October 11, 2012

If Psychiatry Is Committing Suicide, Does That Mean It Needs More Meds?

adhd nyt.jpg
white trash, but white


Three stories which lead to the wrong conclusion if interpreted separately, so don't, put on your thinking caps, ready, set go.

I.

David Healy: Is Psychiatry Committing Professional Suicide?


David Healy is a psychiatrist famous for his harsh criticism of Big Pharma which may or may not have got him fired at the University of Toronto, allegedly.

"It's a miracle that I was asked along to give a talk [here], and I'm extremely grateful," Healy said.

His disquisition was perhaps less humble.


He gave a talk which had two main points: first, that psychiatry's entanglement with Pharma lead to it being fooled by manipulated or hidden data, which lead it to think meds were more effective or safer than they were.  The example he gave was antipsychotic induced diabetes, and it seems crazy that there was ever a time when psychiatrists believed diabetes wasn't a risk, and that time was 1997. 

But that point isn't a new one, it's what he's famous for.  What is notable about  Healy's talk wasn't what he said but where he said it: at the APA.  This is a man who was professionally destroyed because of his anti-Pharma stance back when all the university money was from Pharma, but now that it's all NIH money he's invited to the APA.  Huh. That's interesting, but still not enough to explain his presence-- especially since the issue of hidden data is so well known that it has even been fixed legally (all data must be made public.)  So what does the APA want with him now?


Healy noted further that when data surfaced showing a link between antidepressant use and risk of suicide in children, the APA issued a statement proclaiming that "we believe that antidepressants save lives."

"What I believe they should have said is that the APA believes that psychiatrists can save lives because it takes expertise to manage the risks of risky pills," he said; if psychiatrists' only role were to dole out drugs, then less trained physician's assistants could easily replace them, he noted.


What's the word for being prescient after it already happened?


II.



Antipsychotic Drugmakers Targeting Medicaid Psychiatrists


...Medicaid psychiatrists, however, received a disproportionate, share of industry largesse, receiving two-thirds (66%) of gifts and payments. In 2008 (the most recent data available), antipsychotic use by Medicaid recipients was especially high in the nation's capitol, with approximately 1 in 10 recipients receiving a prescription -- a rate five times higher than the total national population.

A large proportion of Medicaid recipients are children under the age of 18. Antipsychotics can cause sedation, weight gain, diabetes, and other adverse effects. Previous studies have shown a high rate of inappropriate off-label use (for conditions the FDA has not approved). Some adverse events may be more likely to occur in children and young adults.


There are three points you will not have observed:

1. The second paragraph's juxtaposition to the first isn't to inform the reader of why the money is bad, but to give material weight to the presumption that it is bad.   Note that sentence 1 has absolutely no connection to sentence 2 or any other sentence.  You're not supposed to read that paragraph, you're supposed to feel it is there.

2. What the article does not dare to ask is if the antipsychotic prescription rate is  inappropriately high, then should those patients have received a different medicine, or no medicine?  You have to pick one, because those are the only two choices.

Leading to the main point:

3.  Regardless of whether antipsychotics are being overused, they're not always used, there's antidepressants and antiepileptics and benzos and etc; which means that if 1 in 10 Medicaid recipients are getting antipsychotics, then more than 1 in 10 Medicaid recipients have been diagnosed with a psychiatric disorder-- and I'll fill in the gap: temporally coincident to their receiving Medicaid.  Anybody want to tell me how that is physically possible?   "Linkage disequilibrium."  I see, so the answer is science.  That's reassuring, I guess.


III.


A digression but it'll make sense later: I have an example that you're probably going to find supremely racist so you may as well get a drink, I have an 8 year old patient, black, who has the usual constellation of ADHD symptoms that are easily explained by everything else except ADHD, and he's on Concerta and blah blah blah, and the mother of this kid-- let's use the appropriate code words and call her "economically disadvantaged" and "on crack", so this mom who is herself fully loaded with SSI and pointless medications but also Klonopin manages to do what not only is physically impossible but out of the realm of even knowing is possible: somehow this woman goes off all her meds, and then considers, decides, applies and gets her son transferred to a suburban, rich white kid, private school.  That's what's up.

Now the first thought you and I will be having is, will this kid make it in that school? because if he can, it would be awesome.  But that question really is asking, can a good school override the effects of ADHD?  Can it override an "urban" mother?

What happened is significant, results may vary, but what changed wasn't the kid but the mother.  You know how they say you can take the person out of the ghetto but etc etc? Turns out that's completely wrong.  She didn't go to the school, her education didn't improve, she still lived in the exact same house but everything about the way she handled herself, carried herself, drugged herself, even thought-- all that changed, because she wanted to operate in a world that was functioning at a higher level.  Yeah, I said higher.  The point here is that the psychiatric model does not allow this to be a possibility-- "relapse is the rule" and "bipolar is a chronic illness" and so sees her exclusively as a fluke; yet it is the model itself that prevented her from making those changes. In an attempt to manage the mass of poverty that has been relabeled "psychiatric", it must necessarily sacrifice the 10-90% of people who may be able to force themselves up.  Another way of putting this: if, instead of medications and psychotherapy I instead spent the time tutoring all these kids in math, what would be the outcome on the entire community?  For the purpose of this question assume I am good at math.


IV.


Which brings us to the N=1 popular media execution of all this: there's a doctor, a Medicaid doctor, who is handing out Adderall to poor kids for the specific purpose of-- sit down for this--  getting them better grades.


From the New York Times:


Although A.D.H.D is the diagnosis Dr. Anderson makes, he calls the disorder "made up" and "an excuse" to prescribe the pills to treat what he considers the children's true ill -- poor academic performance in inadequate schools.

"I don't have a whole lot of choice," [said Dr. Anderson].  "We've decided as a society that it's too expensive to modify the kid's environment. So we have to modify the kid."

Dr. Anderson is one of the more outspoken proponents of an idea that is gaining interest among some physicians. They are prescribing stimulants to struggling students in schools starved of extra money -- not to treat A.D.H.D., necessarily, but to boost their academic performance.



I should take a second to point out the hopefully now obvious:  the only reason this is about poor kids and in the New York Times is so NYT readers don't feel so guilty about forcing Adderall on their own kids.  "He has problems with concentration!"  Easy, Katniss, I'm not disagreeing.  Though not the point today, it is worth repeating: stop reading the Times.

Note the dichotomy being set up.  Adderall is good for you, antipsychotics aren't. That's why we hear about overprescription of Abilify but an Adderall shortage.  A shortage!  Are you telling me Big Pharma has pulled off a massive conspiracy to effect a shortage of a drug which exists in nine other generic forms and I can make in my basement had I a basement?  But that's the story that has to be told.  "Are you saying there's no shortage?"  How can there be a shortage of a drug that you think is overprescribed for a diagnosis that you say doesn't exist?  Madness!

Why is "inappropriately" giving Adderall to kids to get them better grades morally superior to "inappropriately" prescribing Abilify to a guy so he doesn't punch his girlfriend during the monotonous downtime of SSI?   What's the difference?  "Well, they're both wrong."  Then what should be done instead?

It feels wrong, somehow, and that feeling of wrongness-but-I-can't-explain it is what prompts a national dialogue, but what Dr. Anderson really did that causes the consternation isn't  prescribing the Adderall but saying out loud that it isn't for ADHD-- breaking the unspoken rules of the system by telling the press what none of use dare say even to our patients:  that we're not medicating a diagnosis, we're using a diagnosis to justify the medication we have to use anyway because we have nothing else to do but give out medications.

It's like a surgeon trained on the latest laparoscopic techniques, only to learn his first and only gig post residency is combat surgery in the back of a moving helicopter with a penlight and teeth.  "You know," says his colleague who collects white wines, "a mediolateral approach is preferred."  You don't say?
 

augmentation.jpg

Here's a question none of you can answer: how come the thing with the greatest amount of empirical support is the only one that isn't covered?

The question of whether ADHD or bipolar "exists" is loudly debated because it is utterly meaningless, in battlefield psychiatry no one is treating the diagnosis regardless, we are all treating symptoms; and we're not treating symptoms, we're calling them symptoms because otherwise we don't get paid, you don't get the med, somebody's going to get punched and somebody's going to get sued because somebody didn't "manage the underlying psychiatric process that mediated the assault" which doesn't exist but for some weird reason is widely prevalent in poor blacks and hispanics and whites with calf tattoos.  

