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by
Louis B. Cady, M.D.

from Work Smarter, Not Harder ©2004, James & Brookfield, Publisher

The care, feeding, and driving of one’s own brain is both ridiculously easy as well as extremely complex. Perhaps the best explanation starts with a flashback to an old episode of the comedy, “Gomer Pyle: USMC.”

In the episode in question, Gomer was assigned to take charge of the Army PX on base when the quartermaster was out sick. He promptly reorganized the entire store into his own homespun categories of “animal, vegetable, or mineral.” Although his classification scheme was not “official Army issue,” it was, nevertheless, a useful attempt to impose order on a confusing array of choices… at least, for Gomer.

Based on my training in psychiatry, a decade in private practice, and monitoring my own successes (and failures) in keeping up and keeping pace, I think that a very useful categorization scheme for the care and feeding of one’s own psyche – and life – is a similar tripartite organizational scheme: biological, cognitive, and behavioral. Nor is this just some artificial scheme that some nerdy psychiatrist in an ivory tower dreamed up.

And by the way, here’s a word up front about why you should be reading what a shrink has to say, whether or not you think you’re the most un-neurotic, nonconflicted, happy-go-lucky guy or gal to ever put on a business suit or uniform. I’ve seen every little human foible and frailty pushed to the limit. You say you’ve got problems with procrastination? I see people’s careers ruined from it. You’ve occasionally told little teeny-tiny white lies? I’ve seen lives, marriages, careers, and companies destroyed because of them. You go to work with the sniffles? I’ve seen people who would have died if I hadn’t insisted that their cancer get diagnosed and treated.

Do you have a problem being absent-minded? I can tell you what this seemingly mildly annoying difficulty may stem from, and what you can do to banish it from your life, forever.

Are you tired? We can talk about some medical conditions that you may never have heard of that are slowly killing you. And you don’t even know it.

In other words, I can, and I will, tell you in this chapter what the tiny defects in your performance, efficiency, and energy levels may really be indicating, because in my psychiatric and medical practice, I’ve seen all of them taken to the limit.

Let’s start at the beginning. Psychiatry got its start with an interesting guy, whose original research interest was the sex organs of eels. His name was Sigmund Freud. And his goal was nothing less than the mechanical and methodical understanding of the human mind on purely biological grounds. Along the way, his course detoured dramatically, and he ended his career plumbing the depths of the human unconscious mind… and no longer contemplating eel sex organs.

In Freud’s footsteps, the practice of psychiatry and psychology was organized along the study of the mind: of one’s psychology. In the middle part of the 20th century, the “behaviorists” came along and decided that it really didn’t matter what you thought or if you were “conflicted”: it only mattered what you did. “Change your behavior, change your psychology” was their reasoning. Hence, the behavioral approach came into being.

Now, being upstanding, card-carrying members of the “Prozac generation,” we know that it’s those pesky neurotransmitters that get out of whack that cause all of our problems. We have entered the biological orientation of psychiatry.

Of course, like the three blind men feeling different parts of the elephant, the informed and integrated health care practitioner knows it’s not, as technological expert Daniel Burrus notes, “either/or”; it is, instead, a choice of “both/and.” And in the case of running your brain effectively, it is all three.

OK, I hear you asking. What does all of this stuff have to do with me?

The simple truth is that you would never have picked up this book if you were happy as a clam, sipping a refreshing tropical libation, and contemplating an idyllic beach somewhere with money in the bank to live on for life and no pressing obligations. This is a book for the movers and the shakers: the people who are actively engaged in life and who, in the early 21st century, are now among the most overworked, right-sized, techno-savvy, media frazzled, Wi-Fi’ed, and Starbucks-caffeinated generation ever to inhabit the planet. Like the old Charlie Chaplin flick where the hapless worker is able to crank widgets on the assembly line until the assembly line picks up speed, we’ve done alright until now. Unfortunately, the pace has picked up and is continuing to accelerate.

