Big Pharma causes Big Problems
The more I see of the pharmaceutical industry’s (a.k.a. “Big Pharma”) influence on how we think about human behaviors and their treatment, the more worried I become. Alternet’s articles, ” How Pharma Giants Are Getting Rich By Calling Our Life Problems ‘Medical Disorders’” and “Do You Have Excessive Sleepiness? Shift Work Sleep Disorder? Big Pharma Hopes So” are perfect examples of what I’m talking about. An article in the Daily Finance finds the Food and Drug Administration almost doubling the number of warnings they’re making to drugmakers for questionable marketing practices. The good news? A psychiatrist friend was telling me…
Posted in Someone I Love is Dying
And I cry. I cry as I do dishes. I cry in the car running errands. I cry when I look into those beautiful eyes and know they will not look back at me much longer. And that’s what you do. You cry. Cancer sucks.
New and Noteworthy
Here at Shrink Rap, we get a pretty steady flow of email from book publicists, publishers, and other media sources looking to get some attention for their books, blogs, TV programs, conferences, and causes. Suddenly, we’re faced with questions from our own publisher about where our book should be promoted, do we have any personal media contacts, where should review copies go? Clink and Roy did their forms, and I’ve obsessed. If you’ve hit us up for publicity and your name had CBS, or Simon & Schuster, or some major publication anywhere near your name, you made it to my list. Clink, bless her, listed the name of a forensic psychiatry journal and moved on. I’m thinking Slate, Psychology Today (Roy put that on his list, too), Huffington Post…. so now that I’ve spent the morning looking up contact information for the alumni magazines at Clink’s college and med school (and mine, and Roy’s), I thought I’d do what I always do when I want to make sure I didn’t miss anything obvious: ask you.
Shrink Rap: Three Psychiatrists Explain Their Work–
Our one-sentence description reads:
Three psychiatrists give a candid and understandable insiders’ view of the modern practice of psychiatry.
So where do you think we should suggest the publisher should market our book? And if you happen to be the book editor for the LA Times, would you please send us your contact info?
This has gotta weirdest book writing process ever.
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The Texting Shrink
I like texting. It’s a fast and efficient way to exchange information, and I’m a bit prone to yakking, so this allows for a no-nonsense exchange without all the gabbing about how the kids are doing or the latest on someone’s ingrown toenails, or the usual assortment of small talk items. Running late, order my salad. Yes, Bobby can get a ride home with us. Or, if you’re Roy: “do you have triple sec for the mango margaritas?” Roy makes surprisingly good mango margaritas without using any triple sec. Just so you know– and I don’t mean to brag– I’m fast with the thumbs.
I text with patients as well. Do other psychiatrists do this? It works well for “Need to cancel my session this week, see you next week.” Or “Running 10 minutes late, traffic.” Once in a while I’ll even text a reminder to someone who misses appointments frequently. I was happy to hear that there is a dentist in town who also sends text message reminders.
Here’s the problem with texting patients:
People have taken to texting me with problems. “I feel horrible and like I might want to end it all right now.” (This did not really happen). I’ve done a few back and forths and realized that I’m not good at psychotherapy via text. Usually problem texts get met with “Come in at…..” and if …. is not Very Soon, or if the patient says that’s not good, I call, or text “call me.” I’ve been texted insurance information, drug reactions, appointment changes, negative biopsy results, “will you call refills in to my pharmacy?” and most notably, “Your office door is locked” after I haven’t responded to the knocking, only to find my patient sitting on the hallway floor.
What’s good about it? Somehow it feels less intrusive than a phone call, and the time taken up is more predictable. I’m prone to ramble and so are many of my patients– texts messages take seconds and phone calls can take minutes and involve many phone-tag back-and-forth exchanges. When someone texts their pharmacy number, I can click on it and get through–if it’s on voicemail, I often have to re-listen when I have a pen available, and often the number is at the end of a long message. It seems to me that texting is no less documentable than a phone conversation, so I can’t come up with any legal reasons it’s not kosher.
What’s bad? I have taken to telling patients that while I’m happy to try to negotiate appointment times via text, or “running late” messages, that it’s not a good way to negotiate problems– for drug reactions and symptom changes, we should start with the phone. My biggest concern is that if I’m on vacation, there’s no way to set a coverage text message, and my voicemail has the names and numbers of covering doctors. I’ve been pretty clear with people that I’m not blowing them off, and that if they don’t get quick reply to a text message, they need to CALL the office.
What do you think? It’s a different take on the shrink when there’s nearly instant access a good deal of the time.
