Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Friday, August 07, 2009
I'm awake, my kid is not. I'm in the wrong time zone, so I'm up early for vacation, and the other half of my family is scheduled to arrive tomorrow, so it's teenage girl and me for the moment.
I want to talk about our dinner last night. It's not about psychiatry. Oh, except I think the woman was in the mental health field and her dog was raised in a mental institution (her choice of words).
So tired, jet-lagged teenager and I grabbed a bite at the grill at our hotel. Wine, cheese, calamari, chocolate...what more could you ask for? At the table next us there was a couple on a date. A first date, and not listening wasn't an option....the tables were close, they spoke loudly, it was a get-to-know-you, tell-you-about-myself, trying-to-make-a-good-impression place. She ate half her entree and he ordered a wedge salad which looked like the whole head of lettuce was just dumped on the plate. They shared brulee, after declaring that chocolate molten cake would be too much (we had the chocolate molten cake and it was not too much!).
We weren't there for the very beginning, we were seated as she talked about how her mother was upset that she'd traveled alone in India. Mom doesn't like that she also is always covered in white cat hairs or that she wouldn't go to church with her in high school. Mom is an artist. She is/was a professional belly dancer and spent the Millennium dancing in some golden bird outfit for elders in a Indian tribe in Colorado. I believe she worked at a state hospital in Southern Colorado where everyone worked there or at the prison (ClinkShrink?) and she dated a co-worker who took her for Chinese food. She's glad to be away from Southern Colorado because they have no ethnic food and people ordered hamburgers for lunch....here you get get Vietnamese and other ethnic foods. (Calamari and chocolate brulee, too, apparently). She has a dog (he was raised in mental institution and is good with all sorts of people) and a cat, one sleeps on the bed, the other does not.
And the gentleman...he's from Scotland where his linguist mother drew attention to him by talking to him exclusively in German. Her family is Jewish, his father's is Christian, and he went to Christian schools. He works in the film industry and has read hundreds of bad screenplays. His favorite movie is Looking for Bobby Fisher (it has soul) and when you see a good screenplay, the writing sings.
It was a nice place for a date and he paid.
So daughter and I both thought it was an Internet date--- two people interested in finding someone who are worldly and want to meet another worldly soul. My teenager thought they spend too much time talking about themselves and the woman talked too much about people she's dated before. Conversation seemed to flow, and I found them both likable and interesting. This may have been the best meal I've ever eavesdropped on. We were both dying to know if there would be a second date-- conversation flowed, and he was thrilled to hear she liked Indian food-- but it was a little, oh...trying? I thought he liked her better than she liked him, and my kid thought it was the other way around, maybe slanted by the fact that we were seated facing different members of the couple? I thought Match.com, my daughter thought eHarmony.
Subscribe to: Post Comments (Atom)
It's fun finishing the story about such people in one's head! My daughters like it when I make up increasingly absurd and improbable scenarios about perfectly innocuous looking and sounding people (of the "True Lies" variety)
Eric gets a job at the local Fatso Burger, but doesn't enjoy it. Donna tries to get Eric to come over, since her parents are out of town, but he doesn't understand her hints. Instead, Kelso wants to throw a party at Donna's house. Guest star: Danny Bonaduce.
What I'd be looking for in determining the second date possibilities would be body language. Were they flirtatious? Did they laugh at each other's jokes. Did she play with her hair? Look down then raise just the eyes up. I do think it's a faux pas to discuss previous mates on the first date.
OMG! Dinah, you crack me up! What a great start to your vacation. Nothing like good food, wine & a funny story. Enjoy the rest of your vacation!
No way to comment under Grand Rounds posting so I will leave it here:
In the Child Psych post I LOVED this:
"A recent study has linked the use of stimulant medication (such as Ritalin) with 10 deaths in a sample of 564 children and adolescents who died suddenly for unexplained reasons. It's important to note that the study was unable to demonstrate that stimulant medication was the cause of the deaths." The write goes on to decry negative press coverage of drug side-effects such as death.
A nearly 2% death rate in children and adolescents (which has to be way above the baseline death rate for this age) and the writer feels it's unfair to blame the meds? Ha ha ha ha!!!