If you are convinced that SSRIs don't work and antipsychotics are dangerous and meds are all prescribed off label, conduct for yourself a little experiment: tell a Medicaid patient you're not medicating him.  I'll be in the chopper, where apparently it is safe.

I've said this before and I will repeat it here, you can blame the overuse of medication on anything you want and you will all be completely wrong, the most important reason a medication was used is that the patient showed up, and they showed up because that's where the state told them to go.  In 100% of the cases when a psychiatrist in urban camo tells me he doesn't use antipsychotics or stimulants, I know that all of his prescriptions say "Xanax" and "#120".  And I don't fault him, how could I?  It works for what it's for, and what it's for is not punching your girlfriend in the face, which is the same reason other guys use Abilify or Zyprexa or whatever.  When I graduated from residency I used to look down on the benzo docs because I was an arrogant animal, I had a retiring Puerto Rican psychiatrist tell me that back in PR they used Xanax 2 TID as an antipsychotic "and it worked very well", and I thought, madre dios, this man is a lunatic, how did he get across the border?  And now I'm not so sure they didn't have it right all along.  Or maybe I need a benzo, I don't know.  Jesus Christ, I need a nap.

I'm happy to point out flaws in clinical trials and studies, it's fun and easy but it is ultimately pointless, no one cares, no one listens, I have a blog full of them and it couldn't be less relevant to anyone.  Psychiatry isn't committing professional suicide, Dr. Healy, fear not: the government needs its unarmed security services, now more than ever, and it will get them at cut rate prices because no one can argue that following the next step in a flowchart is worth anything more than a pat on the back.  On the other hand, I get that they have a lot of antipsychotics in Washington DC, but do you know what they don't have a lot of in Washington DC?  Riots.   I guess it all worked out, I have no idea how but you can't argue with results, ask the Athenians and Madridians if their system worked better.  I once had a patient with no pathology whatsoever try to kill me, the gigantic irony of it being that if he had succeeded, who would they have blamed?  Me-- for undermedicating him!  And God bless Dr. Anderson, I don't think it'll help but at least he's trying despite the criticism, at least he's willing to admit that though the whole thing is a carny act he's still the one saddled with the responsibility.

But to the government employees in academia, you cannot assume something is inappropriate if you have no idea about what is appropriate.  And to the government employees in government, you get what you pay for.   No one is saying that there isn't suffering all over the place, but that's different than a psychiatric pathology.   If 70% of the patients are not truly ill, then the sick ones are only getting 30% of the attention, do you see?  If the majority of Medicaid patients aren't real patients, then why would you expect them to get real treatments?







Comments

I'll be in the chopper, ... (Below threshold)

October 11, 2012 6:45 PM | Posted by Claudius: | Reply

I'll be in the chopper, where apparently it is safe.

Somewhere, Dutch Schaefer is smiling.

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You are becoming very, ... (Below threshold)

October 11, 2012 6:50 PM | Posted by Beigbeder: | Reply

You are becoming very, very opaque to non-US audiences, even ones who are aware of the broad structure of social safety nets down there.

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"What's the word for being ... (Below threshold)

October 11, 2012 6:55 PM | Posted by Dave: | Reply

"What's the word for being prescient after it already happened?"

This is absolutely brilliant! I love your writing.

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You're like the David Simon... (Below threshold)

October 11, 2012 7:03 PM | Posted by Anonymous: | Reply

You're like the David Simon of psychiatrists.

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never ceasing to impress. L... (Below threshold)

October 11, 2012 7:32 PM | Posted by Anonymous: | Reply

never ceasing to impress. Loved it.

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I find the trend in stimula... (Below threshold)

October 11, 2012 7:59 PM | Posted by yoshie: | Reply

I find the trend in stimulant use in kids for their "ADHD" to be disturbing. More and more, schools and psychiatrists are trying to insist that learning disabled children are not learning disabled at all...they have ADHD and need a stimulant and behavioral modification. I have even heard such things as "ADHD causes learning disabilities"...unless you count all of the people with ADHD who have no learning disability or are even geniuses :/

It's all very disturbing to me.

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The endnote made my year. <... (Below threshold)

October 11, 2012 8:05 PM | Posted by Anonymous: | Reply

The endnote made my year.

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Dr. LP ... (sigh) ... You n... (Below threshold)

October 11, 2012 8:35 PM | Posted by Icedlatte: | Reply

Dr. LP ... (sigh) ... You never make it easier for me to go to work in the even nastier, drabber, dare I say it manic-er front lines of primary care where twitchy oppositional kids sit with their twitchy angry worried parents who are late for ten meetings and never let me forget that somebody missed soccer practice to be here and that they have an HSA and psychiatric services aren't covered and junior just took a nose-dive en francais and algebra and "acted out" in art class (making collages) and could you PLEASE give him something to behave and I need a refill of my Ambien (for 30 & 90 days) and I think I have a toenail fungus and we all have strep. That that Zoloft you prescribed? My husband hates it because I don't want him to touch me. Perhaps I need to rethink my own stand on Xanax; State Medical Boards love that. Thanks for always giving me some fat to chew while I pound the coffee to survive 20 encounters before lunch.

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Once again: The last thing ... (Below threshold)

October 11, 2012 9:19 PM | Posted by Anonymous: | Reply

Once again: The last thing he said is the MOST IMPORTANT. Anything not about that is red herrings. FOCUS ON THE LAST PARAGRAPH!!!

Since I'm too stupid to make the assessment, I'm putting my trust in a bunch of broken clocks to point me in the right direction. WHAT IS THE RESULT OF SWITCHING FROM PSYCHIATRY TO MATH TUTORING?

That's the question we have to discuss if we want this to be anything productive.

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im not from the US too, but... (Below threshold)

October 11, 2012 10:35 PM | Posted, in reply to Beigbeder's comment, by Anonymous: | Reply

im not from the US too, but what i like about the blog is that you keep reading and reading, not making sense of things; then you realize he's been saying the same things all along. i love re-reading the articles. makes me feel smarter each time. hahaha!

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So what do we do? What can ... (Below threshold)

October 12, 2012 1:55 AM | Posted by Justin: | Reply

So what do we do? What can we do? How do you address (not to mention solve) a problem few know or care about?

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"few know or care about?" ... (Below threshold)

October 12, 2012 3:23 AM | Posted, in reply to Justin's comment, by Tiptoe: | Reply

"few know or care about?"


I beg to differ. I know and care that I am paying to get "pysched" when the first reason I saw a psychiatrist was for some help (or to get my family, friends and assorted folks who look at me strangely off my back) with my mental health. They are armed basically with 4 drugs - antidepressant, antipsychotic, benzo or mood stabilizer/anti convulsant - all of which are proving of questionable efficacy. As I read TLP's post it seems at least their Medicaid reimbursements (although crummy) are headed toward being their meal-ticket. If the APA is now featuring someone they had previously thrown under the bus, and now owning up to the detrimental aspects of benzos and antipsychotics, and antidepressants only work some of the time for some of the people, ultimately this renders the psychs rather noneffective, aside from prescribing APs for riot control.

Perhaps, my own inner narcissist is awakening and it no longer wishes to pay for being psyched/screwed. I say this in true jest as I rely on my doc to keep me from adhering to the ceiling. I do hope TLP's facetious yet prescient post does not mean the profession as a whole has painted itself into a corner.

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He moved the ending section... (Below threshold)

October 12, 2012 10:28 AM | Posted by Anonymous: | Reply

He moved the ending section to section III. This was done after I made my comment about how the last thing is the most important. I don't like the idea of my commentary having that kind of effect on the writing.

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Finally, a post I can share... (Below threshold)

October 12, 2012 10:45 AM | Posted by Gabe Ruth: | Reply

Finally, a post I can share with people who don't already know I'm a degenerate (ie, no porn references).

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For someone who loves comed... (Below threshold)

October 12, 2012 11:53 AM | Posted by Giraldo's Ghost: | Reply

For someone who loves comedy so much, I have to wonder why no tie in to "No Refunds" for this gem?

