What's Your Favorite Shrinky Book?

We're going to start working on The Suggested Reading section for our book. We know what our favorite books are, but if you've read something that's been helpful, we might want to include that. Needs to be mental health related, doesn't need to be either by or for psychiatrists. We welcome your suggestions! And thanks to Alison who gave us The Noonday Demon.

The Stressed Out Shrink Rapper

http://psychiatrist-blog.blogspot.com/2010/05/stressed-out-shrink-rapper.html

Yes, shrinks get stressed out, too. Can I tell you about it?

I hate paperwork, in case I never mentioned it. And I hate dumb things that are mandated by institutions and don't make sense. So I'm getting ready to go to APA this weekend ( see you there?) and I'm trying to tie things up. It's not going so well. Here's my list:

MEDICARE.
Remember I told you that I moved and tried to change my address with Medicare? Ah, 221 downloadable forms on the Medicare website, and not one of them is a change of address form. To change my address, I had to re-enroll. 27 pages. Then they wanted my office utility bills. But I don't have utility bills, they are included in my rent. I faxed my rent invoice--it has my address, and it says "office rent" on it. It's a very nice office. I figured I was done.
Two days ago, I got a letter from Medicare. I've been denied my application as a Doctor of Medicine. I can appeal. Why? I didn't send in three things: 1) Downloadable form 558 giving access to my bank account so they could pay me. Only I'm not an in-network doc. They don't pay me. Ever. 2) my participating agreement. I'm non par and wish to stay that way. 3) my utility bills as proof of address. Am I the only doctor who rents space with utilities included?
I called. Twice. If I won't give them my bank account numbers and routing information, I'm out. Which means I have to leave my clinic job where I've been for 12 years. I don't have to fill out a participating agreement. And they'll take another copy of my rent invoice. I have 30 days to appeal. From the date on the letter which came 2 days ago. The letter is dated in April (it's now May 20th). And I'm really not happy about giving them my bank account information---what happens when they pay me for patients I see at the clinic? I'm salaried there, I don't get paid by the patient, the clinic does. If I do nothing, I'm quickly opted out, and that's a good thing...unless you're my Medicare patient and you no longer can get reimbursement or you're the clinic that wants me there. Have other people had to give their bank account info to change their address? Never done this before. Time expended: who knows. Hours. If you're a non-par provider could you offer some words of wisdom here/?

Next problem:
Clinic says I need to be tested for TB along with all the other employees. So I get a ppd placed, no big deal. Only I work there one morning a week, and in the past, I've read it myself or had a dr. friend sign off on it, because it's a hassle to get to the hospital, park, and take off work for this. Now I'm told I can't read it myself or have another doctor read it, unless it's an internist, pediatrician, or pulmonologist. Okay, found a friend, still have to get the form faxed in. Time expended: 2 hours.

Next problem:
My cell phone blitzed last night. I called. They said I needed updates and they'd push them through. Whatever. The phone worked, I thanked them, and half an hour later, I was on my merry way. Only then the phone didn't work. And my kid's phone didn't work. I called back I held. I powered off, I powered on, I removed the sim cards, I read the numbers, I switched the sim cards, I powered on and off and ate the batteries and prayed for ducks to come. The phones aren't reading the sim cards. I need to get new ones. Okay. Hours. I got to work today. The phone works fine. I called AT&T. Can't be the sim card. Husband's phone works fine. Must be the degrading tower. What's a degrading tower? Does it crumble? Why does husband's phone work? Very strange, no explanation, but tonight, all the phones work. Time expended: 2.5 hours.

I suppose the last thing is the book. Time expended 4,237 hours. Our editor wants it in Mid May. I think that happened. It's almost there. We still need a little polish on the last few chapters and a table of contents and Suggested Reading . If you know a shrink book that's been helpful to you, please let us know in the comments===we'll try to stick it in.

