Love Me, Love My Tats

Recently one of our readers wondered what I thought of a study that was recently reported in Scientific American Mind. It was a study that was done in a forensic psychiatric hospital, looking at the correlation between tattoos and a diagnosis of antisocial personality disorder. Briefly, they examined 36 inpatients for the presence or abscence of tattos and then did semi-structured interviews to assess them for antisocial personality disorder. Unsurprisingly, they found that people with tattos were more likely to be diagnosed with antisocial personality disorder and to have histories of substance abuse and suicide attempts.

My first thought when I read this report was: "This was a forensic fellows' research project."

Psychiatrists in training to be forensic psychiatrists are encouraged to do some type of research project during their fellowship. Since the fellowship only lasts for a year, it can be difficult doing any kind of in-depth or groundbreaking studies. The tattoo project is not a ground-breaking study. The main reason it probably got published was because it was done on forensic inpatients (although Scientific American Mind confuses them with prisoners, they aren't). The research subjects were patients, not prisoners. They were committed to the hospital after being found legally insane (therefore, not a criminal at all) or incompetent to stand trial (mentally unfit to go to court, therefore their guilt is undetermined).

The most interesting aspect of this study was the one that was not addressed at all in the paper:

How did they determine that the patients, all of whom by definition were seriously mentally ill, were competent to give informed consent to a research project?

This question is at the cutting edge of forensic psychiatry these days, a field which is concerned with competency assessments and capacity for decision-making. There are particular ethical difficulties that arise when the research is being conducted on institutionalized subjects like patients and prisoners. I've already blogged about this in detail in my post Guinea Pigs Behind Bars. (Be sure to check out the link to the guinea pig costume web site. I still love it.)

You can download the entire study by clicking on the pdf link at the Wiley web site here.

Scientific American Mind Reviews My Three Shrinks Podcast

Christopher Intagliata, from the magazine, Scientific American Mind, reviewed our podcast in their June/July 2008 issue.  Click the review below to go to the SciAm Mind website.

   "...a few bottles of wine..."  

LOL... if we did that, there'd be no shrill bickering, just dysarthric, discordant "singing".

Go buy this issue (you can even buy a digital version) so you can also read about oxytocin and trust, psychiatric genetics, anorexia, chronic itching, and unleashing your inner genius.

It's Not Supposed To Work This Way

Okay, so pick your psychiatric diagnosis-- only don't pick Adjustment Disorder, or Major Depression, single episode. Pick a psychiatric diagnosis where we Know that it recurs and where long-term treatment is indicated. Let's say schizophrenia, or bipolar disorder, or recurrent major depression with a bunch of episodes. Let's say the episodes are bad and the patient gets lots of symptoms and life gets ugly.

So pick your medicine to treat Illness X. The patient takes the medicine and most of the symptoms get much better, the patient feels better, everyone takes a deep breath, the side effects are minimal or non-existent. Life is good, though the patient still has some problems (ah, don't we all....) and lives a bit on the edge in a way that leaves us wondering-- is there a personality disorder here? A developmental issue? A social issue? Or are there perhaps some residual symptoms? Maybe this is just one of those people who will never fit neatly into a boxed corporate-climbing life, or for whom meds and therapy won't be complete answers.

We're moving along okay, nothing scary is happening, the patient is mostly well, the medicine is tolerated, life is looking up. And then an episode hits---this is not "supposed" to happen. But we all know that the medicines decrease the likelihood of a recurrence of illness, while they are no guarantee.

So we take our ill patient and we do what one might do: raise the dose, assess symptoms, increase the frequency of sessions, get thee to a lab: check levels, look for other things that could account for the sudden symptom exacerbation, think about drug interactions and what's that thyroid doing anyway?

The patient returns. Ah, much better, the symptoms have abated, the patient feels better than ever. The obvious signs of illness are gone. For the sake of clarification, in psychiatry "signs" are thinks we can see-- psychomotor slowing or activation, abnormal movements, changes in the rate of speech, disordered thoughts, conversations with non-existent people...fill in the blanks. The patient is eating and sleeping better, functioning better, less irritable, less chaotic.

