Mental Health Blogs

Archive for the ‘Shrink Rap’ Category

Okay, so I’ve been complaining about the hassles with Medicare since I changed my address. So this morning, Monday at 9:23 AM I decided to call the Highmark Medicare Enrollment Helpline. I went through the assorted menus — with several stops at : Please visit the website. So finally I get to the juncture where I can press O to speak with a live person. Oh, but the message I get is: “We are currently experiencing high call volumes and can not take your call.” They suggest I call back later, and specifically suggest that the best time to call is 8AM-9AM on Mondays. Next week, perhaps? Oy.

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I’m trying to figure out the details of an organizational Facebook Page. Somehow, I made two from the same account, and so you can be our Friend on Facebook, or you can be our Fan on Facebook. There’s a duck. There’s some sideline stuff. There’s our feet. I’m hoping I can get Roy to feed his tweets to the Facebook page so that our posts will show up there. I haven’t got the kinks out, but please do Friend us and Fan us, especially in this heat! If you look for us on Facebook, we’re Shrink Rap, the ones with the feets.

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I’m stealing a post from Jay at Two Women Blogging—-which is interesting because it’s written by three women blogging and you’d think that three bright women could count (maybe even up to five), but okay…. Here is their stolen post and I’ll discuss it below. I think they’ll be okay with my stealing, and here’s a shout out to Tigermom.

Was Harry Right?
~by Jay

Bluemilk got me started thinking about this. I first heard Harry’s thesis advanced by the resident I worked with on my med school psych rotation. She assured me that while I might think I had platonic friendships with men, the men didn’t see it that way. I was pretty sure they did see it that way. I wasn’t naive – I was engaged to be married and had done my share of dating and flirting; I knew what it felt like when a man was interested in me sexually and I knew the difference. I still know the difference, and I still have men friends. For most of my life, my closest friends have been men.

I had a best girlfriend growing up, but we weren’t together very much – she lived in a different neighborhood and had a lot of afterschool activities and we weren’t usually in the same class at school. We didn’t trade sleepovers and call each other to check our outfits and have long closed-door talks like Eve does with her friends. My day-to-day best friend, the person I hung out after school with and rode bikes with and watched TV with and waded in the creek with, was the boy across the street. We were inseparable until he moved away when we were ten.

During that same psych rotation, we had a lecture on child development in which I learned that “all children” had a same-sex best friend during latency. I asked the lecturer afterwards what would happen if a child had an opposite-sex best friend during that period, and she said “gender development would become abnormal”. Perhaps that explains it.

I started to seek out and cultivate female friendships when I was in med school, but I find I still gravitate toward friendships with men. I am blessed, now, with wonderful women friends, and I’m deeply grateful for them, but I still think my psych resident – and Harry – were wrong.
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I picked this post to blog about because 1) I liked having the When Harry Met Sally clip in it and 2) because these kinds of black-and-white statements about How Life Works come up all the time in therapy. In the case above, the teacher tells the student that during latency one must have a same sex best friend. Must. If not, the person grows up to be “abnormal” in their gender development. Show me the science. Oh, first define for me “normal” in terms of gender development? And who out there has “normal” gender development? What’s the goal? Martha Stewart? Barbie? Elana Kagan? J Lo?

What comes up more often in therapy is the question of can you be friends with an ex-girl/boy friend? An ex-husband or wife? I tend to think that it’s usually hard, but there are people who do it, so counseling: “you can’t be friends with an ex” or “you can’t be friends with a member of the opposite sex” or pretty much any absolute, seems, well, not evidence-based. My personal favorite piece of advice– to give– along the ‘absolute,’ non-evidence based line is to tell people to stay away from the person they are so painfully breaking up with for a good long time, at least until all parties are no longer in love and have moved on with their lives. Now all I need is a movie scene.

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In case you missed it, Charlie Rose had quite the guest list this week in Episode 9 of his Brain Series:

Helen Mayberg , Jeffrey Lieberman, Kay Redfield Jamison, Eric Kandel, Stephen Warren and Elyn Saks in Science & Health on Thursday, July 8, 2010

Here is a link with the transcript of the interviews: http://www.charlierose.com/view/interview/11113#frame_top

Nobel Prize winner Dr. Eric R. Kandel co-hosts the show with Charlie Rose, and to quote Dr. Kandel from the transcript:

The whole history of psychiatry, which is a culmination of EmileKraepelin, is interesting.  We’ve known about these illnesses sinceHippocrates, the great Greek physician in the 5th century, who notonly spoke about depression and manic-depressive psychosis butspecifically indicated that these are medical illnesses.

