Mental Health Blogs

Archive for September, 2010

Jill of All Trades, MD is a family physician blogger who has a post on KevinMD titled Why answering a cell phone during an office visit is a problem. She writes from the perspective of a primary care doc, and talks about the awkwardness of patients talking on the phone during their office visits. She talks about it with a detective/spy metaphor:

Me: “Your recent lab test shows that your diabetes is currently not sufficiently controlled with the current regimen. Your hemoglobin A1C, which is a lab test that tells me what your sugar level has been at home for the past three months, is 8.1. We need to add a medication at this point because…”

“Riiinnnggg!!,” a quite startling sound lifts me off my seat, as if signaling a new secret-agent assignment.

Patient: “Oh, Doctor, hold on one minute please.”

Is this a conspiracy? Before I can even respond, she picks up the cell phone and starts talking to this rather shady intruder.

Patient: “Hi, honey. I’m at the doctor’s office. What do you need? …”

I wait about thirty seconds, with what seems like an eternity in the secret agent world, and she is still on the phone with this suspicious invader. At this point, I decide to exit the premises.
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For some people, answering the phone immediately seems to be a bit of a compulsion. And for someone who’s waited a long time to see an over-booked doctor, I can see why they might want to take a call. Maybe it’s a call that was prearranged for a time long after the patient thought they’d be free…but the patient was surprised to find the doctor was running late, and so why should they put someone on hold for a doctor who’s kept them waiting? Why is it a one-way street? Oh, because it is.

In psychotherapy it’s a different story: people pay for time by the chunk and there aren’t patients backed up waiting to fit into the same time slot. I feel like it’s the patient’s time, and I don’t feel like I should say to an anxious mother, “Don’t take that call.” Still, I’m always a bit surprised when people feel the need to take non-urgent calls during an appointment, and to talk for a bit. I feel a little uncomfortable listening. And even for those who quickly say, “I’m with the doctor, I’ll call you back,” I’m not sure what that gains over having the phone off.

Does my phone ring during sessions? Yes, because sometimes I forget to turn it off–and if it rings, I reach over and silence it . Do I answer it during a session? Never. Whatever it is waits until the session is over. The only exception I make is if I’m trying to get in touch with another physician regarding the care of the patient I’m seeing during that block of time.

I let people talk on the phone or text or deal with their families or clients. No one has done it repeatedly or in a way that notably distracts from therapy. I’m a bit surprised when anyone wants to pay my fee to talk on the phone, or even when anyone runs late, but hey. If I weren’t “rented out” in blocks of time, so to speak, I’d be exiting with Dr. Jill-of-all-trades whenever the phone rang.
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And on a completely different note, I noticed that Jill of All Trades has a link on her sidebar to “Shrink Rapping“….I clicked on it thinking it would be us. But, no….There’s another Shrink Rapping doc out there– Dr. Gregory Smith from Georgia and he’s been at it a while. How’d we miss that?

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When you work in any setting, your view of it becomes distorted. Your vision becomes tunneled, and the world looks small. My husband came home one day upset because a client had burst into tears while they were talking. “Why does that bother you?” I asked. Apparently it’s not something that happens a few times a day for him. And when I was a medical student on an oncology ward, one of the doctors came in for rounds late—on her to way to work she’d seen a young man get knocked off his bicycle by a automobile. She’d stopped to help, and her first question to the young man was, “Are you a smoker?” She quickly realized that it was not a particularly relevant question in that setting.

So do people in the real world have questions about psychiatry? What are they? What a time to ask: just as our book goes for it’s final draft. I should have asked before– What do you want to know? Maybe we’re wrong about what we thought people want to know. Maybe we need to write a second book.

The good news is that after several requests, the jacket designer has agreed to add a duck. Bless our editor for asking— no clue how she explained that one.

Why do I feel like we’ve been working on this book forever? Clink will tell you, “because we have.”

So what questions do you think the general public has about psychiatry? Go for it.

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I’m on a New York Times streak….

In yesterday’s paper, Jenny Norberg writes about families in Afghanistan who choose to raise their daughters as boys. Mostly, they do this because it erases the shame the family feels for not having a son, but it also gives the child and the family more freedom (you can’t send a daughter to the store for a loaf of bread…do they have loafs of bread in Afghanistan?) and the child gets more educational and occupational options. Read Afghan Boys are Prized, So Girls Live the Part.

