Sunday, December 09, 2007

My Three Shrinks Podcast 37: Poop-Out

[36] . . . [37] . . . [38] . . . [All]

Sorry for the delay in getting podcasts out, folks. This one may be a bit confusing, as we recorded it prior to the new sound equipment, so it is not "new and improved". This is actually #37. So, the next one to come out will be #39 (later this week... really! :-).

December 9, 2007: #37 Poop-Out

Topics include:

Find show notes with links at: The address to send us your Q&A's is there, as well (mythreeshrinksATgmailDOTcom).

This podcast is available on iTunes (feel free to post a review) or as an RSS feed. You can also listen to or download the .mp3 or the MPEG-4 file from
Thank you for listening.


Anonymous said...

Monetize is not the word you were looking for. It does nto mean the same thing as to fund.

Anonymous said...

Ah yes, the borderline behandling ad. It did lead to a site in Denmark which was questionable, hence the "something is rotten in Denmark line". The thought of anyone being "behandled" was quite amusing but also unsettling. As it turns out, behandling is the Danish word for manage or treat (as in a clinical setting).(In German it would be behandlung.)

Rach said...

Hi Shrinks...

Re: light therapy - it's really helped me. I use this
Light Box
(in addition to running outside during the day whenever I can) in the morning for 45 minutes while I'm at my computer reading blogs and drinking my morning coffee. I've been told by nitwit the shrink not to use the LightBox after 12:00 noon as it may cause mania, but that's my personal predisposition.

I can't say whether this has helped with preventing poop-out because I'm on multiple meds, and we are consistently changing the dosages.

I may write about this on my own blog at some point.

Rach said...

Shrinks... question for you (i'm writing this as you're ending your podcast):

Just wondering what your thoughts are on mental health professionals (particularly psychiatrists/psychologists) who struggle with their own mental illnesses. I'm thinking back to when I read one of Kay Redfield Jameson's books, and was astonished by the degree to which she hid her illness, until it became obvious to her co-workers that her functioning was impaired.

On one hand, yes, I do think I'd like to see someone for therapy who has a heightened awareness to what it's like to have my illness, yet on the other hand, how can I be sure that that individual will remain objective?

Just food for thought... I'm pretty sure you've raised this point somewhere along the way though.

DrivingMissMolly said...

Does the light box work for those that don't have a dx of seasonal affective disorder too? Like MDD?

I've gotten to where I will try anything. I paid a bunch of money for a StressEraser, but got frustrated trying to use it. Oh, well.

The podcast was great. The interaction between all of you is what makes it so good.

Let's say you have 100 patients. How many of them get better on the first drug, get better on a second drug, get better and stay better, and how many don't get better at all?

I was surprised at how many people seem to get better. I pretty much stay the same or take a nosedive. I had a good few days about two weeks ago and probably won't have one for a few weeks to a few months. Lithium keeps me from killing myself, but I don't feel that I am actually *living* at this point.


Midwife with a Knife said...

rach: No doctor can remain truly objective. I had a bad experience once with a vacuum, several years ago back when I was a resident, and a normal term baby died (it wasn't because of the vacuum, it was because of the vacuum and an undiagnosed and very rare condition called neonatal alloimmune thrombocytopenia which causes brain bleeds... which the vacuum may have made worse, but it's a condition that is usually diagnosed in subsequent pregnancies after a baby from that mom has bleeding in the brain after birth). Now I hate using the vacuum and always reach for the forceps first.

Objectively, forceps have a perhaps minimally reduced risk of fetal injury (statistically but not clinically significant), and really although each have their advantages and disadvantages, both are fine tools.

But I can objectively aknowlege that, but still really not like doing vacuum deliveries (I CAN do them, I just try hard to avoid them).

My prejudices and experiences affect my practice, and I think that as long as humans are doctors and therapists, you'll never have an objective doctor. The key, imnsho, is for a doctor to be aware of their biases (or in the case of mental illness, potential to be impaired).

I honestly don't know what happens in the case of potential physician impairment, although if you're actually impaired by means of drug or alcohol abuse most states (I think) have structured requirements that must be met to return to practice.

Sorry for the long-winded comment. And please do get Monkey the parakeet his own mike. I find the chirping cheery!

Anonymous said...

MWWAK: And I'll state my own personal bias as a NICU nurse - if they bring a vacuum OR forceps near me during the birth of my future child, then I'll have the c/s please! Oh yes, we all have our biases, but that is one of my larger ones - perhaps irrational, but strongly felt all the same!

Anonymous said...

