Mental Health Blogs

Archive for November, 2009

Eli Lilly today announced that the FDA has approved its anti-depressant Cymbalta as a maintenance treatment for generalized anxiety disorder. That marks the sixth indication for the multi-billion selling drug, which is also approved for use in depression, anxiety, fibromyalgia and diabetic neuropathic pain.

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After the weekend, the winter fundraiser stands at a total raised to date of $910 from 21 people. And that leaves $3,090 from 79 people to go to reach the overall goal of $4,000 from 100 people by sometime around December 18th. Thanks to everyone who’s contributed to date and is helping to support work that is not elsewhere in the mainstream media, not often at any rate. And it’d be great if this is the week the fundraiser really picks up and begins its inexorable march towards reaching its goal.

If you’d like to contribute, the PayPal button is on the right. Or if you prefer snail mail, send me an email and I’ll send you my mailing address.

I’ll back later in the morning with more posts.

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I know quite a few readers had a very strong, negative response to a New York Times article on Friday which examined psychosurgery–or brain surgery for psychiatric issues–because it showed up on the front page of the paper and to some seemed like promotion of latter-day lobotomies. I disagree. And let me state from the get-go that I am not a fan of the various psychosurgeries out there. They are fraught with tons of risk, the outcomes are unpredictable and sometimes people who undergo the techniques wind up with little relief or permanent brain damage.

I think Ben Carey’s article captured that pretty well and also captured the extreme desperation some people with OCD who are willing to try psychosurgery after anti-depressants and psychotherapy have failed and they are essentially non-functional from the disorder. He got into how psychosurgery is pretty tightly controlled by the medical profession and how it is voluntary for the patients. These aren’t the days of forced, involuntary lobotomies and I don’t think there was anything in the article to raise the specter of those days returning. Still, I do get where people would respond strongly to such an article. I think any journalist who’s thoughtful knows that simply writing about a controversial topic can seem as if you are promoting one side or another of the controversy, even if you’re writing a fairly neutral, dispassionate piece such as Carey did.

Besides, Carey has no control over where the article appears in the paper. That’s a decision made by editors a few rungs above him just as it always has been for me when I was at a paper. Besides, it’s good for Carey internally to have an A-1 story and I suspect people who know his work have enough respect for him to want him to do well and do other fine work in the neuroscience and psychological realms.

What does fascinate me is how many of these psychosurgery cases seem to be connected to people with OCD, very severe disabling OCD. I’ve seen some of these cases firsthand–there’s a man who lives in my part of Seattle who has literally dozens of restraining orders against him because his very severe OCD leads him to repetitively harass people very aggressively, especially women–and it’s so painful to watch that I cannot describe it. If someone like him has been through various rounds of psychotherapy and meds and is in a position to consent to voluntary neurosurgery (and knows the risks), then I wouldn’t want to stand in their way. And just to be clear, I am talking about adults, not children or teens.

I feel the same about the various depression treatment devices that have hit the world in recent years. While I think the jury is still very much out on the vagus nerve stimulation system, deep brain stimulation and transcranial magnetic stimulation, if someone wants to try it, then go for it. It’s their brain after all.

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I just wanted to do an update on where the ongoing fundraiser is at following the holiday and the tumult of last week. Since last Monday, $465 has come in from 13 people and that brings the total raised to date to $910 from 21 people. And that leaves $3,090 from 79 people to go to reach the overall goal of $4,000 from 100 people by sometime around December 18th.

I truly appreciate the contributions that have come in to date, especially since it was during one of the most trying stretches I’ve ever experienced in my personal life.

If you’d like to contribute, the PayPal button is on the right. Or if you prefer snail mail, send me an email and I’ll send you my mailing address.

So late this morning I was walking across the parking lot of a drug store in my neighborhood, when a woman who lives in my apartment building shouted for me. She was holding a large orange cat and standing next to a trash can. She told me that she’d just tossed an empty cigarette package into the trash, heard a cat meow at her, looked back in and found this orange cat trying to get out of the can, which is fitted with a slotted roof-like structure. So she lifted him out and was basically staring at me going “Like what the Hell?”

