Nina Gaby

Essays, art, and healthcare

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Trump Has to Go. It’s Scientific.

I have spent six hours this morning in virtual conferencing with experts from The Harvard Psychopharmacology Master Class. I have fourteen hours to go this weekend. Usually the conference is held in the grand ballroom of the Fairmont Copley in Boston but this year I am in striped socks, hoody, a warm hat, lying on my toile fainting couch with no lines for the bathroom and no fancy lunch. I am writing from my own understanding of today’s information, and my decades of experience with these issues, not the interpretation of the presenters. No one mentioned our administration, no politics. Just to be clear on that.




As I followed along on my screen today I correlated much of what I was hearing to the environment of our present world, considering how I can apply this research to examine how we move beyond all this intact. Or can we?

Dr. Charles Nemeroff, researcher, professor and consultant states in his presentation–“Interface of Medical and Psychiatric Disorders”: “Covid 19 is associated with a cytokine storm (cytokine is a category of peptide proteins associated with inflamation). There will be consequences.”As he continues it becomes apparent that he may not just be speaking to the immediate Corona illness, but to the interconnectedness of systems which we can extrapolate far beyond our own bodies. That is why I think of our survival and the Trump administration and its dangerous effect on that survival.

So these are nuggets from the research presented today about mental and physical health. I will simplify so we can make own extrapolations to why these dangerous times are are deeply exaggerated by our present administration, and administration that promotes hate and greed when simple kindness would go far to ameliorate the physiological responses I am about to describe. When action based on fact and not opinion would go far to ameliorate the world’s stress.

I cannot replicate any of the slides without permission so you will just have to take my word for it.

  1. Our mesolimbic reward circuitry is affected by stress. The limbic system is the walnut sized structure right behind our nose. It is considered the seat of emotional memory and houses the little light switch we call the amygdala, a peanut-sized structure which can modulate the experience of traumatic events. The mesolimbic dopamine system is the normal pathway for feeling good, but its circuitry is supremely sensitive to alterations brought on by trauma and stress. Poetic words such as “cascades” and “first and second messengers” and “de-arborization” and “connectomes” explain the transmission of chemicals–among them neurotransmitters and neurohormones– and also explain the new study of epigenetics. Basically “epigenetics” describes when events can actually influence gene expression (not sequencing) that leads to dysfunction of brain cells and their circuitry. This is DNA stuff.
  2. Alterations in circuitry affect neurotransmitters and hormones. Peptides which affect oxytocin and vasopressin (the attachment chemicals) can also be impaired. Receptors for these are present in the amygdala and affect bonding–between parents and children, between adults. Disruption changes this. Mammals lacking these peptides are at risk of
    attachment disorders as the presence in one mammal stimulates the system in another mammal. Think, “milk let down” in new mothers. Think, children in cages.
  3. Both physiological and psychological damage to these systems have long term implications that travel through generations. Through generations.
  4. The research shows inarguable effects on cancer and depression, as well as other psychiatric disorders. This is the schema:
  5. Increased environmental stress and/ or Adverse Childhood Events increase the inflammatory process (increases in cytokines and other stress chemicals) with increased risk of depression/heart disease/cancer.
  6. There is a proven bidirectional relationship between depression and medical illness. Autoimmune illness is also correlated with these events. Social connectedness has been proven to improve outcomes. I might suggest that concerns for one’s medical treatment and how to pay for pre-existing conditions might influence one’s mood state. The research shows an increase in suicide among certain demographics receiving diagnoses of certain illness.
  7. PTSD goes without saying. And this may also have a bi-directional schema. One must have been exposed to the stressor, and we now know there is a scientific basis for both developing or mediating the disorder. Understanding and providing support to the specific populations most deeply affected by violence and trauma would go far in healing the world. Homophobia, misogyny, racism, bullying, antisemitism, xenophobia has no place in the world we need to develop. (I am editorializing a tad here but the statistics don’t lie.)
  8. Most of the conference is about treatment, specifically medications, and other options. A couple items of interest: The odds of developing a psychotic disorder with high dose daily cannabis use is 3-4X greater. Use of cannabis in adolescence and pregnancy-a big NO. CBD has anectdotal therapeutic implications but metananlysis suggests data inadequate to recommend clinical use. I don’t even want to discuss ketamine. And what does this have to do with Trump? I don’t have the research on that, just opinions. But tomorrow’s another day.




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More than the Sum of its Parts

collage 2

Book collage in process

Composite/collage. Synchronicity in text and image, transparency, translucency, opacity. How do we make it work?

