Mental Health Blogs

Archive for September, 2009

Go to Source

Okay, it’s not psychiatry, but it’s my blog and I’ll divert if I want to. So this looks cool, you can take a popular Harvard course for free and in the comfort of your own home. You know I’m there:

—–
Listen to our latest podcast at mythreeshrinks.com or subscribe to our rss feed.

Go to Source

Yep, today marks the fourth anniversary of this website. I had no idea it would last this long or be as essential as it is to my journalism career or that it would garner such readership. There have been almost 2,500 posts in that time and over 20,000 comments. Kind of mind-numbing.

Thanks to all of you for reading and for your support.

Go to Source

The “pennies a day” marketing scheme has been around a long time, and whoever came up with it showed extraordinary psychological insight. Indeed, science is only now beginning to demonstrate what these marketers sensed intuitively—that people are not entirely rational when it comes to processing numbers. What’s more, the way we think about scales and rates and ratios can make us into either cautious or indiscriminate consumers.

In a way this is obvious. “Pennies a day” is a meaningless ratio, because we’re not really reaching into our pockets each and every day for those copper coins. That’s what the marketers want you to visualize, but most of us are not truly fooled by the ruse. We know automatically–without doing any arithmetic at all—that we’re really talking about dollars a month and maybe hundreds of dollars over a year or years. It’s all a matter of knowing the meaningful scale.

But what if the manipulation of numbers is more subtle, or more complex? Are there marketing phrases and terms that do fool our imperfect minds? University of Michigan psychologist Katherine Burson and her co-workers believe so, and they’ve run a couple interesting experiments to simulate the kinds of offers we might well encounter in our daily lives. Here’s an example:

Imagine you’re in the market for a cell phone plan. After shopping around, you’ve narrowed your choices to two: Plan A costs $32 a month, and for that you’re guaranteed no more than 42 dropped calls out of 1000. Plan B only costs $27 a month, but the number of dropped calls is 65. In other words, you get what you pay for, and consumers make their choice based on what’s more important—money or service.

But what if the same offer was phrased this way? Plan A costs $364 a year, and drops 4.2 calls per 100. Plan B costs $324 and drops 6.5 calls per 100. It takes only the tiniest bit of arithmetic to see that nothing has changed. The offers are identical to what they were before, except that the scale has changed. But actually two scales have changed, and in different ways, so it’s not a no-brainer like “pennies a day.”

So how do consumers process these different offers? The psychologists gave these choices to a large group of volunteers, and the results were interesting. Consumers preferred Plan B when it was described as having a lower price per year, but they preferred Plan A when it was described as having fewer dropped calls per 1000. Notice that it’s the “per year” and “per 1000” that are important. Making the scale bigger also made the difference appear more exaggerated, so emotionally consumers feel like they’re getting much better service or a big savings in cost. Consumers actually changed their preferences with the larger scale—they became more discriminating—even though the real terms remained unchanged.

This is pretty remarkable—and unnerving. But there’s more. In a second experiment, the researchers offered a slightly different choice for movie rental plans. In this scenario, Plan A costs $10 a month for seven new movies per week. Plan B costs $12 a month for nine new movies a week. As before, either choice could make sense, depending on which meets your financial and movie-watching needs.

Then they once again changed the terms: This time the prices stayed the same, but instead of a weekly allotment of movies, consumers now got a yearly allotment. That is, for $10 a month they got 364 movies per year, and for $12 a month they got 468. How did the movie aficionados process these offers? As reported in the current issue of the journal Psychological Science, dramatically more consumers chose plan B when it was expressed in movies per year. It’s the emotional impact of that number–468. That’s a lot of movies, and a lot more than the other plan gets you, and still for only $12 a month. When you come to think of it, that’s really just pennies a day.

Go to Source

One of my favorite critics told me that the post below isn’t clear, that people don’t realize how hard it is to have this disorder, and how hard it is, sometimes, maybe even most of the time, to live with someone who has the disorder.

Rather than go through the DSM checklist (I think it’s in a post in a link at the end of yesterday’s post) let me quote Randi Kreger. She defines Borderline Personality Disorder as follows in her book, The Essential Family Guide to Borderline Personality Disorder (italics are mine):

Borderline Personality Disorder is a serious mental illness that causes those who have it to see people and situations as all good or all bad; to feel empty and without an identity; and to have extreme, blink-of-an-eye mood swings. People with BPD act impulsively; their self-loathing and extreme fear of abandonment can cause them to lash out at others with baseless criticism and blame. Some practice self-harm or see no other option than suicide as a way to end their pain.

People with BPD experience the world much differently than most people. For reasons we don’t entirely understand, the disorder distorts critical thought processes, resulting in emotions and actions that are out of the norm.

