Mental Health Blogs

Archive for December, 2009

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Cuz we’re all sick of the last one.

FD likes to go over the events of the year in December, has been obsessing about this for about a week. Between the two of us, without a blog to record them (for this is not that kind of blog), we try to remember what has happened to us and to the people we know. It’s a long list of remembers.

I’ve just come from my mother’s house, refreshed from a nap on her sofa. The day has started, as usual, at nine in the office, but I cut my afternoon hours to go to the funeral of a close friend, an expected passing. In our community it is tradition, following the service, to follow the mais, the dead person, to the grave, literally walk behind the casket. These days bodies are flown to different destinations, different cities, even countries. So we walk behind the hearse in the cold, the rain, whatever the weather, to say goodbye.

Our friend wasn’t a rabbi, he was just a regular guy, but special of course, to us.

The rabbis of two synagogues eulogized David, spoke of his faith and acceptance of disease, this gorgeous, positive man, his sweet-disposition, how he and his family moved to Chicago thirteen years ago. He helped build two synagogues, two renovations of older buildings, one edifice now more beautiful than the next.

The rabbis of each shul claim him. It wasn’t with money, although I could be wrong, but surely with time, that he gave of himself. Everything takes time, all worthy projects. They speak of him in one of the new synagogues, and after the speeches, we follow our friend, on foot, to the next.

It’s really cold, and me being a cold kind of person anyway, cold-intolerant, wearing a short, fall jacket, could easily opt out of the march down the busy street, but it doesn’t feel like an option. Maybe reading the stories from the Holocaust, the survivor tales, has changed me. I make an association, cold is an obstacle, nothing more or less, and of course, this isn’t Poland, dead of winter, 1942. And that awful awareness of the elements and the coldness of death, too, disappear.

I meet up with FD at the destination, and he greets me with, “I felt I had to walk, even though it’s really cold; that it was an honor to accompany him.” Right there with you, dear.

We walk together to the car in no particular hurry and he continues, “Let’s stay together the whole day. I won’t go back to the office. I’ll go with you, wherever you’re going.” He knows that I’m picking up my mother, taking her to visit my father in the hospital, but there are errands, things to do. The day is full like every other day.

“Sometimes,” he says, as we buckle ourselves in, “I think you don’t need this kind of thing as much as me, just being together, that I’m not so necessary.”

Such bait. I reassure, explain that this isn’t so, and why. You might call this emotional intimacy.

We swing over to the grocery store to pick up an anniversary cake for my parents. I blank on the year, how long they’re married, but have the number 64 in my head (wrong), so I tell the woman behind the counter, “Just write on the cake . . .”

Mom & Dad, 64?

FD picks up champagne and sparkling grape juice, not sure if they’ll let my father have a little champagne or not, and flowers, tulips. I pick out some cards, one from us, one from my mother to my father, forgetting to buy one from my father to my mother. Neither of them is in a position to buy the other anything.

We pick up Mom at her house. She’s waiting at the front door. She doesn’t know we’re going to have a little party in the hospital room to celebrate her anniversary. FD and I are very excited.

Dad is sitting up in a chair, dressed. His hair is getting kind of long, in the hospital eight days. He’s happy for the company but short of breath, six words to a breath, at most, sounds a little like the Godfather. He suggests, as we begin to sign the cards in front of him, that we get some post-its, write on these so we can recycle the cards.

You see, everyone’s green these days.

But the cards are good, spot on, and we save them, so we sign them and hand them over. We don’t stay long because he has work to do, it is time for rehab and if he isn’t rehabbed, then what is he doing here, anyway? We want to keep him out of the hospital, but we’re in no hurry. Every new decision is stressful. It’s hard on my mother to shlep here every day. And she’s lonely living without him, vulnerable, too.

It isn’t easy staying awake on the drive back to the house, but I can’t say this, of course. I flop on her sofa, asleep before I’ve even closed my eyes. While I nap she brushes off an old winter dress coat of hers because I’ve complained about being cold in my jacket, and haven’t bought a new coat for myself in twenty years.

I wake up in a start and eventually ask FD. “What must it be like for her to see me age like this, crash on her couch like I just did? I was out for an hour!”

“We see our kids getting older,” he philosophizes.

Not the same. Anyway. We start recollecting, without a blog, the year.