One little thing, Doctor: "I stopped the medicine."

Oy. So the patient stopped taking the medicine that treats the illness and gets much better. Maybe the problem wasn't a breakthrough of symptoms, maybe it was that the patient was having unrecognized side effects from the medicine and feels better without it? Nope, the symptoms were classic illness symptoms, not side effects. Why would they get "better" from the psychiatric symptoms when the med stops? I have no idea. And yes, I promise you, the patient had the symptoms before any psychotropic medication was ever started-- this isn't simply an adverse reaction to the medication. The best I can do is that the episode was self-limited and happened to end as the medication stopped, but that feels a little lame even to me.

So now what? The patient had numerous episodes of the illness before getting diagnosed and treated. But, really, you can't say to a patient: This is the gold standard of treatment for your illness, take the medicine even though you feel much better since you stopped it. Oh, I guess you could say it, but no patient will listen.

It's hard to prophylax well patients. We could try another medication on the theory that it may protect against future episodes, but if someone is feeling well, there is very little immediate up-side to prophylaxis: You feel well now and you may get side effects (oh, and you'll have to get labs and EKGs and maybe the new medicine will give you lovely adverse effects). We could do nothing and wait: it's pretty clear that it's just a matter of time and the "well" patient is a time bomb.

It's not supposed to work this way.

Cure for Fish Phobia?

Hmm, seems we zipped past our 800th post with Dinah's Dear Fat Doctor.  

So, you've heard of our Sex with Fish post.  And Sex with Fish, Revisited (of course).

Now comes Sex with Feet Feet with Fish. A Virginia salon is pioneering the use of little bitty carp to nibble away your worries... and your dry, flaking skin.

Just dip your tired dogs in the warm water and a hundred puny, puckering, piscine podiatrists suck your feet clean of dead skin.  AP writer Matthew Barakat writes about the tiny "doctor fish", also known as garra rufa, in the Baltimore Sun:

Customers were quickly hooked.

Tracy Roberts, 33, of Rockville, Md., heard about it on a local radio show. She said it was "the best pedicure I ever had" and has spread the word to friends and co-workers.

"I'd been an athlete all my life, so I've always had calluses on my feet. This was the first time somebody got rid of my calluses completely," she said.

First time customer KaNin Reese, 32, of Washington, described the tingling sensation created by the toothless fish: "It kind of feels like your foot's asleep," she said.

It seems that Turkey has used these dermophilic fish for some time to treat psoriasis. For those of you with fish phobias, this might be an excellent way to use exposure therapy ("immersion" therapy, even) to desensitize you to fish.  But can you charge it to your health savings account?

My Rather Weird Life

Just back from meeting with Jon, the idealistic fitness trainer who will save the inner city from the epidemic of obesity and save me from myself.  Every muscle aches.  And so I come upon a box at my front door.  I love presents.  Who doesn't?  Thinking it's a book I ordered, I note the address: 

Dinah, Chef de Haute

Dinah's Tex-Max Bistro

Hmmmm.  Seems unlikely I'd send myself a book to that particular address.  Maybe I was taken over by aliens?

Eagerly I rip open the box.  The contents: 2 boxes of King Arthur Flour (est'd 1790) Quick & Easy Homemade Dog Biscuit Mix from ONLY the finest flour.    Oh, and let's not forget the multi-sized cookie cutter's shaped like dog bones.

My day is complete.  Max's Day is even more complete.   Perhaps Fat Doctor's son (the notorious little boy dog biscuit eater) would like to come over for a snack?  Or Jon's foster dog Molly?  And wait until Tex sees what Max now has, jealously amongst the pooches will abound.

Thank You, Victor.  I'm not sure what else to say.

Ambassadors of Health

So Jon, who has never so much as read a blog, tells me he's vying for a highly prestigious grant. A man of many observable muscles (a walking anatomy lesson so-to-speak) and 1.1% body fat, Jon is a fitness expert. His grant proposes to take high risk inner city Baltimore youth, perhaps even high school drop-outs working on their GEDs, and train them to be certified as fitness and nutritional experts to help a larger population in neighborhoods where healthy eating and regular exercise are not part of the daily routine. In the inner city, lifestyle choices lead to a myriad of illnesses and early-age deaths. So working with the kids to be ambassadors of healthier living: Wow! What a goal; how can you not love the guy?