That's a shocking level of detail - the first question that pops into my head is did you have any conversation of your own?
e.m.e: we had a pretty quiet dinner...the conversation at the adjacent table really overwhelmed our ability to talk, plus we both really wanted to talk about the couple, and obviously couldn't until after, and our post-dinner discussion was incorporated into the post.
Sunny CA-- hmmm...looks like the study identified 564 children who died unexpectedly in an 11 year period, aged matched them for children who died in car accidents, and found that 10 of the children who died unexpectedly had been on ritalin while 2 of the children who had died in car accidents had been on ritalin. I didn't see anything about 2 percent of kids on stimulants dying. Hard to know what any of this means. The studied looked at children who died from 1985-1996; my guess is that a more recent study of any type of child (dead or alive) would show a higher percentage of kids on stimulants.
I chuckled ar the "too much detail" comment, as I just took down a post of my own about an overheard conversation (arguing couple) because MY teenaged kid read the post and said "MOM, you can't post that, too much detail!"
Quite often, I will remember an incredible amount of detail (perhaps because something in the overheard conversation strikes a chord, perhaps because the talkers are loud, or I am bored with my own thoughts or my companion is silent).
In my chaplaincy residency, we did verbatim after verbatim (reviewed with supervisors and peers) of visits with patients, and were not allowed to take notes or use tape recorders, and it sharpened one's memory. Tho, in middle age, I rarely demonstrate it any more...
On the ritalin, I can believe it for a variety of reasons (none scientific, just hunches, based on having kids and friends' kids diagnosed and misdiagnosed ADHD and on and off stimulants over the years, plus observations of side effects and/or mood disorders in the kids and the parents.
1) being on stimulants almost always diminishes appetite (except for those most tempting kiddie junk things like candy, chips,, etc.)When my kid was on them as a grade school kid (for a year) he began to look like a wraith, thin, hollow-eyed, didn't eat, etc At a time when he should have been growing. I took him off for that reason and other worse side effects like agitation, psychosis, etc. In any case, heart muscle is growing at that time. In a sense, many kids on stimulants are dieting, and muscle as well as fat is lost dieting. In addition, little kids diagnosed with ADHD (even if they don't actually have bipolar or something else) tend to be very active, risk-takers, and over=exert themselves. So a lot of their activities put stress on the heart episodically. What if those who were still growing when taking the stimulants had problems with their hearts because of inadequate nutrition?
Famous other examples of this include the health problems of kids who grow "too much" in a short space of time (boys or girls, who shoot up eight inches or more in a year in adolescence, hearts and spines, etc.), large dogs like Great Danes and Shepherds and Retrievers that may have hip and spine and heart problems and die young or be crippled because such fast growth is hard to get the nutrition right for?
Sorry this is lengthy, but I think that anything that interferes with the appetite or reasonable tastes of growing children should be suspect.
2) For those kids that are not actually ADHD but have more stigmatized and controversial diagnoses (eg: the still debated actual incidence of childhood bipolar disorder) I don't have the links, but untreated mood disorders are highly correlated with damage to the heart (people do literally die of broken hearts) and higher incidence of other killer diseases like diabetes, cancer, etc. Even the debate on fattening bipolar and schizophrenic meds is somewhat confused by the tendency of even non-medicated patients with these disorders to gain weight at higher rates than the population at large. (I don't know why, my hunch is just that the disorders physically damage the body. Pain and suffering and agitation hurt the body whether they are psychic or physical in origin)
So, if you have a kid misdiagnosed as ADD who is actually BP, the stimulants will worsen the BP. He or she may become depressed and suicidal on them, or manic and agitated. Perhaps those worsened mood states trigger damage to the heart?
Excuse the verbosity, but from observations of dozens of kids I have known well over years. A biased and concerned observer...
I can't believe you eavesdropped on my date! and then blogged it. how embarassing! but kinda funny. anyway, we went out once more but no real sparks. and it was match.com.
Anon: REALLY??? Which one of the couple are you? We're still talking about it. Would be nice to think there was resolution here (or someone just teasing me??)
I did wonder about sparks.
