tag:blogger.com,1999:blog-266661242024-03-18T03:28:36.624-04:00Shrink RapDinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen. Unknownnoreply@blogger.comBlogger2161125tag:blogger.com,1999:blog-26666124.post-57973784062900234882021-11-18T07:37:00.002-05:002021-11-18T07:37:21.740-05:00<p> Just visiting.....<br /></p><div class="blogger-post-footer">-----
<b>Listen to our latest podcast at <a href="http://mythreeshrinks.com">mythreeshrinks.com</a> or subscribe to our <a href="http://podcast.mythreeshrinks.com/mythreeshrinks1.xml">rss feed</a>. Email us at mythreeshrinks at gmail dot com</b>
Our <a href="http://amzn.to/shrinkrap">book</a> is out now.</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-26666124.post-78759372350968642952018-08-01T21:43:00.000-04:002018-08-15T13:42:56.632-04:00Goodbye, Shrink Rap<br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: large;"><a href="https://quotesblog.net/wp-content/uploads/2015/10/746997da8d3f630b2e7f064001fc9efc.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="523" data-original-width="800" height="261" src="https://quotesblog.net/wp-content/uploads/2015/10/746997da8d3f630b2e7f064001fc9efc.jpg" width="400" /></a></span></div>
<br />
<br />
<span style="font-size: large;">When Clinkshrink, Roy, and I started Shrink Rap in April of 2006, I had no idea of the places that blogging would lead me. We started blogging, and I became a tad obsessed. We all loved the blog, the people we met, and the stimulating discussions and interactions we had with people from all over the world about mental health issues. My thoughts were constantly bombarded with "I have to write a blog post about that!" And write, I did.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">ClinkShrink was a little more hesitant. "You're going to get me fired!"she insisted. Roy worried, too, and in fact, he called himself Deep Cover Roy and swore us to secrecy about his identity. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">We blogged and we blogged. Then Roy insisted we needed a podcast, and 70 episodes of My Three Shrinks went up on iTunes (they are still there). There was chili and beer and guests who came to be interviewed at our dining room tables. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">One night, I was at a psychiatric society dinner, and Roy proudly told someone sitting at our table, "I have a blog!" His secret was out. ClinkShrink decided that it couldn't really be a secret when we were presenting at the American Psychiatric Society's annual meeting. No one got fired.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">We wrote two books, <b><i>Shrink Rap: Three Psychiatrists Explain Their Work</i></b>, and <i><b>Committed: The Battle Over Involuntary Psychiatric Care</b></i>, winner of the APA's Carol Davis ethics award this year. We were on national and local radio, we've been grand rounds and CME speakers for psychiatric societies around the country, and we've given a course on how to blog, podcast and write books. As a direct result of Shrink Rap, we've become columnists for <i><b>Clinical Psychiatry News</b></i> and members of their editorial board. We've blogged on Psychology Today, and you know, it's all been good.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">The writing has been wonderful, but the people have been the absolute best. We met people who became our
real life friends, and we shared in the virtual lives of so many wonderful
people, both mental health professionals and tremendous human beings who
happened to suffer from psychiatric disorders.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">As the years passed, Anne (aka Clink) became busy with so many other projects, and with running the forensic fellowship program for the University of Maryland. Steve (Roy) has changed lives a number of times and now works for SAMHSA. He lost his password to the blog, and while we still get together for crabcakes at Koko's Pub or to hang out in one of our backyards, I've been the only one who has posted on Shrink Rap for quite a long time now. Still, we hold on to our identities as Shrink Rappers, and my friends don't know it yet, but I've reserved us three adjacent rooms (entry set for May, 2053) at a very nice nursing home where they'll let Roy bring his homemade sangria. </span><br />
<br />
<span style="font-size: large;">I've held on to Shrink Rap. For the longest time it was my forum to express my frustrations with the bureaucracy of medicine, with the inconsistencies and unfairness of a constantly changing world that seemed to create mindless hurdles for both psychiatrists and patients. Sometimes I shared the fiction I wrote, other times I just shared whatever I was thinking about, psychiatry or not. And Shrink Rap opened my mind to all sorts of other viewpoints about psychiatric issues. It became a gateway to discussing controversies and it was a reason to keep current with the mental health advocacy world. My relationship with blogger Pete Earley blossomed into a sweet friendship. TigerMom also remains a friend and my Philly resource. And just last night, Anne and I went to the movies with our beloved (and now retired) book editor, Jackie Wehmueller. There are so many more people who have touched my life in such meaningful ways that I can't even begin to create a list. And there were the selfless people I met here who gave so much of their stories so we could write <i>Committed</i>, and the many other people who contributed to all we learned about the good and bad of involuntary treatments. </span><br />
<br />
<span style="font-size: large;">Over the last couple of years, I've also been spread a bit thinner, and I've had more places to express my thoughts. Instead of feeling like I couldn't wait to get home to write a Shrink Rap post, it's become something I tell myself I should do once a month or so. When I do post, the comment section remains quiet, and it was probably time to say good bye long ago. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Psychiatry can be an isolating career. My career has not been isolated or lonely and the connection that came with Shrink Rap has truly been a gift. It's been a fabulous experience, and to all our friends and adversaries, colleagues, advocates, commenters, readers, and all the amazing souls I've been so blessed to share this wonderful journey with, I can't thank you enough. </span><br />
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<a href="https://image.slidesharecdn.com/endofstorytelling-complete-inbound2014-illustrated-final-140916115050-phpapp02/95/a-story-about-the-end-of-storytelling-36-638.jpg?cb=1411117140" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="359" data-original-width="638" height="180" src="https://image.slidesharecdn.com/endofstorytelling-complete-inbound2014-illustrated-final-140916115050-phpapp02/95/a-story-about-the-end-of-storytelling-36-638.jpg?cb=1411117140" width="320" /></a></div>
<span style="color: blue;">Please note that there are over 2200 posts on Shrink Rap about psychiatry in all shapes and sizes. They will remain available and you can use the search box to find our musings on any topic.</span><div class="blogger-post-footer">-----
<b>Listen to our latest podcast at <a href="http://mythreeshrinks.com">mythreeshrinks.com</a> or subscribe to our <a href="http://podcast.mythreeshrinks.com/mythreeshrinks1.xml">rss feed</a>. Email us at mythreeshrinks at gmail dot com</b>
Our <a href="http://amzn.to/shrinkrap">book</a> is out now.</div>Unknownnoreply@blogger.com16tag:blogger.com,1999:blog-26666124.post-47753954121055364252018-06-28T09:27:00.002-04:002018-06-28T09:27:34.231-04:00Anderson Cooper; CNN's special on Finding Hope<iframe frameborder="0" height="234" src="//fave.api.cnn.io/v1/fav/?video=us/2018/06/24/finding-hope-suicide-special-report-full-show.cnn&customer=cnn&edition=domestic&env=prod" width="416"></iframe><br />
<br />
<a href="https://www.cnn.com/videos/us/2018/06/24/finding-hope-suicide-special-report-full-show.cnn">https://www.cnn.com/videos/us/2018/06/24/finding-hope-suicide-special-report-full-show.cnn</a><br />
<br />
If
you are someone with suicidal impulses, please do watch Finding Hope,
it was an excellent show. The host, Anderson Cooper, as well as many of
the guests, have lost a family member to suicide. <div class="blogger-post-footer">-----
<b>Listen to our latest podcast at <a href="http://mythreeshrinks.com">mythreeshrinks.com</a> or subscribe to our <a href="http://podcast.mythreeshrinks.com/mythreeshrinks1.xml">rss feed</a>. Email us at mythreeshrinks at gmail dot com</b>
Our <a href="http://amzn.to/shrinkrap">book</a> is out now.</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-26666124.post-9334690164215673592018-06-06T21:19:00.003-04:002018-06-06T21:19:44.310-04:00Suicidal Thoughts and Suicide Risk/ The New MD Edge Podcast<br />
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<span style="font-size: large;">Today seems like a good day to talk about assessing suicide risk.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">As psychiatrists, we see many people who think about suicide -- suicidal ideation is a common symptom of clinical depression. In fact, it's very difficult to get a depressed patient into the hospital if they are not thinking about suicidal. Insurers are generally only willing to pay for inpatient care for people with life-threatening psychiatric illnesses; it's a standard no other medical specialty is held to. Even when someone is dangerous, and when their insurance is willing to authorize an admission, there is still the very difficult issue of finding a bed. Do check out <a href="https://www.washingtonpost.com/national/health-science/suicidal-be-prepared-to-wait-for-care/2018/05/18/add2ec06-48b4-11e8-9072-f6d4bc32f223_story.html?utm_term=.c704356944b5" target="_blank"> Suicidal: Be Prepared to Wait for Care</a> by Dr. Nathanial Morris, a psychiatry resident at Stanford. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">That said, I wanted to introduce you to the the new podcast over on the Clinical Psychiatry News website. The <a href="https://www.mdedge.com/psychiatry/mdedge-psychcast" target="_blank">MD Edge psychcast</a> is being hosted by Dr. Lorenzo Norris of George Washington University. I found the interview with Dr. Igor Galynker on assessing imminent suicide risk fascinating. Dr. Galynker notes that people who go on to end their own lives often do not say they are thinking of suicide. And yet that is the standard we use to get people into the hospital! It's an excellent interview, and I can't do it justice in a recap, so I'll ask you to invest 25 minutes of your time and listen here: <a href="https://www.mdedge.com/psychiatry/article/165827/depression/approach-assesses-imminent-suicide-risk">https://www.mdedge.com/psychiatry/article/165827/depression/approach-assesses-imminent-suicide-risk</a></span><br />
<br />
<span style="font-size: large;">Finally, ClinkShrink and I were interviewed by Dr. Norris when we were in New York for the annual meeting of the American Psychiatric Association. If you'd like to hear our interview on involuntary treatment, it can be found here:</span><br />
<span style="font-size: large;">https://www.mdedge.com/psychiatry/article/166427/mixed-topics/dr-dinah-miller-dr-annette-hanson-involuntary-psychiatric </span><br />
<br />
<br /><div class="blogger-post-footer">-----
<b>Listen to our latest podcast at <a href="http://mythreeshrinks.com">mythreeshrinks.com</a> or subscribe to our <a href="http://podcast.mythreeshrinks.com/mythreeshrinks1.xml">rss feed</a>. Email us at mythreeshrinks at gmail dot com</b>
Our <a href="http://amzn.to/shrinkrap">book</a> is out now.</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-26666124.post-20430631098552633462018-05-15T07:44:00.000-04:002018-05-15T07:44:34.986-04:00Recap of the APA's Annual Meeting in New York City<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6Gy_RHS_egU6__lFqLeqyNKtLUPIxYrIZsYwhK_70vPM1zi9ezWpP2P__a108hJevXsULqJ93EoCzcBDLhyQDgG_G7w1azhzGSuxrKVd6nyWAcQ_2nVMKe4xZSEaKBSWDPndTWg/s1600/award.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1016" data-original-width="1080" height="188" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6Gy_RHS_egU6__lFqLeqyNKtLUPIxYrIZsYwhK_70vPM1zi9ezWpP2P__a108hJevXsULqJ93EoCzcBDLhyQDgG_G7w1azhzGSuxrKVd6nyWAcQ_2nVMKe4xZSEaKBSWDPndTWg/s200/award.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Heidi Bunes, ClinkShrink, Dr. Joanna Brandt, Dinah</td></tr>
</tbody></table>
<span style="font-size: large;">This year's annual meeting of the American Psychiatric Association was held from May 5th-9th at the Javits Center in New York City. Let me tell you about it!</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">First of all, we were so excited that our book, <a href="https://www.amazon.com/Committed-Battle-over-Involuntary-Psychiatric/dp/1421420783/ref=asap_bc?ie=UTF8" target="_blank"><i><b>Committed: The Battle Over Involuntary Psychiatric Care</b></i></a> was awarded this year's Carol Davis Ethics Award for outstanding contribution to the literature in the ethics of psychiatry. We are pictured here with Heidi Bunes, the Executive Director of the Maryland Psychiatric Society, and with Dr. Joanna Brandt, the Chair of the MPS Ethics Committee. We received many compliments on our book and we both felt it was such an privilege to receive this award. </span><br />
<br />
<span style="font-size: large;">If you've never been to an APA annual meeting, first you need to know that it's overwhelming! There are poster sessions and at any given time there are workshops, symposia, lectures, courses, and events that are held in the Javits Convention Center as well as in the meeting rooms and ballrooms at the Times Square Marriott and Sheraton. If you don't go early to a popular session, you can be sent to an overflow room or simply squeezed out. Some of the sessions I wanted to go to had no room in the overflow rooms! Some years there are very famous speakers: Alan Alda, VP Joseph Biden, Oliver Saks, and Desmond Tutu come to mind from past years. </span><br />
<br />
<span style="font-size: large;">This year, I decided to make a point of covering one of the sessions for my column in <i>Clinical Psychiatry News</i> and you can read <a href="https://www.mdedge.com/psychiatry/article/165066/schizophrenia-other-psychotic-disorders/experts-explore-issues" target="_blank">here</a> about a symposium on <a href="https://www.mdedge.com/psychiatry/article/165066/schizophrenia-other-psychotic-disorders/experts-explore-issues" target="_blank">Issues and Controversies with Medical Marijuana</a> chaired by Dr. Godfrey Pearlson.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">On Tuesday, I chaired a workshop on the Role of Involuntary Treatment in Preventing Violence. On Saturday evening, I attended a session with pianist/psychiatrist Richard Kogan who discussed the life and psychology of composer Leonard Bernstein illustrated with his music. Other sessions I went to included "the gun talk," stimulant use in ADHD, stimulant misuse in ADHD, how the digital world is changing us. Aside from that, there was catching up with friends and checking out the restaurants in the Big Apple. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Next year: San Francisco.</span><br />
<br />
<br /><div class="blogger-post-footer">-----
<b>Listen to our latest podcast at <a href="http://mythreeshrinks.com">mythreeshrinks.com</a> or subscribe to our <a href="http://podcast.mythreeshrinks.com/mythreeshrinks1.xml">rss feed</a>. Email us at mythreeshrinks at gmail dot com</b>
Our <a href="http://amzn.to/shrinkrap">book</a> is out now.</div>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-26666124.post-22415442644903984332018-04-15T18:09:00.000-04:002018-04-15T18:09:54.321-04:00That Way Madness Lies<iframe allowfullscreen="" frameborder="0" height="360" mozallowfullscreen="" src="https://player.vimeo.com/video/229500849" webkitallowfullscreen="" width="640"></iframe><br />
<br />
<span class="yiv0594438566" style="font-size: 12px;"><span class="yiv0594438566" style="background-color: white; font-family: "arial";"><span class="yiv0594438566"><span style="font-size: large;">I thought this would be of interest to our readers!</span> </span></span></span><br />
<br />
<span class="yiv0594438566" style="font-size: 12px;"><span class="yiv0594438566" style="background-color: white; font-family: "arial";"><span class="yiv0594438566"><span style="font-size: large;">“THAT WAY MADNESS LIES…” </span></span></span></span><span class="yiv0594438566" style="font-size: 12px;"><span class="yiv0594438566" style="background-color: white; font-family: "arial";"><span class="yiv0594438566"><span style="font-size: large;">To be screened at the Richmond International Film and Music Festival </span></span></span></span><br />
<div style="text-align: center;">
<span class="yiv0594438566" style="font-size: 12px;"><span class="yiv0594438566" style="background-color: white; font-family: "arial";"><span class="yiv0594438566"><span style="font-size: large;"> </span></span></span><span style="font-size: large;"><span class="yiv0594438566"><b class="yiv0594438566" style="color: #3e3e3e; font-family: Lato, sans-serif;">BowTie Criterion</b></span></span></span></div>
<div class="yiv0594438566" style="color: #3e3e3e; font-family: Lato, sans-serif;">
<span style="font-size: large;">1331 N Boulevard</span></div>
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<span class="yiv0594438566" style="font-size: 12px;"><span style="font-size: large;"><span class="yiv0594438566"></span></span></span><br />
<div class="yiv0594438566" style="color: #3e3e3e; font-family: Lato, sans-serif;">
<span class="yiv0594438566" style="font-size: 12px;"><span style="font-size: large;"><span class="yiv0594438566">Richmond, VA 23230</span></span></span></div>
<span class="yiv0594438566" style="font-size: 12px;"><span style="font-size: large;"><span class="yiv0594438566">
</span><span class="yiv0594438566" style="background-color: white; font-family: "arial";"><span class="yiv0594438566"><span class="yiv0594438566">Saturday, April 28. 2018 at 11:45 am</span></span></span></span></span><br />
<div class="yiv0594438566">
<div style="text-align: center;">
<span class="yiv0594438566" style="background-color: white; font-family: "arial";"><span class="yiv0594438566" style="font-size: large;"><span class="yiv0594438566"><span class="yiv0594438566">Tickets available at: <a class="yiv0594438566" href="https://riff.eventive.org/schedule/5a9b7075bc24000014eeecc2" rel="nofollow" style="font-family: Helvetica;" target="_blank">https://riff.eventive.org/schedule/5a9b7075bc24000014eeecc2</a></span></span></span></span><br />
<span class="yiv0594438566" style="background-color: white; font-family: "arial";"><span class="yiv0594438566" style="font-size: large;"><span class="yiv0594438566"><span class="yiv0594438566"></span><span class="yiv0594438566">Q&A with filmmaker Sandra Luckow </span></span></span></span></div>
<span class="yiv0594438566" style="background-color: white; font-family: "arial";"><span class="yiv0594438566" style="font-size: large;"><br class="yiv0594438566" /><span class="yiv0594438566">New
York, New York April 15, 2018 – THAT WAY MADNESS LIES…, an
award-winning feature length documentary (Best Feature Documentary at
the Hot Springs International Women’s Film Festival) about severe
mental illness and its effects on a family, their struggles with the
mental health system and the law enforcement system, will be shown on
Saturdayy, April 28, at 11:45am, to be followed by a Q&A with
filmmaker and Yale </span><a class="yiv0594438566" href="http://art.yale.edu/FacultyAndStaff" rel="nofollow" style="font-weight: 600;" target="_blank">School of Art</a><span class="yiv0594438566"> faculty </span><a class="yiv0594438566" href="http://www.columbiaspectator.com/the-eye/2017/11/21/bfilm-professor-sandra-luckow-wants-to-change-our-minds-about-mental-health-b/" rel="nofollow" style="font-weight: 600;" target="_blank">Sandra Luckow</a><span class="yiv0594438566">.
