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social, health, political imagery through the lens of George J Huba PhD © 2012-2017

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Early Friday morning Hurricane Florence is going right over my house. The predicted storm center path this for Category 4 hurricane (150 mph) is directly over my town near Raleigh, North Carolina. Expected rainfall is between 10 and 20 inches. Some areas will get 48 inches.

About one year ago, Hurricane Maria went over Puerto Rico, a part of the United States. All the lights went out. All of them. Most of the island was destroyed. And there was no fresh, safe water.

A few days after the storm President Trump announced that 65 people had died. The US government and especially President Trump still cites that number as evidence he does “the best job in the history of the United States” in disaster relief.

Independent studies by two major university Departments of Public Health have shown that 3,000 US citizens in Puerto Rico died. One year later (an hour ago), President Trump continues to tweet that his relief efforts in Puerto Rico were about perfect. The statistics of that relief effort shows that the aftermath of Hurricane Maria was one of the most incompetent relief efforts in USA history.

Just watch the video. And consider that parts of Puerto Rico do not have drinkable water or electricity after a year. And people were drinking drain water from a nuclear waste site for months in Puerto Rico.

I know I will be OK. President Trump says so.

[This morning, the computer predicted path models for the eye of the storm have been revised. The hurricane might go somewhat south of my home, although the path is still quite unpredictable. But there is no victory in that. The new predicted path has the storm going over two major US cities: Atlanta, Georgia, and Charlotte, North Carolina. Death tolls could be event high if the path changes.]

I know I will be OK. President Trump says so.

Trump

I know I will be OK. President Trump says so.

Trump

 

Trumpgate is now running at full speed.

Will Trump EVER stop tweeting?

Will Trump EVER stop lying on Fox TV?

Will even one of the senior Republican elected officials in the United States come out and state how dire the situation is?

Will even one of the senior officials in the religious organization supporting Trump finally come out and state that Trump’s behavior has been immoral?

Where’s the org chart for the Trump crime family?

Where’s the org chart for the Putin crime family? How are the two families interlinked?

Which of the positions in the Trump administration are filled by Russian spies?

When will the overall US Government take the US nuclear codes away from Trump?

by George J Huba PhD (Psychology)

Have dementia? It makes no sense to obsessively ruminate about what you have lost.

It makes a lot of sense to focus on now and then try to maximize your quality of life.

Focus not on what you lost but rather on what you have left and how to maximize how you can have the best quality of life possible. That’s how a deal with cognitive decline.

As dementia has progressed for me, apathy has become a bigger concern as the disease progresses.

Something needs to be done now? Chill dude.

Ask someone else to do something to help you? Happens more and more each day.

Just don’t care about deadlines? Yup.

You need to try to deal with apathy early and later in the course of dementia.

Apathy is a trap.

If you become apathetic, you anger your family and friends and others who can help you.

If you become apathetic, you can miss many important and enjoyable parts of life.

If you become apathetic, you can feel helpless and hopeless.

If you become apathetic, your remaining life can be depressing and limited.

If you become apathetic, your quality of life and that of your family and friends can be adversely affected.

Click the mind map below to expand its size.

dementia? now deal with ...

by George J Huba PhD (Psychologist)

Dementia is not just MEMORY LOSS. In fact, certain manifestations of dementia do not involve significant memory loss.

Virtually all forms of dementia include significant psychiatric symptoms. I certainly experience them.

If your doctor is not prescribing psychiatric medications for depression, anxiety, and anger ask why not.

If psychiatric medications you have been prescribed are not working, ask your doctor, why and if it might be useful to consult with a psychiatric medicine specialist, especially one for those with the brain changes of someone with dementia.

A mind map of some of the issues. Click the image to expand it.

Medications for Anger and Depression During Dementia

by George J Huba PhD (Psychology)

This weekend the American Psychological Association is meeting in San Francisco. While certainly not exclusively so, the meeting tends to be dedicated to the presentation of fairly trivial and limited scope, poorly designed research studies.

