Living, ranting, loving

Yet again, I was right; or, how to completely drop the ball in psychiatry.

2013-04-20T10:29:41Z

For the most part, this hospitalization has been a nightmare. With the exception of one week where I actually felt good and functioned properly, it's been a string of therapists and doctors telling me to snap out of it (in one form or another), blaming me for all my problems (in one form or another), and failing to meet my expectations (in many forms).

Now I actually have proof of it.

See, a while back, I had a severe reaction to a very small dose of an anxiolytic/amnesic/sedative/hypnotic/anticonvulsant/antiemetic/muscle relaxant known as lorazepam, here in Israel known as Lorivan and in the States/Canada as Ativan. It was after an anxiety attack brought on by the incredible stupidity of both my peers and my teacher (who has since graciously retired) in a class on depression an suicide. As per protocol, I took my "as needed" dose of lorazepam, and within a few minutes, I was unable to move my limbs, my speech slurred, and I was taken from the nursing school to the ER until the drug left my system, a little over five hours later. Notably, this was about five months after my heart attack, so nobody was taking chances.

That was then. This is now.

I've been hospitalized at Kfar Shaul Mental Health Center for two months now. I've actually had a similar reaction under the same type of drug - clonazepam (aka Klonopin/Rivotril/Clonex) while here, where my limbs went completely numb and I couldn't stand up. The head of the department accused me of grandstanding.

Wednesday evening, brought on by a bad mix of rage, depression, hopelessness, and suicidal thoughts, I went down to the nurses' station and ranted about how I'm not getting the proper treatment, that I'm not getting better, that they're releasing me within a week without actually doing anything to better my situation, that I'm ready to steal the guard's gun to put a bullet through my head to end the incredible pain that I'm in. This landed me in the closed ward, whether I was going to agree with it or not.

In the closed ward, I showed all of the nurses the bag that contained my past file, which included the full report on the aforementioned ER visit. My valuables were taken from me for safekeeping (I did get them back later), my suitcase locked in a small storeroom, and I was allowed to keep my backpack, for which I was given a locker.

Later that evening, one of the nurses came up to me after drug distribution with a syringe, telling me that he was going to inject me with 4mg lorazepam. That's eight times the dose that landed me in the ER three years ago. I flipped out, and told him that if the hospital wants to kill me, I'd rather do it myself. Several minutes later, after a heated argument over whether or not the idiot doctor that prescribed such a potentially lethal injection read my file, he returned with a different needle, this time with promethazine 50mg (aka Phenergan): a high dose, but something I could probably handle, having had half that dose on a previous unrelated ER visit.

Boy, did it knock me out. I was a zombie well into Friday evening. I barely remember the round-table discussion with the head of the department, my personal psychiatrist, another senior psychiatrist, and the head nurse, when they extended my stay by a week and brought me back to my old ward.

Saturday morning, once I finally found the energy and courage to get out of bed, I went through my stuff, and I found the file that contained that ER report. It was in my suitcase that was locked in the storeroom. Nobody ever looked inside the file, as it was locked away before any doctor would have seen it. So that potentially lethal dose of lorazepam was considered an option, because nobody knew otherwise - despite it being clearly laid out in that ER report.

Laughably, now that I reread the post mentioned above, I said then, "Sadly, Israel is still in the stone age as far as psychiatry is concerned." I guess it still is.

"It gets better"? Try being a psychiatric patient.

2013-03-08T07:56:44Z

Here's the problem that I had with the whole "It gets better" thing for LGBT youth from a few years back. Yeah, it might get better. But right now, I can't see past the fact that I haven't seen my daughers in two weeks, that my career in nursing is yet again in serious jeopardy, that I had to drop out of Hairspray (why haven't you seen it yet?!), that I'm not in the comfort of my own home with the comforts found in my own home, that I'm plagued by unpredictable, indescribable, immeasurable, illogical, incessant, unrelenting pain that comes from absolutely nowhere, that every single little stimulus turns into an amplified screeching forcing me to switch to the worst possible "fight" survival mode, that there is no cure for all this hell I'm going through, and that I don't want to live another minute if it means suffering like this.

So thank you for your "it gets better" message of hope and happiness and unicorn farts and Care Bear ejaculate. But I can't see past that right now I'm dying inside, and whatever energy I'm not wasting trying to ward off how shitty I feel, I'm using it to make sure that I don't actually die.

You want to help? Volunteer at psychiatric hospitals. Get to know patients like me who are in so much pain that they don't want to live anymore. Start to understand that just because you can't see it, and the patient looks outwardly normal and can even act outwardly normal at times, does not mean that everything's A-OK. Learn a little about psychiatry, about how our brain communicates with itself and how it can go horribly, terribly wrong. If you can afford it, donate to psychiatric research, because we're really fucking drowning here.

Speak to the families of these patients and offer them comfort, because they suffer the external signs of the daily crap that their loved ones go through. I love my wife and kids inversely exponentially to how much I hate my disease, but that still doesn't protect them from my outbursts.

And for fuck's sake, I'm bored out of my mind here. Come visit me. I need to see my friends, at the very least to know they care enough about me to recognize that my illness is no less severe than the heart attack I had two and a half years ago. Kfar Shaul Psychiatric Hospital, Machleket Bet. Get yourself to the Har Nof bus terminal (bus lines 8a, 33, 52, 55, 60, 64, 67, 74, 75) and you can get here. Weekdays between 4-9pm, Fridays and Shabbat 8am-10pm. Call me before you show up. Bring food or games, or just yourselves.

Just don't load me with the bullshit of "it gets better". I'm not nearly close to the point where I can believe in that load of shit. That goes double for any mention of God, who is so high on my shit list right now.

Another mass shooting by another psycho

2012-12-16T11:28:25Z

"In the wake of another horrific national tragedy, it’s easy to talk about guns. But it’s time to talk about mental illness."

Mental illness is the elephant in the room that nobody wants to talk about. I hate every single time that these massacres are perpetrated by someone with mental illness because it feeds even more into the stigmatization. And yet, if we don't start talking about mental illness, and if we don't stop the mercilessly cruel stigmatization of it, then we will be doomed to repeat these massacres, time and time again.

I do not identify with the massacre committed, but quite unfortunately, yet again, I am forced to identify with the perpetrator - much like I did with Eric Harris and Dylan Klebold of the Columbine massacre, when, at the time, I myself was a lost teenager in high school, depressed, picked on, and into violent video games. So too the mother who wrote the post linked above, but in her case, it is her son that resembles these perpetrators.

Enable access to proper mental health care, and you break the random outbursts of violence. But then, that would require having a functioning health care system in the first place...

Seriously scaling down my Facebook presense

2012-11-24T20:08:50Z

Recently a study was released by Carsten Grimm, a postgraduate psychology researcher at University of Canterbury in Christchurch, New Zealand, that presents some pretty damning conclusions as to what makes us happy. Read the given link, which is a press release directly from the university, and has a lot more information than the other articles online about the study.

Atheists and party people are proclaiming that "Sex and alcohol bring more happiness than religion? No shit." Religious folk and parenting groups are decrying that people are less interested in what gives meaning to life. The internet, in its usual fashion, has taken an otherwise serious study, and plastered the only results they care about.

What nobody is reporting is to me, one of the most damning conclusions this study receives. So first, the full table, as seen on the UC Press Release:

Average Momentary Ratings of Daily Behaviours

Top-ranked:Behaviour	Pleasure	Meaning	Engagement	Happiness
Sex/ making love	1st	1st	1st	1st
Drinking alcohol/ partying	2nd	10th	5th	2nd
Care-giving/ volunteering	9th	3rd	6th	3rd
Meditating/ religious activities	8th	2nd	7th	4th
Childcare/ playing with children	10th	4th	11th	5th
Listening to music/ podcast	3rd	17th	13th	6th
Socialising/ talking/ chatting	5th	11th	10th	7th
Hobbies/ arts/ crafts	4th	5th	4th	8th
Shopping/ errands	15th	16th	16th	9th
Gaming/ video-games	6th	24th	9th	10th
Lower-ranked
Washing/ dressing/ grooming	22nd	29th	30th	21st
Internet/ on computer	20th	28th	21st	22nd
Commuting/ travelling	27th	23rd	29th	23rd
Paid work	26th	15th	17th	24th
Lectures/ class/ lab	23rd	8th	15th	25th
Texting/ emailing	21st	18th	18th	26th
Studying/ working on education	28th	7th	14th	27th
Housework/ chores/ DIY	29th	27th	27th	28th
Facebook	24th	30th	28th	29th
Sick/ healthcare	30th	25th	25th	30th

Note. Behaviours ranked from highest to lowest on happiness. There were 30 behaviour categories in all; the highest and lowest 10 behaviours on happiness are shown.