There it will receive a special Jury Award. First responders in law
enforcement and crisis management, mental health advocates and families
dealing with a mental health crisis are especially encouraged and
welcome to attend. </span><br class="yiv0594438566" /><br class="yiv0594438566" /><a class="yiv0594438566" href="http://www.peteearley.com/2017/04/10/new-documentary-the-way-madness-lies-most-honest-portrayal-of-how-severe-mental-illness-ravages-families-and-lives-that-ive-seen/" rel="nofollow" style="font-weight: 600;" target="_blank">“Most honest portrayal of how severe mental illness ravages families and lives that I’ve seen!”</a><span class="yiv0594438566"> - Pete Earley, author of </span><i class="yiv0594438566" style="position: relative;">CRAZY: A Father's Search Through America's Mental Health Madness. </i><br class="yiv0594438566" /><br class="yiv0594438566" /><span class="yiv0594438566">Film
synopsis: One woman and her family trek the broken mental health system
in an effort to save her brother as he descends into madness. Beginning
as a testimony of his sanity, his iPhone diary ultimately becomes an
unfiltered look at the mind of an untreated schizophrenic.</span><br class="yiv0594438566" /><span class="yiv0594438566"> </span><br class="yiv0594438566" /><span class="yiv0594438566">Duanne
Luckow, 46, began a scary, dangerous and ever-escalating cycle of
arrests, incarcerations and mental institutional stays. Three months
into his first court-ordered 180-day commitment at Oregon State
Hospital, Sandra Luckow, his sister and filmmaker, visited him. He gave
her his iPhone with 250 video clips. He wanted his experience
documented. With their cameras, they expose an ineffectual and inhuman
system as well as delve deep into the strength of family ties. Yale
School of Medicine and the </span><a class="yiv0594438566" href="http://cugmhp.org/2017/06/02/that-way-madness-lies/" rel="nofollow" style="font-weight: 600;" target="_blank">Global Mental Health Program at Columbia University</a><span class="yiv0594438566"> say
the iPhone footage Duanne shot as he descended into madness offers a
rare, unprecedented, unfiltered look at the mind of an untreated
schizophrenic. This is a specific harrowing story about a singular
family trying to find its way through society's imperfections, stigmas
and prejudice when dealing with mental illness. It is a search for
answers - a free-fall into a quagmire of conflicting interests,
policies, and despair. </span></span><span style="font-size: large;"><br class="yiv0594438566" /><span class="yiv0594438566">“The
title of the film, THAT WAY MADNESS LIES…is a quote from Shakespeare’s
King Lear, Act III, Scene IV. It speaks to the complications of dealing
with mental illness, and our own uncertainties as to which direction we
should pursue towards wellness and peace. “It is my greatest hope that
this film will be an agent for changing the way we deal with our mental
health in America,” says director Luckow. </span><br class="yiv0594438566" /><br class="yiv0594438566" /><span class="yiv0594438566">“This
is the only film that I know of that has risen to the task of
representing the terrors and tragedies of psychosis accurately and with
immediacy and therefore the only one I know of that can truly serve
educational and advocacy functions in changing the mental health system
to one that promotes recovery and community inclusion as opposed to
chronicity and dependency.” – said </span><a class="yiv0594438566" href="http://www.madnessthemovie.com/letters-of-support.html" rel="nofollow" style="font-weight: 600;" target="_blank">Larry Davidson</a><span class="yiv0594438566">,
Ph.D. Professor of Psychiatry, Yale School of Medicine, one of the many
psychiatric professionals around the United States who have called this
film an important and accurate depiction of mental illness — one that
should be seen by policy makers and those who care about the care and
treatment of people living with mental illness in America.</span><br class="yiv0594438566" /><br class="yiv0594438566" /><span class="yiv0594438566">For further information about the film please visit the film’s website at </span><a class="yiv0594438566" href="http://www.madnessthemovie.com/" rel="nofollow" style="font-weight: 600;" target="_blank">www.madnessthemovie.com</a></span><span class="yiv0594438566" style="font-size: 12px;"><span style="font-size: large;">. </span></span></span></div>
<div class="blogger-post-footer">-----
<b>Listen to our latest podcast at <a href="http://mythreeshrinks.com">mythreeshrinks.com</a> or subscribe to our <a href="http://podcast.mythreeshrinks.com/mythreeshrinks1.xml">rss feed</a>. Email us at mythreeshrinks at gmail dot com</b>
Our <a href="http://amzn.to/shrinkrap">book</a> is out now.</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-26666124.post-53204331204936019852018-04-11T11:24:00.004-04:002018-04-11T11:24:56.481-04:00Antidepressant "Withdrawal": Why Aren't Psychiatrists Seeing this "Common" Problem?<div class="separator" style="clear: both; text-align: center;">
<a href="https://e3.365dm.com/18/02/1096x616/skynews-antidepressants-drugs_4237384.jpg?20180222043700" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="450" data-original-width="800" height="179" src="https://e3.365dm.com/18/02/1096x616/skynews-antidepressants-drugs_4237384.jpg?20180222043700" width="320" /></a></div>
<div>
<span style="font-size: large;">Over on <i>The</i> <i>New York Times </i>website, there is an article titled, "<a href="https://www.nytimes.com/2018/04/07/health/antidepressants-withdrawal-prozac-cymbalta.html?rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health&region=rank&module=package&version=highlights&contentPlacement=2&pgtype=sectionfront" target="_blank"><span style="color: red;"><b>Many People Taking Antidepressants Discover They Cannot Quit</b></span>.</a> " Benedict Carey and Robert Gebeloff write about how long-term use of antidepressants is increasing, and some people have difficulties coming off the medications with symptoms that constitute a discontinuation syndrome. I'll let you read the article rather than quote it, because there was a lot wrong with the piece.</span></div>
<div>
<span style="font-size: large;"> </span></div>
<div>
<span style="font-size: large;">It doesn't feel like a new idea that there are people who have
protracted and miserable discontinuation syndromes--distinct from a
recurrence of symptoms-- after stopping antidepressants. People have been writing in to Shrink Rap about these difficulties for the
past decade, there are online forums around it, and <i>The New York Times Magazine</i> did a cover story by a <a href="https://www.nytimes.com/2007/05/06/magazine/06antidepressant-t.html" target="_blank"><b>man who stopped his Effexor </b></a>and went through a difficult time with discontinuation symptoms back in 2007. </span></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">I
don't think any psychiatrists were surprised to read that SSRI's have a
discontinuation syndrome, and because of the symptoms that can develop, we routinely advise people to come off SSRIs and SNRIs slowly, especially from those medications that have a shorter-half life like Paxil and Effexor. The question is not whether people might have symptoms, but about how
difficult it is to manage these difficulties and how long they might last. So while we have
all seen people who have some discomfort after stopping a short
half-life SSRI or SNRI, we think of this as something we manage by
slowing the taper, switching to Prozac with it's very long half-life, or waiting it out with the idea
that symptoms will resolve in 1-3 weeks. What's different in this
article is the idea that this is <i>common</i>, that patients struggle with intolerable symptoms
even when they undergo a very slow taper, and that these symptoms can last for months or even years. </span></div>
<div>
<span style="font-size: large;"> </span></div>
<div>
<span style="font-size: large;"> The article is one-sided in that it talks about the misery of the
discontinuation syndrome with the overtone that "if only the doctor had
told me that this would happen, I never would have taken the
medication." <b>The article completely neglects the misery and dysfunction
of the disorders that lead people to start these medications to begin
with!</b> </span></div>
<div>
<span style="font-size: large;"> </span></div>
<div>
<span style="font-size: large;">The article doesn't mention that one common reason for symptoms upon stopping --for example anxiety or sleep problems -- may be the recurrence of the initial problem that they medication was treating. In some people, depression is an episodic issue and people can come off medications, with other people, depression, anxiety, obsessive compulsive disorder, premenstrual mood difficulties, and other problems these medications are used to treat are more chronic problems. In these cases, stopping the medication may be like stopping insulin or synthroid: the problem is still there and staying on the medicine may make more sense.</span></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">I think it's easy to be dismissive of the
prolonged discontinuation syndrome-- to say that the symptoms simply
don't last that long or cause that much misery, and if they do then the patient has obviously had a recurrence of their initial symptoms, something else is wrong, or it's all "in their head"--meaning we don't believe the person is actually having the symptoms they say they are having and they are a result of suggestibility or hysteria. </span></div>
<div>
<span style="font-size: large;"> </span></div>
<div>
<span style="font-size: large;">So what's good about this article is that it increases awareness of the issue and those people who are having difficult discontinuation problems may well feel a sense of validation in knowing that other people have the same constellation of symptoms. </span></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div>
<span style="font-size: large;">I believe that there are patients
who have these long and miserable discontinuation problems -- many have written into the comment section of Shrink Rap over the years, and <i>The New
York Times </i>found some to interview, including one
psychiatrist who was having trouble coming off Cymbalta. What I
haven't figured out is this: Why haven't I ever seen any of these
patients? It seems that when people have trouble coming off
antidepressants, that slowing down the taper works, or the symptoms are
self-limited and resolve in 10 days, or the patient decides to resume
the medication. So while I've read about these miserable stories for a
decade now, I've never seen someone have a protracted and miserable time coming off despite a slow and careful taper. It's been 25+ years and a lot of SSRIs, including many people who casually mention that they stopped taking their medications without consulting me first. I asked in an online forum if other psychiatrists have seen this phenomena, and a few mentioned that sometimes patients had trouble stopping antidepressants, but no one offered that they had seen this degree of misery. So while I do believe it exists, I also think it's not terribly common in psychiatric practice, that for most people discontinuation symptoms can be managed with careful and thoughtful tapering, and that while some people may have extreme difficulties, these awful scenarios are not "common" as <i>The New York Times</i> article asserts. </span></div>
<div>
<span style="font-size: large;"> </span></div>
<div>
<span style="font-size: large;"> But there is a lot wrong with this article. There is the fear that the article will serve to scare people who might benefit from medications, and thereby discourage people from getting treatment. We've seen that already: when a black box warning was put on antidepressants regarding suicidal ideation in children and adolescents, prescribing went down, and suicide rates went up. Figuring out this balance is difficult, and it would be so nice if we knew who might benefit from medications and who is more likely to be harmed than helped by medications. </span></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">Finally, what's really wrong with this article is that it uses language that likens antidepressants to addictive drugs of abuse, and it stigmatizes those who need to continue them. People don't get addicted to anti-depressants: they don't use them to get high, they don't crave the medications, and they don't engage in addictive behaviors such as escalating the doses without medical guidance or getting medications in deceptive ways. Awareness of a problem may be good, but it needs to be done in a responsible and balanced way.</span></div>
<div class="blogger-post-footer">-----
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<a href="https://aspenvalleyvapes.com/wp-content/uploads/2016/11/stigma-facebook.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="597" data-original-width="800" height="238" src="https://aspenvalleyvapes.com/wp-content/uploads/2016/11/stigma-facebook.jpg" width="320" /></a></div>
<br />
<span style="font-size: large;">Stigma is a sticky, two-sided issue, one that we talk about often in our field of psychiatry. Many things are stigmatized. While mental illness is an obvious one --and I'll come back to this-- many other things are stigmatized as well. To name just a few: drug use, smoking, being a criminal, going to jail, behaving in a disruptive way, smelling badly and being physically unkempt in certain settings, begging for money in public, being on public assistance (in certain circles), beating your children (again, in certain circles), incest (in all cultures), being morbidly obese (especially when it happens in someone who makes poor food choices, as opposed to being the result of an illness), suicide, behaving badly after drinking alcohol, sexually harassing your colleagues in certain circles, and I could go on and on. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Stigma, as you can tell by my short list, is a bit diffuse and subject to individual consideration, pertains to lots of troublesome behaviors, and depends almost wholly on the environment and consideration of others, and what is stigmatized changes over time. While stigma is troublesome in that it causes people to feel shame and self-loathing, it also has a role in society. Stigma inspires some people to change or avoid certain behaviors. People certainly smoke less since it's become highly stigmatized and those who want to smoke at work are sent out into the cold to stand in little boxed off smoking areas. There is a stigma to going to prison and being labeled a criminal and this is part of the deterrent to crime. While suicide rates are rising, many people still don't end their lives for fear of stigmatizing their family, and as much as I see suicidal thoughts as a symptom of an illness, I do imagine that more people would choose to end their own lives if it left a legacy with no stigma whatsoever. While it may have once been cool to be a "player," it's no longer okay to grope your co-workers.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">But what about mental illness? Mental illness is not a behavior and it's not a choice, it's a constellation of uncomfortable psychic events, or symptoms, and sometimes having a mental illness leads people to behave in stigmatized ways. But the illness itself? Yes, it's mostly still stigmatized, despite our best efforts, but some conditions certainly more so than others. We have not really clarified exactly what mental illness even is, but the reaction you'll get to saying you've had panic attacks in the past may be a bit different to the one you'll get if you announce that during manic episodes you run through the streets naked and max out your credit cards. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">So I don't want to talk about the stigma of mental illness and substance abuse today, I want to talk about the continued stigma of <i>getting treatment</i> for these issues. Because one of the problems with stigma is that it discourages people from admitting to themselves or others that they have these problems and getting help, and so the treatment itself is stigmatized.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">This is the funny thing: most things that are stigmatized are unpleasant or have unpleasant consequences. Jail is uncomfortable and leaves you with a bad mark. Getting psychiatric treatment is not usually unpleasant, and it often leads to very GOOD things. Being in therapy is stigmatized in many circles, but once over the hurdle, people ENJOY coming to therapy. You talk to someone who cares about you about the difficult things in your life, you have a safe place to process what goes on in your head, and often just talking is a relief. Most people like their therapists and look forward to sessions. If things are not going well, the session is a place to process what's going on, to have someone who listens with concern, who may or may not offer helpful suggestions, who carries your history and story. This can be a great relief and a tremendous comfort. But people don't just come in when the world is crashing, often they are happy to come to a session and announce that things are going well! They want their therapist to be pleased for them. And therapy is about the same things for everyone: talking about the stuff you can't talk to everyone else in your life about, often talking about issues with interpersonal relationships, and the obstacles to getting what you want out of life. It's the same for those with serious mental illness as it is for those who function well. So why do we stigmatize something that people enjoy, that helps them? This I find perplexing.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">And what psych meds? The stigma that comes with taking them is huge and there is even a culture of what some have called "pill shaming." Granted, some medications have side effects or cause weight gain or sexual dysfunction, it's not all good. But many people take psych meds and feel so much better. They become more functional, they feel less misery, they stop hearing voices, they stop behaving in those ways that are associate with mental illness and they gain a resilience and reserve that is helpful. Yet most people don't proudly announce that they get monthly antipsychotic injections or that lithium has been a live saver that allows them to have their highly functional life. At one point, it was probably fine to say you popped a Xanax for anxiety, but now even appropriate benzodiezapine use use gets lumped in with addictive issues. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">And rehab? Oh, my, outside of Recovery circles, most people don't advertise that they have been to detox or rehab. Why not? Good rehab is a wonderful thing. It takes people out of the foxhole of addictive misery and gets them back into a place where they can love and function. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">We're never going to stop stigmatizing mental health problems, especially if we continue to insist that they are the cause of people becoming mass murderers. But let's work hard on it: mental illness does not explain many things that the American public thinks it does. And let's try very hard not to stigmatize treatment! Treatment is good, it gives people their lives back, it helps them shed oppressive symptoms, it feels good and it's nothing to be ashamed of.</span><div class="blogger-post-footer">-----
