Dr Akiva Daum, MD FAPA

Reclaim Mental Health, LLC

I gave birth! No, it’s not what you think, I did not literally birth a human child. But a colleague and impressive business entrepreneur once described the experience of creating a new business as being similar to giving birth. I certainly cannot understand exactly what she means as I have no ability to compare the two from personal experiences, but I can say that I see the similarities (emotional not physical - this is in no way meant to belittle the pains of childbirth).

Earlier in 2023, after several years working with Kimmel Psychology and Associates, I decided it was a good time to branch out and create my own legacy. Thus was born Reclaim Mental Health, LLC on March 3, 2023. The doors officially opened in April 2023 and it has been quite a whirlwind. To say that medical school provided limited practical training on how to run a business would be an understatement. But thanks to so many family members and friends, colleagues and supports, it happened! I could not have done it without them and there are too many to name, but please know that I am eternally grateful for your guidance, patience, love, compassion, and support.

I would also like to take the opportunity to thank the clients I serve. Of course, I cannot and would not share who you are, but I need to say thank you. Thank you for allowing me to treat you and care for you. Thank you for being patient with me as I learn the ropes of business ownership. Without you, there is no practice. You have placed immense trust in me and I will certainly continue to do my best to provide you with the absolutely best care that I can.

I have now officially relocated to Reclaim Mental Health, LLC. The address is 3275 W Hillsboro Blvd, Suite 300D, Deerfield Beach, FL 33442. I can be reached at 954-451-2592. I will continue to offer telepsychiatry in addition to in person sessions. I am accepting new patients and happy to work with individuals who are struggling with mental health issues including substance use issues. Most importantly, if you find yourself having difficulties, please don’t hesitate to reach out to myself or any other qualified professional – you don’t need to suffer and struggle alone and help is out there.

Enjoy the journey

In the opening credits of the show Doogie Howser, MD, there are several newspaper clippings that show him breezing through his educational milestones. From perfect SAT scores at age 6 and high school in 9 weeks to completing Princeton at age 10. But you know what, he didn't graduate medical school until he was 14. He sped through every other area in school, but medical school still took 4 years to complete.

There are some things in life that you cannot speed up. No matter how smart you are, no matter how capable, some things just take the time they take to complete. If you ask me, there's a valuable lesson there.

All too often people find themselves feeling behind the eight ball, whether they are comparing themselves to others or simply feeling like their goals are unmet. People older and wiser have often said that it isn't just about the finish line, it's about the journey. We grow because of the experience, not just the accomplishment. So with that in mind, my challenge to you is this: what's something you've learned more from having the experience than the end result and did you enjoy the journey?

Over the counter

When it comes to medications, there are a number of ways to categorize things. One such categorization is “Prescription” or “Over the counter”. I want to take this post and provide some insight into what these categories mean versus what they don’t mean because I think that there might be some inappropriate assumptions.

First and foremost, let’s define the most obvious difference. Over the counter medications can be purchased by anyone (more or less) without any medical oversight. Yes, that’s right, you can go to the store and buy as much acetaminophen or ibuprofen as you please. No one will stop you as long as you pay. In fact, you can even go to your local wholesale club and purchase enough of either of these (or both) to satisfy your needs for upwards of a year or more! No one will bat an eyelash.

On the other hand, you have prescription medications. These are medication that must be authorized by a qualified prescriber. Essentially, you have an appointment with a medical practitioner of some kind and they determine you should be given a medication treatment. They determine the dose, the frequency, and the duration. The medical prescriber uses their knowledge base to define the most appropriate treatment.

But. And this is a HUGE BUT. The notable difference between an over the counter medication and a prescription medication is not necessarily based off of the safety profile of the medication. Yes, sometimes it is. And oftentimes, the medications categorized as prescription medications are kept in this category not only due to the risks associated with the medications, but they also require medical oversight. BUT AGAIN it doesn’t mean that over the counter medications do not require monitoring. In no way, should you feel that no harm can come from over the counter medications. In fact, just the opposite. Furthermore, I have had the pleasure of counseling many individuals on the proper and most effective ways to utilize over the counter medications and how to safely manage them in combination with prescription medications.