If you haven't seen it, by all means, watch Hard Times at Douglas High-- an HBO documentary which takes a peek at the population Jon's wants to target. Single parents, teen moms, drug abuse, and incarceration are all the norm. The soccer moms with their minivans and juicy boxes are no where to be found. The children speak a distorted form of English, and even some of the faculty have trouble putting together well-constructed sentences. Standards are set such that it's the teacher's fault if the kids don't pass-- all of which leads to lowering the standards. One child at Douglas scored over 1000 on the SATs and 1 child passed the Maryland proficiency exams in math. And while the 9th grade class has 500 students, many of them repeaters, the graduating class has 60% fewer students with only 200.

Jon asked me if I know anyone who specializes in building self-esteem from a psychological perspective, something he'd like to incorporate into his program. I hesitated, I don't. Certainly, if a child has a psychiatric disorder, it would be good to treat that illness. People with depression often feel badly about themselves, and with treatment, some of these symptoms can get better. But what about kids who feel badly about themselves because they've had rough lives, parental desertion, academic struggles, behavioral and legal issues, neglect, and even abuse? Does counseling make it better? I'm left to say "maybe." I don't know that it doesn't and I don't know that it does. I do know that success builds confidence and that builds self-esteem. And we all know there are Invulnerable, resilient kids out there, people who will succeed or even excel in spite of unthinkable adversities. They are the best.

Okay, my disclaimer of the post: I have no idea what helps struggling kids excel. I don't work with kids, I haven't read the studies, I just like to ramble.

I know as much about what makes kids succeed as I do about betting on horses, so let me try that stab in the dark. I don't know how much counseling would help, but if it were my money and I were deciding where to put it, I wouldn't allocate spending it on psychological treatments in the absence of a psychiatric disorder. Here's what I'd work on: things that help kids feel more confident in a concrete and tangible way. Counseling can feel cliche-- yup, we're all wonderful and special and we can grow up to be anything we want if only we put our mind to it. These kids aren't much for buying that rhetoric. So here's what do I (the rambling, clueless, blogger) think would help inner city kids succeed:

• Jon. He's kind and attentive and very encouraging and who needs a counselor when you have him saying "you're doing a great job!"


• One-on-one reading remediation. Oy, the textbook for this fitness certification trainer thing looked like one of my medical school texts. This isn't easy and any kid who can get through it will feel pretty confident by the end.


• Dental work. Okay, you think I'm kidding, but this is not a population with routine access to orthodontics and dental care and bad teeth make it harder to get employment (my own theory, no research).


• Wardrobe consultation. Watch the documentary and tell me there's one boy in there you'd hire to do anything besides sell drugs.

The point of this post isn't to rag on inner city life, and it certainly isn't to discourage Jon. The world needs more Jons, more idealists, more people willing to take on tasks that feel hard. The point is to say that I'm not sure individual counseling or psychotherapy is the place to start to build the confidence needed to get out of a lifestyle that lends itself to festering in poverty. Job coaching, skills building, health care and dental maintenance, treatment of psychiatric disorders, education, education, and education are the way to go.

And Jon, I hope you get your grant and I hope you like being on our blog!

Dear Fat Doctor

Fat Doctor wrote a post a while back where she worries that her darling toddler son will some day be embarrassed by her weight problem. I meant to comment, I meant to write her, instead I'll put up a blog letter.

First a disclaimer: all kids are different, they come in assorted shapes, sizes, and temperments and I've learned quickly and painfully that a wonderful kid can become a particularly difficult kid-- this with a six week countdown in my family until such kid moves half way across the country to start college. Last year, I thought I'd have a nervous breakdown when he left, this year, he's making it a bit easier to say goodbye, though I'm well aware that I still may have a very difficult time with this departure. There are more difficult kids, there are easier kids. So with two teenagers, and with many friends (and patients) with teenagers, let me write a letter to our dear friend Fat Doctor in the blogosphere.