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You have a remarkable talen... (Below threshold)

October 12, 2012 2:09 PM | Posted by Barry: | Reply

You have a remarkable talent for obfuscating simple statements. I think you're trying to say that US psychiatry drug prescriptions have taken the place of poverty aid programs in the US, and are what makes the system work such that the poor don't revolt.

I used to read a blog of a guy who had recently recovered from a brain tumour. He would change tack halfway through a sentence in a very peculiar way. Needed careful reading to understand him. I'm feeling a little deja vu reading your own writing these days.

Might be nothing. Just saying.

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Just a simpleton here, aski... (Below threshold)

October 12, 2012 3:15 PM | Posted by Anonymous: | Reply

Just a simpleton here, asking a simple question, in "Level of Clinical Confidence" from I-III, does the higher number or the lower indicate greater confidence? It's hard to extrapolate from what's on the page, and googling "level of clinical confidence" doesn't help.

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Barry: I think TLP's obfusc... (Below threshold)

October 12, 2012 3:31 PM | Posted by Mike: | Reply

Barry: I think TLP's obfuscation is deliberate. What's the alternative?

@cleartweeter: US psychiatric drug prescriptions are tools to prevent the poor from revolting. Link to clearly written article: http://blahblah

@cleartweeter's friend thinks, "Wow, that's not what I believe - I already think the opposite, and here are 4 reasons why." The link goes unread.

@cleartweeter has 23 followers.

When you have an unusual opinion, it's better to write in a guerrilla way - to attack your opponent indirectly.

In my experience reading TLP's stuff, having to mull over exactly what his point is and all his random digressions, in addition to the interesting writing style, make him much more persuasive than the typical newspaper prose I'm accustomed to (because it's everywhere now - no one believes in poetry anymore). TLP's prose style reminds me of Nietzsche and Kierkegaard.

Even when I don't agree with what I ASSUME is TLP's conclusion, his writing always makes me think deeply about his subjects. I like that.

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But ADHD IS a learning disa... (Below threshold)

October 12, 2012 4:03 PM | Posted, in reply to yoshie's comment, by Liz: | Reply

But ADHD IS a learning disability. So you've lost me here.

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I don't know where Liz is f... (Below threshold)

October 12, 2012 8:59 PM | Posted, in reply to Liz's comment, by Yoshie: | Reply

I don't know where Liz is from (she may come from a country where it is considered a learning disability), but this is not the case in America. Only about half of all people with ADHD are learning disabled...according to stats I have seen. The other half have no problems with learning. Learning disabilities are based on an IQ/achievement discrepancy. Many people with ADHD who are tested for a learning disability do not have one.

I know one super genius with ADHD who says he can only focus for maybe 5 minutes before his brain wanders, but he's just so bright that it takes him very little time to pick something up. He went to a top 20 university and never received any accommodations for it.

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Troubled people settle for ... (Below threshold)

October 12, 2012 9:12 PM | Posted by antiSuffragete: | Reply

Troubled people settle for anti-psychotics, but what they really would prefer are opiates. We need to make them broadly available over the counter without a prescription.

Then psychiatrists and doctors would be freed to deal with people whose real problems actually require their expertise.

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honestly, I ask: What expe... (Below threshold)

October 12, 2012 11:50 PM | Posted, in reply to antiSuffragete's comment, by Gary: | Reply

honestly, I ask: What expertise do psychiatrists have? AS TLP has stated previously, you can train a reasonably smart person in 6 months to do what a psychiatrist does.

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Insightful!James<b... (Below threshold)

October 13, 2012 12:10 AM | Posted by Anonymous: | Reply

Insightful!

James
http://superpsychologist.wordpress.com/

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Way to go!This is aw... (Below threshold)

October 13, 2012 7:32 AM | Posted by medsvstherapy: | Reply

Way to go!
This is awesome.

I think the abstruce writing style pulls you in and alerts you that there is a great and subtle issues being discussed. This makes you think more deeply abouth what this issue might be.

In my opinion, the push for "reproductive rights," versus the "war on women" is the same social phenomenon: "medicine" and "science" are the pretense for carrying out social control: getting a populace dependent upon "medicine," and quieting a population that otherwise ought to be properly free and boisterous.

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"What's the word for being ... (Below threshold)

October 13, 2012 7:39 AM | Posted by medsvstherapy: | Reply

"What's the word for being prescient after it already happened?" -This is what we need to try to figure out - what is going on right in front of our eyes. In retrospect, we all eagerly nod that slavery was wrong. We imagine each of ourselves as the runaway slave, or the helper in the underground railroad, or the one who would speak out.

Can you name five situations today where we will look back in 100 years and wonder how general society could have accepted and supported some official, legitimate aspect of society? Medicating our kids instead of parenting them is one.

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I am not qualified to talk ... (Below threshold)

October 13, 2012 9:11 AM | Posted, in reply to medsvstherapy's comment, by Anonymous: | Reply

I am not qualified to talk about those things, and I trust that if it's important, there is someone who cares very deeply about it and works as hard as they can every day to make it right. If there isn't, it can't be that important, because the things that really matter get done right because the system collapses when these things are neglected and gets replaced by one that does them right. American cars may not be luxurious but god dammit if the seat belt doesn't hold when your dumb ass decides to use it.

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"WHAT IS THE RESULT OF SWIT... (Below threshold)

October 13, 2012 3:04 PM | Posted, in reply to Anonymous's comment, by Or: | Reply

"WHAT IS THE RESULT OF SWITCHING FROM PSYCHIATRY TO MATH TUTORING?"

The result is that psychiatrists win, probably. Did you read the NYT piece?

"Because their families can rarely afford behavior-based therapies like tutoring and family counseling, he said, medication becomes the most reliable and pragmatic way to redirect the student toward success."

See, tutoring is a "behavior-based therapy". So even if some kid goes off his meds and improves his grades by receiving better instruction, some metastudy can still conclude that therapy improves student outcomes and so we all vaguely know that the medical establishment still has an important role to play in the to Race to the Top. This is some seriously clever semiotic voodoo: change the language ahead of time so you're still relevant by definition if society decides to go a different course.

But the most mind-boggling part of the article came near the end, and I'm surprised Alone didn't bring it up:

"When told that the Rocaforts insist that their two children on Adderall do not have A.D.H.D. and never did, Dr. Anderson said he was surprised. He consulted their charts and found the parent questionnaire. Every category, which assessed the severity of behaviors associated with A.D.H.D., received a five out of five except one, which was a four."

So he just told millions of people, via the NYT, that he doesn't believe in ADHD, and then he's surprised to find out that his own patients don't believe in it either? I guess he considers it a matter of professional decorum not to mention right there in his office that he's just performing a song a dance routine that society demands of him, but does he really think they can't figure that out for themselves? He didn't think that the parents could figure out exactly how to answer the questionnaire to get almost a perfect score? He can say things he doesn't believe and people will take it at face value just because there's a diploma on his wall?

If this guy has kids, he's in for a shock when they become teenagers.

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Here's a question none o... (Below threshold)

October 13, 2012 5:00 PM | Posted by Jay: | Reply

Here's a question none of you can answer: how come the thing with the greatest amount of empirical support is the only one that isn't covered?

Because it is expensive and skilled-labor-intensive, while the others are cheap mass-produced pills.

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What's the word for being p... (Below threshold)

October 13, 2012 9:40 PM | Posted by A.S.C.: | Reply

What's the word for being prescient after it already happened?

Pharmacopeia. Or "Hypocondia", take your pick.

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Cesar Millan says he trains... (Below threshold)

October 14, 2012 12:40 PM | Posted by Stranger: | Reply

Cesar Millan says he trains people, not dogs.

Aren't we proposing the same thing here?

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That stuff's happening in o... (Below threshold)

October 14, 2012 4:35 PM | Posted by Whatever: | Reply

That stuff's happening in other countries too, basically anywhere with a social net system in place, and the reason often is "the patient showed up, and they showed up because that's where the state told them to go."

(Look, I've 30 kids in this class, all "special" in their own right, and I can't be bothered with your little "diamond in the rough." Get him some meds or watch me make your life a hell on earth.)