In order to write in any sort of intimate way about mental health and addiction, I essentially make a hybrid of characteristics of an individual, spanning time, place, gender, symptoms. The point is to paint an accurate image of what without focusing on the who, on the why without the where. For obvious reasons, this allows me to shine a light on an issue without breaking confidentiality, and allows me to honor without alarm. I want the reader to understand what goes on for people in this world of addiction and psychiatric disturbance, within that understanding we might see impact or at least volition for change.

It’s a dilemma. CNF (creative non-fiction writers) will often say, if you can’t tell the whole truth than don’t bother writing about it. Others will find it good enough just to blur the lines. Others use permission contracts and footnotes. At conferences I’ve listened carefully to experts such as Lee Gutkind and Susan William Silverman, Dinty Moore and Jacquelyn Mitchard. My work has been picked apart by editors and lawyers. I don’t have an answer except that there are narratives that need to be told and images that need to be made.

I collage 3-D memoir from mixed media and think about whether transparency can truly exist. I work in porcelain and encaustic as well as words, all radiant in their translucency. I think about politics and the opacity that crushes us. I am proud of these stories I write about people I have been honored to know.

Here is my latest, a Monthly Muse contest winner from New Millennium Writings, “The Sum of its Parts.”

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Original title: I’ll Give You Something to Cry About

In honor of Hillary Clinton’s book which comes out today, which I prefer to call “What the Fuck Happened,” which has already garnered tons of hysterical misogyny and controversy (even though it’s just out)…I am reposting a piece I published on ‘ROAR: Literature and Revolution by Feminist People’ last May.

We changed the title to “Still Training for the End of the World.” Although in retrospect, the original title feels so right, you know when you look back and think, wow, what was I bitching about then?????

Sometimes I like to stand in the very spot where I conceived of this piece back in 2016. And while the husband still sits in his same comfy chair, the TV has a very different message. And I am pissed. I am pissed that Bernie Sanders did not shut up and pivot quickly enough to help avert this disaster. I am disgusted with the so-called “Green” and “Libertarian” party egos who did not have enough sense, among other things, to step down and say, hey lets get behind her before something awful happens. 

Something awful happened. And I’m still screaming.   (donate!)


The Most Horrible Person in the World Goes to a Writer’s Conference


My coffee this morning is in the “Write Like a Motherfucker” mug that my friend that I’m jealous of got me from the last writer’s conference we went to, before this one. It was a gift and she gave me a gift because she did not know yet what a horrible person I am. I either write like a motherfucker or not at all. Because we are all going to die. But I am getting ahead of myself.

I will spend this morning writing for my blog that nobody reads. See where this is going?

I have been having a small, personal festival over the past week. A pity party we might call it at work. I work with addicts and we toss around phrases like that all the time. Usually I hate them, the phrases that is, I love the addicts. They are my tribe and I can help them with my expertise, my script pad, my humor, my success stories. I am at least competent there. I teach them Cognitive Behavioral Therapy, “CBT”. And like the Paul Simon song “Rewrite” or the Vivian Gornick book about situations and stories, just change your story line, man, and you’ll feel just fine. How’s that going for you, I ask myself. Not so hot, I answer, as the list of complaints against the self rolls merrily along.

“You self actualized too early,” a old boyfriend cited Maslow to me in 1975. He looked just like Woody Allen, I swear, which was pretty cool back then. “It’s a set up.” I didn’t know any better, and my first career as a clay artist came easy, every gallery I approached wanted my stuff, I sold every piece I made, they clamored for more, and I ended up with vases in the permanent collection of American Craft at the Smithsonian. Then I went to a hotshot university for a nursing degree, won awards, got a free Master’s Degree, great jobs doing good work, and as much as I complain now, “poor me I did 45 hours of work in three days…” well that means I get four days off to write! It’s not that I didn’t learn my craft (one morning I threw 500 one-handed bowls, Japanese style, on the potters wheel and would not let myself keep a single one, I suffered harshly through Organic chemistry and worse through Research methods) but at least I was in charge of where it was all going. Even my sobriety came easy. I just stopped drinking. Yeah the withdrawals could have been life-threatening, but I didn’t know it then. I even cold-turkeyed cigarettes after smoking a pack a day of Marlboros since the age of 13. I am a lucky girl. One might say determined. Yes, that too.

