Robert Musser, Ph.D.

Even So, Choose Life (though despair and suicide may loom)

For some gloom, despair, and agony are the companions of late. Yet, it’s a new academic year and hope is fired up. Many of us are enthused with the fire of devotion to new learning and hoped-for, meaningful careers. Even the woods seem aflame with color, and the time of harvest is at hand. Maybe the brightness and hope of the season makes that despair for some more apparent, more hopeless. For whatever reason, far too many people suffer from significant depression, from bipolar despair, and suicide. In Arkansas, among people in the 15 to 34-year-old age bracket (which includes the overwhelming majority of you, our UAMS students), suicide is the second leading cause of death. In addition, the overall suicide rate in Arkansas is slightly more than double that of the homicide rate.* Suicide is a significant public health issue for us as medical professionals and for us as stressed, driven, self-demanding individuals.

In the Student Success Center and among the staff of Student Wellness, we are concerned with your academic and personal well-being, and we would wish that no one of you despair to the point of considering suicide. Certainly we wish that you not engage in planning such an outcome, and even more that you not act toward that end. Knowing some of the common danger signs (indicators) is a first step:

Mental health factors such as major depressive disorder or bipolar disorder.
A person’s previous history including-
- The experience of childhood adversities.Previous experiences of suicidal behaviors (suicidal ideation in the past or previous suicide attempts).
- A family history of suicide.
The experience of recent stressful events (especially when multiple stressors are present).
Substance abuse behaviors.
The absence of significant social support.

If you find yourself experiencing these kinds of symptoms, particularly if you are experiencing more than one or if your experience of even one symptom is intense and overwhelming, recognize the signs and take steps to seek out help. Student Wellness is an invaluable resource, available to UAMS students and spouses. Their services are also confidential and do not become a part of your official UAMS medical record. See the text boxes for contact information on this and other resources.

For some of us, the danger is not our own health, but that of friends, family, or colleagues. We may serve that role of significant social support for another. Pay attention and assist your struggling colleague.

Listen to, encourage, notice.

We are in this university together; we walk through this life together. As John Donne, the English poet, observed, “The death of any person diminishes me.” We are not islands unto ourselves, but each a part of the mainland. If you see fellow-students who are struggling, reach out and help them get the help they need. Suicide has been described as a permanent solution to a temporary problem. Without making light of the darknesses that some of us face, a new, better dawn can lie ahead. Let us help ourselves, and let us help each other. I have found meaningful the reminder from the song by REM,

“Sometimes everything is wrong
Now it’s time to sing along
When your day is night alone (hold on)
(Hold on) if you feel like letting go (hold on)
If you think you’ve had too much
Of this life
Well, hang on”

“Everybody Hurts” by Bill Berry, Michael Stipe, Peter Buck, Michael Mills, Warner/Chappell Music, inc., on the REM album Automatic for the People, https://www.remhq.com/music/automatic-for-the-people/.

* See the “Suicide Prevention” webpage at the Arkansas Department of Health, https://www.healthy.arkansas.gov/programs-services/topics/suicide-prevention.

Feeling Well is Part of Being Well

Know what? Sometimes I don’t feel so good. I’m sad. I’m lonely. I’m angry. Other days I feel great! I’m happy . I’m giddy . I’m hopeful. I’m guessing that many of us around here are like me—more comfortable with our intellect than we are with our emotions. Feelings are for poets and mystics and such; they are not the stuff of science and careful reasoning. It’s not so easy to put into words what and how we are feeling. Maybe that’s part of the popularity of emojis. We can depict visually how we feel more easily than we can name our emotions. Indeed, these diminutive symbols have quickly become favorite additions to our notes, so much so that there is now a “World Emoji Day,” July 17, 2019.[1] How do you intend to celebrate?