Nowhere is this more evident than in the lives of my patients, and in the lives of those strangers I meet when I am traveling for business. This perspective – and the tripartite model I shared with you a few paragraphs back – is the “news from the front” I wish to share with you.

Just for a moment, imagine a carpenter building a house. To know how to build a house, but not to build it, is a defect in behavior. To not know how to build a house, but to try to go ahead and build one anyway, would represent a defect in one’s knowledge, or, in this case, one’s psychology. And to both know how to build a house, and to start to build a house, but then to run out of energy: that would be a defect in one’s underlying biology. Let’s start with the mind, and our understanding of the way we are and the way we think.

PSYCHOLOGY

One’s psychology, or the way one sees life, is crucial. Motivational authorities including Zig Ziglar, Jim Rohn, and Brian Tracy all pound home the point. From a utilitarian point of view, it ultimately comes down to a choice that you have to make: “what is the most workable philosophy?” [Note: see the web sources listed at the end of the chapter for more details on these references and multiple other topics to follow in this chapter.]

A dysfunctional philosophy, one guaranteed to beget failure, is this: “There’s no point. The world’s a terrible place. People are just nasty and dishonest. Life ain’t fair. There’s no point in trying. You can’t fight City Hall. The deck is stacked against me.”

Come on. Can you imagine strapping on your business duds and going out into the world to transact business with that poisonous attitude?

A more neutral attitude would be: “On balance, life is fair. I’ll probably get back what I put out. Therefore, I’ll give everything a reasonable effort.”

You’ll probably get a much more reasonable return on your efforts.

Imagine the alternative: a relentlessly upbeat attitude. “Wow! I wonder what exciting opportunities I’ll have today? I can hardly wait to start the day! Whatever I deal with today, I’m sure I’ll do just fine.”

Because of the principle of reciprocity – that is, people tend to give back what they receive – your business interactions with people will be immeasurably improved with this third, and more adaptive stance. I’ve proved it in my own life, and I’ve seen my patients prove it in their lives in the course of their therapy.

In fact, there is a school of psychotherapy known as cognitive therapy. It identifies an incredibly important “cognitive triad” that is just as important for psychiatric patients as it is for average Jane’s and Joe’s out there who are having a tough time at work.

The cognitive triad principle is simple. There’s an event, a perception, and a reaction. For example: someone doesn’t show for an appointment with you. You perceive this situation as a personal rejection. You react emotionally. And it could ruin the rest of your day.

A more adaptive way to deal with unexpected woes is to studiously choose your perception. An alternative way to view the appointment which didn’t occur is: “Oh, well, he probably just forgot about it.” You could even accept some responsibility and learn from it. In casting about for explanations, you would do well to consider what your own contribution was. Perhaps you could have called ahead?

Please don’t get me wrong. There’s already enough stress in most of our lives without needlessly being made to feel worse about our own contributions to our misfortunes. But as Harvey Mackay once dryly noted: “The best place to find a helping hand…. is at the end of your arm.”

Recently, I was riding in the car of a pharmaceutical representative. The company that had hired me for the occasion had paid good money to get my bod to parts northeast in order to give a luncheon and dinner talk, as well as to motor around with the rep and call on physicians. The luncheon came off as scheduled; everything else was a disaster. Doctors were out of their offices. Some were too busy. Not enough people had responded positively for the dinner. It was cancelled.

As we rode around in her car, she railed against how “they should have been more responsible; they should have let me know that they wouldn’t have time today to see us. After all, I called them earlier this week.” Yes, but she hadn’t called that day.

The problem with blaming other people for your every misfortune is, of course, that if it is you that’s the source of your own misfortunes, you’ll never realize it because you’re so busy blaming everyone else!

Let’s get back to that cognitive triad. The event: doctors are not available. The perception: “those irresponsible doctors; they should have known better. How irresponsible of them (and, by the way, there’s nothing I could have done about it anyway).” The emotional reaction: anger and being upset.