I contacted the graduate student who researched this, out of my morbid curiosity as to what was his actual intention, his sample size, and how the research was conducted. Part of what I e-mailed him:

While the internet is laughing it up over the triumph of sex and alcohol over kids and religion, I had a very sobering moment noting the ranking of Facebook. This especially since Facebook was in a separate category from closely related behaviours: "Socialising/ talking/ chatting", "Internet/ on computer", and "Texting/ emailing" - the latter two also ranked on the bottom 10 of the "Happiness" category. I am far from a Luddite, but at the same time I recognize that the less I'm on the computer means the more time I have to spend with my wife and twin 3.5 year old daughters, which to me is infinitely more meaningful than reading up on what 350 of my friends are doing.

He responded in kind with this:

Summary of research: Orientations to happiness and daily well-being.

I believe we need to become more sophisticated in our conversation about happiness. Psychologists are now able to identify that the things that add to our life satisfaction - the cognitive assessment of how we are doing, all things considered - are not necessarily the same things that contribute to our daily well-being (see Kahneman & Deaton, 2010, for an excellent example of this). Understanding those differences, and their implications for our societies, is one of my research interests.

Psychologists (Peterson, Park, and Seligman, 2005) have proposed that individuals may seek to increase their well-being through three main behavioural orientations; via pleasure, via engagement, and via meaning. Endorsing pleasure as a way to happiness means you may focus on feeling good and enjoying sensory pleasures; you are more likely to endorse a statement such as "I enjoy eating dessert first”. Engagement is what you experience when you are totally absorbed in what you are doing; either skiing down a hill or being immersed in your work. Psychologists call this experience a state of “flow” and this may be a dominant orientation to happiness for some people. Having meaning in your life is also a way to pursue happiness; being part of something bigger and contributing to the greater good. It may be that we all have our own blend of orientations to pursuing the good life for us as individuals.

In the current research, 173 participants completed all online personality questionnaires and an acceptable number of text-message replies (≥15 of 21 messages; 71%). Participants received three text-messages (SMS) per day for 7 days, random within each interval in the morning (9am- 12pm), afternoon (1pm – 5pm) and evening (6pm – 10pm). Messages asked participants to say what they were doing at that moment, who they were with, and a rating of the current activity using their phone’s keypad (where 1 = not at all; 5 = moderately; 9 = extremely) of pleasure, meaning, engagement, and momentary happiness.

The age range was 17 - 58, average age was 23. This is therefore a young—and completely non-representative—sample, and younger people tend to be more orientated towards pleasure (Steger, Oishi, & Kashdan, 2009). Caution should therefore be exercised when interpreting the specific behaviour rankings from this one piece of work. Nevertheless, there are some interesting things going on in the composition of pleasure, meaning, and engagement in the daily lives of the participants in this study. For example, gaming (video-games) rated relatively high on pleasure and engagement, but was near the bottom of 30 behaviour categories on average meaning. The reverse is found also; where studying (working on education) was low on pleasure, it was relatively high on meaning. I think the results contribute to the perspective that we can think in more sophisticated terms about the composition of what we are getting out of our daily lives in terms of well-being.

I also found that people who endorsed all three orientation to happiness dimensions—pleasure, meaning, and engagement—tended to be high not only on life satisfaction, but also in daily well-being, ie. how much pleasure, meaning, engagement, and happiness they experienced during the day. This provides some evidence at the daily experiential level of what has been termed ‘the full life’ (Peterson, Park, & Seligman, 2005).

As a personal example of this from my own experience; I tend to score high on an orientation to meaning—which is great for me and serves me well—but I think I could be better at "balancing my happiness portfolio" (my expression). Perhaps if I paid a bit more attention to savouring techniques I could lift my pleasure orientation and I would potentially see that show up in my daily well-being.

I am excited about ways we can inform our understanding of what matters using innovative research, especially as a way of informing policy about what counts in our lives, and what we should be focusing on measuring and understanding. The methodology used in this study is called “experience sampling”. I think this method is a rich and powerful way to get a window into our daily well-being and I am excited about the future possibilities using this technique. In summary, I think the results contribute to the perspective that we can think in more sophisticated terms about the composition of what we are getting out of our daily lives in terms of well-being.

Here's where I step in.

I have issues with Facebook. Personally, with Facebook, Inc., the people I keep in contact with over Facebook, and the groups that I've joined. And I've tried quitting Facebook before, and it was a bit of a bust, because I hadn't clearly defined my quitting terms beyond "cold turkey, no more." Needless to say, it didn't take long until I was back on. Certain friends are absolutely right in pointing this out as I'm about to take another voluntary break from Facebook.

Being realistic, I use Facebook for one of four reasons:

To keep in contact with friends that I would otherwise have no contact with. This usually includes friends and family overseas that I don't see on a regular basis. There are some friends from Toronto that if it wasn't for Facebook, I would have completely fallen out of touch with them. This, to me, is the greatest thing about using Facebook, hands down. It is a one-stop platform from which I can easily maintain friendships that span several time zones.
To keep in touch with local friends that I see on a regular basis or can simply call. Because let's face it, the phone is ancient technology, and nobody SMSes anymore when you can just do it through Facebook. Plus, it's a great way to keep everyone up to date on what you last ate, what you're making for dinner, and that funny little anecdote about your most recent social disaster.
Social media as a marketing platform. This month's Movember was a bit of a bust for me because of, well, that whole war thing. But if it wasn't for that, and if my personal health were to be a little more stable, you better believe that I'd be posting daily about Movember, while networking contacts so that I could help Israel gain official country status for next year's Movember. Likewise, Hairspray Jerusalem, which is going to be the most kickass show you'll ever see not on Broadway.
For teh lulz. I am addicted to internet comedy, and that is, without any softening of terms, a Bad Thing (tm). Let's face it, as funny as the latest meme is, my kids are that much funnier. And while I love the awfulness of internet comedy, and the terrible black humour that comes out of it, it's time for me to shift my focus.

Keeping all of this in mind, as well as my building contempt for how Facebook, Inc. treats their users (see: Privacy policy changes, interface changes, marketing schemes, etc.), I'm quitting Facebook until I have a break between my last exam until the start of the next semester, with the following terms:

No non-networking, non-help-asking, non-big-personal-news posts.
No more gratuitous linking, resharing of lulz or news or whatever, no posting of the latest funny thing that the kids did.
I will only read my friends feed once a week, for one hour only.
I will not respond to anything that's non-networking, non-help-asking, non-big-personal-news posts, unless it's a simple "Like".
Anything that y'all deem to be super-important for me to read, tag me. I may or may not respond.
The only Facebook app I will keep on my phone will be Messenger. I would prefer if you contacted me by WhatsApp.
I may use Facebook for things that are necessary to my school and my volunteer activities. This includes Movember and Hairspray. All attempts will be made to make sure nothing else gets added to that list.

Wish me luck.

The current war.

2012-11-16T07:17:28Z

When New Jersey was hit by Hurricane Sandy, it was disastrous, many people were injured, some dead, there was billions of dollars worth of destruction, and it barely made a dent in the national psyche. Then Manhattan got smacked, and the whole world listened.

Replace "Jersey" with "the South" and "Manhattan" with "Tel Aviv", and that's the feeling in Israel today.

Tel Aviv and Jerusalem were supposed to be the "safe" areas, where people from the South could come because we invited them here and it's safer here.

Not so much so now.

At the same time, the ratio of rockets falling in the South to the Center is roughly 50:1.

Another long-winded post on vaccinations.

2012-11-06T16:04:44Z

A friend of mine posted a link recently to an article about vaccines causing autism-like symptoms in macaques. I responded in kind with my Google-fu coming up with this being a very old story.

Subsequently, I think I might have offended said friend when I referred to parents that don't vaccinate their children as abusive. So here's an extended, open, and honest response.

I understand that my opinion that parents who don't vaccinate their children are effectively abusing their children by denying them basic health care is not a popular one. Call it fear-mongering, call it cruel and manipulative, call it whatever you want. I've yet to be able to soften that view, and I'm not so sure I really want to, because besides being a threat to their own child's health, these anti-vaccination parents are a threat to _my_ children's health.

It's one thing if a child is unable to receive a vaccination because of health issues. Both of the twins had some of their vaccination schedules delayed because of various health issues in their first year, but in the end they both got it. If a child has a specific allergy to a component of the vaccine, I get that too.

What I don't get is religious objection to medical treatment. Whether it's Jehovah's Witnesses refusing blood transfusions, parents who prefer to pray for their child rather than give them life-saving treatment, or parents that insist on pushing off critical medical procedures because it's Shabbat, I just can't wrap my mind around that as a parent, a religious person, and as a human being. I am, on the whole, very tolerant of any religious fanaticism there is out there, even when its within my own religion. Once fanaticism starts to cross the line between crazy and life-threatening, that's when my survival instinct jumps in.

With vaccinations, a mix of my knowledge of the science behind it and my parental instinct play into my vehemence that it is wrong, dead wrong, dangerous, and cruel to not vaccinate one's children. Wakefield's "research", and that of his accomplices, has caused untold damage to the vaccination cause. It's not just bad science, it's criminal, evil, and life-threatening.

