Mental Health Blogs

Archive for February, 2010

Private Murphy smiled. His drill instructor saw the smile and marched over to him, screaming, “What are you smiling about Private Murphy?!!!”

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Our household is a rolling Alfred Hitchcock festival. We almost always have at least one of the celebrated director’s films on DVD, and over the years we have watched most of our favorites—Suspicion, North by Northwest, The 39 Steps—time and time again. It’s a tribute to the master’s skills and sensibility that his films have such enduring appeal, because many films from the same time period have a distinctly “old” feel to them. It’s not just the primitive cameras and films. There is something about the rhythm and texture of early cinema that has a very different “feel” than modern films. But it’s hard to put one’s finger on just what that something is.

New research may help explain this elusive quality. Cognitive psychologist and film buff James Cutting of Cornell University decided to use the sophisticated tools of modern perception research to deconstruct 70 years of film, shot by shot. He measured the duration of every single shot in every scene of 150 of the most popular films released from 1935 to 2005. The films represented five major genres—action, adventure, animation, comedy and drama. Using a complex mathematical formula, Cutting translated these sequences of shot lengths into “waves” for each film.

What Cutting was looking for were patterns of attention. Specifically, he was looking for a pattern called the 1/f fluctuation. The 1/f fluctuation is a concept from chaos theory, and it means a pattern of attention that occurs naturally in the human mind. Indeed, it’s a rhythm that appears throughout nature, in music, in engineering, economics, and elsewhere. In short, it’s a constant in the universe, though it’s often undetectable in the apparent chaos.

Cutting found that modern films—those made after 1980—were much more likely than earlier films to approach this universal constant. That is, the sequences of shots selected by director, cinematographer and film editor have gradually merged over the years with the natural pattern of human attention. This explains the more natural feel of newer films—and the “old” feel of earlier ones. Modern movies may be more engrossing—we get “lost” in them more readily—because the universe’s natural rhythm is driving the mind.

What does this mean? Cutting doesn’t believe that filmmakers have deliberately crafted their movies to match this pattern in nature. Instead, he believes the relatively young art form has gone through a kind of natural selection, as the edited rhythms of shot sequences were either successful or unsuccessful in producing more coherent and gripping films. The most engaging—and successful—films were subsequently imitated by other filmmakers, so that over time the industry as a whole evolved toward an imitation of this natural cognitive pattern.

Over all, action movies are the genre that most closely approximates the 1/f pattern, followed by adventure, animation, comedy and drama. But as Cutting reports on-line in the journal Psychological Science, individual films from every genre have almost perfect 1/f rhythms. The Perfect Storm, released in 2000, is one of them, as is Rebel Without a Cause, though it was made in 1955. So too is The 39 Steps, Hitchcock’s masterpiece from way back in 1935.

For more insights into the quirks of the human mind, visit the “Full Frontal Psychology” blog at True/Slant. Excerpts from “We’re Only Human” appear regularly in the magazine Scientific American Mind. Wray Herbert’s book, On Second Thought: Outsmarting Your Mind’s Hard-Wired Habits, will be published by Crown in September.

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The calorie war is heating up. It’s actually been simmering for some time, sparked by an alarming obesity rate among young Americans and related spikes in diabetes and other health problems. Nobody really disputes this sorry trend anymore, but there is a lot of disagreement over what to do about it. Public health advocates are clamoring for everything from warning labels on junk food to aggressive television marketing campaigns, even for outright prohibitions. Just last week, the Obama administration entered the fray, calling for a total ban on candy and soda in the nation’s schools.

Some see the past tobacco war as the proper model for this public health campaign. Indeed, one idea that has gotten traction recently is another “sin tax”—this one a fat and sugar tax—to dissuade people from eating junk food. Yale University psychologist and diet expert Kelly Brownell, writing in the prestigious New England Journal of Medicine last spring, called for a penny-per-ounce tax on soda sweetened with sugar or corn syrup. Only such a tax, he believes—and not lectures about nutrition and exercise—will make people eat more sensibly, and what’s more, the revenue could be used to promote healthier foods and habits.

Not everyone agrees. Pricing strategies may well be a key to changing behavior, but others favor subsidies over punitive taxes, as a way to encourage people to eat fruits and vegetables and whole grains. The problem is that both these market approaches—taxes and subsidies—are founded on the belief that people make rational economic decisions: Make it cheaper and people will eat more of it, more expensive and people will eat less. But decades of behavioral economics research argues that consumers are not always so rational. And the two strategies have never been tested head to head, to see which one most effectively alters calorie consumption.

Until now. Leonard Epstein, a clinical psychologist at the University of Buffalo, decided to explore the persuasiveness of sin taxes and subsidies in the laboratory, and he did so in an innovative way. He and his colleagues turned their lab into a simulated grocery store, “stocked” with images of everything from bananas and whole wheat bread to Dr. Pepper and nachos. A group of volunteers—all mothers—were given laboratory “money” to shop for a week’s groceries for the family. Each food item was priced the same as groceries at a real grocery nearby, and each food came with basic nutritional information.