There have been other friends who are now gone, young people, at least we think so, one who left us at 50, suffering in silence, telling no one about her disease. A teacher. We call teachers in our community, stars. These are our stars. We lost a star.

Only about five weeks ago we lost another dear friend to a heart attack, 62. Playing raquetball. We escorted his body to the cargo hangar at the airport; he had a ticket to Israel for burial in the holy land. His mother, already there, reportedly said,
“I can accept it. I just can’t believe it.”

The week after that we heard that yet another member of the community had passed away in Spain, and the Spanish authorities want to embalm the body, not a Jewish tradition, unless the community, the family, comes up with $70,000 for transport on a private jet. Somehow this money is found. But an important person talks to another important person and the commercial airliner takes the body, as is.

And so it goes. Two of my uncles leave us, one younger than my father, one older.

People lose jobs, people lose lives, and we understand that 25% of all Americans are in danger of losing their homes. We watch, experience these statistics like everyone else, and worry.

Meanwhile, (K”H*) my brother-in-law has a new lease on life, a new kidney, not an easy find in your sixties, and my father, although gasping for breath, has a fistula and with the help of dialysis, could live for many more years. My grandson, an infant, has a heart that is whole. The surgeon who sewed it up is a doctor without borders who does this surgery on 13 year olds in impoverished villages, children who have not, until their surgery, lived a not-blue day in their lives.

We’ve had many new babies in the family, and marriages.

We have this idea, in my culture, that it’s all decided, everything that happens to everyone in the world is decided on the Jewish New Year, a holiday that rolls around in September or October, depending upon the lunar cycle. We take off time for the holidays, look deeply into ourselves, our behavior, the things we’ve done, that which we haven’t done, and we apologize, mainly to one another, for our greatest deficits, which we feel are communal, social. Then, ten days later, we fast for twenty-five hours, face our King, own up to our garbage, vow to do better, and hope for the best.

But since everyone else reviews their year at the end of December, some of us do this, too. We look back to look forward, as the snow falls and the temperatures drop into the single digits.

And it’s New Years.

To you and yours, may it be happy, healthy, safe, and full of love,

therapydoc

*K”H means, basically, the evil eye should leave you alone.

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Cuz we’re all sick of the last one.

FD likes to go over the events of the year in December, has been obsessing about this for about a week. Between the two of us, without a blog to record them (for this is not that kind of blog), we try to remember what has happened to us and to the people we know. It’s a long list of remembers.

I’ve just come from my mother’s house, refreshed from a nap on her sofa. The day has started, as usual, at nine in the office, but I cut my afternoon hours to go to the funeral of a close friend, an expected passing. In our community it is tradition, following the service, to follow the mais, the dead person, to the grave, literally walk behind the casket. These days bodies are flown to different destinations, different cities, even countries. So we walk behind the hearse in the cold, the rain, whatever the weather, to say goodbye.

Our friend wasn’t a rabbi, he was just a regular guy, but special of course, to us.

The rabbis of two synagogues eulogized David, spoke of his faith and acceptance of disease, this gorgeous, positive man, his sweet-disposition, how he and his family moved to Chicago thirteen years ago. He helped build two synagogues, two renovations of older buildings, one edifice more beautiful than the next.

The rabbis of each shul claim him. It wasn’t with money, although I could be wrong, maybe am, but surely with time, that he gave of himself. Everything takes time, all worthy projects. They speak of him in one of the new edifices, and after the speeches, we follow our friend, on foot, to the next.

It’s really cold, and me being a cold kind of person anyway, cold-intolerant, wearing a short, fall jacket, could easily opt out of the march down the busy street, but it doesn’t feel like an option. Maybe reading the stories from the Holocaust, the survivor tales, has changed me. I make an association, cold is an obstacle, nothing more or less, and of course, this isn’t Poland, dead of winter, 1942. And that awful awareness of the elements and the coldness of death, too, disappear.

I meet up with FD at the destination, and he greets me with, “I felt I had to walk, even though it’s really cold; that it was an honor to accompany him.” Right there with you, dear.

We walk together to the car in no particular hurry and he continues, “Let’s stay together the whole day. I won’t go back to the office. I’ll go with you, wherever you’re going.”

“Sometimes,” he goes on, as we buckle ourselves in, “I think you don’t need this kind of thing as much as me, just being together, that I’m not so necessary.”

Such bait. I reassure, explain that this isn’t so, and why. You might call this emotional intimacy.