Emojis began in Japan and started with the emoticons designed from creative combinations of existing type characters: 🙂 and ;-( and so forth. Coders soon created the take-offs from the smiley face: . Shingetaka Kurit in 1999 created the first of these, and his original 176 emoji are now part of the permanent collection at the New York Museum of Modern Art. Could we say that there is an art to representing our emotions? As you probably know, today there are all manner of emojis, and there have been intentional efforts to represent men, women, children, seniors, turbaned folk, people of color, all varieties of the human range of identity and emotion. In 2015, tears of joy, was named the Oxford Dictionary “word of the year.” Wired.com calls emojis, “a lingua franca for the digital age.” In addition, the same article notes that emojis were “. . . designed to add emotional nuance to otherwise flat text.”[2]

We in the medical sciences ignore our own emotional component to our detriment. We humans are reasoning, sapient beings (homo sapiens). We are also emotive beings, and full healthiness includes “emotional intelligence.” We do feel, and we need to develop our ability to recognize our emotions and to integrate them into a balanced physical, mental, and emotional whole. Be well, then. Think well and deeply. Act well. Feel well and deeply. You will be the better for it. While you’re at it, celebrate World Emoji Day this July 17.

[1] This date was chosen because the calendar emoji highlights July 17.

[2] The information and quotes in this paragraph are largely drawn from Arielle Pardes, “The Wired Guide to Emoji.” https://www.wired.com/story/guide-emoji/.

Toward a Healthy Independence

It’s that time of year again when we Americans celebrate our independence. As with so many of our celebrations, we’re probably not so healthy, and our customs are far removed from the declaration of those colonial signatories. Our American myths tell us to be rugged individualists independent of anyone else, yet politically those colonists recognized that this was a mutually supportive endeavor. Ben Franklin is famously credited with observing, “We must hang together, or we will surely hang separately.”

As it is with political independence, so it is with other kinds of independence: complete isolation, “dysfunctional detachment” as one psychologist calls it,[1] is not healthy for our well-being. If you search OVID for articles on independence, you will find that this concept is an issue for older adults, for patients with impairments, and for person with limited economic resources. In each of these cases the healthiest approach is a balance between self-reliant autonomy and recourse to social support and even assistance from other persons, institutions, and technologies. It is clear from research that either overdependence on others or compete detachment is not productive of our mental health, our success in life, or our ability to relate to others around us. A healthy independence requires both some autonomy on our part and some reliance on others.

When we think about the social markers of independence in our development in this culture, we will recognize that there was both a measure of our own achievement and the encouragement and training provided by others. As youngsters a big step in our independence was toilet training in which we were guided to take care of our own “business.” Later, driving an automobile became a sign of independence, and again we were taught and modeled, and in due time we took the wheel ourselves and practiced until skillful. So too with our education and our career development: we have both leaned on others, and we took independent initiative on our own.

Certainly there are some common barriers to independence: lack of empowerment, coercion from others, our own attachment to the needs of others (when unhealthy it can become co-dependence as we are well-aware), and economic limitations. We do well to recognize these barriers, to limit their influence on us and other people as much as possible, and to be realistic about their presence.

Here in the Student Success Center we want to be part of this process of your healthy independence. We have resources and insight that can assist you toward better academic achievements. We want to help you soar on your own independent flight of discovery. Let us hang together in these tasks of becoming healthy, independent humans.

[1] Bornstein, Robert. Healthy Dependency: Leaning on Others without Losing Yourself. New York: Harper Collins, 2009.

Green Spaces at UAMS

Ever find yourself inside on one of those glorious warm sunny days when nature seems to beckon us to come outside? Maybe, like me, you weren’t raised in the city, and you need some fresh air and a chance to stretch your arms and inhale and exhale deeply. Maybe you miss the chatter of the critters and the sounds of human living going by. It’s rejuvenating (it makes us young again) to smell the delightful aromas of the blooms or of a just-passed rain—you can almost taste the dewy sweetness. How nice to be caressed by the gentle massage of a breeze, to see green plants and birds on the wing, butterflies at a blossom. But, we live in a mini-city of concrete high rises and technological marvels. It’s not so easy to get outside and breathe free.