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First Medical Marijuana, now Healthy Hallucinogens?
Last week’s article in Science looked at the effects of the anesthetic/dissociative drug ketamine (“vitamin K” or “Special K” on the street) in brain cell function in rats, concluding “that ketamine might be useful in treating depression because it increases brain activity instantly – so there is no need to wait weeks or months for the drug to take effect.“
Another article from Nature Reviews Neuroscience reviewed the state of the art in psychedelic science and found that “countless studies show that hallucinogens promote healthy neural activity in the brain. The researchers also created a chart to show what test subjects’ states of mind are, according to studies, when under the influence of various substances.“
Go to Lanny-Yap (great site!) for links to the articles.
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What’s Next?
Cut and Paste. I don’t know what to say. Oh my.
In tomorrow’s New York Times, Lisa Miller will write “Remembrances of Lives Past“
IN one of his past lives, Dr. Paul DeBell believes, he was a caveman. The gray-haired Cornell-trained psychiatrist has a gentle, serious manner, and his appearance, together with the generic shrink décor of his office — leather couch, granite-topped coffee table — makes this pronouncement seem particularly jarring.
In that earlier incarnation, “I was going along, going along, going along, and I got eaten,” said Dr. DeBell, who has a private practice on the Upper East Side where he specializes in hypnotizing those hoping to retrieve memories of past lives. Dr. DeBell likes to reflect on how previous lives can alter one’s sense of self. He, for example, is more than a psychiatrist in 21st-century Manhattan; he believes he is an eternal soul who also inhabited the body of a Tibetan monk and a conscientious German who refused to betray his Jewish neighbors in the Holocaust.
Belief in reincarnation, he said, “allows you to experience history as yours. It gives you a different sense of what it means to be human.”
———————-
I’d comment, but I don’t know what to say.
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The Bickering Friend
Everybody probably knows someone who likes to debate. If you say one thing, they’ll say something different just for the sake of having a discussion and engaging someone. It’s a relationship thing, like talking about the weather. Nobody really cares if it’s sunny or too hot or if there’s a storm approaching, it’s just a way of maintaining a connection. For some people, bickering serves the same function.
I appreciate a good debate occasionally because this keeps me sharp mentally. When someone tells me I’m wrong I question my assumptions, do some homework and learn something. My bickering friend learns something too (I hope). If the debate goes on too long or gets uncomfortable, I disengage or admit that I’m too tired to continue. It’s not a big deal. People who maintain relationships with bickerers can’t be too sensitive. There’s nothing personal about it, it’s just a way of life.
And by the way, Dinah was right: the period goes inside the quotation marks. Dinah effectively affected a change in my writing affectation. Can you guess what her writing quirk is??
Affectionately yours,
Clink
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I Speak Your Language
In spite of crime-solving TV shows like the CSI series, as a forensic psychiatrist I know that real life is much more mundane. Although I get to interview lots of interesting folks, most of the work involves writing extensive reports (or editing the reports of others). And just when I think I’ve got my writing skills down pat, a copy editor comes along to prove otherwise.
Dinah, Roy and I spent several hours together this week going over the proof of our book. We reviewed our editor’s corrections and quibbled about our own. I discovered that Dinah had learned rules of grammar that I had never heard of, and that some of the truisms I learned no longer applied. Language is like that.
Fortunately, as children we pick up grammar and syntax without any conscious awareness. Certain sentences or phrases just naturely “sound right” because they get built into our brains somehow. We speak the language and vocabulary we hear, and we write the way we speak.
This is a problem when you live in Baltimore. Every day I get exposed to Baltimore urban vernacular. In this city people don’t get beaten up, they get “banked.” They aren’t relaxed and happy, they’re “chillin’.'” They aren’t merely annoyed, they’re angry “for real.” And they don’t lose their tempers, they “zap out.”
In my clinical practice it helps to speak my patients’ language. If my patient tells me he “caught a hopper”, I know he doesn’t like his young and restless cellmate. If he asks me for help with an “8-505″, I can explain the legal process for doing this. I am unexpectedly multilingual through the coincidence of where I live and work.
I just have to remember not to write like that or my editor will “zap out for real.”
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Dinah adds:
OMG! I can’t believe we wrote an entire book together and you’re still putting the periods outside the quotation marks! Shoot me now. From Grammarbook.com:
| Rule 1. | Periods and commas always go inside quotation marks, even inside single quotes. | |
| Examples: | The sign changed from “Walk,” to “Don’t Walk,” to “Walk” again within 30 seconds. | |
| She said, “Hurry up.” | ||
| She said, “He said, ‘Hurry up.’” | ||
********************************
Clink responds:
Life is never that easy. See discussion here and here. Nevertheless, I changed them.
