~ There's an article on mental health stigma in The New York Times by Pauline Chen, worth the read: Caring for a Mind in Crisis.
~Since I like to gripe about electronic records and privacy, I'll add this to my list of you-don't-want-to-believe privacy issues: On Campus, A Faculty Uprising Over Personal Data.
On KevinMD, Sanjay Gupta has an article on one of our topics of interest, Medical Marijuana, and there was a Weed special on CNN featuring Dr. Gupta the other night. Interesting that he comes out "Pro" MMJ, even though his article doesn't mention that the little girl with seizures was using a varient of marijuana that was so low in THC that it was unsellable, and that she was taking it orally, not smoking it with a high. I found the CNN show more enlightening than the article but I'll link to the article here.Penn State administrators quietly introduced the plan, called “Take Care of Your Health,” this summer in the deadest part of the academic calendar. But that didn’t prevent some conscientious objectors from organizing a protest online and on their campuses, culminating last week in an emotionally charged faculty senate meeting. The plan, they argued, is coercive, punitive and invades university employees’ privacy.The plan requires nonunion employees, like professors and clerical staff members, to visit their doctors for a checkup, undergo several biometric tests and submit to an extensive online health risk questionnaire that asks, among other questions, whether they have recently had problems with a co-worker, a supervisor or a divorce. If they don’t fill out the form, $100 a month will be deducted from their pay for noncompliance. Employees who do participate will receive detailed feedback on how to address their health issues.
If you're getting mental health care from an agency in New Mexico, sounds like things may be rough. A number of agencies providing care to many patients are being investigated for Medicaid fraud. The state's response: shut them all down. Apparently it's leaving patients without access to treatment and inpatient admissions are rising. Here is a an article from the New York Times but I'm sure there are many other local pieces on line. I have to say, I don't understand the photo that went with the article, but I borrowed it for my graphic here because it was so perplexing to me. What are they doing to that kid's head?
From the Shrink Rappers, over on Clinical Psychiatry News:
I continue to make noise about how psychiatry needs to question our assumptions and to talk about how Dr. Insel's blog post on the NIMH site questioning the effects of long term antipsychotics should shake up the risk/benefit discussions we have with out patient. Read more in Questioning Psychiatry's Assumptions about Life Long Medications.
And, finally, ClinkShrink gets annoyed about the idea that everyone thinks the really sick patients should be someone else's responsibility in Locked In, Eating Cutlery. Yes, she is talking about a patient who eats their forks. Why? Just read.
So why did the font change color in the middle of my post?
your last link links to your article instead of to clinkshrinks.
Thanks, fixed it!
They're buzzing the kids' hair. That's a comb. No idea what that has to do with the article.
Comb and surgical stapler . I've never used a comb with a stapler ( the latter of which I use daily in the OR) so I don't know what they're doing either.
An electric razor. The kid has an apron pulled up around his neck and the razor has little flecks of hair on it. He’s at the barber’s getting a haircut.
Yes, but what does that have to do with Medicaid fraud and the mental health crisis in New Mexico?
Maybe they are messing with our heads? They put up a totally irrelevant photo just to confuse everyone?
Actually, I have a theory! The article says the boy is autistic and no access to a therapist now because the place he was getting counseling at was shut down for fraud.
I wonder if this is a little shout out to people who have autistic kids and how much trouble this kid will have coping with the haircut. He looks a bit nervous about the razor. I was in a hair salon a while back and there was a child with autism getting a haircut. It was nearly impossible for them to buzz his hair cuz he was so sensitive to the electric razor. One second he was laughing really hard cuz it tickled and the next he was really upset. I never saw a kid freaking out like that before. He was shouting he would call the police. One of the hair stylists was saying to another one that she just couldn't work with that kid anymore. I think they had to get a different razor and the mom spent the whole time either trying to console him or threatening to not give him his chocolate milk when they left. That just made the kid even more agitated when he realized he might not get his chocolate milk. It did nothing to get him to calm down. The stylist cutting my hair apologized and explained that the child was autistic.
Without a therapist, the boy in the picture won't learn how to cope.
Hopefully, the psychiatrist who wrote the book concealed the identities of the patients enough so the patients don't recognize themselves. I'm going to hope that that's true, because otherwise I really feel for those patients and what they might go through learning their stories are out there. It's one thing if a patient writes about themselves, but I cannot imagine finding something painful I had shared with my psychiatrist ending up in his book. I know I don't see my psychiatrist to provide material for a book.
Maybe I'm just sensitive but the article about the book written by the psychiatrist kind of made me nauseous. It reminded of a city tour I took recently. As the tour guide drove he said, "If you look to your left you can see a mentally ill woman..."
Come one, come all...look at those with mental illness. Aren't we interesting. Ugh.
Also, not one of the 123 comments in response to the article, "Caring for a Mind in Crisis," mentioned any concern for how the patients discussed might feel reading their story on the New York Times' website or in the psychiatrist's book. Not one single comment. I guess all that matters is that the story is entertaining. Very disheartening.
Regarding "Questioning Psychiatry's Assumptions about Life Long Medications", you might be interested in this letter that one of your colleagues wrote to Dr. Allen France. Scroll down to the last comment by Paul Baker, who posted a copy of a letter that Dr. Dirk Corstens, wrote.
""My present mind-set – my most accurate and honest conclusion about psychosis and medication – is that I really don’t know who needs medication and who does not. I now believe it is better to prevent prescribing medication whenever possible.