We swing over to the grocery store to pick up an anniversary cake for my parents. I blank on the year, how long they’re married, but have the number 64 in my head (wrong), so I tell the woman behind the counter, just write

Mom & Dad, 64?

FD picks up champagne and sparkling grape juice, not sure if they’ll let my father have a little champagne or not, and flowers. Tulips. I pick out some cards, one from us, one from my mother to my father, forgetting to buy one from my father to my mother. Neither of them is in a position to buy the other anything.

We pick up Mom at her house. She’s waiting at the front door. She doesn’t know we’re going to have a little party in the hospital room to celebrate her anniversary. FD and I are very excited.

Dad is sitting up in a chair, dressed. His hair is getting kind of long, in the hospital eight days. He’s happy for the company but short of breath, six words to a breath, at most. A little like the Godfather. He suggests, as we begin to sign the cards in front of him, that we get some post-its, write on these so we can recycle the cards.

You see, everyone’s green these days.

But the cards are good, spot on, and we save them, so we sign them and hand them over. We don’t stay long because he has work to do, it is time for rehab and if he isn’t rehabbed, then what is he doing here, anyway? We want to keep him out of the hospital, but we’re in no hurry. Every new decision is stressful. It’s hard on my mother to shlep here every day. And she’s lonely living without him, vulnerable, too.

It isn’t easy staying awake on the drive back to the house, but I can’t say this, of course. I flop on her sofa, asleep before I’ve even closed my eyes. While I nap she brushes off an old winter dress coat of hers because I’ve complained about being cold in my jacket, and haven’t bought a new coat for myself in twenty years.

I wake up in a start and eventually ask FD. “What must it be like for her to see me age like this, crash on her couch like I just did? I was out for an hour!”

“We see our kids getting older,” he philosophizes.

Not the same. Anyway. We start recollecting, without a blog, the year.

There have been other friends who are now gone, young people, at least we think so, one who left us at 50, suffering in silence, telling no one about her disease. A teacher. We call teachers in our community, stars. These are our stars. We lost a star.

Only about five weeks ago we lost another dear friend to a heart attack, 62. Playing raquetball. We escorted his body to the cargo hangar at the airport; he had a ticket to Israel for burial in the holy land. His mother, already there, reportedly said, “I can accept it. I just can’t believe it.”

The week after that we heard that yet another member of the community had passed away in Spain, and the Spanish authorities want to embalm the body, not a Jewish tradition, unless the community, the family, comes up with $70,000 for transport on a private jet. Somehow this money is found. But an important person talks to another important person and the commercial airliner takes the body, as is.

And so it goes. Two of my uncles leave us, one younger than my father, one older.

People lose jobs, people lose lives, and we understand that 25% of all Americans are in danger of losing their homes. We watch, experience these statistics like everyone else, and worry.

Meanwhile, (K”H*) my brother-in-law has a new lease on life, a new kidney, not an easy find in your sixties, and my father, although gasping for breath, has a fistula and with the help of dialysis, could live for many more years. My grandson, an infant, has a heart that is whole. The surgeon who sewed it up is a doctor without borders who does this surgery on 13 year olds in impoverished villages, children who have not, until their surgery, lived a not-blue day in their lives.

We’ve had many new babies in the family, and marriages.

We have this idea, in my culture, that it’s all decided, everything that happens to everyone in the world is decided on the Jewish New Year, a holiday that rolls around in September or October, depending upon the lunar cycle. We take off time for the holidays, look deeply into ourselves, our behavior, the things we’ve done, that which we haven’t done, and we apologize, mainly to one another, for our greatest deficits, which we feel are communal, social. Then, ten days later, we fast for twenty-five hours, face our King, own up to our garbage, vow to do better, and hope for the best.

But since everyone else reviews their year at the end of December, some of us do this, too. We look back to look forward, as the snow falls and the temperatures drop into the single digits.

And it’s New Years.

To you and yours, may it be happy, healthy, safe, and full of love,

therapydoc

*K”H means, basically, the evil eye should leave you alone.

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I didn’t expect the fundraiser to generate much action after the 22nd and I was right since nothing has come in since. As things stand now, the total raised to date is $3,695.26 from 81 people. Thanks to all who’ve contributed so far. There’s a mere $304.74 to go to hit the overall goal of $4,000 and it’d be swell if that remainder was wiped before year end. On Tuesday (or late Monday), I will have a major post up that I’ve been working on over the holiday weekend that will reinforce for those of you who contribute why you support this site and will hopefully establish for those of you who haven’t why you should. You’ll see what I mean on Tuesday.

