T1-weighted MRI, also known as T1-MRI, is a type of magnetic resonance imaging (MRI) that is used to create detailed images of internal organs, bones, and other structures inside the body. This imaging technique is particularly useful for visualizing soft tissue structures, such as the brain, spinal cord, and muscles, as well as for detecting certain types of tumors and other abnormalities.
The principle behind T1-weighted MRI is based on the behavior of hydrogen atoms, which are present in large quantities in the body’s water and fat molecules. When a person is placed in a magnetic field, the hydrogen atoms align with the field and emit radiofrequency signals, which are then detected by a receiver coil and used to create an image.
One of the key features of T1-weighted MRI is that it can distinguish between different types of tissue based on their water and fat content. For example, fat appears bright on a T1-weighted image, while water appears dark. This makes it possible to clearly see the boundaries between different structures, such as the brain and spinal cord, or the muscles and tendons.
T1-weighted MRI is also useful for identifying certain types of tumors and other abnormalities. Tumors, for example, tend to have a higher water content than the surrounding tissue, which makes them appear darker on a T1-weighted image. Similarly, certain types of cysts and other fluid-filled structures will also appear dark, making them easy to distinguish from surrounding tissue.
Another advantage of T1-weighted MRI is that it does not use ionizing radiation, which is the type of radiation used in x-rays and CT scans. Instead, it relies on a magnetic field and radiofrequency signals, which are considered to be safer than ionizing radiation. This makes T1-weighted MRI an attractive option for people who are at risk for developing cancer, such as children and pregnant women, as well as for those who have already had a lot of radiation exposure.
Despite its many advantages, T1-weighted MRI is not without its limitations. For example, it is not as good at visualizing certain types of bone and other hard tissue, which can make it difficult to detect certain types of fractures and other injuries. Additionally, some patients may find the procedure uncomfortable or claustrophobic, as they need to lie still inside a narrow tube for several minutes while the images are being taken. Some people also cannot receive an MRI due to implanted medical devices or other conditions.
Overall, T1-weighted MRI is a powerful imaging technique that can provide detailed images of internal organs, bones, and other structures inside the body. Its ability to distinguish between different types of tissue based on their water and fat content, as well as its ability to detect certain types of tumors and other abnormalities, make it a valuable tool for healthcare professionals. Its lack of ionizing radiation also makes it a safer option for certain patients, while the limitations of T1-weighted MRI include difficulty in visualizing certain types of bone and other hard tissue and being uncomfortable for certain patients.
The human brain is an incredibly complex and intricate organ, consisting of approximately 100 billion nerve cells (neurons) and trillions of supportive glial cells. It is the central control center for the body and is responsible for coordinating and integrating all bodily functions, from basic reflexes and movement to higher cognitive processes such as learning, memory, and decision making.
The brain is divided into three main divisions: the cerebrum, the cerebellum, and the brainstem. The cerebrum is the largest and most complex part of the brain and is responsible for most higher brain functions. It is divided into two hemispheres (left and right), which are connected by a bundle of nerve fibers called the corpus callosum. The cerebrum is further divided into four main lobes: the frontal lobe, parietal lobe, temporal lobe, and occipital lobe.
The frontal lobe is located at the front of the brain and is responsible for a variety of functions including voluntary movement, problem solving, planning, and decision making. The parietal lobe is located behind the frontal lobe and is responsible, among other functions, for processing sensory information from the body, such as touch and temperature. The temporal lobe is located on the sides of the brain and is responsible for processing auditory information and memory. The occipital lobe is located at the back of the brain and is responsible for processing visual information.
The cerebellum is located underneath the cerebrum and is responsible for coordinating voluntary movement and balance. It also connects to the frontal lobes and other brain regions and is involved in most functions. The brainstem is located between the cerebrum and the spinal cord and is responsible for controlling many of the body’s basic survival functions such as heart rate, blood pressure, and breathing.
The brain is surrounded and protected by the skull, which is made up of 22 bones that are fused together. The brain is also surrounded by three layers of protective membranes called meninges. The outermost layer is the dura mater, the middle layer is the arachnoid mater, and the innermost layer is the pia mater.
The brain is supplied with blood by two main arteries: the carotid arteries and the vertebral artery. These arteries branch off into smaller arteries that supply the various regions of the brain with blood.
The brain receives a constant supply of oxygen and nutrients from the blood and removes waste products through a network of tiny blood vessels called capillaries. The brain also has its own system of waste removal called the glymphatic system, which helps to remove waste products such as amyloid beta, a protein that has been linked to the development of Alzheimer’s disease.
One of the most important cell types in the brain are neurons, which are responsible for transmitting information throughout the brain and body. Each neuron has a cell body, dendrites, and an axon. The cell body contains the cell’s nucleus and other organelles, and the dendrites receive signals from other neurons. The axon is a long, thin extension of the cell body that sends signals to other neurons or muscles.
