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. 

Things I'm Thinking About This Holiday Weekend

Happy Presidents' Day.  I probably have 50 blog posts floating around in my head, but I thought I'd share with you some of the stuff I've been reading on line lately.  


The New York Times Op Ed editor doesn't seem to like stimulants these days.   A few weeks back there was an article talking about a study showing that long-term stimulants aren't helpful, and today there is a piece by a writer who finds distraction helpful...told with some contempt towards his friend's son whom he calls Ritalin Boy.  Steve over on Thought Broadcast has his own take on ADD meds.   
 What do you think: are stimulants helpful or not?  I'll stand aside for this one. 


Then there was the article about the business/computer whiz who put hundreds of thousands of dollars of his own money (and all his time) into a kidney transplant matchmaking service.  If you need an uplifting story, this is an interesting one. 


Over on KevinMD,  Dr. George Lundberg is a bit skeptical of SAMHSA's new defining features for the Recovery Movement.  I more or less agree, it feels like it's more about semantics (what does it mean to say recovery is "person-driven"? as opposed to?) than substance, and a lot of it seems to boil down to the idea that patients should be treated with respect and people with mental illnesses should work towards achieving their full potential.  Those things I agree with, for everyone. 


And finally, for the writers among us, Pete Earley has a Before You Quit Your Day Job post up on his blog.  I'm still pondering the $80,000 advance.  The Shrink Rappers need an agent, oh, but we do love our friends over at Johns Hopkins University Press.  


And finally, for my friend ClinkShrink the Introvert,  who wrote a review of a Quiet: The Power of Introverts in a World that Can't stop Talking (---huh, stop looking at me), here is an article called The Brainstorming Myth by Jonah Lehrer in The New Yorker. 


Okay, lots of links.  This is what I've been thinking about.  Aside from that, I made a quick trip to NYC and had my photo taken with Cookie Monster in Times Square, and I loved Jersey Boys.

Weiner Diagnosis?

 

In Shrink Rapper world, we get a lot of email from publicists about books, TV spots, upcoming events.  This was in my spam box today:

Rep Anthony Weiner is expected to resign today after weeks of scandal surrounding his lewd text messages, tweets and photos.  Even in his tearful media conference, Weiner could not explain why he participated in such behavior.  According to NYU Medical Professor and Internist, Dr. Marc Siegel, the congressman’s behavior is systemic of a larger psychological problem, which must be addressed before fixing the addiction to online sexual activities.  

 

Dr. Siegel says, “This seems to be an example of extreme narcissism, inflated self image, depersonalization, loss of contact with reality, addiction, and the power of the Internet as a medium (like the Wizard of Oz you feel you are hiding behind the curtain)”.

 

To discuss the dangers of addiction and steps to overcome the serious illness, Dr. Siegel is available to offer is medical knowledge.  As a medical practitioner and FOX’s House Doctor, Dr. Siegel has spent years diagnosing and treating people in the national media spotlight.

 

If you are interested in speaking with Dr. Siegel, please contact me at .

 

Best,

Rena  

 

Rena Resnick

5W Public Relations

Oh my, I thought.  I read it twice. An internist is going to comment on Anthony Weiner's narcissism, motivations, sense of self, and contact with reality?   Sounds like a shrinky thing to me, but the Goldwater Rule prohibits psychiatrists from commenting on the mental state and diagnosis of someone they haven't personally examined.  Does that mean it's okay for other specialists to talk about the mental state of someone they don't know?  Hmmm...   I guess we'll see what he has to say, but I'm not so sure about this.

What Do You Think Of This Video Ad?

From yesterday's mail:

I work with FINS.com, a career resource site owned by The Wall Street Journal. We are launching a new national ad campaign starting this week. We produced a series of videos about failed job interviews and what “not to do” tips. The fourth video in the series called “Strengths” (at http://www.fins.com/Job-Interview-Tips) and is set to begin airing early next week. A couple of us over here enjoy Shrink Rap. We thought that because the video is related to psychiatry, that it would be really cool to get your feedback and other reader’s feedback on the video prior to air date.

Thanks for your time in advance.

