Saturday, December 27, 2014

Shrink Rap: Most Popular Posts for 2014

10.  Let's Keep Guns Out of the Hands of.....

9. How Hard Is It To Find a Psychiatrist? Tell me your stories!

8. Insurance (or Not), Flotation Tanks, and Involuntary Commitment.

7. The doctor will see you NOW!

6. Who are the Mentally Ill? Please take my Brief Survey!

(please note: the survey is closed but the results can be found here )

5. Does bad parenting cause mental illness?

4. Should it be a Crime for a Therapist to Have Sex with a Patient?

3. Are Psychiatrists Evil?

2. Why Psychiatrists Don't Participate with Insurance Networks 

1. Is it Ok to Shrink your Sister in an Emergency?


Friday, December 19, 2014

Written Off

Request from a friend.  I donated, if the cause sings to you, I hope you will too.

Hi Dinah,

I'm writing to tell you about the production of a feature documentary some good friends of mine (and extremely talented filmmakers) are producing. It's a compelling life and death saga of young opiate addict aimed at public enlightenment and destigmatization for which I am an advisor and supporter. I think it will have the power to seriously advance the conversations around prevention and treatment.

They are raising money to finish it as quickly as possible, and I wondered if you'd be so kind as to broadcast their Kickstarter campaign through SHRINK RAP. The link is below and contains lots of info and a short trailer.

Very best wishes and thanks,


Tuesday, December 16, 2014

Psychiatry or Bust?

Over on the Neurotransmitting blog, Dr. Joseph Andrews, a 4th year psychiatry resident, writes about Where Psychiatry Sits With Medical Students and What We Can Do About it
He writes, in a good deal of detail, about the finances of it all and about why someone who has taken on a lot of debt to go to medical school might not be able to afford to become a psychiatrist.  This isn't new -- I went to medical school knowing I wanted to be a psychiatrist, and there were medical schools I simply didn't apply to because I knew I would need to take on so much debt that my monthly payments would be more than I could afford on a resident's salary.  Ah, those schools were kind enough to provide that information in blunt terms, I remember pamphlets that said that if you needed to take out a HEAL loan at the high interest of the day, then you could expect to pay back $1700/month.  That assumed no college debt (which I already had) and at the time, residents made roughy $26,000/year.  Those applications went into the trash.

Dr. Andrews also talks about the stigma of psychiatry -- his friend's family would be shamed if she went into psychiatry, and he talks about how there are other mental health professions for those interested in the field.  It's a good post.  And I'm here anyway, though in college I did plan to be a psychologist.  I'm not sure what happened along the way, but suddenly psychiatry sounded better.

So I'm here to say it's still pretty good.  I still like being a shrink, and people get better much more than they ever told me in medical school.  I still talk to my patients and get to know them.  At the end of most days, I feel appreciated.  There is still a lot of variety to what psychiatrists can do -- research, teaching, brief contact practices (many many patients for brief med checks), or high contact practices (psychoanalysis, or less high contact with psychotherapy), administration, and blogging (warning: no pay).  I don't ever wake up and wish I was  a dermatologist.

So do check out Neurotransmitting -- it's one of very few blogs by a psychiatry resident and Dr. Andrews is just getting started. 

Thursday, December 11, 2014


I had a really interesting day yesterday.  I went to Richmond to learn about electroconvulsive therapy, or ECT.  Yes, shock treatments.  Now we have ECT in Baltimore, and all residents see patients on the inpatient unit who have ECT, and all residents do ECT.  I wanted to see it again because it's been a long time since I was a resident in an ECT suite, and thought perhaps something might have changed.  Nothing changed, except that now the psychiatry resident spends a lot of time looking at a computer. 

Why did I go to Richmond?  I'm doing research for our book on involuntary treatments, and in Maryland ECT is only used for people on a voluntary basis.  The only way around this for someone who is so sick that they are in danger of dying if their condition doesn't get treated, is to have a guardianship appointed, and this is quite rare and for quite extreme cases.  In Virginia, ECT is treated like any other involuntary treatment, a magistrate comes to the hospital to hear civil commitment cases, have medication review panels (I'm not sure what they call it there, that's the Maryland lingo) and involuntary ECT is considered another treatment.  Obviously, it's reserved for the very sick, who have not responded to other treatments, or where a quick response is imperative.  I heard about one patient who had been catatonic with a feeding tube and unresponsive to any treatments - a man in his early 50's -- the treating facility's plan had been to transfer him to hospice to die, and instead he was transferred for ECT treatments and he recovered.  

The doctors who do ECT regularly see it as a highly effective treatment, often life-saving, when all else has failed.  Clearly, this is the most controversial treatment we have in psychiatry, some might even say it's barbaric.  

I've hesitated to blog about the research I've been doing as I work on the book -- not because there's anything secretive about it, and it's been a fascinating project for me -- but because I'm not sure how are readers will respond.  Obviously, involuntary treatments make for a controversial and heated discussion.

And if you're interested in the latest on what Maryland's Department of Health and Mental Hygiene is planning to recommend to out state legislature on involuntary outpatient commitment, Here is an article in the Baltimore Sun to check out. 

Sunday, December 07, 2014

Did Adnan do It?

