Or, Learning to Breathe Underwater; a ritual of lemons

Okay, it’s also known as, I Love You, I Hate You, Shut Up & Tell Me Everything! [A mostly-true entirely-honest tale of recovery]. This is billed as a solo punk rock epic poem, written and performed by Teddy Lytle and directed by Harmon dot aut. At first glance you might think this is a cute show with an older boy and his toys, parading around the stage in his pajamas like a madman. That’s before Wilbury veteran Lytle, a force to be reckoned with, literally opens his brain to expose his various addictions and vulnerability. It is raw to the core, and maybe cathartic. Says Lytle, “I’m not sharing my story to blame anyone, or educate people, or try to help anyone. It’s a selfish act. This is my story. And I survived it. This is my way of reclaiming my life.”

This is not the first time Lytle has run this show. Each time it’s resurrected, changes are made to reflect Lytle’s current state of being. This rendition evolved much like the others. “Redirected, trimmed, corrected, never perfect, always better,” says Lytle. He goes on to explain, “Performative inclusion, particularly in mental health, kills people. That is not hyperbole. It felt like a traditional career in the arts, or in entertainment was out of my reach. I felt excluded. My home was the theatre for my whole life and however misguided I was, it seemed to me I had lost that. When I had nothing, I really found my recovery, and in that, I found community.”

This one-hour monologue demonstrates some of Lytle’s musical talents and includes several of Lytle’s provocative songs, sung along to his guitar. We are often referred to a video backdrop of super heroes, his inspirational grandfather affected by Alzheimer’s, his mug shots and several applicable thought-provoking quotes. Lighting design by Max Ponticelli darkens along with the mood two-thirds of the way in, and addiction is explained so vividly you want Lytle to stop making sense. Sobs in the audience leave you wondering if these are affected family members or just your average compassionate viewers. Doesn’t matter, as we can all see someone we know in this sometimes funny, sometimes very poignant depiction of what happens when you mix a host of dependencies with ADHD and the ensuing lunacy of a self-medicated addictive OCD personality. Yeah. Bring tissues.

From her small desk, partner and guardian angel Bay McCulloch sports angelic wings, onesie PJs of her own plus blingy boots, serving as Lytle’s inspiration to keep him on track each time his ADHD takes him astray. She is his sensibility, his muse, his guiding and grounding force. Toward the end of the show, Lytle impressively adlibs answers to all questions posed to the audience right before the show: Ask a question you’ve always been too afraid to ask and/or confess a secret you swore you’d take to your grave. As McCulloch systematically hands him the pre-collected notes from a fishbowl, his in-stride impromptu answers are as funny as they are genuine.

Therapist Vanessa Cubellis, LMHC, was on hand for a “talk back” opening night, answering questions on mental health and substance abuse. Thank you, Teddy Lytle, for totally exposing yourself (well, the tighty-whities stayed on), splitting the atom and leaving no sin unturned. We are happy to learn you are employing many techniques and practices to manage and work with your issues while sharing these extremely personal skeletons with us, and for offering the following helpful link for others with addiction issues: Link to help: https://mhari.org/wp-content/uploads/2021/01/Bridging-the-Divide-Ebook.pdf

Wilbury Theatre Group presents /A.DICK.TED/ through March 4. For more information visit www.thewilburygroup.org.

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Production photos by Erin X. Smithers

The final curtain call for Director, Playwright, and lead actress Cassidy Caduto’s original production Permanent Solutions at AS220 may have been on October 9, but its resounding emotional grit and raw honesty lingered on long after the show ended. 

The two-act play, which premiered at RI Stage Ensemble (RISE) in April 2022 and was brought back as an abridged production at FringePVD in July 2022, takes an unapologetically close look at suicide and mental illness from a survivor’s perspective. And while the show is direct and not for the faint of heart, Caduto’s main goal is to break associated stereotypes and stigmas surrounding suicide and mental health.

“We try so hard as a culture not to think about suicide and mental health until it’s too late. Most forms of mainstream media written on the topic glorify and glamorize it and set a dangerous misunderstanding for those consuming said media,” she said. 

Permanent Solutions centers on main characters Katherine Hudson and Emma Rhodes, two patients enrolled in an assisted suicide clinic who couldn’t be more different yet are able to find common ground eventually. Katherine (played by Caduto) is a cynical rebel who is ready to get it over with but finds herself slowly opening up to the persistently amicable Emma (played by Maggie Scarborough), an eccentric artist with love to spare for everyone but herself.

The assisted suicide process is administered in pill form and consists of two doses – the first, which Caduto said “shuts down the immune system over 12 hours,” and the second, lethal dose that yields “no pain or resistance.” 

As they wait for the first dose to kick in, the two women break the ice and reveal their respective personal stories that ultimately brought them there, through flashback scenes with family and loved ones. What unfolds is a poignant connection amid the grim circumstances, which had the audience (including yours truly) sniffling until the very end.

In the show, “taking your life” holds a double meaning, where you are either deciding to end it or stick around. For Katherine, her decision to take her life stems from being abandoned by others. Katherine doesn’t see the point in sticking around if “everybody leaves,” one of her signature lines in the play, which has echoed in my brain since leaving the AS220 BlackBox theater.

