Baby's First Laptop

I just stumbled across this on the Amazon web site and had to post it. People have been writing lately about the effects of technology on kids, but I guess it's not that serious since we're making 'real' technology for babies now. What's next? Baby-safe web sites? Infant chat rooms? Babble blogs? (Oh what, we've got those already...)

Like Looking in a Mirror

Sometimes, I treat people who have the same problems I have in my personal life. It's hard. Oh, it's really hard. If I'm really distraught about something and a patient calls seeking treatment with a similar life circumstance, I will sometimes turn them away and recommend another shrink. But I don't always screen so carefully on the phone, and often "I'd like to make an appointment," will simply get a time and date.

The feelings get really complicated here.

If I feel I've had a role in creating my circumstances, then I wonder as my patients seek my counsel, Who am I to be making any suggestions, much less giving advice? Why are you looking to me, I've screwed up the same situations. Oh, you say, Dr. Jeff said on KevinMD that Psychiatrist's Shouldn't Give Advice, but you know, some of us do, and even when we don't, our feelings are often relayed through the questions we ask or the comments we make or don't make, or perhaps by the expressions on our faces, even if we don't say "You should do X." I told a friend once that I feel uneasy, guilty even, in these situations, and he replied, "How do you think I feel?" Did I mention he does family work and was in the midst of a stressful divorce? And I have yet to ask a colleague who also does family work how he managed during the years his own children wouldn't speak to him. Oy, life can be tough, for shrinks just like everyone else.

So perhaps I listen to someone talking about his most personal feelings about a situation, and you know, if I've been there before, perhaps it's good that I can empathize. If I'm in the middle of it, sometimes I listen and the patient's words seem so unreasonable, so unjustified, and yet I recognize them as being exactly my own--it's like having my own anxieties bounced off a wall only to ricochet straight back into my face.

Do I tell the patient that I've been in the same place before? Generally, no. Therapy is about his problems, not mine, and I think in these situations my empathy is clear. I say things that are more poignant and resonant than I might in circumstances where I feel removed. And patients never ask if I've been in the exact same place. On some of the harder things-- things that have no precise quick and easy answer-- I've taken to saying, "Not only don't I know what will fix this, I don't know anyone else who does have the answer." This I can say because I've done my own searching.

I hope I'm reassuring and comforting to people who find themselves in the same places I dwell. Certainly, tripping over a few stones on the path makes one walk a little more gingerly and judge a little less harshly those who walk more slowly. Mostly, though, I worry that I'm a little bit of a fraud just for being in the room.

Very Little Very Sad People

I thought I'd give you a heads up that The New York Times Magazine will be featuring an article on Preschooler Depression this weekend. I am working on my ability to see into the future, and it's going well.

Pamela Paul will write:

Diagnosis of any mental disorder at this young age is subject to debate. No one wants to pathologize a typical preschooler’s tantrums, mood swings and torrent of developmental stages. Grandparents are highly suspicious; parents often don’t want to know. “How many times have you heard, ‘They’ll grow out of it’ or ‘That’s just how he is’?” says Melissa Nishawala, a child psychiatrist at the New York University Child Study Center.

And some in the field have reservations, too. Classifying preschool depression as a medical disorder carries a risk of disease-mongering. “Given the influence of Big Pharma, we have to be sure that every time a child’s ice cream falls off the cone and he cries, we don’t label him depressed,” cautions Rahil Briggs, an infant-toddler psychologist at Children’s Hospital at Montefiore in New York. Though research does not support the use of antidepressants in children this young, medication of preschoolers, often off label, is on the rise. One child psychologist told me about a conference he attended where he met frustrated drug-industry representatives. “They want to give these kids medicines, but we can’t figure out the diagnoses.” As Daniel Klein warns, “Right now the problem may be underdiagnosis, but these things can flip completely.”

It's long. Just say, "I saw it at Shrink Rap first."

Emotion versus Mental Illness

My favorite commenter, "Anonymous," wrote in to my Duckiness post to say that it was good I could post something totally silly without being told I need more meds. Oh, if life were that simple. And it is true that once someone has a diagnosis of bipolar disorder, not only does the world question their emotions in a black & white "are you sick again?" kind of way, but patients don't trust themselves to feel for it's own sake.

If you're not sick, then being asked if you took your meds is insulting and degrading. And so I thought I'd put together some guidelines for Emotion versus Mental Illness. I'm inventing this as I go, with no evidence-based anything, so take my suggestions at your own risk.

• If you are ultra-successful, rich, brilliant, gorgeous, famous, and comfortable with your diagnosis, you may want to consider telling people you have a mental illness because it decreases stigma and people like being with the ultra-successful rich, famous, brilliant and gorgeous and won't care that you have a mental disorder. It helps even more if you're charming.

• If you're not ultra-successful, you may want to pick and choose who you tell that you've been ill and are on medications. This isn't always possible, especially if your illness is evident to others or if the presentation of your symptoms resulted in a hospitalization. It's good to tell close family members.

• If multiple people are looking at you strangely, or commenting on your behavior, or saying you need medications, you might want to at least entertain the option that you could be sick. Unfortunately, poor insight and judgment are symptoms of mania.