----So I watched the video and I thought, "Hey no one ever asks me to go their job interviews!" I watched a few of them: they are cute, and make a quick point, but you know, there is one with the tip Leave your Pets at Home. It shows a guy on an interview with a half dozen sweet dogs and cats, and I did wonder, "Well what about the support duck?" The Silence Your Cell Phone flick was so outrageous, but I don't doubt it happens at all. And Proof Your Resume....well maybe she should have gone with the flow when the interviewer was so impressed with her 'passion for finance' and not said she meant it to read 'passion for her fiance!'

So what do you think of the Strengths video? Are they poking fun of patients and shrinks, or is this something that has really happened and is it a valid tip? Yeah, it pokes fun, but so do all the others. Does it annoy you? Does it increase stigma? Is it cute with a reasonable point to make about how not to advertise one's weaknesses during a job interview?

Well those Wall Street Journal affiiliated folks want your input. Go for it!

The Year In Homicide

There has been a lot of stories in the news lately about homicides committed in hospitals. Just out of curiosity, I went to the Bureau of Labor Statistics web site and pulled some data from their Census of Fatal Occupational Injuries. It confirmed what I suspected, that homicides of workers in hospitals have increased at twice the rate as correctional facilities, where worker homicides have remained stable. Here's the graph I was able to make from the BLS data:


OK, I'm in a hurry and the graph is small and fuzzy. I'll try again later, but the upshot is that the red bars (hospital murders) are up to 6 and 7 homicides per year while the blue bars (correctional facility murders) have remained stable at about 3 per year. This is only for the employees who have been murdered, not all murder victims. When I get a chance I'll go to the Bureau of Justice Statistics and see if I can find data for all murder vicitms in hospitals versus correctional facilities, not just employee victims.

When we consider the cost and repercussions of increased hospital security, think about this trend. We people wonder if it's safe to be a forensic psychiatrist in corrections, I will bring out these numbers. It does seem to be safer to work in prison than in a hospital.

Drug Reps in the Waiting Room.

Sarebear has been commenting on our posts for years now, since the very beginning of Shrink Rap. She sent us a link to one of her blog posts on Pie-Bolar Served w/ 3 Flavors of Anksia Tea and the post was a detailed discussion about her session that day with her psychiatrist. Lots of details and lots of sadness and angst, but a wonderful glimpse in to what happens in a session with a psychiatrist. I especially loved that Sarebear started her account in the waiting room where she sat with her family...the psychiatrist was running late and two drug reps were sitting there talking! What does a patient think about when such things intrude on their care? With permission, here's Sarebear's thoughts on Drug Reps in the Waiting Room:

My psychiatrist was twenty minutes late today, which means that she got in to the office at 9:20, which was when she was supposed to see ME, but her FIRST appointment, her 9:00, was still waiting to be seen, so I had to wait longer. UGH!! She said, "I'm sorry I'm so late!!", and the other patient said, "Don't worry about it", but I said absolutely nothing . . . . . lol. Can you tell I was a little peeved? In early morning traffic, it takes about 35 minutes to get there, so we had gotten up early, and had gotten there 10 minutes early, even, not wanting to shave it right to the minute. I suppose everyone has an off day, though. It's still annoying for me, as the patient! Guess I wasn't very "patient", heh. While I waited, just after the first patient went in, a pair of drug reps, one in training, came in, and dropped off some samples in her back room, then sat down to wait. I vowed that I'd get seen before them, because patients are more important. They talked alot of business, and about where each of them had worked, and some of the details of the software they were using on the laptop, that they wish they'd had at the previous place, and stuff. It was interesting to listen to them talk. Drug reps are a sadly necessary "evil" of the medical practice, because they provide drug samples for the doctors, without which you wouldn't be able to start some of the initial doses of certain medications, and sometimes the samples are used to help some patients afford the medications, although they do NOT replace the pharmacy, not at ALL. The drug reps also provide coupons and promotions for the patients to redeem for free two week or one month supplies of the medication, with prescription, at the pharmacy, whenever their companies are offering such coupons and promotions, so again, these things are good for the patient's pocketbook, their bottom line, for being able to afford the medications, when the insurance situation isn't ideal. Obviously some of these don't last very long, while other programs will, say, take half off the cost of the medication for a year, but whatever can help the patient, is a GOOD thing. It's just, the whole salesman aspect of the thing, seems a little . . . smarmy. It also feels a bit intrusive, to have salesmen in the medical setting like that, but as I say, it is a necessary "evil", even if one wonders about the influence that they may have over a doctor's prescribing practices. The most ethical doctors will not be influenced, but no one is perfect. Anyway, sitting there for awhile, listening to them, I didn't think they worked for Pfizer, the makers of Geodon, the medication I had been reduced in dose after my recent bad experience on, and was here today to be likely removed off of and put on possibly something else, but if they did, I wanted to tell them I thought it sucked. So, I asked them eventually, "Do you work for Pfizer?" They said, "No", so I continued anyway, since they'd still have an interest, and they did, and I said, "Well, Geodon sucks". They said, "We think so too, we sell a competing product." I said "Oh, okay. I hate it, because I had unexpected side effects." They then expressed their regrets to me that I'd had a hard time, and again said that they didn't like the med. I thought the whole interaction was a little bit funny, hee. Normally I wouldn't, as a patient, have any kind of interaction with drug reps at all, but since my psychiatrist was late, and since they'd been chatting for awhile so freely in front of my husband, daughter and I in the waiting room (after all, this is the type of location that is basically their workspace for the whole day; that, and their car, so one can't expect them to just sit there silently), so their chatting had encouraged me to eventually strike up a conversation, since there was nothing else to do while I waited for the doctor. When she eventually came out, as she walked past them to the front desk, she asked them if she needed to sign something, (I assume as in, to sign for the samples they'd dropped off in her back room) and they stood up and handed her a clipboard and started talking with her, the one in training did. I wondered if he'd bring up with her anything about the competing product for Geodon, since he knew she'd be bringing me off of that one, and potentially on something else, but it seems they had enough discretion NOT to go there, which amazed me slightly, for salesmen. They just brought up the coupons and promotions that are so helpful for patients, and got the signed clipboard back, and in the middle of signing it, she called me in to the office, which helped let the drug reps know that she'd not be spending a lot of time with them, and made me feel like I was her priority. I didn't feel badly that she'd signed for the samples, because otherwise these men would just be sitting around for another 25 minutes doing nothing, when just 2 minutes of her time took care of the whole matter.