Dear Fat Doctor,

Please don't worry that your son will be embarrassed by your weight. He won't be. And because he's a boy, he probably won't care what you wear. Kids don't worry so much about what their mothers look like, oh, except for girls, who are known to yell: You Can't Go Out Looking Like That! Especially not where their friends might on the same planet.

While you don't need to worry about your son being embarrassed by your weight, there are a few things he will be embarrassed about.

• Your mere existence.

• Every word you say.

• Especially words that date you. Gosh darn is probably not real cool.

• References to TV shows, movies, politics, or events from the days of old.

• The music you listen to.

• The songs you hum. Oh, gosh, don't hum.

• The gestures you make.

• The things you say about him, no matter how glowing. Don't talk about him. Ever.

• The fact that you greet his friends. Do you really need to ask how they are and interrogate them about what they are doing and what they'd like to drink?
  

• The fact that you are not invisible.

• Your ideas. Especially if you express them.

• Oh, and your core beliefs, what ever they are, they are embarrassing.

• Your expectations of him.

This is only a partial list, but Son won't care about your weight. I hope this helps you sleep better.

With kind thoughts. By all means, continue to enjoy the next 10 wonderful years.
Dinah

Up From The Floorboards

Wow, almost three weeks since my last post. Life has moved quickly, but all for the better. Roy has his new iPhone, Max has a new bandana (quite attractive for a dog), and I have a new job. Here is my favorite quote from orientation:

"The people here are dangerous, no if's, and's or buts about it. It's a fun job, though."

Hard to beat an introduction like that. And it's true that security was called to the wards twice in one day during my first week. It's also true that I think this is going to be fun.

More later. I'm still catching my breath.

iPhone 3G Activation Blues

I thought I'd share my iPhone experience, not that it has anything to do with psychiatry, but I know a lot of our readers and listeners are Apple fanfolks, including yours truly. (Full disclosure: I own a whopping 9 shares of Apple stock, so assume some bias.)

As you may already know, Apple released it's 2nd version of its cell phone, the iPhone 3G (not a third generation phone, but the "3G" refers to its use of a third generation cellphone network) on Friday, July 11, 2008, at 8am local time 'round the world. Our Grand Rounds post on June 24 foreshadowed this release. Unfortunately, Friday's release was a disaster, and the dust has not even settled yet.

Apple ran out of its old iPhone in stores over a month ago, so demand has been building, as well as interest in the 3G's upgrades, which include a faster cell network, a regular-size headphone jack that does not require carrying around an adapter, and a price that is about half that of the first phone.

The usual Apple build-up and mystique contributed to people starting to get in line for the iPhone a full week ahead of release date (this is insane). Even my going to stand in line at 7am was a bit much, as I'm sure I could have gone the next day, walked in and got one.

Anyway, on the left is a picture I took with my Treo (I've had Palm devices since the original Palm Pilot way back in 1996) after getting in line, with about 100 people in front of me. Two hours later, by the time I reached the front of the line to get into the store, there were another 150 or so people behind me. Note that there were two other line opportunities at the mall... the AT&T store and the AT&T kiosk.

The ratios of people standing in line went like this: Apple:AT&T:Kiosk::25:5:1. The buzz in the line related to guesses about how many 16GB iPhones the Apple store had in stock versus the other two stores. It would be interesting to find out if the line proportions mirrored the stock proportions... you know what they say about the wisdom of crowds. Unfortunately, none of the stores' workers would tell us how many they had in stock, which is not very smart, as there were many reports of pissed off AT&T line standers getting upset when the manager later emerged, predictably telling them that they had no more of the precious phones in stock.

As we got closer to the front, I measured the pace of people leaving the store at about 1 person every 2 minutes. Nine people away from entering the store, and then people stopped coming out of the store (and we stopped going in). We found out that the same thing happened at the AT&T store (which we could see from where we were). Soon after, an Appler came out to tell us that the servers handling the phone activations were down, apparently crashing under the heavy load.