Neurons communicate with each other through a process called neurotransmission. When a neuron receives a signal, it sends an electrical impulse down the axon to the terminal buttons, which release chemical neurotransmitters into the synapse (the small gap between neurons). These neurotransmitters bind to receptors on the dendrites of the receiving neuron, transmitting the signal across the synapse.
In addition to neurons, the brain also contains a variety of other cell types, including glial cells. Glial cells, also known as glia, are non-neuronal cells that provide support and insulation for neurons. There are several types of glial cells, including astrocytes (astroglia), microglia, and oligodendrocytes. There is a growing interest in the functions of glial cells, including their role in neuroinflammation, metabolism, and other functions.
In summary, the brain is complex. It allows us to have life as well as learn from and experience the world around us.
The psychology of happiness is one of the hottest topics in the modern world. This is because people are increasingly looking for ways to improve their mental health and well-being. In this article, we will discuss the psychology of happiness and how it can help us cultivate a more positive attitude toward life. We will look at the definition of authentic happiness, the connection between positivity and happiness, the biology of happiness, and strategies for cultivating happiness. Finally, we will discuss the impact of happiness on our lives and the science behind it.
What is the psychology of happiness? The psychology of happiness is a branch of psychology that focuses on understanding the positive emotions and mental states that are associated with happiness. It involves exploring the ways that people can increase their levels of happiness, as well as understanding the factors that contribute to a person’s overall level of happiness. The goal of this branch of psychology is to help people achieve a higher level of well-being and to understand how to use positive emotions to improve their lives.
The psychology of happiness is a relatively new field of study, but it has already gained popularity among scientists and psychologists. It is based on the idea that happiness is not just an emotion, but a state of being. It is a way of living in which people experience a greater sense of well-being and satisfaction with life.
At its core, the psychology of happiness is focused on understanding how positive emotions can be used to improve mental health and well-being. It also looks at the importance of cultivating positive emotions and how they can be used to increase overall happiness.
Defining authentic happiness Authentic happiness is a term used to describe a state of being that is characterized by a sense of joy, contentment, and satisfaction with life. It is a state of being that is more than just a fleeting emotion, but a mindset and lifestyle that is based on the pursuit of joy and contentment.
Authentic happiness is not dependent on external factors, such as material possessions or recognition. It is based on a person’s internal sense of happiness and well-being. It is a state of being that is based on the idea that happiness is an inside job.
Authentic happiness is closely related to the concept of positive psychology. Positive psychology is a field of study that looks at ways to improve mental health and well-being. It is focused on understanding the factors that contribute to a person’s overall level of happiness, as well as the strategies that can be used to increase it.
Positivity and happiness Positivity and happiness are closely related. Studies have shown that positive emotions can have a powerful effect on our mental health and well-being. People who experience more positive emotions are more likely to be happier and have a better outlook on life.
Positivity can also help us to cope with difficult situations. Studies have shown that more positive people are better able to cope with adversity and persist in the face of challenging circumstances.
There are several ways to increase positivity and happiness in your life. One way is to practice mindfulness, which is a form of meditation that involves focusing on the present moment and accepting it without judgment. Mindfulness has been shown to reduce stress and anxiety and increase feelings of joy and contentment.
Another way to increase positivity is to practice gratitude. Gratitude involves recognizing and appreciating the good things in your life. Studies have shown that people who practice gratitude are more likely to be happier and have a better outlook on life.
Understanding the biology of happiness The biology of happiness is an important part of understanding the psychology of happiness. Our brains are wired to respond to certain experiences and stimuli in a certain way. This is why certain activities, such as exercise, can have a positive effect on our moods.
The brain releases certain hormones and chemicals when we experience positive emotions. These hormones and chemicals, such as dopamine and serotonin, are responsible for the feelings of joy and contentment that we experience when we are happy.
The biology of happiness is closely linked to the concept of positive psychology. Positive psychology is based on the idea that we can use our biology to increase our levels of happiness. By understanding the biology of happiness, we can better understand how to use positive emotions to improve our well-being.
Benefits of cultivating happiness Cultivating happiness has numerous benefits. It can help to reduce stress and anxiety, improve mental health and well-being, and increase overall life satisfaction. It can also help to increase productivity and creativity.
Studies have also shown that cultivating happiness can have a positive effect on physical health. Happier people are more likely to have a healthier lifestyle and to take better care of their bodies.
Finally, cultivating happiness can have a positive effect on relationships. Happier people are more likely to engage in positive interactions with others, which can help to strengthen relationships.
Practical tips for cultivating happiness There are several practical tips that can be used to cultivate happiness. One of the most important tips is to practice mindfulness. This involves focusing on the present moment and accepting it without judgment. Mindfulness has been shown to reduce stress and anxiety and increase feelings of joy and contentment.