Sometimes, a medication may start as a prescription medication and then as more data becomes available, the medication may cross over into an over the counter medication – such examples include loratadine (Brand Claritin) and fexofenadine (Brand Allegra). There may also be certain medications that straddle both sides based on dosage – such as ibuprofen 800mg versus ibuprofen 200mg.

And finally, putting on my addiction subspecialty hat, there are the “behind the counter” over the counter medications. These are medications that are deemed to be reasonable to be taken without a prescription but have other risks that require certain other types of monitoring.

So why am I bringing this up? Quite simply, I think it’s important to be mindful of the facts. Medications, regardless of whether or not they are over the counter, prescription, or even complementary alternative medications should all be felt to be important enough to discuss with your medical practitioner. It just might prevent a dangerous combination from happening, or even more likely, you might realize that the fluticasone nasal spray didn’t work right away because it takes about a day or so (at least) to start working in your system.

What is ADHD

In the Winnie the Pooh stories, Tigger is believed to be the prototypical example of ADHD – he is highly energetic, interrupts, and is impulsive. He bounces everywhere and invades other characters’ personal space by pouncing on them. I’d like to shed some more light on ADHD though because there is certainly more to the ADHD picture.

Attentional deficit hyperactivity disorder (AKA ADHD) is an illness which can best be characterized by a disruption of executive functions. It includes not only attentional and focus difficulties, fidgeting, and impulsivity, but it reaches as far as to impact one’s ability to be flexible, to manage sudden changes to a schedule, and to tolerate the frustrations of these difficulties. And because of all of these challenges, it can impact an individual socially; not just academically.

I don’t want to give the impression that someone with ADHD is “bad” or in any way cannot succeed – quite the opposite. But I do want to impart the understanding that it is so much more than just an inability to focus. Too often I see people who come to me and say that they have “ADHD” because they can’t focus. Focus and attention are complex tasks that can be affected by a large number of factors – lack of sleep, mood disturbances, anxiety, substance use, hunger, pain, stress – just to name a few. And like every other illness, referring to a lack of focus should not be phrased as “it’s just my ADD acting up,” especially if you don’t have a diagnosis of ADHD (and one more thing, ADD is no longer a diagnosis in the DSM).

An instruction manual for living

Instructions come in all forms. They are included (hopefully) with new purchases of devices/electronics, they come stuck beside the furniture that reads “some assembly required,” and they can even be found in the restroom. Yes, that’s right, the instructions on the wall of nearly every public restroom explaining how to effectively wash your hands. One in fact encourages you to “try and sing the ABC’s” – Adorable to hear from children, perhaps off putting from a grown adult. In any case, I’m all for instructions. I think that the idea of having a guide for how to accomplish something can not only make completing a task more manageable, but it can also assist in one’s ability to complete related tasks.

This last point, of course is what this post is all about. It’s not uncommon for me to work with someone who is trying to learn something new, be it changing a behavior or modifying a thought process. And all too often, the individual becomes overwhelmed at some point. They can fall into a despair about all that they have to come up with and change, as if it is really a brand-new skill. But here’s the best part: it usually isn’t. We learn and incorporate high frequency thoughts and behaviors all the time, and more often than not, those thoughts and behaviors are transportable. They become a skill you already have that just needs to be used in a different scenario.

Since this is becoming a bit too esoteric, I’ll offer an example. Say you have trouble with losing patience with family. Maybe you find that you can’t seem to respond to them in a calm and proper tone. Of course, this is something you want to work on – you love your family (I’m assuming) and don’t want to hurt their feelings. Adding to that scenario, you might also be a person who interacts with others in other settings – maybe professionally or at school or even when you are shopping. Are you able to respond appropriately in those situations? Do you utilize a different level of patience when you are purchasing groceries? I bet you’re still the same person. So do you have to learn how to respond to them completely differently when you’re at home? Not at all. You just need to incorporate the steps that work for you in one setting into another.