Although the play’s short run at AS220 is over, Caduto does plan to stage it again in 2023, due to the overwhelmingly positive response. “The responses I’ve gotten from audiences after each performance have been unreal,” she said. “The amount of strangers who approach me in tears ready to share intimate stories of their struggles or of loved ones is the most powerful thing I’ve ever experienced as a writer.”

The play’s reach has also expanded, and Caduto is excited to see where it will go next.

“The audiences have only grown in both size and enthusiasm every time we bring it back and I plan on riding that wave wherever it goes, whether it’s a professional local theater or New York City,” she said.

Caduto penned the first draft of what would later become Permanent Solutions over a decade ago, just a year before her own suicide attempt in 2013. “It wasn’t until recently that I realized that my beginning this project all those years ago was an attempt at a goodbye note,” she said in her Director’s Note.

When it comes to sharing her own struggles through her work and interactions with others, Caduto considers herself an open book who isn’t afraid to share anything. “At this point, I have no apprehension in talking about trauma or my own history with mental illness,” she said. 

Hearing others be open about their own experiences inspired Caduto to share her own truth and perspective, which has been healing. “The first time you hear someone confidently and honestly talk about something that you’ve been conditioned to be ashamed of can be earth-shattering,” she said.

Caduto is all about advocating for others who are struggling with their mental health by talking about her own experiences. “If I could make someone who didn’t feel they could ask for help realize that it’s okay to get help, and that it isn’t weak to want to connect, then I will have done exactly what I set out to do.”

Permanent Solutions has undergone 10-15 drafts and has evolved between productions as well. “Even the version seen at RISE was quite different from what was put on at AS220,” she said. Caduto expects for it to return next year on a larger scale and is excited to see what impact it will continue to make.

For now, the play’s takeaway is pretty clear: While everybody does leave, whether voluntarily or by pure circumstance, it doesn’t mean that you have to.

“The black and white photo of the dark-haired girl crying alone behind the bleachers at school isn’t the face of depression. Robin Williams was the face of depression. Suicide isn’t beautiful or poetic, it’s hideous and tragic.”

Summer is here and it’s time for fun. The last thing you want to do is put yourself on the sidelines by getting injured early in the season. Dr. Michael Zola, a chiropractic physician on the East Side of Providence who has been in practice over 30 years, has some tips on how to stay in the game.

Cathren Housley (Motif): Are there any unusual problems this year due to the pandemic?

Dr. Zola: Masks were important in helping to control COVID-19 transmission, but people shouldn’t be doing strenuous activities with their masks on. We rebreathe the carbon dioxide that we are exhaling and when this goes back into the blood, it shifts the pH to become more acidic. This affects every other function in our bodies. People aren’t protecting themselves by using masks during exercise – when we’re outside in open space there is no danger of spreading COVID-19.

CH: What are the most common mistakes that people make early in the season?

Z: Going too aggressively at the beginning – if you take up where you left off last year, you’re overdoing it. If you’ve led a sedentary life over the cold months, you really need to start again as if recovering from an injury because you are, in fact, recovering from deconditioning. 

Extra weight, another common by-product of winter inactivity, can also make you more prone to injuries. There’s more stress on the feet, knees and hips, and the arch of the foot is more likely to collapse.

CH: Even the most careful exercise enthusiast can get unexpected injuries. What then?

Z: First – you don’t always know that you’ve injured yourself when you cause the actual injury. It can take a day or so before you realize that serious damage has set in. 

CH: How do we tell if there’s a serious problem?

Z: Look at the injury – is there rapid onset of swelling or bruising? That’s when you see a medical professional. You can walk off plain old sore muscles, but if the symptoms go on, there is a problem.

CH: What is the best immediate treatment after any injury?

Z: Make sure you stay hydrated. Then, ice is good in the initial stages of an injury, but you’re only going to apply it for 10 minutes at a time. This prevents cells that were injured from dying off too fast. Afterwards, soaking in Epsom salts dissolved in warm water can be very effective in promoting healing.

CH: What about getting back on track?

Z: The old way was “you get injured, you rest.” Now we know that activity gets your heart pumping and the immune system circulating through your entire body. This actually helps the healing process.

CH: But what if something is torn or broken and cannot be moved at first… how do you know when to start moving, and how much?

Z: If you need emergency medical care, afterwards it’s best to put yourself in the hands of a chiropractor, physical therapist or trainer.

CH: That brings up the question of soaring medical expenses. They do so many tests just figuring out what is wrong that you can end up going bankrupt from a sprained ankle.

Z: A faster and cheaper way to find out what’s wrong is to see a doctor of chiropractic medicine. You can get a faster diagnosis – and get out of pain sooner.

CH: How can we manage recovery on our own?

Z: If you’re ambulatory, you don’t want to rest completely, but it’s best to start with short intervals of activity. You are going to have to go by what your body tells you – do an activity and then see how you feel in a day or two. It can take that long to realize you’ve aggravated something more. 

CH: What about using medication to reduce inflammation?

Z: NSAIDs such as ibuprofen and acetaminophen can inflame the GI tract and cause other serious problems. They actually delay healing by keeping inflammation down. Inflammation is a natural part of healing. Whenever there is an injury, inflammation reaches a certain point, then begins to resolve. 