Another tip is to practice gratitude. Gratitude involves recognizing and appreciating the good things in your life. Studies have shown that people who practice gratitude are more likely to be happier and have a better outlook on life.
It is also important to engage in activities that make you happy. This could include exercising, spending time with friends, or pursuing hobbies that bring you joy.
Finally, it is important to be kind to yourself. Self-compassion is a powerful strategy for cultivating happiness. It involves treating yourself with kindness and understanding, even when you make mistakes or feel down.
Conclusion In conclusion, understanding the psychology of happiness is a key part of improving mental health and well-being. It involves understanding the definition of authentic happiness, the connection between positivity and happiness, the biology of happiness, and strategies for cultivating happiness. It is important to understand the impact of happiness on our lives and the science behind it. Finally, there are several practical tips for cultivating happiness, such as practicing mindfulness, gratitude, and self-compassion.
Chronic pain is defined as pain that persists for longer than six months. This type of pain can affect a person’s cognitive abilities, emotional well-being, and overall quality of life. It can have a significant impact on the human brain.
One way in which chronic pain affects the brain is by altering its structure and function. Chronic pain can cause changes in the brain’s gray matter, which is the part of the brain responsible for processing sensory information, controlling movement, and controlling everything else we think. Brain changes associated with chronic pain can lead to a changed ability to process and interpret sensory information, as well as a changed ability to control movement. Difficulty concentrating, depression and anxiety, and some memory issues are possible with chronic pain.
Another way in which chronic pain can affect the brain is by altering its neurotransmitter systems. Neurotransmitters are chemical messengers that help transmit signals between neurons in the brain. Chronic pain can cause changes in the levels of neurotransmitters, including serotonin, dopamine, and norepinephrine, leading to an imbalance in the brain’s signaling system. This can result in a range of cognitive and emotional symptoms, such as difficulty with concentration and memory, irritability, and mood changes.
Chronic pain can also have a negative impact on a person’s emotional well-being. It can cause feelings of frustration, anxiety, and depression, which can further contribute to cognitive and emotional symptoms. This can lead to a decrease in overall quality of life, as well as an increased risk of developing mental health disorders such as depression and anxiety.
In conclusion, chronic pain can have a significant impact on the human brain. It can cause changes in the brain’s structure and function, alter its neurotransmitter system, and have negative effects on a person’s emotional well-being. It is important for individuals experiencing chronic pain to seek medical treatment and support to manage their symptoms and improve their overall quality of life.
Sigmund Freud is considered the father of psychoanalysis, a revolutionary approach at the time to understanding the human psyche. His theories and methods, while largely discounted now, have had a profound impact on the field of psychology and continue to influence our understanding of human behavior and emotions.
Freud’s most famous theory is the concept of the unconscious mind, which he believed was the source of many of our thoughts, feelings, and behaviors. He believed that our conscious thoughts are only the tip of the iceberg, with the majority of our mental processes occurring outside of our awareness. One of the most significant contributions of Freud’s legacy is the emphasis on the importance of exploring and understanding the unconscious mind. His theories have paved the way for a deeper understanding of the complexities of the human psyche and have provided insight into why we behave the way we do.
Freud also introduced the idea of repression, where traumatic experiences or uncomfortable thoughts are pushed into the unconscious mind in order to protect the individual from psychological distress. He believed that repressed thoughts and emotions could manifest in various ways, such as through dreams or symptoms of mental illness.
Freud’s theories have also influenced the development of various therapeutic techniques, such as free association and dream analysis. These methods, while with weak scientific evidence at best, are reported to have helped some individuals better understand their own thoughts and emotions, leading to improved mental health and well-being.
Freud’s theories and methods have been both praised and criticized over the years. Some argue that his theories are outdated and not supported by scientific evidence, while others believe that his ideas continue to be relevant and have greatly influenced the field of psychology. His ideas are generally appreciated for their historical influence but are otherwise not generally accepted due to limited scientific evidence to support them.
The legacy of Sigmund Freud is vast and significant. His theories and methods have greatly influenced our understanding of the human psyche and continue to indirectly shape the field of psychology. While his ideas may be controversial, there is no denying the impact they have had on our understanding of the human mind.
Nearly 1 in 7 older adults die within a year of undergoing major surgery, according to an important new study that sheds much-needed light on the risks seniors face when having invasive procedures.
Especially vulnerable are older patients with probable dementia (33% die within a year) and frailty (28%), as well as those having emergency surgeries (22%). Advanced age also amplifies risk: Patients who were 90 or older were six times as likely to die than those ages 65 to 69.