Retriever, you said:
"but untreated mood disorders are highly correlated with damage to the heart (people do literally die of broken hearts) and higher incidence of other killer diseases like diabetes, cancer, etc. Even the debate on fattening bipolar and schizophrenic meds is somewhat confused by the tendency of even non-medicated patients with these disorders to gain weight at higher rates than the population at large. (I don't know why, my hunch is just that the disorders physically damage the body. Pain and suffering and agitation hurt the body whether they are psychic or physical in origin)"
Hmm, my cousin was extremely positive and still died of cancer at a young age. Another relative was very negative and lived until 93.
To be honest, linking mood disorders to everything under the sun (probably some researcher has linked it to the fact I broke my finger a few years ago) is totally suspect. That is just statistically impossible.
Your statement on the bipolar and schizophrenic meds is eerily similar to the doctors attitudes when complaints came in about antidepressants causing weight gain. Patients were blamed but finally, that attitude changed.
Here is a link to an abstract on APs causing diabetes.
Frankly, as one who has suffered devastating side effects from these meds including a hearing loss which I am sure is also blamed on depresssion, I am frankly tired of medical side effects being minimized and blamed on the person's illness.
That is frankly a horrible and cruel thing to do to a person and is far worse than any depression or anxiety I might have dealt with.
Anonymous, I certainly didn't mean to sound like a drug rep or callous pill pushing MD. It's just that I have so many people in my family who have been so ill.And tho the meds suck, have vile side effects, if they even help at all (about 1/3 are helped by them), the untreated relatives are all either dead or chronically ill, multiply divorced, etc. I have a sister who has been hospitalized maybe 20 times for violent mania, and suffered terribly there. Lost years of her life, been badly treated, abused, etc. Even meds that are only partially effective and make her gain weight make it possible for her to live in her own home, work, have loving relationships with her daughters, pursue hobbies and interests, keep pets, dump a horrible husband. My mom was less helped by the meds, but during one of maybe 50 manic episodes after she went off them, she jumped out of a window and was crippled. Ten years of life thereafter with only limited use of her arms and hands and otherwise paralyzed was much worse than feeling crummy on her meds.
But all any of us have to go on are our own experiences. I am so sorry your meds have had such unhealthy effects.
I have had to fight to get my kid off things that his more pill happy doctors have wanted to keep him on. Right now a reasonable balance, without awful side effects.
I think that for many people the pills just mobilize the placebo effects (there is some interesting stuff out now on differences in natural opioid receptors in the brain and response to antidepressants looking at differences between people who respond to treatment and those who don't). My personal belief is that competent therapy can be more effective for certain conditions, without the bad effects. Tho not severe mania, catatonic depression, or schizophrenia or psychosis.
The trouble is,there aren't enough good therapists, and insurance usually won't pay for enough time with them. Don't even get me started on those useless CBT courses of 12 group sessions with nearly untrained group leaders that insurance companies think can cure depresssion...forever..
If someone told me: you can either have a 500 dollar a month pill or 2.5 meetings with a good psychiatrist who does therapy and can monitor a cheaper med, I would unhesitatingly choose the MD over the pill. It's bizarre that the new drugs are now so expensive that it might end up being cheaper or at least similar in cost for a person to be in therapy.
But I have no illusions that talk can help everything. My kid had hallucinations and terrors and bizarre thoughts as an 8 year old that completely vanished on a small dose of atypicals. That was night and day difference in his quality of life. Where it gets tricky is when a doctor is burned out and starts throwing everything but the kitchen sink at a "treatment resistant" patient (talk about language blaming the sufferer?).
I greatly appreciate your post and am sorry for the pain your family has been through, including your mom,
The only caution I want to add is that experiencing symptoms going off meds isn't necessarily a return of the illness as it can be due to withdrawal symptoms. Especially, if the person cold turkeyed or tapered too quickly.
Let me give you an example. - The son of the moderator of Paxil Progress Boards became homicidal/suicidal due to a Paxil tapering schedule that was way too fast.
Fast forward to being five years off the meds - He has not mental disorders whatsoever.
I don't mean to minimize your mom's suffering as it sounds horrible. But I think it is important to make that distinction as too many people assume that if they go off meds and have psychiatric symptoms, they need to stay on them for life.
I do relate to the "kitchen sink" comment. Because my rebound insomnia has severely worsened, I had to updose my med.
I am looking for a medical professional who can help which is a whole other post. But if all the person is going to do is use a dartboard approach without truly understanding what meds do, I will simply go at it alone. Been there, done that.
Good luck to you
Post a Comment