We walked back to our building and took the cat into her apartment. Kitty was pretty freaked and we discussed whether he’d been dumped by some idiot or gotten into the can some other way. I printed up “Found Cat” signs and stapled them to a few telephone poles in the area and also posted an ad on Craigslist. The cat, a sweet 25-pounder who I soon dubbed “Oscar,” hung out at my neighbor’s apartment. She has a cat already and can’t have another, so we both hoped whomever owned the cat would run into one of the signs and that this wasn’t a dumped cat.

Fortunately, around 2.30 pm my neighbor’s phone rang and the owner was on the other end. She came over soon to retrieve her cat named Boots, who’d somehow gotten out of her apartment and into the street that morning. Lucky woman, lucky cat. No word on what Boots was chasing into that garbage can. Possibly one of his nine lives. I’m glad my neighbor and I were able to help him out.

There’s so much odd karma for me around cats lately. I know of two friends of mine who’ve had to put down their old cats in recent weeks and I know three other people who are all on the verge of having to do the same thing with their old cats. That’s a very odd convergence.

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Benedict Carey writes about surgical treatments for obsessive compulsive disorder in yesterday’s New York Times in “Surgery for Mental Ills Offers both Hope and Risks,”

In one procedure, called a cingulotomy, doctors drill into the skull and thread wires into an area called the anterior cingulate. There they pinpoint and destroy pinches of tissue that lie along a circuit in each hemisphere that connects deeper, emotional centers of the brain to areas of the frontal cortex, where conscious planning is centered.

This circuit appears to be hyperactive in people with severe O.C.D., and imaging studies suggest that the surgery quiets that activity. In another operation, called a capsulotomy, surgeons go deeper, into an area called the internal capsule, and burn out spots in a circuit also thought to be overactive.

An altogether different approach is called deep brain stimulation, or D.B.S., in which surgeons sink wires into the brain but leave them in place. A pacemaker-like device sends a current to the electrodes, apparently interfering with circuits thought to be hyperactive in people with obsessive-compulsive disorder (and also those with severe depression). The current can be turned up, down or off, so deep brain stimulation is adjustable and, to some extent, reversible.

In yet another technique, doctors place the patient in an M.R.I.-like machine that sends beams of radiation into the skull. The beams pass through the brain without causing damage, except at the point where they converge. There they burn out spots of tissue from O.C.D.-related circuits, with similar effects as the other operations.

Carey goes on to talk about the rigorous screening, the risks of surgery, and tells stories of both good and bad outcomes.

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Lodz ghetto, circa 1939.

Hard to believe that anyone would be sitting around on Thanksgiving reading blogs, but here I am, writing one, so there are probably a few of you reading. Mostly recipes.

Last Saturday I was a little down. And sometimes, when things are going wrong for me, when life feels more than out of control, I like to read about the Holocaust.

Crazy coping strategy, I know, but it works every time. There are many collections of stories about the Holocaust, and I happened to have had one on hand, a survival story. Here’s a mini-review, not on the level of one you might find at Jew Wishes, but it is what it is.

Sisters of the Storm, (from the Holocaust Diaries series), by Anna Eilenberg-Eibeshitz is the story of two young teens trapped in Lodz, Poland, a ghetto established by the Gestapo in 1939, a home to approximately 200,000 Jews, surrounded by barbed wire. According to DeathCamps.org inhabitants

“vegetated in wretched wooden houses comprising 31,271 apartments. Sanitary conditions were disastrous. Apart from the lack of food, only 725 apartments had running water. There was no sewerage, no coal or wood for heating the rooms, no warm clothes and shoes. As a consequence, 21% of the ghetto population died in various epidemics, of starvation or were frozen to death.”

No turkey, baby.

Those who survived only survived to be deported to concentration camps, Auschwitz in particular, and the gas chambers. An estimated 6 million Jews were murdered in this war, another 6 million non-Jews fell to the Nazis.