The study in JAMA Surgery, published by researchers at Yale School of Medicine, addresses a notable gap in research: Though patients 65 and older undergo nearly 40% of all surgeries in the U.S., detailed national data about the outcomes of these procedures has been largely missing.
“As a field, we’ve been really remiss in not understanding long-term surgical outcomes for older adults,” said Dr. Zara Cooper, a professor of surgery at Harvard Medical School and the director of the Center for Geriatric Surgery at Brigham and Women’s Hospital in Boston.
Of particular importance is information about how many seniors die, develop disabilities, can no longer live independently, or have a significantly worsened quality of life after major surgery.
“What older patients want to know is, ‘What’s my life going to look like?’” Cooper said. “But we haven’t been able to answer with data of this quality before.”
In the new study, Dr. Thomas Gill and Yale colleagues examined claims data from traditional Medicare and survey data from the National Health and Aging Trends study spanning 2011 to 2017. (Data from private Medicare Advantage plans was not available at that time but will be included in future studies.)
Invasive procedures that take place in operating rooms with patients under general anesthesia were counted as major surgeries. Examples include procedures to replace broken hips, improve blood flow in the heart, excise cancer from the colon, remove gallbladders, fix leaky heart valves, and repair hernias, among many more.
Older adults tend to experience more problems after surgery if they have chronic conditions such as heart or kidney disease; if they are already weak or have difficulty moving around; if their ability to care for themselves is compromised; and if they have cognitive problems, noted Gill, a professor of medicine, epidemiology, and investigative medicine at Yale.
Two years ago, Gill’s team conducted research that showed 1 in 3 older adults had not returned to their baseline level of functioning six months after major surgery. Most likely to recover were seniors who had elective surgeries for which they could prepare in advance.
In another study, published last year in the Annals of Surgery, his team found that about 1 million major surgeries occur in individuals 65 and older each year, including a significant number near the end of life. Remarkably, data documenting the extent of surgery in the older population has been lacking until now.
“This opens up all kinds of questions: Were these surgeries done for a good reason? How is appropriate surgery defined? Were the decisions to perform surgery made after eliciting the patient’s priorities and determining whether surgery would achieve them?” said Dr. Clifford Ko, a professor of surgery at UCLA School of Medicine and director of the Division of Research and Optimal Patient Care at the American College of Surgeons.
As an example of this kind of decision-making, Ko described a patient who, at 93, learned he had early-stage colon cancer on top of preexisting liver, heart, and lung disease. After an in-depth discussion and being told that the risk of poor results was high, the patient decided against invasive treatment.
“He decided he would rather take the risk of a slow-growing cancer than deal with a major operation and the risk of complications,” Ko said.
Still, most patients choose surgery. Dr. Marcia Russell, a staff surgeon at the Veterans Affairs Greater Los Angeles Healthcare System, described a 90-year-old patient who recently learned he had colon cancer during a prolonged hospital stay for pneumonia. “We talked with him about surgery, and his goals are to live as long as possible,” said Russell. To help prepare the patient, now recovering at home, for future surgery, she recommended he undertake physical therapy and eat more high-protein foods, measures that should help him get stronger.
“He may need six to eight weeks to get ready for surgery, but he’s motivated to improve,” Russell said.
The choices older Americans make about undergoing major surgery will have broad societal implications. As the 65-plus population expands, “covering surgery is going to be fiscally challenging for Medicare,” noted Dr. Robert Becher, an assistant professor of surgery at Yale and a research collaborator with Gill. Just over half of Medicare spending is devoted to inpatient and outpatient surgical care, according to a 2020 analysis.
What’s more, “nearly every surgical subspecialty is going to experience workforce shortages in the coming years,” Becher said, noting that in 2033, there will be nearly 30,000 fewer surgeons than needed to meet expected demand.
These trends make efforts to improve surgical outcomes for older adults even more critical. Yet progress has been slow. The American College of Surgeons launched a major quality improvement program in July 2019, eight months before the covid-19 pandemic hit. It requires hospitals to meet 30 standards to achieve recognized expertise in geriatric surgery. So far, fewer than 100 of the thousands of hospitals eligible are participating.
One of the most advanced systems in the country, the Center for Geriatric Surgery at Brigham and Women’s Hospital, illustrates what’s possible. There, older adults who are candidates for surgery are screened for frailty. Those judged to be frail consult with a geriatrician, undergo a thorough geriatric assessment, and meet with a nurse who will help coordinate care after discharge.
Also initiated are “geriatric-friendly” orders for post-surgery hospital care. This includes assessing older patients three times a day for delirium (an acute change in mental status that often afflicts older hospital patients), getting patients moving as soon as possible, and using non-narcotic pain relievers. “The goal is to minimize the harms of hospitalization,” said Cooper, who directs the effort.