Hanging on for: http://www.patobriens.com/patobriens/havefun/hrricane.asp

Thank you for humoring me tonight, please send a bill

Name That Tune!

As you may remember (or might want to forget) we three Shrink Rappers are writing a book. Taken in bits from our blog, it's a more serious endeavor to describe what it is psychiatrists do and to explain and discuss our work. It's written for anyone who is interested in psychiatry--the lay public and students of the field, but not for psychiatrists.

It feels like we've been at this forever and a day. We put the proposal together, we searched for a publisher, there was the whole approval process, and finally a contract. The contract was an eighteen month project, so our drop dead date is in late June, and we're about ready to drop dead. Final draft here, and we are so grateful to our patient families, and our reviewers. It's nothing short of a miracle that I haven't killed Roy. Really. And vice versa, I'm sure.

So we've had an issue that we've been stuck on, and if you've been following us throughout this, you know that we can't figure out what to name the book! For a while, we were using Off the Couch...and I liked it and ClinkShrink liked it, but Roy didn't and our editor was blah on it, and then last week, another book was released on psychoanalysis called....Off the Couch! So much for that.

Tonight we got together with a mission: Name That Book. We came up with Four potential titles. I'm fine with all of them. And once again, I'm asking your opinion. Please, no Sex with Fish recommendations.

Details: more to follow, but the book, whatever its name might be, will be released in Spring of 2011 by Johns Hopkins University Press.

Please bear with us and vote once again on a possible title!

I Don't Know What to Charge!

I got a letter today from a patient asking me to explain why I've billed him roughly $4.50 more than Medicare allows. He included a statement from...?Medicare or it's administrators saying that this lower amount is the Medicare-allowed amount and that if his doctor charged more, a refund is due.

Every year, in December, I try to figure out the Medicare fees. Mostly I call a shrink friend who is in the same jurisdiction who is also a non-participating Medicare provider, which is different then someone who "opts out." I have to charge the Medicare amount, but it's always this funny challenge to figure it out just how much that is. At one point, I couldn't even figure out where I practice---in Maryland there are two districts, 01 and 99, and my office appeared to be located in neither. So now I think I know where I am (no one else I asked was completely certain either). For the record, it's not easy to find the fees, they vary by district and by procedure and by whether you are a facility or non-facility, participating, or non-participating, and there is the limiting fee and caps, and it gets mailed to me as a CD that doesn't open, and it's not on a website that I can find and the psychiatric society doesn't always have any better luck, and some of my friends are "participating" and have different fees, and most have "opted out" and one just can't deal so he doesn't charge any Medicare patient any fee and he doesn't submit...easier to work for free.

Okay, so every year for the past couple of years, Medicare is cutting fees by 21% or 24%. But at some point, Congress changes their minds and undoes the cut, so I've taken to keeping my fees the same, with the idea that it will be easier to reimburse patients (or credit their accounts) then it will be to tell patients that I was wrong to drop my fees and they now owe me money. And every year, Congress votes, after a period of ranting and uncertainty, to undo the fee cut. This year, Congress seems to vote to delay the cut multiple times every few weeks. I called a friend, he got a similar letter from a patient. The tone of the letters imply that we are purposely overcharging or willfully committing Medicare fraud.

The executive director of our state medical society got pulled in. He sent out a newsletter from the Medicare folks. It states:

On April 15, 2010, President Obama signed into law
the “Continuing Extension Act of 2010.” This law
extends through May 31, 2010, the zero percent
update to the Medicare physician fee schedule
(MPFS) that was in effect for claims with dates of
service January 1, 2010 through March 31,
2010. The law is retroactive to April 1, 2010.
Consequently, effective immediately, claims with
dates of service April 1, 2010 and later, which were
being held by Medicare contractors, have been
released for processing and payment. Please keep in
mind that the statutory payment floors still apply and,
therefore, clean electronic claims cannot be paid
before 14 calendar days after the date they are
received by Medicare contractors (29 calendar days
for clean paper claims).