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://www.mdedge.com/sites/default/files/Image/March-2018/131474_photo_web.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="682" data-original-width="800" height="272" src="https://www.mdedge.com/sites/default/files/Image/March-2018/131474_photo_web.jpg" width="320" /></a></div>
<span style="font-size: large;">Yesterday, I was reading an article on how people make assumptions about animal motivation. It is called "<a href="https://www.nytimes.com/2018/03/27/opinion/dogs-happy-hollywood.html" target="_blank">Is This Dog Happy</a>," and it reminded me of a post I wrote on Shrink Rap years ago called "<a href="http://psychiatrist-blog.blogspot.com/2006/07/what-max-wants.html" target="_blank">What Max Wants</a>," about the desires of our beloved late pet, Max. I showed my daughter the old post from 2006, and as I was surfing around those early days of Shrink Rap, I remembered that I used to blog here a lot more. In 2007, when all three of us were actively blogging, we had over 300 post. Also, I realized I used to be a lot more FUN. Or at least I use to write about more light-hearted things. Now I come to Shrink Rap when the world is bothering me, maybe once a month, and I have other venues for expression. But I am also not as fun it seems, I often write blog posts about more serious shrinky areas of distress. Oh well, what can I say? I am still fun sometimes in my real life, and the other day I made an emoji character of ClinkShrink. I don't think she likes it, so I won't post it here, but I think it captures her. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">That said, I now want to point you to the more serious stuff I have been been writing and thinking about lately. For the first (and last) time ever, my original artwork is available to be seen in a national publication. Over on <b><i>Clinical Psychiatry News</i></b>, I have an article talking about the very moving #MarchForOurLives rally I attended in Washington, D.C. on March 24th. The speakers were all children and teenagers and they were amazing! I wanted to add one thing to their requests for gun control: a plea for Smart Guns. The artwork, as seen above, is the sign I made and carried. As you may be able to tell, my artistic abilities arrested somewhere in late elementary school. That said, please do read my article <a href="https://www.mdedge.com/clinicalpsychiatrynews/article/161834/health-policy/why-isnt-smart-gun-technology-parkland-activists" target="_blank">here</a>:</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><a href="https://www.mdedge.com/clinicalpsychiatrynews/article/161834/health-policy/why-isnt-smart-gun-technology-parkland-activists">https://www.mdedge.com/clinicalpsychiatrynews/article/161834/health-policy/why-isnt-smart-gun-technology-parkland-activists</a></span><br />
<span style="font-size: large;"><br /></span>
<br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: large;"><a href="https://www.mdedge.com/sites/default/files/Image/March-2018/weinstein_michael_pa.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="192" data-original-width="150" src="https://www.mdedge.com/sites/default/files/Image/March-2018/weinstein_michael_pa.jpg" /></a></span></div>
<span style="font-size: large;">The other piece I would like to direct you to is is also in <b><i>Clinical Psychiatry News</i></b>. You may recall that I linked to an essay in the <i><b>New England Journal of Medicine</b></i> by Dr. Michael Weinstein about his experiences with involuntary psychiatric treatment and his successful journey to recovery from a severe episode of major depression. Please do first read his article, <a href="http://www.nejm.org/doi/full/10.1056/NEJMp1715418" target="_blank">Out of the Straitjacket</a>. </span><br />
<br />
<span style="font-size: large;">Dr. Weinstein's essay caught my interest, because in researching <i><b><a href="http://committedbook.com/" target="_blank">Committed</a></b></i>, I did not find that most people who were involuntarily treated felt gratitude--especially if they were physically restrained--even if they did get well. I called Dr. Weinstein and he agreed to speak with me specifically about his experience with involuntary psychiatric care. Please do read about our discussion at <a href="https://www.mdedge.com/clinicalpsychiatrynews/article/161357/depression/trauma-surgeon-shares-story-involuntary-commitment" target="_blank">HERE</a>:</span><br />
<span style="font-size: large;"><a href="https://www.mdedge.com/clinicalpsychiatrynews/article/161357/depression/trauma-surgeon-shares-story-involuntary-commitment">https://www.mdedge.com/clinicalpsychiatrynews/article/161357/depression/trauma-surgeon-shares-story-involuntary-commitment</a></span><br />
<span style="font-size: large;"> </span><div class="blogger-post-footer">-----
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://screenshotscdn.firefoxusercontent.com/images/71c328f9-4d85-47a9-98d7-a95439a827ba.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="423" data-original-width="800" height="337" src="https://screenshotscdn.firefoxusercontent.com/images/71c328f9-4d85-47a9-98d7-a95439a827ba.png" width="640" /></a></div>
<span style="font-size: large;">In the <i>New York Times</i>, Benjamin Weiser has a beautiful and moving story about Nakesha Williams, a lovely and vibrant woman who graduated from Williams College and then became ill with a psychotic disorder. She lived for years on the street in New York City. Please do surf over to Mr. Weiser's story, <b><a href="https://www.nytimes.com/2018/03/03/nyregion/nyc-homeless-nakesha-mental-illness.html?action=click&module=MostEmailed&region=Lists&pgtype=collection" target="_blank">"A 'Bright Light' Dimmed in the Shadows of Homelessness." </a></b></span><br />
<br />
<span style="font-size: large;">The story is a tragic one about a promising woman whose future, and ultimately her life, are lost to mental illness. Despite so many people who loved and cared about her, and so many who tried to get her help, Ms. Williams dies alone on the street. She is young, and she dies of a treatable disease, a pulmonary embolism. Mr. Weiser does a commendable job of re-creating her story and tracking down the people who knew her in the years before and during her psychiatric decline. To his credit, he just tells the story; he doesn't turn it into a plea for laws that make it easier to involuntarily treat people, and he doesn't go on about how this was a life that could have been so much different if only she had been forced to have psychiatric care. I found the story to be a richer one told simply as it was without the moralizing.</span><br />
<br />
<span style="font-size: large;">So having said that, I am now going to invoke my role as an expert on involuntary treatment to talk about the plight of the "homeless mentally ill." Why the quotation marks? Well, first I'd like to differentiate those who are homeless from those I prefer to call 'street people.' You are <b><a href="https://www.nhchc.org/faq/official-definition-homelessness/" target="_blank">homeless</a></b> if you are an adult without a stable residence, and most people who are homeless are not sleeping on the streets. They may be in shelters, in motels or the single room occupancies, or staying in the guestroom or on the couch of a friend or relative. Those who are actually sleeping on the streets are our society's sickest and most disenfranchised members. The quotations also serve to remind me that "the mentally ill" is not a term I like to use: these are people with psychiatric disorders, not to be defined by those disorders. While many like to talk about the plight of the homeless mentally ill, I'd like to suggest that as a society, we should invest our resources in helping all of our countrymen who sleep on the streets, whether they are mentally ill, addicted, or simply indigent. </span><br />
<br />
<span style="font-size: large;">In a wealthy country such as we are, the fact that there are people who spend their nights on the street should be a source of shame to all of us. Logically, this can't be about money: there is nothing cheap about leaving people on the street-- to start with, they have high medical expenses, and high incarceration rates. One way or another, they cost us all money. Personally, I don't believe it should be legal to sleep in public places, and as a society, we should feel obligated to provide sick and destitute people with more than a nighttime cot in a room with other people where they may not be safe. </span><br />
<br />
<span style="font-size: large;">If you've followed my Shrink Rap posts, or read our book, <a href="https://www.amazon.com/Committed-Battle-over-Involuntary-Psychiatric/dp/1421420783?SubscriptionId=AKIAIRKJRCRZW3TANMSA&amp;tag=psychologytod-20&amp;linkCode=xm2&amp;camp=2025&amp;creative=165953&amp;creativeASIN=1421420783" target="_blank"><i><b>Committed: The Battle Over Involuntary Psychiatric Care</b></i></a>, then you know that the issues of involuntary treatment are nuanced and complex, and that I think it should be avoided when possible as there is the risk that involuntary care leaves some people feeling traumatized and angry, and because we all cherish the right to make our own medical decisions. You also may know that I'm not much for invoking "anosognosia" as a reason to force people to have treatment, and do see <b><a href="https://www.psychologytoday.com/blog/committed/201802/the-perplexing-semantics-anosognosia" target="_blank">my post</a> </b>on this over on Psychology Today. But you may also know that I believe there are times when there really seems to be no choice but to force treatment, and when it is simply the right thing to do to keep everyone safe. A traumatized patient is better than a dead patient. </span><br />
<br />
<span style="font-size: large;">So what about Nakesha Williams, and others like her who are "dying with their rights on." I messaged Mr. Weiser, the NY Times journalist, and asked him if she had ever been treated. In the article he talks with friends who have tried to get her help, and with case workers from a mental health agency who tried to engage her, all of which she refused. Mr. Weiser thought Nakesha had been in treatment briefly when she was younger--he didn't know for sure if she had ever taken medications-- but it does not appear that she had any treatment in the years she lived on the streets of New York City. Her family had long before lost contact with her.</span><br />
<br />
<span style="font-size: large;">So Mr. Weiser didn't say it, but I will: if people suffering from psychosis are living on the streets, unprotected from the elements, at risk of illness or of being prey to criminals, and they are so ill that they are refusing offers of housing, healthcare, and help getting financial entitlements, then they should be hospitalized and treated against their will. As traumatic as forced care can be, I believe it is preferable to the obvious risks people on living on the streets face each and every day, and would offer them a chance at a safer and more productive, less tormented existence. Ms. Williams was certainly a risk to herself, and her story is one of society's shame. </span><br />
<br />
<span style="font-size: large;">So do we need new laws to get Ms. Williams and those in her situation care? I don't believe we do: she was a risk, as can be seen by her untimely death, and as I've said above, I don't think it is a person's right (or it shouldn't be) to live in public places. Would treatment -- and in this case, I specifically mean antipsychotic medications-- have changed her life? I don't know, but I would hope so. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">There, I said it. Now please let me add a plug for Housing First options that place people in housing without first requiring them to be free from drugs or alcohol, or to accept psychiatric care, as a condition of housing. </span><div class="blogger-post-footer">-----
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKcETb8qp40tWiAjOIaYnM-pBM7Y_phsfZ_81bRa82KWLKRfukXAfHRhug475V1BTL8A16Fwxo_pRGltpZ4Kt2tKw22DhNFsNAFRmU7gYegMwGF4Y0o8HX9kLa1SPEXF57nOemIA/s1600/IMG_7145.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="974" data-original-width="1600" height="241" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKcETb8qp40tWiAjOIaYnM-pBM7Y_phsfZ_81bRa82KWLKRfukXAfHRhug475V1BTL8A16Fwxo_pRGltpZ4Kt2tKw22DhNFsNAFRmU7gYegMwGF4Y0o8HX9kLa1SPEXF57nOemIA/s400/IMG_7145.jpg" width="400" /></a></div>
<span id="goog_1222588726"></span><span id="goog_1222588727"></span><br />
<span id="goog_1222588726" style="font-size: large;">It's been just about a month since I last posted here, and what a month it's been. I was away for a couple of weeks on a wonderful family vacation to Vietnam and Cambodia. While it was a mostly psychiatry-free trip, the sign above did grab my attention. It was a sign at the ecolodge where we were staying in Mai Chau, a rural area of Vietnam where water buffalo are still used as work animals in the rice paddies. Why are persons with mental illness not permitted in the pool? I have no idea, but it seems that stigma is rampant everywhere. </span><br />
<br />
<span id="goog_1222588726" style="font-size: large;">So do let me give links to the things I've been writing and thinking about. </span><br />
<br />
<span id="goog_1222588726" style="font-size: large;">~When I <b><a href="http://psychiatrist-blog.blogspot.com/2018/02/insurers-not-legislators-are.html" target="_blank"><span style="color: #b45f06;">last posted</span></a></b> on Shrink Rap, it was in response to Pete Earley's mention of 'the worried well.' Pete also ran my response and John Snook of the Treatment Advocacy Center wrote Pete a separate letter which he put up as it's own<a href="http://www.peteearley.com/2018/02/09/severe-mental-illnesses-demand-immediate-and-targeted-attention-not-being-swept-under-the-rug-john-snook-responds-to-worried-well-blog/" target="_blank"><b> <span style="color: #b45f06;">post.</span></b></a> By all means, do join in the fuss over on <a href="https://www.facebook.com/peteearley/" target="_blank">Pete's Facebook page</a> where he entertains comments. </span><br />
<br />
<span id="goog_1222588726" style="font-size: large;">~I moved venues and put up a somewhat related post on PsychologyToday called <a href="https://www.psychologytoday.com/blog/committed/201802/the-perplexing-semantics-anosognosia" target="_blank"><span style="color: #b45f06;"><b>The Perplexing Semantics of Anosognosia: Why An Obvious Phenomena Has Sparked Controvery.</b></span></a> See what you think, and I look forward to your comments.</span><br />
<span id="goog_1222588726" style="font-size: large;"> </span><span id="goog_1222588726" style="font-size: large;"> </span><br />
<span id="goog_1222588726" style="font-size: large;">~Over on Clinical Psychiatry News, I've written two articles on everyone's favorite topic: Medication Prices. In the <a href="https://www.mdedge.com/clinicalpsychiatrynews/article/156908/business-medicine/you-paid-how-much-medicine" target="_blank"><span style="color: #b45f06;"><b>first article</b></span></a>, I did some comparison shopping for Abilify (aripiprazole) and Provigil (modafanil) and found that the prices varied by HUNDREDS of DOLLARS (and yes, I did mean to yell) per month, depending on the drug store. In the <a href="https://www.mdedge.com/clinicalpsychiatrynews/article/157623/business-medicine/medication-pricing-so-how-it-works" target="_blank"><span style="color: #b45f06;">Second article</span></a>, I interviewed GoodRx.com co-founder Doug Hirsch and learned about how drug prices are set and why GoodRx is able to offer deep discounts. </span><br />
<br />
<span id="goog_1222588726" style="font-size: large;">Finally, I'd like to send you over to today's <i>New England Journal of Medicine</i> to read a <a href="http://www.nejm.org/doi/full/10.1056/NEJMp1715418#.Wpc_xwW9SJQ.twitter" target="_blank"><span style="color: #b45f06;"><b>powerful article </b></span></a>about a surgeon who was involuntarily treated for a suicidal major depression. </span><div class="blogger-post-footer">-----
<b>Listen to our latest podcast at <a href="http://mythreeshrinks.com">mythreeshrinks.com</a> or subscribe to our <a href="http://podcast.mythreeshrinks.com/mythreeshrinks1.xml">rss feed</a>. Email us at mythreeshrinks at gmail dot com</b>
Our <a href="http://amzn.to/shrinkrap">book</a> is out now.</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-26666124.post-89504461404885965462018-02-01T08:30:00.000-05:002018-02-01T08:30:36.838-05:00Insurers, Not Legislators, are the Gatekeepers to Care, and a Call to Deep Six the Term "Worried Well."<div class="separator" style="clear: both; text-align: center;">
<a href="http://assets.gocomics.com/uploads/features/tww/widgets/link_w_title_large_tww_TheWorriedWell_Website_740x440.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://assets.gocomics.com/uploads/features/tww/widgets/link_w_title_large_tww_TheWorriedWell_Website_740x440.jpg" data-original-height="440" data-original-width="740" height="190" width="320" /></a></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
</div>
<div>
<span style="font-size: large;">Over on <span style="color: blue;"><a href="http://www.peteearley.com/blog/" target="_blank"><b>Pete Earley's blog</b></a></span>, there is a post titled: </span><br />
<h1 class="entry-title">
<a href="http://www.peteearley.com/2018/01/25/senators-letter-to-samhsa-is-wrongheaded-dr-mccance-katz-is-simply-doing-what-congress-demanded/" target="_blank"><span style="font-weight: normal;"><span style="font-size: large;">Senators’ Letter To SAMHSA Is Misguided: Dr. McCance-Katz Is Doing What Congress Demanded</span></span></a></h1>
<span style="font-size: large;"> </span></div>
<div>
<span style="font-size: large;">Pete is on the Interdepartmental Serious Mental Illness Coordinating Committee, a group operating under the Department of Health and Human Services. He is an extraordinary writer and a tremendous mental health advocate. His post inspired me to rant at him (Me rant? Shocking, I know...) and Pete and I are both posting my response. I can't begin to capture the essence of his post on the controversy over the NREPP website, nor will you need to understand that to read my response, but please read about it at the link above. </span></div>
<div style="text-align: center;">
<span style="font-size: large;"> ____</span></div>
<div>
<span style="font-size: large;">Dear Pete:</span></div>
<div>
<span style="font-size: large;"><br clear="none" /></span></div>
<div>
<span style="font-size: large;">Thank you for your
latest blog post on the work Dr. McCance-Katz is doing and thank you,
again, for serving on the ISMICC. Let me start by saying that after 25+
years as a psychiatrist, I've never heard of the NREPP website, so I'm
not certain whether it's it is a good thing or a bad thing that the
website is now down. Instead, I'd like to respond to some of the things
that were said in the course of your blog post.</span></div>
<div>
<span style="font-size: large;"><br clear="none" /></span></div>
<div>
<span style="font-size: large;">You
used the term "worried well." Please don't use that term, ever. It
implies that there are people with legitimate suffering because they
have "real" mental illnesses, and those whose suffering is trivial
because they don't have "serious" mental illness. Suffering is
suffering-- it all hurts, and sometimes those with no obvious signs of
mental illness surprise us all when something suddenly goes horribly
wrong. Psychiatric care is expensive, poorly reimbursed, time consuming,
and stigmatized; people don't present for treatment for trivial
reasons. There is the implication that some people are more deserving of
care in a way we would never dream of bifurcating in any other field.