She told me about a recent patient, whom she described as a “social woman in her early 80s who was still wearing skinny jeans and going to cocktail parties.” This woman came to the emergency room with acute diverticulitis and delirium; a geriatrician was called in before surgery to help manage her medications and sleep-wake cycle, and recommend non-pharmaceutical interventions.
With the help of family members who visited this patient in the hospital and have remained involved in her care, “she’s doing great,” Cooper said. “It’s the kind of outcome we work very hard to achieve.”
We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues.
The latest covid-19 surge, caused by a shifting mix of quickly evolving omicron subvariants, appears to be waning, with cases and hospitalizations beginning to fall.
Like past covid waves, this one will leave a lingering imprint in the form of long covid, an ill-defined catchall term for a set of symptoms that can include debilitating fatigue, difficulty breathing, chest pain, and brain fog.
Although omicron infections are proving milder overall than those caused by last summer’s delta variant, omicron has also proved capable of triggering long-term symptoms and organ damage. But whether omicron causes long covid symptoms as often — and as severe — as previous variants is a matter of heated study.
Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, is among the researchers who say the far greater number of omicron infections compared with earlier variants signals the need to prepare for a significant boost in people with long covid. The U.S. has recorded nearly 38 million covid infections so far this year, as omicron has blanketed the nation. That’s about 40% of all infections reported since the start of the pandemic, according to the Johns Hopkins University Coronavirus Research Center.
Long covid “is a parallel pandemic that most people aren’t even thinking about,” said Akiko Iwasaki, a professor of immunobiology at Yale University. “I suspect there will be millions of people who acquire long covid after omicron infection.”
Scientists have just begun to compare variants head to head, with varying results. While one recent study in The Lancet suggests that omicron is less likely to cause long covid, another found the same rate of neurological problems after omicron and delta infections.
Estimates of the proportion of patients affected by long covid also vary, from 4% to 5% in triple-vaccinated adults to as many as 50% among the unvaccinated, based on differences in the populations studied. One reason for that broad range is that long covid has been defined in widely varying ways in different studies, ranging from self-reported fogginess for a few months after infection to a dangerously impaired inability to regulate pulse and blood pressure that may last years.
Even at the low end of those estimates, the sheer number of omicron infections this year would swell long-covid caseloads. “That’s exactly what we did find in the UK,” said Claire Steves, a professor of aging and health at King’s College in London and author of the Lancet study, which found patients have been 24% to 50% less likely to develop long covid during the omicron wave than during the delta wave. “Even though the risk of long covid is lower, because so many people have caught omicron, the absolute numbers with long covid went up,” Steves said.
A recent study analyzing a patient database from the Veterans Health Administration found that reinfections dramatically increased the risk of serious health issues, even in people with mild symptoms. The study of more than 5.4 million VA patients, including more than 560,000 women, found that people reinfected with covid were twice as likely to die or have a heart attack as people infected only once. And they were far more likely to experience health problems of all kinds as of six months later, including trouble with their lungs, kidneys, and digestive system.
“We’re not saying a second infection is going to feel worse; we’re saying it adds to your risk,” said Dr. Ziyad Al-Aly, chief of research and education service at the Veterans Affairs St. Louis Health Care System.
Researchers say the study, published online but not yet peer-reviewed, should be interpreted with caution. Some noted that VA patients have unique characteristics, and tend to be older men with high rates of chronic conditions that increase the risks for long covid. They warned that the study’s findings cannot be extrapolated to the general population, which is younger and healthier overall.
“We need to validate these findings with other studies,” said Dr. Harlan Krumholz, director of the Yale New Haven Hospital Center for Outcomes Research and Evaluation. Still, he added, the VA study has some “disturbing implications.”
With an estimated 82% of Americans having been infected at least once with the coronavirus as of mid-July, most new cases now are reinfections, said Justin Lessler, a professor of epidemiology at the University of North Carolina Gillings School of Global Public Health.
Of course, people’s risk of reinfection depends not just on their immune system, but also on the precautions they’re taking, such as masking, getting booster shots, and avoiding crowds.
New Jersey salon owner Tee Hundley, 43, has had covid three times, twice before vaccines were widely available and again this summer, after she was fully vaccinated. She is still suffering the consequences.
After her second infection, she returned to work as a cosmetologist at her Jersey City salon but struggled with illness and shortness of breath for the next eight months, often feeling like she was “breathing through a straw.”
She was exhausted, and sometimes slow to find her words. While waxing a client’s eyebrows, “I would literally forget which eyebrow I was waxing,” Hundley said. “My brain was so slow.”
When she got a breakthrough infection in July, her symptoms were short-lived and milder: cough, runny nose, and fatigue. But the tightness in her chest remains.
“I feel like that’s something that will always be left over,” said Hundley, who warns friends with covid not to overexert. “You may not feel terrible, but inside of your body there is a war going on.”