Given the uncertainty regarding MPFS claims with
dates of service June 1, 2010, and later, please
watch your listservs and your contractor‟s website for
more information.

So Medicare is saying there is no decrease, at least not for the next 2 weeks, at which point we can again try to figure out what to charge. But CMS is telling patients that the fees we are charging are illegally high. Whistle blowers and Medicare fraud publicity and fines, leave me wishing it was easy for everyone to simply know the correct fees.

Death and Mental Illness

Huffington Post May 11, 2010 Lloyd I. Sederer, MD

Deadly Consequences: Why We Need to Integrate Health and Mental Health

Dr. Sederer talks about how people with severe mental illnesses die an average of 25 years younger than the general population--
He talks about lifestyles, the lack of a medical home, the contribution of medications to chronic illnesses, nicotine, and the role of prevention and early diagnosis.

Alarming evidence has emerged in recent years, from studies of people treated in the public mental health care system, that adults with serious mental illness die on average 25 years earlier than the general population. For a decade or two before their demise they suffer from early onset diabetes, high blood pressure, heart and lung disease and cancer. Why? Their habits place them at great risk for these conditions. They eat poorly, are sedentary and don't have a primary care doctor -- or if they do they don't go and get preventive and ongoing physical healthcare. They smoke heavily, with more than three out of four being nicotine dependent (see my previous blog on this issue here).

The psychiatric medications many receive for their mental illnesses increase the likelihood of weight gain, diabetes and cardiovascular disease. Mental health professionals have discovered what the Craig family painfully learned: physical disability and early death add to the burden of mental illness for those affected and their families. The burden does not stop there since our health care system, already groaning from the weight of the consequences of American habit disorders, shoulders the extraordinary health costs of this high need population.

What can be done? A lot.

Click here to read the whole article. Well worth reading.

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The Vicar of Towson or Another Shrink with a Blog

Roger Lewin is a psychiatrist/writer with a blog. He writes fiction and poetry and about psychiatry. I like people like this.

Roger's blog is so much simpler, quieter, and more elegant than Shrink Rap. His home page has a single word: Welcome. Nowhere on his website is there a picture of his feet.

I'll link to a really gentle, non-fiction piece called The Vicar of Towson, where Dr. Lewin talks about the vicarious life he lives listening to his patients:

Proust wrote that “the only real voyage of discovery consists not in seeing new landscapes, but in having new eyes, in seeing the universe with the eyes of another, of hundreds of others, in seeing the hundreds of universes that each of them sees.” Psychotherapy is an art of such listening that the other can world forth a world, this world being his world - and have it shared, not statically, but so that it can live and breath, declare itself and grow. Psychotherapy is a partnership in presence. A good psychotherapist is a gifted story listener.

He goes on:

Each patient is a dream. Every way of living is a way of dreaming. Part of what language makes possible is that this waking dreaming should be able to be made sociable. I listen to my patient talk about how hard his conscience makes life for him, finding fault with him wherever he goes. I see a lonely little boy, one who does not know what he can count on. I see myself as a lonely little boy.

Fishy Pedicure Ban

I was rummaging through the legal news lately when I came across a case that made me flash back to our old Cure for Fish Phobia post.

It appears that the state of Arizona has passed a law banning the use of tiny little fish for pedicures. Arizona wasn't the first either. New Hampshire decided that the fish were "beauty salon tools" that had to be cleaned in between use. Texas is concerned that the fish bowls aren't cleaned between use and could transmit disease.

Will pedicure fish now come with a black box warning? CAUTION: Fish, use only as directed. For external use only. Possible side effects may include drowsiness, dry mouth, blurred vision, constipation, the aftertaste of sushi, syncope, seizures, coma and death. Oh yeah, and scaly skin.