Pain has a purpose – it’s intended to warn us when there is a problem.

CH: What else can speed healing? 

Z: Lifestyle is the biggest deciding factor. You want to rebuild yourself with the best materials. When you’re sedentary and eat crappy food, you are building with sub-par materials at a much slower pace. 

CH: We usually don’t see how that impacts our health until we’re older.

Z: From about birth to 34, 35, people seem immortal. Professional athletes retire by then – they can’t recover from injuries quickly enough to stay competitive. But the time to think about prevention is when you are young. Once people have decades of abuse piled on, it’s much harder to change. That’s why holding onto good habits in your 30s and 40s is so important.

CH: Any last words of advice?

Z: Prevention is the best protection. A healthier lifestyle – good nutrition, stress management, quality sleep and movement – is health assurance you can afford.

Find out more about Dr. Zola at drmichaelzolaonline.com 

According to the National Alliance on Mental Health (NAMI), one in five young people in RI is affected by mental illness. Sometimes instead of getting treatment, they deal with it themselves or even take their own lives: like 10-year-old Isabella “Izzy” Tichenor from Utah, who died of suicide in November 2021 as a result of incessant bullying.

Out of 211,453 children in RI, 9,000 of them aged 6-17 have depression. High school students with depression are more than twice as likely to drop out as their peers. And seven in ten youth in the juvenile justice system have a mental health condition.

It’s clear that mental illness has become a serious problem and is hitting school-aged kids now more than ever. 

Being a kid in school is tough enough already. Along with bullying, identity crisis, and academic pressure, the past two-plus years of the pandemic have interdicted the social interaction that kids need to thrive.

Thanks to recent grant funding, schools in the Providence Public School District currently have support resources available to make sure students with mental and emotional issues are being attended to.

Beefing up Mental Health Staff in Schools

As reported by the National Center on Safe Supportive Learning Environments, the Rhode Island Department of Elementary and Secondary Education along with five other state agencies received a 5-year School-Based Mental Health Services grant in 2020. The purpose of the grant is to “increase the number of qualified mental health service providers that provide school-based mental health services to students in local educational agencies (LEAs).”

With the grant, the selected state education agencies (SEAs) work with LEAs to mainly provide telehealth services, hiring incentives (including pay increases and creation of hybrid roles), and the support of “cross-state licensing and certification reciprocity for service providers.” 

Gaining Awareness on Mental Health through Project Aware

Project Aware is a 5-year grant awarded to the Rhode Island Department of Education (RIDE) in two parts —the first was granted in 2018 for pilot school districts in Providence, Pawtucket, and Woonsocket, and the second in 2021 for the Cranston, West Warwick, and Westerly school districts.

The goal of the grant is for RIDE and the Rhode Island Department of Children, Youth, and Families (DCYF) to “work with districts and community partners to increase awareness of mental health issues, provide training for school personnel, and connect students and families with the mental and behavioral services they need.”

While the first grant was awarded pre-COVID-19, it was delivered on the heels of a homicide that occurred in the city of Providence in 2018.

Amy Messenger, a Licensed Independent Clinical Social Worker (LICSW) in the Providence Public School District, coordinates Project Aware and the School-Based Mental Health Services Program to support social-emotional learning and mental health and wellness.

“Through Project Aware, there are pilot schools within the district to implement and promote sustainable changes related to social-emotional learning and mental health and wellness,” Messenger said.

One of those schools is the Alfred Lima Elementary School in Providence, where Messenger serves as a mentor by working directly with the mental health team, which includes school counselors and psychologists. “Beginning last school year and throughout the current school year, I worked directly with [them] to look at the current practices, the needs of the school, and address those needs through the support of the grant,” she added. 

To address those needs in the PPSD, professional development was provided to staff, along with an “evidence-based social-emotional curriculum for students.” Collaborations were also formed with other existing district initiatives in the realm of mental and emotional health. 

According to RIDE, the social and emotional learning curriculum for students includes “recognizing and managing emotions, developing care and concern for others, establishing positive relationships, making responsible decisions, and handling challenging situations constructively and ethically.”

Resources like the virtual wellness room, developed for Narragansett School District by Social-Emotional Learning Coordinator Karen Festa, help students regain control over their emotions by clicking through relaxing images or participating in breathing exercises.  In the wake of the COVID-19 lockdown, having resources and safe spaces for students to cope with mental and emotional issues is a must, and student assessments are a necessary component to help develop them.

Diagnostic and Support Resources to Assist Students

In accordance with guidance from RIDE, PPSD uses universal behavioral and social-emotional screeners to “produce student outcome data that informs decisions on school-wide and classroom practices, strategies and program structures, and student groups in need of targeted interventions.”

“Those screeners can give school-based mental health teams’ data to guide support that our students may need,” Messenger said.

These assessments, which are easily scorable, are administered to students quickly and easily throughout the school year. The results broadly evaluate the progress of social, emotional, mental, and behavioral skills and abilities they’ve developed, to paint a picture of their overall health and well-being. 