Psychology should be embarrassed that the focus of the meeting is not developing new and better ways of addressing psychological problems. For instance, I have dementia. So do many millions of people worldwide. At this psychological meeting, there is little focus on actually improving the lives of persons with dementia. The same is true for many other psychological disorders.

How has psychology failed persons with dementia? The following mind map presents my assessment of the situation.

Why does psychology fail persons with dementia? I believe it is because the field wants to pretend it is a science of the rigor of biology and physics, rather than focusing on becoming an evidence-based way of developing better ways of patient assessment, screening, treatment, and communication. What a waste. And remember that I am a person with degenerative cognitive and behavioral disease and I get it. Shame on psychology.

Click the image to expand it.

By George J Huba PhD (Psychology)

Several times over the past six years, I have written similar posts suggesting strategies for minimizing the symptoms of dementia.

This is my current scorecard and suggestions about how to deal with the symptoms of the disease.

This is a totally new effort (I did not go back and look at the prior posts on this topic). If you want to know what I felt about my own dementia at various times since 2012, you can go back and look at my prior posts. To do so, on the left of any of my blog pages you can click on the month and year and see all of the posts from that time period. Alternately, in the search box, you can type in some keywords and see a chronologically-ordered list of my posts on that topic.

Here is a mind map of some strategies for minimizing the symptoms and effects of your dementia (or that of a person with dementia under your care).

Click on the image to expand it.

 

 

#dementia #MindMap @DrHubaEvaluator #GeorgeHuba

 

 

by George J Huba PhD (Psychology)

Dementia is a time that gets extremely complicated for a person with dementia and their spouse, family, friends, new social acquaintances, healthcare providers, and caregivers.

Probably the biggest issue is that those who interact with the person with dementia expect the PWD to communicate in a way that is diminished but still like the way a typical person without dementia communicates just now at a lower level.

It is difficult to communicate with a person with dementia because their own experience of communications is now shaped by the brain changes and other symptoms of dementia. What about your Mom who no longer smiles when you say something she has always liked or when you bring her the pistachio ice cream she has always loved? Ever consider the possibility that she thinks she is smiling but has no control over nonverbal communication such as her smile. Brain damage of various types can cause the loss of nonverbal communication abilities or control of facial muscles.

Why does your friend always get overwhelmed and say something stupid when there are lots of other people around? Perhaps they can’t focus on what you are saying because there is so much noise and motion from distracting sources?

Ever wonder why your friend with dementia comes back with an answer to a question five minutes after you asked the question? Brain changes and damage during dementia may make it hard to retrieve information or think and a loss of a sense of time may mean your friend keeps working on answering the question long after the conversation has moved on.

In dementia, a daydream may be as vivid as something in the real world, and just as distracting. In dementia, you can’t deal with too much information because it distracts you and can’t “fill in the blank spaces” if you receive too little because your “executive functioning” has been destroyed. You tend to get anxious during a conversation not only from unpleasant topics but also from worrying so much about missing a word or forgetting a name or misinterpreting a suggestion as hostile when it was just a normal joke.

The physical and psychological consequences of dementia combine to make it seem that a person with dementia is speaking a different language. They are.

And yes, those 20 or more pills the person with dementia may take daily can affect the ability to speak clearly, pay attention, be sleepy, look like they are bored when they are not, or become even more anxious.

Additional thoughts are arranged on the mind map below.

Click on the image to expand it.

Always try to remember that the person with dementia is often not disinterested or misunderstanding you or too tired to think or extremely distracted in what you think is a peaceful environment.

And if you are a person with dementia, remember that your friend is not trying to mislead you or express hostility and disapproval. They are not trying to trick you or harm you or pick a fight. You might not remember a conversation your caregiver says you had 10 minutes ago, so get over it and trust the other person. Nobody is criticizing you as a person because you can no longer tie your shoelaces or your necktie.