Meet Prozac Pilot

Prozac Pilot!
Collin Hughes gave up his career as a pilot so he could get treatment for depression. He has a blog. He's now on the CNN home page. Watch his 'Coming out of the Hangar' video:



On CNN, Jeanne Meserve and Mike M. Ahlers write:
Meet Collin Hughes, a one-time rodeo cowboy turned jet pilot turned fledgling insurance agent, whose hope of returning to the sky has been reinvigorated by the new FAA policy. And who now hopes his story will embolden other pilots to address their depression.

Fly Those Friendly Skies

We've talked before about whether having the diagnosis of a mental illness should prevent a person from pursuing certain careers. We've also mentioned that pilots, in particular, can not be on psychotropic medications. One concern is that a depressed pilot might not seek treatment because s/he fears losing her job. Is it better to have a pilot with untreated mental illness, or one on medication?

In The Wall Street Journal, Shirley S. Wang and Melanie Trottman write that the FAA has reconsidered this policy and will allow pilots to fly if they are being treated with Zoloft, Celexa, Lexapro, or Prozac. They write:

The new policy doesn't mean pilots who want to begin taking one of the medications can get in the cockpit right away. Before being granted a waiver by a physician certified by the FAA, a pilot must be considered "satisfactorily treated" for 12 months; in the meantime, he or she will be grounded.

For pilots who have been secretly taking antidepressants, the FAA is offering a grace period. The agency said it wouldn't take action against such pilots if they come forward within six months. However, pilots with a recent case of depression or who want to begin a new medication regimen will be subject to the one-year waiting period, according to FAA spokeswoman Alison Duquette. "We're really looking for stability," she said.

Grounded for 12 months? Seems like a long time. What do grounded pilots do? Do they get paid? Is this really destigmatization?

SAMHSA Report: 7% of Fulltime Workers Had Depression

SAMHSA reports [pdf] on Major Depression rates for various occupations, finding that 7% of full-time workers have had a Major Depressive Episode over the past year.

People in the personal care (childcare, eldercare) and food and beverage service (waitstaff, bartenders, food prep, etc) had the highest rates, at 10% (women in this group had the highest of all rates, at nearly 15%).

Engineers, architects, and surveyors had the lowest rates.

The report is based on interviews of over 107,000 people, and uses a DSM4-based questionnaire to determine past-year depressive episodes. One of their main points is that employers lose $30-44 billion annually due to employee depression.