Surf Therapy for Combat Veterans: A Conversation with VA Psychiatrist, Dr. John Straznickas

Dr. Claire Unis is a writer, pediatrician and mom living and working in Auburn, California. The author of the recent memoir Balance Pedal Breathe: A Journey Through Medical School, Claire embraces and blends both facets of herself, and uses her passions and skills as a pediatrician, memoirist and practitioner of narrative medicine in concert, to work with her young patients and forge a new path for herself and her colleagues. There is a huge overlap with writing and medicine, involving the power of observation; not to mention the need for doctors to engage in other activities to remain sane and healthy. Claire finds this union of disciplines particularly helpful and satisfying with adolescents, as well as helping healthcare workers process tragedy and trauma. Join Paul and Claire for a fertile conversation about the power of journaling for both patient and doctor and how regular emotional check-ins can create a path forward for patient treatment and healing the healer.

Medicine is more of a team sport than we might like to admit, and yet the romance of one-on-one care glorified in TV shows like Marcus Welby, M.D. continue to be mythologized. Airing from 1969-1976, the show starred Robert Young as the title character, a family practitioner with a kind bedside manner, who was on a first-name basis with many of his patients (and who also made house calls).  There have been tectonic shifts in medicine both in terms of treatments and the delivery of care since the 1970’s and our balkanized healthcare system was struggling before Covid. In the last 30-40 years, the escalating costs and dizzying systemic gyrations—from HMOs structures to the ACA overhaul—have left many patients confused, underserved and overcharged. Despite heroic efforts from practitioners there will most certainly be lasting structural and care delivery effects from the pandemic, so it is a good time to take a look at this pivotal role in our healthcare system. Primary Care Medicine is supposed to serve as the patient's entry point into the health care system and as the continuing focal point for all needed health care services. A primary care physician is a specialist in family medicine, general internal medicine or general pediatrics who provides patient care and takes continuing responsibility for providing the patient's comprehensive care. Healthcare delivery and structure is ever morphing in our for profit system, and we are once again seeing a big shift. Join Paul for a lively conversation with Dr. John Mendelson, an addiction researcher and physician, startup co-founder and primary care physician for more than 30 years. John recently gave up his primary care practice, but has tremendous insight into the past, present and future of Primary Care Medicine.

Jeb Berkeley, PhD is a clinical psychologist in San Francisco whose practice focuses on the treatment of the symptoms of anxiety and depression expressed in the realms of love, family, partnership, loss, addiction, work, health, uncertainty and pleasure. With 40 years of experience, Dr. Berkeley shares mental health insights into the challenges and opportunities the global pandemic has created during the last two years. With therapists sharing the trauma with patients, and unable to provide a physically ‘safe’ environment for therapy, most counseling went online. He says he recently heard a comedian say “doing therapy on zoom is like sex with a condom; it’s safe but you lose something.” And yet, as a person who self describes as someone ‘who runs hopeful,’ he found a number of positives in his practice during this difficult era. The unique global experience of uncertainty, created immeasurable stress and suffering for so many, but despite a trend of Covid divorces, Jeb says he witnessed some surprising unexpected areas of growth for patients and therapists. Join Paul for a revealing conversation about how this crisis has upended, transformed and changed the course of therapy, while stimulating both profound suffering and remarkable resilience in so many. The covid chronicles are far from over, but it is enlightening to investigate the odyssey of our times, and the implications for health and wellbeing, all with a warm sense of optimism and humor.

Created and hosted by a seasoned San Francisco psychiatrist and author, Paul R. Linde, MD, the trailblazing podcast "Hippie Docs 2.0: Re-Humanizing Medicine” seeks to examine the good work that’s already happening in medicine while simultaneously exploring ways to re-imagine our healthcare system. Many of our episodes discuss the power of progressive medicine and how a return to a more mindful and heart-based medical practice makes for a more humane and effective model. We look closely at how master clinicians make connections with their patients in our current era of the doctor-patient relationship under siege.  Hippie Docs investigates a wide variety of topics — from healthcare inequalities to pioneering treatments such as the use of psychedelics for PTSD and depression, advances in healthcare education, the unintended effects of electronic medical records, the crisis in nursing, homeless healthcare, human rights medicine, and surf therapy for combat veterans. Join Paul and the Hippie Docs team for an enlightening deep dive into the immediate realities of our current healthcare crisis, including its systemic challenges, all the while asking this question of the listener: "What part can you play in re-humanizing medicine?