  But this basic idea was lost on European medicine for thelongest period of time.  During the middle ages, even later inthe Renaissance period, these were thought as demonic disorders,people possessed by the devil or moral degeneracy.

  And people with mental disorders were put away in insaneasylums usually far removed from the center of town and oftenthey were kept in chains so they don’t move around.

  Fortunately, this situation was reversed in about 1800.  TheParis school of medicine began to really express a very modernview of medical science.  And Philippe Pinel, a great Frenchpsychiatrist, realized psychiatric disorders, as Hippocrates hadsaid, are medical illnesses, and he began to institute humanetreatment, the beginning of psychotherapy with mental patients.

  But from 1800 to about 1900, no progress was made inunderstanding psychiatric disorders.  One couldn’t localizethem specifically so one didn’t know is there one mental illnessor are there many?

  And that’s when our mutual hero, Emile Kraepelin, came on thescene. And his textbooks which began to emerge around 1902 andcontinued until he died in 1926, he outlines, for example, in thisbook in his first three chapters he defines the fact that mentalillnesses are not unitary.  They affect two different processes,they affect mood, emotion on the one hand, and affect thinking onthe other.

  And he defined the disorders that affect mood -- depression andmanic-depressive disorder, and he defined the disorders of thinkingas schizophrenia.  He called it dementia praecox.  He thought itwas a deterioration of cognitive process in the brain early in life,praecox.

  And as you outlined, we have some insight into the nature ofthese diseases.  We know that depression is an illness that involvesmood, which is associated with the feeling of worthlessness, aninability to enjoy life.  Nothing, it’s all pervasive -- nothinggives one pleasure.

  And there’s a feeling of helplessness, of worthlessness, oftenleading to thoughts of suicide and, tragically, to suicide attemptsthemselves.

  And 25 percent of people that have depression also have manic-depressive illness.  They have the opposite end of the spectrum.They feel fantastic at the beginning of the disease.  They feelbetter than they’ve ever felt in their life.  But ultimately thisleads to grandiosity and frank psychotic episodes.

  Schizophrenia is a thought disorder that has three types ofsymptoms-- positive, negative, and cognitive.  The positive symptomsare characteristic I can of schizophrenia.  It’s the thought disorder,hallucinations, delusions, the acting crazy.  The negative symptomsare the social withdrawal, the lack of motivation.  And the cognitivedisorders are the difficulty with organizing one’s life and adifficulty with a certain kind of memory, called working memory,short-term memory.

  Fortunately, as you indicated, we can now see people who have hadeffective treatment who have very productive lives.  And Kay Jamisonand Elyn Saks, despite the fact they suffered the this disorder muchof their life, have rich personal lives, both of them involved inmeaningful interpersonal relationships, marriage, that is verysatisfying to them and having spectacular academic careers.

  So there’s tremendous hope for the treatment of the disease.

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There’s an article in The New York Times by David Pogue and I think it was written just for Roy.

Roy, in case you didn’t know, is a really really smart person. He knows a lot about psychiatry, and maybe more about technology. The only thing is, he sometimes assumes that everyone else knows what he knows and speaks his language, and often that language includes a lot of technospeak. Try writing a book with someone like this! Oh, I did. So glad to be done for the moment.

So Mr. Pogue tells us that The New York Times editors asked their writers not to use the word “tweet” anymore for fear that readers wouldn’t understand. Mr. Pogue writes:

“We don’t want to seem Paleolithic,” he wrote. “But we favor established usage and ordinary words over the latest jargon or buzzwords.”

That the Internet’s reaction was so swift and harsh only proves the point: the techno-savvy population can’t even conceive of the existence of a less savvy crowd. If you use jargon every day, you can’t imagine that millions of people have no idea what you’re talking about.

I do a lot of public speaking. And even today, when I ask my audience how many know what Twitter is, sometimes only a quarter of the hands go up.

The article goes on to define the basics for the uninitiated: Facebook, Twitter, Yelp (my favorite), Foursquare (Huh?), and Linkedin. Mostly, though, I liked that it made me think of Roy. So Roy, can you imagine a world where three-quarters of the people don’t know what Twitter is?