Modern psychiatric practice tends to endorse that people with psychotic experiences – or what psychiatrists believe are psychotic experiences – rarely get access to psychological therapies, and almost never as a first-response treatment (despite robust evidence that it works). Without much communication, and almost automatically, antipsychotics are prescribed. As you may know, in some European countries young patients are even prescribed three different medications at a time. Modern psychiatric practice is ruled by a fundamental fear of psychotic experiences and the objectively false premise that antipsychotics eliminate it. There is abundant reason to change this mind-set: communicate, care, and support. Wait, create a safe environment. Wait and listen. Try to make sense of experiences. Only prescribe low doses when necessary and stop when possible.""
Just heard Drs. Elspeth Ritchie and E. Fuller Torrey on the CBS NewsHour. Disussing the Washington shooter, Aaron Alexis, who just shot and killed at least twelve people. Dr. Ritchie pointed out he was paranoid schizophrenic and schizophrenics often do not realize they are sick. She noted he might well have been offered treatment but refused it. She also noted the ease ith which he legally bought his gun. Dr. Torrey noted the destruction of the public mental helth system, putting so many very sick people on the street without adequate treatment.
Jesse, did Dr. Elspeth Ritchie mention having examined the shooter?
Jesse, Can you find me a link?
Pseudo-Kristen: I wondered this as well.
The details are still emerging, it seems too early to comment.
@P-K, no they both noted that they were going on the information tht had been made public, which did inlude his symptoms of paranoia and hearing voices. They were both careful to note that they were going on that public information. It is an excellent interview with both of them and they were thoughtful and insightful. Dr. Ritchie differentited PTSD from schizophrenia and said that hearing voices and paranoa are not ymptom of PTSD.
So your question is an excellent one. No one will be examining the shooter, of course, as he is now dead.
One of the points they made was the difficulty of assembling an accurate profile/diagnosis ahead of time, and how common it is for patients with an illness such as his to disguise and deny the symptoms they are experiencing. They were not symplistic and Dr. Torrey truly sought to emphasize the problems that have resulted from the lack of funds for mental illness.
I thought that both doctors were thoughtful and moderate, and not doctrinare. P-K, I think you would appreciate what they said and how they said it.
Ii miswrote: the PBS newshour, not CBS. And I watch it almost every day!
I didn't listen, but I did read the transcript, and I think that while the two psychiatrists give the caveat that they didn't examine the man in question, they go way over the line in discussing the diagnosis and interior life of someone they didn't know:
E. FULLER TORREY: No, I strongly agree with that. I think there was any PTSD here, it was a very minor issue on it.
This fellow had a brain disease that we call schizophrenia, almost certainly, on it. The question is why he wasn't being treated. We don't have enough information to know that. If he had been treated, we probably wouldn't be seeing this.
ELSPETH CAMERON RITCHIE: But we do know that schizophrenics often have no insight into their disease, as you mentioned. So it's likely that treatment was offered and he said, no thanks, I don't need this.
We have very little information, and it changes hourly. We do know that he worked for an agency, left, and was re-hired by them. He was employed and had access to care, and went to the VA twice in the last month complaining of insomnia, and was given trazodone. He had 2 gun charges and was jailed for a bar fight.
There are all these assumptions that a) he had classic paranoid schizophrenia (Torrey says this earlier, yet he has a long employment history) b) he had no insight c) if he had PTSD, that wasn't the problem, d) he was likely offered help and e) he refused it. f) any of this has anything to do with a lack of state hospital beds (the man had military benefits and may well have had private insurance) g) he wasn't getting mental health care -- we don't know that, maybe he was. His job had him moving so maybe there was an ongoing psychiatrist at home, we just don't know.
I could come up with all sorts of scenarios, possibilities, and assumptions, but that is what they'd be.
I think the interview made way too many assumptions and was very irresponsible.
Ugh, I'm annoyed:
ELSPETH CAMERON RITCHIE: I would add we also have to look at our gun laws, the fact that somebody with mental illness could go purchase a gun that day and use it.
We don't know if he did or didn't have a documented history of mental illness and do we really want "mental illness" all shapes and sizes, as the defining issue in gun purchases? Or do we want to say 'why did someone with 2 gun charges, jailed for a bar fight, who is said to have claimed he had an anger-induced blackout, allowed to buy a gun in a state he doesn't live in and walk out of the store with the gun on the same day?
Finally, I have no facts here except what I read in the article Jesse linked to and 2 New York Times articles. But as I've already stated, I'm in favor of strict gun control, for everyone, not just people with insomnia, schizophrenia, mental illness, PTSD, etc.
ClinkShrink, where are you when we need you?
Amazing! Dinah ,thanks for your sharing.
Before the articles about the shooter's mental health history came out, I greatly feared that was going to happen for various reasons. And as Dinah wonderfully points out, once again irresponsible journalism is taking place. The press ought to be ashamed of themselves for this irresponsible speculation that I greatly fear is going to do more to stigmatize people who have an "MI" label. But I guess as long as ratings drive journalism, that sadly will not change.
Jesse, calling Dr. Torrey moderate is like calling George W a liberal.
Ug it ate my comment and tis is my tird kindle, second repkacement tey are kinda junky see these toucscreens screwup alot i am toucing proper keys real slow time for yet anoter factory reset.
So. I saw tis, unusual for me, and tougt ug ug ug. Half my keys aren't pressing. Anyway, srinks like that aren't helping the situation muc nor teir profession. I tougt of you dina throug te whole interview. No i am not typos i am watcing every keyi it. After getting two free replacements I'm yper aware of this,r well anyway enoug bout tat lol
Thank you for the response. I guess I didn't see the interview the same way. Admittedly, it's difficult for me to listen with an open mind when I hear Torrey is involved. I find his agenda reactionary and pretty darn scary. He didn't disappoint. I put more of my thoughts on the interview in ClinkShrink's post.
I meant, I put more of my thoughts in the "comment section" of ClinkShrink's post.
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