After a bit more waiting, a gush of people came out, iPhone bags in hand. But they didn't have that gleeful look on their face. One of them told us that the servers were still down, and that they'd have to activate their phones at home via iTunes. (This is how it was done with the first iPhone, but AT&T insisted on in-store activations this time to reduce the number of phones that get sent internationally to get unlocked later, so they can be used with any cell network.)

We started moving again and the rest of the experience was uneventful (fortunately, given that my bladder was extremely full by then). I walked out with an unactivated iPhone and was able to get it activated later that evening.


So, what went wrong?

It looks like that someone woefully miscalculated the combined effect of the following things happening all on the same day:

-a zillion in-store iPhone activations
-the release of an update to the iTunes software, version 7.7 (a 50MB download)
-the release of a firmware update (iPhone 2.0) to the 6 million first-gen iPhone and iTouch devices
-the release of a new iTunes App store (as in Application Store)
-the conversion of Apple's .Mac service to the new Mobile Me service

On top of all that, existing iPhone users who tried to update their firmware found that their iPhone was now as useful as an iBrick.

The postmortem analysis points to iTunes, not AT&T, as the Achilles heel in the fiasco. Apple has traditionally provided excellent service, so this experience has been particularly painful for many Apple watchers. Hopefully, they will do better next time.

He Got It!!!

Four hours in line, with details along the way.  The power went out, the biology of it all got a bit uncomfortable (or so I'm told).  The fear that they might run out....it was intense.  Oh, Roy will say I'm exaggerating, overly dramatic, catastrophic even.  After all, it's just a cell phone.  And apparently there were, indeed, lines.

Now where is Roy with his new iPhone?

I asked if takes pictures?  So far no answer.

I called, got the same old message.  Is Roy one person or does he now have two cellphones?  Does he have a new number?  Will I ever hear from him again, or is my Samsung slide (with no internet capability) no longer in his league?  Mine does have a camera.  I think I'll send Roy a picture of my feet.   I got my toes to smile.

I want to see it!  Is it bigger, better, more more more than last year's model?  Someone I work with has the old iPhone, can I introduce them, do side-by-side shopping?

----

Finally, while I'm rambling silliness on such a serious topic as the new iPhone, I want to take this opportunity to thank ClinkShrink for staying with Max and teenager the last few days so I could have a mini-vacation.  I'm recharged and so happy that everyone here is alive and well.  I am sorry that teenager ate the Reeses Puff cereal that Clink likes.

Landmark Medicare Bill Passes Senate; Removes Federal Discrimination Against Mentally Ill

Yesterday, the US Senate passed, by a 69-30 vote, a bill that would finally remove the anachronistic and discriminatory "brain tax" from Medicare.  Elderly and disabled on Medicare have had to pay a 50% copay for outpatient treatment for mental illness since Medicare started in 1965.  Any other type of illness requires only a 20% copay.

But mainstream media is largely ignoring this historic success in the fight against this discrimination.

This blatantly discriminatory and stigmatizing financial penalty against America's seniors has long resulted in undertreatment of mental health problems, often leading to even higher costs for other somatic conditions due to self-neglect.  Finally... a Medicare parity bill that passed both House and Senate!

I did a search on Google News for "medicare bill +mental|psychiatric" and "medicare bill -mental|psychiatric" to determine the number of articles in the past month on the Medicare bill which either did or did not mention the words "mental" or "psychiatric."

6,466 Articles . . . . . DO NOT mention the bill's mental health provisions

   408 Articles . . . . . DO mention the bill's mental health provisions

Please write to these article's authors and tell them to get a clue.  And let Bush know that you don't want him to veto the bill (McCain has already said he would have voted against it).  

This is much bigger news than the annual passage of a bill to block cuts in Medicare physician (and all other providers, BTW, incl. social workers, psychologists, etc) fees.

A Very Seinfeld Grand Rounds

TBTAM does an excellent job on Grand Rounds this week, noting that each submission relates to a Seinfeld episode. Excerpt:

Grand Rounds? Can someone please explain what that's about? I mean, is it Grand as in "large"? Or Grand is in "Isn't that grand?"

No one says "Isn't that grand?" anymore unless they're 95 and in a nursing home for retired stage actors. In which case they should definitely not be practicing medicine.