So you go to the doc which 9 times out of ten says yeah, it's ADHD, worst case I've ever seen, here take those 'phetamines.

What rarely happens is, for a parent to throw that crap away and give the kid some vitamins instead ("Yes, teacher, I took my meds today.") along with a better home life, another school or at least some solid tutoring. No, no time for that. The parents have to bust butt to pay off the second car and fancy clothes.

True story.

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Oh, the same could be said ... (Below threshold)

October 14, 2012 4:39 PM | Posted by Whatever: | Reply

Oh, the same could be said for the rest of the medical or even lawyer profession, 70% of the visits are mostly unnecessary.

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As someone who's had tranqu... (Below threshold)

October 14, 2012 5:12 PM | Posted by Sarah Harper: | Reply

As someone who's had tranquilizers forced on me in psych wards, and is personal friends with several Medicaid psych patients: I don't agree with you on everything, but thank you for telling it like it is. Psych medications don't "work" in the sense of solving people's actual psychological problems, but that's not what they're used for down here--they're used to keep unruly young people and unruly poor people too zonked out to riot.

As for treating the underlying "disorder", that involves getting those suffering from it decent jobs, an endeavour that sadly is devoid of opportunity for Big Pharma kickbacks: http://www.madnessradio.net/madness-radio-depression-and-oppression-alisha-ali

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The only reason most of us ... (Below threshold)

October 15, 2012 12:35 AM | Posted by Josie D: | Reply

The only reason most of us have any problems at all is because our society has legislated away hope!!! Anybody who's stressed out screaming for a decent break in life, but doesn't get the opportunity to get this break they need!!! THAT IS WHY PEOPLE GET VIOLENT, as well as every other 'symptom' of mental illness that's been ever described! People who have the means to get ALL the things they need to make a decent life don't act antisocial & loony! And those who have hope that's real and physical for a better life, don't go crazy! Drugs avoid the real social issues at stake in mental health! You have to fix society to restore hope! Hope then can fix our bad attitudes, whether bipolar, Adhd, depression, anxiety, even schizophrenia! If you stress anyone out enough, anyone will act "crazy". So if you stop stressing them out, their "symptoms" will go away too!!! Nobody would expect an abused person to sit by calmly while being abused! Yet, that's exactly what we expect of anyone who's ostracized enough to need MediCaid! This argument isn't new. Thomas Szasz wrote about it in "The Myth of Mental Illness". In it he drew a continuum about how 2,000 yrs ago people persecuted anybody who wouldn't worship the Caesar! That's why they crucified Christ, among others. Then Szasz states that in the Middle Ages we tortured anybody that said anything against the State! Now science has discredited the myths involved with religion and the state. Now the only thing left is to label undesirables "mentally ill" so we can find another way to torture and rid ourselves of people who bother us! Psychiatry is just the bastions of torture as a means to separate desirable from undesirable! And drugs are just a modern "chemicalised" torture method! Just like the ancient romans, Greeks, Athenians, and the middle ages! History proves that man learns nothing from history! He just finds higher tech ways of committing the same atrocities!

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You are becoming very, v... (Below threshold)

October 15, 2012 5:45 AM | Posted by fraula: | Reply

You are becoming very, very opaque to non-US audiences, even ones who are aware of the broad structure of social safety nets down there

By you saying "down there" it seems you're Canadian, which makes your overstatement even less believable. I live in France, and although I'm originally from the US, I've been in Europe for 15 years now and the US has essentially become a foreign country to me. I mean, PACs? Biden's aggressive and Romney wasn't? I keep waiting for the breathless anti-European media to come out and admit they've been using Orwell's 1984 as a guide, but hey, gotta keep creating thoughtcrimes ("aggressivity in our opponent is BAD!") and reminding people that Eurasia is at war with Oceania. Or Eastasia. It doesn't matter as long as you think you're right and you can think you're right because the media tells you that you can.

Back to the subject at hand. TLP's writing is not opaque. The same thing goes on in other countries. In 2008 it was found that the French consume more anti-depressants than any other country.
http://www.france24.com/en/20110802-france-world-most-depressed-nation-who-study-research-headlines-antidepressants

Americans: hyperactive
French: depressed (and yet they still strike in one year more than Americans have in the last ten or even twenty)

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The piece is really good bu... (Below threshold)

October 15, 2012 1:54 PM | Posted by Anonymous: | Reply

The piece is really good but the accompanying photograph and caption don't add anything to it and probably detract from it. I think you should remove or replace it.

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Thanks for reminding me why... (Below threshold)

October 17, 2012 12:32 AM | Posted by Chris: | Reply

Thanks for reminding me why I do general adult and not kiddie psych.

To the non psychs who read this...

1. The thing that most people and most managers want is a quick fix. Most people think that comes in the form of a pill.

2. Almost all the pills work for multiple symptoms, and for multiple reasons.

3. A LOT, LOT, LOT of organizations want you to do something to sort out the behaviour -- you get teachers, caregivers etc wanting the local favourite. (you can make that favourite fairly non toxic over time(.

4. Therapy is going to be cheap because the Aussies are computerizing it, with good results. But that work will not be read by US psychiatric politicians and managers (the APA has very little to do with science) and therapy or behavioural management by people is incredibly expensive. So the managers want you to prescribe.

There are two places where you can get away without using meds. One is psychoanalytic practice: the other is in the NHS where NICE will protect you by making guidelines that add cost to the outcome mixture, at times outweighing other factors.

Finally, for most shrinks, the drug company rep is a respite from dealing with grumpy case managers, nasty nurses, and scared patients. I see drug reps. Most of us do: not for the pens but for the break in the clinical day.

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The Counselling institute o... (Below threshold)

October 17, 2012 3:37 AM | Posted by Dr Kamal Khurana: | Reply

The Counselling institute offers advice, relationship, Family, Pre marriage, child-Teenage, marriage, remarriage counselling, sex therapy, workshops, mediation, personal coaching consultations and support face-to-face, by phone and through this website.
De Addiction counselling

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Great post! Not everyone n... (Below threshold)

October 17, 2012 4:51 AM | Posted by Therapy Sites: | Reply

Great post! Not everyone needs therapy. But, I do believe that psychotherapists want us all to believe that we require help. Maybe lots of people would prefer a more relaxed pace of self-discovery.

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This is a pretty good read,... (Below threshold)

October 17, 2012 3:18 PM | Posted by anonymous: | Reply

This is a pretty good read, i really enjoy the writing style.
Kudos on the blog, i'm keeping this bookmarked!

I do have a suggestion though, please try to better cite your references when you quote sources - the integrity of the data is always the integrity of the argument. At least, this isn't science, and i heard there isn't going to be a test, but for the sake of good journalism. I'd go for the numbers in brackets and a numbered references list at the bottom of the article, takes up as little space as possible and copy & paste friendly.

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He's *becoming* very opaque... (Below threshold)

October 18, 2012 1:49 AM | Posted, in reply to Beigbeder's comment, by Chiara: | Reply

He's *becoming* very opaque??

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Or perhaps you can't help p... (Below threshold)

October 18, 2012 6:37 PM | Posted by whatever: | Reply

Or perhaps you can't help people because your tools are rather limited and what you view as "bad" is wrong.

Is Greece better than Washington? I image that depends on whether you ask a Goldman Sachs executive or a poor person.

The Puerto Rican doc was interested that the animal comply and suffer without causing trouble for his betters. He had drugs to help him force the animal to comply.

Since helping the animal get out of the unpleasant situation he has been forced into is helping the animal to NOT COMPLY then obviously this is making the problem WORSE not BETTER. Even though the patient himself/herself will be happier. Because the patients happiness is irrelevant. Their COMPLIANCE is the only think that matters.

Does that clear a little bit of your "confusion" up?

Also, we must never, ever say, or even BAD THINK, that the situation the animal... errr.... patient... has got himself into is anything but absolutely and totally his fault. You say I exaggerate? Hardly. Quit covering for your buddies and lying. Read the Alcoholics Anonymous "rules" and explain to me how they apply to someone who was forced to attend by the courts because he blew as BAC of 0.10 (actual BAC was 0.06, but heh, breathalyzers are just a little buggy, dude) after he got plastered after his 45 year old brothers funeral. Cause you know, NOTHING JUSTIFIES WHAT HE DID. Unless he didn't get caught. In which case we have to ask, if someone gets drunk in a forest and there isn't a woman to yell at him, did he still kill four imaginary children?

