How About a Little Inspiration?

Anyone who knows me as a therapist knows that I believe that change is difficult, and that for the most part, people come flawed.  We seem to spend an inordinate amount of time identifying and trying to fix our flaws so that we conform to some standard of how we're supposed to be, and this leads people to feel badly about themselves and have the infamous  Low Self-Esteem.  Or to feel badly that they aren't richer, prettier, smarter, tougher, whatever.  

I think people should come to terms with who they are and say Yup, I suck at this.  And then they should not spend much time thinking about what they are bad at and they should figure out what things they like and how to grow those aspects of themselves and make those characteristics work for them so they can live a more fulfilling life.  

Obviously, there are exceptions, and I don't think people should say, "Yup I'm a sociopath and I kill people, get used to it,"  Nor do I think people should embrace their mental illness without trying to get help.

That said, and with minimal relevance to what I really want to share, I really enjoyed this TED talk by Dan Gilbert on the pursuit of happiness, and I hope you will too.  I wish I could speak like this (maybe with a little bit more air exchange).  And I stole the Seuss cartoon from Kathy's facebook page.  Enjoy.

The Top Ten or More Things That Annoy Me About Psychiatry Haters

I'm trying to heat things up a little in anticipation of our "Hot Grand Rounds."

The Top 10 (or more) Things That Annoy Me About Psychiatry Haters

10.  Repetitive posting to the same anti-psychiatry links on Shrink Rap comments.
  9.  Insults directed by psychiatry haters at the Shrink Rap bloggers.  Disagreement is one thing, insults are another.
  8.  Insults directed at other commenters on Shrink Rap. 
  7.  The implication that all (or even the majority) of psychiatrists are purposefully evil and have mean intentions when treatment has bad outcomes.  Most of us don't have personal relationships with the devil. At least I don't think so.
   6.  The implication that we can foresee that medications will cause side effects, adverse effects, or be ineffective, or that we're using them with the intent to control people.  Our knowledge is limited by a lack of  research in our field, a limited number of available treatments, and the fact that people respond differently and unpredictably to the same the treatment.
   5.5 The implication that psychiatrists uniformly push medications on unwilling patients.  In the outpatient setting, patients often come requesting medications, or requesting to continue medications that they have found to be helpful.
   5.  Statements that someone was perfectly fine until they took psychotropic medications.  People generally seek psychiatric care and medications because something is wrong.  This is not to say that medications don't have side effects that might be worse than the problem they were treating.
   4.  Statements that psychiatrists personally benefit by keeping patients in the hospital and  "incarcerating" people who are well for prolonged periods of time.  Psychiatrists are under tremendous pressure to keep lengths of stay as short as possible, they have to personally call and argue with insurance companies to justify each day of inpatient care--this is not fun.  
    3.  Statements that psychiatry "incarcerates" people without due process.  There is due process, but it takes time, and it is true that someone can be kept on a hospital unit for days until 1) the psychiatrist is able to make a reasonable evaluation and 2) the legal system is put in motion-- most hospitals have a specific day of the week where a judge comes to hear both sides.  In any system that employs due process, there is the possibility of miscommunication, misinformation, misunderstanding, lying, or mistakes. 
     2.  The implication that the average practicing psychiatrist had some way of personally knowing that Big Pharma manipulated research and withheld side effects and adverse effects of medications and they should have not prescribed those medications.
    1.5.   Sensationalism by the media on the all of the above in an unbalanced way.  For example, there was a recent news story about how atypical anti-psychotic medications are prescribed for agitation to patients with dementia when they do not have a FDA approval for this indication.  The article did not mention that there is no medication that has FDA approval for agitation in dementia.  The article also does not give any examples of things such as patients who are miserable in their agitation, who strike their caregivers, who repeatedly end up injuring themselves.  (This isn't to say that I believe that it is always appropriate to give patients with dementia antipsychotic medications, or that giving these patients a better environment or improved care wouldn't allow them to manage without them, it's simply to say that I would want journalists to present a balanced view with a number of scenarios).
  1.25  Implications that psychiatry as a field is inflexible, finds itself above reproach and is unwilling to listen to criticism.  We still have a long way to go to reach perfection, but every year things change:  we've come a long way from the days when someone could be committed to a hospital for years for trivial reasons, we look at treatment more as a partnership, and we have more (albeit imperfect) treatments to offer.   There are too many ways to list how care has changed over the last 50 years.  My gripe is not with criticism or with a desire to change the way things are done, it's with a particular form of delivery of the message.