There are some green spaces around UAMS, don’t you know. Tucked here and there are some spaces where you might decompress for a few moments. You might even take your studies and work outside. I’ve located and noted places around the campus with benches, in some cases tables and shade. I have tried to indicate which areas are accessible to wheelchairs and to persons who have trouble navigating steps. For the most part, these are also green spaces designed with a variety of plant life and often soothing water feature backdrops. Come outside and enjoy.

Green Spaces at UAMS

The Chancellor’s Garden on Campus Drive outside the Chancellor’s suite and accessible from the sidewalk on Campus Drive. This is an accessible area.
The PRI Entrance Garden with benches and a tranquil water feature. This area is accessible from above from the hospital entrance, but only accessible by steps from Hooper Drive.
The PRI perennial beds near the west entrance.
(The PRI Healing Garden)—available to PRI patients only.
The Bruce Fountain with benches in front of the main entrance to UAMS. This is an accessible area.
(The gardens among the CHP buildings). There are 3 courtyards on the main level and a small section on the lower level. These areas are currently unavailable and being renovated. Currently the courtyards are sunken and require steps down to enter.
(The CHP lower level section). See # 6 above.
There are some shaded tables and chairs outside the student center (around the side of the building from the entrance). This is an accessible area.
Resident Hall. There are some shaded tables and chairs outside the Resident Hall Administrative Services building. This is an accessible area.
Wilson Park—on the hill behind and above I. Dodd Wilson building. This area is not accessible from IDW, but can be accessed without steps from the parking lots near the Student Center and Admin West building.
Shorey Entrance. On Campus Drive, there are benches. This is an accessible area.
Anna Mae Garden located between the back entrances to Radiation Oncology and the Outpatient Center. There are benches, a pergola, and beautiful flora. I could not locate an accessible entrance to this area.
Spine Center Entrance. There are tables and chairs and a bench. This is an accessible area.
IOA Garden.
Cancer Center Entrance includes container plants and benches. This is an accessible area.
Cancer Center Healing Garden with tables, paths, and a variety of plantings. This area is accessible, but it has multiple areas with steps between, and they are not directly accessible to each other.
Biomedical Center, tables in 3 locations.
(The Rooftop Garden). Atop Parking 1. Currently unavailable, undergoing renovation. This area has been accessible.
There are shaded tables and chairs outside the cafeteria which is located on the ground floor of the Central Building. There are often several people in this area, eating and visiting so it may not be as conducive to study and quiet. This is an accessible area.
There is a small area with a bench tucked in between the Outpatient entrance and the Jones Eye Institute entrance.

It does a body good to taste and see and hear and smell and touch these worlds of beauty. Come outside and enjoy.

The Creative Power of Restraint

Restrained drivers are safer drivers. Restrained passengers will be safer passengers. In life and in vehicles restraint can work well for our success and our creative impulses.

On May 24, 1954, Life magazine published an article by John Hersey expressing the views of a committee of parents and educators in Fairfield, CT (1). The article voiced a perspective that American youth, especially boys, were falling behind in their reading skills. Among other diagnoses and repairs, Hersey and the committee observed that the prevalent grade school readers about Tom and Betty (more commonly experienced as Dick and Jane) were frankly boooring! Given the competing visual stimulation of comic books and television, who could blame the youngsters’ lack of interest. Hersey’s article would stimulate the interest of William Spaulding, the director of Houghton Mifflin’s educational division. Spaulding invited one of his up-and-coming authors to dinner and reportedly repeated several times, “Write me a story that a first grader can’t put down.” The author, Theodor Geisel, struggled for more than a year with the restraint, trying to write an interesting tale limited to 225 words on a first grade reading list. Alas, he didn’t succeed; The Cat in the Hat used 236 words, but what a beginning. Geisel is better known as Dr. Seuss, and a year or so later he would make an outlandish bet with his publisher, Bennett Cerf. Seuss bet $50 that he could write an interesting story using 50 words or less, words that were on early readers’ vocabulary lists. Using exactly 50 words, only one of which (“anywhere”) is more than a single syllable, Green Eggs and Ham was finished. As a product of the Dick and Jane readers, I am grateful for the spark in the creative fueled by the restraint. Perhaps the restraints on our time and energy could be food for our own creative endeavors. Who knows what wonderful new directions in medical sciences could emerge.

