'Tis the Season

Stolen from the facebook page of another shrink:

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.

Three Shrink Rappers Meditating on a Mountain Top....

On my post on meditation, Guzman from Montevideo, Uruguay left us a joke. I mentioned in that post that my mother took me to learn Transcendental Meditation when I was 10. Odd coincidence, but my mother also worked at the US embassy in Montevideo, long ago. Did you know her Guzman? It was many decades ago.

So I took Guzman's joke and I modified it to suit us three Shrink Rappers because it kind of suited our personalities:
Guzmán. said...

Jiddu Krishnamurti telling a joke...

“There are three shrink rapping monks, who had been sitting in deep meditation for many years amidst the Himalayan snow peaks, never speaking a word, in utter silence. One morning, Roy one of the three suddenly speaks up and says, ‘What a lovely morning this is.’ And he falls silent again. Five years of silence pass, when all at once a bird flies over and pulls the duct tape off monk Dinah's mouth and she speaks up and says, ‘But we could do with some rain.’ There is silence among them for another five years, when suddenly ClinkShrink, the third monk says, ‘Why can’t you two stop chattering?”


http://www.katinkahesselink.net/kr/jokes.html
http://seaunaluzparaustedmismo.blogspot.com/

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.

Recommend A Novel to A Blogger

Enough psychiatry! I need an escape...from the psychiatry day job, the psychiatry blog, the psychiatry book, the psychiatry TV series. I'm not particularly fond of heights, and unlike ClinkShrink, I can't imagine lowering myself down a 170 drop pretending to be SpiderShrink.

So, someone, please recommend a novel! I'd like a great novel, one so compelling I can't put it down. I read Out Stealing Horses a couple of weeks ago and that was good, but heavy and brooding, it left me feeling cold and dark all day (it takes plays in Scandinavia). Any suggestions?

Over at the Well blog....

You know I like all the Service Animal stuff the New York Times writes about. In fact, the Emotional Support Duck started off our duck obsession here at Shrink Rap.

From the NYTimes Well blog, Dogs and Autism:

A legal battle in New York City highlights the healing power of dogs for children with autism and Asperger’s syndrome.

Manhattan federal prosecutors have accused the owners of an Upper East Side residence of discriminating against 11-year-old Aaron S by preventing him from having a dog, The New York Daily News reports.
The report goes on to explain:

According to the newspaper, a lawsuit claims the building owners violated the Fair Housing Act by imposing unreasonable demands on Aaron’s parents before allowing a dog. Among the restrictions reportedly imposed by the building: the dog couldn’t be left alone for more than two hours, it would have to be taken in and out of the building on a service elevator, monitoring of dog walkers who might take it for a stroll, and $1 million in liability insurance for any injury or property damage caused by the dog. A company-hired doctor reportedly agreed the dog was medically necessary.

Oh, I'll let you all do the commenting.






NOTE from Clink: Now the duck works.

Eat, Pray, Love: One woman's quest to find herself

 Elizabeth Gilbert is a novelist.  In her non-fiction real life, she had a bad spell: a contentious, ugly divorce, an overly needy relationship with a distant rebound lover, a bout of depression.  She goes on a journey to heal, to find herself-- a pre-planned, publisher-financed 4 months of pasta and language classes in Italy, 4 months of meditation at an ashram in India, 4 months with a medicine man in Bali.  It's kind of everyone's fantasy, no?  Okay, parts of it are kind of my fantasy.  Parts of it.

When I read a book, or listen to a lecture, or turn on the TV, grab my popcorn at a movie, I'm looking for something.  Sometimes, I simply want to be entertained (a worthy goal in and of itself).  Sometimes, I want to learn something that will change how I see the world, or how I relate in some small way.  Sometimes, I'm looking for something that resonates, that I can relate to, that holds true.  A great plot will draw me in-- so nothing about 24 or The Sopranos or LOST feels anything like my life, but still, they draw me in.  