So here's the very simple fact of vaccinations: They work to prevent the spread of dangerous and harmful diseases. If everyone's vaccinated, we can eliminate certain diseases that have plagued this planet for millions of years - like we did with smallpox, like we're almost at with polio. All diseases come with complications, and it's not worth risking any lives over it. This includes chicken pox and the more recent H1N1 "swine flu". People can die from these diseases, and if the disease itself doesn't kill them, it can seriously cripple them for life, ultimately cutting their lifespan much shorter than it would be if they were immune.

Aside from direct complications, there's also the mutation issue. Fact is, viruses and bacteria, much like every other organism, will do anything to survive. Sometimes, a large amount of luck (or divine providence, your choice) is involved, and the organism's genetic code mutates to allow for an advantage that would help them survive. An obvious case in point is the case of antibiotic-resistant bacteria, commonly known as superbugs. Methicillin-resistant Staphylococcus aureus, abbreviated as MRSA, is one such superbug. MRSA developed shortly after the introduction of the antibiotic Methicillin, around 1960. All it took was for one bacterium of Staph A to mutate, and then it survived over all its brethren to infect and spread. The theory goes that if the initial Staph A infection was treated before the mutation, or better yet, prevented through vaccine, then the Staph A wouldn't have a chance to develop into MRSA, and in turn wouldn't be perpetuated to other patients through cross infections.

In vaccinations, there is a concept of "herd immunity". The idea is that if enough of a certain population is immune to a certain disease, then those that aren't immune are much less likely to be infected. The problem with this concept is that if one non-immune individual gets infected, that opens a window of opportunity for the infectious agent (virus, bacteria, whatever) to mutate. Mutations could mean the infectious agent will be immune to drugs that fight it, or worse yet, that those immune to the original infectious agent will no longer be immune to the new strain. So from the non-immune individual spreads the mutated infectious agent to otherwise immune people, and voila, a new epidemic appears.

This is not science fiction, though it has been portrayed in many different media as such (Outbreak is an excellent example, and an awesome movie for reasons other than Dustin Hoffman and Cuba Gooding Jr.). This is a reality that exists. In our global village, diseases spread worldwide with alarming speed (eg swine flu, SARS). So when I hear that someone doesn't vaccinate their children, I, like any parent, lose all sense of rationality and only see a potential threat to my child's health and well-being.

A personal anecdote: Last year, I came down with a freak case of shingles. This happens on rare occasion to adults who had chickenpox when they were younger, is usually localized, and still very contagious. Both girls had already received their chickenpox vaccinations, but despite this, Eliana came down with a case of it. Here's the gist - if she wasn't vaccinated, she would have been a prime candidate to develop complications. The chickenpox vaccine protects against the more virulent strains of the disease that can cause permanent damage, disability, and death, and lowers the potential damage caused in the event of infection. So while there's the issue of preventing parents from losing work, much more importantly than that is that it also potentially prevents parents from having to bury their child. And even if Wakefield (yimach sh'mo) was right, I'd rather my children have autism and live than die because I didn't vaccinate them.

Rosh Va'ad Bayit

2012-07-23T07:58:30Z

After four frustrating years of not having a proper va'ad bayit in our building, I'm taking on the responsibility of being the head of our va'ad bayit in our building. I did this once before, but it was barely payed any lip service. Now we have two renters in our building that are used to the concept of having a va'ad bayit that actually *gasp* makes sure that the stairwell is cleaned every week and *double gasp* doesn't let a single night go by without having the necessary lighting in the stairwell, barring large power outages that affect multiple apartments/buildings.

Anyhoo, I have a few questions. Since I'm too lazy to google them each individually, I'm going to turn to my internet hive-mind for help.

Do va'ad bayits get to open a bank account? Get a credit card?

Is it normal to slightly overcharge each month for va'ad bayit so as to generate savings? What's normal for this?

How much does a stair room cleaner cost? Where would I go about finding one?

How do I deal with renters? Their landlords?

How do I deal with people who refuse to pay?

How important is it to sign up with Aguda L'Tarbut Hadiyur?

What do I do about big projects like replacing our front door, painting, and redoing our lighting system?

How can I enforce order, if not cleanliness, in the stairwell? Especially for the downstairs bomb shelter.

Anything else in particular I need to know?

Super-Pharm's removal of women from ads

2012-07-11T18:21:51Z

I had originally prepared a post with plenty of opinionating, and have since decided against it. The simple story is that I had a day off of work, and spurred on by the recent Facebook uproar that Super-Pharm is removing a female model from their ads in Jerusalem, I decided to do some investigation of my own. What follows are the pictures of various Super-Pharm ads and stores in Jerusalem, with brief explanations of the demographics of the areas in which the pictures were taken.

If there is someone willing to translate this to Hebrew, then please feel free. I'm writing in English because it's my mother tongue and despite my near-fluency in Hebrew, I do not feel comfortable enough with the language to do it myself (read: I don't have the time or energy to translate).

This map shows the path I took:

Numbers will correspond to particular picture sets. (Credit goes to an anonymous friend for helping me with the map file. She put two screenshots together seamlessly, I messed up the rest. Wow, do I suck at graphics.) All pictures will have an alt-text with the timestamp from my phone. All pictures were taken on Tuesday July 10, 2012. The photos have been completely untouched except for necessary rotation.

1. Intersection of Palmach, Fichman, and Shai Agnon
This ad is in a residential neighborhood that has little to no ultra-Orthodox population. It seems to be the original ad without alterations.

2. Yitzchak ben Tzvi, between Gan Sacher and Wolfson Center
The original tip referred to this being the censored sign. This location is on a main road in Jerusalem. On one side is Gan Sacher, a popular park for all Jerusalemites, though it's not too common to see what you'd tag as an ultra-Orthodox extremist. On the other side of the road is a large, somewhat upscale apartment complex and shopping center called the Wolfson center, with little to no ultra-Orthodox population. Just past the Wolfson center is a neighborhood that has an ultra-Orthodox population, though it's largely American immigrants that are much more used to advertising.

3. Super-Pharm Midrochov, 3 Histadrut
The center of town, right near Ben Yehuda. Ultra-Orthodox Jews do come out to this part of town, though not exactly in noticeable numbers. Not far from here, just north of HaNevi'im street (see map) are the neighborhoods Geula and Meah She'arim. The former is the most prominent ultra-Orthodox neighborhood in Jerusalem, and contains the full spectrum of ultra-Orthodox Jewry. The latter is a hotbed of extremists, zealots, and the origin of some of the worst stereotypes about the ultra-Orthodox.

4. Super-Pharm Mamilla Jerusalem, 9 King Solomon
Mamilla is a relatively new development in Jerusalem, built on the over 2000-year-old street that used to contain merchants selling their wares to pilgrims to the Temple. The usual customers at Mamilla tend to be tourists, Muslim Arab Jerusalemites, and the occasional Israeli. There is a certain level of ultra-Orthodox here, probably slightly more than Ben Yehuda.

5. Super-Pharm Beit Haumot Jerusalem, 101 Derech Hebron
I don't know much about the demographics of who would shop at this location, though I can say that this branch is surrounded by somewhat upscale Jewish areas, and a number of Arab areas of varying wealth. Notably, this branch does have a lot of Arabic-speaking employees. Due west is the Haas Promenade, a public park with a breathtaking view of the Temple mount and Mount of Olives.

End - Super-Pharm Talpiot (in Hadar Mall), Pierre Koenig 26
Hadar Mall is located on the main street of Talpiot's commercial zone. It serves many neighborhoods surrounding it, all of which are non-ultra-Orthodox. It is one of Jerusalem's most popular malls. Unlike Malcha Mall, Hadar is not frequented by the ultra-Orthodox.

So there you have it. Of note is the contrast between the two street ads, the storefronts, and the ceiling ads. Draw your own conclusions. I'm going to bed.

Censorship of women in Israeli advertising

2012-07-09T12:37:42Z

https://www.facebook.com/super.pharm.co.il/posts/10150917452471820

An interesting development in Israel's ongoing fight against ultra-Orthodox extremism. A number of companies here have been called out because they choose to edit women out of their ads, especially in Jerusalem. These companies claim that it is due to the population's sensitivities. This is, of course, pure bullshit since many of the signs where pictures of women are excluded are in non-ultra-Orthodox neighborhoods. This particular link is to a post on Super-Pharm Israel's Facebook where a woman asked why the female model used in their ads was cut out of the ads around Jerusalem. Super-Pharm responded, "Super-Pharm serves the entire population of Israel and does its utmost to respect the needs of different populations, thus advertising in religious areas is customized accordingly." (My translation, roughly accurate.) It should be noted, however, that the signs with the female model removed are seen all over Jerusalem, including "secular" areas where there is little to no ultra-Orthodox population.

The further responses condemn Super-Pharm for taking this stance, and then Super-Pharm tries to whitewash by saying they hire over 50% women, over 50% of franchisees are women, and that they also advertise in Arabic and Russian for those populations.

What would interest everyone about this the most is that Super-Pharm is owned by the Koffler family - the same family that owns Shoppers Drug Mart, a large chain in Ontario and Quebec. So while there is a lot of local Jerusalem politics involved, the censorship of women over so-called "religious sensibilities" in this case is also a Canadian issue, a Jewish issue, and a feminist issue.