Current assessments that are administered include RIDE’s Early Warning System tool, which helps identify and intervene on 6th-12th graders at risk of not graduating high school; Youth Risk Behavior Survey, which measures behavioral health risks of 6th-12th grade public school students (including depression, violence, and drug use); and Attendance/Chronic Absence to identify attendance issues early on and regularly.

Once the data is obtained through the assessments, district and school leadership teams use it to support student mental health by “improving school climate, promoting student and staff well-being, and addressing individual students’ strengths and needs.”

Other measures to directly support students who are struggling mentally and emotionally, include having “school-based mental health staff in every school,” as funded by the School-Based Mental Health Services Program grant. “Some of these supports include individual check-ins or counseling, group counseling, or referrals to outside agencies,” Messenger said.

And with the grant funding in place, the Providence Public School District (PPSD) can partner with community agencies like Family Service of RI, the Providence Center, Children’s Youth Cabinet, and RI Student Assistance Services, which operate within schools to provide resources to students and families.

Another agency doing important work for student mental health in the state is NAMI RI, which gives regular mental health-related presentations at schools for students and staff.

“NAMI is not a clinical agency but provides support and education. We talk about different mental illnesses, stigma, and young people share stories, in conjunction with [school] health classes,” said Penny Ferrara, manager of School and Public Education at NAMI RI.

The organization recruits college students dealing with mental illness to share their stories, so younger students can identify with them and see what their experience is like. “They talk about what it is like for them and [students] can see that treatment works after talking about how difficult it is,” Ferrara said. “It gives a piece of hope, which is best shown by those that go through it.”

NAMI gets regular requests for mental health presentations, which have been recently conducted via Zoom. “We’ve gone to a few schools, up to 6 classes per day, with the 9^th and 10^th graders doing mental health in their curriculum,” said Ferrara. The goal is to “create an atmosphere that is supportive,” where students are sensitive to the struggles others face and those in distress can feel open to tell someone about their struggles.

Ferrara also explained that the key to helping students is to normalize mental illness like any physical illness or ailment, such as breaking your leg. “Mental illness is an illness you can’t see,” she said. And the impact is astounding. Ferrara has seen more kids involved or asking questions than ever in her 12-14 years with NAMI. 

Presentation topics include anxiety, depression, suicide and others that focus on a specific mental illness or disorder (such as What is Bipolar Disorder?). Ferrara said that the rate of kids experiencing issues at school is growing, due to the lack of social interaction that comes from social distancing and remote learning during this pandemic.

“A lot of teachers report that socially, kids are having a hard time. Teachers are good at noticing and can refer students to social workers while at school but not when kids are at home. School is a good resource when they can’t turn to parents,” she said.

NAMI RI is always looking for speakers aged 18 or older whothat have dealt with and overcome mental health issues to present at schools. To advocate for public policy, share your story, or take the ‘Stigma Free’ pledge, visit NAMI RI’s Advocacy Page. Anyone experiencing a crisis or in need of group support can call (800) 950-NAMI or sign up for virtual peer support groups and social gatherings. “It’s a good feeling to know you’ve shared, and you are teaching by sharing,” Ferrara said. “We’re no different from them except that we got help.”

While information about mental illness and getting help for it is vital, prevention is also key. Messenger spoke about a Prevention Education series that plans to lead monthly visits to Juanita Sanchez Educational Complex health classes in Providence, in conjunction with the school’s Rhode Island Student Assistance Services (RISAS) counselor.

“Rose Molina, school social worker at Juanita Sanchez, has led a mental health awareness week in the month of May (which is Mental Health Awareness Month) that brought much attention to preventative work in the area of student mental health,” Messenger said. As far as the Prevention Education series, Messenger noted that it is “the first year in piloting such an approach with mental health awareness practices.”

Another effort overseen by Molina includes running the Kindness Crew, “a non-profit student-led initiative around spreading kindness and linking it to the mental health of students.” 

“The Kindness Crew was founded in 2016 and has since grown into its own non-profit organization assisting elementary schools in creating their own Kindness Crews, kindness reading partnerships, and spreading kindness throughout Providence,” said Molina.

Through the crew, students learn the power of coping strategies to overcome health challenges, while bringing mental health awareness to Juanita Sanchez. 9th-12th grade students from Juanita Sanchez participate and are required to apply by teacher recommendation and personal statement.

Initiatives led by The Kindness Crew in 2021 include buying and delivering groceries to community members in need and reading books about kindness to students at other elementary and middle schools across RI. The website also has a shop which sells graphic t-shirts, face masks, and stickers, as well as opportunities to buy an act of kindness for someone in the community.

Teachers, on the other hand, are being armed with tools through professional development, as Messenger mentioned before.

“These professional development sessions have included topics on trauma-responsive educational practices, positive behavioral interventions, empathy mapping, and relationship building during a pandemic, as well as suicide prevention training,” she continued.

Addressing Mental Health During the Pandemic

It’s apparent to teachers and staff that students are struggling, especially amid the pandemic.

“Our students’ mental health needs are more noticeable now and prevalent now more than ever,” Messenger said. “There is a rise in the amount of risk assessments social workers and school psychologists are completing.”

