Mental Health Blogs

Archive for August, 2009

Choosing a therapist is a very tricky business.  Personalities must mesh and there must be some agreement on the purpose of the process and how to proceed.

1.  How do you work through your own issues?
This is not the same as asking what the therapist's issues are.  That would be TMI (Too Much Information) and would put the focus on her instead of on you, which a good therapist will not allow to happen.  But asking how they work through issues is a reasonable question.  If they deny having any issues, RUN.  Everyone has issues, that includes therapists.  If they are not self aware to know that they have issues, what they are and how they are addressing them, how are they going to help you become more self aware?

2.  How do you deal with religious issues in therapy?
This is not the same as asking what the therapist's religion is.  Again, this is TMI and puts the focus on them.  What you really want to know is how they are going to work with your religious beliefs in therapy.  Some appropriate ways are: 

• They clearly identify the religious philosophy they practice in the first appointment and tell you how they plan to incorporate that philosophy into their clinical practice.  For instance, a "Christian counselor" might bring prayer and forgiveness into sessions and interpret behavior using a biblical perspective.    
• They do not bring their religion into the session and work solely from your paradigm.  If you are Muslim, they work from the teachings of Islam.  If you are Christian, they work from within that framework.  If you are an atheist, they do not bring up spirituality or religiosity.

Some inappropriate ways in which therapists may deal with religious issues is to be working from a certain religious philosophy and not identify themselves as such.  Another inappropriate way is to fail to address the issue with you and to bring their personal religious philosophy or dogma into the session without your permission during subsequent sessions.  A counselor or therapist should not use the counseling session to proselytize their faith without informing you up front of their intention to do so and having your consent.  This is completely unethical.  They should also not disparage, deny or in any way disrespect your religious beliefs.

3.  How do you help people with therapy (or counseling)?
If they give any type of answer which indicates they believe they will fix you, RUN.  Therapy should be about helping you find your own way, not about the therapist demonstrating what a great healer they are.  You should discover how strong and intelligent you are, not how great they are.

4.  I would like a brief explanation as to what I can expect to happen in my sessions.

A therapist should be able to tell you the types of techniques they will utilizing and the theoretical basis of therapy which they employ.

5.  How will my confidentiality be assured?

It is completely appropriate to ask how your files and information are stored and where.  Who has access to them.  How will the therapist handle it if your mother or your ex-husband call and ask about you?  If you are in the middle of a custody battle for a child or a divorce, what will happen if the other side subpeonas the therapist's records?

6.  What happens when I have a crisis on the weekends or on holidays?

Does the therapist have an after hours number or is there someone on call during these times?  If not, who should you call or what services should you access?

7.  How much do you charge per session?

Do not be shy about money.  You are procuring the services of a professional and he should be able to tell you exactly what sessions cost.

8.  How long are sessions?

Sessions typically run from 45-50 minutes in order to allow the clinician 10-15 minutes to document the session.

9.  What are my treatment options?

You have a right to know other methods available by which your symptoms or issues could be addressed whether it be with medication, lifestyle changes, dietary changes, or alternative healing methods.  The therapist should be willing to discuss the pros and cons of each treatment modality to the best of their knowledge as well as the pros and cons of talk therapy.  

10. What could have caused my condition (e.g., depression, anxiety, stress disorder) to develop? How common is it? Could it have hereditary roots? How is it related to my age, lifestyle, gender, current medical condition, or a recent occurrence or set of circumstances in my life?

Different therapists have different opinions and viewpoints about the causalities of symptoms and behaviors.  What they view to be the cause of a behavior will determine how they treat it. 

The therapist is not a physician (unless they are a psychiatrist, but they are still not practicing general medicine) and should not be dispensing medical advice.  However, they can make you aware of any knowledge they have of how certain lifestyles or situation can affect you.  They should also be able to tell you the differences in how symptoms are manifested in men vs. women, in different ages and in different circumstances. 

If you suspect a possible medical cause, please have a complete physical with your medical doctor before contacting a therapist.  If your therapist suggests a potential medical cause they may refer you for a complete physical before proceeding.