Application for Parenting Olympics

2012-06-03T17:36:53Z

A real Google Chat:

Daniel: I'm sick.
me: So's Eliana.
Daniel: So's Chunjiban
me: I just had one of the craziest parenting experiences over Eli's being ill.
Daniel: Oh?
me: Will be posting it to LJ shortly.
me: Most definitely blog-worthy.
Daniel: Don't call me shortly.
me: That joke only works if there's a comma after the first segment of the sentence.
me: In writing it doesn't work.
Daniel: It works fine for me.
me: eg., "Surely you can't be serious." "I am serious, and please don't call me Shirley."
me: Not nearly as funny as if it were to be told verbally. In writing, it doesn't work.
me: The advent of writing has killed so much comedic potential.
me: I say we stop writing altogether and focus on the spoken word.

The scene: One stop before Hadar Mall, on the bus.
The players: One sick, feverish, lethargic Eliana; one mildly stressed out Shawn trying to get stuff done for his brother-in-law's wedding next week.
The event: Vomit clean-up and dash.

The story:
Yesterday we walked to my in-laws to celebrate my mother-in-law's birthday with a festive Shabbat lunch. Eliana, about halfway through the walk, started getting tired. When we got to the in-laws' apartment, Eliana was not interested in eating, and she actually put herself down for a nap. When she woke up, she was feverish. She spent all last night tossing and turning and whining and feverish and keeping up her two very overtired, overworked, and over-stressed out parents.

The plan for today was that I would go to work early, leave when Yaffa had dropped the girls off at gan, meet Yaffa in town so we could shop for the upcoming wedding, go to an appointment together with Yaffa, then part ways. Yaffa would go to work, I would go to the shuk to get a replacement hose for our vacuum cleaner and extra bags for it, and around then meet up with a friend of mine from nursing school that I hadn't seen in a long time. (That's what happens when you take a year off school.) I would head over to Hadar Mall to pick up prescriptions and drop off my pants to be tailored and cleaned. Time would have worked out that I'd meet up with Yaffa at the gan for our very first parent-teacher interview, and while we were doing that my mother-in-law would take care of the girls. Afterwards, I'd run off to an eye exam with the optometrist that Yaffa works for, and Yaffa would take the girls home. A moderately complicated, but otherwise well-planned out day.

Instead, this happened.

This morning, I go into work early after barely sleeping, then ran out of work by 8am, much to the dismay of my bosses and co-workers that were now stuck with one less worker to do an unusually large order. Yaffa dropped off Bracha at gan (preschool), then she went to town with Eliana where I met up with them. We did manage to get some stuff done for the wedding, and my outfit is nearly complete. Yaffa, unfortunately, did not get a chance to get stuff for herself. By some miracle, this was all done in time for us to make it on time to our appointment. We even had a bit of extra time, so we stopped by a local cafe and got some food.

Around this time, we noticed that Eliana was not doing well. She was getting feverish again, despite receiving children's tylenol shortly before. She was acting kinda lethargic, and didn't have much energy to even keep her eyes open.

Yaffa and I decided that the better idea was for me to skip the shuk, go to Hadar, get my prescriptions filled and my pants tailored and drycleaned, then head home so Eliana could get some much needed rest. If I would still be able to meet up with my friend, then so be it. We planned that I should be able to take Eliana to gan so that my mother-in-law would still be able to watch both girls, and the day's plan would continue as was originally intended.

Instead, Eliana upchucked everything she didn't eat for the past two days about one bus stop before we got to Hadar mall. Her shirt, her pants, and the stroller were all filthy. The floor of the bus was mercifully spared.

Oh, and while cleaning her up I ran out of wet wipes and tissues. Hoo boy.

At that point, I debated briefly if I should just run her home, which would take another ten minutes, or if I should run her into the mall, clean her up, then head home. I chose the latter, running right past the security guard. He's shouting at me, "Do you have a weapon?" I motor right past him through the doors and say, "No! But I'm in a bit of a rush!"

I run Eliana to the bathrooms, only to notice that the diaper changing room is occupied. Somewhat guiltily, I then took her into the spacious handicapped bathroom to try and clean her up there. The whole time, she's shivering and whimpering, as I manage to take off all her clothes and rub her down with water from the tap to try and clean her off as much as possible. The clothes are a complete write-off until they get cleaned at home, so I search the diaper bag for a spare outfit. And all I find is a pair of underwear and pants. No shirt. And Eliana's shivering and whimpering and cranky. Oh shit.

I clean off the stroller as best as I can, grab one of the spare bags I had from the earlier shopping spree and put it down to cover the still extremely dirty and stinky stroller chair, throw Eli in the stroller, wash my hands, and run off to Fox.

If you saw a frazzled-looking father running around a Gap-like clothing store with a topless 3-year-old, you might've called the cops. Heck, I would probably do that myself.

I ruffled through the baby clothes as fast as I could, noting that there was absolutely nothing for age 3. So I scooted over to the Kids section, and couldn't find any age 3 things either. A salesperson must have noticed my frantic search, and tried to calmly help me. He found one shirt that was 3, but Eliana rejected it. I figured, screw it, I just need her to wear a shirt, so I grabbed the closest shirt that said size 4 and she agreed. 40 shekel later, my kid was wearing goofy-looking oversized shirt.

Somewhat calmer now, I asked Eli if she was feeling ok. She said, "I'm sick," with the saddest eyes I've seen on her in a long time. I asked her if we could do some things before we head home, and she gave a weak "O.K." Poor kid.

This let me pick up my prescriptions, as well as drop off my pants to get tailored and drycleaned. We then walked home. I schlepped her and the stroller and all the bags from the day upstairs. Seeing as to how she still smelled of vomit, I gave her a lightning-fast bath and let her lay down in our bed to watch a bit of Barney. I then asked for her permission to shower (because when a child vomits, the parent smells of the clean-up efforts), explaining to her that I'll leave the door open so I can hear her and she can call for me if she needs anything. She said it was ok, so I hopped in the shower with the stroller and clothes, and hopped out as quickly as possible. When I checked on her after getting out of the shower, she said she was tired so she laid her head down and was asleep within seconds.

A quick change in plans had my mother-in-law pick up Bracha from gan then come to our place while Eliana slept. I missed most of the meeting with the ganenot (preschool teachers), but managed to make it in for a bit before I had to leave for my eye exam. Back home to Yaffa and the girls, and the rest of the day ended normally.

Well, as normally as could be expected.

May the rest of this week be considerably less hectic than today was.

Neglecting LJ is a sign of mental stability

2012-05-21T12:58:20Z

Looking back on my prior entries, of which the last one was in February, it seems as though most of my entries in the past year have been to whine and bitch about my fractured mental state. Which means that it's not a good sign that I'm posting again.

Or, from another point of view, it's the first time in a very long time that I've made it a point to sit my ass down at my computer and hack away at the keyboard to pour out thoughts that can't be expressed in the overly ADD Facebook format.

Or, I'm not the digital exhibitionist I once was. Given my drop in FB usage, this is also a likely scenario.

Either way, I'm posting here because I need to release some serious verbal diarrhea on how treatment's been going. And up until about a week ago, it was pretty.

I had a bit of a falling out with my CBT therapist at Nativ, around the time of another round of depression. Don't quite know what it was, nor can I pinpoint when it was, but basically, I went for several weeks in a depressive state and no intervention was staged. Whether because the psychiatrist was ignorant, the therapist was keeping him ignorant, or I just had no way of expressing the need for help, things went horribly wrong. Finally, at some point, the psychiatrist suggested switching therapists, which to me signaled that someone screwed up somewhere and I felt like I was being jerked around by a private clinic that viewed me as a cash cow. When Yaffa and I sat down with the psychiatrist, we expressed our discontent with how things were, especially with the lack of progress in treatment. The doctor claimed that the CBT had worked up until a certain point, but now it's time to try something new. Neither of us were particularly thrilled with this excuse, but we've been going along with it since then because up until really recently things have been actually good.

About a month ago, I was put on a new drug regimen. 20 mg of Ritalin first thing in the morning, 27+36mg of Concerta three hours later, and stop the Cipralex. This was essentially to test the doctor's theory that if we treat the ADD, it'll help the depression. For the first week or two, it worked wonders. I was in a good mood, I could compartmentalize the various aspects of my life (work, family, school), and I was a functioning father and husband for the first time in, well, ever. The only complaint was that around 4pm I started losing track of things, which could be easily corrected by taking another 20mg of Ritalin at the end of the work day. The doctor also suggested increasing the Concerta dosage by another 36mg to get me up to a more functional dose.

Then, about a week ago, I had a major crash. I was aggressive, short on temper, lacking energy and motivation, and my thoughts were not clear. At one point last Wednesday, I snapped at Yaffa and said some horrible things that no husband should ever say to his wife. After she rightfully (and calmly) said that things aren't right, I sat down to relax and later told her, "I'm not feeling well." To which she responded, "Gee, you think?"

