Saturday, August 10, 2013

Back from Vacation: Roundup of Psychiatry in the New York Times

It's August, and  I've been away.  Now I'm back.  While I was gone, there were a number of articles in the New York Times that were Shrink Rap material.  Here is a list, with thanks to Jesse for keeping me informed:

Mark Epstein on The Trauma of Being Alive.  It's a nice piece about how people deal with loss, and it's feeling a little to relevant these days. 

Here are the response letters to the article. 

 I didn't see Epstein's article as a deterrent to getting care, as one trauma therapist who responded did, but rather as a suggestion that we take grief as it comes, however it comes, with no comment on what more to do about besides accept and "lean into" the emotions (whatever that may mean).  I figured that if one's response to the distress of a loss was to want to seek help, then the author,  a psychiatrist, probably wouldn't be blocking the door.   

Pam Bellack wrote on the successes of forced outpatient care in Programs Compelling Outpatient Treatment for Mental illness is Working, Study Says.

In a response letter, three professors wrote about Forced Drug Treatment.

Don't hold your breath waiting for the Shrink Rapper book on this -- it will be years in the coming.

In Lawyers of Sound Mind, Melody Moezzi writes about the hassles newly minted lawyers have to go through in some states to enter the Bar if they've been treated for psychiatric disorders. 

In When Doctors Discriminate, Juliann Garey writes about her experiences with doctors who've dismissed her health problems after learning she takes psychotropic medications.

And in New Sign of Stimulants' Toll on the Young, Sabrina Tavernese discusses the increased rate of ER visits for stimulant-related problems, especially for those who obtain them without a prescription and for those who combine stimulants with alcohol. 

And over on Clinical Psychiatry News, ClinkShrink chides the president of APA for irresponsible tweeting.  


Joel Hassman, MD said...

Hmm, interesting, I read your colleague's opinion about the APA President's tweet regarding the Fort Hood shooting, and the general issue of commenting about media matters.

Umm, maybe the bigger issue facing psychiatry is being involved in these various "social" media elements like Twitter, Facebook, and other overused commentary sources. You could challenge me by my writing a blog being a hypocrite and inconsistent, but, the beauty of having to write rather long and large items that blogs are used for makes one a bit more invested and pensive, versus just scribbling a 140 character rant or spontaneous thought without little time for reflection.

Plus, when you are in a position of authority or power, you might want to be careful using these media elements that have little editing or supervision for accountability.

Like that Facebook page of the man who shot his wife and posted it for what, glamour and glory?

And how lame is it to use a term like "Tweet"? Yeah, works for me, we are a culture of birdbrains these days. Lead by a nefarious group who want you all to stay dumbed down and uninvested in the realities of the real world.

So maybe it isn't just about comments in the press, but, why aren't we calling out people for what they are doing that is detrimental and disruptive? And isn't it an embarrassment for psychiatry that one of the worst shooting incidents in this country was by one of our own? Yeah, this is a guy you want to ostracize and distance from ASAP!

Just my opinion. Hope you had a nice vacation. Interesting use of picture for your post, not related to one I am using for my Summer Daydream series, hmm?

Anonymous said...

I thought it was sad that despite how supposedly effective the forced outpatient treatment was, the article did not include even one patient perspective. Surely they could have located at least one patient who has since been released from forced outpatient treatment who has something positive to say about it?

I would be interested to know:

* How many people who are committed to outpatient treatment programs go into hiding, and/or flee the state to avoid forced commitment?

* How many patients once released from forced outpatient treatment continue with treatment voluntarily? (I know I wouldn't).

* Do the states with outpatient commitment laws follow the patients once they are released from the forced outpatient commitments to see how people are doing long term?

It's a big mistake to assume that decreased admissions means the patients are improving. The decrease in admissions may mean that the care was so bad or scary that patients no longer feel safe enough to share their symptoms (as was the case in my situation). That is not success. That is failure.

In the article, they did make a good point that the improvement may also have to do with the provision of services (that is not there for a lot of patients, until things get really bad). Maybe we ought to try offering care without force first to see what happens.

A lot more information is needed than is presented in the article. It would be really good to hear from the patients who have been released from the program to see what they have to say.


Dinah said...

It finally happened: I agree with Pseudo-Kristen. I read this article and wanted to know why they hadn't looked a patient satisfaction and other patient-centered variables (like employment). The article was mostly about finances, so fewer hospitalizations is a success and the "why" is not what matters -- the measurement of success is money, it doesn't matter if the patient doesn't return because they hated the treatment, what "matters" is the cost of care. (to these researchers, not to me).

I do think that fewer incarcerations in jail as a measure of success is reasonable, on the theory that society does not want to pay to imprison people and people generally don't like to be in jail.

Anonymous said...

Dinah, lol. See, I'm not always unreasonable. Always opinionated, but not always unreasonable. Ha!

The study may address this, but does fewer incarcerations mean in the state of commitment only? For example, let's say John Doe gets an outpatient commitment and flees New York, only to get arrested in Iowa. I wonder if the arrest in Iowa would be captured in the data, or if John Doe would be seen as a success since he was not re-arrested in New York? Maybe this is addressed, I don't really know. Would be important data, though, because it could be that we have a situation like the states that give bus tickets to send their psych patients to other states. Nothing is solved, the burden is just shifted to other states.


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