Archive for September, 2010
Brains, Behavior and Football
In psychiatry, we’ve had a hard time drawing precise links between brain pathology and psychiatric disorders. We can do it for groups of people: Disease X is associated with changes in brain structure of Brain Area Y or metabolic changes in Brain Area Z. But it’s groups, not individuals, and it’s an association, not a cause>effect, or a definite. We still can’t use this information for diagnosis, and there are still patients with any given psychiatric diagnoses who will have brains where Area Y is the same size as those without the disorder.
We’re learning.
From what I read in this New York Times article, Owen Thomas was a bright, talented young man with no history of psychiatric disorder, and no history of known concussion. In April, he committed suicide– a tragedy beyond words. Sometime people commit suicide and every one is left to wonder: there was no depression, no obvious precipitant, no note left behind, and every one is left to wonder why. The guilt toll on the survivors is enormous, as is the grief for their families and communities. In this case, according to the Philadelphia Inquirer, the young man was apparently struggling with the stress of difficult school work and concerns about his team and employment.
Owen’s family donated his brain to Boston University’s Center for the Study of Traumatic Encephalopathy.
They discovered that Owen’s brain showed damage similar to that seen in older NFL players who’ve– he had a condition called Chronic Traumatic Encephalopathy. In terms of Owen’s suicide, it’s hard to know what this means: did the brain injury contribute to or cause a psychiatric disorder, such as depression, that led to his suicide? Did it make him more impulsive, so that he was more likely to act on suicidal thoughts? It’s hard to say: suicide is a common cause of death among young people who die. This is the first documented case of chronic traumatic encephalopathy in a college football player. It’s not, however, the first suicide of a college football player.
The only way to know if encephalopathy causes depression which causes suicide, is to keep studying it. It’s horrible to lose a child, and I applaud this young man’s parents for contributing his brain to a research project, and for making his situation public. Millions of young people play football each year: maybe we need to be doing more to protect their brains, though that will not be popular statement among die-hard football fans (some of whom are my relatives). When it comes to sports and driving, we tend to minimize the risks. On the other hand, it’s hard to live life with the shutters drawn.
If you’re an athlete, help the cause and donate your brain here.
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Posted in The Last Psychiatrist and "Honor Killings"
On his blog, The Last Psychiatrist, discusses 2 cases of “honor killings”. He explores the motivations behind them and suggests an interesting solution for preventing them in future generations.
What to do when your Patient Friends you on Facebook or Follows you on Twitter
Excerpt:
Jane is your client. Both of you live and work in the same community. Jane is the director of a local charity. She sends you an invitation to be one of her contacts on LinkedIn.
Marcie is a former client. She was a teenager when you treated her. Several years later she has friended you on Facebook with a private message thanking you for being such a positive influence in her life.
John is a current client who has begun following you on twitter. He has send you a direct message and has also sent you an @reply to one of your tweets. He recently posted a tweet stating what a great therapist you are with a link to your website.
Mary has been your client for over a year. She has a history of childhood abuse and you have encouraged her to write in a journal. You receive an email from her asking to change times for her next appointment. She closed her email with “By the way, the journal writing has been so helpful, I have decided to start a blog. Here’s the link! www.maryrevealsinherblog.com. You open the link to discover that her first blog entry contains emotionally charged and highly graphic information about past childhood sexual abuse she has not previously revealed in therapy.
Kim was your client for over a year. You have not heard from her in at least that long. She was often hostile during sessions and would call between sessions feigning crisis and then apologise for her behavior during the previous session. The reason for termination was due to her move out of the area. Today you do an internet search for your name and you see that Kim has created a website, www.bewareofbadtherapy.com. Your name is on the website’s blacklist with links to excerpts of verbatim chat transcripts from sessions you held with Kim online.
To listen to their responses to these scenarios, watch the video at http://www.onlinetherapyinstitute.com/ethical-implications-for-therapists/ (the weird sound effects at the beginning last about 20 seconds or so… just wait for them to stop, it’s worth it… and you get to hear input from their Second Life cat, Reva).
It would be great to hear your experiences with this issue in the comments, whether as a patient or as a therapist.
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KevinMD in the New York Times Magazine and When the Internet is Really Cool
This past weekend, in “The Heat of the Night,” Lisa Sanders, MD wrote one of those mystery medical cases in the New York Times Magazine. She walked through the puzzling presentation of a man with fever and a liver mass. His physician friend was worried.
Schumann was worried, too. He lived nearly a thousand miles away — too far to come and see his friend. Besides, the patient was posting all his test results for his friends and family, so Schumann was following the case from a distance, and he still had no idea what was going on. If he was the second opinion, then the patient clearly needed a third. Suddenly Schumann had an idea. What if they opened the mystery of his symptoms to other doctors? What if they put his case on the Internet — on a blog read mostly by doctors — and let some new eyes and brains work on this problem? The patient was excited by the idea.