Could you imagine if you went to the ER with chest pain and were derided
because it turned out you had heartburn or a pulled muscle and were not
having a heart attack? As doctors, we help people who are in distress,
we don't make the distinction about whose suffering is valid and worthy
of treatment. </span></div>
<div>
<span style="font-size: large;"><br clear="none" /></span></div>
<div>
<span style="font-size: large;">I am all in favor
of giving more resources to people with chronic and disabling mental
illnesses -- these are society's most disenfranchised members, their
suffering and the suffering of their families is immense, and they use
our resources one way or another. If not through appointments with
psychiatrists and the cost of their medications, then through lost
productivity, the cost for medical care incurred from unhealthy life
styles, and the cost of institutionalization. What I find difficult
about these discussions is that psychiatry is the only arena where
advocates ask for money for one set of patients at the expense of
another. We don't ever suggest that money to treat metastatic lung
cancer should come from denying treatment to those with basal cell
carcinomas.</span></div>
<div>
<span style="font-size: large;"><br clear="none" /></span></div>
<div>
<div>
<span style="font-size: large;">While
I have you here, I'd like to bring up a related topic that perhaps you
can get the ISMICC committee to look at, one that all of us might be
able to agree on. When the topic turns to<span class="yiv6697237829ydp86a9c006yiv1688698724"><span class="yiv6697237829ydp86a9c006yiv1688698724">
serious mental illness, the loudest and most controversial agenda is
about legislation to make it easier to involuntarily hospitalize
patients. While there are cases where this is an issue, for those of us
in practice, there is a bigger issue: the real
gatekeeper to getting very sick people adequate and optimal care is not
the law, the gate keeper is the insurance/mangled care industry.
Insurers have a erected a barrier to inpatient treatment which has
set the standard for admission as "imminent danger." There are times
when everyone can agree
that a patient needs to be in the hospital: the patient, the family, the
doctor, but if that patient does not present as being dangerous, it has
become nearly impossible to get him or her into a hospital bed. This
has
trickled into our standard of care: psychiatrists no longer try to
hospitalize patients who are not dangerous (usually suicidal) because
they believe an insurance company will not authorize the the admission,
that an ER will release the patient. </span></span></span></div>
<div>
<span class="yiv6697237829ydp86a9c006yiv1688698724" style="font-size: large;"><span class="yiv6697237829ydp86a9c006yiv1688698724"><br clear="none" /></span></span></div>
<div>
<span class="yiv6697237829ydp86a9c006yiv1688698724" style="font-size: large;"><span class="yiv6697237829ydp86a9c006yiv1688698724">So
the few available beds fill with
admissions from the ER of people who are so depressed or so psychotic as
to be dangerous, and elective admissions just don't end up
happening. What does happen is that the few available inpatient beds get
taken by very ill, very dangerous patients and the acuity level on
inpatient units is very high. They often require security officers, and
the environment is anything but healing; in fact, inpatient units have a
high rate of assaults for both the patients and the staff. And then we
wonder why people won't voluntarily admit themselves to these units
when they are sick. This is the point where people in favor of easier
standards to involuntarily admit patients shut me down: they say the
patients have anosognosia, they don't know they are sick and they won't
get care no matter what, and issues of safe, healing environments or
medications that don't cause awful side effects are irrelevant. I beg
to differ with that argument, and still contend that if psychiatric care
was kinder, better funded, more palatable, and not stigmatized, then
more of those who are not aware they are ill could be swayed to get
care. </span></span></div>
</div>
<div>
<span style="font-size: large;"><br clear="none" /></span></div>
<div>
<div>
<span class="yiv6697237829ydp86a9c006yiv1688698724" style="font-size: large;"><span class="yiv6697237829ydp86a9c006yiv1688698724"><b>Psychiatry is the only medical specialty where the standard for
admission has become life-threatening illness, not just being really
sick. </b></span></span></div>
<div>
<span style="font-size: large;"><br clear="none" /></span></div>
<div>
<span style="font-size: large;">It would
be so helpful to all of us if there were more beds available and if
insurance companies were not allowed to deny admission to very sick
people because there was not an imminent threat of death. I do believe
that is something that everyone in all the tents can agree on, and it's a
good starting gate for all of us. </span></div>
<div>
<span style="font-size: large;"><br clear="none" /></span></div>
</div>
<span style="font-size: large;"><span style="font-family: "times";"></span><span style="font-family: "times";"></span><span style="font-family: "times";"></span><span style="font-family: "times";"><i>Dinah </i></span></span><div class="blogger-post-footer">-----
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Our <a href="http://amzn.to/shrinkrap">book</a> is out now.</div>Unknownnoreply@blogger.com10tag:blogger.com,1999:blog-26666124.post-62018050544693117962018-01-09T20:21:00.003-05:002018-01-09T20:24:30.480-05:00One Doctor's Struggles With Depression, Addiction, and Recovery: Finding Hope in An Intolerant Profession<div class="separator" style="clear: both; text-align: center;">
<a href="https://www.healthecareers.com/binaries/content/gallery/healthecareers-us-en/article-features/february-2016/physicianburnout.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="315" data-original-width="615" height="163" src="https://www.healthecareers.com/binaries/content/gallery/healthecareers-us-en/article-features/february-2016/physicianburnout.png" width="320" /></a></div>
<br />
<span style="font-size: large;"><i>Psychiatric News</i> is running a series on Physician Burnout, part of an initiative by APA President Dr. Anita Everett. They asked me to write about medical licensing for the series, and in the course of writing the article, I spent a while talking to Dr. Luther Philaya, an Emergency Room doc who lost his license for his addiction to alcohol and opiates. Dr. Philaya sought help and things did not go smoothly. Instead of writing about licensing, I ended up writing about Luther, and I'll invite you to read, "<a href="https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2018.1a6" target="_blank">System Changes Needed to Support Physician Seeking Help</a>." </span><br />
<h1 class="article-headline" itemprop="headline">
<a href="https://cdn.giving.massgeneral.org/assets/recovery-banner.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="287" data-original-width="800" height="71" src="https://cdn.giving.massgeneral.org/assets/recovery-banner.jpg" width="200" /></a><span style="font-size: large;"><span style="font-weight: normal;">Dr. Philaya had more to say about the stigma of being a physician in recovery and wrote his own Op-ed piece for the Star Tribune. Reprinted below, with his permission </span></span></h1>
<h1 class="article-headline" itemprop="headline">
<span style="font-size: large;">Recovery from addiction doesn't get the community support it needs</span></h1>
<span style="font-size: large;">
</span><br />
<div class="article-subhead" itemprop="description">
<span style="font-size: large;"> It's no small achievement, but, surprisingly, it's greeted as an ongoing social stigma. </span></div>
<span style="font-size: large;">
</span><br />
<div class="article-byline-mod ">
<div class="article-byline">
<span style="font-size: large;"><b>By
Luther Paul Philaya
</b></span> </div>
<div class="article-dateline">
<span style="font-size: large;"> January 8, 2018 </span></div>
</div>
<span style="font-size: large;">
</span><br />
<aside class="article-share"><span style="font-size: large;"><br /></span></aside><span style="font-size: large;">
</span><br />
<div class="article-body resizeFont" itemprop="articleBody">
<div class="DropCap_Whitman">
<span style="font-size: large;">In
the fall of 2012, I entered treatment for addiction as a broken
physician and man. Opioids were one of my drugs of choice, as they are
for so many in today’s society. After weeks of intensive therapy, I was
able to let go of the demons that had haunted me for decades, ones that I
had medicated away with drugs and alcohol. More than 100 days later, I
left the treatment facility with a renewed vigor for life — physically,
mentally, emotionally and spiritually. I was eager to return to my
medical practice with a completely different perspective, including a
heightened sense of compassion and empathy for patients struggling with
mental illness and addiction.</span></div>
<div id="zdt_display_placeholder_364488">
<div id="zdt_364488_1" style="margin: 0px auto; position: relative; width: 500px;">
<span style="font-size: large;"><img height="24" src="https://ss3.zedo.com/jsc/images/zplayer/inarticle-Close-Btn.png" style="left: 500px; position: absolute; top: 0px; width: 24px !important;" width="24" /></span></div>
</div>
<div class="Text_Body">
<span style="font-size: large;">I looked
forward to being welcomed back at my place of work as well as in my
community. As with a cancer patient enduring grueling treatment and
receiving compassion and empathy from family, friends and co-workers,
surely there would be those eager to help with my transition. Maybe a
casserole or two would be waiting, or a few get-well cards. Without a
doubt, my workplace would help with my reintegration back into practice.</span></div>
<div class="Text_Body">
<span style="font-size: large;">Sadly, I
quickly realized that recovery from substance-use disorder is not
celebrated by those outside of the recovery community. To the contrary,
recovery — like active addiction — is stigmatized in our society. Rather
than welcoming me back, I became a pariah among my co-workers of 22
years. Former friends were, for the most part, gone. What support there
was came from the recovery community, but even there I fought shame. I
learned to quickly — quietly and with furtive glances — enter and exit
church basements or recovery clubs.</span></div>
<div class="Text_Body">
<span style="font-size: large;">“Anonymous”
became my mantra. The guilt and shame I experienced while in active
addiction were there to welcome me into the recovery world as well. I
began meetings by proclaiming, “Hi, I’m Luther and I’m an addict. I’m
powerless over my addiction.” I learned to fear that I was one small
step away from relapse.</span></div>
<div class="Text_Body">
<span style="font-size: large;">Recovery
organizations such as AA have done incredible things in the battle
against substance-use disorder. I have benefited from their program. But
as a person in recovery, now that I have a clear mind, I believe I’m
quite powerful against returning to my addiction as long as I maintain a
disciplined recovery lifestyle. My rational brain is able to make the
choice not to return to that life. Being reminded that I am an addict
only perpetuates my shame, while trapping me in a toxic thought process,
including ongoing shame about my own recovery.</span></div>
<div class="Text_Body">
<span style="font-size: large;">A while
back, I decided that I couldn’t survive my own recovery this way. I am
proud of that decision; it is the crux of all aspects of my health. I’m
done hiding my recovery. I will let the public know I’m not ashamed.</span></div>
<div class="Text_Body">
<span style="font-size: large;">I admire
the tenacity and persistence of those involved in changing the public
stigmatization toward the AIDS epidemic. Through hard work by activists,
the public perception of HIV as a gay man’s disease brought on by poor
moral choices has changed. Where once HIV was feared and the sufferers
stigmatized, it has become one of the many diseases that afflict
humankind. Today, HIV sufferers no longer need to hide in closets of
shame.</span></div>
<div class="Text_Body">
<span style="font-size: large;">Recovery
needs to be treated in a similar manner. There are movements afloat that
celebrate recovery. The message is getting out that recovery need not
be shameful. But the public needs to embrace those on this journey as
well. Communities, not just recovery organizations, need to become
recovery-friendly.</span></div>
<div class="Text_Body">
<span style="font-size: large;">Imagine a
sign reading: “Welcome to Minnesotaville, a recovery-friendly community”
or “Welcome to our coffee shop, a recovery-friendly establishment.”