All parties in a conversation with a person who has dementia need to realize that the “rules” for the social encounter have changed because of the disease. Both persons with dementia and their families and friends and caregivers need to realize that is just as hard for all parties to figure out this new “language of dementia.” But it can be done and when mastered can liberate everyone to some degree.

Learn to laugh and smile and enjoy the company of each other again. The positive emotions are still there but they may have to be expressed in different ways. Learn how to express oneself when one or more parties has dementia. It’s worth the time. For everyone.

 

what makes conversation difficult for a person with dementia

 

#mindmap #mindmapping #dementia #Alzheimers @DrHubaEvaluator

By George J Huba PhD (Psychology)

After working hard (or some would say, “struggling) to continue having a good life with dementia, many (including me) find they must eventually come to the final obstacle of almost debilitating apathy and hurdle over it. It is very hard to commit the energy and time to fight back against the apathy which naturally results from knowing you will have to keep working so hard at fighting back for the rest of your life.

Take a deep breath. You can do it and then do it again tomorrow. Do remember that all of us who deal with dementia face the same general set of obstacles every day. And maintaining a “normal” or typical lifestyle is well worth it.

A mind map showing the major issues. Click on the image to expand its size.

Dementia Hurdle

By George J Huba PhD (Psychology)

As part of its Healthiest Communities initiative, the Aetna Foundation recently hosted a panel discussion on improving community health in order to serve individuals and residents with programs that could result in better health. The panel was broadcast on Facebook Live. A video copy of the event can be accessed HERE.

The panelists include:

  • Dr. Garth Graham, President, Aetna Foundation
  • Lauren Singer, Environmental Advocate and Zero Waste Blogger/Author of TrashIs4Tossers
  • Dr. Pedro Noguera, Distinguished Professor of Education, UCLA
  • Jane Sarasohn-Kahn, Health Economist and Founder of the strategic health consultancy THINK-Health

Each of the participants brings unique expertise in trying to understand and enhance service systems as it relates to their respective fields, including public health, education, and community resources and environment. The panelists’ diverse professional training and experiences also brought different viewpoints and ways of interpreting what they observe and understand about community health.

I found the panel to be a very valuable one – full of ideas, suggestions, experiences and planning topics for those who want to intervene to make their communities more responsive to local needs and better able to promote health among their residents.

In order to put the process of community change into context, I watched the video of the panel and prepared two mind maps to show major themes that were discussed. In case you have not read a mind map before it is a fairly easy thing to do. Start at the big graphic in the center and then follow each branch to its end to see a major idea unfold. Mind maps are often used to present complicated relationships ideas in a visual form that is relatively easy to understand and which promotes better information retention and analysis.

The first mind map shows a summary of some general steps and issues important in developing a plan for a community to change some of its services and procedures to support healthy behaviors and effective treatment and intervention.

Please click the mind map to increase its size.

This second mind map shows detailed steps that can be taken in order to implement system change. While the process seems complicated it really is a series of “baby steps” designed to allow community members and organizations feel RESPONSIBLE and EMPOWERED.

Please click the image to increase its size.

Systems change in communities is very hard because many traditional departments (of health, social care, law enforcement, mental health, housing, and supplying food) need to be involved. Many community members wish to help but not if a treatment facility or homeless shelter or parole center is located near their homes. Many professionals and workers at County service facilities want to help and increase services but they are already over-worked and largely underpaid. Creative solutions are needed.

I collaborated with the Aetna Foundation to share their work and research on community health tied to my own expertise in working with county-wide service systems dealing with drug abuse, mental illness, and issues of service access for disenfranchised individuals. These include: poor/homeless individuals, drug abusers (often addicted to heroin, amphetamines, cocaine, and other drugs), those involved in the criminal justice system, street sex workers, extremely physically ill individuals, those diagnosed with a number of behavioral and mental problems, as well as those incapable of accessing services themselves. Over several decades Dr. Lisa Melchior of The Measurement Group and I developed services for the poorest and most fragile members of our society. Dr. Melchior continues our work. 