I started Eat, Pray, Love, and honestly, the author felt like a patient.  Her life is chaotic, her relationships packed with drama, she spends an awful lot of time sobbing on bathroom floors, and she makes no secret of her love-hate relationship with anti-depressants and what her therapist advises.  Her therapist and her Guru.  At first, I found it hard to relate to her, even though she was running away from her real life.  Does everyone else occasionally have this fantasy, even if real life isn't so bad?

I got to page 154, somewhere in India, and suddenly Elizabeth Gilbert became someone I could relate to.  Now people who don't know me very well sometimes think I'm laid back.  Anyone who does know me knows I'm a worrier, prone to obsessing about....anything and everything.    So Elizabeth Gilbert is talking about Sean, an Irish farmer she's met at the ashram and she's talking about Sean's "search for inner peace through Yoga."  He's home in Ireland, sitting with his serene dairy farmer father in front of the hearth, telling him about the wonders of his spiritual discoveries:  

      Da--this meditation stuff, it's crucial for teaching serenity.  It can really save your life.  It teaches you how to quiet your mind.

      His father turned to him and said kindly, "I have a quiet mind already, son," then resumed his gaze on the fire.

     Gilbert goes on to talk about people who don't have quiet minds, who are restless, and she includes herself in this group.

     The other day in prayer I said to God, "Look-- I understand that an unexamined life is not worth living, but do you think I could someday have an unexamined lunch?"

    In my last post on impulsive suicides, when I mentioned writing about this book, a few readers wrote in asking about the Amazon reviews-- one in particular calls her 'self-absorbed and irritating.'   Self-absorbed, self-indulgent, absolutely.  At some level, aren't most people self-absorbed?  I suppose it's a matter of degree-- since I listen to people's self-absorption all day, it doesn't particularly bother me, it's not a fatal flaw.  I wasn't irritated.  I suppose at some level, I just enjoyed the fantasy of it all.  The journey to self-discovery is, of course, and old and oft-told story.  Now please excuse me while I boil the pasta and recite my mantra for a while.

The Journey Versus The Destination

In psychotherapy, people often talk about how they are disappointed with their station in life. By any given age, they should have had more toys, done more stuff, accomplished more More. Some people feel this way because the course of their life has varied a bit from what they'd mapped out-- maybe they didn't make it through college, maybe the love of their life disappointed them, maybe a bad break derailed them. Maybe they didn't like what they started out to do and changed paths a bunch of times in search of something more interesting.

I've taken to saying to these people (and I say it a lot) "For some people life is about the journey, for others it's about the destination. For you, it's about the journey." So what if someone hits 25 or 30 or 90 and they haven't finished college or they haven't finished law school or they aren't well up that longed-for (and often miserable) corporate ladder. If you aren't there, if you don't have the car/house/whatever you thought you'd have, it's disappointing and it causes a lot of preoccupation. I'll point out, however, that many people objectively have all the things one "should" have by whatever age, in the world's eye they have every measure of "success" and yet they still strive, still feel disappointed. There's always more money to be made, more toys to be had, another promotion that should have been gotten, more grants, more publications, the vacation home: a story of failure.

Why do we do this? Why are we always measuring ourselves and why have we set it so that some people are deemed failures (by themselves, by others). It's good if you can support yourself financially, it's good to be happy, enjoy the journey.

If my teenagers read this they would deem me the world's biggest hypocrite. They would be right. I am a destination person: I wrote my eighth grade career report on becoming a psychiatrist (I think I was going to do research at Duke running rats through mazes, but hey...). I went through college in three and a half years, went straight to medical school then residency, was a mom by 30, and I've encouraged (the older one would say "pushed") my kids to do well in school and strive. I struggle with a teenage boy who values television and video games and sees my life as a rat race. Last year he told me his "goal" was to win three-quarters of his on-line games. Oh, he's on the same trip (I think), off to college in the fall, but he'd rather not let anyone know.

So two more comments on journeys versus destinations:
One on the college application process--- oy! The kid filled in one application that had 5 essays: they included asking what professor he wanted to do research with, and "write page 217 of your 300 page autobiography." All the colleges asked what he had to add to ...diversity, life, whatever. It seemed like a lot of clarity, focus, accomplishment and form was wanted from a 16 year old boy. The college application process is a destination thing.