Wait a minute! Maybe at work it’s different. After all, they pay you at work. You could get fired if you aren’t careful how you speak to your boss. Is your family really less important? Less valuable? Or are you just banking on the fact that they love you and will forgive? The converse though, is that you love and care about them too. You may not see a tangible financial gain from your family, but rest assured, it exists. It comes out in every interaction you witness your children in. How do they speak to others? Are they calm and respectful? Are they patient? Or are they short with others, especially close friends and loved ones? There nothing like looking at your own actions through the lens of seeing your prodigy interact with the server at a restaurant.

So maybe I’ve touched on two topics inadvertently here. It’s ok, I haven’t posted in a while. Here's the summary:

1) You don’t always have to start from scratch when you want to make a change. You probably already do it differently in another area of your life. Find what works and how to make it fit.
2) Please consider carefully what you are teaching your children. They are sponges and will mirror what they see you doing. If you don’t like how they are acting, it may be time to evaluate your own behaviors.

Who are they talking to and why?

I’ve recently been watching live TV and I have noticed a trend in the commercials. I won’t say it’s new, but it does seem to be more extreme – the advertising of prescription medications. There are two countries in the world where prescription drugs can be marketed on TV – New Zealand and the US. I must say, I was trying to come up with other things the general public can’t buy and aren’t advertised, but apparently you can buy Uranium and rocket fuel in small amounts on the internet. Suffice it to say, I think you get the question.

So why are the pharmaceutical companies spending massive amounts of money marketing medications and devices to people who can’t procure them on their own? Before I tackle this frustration, I’m going to take it one more level…For at least many of the psychiatric drugs being marketed, they aren’t even being sold for their primary indications! One particular example is a certain medication with ads all over for the “adjunctive treatment of major depression”. The medication’s primary FDA approval was for adults with schizophrenia - and I have theories as to why this is not the population being advertised towards.

Now I’m not saying that this or any other medication that happens to be effective for more than one condition should not be used in these ways. I am also not saying that medications should not (with appropriate evidence) be used for conditions that they were not originally intended for, whether or not the company paid for the FDA approval. I am saying that it should NOT be put on the individual person to go to their medical professional and ask for a particular medication by name. These are not things that should be advertised and it creates a major hurdle for the medical field.

Think back to when valacyclovir (Brand name Valtrex) was being advertised (you know, before there was a generic option). Those ads consisted on people riding horses on the beach cliffs. What does that have to do with Herpes?!? I’m curious how many people “asked their doctor about Valtrex” because they wanted to be more outdoorsy?

At the end of the day, I would posit that marketing prescription pharmaceuticals only serves as another way to further muddy and confuse the medical care system we have in this country. Between all of the other hurdles that exist to getting quality healthcare, do you really also want to have to pick your own medications? Especially ones that are not necessarily better than an older cousin which happens to be generic? Prescription drug commercials are an attempt to recoup the research and development costs. The goal is NOT to inform and enlighten, it’s to make money.

Keep your cool and how

The other day I needed to call my loan servicer about an error that was made. Before I could even select the person to get on hold waiting, 7 minutes had passed of automated messages that had nothing to do with my call and were completely unrelated to me (and probably most other people). I finally got to select the agent I needed to speak to and was told my wait time would be “about 1 minute.” Fifteen minutes later I was finally speaking to another human being. I would ask if you can imagine how frustrating this is, but I don’t think anyone is left who hasn’t had this experience if they are over the age of 18!

About 10 minutes into my holding and listening to slow elevator music with the occasional teasing interruption from an automated voice I realized something – hence this post. The agent who answers is being set up for an attack! The agent I spoke with was wonderful, polite and apologetic for the error even though she had absolutely nothing to do with the issues. I politely pointed out the frustrations with the system and that it was certainly not her doing. The agent expressed how appreciative she was that I was so kind and polite.