The good thing about the blowup being on Wednesday is that Thursday is therapy day, and it was made quite clear that perhaps this drug change wasn't the greatest idea. The psychiatrist decided to let it continue for just a bit longer before he made any snap decisions to put me back on the Cipralex.

Shabbat was not good at all. I was irritable and the slightest thing threw me off. Hearing the girls' voices made me agitated. I didn't want to get out of bed, wanting to sleep as long as possible. I was whiny, upset, sad, tired, aggressive, and generally in a bad state. Our original plan to walk to the in-laws was replaced with Yaffa taking the girls to her parents so that I could sleep it off. After she left, I decided to get up, get dressed, and chase after her to try and make it up. This was a massive failure on my part. We met up again and had lunch with her parents, but I then spent the rest of the day sleeping and feeling sorry for myself. It was decided that I would call the psychiatrist as soon as I could.

Yesterday I set an alarm at 8:30am to call the office. I kept on getting an answering machine. I called every half hour until noon, at which point I stormed out of work, pissed off and hurt, and made my way to Nativ. I storm in to see the doctor nonchalantly talking to the secretary, and demand to know what the fuck is going on. Turns out that there was something wrong with their phone system, and they weren't getting my calls or messages. The soonest I could speak to the doctor would be by phone at 6pm. I went home and proceeded to crash in bed until Yaffa suggested that I write him an e-mail. It took me two hours to write something, and another hour to make it sound coherent, at which point it was 5:30pm. 6pm passed, 6:15 rolled around, and I decided to roll out of bed to make my way back to Nativ. As I'm getting dressed, the doctor called, and I ranted at him for a few minutes until he told me, "go back on the Cipralex right way." I started it that night.

Today is my lowest day so far. On Mondays I normally let Yaffa sleep in a bit and I take the girls to gan before heading to work. After a failed attempt at trying to help, Yaffa got the girls dressed and out the door. I cancelled work, knowing that it's just not doable. Up until about 2:30pm, I've been languishing in bed. I got up only because I was thirsty and hungry, and even that took a lot of effort. All I've had was a glass of water and a peach, and now I'm struggling to continue to type this.

I just hope I bounce back as fast as I fell behind. My family deserves better than this. My wife shouldn't have to deal with rapid mood changes, temper tantrums, and a stream of emotional and verbal abuse. The girls shouldn't have to lose their father every few weeks. Hell, even I deserve better than this.

Tovi

2012-02-01T18:37:52Z

It's weird, now that I've had a little bit of a chance to process the information I got early this morning. Right now I'm nursing a whiskey-on-the-rocks, my first in a very long time, so as to make it easier to type what I'm feeling. What I'm feeling is a mix of emotions, none of them particularly coherent or cohesive.

I am deeply saddened by the news that Tovi passed away. At the same time, I knew that this phone call would come, that it would only be a matter of time. Since Tovi was hospitalized a few months back in the ICU for an attempted overdose, I knew it wouldn't be that far away. And it doesn't make it hurt any less, nor does it ease how sad the entire thing is.

Tovi and I more or less bonded over our depressions. It was our common ground, the way we identified with each other. There was a lot more to our friendship than just that, of course, including a lot of coffee (and I do mean a LOT of coffee), her dog, our mutual friends, our similar upbringing in Toronto, life in general. But when you boil it down, we were searching for someone who actually Gets It (tm). Who knows what it's like to battle your own brain. Who can be there for you to say, "I understand" and for them to actually understand.

We dated for a bit. I don't remember when it started or ended or why it started or ended, but either way we remained close friends.

I haven't really been in contact with Tovi for about four years now. The past two (three?) times I was in Toronto, I tried to set up a meeting with her, but either it didn't work out or she wasn't feeling well. My contact with her lately has been through a mutual friend. Any information about her came through this friend. This, in some twisted way, softened the blow of this morning's news, but also complicated it. I miss her dearly, but I've been missing her dearly for some time now.

I've moved on in life. I moved to Israel, got married, had kids. Tovi... well, she never managed to break out of the vicious cycle of depression and anorexia. She progressively got worse over the past few years, and all I could do was watch from thousands of kilometers away as my best friend's condition, both mental and physical, deteriorated. This was very painful for me as I couldn't be there to be a shoulder for her to cry on, an ear to listen, a voice to say... whatever I would need to say.

The cause of death is irrelevant, be it direct suicide or a fatal heart attack from years of anorexia. That may or may not be revealed publicly at some later point. But it doesn't matter either way. What does matter is that mental illness is a terminal illness. The entire philosophy of mental health care is to not let it become a terminal illness while improving the quality of life of the patient. This is the duty of the care team as well as the patient. But I can't help but start to blame her doctors for dropping the ball as much as they could. (Yes, blaming is part of the Kubler-Ross theory of grieving.) I know that the patient in this case, like in every other case, isn't 100% blameless, but knowing the excruciating pain of depression as I do, it's very hard to let Tovi shoulder too much of the blame. She was an individual in pain, both mental and physical, and she was simply not getting the treatment she needed to not be in pain.

But now, she isn't in pain anymore. At least, that's what her death supposedly means. We try so hard to delay death in medicine that sometimes we fail to see the redemption that it brings. It hurts me like a thousand stabbing needles, but at least Tovi is no longer in pain. And I miss her, and her friends miss her, and her family misses her. And we all grieve over her death.

And yet, in some twisted, sick way, I take comfort in knowing that her pain has finally ended.

There's no more whiskey left, just a few partially melted ice cubes. I don't have much more to say. I miss Tovi, but at least she's no longer suffering.

Tammy Sharon Speisman, 1979-2012.

Writer's Block: Trading Places

2012-01-13T05:12:00Z

If you could be anyone else for a day, who would you want to be, and why?

First question listed was submitted by prettygrl0526. (Follow-up questions, if any, may have been added by LiveJournal.)

View 402 Answers

My wife, so that I could understand her better, and to be able to understand things from her point of view.

I think that would be the ultimate marriage counselling, don't you?

Rehabilitation of the psychiatric patient

2011-11-15T09:01:15Z

This is the most interesting part of the exam, because it's so personally relevant and it's barely mentioned in the textbooks.

There's a law in Israel that came out in 2000 called the Law for the Rehabilitation of the Disabled Mentally Ill in the Community. Had I known about this law when I first moved to Israel, I would have used it to the utmost of my ability, even though I'm sure I wouldn't be eligible for all of its benefits.

Did you know that according to the law, anyone with any kind of psychiatric condition can get:

Help finding and keeping an apartment, be it a general hostel, protected living center, or private apartment

Help finding and keeping a job, writing a resume/CV, interview training, the option of working in a protected factory

Education services for students, including learning disabilities and exam help

Help finding and financing exercise, such as gyms or pools

Parking for the disabled

A monthly stipend for living expenses

Other things listed in the Rehabilitation Basket available to people with things like strokes, physical handicaps, or other disabilities

Yes, Yaffa, I will continue looking into this.

Studying for Psychiatric nursing

2011-11-14T12:29:37Z

Stabbity stab stab stab.

Stab.

Stab some more.

Die.

*whine* Make it go away.

I've spent the last six hours, nearly nonstop other than bathroom breaks and a coffee, studying psychopharmacology. I know psychopharmacology personally, and yet not enough to actually pass an exam that's largely based on what drugs to give to the patient and when we can forcibly hospitalize the patient.

This is me complaining about school. In other words, nothing's new. I am so never going to do a masters' degree. Never, ever, never. If I ever mention the possibility of doing more school, it's a good sign that I do need to be checked in to a psych ward. A stronger sign of masochistic suicidal tendencies is rare in me. Let this degree be over already, I've suffered enough.

*sigh* One year off to get my head on straight, then one last year of grueling torture and I'm done with school for the rest of my life.

Hate and stab and stab and hate. *whine and cry*

Still alive and busy

2011-10-16T09:22:02Z

I had an oral exam in Public Health last week, and by my count, I bombed it, just pulling off a passing grade. I'm almost thinking it was a pity grade, but at this point with the nursing school I'll take anything I can get.

Next week I have both Pediatrics and Mental Health. Pediatrics is a monster of a course that has a good ton or two of course material to slog through. By a regular measurement of 80 pages of notes per course by one classmate, she took nearly double that for Pediatrics. And I really don't like or understand pediatrics. Little people are weird. Their parents are insane. And I say that as a parent who's had kids in the hospital.

God Bless YouTube, for it has every physical exam and reflex video I need to understand wtf is going on in this course. How else would I be able to remember what the Moro reflex is? And God Bless my classmates for making such thorough notes, and the classmate that made the thorough yet extremely condensed version that I could print out and take with me.

Despite it having less than half the material, Mental Health might prove to be more harrowing to study for. Y'know, having been there, and all, and it still being a very personal issue. Good news is that after this summer spent in Maon Yerushalayim, my time in an outpatient program has given me great insight into how nursing for mental health works.

If I don't pass either of these two exams, it seems as though my year off won't be a full year off, and I'll have to take these courses. I'm thrilled about that prospect, and hence why I'm wasting time posting here instead of studying.