Online you can find several examples of the six-word memoir, reflection that is also creative restraint. Here are few favorites that can be found at https://www.womenshealthmag.com/life/a19929053/memoir/.

Stephen Colbert, “Well, I thought it was funny.”

Wendy Lee, “Asked to quiet down, spoke louder.”

Janine Goss, “Lived in moment until moment sucked.”

The Haiku, strict poetic structure from Japan, enables rather than hinders evocative imagery, often beautiful, sometimes humorous :

“Winter seclusion
Listening, that evening
To the rain in the mountains”
by Kobayashi Issa.

“A cicada shell
It sang itself
Utterly away”
by Matsuo Busho.

“Over-ripe sushi
The master
Is full of regret”
by Yosa Buson, translated by Robert Hass.

All of these can be found at www.poemhunter.com.

Be creative and succeed. Use the restraints placed upon you. Pay attention to them; value them. Restrain yourself, and may the world be enriched by your creative output.

1. John Hersey, “Why Do Students Bog down on First R?” Life. May 24, 1954, pp. 136-150.

See SPOT, Run See SPOT: Therapy Dogs and You

“See Spot run. Run Spot run.” I learned to read with Spot and his family: Dick and Jane and Sally and kitty cat Puff. The cute cocker spaniel Spot was the star as far as I am concerned. Later I delighted in Go Dog Go. The dogs wore hats, worked at jobs, conversed with each other and at the end of the week they raced off in their cars and on scooters, urged on by the narrator, “Go dogs, go!” Momentarily paused at the traffic light, they sped on again, parked, ran, up the big tree they went. Finally, they reached their spot, a big dog party in the sky atop that tree. Fanciful, I know, but what fun. Later still, I read my two boys the stories of Clifford the big red dog. He was easy to spot when he grew from the runt of the litter to 25 feet in height give or take (he varied somewhat from story to story).

We have our own pack to entertain us now: Bubba the aging poodle mix as non-alpha as a dog can be; Chris-O our son’s escape artist dog burrowing under or leaping over our backyard privacy fence; Maddie so named by the workers at the Pound because she resembles Eddie from the “Frazier” TV show—as a Jack Russell she owns everything in sight and expects servile compliance from the other dogs; Angel and Remington (“Remmie”), our two newest. Rescue dogs all, we spotted them along the way, and they are rescuing us too, it seems.

Now it’s your turn. When you are dog-tired the next several weeks, take advantage of the visits from the SPOT therapy dogs. These dogs and their attached humans will be visiting several times as the semester winds down. A number of studies indicate the healthful benefits of interaction with these dogs. Stress reduction along with increased energy and happiness are the benefits most often identified. In turn, stress reduction, increased energy, and an optimistic attitude are beneficial for academic success. Spot yourself a few bonus points of preparation. Come, enjoy the ministrations of these UAMS therapists. The schedule when they will visit is as follow:

Nov. 28 (Wed.) 11:00-12:00

Nov. 29 (Thurs.) 12:00-1:30

Nov. 30 (Fri.) 11:00-12:30

Dec. 13 (Thurs.) 12:00-1:30.

They come to the first floor of the library near the bottom of the stairway. Again, come be refreshed by the kin of Spot and Clifford. Come to our small dog party.

Be a Subversive, Read a Banned Book

Feeling a little subversive? Me too. We’re in luck. This week (September 23-29) is Banned Books Week. Sponsored by the American Library Association and other organizations, “. . . Banned Books Week draws national attention to the harms of censorship.”[1] At UAMS we may forget that challenges to learning and restrictions on reading significantly limit education and negatively impact optimal quality of life. Banned Books Week reminds us that a healthy life is an informed, broad-minded life.

Book banning has existed for centuries. In addition, access to certain books has been restricted from certain age groups or restricted to privileged or initiated groups. Thoughts and words are dangerous! Who knows what revolutionary movements might be spawned? In the United States between the years 2000 and 2009 the Office of Intellectual Freedom at the American Library Association received over 5,000 reports of either challenges to remove and restrict books or instances of books being banned. Complaints were most often about sexual content, either that it was explicit or that the nature of the sexual behavior was contrary to the complainant’s standards (HGBTQ issues, violence, behavior by minors, for instance). Other common complaints were about language or violence or about the book being unsuitable for a particular age group.