11. How likely is it that my symptoms will return in the future? What can I do to help prevent that from happening?

Your therapist is not a psychic and cannot foresee the future or all possible outcomes.  However, they may be able to provide you with possible scenarios or situations which might provoke your symptoms to return.  They should also be able to provide you with assistance in developing coping skills which will allow you to deal with a reoccurrence of symptoms. 

12. Are there any alternative treatments (e.g., special diet, acupressure, massage therapy, biofeedback, vitamin/mineral regime, yoga, exercise program) that would complement my recovery program and help me feel better faster?

Most therapists are aware of other practices which will help in psychological healing.  No therapist is an expert in every possible intervention which might help, but they should be fairly well versed in helping you help yourself.

13. Can you think of anything more that I should be asking or considering?

This is an excellent question I wish more people would ask.  Many times I am aware of things which might be helpful they might not be aware of.  An open ended question such as this allows the clinician to provide answers to questions you might not have thought of. 

14. When my family or friends ask how they can help me with my recovery, what things can I suggest?

This is a great question that any question should be happy to answer.  Support systems are crucial in healing and determining how to request help and what type of help would serve you best is important.

15. Is there a video, book or any other printed literature that contains useful information about my symptoms and recovery plan?

This is another good question.  Often, therapists have a list of resources for self education on various issues.  If your therapist frequently has no answer for this, I would have to wonder how well read they are on the topic.  Books, videos and other literature recommended by your therapist should take into account your personal belief systems.  Once again, recommending literature to a Muslim which has a heavy Christian message would be highly imappropriate unless the therapist addresses this in advance.

16. Are there lifestyle changes I can make that will speed up my recovery? Would I continue these changes just until I begin to feel better, or would they need to become a permanent part of my everyday routine?

This is an excellent question which I wish more clients would ask of me and their medical doctor.  So often, there are simple but powerful changes they can make in diet and habits which can affect not only their mental health but their physical health, yet no one ever tells clients or patients of this self care.  The ability to care for yourself and heal yourself not only exponentially increases the likelihood of success, but empowers you to take care of yourself.  A therapist should be happy to talk to you about this and have answers ready which are sensible and make sense to you.

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She's outraged.  Everyone in the girl's dorm is mad at her.  Everyone at work is mad at her.  Everyone in her family is mad at her.  Even her boyfriend is mad at her.  She fumes about injustices, favoritism and toadying.  She's weary from battle and furious at the wrongs of society.  She's targeted, gossiped about, confronted, ostracized and perceived to be a troublemaker.  Does this pattern sound familiar? 

This young woman is the scapegoat in her family of origin.  If you were the scapegoat (the black sheep, the screw up, the problem child) in your family you probably replicate that pattern in all of your adult relationships.  Whether it's colleagues at work, friends or romantic partners, somehow you end up being the scapegoat in every situation.  How does this happen?  How do you stop the pattern?

I was the scaepgoat in my family, so this is a subject that is near and dear to my heart.  Do I still replicate the pattern?  I tend to, but I'm becoming better and better and stopping the pattern.  It is hard work.  You have to be willing to take a long hard look at your own behavior and own up to the part you play in recreating the role.  You have to be willing to give up long held beliefs and ideals.  You have to be willing to do something different.  But I believe that if anyone can own what they are doing and take responsibility for it, it is a scapegoat.  They are strong this way and they value the truth – at any cost – even if it means recognizing they are the heart of their own problems.  

Is it worth it?  YES!  Life is so much easier when you are not walking around with a target on your back. 

What are the behaviors you might be doing to cause the role reenactment?

Identifying these patterns of behavior and thinking are also difficult to identify.  You've been programmed all your life to act and think this way.  I spent years groping around in the dark because I found nothing written about this anywhere.  I decided to write down what I've learned so perhaps other scapegoats won't have to be in the dark as long as I was.  There are many, many different ways to be a scapegoat, but here are some I've found. 

If you aren't sure if this describes you or not ask a friend or family member who will give you honest, but compassionate feedback. 