Here are a few hungry people on the way to Auschwitz in a rare photograph ostensibly to die.

Anna witnessed the torture and murder of family and friends, including her mother and brother. She survived the ghetto to be shipped like cattle, handled less well, in a cattle car, hundreds to a car, little air to breathe, no room to move, certainly no bathroom facilities, to Auschwitz. You must know what happened there. I can’t go into it now. It’s a holiday.

It’s hard to read these things, but hard not to, for some of us. On page 90 the author describes how her brother, at 22, before his death from tuberculosis, married knowing that the Germans were intent upon eradicating the Jews. Anna’s brother contracted tuberculosis carrying human waste, his job at the ghetto. He married with the intent to have a child, to stick it to the Nazis, to say, “You can’t stop us. We shall survive, we will continue.”

Ms. Eilenberg-Eibeshitzs writes (italics in parentheses are mine) :

My father came home one day with a very pale face. I tried to talk to him, but it took him a long time before he was able to speak to me. It seemed that he had seen Brocha (Anna’s new sister-in-law)walking in the street, and she was obviously pregnant. I understood why my father was so firghtened; pregnant women were a favorite target for the Nazis. I offered up a silent tefillah (meaning prayer) that everything would be all right.

I grew more and more worried as the days passed by. . .I gradually came to understand that Brocha had been taken for deportation. (The Nazis killed mother and child as a matter of course. Babies filled in the gaps in mass burials before the Nazis came up with the Final Solution.)

Generally you hear a woman is pregnant and the response is joyous, gleeful. Happy.

Sisters of the Storm becomes more and more violent, more and more impossible to read, gut-wrenching. You wonder, you really do, when you read about such torturous conditions, starving people sleeping, if you can call it sleep, on dirty floors, punished with dirty (yellow) water for days at a time, for the simple crime of their genetics, you wonder how anyone can survive such conditions. Always at the other end of the boot, always slapped, beaten, waking to new corpses in the barracks. Forever grieving, fearful. Yet many who survived kept their religion, stayed observant even within the camps, to the degree it was possible.

Survivor stories are told less often now, for the survivors of World War II are in their 70’s, 80’s and 90’s. They are leaving us. We go to museums to hear them speak to us from videos, through headsets, or we read books to remember them. My cousin works for the Wiesenthal Center in Los Angeles, he travels all over the world to tell the story of the Holocaust, to tell people that history can and will repeat itself. He recently spoke in Mumbai, a city on the watch for terrorism, bombs. At dinner last night he regaled us with stories of his travels. We must not forget.

Everyone takes something else out of survivor stories, for me it’s how amazingly little we need to survive (when it comes to food) and how precious survival, life really is.

Lo aleinu, we say in Hebrew. Such things should not happen to us. We mean, really, that these things should not happen, and we’re thankful, lo aleinu, that we’re not suffering like this. We feel better somehow, telling ourselves, whispering, lo aleinu, some kind of talisman, a quick nod of thanksgiving, no one, none of us, should ever be hungry like that, should ever suffer like that. No one should. The downside of life can get pretty down.

My favorite journalist, Peggy Noonan, writes for the Wall Street Journal, and last Saturday she wrote a piece about being thankful. We’re Still Here After a Rough Year–We’re serving up a new gratitude this Thanksgiving. I liked it very much and am copying it below because we are thankful this week, as Americans. Last year was a difficult year. Our country, once a super power, is less super, we all agree. We don’t trust, we are afraid of the future. But it’s better now, today, than it was a year ago. We survived, she’s suggesting.

And all I can think is,

Survival. It’s surely relative.

therapydoc

*For those of you new here, shul is yiddish for synagogue, and on Saturday it’s traditional to make it over there for services. I wrote this last Saturday night.

Here’s Ms. Noonan’s piece.