Although each omicron subvariant has different mutations, they’re similar enough that people infected with one, such as BA.2, have relatively good protection against newer versions of omicron, such as BA.5. People sickened by earlier variants are far more vulnerable to BA.5.
For now, the only surefire way to prevent long covid is to avoid getting sick. That’s no easy task as the virus mutates and Americans have largely stopped masking in public places. Current vaccines are great at preventing severe illness but do not prevent the virus from jumping from one person to the next. Scientists are working on next-generation vaccines — “variant-proof” shots that would work on any version of the virus, as well as nasal sprays that might actually prevent spread. If they succeed, that could dramatically curb new cases of long covid.
“We need vaccines that reduce transmission,” Al-Aly said. “We need them yesterday.”
Human emotions are powerful. From love and joy to fear and anger, our emotions have the ability to impact almost every aspect of our lives and even determine how we respond to life’s challenges. And while it may seem like emotions are beyond our control at times, the truth is that whether we feel good or bad on any given day is within our power. The way you feel on any given day has a lot to do with your perception—how you see things—and not necessarily the events themselves. For example, if you read a news article and think, “This news makes me sad;’ then, chances are you’ll also feel sad for the rest of that day. But what if instead of thinking about the news as “making” you sad, you recognized it as sad but not something you can control or that can control you. Chances are you will remain happier that day. This goes for anything in life. If you change your perception from negative to positive, almost all bad events will seem less challenging and more manageable. This can be accomplished by taking control of your responses and not seeing events as “making” you do or feel something.
How to Stay Positive in a Negative World
Our world can be a challenging place sometimes, and when we are met with negative people, situations, and emotions, it can be easy to fall into negative thinking and feeling. However, as you work to stay positive, it is important to remember that all situations and emotions can be interpreted differently. Although they may appear to be negative, they are only that way if we allow them to be. When we start to view negative events and situations as neutral, we begin to have more choice in how we respond to them and how we let them affect us. Instead of letting negative emotions take over and cause us to fall into a spiral of negativity, we can choose to let them exist, acknowledge them, and simply walk on by.
One of the best ways to keep your mind focused on positivity is through mindfulness. Mindfulness is a practice that has come from many different cultures and traditions, and it has been shown to provide many positive benefits in mental health, including the ability to stay focused and positive. When you practice mindfulness, you bring your attention to the present moment in an open, non-judgmental way. This helps you to view negative thoughts as just that—thoughts—and nothing more. You can then choose to let them pass through your mind without holding onto them or allowing them to affect your mood.
Commit to Positivity
One of the best ways to stay positive is to commit to it. When you commit to positivity, you choose the importance of your well-being. This kind of commitment can help you to focus on the things that are good in your life and that support your mental health. In turn, this commitment to positivity will help you to overcome negative thoughts and emotions when they do arise. If you decide that staying positive is truly important to you and you are ready to commit to it, you can create your own personal plan to help you stay on track. There are many different ways you can do this, and it may take some time before you feel like you have the right formula that works for you. Make your own small goals to help you practice positivity each day.
Finding Meaning in Everything
When you focus on the positive, it’s important not to ignore the negative, but rather to see it as an opportunity to find meaning. You can find positive meaning in all situations, even those that appear negative. For example, if you lose your job, you can find a positive meaning in it by realizing that now is a time to pursue your dream job or to improve your skills or change careers. If a loved one is diagnosed with a serious illness, you can find a positive meaning in it by realizing that you have a chance to become closer as a family and make the most of the time you have left with them. That doesn’t remove the pain or hardship but it does allow for flashes of joy and learning. Every situation holds an opportunity for positive meaning, and it’s up to you to see it that way.
When you are feeling down or anxious, remember that your emotions are not permanent. It can sometimes be difficult to see this when you are in the middle of a challenging situation, but once you are out of the situation, you will see that you can let those emotions go and move on from them. Remember that your emotions are connected to your perception and that how you choose to perceive situations can have a huge impact on how you feel. When you are faced with a difficult situation, take a step back, take a deep breath, and ask yourself what you can learn from the situation and how you can use that to make your life better in the future. When you stay positive and use your emotions to your advantage, you are better able to cope with life’s challenges and have a more fulfilling life.
Dr. Keith Corl was working in a Las Vegas emergency room when a patient arrived with chest pain. The patient, wearing his street clothes, had a two-minute exam in the triage area with a doctor, who ordered an X-ray and several other tests. But later, in the treatment area, when Corl met the man and lifted his shirt, it was clear the patient had shingles. Corl didn’t need any tests to diagnose the viral infection that causes a rash and searing pain.
All those tests? They turned out to be unnecessary and left the patient with over $1,000 in extra charges.