Black and White Thinking

Scapegoats tend to have very black and white thinking.  Things are either all good or all bad.  They are completely right or completely wrong.  This kind of thinking ties in closing with maintaining some of the behaviors listed below.   This is one of things which will make change difficult.  Convincing a scapegoat that a little wrong can be good or that giving in a little bit is not weakness. They tend to see everything as all or nothing. 

To overcome this, try to identify when you are reducing complex things to black and white thinking.  Try to develop a more balanced view of things.  Is it possible something could have pros and cons?  Good and bad qualities?  Is it possible that always telling the truth might not be a good idea?  Can you think of instances when it would not be?  Look for words in your thinking which indicate black and white thinking; always, never, perfect, impossible. 

Idealism

Scapegoats can be the ultimate idealists.  They believe in ultimate truth and absolute justice and they are quick to grab their sword and shield and fight for their ideals.  Therein lies the problem.  Scapegoats have little tolerance for people who don't life up to their ideals and this is most people.  Life and the human beings in it rarely life up such perfection. 

To overcome this do a reality check.  Do you expect things of other people you do not manage yourself?  Do you set the bar so high no one could ever live up to it?  Do you expect perfection instead of humanity?  To live and play well with others you have to allow other humans their flaws and their foibles.  Instead of idealism, embrace tolerance.

Defender of the Weak, Righter of Wrongs

Some scapegoats love to fight for the underdog whether it be a person or a cause.  They rush in with their sword and shield ready and anxious to do battle.  They believe with all their hearts that this is what caring people do for each other and anyone who does not defend those who are less fortunate are weak, heartless or cold.  We love scapegoats for this, and their willingness to fight for others comes from their good hearts, but it truly hurts them in the end. 

When other people find out the scapegoat takes up their battles for them, they will go out of their way to bring all their complaints to the scapegoat.  So it looks like this:  Ms. Scapegoat is happily working away until "Joe" comes over to complain about the increased work load everyone in the department is being given.  He complains how unfair it is (a magic word to incite a scapegoat – "unfair") that this burden is being placed on them and not some other department which has a lighter work load.  Ms. Scapegoat feels her dander rising as Joe talks on and eventually finds herself worked up into a lather.  She marches off to the boss' office to tell her just how unjust she feels this situation is while Joe saunters back to his cubicle. 

The problem with this type of thinking is that it isn't really fair to the person being defended.  If someone else always fights their battles for them, they never learn to stand up for themselves.  In fighting their battle for them, the scapegoat communicates to them that they are too weak to help themselves and only the scapegoat can save them.  This glorifies the scapegoat more than it helps the defenseless.  To truly help someone, you help them stand up for themselves and fight their own battles. 

This constant fighting of other people's battles also makes the scapegoat a target.  They are labelled a troublemaker, a complainer, a problem employee who is always grousing about something.  It makes it twice as difficult for the scapegoat to get their own needs met.  If the scapegoat has gone to the boss every week for 10 weeks in a row to complain about some injustice that is being done to so-and-so, when the scapegoat goes to the boss on the 11th week to ask for something they themselves need, the boss is already sick of them complaining and turns a deaf ear.

How to stop it?  Ask yourself, "Did I care about this before Joe came to me about it?"  If Ms. Scapegoat heard the news about the increased work load and had no feelings about it before Joe came along, then the problem belongs to Joe, not to them.  So she needs to sit down and let Joe work it out.  If Joe is so upset by it, let him go talk to the boss about it.  If Joe is not enough upset by the change to take it to the boss, perhaps the scapegoat should not act on it either.

Words to watch for when you are replicating this behavior may be; unfair, unjust, right, should, can't ought.  some ideas which may indicate this line of thinking might be; "It's not fair", "That isn't right", "They shouldn't treat people that way", "They ought to do it the right way", "They can't get away with that". 

The Truth Teller

In their family of origin, the scapegoat was probably the truth teller.  The scapegoat would be the one to say out loud that dad was not "sick", he was drunk.  Mom is not "resting", she is high.  Aunt Sally is not "under the weather", she had a psychotic break.  Grandpa Smith is not "odd", he is a pervert.  This truth telling had a purpose in their family of origin.  It brought out the real issue behind the dysfunction.  But scapegoats often carry over this need to tell the truth into their adult lives with disastrous results. 