Lessons Learned

Here are a few key lessons from the Facebook Live video and the broader Healthiest Communities research.

  • Building a healthier community is a very complicated process that involves hundreds (if not, thousands) of agency and individual stakeholders representing a large number of constituencies. Short video conferences such as the one summarized here can prove to be extremely valuable resources for many groups focusing on systems changes. A website featuring video presentations, townhall meetings, and discussions will prove invaluable for many U.S communities throughout the country look better and will help them become better and more efficient by learning “the secrets” of building successful change processes from others who have attempted such changes earlier.
  • Most communities that wish to develop and support change processes usually start with a “needs assessment” of where the community has already built important processes of developing and maintaining services and where the community would benefit from new efforts. A comprehensive database containing concise and valid rankings and research conducted by the Aetna Foundation and US News provides each county a “free needs assessment” or comparison of the community to its peer communities. Rather than requiring an investment of additional resources into expensive analyses of unmet needs, the presence of a mature and valid dataset will permit communities to very quickly review needs established in the existing work and then focus their own efforts and resources on developing plans for addressing the largest needs of the community.

This morning while I was working on Twitter I looked at the bios of various followers of mine in order to see who they were and what they were doing.

One of the best bios I have seen on Twitter is that of Dr Sukant Khurana. His twitter (@sukant_khurana) and blog http://www.BrainArt.com are highly recommended.

I suspected that Dr Khurana might appreciate seeing how his bio could be turned into a mind map by a person with dementia (me) who is using visual thinking methods to continue to have a good life. Dr Khurana, your bio, twitter, and blog are inspiring.

 

the ticket to a good life (adapted from the twitter bio of @sukant_khurana)

It just takes a little time every day to learn and use advanced ways of organizing your thoughts and experiences.

It costs a few cents a day over a lifetime.

It builds cognitive reserve.

It potentially builds a mind more able to deal with the challenges of cognitive impairment and dementia.

Why not?

Click on the image to expand it.

 

The Veterans Healthcare System is the most important one we have in the USA.

VA

One thing that all of the cable news networks and newspapers agree on is that issues of veterans’ health are ones on which all members of Congress seek to achieve a consensus. An interpretation of this that I have heard from the TV pundits is that all members of Congress, whether veterans or not themselves, respect those who risked their lives to protect the United States and police the world. Another interpretation I have heard is that all members of Congress need to face constituents who value service in the military and would not vote for a potential member of Congress who does not protect those rights. I prefer the first interpretation, although I would also accept the second. Veterans have earned lifetime healthcare services and those services should be the very best that the medical and social services can provide.

I was very happy to see the strong reaction of Congress to the poor candidate nominated recently to head the Veteran’s Administration. A doctor who has managed a staff of 70 healthcare providers is probably inadequately prepared to run a large federal agency with hundreds of thousands of employees, 9 million patients, facilities across the US, and many political entanglements. Just because you are the personal physician of the US presidents and praise the current president’s health in spite of his all-fast-food diet, borderline obesity, and behavior that indicates high levels of stress does not mean that you should be rewarded with a job in charge of the quality of the healthcare of 9 million veterans. And no doctor who hands out medications on airplanes without prescriptions or having personally met with the recipient (patient) and is accused of inappropriate interpersonal behaviors is deserving of being trusted with the health of our veterans.

For once, Republicans and Democrats agree that the candidate was not qualified to head the Veterans Administration. And they achieved this conclusion by consensus.

So the nominee did the right thing and withdrew from his candidacy after a lot of pressure from the White House.

188_VVNBX2ZsYWctc3RhdGVzVVNBX2J3.jpg

Wouldn’t you like to see our elected representatives act with similar wisdom and common sense every time they make a decision? CONSENSUS!

Tinkerbell thinks so.

tbell

And I am wishing upon a star.

 

 

Having dementia is, OBVIOUSLY, not a lot of fun. You feel bad mentally and physically and tired after just a little physical or mental activity. A couple of weeks ago when I had a six-hour professional meeting with two other people I went home and immediately went to sleep for 14 hours.