Unhinged-- The Trouble With Psychiatry by Daniel Carlat, my Review

Unhinged. The Trouble with Psychiatry--A Doctor's Revelations about a Profession in Crisis by Daniel Carlat.


Disclaimer: I wrote this book review while I was working on the final draft of our own book, so it's hard not to compare our book and style to those of Dr. Carlat. Ours is better (just so you know). This is not the result of a controlled study and there was no pharmaceutical agency support. It's simply my biased opinion.

So, I started out poised to hate this book. Dr. Carlat is a shrink/writer who has both a blog and an e-newsletter. He has a good reputation in the medical blogosphere, at least I think that's the case. So why was I poised to hate the book? I was offered a review copy by the publisher -- an inquiry email came with hype: "Carlat exposes deeply disturbing problems plaguing his profession." “The shocking truth is that psychiatry has yet to develop a convincing explanation for the pathophysiology of any illness at all.” "This has to stop—and it can. Throughout the book, Dr. Carlat provides empowering advice for prospective patients, describing the kinds of treatments that work, and those that should be avoided. In the final chapter, he provides a powerful prescription for how to get psychiatry back on track."

Yup, it's true, we don't know the actual pathophysiology of most of the psychiatric disorders. Is this shocking? Deeply disturbing? We've got a long way to go and we've got issues in our field. . Does it help to use language that sensationalizes these problems? It's kind of shocking that we haven't cured cancer, dementia, or obesity . I started reading. Carlat presents the fact that we don't know the actual causes of psychiatric disorders as though it's some big secret, something we purposefully withhold from our patients. He doesn't say that exactly, but he implies it with statements about how doctors don't like to admit what they don't know.

Okay, so the book is full of Carlat's epiphanies and revelations: he starts with the realization that it is limiting to see patients for a 50 minute evaluation, write a prescription, and then have the patient come back in a month for a 15-minute visit and refer them to a social worker or psychologist for therapy. Maybe this isn't the type of practice Dr. Carlat was meant to have! It's the way some psychiatrists practice, but it is not the way all psychiatrists practice. He writes as though this is the standard in the field and what we're "taught" to do. It's what some docs do and are comfortable with, but we aren't told that this is how you must practice, and no one packages this version of care as the best, highest standard of treatment. I personally don't like that he peddles the notion that a large volume/brief contact practice is the only thing psychiatrists do.

Later in the book, he talks about the use of therapy by psychiatrists, and discusses one psychiatrist who sees patients for psychotherapy -- she lives in a rural area and she makes half the income of the average US psychiatrist. She is the only psychiatrist he talks about who sees patients for psychotherapy--the others are a now-retired, lost generation of older docs who had it right. I know psychiatrists with psychotherapy practices who make reasonable livings. He doesn't even touch on this possibility, and in a single sentence he dismisses the idea of a fee-for-service, non-insurance based practice. It's not reasonable to present the field in the light that all psychiatrists do is write prescriptions....quickly and badly at that...and that there's no time for thoughtfulness. It got me thinking that -- at least among Shrink Rap readers -- and our informal, non-scientific polling reveals that 44% of readers who responded see their shrink for 45-60 minutes per session (the most frequent answer by far) and that less than 20% of readers see their psychiatrists for 15 minutes or less. Granted, we may have a skewed readership of those who are thinking a lot about their care and perhaps more apt to seek out something more fulfilling. A quarter of our readers see their psychiatrist weekly (also the most common answer but not by much), about the same number who see their psychiatrists every three months. At least among Shrink Rap readers, we can conclude that psychiatrists practice in a variety of ways and it's not uncommon for people to see psychiatrists for 50 minute sessions, or to see them weekly. I'm sure this varies depending on the region of the country, the availability of psychiatrists, the financial needs of those psychiatrists, the setting in which treatment takes place, and the role insurance has in determining care, and the age of the practice-- with the idea that patients may start out with weekly treatment and move to every one-to-three months after they get better. But Carlat glances over those issues. Dr. Carlat notes that fewer docs offer all their patients psychotherapy. One of the figures he quotes is that only 11% of psychiatrists offer psychotherapy to all patients at every visit. Hmm... All patients. Every visit. Some of this might depend on how we each define psychotherapy -- and there is no standard to that -- but if I was asked this same question, I'd say No. I work a half day a week in a clinic and there I see patients who also see a social worker/therapist. I see two patients an hour there, and sometimes they talk and I listen and sometimes it feels a lot like psychotherapy, and sometimes it doesn't feel anything like psychotherapy, but I would say that No, the therapy is done by the social workers and I don't "offer" psychotherapy to "every patient" I see in every capacity of my practice of psychiatry. And I would ask, "how exactly are you defining psychotherapy?" Read the Shrink Rap book (Spring, 2011) and we'll talk more about this. Interestingly, by the end of the book, Carlat talks about doing psychotherapy in 20 minute sessions.