And why do they call it "Rounds"? Is everyone standing in a circle singing Row, Row, Row Your Boat? What's that got to do with medicine?

Or is it Rounds like a round of golf? D0 you guys keep score? "I shot a bogey on that appendectomy today. Lost a Titelist sponge somewhere behind the cecum."

Doesn't that make your nurse sort of like a caddy? "Nurse, hand me my 9 scalpel. Or do you think I should wedge it out?"

Grand Rounds. Now that I think if it, it sounds like some sort of Melba cracker you serve with cheese. "Would you like some Gruyere on a Grand Round? Oh do try it - It's Grand!"

Cut to Jerry's apartment, where his friend Dr Crippin, visiting from the UK, is ranting about how he is tired of the livers of his fellow citizens being given out to foreigners. Not an English citizen? NO LIVER FOR YOU!

Check out The Blog That Ate Manhattan for more.

Eat, Pray, Love: One woman's quest to find herself

 Elizabeth Gilbert is a novelist.  In her non-fiction real life, she had a bad spell: a contentious, ugly divorce, an overly needy relationship with a distant rebound lover, a bout of depression.  She goes on a journey to heal, to find herself-- a pre-planned, publisher-financed 4 months of pasta and language classes in Italy, 4 months of meditation at an ashram in India, 4 months with a medicine man in Bali.  It's kind of everyone's fantasy, no?  Okay, parts of it are kind of my fantasy.  Parts of it.

When I read a book, or listen to a lecture, or turn on the TV, grab my popcorn at a movie, I'm looking for something.  Sometimes, I simply want to be entertained (a worthy goal in and of itself).  Sometimes, I want to learn something that will change how I see the world, or how I relate in some small way.  Sometimes, I'm looking for something that resonates, that I can relate to, that holds true.  A great plot will draw me in-- so nothing about 24 or The Sopranos or LOST feels anything like my life, but still, they draw me in.  

I started Eat, Pray, Love, and honestly, the author felt like a patient.  Her life is chaotic, her relationships packed with drama, she spends an awful lot of time sobbing on bathroom floors, and she makes no secret of her love-hate relationship with anti-depressants and what her therapist advises.  Her therapist and her Guru.  At first, I found it hard to relate to her, even though she was running away from her real life.  Does everyone else occasionally have this fantasy, even if real life isn't so bad?

I got to page 154, somewhere in India, and suddenly Elizabeth Gilbert became someone I could relate to.  Now people who don't know me very well sometimes think I'm laid back.  Anyone who does know me knows I'm a worrier, prone to obsessing about....anything and everything.    So Elizabeth Gilbert is talking about Sean, an Irish farmer she's met at the ashram and she's talking about Sean's "search for inner peace through Yoga."  He's home in Ireland, sitting with his serene dairy farmer father in front of the hearth, telling him about the wonders of his spiritual discoveries:  

      Da--this meditation stuff, it's crucial for teaching serenity.  It can really save your life.  It teaches you how to quiet your mind.

      His father turned to him and said kindly, "I have a quiet mind already, son," then resumed his gaze on the fire.

     Gilbert goes on to talk about people who don't have quiet minds, who are restless, and she includes herself in this group.

     The other day in prayer I said to God, "Look-- I understand that an unexamined life is not worth living, but do you think I could someday have an unexamined lunch?"

    In my last post on impulsive suicides, when I mentioned writing about this book, a few readers wrote in asking about the Amazon reviews-- one in particular calls her 'self-absorbed and irritating.'   Self-absorbed, self-indulgent, absolutely.  At some level, aren't most people self-absorbed?  I suppose it's a matter of degree-- since I listen to people's self-absorption all day, it doesn't particularly bother me, it's not a fatal flaw.  I wasn't irritated.  I suppose at some level, I just enjoyed the fantasy of it all.  The journey to self-discovery is, of course, and old and oft-told story.  Now please excuse me while I boil the pasta and recite my mantra for a while.

Don't Jump!!!

I enjoyed Roy's Sunday Morning Coffee Links, especially the pictures of the giraffes.