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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’ve written before about the difficulties I’m having with Medicare because I simply wanted to change my address. Medicare has 221 downloadable forms, none of which are change-of-address forms. In order to do this, I needed to fill out a 27-page enrollment form. I did, but was rejected because I didn’t also fill out a 5-page form giving Medicare access to deposit funds in my bank account. Oh, but I’m a non-participating provider— Medicare pays the patient, not me. And, I work in a clinic where they bill Medicare for my work under my name, and I certainly don’t want money that belongs to the clinic going to my bank account. There’s no upside to them having this information, and much potential for hassles. I filed an appeal, and it was denied. This has been going on for months. I’ve stopped being aggravated, and I was pleased when one of my patients mentioned she’d gotten a reimbursement check, so who knows how long I will exist, and I may surrender and send them my bank information and hope for the best.

You can read about my prior rantings Here and Here.

So the day of my latest rejection by Medicare, Meg was kind enough to send a link to an article about a Medical Society President (a dermatologist) who opted out of Medicare. The Business Review writes:
Dr. Leah McCormack, who has a dermatology practice in Forest Hills, said in an open letter dated June 30 that “I can no longer bear the shackles of government and insurance company rules, the burdens of their regulations and the fear of their retributions for the paltry reward of their monetary compensation for my services.”

The article goes on:
“I have been in the solo private practice of dermatology for 25 years,” she wrote. “I have tried to practice with the total focus on my patients, but this has become impossible. My staff and I spend an exorbitant amount of time dealing with claim denials, insurance managers, pre-authorization managers and pharmacy benefit managers. There is so much health system managing that there is little time for health care.”

Thanks for the heads up, Buggy!

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So usually we figure this stuff out by ‘evidence-based’ research…you know, the whole double-blind, placebo-controlled study using only those perfect research subjects who don’t have other problems like substance abuse, pregnancy, childhood, or co-occurring disorders.

This month, Consumer Reports gives their own breakdown of what works for the treatment of depression and anxiety. Here’s the Link to their overview. Buy a car, buy a dishwasher, get a shrink…same idea.

Ali writes to us:

http://www.consumerreports.org/cro/magazine-archive/2010/july/health/depression-anxiety/overview/index.htm

Hmmmmm, so how come they didn’t ask if therapy with a psychiatrist works better?

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Dr. Psychobabble is a new intern in New York and she’s reading the manual on how to work her pager. Her pager? They don’t just call/text housestaff on their cell phones, they still need hospital pagers? It got me thinking about my old pager back when I was an intern in New York…..

I saw my first cell phone when I was in medical school. It was in a suitcase. I didn’t see another one for years, and I didn’t get my own until 1996. My entire training occurred in the virtually pre-cell error. As an intern, I was given a pager. It beeped, then shouted out the number I was being paged to call. The owner of the pager had to listen, it was a auditory thing, not something you could read. In the bathroom, the voice of pager woman reverberated off the tile walls in an particularly intrusive tone. For months after I no longer carried the thing, I jumped when the microwave went off (post-traumatic pager disorder). Talk about an object to hate!

PCs showed up when I was in college, but few people had them. A research team I worked with did, and so I learned Volkswriter (? a predecessor of Word) fairly early. Mostly I remember the group panic when the computer lost an 80-page original research document. I did think it was fascinating that you could push one button and have the thing blast out 80 of the same letter addressed to different people. For my own papers, I still used a smith corona and I remember being up all night writing a paper my senior year on bulimia. Mostly I remember that the professor pointed out to me that I’d misspelled bulimia (and Roy says….sigh…and wishes I were obsessional and detail-oriented). I can’t imagine what college would have been like for me with internet access. I may not have made it: Facebook might have diverted me from any goal-oriented behavior. How would I would have sat in class and texted my heart out. Oy. But all the professors I was too intimidated to speak to– I would have emailed them my every thought and it might have been a richer experience…or not?

By med school, word processors were more widely available—there was a whole bank of computers in the library and the night before a paper was due, we’d all be there typing…er, keyboarding. No real Internet yet, and I never had much use for the computer beyond the word processing capability.

I did get an answering machine in medical school, something that truly freed society from sitting by the phone waiting for a boy, a job, a residency interview.