In addition to students needing more attention, structure, and problem-solving support, Messenger noted an increase in anxiety, which affects attendance and classroom engagement. “Students returning after long absences or having been away from school during the pandemic are overwhelmed, stressed, worried, or disengaged in the academic process as well as the workload involved to catch up,” Messenger added.

Advocating for mental and emotional wellness is a community effort, which includes showing students that it is appropriate to reach out for help when needed. Ferrara said she noticed that students want to talk about tough topics such as suicide and she explained how NAMI strives to convey the message that help is available when needed. 

After completing a presentation at a school on one occasion, she recalls five students coming up to their teacher while another student made an appointment with a counselor. Teachers have told Ferrara that more kids have been seeing the guidance counselor or social worker after the presentations and fellow students have become involved with supporting classmates who are struggling.

“We provide good information to kids that don’t have mental health issues, for them to notice a classmate that may need help,” she said. “We teach them that if someone they know is trying to get treatment or if they feel there is stigma, to include them in plans and let them know you care enough to think of them. Knowing someone is there, helps.”

For Messenger, partnerships with community-based agencies, parents, families, and community members are necessary with the surge in social, emotional, and behavioral challenges of our current pandemic-ravaged landscape. 

“I hope that from this article, we can come together as a community and focus on healing-centered engagement,” she said. 

“We have to take into account that the trauma did not just happen to our students, it happened to our entire community. My hope from this article would be that we ask ourselves each day what each one of us can do to promote the health and healing of our community.”

Spring is on its way! RI has been shivering under the icy breath of winter, but the days are growing longer and the earth is tilting on its axis. Soon, buds will be bursting into clouds of bright green and crocuses will be pushing their noses up through the snow. A great number of people are going to find themselves horny as hell – and there will also be those who instead become antsy, anorexic or unable to sleep. We may attribute all of those things to various random causes in our personal lives, but there is a vaster, more universal system at play here which governs humans, plants and animals alike.

As far back as the 18th century, researchers noticed that certain plants would open their leaves at sunrise and close them at sunset even in the absence of lighting cues. But it was not until 2017 that three U.S. biologists brought international attention to the underlying phenomena. Jeffrey C. Hall at the University of Maine, Michael Rosbash at Brandeis University and Michael W. Young at Rockefeller University shared the Nobel Prize in Medicine for their discoveries of the genetic and biomolecular mechanisms by which the cells of all living organisms mark the 24-hour cycle of day and night: circadian rhythms. It is now known that the circadian clock is involved in every piece of human physiology; it influences everything from emotions to endocrinology to metabolism.

So – what exactly is circadian rhythm?

Circadian rhythm is the 24-hour internal clock in our brain that regulates cycles of alertness and sleep by responding to changes in our environment. Our physiology and behavior are shaped, in essence, by the Earth’s rotation on its axis. For example, your body temperature rises just before dawn, enabling you to feel alert and ready to start the day; it drops again at night to help promote sleep. This biological circadian system has evolved to help humans adapt to changes in our environment. With its help, we can anticipate changes in radiation, temperature, and food availability. When your body clock is disrupted or thrown off balance by changes in sleep patterns, increasing or decreasing light exposure or other alterations in schedule, your natural circadian rhythms can go off kilter, leading to an astonishing array of symptoms and behaviors.

One such disruption is the coming of spring.

In animals, seasonal changes over the year trigger phenomena such as breeding, migration, and hibernation. In humans, these changes are more complex – reactions vary widely from individual to individual and some are more vulnerable than others. About 6% of Americans have symptoms severe enough to require medical treatment for seasonal affective disorder (SAD).

The primary instigator is a small endocrine gland in the brain called the pineal gland. The pineal secretes melatonin, which influences our sleep/wake cycles. The production of melatonin is drastically affected by available light – in the winter, we produce more of it, which can cause depression, fatigue, oversleeping, weight gain, and irritability. In the spring when available light increases, we can experience anxiety, weight loss, and insomnia. And, like the animals, we can be driven by an overwhelming urge to mate.

Motif spoke with Dr. Gene Jacobs, a Warwick-based clinical psychiatrist who sees the effect of seasonal change every year. He told us that patients with bi-polar disorder are particularly sensitive to the effects of light, and added: “the balls in a male’s scrotum raise or fall with temperature –  in winter, when cold, they retract more into body, and in summer, when hot, they drop away from body.”  

But that’s not all – disruptions in our circadian rhythms can accelerate, or even cause, medical conditions such as asthma, cardiovascular disease, hypertension, and neurological disorders. 

Considering the possible consequences, is there anything we can do to protect ourselves from potential repercussions? Fortunately – yes. 

• Get out of the house! Expose yourself to as much natural light as you can, right now. This decreases the shock to your system when daylight lengthens. 

• Get up out of your chair and start moving! Walking and exercising through the winter and early spring months helps to keep your immune system healthy while increasing sunlight exposure. This will help you contend with the pollen and viruses which hit as soon as the plants wake up. Wearing a good mask is protection against both.

• Stay hydrated – this is a good way to keep your system in balance. And eating a healthy, well-balanced diet helps you to be your best year-round. 

