When I was looking at the acknowledgments at the beginning of a book by Kate DiCamillo called The Tiger Rising, I noticed that the acknowledgments ended with thanking a specific person for "believing that I could and that I can. And that I will." I rarely look at this section of a book but I did this time and really only at the end that I have quoted above.  Who knows why?  However, I believe that this is one way of talking about or describing what being supportive and encouraging is.

This is important to me because when I am helping my patients to stop feeling and acting responsible for others, they need to have something that they can replace that with. I believe that being encouraging and supportive is a good way to interact with others. However, defining it has been difficult for me. That is why I was encouraged when I saw what Kate DiCamillo had written in her acknowledgments. So, is believing in someone part of being encouraging and supportive?  I think it is and I have focused on people seeing the strengths in others and communicating this to them as a way of being supportive and encouraging. This does not involve giving advice, making suggestions or taking on responsibility for the other person. Often people that we want to help are not feeling confident, nor recognizing their strengths and abilities.  That is why it is important to recognize the strengths of people we care about and also why it is so very important to not undermine their confidence by giving advice or taking over for them.

I have repeatedly seen that it is critical to not take over for others as this undermines their confidence and is not kind or caring or loving. Now, if someone is used to being dependent on others to do for them and people start expecting them to manage for themselves, they may react negatively at first.  Their reaction indicates that they have a beginning awareness of their need to take responsibility for themselves. So, if you are encouraging and supporting others, they may get mad at you.  This is a good thing as it means that they are more likely to change and start taking responsibility for themselves.  What do you think?



People who threaten others should not have access to weapons. As long as we continue to be obsessed with owning guns, even with the evidence that easy access to guns leads to deaths of many innocent people, it is critical that we put safeguards in place to protect innocent people from potentially dangerous people. The information in the title comes from an editorial entitled "The Terrors of Hearth and Home" in the December 32, 2017 New York Times. The editorial talks about the need for laws that allow police or concerned family members to petition the courts to issue orders that prevent potentially dangerous people from purchasing guns. A few states have the option of the police or concerned family members petitioning the courts to issue an extreme risk prevention order keeping individuals from purchasing guns. This can be critical as very often people who are being bullied and emotionally abused are afraid that obtaining a restraining order will lead to the abuser becoming more violent.  Domestic violence accounts for more than 50% of mass [4 or more people] shootings. To be able to prevent access to guns for people involved in domestic disputes who have threatened family members, could save the lives of family members including many children. 

So, if you feel that being able to temporarily keep violent people from buying guns is something we need in our country to save lives then let others know, including local, state and national government officials.



In a guest column in the November 5, 2017 edition of the Asheville Citizen Times by Marsha Fretwell, M.D., she has concluded that she might be the last happy doctor.  This is because she had practiced as a geriatrician and thus had only Medicare to interact with as more than 96% of her patients were covered by Medicare. This allowed Dr. Fretwell to spend the 30 minutes per patient that she feels she needs to properly listen to and care for her patients. The predictable [compared to for profit insurance companies?] reimbursements from Medicare allowed her to reduce her staff as they did not need to spend longer periods of time with for profit insurance companies to get reimbursed for her services. 

Dr. Fretwell also indicated that our country's Surgeon General reported that second only to the opioid addiction crisis, physician burnout is the next most critical issue in health care. Even though Family Practice, Psychiatry and Internal Medicine are typically paid 50% of what other medical specialties are paid, the most often cited factor in burnout was not inequality of pay but the paperwork demands of insurers that took them away from direct patient care. The ability to form relationships with their patients was felt to be critical to providing quality health care and critical to the satisfaction of patients and physicians.  

I firmly believe and have seen in my practice how important spending time with my patients is.  That is why I do not accept payment from insurance companies.  I have maintained a minimum of 30 minutes with my patients and will often spend 60 to 75 minutes depending on the needs of each patient.  Without a relationship with my patients it is much harder to help them to recover from their anxiety, depression, flashbacks, difficulty concentrating, etc. and experience an improved quality of life that they desire.

Dr. Fretwell goes on to advocate for universal health care as she notes that since for profit health insurance providers have been on the scene, overall health care has declined in the United States.  Dr. Fretwell believes that universal health care will lead to less expensive care, better outcomes, and happier patients and physicians. 

What do you think?



We own more than 310 million guns [2009 National Institute of Justice report]. This is the most of any nation in the world with India coming in second with an estimated 46 million guns. So, we have more than seven times the number of guns compared to the second place country. We are also the world leader in gun violence. Every day 93 people die from guns in our country and this number includes 7 children and adolescents.  Congress continues to refuse to expand background checks [make it universal] before gun purchases even with evidence that this would save lives.  There are gun suppliers who can review their store cameras and see people who bought a gun and then are in the paper the next day having killed themselves with the gun that was sold to them the day before. Of course, owning guns is dangerous to children and adolescents.  According to the Centers for Disease Control and Prevention [CDC] in 2015, 26,252 of us in our country died from gunshot wounds and this included 2824 children and adolescents who died from unintentional shootings and firearm homicides. So, why won't congress pass legislation mandating background checks [representing a delay before a gun can be purchased] when it is so clear that many of us can not manage owning guns safely and it is estimated that more than 90% of us want universal background checks. Is Congress' reluctance related to the fact that the National Rifle Association [NRA] provided more than $50 million to the campaigns leading up to the election of Donald Trump.  Mr. Trump got more than $30 million for his campaign. 

Do we need to let our congress know that we want them to expand background checks or they will risk not being re-elected?  Do we care enough to speak out? Is it the right thing to do? What do you think? 



I've had several patients tell me that they couldn't forgive people who had abused them but they were no longer troubled by thinking about them. Then a few other patients told me that they were finally able to forgive their abusers and felt more at peace about it now.  So, do we need to forgive those who abuse us to be able to not be troubled by these events anymore?  What is forgiving? Some definitions focus on it being deciding to stop feeling anger towards someone and others mention a willingness to allow room for error or weakness. Others use words like:merciful, lenient, compassionate, magnanimous, humane, softhearted, forebearing, tolerant, indulgent, etc. as ways to decribe someone who is forgiving. Now lenient, softhearted, tolerant and indulgent don't sound so good.  It makes it seem that forgiviing someone is being too kind and is letting them get away with it. What are they or have they gotten away with? They know that they have violated you and you know that you were violated.. They have to live with this and if you forgive them then maybe you won't have to live with it anymore. You will be able to shed the weight of this memory and let go of any lingering feeling of responsibility. 

So, it seems that we forgive to help ourselves be released from the anger and hurt that really is our problem and won't be resolved until we can stop reacting to something that is in the past.