Okay, so he says psychiatrists are taught to write prescriptions and aren't taught how to do therapy. Only he talks in some detail about his therapy supervisors, their thoughtful insights, how he was supervised in a psychodynamic style, and later he talks about how his training program educated residents in Cognitive Behavioral Therapy. Are we taught therapy or not? This all sounds quite reasonable-- what's he complaining about? For the record, I think I finished training at the same time Carlat started (so, 3 years earlier than he) at an institution with a strong biological focus, so I don't think our differences in opinion on how docs practice is about orientation or timing .At the end of the book, Carlat proposes some solutions: Psychiatrists should NOT go to medical school, it's a waste, and they should have more stream-lined training. All psychologists should be taught to prescribe medications. He had no problems with the DOD program in Louisiana, where 7 years of the program taught a total of 10 psychologists to prescribe. He says this type of program is safe and works well. He fails to note that it cost the military over $600,000 per psychologist (why? no idea?) and that's why they stopped it. Or that it did not decrease the mental health treatment shortage in Louisiana. I'll spare you my rants, you can read about psychologist prescribing here, in a piece by Ron Pies and the article does reference Dr. Carlat. He talks about his own revelations that Cognitive Behavioral Therapy works well, that it's good to ask a patient with a recurrence of depression if anything is going on in their lives (funny how that works), and how he he now does a brand of therapy that he calls "therapy lite." I found the examples to be a bit condescending -- his description of therapy sounds a bit like common sense.

Carlat's book may make him enemies. I'm wondering who his audience is:

-- it might appeal to the anti-psychiatry audience, at least from the cover hype, only much of the book is a fairly reasonable discussion of our work, and so it's not really anti-psychiatry.

-- I don't think many psychiatrists will agree that medical school should be done away with for us, or that other professionals can do what we do as well and as safely.

-- The alarmist tone just didn't go over well with me.

-- Sometimes it felt like he quoted studies when they fit his agenda. There were several mentions of how psychiatrists feel inferior to other doctors, and I'm not sure what to make of that one. Is this a universal phenomena?

-- His bash on how pharmaceutical companies interface with psychiatry include some of our major psychiatrist players here. But if you want to hate the drug companies, this is the book to read.

So what was good about it, why did I read it to the end, and why would I ever put this review on Shrink Rap? After the beginning, Carlat presents a reasonable view of how the DSM is crafted, including the controversies about disclosure in the process of writing the new DSM-V. The most interesting part of the book, however, is his discussion of how the drug companies have influenced research, publications, and practice. Some of this I had read in the New York Times. Some was news to me. I've never seen this side of the pharmaceutical hard-sell -- it was interesting, a bit shocking, and definitely eye-opening. His insider's view of this world is revealing.

So is Daniel Carlat the emissary of truth and ethics while the rest of us remain busy trying to get the big bucks by seeing too many patients too quickly or by getting money unjustly from the pharmaceutical industry? Read the book and see what you think.

Why Am I Asking All These Questions?

