuring me to eat. Bliss!

But most people with anorexia are not stranded at sea with poisonous food, so in Part 3 I will move on to what else might be going on.

-Dr Martin Russell

Depression Solutions… Can You Help?

With the recent studies showing antidepressants to be far less effective than previously reported, this leaves a big gap in the field.

What can take the place of antidepressants?

What solutions are already out there for depression?

What books, courses, websites, resources of any type are there for “curing” people who have been given the label “Depression”?

I’d like to know of ones you think work, and any you don’t think work as well, with enough details for me to find the resource, and what thoughts you have about it.

Yes. Self promotion is allowed. If you’ve got something good enough then great!

It will be interesting to know whether there is anything that might fill the therapeutic vacuum.

You can put your thoughts as a comment below.

Much appreciated.

-Dr Martin Russell

Shake-up Or Wake-Up

The commotion over the study that said anti-depressants are a waste of time for all but the most severely depressed people, has continued to escalate.

It hit the middle editorial pages of my local city’s newspaper, and that means the story is big!

Much of the criticism that I have read of this study has been badly unscientific. A number of medical authorities seem to have come out with rather rash and half-baked defenses of their position.

Meanwhile there is a small debate building around the actual study itself which was published online in a format that allows comments.

For reference you can find the original study here:

Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration

This is an excerpt from my comments on the site:

It is interesting to see the commotion this study has caused, and rightly so.

Even more interesting has been the media reporting. They have been talking about the biological description of depression (eg biochemical imbalance in the brain) even as they are reporting that the drugs don’t work to anywhere near the level previously promoted.

The media is brainwashed to parrot what it has been told, even when there is a gaping hole in the theory.

Brain chemistry is not like insulin for diabetics.

It is also interesting to hear people who have received anti-depressants, and clinicians who prescribed them, somehow thinking they could not be responding to a placebo.

“All this evidence I have seen with my own eyes can’t be wrong” had been the catch-cry of quacks and the quasi-scientific, but it seems it is just the same here. Too many doctors, and patients, are not going about this scientifically.

If this paper is right then it says these drugs should not have gotten onto the market in the first place…

… We can’t offer talk therapy to all of the 5-15% of the western world that is supposedly “depressed”, but it’s no value overstating the benefits of medication either.

Far from being a step backwards I would like to see medicine, and psychiatry in particular, take this as a giant wake-up call for the 21st Century.

Hey, well I’m a wishful thinker 🙂

You can find all the direct comments on this landmark study here.

-Dr Martin Russell

It’s All In Your Head

A man came to me for hypnotherapy because he was vomiting. Not just any vomiting either. He had had to be hospitalized and rehydrated.

His doctor’s couldn’t find a cause, so they did what doctor’s do when they can’t explain something. They suspect it’s in your head, give it an impressive label like psychogenic hyperemesis, and then they send you off to someone like me.

I did no hypnotherapy in the first session with him. Instead I took a detailed history and asked him, and his wife who came with him, as many questions as I could.

In the end I explained to them that although I could give hypnotherapy a go, I could find no clear psychological reason why he would be vomiting. I had no other explain for why he was vomiting, but as far as I could work out it was not in his head.

His wife and he went away disappointed.

Later that year I was at the only counseling conference I have bothered to go to since I started my counseling work, and someone happened to present a series of cases of vomiting of unknown origin. My ears pricked up. The extra factor was that the people in each case needed to take lots of really hot showers or baths, up to 10-15 times a day so they could feel better.

The connection was found to be chronic high-dose marijuana use and severe, hospitalizing vomiting was a newly reported side-effect of cannabis!

Bingo!

I phoned up the man who had come to see me earlier that year and spoke to his wife.

Turned out he was in hospital again for dehydration and even worse than ever. So I arranged to go and visit him in hospital, and just in case he was going to deny any drug use I didn’t mention it on the phone.

When I got to the hospital I spoke to the doctors looking after him and they listed the battery of tests that they had run on him in this admission and previous ones. I was horrified to discover that they had already done a general drug screen, and it was negative for cannabis. My big idea was shattered.

I went in and spoke to the man and his wife, but it was true. He had no interest in hot showers. In fact he said to me he wished he did because then he could have been cured by simply stopping smoking. He was looking in particularly bad shape and was looking for any cure. I sat down and tried a little relaxation hypnosis with him, but it didn’t seem to help either of us.

About 6 months later I got a call from his wife. She was calling to let me know that her husband had died, and to say thankyou to me for my efforts.

A couple of months before his death they had in fact found a diagnosis. I think it was amyloidosis. I just remember the wife saying that the diagnosis had come up twice on episodes of the TV show “House”.

But instead of diagnosis in days like on TV, her husband’s diagnosis took years and by then it was too late stage.

I was very glad to get the feedback about what really happened.

I got feedback. She got a prematurely dead husband.

That’s all that is in my head now.

-Dr Martin Russell

The Strange Behavior Of Anorexia – Part 1

Many years ago now I went to a meeting of a local self-help group for people with eating disorders.

They didn’t usually allow outsiders to come along but because I am a medical doctor they were willing to make an exception. It seems that medical doctors don’t often ask to go along to self-help groups. At least that’s what various groups have told me when I have gone along.