There you go. Now maybe the post below will make more sense

Thanks for your opinion, MK.

therapydoc

Go to Source

Another $391.26 came in yesterday from seven people bringing the total raised so far to $3,230.75 from 68 people. That leaves $769.25 to go from 32 people to reach the overall goal of $4,000 from 100 people by the end of today. Thanks to all of you who’ve contributed so far.

Today is the final day of the fundraiser–I’m not going to extend it any further–and I’d like it to end successfully. It’ll take a few days to determine whether it’s reached its goal or not due to the vagaries of the US mail, of course.

You can help things end on a successful note by making use of the PayPal button on the right. If you prefer using snail mail, send me an email and I’ll send you my mailing address.

Go to Source

A new study out in the BMJ yet again links anti-depressants to birth defects due to women taking anti-depressants in the first trimester of a pregnancy.

“Still, the authors said the absolute risk is relatively low: 246 women would have to take such medication in order to see one septal heart defect. And 62 mothers would have to take more than one SSRI to see a problem in one child.

“‘A potential association with malformations must be considered in the choice of treatment of depression during pregnancy,’ said Dr. Lars Henning Pedersen, lead author and a research assistant in the department of epidemiology at Aarhus University in Denmark. However, ‘if our data is correct, the absolute risk is low, which must be balanced against the potential substantial risk of under- or untreated depression during pregnancy.’”

Oddly enough, the study didn’t turn up problems with Paxil–usually thought to be the worst of anti-depressants for birth defects–and Prozac. The risks were seen with Zoloft and Celexa (and that would mean Lexapro too).

While the risk isn’t high in an absolute sense–less than one-half of 1 percent–that’s small comfort to a pregnant woman taking anti-depressants.

I’ve long considered the evidence of birth defects problems with anti-depressants to be mixed. Now, I’m more convinced than ever that something is going on here.

Go to Source

By which I mean that Bob Fiddaman of Seroxat Sufferers fame has gotten pdfs of opening arguments and the testimony of psychiatrist David Healy and another plaintiff’s expert witness and put them online right here. More will come later as the trial, which is taking place in Philadelphia, continues. This will include some never-seen-before documents regarding what GlaxoSmithKline knew and when it knew it about birth defects problems with Paxil.

The opening arguments–both sides–are well worth a read.

Go to Source

The Federal Trade Commission is going to hold public hearings on creating regulations so that pharma companies can use social media (ie, Facebook, Twitter, networking sites) to promote their drugs. Like they don’t have enough promotion opportunities already. I’d assume the FDA will also have to get involved in this somehow since drug promotion is also its regulatory bailiwick.

The folks at digidaydaily.com think it’s a lovely idea–I don’t–and have a suggestion:

“Create Fan Pages: It’s in the company’s best interest to supervise and add some credibility to a Seroquel community for bipolar adults, or a Paxil community for depressed patients. If you don’t agree go on Facebook and look at the unsupervised version.”

Whomever wrote this is utterly clueless if he thinks Seroquel and Paxil are drugs that would generate a fan base. More like an anti-fan base. And would pharma companies allow criticism, even the honest kind, on their drugs’ social networks? Probably not. And how would they keep kids under the age of 18 from viewing the pages?

Go to Source

Originally I just wanted to tell the story about the stand underneath my fish tank, how I found it at Bed Bath and Beyond while shopping for a gift for a shower (yes, I had the coupon), shlepped it to the office myself, borrowed a screwdriver, for mine is never where it’s supposed to be, and put it together in little under two hours. Of course I knew the secret about the cam screws. Put them in, tighten them up, last.

I see this sort of behavior as fairly normal, if a little impulsive, sure, because ordinarily I’d ask FD to put it together for me. But doing something physical and challenging is a nice way to distract a person from thinking, and sometimes we just think too much. So I’m always telling people to do something. You feel better if you can distract.

And the computer desk that supported the tank just didn’t cut it.

Then I found myself talking about Borderline Personality Disorder, BPD. This disorder is very much about impulsivity, which substantiates the rule that things that are thought to be pathological can be perfectly normal in a different context.

Impulsively buying a bookcase that matches your furniture, even if it weighs more than you do, and putting it together yourself, even if your best tools are a hole puncher and a nail file, beats impulsively getting drunk to feel less edgy (a “borderline” thing to do), impulsively cutting one’s self (another “borderline” thing to do), or impulsively whacking someone across the face because you’re jealous or in a bad mood. You get the idea.

And if the impulsive act also functions to build your self-esteem, as opposed to, say, lowering it, then it’s a good thing to be impulsive, right?