The mistaken belief here is that the truth must be told at all times.  See the black and white thinking?  All truths must be told every time.  Now we all know that simply isn't true.  If your wife turns and ask you, "Honey, do you think this makes me look fat?" do NOT tell the truth. 

The belief that the truth must always be spoken is paired with a belief that failing to tell the truth makes you weak or hypocritical (because the people in their family of origin were too dysfunctional to deal with their truth).  The scapegoat generalizes this opinion to everyone in their lives.  They fail to realize you might fudge on the truth to spare someone's feelings.  You may fudge on the truth to avoid a confrontation with someone who is unreasonable or about an issue you don't care about.  The scapegoat will not realize that other people may be just as capable of fighting battles of their own, but unlike the scapegoat, they carefully pick their battles rather than taking on every battle that comes their way. 

To change the behavior the scapegoat has to realize that letting the truth slide a bit can smooth out their rocky relationships and go a long way in avoiding frivolous and self-defeating confrontations. 

Rule Enforcer (Self-Righteousness)

Self-righteouosness is a heady and intoxicating emotion and is found in some scapegoats.  The self-righteous assume that they know the only proper way of doing things and that other's should see things their way.  They may assume that there is only one right way of doing things.  Again, you can see the black and white thinking.  The self-righteous also believe that it is their task to ensure that others do things in the way the self-righteous have determined to be right  or correct. 

The client in the opening scenario felt the need to constantly remind the girls in her university dorm that smoking in the rooms was not permitted.  She could not understand why she was targeted for this behavior since she was only pointing out the rules.  Technically this is true.  She was pointing out the rules and smoking was against the rules.  But you can imagine how unpopular this made her with the other girls.  Intolerance of human foibles can definitely put a big target on your forehead.

How to change it?  A friend once asked me as I was gearing up for a battle, "Is this really a hill you want to die on?"  It had never occurred to me that I could pick my battles.  Ask yourself if you really want to die on this hill.  Do you really care if they smoke or not?  Is this really where you want to spend your energy?   Is it really affecting you?

Words to watch for; should, must, right, correct, wrong, proper, acceptable, suitable, can't.  Ideas which might indicate self-righteousness;  "They should do it this way", "It must be done this way", "That isn't right!", "That is just wrong", "That isn't the way to do it properly", "That isn't acceptable", "They can't get away with that". 

Odd Man Out

People who are isolated, odd or different are easier to scapegoat.  People who are disliked are easier to scapegoat.  People who create fear, aversion, fatigue, anxiety, envy, guilt or other negative emotions in others are easier to scapegoat.  This is why people who are sexually (i.e. gays or lesbians) or religiously (i.e. muslims, pagans) different can become targets.  This is why people who have annoying or frustrating behaviors can be targeted.  We often see a disabled child being made the scapegoat of the family.  Or the "odd" child.  A child with whom the scapegoating parents easily identify with may also make an easy target.  For instance, if a mother has a problem with her own sexuality, her daughter may act out sexually when she starts dating and become a target for mom's scapegoating.  A father with anger issues whose son can't control his temper may target the son.  A child with behavior problems may become the scapegoat because the behavior problems make managing them difficult.  This is why you will sometimes see an autistic child or a child with conduct disorder being scapegoated.  Since driving the scapegoat away from the group is part of the interaction, someone who is already operating on the fringes makes a more desirable target.  The group does not have to lose a valued member. 

What positive steps can you take to stop replicating the scapegoat role?

Build Bridges

Therefore, if you are trying to break free of the scapegoat pattern it is important to "play well with others".  Work hard at building bridges with the other people in your group – whether it is a group of colleagues, roommates, family members or friends.  Not being isolated to the outer fringes of the group makes you harder to villify and scapegoat because you are one of them.  Generating positive feelings in others makes it harder for them to scapegoat you. 