Last Thanksgiving, it looked as if a hard year was coming, and it was and it did. The holiday was shadowed by a sense of economic foreboding—Wall Street failing, companies falling and layoffs coming. It isn’t over—no one thinks it’s over. But the mood of this Thanksgiving looks to be different.

An unofficial poll of a dozen friends yields two themes: “We’re still here,” and, “I am so grateful.” Almost all experienced business reverses, some of which were deep, and some had personal misfortunes of one kind or another: “I am thankful that my mother’s death was fast and that she did not have to suffer,” wrote a beloved friend. But something tells me that a number of Thanksgiving dinners will be marked this year by a new or refreshed sense of gratitude: We’re still here. I am so grateful.

I felt it the other night, unexpectedly, in a way that reminded me of the anxieties of last year. I had been away from the city. I was in a cab going down Fifth Avenue. I hadn’t been there in months. I looked up and suddenly saw, looming in the darkness to my right, the white-gray marble and huge windows of the Bergdorf Goodman building—tall, stately, mansard-roofed. Its windows were covered, but some lights were on, and there seemed to be people inside. They were preparing its Christmas windows. Something about the sight of it caught me—proud Bergdorf’s, anchor of midtown commerce. It looked exactly as it looked 10 years ago, 20, only better. Because it’s there. New York has been so damaged by the crash, and last year at this time small shops, the ones with the smallest margin for error, were closing. And now I see more that are opening, and Bergdorf’s is preparing its Christmas windows. The sight of it came like an affirmation. We’re still here. I am so grateful.

What are you most thankful for in 2009? I asked an old friend, a brilliant lawyer who lives in a New York suburb. “I saw my 6-year-old son run a mile, and catch a bunch of fish,” he immediately replied. He saw his wife, a journalist, “dodge the firings” in her office. He still has a job, too. All of this sounds so common, so modest, and yet, he knows, it is everything. A child caught a fish, he ran, his father saw it. “Broadly,” he added, “I am grateful to America for its freedom, for its yeastiness and, at times, its noise. Dee Snider belting out ‘I Wanna Rock’ is so America.”

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My friend Robert wrote, “I am thankful that I lived to see a person of color sworn into the office of President.” He takes heart that America has set a new face toward the world. “I am thankful and proud when I am in London and people ask me about my president and show great interest in him.” And, “I am thankful that my friends survived the global financial disaster. I am thankful America survived it.”

A real estate lawyer in Washington emailed, “Whether you agree with the policy decisions made by the new administration or not, let’s be thankful that our economy did not fall apart since last Thanksgiving.”

A Washington journalist: “I am thankful that this is still a normal country, with predictable common-sense reactions to excesses. The American people served as a counterweight to the excesses of the Bush years, and are now serving as a counterweight to the excesses of the Obama years.”

A friend who emigrated from Nicaragua 21 years ago and lives now in New York knew right away what she was thankful for: her still-new country. “I’m mainly grateful that I could raise my son in freedom. I could vote for the first time in my life. I could express my opinions without being shot on the spot, jailed, or exiled like my grandfather. I could sleep through the night without fearing for my life. I could work and buy food without rationing.”

My friend Stephanie is grateful that she got health insurance despite a pre-existing condition. Another friend, an academic, was grateful to have been raised in America that taught well the rules of survival—perseverance, discipline.

Jim, who owns a small business, told me that as 2009 began, with all its troubles, “the number of frowns” he saw on the street “was overwhelming.” He decided to take action. “I now make a conscious effort to smile at people in the street, in a bus, while waiting in line. It’s such a simple form of connection, and it only takes one smile returned to make a difference in my day, and I hope the same is true for the other person smiling back.” He hopes to start “a smiling epidemic” in Chicago.

My friend Vin said, when I asked him what he was most grateful for in 2009, “I remember reading that survival rates for breast cancer have been improving. I remember thinking: Thank God.”

