You Need Help!

Sometimes in my real life it becomes obvious that a friend or acquaintance is having a problem. Either they are wearing obvious signs of mental illness or they just show signs of being 'stuck' in life or, worse, of moving backwards. Often they don't see it. I suppose there is the outsider's vantage point of making a judgment that may reflect my own value system and not their reality: to me, I may see someone who has family and job and connections who sees leaving those things as a healthy escape and their withdrawal as a good kind of comfort with keeping their own company. Usually these aren't my close friends, but what do you do when you notice that someone in your life is changing and might possibly benefit from help?

In general, I've found that "You need help" is not helpful. People hear this as an insult, not as a kind suggestion from a concerned friend. And from a psychiatrist friend it may be worse and easier to blow off---shrinks think everyone's crazy, they push drugs, they think everyone needs therapy, they see the world in a skewed way (at least this is how the commercial runs).

So I wondered: how do people let their friends know they need help in a way that inspires them to get it in the absence of a crisis? If you're in treatment because someone else suggested it, what enabled you to hear the suggestion without being wounded or insulted?

Am I Normal?

Paperdoll commented that ?she (?he-- do paperdolls have gender?) likes posts about "normal."

The quick answer is: No, you're not normal! Normal people don't call themselves "paper doll." Normal people also don't write blogs called "Shrink Rap" or post photos of their feet all over the internet.

I'm a psychiatrist and people ask me all the time "Is that normal?" or worse, "Am I normal?"
And we start with a semantic disconnect here: I equate "Normal" with "Booooring!" and would gladly wear a pin that says "Why Be Normal?" Like Why? What is normal? Why would anyone aspired to that. Normal is an IQ of 100, corn flakes for break fast and tuna fish for lunch (ok, I like tuna)..normal entails conforming to some exact mediocre standard. Why would you want to be Normal. Please don't call me normal (I think I don't have too worry too much here).

To my patients, however, "Am I normal?" doesn't mean Am I normal, it means "Please tell me I'm not crazy." You're not crazy. Okay, Paperdoll, I don't know you, and I don't know what crazy means to you, but there's probably a good shot you're not crazy. And I am definitely not crazy. Oh, yeah, I'm a psychiatrist and I'm not supposed to use the word crazy. Okay, you're normal.

So sometimes I'm told that I'm too normal to be a psychiatrist. Oh, all the Shrink Rappers---believe it or not--- kind of "look" normal....except for ClinkShrink who has started acting like Spiderman while she repels off steep cliffs. Apparently-- or so I'm told-- psychiatrists don't look normal.

Where am I going with this? And why? Is this kind of bloggy discourse normal?

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.

Leave Me Alone: Does SHU Syndrome Exist?

[Note: This is the second in a two part series discussing the effects of longterm segregation. The first part in the series can be read here.]

When you read legal opinions or listen to professionals talk about the psychiatric effects of longterm segregation you will sometimes hear them refer to something called the "SHU syndrome". The "SHU" stands for Special Housing Unit, another name for a control unit prison or a tier in a regular prison where inmates are kept in longterm segregation.

The commonly accepted definition of "syndrome" is a constellation of signs and symptoms that are common to all sufferers of a disease. Syndromes are validated by showing that the particular syndrome can distinguish between people who have the disease versus those who don't, and can distinguish one disease from others.

The SHU syndrome has had a variety of symptoms attributed to it, but they generally include some type of altered mental state, specifically changes in mood and cognition or orientation. It is presumed to be caused by the conditions of confinement in segregation. One of the earliest descriptions, and the one that probably gets cited most often by correctional experts and the judiciary, is in a 1983 article by Grassian, The psychopathological effects of solitary confinement. He interviewed fourteen segregation inmates who had been confined from eleven days to ten months. These inmates reported heightened sensory acuity, affective disturbance (particularly anxiety), difficulty with concentration and memory, as well as illusions and misperceptions. All symptoms reportedly resolved within hours of release from segregated confinement. It should be noted however that all the subjects in this study were inmates who had filed a class action Eighth Amendment suit based upon their condition of solitary confinement. The author himself noted that he was required to “actively encourage disclosure of information” in order to obtain symptom reports, because the subjects initially denied problems. This aspect of the study is rarely (make that never) cited in legal opinions.

I could post a series of studies, using small sample sizes of actual prisoners, to detail things people have done to see if segregation actually does cause physiologic changes or changes in psychiatric symptoms, but that would basically end up being a tedious listing of article summaries (a big reason why my book chapter on the effects of segregation was never finished---I even bored myself!). The bottom line is that studies using control groups showed either no significant differences with controls, or only minor differences that disappeared quickly after removal from segregation.

If anyone really really wants me to post the draft of a book chapter I could but I'm not sure my co-bloggers would forgive me.

**********

Grassian, Psychopathological effects of solitary confinement, American Journal of Psychiatry 140: 1450-1454, 1983.