There has been a renaissance of interest in the boundary-pushing, consciousness-altering medications for alleviation of suffering in psychiatric patients. Bipartisan in nature, and with a growing public interest from politicians and donors, this movement is spurred by a cultural shift away from the War on Drugs. Mainstream explorations and writings by the likes of Michael Pollan have raised public awareness of how psychedelics may work in treating Depression, Anxiety, and PTSD. Medicines such as ketamine, MDMA and psilocybin work in the brain by inducing neuroplasticity, lighting up the brain in a sense. This process can help patients confront deeply rooted traumas and modify their maladaptive reactions and responses in a variety of life situations. These groundbreaking treatments are provided in conjunction with psychotherapy and take place in calm and therapeutic settings, contrasting with the recreational use of these substances. Join Paul and Dr. Guo for a deep dive into this creative therapy -- an innovative tool and much in demand given the mental health crisis exacerbated by Covid.

The ravages and toll of the Covid pandemic with its associated breakdown in civility, complicated by a flawed pipeline in Nursing education, define the current challenges facing our beleaguered Nursing workforce in the U.S. An insufficient investment of both time and money, a misplaced hero worship, disinformation, and an unrealistic expectation for sustained effort in the face of perpetual tragedy contribute to a slow but steady erosion of the foundation of Nursing. Dr. Sharon Goldfarb knows this all too well. Ranging from her early days working via an outreach van with a group of HIV-positive substance-using people in Harlem to her distinguished career as an educator to her clinical and administrative field work with the unhoused to her current role as a vocal advocate for the national pandemic response, Goldfarb has witnessed the arc of change in the world of Nursing. She continues to work tirelessly to ensure the sustainability and future of the vocation from all these vantage points. Join Paul for a rousing discussion on the state of Nursing in 2021 and the implications for this vital and essential part of our nation's health care system.

When it comes to treating depression, it's the rest of the world that is delivering health care innovations to the United States. The global burden of unrecognized and untreated depression in terms of suffering and lost productivity is staggering. This is not just true in economically developing countries, but in the United States as well. A lack of broad access to affordable, effective, quality-based mental health care is a universal problem. In recent years, innovative research has driven the development of treatment strategies for depression, with the bulk of this work occurring in under-resourced areas of the world such as India and Africa. Much of this research, and its application has come from the scholarly work of Dr. Vikram Patel, a UK-trained Psychiatrist and Endowed Professor of Global Health at Harvard Medical School. Dr. Patel's work has focused on the burden of mental health problems across the life course, their association with social disadvantage, and the use of community resources for their prevention and treatment.   Dr. Patel speaks with Paul about these challenges and possible solutions provided by the Harvard-sponsored ‘Empower Initiative’ program, which is a model for improving depression care at the community level. This multi-dimensional, holistic, and humanistic approach is now being brought to Texas in the form of the "Lone Star Depression Challenge". Using strategies honed in rural communities worldwide, the project seeks to make depression care more widely available via the use of front-line health workers using evidence-based digital treatment tools. In our third episode of Season 2, focusing on health equity, Paul and Vikram delve into these topics, describing a potential roadmap to reducing the global burden of depression into the 21st Century.