In somewhat related news, I started using Ritalin again for the first time in about 17 years. I use the term "use" because it's still, in my mind, a street drug with huge potential for abuse. I've found myself singing Third Eye Blind's "Semi-Charmed Life" in reference to my new meth of choice quite a bit. But it's working, and I don't have the jittery explosiveness that I had when I was 12. Despite that I'm posting here, it's working. On Yom Kippur, for the first time in years, I was actually able to concentrate on my praying, instead of having my head jump to every subject not connected to prayer. When I study, I can go for full half-hour periods without jumping out of my chair, and can last the full four hours until the drug wears off on a study session. It's wonderful and amazing and scary. Even the Internet is less of a distraction. Being off Facebook is also a great help in that :P

As for the depression, it's still there and lingering and driving me up a fucking wall. I still sleep over 12 hours a day, or so it seems. Still trying to kick it. All this because the dean decided to question my ability to treat human beings based on the status of my mental health. I guess I am proving her right, though I'd really like to try and prove her wrong in the end.

Random thought of the moment - if I end up working in America briefly, it'll be the first time I'll be dealing with uncircumcised penises. Yes, this is the regular thought of a student nurse in Israel.

My recently purchased second-hand BlackBerry is dead, or so it feels. I need to run through the CrackBerry forums to find out what could be causing the phone to be so slow and unresponsive. It's like running Windows 95 on a phone, minus the blue screens. So I'm mostly using my old Sony Ericsson W595, which now has a broken battery cover but at least is more reliable than the BlackBerry. I want a Samsung Galaxy S II :(

A reminder, yet again, I'm doing Movember this year, and you can sponsor me here.

Saving the best for last, the family is doing well. Yaffa's looking into a Masters program again, still trying to figure out what she wants to do with her life. We think we've got it this time, but the path to it will be long and tedious. The girls are 2 years and 8 months, and are amazing spectacles of awesomeness. The pre-school they're at is doing wonders in teaching them new things. They know about Rosh Hashana, and insist on blowing the shofar I got for my bar mitzva, which consists of putting their mouth to it and screaming, "tooooot!" They've learned about Sukkot, that we build a Sukkah and put Schach on it, and we shake the Lulav and Etrog. They're learning so much, it's making me swell with such pride knowing that their minds are developing so well.

Starting treatment

2011-09-18T17:31:49Z

First, a donation from one Daniel Sterman, who gives us how the undead sweeten their coffee.

Today I saw my regular therapist. It felt good to go back to my regular therapist, calming in a sense, to be back in therapy with someone that's known me (on and off) for six years, and has been with me shortly after I moved to Israel. I feel comfortable with her, and it made me realize how uncomfortable I was with my therapist at Maon Yerushalayim. The psychotherapist must create an environment of calmness and comfort, which I didn't feel I had with my therapist at Maon Yerushalayim but I do feel with my regular therapist. So it's good to return to her. I didn't bullshit her either (she knows how to call me on it anyway), I told her that since I left the program things haven't been 100%, or maybe even 50% functioning, but I know that I'm on a path to get better. I'm going to be seeing her regularly, probably weekly, maybe every other week.

I also started with my therapist from Nativ that will be doing cognitive-behavioural therapy (CBT) with me. He seems to be a guy that I can work with. Our first session I ran through my patient history with him, which is always a harrowing process since I feel like I'm repeating myself a thousand times over. I wish I could just print off a complete history and give it to health care professionals as required reading. Anyhoo, the CBT part of the session was to talk about what exactly CBT is and how it works, and we started on an exercise to identify various common cognitive distortions, such as assuming that I know what someone else is thinking, catastrophizing (this is the most disastrous thing ever), labelling (I'm such a failure), overgeneralization (this always happens to me), etc etc ad nauseum. All things that I do. I'm supposed to keep a diary of these various thought distortions over the next week, then I'll bring it in to him and we'll work on it.

Tomorrow I'm working a catering with Holy Bagel. Working is a good thing for me, it keeps my mind off of the depression and everything surrounding it. It's a therapy in and of itself, in the sense that I get to do something that I'm good at and feel good about it. I want to work more often, not only for the therapy, but also so that I can feel somewhat like I contribute to our family's financial stability.

As a last point, while I do somewhat miss Facebook, I don't regret the decision at all to quit. I've had so much more free time because I'm not constantly checking my news feed. I've been actually talking and meeting with friends, instead of chatting and saying we'll meet up. And I'm actually getting on the floor to play with the girls instead of sitting in my computer chair, scrolling down the screen, and intervening only when they're whining. Good deal, I say. Had I the self-restraint to naturally do that, perhaps I'd still be on Facebook, but I don't, so I'm not. And I'm fine with that.

Circumcision and drinking

2011-09-14T16:59:21Z

I attended a brit mila (ritual circumcision) of a classmate's 8-day-old son today. I'm not good with these things, as I tend to take the pain of the baby too much to heart. I'm not an intactivist by any measure of the word, but circumcision does make my skin crawl when it's done on an 8-day-old baby without a true sterile environment and real anaesthetic (gauze soaked with wine to suck on, while awesome, is not an anaesthetic). Shortly after the cut was made, and the poor kid was wailing his lungs out, I texted Yaffa and told her we're never having boys, ever. She made me a deal that if we have a boy, I can get nice and sauced at the brit. I want to add to that and say that my son's first taste of wine will be a damn good wine. I mean, upwards of 110 NIS ($30) a bottle. I'm thinking even double that as a standard. And then, plenty of single malts and bourbons to go around. Yes, and even Canadian blended whiskey. All this to forget the fact that I'm causing this much pain to my 8-day-old son. (Sterile gloves, a surgical mask and cap, sterilization and anaesthetization of the area will be a prerequisite before letting any butcher near my kid to perform this surgery.)

Somewhat related to this, working at Holy Bagel means that some times I can get extremely lucky and catch a ride with them to the event. Today was no exception, as no busses run to Efrat in the morning.

In other news, I've been slowly telling my classmates about what happened this past summer, and my plans to take a year off. I'm really going to miss this class, it's made up of so many excellent future nurses. My initial class, the one I was with in my first year, graduated this year and just wrote their national certification exam. To them I wish lots of luck and happiness in their nursing, and I look forward to never seeing them as a patient. Though if I did, I know I'd be in good hands. While I'm absolutely positive I want to take this year off to sit back, relax, and be with my family for the first time, well, ever, I am looking forward to going back to school next year.

The girls are, as always, absolutely wonderful. I love that I'm getting to spend more time with them. Just now, before I put them to bed, they played a new game. Bracha stood with her back to me and said, "Where's Bracha?" I echoed, then she turned around and laughed and fell in my lap. Eliana thought this was a good enough game to do the same. All this stuff that I've missed between school and being ill and generally being ignorant to how awesome the twins are.

Yesterday the four of us took off to the Israel Museum. It was Yaffa's first time there since the renovation. The Israel Museum never disappoints. For all my exclamation that Duchamp is not art, and the Israel Museum has a lot of his so-called "readymade" pieces, the Calder mobiles alone make up for that. Seeing wonderful Matisse, Picasso, Van Gogh, Magritte, Rodin, and Warhol pieces make me downright happy.

Today's treatment plan

2011-09-13T08:02:45Z

I dropped out of Maon Yerushalayim after an extended period of annoyance with several staff members, including my personal therapist who I simply couldn't stand. This ends a period of treatment that, while frustrating through most of it, has done an exceptional job of helping me break out of my crisis with my life intact. I said from the beginning that I didn't plan on sticking around the full three months allotted, and I stuck to that. The lack of cognitive-behavioural therapy that was supposed to be an integral part of my treatment was the deal-breaker; that I was not all allowed to find help elsewhere because the program itself didn't have it was simply too much for me. I around as long as I could until I realized it was time to move on. Then I waited three weeks to make sure I was making the right decision. Then I followed up on that decision. Last Thursday was my last day at the program.

Friday and Saturday were somewhat down days, as I spent many hours in bed on Shabbat due to what I thought was just general exhaustion, and connected it to some left shoulder pain that had been going on for a few days and some chest pain in the same area, and took myself off to the doctor on Sunday. My regular doctor wasn't in, so I had to go to some generic doctor that didn't know me or my story. She kinda freaked out, sent me for an EKG and heart ultrasound, and both came back completely clean. Regardless of this, she ordered an ambulance and had me sent off to Hadassah Ein Karem. All so we could check a specific marker in blood for heart attacks, which came back negative for any heart damage. I took up an ambulance and then a bed in the ER all for this. At least my health fund is paying for it. On the lighter side of things, I got to see all my old colleagues from when I did my rotation in the ER. While being wheeled in, the social worker said, "What are you doing here?" The in-charge nurse sent me to my bed, telling the EMTs that I'm one of their students. One of the doctors recognized me, gave me a stern motherly look and said, "Chest pains?" The nurse on my wing of the ER asked, "What, you were that bored that you had to come here?"

Long story short: the exhaustion is depression, the shoulder pain is because I slept on it wrong some time last week.