If you are an employee, but happy and pleasant about where you work.  Be determined to work in harmony with others and let gossip, office politics and other people's opinions and issues fall away.  If Angie has a problem with Mark, let it stay with Angie.  You don't have a problem working with Mark.  I once caught myself listening to my colleagues gripe and complain about another colleague, "Miguel".  They had problems working with him and held a lot of resentment about things he did that made their work harder or disparaged their work.  I was getting truly incensed at Miguel's bad behavior when I caught myself.  Wait a minute!  I never had a problem working with Miguel.  He had a few flaws, but I really like to talk to him because he was very, very intelligent and had a lot to say I'd never heard before.  Miguel and I worked quite well together.  So what was my problem?  It wasn't my problem.  It was theirs.  And I almost picked it up and ran with it.  Whew!  A near miss.  But I'm getting better at catching myself.  This brings me to my next point.

Avoid Negativity

As a scapegoat, I seemed to surround myself with gripers and complainers.  People who brought whatever they were unhappy about to me.  Why?  So I would fight their battles for them.  Part of my "rehabilitation" was to change the people with whom I surrounded myself.  Remember, GIGO.  Garbage In, Garbage Out.  I stopped listening to gossip and negativity.  When it started, I went back to my office.  I cut off endless negative comments about other people.  I stopped my own griping.  If you are not happy about where you are – move.  Whether it is a job, a geographical location, a living situation or a relationship.  Change it or leave it.  Don't sit around griping about it.  No one wants to be a around a complainer, unless they are dumping their negativity on you to carry for them.  Negativity draws negativity to you.  Stop carrying other people's emotional garbage around. 

Well, that's what I've learned so far.  In my new job position, I have totally broken the scapegoat role and get along famously with all my colleagues, even Miguel.  Life is so much simplier.  As I learn more about breaking this role pattern, I will keep posting here so stay tuned.  You can find all my articles about the Scapegoat Role in the Categories List at the right. 

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Psychiatrist and former podcast guest Dr. Mark Komrad asks:

As Chairman of Ethics at Sheppard Pratt I have been approached with a question that seems to stand at the border between ethics and “practice guidelines.” The question is: “What is the maximum number of patients that a psychiatrist can/should see in an hour to be safe and effective?” In other words, the concern is about certain psychiatrists who are starting to see 8, 9, even as many as 12 patients in an hour (these would average to 7.5-10 min per patient if no breaks). This is an entirely new level of caseload that is emerging, and the question came to me “at what point does it start to become unethical or bad practice.” I find this difficult to answer, but thought it a good question to submit for discussion on this list. Afterall, if memory servies, I read somewhere that the typical Primary Care doc is gives each patient an average of 8.5 minutes. Is it possible to do psychiatry with that kind of average time per encounter? Your thoughts?

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Here’s an op-ed piece from the New York Times about Freud’s visit to the United States 100 years ago. It’s an interesting historical perspective.

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An utterly fascinating piece appeared in the St. Petersburg Times today by Katherine Snow Smith who recounted a series of blow-ups with her three children, the final straw being one over her kids fighting over Miley Cyrus and Hannah Montana DVDs. Mom ends up on meds–she doesn’t identify which one–and with the fight over the Disney material the thing is so All-American that it gives a lovely picture of our times.

“Late that night I called my husband, who was out of town, and told him of my blow-up. (My confessional left out the four-letter word.) He said, as he usually did when I came clean about screaming at the kids, that they pretty much deserved it. Maybe just don’t reprimand them so loudly the next time.

“The next morning I had a slight sore throat from yelling. It was like the hangover an alcoholic faces. Or the empty brownie pan soaking in the sink that makes a Weight Watchers’ lifetime member cringe because she ate them all, one thin slice at a time, after everyone else was asleep.

“This, I decided, was the last sore throat I would incur from yelling at my kids. It was time to seriously consider joining the thousands of other women in the world who take prescription medication to help control their moods, temper, anxiety or depression.