And the number one thing that psychiatry haters say that annoys me:


 1.  The implied statement, "This psychiatric medication harmed me so it should be illegal for anyone else to take any psychiatric medication."   It's disrespectful to those who find medications to be beneficial.

To read many of the comments on our Shrink Rap posts, one might think the psychiatrist-patient relationship is an adversarial one.  I just haven't found that to be true.

Comment away, and please don't forget to submit your Grand Rounds posts by Sunday night!












  

i before e, except after w?

I mean we're shrinks, we deal with the weird everyday. If anyone knows weird, it's us.

So I get this email from Roy. Stop spelling it "wierd" it's "weird" you have it stuck in your head wrong. He's right and he gave me a long list of places on Shrink Rap where weird is misspelled as 'wierd.' Only they weren't all me. Clink did it a couple of times. Sarebear did it in our comment section. I did it a bunch. This is weird. But it is "i before e except after c"...right? Why is weird spelled weirdly?

Maybe I need a new word. Strange. Unusual. Unconventional. Odd. That's a good one, even I can't spell "odd" wrong.

From Wikipedia:

Old English wyrd is a verbal noun formed from the verb weorþan, meaning "to come to pass, to become". The term developed into the modern English adjective weird. Adjectival use develops in the 15th centrury, in the sense "having the power to control fate", originally in the name of the Weird Sisters, i.e. the classical Fates, in the Elizabethan period detached from their classical background as fays, and most notably appearing as the Three Witches in Shakespeare's Macbeth. From the 14th century, to weird was also used as a verb in Scots, in the sense of "to preordain by decree of fate".

The modern spelling weird first appears in Scottish and Northern English dialects in the 16th century and is taken up in standard literary English from the 17th century. The regular modern English form would have been wird, from Early Modern English werd. The substitution of werd by weird in the northern dialects is "difficult to account for".^[1]

The now most common meaning of weird, "odd, strange", is first attested in 1815, originally with a connotation of the supernatural or portentuous (especially in the collocation weird and wonderful), but by the early 20th century increasingly applied to everyday situations.^[2]

Enough. It's all too weerd. The chinchilla is for Jesse because his preoccupation with the little rodents is kind of ....different.

Did Your Cat Cause Your Schizophrenia?

From the front page of today's Baltimore Sun: Researchers Explore Link Between Schizophrenia, Cat Parasite.

Frank D. Roylance writes:
Johns Hopkins University scientists trying to determine why people develop serious mental illness are focusing on an unlikely factor: a common parasite spread by cats. The researchers say the microbes, called Toxoplasma gondii, invade the human brain and appear to upset its chemistry — creating, in some people, the psychotic behaviors recognized as schizophrenia. If tackling the parasite can help solve the mystery of schizophrenia, "it's a pretty good opportunity … to relieve a pretty large burden of disease," said Dr. Robert H. Yolken, director of developmental neurobiology at the Johns Hopkins Children's Center.

Roylance continues:
A University of Maryland study last year found that people with mood disorders who attempt suicide had higher levels of T. gondii antibodies than those who don't try to take their own lives. Still, the links between schizophrenia and toxoplasmosis are not simple. For example, most people infected with T. gondii never become schizophrenic. And not all schizophrenics have been exposed to toxoplasma. Yolken believes additional factors, such as an unlucky combination of genes, are probably needed to produce schizophrenia among Toxoplasma-infected people. The parasite's DNA may also be important, since some strains are known to cause more disease.