I'm reading a book where the shrinky author starts off with a revelation: it's not the best care to see patients for a 50 minute evaluation, start a medication, have them come back in a month for a 15 minute med check, and refer them to a social worker for psychotherapy. It does sound like a good way to make a lot of money. If you aren't totally exhausted, overwhelmed with the phone calls and paperwork you must have seeing that huge a case load, and are someone who is gratified from this type of work, then it's cool by me. It's not what I want to do.

The author trained at about the same time as I did, and trained at an institution with a biological orientation, like the one I trained out. He talks about this kind of care as though it's standard and the usual and expected. I've never heard this as standard, and in my private practice, I see new patients for 2 hours, and want people to come back weekly for 50 minute sessions until -- they are no longer symptomatic, or they've gotten what they want out of the treatment. Some people come into treatment without symptom---their old shrink moved or died, and they just want a script and someone to rely on if they get sick. I don't insist they come every week, but I'll ask them to come more frequently than they are used to coming for a little while until I feel like I know them. Some people can't afford weekly psychotherapy or find it to be a burden, and I often respect their wishes to come less frequently, unless their illness is destroying their ability to function, in which case I think they need to come weekly. I don't see anyone more than once a week (unless there is an emergency) routinely, and I never seem to have patients who come requesting twice weekly therapy sessions. Almost everyone comes for the full 50 minute session. A few people who just aren't talkers come for half hour sessions.

I've worked in a number of community mental health centers. I know some clinics have huge caseloads and a full-time doc may have 500-1000 patients. I've never worked anywhere like this. Most of the clinics I've worked in have left the frequency of visits up to the doc, though certainly there is a clinic tone. In one clinic I worked in, most patients saw the doc once a month, where I work now, it's once every three months for patients who are stable. The therapist attends those sessions, and they may be quite brief....many of the patients don't seem to want to talk, and the paperwork burden imposed by the regulatory agencies are very heavy. Still, the standard at all the clinics I've worked in is 2 patients an hour. The no show rate is high, and sometimes a 3rd patient may be squeezed into the schedule if there is a scheduling problem.
My record is 15 patients in one day, and this was while I was volunteering at a clinic in Louisiana after Katrina, and the clinic had no full time doctors and a huge demand. It was 15 patients I'd never seen before, some were quite troubled, and it was a tiring day for me. So my hat goes off to those docs who see 4-6 patients an hour. I couldn't do it.

So what is the standard? I thought I'd ask. Of our readers, it looks like many see their psychiatrists weekly and many see them for 50 minute sessions. Just thought I'd ask. Thank you for taking my surveys and please do add your comments.

How Long Do You See Your Psychiatrist For?

Again, just psychiatry visits, not sessions with a non-MD therapist. Thank you and I'll explain soon.

How Often Do You See Your Psychiatrist?

If you haven't take our poll on Why You See A Shrink, then please do! This is just for fun, it's not real science.

So today is Sigmund Freud's birthday. He would be 154 years old.

Today's poll asks How Often Do You See Your Psychiatrist---and I'll ask that you limit your answers to psychiatrists-- M.D.'s or D.O's-- so if you see a non-psychiatrist therapist for therapy, and a psychiatrist for meds--I mean the med check person, and if you're in psychoanalysis with a psychiatrist, I mean the couch person. But I'm not interested in how often you see your social worker/psychologist--- maybe another day.

Why Do You See A Psychiatrist?

People see shrinks for a variety of reasons. These days, I think people come mostly for treatment of psychiatric disorders--also called mental illnesses-- like depression, bipolar disorder, anxiety, schizophrenia. But people come for other reasons. Sometimes they have personality styles that aren't working for them, or they have behaviors that they troublesome, like drinking too much or using drugs or gambling. Some people want to understand themselves better and use therapy for this purpose. Others need help coping with major losses or stresses.
Most of these issues do fall under the categories of psychiatric disorders--- so someone with a maladaptive personality disorder or a behavioral problem will fit into a diagnostic category, but with respect to the types of treatments offer, there aren't medicines for all of these, and in some cases, therapy gets a bigger role. So if you've seen a psychiatrist, I'll ask why. I'll have more questions later. Thank you for participating.