Should he still admits his powerlessness before alcohol and apologize for all the imaginary harm he caused?

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Your comment reminds me a b... (Below threshold)

October 18, 2012 9:42 PM | Posted, in reply to Whatever's comment, by Verdius: | Reply

Your comment reminds me a bit of what Alone would say.

Speaking of which, please continue Alone.

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A person court ordered to a... (Below threshold)

October 19, 2012 8:35 AM | Posted, in reply to whatever's comment, by Narcissus Thespiae: | Reply

A person court ordered to attend AA meetings can do so without ever saying they are an alcoholic. They don't have to say anything actually. The "sentence" is about exposure to real addicts for you to determine if you need help. So if you or someone else is required to attend x amount of meetings AND goes ahead and admits to being an alcoholic without believing themselves to be, than this might just be the blog for you.

One of the AA books, "AA comes of Age" actually states that within every alcoholic is a ego-centric, narcissistic core. That is when you are done getting shit faced in the remote woods of course, all by your lonesome, to make a point. : )

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I am on my eleventh year ... (Below threshold)

October 19, 2012 1:14 PM | Posted by Harry Horton: | Reply

I am on my eleventh year with a serious metabolic disturbance from making the mistake of taking 1/2 to 1 mg daily dosage of risperdal back in 2001. The misinformation concerning these drugs has created something of a crackhouse environment way of conducting psychiatry today. In anycase the following quote comes from an article "Depression: a metabolic perspective" Richard Fiddian Green 27 October 2012, BMJ. Its interesting that a simple accurate factual voice (R.F. Green's voice that is) on what anti depressants and antipsychotics really do in the real world shows up in the British Medical Journal. Why such common sense approaches does not show up with the APA is bewildering? In anycase here is the quote:

"Conventional drug therapy leaves much to be desired from the metabolic perspective and needs to be re-evaluated with some urgency. If administered to persons whose capacity fro replenishing intraglial glycogen and intraglial and intraneuronal ATP stores is impaired mood elevators that act by enhancing neurotransmitter release and increasing the slope of neuron action potentials may compound the severity of the energy deficit present by increasing the demand for ATP hydrolysis beyond the capacity to replenish ATP stores. Any severity of any energy deficit present is likely to be compounded by those antidepressants that impair mitochondrial oxidative phosphorylation. It might also be compounded by drugs used to treat co-existing cardiovascular disorders, notably beta blockers and statins. Of great concern is that any medication or mixing of medications that either induces or compounds the severity of an intracerebral energy deficit might increase the likelihood of developing neurodegenerative disorders in later years especially if the medications are administered for extended periods." end quote.

The above from 2003 is a simple factual illustration of the cause and effects of anti depressants and antipsychotics on a patient's metabolic profile. Yet it seems the APA has trouble addressing these facets of the medications while all the other scientific and medical journals and research studies thankfully honestly relate the implications and nature of what the neuroleptics do. Kafka's cockroach may be running the APA these days, who knows.

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A person court or... (Below threshold)

October 20, 2012 1:45 AM | Posted, in reply to Narcissus Thespiae's comment, by whatever: | Reply


A person court ordered to attend AA meetings can do so without ever saying they are an alcoholic. They don't have to say anything actually. The "sentence" is about exposure to real addicts for you to determine if you need help. So if you or someone else is required to attend x amount of meetings AND goes ahead and admits to being an alcoholic without believing themselves to be, than this might just be the blog for you.

One of the AA books, "AA comes of Age" actually states that within every alcoholic is a ego-centric, narcissistic core. That is when you are done getting shit faced in the remote woods of course, all by your lonesome, to make a point. : )

You are funny. I have never know an authority figure that did not require the animal to admit guilt.

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I was diagnosed with Touret... (Below threshold)

October 20, 2012 9:02 AM | Posted by Anonymous: | Reply

I was diagnosed with Tourette's syndrome when I was 10. For 14 years I've been taking clonazapam and risperidal in order to "treat" my Tourette's. I've seen specialists after specialists and tried many different kinds of "cure". Around the age of 24, I finally became fed up living as a "disabled" person and decided to control my tics through will power alone. Well, I've been off my medications for a few years and my life has changed so much now that it's almost unreal. Looking back, me and my family placed so much reliance on the "experts" that the thought of overcoming my "disability" through will power had never ever occurred to me. We were so sure that I had a biological problem (through genes and etc) that we spent all our efforts looking for external intervention. Even today, no one knows exactly what causes Tourette's syndrome. Which makes me wonder, did I really had Tourette's syndrome or was my diagnosis just a self-fulfilling prophecy?

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Yes, I know I'm mostly repe... (Below threshold)

October 21, 2012 3:50 AM | Posted by O.whatever: | Reply

Yes, I know I'm mostly repeating what he said. The only difference is, I'm not a shrink, I'm in ground 0.

So basically I'm recounting my experiences, that happen to match with his views sometimes.

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I keep hearing people compl... (Below threshold)

October 23, 2012 7:41 PM | Posted by indigorhythms: | Reply

I keep hearing people complain about how psychiatric drugs are overprescribed however when I experienced a psychotic depressive episode that started about two years ago I had a hard time getting admitted into a hospital and getting any medication.The antipsychotic that was prescribed was so expensive and the side effects so annoying that I ended up not continuing it... I have lived around two years now with voices/depression and no medication.

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If this is for real, you re... (Below threshold)

October 23, 2012 9:28 PM | Posted by medsvstherapy: | Reply

If this is for real, you really could benefit from a decent assessment, since there is a high likelihood you will be able to benefit a fair amount without much bother from side effects.

One of the problems of the way psychiatry works today is that the people who don't really need psych med treatment are getting it because they are persuadable and have good insurance, or are playing along with the disability charade, and those who really need all of the best that can be delivered are those without a funding source and are not easy to treat.

If this is true, it is worth discussing and revealing on a blog. How can things be up-side-down? Because it works for those in power. But that type of discussion doesn't help the depression or voices.

I would try to get a decent eval - there are a few reasons you might have depression and also hear voices. Treatment may vary depending upon the reason, which a great diagnostician should be able to figure out - plus some stuff like MRI might be considered.

For the most part, though, whatever the reasons, there is likely an inexpensive prescription drug that may provide a fair amount of relief that would really make your life a lot better. Not perfect, but likely much better than where you are at now.

According to analyses, the new, expensive antipsychotics are hardly any better than the older, less expensive ones. Side effects are not great for the old, but that can be explored and managed, esp bang for the buck - taking a lower dose and getting significant relief even if not optimal.

You may need to find a doc or setting that can provide some care at a charity level - if you cannot get in your public system, or if public just cannot give proper evaluation/diagnosis time.

Because there are a few diverse ways you could be having depression and hearing voices, many places may be wary of doing charity care - if the picture were more straightforward, they might be more willing.

Either way - I would be contacting the local public system and also the local National Alliance for the Mentally Ill group to get some local info on providers. Local - moms - not the national orgainzation.

Considering, of course, that this is basically a true story. People say all kinds of things on the internet.

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Personally, I have nothing ... (Below threshold)

October 26, 2012 2:27 PM | Posted by Altostrata: | Reply

Personally, I have nothing good to say about psychiatric medications as I've been suffering from Paxil withdrawal syndrome since 2004 and disabled by it for the last 4 years.

The psychiatrists at UCSF Langley Porter did not have a clue about how to taper or what to do with severe withdrawal symptoms, so I've had to cope with the neurological damage all this time.

Occasionally, I meet a psychiatrist who is also a good doctor and minimizes prescription of the drugs, but they're few and far between. Most have drunk the Kool-Aid but make pathetic excuses like health insurance makes them do it.

Denial is a river in psychiatry. David Healy has his faults but somebody had to say psychiatry did it to itself.

PS The world truly needs endocrinologists. Psychiatric medications are generating more diabetes, as though the general population needs more diabetes risk.

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Was David Healy the new, mo... (Below threshold)

October 27, 2012 5:27 PM | Posted by onceagain: | Reply

Was David Healy the new, more hip version of Peter Breggin? Why was a new version needed?