The depression sucks, because I thought I was temporarily over that shit. But go figure, it comes back just as I quit the program.

I'm starting my therapy for ADHD at Nativ on Sunday. I'll be seeing my psychiatrist on Monday to see what he's got to say about the last two months. I should set up an appointment with my usual therapist to give her an update as to what the hell happened. In the meantime, I'm doing what I can at home, taking some time to myself and cleaning around the apartment. I'm going to try to blog once every other day or more just so I can get my thoughts out.

Today I've got to get to a bank to deposit money from Canada, maybe get to my health fund to take care of some paperwork, and start bugging the hell out of Maon Yerushalayim until I get an answer as to when my paperwork will be ready. Dishes to wash, laundry to take care of, the office to clean, and tons of paperwork to sort. Somewhere in all that, I'd like to take a chance to exercise a bit, as I've been neglecting that something fierce.

But for now, listening to Q107 (Toronto's classic rock station!) and taking it easy.

Some thoughts on leaving Facebook

2011-09-12T15:36:55Z

Yesterday was the day when, as one of my friends so colourfully put it, I "committ[ed] facebook suicide".

I've been on Facebook since March 7, 2007, when my sister so lovingly wrote, "STOLEN THE WALL VIRGINITY!" I joined at her suggestion. It's been downhill since then. I've wasted four and a half years on this social network, and I haven't got a clue as to why.

Well, that's not entirely true. I haven't wasted four and a half years, per se, and I have got a clue as to why I spent so much time on Facebook. Since Gavi showed me how to download all my data, I've been running through some ancient posts just to see what kind of stuff I used it for in the beginning. Not much has changed. Facebook is a wonderful social tool, but one that eats tons of time. I will miss talking to old friends, but there's always e-mail, not that anyone uses it anymore.

I do hope that this doesn't actually harm my social life in any way. At least, I'm confident it won't do too much damage to my social life here in Israel, where I'm still in touch with various Google/Yahoo groups with my friends, as well as there always being the phone.

More at risk than my friendships here will be my friendships abroad, including many that I still keep in touch with on a regular basis thanks to Facebook. For those in this category, and you all know who you are, I do want to keep in touch with you somehow. I'll still be blogging here, and these posts will show up on Facebook automatically. LiveJournal also allow you to post responses under your Facebook ID, so we can still have some kind of discourse here.

If that's not good enough, my email is shmuelyonah@gmail.com. I'll be on Google+ under Shmuel Yonah, my BBM pin is 25645D2B, and, as always, my cellphone is available at 011-972-52-804-4452.

Orthopraxy

2011-08-28T05:12:21Z

stone_ mentioned this concept to me, said it would be an interesting concept for me, given my state of Judaism. I sorta don't get it, unless I remembered the term wrong. Thing is, what I get from various blogs etc. is that Orthopraxy is just Orthodoxy without the faith, which certainly doesn't describe my state of Judaism. I do prefer Orthopraxy as it involves actually getting up off your ass and doing things, whereas Orthodoxy preaches pure faith. But this doesn't mean that I believe in Hashem any less. My main beef is with His followers, and His self-appointed faith leaders.

The Torah, specifically Torah Sh'Bichtav (The Written Law), is the Word of God, given directly to Am Yisrael at Har Sinai, and every word of it is relevant, even the bits about the sacrifices and the mishkan even though they're not relevant today. (I'd like to think that those bits give us a view into how the world worked 3000 years ago, and of course God had to frame it in those terms to make the people understand.)

Not so similarly, the Torah Sh'be'al Peh (The Oral Law, commonly known by its acronym of Toshba) is a line transmitted from Moses to our current day, and has been bastardized and reinterpreted and written down and today is a mockery of itself. Not all of it is crap, but let's face it: Torah Sh'bichtav was written by God and has been meticulously copied from one generation to the next, Toshba is a game of broken telephone by humans.

Two semi-joke examples that I'm sure I've told before.

One: Moses was on Sinai learning the Torah from Hashem, when He came to the first instance of "Do not cook a baby goat in its mother's milk." Moses says, "Oh, I understand, we mustn't eat milk and meat together." The second instance comes up, and Moses says, "Now I see. We must wait a certain amount of time between eating one after the other." The third and final instance comes up, and Moses says, "I get it now. We must have separate dishes and must be very careful to not mix the two." God says to Moses, "Whatever you say, Moses."

Two: Let's say that at one point, two thousand years ago when the Gemara was written down, somewhere in Tractate Shabbat a Rabbi said that we should eat one fruit each day, and two on Shabbat, basing it on God's commandment to enjoy the fruits of one's labours. Somewhere down the line, Rashi says that the fruit must be an apple. Tosafot says that it must be a green apple. Further down the line, it's interpreted to be a sweet apple, then several generations later the interpretation is given that it must be two-thirds the size of one's fist. At this point, nobody's questioning why every day we're eating green and sweet apples that are two-thirds the size of one's fist, and even when we train it back to the initial gemara, nobody can figure out the very casual link between the Rabbi's ruling and the Torah.

The first is just one way that humans give meaning to something they don't understand, and with each repeated instance they get more stringent. The second is the game of reinterpretation and broken telephone, coupled with a complete lack of, well, asking questions on the origins. Both are extremely dangerous pitfalls into which current Orthodox Judaism has fallen, and both, to me at least, are essentially anti-Jewish.

To me, as part of a belief that was first introduced to me by my wife, the Oral Law should evolve with the times and the Nation of Israel. The Oral Law should reflect changes on the ground. We're not getting messages from God anymore because we suck, so the very least we should do is adopt the Torah to what external forces are pressing on it - otherwise, we, as Jews, truly face extinction by modernity. This is why some people have adopted the "Modern Orthodox" stance. The problem with the "Modern Orthodox" stance is that it's this amorphously huge glob of loosely-connected ideas that basically boils down to "you can be Jewish and observant in the modern world." The spectrum of observance here is massive, and elements within the spectrum usually vehemently disagree one with another on most basic tenets of current faith such as the State of Israel and its place in Jewish Law.

Not that vehement disagreement is a bad thing, mind you - it's been a part of our faith since well before Korach faced down Moshe. Read a bit of Mishna and Talmud and see how the Rabbis throw down their gloves and bicker nonstop. And the best part of this disagreement is that it gives rise to the spectrum. But the problem with the disagreement is that when push comes to shove, someone's gonna call another a fake Jew, be it because they're Reform, believe in the State of Israel, or don't have the right length of payis (sidelocks). Once we start deviating from the definition of "Who is a Jew", and allowing ourselves to fall into the trap of "S/He's not Jewish because...", we break apart the very fabric of our People.

Which brings me to another point that threatens the very being of Judaism. There are so many weasel words used in describing parts of Judaism today. As in, "that's not kosher enough for us." Or, "he's not really observant of the Sabbath". Or, "that's not in the spirit of the law." They're all ways of saying "you're wrong, I'm right". The best examples of this are in Kashrut, as one certification isn't as good as the next. So what's Kosher for me isn't "Kosher enough" for someone else. I freakin' hate that. If it's Kosher, it's freakin' Kosher. There are certain things that are black-and-white in Judaism, and I don't care if it's in the spirit of the law or not, if the law doesn't prohibit it, then it's freakin' allowed. Technically, there's no reason why I shouldn't be able to eat at a vegan or vegetarian restaurant that doesn't have certification. All the excuses that can be made can be very easily countered. Cheese: not applicable to vegans, and vegetarians are extremely careful not to use animal rennet. Grape extract: neither alcoholic nor even close to anything that would cause intermarriage. Dishes: dipping dishes in a mikvah is not applicable to non-Jews, and far under 1/60th of the time everything's new and untampered by meat. Dough again, taking Challah is not applicable to non-Jews. Lighting the oven: a stringency only applicable to those that choose to observe it, and even then not applicable to modern life. Dairy: if you buy into that Cholov Yisrael crap, I trust state inspectors more than I trust Rabbis. Ma'aser: So take a tenth of your plate and leave it. Fish: you can't make kosher fish suddenly non-kosher, unless you bake it with butter and beef extract. Eggs: not relevant to vegans, and the methods used for industrial, and even organic free-range, egg farming today simply doesn't allow for blood spots. "But it's not in the spirit of the law." Well, guess what: my vegetarian restaurant without certification is still, in my mind, more trustworthy to be kosher than your meat restaurant with certification.

I believe that God wanted us to be Good Jews, but more than that, he wanted us to be Good People. I said it once and I'll keep saying it. You can pray three times a day, but if you're a crook in business, you're a bad Jew. Full stop, no excuses. If we don't practice the commandments between Man to Man, applying it to all genders, sexes, sexual orientations, races, religions, nationalities, etc., then we fail as Jews. I don't think Modern Orthodoxy reflects that properly nowadays, and it's a huge part of why I've become disillusioned with institutionalized Judaism for the past ten years or so. If placing Bein Adam L'chavero (man to man) at least on the same level, if not higher than, Bein Adam L'makom (man to God), is wrong, then I've just about had enough of your strain of Judaism.

Less than enthused about this drop in mood.