Second: yes, I really did write about wanting to be a psychiatrist when I was 13. Why? Yeah, why? I'd never met a psychiatrist, no one in my family is a doctor (much less a shrink), and I'd never met anyone with a mental illness. If anyone figures it out, please call me.

So: my take on it: Clink is a destination person, even if she does stop to smell the mushrooms. Roy is also mostly a destination person, but within the path, he swerves around a bit.

Dinah: I Have Relatively Moderate Wisdom

It's Sunday morning (2pm is still "morning," right?) here in Shrink Rap land. I've had coffee with the judge, I've done a load of laundry, I've run a 10 minute mile and then walked another one, and, of course, I've read part of the Sunday New York Times.

It's been an exciting morning with the paper. I've discovered that I'm either middle-aged or on the cusp of it. This is okay, not really news and now that I have teenage kids, I think I'm entitled to it.

So, first I read a review of a book by Gina Kolata called Rethinking Thin. The book reportedly downplays the dangers of obesity (let's not go there) and trails four patients as they go through a clinical trial at a University of Pennsylvania obesity treatment group. Back in the day when middle-age wasn't even on my radar, I worked as a research assistant in that group--some of those folks are even still there (I think that makes them Old). I hear the book isn't all flattering to the group, but I may have to buy it anyway.

So now that it may be okay for me to be fat, I moved on to the issue of Wisdom, a rather vaguely defined condition and it was sort of amazing that so long an article could say so little. I thought of Roy when I read, "One of the most interesting areas of neuroscience research involves looking at the way people regulate their emotions and how that regulation can change over the course of a lifetime." Roy, why aren't you here? Yes, yes, yes: there were fMRI studies quoted, not to mention salivary cortisol levels. No oxytocin, I'm so sorry. Okay, so I read and read, all the time wondering if I am Wise. I got to the end of the article and there it was, a link to an on-line test I could take. I was on it-- the test scored as 1-5 and answering quickly, I scored a 3.7. I have relatively moderate wisdom. Probably one different answer and I could have gotten a 4 and had moderately high wisdom. Okay, I'm off to test my husband (who is definately wise), maybe the kids, maybe Max, and I still have to read the article on the guy who stopped his anti-depressants. I may be back.

Laughter is a drug

This started out as a comment to respond to some comments in Your Doctor is Making Jokes About You, but it got so long that I thought I'd post it. Midwife's comments (dang, I see she removed them but they deserved to remain) about being able to laugh at tragic circumstances provoked some anonymous comments about insensitivity, which is the other side of the coin to humor (all humor has this Janus quality... it is insensitive to laugh at that poor chicken's difficulty getting to the other side of the street). Mid wife apologized for inciting a riot.

There's no riot. This is a healthy discussion about what it is like to work in a job where one deals with human tragedy on a daily basis.

The problem, I believe, that the anonymous poster has trouble getting his or her arms around, is that physicians (and here I mean all health care "professionals") are not perfect. We do not possess some unique ability that shields us from anger, fear, depression, loneliness, despair. Yet, for some reason, there is an expectation that we are somehow above these human foibles.

We are not.

In the past week, I have dealt with near-lethal suicide attempts, single women who have had their children taken away from them (probably forever) because their brain illnesses currently prevent them from providing adequate parenting, people who have recently lost a loved one, a home, a job, their freedom. I have also dealt with people making more incremental steps of improvement in their life (another week of sobriety, making it to their follow-up appointment, getting a job, making a new friend).

And, I'm afraid, this is a typical week.

Just writing this comment, I feel tears welling up. That's fine. I'm in touch with my pain. I'm down with that. Woo. But I cannot be in touch with it all the time. That may work for some, but for me it would impair my ability to be effective.