That afternoon Schumann put the case on a blog (glasshospital.com) he was writing and contacted Kevin Pho, who has a popular medical blog (www.kevinmd.com), who then posted it, too. Within hours, a dozen comments were posted in response. Several pointed to a series of reports similar to this very case: patients with large hemangiomas and persistent nightly fevers. In several cases, simply removing the tumor stopped the fevers.
So like, how cool is that?
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The Art of Trauma
If you want to know what is going on in a child’s mind, the best thing to do is hand them a crayon, not talk to them.
Clients, Politics and Religion
A close colleague, Dave Ray, has posted an interesting article on his website about social work and politics. His observations about the place of policitics in social work with clients is intelligent and germane. The same should be said of religious views.
Finally, Someone Agrees: Anger is Normal
Dr. Ken Eisold, a psychoanalyst writing for Psychology Today states in his article, “Anger and Exercise”, “Anger is a normal and adaptive response to an attack or a threat. It has been useful in our evolutionary struggle for survival. The brain detects the danger and the body is aroused and energized to react with fight or flight.”
Making Mango Margaritas as a Metaphor for Life
Roy came to a cookout at my house this weekend. He came late, and probably only because I sent him a text message at noon that said, “Remember, you’re coming to dinner at my house tonight.”
So here comes Roy, and as I’m schmoozing with guests, he tells me he’s brought the makings for mango margaritas and where is my blender? By the sink. He goes inside. He comes back outside– can’t find the blender. I go inside and point to the blender next to the sink. He never noticed that sink. Will it chop ice? Will it chop anything? It’s not a very good blender. He fills it with mango stuff and I start smashing ice with a crab mallet. The blender goes grrrr and nothing happens. I dump everything into the food processor and go back outside.
The food processor is leaking. Roy has come to find me. Are food processors supposed to handle liquids without leaking? I make gazpacho in it, but it leaks and I do it near the sink, pour fast, and wipe up the spillage. So it’s no surprise at all to me that the food processor is leaking mango margaritas. But wait, Roy says, we have to find the source of the leak. What? Why? Who cares where the source of the leak is? In a million years, it wouldn’t occur to me to ask this. I pour the mush into a pitcher. Oh, only it’s not mushed enough. Roy wants me to regrind half. I toss the whole thing back in and push the button. Orange junk explodes everywhere. The whole episode feels exactly like writing a book with Roy. I just want to get it done, and he’s dealing with the details of the second sentence when there are chapters to go before we sleep. Who the hell cares if there is a comma there? Or orange goo on the counter.
Can we leave the alcohol out of some of the mix so the kids can have some? That, I’m told, will mess up the proportions. Proportions? I cook and bake by adding “some”….Roy reminds me of my mother who seemed to think I should measure, or be able to tell her how she could make the muffins I’d made. Measure? Proofread? Proportions? A cocktail needs proportions? Look, no one has ever left one of my cocktails unhappy. You add cranberry juice until the color is right: voila, Cosmo! Roy will want me to figure out how to get blogger to add the accent squeal over the ‘a’ in voila.
Okay, so Roy’s mango margaritas were a hit. Very good. A little later in the evening, I looked down at myself and realized my black shirt was splattered with large orange flecks all over it, but hey. And in his honor, we threw out the blender.
So I haven’t quite figured it out: Roy is meticulous and a bit obsessive and very detail-oriented, except when he isn’t. The time before when he made the drinks, he texted me asking if he could borrow triple sec…when I was out, he actually made them without it– a recipe made with one ingredient missing! (–years of psychoanalysis, I’m sure) And the meeting he was supposed to be at this morning at 9 am? Let’s just say he texted back, “Yikes!”
Please, God, don’t let Roy write a post about me.
From foodnetwork.com:
Ingredients
For the Mango Margarita Mix:
- 1 1/4 pounds fresh mangoes
- 1 cup water
- 1/2 cup sugar
- Gray salt
For the drink:
- 3 cups ice
- 1 1/2 cups Mango Margarita Mix
- 4 ounces tequila
- 2 ounces triple sec
- Lime wedges
- Mint Salt, recipe follows
Directions
Peel and pit the mangoes and cut them into large chunks. Place the mango in a blender with the water, sugar, and a pinch of salt. Blend until smooth. Taste and add more sugar, if necessary.
Fill the blender with ice and add the Mango Margarita Mix, tequila, and triple sec. Blend until smooth. Rub the rim of a margarita glass with a lime wedge and dip into Mint Salt to coat rim. Fill glass and enjoy!
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Psychiatric Medications as a "Crutch"
Throughout the years I have worked with several clients who were criticized or rebuked by family members or Alcoholics Anonymous sponsors for using psychiatric medications as a “crutch”.