Here’s an alternative view. The event: doctors are not available. The perception: “Hmm, I know they’re busy, and, after all, I didn’t call to confirm the appointment. That’s why it didn’t come off.” The emotional reaction: neutral, or, perhaps, rueful. The exciting thing: the presence of a take-home message! “Hmmmm. I have identified a deficiency in my sales technique and appointment-making style. Perhaps if I had called in advance to confirm, the doctors would have been available.”

Unfortunately, you will never get to this clear-headed state if you just let your perceptions and emotions run away with you.

David Burns, in his excellent book, Feeling Good: The New Mood Therapy, lists some of the more common cognitive distortions. At the risk of harping on the hapless pharmaceutical rep, let me take that situation and run through some of them. Keep in mind that in order to really do these distortions up right, you have to begin your dysfunctional statement with the dependent clause, “In my all-knowing, omniscient, and God-like knowledge and power, I know that…” and then just fill in the blank. Let’s have some fun and do some. I’ll list the technical name of the distortion first, then give you an example.

· Mind-reading – “In my all-knowing, omniscient (etc.) way, I know that they didn’t really want to see me today. That’s why they stood me up.”
· “Fortune telling” or “predicting the future” – “Gee whiz, it’s always going to be like this. They’ll always be standing me up. Why even try?”
· Catastrophizing – “This ruins my entire day. Nothing else matters.”
· “Mental filter” (seeing just the negative) – “Forget about the great sales call I just had with the doc. That receptionist surely was unpleasant.”

You can quickly see that going through the day with this mentally poisonous routine would ruin it!

Here’s Doc Cady’s down-home way to counteract the mental poisons: identify the problem, then run it through The Five P’s. Here’s how.

Throughout the day, take the smallest, cheapest hand-held recorder you can obtain with you. When something occurs that really steams your veggies, make a voice note of it. Example: “I’m really annoyed that those doctors flaked out on me when I set up an appointment.” That’s it. No long and introspective circumlocutions: just a quick little verbal note. Let’s say another thing that went wrong is a physician didn’t listen to you particularly well – and this happens to both reps and patients! Make a note.

At the end of the day, take your microcassette tape or digital recording, play it one time, and carefully write down what’s bugging you, at the top of one page of paper. Write only one “downer” per page. This is the toxin. It’s now time to construct the anti-venom. Take a deep breath. Flip back to your first page.

The first step is to determine what’s pertinent. What are the facts? The doc stood you up for an appointment, let’s say, or your major client didn’t call you back. That’s what happened. But what was your contribution? Let’s say you didn’t call to confirm in advance. That’s what’s pertinent. Write it down.

Step two is what’s personal. In other words, what can you personally do about the situation? You talk to the client on the telephone in advance! Write it down.

Step three is proactive. In other words, it’s up to you. YOU have to take an action, or series of actions, in advance to get what you want. Make the list!

Step four: figure out what that action will be, and what the results will look like, in a positive fashion. This is incredibly important. In other words, don’t visualize it, or articulate it like this: “In order to keep my scumbag clients from canceling out on me at the last minute, I guess I gotta…” This is the blame game, and it’s for losers. Instead, conceptualize a positive outcome: “In order to have the privilege and opportunity to represent my product in a maximally productive way, I…”

Finally, step five. Articulate your vision in the present tense.

Here’s where it gets interesting. You’re not done yet. Review the notes you made, then craft a custom made affirmation for yourself in order to deal with every frustration and personal outrage of the day. Remember that you have to accept responsibility for your share. This doesn’t mean you have to accept responsibility for a mugging, or for your business burning down. But let’s say you get cut off in traffic by a pushy driver. Why is it eating on you so much? Maybe because you’re running behind too. Maybe you didn’t get up early enough. Maybe you’re over-committed and overwhelmed, and your life has to go perfectly in order for you to not be stressed! If you’d been happy as a clam motoring on down the road, chilled, groovin’ to your favorite tunes on the radio and not white-knuckling it to get to the next appointment, maybe the pushy chap wouldn’t have discombobulated you and rained on your parade!