When you have dementia, it takes a lot of energy to just get through a day and figure out what you can do and how to do it. I have trouble with buttons so I find that I am leaving my preferred “office” shirts buttoned and just pull them over my head. I go to the trouble because wearing a dress shirt during the day — albeit without a tie and with the sleeves rolled up — makes me feel better.

Social interactions are among the most difficult things I have to deal with during the day. They are also the most upsetting to other people because they can see my vulnerabilities at the same time I may annoy the heck out of them.

So, one thing I try to do is to follow the 10 courses of action listed in the mind map below. I have increasing dementia after all so no matter how hard I try I doubt I get more than 80% of these things right. But by trying hard, my efforts are appreciated and reinforced by those family members, service providers, and others who have to deal with me when I am at my most stressed and tired and grouchy. And the fact I am trying lowers their stress.

Just because you have dementia, you are not excused from trying or being nice or appreciating others.

Click on the image below to increase its size.

 

Being the Best You Can Be with Dementia

Made on the GapMinder.org Web Site.

If North Korea became just like South Korea, their per capita income would be TEN TIMES higher. The North Korean life expectancy could increase by TWELVE YEARS. Democracy, a battery-powered car and 2 television sets, a great education for your kids, a couple of trips to Hawaii, and 12 more years of life. Turn off the nuke production and increase the quality of life.

The #1 thing that I have learned over almost a decade of living with dementia is that thinking in pictures (images, diagrams, doodles, etc.) is much more effective than using words alone. Hedge your bet. Use pictures that associate with words rather than just words. After all, in many types of dementia, you lose your words at the end while the pictures may escape loss.

Try it. You will probably like it. Creating visualizations of important events, ideas, feelings, and other information can be FUN.

I’ve been using visual thinking methods for the past 10 years. They work (for me).

In March 2018, @USNews and @AetnaNews published key results from their study of approximately 3,000 US counties. Each of these counties received a total score as an index of how healthy the community is as well as scores on 10 component parts of being a healthy community. Eighty indicators of community health were developed from standard, well-constructed, and valid datasets.

The Healthiest Communities rankings are based on well-collected longitudinal survey data from US government databases and those of well-established, not-for-profit organizations.

Click here to see the full report in a new window.

My professional conclusion is that the study is valid, reliable, and relevant. The index scores are based on a combination of expert judgment from independent professionals and data sources that are among the best available. Statistical analyses appear to be appropriate and expertly applied. Of course, as with all such studies, over time additional analyses can be made, interpretations can be added by experts of many disciplines not limited to health, and supplemental quantitative (numerical) and qualitative (judgment) data can be collected.

The report on America’s Healthiest Communities provides a summary of the top 500 communities. The remaining rankings are not revealed as the intent is to identify excellence and study it to establish models for other counties that are also working to improve the quality of life for their residents.

Data available on each community includes well-constructed indices of the following characteristics listed in the mind map below. Click on the map to increase its size.

3D What is a Healthy Community ##### U.S. News & Aetna Foundation

I spent more than 25 years in my post-doctorate career studying the health of communities throughout the USA, including  a) small “frontier counties” too small to be considered rural where there were 5 times as many cows as people and the trip to a doctor was more than an hour for more than 50 percent of the population; b) the fourth largest U.S. county in a location on the Mexican border; c) large-city neighboring “bedroom” counties; and d) healthcare systems in more than 100 other U.S counties. My work (in collaboration with my business partner Dr. Lisa Melchior and our staff at The Measurement Group) was primarily focused on developing high quality, effective, and accessible care and treatment for people with mental health problems, drug and alcohol abuse and addiction, HIV/AIDS, extreme poverty, unstable families, inadequate or housing, poor education, immigration status, criminal justice system involvement, dependence on public-supported health- and social-care systems, and legal unemployment with a subsequent dependence upon “illegal employment” such as selling drugs and sex work in order to support themselves and their minor children.