“About a year before this, a friend of mine had gone on a girls’ weekend with eight moms she casually knew. She later told me six of them were on some kind of meds. They compared the benefits and side effects Paxil, Lexapro, Cymbalta, Prozac and others. Some made you gain weight, some made you lose. Some decreased sex drive. All of them, it seemed, made them feel like they were better moms, wives and daughters.”

Six of eight? Better moms? Huh? I cannot criticize Smith’s personal decision. It’s her body, so have at it. But I do have to ask: What the hell is going on with this country and its people that we’re getting all doped-up on SSRIs and the like over the stresses of daily life and parenting and think that’s making us better? Where has this kind of thing gone on before?

Oh, wait. It was in America in the 50s, 60s and 70s when stressed out, agitated, anxiety-riddled Americans were taking Miltown, Valium and all those other benzos and downers and whatnot. We know how that turned out: Miltown pulled from the market and Valium junkies all over the place. It’s difficult to make an argument that anti-depressants are really awesome drugs on a culture-wide basis. The drugs have too many problems. You know about that already.

“My doctor said he prescribes mood-enhancing medications about 10 times a week. He showed me a diagram of the brain and how certain medications can restore the balance of serotonin, a natural substance in the brain, which helps improve certain mood problems. [How did that last line get past an editor? The serotonin hypothesis is just that, a hypothesis not settled science.]

“My friend called her doctor to make an appointment and talk about going on Paxil. The nurse said she would just call the script into the pharmacy. No appointment necessary.

“These meds are probably overused and too easy to get. I wasn’t suffering from depression, which is a very serious problem. Medication has proven to change and save lives of depressed people. I was anxious. I was having meltdowns way too often.

“Maybe moms like me should do more yoga, cut back our responsibilities, see a therapist, exercise more, put duct tape over our mouths every day after 5 p.m. Maybe we should do anything to avoid relying on drugs to become calmer, happier people.”

Smith pretty much answers her own question in the last graf, but you’ve got to wonder–knowing what she knows and acknowledges–what kind of example she’s setting for her children in turning to drugs (ones she could become dependent on, at a minimum) in settling her own situational anxiety.

I know these are deeply-trying times in America (and elsewhere, too, of course). They are for me, too. But turning to a class of drugs known to be dangerous in some cases and with a dizzying host of side effects in many cases doesn’t strike me as an intelligent way to operate as a culture. And to write about it all so blithely…well, you just don’t know what to say.

Yoga, yes. Prozac, no.

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That doesn’t mean lying is okay, and both father and son know this. It’s uncomfortable to watch Nick squirm through his lies as he digs himself in deeper. And Steve is a fairly typical parent too, in the sense that all parents are very bad at lie detection. What’s more, Nick likely learned to lie from watching his parents tell white lies. Parents typically view precocious lying as innocent, something that will correct itself; but in fact a lot of kids get “hooked” on lying very early.

Nick’s story comes from science writers Po Bronson and Ashley Merryman, who include it in NurtureShock, their delightful new collection of essays on the “science of kids.” Though not exactly a parenting manual, the book does offer a lot of useful information on why kids do what they do. For example, Talwar and her colleagues have tried using stories to teach kids like Nick to curb their lying. In one study, they had kids listen to either “The Boy Who Cried Wolf” or “George Washington and the Cherry Tree”; they heard the story after they had cheated, but before the psychologist asked them about cheating.

For those who don’t recall: In “The Boy Who Cried Wolf,” the shepherd boy lies repeatedly about a wolf, and in the end is eaten by a wolf when nobody believes his calls for help. So it’s about severe punishment for lying. George Washington, by contrast, tells his father the truth about chopping down the tree, and is forgiven and praised for his truthfulness. When Bronson and Merryman conducted a survey, three of four respondents said the wolf story would be the more effective teaching tool, but in fact it was the opposite. The honest George tale cut lying by 75 percent in boys, and 50 percent in girls.

Why? Probably because kids already know that lying is a punishable offense; they’re not learning anything new there. What’s new—and welcome information—is that honesty might bring them both immunity from punishment and parental praise.