There are many times when the system frustrates us. We get annoyed, angry or downright agitated with errors and mistakes, and all the more when we are in the right. Dealing with these issues takes time and energy and is wasteful. So how do we avoid expressing these in an inappropriate direction? How does one keep their cool under annoying circumstances? I’d like to offer the following suggestions:

1) Remind yourself that the person you are talking to probably had nothing to do with the error. There are usually huge systems when errors like this occur and the hierarchical system does not leave you speaking to the person responsible.

2) It is more efficient to be polite – we have all experienced the other end of this scenario, where we have to clean up someone else’s (or a computer’s) mistake and I will say with fair confidence that everyone probably felt more motivated to help the polite person than they did someone who was yelling and rude.

3) Humor helps – using humor (not nasty humor though) for many is an effective way to point out frustrations without letting it come off as angry. If humor is not your skill, simply express your frustration amicably. Just because you are making an effort to not attack the middle person, doesn’t mean you shouldn’t be able to point out that the error is not acceptable.

4) Offer to suggest an improvement – Almost all of these large companies have surveys that they send out. Perhaps fill one out. There might be a chance that if enough people complain about the same issue, it may be changed. It also offers you an opportunity to praise a helpful agent.

5) Most importantly, remember that you are fixing something for yourself. No matter how frustrating it can be to deal with someone else’s mistakes, you must always remember that you are important enough to get the issue resolved. It isn’t a waste of time if you remember it’s for someone important.

I hope these suggestions help. Please let me know if you have others that have worked for you.

“Be yourself; everyone else is already taken” – Oscar Wilde

The idea that a leopard cannot change its spots is not an uncommon theme in movies and books. Isn’t it interesting that despite seeing this message everywhere, many still struggle with this concept. Now I’m not talking about whether or not one can modify their physical appearance, or better themselves in some internal way. I’m specifically talking about Identity.

Identity is defined by Merriam-Webster as “the distinguishing character or personality of an individual”. Identity is who you are. It compromises a multitude of roles and qualifiers though and is not defined by just one of them. It is because of this, that medicine made the shift long ago to not refer to individuals as their illness. You are not “the diabetic on the gurney,” you are “a person with diabetes.”

Now this difference may be subtle, but we must realize that if you don’t know who you are, then your identity is uncertain. This is why people struggle during transitional times in life. Throughout childhood is the obvious one, but what about when your children leave for college or when you decide to retire? I have seen many who struggle during these times. In fact, parents who have no children at home are referred to as “empty nesters”. Some one who is retired is a “retiree.” If you spent 8+ hours a day doing a job (or as a parent even more time) and suddenly you have a different title, it’s no wonder that people have a difficult time adapting. Maybe we should take a page from medicine and stop calling people by one identifying characteristic, it may just help save their identity.

Reflections on Thanksgiving

Thanksgiving is my favorite secular holiday. I enjoy getting the opportunity to spend time with family and relaxing. I realize that this is not the case for everyone. There are those who do not have family or do not have access to family. There are those who spend a great deal of time in the kitchen, preparing, cooking, cleaning, and repeating and then feel exhausted. Further still there are those who spend time with family and dread it. Moreover, Thanksgiving for many is the start of the “holiday season” which could mean anything from significant spending, lots of family time (for better or worse), decreased or increased work, etc. Yes, I did mix in the good and bad together as this is the reality – there are good and bad aspects to everything.

In a Jewish wedding, there is a tradition of inviting strangers as guests, having a table prepared for those less fortunate to come and celebrate. This is a time of year when many people are reminded of just how alone they are. It’s unfortunate that we as a society view these individuals with pity. Perhaps they have simply chosen to distance themselves from those who cause them harm or are destructive influences. Whether they have chosen to stay away from bad relationships, or whether past actions have led them to be alone and they are now working on improving their lives, there is no reason to feel sorry for anyone. Mutual support groups like AA often have 24-hour marathon meetings for people in recovery to attend during the holidays. There is an understanding that these days can be difficult and more support is needed. But they don’t force people to show up. Individuals are made aware that these supports exist, and it is then up to them to utilize the support.