The cultural issues are fascinating, but that’s not why this article caught my attention. In psychiatry we deal with issues of gender identity and we haven’t fully figured out how much of gender identity is determined by unknown genetic influences versus cultural influences versus other factors– intrauterine exposures, viruses, you name it: we don’t know. It was interesting to read the article and read that some girls remained comfortable in the male role– their ‘conversion’ to their biological gender with puberty, often heralded with an arranged marriage, was confusing and uncomfortable. One of the women continued to wear pants in private, while another girl was uncomfortable with the male role and wanted to be live as a girl, even though boyhood gave her more freedoms. I wondered, too, how much of the gender switching was random selection—did parents sense that a girl might blend into male life more easily and so pick her, rather than one of her sisters, to live a switched childhood? Does seem like this would make for some wonderful research into gender identity….

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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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The Department of Justice has issued a press release regarding criminal charges against the pharmaceutical company responsible for the manufacture of Lexapro and Celexa.

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Alcoholics. A recent article in Time reports that heavy drinkers live longer than nondrinkers. Moderate drinkers faired the best. But the finding that heavy drinkers came in second – above teetotalers – stunned many.

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I work in a homeless shelter so I see a lot of street people. While leaving the building the other day I overheard two coworkers derogatorily discussing a well known prostitute who was in the alley. It made me sad. If only they knew.

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No, this is not about homosexuality.

Many of you probably noticed that there’s no systematic posting here on Everyone Needs Therapy. And it kills me, too, because this used to be so much fun, always on my mind.  And it still is, but a little less so. A lot less so.

Blogging for me used to work like this:

I’d be hanging around, minding my own business, maybe praying, and a thought, or a news story would catch my attention.  Like yesterday, early morning teev, a reporter zeroes in on a cult in Palmdale, CA.  Someone alerted authorities that cult members intended to carry out a mass suicide.  Police intervene, prevent the slaughter. It is rumored that cult members forwarded messages to their families, maybe tweets, who knows,  messages like

It’s okay. See you in Heaven. Please say goodbye to Gramma.  Feed the cat.

See, that was blogworthy.

You may know that my father’s illness and finally his death, knocked me out of the box this year. Blogging, like a lot of other things, had to be pushed down on the list of things to do.  There was the shlepping him to the hospital, the new furnace, the garage.  You don’t even know about the garage. Now it’s the packing up the house, preparing Mom psychologically to move, and the sadness and crying, mostly mine. And the practice, too, needs time, as well as the other humans who live with me, who used to like my bag lunches. The secret, you know, is the wax paper.  I learned this from FD. Always credit someone who teaches you anything.

The good news is that by not blogging so much I figured out how to stretch my recipe for nine muffins to one that serves twelve.  Food is love, so this is a very good thing.

So it wasn’t all gloom and doom at all this year, especially because the grand-kids visited over the summer and these creatures are most demanding and play a mean game of tennis.  Priorities are priorities. I love all of you, but seriously, none of you are five years old, or even eight, and most of you don’t especially find much joy in a bug.

And yet.  I feel I’ve been dishonest, that I’ve been sneaking around, that I’m a slime, for I have committed several indiscretions.  Perhaps you suspected, and you were right.  Therapydoc has been cheating.

The Story:

Way back when, can’t remember, must have been July 2009,  I purposefully asked readers for suggestions for songs, films, and videos that had themes of sexual harassment and violence.  I needed to learn more about our cultural mindset via culture, art, and music.  Our cultural lens. The academic stuff I know.

You came through brilliantly, by the way, I learned so much, and am so grateful.

It was all to launch a new initiative.  And to do that, in our blog-addicted universe, an initiative needs a blog. So some of you might have noticed that the ENT sidebar therapydoc Tweets directed you to RelationshipWise, specifically http://Relwise.blogspot.com. (a Blogger loyalists to a fault).  The voice of that writer sounded suspiciously like mine.

But as you know, I’m a paranoid Jew, an anxious neurotic when it comes to coming out on the Internet, to just being me, a person with a proper name and street address. As it is, every creak in the house, every construction worker or landscaper outside, is a shout to my hyper-vigilant ears that a home-invader is surely in the house, intends to kill me.

The joke is that as an athlete, a fairly wiry, energetic, fairly caffeinated individual, I do pity the poor bloke that tries. And did I tell you I have a sword? (See comments on the garage sale post). When a young man really did try to rape me in college I forcibly pushed him out of the dorm room with psychotic, panicked muscle, sorry only that he left with no broken anything.

Anyway, the good news is that DaMomma has made me a deal that I cannot refuse.  She will be editing the next three posts on Everyone Needs Therapy. She is an amazing writer, a real writer, and it is certain some of you will appreciate the editing.  I know I sure will.

But I want to continue to work on violence prevention and am asking for your help, not your money. Unless you have this to spare, which is not possible, so what are we talking about.