I am grateful for a great deal, especially: I’m here. I’m drinking coffee as I write, and the sun is so bright, I had to close the blinds to keep the glare from the computer. When I open the blinds, I will see the world: people, kids, traffic, dogs. Too many friends have left during the past few years, and it reminds us of what death is always trying to remind us: It’s good to be alive.
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Read Peggy Noonan’s previous columns

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And after that, after gratitude for friends and family, and for those who protect us, after that something small. I love TV, and the other day it occurred to me again that we are in the middle of a second golden age of television. I feel gratitude to the largely unheralded network executives and producers who gave it to us. The first golden age can be summed up with one name: “Playhouse 90.” It was the 1950s and ’60s, when TV was busy being born. The second can be summed up with the words “The Sopranos,” “Mad Men,” “The Wire,” “Curb Your Enthusiasm,” “ER,” “24,” “The West Wing,” “Law and Order,” “30 Rock.” These are classics. Some nonstars at a network made them possible. Good for them.

I leave it to others to dilate on why TV now is so good and movies so bad, since both come from the same town, Hollywood, in the same era. But there is a side benefit to televisions’s excellence, and that is the number of people who follow a show so closely, and love it so much, that after it’s aired they come together on long threads on Web sites and talk about what happened and what it means. People use their imaginations and unfocused creativity to add new layers of meaning and interpretation. “You know that was a reference to ‘Chinatown.’” “Did anyone notice what it meant when Peggy told Mr. Sterling ‘no’ when he asked for the coffee? A whole revolution captured in one word!”

Those threads are golden. We rightly discuss the fact that media now is fractured, niched and broken up, that we no longer watch the same shows or have the same conversation. But what’s happening now on the Internet after a good show is a conversation, a new one, and it’s sprung up from the technology that helped do in the old one. How ironic and predictable, and another cause, however small, for gratitude.

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I’ll apologize for not offering hard numbers, but I’ve been too rattled to keep on top of the fundraiser the last couple of days. As on Monday, about $100 came in yesterday from three people, so the fundraiser has pulled in about $650 to date from about 12 people. That leaves about $3,350 to go from 88 people to reach the overall goal of $4,000 from 100 people somewhere around December 18th. Thanks to all of you who’ve contributed so far.

If you’d like to join them, the PayPal button is on the right. If you prefer snail mail, send me an email and I’ll send you my mailing address.

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I suppose I’ve been expecting some news along these lines concerning the accused Fort Hood shooter, an Army psychiatrist. The Wall Street Journal is now reporting:

“Maj. Hasan’s lawyer, John P. Galligan, separately said he was considering an insanity plea for his client. ‘Based on my preliminary assessment, it’s very clear that mental responsibility issues will play a very important part of the case,’ he said in a telephone interview.”

If Maj. Hasan has mental health issues, then it might certainly bolster the case some readers have made that they suspect he was on anti-depressants and that those may be connected with his behavior. I have my doubts, but we shall see.

The other thing is that if Maj. Hasan had problems, then why didn’t his psychiatrist colleagues pick up on them and push for a fitness-for-duty evaluation?

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I appreciate the literally dozens of kind comments that have come in about the passing of my cat Katie (and her appearance on the Cat Blogosphere). 2009 has been a very bad year for me, ranking right up there with 1978 and 1988 as the worst year of my life, and this November has been unusually bad in an unusually bad year. A woman I was dating who I’d just gotten to the relationship point with bailed out on me on November 1 (it was her not me, I assure you) and at 2.30 a.m. this past Saturday I was twice pushed down a flight of stairs in my apartment building by a couple of very drunk, drugged out 20somethings who were making a ton of noise and who I’d simply asked to be quiet. I was lucky that I didn’t break anything and they were lucky I didn’t press charges. But I wanted to put all my energy into Katie, not those jerks (who don’t even live in my building, but had arrived for some late night partying). Besides, when I managed to get back up the stairs the second time, I punched one of them in the face and knocked him to the ground. Not that I felt good about it (I haven’t been in a fight in over 13 years), but he did get what he deserved.

Anyway, November has been truly rough and I appreciate everyone’s kindness.

Have a Happy Thanksgiving wherever you are.

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