But people who suffer from BPD have a helluva time trying to reign in their impulsivity, and the folks who try to love them, who want to help them, get worn out by the drama.

It’s easy enough to start to write something, quite another to finish, and that’s what happened to this post. Then then something cool happened. Retriever wrote to me to ask what I thought about something going on at Dr. Helen’s Blog and Dr. Bliss’s blog over at Maggie’s Farm. Both docs are writing about BPD, and lo and behold, Doc Helen has a video interview with my new favorite self-help guru, Randi Kreger.

Randi Kreger (Walking on Eggshells) has a fairly new book, The Essential Family Guide to Borderline Personality Disorder. I read it cover to cover in a night only a few weeks ago, found it a terrific resource, funny, easy to read, and full of information that everyone should know. Especially if you have someone in your family who is “impossible”, who can’t regulate his or her emotions, who acts impulsively to dampen heightened negative arousal, like anger.

And she has a great section called Tools in the back of the book.

I’ll throw one at you right now, a favorite I’ve suggested many times to people in therapy. Randi would call this intervention an incompatible behavior. I’ve always called it The Fake.

The idea is that a person can’t be obsessing and angry about something if something else is a more attractive option. It’s no different than distracting a whining three year old with a shiny yo-yo. All of a sudden the icecream he wants isn’t important anymore.

With kids it’s always,

Outsmart them. You’re older. You can do it.

With older people who simply can’t let something go, who are stuck on abusing you or raging about something or someone, who really will not stop to listen to anyone else’s point of view or entertain other positions, it has to be,

Did you hear the one about. . .

Or

Did you hear what happened to So and So?

Good gossip is sheer genius. Gets ‘em every time.*

My favorite fake is laughter. You laughing at your tormentor.

This person is tormenting you, criticizing you, ranting, and you break into hysterics, literal belly-bending, on the floor, doubled over with laughter hysterics. You do it respectfully, though, for you are complimenting the person who is clearly trying to upset you. But now the abuser sees himself, herself, as a good person, someone who can make you laugh, not just laugh, but laugh hard, and that fleeting self-esteem returns with your praise. Now we’re all comedians, should work stand-up.

If you throw someone off like this, anger and blame are impossible.

And the truth is, most people with this disorder are smart, and they can really be very funny.

Traditionally with people who have Borderline Personality Disorder, once they’re flying, meaning angry, there’s no stopping them. The anger is a manifestation of pain. If you can’t see that, then there’s no helping your spouse, your child, your friend, your mother, whoever it is who is unable to regulate emotion. When the plate needs shattering, it will shatter. When they need love, they’ll find someone to sleep with. When a car needs to be keyed, it will be keyed.

When it’s all over, it’s What’s for Dinner? As if nothing happened. So in therapy we’re forever working on strategies that will work, that will distract, end an episode.

If you think of this as an episode of true psychopathology and pain, then it’s a lot easier to swallow the negative behavior.

And you have to see them as capable of seeing life differently, seeing themselves as their greatest allies, capable of rational, laudable behavior. Good lives.

I work dialectically with suicidal, self-destructive people who have BPD , for you have to do this, dialogue in an empathic way, one that reaches them, meets that place in the ego that wants to live. Typical questions from me include:

(1) Would you want your niece to cut herself? No? Then why are you setting an example? You think she doesn’t respect you, look to you as a role model?

(2) Do people deserve to have quality lives?

(3) Aren’t you a person?

People tend to agree. They deserve better. They are capable of better. They want more out of life. They want quality lives.

Then the question becomes how to get it.

And it isn’t an impossible quest, an impossible, reprehensible therapy. I’ve referred to ACT, Acceptance and Commitment Therapy here in this blog, and it helps to know DBT, Dialectical Behavioral Therapy, and Schema Therapy. There is progress and people do get better, so I’m a little miffed, frankly, at all the negativity I read on the Internet about BPD, avoiding BPD patients.

Yes, people can be difficult. They can be high maintenance, and yes, group therapy surely helps, and for sure, without a team it is so, so hard to work a successful therapy. I get it that people with Borderline Personality Disorder can be more than difficult, that they can and will make your life a living hell without help. And yes, therapists try to avoid treating the disorder, need help for ourselves to cope with all the drama.

But with help? With time? (lots of this, endurance is the essence)

There’s no greater therapy, no greater pleasure, no greater success than helping someone with this disorder get well.

That’s all I’m gonna’ say. I have some algae to scrape off my tank here at home, and spilled some sugar behind a cabinet. There’s a lot to do, basically.

therapydoc

*Okay, not every time. Go ahead, talk about it.
See the Second Road on Self-Pity.
Other posts by me about BPD

Go to Source