Imagine a bumper sticker that reads: “Proud parent of a child in
recovery.” Imagine communities making recovery fashionable, trendy and
celebrated. Rather than wringing our hands over the depth and breadth of
the current drug epidemic, communities can offer warm, welcoming
environments.</span></div>
<div class="Text_Body">
<span style="font-size: large;">I’ve
changed my perspective. Rather than proclaiming that I’m an addict, I
will proudly introduce myself as “a person in long-term recovery, which
means I haven’t had a drink or used a drug since Oct. 11, 2012.”</span></div>
<div class="Text_Body">
<span style="font-size: large;">Now that’s recovery.</span></div>
<div class="Text_Endnote">
<br /></div>
<div class="Text_Endnote">
<span style="font-size: large;"><i>Luther Paul Philaya, of Woodbury, is a physician.</i></span></div>
</div>
<span style="font-size: large;">
</span><br />
<div class="article-author-contact">
<div class="article-author-hcard">
</div>
</div>
<span style="font-size: large;">
<a class="js-comments-show comments-count-link" href="http://www.startribune.com/recovery-from-addiction-doesn-t-get-the-community-support-it-needs/468386213/#">
</a></span><span style="font-size: large;">Link to the original: http://www.startribune.com/recovery-from-addiction-doesn-t-get-the-community-support-it-needs/468386213/</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<br />
<div class="ProfileTweet-actionList js-actions" role="group">
</div>
<div class="blogger-post-footer">-----
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Our <a href="http://amzn.to/shrinkrap">book</a> is out now.</div>Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-26666124.post-31749510876402768202017-12-30T20:58:00.002-05:002018-01-01T20:58:47.572-05:00Oh For A Self-Correcting World<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1dQBtg3Z6V0koycjAKLAnlqDhkJia2kVhgWzaiuwOybbBXbuWgGZRJV0NXYjTaeD2UtaMAT6FKOIyy-PM7ahkGoi1w7YeHX8_E8NRskR7NOOMxYRwyr838IrQf9dBjw-_AJJO/s1600/PB270105.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="1200" data-original-width="1600" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1dQBtg3Z6V0koycjAKLAnlqDhkJia2kVhgWzaiuwOybbBXbuWgGZRJV0NXYjTaeD2UtaMAT6FKOIyy-PM7ahkGoi1w7YeHX8_E8NRskR7NOOMxYRwyr838IrQf9dBjw-_AJJO/s1600/PB270105.JPG" width="320" /></a></div>
<span style="font-size: large;">Good bye, 2017. Personally, it was a good year. Politically, not so much. Our country has become so alarmingly polarized, and it seems we have so many problems! </span><br />
<br />
<span style="font-size: large;">Here in Baltimore, things are difficult for so many people: firearm deaths have surged, with 345 deaths this year -- a far higher number than New York City where there are under 300 deaths, even though New York has many times the population that Baltimore has. Overdose death have surged as well. Crime, poverty, homelessness,--they are all big problems. The latest tax cuts promise to help corporations, and perhaps they will be good for the overall economy, but I worry about the effect these legislative changes will have on access to health care, and on our country's most vulnerable people. And even among the "haves," depression and anxiety is rampant, suicide rates are high, substance abuse disables and kills, and we talk about doctor burnout and suicide in a country with physician shortages. It's all disheartening.</span><br />
<br />
<span style="font-size: large;">I wish innovation were easier. Our war on drugs has been a failure, and in moments of desperation, all sorts of things get tried. Then sometimes, the 'solutions' become part of the problem. For example, Physician Health Programs were an innovation to help struggling docs, and they have been very helpful for many, but there have been reports of abuses, and over on Clinical Psychiatry News, I wrote an article asking if PHPs were <a href="https://www.mdedge.com/clinicalpsychiatrynews/article/153573/depression/physician-health-programs-diagnosing-dollars" target="_blank">diagnosing for dollars</a>. Rehabs have popped up everywhere, but many of them are not using evidence-based treatments, and so much of treatment for opioid abuse still focuses around blaming the patient, moral failures, and an emphasis on abstinence-based treatments which are wonderful if they work for you and terrible if they leave you dead when a medication-based treatment might have given you some chance to live. Given all the failures in our war on drugs, I might like to see how things transpire if we decriminalized all drugs of abuse, but somehow these things happen in sweeping moves, and if that doesn't work, it's hard to undo. </span><br />
<br />
<span style="font-size: large;">Medicine has adopted Electronic Medical Records as a standard. They add hours to a doctors day, contribute to physician burnout, and don't clearly improve the quality of patient medical records or clinical care: in fact many patients don't like talking to doctors who are clicking away and not getting to know them as people. Maybe it's still growing pains, and surely the databases they generate are helpful in research to learn about factors that effect disease and the efficacy of treatments. Maybe we will grow into these records, but they were rolled out with incentives, or in hospitals where they cost hundreds of millions of dollars, so at this point, there is no going back.</span><br />
<br />
<a href="https://w-dog.net/wallpapers/3/0/424965303123425/earth-world-space-stars-planet-space-star.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="512" data-original-width="800" height="127" src="https://w-dog.net/wallpapers/3/0/424965303123425/earth-world-space-stars-planet-space-star.jpg" width="200" /></a><span style="font-size: large;">So I long for a world where we could try innovative changes -- in how we tax people, in how we address epidemics, in how we solve a multitude of problems, not by using the methods of the person who speaks (or tweets) the loudest, but by trial and error, with test runs on small segments of the population, with the ability to go back or try something new (easily) if what we try doesn't work. Gun control, physician burnout, drug treatments, interventions for those who are suicidal...you name your problem. Oh for a self-correcting world. </span><div class="blogger-post-footer">-----
<b>Listen to our latest podcast at <a href="http://mythreeshrinks.com">mythreeshrinks.com</a> or subscribe to our <a href="http://podcast.mythreeshrinks.com/mythreeshrinks1.xml">rss feed</a>. Email us at mythreeshrinks at gmail dot com</b>
Our <a href="http://amzn.to/shrinkrap">book</a> is out now.</div>Unknownnoreply@blogger.com3tag:blogger.com,1999:blog-26666124.post-41288274981788512962017-12-04T20:16:00.000-05:002017-12-04T20:16:51.465-05:00Recent Reads: Black Man in a White Coat and Vengeance<br />
<br />
<span style="font-size: large;">I just wanted to put up a quick note about two books I've read recently.</span><br />
<a href="http://media2.s-nbcnews.com/j/newscms/2015_42/1261881/black_man_in_a_white_coat_revised_nyt_de92c2188262bdc4a65f0b656fafe6cf.nbcnews-ux-2880-1000.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://media2.s-nbcnews.com/j/newscms/2015_42/1261881/black_man_in_a_white_coat_revised_nyt_de92c2188262bdc4a65f0b656fafe6cf.nbcnews-ux-2880-1000.jpg" data-original-height="800" data-original-width="526" height="320" width="210" /></a><span style="font-size: large;"><br /></span><br />
<span style="font-size: large;"><b><i>Black Man in a White Coat</i></b> is a memoir written by Duke psychiatrist Damon Tweedy. So what's it like to be a black med student and doctor, and not just anywhere, but at Duke. Tweedy notes that he was accepted at other top medical schools, but that he went to Duke because the only way they could attract African American students was by giving large scholarships. That gives you a hint as to what the environment was like. So it's not surprising to read that Tweedy was standing with a classmate, purposefully dressed in a polo shirt and khaki's, only to have the professor walk into the lecture hall and ask if he was there to fix the lights. Ugh. So not specific to psychiatry, but a good read with important insights into how racial issues play out in medicine. </span><br />
<span style="font-size: large;"><br /></span>
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<a href="https://www.ammoland.com/wp-content/uploads/2017/10/Vengeance-by-Newt-Gingrich-199x300.jpg?101202" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="300" data-original-width="199" src="https://www.ammoland.com/wp-content/uploads/2017/10/Vengeance-by-Newt-Gingrich-199x300.jpg?101202" /></a></div>
<a href="https://www.ammoland.com/wp-content/uploads/2017/10/Vengeance-by-Newt-Gingrich-199x300.jpg?101202" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Moving on to fiction, you may remember Pete Earley from <i>Crazy: A Father's Search Through American's Mental Health Madness.</i> Pete is a mental health advocate, but at night, he steps into a phone booth (remember those?) and steps out dressed as a novelist. Paired with Newt Gingrich, this fabulous novelist duo has now written 3 books in a series: <i>Duplicity</i>, <i>Treason</i>, and now <i>Vengeance</i>. They follow Major Brooke Grant as she travels around the world chasing the Falcon, a dangerous terrorist who ultimately knocks off everyone Brooke loves (or almost). <i>Vengeance</i> is by far the best of the three books, and I don't want to say too much, because it's a better read without the plot spoilers. </span><div class="blogger-post-footer">-----
<b>Listen to our latest podcast at <a href="http://mythreeshrinks.com">mythreeshrinks.com</a> or subscribe to our <a href="http://podcast.mythreeshrinks.com/mythreeshrinks1.xml">rss feed</a>. Email us at mythreeshrinks at gmail dot com</b>
Our <a href="http://amzn.to/shrinkrap">book</a> is out now.</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-26666124.post-11492862155763688752017-11-27T09:02:00.001-05:002017-11-27T19:32:27.551-05:00Happy Holidays from Shrink Rap: Free Kindle Novel Promotion!<div style="text-align: center;">
<br /></div>
<div style="text-align: center;">
<span style="color: red;"><u><b><span style="font-size: large;">Happy Holidays!</span></b></u></span></div>
<br />
<span style="font-size: large;">At
this time of year, I like to set up <span style="color: red;"><a href="https://www.amazon.com/Dinah-Miller-MD/e/B004GDR7SK" target="_blank">free downloads</a></span> to two of my novels.
You can get these books for free on your Kindle from Tuesday, November 28th through Saturday, December 2nd at no cost.</span> <br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsIBap_TLJolNr_bks2lxrE5QikSkctVNMMViEMZP0oLMnjHHqhRcVzc3WhFnKK62snCCzZeA5iJKCtcH0kSixWjhu8Y5LN9SZfTLl1epIwL3gVTio2-Aru1ZAArDXtS1_1XwlsA/s1600/precover.dbl.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsIBap_TLJolNr_bks2lxrE5QikSkctVNMMViEMZP0oLMnjHHqhRcVzc3WhFnKK62snCCzZeA5iJKCtcH0kSixWjhu8Y5LN9SZfTLl1epIwL3gVTio2-Aru1ZAArDXtS1_1XwlsA/s1600/precover.dbl.jpg" width="214" /></a></div>
<span style="font-size: large;"><span id="yiv254706304yui_3_2_0_23_13479728686951456"><i><b>Double Billing</b></i> is the story of a woman whose life changes when she discovers she has
an identical twin. It's a quick read with a little psychiatry sprinkled in. One reviewer said:</span></span><br />
<br />
<blockquote class="tr_bq">
<span style="font-size: large;">
<span id="yiv254706304yui_3_2_0_23_13479728686951456"> </span><span id="yiv254706304yui_3_2_0_23_13479728686951456"><i>The book was a page-turner because of elegant structure and pacing. I really
cared about the author’s take on things –because she is a psychiatrist?
because I’ve followed her blog for a while?– which meant that I was
interested in the protagonist’s thoughts, feelings and actions. At
times I ached for the mess her life was in, at others I wanted to shake
her into action, and then she’d find her backbone again, just in the
nick. </i> </span></span></blockquote>
<span style="font-size: large;">
<span id="yiv254706304yui_3_2_0_23_13479728686951456"><span style="color: red;"><a href="http://www.amazon.com/Mitch-Wendy-Lost-Adventure-ebook/dp/B0092KPAWC/ref=la_B004GDR7SK_1_5_title_1_kin?ie=UTF8&qid=1348086405&sr=1-5" rel="nofollow" target="_blank"><span style="font-style: italic;"><span style="font-weight: bold;"><br /></span></span></a></span></span><span id="yiv254706304yui_3_2_0_23_13479728686951456"><br /></span></span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-J3gNO4Uleez4R2KE5S5_yfDVxit3PWVic1aBMzzxo1NCUt6oj2qQST_-nBT2ifG_OtISyaxpc9VlGCHZ54f5WC8RP6Qg7XayheRPoVjCs1ipvhWjuQ52ocv6Krto20SzLtMBIQ/s1600/HomeInspection_KindleCoverfinal.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-J3gNO4Uleez4R2KE5S5_yfDVxit3PWVic1aBMzzxo1NCUt6oj2qQST_-nBT2ifG_OtISyaxpc9VlGCHZ54f5WC8RP6Qg7XayheRPoVjCs1ipvhWjuQ52ocv6Krto20SzLtMBIQ/s320/HomeInspection_KindleCoverfinal.jpg" width="188" /></a></div>
<span style="font-size: medium;"></span><span style="font-size: large;"><span id="yiv254706304yui_3_2_0_23_13479728686951456"><span style="color: red;"><span id="yiv254706304yui_3_2_0_23_1347972868695791" style="font-style: italic;"><span id="yiv254706304yui_3_2_0_23_1347972868695790" style="font-weight: bold;">Home Inspection</span></span></span> is a story told through psychotherapy sessions in a format that is similar to the HBO series <span id="yiv254706304yui_3_2_0_30_1348086496107219" style="font-style: italic;">In Treatment</span>. </span><span id="yiv254706304yui_3_2_0_23_13479728686951456">Dr. Julius Strand is a psychiatrist who plods along in his
already-lived life until two of his patients inspire him through their own
struggles to find meaning. </span><span id="yiv254706304yui_3_2_0_23_13479728686951456"><span style="color: red;"><span style="font-style: italic;"><span style="font-weight: bold;"> </span></span></span></span>One reviewer wrote:</span><br />
<br />
<blockquote class="tr_bq">
<span style="font-size: large;"><i><span class="a-size-base review-text"> I like to read all sorts of
books, but books where there's something in it that reflects a part of
me, a part of my life, a part of my experiences, are something I go out
of my way to find. I have not found any fiction book that does nearly
as much to show what psychotherapy is like.</span></i></span></blockquote>
<span style="font-size: large;"><br />
<span id="yiv254706304yui_3_2_0_23_13479728686951459">There is is a single link to my Amazon page with all my books<span id="yiv254706304yui_3_2_0_23_13479728686951109" style="color: #ff007f;"><span id="yiv254706304yui_3_2_0_23_13479728686951076" style="text-decoration: underline;"><span id="yiv254706304yui_3_2_0_23_13479728686951075" style="font-weight: bold;"> </span></span></span><a href="http://www.amazon.com/Dinah-Miller-MD/e/B004GDR7SK" id="yiv254706304yui_3_2_0_23_13479728686951104" rel="nofollow" target="_blank"><span id="yiv254706304yui_3_2_0_23_13479728686951076"><span id="yiv254706304yui_3_2_0_23_13479728686951103" style="font-weight: bold;"><span id="yiv254706304yui_3_2_0_23_13479728686951075"><span id="yiv254706304yui_3_2_0_37_1347987256290117" style="color: #ff007f;">here</span>.</span></span></span></a></span></span><span style="font-size: large;"><span id="yiv254706304yui_3_2_0_23_13479728686951456"> </span></span><br />
<br />
<span style="font-size: large;"><span id="yiv254706304yui_3_2_0_23_13479728686951456">If you don't own a Kindle reader, you can install a <b>free</b> Kindle app on your computer, tablet, or cell phone by going </span>
<span id="yiv254706304yui_3_2_0_23_13479728686951459"><a href="http://www.amazon.com/gp/feature.html?ie=UTF8&docId=1000493771" id="yiv254706304yui_3_2_0_23_1347972868695753" rel="nofollow" target="_blank"><span id="yiv254706304yui_3_2_0_23_1347972868695387" style="color: red; font-weight: bold;">here</span></a> and then you can read any Kindle book. You don't need to buy a Kindle to read on your computer, tablet, or smartphone. </span><br />
<br />
<span id="yiv254706304yui_3_2_0_23_13479728686951459"><span id="yiv254706304yui_3_2_0_23_13479728686951076"><span id="yiv254706304yui_3_2_0_23_13479728686951103" style="font-weight: bold;"><span id="yiv254706304yui_3_2_0_23_13479728686951075"> </span></span></span></span><span id="yiv254706304yui_3_2_0_23_13479728686951459">Both
novels are also available as as paperbacks from Amazon, but not for
free. And our two non-fiction books can also be found on that page, but
again, not for free.</span><br />
<span id="yiv254706304yui_3_2_0_30_1348086496107234"><br />
I'm
more than happy to have people download my novels at no
cost </span><span id="yiv254706304yui_3_2_0_30_1348086496107234">-- I'll be keeping the doctor day gig -- so please tell/tweet/blog/share the free promotions to anyone you
think might be interested.