The excessive testing, Corl said, stemmed from a model of emergency care that forces doctors to practice “fast and loose medicine.” Patients get a battery of tests before a doctor even has time to hear their story or give them a proper exam.
“We’re just shotgunning,” Corl said.
The shingles case is one of hundreds of examples that have led to his exasperation and burnout with emergency medicine. What’s driving the burnout, he argued, is something deeper — a sense of “moral injury.”
Corl, a 42-year-old assistant professor of medicine at Brown University, is among a growing number of physicians, nurses, social workers and other clinicians who are using the phrase “moral injury” to describe their inner struggles at work.
The term comes from war: It was first used to explain why military veterans were not responding to standard treatment for post-traumatic stress disorder. Moral injury, as defined by researchers from veterans hospitals, refers to the emotional, physical and spiritual harm people feel after “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.”
Drs. Wendy Dean and Simon Talbot, a psychiatrist and a surgeon, were the first to apply the term to health care. Both wrestled with symptoms of burnout themselves. They concluded that “moral injury” better described the root cause of their anguish: They knew how best to care for their patients but were blocked from doing so by systemic barriers related to the business side of health care.
That idea resonates with clinicians across the country: Since they penned an op-ed in Stat in 2018, Dean and Talbot have been flooded with emails, comments, calls and invitations to speak on the topic.
Burnout has long been identified as a major problem facing medicine: 4 in 10 physicians report feelings of burnout, according to a 2019 Medscape report. And the physician suicide rate is more than double that of the general population.
Dean said she and Talbot have given two dozen talks on moral injury. “The response from each place has been consistent and surprising: ‘This is the language we’ve been looking for for the last 20 years.’”
Dean said that response has come from clinicians across disciplines, who wrestle with what they consider barriers to quality care: insurance preauthorization, trouble making patient referrals, endless clicking on electronic health records.
Those barriers can be particularly intense in emergency medicine.
Corl said he has been especially frustrated by a model of emergency medicine called “provider-in-triage.” It aims to improve efficiency but, he said, prioritizes speed at the cost of quality care. In this system, a patient who shows up to an ER is seen by a doctor in a triage area for a rapid exam lasting less than two minutes. In theory, a doctor in triage can more quickly identify patients’ ailments and get a head start on solving them. The patient is usually wearing street clothes and sitting in a chair.
These brief encounters may be good for business: They reduce the “door to doc” time — how long it takes to see a doctor — that hospitals sometimes boast about on billboards and websites. They enable hospitals to charge a facility fee much earlier, the minute a patient sees a doctor. And they reduce the number of people who leave the ER without “being seen,” which is another quality measure.
But “the real priority is speed and money and not our patients’ care,” Corl said. “That makes it tough for doctors who know they could be doing better for their patients.”
Dean said people often frame burnout as a personal failing. Doctors get the message: “If you did more yoga, if you ate more salmon salad, if you went for a longer run, it would help.” But, she argued, burnout is a symptom of deeper systemic problems beyond clinicians’ control.
Emergency physician Dr. Angela Jarman sees similar challenges in California, including ER overcrowding and bureaucratic hurdles to discharging patients. As a result, she said, she must treat patients in the hallways, with noise, bright lights and a lack of privacy — a recipe for hospital-acquired delirium.
“Hallway medicine is such a [big] part of emergency medicine these days,” said Jarman, 35, an assistant professor of emergency medicine at UC-Davis. Patients are “literally stuck in the hallway. Everyone’s walking by. I know it must be embarrassing and dehumanizing.”
For example, when an older patient breaks an arm and cannot be released to their own care at home, they may stay in the ER for days as they await evaluation from a physical therapist and approval to transfer to rehab or a nursing home, she said. Meanwhile, the patient gets bumped into a bed in the hallway to make room for new patients who keep streaming in the door.
Being responsible for discharging patients who are stuck in the hallway is “so frustrating,” Jarman said. “That’s not what I’m good at. That’s not what I’m trained to do.”
Jarman said many emergency physicians she knows work part time to curtail burnout.
“I love emergency medicine, but a lot of what we do these days is not emergency medicine,” she said. “I definitely don’t think I’ll make it 30 years.”
Also at UC-Davis, Dr. Nick Sawyer, an assistant professor of emergency medicine, has been working with medical students to analyze systemic problems. Among those they’ve identified: patients stuck in the ER for up to 1,000 hours while awaiting transfer to a psychiatric facility; patients who are not initially suicidal, but become suicidal while awaiting mental health care; patients who rely on the ER for primary care.
Sawyer, 38, said he has suffered moral injury from treating patients like this one: A Latina had a large kidney stone and a “huge amount of pain” but could not get surgery because the stone was not infected and therefore her case wasn’t deemed an “emergency” by her insurance plan.
“The health system is not set up to help patients. It’s set up to make money,” he said.
