Update on my mood issues

In the last couple of days I have:

1. Called and made an appointment with my psychiatrist.
2. Received a phone number for a therapist a friend goes to that he thought would help me.
3. Received a phone call from the lady I spoke with the other day who said that despite my severe depression, they were willing to have me participate, so I'll meet with her on Tuesdays (she's a behavioural therapist) and with a behavioural coach on Thursdays.

It can't hurt to have too much intervention, I don't think. I meant to call my friend's therapist yesterday when I was off from work, but was too loopy to remember after the MRI.

I've known for awhile that I needed to get into therapy and that I was feeling down, I just didn't really realise how bad it had gotten till I'd spoken with the woman from Able To, which partnered with UnitedHealthcare. Being given the 988 number plus the closest hospital for mental health crises was kind of a wake up call. Her first appointment was in March, but she decided she wanted to start things this month, in a couple of weeks. I think she was afraid to let it go longer. So that's that. I'll have a whole team to help.

I think even people who have a background in psychiatry tend to think of the manic phase of bipolar disorder more than the depressive one. I spent most of my childhood, in retrospect, fairly depressed, and was very depressed when I was a teen and young adult. Since then I've cycled between both occasionally, with hypomania less than depression [I've never had a true manic episode--I think--but plenty of hypomanic ones, so I'm considered Bipolar II in terms of classification. Also, I used to have (before medication) these emotional storms that were so overwhelming. often lasting about 20 or 30 minutes, coming on like a seizure. I'm not sure if they're related to that, or not. They were the closest I ever got to actually killing myself that I've really gotten to, especially if driving (I have driving anxiety, which I think contributed, as anxiety seems to fuel my depression and vice versa). If I were home I could get into bed and ride it out. But they were draining. Once I was given mood-stabilisers, it helped so much, and I haven't had one in years. I never have done cutting, but I have ruminated over self-harm and/or dwelt on the idea that the world would be better off without me. And that scares me. And I've been thinking on and off that way since about November, so it's lasted several weeks. I'm hoping my psychiatrist can help in the short term and getting therapy will help in the long run. Just taking those steps have helped a little, I guess. I'm not feeling quite so overwhelmed. So here's helping all this helps.

The monumental task of revising psychiatry's bible continues

And these are some of the stickiest to define:

Thinking Clearly About Personality Disorders

For years they have lived as orphans and outliers, a colony of misfit characters on their own island: the bizarre one and the needy one, the untrusting and the crooked, the grandiose and the cowardly.

Their customs and rituals are as captivating as any tribe’s, and at least as mystifying. Every mental anthropologist who has visited their world seems to walk away with a different story, a new model to explain those strange behaviors.

This weekend the Board of Trustees of the American Psychiatric Association will vote on whether to adopt a new diagnostic system for some of the most serious, and striking, syndromes in medicine: personality disorders.

How a book's wording can change lives--for better, or worse

New Definition of Autism Will Exclude Many, Study Suggests

Proposed changes in the definition of autism would sharply reduce the skyrocketing rate at which the disorder is diagnosed and might make it harder for many people who would no longer meet the criteria to get health, educational and social services, a new analysis suggests.

The definition is now being reassessed by an expert panel appointed by the American Psychiatric Association, which is completing work on the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, the first major revision in 17 years. The D.S.M., as the manual is known, is the standard reference for mental disorders, driving research, treatment and insurance decisions. Most experts expect that the new manual will narrow the criteria for autism; the question is how sharply.

Psychiatry is not an exact science, and has in the past been (and surely will, in the future, be) subject to fad diagnoses of one sort or another. But just because a diagnosis becomes popular does not mean that it isn't devastating on a personal level. I hope a compromise can be found in terms of making the diagnostic criteria meaningful and still helping those who need assistance.

Somewhat on topic, I saw this: A French Film Takes Issue With the Psychoanalytic Approach to Autism

The documentary, the first film by Sophie Robert, follows two autistic boys: Guillaume, who has been treated with the behavioral, or “American,” approach; and Julien, who has been kept in an asylum for six years and treated with psychoanalysis. Guillaume, though challenged, is functioning at a high level in school. Julien is essentially silent, locked out of society.

Since Sept. 8, when the film first became available on the Web, it and Ms. Robert, 44, have been the targets of criticism from both the analysts who appear in the film and from within the country’s psychoanalytic establishment. Three of the psychoanalysts whom Ms. Robert interviewed for the film have sued her, claiming she misrepresented them in the 52-minute documentary, which has not yet been screened in cinemas or on television.

On Jan. 26, a court in the northern city of Lille will decide whether Ms. Robert must remove their interviews from the documentary if she wishes to keep screening it. The plaintiffs are also seeking damages of €300,000, or $384,000. The lawsuit might be futile, since the film is widely available on the Web (with English subtitles), having been viewed on YouTube more than 16,000 times. (Ms. Robert argues that the plaintiffs, all of whom appear in the film, signed detailed releases.)