You are not surprised that around 2/3 of the complaints were in reference to school libraries and classrooms. Only around 150 of the complaints were associated with higher education. Slightly over half of the complainants were parents. If you would like to know specific books check out the American Library Association’s web pages. You’ll find books you expected and some surprises (maybe like me, you develop a reading list).

Generally I am completely opposed to censorship of information by any group. Be they political, religious, or public-minded, such groups always support their own interests and biases. It is certainly appropriate for parents to guide carefully their children, but to limit choices for others poses a problem. In the medicine we are taught often and early the importance of informed consent, and informed consent requires access to full information.

I was interested to find that books related to medical issues have been challenged, removed from publication, and even banned. In 1822 the British government banned The Natural History of Man by Sir William Lawrence because the author claimed that religion and metaphysics have no place in medical research. Charles Darwin’s Origin of Species is one of those pesky books which have been challenged, restricted, and banned periodically since its publication. An anatomy textbook from the 1970s was removed from publication both because of its text and the objectionable way in which women were portrayed in pictures. Several books by William Reich were destroyed by the U.S. government after the influential psychiatrist was convicted of medical quackery and served time in prison where he died. In 1997 The publisher of the Atlas of Topographical and Applied Human Anatomy by Eduard Pernkopf stopped further publication after Pernkopf’s ties to Nazi Germany came to light. Look also into the story of Henrietta Lacks. You might be interested to know that our library has some of these volumes in its collection.[2]

Read on! In honor of this week start reading a banned book. It will do you good. If you are interested, drop by during the week. I have displayed materials related to the topic, and I’ve brought some of the banned titles we have in our own family library.

[1] http://www.ala.org/advocacy/bbooks. The American Library Association has a number of webpages devoted to this topic and I relied on them for much of the general information in this blog.
[2] https://becker.wustl.edu/news/banned-medical-books/. https://www.libraries.rutgers.edu/rwj/banned-medical-books. Thanks also to the Department of Medical Humanities here at UAMS for their help in pointing to resources for this blog. Rebecca Skloot, The Immortal Life of Henrietta Lacks. Johns Hopkins also has a brief statement about Ms. Lacks and a short video about her legacy, https://www.hopkinsmedicine.org/henriettalacks/index.html.

“There’ll Be Days Like This Celebrate!

As Van Morrison remembered his mother’s wisdom, so I have found, sometimes “there’ll be days like this.” You will graduate. Life is pleasant; it is worth enjoying. This morning, being a Monday, I work from 11:00 to 7:00 so the parking places are fewer and farther away. The bus runs less frequently and is not the direct express. But today, a space was open two slots from the bus stop. What is more, the weather is delightful, and the bus appeared immediately. I’d be spoiled if all days were like this.

Just so Van Morrison suggested in his song. The first verse celebrates days when everything falls into place. That’s cause for celebration. The second verse reminds of the days when you don’t need to worry, and there is no betrayal by a supposedly close friend. The third verse says on some days all the puzzle pieces start to look like they fit. Fourth, on some good days you don’t get hassled by the powers that be, and you can live your life as you please. And finally there will be days when nobody steps on your dream and everybody gets what you say and sing. This upcoming graduation is one of these good days—celebrate!

As you know well, there are other days too. Van Morrison’s song drew upon the earlier Shirelle’s song that wonders if love and life has passed me by. “Mama said there’d be days like this.” We’re on the outside of the wedding chapel wishing to be in. You’ve endured some of those tough days. You lasted through the program. Remember, when you face similar struggles in the future, wise Mama said, “There’d Be Days Like this.” Take heart.

Today, celebrate this good graduation day when it is falling into place, the puzzle is beginning to be solved, and the dream is realized and your voice heard. Wise Mama said, “There’ll Be Days Like This.” It seems fitting that graduation and Mother’s Day falls so closely together. Enjoy and thank her for your good life, for your graduations along the way and still to come, of which she is a part.