2011-08-20T19:29:47Z

The problem with the honeymoon period after receiving good news during depression is that it tricks you into thinking that you're out of the depression. Then when you crash and burn after it ends, it takes a good chunk of your self-confidence with it.

And that's what happened to me this weekend. I hope yours was better.

Already by Wednesday night I was starting to notice signs of a drop in my mood. Hunched back, shoulders down, head drooped. Somehow the physical signs tend to show up before the mental, and I should have paid attention. Yaffa noticed it, and mentioned it. I waved it off as just another brief drop.

Thursday, Yaffa was feeling tired, so I took the girls to play in the playground for two hours or so to give Yaffa a chance to sleep. I skipped program that day. The psychological manifestations of the depression were starting to take hold as I noticed that I was more edgy with the girls, less patient and less tolerant of their whining. Later that afternoon, Yaffa took the kids over to friends of ours, went to the pharmacy for me, only to tell me that they didn't have most of my psych pills, and that there's a general shortage of Prozac in Israel, so nobody would have it. It was then that I realized that I skipped my morning dose of pills, and braced myself for the disastrous downfall of what was left of the good mood.

Friday morning I wake up before dawn so I can get to work for 5. At some point my boss tells me to go home and get changed, I'm going on a catering. My original intention was to go straight after work to pick up more pills since I'd run out of almost everything, but with the catering, I wouldn't have a chance to get to a pharmacy before they close for Shabbat. When I get home to change from my factory clothes into my catering outfit, I tell Yaffa this. She heads out with the girls to get my pills (still no Prozac in Israel), and I'm in free-fall mode. I get home after work, tired from waking up at 4am and busting my ass for 8 hours at work. The rest of Friday is a blur, as all I really remember is how annoyed I got at the girls when they were whiney (which they weren't that much, but enough to set me off), and how incredibly tired I was.

Today was an unmitigated disaster. I spent most of my day in bed. The depression-exhaustion consumed me, and I feel like I completely abandoned my family. We didn't even make it to synagogue. I must have slept for at least 9 hours total throughout the day, and I'm still tired. Writing this post is taking up energy I don't have, and my typing mistakes are getting more common.

It's a good thing that my wife is so much smarter than me. She's absolutely right to have told me to not drop out of the program yet, despite how much I wanted to. I just wish I could stop disappointing her by having her husband show up one week then having this sulking monster show up the next.

Another attempt

2011-08-11T18:05:07Z

Posting from my BlackBerry.

Posted via m.livejournal.com.

Ups and downs - and uppers

2011-07-29T09:09:23Z

It's been three and a half weeks since I started the day program at Kfar Shaul's Maon Yerushalayim. (No official website for anything beyond "under construction". But I did find an article saying that on a random unannounced visit, deputy health minister Yaakov Litzman said if he could, he would close Kfar Shaul - and an English equivalent. Granted, this is the same haredi non-minister that wants sex segregation as well. Way to go, mental health!)

My progress has been nominal, at best, and has been met with some regression, to boot. While there has been a marked improvement in my depression and anxiety, my ability to concentrate and sit still has taken a dramatic turn for the worse. The drugs may be working, but I get the impression they're also uncovering my ancient ADHD diagnosis.

With the depression, at least I have the ability to go about my life without moping around the whole day. I can manage to make it more than an hour without thinking of new and creative ways to off myself. (Oh, the dangers of an education in human physiology.) I still want to spend the whole day in bed, but I can fight it easier. I can actually laugh and enjoy my surroundings to a certain extent, and I'm not completely shut off to the amazingness that is my daughters. It's not gone, and is far from optimal, but at least the depression isn't as debilitating as it was a month ago.

The anxiety has a lot longer to go before it's at a remotely acceptable level, but it has gotten better. I'm not freaking out at every little thing, and can contain myself better than before when faced with a defiant two-and-a-half-year-old. Heck, there's even been a decrease in the intrusive thoughts of harming myself or those around me (please note that acting on these thoughts is not remotely likely as I've got an incredible defense system in place). But like with the depression, the anxiety is still there. As with a month ago, the anxiety is worse than the depression, and while there's been a marked improvement in my depression, the anxiety is even farther from optimal. I still have weekly mini-panic-attacks on Fridays, usually minutes before Shabbat starts.

My current drug regimen is now fluoxetine (Prozac) 40mg, perphenazine (Trilafon) 4mg, and lamotrignine (Lamictal) 50mg in the morning, and escitalopram (Cipralex) 10mg in the evening. I have the option of lorazepam (Ativan) 0.5mg as needed for panic attacks, which is currently around two a week. The side effects are numerous - dry mouth, drop in libido, increase in weight, little to no ability to self-regulate how much I eat, exhaustion, sleep disturbances, and one hell of a low alcohol tolerance.

But of all the "side effects" that bug me, it's my near-complete inability to concentrate on one thing at a time and my inability to sit on my ass for longer than a few minutes. I always hated the ADHD theory; I hate the disorder, the lack of a diagnostic tool or practice, and I especially hate the treatment, and I really fucking hate how every other child in America is on uppers of some sort because they're, well, kids. I was given an extremely half-assed diagnosis at 12 and put on Ritalin. Instead of having its "intended" effect, the Ritalin had its actual effect of overclocking my brain beyond what most would consider physiologically possible. At 12, I got high on a street drug because some jackass doctor suggested it, and my parents, in their innocent ignorance, agreed to it.

Truth be told, now that I think about it, I've been experiencing a drop in concentration for a few months now. Sitting on my ass to study for exams was a marked difficulty for me, and writing that massive 15-page paper was hell. I'm wondering if my lack of blogging can be attributed to it, too - I'm having trouble just sitting here, typing this up. No wonder Twitter is so popular - we've raised a generation of kids with zero attention span.

I usually attribute my complete lack of zetzfleish (Yiddish, literally "flesh on one's seat", meaning inability to sit still) to being raised in a day and age where everything is instant, from instant food (microwaves) to instant entertainment (TVs) to instant answers (the Internet). In this sense, I feel I am no different from anyone else who was born past 1975. But at the same time, my age-group peers almost all have degrees, whereas I don't. Most of my friends can concentrate on one thing for longer than a few minutes, whereas I can't. Of my religious friends, most have the patience to go to a full prayer service, whereas I can't even make it through the most basic prayer without my mind wandering. My usual psychologist has been pushing me to get treated for ADHD for the past few years, and every time I just wave it away by simple denial or flat refusal.

In the past few weeks, I've been facing this drug-dealing demon by trying to very strongly hint to the staff at the day program that maybe, just maybe, we need to look at my fractured mental state from a different angle. I've been unable to get through to my psychiatrist or my therapist, which means that this week I'm going to try and talk it through with the nurse that I can tolerate (the head nurse is a haughty self-absorbed insulting dickhead). I kinda feel like most practitioners of psychiatry have been just as badly burned by the ADHD craze of the mid-90s as were the patients. At the same time, there has been plenty of documentation since of true cases, ones where the medication worked. Diagnostic tools, though still iffy, have been invented and improved. There's more pharmacological treatment plans available, and the notion of therapy has been expanded.

So while I don't like it, and I really, really don't like it, it's worth a shot. Who knows? Maybe I'll even be able to return to being myself for the first time in months - years, even.

(Note: This post was written at the beginning of the week, but couldn't be posted since LJ got DDOSed. The week that followed was probably my most unstable week since I started the program. More on that later.)

A brief update on my mental state

2011-07-20T04:30:53Z

I only have ten minutes, and gosh darn it, I'm so not going to be able to stick to that.

There's been a slight improvement in my mood lately, with a decline in my attention span. Which, if we add back to my list of psychiatric ailments the looming ADD/ADHD diagnosis, then we do have a proper lead. The OCD is still there, with the occasional intrusive thoughts, and the depression is still there, with repeat episodes of disinterest, unexplained sorrow, bouts of crying, emotional eating, disturbed sleep patterns, and lack of will. The anxiety is still nagging away at me, and every time I hear the girls start to whine or cry I hit a mini-anxiety attack which can lead quite easily to a medium-level attack though normally not to a full-blown attack. What's bugging me now is that I can't sit on my ass for a few minutes without fiddling with my cellphone, struggling in my seat, or staring aimlessly into space.

The current list of drugs (fluoxetine [Prozac], escitalopram [Cipralex], perphenazine [Trilafon], and lamotrignine [Lamictal]) work as my first line of defense, anti-anxiety, and mood stabilizer. I had a severe adverse reaction to methylphenidate (Ritalin) when I was 12 (i.e., it worked as Speed rather than as Ritalin is supposed to work for ADD), and I don't want to repeat that mistake, but dextroamphetamine (Dexedrine) isn't exactly available in Israel because of its illegal market value and Adderal would only complicate my current sleeping patterns even more. Way to go, ADD drugs!

I'm quite averse to even admitting the ADD diagnosis might be right, due to being so badly burned as a kid by it. But just as I've jeopardized my future as a nurse by even joining this program, I might as well take another leap of faith and see what else can help. I've got to get better. This is not a tenable status quo.