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Very Little Very Sad People
I thought I’d give you a heads up that The New York Times Magazine will be featuring an article on Preschooler Depression this weekend. I am working on my ability to see into the future, and it’s going well.
Pamela Paul will write:
Diagnosis of any mental disorder at this young age is subject to debate. No one wants to pathologize a typical preschooler’s tantrums, mood swings and torrent of developmental stages. Grandparents are highly suspicious; parents often don’t want to know. “How many times have you heard, ‘They’ll grow out of it’ or ‘That’s just how he is’?” says Melissa Nishawala, a child psychiatrist at the New York University Child Study Center.
And some in the field have reservations, too. Classifying preschool depression as a medical disorder carries a risk of disease-mongering. “Given the influence of Big Pharma, we have to be sure that every time a child’s ice cream falls off the cone and he cries, we don’t label him depressed,” cautions Rahil Briggs, an infant-toddler psychologist at Children’s Hospital at Montefiore in New York. Though research does not support the use of antidepressants in children this young, medication of preschoolers, often off label, is on the rise. One child psychologist told me about a conference he attended where he met frustrated drug-industry representatives. “They want to give these kids medicines, but we can’t figure out the diagnoses.” As Daniel Klein warns, “Right now the problem may be underdiagnosis, but these things can flip completely.”
It’s long. Just say, “I saw it at Shrink Rap first.”
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Emotion versus Mental Illness
My favorite commenter, “Anonymous,” wrote in to my Duckiness post to say that it was good I could post something totally silly without being told I need more meds. Oh, if life were that simple. And it is true that once someone has a diagnosis of bipolar disorder, not only does the world question their emotions in a black & white “are you sick again?” kind of way, but patients don’t trust themselves to feel for it’s own sake.
If you’re not sick, then being asked if you took your meds is insulting and degrading. And so I thought I’d put together some guidelines for Emotion versus Mental Illness. I’m inventing this as I go, with no evidence-based anything, so take my suggestions at your own risk.
- If you are ultra-successful, rich, brilliant, gorgeous, famous, and comfortable with your diagnosis, you may want to consider telling people you have a mental illness because it decreases stigma and people like being with the ultra-successful rich, famous, brilliant and gorgeous and won’t care that you have a mental disorder. It helps even more if you’re charming.
- If you’re not ultra-successful, you may want to pick and choose who you tell that you’ve been ill and are on medications. This isn’t always possible, especially if your illness is evident to others or if the presentation of your symptoms resulted in a hospitalization. It’s good to tell close family members.
- If multiple people are looking at you strangely, or commenting on your behavior, or saying you need medications, you might want to at least entertain the option that you could be sick. Unfortunately, poor insight and judgment are symptoms of mania.
- Tell the people close to you not to make medication jokes. It confuses the issue if you seriously do need medication changes, and it’s rude, degrading, dismissive, and disrespectful. There, I said it.
- If you want to be silly, go for it. Be silly when you’re well so that being silly is part of your baseline personality and no one equates this with being out-of-character. You’ll note the duck invaders did not come after me, rather they said, “There’s Dinah posting yet another stupid duck post.” If I’d posted about why chocolate should be outlawed and made into a controlled substance, those same duck invaders would be asking “What’s wrong with Dinah?”
- Mental illnesses come as constellations of symptoms. There is no “Sending out silly duck stuff” as a symptom. People think about mania when the ducks are combined with more energy, racing thoughts, a decreased need for sleep, increased mood OR irritability, and other symptoms of mania. Know the list and if someone bothers you, say, “I posted about ducks, I do not have any other associated symptoms.” Recite them if necessary. If you do have the other symptoms, refrain from posting about ducks. I don’t want Posts Duck Blog Posts to show up anywhere in DSM-V and these days you just never know.
- No one controls how any other person thinks of them or judges them and it’s not reasonable to live life ruled by a desire to be perceived in a certain way . It’s another form of poultry, but Don’t Let the Turkeys Get You Down. There are a lot of turkeys out there.
Moods happen on a spectrum. Some people have large variations in their mood—large enough or severe enough such that it causes suffering, and we call it an illness. Some people don’t have much variety to their moods and live in a calm, even-keel place, and it’s great that we have such people. But, I absolutely promise you that if we lived in a world where everyone had a very narrow range of mood, this would be one terribly boring planet. We should celebrate our diversity, not condemn those who like ducky stuff.
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