Back to business. Let’s look at your 5 P’s. We’ll continue using my hapless pharmaceutical rep acquaintance as an example.

Here’s a pertinent, personal, positive, proactive and present tense affirmation: “In order for me to be able to sell my incredibly valuable product [positive], and so that my appointment will be secure with Dr. X [pertinent and proactive] I will [personal and proactive] call in advance on the day of the appointment so that I will have the opportunity to adequately explain such-and-such [positive]. In this manner, the sales presentation and the opportunity will take care of itself [positive!].”

If all you did was just sit down at the end of the day, make this list, craft your affirmations, and run through them one time, you would be ahead of the competition. But you really want to Work Smarter, Not Harder, don’t you? Then you need the ultra super-duper luxo-version of the above.

After you write down your statement encompassing the Five P’s, you record your statement. You can do this on a cheap audio cassette recorder which you can take with you in your car. In order to get the best possible results, my recommendations are that you record a sentence at a time, with a pause after every sentence so that you can repeat your words aloud while you’re listening. You can play the tape in your car, or play it in your bathroom while you’re getting dressed for work. You could do both!

By contrast, here’s what the losers mumble to themselves trudging away from another missed appointment on the way to their cars. “Awhh, it happened again. [pertinent!] They did it to me again [avoidance of personal responsibility]. I don’t know what I can do about it [abdication of proactive stance]. Gee, if this kind of garbage continues to happen [certainly no positive notions here], I don’t know if I’ll ever be able to garner any kind of success with this company [future orientation, neatly combined with “fortune telling” and “catastrophizing”].

The contrast between these two paradigms is nowhere more crisply defined than by Prof. W.W. Broadbent, MD, PhD, at the University of Southern California Medical Center: “The major way of doing anything with one’s self is to own one’s self. This means to take full responsibility and accountability for whatever I am doing at any moment, with anybody. It means, among other things, that I get rid of all the extra fingers that I point at people and situations to explain my behavior. When a person says ‘He made me mad’ that is not accurate. It is ‘I made me mad.’ When I permit myself the luxury of taking that full responsibility, then I’m on first base, at least, because then I can do something about it.”

The sad thing is, some people trudge through their entire business and personal lives saying “other people made me mad” and “other people stood me up for appointments.” Is it any wonder that with the increased pace of business, coupled with the fact that people are never really taught how to “run their brains” either by their parents or in school, that there’s such an epidemic of depression, anxiety and obesity in society today?

BEHAVIORAL

The idiocy of a totally focused “behavioral” approach to solving problems is nowhere more clearly demonstrated than in W. Edwards Deming’s famous “red bead” exercise. The gist of the scenario is that participants at his seminars were asked to dip a paddle with indentations in it into a container of white beads with a few red beads mixed in and then pull out their paddles containing only white beads. When people were obviously unable to succeed, he would exhort them with cries of “Try harder!” or “We need to reconfigure and re-engineer the team!” or “Maybe we need to fire the incompetents!”

The message, obviously, was that it was the system that was flawed, not the people. Indeed, Professor Russell L. Ackoff, at Wharton Business School, notes: “To manage a system effectively, you might focus on the interactions of the parts rather than their behavior taken separately.” So a total “behaviorist” approach to working smarter, not harder, will not – ultimately – be smarter. It may be harder!

Nevertheless, like our lazy carpenter friend, if we know how to build the house but don’t pick up the hammer, we won’t make much progress.

Here are some tips I’ve shared with some of my patients and which I use in my own life. This is not the “ABC’s” of behavioral management. It is the “ABCDEFG’s.” Let’s take a look.