Dr. Melchior continues our work.

As we worked with health systems and clinics, what I concluded was that a very comprehensive service system with widespread support among residents, service providers, and elected officials was necessary to make a community healthy. It was clear that all of the major stakeholders in the system need to communicate clearly to the other stakeholders about what they could and could not do with available resources. Stakeholders needed to learn to how to leverage their resources with those of other stakeholders to provide better services for a lower cost. A permanent system of making decisions and sharing resources and improving services needed to be formed and nourished.

The basic components of our work included assembling data from sources such as surveys, focus groups, interviews, and public databases. We presented these data to groups of stakeholders and facilitated discussions on how various systems such as healthcare, public housing, law enforcement, and education-training could work together and share resources. Progress was monitored and evaluated and new cycles of data gathering, communicating, discussions, and program alterations were conducted.

The following diagram shows the steps our process went through in order to build a self-sustaining system of interdependent services and joint decision-making in order to make a community more healthy. Click on the mind map to increase its size.

It is often said that “it takes a village” to plan and implement long-lasting improvements in a community. It does, but it takes a few other things also as well. Click on the diagram to increase its size.

It Takes a Village

 

#13) The diagram below is a sketchnote, a new method for recording information developed by Mike Rohde about 10 years ago.

In my personal experience (using it to deal with my dementia) this works far better than a “regular To Do List” for helping me remember and stay motivated.

It would take you 10 minutes to try this yourself whether or not you have cognitive impairment.

[Go buy some erasable markers.]

12thingsIlearnedabiytdenebtua

A caregiver looking at a person with (advanced) dementia can easily conclude that it is impossible to motivate them to do tasks that are “easy” (washing dishes, taking the garbage to the recycling bin, calling and making their own doctor appointment, or cleaning out the garage).

Motivation from the standpoint of the person with dementia such as myself is a much more complicated phenomenon. If you don’t have dementia you may not see it the way I do. Most people who have dementia will not articulate these issues in the way that I do (I have had 30+ years as a psychologist and this medical-psychological language is natural to me). I am convinced, however, that most people with dementia feel some of the things that I describe below. I not that I object to cleaning the garage but rather that in order to clean the garage I have to overcome dozens of fears and anxieties and find different ways to do simple things because I can no longer remember the order of the steps needed to do what seem to be simple tasks.

Please click on the mind map to expand its size.

LOSS OF MOTIVATION DURING DEMENTIA SOME REASONS WHY

If this is more than the second time you have ever read a post on my blog, you know that Donald Trump is not “well received” on my blog site.

Here is the worst tweet he has ever posted.

Trump is so obsessed with his “button” working that he has ignored and hidden the fact that his brain is not.

And here is a tweet from Lindsey Graham who has recently become Trump’s chief sycophant.

Mind maps are extremely useful for expressing an opinion or conclusion. Along with my conclusion that Donald Trump should be forced to resign, I also espouse full human rights for all without regard to the cost, banning all weapons of mass destruction held by ALL countries, and the full array of universal human rights specified by the United Nations. I also support allowing the figure-skating, Olympics-qualified couple from North Korea to attend the 2018 games in South Korea and enjoy the kindness of the host country and the support and friendship of the athletes of the world.

The President and his sycophants like Senator Graham need to be evaluated for their fitness to hold public office.

2018

Modern terminology for Frontotemporal Dementia (FTD) has been expanding. Now, FTD is included within a larger group of neurodegenerative conditions including Progressive Supranuclear Palsy (PSP), Corticobasal Degeneration (CBD), FTD with Parkinsonism, and FTD with Atrophic Lateral Sclerosis (ALS). The combined set of diseases including FTD behavioral variant and PPA is referred to as Frontotemporal Lobar Degeneration (or Dementia).

At the present time, a variety of factors (including the research literature, the interests of advocacy groups for individual diseases, and prior medical practices) continue to the nomenclature and typology of these diseases inconsistent in different places.

Types of Frontotemporal Lobar DiseaseDementia