What happens when the fiscal cliff is reconciled. Taxpayers will be fully and completely hamstrung. medicaid dollars contract, more people need its services, obamacare is implemented, taxes increase.

Taxpayers will not be labeled racist teabaggers when they say, 'we don't want to fund psychiatric meds for the poor and most vulnerable in society. we think these disorders are expensive frauds and we would like to fund instead if we have to less expensive alternative treatments like therapy and extra attention at school.'

Big Pharma is done. Too many people know it is a con and when there is no more money to finance the illusion that it's not, game over.

Big Pharma et al. will be facing taxpayers who are actually paying attention to their finances and what the hell their taxes really pay for, it will be much more difficult to continue the fraud.


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Onceagain - If you look at ... (Below threshold)

October 28, 2012 5:48 AM | Posted, in reply to onceagain's comment, by Anonymous: | Reply

Onceagain - If you look at defense procurement spending, the budgetary and economic canards employed to drum up the "fiscal cliff" in the first place, I'm not sure we're talking about the same government or the same set of taxpayers. That notwithstanding most people couldn't give less of a shit.

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I agree, the "fiscal cliff"... (Below threshold)

October 28, 2012 12:13 PM | Posted, in reply to Anonymous's comment, by Altostrata: | Reply

I agree, the "fiscal cliff" is a pseudo-crisis manufactured for political purposes -- like the mood disorder epidemic manufactured for pharma profit.

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@medsvstherapy Thanks for t... (Below threshold)

October 29, 2012 12:55 AM | Posted by indigorhythms: | Reply

@medsvstherapy Thanks for the concern/advice. I've been debating for about two years now whether I should ask my general practitioner/a new psychiatrist for another antipsychotic however I felt too embarrassed and in addition the voices are much more internal/quiet now than in the beginning. When I was admitted to the hospital, two years ago, the psychiatrists seemed fairly competent although I didn't receive an MRI. I went to the ER about thirteen times.I was admitted on the fourth time but I kept going back after that since the voices insisted that I should.

Around the thirteenth time the ER doctors mentioned that my condition probably wasn't schizophrenia since I was first experiencing this at the age of 39. They mentioned my symptoms could be due to antidepressant withdrawl. I have a suspicion though that this episode might be due to the antidepressant(Wellbutrin) I was taking for a number of years and stress.

Prior to this episode I was simply considered dysthymic however I believed something else was wrong since the various antidepressants did nothing for me and caused increased anxiety which had to be manged with tranquilizers. I tried to get a consultation but found it difficult due to lack of mental health insurance.

I mainly brought my case up because I think there is a certain percentage of people, like me, who are underinsured and undertreated. I wish someone would address this problem more.

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IndigoRythms - an mri is no... (Below threshold)

October 29, 2012 9:23 AM | Posted by medsvstherapy: | Reply

IndigoRythms - an mri is not necessarily a part of a decent psychiatric assessment - you can find out what is and is not by looking online or buying some old copy of kaplan and sadock guide to psychiatry - that can give you some idea.

the one doc was right that garden-variety schizophrenia does not start at the age of 39. somewhere in the archices, the last psychiatrist has a post where this types of problem get sorted into two cateogories - one where the etiology is known/recognized, and one where it is not. he makes the case that 'schozophrenia' is a term for a set of similar syndromes where the cause is unknown, and he makes the case that while this is how it works, no one describes it this way - the problems that get thrown in the schizophrenia category are perceived as if they are some known, recognized disorder.

well, to a degree they are. based on my experience working in inpt and outpt psych, including being a diagnostician, i believe that 'schizophrenia' exists, and has a heavy genetic component. i could be wrong, and am open to different explanations, and to the idea that 'schizophrenia' may be a collection of differnt problems put under one label, with that set of problems getting smaller as knowledge advances and some of those problems get moved into their own cateogries.

so, the 'schizophrenia' pattern is recognized, and the emergence after the age of 25 in males is unusual - that should make a doc consider other things.

online, or in a textbook, in the old days you would find a category of problems called 'organic' problems. this was the old-school term for someone hearing voices, or seeing things, when it was pretty clear that the brain had suffered some kind of injury or damage. the term 'organic' got applied to this somehow.

i worked with a couple ppl who had either voices or seeing things appear after chemical exposures in the chemical injury, and one guy began seeing things pretty persistently after getting hit in the head with a forklift fork on the job.

some ppl who damage their brains with drugs - esp huffing or with hallucinogens - can end up seeing things regularly.

i think my base of experience in talking with ppl taking wellbutrin for a long time is too small to guess whether that drug could have a side efect of giving somone auditory hallucinations. it seems unlikely to me. but like i said my base of experience is not high.

there are a lot of long-term wellbutrin users out there - maybe some website has tem chatting.

wellbutrin does give some ppl very vivid, life-like dreams. to some, these are bothersome, but to others (i suspect those who look at pr0n a lot and so have that on their mind) the dreams are welcome.

there is one other med i have heard ppl say gives vivid dreams but i cannot recall that now. -its been a long time since i have been around numbers of ppl taking that one, i guess.

so, something to look into is whether there could be an 'organic' problem. you could search that on the web, and talk to a doc abt this. my guess is any doc, even primary care, may have this concept of 'organic' disorders. older docs do. they dropped it out of the dsm system i think from dsm iii to dsm iv - i think the story is because it impled the organic disorders had an actual physiological basis, which is not good for the field of psychiatry since this is their marketing ploy for ALL disorders - shift-work sysndrome, abandoned-while-pregnant disorder, etc. you get a pill no matter what cuz the prob is re-defined as 'biologically based brain disorder' -NAMI's slogan.

somewhere on the internets you can find info on 'organic' disorders, and what they could be caused by, such as chemical exposure, head injury, etc.

i cannot say or direct too much from my armchair cuz i simply would do things and ask things very differntly in person if i were hired to help you. you can explore yourself, and get a doc to help you.

the issue is: getting a doc to explore. like i said before - this is not the model of care - the model of care is really a matter of off-the-shelf care, with no tailoring. if you complain of depression, you get an antidepressant plus maybe an antianxiety so you will sh ut up and be compliant, since you are getting a buzz paid for by insurance.

the ER is no place to get a decent evaluation. i would expect nothing more than for them to assess whether there is an immediate crisis, and get you out so they can deal with the kid with the runny nose and the gun-shot-wound.

other than that, it seems that in public or private care, complaining of voices and depression with an onset at an age beoynd 30 would definitely put any psychiatrist on the 'organic' disorder track.

that's why i think you might want to read abt this and discuss with a doc.

if this leads up any fruitful path, they should be able to figure out a series of meds to trial to see if one works.

the alternate path is to pursue talk therapy. 'psychotic depression' is on the interweb. ppl can go so far into depression that hearing voices shows up as a symptom - but the voices are usually only around when the depression episode is pretty bad, and you say voices have been present over a really long time.

but who knows - if you could get into talk therapy - in public care (rare) or private (not rare if you have insurance) or at a trinaing site where session cost can be much lower - like at a university where counselors are being trained - that can be affordable, but you get someone who likely has limited experinence. while that is likely, they will be supervised by someone who ought to have a good background, and so would guide assessment and care better.

sone things to look into. if only you can get lined up with a circumstance where a person with some knowledge can devote some time.

sadly, this can be rare.

Jesus said it is not the healthy who need a doctor, it is the sick (you can google this and look it up for your next Bible study)- but to a fair degree, this is not how our medical system works. Frankly, for me, just yet another indicator that the Bible is spot on and many of us are fools to underestimate knowleldge and wisdom from the creator of everything who knows everything.

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Yes, there are peer support... (Below threshold)

October 29, 2012 1:52 PM | Posted, in reply to medsvstherapy's comment, by Altostrata: | Reply

Yes, there are peer support sites for "chatting" about prolonged antidepressant withdrawal syndrome, one such is http://survivingantidepressants.org

One woman got hallucinations while tapering Paxil. She carefully switched to Prozac, tapered off that, no more hallucinations. She is also taking niacin, which she believes subdues the voices.