A is for AWARENESS. In a sense, that’s the “psychology” section we just completed. “The ultimate value of life depends upon awareness,” commented Aristotle, “and the power of contemplation rather than upon mere survival.” The Doc Cady version of the great philosopher’s message is: “You’ve got to be aware of the problem of getting stood up for appointments (or whatever) or you won’t sell many widgets!”

B is for BELIEF. This is actually pretty simple for anyone who is not psychotic. If you’re psychotic, then you have more problems than I can deal with in this book. But for most rational folks, the simple commonsensical beliefs are enough. If what you do is positive, you’ll get positive results back, and if what you do is negative, you’ll get negative results back.

Insult the customer, get turned out on your ear. Be nice to the customer, get more business. Lose appointments? Starve. Get appointments? Have more chances for success. Don’t use a planner? Be disorganized. Don’t sell much. Starve (again!). Use a planner? Be organized. Plan your strategies. Secure the appointments. And have more chances for success.

C is for CONCEPTUALIZATION. In this case, conceptualization is a noun which calls for you to do something. The noun form, or “thing” is what you form in your mind about what’s causing your success (or lack of it). But that’s only half the story. For the unsuccessful pharmaceutical rep, the original “conceptualization” was that “the doctors are irresponsible and are not following through on their appointments with me.” The successful conceptualization must involve a behavior. That is, you sit down, reason the situation through, and formulate the most adaptive or positive conceptualization you can muster; then you affirm it onto a tape recorder. If you’re really techno-savvy, a digital or mp3 file will also work well. The bottom line: in order to have your conceptualization, you must conceptualize. You must do something in your head.

D is for DO IT and DOCUMENT IT! “He only earns his freedom and his life who takes them every day by storm,” commented Johann Wolfgang von Goethe. More colloquially, like our edified but behaviorally challenged carpenter, you’ve got to pick up your hammer and start pounding nails if you know how to build a house… and if you ever want to live in it or sell it. You also get to serve as your own “construction foreman.” In order to know how your building is coming, you need progress reports. You need to know what’s coming up tomorrow, and the day after that, and the week after that. You need to know where your next job is coming from. You need contact information for your suppliers and customers. In other words, you need: a planner.

The most successful thing I’ve ever done with patients who are mired in helplessness and hopelessness in order to get them off the dime is to have them document what they are doing. Like the Heisenberg “Uncertainty Principle,” the very act of observing a phenomenon changes it. If you have to write down in your planner, regarding your day’s activities, “missed every appointment because no one was there,” then even the most business-challenged among us would recognize that there was a common theme here and perhaps we should learn the tune.

The flip side is that when we commit to action and get results, we also need to have that written down. By so doing, we can experience the Law of Cause and Effect again, and internalize it at our deepest level. This law, according to Doc Cady, is, “You do what you need to do and you get the goodies. You don’t do what you know you need to do, and you won’t be getting the goodies.” Documenting it allows us to celebrate our success and what got us there.

E is for Expect Results! This gets easier as time passes and you DO IT more and DOCUMENT IT more. As it becomes clear that your results are coming directly from the efforts you’re putting forth, it becomes much easier to trust, on faith, that you have every right to expect results – and good ones at that – from your efforts. There are many wonderful books and audio programs available which will put you in a mindset of “positive self-expectancy” and allow you to expect positive results in the future before you even achieve them, based on anecdote after anecdote, and case study after case study. Eventually, if you just keep putting enough of the good stuff in, your negative self-talk will be pummeled into submission.

FAILURE is to be Expected. I love what the relentlessly upbeat Zig Ziglar has to say about failure. “Failure is an event…it’s not a person. Yesterday is a cancelled check. Today is a brand new day, and it’s yours!” Look. Given that this is not a perfect world, and “the system” does not always give back to you perfectly what you put into it, you will occasionally encounter unexpected failures and setbacks. Expect them to occur occasionally, just as you expect your good results. After these occasional mishaps rock your world, put them behind you and go on. Pop in a motivational audio. Read some good books. Dissect the event dispassionately; see if there are things you can learn from it. Then move on!