The best way to approach this problem, he said, is to help future generations of doctors understand “how decisions made at the systems level impact how we care about patients” — so they can “stand up for what’s right.”
Whether these experiences amount to moral injury is open for discussion.
Cynda Rushton, a nurse and professor of clinical ethics at Johns Hopkins University, who has studied the related notion of “moral distress” for 25 years, said there isn’t a base of research, as there is for moral distress, to measure moral injury among clinicians.
But “what both of these terms signify,” Rushton said, “is a sense of suffering that clinicians are experiencing in their roles now, in ways that they haven’t in the past.”
Dean grew interested in moral injury from personal experience: After a decade of treating patients as a psychiatrist, she stopped because of financial pressures. She said she wanted to treat her patients in longer visits, offering both psychotherapy and medication management, but that became more difficult. Insurers would rather pay her for only a 15-minute session to manage medications and let a lower-paid therapist handle the therapy.
Dean and Talbot created a nonprofit advocacy group called Moral Injury of Healthcare, which promotes public awareness and aims to bring clinicians together to discuss the topic.
Their work is attracting praise from a range of clinicians:
In Cumberland County, Pennsylvania, Mary Franco, who is now 65, retired early from her job as a nurse practitioner after a large corporation bought out the private practice she worked in. She said she saw “a dramatic shift” in the culture there, where “revenue became all-important.” The company cut in half the time for each patient’s annual exam, she said, down to 20 minutes. She spent much of that time clicking through electronic health records, she said, instead of looking the patient in the face. “I felt I short-shrifted them.”
In southern Maine, social worker Jamie Leavitt said moral injury led her to take a mental health break from work last year. She said she loves social work, but “I couldn’t offer the care I wanted to because of time restrictions.” One of her tasks was to connect patients with mental health services, but because of insurance restrictions and a lack of quality care providers, she said, “often my job was impossible to do.”
In Chambersburg, Pennsylvania, Dr. Tate Kauffman left primary care for urgent care because he found himself spending half of each visit doing administrative tasks unrelated to a patient’s ailment — and spending nights and weekends slogging through paperwork required by insurers.
“There was a grieving process, leaving primary care,” he said. “It’s not that I don’t like the job. I don’t like what the job has become today.”
Corl said he was so fed up with the provider-in-triage model of emergency medicine that he moved his ER clinical work to smaller, community hospitals that don’t use that method.
He said many people frame burnout as a character weakness, sending doctors messages like, “Gee, Keith, you’ve just got to try harder and soldier on.” But Corl said the term “moral injury” correctly identifies that the problem lies with the system.
“The system is flawed,” he said. “It’s grinding us. It’s grinding good docs and providers out of existence.”
Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.
Years ago I wrote an essay about the death of psychotherapy. While I did not state that psychotherapy is currently dead, I did state that much of it might die in the wake of advances in understanding the neurobiology of psychological disorders. It will take decades for these advances to occur (if they ever do) so this post will now serve to balance my post from years ago.
I’m going to start with a story about two people (these are based on real events but names, situations, and identifying details have been changed to protect confidentiality). Jim was convicted of a violent crime and spent a number of years in prison. He was required to attend treatment throughout his years in prison – anger management and other therapies. He had a history of alcohol and drug abuse. A while after he got out of prison, he started therapy again to help him through some difficulties, including his experiences with homelessness. Jim was a very pleasant person to interact with; he was well-read and insightful. He was trying to improve his life.
The second person was named Frank. He was also homeless but was staying with a friend. He had past drug and alcohol abuse but had been free from drugs for about a year. He was anxious, paranoid, and not the most pleasant person to interact with. He had never received treatment for depression, which he experienced chronically and severely. He exhibited little insight into his problems. He thought the negative events in his life were all someone or something else’s fault.
The first patient had learned a lot from his psychotherapy over the years. The second never had therapy. While they were very different people, they experienced similar challenges and psychological issues over the years. Without disregarding individual differences, the patient who had had years of therapy had a lot of insight and self-knowledge but the other patient had very little.
Jim had been a violent man but over the years and through therapy, he learned a great deal of self-control and restraint. Psychotropic medications could not have taught Jim this. For him, psychotherapy was highly successful. Without out it he might not have been the pleasant person that he was.
Therapy teaches you skills; it gives you tools to deal with maladaptive thoughts and behaviors. It allows you opportunity to sort through your experiences and thoughts in a safe place. It allows to to talk to someone else without being judged. Therapy is thus treatment and education. It can have as strong or stronger effects on mood and behavior as medications and the benefits can last longer. Understanding biology is necessary to understand behavior but it is not sufficient to explain all behavior, at least not with our current knowledge. Will we ever had sufficiently advanced knowledge of neuroscience and biology to no longer need psychotherapy? I don’t know but if we do, it won’t happen for many years.