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.
Showing posts with label deep brain stimulation. Show all posts
Showing posts with label deep brain stimulation. Show all posts
Monday, March 05, 2012
Does Botox Change The Shrink?
So I'm a little older than I used to be and recently when I look in the mirror, I've noticed some lines in my forehead when I make specific expressions. I'm not so sure I like them; when they show up in photos, they definitely make me look older. And yet, I know that these lines aren't just from aging, they are an occupational hazard. Part of attentive listening in psychotherapy involves using your face to convey, in non-verbal ways, obviously, feelings and expressions and interest and even questions. These are my quizzical lines. Really? Don't you think you're kidding yourself there? Give me a break. Not a word gets uttered, but oh so much gets communicated in silence, with the movement of just a few muscles. Yes, Clink, here and there I have a moment of silence. A short moment, but still. Wrinkles as an occupational hazard.
Every now and then I have the thought that maybe I should Botox those lines away, but my first thought is always, will it interfere with my work? Who am I as a psychiatrist without the Quizzical Look? Will my patients relate to me differently? Will they have worse/different/better therapeutic outcomes if my facial muscles are paralyzed? Oh, and since they came from my work, can I tax deduct the cost of botox treatments?
No worries, I'll stay wrinkled....or quizzical....as long as Clink continues to be a nun look-a-like and Roy remains a geek.
Thursday, February 24, 2011
Video Report: Deep Brain Stimulation for Psychiatric Disorders? : Clinical Psychiatry News
Sunday, September 20, 2009
More on the Red Book

I got my wish; I got to read the rest of the NYTimes Magazine article, "The Holy Grail of the Unconsious" by Sara Corbett about Carl Jung, on the patio with coffee, a bagel and lox, on a gorgeous Sunday.
The article left me thinking-- perhaps it left me longing-- and maybe this will be more of a journal entry then of a blog post. You'll forgive me for being a bit raw.
I read the article and I was drawn in-- I want to read the Red Book-- the soon to be published work of Jung about his own exploration of his unconscious. Much of Jung's journey occured during a difficult period in his life, and Corbett writes:
Whatever the case, in 1913, Jung, who was then 38, got lost in the soup of his own psyche. He was haunted by troubling visions and heard inner voices. Grappling with the horror of some of what he saw, he worried in moments that he was, in his own words, “menaced by a psychosis” or “doing a schizophrenia.”He later would compare this period of his life — this “confrontation with the unconscious,” as he called it — to a mescaline experiment. He described his visions as coming in an “incessant stream.” He likened them to rocks falling on his head, to thunderstorms, to molten lava. “I often had to cling to the table,” he recalled, “so as not to fall apart.”
I wonder, if I read this will I just dismiss Jung's words as products of an illness, not worth analysis in their own right? Humanity has had a complicated relationship with the ideas of people suffering from mental illness (and it sounds like Jung was indeed tormented)...sometimes they are revered as holy, sometimes they are dismissed as disorganized, other times they are seen as evil. My best guess is that I will feel the Red Book is over my head, too philosophical, too complex for me to understand. The book can be pre-ordered from Amazon, and for $105, well, I'm thinking about it. I'm thinking, too, about visiting The Rubin Museum to see the exhibition with the original Red Book.
But I know very little about Jung, and it's not Jung, or even the Red Book, that really grabbed me about this article. The story included the stories of some people, one of them Dr. Stephen Martin, a Jungian analyst and founder of the Philomen foundation. Dr. Martin has one of Jung's hankerchief's framed in his office. He's devoted himself to Jung, he believes in him with all his heart. Corbet writes:
Just as I had, Stephen Martin flew to Zurich the week the Red Book was taken from its bank-vault home and moved to a small photo studio near the opera house to be scanned, page by page, for publication. (A separate English translation along with Shamdasani’s introduction and footnotes will be included at the back of the book.) Martin already made a habit of visiting Zurich a few times a year for “bratwurst and renewal” and to attend to Philemon Foundation business. My first morning there, we walked around the older parts of Zurich, before going to see the book. Zurich made Martin nostalgic. It was here that he met his wife, Charlotte, and here that he developed the almost equally important relationship with his analyst, Frey-Rohn, carrying himself and his dreams to her office two or three times weekly for several years.
People are searchers, some more than others. Some people are content as is, they look for nothing. Others scour their worlds, looking. Looking for what? I suppose it depends on the individual and I suppose that many who search have no idea what it is they are looking for.
So there is a piece of me that's jealous of Stephen Martin, without ever having met him, without knowing a thing about him (except for these excerpts in the NYT magazine). Why? I suppose because he seems to be someone who is able to believe in something so strongly, so wholly, and with such devotion. I imagine someone who devotes themselves to a cause and a belief with such certainty and reverence, feel sure that Jung had the answers. In Corbett's article, he likens his devotion to a religion, and it's hard for me to imagine ever believing that another human being has something worthy of this kind of worship--if that's the right word. I think I'm jealous of what Dr. Martin believes he has found-- whether it's right or not, he still has the ability to believe so completely in the rightness of someone and something, and presumably it's because Jung gave him something he's found worth having.
Jung is not what I've been looking for. I might might read about his journey, or I might want the book just to have it, because some things are worth having just to be had, even if I never read it, even if I never open it. And maybe Dr. Martin is just one more tormented soul, but for today-- a day which started with a bagel and lox and an absolutely gorgeous morning-- I wanted him to be someone who searched and found what ever it was he was looking for.
Thursday, November 08, 2007
Guest Blogger Dr. Peter Rabins on Deep Brain Stimulation

A while back we were talking about treatments for depression and some of our commenters asked about the newer, non-pharmacologic treatments out there. It was on my list, or maybe I was hoping Roy would jump in with some answers-- he likes gadgets and gizmos. We'd moved on and I forgot about this, but then we got an emailed request from JCAT in South Africa, asking for our thoughts on surgical treatments for depression, specifically Deep Brain Stimulation and Vagal Nerve Stimulation. I can't say I've ever recommended these treatments for any of my patients, I've never met anyone who has had them, and I don't have an opinion. I did, however, hear Dr. Peter Rabins talk about DBS as a treatment for depression last year, and so I thought I'd ask his opinion.
Dr. Rabins is a Professor of Psychiatry at Johns Hopkins Hospital where he is co-director of the division of Geriatric Psychiatry and Neuropsychiatry. He is the author of The 36-Hour Day, and more recently of Getting Old Without Getting Anxious.

Dr. Rabins writes:
There has been an amazing amount written in the popular press about the potential for Deep Brain Stimulation (DBS) to be usedto treat certain psychiatric syndromes. Right now, there are preliminary and promising results for severe, treatment-resistant major depression and OCD but very little information has been published in the peer-reviewed literature. In Europe, DBS has also been used to treat anorexia nervosa,various substance abuse disorders, and even aggressive behavior. Given what happened with 'lobotomy' surgery 60 years ago, I believe it is incumbent upon the mental health community and especially psychiatry to publicly and persistently urge that the topic be approached from a scientific point of view, that carefully designed studies with long-term follow up data bemade publicly available, and that very ill and vulnerable individuals be protected from the harm and abuse that can result from inappropriate claims, unnecessary and non-beneficial surgery, and being taken advantage of financially. Many ethical and careful researchers have begun to study DBS for psychiatric illness but it will take time before results can tell us whether it is helpful and worthwhile. In the meantime, it is best to keep expectations down, to remind people that this is a very expensive treatment that will likely only be used for severe disease that has not responded to other less invasive and less expensive approaches, and that the treatments we have now for major depression, including ECT,help the majority of very ill individuals.
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