G is for GO BACK and keep trying. One previously severely ill patient with whom I have worked for almost a decade has struggled for the last four years to get her ex-husband to pay her what’s her due in a divorce settlement, has struggled to get him to pay her kids’ medical expenses, has taken personal bankruptcy, wrangled with the IRS, suffered woes with a string of lawyers and has not unexpectedly teetered close to suicide many times. I kept focusing on having her go back and keep trying. We went through every letter you just read: A through F. Failures kept occurring – some through lack of knowledge on her part, and some because she didn’t have the biological strength to fight. She persisted. She kept going back. And she is now winning big. Her life and those of her two children are all radically improving.

I have had some patients who have not gone back and kept trying. The most severe of these cases of personal suffering are now dead by their own hand. The human tragedy is that suicide is a permanent solution to what, upon closer inspection, is almost always a temporary problem. It is an emotional decision, founded on false logic, and predicated upon almost unbelievable psychological pain and agony.

The alternative is to GO BACK and keep trying. I’ve never had a case where it didn’t work.

BIOLOGICAL

Greg Anderson, an NBA forward/center for the San Antonio Spurs and the Atlanta Hawks, has cogently observed that, “The concept of total wellness recognizes that our every thought, word, and behavior affects our greater health and well-being. And we, in turn, are affected not only emotionally but also physically and spiritually.”

He is profoundly correct, and his statement should indelibly cement the connection between your psychology, your behavior, and your biological state.

Renee Descartes, the philosopher, not a basketball player, has caused much devilment with his notion of the “dichotomy” of the mind/body connection. Essentially, his position was that the mind didn’t affect the body and the body didn’t affect the mind: they were autonomous. Wrong!

We can see this now on functional brain images, where actual changes occur in our biology based on what we think. Over a decade ago, Konrad Schwartz at UCLA did some groundbreaking work on this with functional brain imaging and what he termed “cognitive bio-behavioral therapy.” He was actually able to show changes in brain activity based on his therapeutic model. This experiment showed why psychotherapy had been able to get people better before any of the antidepressants were introduced in the mid-twentieth century. “Change your thoughts, change your mood, and you change your underlying brain biology,” was the way it worked.

So far, we’ve talked about changing both your thoughts and your behaviors. In psychiatry, we know that increasingly excellent medications can, on a purely biological basis, change your thoughts – lifting you out of a depressive state, for example – and then with therapy you can change your behaviors. Thus, the mind-body duo works both ways in terms of cause and effect.

Here’s the rub. It doesn’t matter how positive you are in your psychology, or how willing you are to engage in the appropriate behaviors if your body answers your call to achievement with, “I just can’t.”

The all too often result, which is a tragedy, really, is that the hapless victim of his or her biology concludes – wrongly – that she/he is just being “lazy”, or “scatterbrained”, or “unmotivated” and that “it’s hopeless” and “I’ll never be able to change.”

Over and over again, I’ve seen good men and women who come in to my practice with undiagnosed medical problems. Sometimes the “psychiatric problems” they present with are either entirely medical in origin (hypothyroidism, for example, masquerading as depression) or else medical issues strongly compounding their psychiatric conditions.

Some of what I’m about to list will be controversial; some won’t. [Check the web resources for further details.]

Attention Deficit Disorder – (with or without being “hyper”). I’m starting with this one for two reasons: (1) I see it more in entrepreneurs than in any other patient population – and the target audience for this book will have a highly entrepreneurial mindset. (2) If you are feeling the need to “Work Smarter and Not Harder” then you either think you’re working dumb or not hard enough. In either case, “ADD” may be the culprit.