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In the interest of clarific... (Below threshold)

October 29, 2012 5:28 PM | Posted by indigorhythms: | Reply

In the interest of clarification the hospital where I was admitted was a teaching type hospital and I still have a suspicion that the medication( Wellbutrin/Depakote) might have precipitated the episode before I even started to taper the antidepressant on my own.

This brings up another question. Are these medications creating more problems than they are treating?

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For Dr. Last and other US p... (Below threshold)

October 30, 2012 2:12 PM | Posted by Altostrata: | Reply

For Dr. Last and other US psychiatrists reading this --

When was the last time you brought your concerns up to the leadership of the APA?

The APA is psychiatry's primary lobbying arm in Washington. That extortionate dues arrangement, plus millions from sales of the required-reading but bogus DSM, plus (in the past) generous grants from pharma pay for APA lobbyists.

You can bet that 10 or 20 years ago, when pharma lobbyists sat down with Federal agencies to set guidelines for reimbursing psychiatric care, APA lobbyists were there passing the canapes. They might even have been the same lobbyists.

Now that it's clear the birthright you earned in med school has been traded for a bunch of pharma profits, what are you doing to goose the APA into representing your interests?

What is the value-add psychiatrists bring to psychiatric care, anyway? It's your professional organizations and research psychiatry who've dumbed down psychiatric care to supposedly foolproof algorithms like TMAP that even a physician assistant can follow.

Why aren't clinical psychiatrists up in arms at the proposal that GPs are as good at making complex diagnoses that psychiatrists don't even understand and prescribing cocktails of powerful drugs with dubious benefits to be taken eternally? Why haven't you ridden John Rush out of the profession on a rail?

Why haven't the young Turks taken over the APA? (One might surmise the presentation of Carlat and Healy to be a sop to criticism.) Why do they do nothing but whine on blogs?

Who's afraid of Charlie Nemeroff? Not only the poster child for everything that's wrong in psychiatry, he's apparently been the profession's enforcer. It was Nemeroff who threatened David Healy in 2001 after a speech in Toronto that was only incidentally about suicide risks on Prozac. http://1boringoldman.com/index.php/2012/01/22/before-that-became-cool/

(Later publicly disgraced, cast out from Emory, Nemeroff found a sinecure at the U of Miami through the good offices of his friend Thomas Insel and hints of pharma largesse to the cash-strapped school. Nemeroff's partner in crime, Alan Schatzberg, was president of the APA 2010-2013.)

By the way, those antidepressant suicide risks disappear from the data only after assiduous massaging. Where is clinician outrage about Robert Gibbons's latest attempts to rewrite the record?

Where is the clinician outcry for retraction of the crooked Paxil Study 329 recommending Paxil for children, featured so prominently in the recent GSK fraud investigation www.justice.gov/opa/documents/gsk/us-complaint.pdf, which resulted in a penalty of 3 BILLION DOLLARS?

For example, do you think it would be too dangerous to your career to propose to the APA a different dues structure so that psychiatrists may belong to their regional associations without paying fealty to an organization that's done nothing but sold the dignity of their profession down the river?

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Really love your blog. It i... (Below threshold)

November 4, 2012 1:18 AM | Posted by jerry: | Reply

Really love your blog. It is very enjoyable and insightful

http://mentalhealthlivingwithbipolar.blogspot.com

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Mental illness is only abou... (Below threshold)

December 1, 2012 2:08 PM | Posted by Jonathan Bernier: | Reply

Mental illness is only about sexual perversion, and nothing else. The brain is perfectly healthy, and the medication is perfectly useless. The Supreme Court of America is against psychiatry, I repeat, it is against psychiatry. If the good doctors want to commit suicide, they are strongly encouraged to do so. We don't need them. The issue has nothing to do with medicine. It must be abolished, once, and for all.

- Mankind

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Mike: "TLP's prose style re... (Below threshold)

December 19, 2012 10:14 PM | Posted, in reply to Mike's comment, by Bonze Anne Rose Blayk: | Reply

Mike: "TLP's prose style reminds me of Nietzsche and Kierkegaard."

Yea, I've been reading over this blog all day… because it's delivering "LOL-stage enlightenment", and though I'm already through that myself, it's great to see someone who is (apparently) a practicing psychiatrist "being real"?

It's a tough call: What's more frightening… the state of The Last Psychiatrist's soul, or the prospect of the ÜberShrink?

Sincerely,
- bonzie anne

PS: The style is not actually so much like Nietzsche's, but the awareness is somewhat similar, to my mind at least.

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Since this article was abou... (Below threshold)

December 21, 2012 6:30 AM | Posted, in reply to Beigbeder's comment, by Anonymous: | Reply

Since this article was about the well so called controversy of over prescription of medication, along with the hypocrisy of the so called shortage of Addarall in the united states, along with the medicare system (which honestly most Americans not on it are probably at best briefly acquainted with), in the United States, it's rather difficult to not be so. Well it would be possible if she wanted to spend twice the length of the current article explaining necessary background.

Or to be amerocentric this is a article by a murican about murica best country in the world which everyone should know every thing about.

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I tried to read one or two ... (Below threshold)

January 6, 2013 9:15 PM | Posted by RedScourge: | Reply

I tried to read one or two of this guy's blog postings, but they are so painfully incoherent and devoid of usefulness that I cannot continue. It was interesting however to witness someone who could clearly use an antipsychotic yammering about how the people who need help the most often are the ones not getting it.

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Ya, when do you start worki... (Below threshold)

February 26, 2013 2:18 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

Ya, when do you start working on your awesome HBO show?

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i feel to be proud after re... (Below threshold)

March 4, 2013 8:28 AM | Posted by essay help: | Reply

i feel to be proud after read your article. Actually its a need of human and Developing is must for us successful in life.

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soma! soma! soma! soma!... (Below threshold)

March 29, 2013 4:24 PM | Posted by fwit: | Reply

soma! soma! soma! soma!

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TLP may not be trying to ma... (Below threshold)

April 12, 2013 4:46 AM | Posted by Emilymkf: | Reply

TLP may not be trying to make this point but i am so tired of hearing about over medication or inappropriate use of medication to treat a disorder that many psychiatrists don't believe exist. I'm referring here only to ADHD. I am a psychiatrist. I've been treating adults for 30 years in private practice. Because I ended up working in an upscale neighborhood, the majority of my patients can pay me without insurance. I began to pick up that a sizable number of people who came in with anxiety or depression, and had careers considered professions were hiding behind a wall of shame - houses they could not ever get close to order, jobs they got because somebody suggested they try (fill in the blank), did well in school but didn't have a plan for what to do with it, were always early and never lost their keys but couldn't let themselves be late and their keys were anchored to their bodies. They learned to pass for normal. I wore them down by relentless listening way past the 50 minute hour. And by going to their houses. Undiagnosed adults with ADHD. And PTSD from harsh punishment as kids. I treated both. Stimulants worked at any age. The world opened up to them. Crippling shyness fell by the wayside.

I got so tired of having to battle with family, their internists, other psychiatrists who tried to tell them I was putting them on speed and sometimes losing patients for whom the world finally made sense because of social pressures, callous pharmacists..the list goes on. My income dropped because I was spending so much time with them and charging my standard $200/hr for two hours of time in my office at the same fee. PLEASE EVERYBODY LISTEN - THIS DISORDER DESTROYS LIVES. And it's safe and treatable. The medication works. Don't belittle it. Ok - I am done.

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Of course ADHD medication w... (Below threshold)

April 12, 2013 1:54 PM | Posted by Altostrata: | Reply

Of course ADHD medication works well for everyone, providing motivation, energy, and focus -- it's speed!

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Hi, Altostrata, Than... (Below threshold)

April 12, 2013 7:55 PM | Posted, in reply to Altostrata's comment, by Emilymkf: | Reply

Hi, Altostrata,
Thanks for reading my long post and not just blowing it off but sending me a response.

I was writing a careful reply when my internet connection broke off and sent my incomplete response to cyberspace. So before that happens again I'm going to write it elsewhere and copy it in. Since I have to go to work, I can't write it now but really want to answer you with my thoughts about your take on what I wrote.

I love the Internet especially when it connects people to each other. Maybe it will be a conversation - there's a dying species.

One quick thing - did I really say ADHD medication works well for everyone? I re-read what I wrote and couldn't find it. Maybe I implied it someplace and didn't realize it? Take a peek if you can and tell me. More later...