ClinkShrink - have you seen the series in the "Boston Globe" on mental health and suicide in prisons? Check out for the links. I'd be interested in hearing your comments.

AA said...

Whatever happened to "The Little Antidepressant that Could"? He didn't poop out. Although, once he got to the top of the hill he did have to go back down. Maybe that's the same thing?

On the subject of light boxes, I've been looking into purchasing one for the past several years. The most common guideline is to get one that provides 10,000 lux, but when you actually go to buy one, that magic number can be hard to find.

And the websites that hawk these things are all a little flakey. And the lamps have names like "Sadelite" and "HappyLite" which always seems somehow condescending to me.

And solid information on what's good and what works is nowhere to be found. Some places will say that the blue wavelength ones work whereas other sites cast doubt on that. I've read that as low as 2,500 lux works (but with increased treatment times) but most places just cite the 10,000 number.

I still haven't purchased a lamp. Because they cost so damned much, I don't want to go waste what little spare cash I have on something that doesn't work.

ClinkShrink said...

Miss Mouse: I hadn't seen the article so thanks for sending the link. I read it, as well as the full 63 pages of the Lindsay Hayes report which is available on the Mass. DOC web site here.

My initial thought is that I could write a full post on this topic and tackle several different aspects of it, but I'm never going to get around to it with the holidays coming up.

The premise behind the story is that the state prison system is experiencing an epidemic of suicides and this indicates multiple failures in the care delivery process. Unfortunately, the story is written in such a provocative way that it seems intentionally designed to provoke outrage rather than thoughtful consideration. It is a hatchet piece disguised as an expose. Unfortunately, this is the standard approach for any media coverage related to prisons.

The first question that needs to be considered is whether or not the recent upward trend in suicides is indeed a Massachusetts-specific problem or part of a wider national trend. Right now we don't have the data to make that distinction. The "official" national prison suicide data comes from the Bureau of Justice Statistics, and so far they have only published data through 2002. We don't know yet what's happening nationally from 2002 to present. Informally I can tell you that I have heard from colleagues in jails and prisons in many jurisdictions that the last two or three years have seen an uptick in deaths. I don't think this problem is isolated to a single state. No one knows why; it happens even in states that have well established suicide prevention plans.

In reading the Hayes report I can tell you that the basic elements of a suicide prevention plan all do appear to be in place in Massachusetts, and almost all the suicide cases were identified as mentally ill and were receiving treatment at the time of the death. Half were on observation or in special housing at the time of death. I obviously can't comment on individual cases since I don't have access to those materials. The most concerning thing I see from the Hayes report is that the physical structure of the cells being used for observation appear to be inadequate to the task, based on Hayes description, with obvious protrusions or fixtures that were used to tie ligatures. Of the most concern to me was the fact that in two of the reviewed cases paramedics in free society refused to transport the prisoner during the immediate response phase. This is horrifying.

Maybe this should have been a post, but then I never would have gotten around to writing it.

Anonymous said...

I tuned into “Poop out” and was surprised to hear that use of the SAD (seasonal affective disorder) light is still so rare and misunderstood. I strongly urge you – almost beg you! - to learn much more about this treatment.

Exposure to light is awesome for SAD but also for some forms of insomnia and any form of depression :

I use the light daily and have done so for over a year (I'm using it as I write) and find it easy, powerful, and cost effective. This treatment has beaten back my lifelong battle with severe SAD and insomnia. BTW – I use this in conjunction with Welbutrin. I live in Wisconsin where hanging out outside for 30 – 45 minutes gets difficult and maybe dangerous (sleet/ice/blizzards/sub-zero wind chills). Plus the self-discipline of sitting and reading is doable vs. putting on long underwear/coat/boots/gloves and then shuffling along on icy streets and sidewalks... I am in my robe and getting light therapy!

I get up in the morning and have 2 cups of coffee and read blogs in front of the light, which is always on my desk.

I have experience with 2 models of SAD light, I have read Winter Blues by Norman E. Rosenthal, and I have spent a good deal of time learning about SAD on
the Center for Environmental Therapeutics. There you will find a self assessment and an extensive question and answer forum with specialists from CET and Columbia University Medical Center's Center for Light Treatment and Biological Rhythms:

FYI – I do not sell light boxes (but maybe I should). I purchased both of mine through The first was just alright (“Naturebright Suntouch”) and the 2nd is awesome (“Uplift Technologies DL930”). The 2nd light is large and is positioned above the head to angle light downward – hits the receptors in the bottom of the eye ( had info. on that.)