Estimates for the percentages of this condition in the United States range from 4 to 8 percent of children. The rate is fairly consistent across the world. (It’s not a “U.S. condition.”) It’s so intensely biologically inherited, it’s almost tied with height as determined purely on a genetic basis. (In other words, you can’t “catch it” or have MTV “infect you”). About half of these kids continue to have some difficulty as adults. This doesn’t mean that adults with ADD are “hyper” or that they’re globally inattentive. But they might be endless procrastinators, lose things easily, get behind constantly, or be easily frustrated and even explosive at times. (If any of this applies to you, you may have the sense that you need to work smarter and harder!) Medication works, and is now considered appropriate in adults.

Anxiety disorders – rampant in our society. If you’re quivering in your boots, you won’t be successful in making appointments or keeping them. Non-addicting, non-“dope-you-up” medication strategies are available. Do yourself a favor and find out about them.

Depression – Most people know about this one. It’s currently estimated that 6 percent, or 13 million Americans, suffer from depression each year. Only 1 out of 4 get adequate treatment. Not surprisingly, it’s the number one leading cause of disability and costs the economy an incredible 30 billion dollars a year in lost productivity.

I estimate that a considerably higher number than 6 percent of the readers of this book will have depression or a variant of it, simply because of the nature of the book. Again, anyone who feels the need to “work smarter, not harder” is already stressed, and stress tends to bring on depression if you’re vulnerable. It doesn’t mean that you’re weak or a wimp; it may mean that you’ve got too much on your plate. Help is available.

Quickly, here are some medical conditions which can nail you:
· “Adrenal burnout”: This is the stress disease of the late 20th and early 21st century. Your adrenal glands sit on top of your kidneys and pump out hormones to help you deal with stress, inflammation, and sugar and salt balance. Felt any stress lately? Felt nothing but stress lately? Perhaps you’re essentially a happy cheerful, motivated person, but it feels like somebody has pulled the plug on your energy. Easy laboratory evaluation is available, including some which can be done just using your saliva. Treatment by a holistic and sophisticated medical practitioner can restore your energy.

· Hypothyroidism: I have seen this diagnosis, as well as its treatment, butchered repeatedly by well meaning practitioners. The typical difficulties are checking only an indirect measurement of thyroid function, called “TSH”, instead of checking out the whole system. Other errors include over-simplified thyroid hormone replacement, usually with just one hormone, and following this intervention by just checking one or two levels. Bad treatment of thyroid dysfunction can rob you of your life, energy, and health, and in certain cases can end up costing you your thyroid gland, resulting in your having to pop a thyroid pill every day for the rest of your life. There are fabulous laboratory assessments available – such as this one, from Great Smokies Diagnostic Laboratories – which encompass all aspects of thyroid functioning, including TSH, T3, T4, and antibodies to the thyroid gland – both antithyroid antibodies and anti-thyroglobulin antibodies.

· Obstructive sleep apnea: This little jewel I encountered first in my psychiatric residency, and then later when I served as the medical director of the Sleep Diagnostic Center of Indiana. Typically, but not always, this is a condition signaled by loud and obnoxious snoring and ominous stop-breathing episodes during sleep. The afflicted sufferer is usually the last to know. A gradual draining of one’s energy and mental faculties, a slow rise in blood pressure, and death by heart attacks, strokes, or traffic wrecks (because of going to sleep at the wheel of a car) are the outcomes. This condition will rob you of your career, then kill you. Do not treat it lightly.

· The two “easy” cancers: This one is “good news, bad news.” Both of these are incredibly easy to diagnose and treat when caught early. Both will typically kill you if caught late. They are cervical cancer in women and prostate cancer in men. Both require examination in your private areas. For men, the American Cancer Society recommends digital rectal examination and a blood test, called the PSA, yearly if you are over fifty. Women don’t get a “pass” until fifty, however. Recommendations are usually for pelvic exams and Pap smears once a year from adulthood on, or when sexual activity commences. Tragically, “between 60% and 80% of American women with newly diagnosed invasive cervical cancer have not had a Pap smear in the past 5 years, and many of these women have never had a Pap test,” according to the American Cancer Society.