• Tell the people close to you not to make medication jokes. It confuses the issue if you seriously do need medication changes, and it's rude, degrading, dismissive, and disrespectful. There, I said it.

• If you want to be silly, go for it. Be silly when you're well so that being silly is part of your baseline personality and no one equates this with being out-of-character. You'll note the duck invaders did not come after me, rather they said, "There's Dinah posting yet another stupid duck post." If I'd posted about why chocolate should be outlawed and made into a controlled substance, those same duck invaders would be asking "What's wrong with Dinah?"

• Mental illnesses come as constellations of symptoms. There is no "Sending out silly duck stuff" as a symptom. People think about mania when the ducks are combined with more energy, racing thoughts, a decreased need for sleep, increased mood OR irritability, and other symptoms of mania. Know the list and if someone bothers you, say, "I posted about ducks, I do not have any other associated symptoms." Recite them if necessary. If you do have the other symptoms, refrain from posting about ducks. I don't want Posts Duck Blog Posts to show up anywhere in DSM-V and these days you just never know.

• No one controls how any other person thinks of them or judges them and it's not reasonable to live life ruled by a desire to be perceived in a certain way . It's another form of poultry, but Don't Let the Turkeys Get You Down. There are a lot of turkeys out there.

Moods happen on a spectrum. Some people have large variations in their mood---large enough or severe enough such that it causes suffering, and we call it an illness. Some people don't have much variety to their moods and live in a calm, even-keel place, and it's great that we have such people. But, I absolutely promise you that if we lived in a world where everyone had a very narrow range of mood, this would be one terribly boring planet. We should celebrate our diversity, not condemn those who like ducky stuff.

Movie Review: Oasis

I saw this film over the weekend after a recommendation from a friend. It's a Korean film about ostracized misfits who find one another in the midst of a harsh society. The main character, Jong-du Hong, is released from prison after serving time for killing someone in a drunk driving accident. His family are not happy to see him again. They are hard-pressed for money and have had to squeeze into a small apartment with his many siblings. His family does not hesitate to tell him that he is a burden and that they were better off when he was locked up.

He visits the family of the person he killed to make amends, only to find them in the process of moving out of their apartment. They are leaving behind the child of the accident victim, Gong-ju Han, a severely disabled woman with cerebral palsy. Jong-du confronts her brother as they are leaving and demands to know who will take care of her. He is kicked out of the apartment and she is left alone, with physical contortions that horribly distort her limbs. It was painful to watch.

Jong-du returns repeatedly to try to visit Gong-ju, to bring her flowers and to check on her. Finally, one day he is let into the apartment. He tries to rape her then flees when she passes out.

This is the point where the movie becomes inexplicable to me. Following the attempted rape Gong-ju fantasizes about Jong-du and imagines having a lover, and struggles against her cerebral palsy to put on makeup. Jong-du returns and the two become lovers. Their train-wrecked lives come together in a predictable way. One physically damaged, one psychologically damaged, both without psychological or social support. The result is inevitable and predictable.

The Rotten Tomatoes web site gave this film an 89% favorable rating, although I'm not sure why. One of the difficulties of this movie, besides the implication that rape can trigger love, is the fact that Jong-du's facial contortions made it impossible to read her emotions, and I was left wondering if she was in pain, afraid or ecstatic. When it was crucial to directly tell the audience what she was feeling the director cut to a fantasy mode, and the physically-whole actress acted out Gong-ju's feelings. We learn she is entranced by this man, that she fancies herself teasing him and playfully flirting with him, that her days are filled with wonder and fulfillment when he is around.

The most potent part of the film was the portrayal of how this disabled woman was treated by Korean society----she was refused service at a restaurant and rejected at a family gathering---overt discrimination highlighted by Jong-du's naivety. He brings her to his mother's birthday party only to be confronted by his siblings about his inappropriateness. Gong-ju's family can't even imagine that anyone could love her, and they take it for granted that he is abusing her when they finally do make love.

Jong-du ultimately goest to prison after a false rape allegation, but personally I think he should have been there quicker after the first, real, attempt.

Who Else Wants To Climb Like An Orangutan?

(See more rock climbing designs from CafePress.com. While you're at it, pick up a My Three Shrinks t-shirt.)

While googling around the Internet I found an article by Steven Kotler on the Psychology Today blog entitled "How We Learned To Walk: The Uneasy Origins of Rock Climbing". Talk about a surefire, catch-Clink's-attention title!

The article reviews anthropology finds over the years and talks about a new theory of human evolution, specifically how humans began to walk upright. Anthropologists once thought humans started walking upright after they came down from trees. Now primatologists are suggesting that walking is a natural offshoot of climbing. They site orangutans who have been observed "tree walking", or walking across branches while holding an upper branch with both limbs (a bit like a toddler 'cruising' while holding on to furniture). This climbing method is energy efficient and stable because it allows for four points of contact at all times---it also happens to be the way a beginning rock climber climbs.

OK, so it's a bit of a stretch (literally) but at least it gave me a chance to link some of my favorite subjects together in one post.