The mother-volunteers went shopping several times in the simulated grocery. First they shopped with the regular prices, but afterward the researchers imposed either taxes or subsidies on the foods. That is, they either raised the prices of unhealthy foods by 12.5 %, and then by 25%; or they discounted the price of healthy foods comparably. Then they watched what the mothers purchased.

It’s important to know how the scientists defined healthy and unhealthy foods. They used an index called calorie-for-nutrition value, of CFN, which simply means the number of calories one must eat to get the same nutritional payoff. So for example, nonfat cottage cheese has a very low CFN, because it is packed with nutrition but not with calories; chocolate chip cookies have a much higher CFN. The most sinful food in the store was commercial iced tea, with a whopping CFN equivalent to ten times that of chocolate chip cookies. The researchers also measured the energy density—basically calories—in every food.

Then they crunched all the data together, and the findings were striking. To put it bluntly, taxes worked and subsidies did not. Specifically, taxing unhealthy foods reduced overall calorie intake, while cutting the proportion of fat and carbs and upping the proportion of protein in a typical week’s groceries. By contrast, subsidizing the prices of healthy food increased overall calorie consumption without changing the nutritional value at all. Why? As reported on-line last week in the journal Psychological Science, it appears that mothers took the money they saved on subsidized fruits and vegetables and treated the family to some chips and soda pop. Taxes had basically the opposite effect, shifting spending from junk to healthier choices.

The scientists conclude that subsidizing broccoli and yogurt—as appealing as that idea might be to some—is unlikely to bring about the massive weight loss the nation now requires.

For more insights into the quirks of human nature, visit the “Full Frontal Psychology” blog at True/Slant. Excerpts from “We’re Only Human” appear regularly in the magazine Scientific American Mind. Wray Herbert’s book, On Second Thought: Outsmarting Your Mind’s Hard-Wired Habits, will be published by Crown in September.

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Our state is considering legalizing medical marijuana.

As a psychiatrist, my first thought is : NO! We treat addictions, and we try hard not to cause them. Marijuana (and many other illegal substances) may help mood and anxiety in the moment, but they don’t seem to fix things for the long haul. And chronic pot smoking decreased motivation, burbles your brain, and does nothing good to your lungs. I have visions of patients at the door saying they need me to prescribe pot for their anxiety. Please, doctor, please.

But then I think of end-stage cancer patients, and it really doesn’t bother me if a little cannabis helps with their symptoms.

There are those who claim that oral THC (marinol) can be helpful for many symptoms, oh, but unliked the smoked stuff, Marinol doesn’t get you high. There’s less evidence about inhaled marijuana being effective.

So here’s my question: How does medical marijuana work in your state? How widespread is the use? What are the terms and conditions under which it can be prescribed? Who gets it and with what regulation? Is it a good thing or a bad thing and why? And please, if you have links to data or studies or interesting articles about the legalization of medical marijuana, by all means put them in your comments. If you want to tell me why cannabis should be legal and it’s a government plot to keep it illegal and any information from NORML, you can hold off on those links…I think I’ve heard that side of the story.

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Listen to our latest podcast at mythreeshrinks.com or subscribe to our rss feed. Email us at mythreeshrinks at gmail.

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One of the most distressing symptoms of trauma can be the nightmares it evokes. They attack when you are peacefully asleep and off guard. Not being able to get a good night’s rest can seriously compromise your mental health and make other trauma symptoms worse. If they persist you may even develop a fear of going to sleep.

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I think a lot of clients (and some therapists unfortunately) have a misconception that therapy should make you feeling nothing but good. This is simply not true.

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Clink and I have been having a discussion about insurance participation. It’s for the book. We think.

So I’ve made the statement that given that insurance companies reimburse according to their somewhat random (and generally reduced) rate of Usual & Customary Fees, that they require paperwork and hoops to jump through, and that there is financial incentive for seeing a lot of patients in less time, more so then in giving slow and thoughtful care, that in some communities there is a force of natural selection and that the Best docs may be the ones who won’t participate in insurance networks. Is this completely true: of course not. Some really good docs (especially inpatient and consult-liason, where there is very little option) participate with insurance companies. Maybe they live in communities where it’s the only feasible way, maybe they like having high-volume practices, maybe they just participate with one or two selected insurance companies to accommodate select patients (or because they’ve heard the company is easy to work with, or reimburses well), or maybe they feel it’s the socially responsible thing to do. Oh, or maybe they worry that if they Don’t, they won’t get enough referrals and make it in private practice.

So, in thinking about this, I realized I know very little about docs who participate with insurance networks. None of my friends do. I participated in Blue Cross for 7 years—they never sent me referrals and they’d send me random checks for $12.44 (like what was that a portion of?) or $44 something. The UCR was different for each patient, and they were all much much less than going fees back then.