I figured I'd join the bandwagon of bloggers talking about The Serial Podcast.   I'm taking a break from psychiatry for the moment.  If you haven't been listening, Sarah Koenig is orchestrating a year-long investigation into a 1999 murder. 17-year old Adnan Syed was convicted of killing his ex-girl friend and there are a few things that have caught Koenig's attention about the case: an alibi witness was never interviewed, Adnan was a good kid who followed the rules and was no one's pick as a would-be murderer,  and there was no physical evidence.  Koenig has been hunting down every detail, interviewing Adnan (an inmate in the Maryland state penitentiary), his family, his friends and teachers, and making her way through all the records from the trials.  She plays tapes of her discussions with these people, and plays snippets of the trial.  The victim's family has not been heard from, and the story is tragic from every direction, and yet still somehow weirdly compelling.  The episodes get posted on Thursday mornings, and I believe each episode has over 2 million listeners.

Clink and I have been listening.  She is the only person I know who doesn't like it.  She says the crime is unremarkable and she's tired of Sarah Koenig's back and forth debate with herself of 'did he do it?' or 'Didn't he do it?'
    "She doesn't know.  We get it," Clink says.
I asked why she's continued to listen and Clink tells me that once she's started something, she has to finish, whether it's a book or a podcast.  If I had this issue, I'd be really picky about what I started.

I like Serial.  I really like it.  I discovered the series after 3 episodes had been posted, and I listened to all three at once -- strange for me, I'm not a binger when it comes to entertainment.  I look forward to Thursdays and the next episode, and I feel sad when the episodes are over.  I know that ultimately it's bound to be a letdown: the series will end in a few weeks with no definitive answer, or so I imagine.

Okay, so it does feel odd to listen to the story of a real life murder as entertainment.  I worry that the victim's family might be injured by it.  If they feel that Adnan was guilty, then knowing that someone is out there revisiting the trial of their family member's murderer must be awful.    But, I'm going to rationalize this: we read books about murders and tragedies  all the time.  Is this different then say reading The Devil in The White City where part of the plot followed an evil serial killer? Or Truman Capote's In Cold Blood about a family that was killed? Maybe.  But what if Adnan didn't kill Hae, and what if this podcast inspires freeing an innocent man and perhaps even finding the person who actually did do it?  Koenig started investigating this at the request of a family friend of the Syed's. 

Issues of justice are compelling -- if you don't think so, check out the reaction people have had to recent police killings.  We want the bad guys to get what they have coming to them, and we don't want to see innocent people wrongly incarcerated.  And I've spent the last number of months doubling as a journalist researching involuntary psychiatric care; it leaves me in awe of Koenig's reporting.  She's a remarkable journalist, but even more, she's a truly wonderful story-teller.  She knows exactly how to rope a listener in, and how to keep them listening.  Honestly, I think if Sarah Koenig was talking about how to boil an egg, she'd have me transfixed.

Okay, so I want Adnan to be found innocent.  The series will be disappointing if he isn't.  Guy kills a girl  and there's a witness who helped bury the body.  Then a journalist  questions his guilt and reopens all the wounds and issues, and it turns out he really did do it; that doesn't quite make for a good story if you're telling it knowing how it ends.  Adnan is smart and personable --a model prisoner who is faring quite well on the inside-- and it would be nice for the story line if he didn't do it, though really tragic for the victim's family.  So far, though, I have to say that the evidence sounds like he may well have done it.  

Monday, December 01, 2014

So You Like To Write

 From my email, I'm passing this along.  This organization has no ties to Shrink Rap:

 Beyond Crazy

Deadline: February 9, 2015
Every year, one in four American adults will endure the trials of a diagnosable mental health disorder. But although many Americans have experienced a mental illness, either firsthand or through a family member, friend, or colleague, the stigma surrounding mental illness remains. We believe that the most important tool we have for defusing the power of this stigma is sharing true stories and revealing the real people beneath labels.
In Fact Books seeks original stories for an upcoming anthology tentatively titled BEYOND CRAZY: TRUE STORIES OF SURVIVING MENTAL ILLNESS. Stories should combine a strong and compelling narrative with an informative or reflective element, reaching beyond a strictly personal experience for some universal or deeper meaning.
We’re looking for well-written prose, rich with detail and a distinctive voice; writing should be evocative, vivid, and dramatic. All essays must tell true stories and be factually accurate. Everything we publish goes through a rigorous fact-checking process; editors may ask for sources and citations. Authors of accepted essays will be awarded a modest honorarium upon publication.
Guidelines: Essays must be previously unpublished and no longer than 4,500 words. Multiple entries are welcome, as are entries from outside the United States.
You may submit essays online or by regular mail:
By regular mail  Postmark deadline February 9, 2015
Please send your manuscript; a cover letter with complete contact information, including the title of the essay and word count; and an SASE or email for response to:
    In Fact Books
    c/o Creative Nonfiction Foundation
    Attn: Beyond Crazy
    5501 Walnut Street, Suite 202
    Pittsburgh, PA 15232

Online Deadline to upload files: 11:59 pm EST February 9, 2015
To submit online, click here. (Note: There is a $3 convenience fee to submit online.)
Creative Nonfiction | In Fact Books
5501 Walnut St | Ste 202 | Pittsburgh | PA | 15232
412.688.0304 | F 412.688.0262