As usual, the PayPal button is on the right. If you prefer using snail mail, send me an email and I’ll send you my mailing address.

Thanks in advance for your support.

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Over the weekend I finally got time to roll through the recently-passed Senate health care reform bill and, like its House cousin, it contains much of the language of the controversial MOTHERS Act. You can download the Senate bill here and start reading at page 595.

As I noted in October when the House Democrats rolled out their version of health care reform, let me just carefully point out that it confuses me that legislation that is supposed to gain uninsured Americans access to health care (out of their own pockets in many cases) contains an Act that is little more than a postpartum depression screening program and public health awareness raising nation-wide education campaign. That helps uninsured Americans gain access to health insurance how? It makes me wonder what Senate (and House) members pushed for its inclusion and on what basis. I know the Act has been knocking around Congress for much of the past decade and could never gain passage, so I guess this was the most efficacious manner for its backers to get it through.

The MOTHERS Act itself has been the object of much criticism–by women even and a psychiatrist–as a disease mongering gift to pharma companies. Feel free to draw your own conclusions. I’ve learned from bitter experience that it’s probably not very wise for me to have an opinion about the Act itself.

The Senate bill also contains language supporting basic research of the causes of PPD, epidemiological studies of its frequency, “the development of improved screening and diagnostic techniques” and “clinical research for the development
and evaluation of new treatments.”

One wonders what new treatments those might be–isn’t Paxil in pregnant women working out just fine so far for mother and child? Is there some new drug on the horizon specifically tailored to PPD? Is there some new psychotherapy on the horizon? Or are they just going to hand out money so that some researchers can pretend that there might be when, in fact, we’re probably stuck with the pills and therapies we already have? And all of this affects Americans access to affordable health care how?

Inserted into the language on PPD research and education, the bill contains language similar to the House bill (which I wrote about here) on researching the mental health outcomes of women who have abortions or otherwise resolve a pregnancy. To whit:

“It is the sense of Congress that the Director of the National
Institute of Mental Health may conduct a nationally representative longitudinal study (during the period of fiscal years 2010 through 2019) of the relative mental health consequences for women of resolving a pregnancy (intended and unintended) in various ways, including carrying the pregnancy to term and
parenting the child, carrying the pregnancy to term and placing the child for adoption, miscarriage, and having an abortion. This study may assess the incidence, timing, magnitude, and duration of the immediate and long-term
mental health consequences (positive or negative) of these pregnancy outcomes.

As I wondered aloud in October, it’s not clear to me how such a study would affect Americans access to health insurance, but perhaps I am a blockhead. I also wonder who pressed to have this provision stuck into the bill since it’s not clear to me whether such a study would serve the interests of pro-lifers or pro-choicers.

If anyone knows, feel free to enlighten me.

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A study by Harvard’s Joseph Biederman and others at Harvard/MGH in the November Journal of Clinical Psychiatry, which just went online, and reached one of the least controversial findings of the controversial psychiatrist’s career: adults with ADHD (and that’s the term researchers used instead of ADD) have more difficulty with sleep than do people without ADHD.

“Results: Adults with ADHD went to bed later than control subjects and had a wider range of bedtimes (mean ± SD = 18 ± 92 min vs 54 ± 69 min before midnight; P < .001), were more likely to take over an hour to fall asleep (OR = 5.22, P = .001), and were more likely (P < .003) to experience difficulty going to bed, going to sleep, sleeping restfully, or waking in the morning. Adults with ADHD experienced daytime sleepiness more often (OR = 2.23, P = .003) and reported more sleep problems (mean ± SD = 6.7 ± 2.5 vs 4.3 ± 2.2; P < .001) than controls. All sleep impairments were significantly associated with ADHD independent of contributions to sleep disruption from ADHD pharmacotherapy, comorbidities likely to contribute to sleep disturbance, and age at ADHD onset.

“Conclusion: Sleep disturbances that are not attributable to comorbid mental health conditions or ADHD pharmacotherapy are associated with ADHD in adulthood. Clinicians and researchers should consider the potential contribution of sleep disruption to the clinical presentation of adults with ADHD.”