Bronson and Merryman’s essay on lying is representative of this engaging volume, in its mix of pitch-perfect science writing and soft-pedaled guidance for parents. Many of their essays—on sleep, racial attitudes, self-control, sibling relations, and more—are animated by actual flesh-and-blood kids, who we meet on an excursion through many of the nation’s top child psychology laboratories. It’s a rewarding and entertaining excursion. NurtureShock is published by Twelve Books, and is in bookstores now.

For more insights into the quirks of human nature, visit the “Full Frontal Psychology” blog at True/Slant. Selections from “We’re Only Human” appear regularly at Newsweek.com and in the magazine Scientific American Mind.

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I entered the yard and started cleaning up a bit. I pick up the end of the hammock that had fallen, shook it out, and reattached it to the tree. I finished and reached for my keys to go inside.
“Hey.”
I turned. No one was there. But I’d heard the “hey” distinctly, though my ears, really. I waited, no one said anything. I looked up at the windows, maybe one of my kids had called out. But, no, the windows were closed.
My first voice, I thought. This must be what it’s like. There wasn’t really anything to do, it was just a simple “hey” loud and clear. It was a bit disconcerting, but I went inside and promptly forgot about it.
My cell phone was on the counter. I picked it up and saw a message. Roy had texted. “Got here early and I’m sitting on the patio.” Ah! My voice! It was Roy, of course, lurking in the bushes.
“Why didn’t you say anything else?” I asked.
“I didn’t want to scare you,” he said.
Oh. And of course there’s no one else whose voice I’d rather hear!

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When I was in graduate school they told me that you shouldn’t hand people the tissues when they’re crying because you want them to know that it’s okay to do that, cry, and if you hand over the tissues then you’re giving the message that you want them to stop.

I thought that was powerful but dumb, because you could hand over the tissues, which might make some people more comfortable, blowing their noses into a tissue, as opposed to say, on a sleeve, and you say,

“This is not to tell you to stop crying, cry away, please. Crying is good for you. In moderation, obviously, to a degree, for sure, but with me, it’s always good.”

Anyway.

We’ve joked about me wanting a sponsor for the blog, mainly Puffs or Kleenex.

But who has time to really pursue this? I did go after one of the tissue companies, actually, maybe both, and remember a resounding rejection. Life hurts, is the truth.

Generally, when I shop, it’s a guerrilla mission, no time to go through all of the aisles. I know, however, when I’m getting low on tissues at the office, that this will be on my grocery list– KLEENEX.

Because Kleenex is another word for tissues, right?

As a c0-parent of five, and a person who likes to eat, I save a few cents if possible, buy the generics. So the cart fills up with generic tissues, off-brands if they look okay, especially if they come in a pretty box. You have to buy in bulk if you’re a therapist because they go, as we say, in a good week. A good week is a good cry or fifteen.

Anyway, in over the years, very occasionally, someone will say,

“You need better tissues. Buy Kleenex or Puffs. People don’t want to think they’re using up all of your tissues.”

Pretty amazing, but it happens, and of course I say thank you for the advice, because you have to thank a person for asserting, for trying to get the needs met.

I might even say, “Thanks, I don’t hear this much, but I’m not going to take it personally.” This makes the event an intervention. People take way too much personally and it gets them into trouble emotionally. Something to talk about.

“No problem, Glad to oblige,” my clientele will say. People are nice like this.

So this morning I go to the grocery store, and buy several brands of tissues thinking, “We’ll give this a whirl, see which one really is the best, which is the best for the money, which makes a person feel worse, might make a person think, My life is so bad, I even get a cheap therapist! Everything is bad! I’m born under a dark star.

We’ll see what happens.

therapydoc

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Several readers thought I was far too kind to ABC’s “Primetime” program of Tuesday night on Mad Pride. Fair enough. I guess I was so staggered that we didn’t have the usual major media completely screwing up a mental health story situation that I lost control of my critical faculties.

Fortunately, Liz Spikol live-blogged the show the other night and brilliantly so. Here, she picks things up when the show spins away from dealing with Mad Pride, the stated purpose of the program, and plays the violence card:

“‘But critics worry …’ That’s journalism-speak for ‘We don’t have any specific sources who say this, but we’ll generalize it so we have reason to focus on …’

“… violence. That’s what they’re focusing on. Why am I not surprised?