The article takes an interesting look at how some disorders (say, ADHD) or treatments (like behavioural therapy or mediciations) have a stigma of being thought too 'American'. It's worth a look. The film, Le Mur (The Wall), is viewable on YouTube with English subtitles.

Hmmm....

Do some cultures have their own ways of going mad?

Anyone who follows psychiatry has noticed that the field is now in the midst of a debate that galvanizes its members every 10 to 20 years. At the center of the hubbub is psychiatry’s most sacred text: the Diagnostic and Statistical Manual of Mental Disorders.

The DSM, for short, is a compendium of over 350 ways our minds can fail us, from autism to kleptomania to voyeurism. What makes it onto the list matters: The DSM’s definition of “mental illness” can dictate whether an insurance company covers a treatment, or even whether a murderer is fit to stand trial. With the American Psychiatric Association gearing up to revamp the manual for the first time since 1994, mental health specialists have begun jostling over some of the most divisive issues in the field: whether someone mourning the death of a loved one can be justifiably treated for depression, for instance, or whether overdiagnosis and a black market demand for Adderall have trumped up a false ADHD epidemic.

And then there’s the back of the book.

If you turn to page 898 of the current edition — past the glossary and the alphabetical index of diagnoses — you’ll find a list of 25 little-known illnesses. These are the “culture-bound syndromes”: mental illnesses that psychiatrists officially acknowledge occur only within a particular society. Take, for instance, susto — a distinctly Latin American fear that one’s soul has panicked and left one’s body. Or pibloktoq, also known as “arctic hysteria,” in which Greenlandic Inuit strip off all their clothes and run out into the subzero Arctic tundra.

Depending on whom you ask, the notion that some cultures have their own ways of going crazy is either the ultimate in cultural sensitivity or the ultimate in Western condescension. And although these syndromes haven’t attracted nearly as much attention as Asperger’s or binge eating disorder, they are starting to come under fire from critics who don’t think that the appendix belongs in the book at all. Since the last edition of the DSM, in lectures and research journal articles around the world, a cluster of psychiatrists, anthropologists, and historians has attacked the validity of specific disorders on the list. To these critics, the very notion of a “culture-bound illness” is an outdated relic from the days of European empires.

Odd Kentucky story of the week: rampaging psychiatrist with sword!

A psychiatrist and doctor of internal medicine, Dr Douglas Rank, attacked a woman with a sword, stabbing her in the chest, in northern Kentucky Sunday. Dr Rank had previously practiced in Lexington, but his licence was suspended for a time over sex with a female patient. Apparently he's also been in trouble over his prescribing practices. The Kentucky Board of Medical Licensure found that Rank had given a patient 57 prescriptions, including narcotics, over a 14 month period. According to the police report, Rank had drunk a fifth of brandy and taken two Clonezapams before stabbing the woman. Neighbours heard the woman scream (his office is downstairs, his apartment upstairs) and were able to distract him enough for the woman to get away. The attack took place upstairs and it was unclear whether the woman was a patient or not. I would make a crack about how she shouldn't be billed if she were a patient, but it was pretty serious and she could have died. Fortunately, she's listed as recovering.

(Shakes head.) There are some real looneys out there, and some of them have medical degrees.

Well, yes, that's a no-brainer

but it's alarming that the number of psychiatrists who perform psychotherapy rather than just medical management is declining. It can't all be reduced to a pill, although medications can do a lot. I think we rely too much on 'brief supportive visits' such as mentioned in the article for our mental health care. I've only had clinical social workers and trainee psychologists as therapists, and they're a mixed bag. I think I have a decent counselor now, but I sometimes wonder if I don't need fairly intensive psychotherapy from a trained physician.

Long-term psychotherapy is superior, study finds

Frankly, I think this hospital's licence should be yanked

This made the news whilst I was incommunicado, but they've released some more information, so I thought I'd mention it here. It's horrible.

Woman who died on hospital floor called 'beautiful person'

On June 19th, Esmin Green, a native of Jamaica who had been involuntarily brought to King County Hospital in Brooklyn due to 'agitation and psychosis', died on an emergency waiting room floor after waiting nearly 24 hours for a bed. Security cameras show her falling off her chair and convulsing. At no time did staff respond to her distress. Then she went still. For nearly an hour she lay on the floor dead until finally someone came up and nudged the body wit a foot and called for assistance. By that time, it was far too late. On top of that, staff falsified the records regarding the timeframe, making it seem like she was sitting quietly in her chair at the time she died.

Seven members of the staff have been fired or suspended: the chief of psychiatry, chief of security, a doctor, two nurses and two security guards. I don't think that's enough. The hospital has a history of problems, including a recent lawsuit alleging a poor standard of care and lack of basic sanitation.

Did this woman die because she was black, because she was mentally ill, or because she didn't have any money, or simply because of an environment of neglect and malpractice? I don't know. They're still investigating how she died, for that matter. But this mother of six who came to this country for better opportunities found precious little on a cold hospital floor.