So humor is my way of managing these emotions, both in me and in others. And I use it like I use a medication... with a particular dose to achieve a desired outcome (that is, in my work with patients and staff... at home, my humor is much more random... in my posts, it is somewhere inbetween, depending on the topic). (Mind you, I am not talking about "humor" where one laughs at another's misfortune in a way that is intentionally harmful/evil/superior to that person... that is not what I am talking about here.)

My intent is to heal... both myself and others. Just like a drug may have unintended side effects and be harmful, so might humor. I choose medication which I think is uniquely appropriate for a given patient. My patients do not get angry and hurt when a drug makes them have a dystonic reaction. A shot of Cogentin makes it better, and I avoid that type of drug again. They know my intent was to help.

Similarly, I choose the words I use intentionally for a given patient because it is important to use language that they often use. It helps us understand each other. When my humor has an unintended side effect and is experienced as harmful, my patients also do not get angry and hurt. An Apology makes it better, and I avoid that type of humor again. They know my intent was to help.

On the internet, when one stumbles onto a near year-long, extended conversation about psychiatry, mental health, blogging, ducks and fish, it is all too easy to jump right in, read some comments that appear hurtful or mocking, and take offense. This casual blog observer does not know what the intent is, unless they take the time to understand. Similarly, in the hospital, it would be easy to judge me, for example, as insensitive if I am administering one of my therapeutic aphorisms and someone walks past the door, only to hear "You gotta cut this shit out, Joe," or "So your right arm became paralyzed just after your boss told you that you didn't do a good job on the report that you've spent all month working on? I tell ya, it's a good thing it happened when it did, because if that woulda happened to me, I would have wanted to punch him right in the nose."

My approach (in life, but especially on the net) is to assume benign intent. This takes work, because I am, deep down, somewhat suspicious. But at the end of the day, I am convinced that this way of viewing the world makes the world a better place.

Your Doctor Is Making Jokes About You

And Other Things You Don't Want to Know About Medicine

You deserve to know the truth. The truth is, your doctor may be telling jokes about you. Well OK, not necessarily about you, personally. But about medicine. About the experience of treating patients with common conditions in common circumstances. Stories about patients with unreasonable demands or unreasonable behaviors who come back repeatedly for repair after refusing to change the very things causing them problems. With regard to psychiatry, doctors who have been assaulted by a patient in seclusion may use humor to relieve the fear and anxiety associated with caring for a potentially violent person. In situations like this it's better to make a joke than to scream, throw up your hands and walk away.

Sometimes in psychiatry you work with patients who aren't very nice to you. They may be angry and they may say things that are hurtful. As professionals it is our responsibility to take this dispassionately and allow the patient to be honest about their feelings. We cannot snap back or be retributive or let this influence our judgement. Psychiatrists must be dispassionate, supportive, sensitive and empathic.

Frankly, that's hard work.

Humor is one way of dealing with this. People who read this blog know that we use humor a lot. We tell jokes about medications, about diseases, about the pitfalls of psychiatric practice and about each other. (Well OK, usually about Dinah but that's just because she leaves herself so gosh-darn open to it. And because she takes it so well. Believe me, she can give it as well as she takes it.) According to our readers' comments one of the things people like about this blog is that it gives them a behind-the-scenes glimpse of the human side of psychiatry. That may be disturbing to folks who don't want to think about their psychiatrists in that way.

Every physician at some point in time has used humor to mediate stress and vent frustration. Heck, even an entire television series was based on this premise. The legendary Hawkeye Pierce used humor and practical jokes to highlight the idiocy of military (and medical) bureacracy all the while giving terrific patient care. I imagine my opthalmologist, my dentist, my primary care doc and even my gynecologist have their own brand of behind-the-scenes humor that I as a patient have never heard. (I have to admit I've come up with a few thoughts on my own while straddling the stirrups. And here's an informal survey: how many of you have gynecologists who post cartoons on the ceiling above the exam table?)

Personally, if it keeps my dentist sane and available for me and helps him be more tolerant of me as a patient I'm all for it.

I'll bet he's laughing at how I walk.

**********

Warning: This blog features graphic scenes of psychiatric humor that may be disturbing to some readers. Reader discretion is advised.