• Perhaps, as Alfred, Lord Tennyson wrote, “in Spring a young man’s fancy turns to thoughts of love.” But unprotected sex can turn into an STD or unwanted pregnancy. In case of sudden overwhelming lust – carry condoms!

Yes, it seems like the Lifespan/Care New England merger deal was rejected by both Attorney General Peter Neronha and the Federal Trade Commission. But our hackers found documents indicating that plans remain in place… This story and analysis came up through back channels and was written with repressed bile and intestinal fortitude…

“There is always a path forward, and we will explore all options to find the best possible…”

–Dr. James E. Fanale, Care New England President and CEO, as quoted in The Providence Journal

Big may have died because of his Peloton, but for Rhode Island, big healthcare will  still be better.

Ignoring warnings from the Rhode Island Attorney General, Federal Trade Commission, physicians and small medical providers, it looks like the smallest state may someday only have one health care company. 

“With our proposed merger of Lifespan and Care New England, we expect all other competition to wither and die,” said Dr. Ima Freud, the new Chief Splicer for Corporate Copulation. “Our research shows no need for small medical businesses to exist.

“When people go to ‘their doctor’ they take their time explaining their problems. They expect listening, and even empathy. This slows the healing process down. We’ve added keystroke counting software to examining room laptops. We call it ‘Docking Docs for Dallying.’”

Warehousing Medical Records 

One of the biggest complaints about the medical industrial complex—er, medical providers—is the lack of communication between different offices. The merger will solve that with a new system called All Records Gathered Here, or ARGH.

“Your randomized doctor will be able to know at a glance what venereal diseases you had as a youth,” Dr. Freud explained. “We’re even syncing it with your Stop and Shop and Whole Foods customer care numbers so we can tell whether you’re lying about soda and potato chips.”

When questioned about software glitches and data security breaches, Dr. Freud waved away concerns and told us that the problems faced by UHIP and RIPTA are “Just psychosomatic.” 

Other proposed merger benefits:

• Larger buildings in fewer locations with smaller offices and starker lighting.
• More employees focused on maintaining a “quality customer experience.”
• Data Driven Digital Doctoring with mandatory linkage between cell phones, watches and fit-bit-type tech. “If you walk fewer than 10,000 steps a day, your risk of a heart attack doubles, so we’ll charge you more.”
• A reduction in the number of physicians and an increase in nurse practitioners, physician assistants and traditional alternative medicine providers (TAMPs). “Folk medicine and quack cures might not work,” Dr. Freud said, “but they make people happy, and it costs less! President Trump proved it.”
• Single-payer pricing for prescriptions combined with targeted billing. “Essentially, we’ll be able to charge whatever we want for aspirin and ibu!”
• And of course, the latest Assessment Robots Scanning Everything (Project ARSE).
  “We’ve learned a lot from the recent releases of Alien Technology by the US Government,” said Dr. Freud, “about combining CAT scans with automatic rectal probes. We call it ‘Bend over and smile!’”

So, what’s the new company called?

According to the Internet, “LifeCare.org” has already been claimed by an end-of-life hospice in Lower Cape Fear, and the association was deemed too negative. “NewLife.org” is a Christian Church in Concord, MA.

Fortunately, following focus groups, where Rhode Island natives had trouble spelling any proposed name after only hearing it, the huge MediCorp settled on the perfect name of “Spanker,” pronounced, “Spanka.” 

“You come into the world with a spank,” Dr. Freud explained. “It works. You yell and scream, but you’ll live. We just want to keep up the practice. It’s not abuse if we legislate profits ahead of patients. Our new motto? Spanker: It’s for your own good.”

Note: this is a work of satire and not necessarily completely factual. It does not necessarily represent the opinions or views of Motif.

You may have heard of this forward-thinking RI Department of Health initiative that is beginning to serve as a national model for community-driven health. But what is a Health Equity Zone, and how does it work?

What Are Health Equity Zones? 

Ana Novais, deputy director of the Rhode Island Department of Health, defines Health Equity Zones this way: “Health Equity Zones are community-led collaboratives that are in a very specific geographic area making decisions about what health is, what health means to [community members], what’s important to them, and how they want to address those issues.”

Each geographically defined zone is headed up by a “backbone agency,” usually a non-profit that has the capacity to build an array of partnerships to help carry out the mission of the Health Equity Zone. In the Central Providence Health Equity Zone, ONE Neighborhood Builders is a community development corporation that acts as this convener. 

What Inspired this Approach? 

Jennifer Hawkins, executive director of ONE Neighborhood Builders, says that 80% of our health is determined by social, economic, environmental and behavioral factors, and just 20% comes from genetics and clinical care. This means that if the Rhode Island Department of Health focused simply on medicine, they would truly be missing the mark when it comes to the root causes of health disparity. 

Hawkins acknowledges that a development corporation cannot solve health issues alone: “You can’t build your way out of systemic inequity,” she remarks, and goes on to say that tackling the root causes of inequity requires a more holistic, comprehensive approach to health. 

“Why do homeless people end up in the emergency room more often? It’s because they’re homeless,” Hawkins says. We can continue to treat them with expensive ambulance rides and emergency room visits, or we can get to the root of it and get them stable housing. 

How Does Funding Work? 