Go then with our blessing and good wishes. We celebrate with you one of these good days when life goes happily.

Finding Balance: A Life Skill

Balance: the focus of jugglers, gymnasts, Tibetan Buddhist monks, Navajo healers. The mandalas of the monks are intricately created symmetrical sand paintings hand-built, grain by grain, over several days as an act of devotion. Navajo healers devoted to the restoration of health for an ill person similarly create an elaborate symmetrical sand painting, grain by grain. And at the end of each ritual the two traditions share another similarity. What looks to many of us like priceless art is dis-integrated, the individual sand returned to the sea and to the desert respectively. To live well requires the ongoing practice of balance by each of us individuals in the great community of life.

And likely each of you as a student finds balance hard to come by sometimes, perhaps especially as the semester winds up toward its normal frenetic finish. Yet balance is important; the psychologist Alex Lickerman, writing in the journal Psychology Today, notes his own struggles to balance his life in the light of:

family responsibilities (including his relationships with his cats),
professional responsibilities and development,
personal self-care,
leisure
basic tasks such as laundry, shopping, house-cleaning, and so on.

Yet Dr. Lickerman suggests we do need to develop balance so we don’t “fall over,” physically or psychologically.

The following suggestions drawn from my own experience and from the insight of others may be helpful:

Learn to focus and pay attention to the task at hand. Dr. Lickerman recommends “disconnecting” (turning off phones, email, and other possible distractors) for some time each day.
Schedule ahead of time and as much as possible discipline yourself to stick to that schedule. Scheduling helps us not to forget or omit important items, and it is useful for prioritizing—identifying and then completing the important.
Grant yourself some latitude. Neither you nor I will be completely perfect in this life. Be OK with excellence and improvement.
Develop a method or a ritual for reset. Many diverse cultures have some designated way in which error is recognized and then corrected. Develop your own procedure. Restoration is an important part of the balanced life.

Finally, bear in mind a few observations about balance:

It is a process and never a static state to be achieved.
It is easier achieved with another person involved. Ideally you each balance the other.
Failure and success are both part of the balance of life.

It’s the Real World-We Need to Cooperate and Collaborate

All the time I have been in academia I have heard people talk about “real life out there.” College is not the “real world.” Yet in college, at university, there are turf wars, political maneuvering, rotten apples and the good ones, the used and the users (and most of the rest of us who do some of both). There are the “skill” positions on the team and the “grunts.” There are personal disappointments and proud achievements. There are relationships that deepen and engage us and those that go south. What is not real about life here?

Cooperation and Collaboration

So it is that we are here together, as in real life, social animals required to cooperate and collaborate in this project we have going here at UAMS. Ours is a group project like the multiple award winners in the scientific categories of the Nobel Prizes. Since 2010 these prizes have usually included at least 2 and often 3 concurrent winners. Ours is not like the solitary awards to the literary set, one person each year in that same span since 2010. So, in this corner of the world, we are required to work together. It’s helpful to remember that group work might be done in one of at least two ways. We might cooperate. We might collaborate.

To cooperate is to work independently toward a common goal. A medical care team with its therapists (occupational, respiratory, physical, and so on), its nurses, doctors, chaplains, patient care attendants, case managers, pharmacists, patients and caregivers and more is a good example of cooperation. In the ideal situation each exhibits her or his special expertise toward the wellbeing of the patient.

To collaborate is deeper. To collaborate is to work together toward a common goal. Well, now that I think about it, a medical team is often working together and not just independently. There are rounds and shared planning and consultation. These are marks of more than simultaneous cooperation.

I encourage you to work on both of these skill sets while a student here at UAMS. This is a kind of simulation lab much like the real world. Here, you can learn by doing, reflecting on your doing, and improve the next go-around. Work on cooperating—help each other out with your own independent contributions toward the wellbeing of each and of all. Work on collaboration—practice working together, consulting, shared planning toward the wellbeing of each and of all.