· Obesity and smoking: I don’t differentiate between these either in terms of addictive potential, the possibility of wrecking your health and killing you, or how innocently people can slip into them. Frequently you need professional help in dealing with either one (or both) of them. Please get it. [See web resources for details.]

BIOLOGY: The “Graduate Program”
Functional Medicine and Age Management Medicine

Functional medicine may be thought of as the analysis and stabilization of the human physiological “platform” for optimum, and not just adequate, functioning. The field is broad and deep; it is also solidly supported by peer-reviewed medical literature. Many people don’t take advantage of this state-of-the-art care because their own medical practitioners do not know about it… and most patients don’t know to ask.

Remarkable tests are currently available. One, from Spectracell Laboratories in Houston, TX, allows an assessment of vitamin and nutrient levels based on whether or not T-lymphocytes, removed from your body with a conventional blood draw and grown like little pets in a laboratory, can replicate efficiently in specific formulations of nutrient deprived media, which are absent only one nutrient. This is an amazing test.

There are two ways to look at “Age Management Medicine.” One way is conventional medical practice, an approach which is so familiar and orthodox that average practitioners at any AMA meeting would be very comfortable with it. This includes “watching your cholesterol”, “controlling your weight,” “exercise,” and the like.

In addition to the more typical orthodox and physiological functional medicine approaches, the way that I look at age management medicine is not just the treatment of medical and psychiatric illness, but also the aggressive prosecution of a relentlessly positive physiological agenda. In addition to evaluating for both male and female hormone imbalances, there are other values which should be investigated as well. Most people, and even male chauvinist pigs in recovery, know about menopause. What most people (and many doctors) either don’t know or aren’t sufficiently aware of is that there are two critical sex hormones in women (both of which can go down), and, of course, one critical sex hormone in men which can go down early – sometimes as early as a man’s forties! Indeed, men can hit “andropause” before women hit “menopause.” I truly knew that age management medicine was about to “go mainstream” when I saw a cover article on low testosterone in males in one of my conventional psychiatric journals.

One of the most controversial aspects of age management medicine today – which is very hotly debated, is the use of human growth hormone to treat mild deficiencies in adults. I have created a resource page about this topic of age management medicine in that section of my web site.

Using the diagnostic and therapeutic tools of functional medicine and age management medicine, people’s energy levels and enthusiasm can frequently be restored to what they were in one’s thirties. Imagine what you could do with that kind of energy!

CONCLUDING FORMULATIONS

Lao Tse, the great Chinese philosopher and founder of Taoism, observed: “The new life created by the final integration is self-aware yet without ego, capable of inhabiting a body yet not attached to it, and guided by wisdom rather than emotion. Whole and virtuous, it can never die.”

In this chapter, I haven’t offered you the path to physical immortality, but I have offered a path to integration: of self-awareness and of ideas about how you can be “guided by wisdom rather than emotion.” Emotions are fine – as long as they are occurring because of your pleasure at your own efforts. They are not fine when they result from knee jerk, automatic, unconsidered responses to stresses in your environment.

Stay well. Insure that you get the medical screening tests you need to hang on to your life. Consider dedicating a small portion of your efforts to achieving maximum performance out of your physical being. Monitor your thoughts carefully for self-deception, and your behavior for supporting your maximal efforts.

If you do, truly you will have achieved the desired end of Working Smarter: Not Harder, and will lead a life of achievement, emotional wellness, and maximum accomplishment.

Coming soon in March 2008:
Additional resources and links for more information on Age Management Medince, as well as Dr. Cady’s “Top Tips” for personal and professional productivity! Check back often!

Copyright © 2004 Louis B. Cady, M.D., Inc. All Rights Reserved.