While I don’t necessarily buy researchers’ implied argument that going to sleep before midnight is the gold standard of sleep (especially if someone works swing or graveyard shifts. Do Biederman et al. really believe that everyone works 8 to 5 and that that’s the appropriate standard for poking into sleep and ADHD? Ah, ivory towers and pharma dough!), I have no problem with the idea that sleep difficulties could be tangled up with adult ADHD (A dx I’m somewhat dubious of, but I’ll leave that be for now). The fact is sleep problems are entwined with several mental disorders, depression and bipolar disorder most prominently.

I’m not quite comfortable with the researchers’ assertion that the sleep problems can be determined to be independent of ADHD meds or a history of taking ADHD meds and other psychotropics. I mean, maybe they can get there statistically. But over the years of doing this site and hearing from readers and from just your basic workaday observations of people with depression, bipolar disorder and ADHD, I’ve come to the conclusion that psych meds are almost always at least partially implicated in sleep problems (both in sleeping too little and in sleeping too much and in general difficulties falling asleep). In the years since I became meds-free (and it’s nice to be able to say “years” in that regard), sleep has come more easily and been of better quality. Of course, if the Biederman crew took a look at what time I go to sleep most nights (2 a.m.), they’d be screaming “ADHD” at me. But I’ve been a late-night type since my college days. I had little choice since I was taking a full load, working five hours a day and studying six hours a night along with getting up at 6 a.m. to run three miles and go lift weights before breakfast. ADHD had nothing to do with that pattern establishing itself.

The other thing I’ve picked up on over the years from reader emails and the real world is that far too often people with depression, bipolar disorder and whatnot spend way, way too much time on their computers late into the evening. Computers and the ‘Net have become such deeply distracting, “You must multi-task on me or leave society” devices that I wouldn’t be shocked at all if they are as much at the heart of adult ADHD problems as are sleep problems and ADHD itself.

I know a psychologist in Seattle who’s been working with kids and teens and ADHD and conduct disorders and such for 30 years. I ran into her at a party perhaps a year ago and amidst telling me that she thought the entire bipolar child paradigm was BS, she said that when a new teen client came in with his or her parents she told them that if they didn’t agree to limit computer/call phone use at home to one hour a day, then she wouldn’t work with them. She couldn’t control how much a kid was forced to use a computer at school, but getting them to back off the many hours a day kids spent using computers (and MySpace and IMs and text messages) each day in almost every case went a long way to resolving the kids’ problems. They were less distracted and slept better. Or so she told me.

I wonder if the Biederman crew made any attempt to account for computer/Internet use confounds in its study. As far as I can tell, they didn’t.

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t’s with a lot of sadness that I pass along news that the great singer-songwriter Vic Chesnutt died yesterday, aged 45. He’d been in a coma and some reports indicate that was as the result of a suicide attempt. A paraplegic since a car accident in his teen years, Chesnutt was reportedly facing $70,000 in medical bills due to recent surgery and was unable to pay. I have no idea if that fed into his possible suicide attempt.

I once saw Chesnutt play a show in San Diego back in 1992 or so. I bought a cassette tape of his wonderful album “West of Rome” off him at the show and chatted with him for a bit. Nice guy. It sucks that he’s gone. RIP.

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I hope you all are having a nice, peaceful holiday regardless of what you celebrate. My flight down from Seattle to Tucson yesterday was a complete pain in the butt–what has happened to air travel?–and I’d just like to say that US Airways stinks. But I’m enjoying the nice weather in Tucson–low 50s, sunny and two more hours of daylight a day than in Seattle this time of year. I need it.

I’ll be back to regular posting on Monday.

Oh, yes, the Senate Dems passed their health care reform bill earlier today. I don’t have much to say about it right now since the real action will come after the New Year when it has to be reconciled with the House version of the bill. That said, I’m sure you are all aware that the Senate bill is drawing heaps of criticism from both the political left and right. One writer at Firedoglake.com, about as lefty a joint as you’ll find on the ‘Net, described the whole business as “Obama’s Health Care Cult of Personality” and offered a fairly decent critique of the bill. In less than one year, the President’s most ardent supporters have turned into some of his biggest foes. Not sure if I saw that coming. I’m sure you can imagine what conservatives are saying about the bill.

Anyway, I hope the year winds down peacefully for you all.

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