Anyway.  If you have a minute this week, read some of the posts on the other blog, maybe comment even.  Please Do NOT affectionately or even spitefully refer to me over there as therapydoc or TD. Please.  Best would be to follow me, request emails or whatever it that following really means.  Hey, if you do follow RelationshipWise then you don’t have to even read anything. Just visit once in awhile.  We don’t ask much around here, but at the end of the day, the Jewish mother has to come out.  It’s all I ask, a visit.  A cup of coffee. 

The likelihood is that my anxiety will take over and I’ll take this post down, maybe soon, get back to suicide cults, codependency, and sex (oh, such a good one coming up, seriously– the patient tells me–Dr, you should have recorded our visit last week, the things you said–and I had been thinking exactly the same thing.  They’re there somewhere, what was said.  Not sure where, exactly.  And we’ll have DaMomma, a professional writer, to edit a few things on this blog.  For I am, alas,  just your basic

therapydoc

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Through the years I have attended numerous Suicide Prevention training programs. They always raise a great deal of concern and many questions for me. My colleagues and I often discuss this, but rarely do so in public. Perhaps the conversation should be brought to the fore.

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I’m not a big toy person (I don’t think). I didn’t stand on line for an iPhone, I don’t have a Kindle—I actually read these old paper things called books, and I don’t greet strangers with, “Wanna see my apps?” Roy and Clink like toys more than I do. But yesterday I was reading the New York Times magazine online (because my hard copy never came, but thank you to the judge who brought me hers) and I came across this article on the LiveScribe pen.

Oh, my: I want one. But for what? It would have been great when I was a student. I was an excellent note taker, but to have been able to re-listen to lectures on specific parts of my notes–that would have been really helpful. Now? I take notes during the initial interview with patients, and sometimes I reference those notes, but I can’t say I ever have any desire to replay the whole interview, or that there are times when this would help with clinical care. Face it, cool toy, but I don’t really need it.

So I started thinking about how a LiveScribe might be useful in psychiatry and this is what I came up with: it could help in psychotherapy supervision. Residents take process notes on sessions, but it would be cool to have them selectively play parts of the session. Oh, why not just record the sessions and play the whole thing? Oh, that would work, too, except that it never works. It’s rare that a resident comes in with an audible audio recording of an entire session. Despite all the technology, the residents come with the same little cassette recorders that I used…and never worked…year ago.

Just an idea. What do you think? And will Roy get one???

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In today’s New York Times in “Just Manic Enough– Seeking Perfect Entrepeneurs,” David Segal writes about enterpreneur Seth Priebatsch:

According to the Diagnostic and Statistical Manual — the occupation’s bible of mental disorders — these symptoms include grandiosity, an elevated and expansive mood, racing thoughts and little need for sleep.

“Elevated” hardly describes this guy. To keep the pace of his thoughts and conversation at manageable levels, he runs on a track every morning until he literally collapses. He can work 96 hours in a row. He plans to live in his office, crashing in a sleeping bag. He describes anything that distracts him and his future colleagues, even for minutes, as “evil.”

He is 21 years old.

So, what do you give this guy — a big check or the phone number of a really good shrink? If he is Seth Priebatsch and you are Highland Capital Partners, a venture capital firm in Lexington, Mass., the answer is a big check.

But this thought exercise hints at a truth: a thin line separates the temperament of a promising entrepreneur from a person who could use, as they say in psychiatry, a little help. Academics and hiring consultants say that many successful entrepreneurs have qualities and quirks that, if poured into their psyches in greater ratios, would qualify as full-on mental illness.

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There are people who are bright, exuberant, fast-thinking, productive, and filled with energy and ideas. It’s a question we’ve been asking for a while: is this a temperament or a disorder? I would contend that no one goes to a psychiatrist saying “Hey, I accomplish too much, I’m happy and have a lot of energy.” People come to psychiatrists because they are suffering, or because they’ve moved far enough from reality that others are alarmed. We can joke an call it ‘hypo-mania’ but it’s where we’d all like to be.

Having said that, it feels like Segal writes this from the perspective that his subject is certainly not ill. Psychiatric diagnoses are made over time and it seems perhaps irresponsible to use high-energy, successful people as examples of those who might be teetering on some genius–insanity tightrope. The answer —if there is one– lies in the course of a lifetime. If the same highly productive, sleep-defying entrepreneurs later become depressed, despondent, and unable to crawl out from under the covers, then it would certainly make sense to consider periods where he went 96-hours without sleep as part of the whole picture. If such a person never becomes depressed, well….they make lots of money, stay far away from shrinks, and oh, can I have a little of that energy?

Thanks to Jesse for telling me about the article. My New York Times didn’t come today. You’d think with all the free publicity I give them on Shrink Rap…..

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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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