<span id="yiv254706304yui_3_2_0_31_1348086496107127"><br /></span><br />Finally, If you do read any of the books, please consider putting a review on Amazon. </span><br />
</span><div class="blogger-post-footer">-----
<b>Listen to our latest podcast at <a href="http://mythreeshrinks.com">mythreeshrinks.com</a> or subscribe to our <a href="http://podcast.mythreeshrinks.com/mythreeshrinks1.xml">rss feed</a>. Email us at mythreeshrinks at gmail dot com</b>
Our <a href="http://amzn.to/shrinkrap">book</a> is out now.</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-26666124.post-3857317168870878852017-11-20T21:51:00.000-05:002017-11-20T21:51:13.237-05:00Laura's Law (outpatient commitment): The Answer to Preventing Mass Murder?<div class="separator" style="clear: both; text-align: center;">
<a href="https://www.novilaw.com/images/mass-shootings-candle.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="315" data-original-width="620" height="162" src="https://www.novilaw.com/images/mass-shootings-candle.jpg" width="320" /></a></div>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">2017 has broken the record for the most mass murders in a single year -- not something to be proud of, my fellow Americans.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">After the latest mass shooting in Tehama, California, John Snook, the executive director of the Treatment Advocacy Center had an op ed piece in the The Sacramento Bee titled <br /><a href="http://www.sacbee.com/opinion/california-forum/article185089268.html" target="_blank">"Tehama Country had a tool to Get the Shooter Into Treatment. It Just Didn't Use it and the System Failed." </a> The article notes that <a href="https://en.wikipedia.org/wiki/Laura%27s_Law#Assisted_outpatient_treatment_eligibility_criteria" target="_blank">Laura's Law</a>, where a judge orders a patient to get outpatient treatment, exists in many California counties, but not the one where the shooter lived. If only, if only.</span><br />
<br />
<span style="font-size: large;">We know little about this shooter. He was a violent man with a history of stabbing a woman (he was out on bail) and of shooting at neighbors. His sister has stated that he had a long mental health and he was paranoid, and anti-government. Prior to his shooting spree, he killed his wife and buried her in the floors. The shooter worked as a marijuana farmer, we know nothing about his drug use or his treatment history. He was known to the police, and clearly repeatedly dangerous, but the judicial system saw fit to let him remain out of jail on bail, which his mother in North Carolina posted, while he awaited trial. His guns were made by the shooter with pieces he had ordered and assembled, other guns were registered to someone else (?stolen). He had a history of violence, and this crime does not sound to have been a surprise to the neighbors who feared him; one of the victims was the woman he had previously stabbed.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">So would this mass shooting have been prevented if Laura's Law was implemented in his country?</span><br />
<span style="font-size: large;">First off, we don't know about the shooter's mental health history. Oddly enough, while Tehama does not have outpatient commitment, the shooter could have been confined on an inpatient unit if a "5150" had been filed to detain him for an evaluation on an inpatient Also, the shooter had multiple charges for violent crimes -- he could have been diverted to a mental health court and mandated into treatment through the legal system. That also didn't happen-- or at least we haven't heard about any of those actions happening. I suspect that the shooter fell through the mental health system cracks, but it's clear he fell through the cracks in the legal system. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">So would Laura's Law have prevented THIS mass shooting? Perhaps, if the following list of stimpulations were met:</span><br />
<span style="font-size: large;">~If the shooter's violence was a product of his mental illness. People without mental illness are violent, and people with mental illness are violent for reasons unrelated to their psychiatric disorders.</span><br />
<span style="font-size: large;">~If the shooter's symptoms that caused him to kill people were eliminated by the use of psychiatric medications. Not everyone has a good response to medications and so far, we haven't heard that he was so much better when he took medications. Forcing people to take medications doesn't fix/prevent everything, and the average length of stay in a forensic facility for people who have committed violent crimes due to their mental disorders is YEARS. Sick, violent people don't magically get better with a judge's order. </span><br />
<span style="font-size: large;">~If the perpetrator was ordered to treatment and if he complied with the order to go to treatment and to take medications. Not everyone does, and from what we know, this man broke laws, both with his violent behaviors, and with his planned and purposeful assembly of illegal weapons.</span><br />
<span style="font-size: large;">~If services were available for the perpetrator to receive them. In half the counties in this country, there are no mental health professionals.</span><br />
<span style="font-size: large;">~Does Assisted Outpatient Treatment prevent gun violence? We don't know. In New York, where AOT has been studied, one large study showed AOT, with partner services including case management and housing prioritization, AOT reduced hospitalizations and incarcerations, but people with a history of violence were excluded from the AOT study. We don't know that outpatient commitment reduces violence or gun violence.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Just a thought: other countries have mental illness illness. Other countries don't have mass shootings. What else they don't have? One gun for every citizen. </span><br />
<br />
<br /><div class="blogger-post-footer">-----
<b>Listen to our latest podcast at <a href="http://mythreeshrinks.com">mythreeshrinks.com</a> or subscribe to our <a href="http://podcast.mythreeshrinks.com/mythreeshrinks1.xml">rss feed</a>. Email us at mythreeshrinks at gmail dot com</b>
Our <a href="http://amzn.to/shrinkrap">book</a> is out now.</div>Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-26666124.post-28094795133784328312017-11-14T08:41:00.000-05:002017-11-14T08:53:59.345-05:00When Paranoia Meets Reality: Your Medicine Snitching On You<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://www.newsmax.com/Newsmax/files/78/78c3a139-6289-4046-b4c5-6749c8a8189e.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://www.newsmax.com/Newsmax/files/78/78c3a139-6289-4046-b4c5-6749c8a8189e.jpg" data-original-height="500" data-original-width="600" height="266" width="320" /></a></div>
<br />
<span style="font-size: large;">Medication non-compliance is a problem: patients don't take their pills. We hear about it all the time in psychiatry: people don't take their medications and they relapse. Sometimes they decide they don't need them when they do, sometimes they don't like the side effects or risks of the medications, but mostly, they just forget. You may hear about this problem as if it belongs to psychiatry, but it doesn't. <a href="https://www.nytimes.com/2017/11/06/upshot/dont-nudge-me-the-limits-of-behavioral-economics-in-medicine.html?rref=collection%2Fsectioncollection%2Fupshot&action=click&contentCollection=upshot&region=stream&module=stream_unit&version=latest&contentPlacement=3&pgtype=sectionfront" target="_blank"><b>Patients don't take their cardiac medications</b></a>, either; in fact humans are only randomly compliant with all types of meds.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Swoop in technology, here to solve the problem. Now sensors placed in tablets can notify the doctor and up to four other people to inform them if and when a patient has taken their pill! And what pill was was the first to be approved for the use? Abilify: an anti-psychotic medication used to treat schizophrenia and bipolar disorder, and also used to augment anti-depressants. Was that the wisest choice? To have a tattle-tale system in a medication used to treat paranoia? I'm thinking there could be a better place to start.</span><br />
<br />
<span style="font-size: large;">So the patient swallows a medication and his stomach acid signals the sensor. He also has to wear a skin patch on his abdomen, under his ribs. A notice goes out to an App on his doctor's phone, and to anyone else he wants notified (presumably himself). He has to consent to this, but questions have been raised about whether the courts will require patients to do this in terms of release from incarceration, for mental health courts, or if it will be priced in such a way to incentivize it's use. Will people be coerced? Will they like it? Will they remember to check their App to see if their loved one took their medication? Do doctors really want to be notified every time a patient takes their medications? Will EMRs now have boxes to check to verify that the doctor has looked to see if the patient has swallowed his pill, as directed, daily, at the correct times? Will doctors be liable if they fail to check results and take action when patients aren't taking their medications and if there is a bad outcome? Will sensors work to improve medication adherence? And then there is the Creepiness Factor. You can tell I'm a bit skeptical of this, but that's not new. ClinkShrink will happily tell you that I was wary of the Internet the first time I went surfing: too slow, it will never catch on. I was wrong. </span><br />
<br />
<span style="font-size: large;">Want to read more? Here's the New York Times article: <a href="https://www.nytimes.com/2017/11/13/health/digital-pill-fda.html" target="_blank"><b>First Digital Pill Approved to Worried About Biomedical Big Brother</b></a>.</span><br />
<br />
<span style="font-size: large;">Your thoughts? </span><br />
<br />
<div class="blogger-post-footer">-----
<b>Listen to our latest podcast at <a href="http://mythreeshrinks.com">mythreeshrinks.com</a> or subscribe to our <a href="http://podcast.mythreeshrinks.com/mythreeshrinks1.xml">rss feed</a>. Email us at mythreeshrinks at gmail dot com</b>
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<a href="http://pravda-team.ru/eng/image/photo/9/2/4/72924.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://pravda-team.ru/eng/image/photo/9/2/4/72924.jpeg" data-original-height="452" data-original-width="680" height="212" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Really, this is a post for ClinkShrink, but she's been busy with other things. Do you miss her? Let me invite you to listen to Clink's interview on Tier Talk/Corrections One, where she was interviewed about <a href="https://www.correctionsone.com/facility-design-and-operation/articles/428319187-Tier-Talk-Podcast-Are-prisons-turning-into-mental-health-hospitals/" target="_blank"><b>Are Prisons Turning Into Mental Health Hospitals? </b></a></span> <br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Yesterday, I heard Dominic Sisti talk at Sheppard Pratt Hospital about mental health and incarceration: Dr. Sisti is the director of the Scattergood program for the Applied Ethics of Behavioral Health Care at the University of Pennsylvania, where I was an undergraduate just a few (hmmm) years ago. I tweeted the lecture, as best as I could, along with photos of some of the slides, so do check out the hodgepodge of venting that is <a href="https://twitter.com/shrinkrapdinah" target="_blank">my twitter feed.</a> </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">I want to use this opportunity to talk a little about the highly publicized statistics that many many people in jails and prisons are suffering from mental illness. Many believe that correctional facilities are the new psychiatric facilities. Why is this?</span><br />
<span style="font-size: large;">~Dr. Sisti and the <a href="http://www.treatmentadvocacycenter.org/" target="_blank">Treatment Advocacy Center</a>, and many others, will contend that part of the issue is that state hospitals have closed their beds without providing for adequate community services, so this represents a "transfer" of people from one institution to another. </span><br />
<span style="font-size: large;">I will add: </span><br />
<span style="font-size: large;">~Many people have psychiatric problems -- per NAMI, 1 in 5 in any given year --so we certainly would expect some people in jails and prisons to have mental disorders.</span><br />
<span style="font-size: large;">~Mental illness often co-occurs with substance abuse, and substance abuse is a crime in our country.</span><br />
<span style="font-size: large;">~Mental illness causes people to be poor, and poor people are more likely to be in correctional facilities, because poverty may lead to crime (eg. stealing food), and poor people can't afford bail or expense defense attorneys so they may stay in jails longer than people with financial resources.</span><br />
<span style="font-size: large;">~Our country has the world's highest incarceration rate, and we imprison people we are mad out, not just those we are afraid of. There has to be a better option than imprisoning people for nuisance/non-violent crimes. Many, many people go to jail for "violation of probation" when they can't meet the conditions set by judges -- for many of these folks, showing up is something they just don't seem to be able to negotiate. For some, there is home monitoring, for others there is weekend jail, but there are many people in our jails where incarcerating them amounts to our society cutting off it's nose to spite it's face: a legal record makes it harder to find employment and the cycle of crime continues.</span><br />
<span style="font-size: large;">~Incarceration rates have gone up with the "War on Drugs," minimum mandatory sentencing requirements, and an increase in drugs and guns in our society in the decades following the closure of state hospitals. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Sometimes people suffer from mental disorders, and the symptoms of their disorder directly leads them to commit crimes. For example, a person who is delusional and believes someone is going to harm him, so he hurts that person in what he perceives to be an act of self-defense and has no appreciation that this is wrong. Or maybe the logic isn't that clear, but the role of illness is, such as shooting a president to impress Jody Foster.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Sometimes people have symptoms of mental illness that lead them to commit crimes, but with a less obvious link to their illness. For example, people with depression are often very irritable, so someone who is unusually irritable may lose their temper and get into a fight that they would not have if they were not ill.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">As mentioned above, sometimes mental illness leads people to conditions that make them prone to certain crimes -- for example someone who is too sick and disorganized to maintain housing may be more likely to be arrested for loitering or trespassing than someone who owns a home. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">I mentioned co-morbid drug and alcohol addictions, and those lead people to illegal drug use, belligerent behavior while intoxicated, crimes to obtain money to obtain drugs, job and family loss and many circumstances that may lead to criminal behavior. While many people in jails and prisons are mentally ill, many more have committed crimes related to drug use.</span><br />
<br />
<span style="font-size: large;">Sometimes people who have mental illness commit crimes for reasons that have nothing to do with their mental disorders. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">If someone is obviously very ill and unable to appreciate that their crime was wrong, then many states have a way out of the corrections system: they can plead Not Guilty By Reason of Insanity and be sent for treatment rather than jail. This doesn't always go smoothly, and I'll invite you to read a recent New York Times Magazine article: <a href="https://www.nytimes.com/2017/09/27/magazine/when-not-guilty-is-a-life-sentence.html?_r=0" target="_blank"><b>When 'Not Guilty' is a Life Sentence.</b></a> </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Finally, mental health courts provide for diversion -- people who have been identified as having mental disorders can agree to treatment in order to mitigate their legal problems, and we discussed these courts in some detail in <b><a href="http://committedbook.com/" target="_blank"><i>Committed</i></a></b>. There are a few caveats to mental health court: the person must admit to having committed the crime, and certain crimes are excluded. When I was researching this chapter, I spend some time in the Baltimore City mental health court with Judge Jack Lesser. While Judge Lesser noted that people were identified for the court, it just mattered that they suffered from a mental illness, there did not need to be a clear link from the illness to the crime. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">So what's the answer? Dr. Sisti suggested that we should return to the days of asylums, in the true sense of the word: humane places to care for people who can not care for themselves. See an article in The Atlantic: <a href="https://www.theatlantic.com/health/archive/2015/01/should-the-us-bring-back-psychiatric-asylums/384838/" target="_blank"><b>Should the U.S. Bring Back Asylums?</b></a> I will tell you that I agree with Sisti: there should be somewhere for people to be when they can't care for themselves. I would add that I want housing for ALL people, not just those with mental illness: that we have people living on our streets is an enormous shame for our country and whenever I hear advocates talk about the homeless mentally ill, I want to groan. In fact I do groan: why don't we care about all homeless people? Why just those with mental illness? But I would add that if we return to asylums, that these institutions must be voluntary, otherwise they simply become human warehouses without an exit and an alternative form of incarceration. If people can be sent to these asylums against their will, society loses an incentive to work towards helping people survive in the least restrictive environment, it becomes much too easy to toss people in these places and throw away the key, and return to the abuses of the past.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">So what is the answer? I wish I knew. I'm here today to tell you the problems, but I'll invite you to add your comments and suggestions.</span><div class="blogger-post-footer">-----
<b>Listen to our latest podcast at <a href="http://mythreeshrinks.com">mythreeshrinks.com</a> or subscribe to our <a href="http://podcast.mythreeshrinks.com/mythreeshrinks1.xml">rss feed</a>. Email us at mythreeshrinks at gmail dot com</b>
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<a href="https://cdn.opendemocracy.net/files/LouisaHarvey.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="530" data-original-width="800" height="212" src="https://cdn.opendemocracy.net/files/LouisaHarvey.jpg" width="320" /></a></div>
<span style="font-size: large;"><span><span class=" UFICommentActorAndBody"><span><span><span data-ft="{"tn":"K"}"><span class="UFICommentBody _1n4g"><span><span>There's an on-line psychiatrist discussion group where docs exchange information, ideas and resources. As in all things on-line, it's sometime is invaluable, and it sometimes makes me shake my head. Today, I was tagged in a post that discussed an article in Psychiatric Times called <a href="https://www.opendemocracy.net/transformation/louisa-harvey/we-need-to-talk-about-stigma-within-mental-health-system" target="_blank"><b>We Need to Talk About Stigma in the Mental Health System</b></a>. Louise Harvey writes about her hospitalizations in the UK. Here is an excerpt so that you get the idea, and in the UK the term "sectioned" means involuntarily hospitalized.</span></span></span></span></span></span></span></span></span><br />
<span><span class=" UFICommentActorAndBody"><span><span><span data-ft="{"tn":"K"}"><span class="UFICommentBody _1n4g"><span><span><br /></span></span></span></span></span></span></span></span>
<blockquote class="tr_bq">
<br />
<div class="normal">
Quickly
it became clear that I was considered to be a histrionic, attention-seeking
young woman whose problems amounted to an individual moral failing, and a
refusal to take responsibility. I was not alone. There were other young women
my age and we were all subject to the same invalidating experiences which
served only to exacerbate our distress. </div>
<div class="normal">
Our
common presentation was self-destructive; we self-harmed and attempted to take
our own lives, refusing to suffer silently once our despair had surfaced, the
seasons of being able to keep our demons under lock and key well and truly
over.</div>
</blockquote>
<br />
<blockquote class="tr_bq">
<div class="normal">
The
common refrains we would hear from mental health nurses and doctors went like
this: ‘just take responsibility;’ ‘there’s nothing wrong with you;’ ‘you are
bed-blocking’ (even though they had sectioned many of us, including myself, and
it wasn’t in our power to free up any bed); ‘stop playing games;’ and the worst
of all, ‘no one believes you.’</div>
</blockquote>
<br />
<blockquote class="tr_bq">
<div class="normal">
Despite
being considered a risk to myself, and lacking mental capacity, these
judgements were accusations of mere misbehaviour and laden with mixed messages:
‘you are too ill to make your own decisions,’ and simultaneously, ‘you should
stop being willfully disobedient.’ It must be noted that these comments were
not levelled at the male patients on the ward, and were not reserved solely for
younger patients.</div>
</blockquote>
<br />
<blockquote class="tr_bq">
<div class="normal">
This
kind of treatment followed me for years until a desperate attempt to take my
own life by jumping from a bridge startled others into taking me seriously. I
wasn’t meant to survive. I felt that I was a lost cause and that my inability
to just snap out of the madness was a personal failing. </div>
</blockquote>
<br />
<blockquote class="tr_bq">
<div class="normal">
I
may not have died, but stigma within the system <em>kills</em>. It is far deadlier than any amount of stigma that one might
face outside of the system because these are the professionals we are told to
go to for help. Many of my friends who were treated as I was have since taken
their own lives because their distress was not taken seriously.</div>
</blockquote>
<span><span class=" UFICommentActorAndBody"><span><span><span data-ft="{"tn":"K"}"><span class="UFICommentBody _1n4g"><span><span></span></span></span></span></span></span></span></span><br />
<span><span class=" UFICommentActorAndBody"><span><span><span data-ft="{"tn":"K"}"><span class="UFICommentBody _1n4g"><span><span><br /></span></span></span></span></span></span></span></span>
<span><span class=" UFICommentActorAndBody"><span><span><span data-ft="{"tn":"K"}"><span class="UFICommentBody _1n4g"><span><span></span><span></span></span></span></span></span></span></span></span><span style="font-size: large;"><span><span class=" UFICommentActorAndBody"><span><span><span data-ft="{"tn":"K"}"><span class="UFICommentBody _1n4g"><span><span>This was my response to the group of psychiatrists, based on my experience as a clinical outpatient psychiatrist and upon the research I did for our book, <i>Committed</i>. Just so you know, within minutes, another psychiatrist called me out as being wrong, so take it for what it's worth. And remember, these issues of how to manage chronically suicidal people are very difficult for everyone: the patient, the family, and even the psychiatrist.</span></span></span></span></span></span></span></span></span><br />
<span style="font-size: large;"><span><span class=" UFICommentActorAndBody"><span><span><span data-ft="{"tn":"K"}"><span class="UFICommentBody _1n4g"><span><span> -----</span></span></span></span></span></span></span></span></span><br />
<span style="font-size: large;"><span><span class=" UFICommentActorAndBody"><span><span><span data-ft="{"tn":"K"}"><span class="UFICommentBody _1n4g"><span><span>Thank you</span><span>
for tagging me. This is a wonderful article, it gives us an insight
into the world of the patient. I think we've all been ingrained (as
people, not psychiatrists--if those can be different) that if someone
does something negat</span></span><span><span><span>ive to get
attention, then we should ignore it so as not to reinforce it, and
people who get suicidal as a means of 'seeking attention' (a horrible
thing...note sarcasm) are often dismissed, or punished-- and the
inpatient unit here is often used for punishment. The label "borderline"
turns into name calling/blaming, and not the acknowledgment of a
personality gone awry and something that no one would ever want to have.