I was away for part of the holiday weekend, rediscovering the value of R & R (good stuff). I got to the New York Times Magazine a little late, but there was a terrific article about impulsive suicides. The article, The Urge to End It, by Scott Anderson, made the point that the most lethal of suicide methods-- firearms and jumping from high places among them-- are often the methods used by people who attempt suicide on impulse and that blocking access to these means often prevents people from dying. He points to the fact that 90% (at least) of those who've been stopped from jumping off the Golden Gate Bridge don't end up dying of suicide, that suicide rails lower the rates of completed suicide, that the suicide rate in Britain dropped with the elimination of coal gas:

For generations, the people of Britain heated their homes and fueled their stoves with coal gas. While plentiful and cheap, coal-derived gas could also be deadly; in its unburned form, it released very high levels of carbon monoxide, and an open valve or a leak in a closed space could induce asphyxiation in a matter of minutes. This extreme toxicity also made it a preferred method of suicide. “Sticking one’s head in the oven” became so common in Britain that by the late 1950s it accounted for some 2,500 suicides a year, almost half the nation’s total.

Those numbers began dropping over the next decade as the British government embarked on a program to phase out coal gas in favor of the much cleaner natural gas. By the early 1970s, the amount of carbon monoxide running through domestic gas lines had been reduced to nearly zero. During those same years, Britain’s national suicide rate dropped by nearly a third, and it has remained close to that reduced level ever since.

It's a good article, well worth the read.

Someone remind me that I want to talk about Elizabeth Gilbert's book Eat, Pray, Love.

Sunday Morning Coffee Links

Just sitting around, browsing StumbleUpon with my coffee. Thought the following were interesting/educational/funny/weird.

Economic models expained with cows

Primer on The Brain

Interactive models to learn about pharmacodynamics

Nick Brandt's B&W animal safari photos

Mouse Party: This is your mouse on drugs (very engaging)

Funny classifieds

Benjamin Krain, Photojournalist

Computer-generated ambient music w/psychedelics

TKA: Flickr typography tricks

Screenvader: Flash music creator

Drug library of patient experiences with meds

What I Like About You

As I've aged -- ripened, mellowed, whatever-- I've gotten more emotional and effusive.  At least I think so-- Roy? ClinkShrink?  They've known me for a while.  I used to hold it in reserve when I liked someone, and in recent years I've been much more likely to tell people what I like about them, what wonderful friends they are, how much I treasure them.  

It's not the usual thing to do in psychotherapy, at least I didn't use to think so.  There's that whole blank screen thing and the psychoanalytic influence that makes it a no-no to say I Like You. We're supposed to look at what the patient brings, and if they wonder how I feel about them, well, more grist for the mill, so to speak.

People come to therapy hurting, sometimes injured or even damaged, and often feeling badly about themselves.  They nitpick, they blow their faults up, they talk about their strengths with ambivalence.  Oy.  And sometimes they're right about their faults, but last time I checked, I couldn't locate the perfect person and everyone has  a few.  I'm told I talk too much.  So what, who cares?  So I talk too much and my hair frizzles ...it's who I am.  Psychotherapy isn't about fine-tuning people into perfection, but sometimes it is about helping them to become more comfortable with the imperfect person they happen to be.

I've taken to pointing out to patients some of their finer points.  I don't usually tell people I like them, but I do sometimes tell people that they're likable (this means I like them) or that they have a good personality.  Sometimes I list their strengths-- you're bright, creative, intuitive, thoughtful, considerate, you have high moral standards, a great sense of humor, and the list marches on.  I don't lie and I don't comment on peoples' physical appearances (-- hmmm--You're a great person despite that wild head of frizzly hair...I don't think so!).      

People come to therapy feeling vulnerable.  I hope it helps to counter a negative focus with a some reality cues-- most people aren't all bad.  I also think people sit on the couch feeling pretty vulnerable, and it helps to know that a therapist doesn't see them as a miserable creature.  Most patients seem comfortable with this.  Occasionally I have to be careful-- a compliment is heard a negation of someone's feeling-- as though I don't believe they are as bad as they want me to believe, as though I'm not really listening or I'm arguing.  

I do my best.  I'll stop talking now.  And if you want the music, try THIS.