Meow?

She likes it! She likes it!

Do you remember the cereal commercial where everyone shoves a bowl of cereal at the dumb little brother to watch for his reaction? Mikey won't like it, he hates everything! But surprise, Mikey does like it!

We sent the final chapters of the draft of our book to our editor. So far, the process entails a bounce back, and sullen words like "this isn't working"...and then a lot of obsessing, a re-write, and finally we get to, "this is much better." It's become a bit of a joke--we build in time for her to hate it.

This Sunday, I stayed in my pajamas. I sat in front of a computer all day long. I didn't go out. I was ironing out the kinks in the last two chapters. Roy...well, I knew he was trying to write because he was commenting on old blog posts and he opened a new Facebook account. Why? I was ready to scream. I told Editor and ClinkShrink which day to reserve for Roy's funeral and to get their suits out. Roy didn't get it, he informed me he would be out of town that day and could go to a funeral on Sunday. Maybe he did get it.

Put the suits away. 12:30 AM and Roy's chapter was sent to our editor. Mine were sent a few hours earlier. Much quicker turnaround than usual: She likes them! I feel like those little kids when Mikey likes the healthy cereal.

I'm taking a moment now to just be happy.

Good News: Bigger May Be Better!

From the New York Times, an article that made my day: Excess Pounds, But Not Too Many, May Lead to Longer Life.

The report, published online last week in the journal Obesity, found that overall, people who were overweight but not obese — defined as a body mass index of 25 to 29.9 — were actually less likely to die than people of normal weight, defined as a B.M.I. of 18.5 to 24.9.

By contrast, people who were underweight, with a B.M.I. under 18.5, were more likely to die than those of average weight. Their risk of dying was 73 percent higher than that of normal weight people, while the risk of dying for those who were overweight was 17 percent lower than for people of normal weight.

The finding adds to a simmering scientific controversy over the optimal weight for adults. In 2007, scientists at the Centers for Disease Control and Prevention and the National Cancer Institute reported that overweight adults were less likely than normal weight adults to die from a variety of diseases, including infections and lung disease.

Shrinky Stuff

Behind me, a teenager is watching a Law & Order episode about a dead psychiatrist who was sleeping with one of his child patients. And his wife was a former teenage patient. Great.
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Here's a link to a new Psychiatry Blog, Frontier Psychiatry: http://www.frontierpsychiatrist.co.uk/
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Oh, and here's a grassroots mental health organization, check it out: http://www.everyminute.org/index.html

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And from today's New York Times, pointed out by one of our readers, Penelope Green writes about psychotherapists' home offices in What's in a Chair?
and with such a topic, we're brought back to HBO's In Treatment. I'm on hiatus, maybe tomorrow.

TWO Sundays ago, Lewis Aron, director of New York University’s postdoctoral program in psychotherapy and psychoanalysis, organized a salon for his peers. The topic? “In Treatment.” Two hundred analysts showed up. “It went like this,” said Dr. Aron. “Someone would stand up and say, ‘Hi, my name is Judy X and I’m addicted to ‘In Treatment,’ and then everybody would say, ‘Hi, Judy!’ ” For two hours, the analysts discussed the various mistakes Weston makes regarding boundary issues, and one analyst broached the idea that the placement of his office in his home was the cause of his many transgressions.

No, I don't need a self-help group. I'm not sure if the Times article is more interesting in it's mention of the psychiatrist who had nude watercolors of herself in the waiting room, or the doc with the dog, training pads and all, in the office. None of the Shrink Rappers have home offices. Roy, however, does have a 28-inch monitor, and I have monitor envy.

Glow in the Dark Cats

Apparently, the South Koreans have cloned Glow-In-The-Dark Cats! Wow!
Max and I want one. My family has never owned a cat, but just think how cool it would be to be the first on the block to have one of these? Hopefully they'll be easier to get than that Nintendo Wii thing was.