Would you want to live a life where stress made you feel suicidal or
where slicing your skin was the only thing you could find to alleviate
psychic pain? Of course not, and yet we, too, often blame the patient. </span></span></span></span></span></span></span></span></span></span><br />
<br />
<span style="font-size: large;"><span><span class=" UFICommentActorAndBody"><span><span><span data-ft="{"tn":"K"}"><span class="UFICommentBody _1n4g"><span><span><span>What the behavioral 'ignore it' doesn't include is the Skinnerian
concept of an "extinction burst." If you ignore a behavior to get rid
of it, the behavior escalates before it extinguishes and in these cases,
you end up with a dead patient. I fully believe that if someone is
asking for attention with suicidal threats/gestures, you give them
attention, in a kind and caring way. And you point out to them what
they are doing, how upsetting it is, and you suggest that if they need
attention, they might try asking for it rather than upping the ante.
I've been known to call family members and say "your family member needs
some TLC, they are feeling suicidal and would really appreciate some of
your time and attention." It's a much quicker phone call than looking
for a bed, and so far this hasn't come back to bite me, fingers crossed,
no one has ended up dead. And I have been known to talk suicidal
borderline patients out of going to the hospital (although I do say, if
you really think you are actually going to kill yourself, then do go to
the ER!). </span></span></span></span></span></span></span></span></span></span><br />
<br />
<span style="font-size: large;"><span><span class=" UFICommentActorAndBody"><span><span><span data-ft="{"tn":"K"}"><span class="UFICommentBody _1n4g"><span><span><span>Short term (few day) hospitalizations may help people to
regroup and live through a rough moment alive and so it should be done
if there is no alternative, but this is not the best setting for a
person with a personality disorder, and if the wrong chemistry occurs on
a unit, things may get worse. Also, people with borderline
personality disorder generally have co-morbid mood disorders that should
be treated aggressively. Many people who behave terribly stop doing so
when their mood is better. More than you wanted, and you know, it's a
hard group of people to work with, and I am not the best at it. No
deaths, but often these patients leave my care, and sometimes to my relief.</span></span></span></span></span></span></span></span></span></span><br />
<br />
<span style="font-size: large;"><span><span class=" UFICommentActorAndBody"><span><span><span data-ft="{"tn":"K"}"><span class="UFICommentBody _1n4g"><span><span><span>Also, do see my article over on Clinical Psychiatry News called <a href="http://www.mdedge.com/clinicalpsychiatrynews/article/147299/depression/suicide-surprisingly-ambivalent-topic" target="_blank">Suicide: A Surprisingly Ambivalent Topic </a></span></span></span></span></span></span></span></span></span></span><div class="blogger-post-footer">-----
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<br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: large;"><a href="http://www.peteearley.com/wp-content/uploads/2012/12/Elyn-and-me.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="530" data-original-width="800" height="212" src="https://www.peteearley.com/wp-content/uploads/2012/12/Elyn-and-me.jpg" width="320" /></a></span></div>
<br />
<span style="font-size: large;">Move over, there's a new federal mental health committee in town. The department of Health and Human Services has formed the<a href="https://www.hhs.gov/about/news/2017/08/16/public-members-appointed-new-federal-effort-address-serious-mental-illness.html" target="_blank"> <b><span style="color: orange;">Interdepartmental Serious Mental Illness Coordinating Committee</span></b></a><b><span style="color: orange;">. </span></b> My friends Pete Earley and Elyn Saks are both on the committee, and Pete has been <span style="color: orange;"><span style="color: orange;"><b><a href="http://www.peteearley.com/blog/" target="_blank">blogging</a> </b></span></span>about the committee for a couple of weeks now-- the good, the bad, the ranting, and the missed opportunities after the first day of meetings last week. You'll be pleased to know that I didn't miss the opportunity to put in one of my concerns: I emailed Pete and Elyn to tell them how pre-authorization for medications is having a negative impact on the practice of medicine, and psychiatry in particular. Nothing new, but it's a topic that every medical organization has been fighting for years and nothing ever gets done, so I thought I would ask that it be brought up again. My thanks to Pete for including my concern on <a href="http://www.peteearley.com/2017/08/30/agenda-for-federal-advisory-committee-meeting-and-suggestions-ending-hotline-for-snow-anxiety/" target="_blank"><span style="color: orange;"><b>one of his blog posts</b></span></a>. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">When people talk about serious mental illness (SMI), I always have the same reaction: What is it? From what I can tell, one gets the designation with a diagnosis: schizophrenia or bipolar disorder or severe depression. Apparently it's not about illness chronicity or impairment, or spending time in institutions, or whether an illness responds to treatment. I'm always at a loss: as <a href="http://psychiatrist-blog.blogspot.com/2015/02/on-government-oversight-and-caring-for.html" target="_blank"><span style="color: orange;"><b>I've said before</b></span></a>, our diagnoses are not precise, prognoses can be wrong, and people can be very sick at one point in time and very well at others. So while 1 in 8 adults are on SSRI's, 1 in 5 suffer from an episode of mental illness during the course of a year, and half of us will have an episode of mental illness during the course of a lifetime, these people with serious mental illness are quite few: 4.5 million Americans. I wish these people wore signs so we knew who they were and could divide the resources appropriately. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">That said, the conversation about SMI often flows to the topic of involuntary treatment. It goes along the lines of ...if only. If only we could force sick people to get treatment then they wouldn't end up in jails and prisons. If only we could force sick people to get treatment then they wouldn't be homeless, on the streets, committing violent crimes and mass murders. If only. If only it were that simple. What gets missed is that addiction co-occurs with mental illness, and poverty confounds it all --so if only people were not raised in poverty, exposed to violence, and addicted to drugs and alcohol, then so many fewer people would be living on our streets, in our jails, and committing acts of violence. If only. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">There is another problem with this kind of thinking. It divides us into those who are FOR and those who are AGAINST forced care. It leaves out the key factors of Access to Treatment and Engagement. Not everyone who needs care can get it: we have a psychiatrist shortage in this country. And not everyone who says No to treatment will continue to say No, but if they do say No and the response is to have guards brutally tackle them and inject them with sedating medications, then there is a good chance that future efforts at engagement may be met with resistance. Sometimes, it helps to meet people on their own level, to get to know them, to let them become comfortable and trusting, and then some of these people who initially said No may become agreeable to getting care. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">The argument goes that those who refuse treatment have an inability to see they are sick, that this lack of insight it a symptom of the illness, and therefore it is a medical issue, not a civil rights issue. I hesitate to use the term "anosognosia" because the word has become so politically loaded; those who use it believe that involuntary treatment is often the only option. I would contend that people who don't believe they are ill can often be engaged in treatment. I'm not one for standing in someone's face and asking, "Do you know you have a mental illness?" Instead, people will often take medications because they feel better on them, because they are good patients who do what the doctor says, because a family member asks them to, or because while they may not think they are mentally ill, they do notice that life goes better if they swallow a pill everyday. </span><br />
<br />
<span style="font-size: large;"><span style="font-size: large;">Yes, I do
know that there are some very sick people who are offered quality care
and who just can't be engaged, and who would benefit from care that is
not voluntary. But it's not a clear pro-force/anti-force picture, and
it's always better to work with a patient if you can.</span> </span><br />
<br />
<span style="font-size: large;">So thank you to my friends in high places who are giving their time, energy, and efforts to helping our federal government figure out how to help people with serious mental disorders. I look forward to reading more about your endeavors!</span><div class="blogger-post-footer">-----
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<a href="http://static.psychguides.com/wp-content/uploads/psychguides-shutter137890340-inpatient-group-psychotherapy.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://static.psychguides.com/wp-content/uploads/psychguides-shutter137890340-inpatient-group-psychotherapy.jpg" data-original-height="225" data-original-width="300" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">I'm going to send you over to the <i>Washington Post </i>for an article that was published last week, written by Stanford psychiatry resident Dr. Nathanial Morris: please check out <a href="https://www.washingtonpost.com/national/health-science/psych-wards-arent-what-you-think-ive-seen-lives-saved-there/2017/07/21/cb92acb6-619e-11e7-a4f7-af34fc1d9d39_story.html?utm_term=.7a623347d667" target="_blank"><span style="color: red;"><b><span style="color: #783f04;">'Psych Wards' aren't what you think</span></b></span></a>. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Morris makes the point that the inpatient psychiatry units is portrayed something out of a horror show, when really it is a place of healing. He writes:</span><br />
<br />
<blockquote class="tr_bq">
<span style="font-size: large;">These are places where patients put their lives back together, picking
up the pieces torn apart by such illnesses as depression, bipolar
disorder and schizophrenia. Caregivers from doctors and nurses, to
social workers and psychologists work to heal the sick, to guide
patients out of the abyss. Families often reconcile with loved ones.
Patients may find hope in one another, opening up in groups, sharing
meals, discovering the comfort of shared experiences.</span></blockquote>
<br />
<span style="font-size: large;">Morris is right. People go in to hospitals in miserable states and they come out better. They don't, however, necessarily appreciate the care they've received. As we note in our book, <i><a href="http://committedbook.com/" target="_blank"><b>Committed,</b></a></i> some people come out feeling terribly traumatized. If they feel better, they may attribute it to reasons other than the psychiatric treatment they received. Perhaps they healed from time, or being away from their problems, or the kindness of a nurse or their fellow patients. Ah, yes, moments of healing.</span><br />
<br />
<span style="font-size: large;">Morris points out that part of destigmatizing inpatient care involves acknowledging psychiatry's dark past. Again, he's right. What he doesn't say is that psychiatry continues to be dark in many ways related to inpatient care. Psychiatry is not a money maker -- the resources are not always there for the luxury rooms and pleasant surroundings that might be found perhaps on the orthopedic floor. And beds are reserved for the sickest of the sick: those who are both ill and dangerous. We remain the <i>only</i> specialty where pre-authorization for inpatient care demands a life-threatening level of acuity-- if you're not suicidal, you go home. It means the inpatient units are full very sick people and sometimes there are dangerous, patients may hurt each other or the staff or themselves; it's the sad reality. And treatment is sometimes dictated by doing what needs to be done in an understaffed environment to keep people safe, even if it means the care is not what is ideal in the long run for the individual patient. This is not to ruin such a lovely article because Dr. Morris is right (once again)-- psych units are full of tender moments, they are about healing, and they aren't about torture. Often, they are about pressing the 're-set' button after the power has gone out.</span><br />
<br />
<span style="font-size: large;"> We're short on beds and negotiating the system is difficult. It should be easy. If more people could or would get the care they need, we'd have fewer suicides, less suffering, and fewer people in jails. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Morris goes on to say: </span><br />
<span style="font-size: large;"><br /></span>
<br />
<blockquote class="tr_bq">
<span style="font-size: large;">Overcoming the stigma against psychiatric units won’t be easy. But I think it’s possible.</span></blockquote>
<br />
<blockquote class="tr_bq">
<span style="font-size: large;"> </span><span style="font-size: large;">Familiarizing
the public with psychiatric care is a first step. Stereotypes against
psychiatric units endure when these places remain unknown and out of
sight. By opening up about the realities of mental-health treatment,
providers and patients can address the pervading views of the “psych
ward” as a place of torture and imprisonment. This kind of transparency
can illuminate psychiatric care’s potential for healing rather than
horror.</span></blockquote>
<span style="font-size: large;">Bravo! </span><div class="blogger-post-footer">-----
<b>Listen to our latest podcast at <a href="http://mythreeshrinks.com">mythreeshrinks.com</a> or subscribe to our <a href="http://podcast.mythreeshrinks.com/mythreeshrinks1.xml">rss feed</a>. Email us at mythreeshrinks at gmail dot com</b>
Our <a href="http://amzn.to/shrinkrap">book</a> is out now.</div>Unknownnoreply@blogger.com9tag:blogger.com,1999:blog-26666124.post-70296117079304479622017-07-18T22:12:00.000-04:002017-07-18T22:15:19.387-04:00Swiping for Therapists<div class="separator" style="clear: both; text-align: center;">
<a href="https://www.apkrec.com/wp-content/uploads/2016/05/Tinder-APK-Screenshot.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="250" data-original-width="400" height="200" src="https://www.apkrec.com/wp-content/uploads/2016/05/Tinder-APK-Screenshot.jpg" width="320" /></a></div>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Over in <i>The New York Times</i>, Melissa Miller has an article titled "<span style="color: orange;"><a href="https://www.nytimes.com/2017/07/17/smarter-living/how-to-find-the-right-therapist.html" target="_blank">How to Find the Right Therapist</a>.</span>"</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Miller compares it to dating, and she makes the very valid point that good chemistry helps, it's really nice to like and respect your psychotherapist, and to feel a sense of rapport. In psychotherapy, the talking is an integral part of the treatment and the relationship itself can be healing. So it is important in therapy that the patient be comfortable confiding in the therapist, be open and honest, and feel safe saying things that can make one feel vulnerable.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Miller compares it to dating, and talks about the pleasure of comparing wedding plans with her finally-found perfect therapist. She then offers advise on how you, too, can find a good therapist. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Her advise is awful. Really. It's not that some of her points aren't valid, but she starts by giving a quick summary of what type of professional you should see:</span><br />
<span style="font-size: large;"><br /></span>
<br />
<blockquote class="tr_bq">
<h4 class="story-subheading story-content" data-para-count="44" data-total-count="969">
<span style="font-size: large;"><i>Determine the type of professional you need.</i></span></h4>
<div class="story-body-text story-content" data-para-count="370" data-total-count="1339" id="story-continues-2">
<span style="font-size: large;"><i>If
you’re suffering from ailments like panic attacks, depression,
post-traumatic stress disorder or obsessive-compulsive disorder, look
for a clinical psychologist or social worker rather than a psychiatrist,
said Dr. David D. Burns, adjunct clinical professor emeritus at the
department of psychiatry and behavioral sciences at Stanford University
School of Medicine.</i></span></div>
<span style="font-size: large;"><i>
If the issue is something more like bipolar disorder, major depressive disorder, sociopathy, borderline personality disorder or <a href="https://www.nytimes.com/2016/01/28/health/schizophrenia-cause-synaptic-pruning-brain-psychiatry.html">schizophrenia</a>, it’s best to see a psychiatrist or a psychologist with considerable experience in that specialty</i></span></blockquote>
<br />
<span style="font-size: large;">I don't know Dr. Burns, whom Miller quotes, but really? Don't see a psychiatrist for panic attacks, depression, PTSD, or OCD? But, hey, we apparently do a great job curing sociopathy! I don't get the division, and I'd suggest that all of those conditions are well-treated by psychiatrists (which may or may not include medications in the treatment). </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Miller advises readers to check therapist reviews on-line. She doesn't point out that anyone can review anything and there is no way of knowing that good or bad reviews are not verified to be from patients and may be from best friends, ex-lovers, or even the therapist himself. I'd go for personal recommendations from doctors or known patients myself. And Miller proudly touts that she ghosts her eating disorder counselor and 'broke up' with her therapist by text. Hmmm.....</span><br />
<br />
<span style="font-size: large;">Do some research, she suggests, and it seems reasonable to check to make sure the therapist has reasonable credentials and hasn't been sanctioned by a licensing board for something egregious. A quick telephone discussion is also reasonable, but the author suggests asking the therapist what they like most about being a counselor. Again, really? Maybe stick to 'Do you have experience treating my problem.' I'm not sure it's best to start a relationship with a therapist by inquiring about their personal motives for going to work each day; much as I love my work, being asked what I like best about my work by a stranger looking for treatment might make me feel like a college student being asked that wonderful question of "where do you see yourself in 10 years." </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">She goes on to address issues of insurance participation and finances. She suggests that if it's too expensive that the patient should switch the sessions to once a month (not necessarily a bad idea, but shouldn't the therapist be consulted?) or use Skype or email for sessions -- and why would Skype be cheaper? And how would email work? She goes on to quote Michelle Katz, a nurse/health advocate:</span><br />
<span style="font-size: large;"><br /></span>
<br />
<blockquote class="tr_bq">
<div class="story-body-text story-content" data-para-count="94" data-total-count="7069">
<span style="font-size: large;"><i>“They become family to you, so you can ask them to work on a payment plan,” Ms. Katz said.</i></span></div>
<div class="story-body-text story-content" data-para-count="299" data-total-count="7368">