My Name is Dinah and I am an Addict

From The Huffington Post, here is an article on people with PDA addictions. I can relate. Only I can relate pro-actively. I knew the first time I saw email that it would ruin my life. I kept it in my office, but I found myself wanting to go to work to check my email. Eventually, I surrendered and brought it home. It ruined my life.

I don't have internet access on my cell phone or PDA. Why? Because I check it all the time. I check it in traffic. I check it when I'm on line at the grocery store. I check it after I check it. Repeatedly. What am I looking for? Does it matter? It's bad enough that I'm glued to my laptop at home.

I don't have internet access in my office. No, I'm not kidding. I'm there to be at work, and I'm supposed to be with my patients. If I had a computer, I'd be peeking at email, waiting for time between patients to check, to blog, to plug in.

Huffington writes:

We realize that this is a widespread malady. Consider these stats:

• In 2009, the average American watched more than 151 hours of TV a month -- an all-time high
• 84% of people check their PDAs just before bed and as soon as they wake up -- and an astounding 85% peek at their PDAs in the middle of the night!
• One survey found that over a third of smartphone users would pick their BlackBerry over their significant other if they had to choose one to live without!

If all this sounds like addiction, well, it probably is. In a new study, college students who went 24 hours without using any media -- no cell phone, iPod, TV, etc. -- then blogged about their experience, using terms of addiction to describe their feelings: in withdrawal, frantically craving, miserable, jittery, crazy.

I can relate.

Health Care Reform and Mental Health--stolen from Kevin MD

Who could follow the Obama Health Care reform debates? Thousands of pages and emotions flying high, and it all became a partisan fiasco, where the patients got lost in the reams.

So Kevin MD --- links to How Heath Care Reform Will Affect Mental Health-- a post by blogger Diane Lee at Somebody Heal Me. It's a hopeful and optimistic post about how reform will increase the number of insured, increase access to treatment and medications, shrink donut holes, prevent insurance companies from refusing to insure those with mental illness, and do overall good things for the country. I like optimism.

Are you feeling hopeful?

Just the Facts, Ma'am

In The Data Driven Life in today's New York Times Magazine, Gary Wolf writes about people who track their activities in fine detail. Coffee or alcohol consumption, calories, menstrual cycles, ideas, time spent cleaning up after roommates---you name it, it can be tracked, and the online life makes it oh-so-easy. If you've got obsessive compulsive tendencies, this may be heaven, or it may drive you over the edge. And of course, there are some practical applications for psychiatry. Wolf writes:

Jon Cousins is a 54-year-old software entrepreneur and former advertising executive who was given a diagnosis in 2007 of bipolar affective disorder. Cousins built a self-tracking system to help manage his feelings, which he called Moodscope; now used by about 1,000 others, Moodscope automatically sends e-mail with mood-tracking scores to a few select friends. “My life was changed radically,” Cousins told me recently in an e-mail message. “If I got the odd dip, my friends wanted to know why.” Sometimes, after he records a low score, a friend might simply e-mail: “?” Cousins replies, and that act alone makes him feel better. Moodscope is a blended system in which measurement is supplemented by human sympathy. Self-tracking can sometimes appear narcissistic, but it also allows people to connect with one another in new ways. We leave traces of ourselves with our numbers, like insects putting down a trail of pheromones, and in times of crisis, these signals can lead us to others who share our concerns and care enough to help.

The point of the article? Other than a long-winded way of saying, Hey, look what folks are doing! I'm not so sure there was one. And while you're keeping track, Victor took second place in the salsa contest (the dip, not the dance).