Perhaps we can take a lesson from their pages. I propose the following: if you have family to see (or family that you like to see) then spend time together. And if you have friends or know people who are alone, include them. And if you are alone, there is no shame in accepting an invitation. There is also no shame in asking to be included. Perhaps this is truly something we can work on – looking to feel included doesn’t have to mean something negative, in fact it means something positive.

“Always look on the bright side of life”

“Some things in life are bad, they can really make you mad…when you’re chewing on life’s gristle, don’t grumble, give a whistle…”. For those curious, that is a quote from a Monty Python song: “Always look on the bright side of life.” It’s rather amusing if I do say so myself, but I think it also showcases a great point – Always looking on the bright side of life is really difficult and sometimes impossible. There are going to be hard times, times that seem insurmountable. And sometimes the only thing that makes it seem less challenging is because you hit an even more challenging barrier!

We have so many phrases to combat this reality and they come in all flavors, from the cat hanging on the rope with the caption “hang in there baby” to S% Happens. Some say to keep persevering and others say, “you can’t win them all.” At the end of the day, I’d like to think that the most important message from any or all of these is that there are things in life that we have no control over. There are things that happen that the phrase “this sucks” seems fantastically inadequate (and I could use a number of other 4 letter words that still probably wouldn’t adequately describe the frustration).

The Serenity prayer has a long history of acknowledging this idea and offering strength to those who utilize it. So much so, that they have even done studies to show its effectiveness using fMRI (which is pretty cool). This is not the only concept that acknowledges this idea though. In Judaism, there is a concept known as Bitachon. There are certainly many more, but I’m pretty sure they all boil down to the same idea – we don’t have the ability to explain everything and terrible things do happen. We don’t know what to say sometimes and other times there is nothing to say. To try and do so is not only futile, but will more often than not anger and offend.

I’ve said before about how sometimes we must just be in the moment with others. There are also times we must be in the moment with ourselves. It can be very uncomfortable, and it is often something that gets worked on in therapy. I am not advocating blind faith, or a “come what may” attitude. Rather that there are times when there is no great answer, or even a good answer and we just need to sit with it. Get your bearings and assess the situation, even if you can’t change it. If you can look for the hope and faith, even better. If you can find gratitude, better still.

Pinocchio

Time for another rant about a Disney movie. I was watching the remake of Pinocchio and wow…it's almost as if turning a cartoon into a live action movie is just clearly a terrible idea, but that's not what I'm intending to write about.

I'm specifically focusing on the part where the kids and Pinocchio go to Pleasure Island (Spoiler alert, but I'm sure you'll thank me for saving you the hour and a half). In the original movie, Pinocchio and the boys go to Pleasure Island. They drink beer and smoke ci**rs and their terrible behavior turns them into donkeys. But in this remake, apparently the very "thoughtful" motion picture raters were too concerned to show children drinking and smoking so they opted to lose the valuable lesson. As I'm typing this, I realize that of course this was the decision, heaven forbid Disney movies teach a valuable lesson.

There are a lot of reasons why people start using drugs (including to***co and alcohol, which are drugs). I don't believe that I've ever met anyone, patient or otherwise who started because of watching Pinocchio or Snow White. The lesson lost though is clear and my true gripe goes with baseless censoring. Perhaps you are thinking to yourself, “What is he talking about this time?” I’ll respond with this question - how come we don’t allow Fred Flinstone to advertise Winston ci******es anymore but we can still sell Fruity Pebbles flavored vapes?

Diagnoses are not euphemisms

Language is powerful. I've written before about the value of language and how important word choice and mindful self talk is. Language is how we convey our thoughts and feelings; it is how we do everything from profess our deepest love to inquire about the current cost of gasoline. If you doubt for a second just how crucial language is, just find a lost tourist trying to get directions (or consider the last time you were in this position).

One critical facet of language is diction (word choice), which brings me to the topic at hand. Euphemisms. George Carlin had an entire skit on euphemisms and how this style of language conceals the truth because it softens reality. I can't agree with him more!

These days there is a movement to swap out seemingly harsh or difficult to hear medical terms for kinder verbiage. But the problem is, medicine is neither kind nor ruthless. Medicine is based on science and facts. Now I would never suggest that it doesn't grow and change, of course it does and it must. The problem is not when a diagnosis or term becomes outdated and must retire. The problem is when an accurate description gets modified because it doesn't make us feel good.