That evening one of the topics for discussion was a recent tour that some of the volunteers, staff and members had done to the outlying communities around the state.

They were discussing how ignorant people were of anorexia and how badly education was needed.

One of the staff related a story from one of presenting a meeting to a group in a small town.

As they started up the meeting they asked for any questions or comments, and apparently a fat woman spoke up in a loud voice and said “Oh yeah, I would like a week of anorexia.”

The presenter was totally insulted, and outraged by this comment.

I had to agree with her. However I also had to agree with the woman who spoke up in the meeting.

I’m sure many people have wanted to lose weight by a week of anorexia, and I’m sure that many people with anorexia would be delighted to have a switch to turn it off after a week. Just try it for a while, if you don’t like it, turn it off and move on.

In fact the real problem with anorexia is that there is no such magic on/off switch, or at least that’s how it seems.

Anorexia, ie not eating enough to maintain a “healthy” weight, is a seemingly strange behavior for a human being. But nevertheless people do it.

Whenever you come across a strange behavior you can ask the same question as you would with your emotions as I described in a previous post, “Under what circumstances would this behavior actually be entirely appropriate?”

Have a think about it, even leave a comment with your opinion, and in Part 2 I’ll tell you what I came up with when I first asked this question myself.

Find Part 2 here. 

-Dr Martin Russell

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Do You Have A Healthy Relationship With Your Emotions?

When people come to me with problems often they think of their problems as “irrational”.

The really interesting part is that their emotional response is always the bit that is irrational.

It doesn’t enter their minds that perhaps the most irrational part of what is going on is that they are they are believing their logical thinking.

Human beings are remarkable poor at using logic, despite all our efforts. We are incredibly self-deluding, and disturbingly unaware of most of what goes on in our lives.

So give your emotions a break.

Here is a first step to making sure you have a health relationship with your emotions.

Check for any emotional reactions that you think are “irrational”, or that you are “battling”.

I’m not going to try to convince you that your emotions are correct or that you should give in to them. I don’t know you or your emotions, and yes emotions aren’t always the most accurate guide either.

But here is the question.

Can you think of a time when that emotional reaction WOULD be exactly what you want to have happen in your life?

Emotions are part of the range of being human, so where do they fit appropriately into your life, even if only in rare circumstances.

If you are doing this as an academic exercise and don’t have a personal example, then let me set a few challenges for you.

Where would you like to have a phobia in your life?

Where would you like to hesitate more, or be confused?

Where would it be appropriate to have a craving in your life?

Where would you like to be more stubborn?

All these emotions have a place in a healthy human being. Rather than avoid them, how about figuring out where they fit for you?

-Dr Martin Russell

The Decade Of The Brain

When I was going through medical school it was a really exciting time in psychiatry.

Just as I began in medical school the new generation of anti-depressants arrived. Most famous of all was Prozac, which is still one of the most prescribed anti-depressants in the world.

Then the 1990s was called by US Presidential decree the “Decade Of The Brain”.

All very exciting.

Among the new scanning technologies, research findings, and biochemical breakthroughs there was one key outcome of this period that has forever changed psychiatry and neurobiology.

In the last years of the Decade of the Brain, it was discovered that human beings do in fact grow new brain cells. One key paper came out as late as October 1999.

This may not seem such a novel idea.

We are used to the rest of our body growing and adding new cells, but the brain was meant to be different.

The belief in medicine was that at a very young age you had produced all the brain cells you would ever have.

After that point you would slowly lose brain cells until you ran out. It was all downhill from there, so you best take good care of them and not kill them off with alcoho, drugs, or various forms of contact sport.

Somehow the brain was meant to be similar to teeth, or like female eggs cell in human ovaries where you start with a set number and they run down until menopause when they’re all gone.

Why the brain was more like ovaries and eggs, than like testicles and sperm, I never did work out.

But this turned out to be wrong.

All through the human brain we have nerve cells dividing and creating more neurons.

This new finding added enthusiasm for the idea that you could regrow nerve cells after strokes and spinal cord injuries.

This idea was most publicly promoted by ex-Superman actor, Christopher Reeve.

In practice regrowing nerve cells hasn’t turned out to be as simple as it sounds.

However in my work in counseling, this one breakthrough opened up a huge new vista of hope.

Suddenly all the permanency of the brain and it’s behaviors became up for grabs again. You didn’t just have to tell people about “growing new connections” which was already known to be true, but in fact there was no built-in decay process either. The brain could add more cells and by implication could change more radically than previously thought.

There was one additional message which was important for me and my work – important in fact for the thinking behind this blog too.

I don’t use it in counseling with patients, but I do use it as a fundamental piece of how I think about everything I do as a helping practitioner.

Here is the message:

  • The medicine I was trained in got it wrong!

Not just slightly wrong either. Totally, horribly, 180 degrees wrong.

They asserted an idea that the brain could not create new nerve cells because they couldn’t detect it. They took this lack of evidence and claimed it to be a truth.

What other basic assumptions is medicine wrong about even today?

Lots. You can be certain of that.

-Dr Martin Russell