‘If America catches a cold, black folks get pneumonia’ is a common phrase in the African-American community, and we have seen the suffering during Covid fall disproportionately on communities of color. Thirty years ago, Dr. Scott Cook wrote his thesis on “The Public Health Implications of Institutional Racism and how it Affects the Health of African American Males”. He was given some pushback on the topic at the time. Homicide, gun violence, and alcohol/drug dependence just then being understood as public health crises. Today, climate and environmental dangers, housing issues, nutrition, trauma, and poverty can be added to the growing list of forces that are associated with poor health outcomes. Dr. Cook, a physician, international lecturer on racism and health disparities, as well as an addiction specialist, has spent much of his medical career identifying, studying, and attempting to remedy these social determinants of health. If racism = prejudice + power, we have a long road ahead of us in our work as a society to achieve health equity, diversity, inclusion as well as recruitment and retention in medicine among people of color. Join Paul for his conversation with Dr. Cook as they explore these facets of the American medical system, and how we continue to attempt and fail at making medicine— both an art and science— more equitable and just. What are the best ways to improve experience and outcomes? This frank and personal discussion, with a prominent and vocal agent of change, yields many insights and prescriptions for how we can and must do better.

The Covid pandemic has starkly demonstrated the reality that those individuals experiencing poverty and social inequality get sick and die at higher rates than the general population. This is also true with other illnesses. Inflammation is the body’s response to infectious agents and environmental toxins but also to chronic stress and suffering inflicted by things like poverty and structural racism. It is not hyperbolic to say at this juncture that we are an ‘inflamed’ society and planet, and radical change is needed.   “Most patients you sit with long enough will tell you why they are sick,” says Marya. However, for doctors to truly identify and treat the underlying causes of ill health, the authors argue that we must start by understanding how systemic racism, inequality, and environmental degradation all contribute to a type of persistent, harmful inflammation leading to an illness of not just the body but also of our political, economic, and health care systems. As doctors and advocates, these two disruptors have both been in the trenches, the streets, the villages, and worked in some of the most prestigious academic and medical institutions in the world. Dr. Patel is a PhD, journalist, author, father, and academic, often referred to as "the rock star of social justice writing”. Dr. Marya, when not working as an internal medicine specialist at UCSF, is an activist as well as a mother, composer, singer, and guitarist, fronting the global alternative group Rupa and the April Fishes, infusing her music with the same passion and urgency. It is this combination of activism, academia, medical experience, creativity and tireless spirit that has propelled our guests to demand radical change in our world view and approach to illness and medicine. They are daring us to not only listen to their analysis, but become a part of the change.  In this provocative and groundbreaking work, the pair endeavors to shift the traditional paradigm. Marya and Patel explain the unique tasks performed by each operating system of our amazing human bodies, head-to-toe and everything in between, tying each to its approximate counterpart in our healthcare system. Inflamed is not a work of naivete but one that delivers a message of precarious hope, offering a clear diagnosis and treatment plan but with a truly uncertain prognosis. Join Paul for a lively discussion of the book, their life’s work and the revolutionary path they are proposing to humanize medical care for all.

The emotional world and the ocean realm share many parallels. San Francisco VA Psychiatrist Dr. John Straznickas, cofounder of the Veterans Surf Alliance, takes small groups of combat veterans out to ride the waves on his own time. It marks an outside-the-box and humanistic approach to treatment. Many of these vets suffer from PTS — sans D as post-traumatic stress occurs on a spectrum and the symptoms are considered a normal response to abnormal circumstances.  Struggling at times with reintegration into civilian life, many of these veterans have gone from badass warriors to finding a visit to the supermarket overwhelming, and the repercussions in their personal lives can be devastating.  Advice for veterans coping with PTS symptoms translates well into surf metaphors:  "Don’t sweat the seaweed, read the wave, the ocean is big, if you get caught in a rip current just float, avoid conflict, swim away." Many of these veterans find peace, serenity, ocean wisdom and a sense of being a part of the Surf and Ocean community, including nature’s magnificent sea creatures: pods of dolphins, breaching whales, swooping pelicans, and curious seals swimming around them. The goal is to get these soldiers out on the water into the sights, sounds, feel, and smell of the ocean to ‘promote stokage’ for life.  Join us for a conversation between Paul and Doc Straz about how surfing and the entire Zeitgeist of the activity has a remarkable impact on combat veterans, while also helping to recharge the healthcare workers who can face burnout carrying the ‘limbic load’ of so much trauma.