What prompted this post was in fact a song espousing the need to rename attention deficit hyperactivity disorder because it doesn't sound "nice." I ask you this, “What does nice have to do with it?” When I heard this song, my immediate thoughts were about all of those individuals who even today are told that they don't have a "real illness"; that they should just try harder. I'm disgusted. Individuals who struggle with ADHD aren't just choosing to not pay attention. They aren't just defiant and they certainly don't want to have additional challenges in work, home, social interactions and school (yes all of these areas are affected). The idea that this condition (or any) shouldn't be called a disorder runs the risk of further marginalizing people. And yes, I used the term disorder, which the Oxford dictionary defines as "an illness or condition that disrupts normal physical or mental functions." It's not mean or offensive. It denotes the reality that someone is experiencing.

Please don't misunderstand me. I'm not advocating insensitively discussing a diagnosis nor am I suggesting that we don't need to constantly look for updates and new data in order to better classify and clarify that which is or is not pathological. But I am advocating for being sensitive and sensible when it comes to the terms we use. Euphemisms and euphemistic language have caused irreparable damage through marginalizing and minimizing experiences. Taken to an extreme, they have allowed people to get away with horrible political campaigns, genocide, and war. So please, I beg of you, be careful with your words, but say what you mean and mean what you say.

What would you do?

I'm currently reading a fantastic book entitled "It's all the same to me". It posed a phenomenal question - "what would you do if you had everything you wanted." Go ahead, take a moment to consider.

Well, what would you do? Did you think about having something material? Eating at a fancy restaurant? Being in an exotic location? Or maybe you thought about who you would spend time with, what you would do with the people you loved?

No judgments here. If you thought about something other than who you would be with and what you would do with them, is it possible you didn't take a long enough time to consider?

The question reminds me of an old story about a businessman who goes on vacation to an island and sees another man fishing in a small boat. The businessman yells over to him and asks what he is doing. The other answers "I'm fishing." The businessman is perplexed. He exclaims, “You know, I could give you a loan and you can buy a bigger boat, hire others to fish, expand into a large operation, sell it for millions and then retire!” He goes on to say how with all that money, the man could spend his remaining days relaxing on a small boat fishing…

This isn't meant to be a callous suggestion that working is pointless or to belittle the financial difficulties many people go through. It IS meant to be a reminder to not lose sight of what you want and why it is you do what you do. It's an encouragement to take at least some time every day to focus on what you have right now.

I'll ask you again to consider what would you do if you had everything you wanted.

Acceptance

I was recently on a trip to Washington DC and on a bus tour. As we passed the Holocaust museum, the recording mentioned that the museum would not be a "fun" visit, but rather it was a necessary and important visit, and that the museum serves as a reminder of the consequences of fear and hate.

This got me thinking about where we are currently in the world. In an era where we are both seeking safe freedoms and equality among all people, we are also banning books, changing the narrative of our history, and in some cases, discriminating against those who hold different beliefs.

How can these two contradictory practices coexist? The answer is they can't - and I believe myself to be someone who is adept at "holding life in shades of gray"!

So what do we do now? Luckily, I am not someone who likes to open problems without an idea for a solution. So here's my idea (hold on tight cause it's a doozy): ACCEPTANCE. I know it's not original, but it is still hardly practiced.

Acceptance is a "middle of the road" concept. It does not mean forget your past nor does it mean you need to "be ok with everything." It means you acknowledge what was and work on what is. It means if you don't agree with someone else's choices, then don't make them for yourself. No, don't condone someone hurting or discriminating against someone, that is not being accepting. But if you don't like what's on the radio or television, change the station/channel. Libraries have lots of books and you don't have to read something you don't want to. Or better yet, maybe listen to it or read it once and decide if it really is something you don't agree with or enjoy. Who knows, you might be surprised. It's just my two cents, but maybe we should cancel this current "cancel culture."