I’ve been assuming that to make a living accepting insurance, that the doc needs to see a high volume of patients. That’s not to say that a psychiatrist might not be willing to see a portion of their practice as psychotherapy patients and take a lower hourly fee for that, and compensate by doing high volume work the rest of the day, or by offering different levels of care based on insurance. That’s not to say that there aren’t psychiatrists who don’t participate with insurance but still have very high volume practices, but they make a lot more money then I do (or so I believe).

But it’s occurred to me that I really don’t know much beyond what I learned when I was in a group practice way back when. If you take health insurance, tell me how your practice works– how many patients do you see in an hour, do you get paid from the insurance companies, do you like your work, do you feel the care you give is as good? And if you see a psychiatrist in your insurance network, please tell us how that goes….how long are the appointments, how often do you go in, how does the billing and co-pay work? And if you’ve seen both in- and out- of network shrinks, how were they different and what worked better for you?

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Listen to our latest podcast at mythreeshrinks.com or subscribe to our rss feed. Email us at mythreeshrinks at gmail.

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I wanted to move on, to talk about failure, but then I get this comment on the last post. It’s about failure, but not exactly the failure I had in mind, and not being a failure, but fearing failure. You’re not exactly a representative sample, not if you read me, but still. What do you think?

The comment is in response to my hard stand about taking Viagra for anxiety that’s situational: a young woman expects a good sexual performance very early into a relationship, maybe even the first date. And a young man wants to rise to the occasion. PRESSURE.

Mr.P and Vitamin V said…

Doc,

1st of all, I’m a huge fan!!!

Let me represent Mr. P and Vitamin V for a moment..

I can tell you that very often by the 3rd date, if the man hasn’t made some sort of sexual “move”, the woman gets insecure and feels that something is wrong with her..And trust me, talking about how wonderful she is and saying that I like to take things a little slower does not work at all..

She wants something to happen!! Granted, I’m not complaining about that, but if something is going to happen, I like to insure that it actually happens..Without Viagra early in the dating process, my anxieties often take control and make things not work properly..

And oh my goodness, if it doesn’t work, she either feels that she’s not attractive OR she thinks something is wrong with me…It’s not necessarily about her achieving an orgasm, it’s more about showing her that I like her and I’m attracted to her. It doesn’t have to be spectacular the 1st, 2nd or 3rd time, etc..It just has to happen…As things progress and I feel more comfortable, I don’t need the V..

And your description of the healthy relationship is what I would love to achieve..I guess what I’m trying to say is that early in a relationship, words don’t seem to have as much of an impact..They’re not believed as much as they should be…Later on, words mean more..And one more thing, Doc!! I don’t see 2 women for every man out there.

February 11, 2010 10:59 AM

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As many of you know, a draft of the proposed DSM-5 is just out and it’s bound to stir plenty of comment and controversy. First, I’ve got to congratulate the DSM-5 crafters for making the draft public and for seeking public comment. That’s right: the APA wants to hear from members of the public, not just medical professionals. So let them know what you think.

Meanwhile, let me offer some preliminary comments:

1. Internet addiction isn’t included, which is fine by me and likely will save the APA much sniggering and criticism.

2. Bipolar disorder type 3 or subthreshold bipolar disorder is not included either and that is definitely a victory for critics like me who’ve long held that the softening of mood disorders–such as with bipolar disorder type 2–has led to millions of Americans being overdiagnosed and overmedicated.

3. Perhaps the biggest losers in the politics of DSM-5 are the Harvard child psychiatry crew and the FDA. The Harvard folks have pressed hard for over a decade to establish mood lability and temper tantrums in children as pediatric bipolar disorder or child bipolar disorder. Harvard’s Joseph Biederman and others claimed they had nothing but sound science driving their claims, ones the FDA bought hook, line and sinker. This all led to the wild overdiagnosis and overmedication of millions of American children, basically to shut them up when arguably they needed more attention to their diets and lack of physical activity.

Now, the DSM-5 authors have not included PBD in their proposal, certainly giving the lie to the Harvard crew. Instead, they chose to label these kids as having Temper Dysregulation Disorder with Dysphoria. While anything that steers diagnosis and treatment away from meds first, last and always is to be welcome, I cannot help but feel that slapping a syndrome of any kind on children is dangerous. Especially since the new syndrome is describing behavior that’s been around for eons and hasn’t been particularly troubling for humanity until child psychiatrists and pharma companies got their hands on all of this in the 1990s.

I’ll have more to say on this one as the implications become clearer.

4. Advocates for including psychosis prodrome have won a victory as the DSM-5 draft contains a disorder called Psychosis Risk Syndrome. The research on all of tis is quite slim and such research as exists hasn’t pointed to a high percentage of youngsters allegedly at-risk of developing a full-blown psychotic disorder as being readily identified by precursor symptoms. And those who recall the disastrous PRIME study will remember that medicating teens sure didn’t help them out. I hope this proposed diagnosis is promptly dropped from inclusion in DSM-5.

5. I’ve not been able to poke into the newfangled, proposed severity scales for anxiety and depression, so that’s something I’ll have to push off until later. You can see an example here, however.

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