“So of all the things they could talk about related to Mad Pride — and related to mental health — this is what they’ve come up with: criminals and violent crime. Ugh. TV is so predictable and depressing.

“Okay, so now we’re telling the story of a kid with hallucinations and delusions (the CIA, yadda yadda) who KILLS HIS MOTHER? Does the average American viewer understand how fucking rare this kind of thing is? That it’s not the necessary result of deciding not to take meds?”

Liz is right: folks with psychotic disorders going off the reservation, so to speak, and committing unspeakable violence is actually a pretty rare event. What’s more, she’s right that these rare acts seem to occur independent of someone’s medication status. The NAMI and Treatment Advocacy Center crowds rarely acknowledge that. TAC is of course quick to waive the off-meds argument around anytime an incident pops up where a person is off-meds, but is utterly silent when someone happens to be treatment compliant, to use their terminology.

It’s also kind of offensive–now that I’ve reflected on things a bit–to present David Oaks (of MindFreedom, once upon a time diagnosed with schizophrenia), Madigan Shive (who I believe is connected with the wonderful Icarus Project and has a diagnosis of bipolar disorder) and Joe Pantoliano (of Sopranos fame and chronically depressed) as the faces of Mad Pride when none of them have ever been connected with anything violent, ever. It’s cheap shot journalism. Oddly enough, Pantoliano’s medication status is not discussed on the program. (And how does depression get hooked in with the program’s “psychotic and dangerous and off-meds” theme? ABC’s evidence would be what?)

Spikol sums it up nicely:

“This show is so bad, it’s like a joke. I guess it all goes back to what producer Ia Robinson told me, when we discussed my being on the show: She doesn’t have any friends or family who have mental problems, so the whole topic was like ‘walking on the moon.’ Yes, that’s the phrase she used. The show should’ve been blasted out to Mars.”

I also spoke with Robinson a few months ago when she was in the early stages of reporting for the show. Within five minutes I could tell she was someone who was way out of her depth with mental health issues and had that typical network news superficial take on things that leads no place good. She then had to go into a meeting for something or other and excused herself. I didn’t bother calling her back.

Not to be too much of a dick, but why are folks like that employed full-time in journalism when reporters like me are on the sidelines?

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This one is called lurasidone and it’s developed by Japan’s Dainippon Sumitomo Pharma. The company is so pleased by its phase 3 trials results that it’s going to submit it to the FDA early next year for approval as a treatment for schizophrenia. If approved, the drug would be the third new antipsychotic approved by the FDA in about one year’s time. Vanda’s Fanapt was approved earlier this year although it’s not yet on the market and Schering-Plough’s Saphris, which was approved earlier this month for use in schizophrenia and bipolar disorder.

It’ll be interesting to see how all these new drugs work out in a field crowded with second generation antipsychotics, especially with some of those drugs being off-patent (Risperdal) or about to come off-patent (Zyprexa and Seroquel). These new drugs would have to be pretty spectacular performers–or their makers would need to come up with an appropriate smoke-and-mirrors marketing campaign–to capture many sales because they’ll be competing with mostly generic drugs.

A former FDA reviewer has called Saphris flat-out unsafe and there’s been some skepticism expressed about just how great Fanapt is as well.

The companies with the new drugs have so far mostly claimed that they work as well as nasty drugs like Zyprexa while having fewer side effects. To my ears, that sounds like what Lilly and its shills in academia were saying about Zyprexa vis a vis Haldol in the 1990s. We know how that turned out.

Here’s what a researcher who ran trials of lurasidone said about the drug:

“‘If you look at the weight gain, the lipid changes, it’s among the most benign of any antipsychotic drugs, clearly better than olanzapine, clozapine and Seroquel,’ [Herbert] Meltzer [of Vanderbilt University] said.”

Benign and antipsychotic are two terms that I don’t think anyone can use together with a straight face.

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