So I go to this writer’s conference in Mississippi. Where everyone is charming and I’m anxious because of the red/blue problems, I have preconceived ideas. I remember visiting my aunt in Nashville every summer. I am the daughter of a liberal Jewish very northeastern set of parents, my father a writer whose short story about southern graft got him on Alfred Hitchcock and then a screenplay bastardized into the cult classic Hot Rods to Hell. I remember my aunt and her friends, whenever they were ready to dish mercilessly about someone, would start with… “Well bless her precious little heart….”. At the conference I am very mad at myself for not writing an essay for the Creative Non Fiction contest “Southern Sin,” but then the winner of the contest reads his essay on Friday evening and I am very glad I didn’t even try. He was brilliant. During the conference the friend I am with, talented and young, finds out she won a teaching award. She has just gotten several pieces published. Everyone clamors for her memoir proposal. She reminds me of me, how must it have felt for my friends back when I was winning everything. But I don’t care. I am jealous. Then I get an e-mail that a piece that I’ve just submitted to Rumpus (the Write Like a Motherfucker people) has just been rejected and I can’t sleep. Then Facebook announces that my best friend from nursing school has just gotten an amazing thing (not at liberty to describe) AND she has just developed her own App for patient education. I have done none of those things. I hate myself and everybody else. I am not consoled by my own publication list. I am not consoled by the godfather of the genre of creative non fiction telling me I’m a great writer, the proof being that he selected my piece to go into one of his collections. I am not consoled by listening to the esteemed conference panel discuss the years they put into their success. One panelist reminds us to write because we are going to die. I’m going to die a whole lot sooner than the friend I am jealous of.

But I am buoyed by the charm and sweetness of the southern way, it’s like an immersion into CBT, just being nice, it feels good. And so I bounce along, my horribleness known only to me. Till now. One gentleman who I’d call pretty “red” talks about marbling, the red and the blue, we’re marbles. He literally embraces my conflicted northern self. I want to move down there, maybe I’d become a better person. But it’s muggy most of the year and my mascara and my masquerade would wear thin quickly.

So now you know. And this writing thing, well it is hard. I was set up, as the old boyfriend warned. But there’s no choice. So after a week of heavy partying (pity, that is) and too much TV, I’m still at it, bless my precious little heart.


“May I never see in the patient anything but another creature in pain.” Oath of Maimonides 1135-1204: Trauma Informed Care and Compassion Fatigue, Is there a connection?

What is to give light must endure burning.”
Viktor Frankl 1905-1997

It is National Nurse’s Week and I am preparing a presentation for our nursing staff on the phenomenon of vicarious traumatization, the subject I tackled in my last blog and most recent essay “Don’t Touch the Mustard; Notes on Being in Lockdown With my Daughter.”

Vicarious trauma is a contagion, it is what happens to nurses and other caregivers who spend time helping others move through illness and crisis. We absorb the pain that surrounds us. Its sister, compassion fatigue, is the “debilitating weariness brought about by the repetitive, empathic responses to the pain and suffering of others” (LaRowe 2005) and “very much the landscape for today’s professional” (Showalter 2010).

My hypothesis for this presentation is this-If we look at trauma differently, will we respond differently? I am briefly commenting on this in honor of nurses everywhere who risk burnout, fatal weariness, and with concern for our healthcare system which suffers from the turnover that this fatigue costs all of us.

Trauma Informed Care

“A thorough understanding of the profound neurological, biological, psychological and social effects of trauma and violence on the individual” (Jennings 2004).

“Trauma is a disease of disconnection.”
Bessel van de Kolk Lecture, October 2011

Traditional treatment demands “compliance,” how would it be different to ask for “collaboration?” Would a change in a power differential actually ease the burden on the caregiver? Or is the potential for connection threatening? This is a question begging far more time and energy than is possible for this caregiver and blogger right now.

Can symptoms be looked at as adaptive rather than destructive? Normal responses to abnormal experiences?

For traumatized patients, all behaviors were directed towards survival. Over time they may have become “dysfunctional” with high incidence of substance abuse, psychiatric symptoms, and repetition compulsion. If we intervene with a clear understanding that these symptoms were lifesaving behaviors, we can respectfully help suggest alternatives. The same alternatives that might help any one of us.

Should we say- what happened to the patient rather than what is wrong with the patient? If we practice this with others, might it be easier to look at ourselves with more compassion?

Viktor Frankl also suggests that we honestly assess whether in the same situation might we do the same thing that we see our patients doing? This would go far in reducing the ‘us and them’ mentality that often gets in our way.

And then there is humor. Wish I had more time. Suffice to say it is the rare situation, with patient or colleague, that doesn’t get a whole lot better with humor. Or food. Another subject for another blog.

I need to get this on Powerpoint. In the spirit of collaboration, I will use more questions than answers. And bring lunch.