<span style="font-size: large;"><i><br /></i></span></div>
<div class="story-body-text story-content" data-para-count="197" data-total-count="7565" id="story-continues-5">
<span style="font-size: large;"><i>“Anything
is negotiable, and if a therapist is not willing to negotiate with you,
especially after you’ve been with them for a while, it’s probably not a
good match for you,” Ms. Katz said.</i></span></div>
</blockquote>
<div class="story-body-text story-content" data-para-count="197" data-total-count="7565" id="story-continues-5">
<br /></div>
<div class="story-body-text story-content" data-para-count="197" data-total-count="7565" id="story-continues-5">
<span style="font-size: large;"> Finally, Miller talks about timelines for treatment and quotes Dr. Burns again:</span></div>
<div class="story-body-text story-content" data-para-count="197" data-total-count="7565" id="story-continues-5">
<span style="font-size: large;">“If my son or daughter were depressed, I’d want them to go to a
therapist who can get them dramatic improvements in just a few sessions,
not just have them pondering their life for months or years without
change,” he said.</span></div>
<div class="story-body-text story-content" data-para-count="197" data-total-count="7565" id="story-continues-5">
<br /></div>
<div class="story-body-text story-content" data-para-count="197" data-total-count="7565" id="story-continues-5">
<span style="font-size: large;">Rapport is important; feeling cared about, feeling comfortable-- these are all good. Competency is also important, and Miller doesn't address this beyond a minimal level. She talks about looking for a therapist like looking for a date, and she assumes the date has no needs of his own: that every patient's a great catch who every therapist would be thrilled to have. But mental health care is often limited by huge demand, and therapists might not negotiate rates because they have mortgages, student loans, childcare, and food costs. It's a give and take -- skype and email sessions might not be in the patient's best interest or convenient for the therapist. And if you call my office, before you even know me, please don't quiz me on what I love best about my job. Just sayin'. </span></div>
<br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">So finally, if you want my thoughts on how to find a psychiatrist, I'm going to link you back to an old Shrink Rap post: </span><br />
<span style="color: orange;"><a href="http://psychiatrist-blog.blogspot.com/2010/10/how-to-find-psychiatrist.html"><span style="font-size: large;">http://psychiatrist-blog.blogspot.com/2010/10/how-to-find-psychiatrist.html</span></a></span><br />
<br /><div class="blogger-post-footer">-----
<b>Listen to our latest podcast at <a href="http://mythreeshrinks.com">mythreeshrinks.com</a> or subscribe to our <a href="http://podcast.mythreeshrinks.com/mythreeshrinks1.xml">rss feed</a>. Email us at mythreeshrinks at gmail dot com</b>
Our <a href="http://amzn.to/shrinkrap">book</a> is out now.</div>Unknownnoreply@blogger.com9tag:blogger.com,1999:blog-26666124.post-85430249632254736562017-07-08T15:18:00.002-04:002017-07-09T08:13:06.240-04:00The Interesting Thing About Reviews of Committed.....<div class="separator" style="clear: both; text-align: center;">
<a href="https://yemiks.files.wordpress.com/2015/10/wpid-pendulum.png?w=994" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="534" data-original-width="800" height="213" src="https://yemiks.files.wordpress.com/2015/10/wpid-pendulum.png?w=994" width="320" /></a></div>
<br />
<span style="font-size: large;">Hello! It's been a month since the last Shrink Rap post, and it's now summer. I love the long days and the slower pace. There have been many times when I have read something and have thought, 'I want to write a blog post about that....' but then time gets the best of me and I end up tweeting it instead. I do believe my brain has reduced itself to 140 character thoughts. Please do follow me on Twitter at h<a href="ttps://twitter.com/shrinkrapdinah"><span style="color: red;"><b>ttps://twitter.com/shrinkrapdinah</b></span></a></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">As you may know, <a href="https://twitter.com/clinkshrink" target="_blank"><b>ClinkShrink </b></a>and I are the authors of <a href="https://www.amazon.com/Committed-Battle-over-Involuntary-Psychiatric/dp/1421420783"><i><b>Committed: The Battle Over Involuntary Psychiatric Care,</b></i></a> released by Johns Hopkins University Press on November 1st. The last few reviews of the book have reminded me how divisive the topic can be. While all the reviewers have talked about the book as being readable and dressed in the stories of people, the reviewers themselves have opinions on the topic and let them be known. Let me tell you more.</span><br />
<br />
<span style="font-size: large;">In <b><i>Committed</i></b><a href="https://www.blogger.com/null">,</a> we talk about the anti-psychiatry groups, and we give a voice to those who feel psychotropic medications are ineffective, harmful, or even the cause of psychiatric symptoms. Reviewers from these groups have invariable noted that, as psychiatrists, we go on to write about the different aspects of forced care with the supposition that psychiatric treatments work, and we don't do a comprehensive challenge of their efficacy. These reviewers are right: our combined 50+ years of experience is that our treatments are helpful to many people, and we limited our perspective to that of involuntary care. We were not interested in writing a book that questions the efficacy of the treatments -- that's been done by others, and the idea that psychotropic medications don't help everyone or cause some people to have intolerable side effects, is something we discussed in our first book, <a href="https://www.amazon.com/Shrink-Rap-Three-Psychiatrists-Explain/dp/142140012X/ref=mt_paperback?_encoding=UTF8&me=" target="_blank"><i><b>Shrink Rap: Three Psychiatrists Explain Their Work</b></i></a>. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">On the Mad in America website, Dr. Sandra Steingard starts <a href="https://www.madinamerica.com/2017/02/committed-battle-involuntary-psychiatric-care/"><span style="color: red;"><b>her review </b></span></a>with: </span><br />
<br />
<blockquote class="tr_bq">
<span style="font-size: large;"><i>Dinah Miller and Annette Hanson are two of the three psychiatrists who blog at <a href="https://psychiatrist-blog.blogspot.com/">Shrink Rap</a>.
After I started blogging, I began to search out other blogging
psychiatrists and I found them. They also have articles published in
Clinical Psychiatry News. My impression is that they are decent,
well-meaning, and thoughtful psychiatrists (not unlike most of the
psychiatrists I know) who want to demystify our profession. Their
writing is clear, straightforward, and accessible. Like me, they are all
practicing psychiatrists and they deal with the pragmatic challenges we
face in our daily work. They offer critical views but they overall seem
proud of their profession and their careers. While I respect their
work, in that area we seem to differ; they do not seem to be burdened by
the professional existential angst that besets me.</i></span><br />
<br />
<span style="font-size: large;"><i>On one topic we agree — the subject of involuntary care is the most
vexing, contentious, and troubling topic for psychiatry. To their great
credit, they have directed an enormous amount of attention and effort to
this subject in their latest book, <a href="https://www.amazon.com/Committed-Battle-over-Involuntary-Psychiatric/dp/1421420783/ref=sr_1_1?s=books&ie=UTF8&qid=1470260964&sr=1-1&keywords=committed+dinah+miller"><i>Committed: The Battle Over Involuntary Psychiatric Care.</i><i> </i></a></i></span></blockquote>
<br />
<span style="font-size: large;">I found it interesting that later in her review, Steingard talks about the concoction of medications that Eleanor (the patient against involuntary treatment) was placed on in the hospital -- she calls it a 'shocking cocktail" and talks about our 'unexamined confidence.' Ah, Dr. Steingard wasn't there for our behind-the-scenes discussion, or for the article that came out of this particular discussion-- <a href="http://www.mdedge.com/clinicalpsychiatrynews/article/77644/questioning-psychiatrys-assumptions-about-lifelong-medications" target="_blank"><b>Questioning Psychiatry's Assumptions About Lifelong Antipsychotics</b></a>-- it was far from unexamined. I was astounded by the cocktail of medicines-- in the Clinical Psychiatry News article, I refer to it as 'enough medication to drop a Clydesdale-- but in criticizing it for <b><i>Committed</i></b>, Clink felt we were throwing the treating psychiatrist under the bus. We decided to report the cocktail and leave it to any reader in the know to be shocked (as we were), and suffice it to say, this was not a combination of medications we could imagine prescribing. Does that make it wrong? Eleanor, as the chapter notes, had many side effects, but she also got better. While I don't advocate this particular cocktail, we decided it wasn't fair to comment on another doctor's prescribing when we weren't there and the patient ultimately got better --though not with her own share of distress and trauma from the admission. The Monday morning quarterback always play the game better.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">On the other side of the debate, Dr. Lloyd Sederer has posted <a href="https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201707/committed-the-battle-over-involuntary-psychiatric-care"><span style="color: red;"><b>his review</b></span></a> of <b><i>Committed </i></b>on the Psychology Today website. Sederer starts by talking about the topic in broad terms:</span><br />
<span style="font-size: large;"><br /></span>
<br />
<blockquote class="tr_bq">
<span style="font-size: large;"><i>Americans act
as if they have a covenant that demands of them considerable liberty
and privacy. These warranties have, at times and in my opinion, exceeded
other warranties such as public safety and the public’s <a class="inline-links topic-link" href="https://www.blogger.com/null" title="Psychology Today looks at health">health</a> – sometimes even common sense.</i></span></blockquote>
<span style="font-size: large;">Sederer's perspective, as you might imagine, feels to be more pro-involuntary treatment, although he goes on to say that the pendulum needed to swing away from a doctor-knows-best stance, then he asks if it has swung too far<i>. </i>He goes on to write:</span><br />
<br />
<blockquote class="tr_bq">
<span style="font-size: large;"><i>This is the important question and challenge that Drs. Miller and Hanson
have undertaken in what is an exceptionally intelligent, clear,
readable and well researched manner. They do have a POV (point of view),
which they express early on and weave into the book’s narrative: they
call for “…the judicious and limited use of involuntary and humane
psychiatric care, as a last resort, after every attempt has been made to
thoughtfully engage patients in accessible, kind and comprehensive
services on a voluntary basis.” </i></span><br />
<span style="font-size: large;"><i></i><i><br />Their book first describes the “for” and the “against” arguments for
involuntary treatments. They have tapped the nation’s authorities on
these subjects so we gain access to the clearest and most informed of
sources. Then comes a section on “Civil Rights”, where we learn about
the history and processes of commitment laws. The authors then turn
their attention to hospitals (general, public and private hospitals),
and their delivery of emergency room, inpatient, crisis and outpatient
care. They handle this (in fact, all material) in a story-based manner
with abundant actual clinical examples, using pseudonyms to protect
privacy. It is like we are there to share the dilemmas that patients,
families and clinicians face in profound and uncertain ways.</i></span></blockquote>
<br />
<span style="font-size: large;">We have been pleased: the reviews of <i>Committed: The Battle Over Involuntary Psychiatric Care</i> have been uniformly positive from both sides of the battle field. It is, as we knew, a book that everyone might hate: for the pro-involuntary care side, we don't take a strong enough view; for the anti-forced care side, we are not critical enough of our field. Again, thank you to all the reviewers, and to all of our blog readers who contributed to the book, and to those who inspired us to write it!</span><br />
<br />
<div style="text-align: left;">
<span style="font-size: large;">Are there messages I'd like to get across? Yes:</span></div>
<ul>
<li><span style="font-size: large;">Be kind to the patients.</span></li>
<li><span style="font-size: large;">Patients may be traumatized by involuntary care, so it should not be undertaken lightly.</span></li>
<li><span style="font-size: large;">Forcing treatment won't cure society's problems, but there are times when it may well help the individual involved.</span></li>
<li><span style="font-size: large;">It's kind of crazy that we put so much emphasis on debating forced care when there are so many people who want the treatments we have to offer but can not access them voluntarily.</span><span style="font-size: large;"> </span></li>
<li><span style="font-size: large;">Our mental health system is a mess and forced care is a very complex topic. </span></li>
</ul>
<span style="font-size: large;">If you want to learn more about <b><i>Committed</i></b>, do visit our website at <a href="http://committedbook.com/"><b>CommittedBook.com</b></a>. </span><br />
<br />
<span style="font-size: large;">Finally, I am going to change the topic and send you over to Pete Earley's blog. I recently wrote about the <a href="https://www.psychologytoday.com/blog/committed/201706/namis-identity-crisis" target="_blank"><b>NAMI elections</b></a> and how they were really about involuntary treatment. Since then, the elections have happened, and Pete writes about the results in <span style="color: red;"><b><a href="http://www.peteearley.com/2017/07/01/nami-elects-new-board-members-but-not-without-controversy/">NAMI Elects New Board Members But Not Without Controversy</a>. </b></span></span><div class="blogger-post-footer">-----
<b>Listen to our latest podcast at <a href="http://mythreeshrinks.com">mythreeshrinks.com</a> or subscribe to our <a href="http://podcast.mythreeshrinks.com/mythreeshrinks1.xml">rss feed</a>. Email us at mythreeshrinks at gmail dot com</b>
Our <a href="http://amzn.to/shrinkrap">book</a> is out now.</div>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-26666124.post-15622516631344864842017-06-06T21:23:00.002-04:002017-06-06T21:59:32.738-04:00NAMI: or It's All in the Words....<div class="separator" style="clear: both; text-align: center;">
<a href="https://www.deepdotweb.com/wp-content/uploads/2014/03/dictionary1.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="468" data-original-width="750" height="199" src="https://www.deepdotweb.com/wp-content/uploads/2014/03/dictionary1.png" width="320" /></a></div>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">As I mentioned earlier, I've written a <a href="https://www.psychologytoday.com/blog/committed/201706/namis-identity-crisis"><span style="color: red;"><b>post</b></span></a> over on PsychologyToday about how I believe the upcoming NAMI election and the question of whether NAMI will cover a 'big tent' or a 'small tent' -- a focus on severe mental illness versus all mental illness-- is about forced psychiatric care.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">One the candidates for office, DJ Jaffe, responded to my PsychologyToday post and said it's wrong, and I should change it. It's an opinion, not a statement of fact, so I'm hanging out with my first amendment right to free speech. Mr. Jaffe included his whole campaign speech and you're welcome to<a href="https://www.psychologytoday.com/blog/committed/201706/namis-identity-crisis"><span style="color: red;"><b> check it out</b></span></a>. His contention is that in broadening the tent to include all, the SMI (serious mental illness) agenda has been pushed out into the rain, not included, and goes point-by-point through why this is so. I'm moving the discussion here because it's an easier venue for me to negotiate (PsychologyToday has a more difficult template and requires editorial approval).</span><br />
<br />
<span style="font-size: large;">Just some thoughts: </span><br />
<span style="font-size: large;">Mr. Jaffe writes:</span><br />
<blockquote class="tr_bq">
<span style="font-size: large;">For example, in almost all their communications NAMI National has
replaced the phrase “mental illness” with the phrase “mental health
conditions” as if mental illness were a dirty phrase not to be uttered
in polite company. </span><span style="font-size: large;"><br /></span><br />
<span style="font-size: large;"><br /></span></blockquote>
<span style="font-size: large;">My feeling is that I'm a psychiatrist and I treat psychiatric conditions, just as a dermatologist treats dermatologist conditions, or one might see a nephrologist with a kidney condition. Mental health conditions, mental illness, psychiatric disorder. The truth is that we don't really have a definition for this: DSM-V has nearly 300 diagnosis, it's easy to get into a box if you want. The SMI folks tend to focus on diagnosis as though it's absolute and accurate and each one has a uniform prognosis, specifically schizophrenia, bipolar disorder, and severe depression. Diagnosis can be wrong, it can have a variety of prognoses, and other illnesses-- such as severe obsessive compulsive disorder, severe anxiety, and eating disorders --can be terribly disabling and can cause incredible psychic torment. "Minor" problems such as adjustment disorder, can result in suicide. My pet peeve is with calling psychiatric disorders "behavioral disorders." Many of the people I treat are lovely human beings who behave just fine, thank you.</span><br />
<br />
<span style="font-size: large;">Mr. Jaffe says that anosognosia is far more important than access to services in keeping people from getting care. Clearly, Mr. Jaffe has not tried to get care using his public insurance at a clinic in Baltimore. </span><br />
<br />
<span style="font-size: large;">Finally, in terms of words, I'm told that it's objectionable to those who advocate for the SMI population to use the words Hope and Recovery. Who could be against Hope? Who wants to go see a psychiatrist to be told there is no hope, that they will never get better? Of course people get better, why else would they come? All better? What does that mean? Most people experience a decrease in symptoms. Many find that therapy helps them to understand their issues and communicate in a more functional manner, which makes their lives go more smoothly. (Oh, but much of SMI advocacy is about medications with little thought to therapy). Many people come in looking horribly sick, tormented and suffering, and then do get better: they return to work or to school or to having meaningful relationships. It often takes time; it's unfair to tell people that they won't get better and have a poor prognosis because we just don't know. SMI often gets to be about forced medications, and distress about homelessness and incarceration. If you want people to be housed, might I suggest providing them with housing?</span><br />
<br />
<span style="font-size: large;">And finally, I am perplexed that NAMI objects to the term 'suffering.' It's an important word for the sake of helping to convey your psychic pain to another human being, and I often ask people if they are suffering or tormented, and those who look quite well, often say yes. </span><br />
<br />
<span style="font-size: large;">Ah the words. So much power to injure, but these particular words don't have much power to heal.</span> <br />
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