The Health Equity Zone initiative truly is a grassroots approach: The RI Department of Health provides infrastructure grants to backbone agencies to help offset the cost of collaboration and accomplishing their missions. This is a relatively new approach; Departments of Health across the United States historically have relied on much more controlled, top-down approaches to solving systemic health inequity, rather than trusting community organizations to decide for themselves what is more important to them. 

What Are Some Successes of the Program? 

After a series of community feedback sessions, ONE Neighborhood Builders identified economic opportunity as one of the biggest factors of health inequity. So with Department of Health support, they launched their Community Health Worker Registered Apprenticeship initiative. The program trains community members with 144 hours of classroom education and 2,000 hours of on-the-job training to become certified Community Health Workers; this achieves the program’s dual goal of economic empowerment and health disaster preparedness. Read more about ONE Neighborhood Builders’ other HEZ initiatives on their website. 

Hawkins pointed out, though, that every Health Equity Zone is unique, and other backbone agencies might focus on areas such as family health or food insecurity. It really is all up to the community. 

How Can I Get Involved? 

Hawkins says that we all can support the Health Equity Zone initiative by championing the idea that social determinants of health matter, and that we all have a part to play in advancing this important cause. 

To learn more about the program or explore a partnership, contact Ana Novais at Ana.Novais@health.ri.gov. Support a backbone agency near you, look at this list of Health Equity Zones, backbone agencies, and contacts in Rhode Island. 

Music predates human language – it is woven into the history of every culture and into the rites and rituals of every religion. What is less known is that one of its most ancient uses was not as a form of expression – music was also one of the earliest forms of medicine. 

For centuries, music has been an integral aspect of the healing arts. The Aboriginal people of Australia were the first known culture to heal with sound. Sound vibration is part of healing in yogic traditions. Chinese Qi Gong uses specific mantras, chants and sounds to stimulate specific organ systems in the body. Tibetan singing bowls, Himalayan suzu gongs … the instruments and methods are endless throughout recorded history. Alternative healing has embraced music therapy for many years, but today, research into the neuroscience of music is discovering just how extensive the  powers of music can be. 

I spoke with Annette Mozzoni, director of education with RI Philharmonic Orchestra & Music School, and learned that music therapy and wellness has been a part of their school’s program since 2005; they currently employ two certified music therapists in addition to the skilled musicians on staff. In 2011, they launched a partnership with the Autism Project, an organization committed to serving the needs of the teachers, parents and caregivers who work with children on the autism spectrum. Mozzoni said that the majority of people who seek help with their music therapy program have an autism spectrum disorder. Music therapy is especially effective for these clients because of its ability to address their styles of speech and nonverbal communication skills. Each client who comes to the school is carefully assessed to determine the appropriate therapy, which might include creating, singing or moving to and/or listening to music. Results from this type of therapy can transfer to other areas of their lives, providing avenues for communication that can be helpful to those who find it difficult to express themselves in words.

Not all therapy at the school focuses on psychological and neurological disorders – Jane Murray conducts individual one-hour sessions of body mapping, a therapy that applies the principles of anatomy to movement. This program is popular with musicians who are suffering the repetitive motion injuries that can come as the result of practicing and performing the same highly controlled movements over and over again in their work. During sessions, students learn the mechanics of their own bones, muscles and connective tissue, and develop the ability to correct inaccurate movements. The result is an improvement in both the structural health and the performance and efficiency of instrumental players and vocalists. 

Another program offered at the school focuses on the Alexander Technique, named after creator Frederick Matthias Alexander, a dramatic performer in the 1890s who specialized in reciting classical Shakespeare. When voice loss during public performances threatened to end his career, Alexander began developing his technique, using mirrors to observe himself. He discovered that poor habits in posture and movement were to blame for both his damaged spatial self-awareness and his health. The highly effective technique he developed is now taught at performing arts schools in Europe, the US and around the world, including such prestigious institutes as the Juilliard School and UCLA. It is not only studied by numerous actors and musicians, but also by athletes to enhance performance. The results were so impressive that the technique has been investigated by medical researchers in the treatment of Parkinson’s disease; as yet there is insufficient evidence to warrant insurance coverage.

Why does music therapy have such a powerful effect on our brains and our bodies? The human brain and nervous system are hard-wired to distinguish music from noise and to respond to rhythm and repetition. And while this provides humans with entertainment and the motivation for movement, it also produces activity changes in brain structures – the amygdala, hypothalamus, insular and orbitofrontal cortex – known to modulate heart function. We are just beginning to learn the potentials of music therapy in the treatment of conditions ranging from anxiety and depression to PTSD and dementia.

Mozzoni sums it up: “Music therapy unlocks barriers and creates a pathway out of isolation. Through this work you also find the connective tissue that builds a bridge for expression and communication.”

To learn more, visit ri-philharmonic.org/MusicSchool/Programs/MusicTherapyWellness/tabid/227/Default.aspx

Aisha Jandosova hopes for years full of life rather than a life full of years, but recognizes that a lot of elderly people don’t get that experience. “When you become a certain age, you’re out of sight out of mind. Especially when you move to assisted living. Suddenly, you’re on the margins of society,” she said.