A few years after I finished residency, the Internet really caught on and I had no real idea. Clink of course, knew it all. I asked her to come show me, so she comes with a laptop and plugs it in to my phone line. She loaded a page and waited. And waited. This was not for me. I wanted to try email. One of her contacts was a mutual friend, a man who’d trained with us and then moved to Minnesota. I sent him an email. He wrote back: he and his wife and two small children were coming to visit, could they stay with my family (in my very small house, with our two small children) for a week? I wasn’t so sure about this email stuff.

So now we have a blog, a sometimes podcast, I have a desktop, laptop, iTouch, husband has an iPad and blackberry, kids have laptops and iTouches, everyone has a cell with a zillion minutes and unlimited texting. TV with satellite and DVR and four remotes and a sound system. There’s a bunch of digital cameras in the mix, two types of speaker docs for music, voicemails and emails. listservs, and things to check out the wazoo….we all have Facebook pages and some days we’re friends and most days we’re not. Twitter me this, send me the link to that, YouTube, MySpace, ITunes, oy. When’s Roy gonna make a Shrink Rap iPhone app?

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And now for announcements:
Happy Fourth of July weekend, Everybody!!!
Happy Birthday, David. I love you and you were great on TV this week.
Welcome home, DB, two delayed flights, days of travel and I’ll be glad to have you home and out of Africa, can’t wait to see your pics and I love you, too.
Roy? Has anyone seen Roy? Did he eat the beauty queen podcast???
And finally:
Congratulations, Clink and Victor!

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ClinkShrink wrote about her taxicab driver in New Orleans and how a psychotherapist had changed his life in a single session. Psychobabble (a medical intern, soon to be a psychiatry resident…I think), wrote and told us about her experience with a kind cab driver who listened to her problems and provided free psychotherapy during a taxi ride to an exam after her car had been towed after she’d been on call (…Talk about a bad day!) You can read more Here! And welcome to the psychiatric blogosphere, Psychobabble.

This all reminded me of the essay/personal statement I wrote when I was a fourth year medical student applying to residency. I wrote an essay about the different experiences I’d had that influenced me to want to go into psychiatry. I had a bunch of experiences– I’d known I wanted to be a psychiatrist or psychologist fairly early on, and I’d done rotations at other hospitals and had gotten a Mellon Fellowship at the University of Pittsburgh’s psychiatry department one summer. I thought I looked good on paper.

I showed the essay to my adviser, he read it, looked unimpressed, and said, “It looks like everyone’s essay.” Great. What else did I have to say for myself? I did what I had to do. I bought a bottle of wine and went home to the typewriter (those were the days).

The essay that emerged began by saying that if I wasn’t going to become a psychiatrist, I would be a taxicab driver in New York City. I rambled a bit, talked about what the experiences I’d had, said nice things about taxicab drivers and finished it up. I don’t have a copy of the essay, it was long ago filed and lost, and it probably wasn’t as interesting as I thought it was. My adviser liked it better, and oh, it made for some funny looks at my interviews. Thanks for the memories, Psychobabble.

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Another story came out of the APA conference that Dinah wanted me to blog about.

I was in a cab going to pick up Dinah for dinner. The cab driver found out I was a psychiatrist so he told me about his life-changing experience with therapy. At one time he was having an incredible problem with his life. He was using cocaine, couldn’t keep a job and his relationships were going down the tubes. Therapy helped him quit cocaine and change all that. (Which was good, since he was the driver of my cab. I really wanted him not to be high or in distress.) This kind of turn-around story isn’t unusual for me; parolees will often come back and tell me about things they’ve done in free society that they’re proud of.

The unusual part of this story is the fact that he made all of these changes after a single one hour session.

OK, that got my attention. What was it about this therapist?? What happened in the session?? I had to ask all the questions.

The cab driver told me that it wasn’t so much what the therapist said, but rather who she was. She was a kindly, older woman who was sincere and compassionate. She told him he needed to start taking care of himself, eat better, get enough sleep, etc etc.

And that worked. Geez, I was impressed. It changed his life. The last remaining habit he wanted to fix was his smoking. He wanted to go back and see his therapist again, but she had retired. He was sorry he couldn’t go back, and so was I.

That’s my cab driver story.

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Wait, says Dinah (who added the pic and subtitle): you told it in a more dramatic fashion at the time. He was running 8 miles a day now. There was a religious/spiritual component, something profound about the experience and about the therapist. Oy…we’ll never make a novelist of you, Clink.

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