To help people add life to their years, Jandosova and Jeff Warren began holding weekly intergenerational art making workshops at Tockwotton on the Waterfront, an assisted living facility in East Providence.

“One thing we noticed straight away,” said Jandosova, “was that when you live in a long-term care facility, you receive a daily schedule from 8am to 9pm. And just seeing that really made a big impression because it’s not how most of us life our lives. Instead, your schedule is written for you. Most activities are, many times, repetitive. And when we started these workshops, we wanted to be an antidote to that.”  

Pre-pandemic, residents, artists, grandchildren and friends would gather around tables in Tockwotton’s cafe for the workshops. “There’s an intangible feeling of getting people into a space,” said Warren. “We put on music. We have a portable record player and give it a loungey vibe. We make a space.”

Recognizing the different abilities of Tockwotton residents, Jandosova and Warren choose projects that are more about the process than the end result. “We use all the senses,” said Warren. “Touch, smell, feel. Maybe a different temperature. Those are all part of the process.”

In one workshop, makers were given a flower and invited to draw it blindfolded, using only their sense of touch to recreate the object. Another day, Jandosova and Warren hauled in a cooler of fish and led a gyotaku workshop, a traditional Japanese method of printing making.

Over the last year, Jandosova and Warren have run virtual workshops through Federal Hill House, a community support facility in Providence, but they’re eager to work with people in person again. “The pandemic really showed us the value of sharing space with each other, being next to each other to make things and build memories,” said Jandosova.

Follow Aisha Jandosova at towardsanidealplace.com; For information on their programs, go to tockwotton.org or federalhillhouse.org

Sandra Musial, MD, is passionate about food, its impact on health and sharing that knowledge with others. So she, along with two other doctors who share her passion, started a group called Plant Docs. In pre-pandemic days, the Plant Docs ran five-week workshops in the basement of vegan food hall Plant City that taught people how to embrace a whole food, plant-based diet. “Pairing medical intervention with a restaurant is a cool concept,” said Musial. “It’s about health, but it’s also about enjoying food.” I recently spoke with Dr. Musial about the health-transforming power of plants.

Emily Olson (Motif): When it comes to their diet, what do Americans get wrong?

Sandra Musial: The traditional western American fare is leading to crazy levels of obesity, hypertension, diabetes, cancer. All of these are diseases of the western world. Countries that are still eating from the land have lower rates of all of these diseases. Instead of eating whole foods — fruits and vegetables, whole grains and legumes — people are eating highly processed foods with lots of added sugars, oils and refined flours. I work at a pediatric obesity clinic and there are kids who in an entire day will never eat a fruit or vegetable.

EO: School-provided lunches must drive you mad.

SM: I think if we improved school lunches, it would have a mass effect on the whole US population. And children would bring that education home. A few years ago, WIC [the nutritional program for women, infants and children] improved the quality of their food package by limiting juice and decreasing refined flours and flour products. The national rates of obesity in that 3- to 5-year-old range went down, and they think it’s attributed to this mass improvement in the federal WIC package.  

EO: What impact can a whole food diet have on health?

SM: You can reverse many of the diseases of the western world. Obesity, Type II Diabetes can be reversed, you can open some of the plaque in the coronary arteries. Studies have shown that end-stage cardiac patients, when put on a strict healthy diet, can add years to their life.

EO: Then why do we turn to medicine to correct these problems?

SM:  I don’t know that people are being told it’s an option. But if every doc said, “You can go on this pill that you can take for the rest of your life and have surgery and die early, or you can have a lifestyle change,” people still might not want to make changes.

EO: Is it an economic issue?

SM: There is some truth to that. Broccoli is more expensive than soda, but on the same budget, if you buy dried beans and that’s your protein, that’s the most economic and nutritious protein there is. It’s more complicated than that, of course. People who live in the inner city don’t always have access to fresh whole foods. And it’s a multigenerational thing. If that [style of eating] is all you’ve ever known, it’s hard to get away from it.

EO: So what’s the answer?

SM: I think we have to have a multi-pronged approach to education, and I think it has to start with one-on-one at the doctor’s office. Medical schools have to do a better job teaching future doctors about nutrition. And there needs to be more community and government involvement to reverse what has happened [in food policy] over the last 30 years.

EO: Tell me about the Plant Docs classes.

SM: We limited each class to 20 people who want to learn the importance of eating plant based. Each participant would meet one-on-one with a doctor at the beginning and the end of the series, and we’d send them to a lab for blood work during the first and last weeks. Participants come from all walks of life. We’ve had vegetarians who want to give up dairy and want more ideas for vegan cooking, and we’ve had people who are scared after a heart attack. If there were enough people, I’d love to do a series with special interest groups.

EO: Any final thoughts?

SM: [Holistic health practitioner] Ann Wigmore said, “Food can be the most powerful form of medicine or the slowest form of poison.” I love that. Our cells become what we feed them. If you feed them whole foods, they become healthy, boost your immunity and fight disease. Or you can slowly kill yourself. You really are what you eat.

The Plant Docs will resume classes when it is safe to do so. Email sandy@plantdocspvd.com to get on a mailing list. For more information, go to fb.com/plantdocspvd or plantdocspvd.com. Scholarships for classes are available.