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Once more - a quick respons... (Below threshold)

April 12, 2013 8:08 PM | Posted, in reply to Altostrata's comment, by Emilymkf: | Reply

Once more - a quick response. I'm brand new to this site but I scrolled up quickly and saw you are not a newbie. I will learn the ropes from you maybe.

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I saw you were personally i... (Below threshold)

April 12, 2013 8:18 PM | Posted, in reply to Altostrata's comment, by Emilymkf: | Reply

I saw you were personally injured.
I was sorry to read that.
Primum non nocere.

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Thanks for going out of you... (Below threshold)

April 12, 2013 10:59 PM | Posted, in reply to Emilymkf's comment, by Auntiegrav: | Reply

Thanks for going out of your way to do your work well, Emily. There are so few who do so, and so many whose decisions are made by the numbers on a computer screen or infomercial.
There just isn't a whole lot of real thinking and creating going on these days. It's all just so much busy work and lip service.
Philosophers want to avoid the substantive rigor that Wittgenstein offered up as reality. Politicians want to let the economy be their scapegoat. Doctors are imprisoned by their lawyers and insurance corporations. Scientists are enslaved by model substitution mathematics and fundraising.
I once was interviewing for a job when the VP of Engineering said, "Wow! You're a THINKER." and I thought to myself, "as opposed toooo....?"
Since then (wow, that was 20 YEARS ago?), the culture of unthought and consciousness suppression has continued to envelop nearly every corner of our physical needs (food, medicine, human usefulness). If our food and information systems make us stupid and lazy, how will our children ever find out?
...being somewhat in the belly of the hipster organic beast myself, I have often found humor in their rituals, but I wonder whether they or the majority are really going to have the last laugh. The granola eaters may be paying crazy prices for organic food, but the rest of the world doesn't understand that the food they eat costs the same; the price is paid in wars, health (mental and physical), soil loss, pollution and taxes rather than cash to a bearded guy with a ponytail.
Potatoes get you through times of no gold better than gold gets you through times of no potatoes. The apparent cost of spending a ridiculous amount of money on a liberal education (by 'liberal', I mean "lots of education")should be tempered with the fact that our government is attempting to inflate away its debt load and make future money worth even less than college money. Better to get rid of the money now, and have something you can take with you to discuss in the eggplant fields than skipping college and trying to make conversation about NASCAR and football that no longer exist.(putting tinfoil hat back on now) ;-)

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I am irked that I cannot gi... (Below threshold)

April 13, 2013 7:51 AM | Posted, in reply to Auntiegrav's comment, by Bonze Anne Rose Blayk: | Reply

I am irked that I cannot give Auntiegrav's comment here 10 Pluses, just for that first paragraph?

Color me "aggrieved". - bonzie anne

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Emilymkf, if you think you'... (Below threshold)

April 13, 2013 1:47 PM | Posted, in reply to Emilymkf's comment, by Altostrata: | Reply

Emilymkf, if you think you're doing God's work, no amount of discussion is going to discourage you from overprescription of psychiatric medications.

You will see patients with "true" ADHD benefit from ADHD medications in terms of increased concentration and success at work and school. You will see people with no ADHD experience the same benefits.

Why? Because ADHD drugs are a state-sanctioned form of speed. That is why college students are trading them among themselves at exam times. 50 years ago, they were doing the same thing, but instead of faking ADHD (or convincing themselves they had it) and getting a prescription, they were buying it from the local drug dealers.

Prescription speed may have the advantage of fewer impurities and standardized dosages and not cause physical deterioration as fast as street speed, but it can cause dependency and addiction all the same.

There is no distinction between the benefits of speed analogs for people with the "brain disease" ADHD and people without it. Post-hoc claims of successful treatment with the drugs does not prove you have been treating ADHD, it proves you have been distributing speed.

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It's a bit difficult for me... (Below threshold)

April 14, 2013 3:44 AM | Posted, in reply to Altostrata's comment, by Emilymkf: | Reply

It's a bit difficult for me to tell if you are in any way curious about how make treatment decisions with my patients, or if the thrust of your comments is to emphasize that my treatment for ADHD involves speed and everyone would get improved focus, motivation and energy if they took it. I don't want to argue about this. I could raise my experiences that are different than what you are describing I'm doing, but that won't have much meaning if you aren't interested. (I am fine if you aren't. I would just know to end my expectation of a mutual exchange, wish you a better future and drop the subject with you.)
The thrust of my original statement that ADHD can produce impairments, it is a serious illness, it is a treatable illness, and that I found significant bias, including within the psychiatric community, about dealing with it as a treatable illness. Most MD' s ,including psychiatrists, don't want to treat the disorder. They typically dislike using amphetamines and methylphenidate. It's puzzling and troubling to me.
I think God can do his own work.

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Emily, I have no doubt what... (Below threshold)

April 14, 2013 12:23 PM | Posted, in reply to Emilymkf's comment, by Altostrata: | Reply

Emily, I have no doubt whatsoever that any doctor who treats ADHD believes he or she has found a nest of "true" ADHD.

Like any condition treated with psychiatric drugs, it is vastly overdiagnosed. Are you the outstanding doctor able to recognize the rare case of "true" ADHD? How would you know? How would I know?

I've participated in many, many online discussions with psychiatrists who are convinced they are a cut above no matter what kind of stupid drug regimens they prescribe (cf STAR*D). My criteria for an extraordinary psychiatrist are being highly suspicious of pharma claims and using drugs very, very sparingly.

Few psychiatrists meet those criteria.

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I was once asked if I ever ... (Below threshold)

April 15, 2013 1:38 AM | Posted, in reply to Altostrata's comment, by Emilymkf: | Reply

I was once asked if I ever thought I might have ADHD. My spontaneous answer was "No". Then I was told that maybe I should think about it. This was in 2004. I had begun to diagnose and treat this condition about 5 years before that question. It never occurred to me to think about my own life.

Whether it is treated by the commonly used medications approved for it or not, it exists. Some people's lives end in a kind of sadness from it. Some people's lives just end too young, in some tragedy for unclear reasons even if the biological cause seems to be known.

There is much anger on this blog site. I think I'll go now and listen to Gerry Mulligan and Chet Baker blend together in Lullaby of the Leaves. And wonder why Chet could play that trumpet and sing like an angel but still need all that heroin.

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And thank you for your kind... (Below threshold)

April 15, 2013 1:49 AM | Posted, in reply to Auntiegrav's comment, by Emilymkf: | Reply

And thank you for your kind thoughts. I am always trying to listen. Sometimes what I hear is followed by my own tears. I can't seem to easily get up and leave my office and go home tonight. Writing here helps.
That engineer wasn't listening to himself when he spoke to you.
I think of school as the good old days too.

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We are really grateful for ... (Below threshold)

April 25, 2013 5:38 PM | Posted by halftone fonts: | Reply

We are really grateful for your blog post. You will find a lot of approaches after visiting your post.

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This is a great inspiring a... (Below threshold)

April 25, 2013 5:39 PM | Posted by usnam: | Reply

This is a great inspiring article.I am pretty much pleased with your good work.You put really helpful information. Keep it up.
halftone fonts

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Sir,There's more tru... (Below threshold)

April 27, 2013 7:30 PM | Posted by pazenadam: | Reply

Sir,
There's more truth in a single paragraph of your article, than there is in volumes of crap they pass as scientific literature these days. Thank you.
Sincerely.

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It must be hard to be a psy... (Below threshold)

April 28, 2013 12:50 PM | Posted by Altostrata: | Reply

It must be hard to be a psychiatrist with a conscience, any analytical ability, or recognition of social context.

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Maybe it is the case that a... (Below threshold)

April 28, 2013 8:21 PM | Posted, in reply to Altostrata's comment, by Lori: | Reply

Maybe it is the case that a psychiatrist with a conscience is called a psychoanalyst?

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I read somewhere that the c... (Below threshold)

April 28, 2013 11:20 PM | Posted, in reply to Altostrata's comment, by Emilymkf: | Reply

I read somewhere that the current Dalai Lama said, when asked, that his religion was kindness. I think it is hard to follow this unless you can look at someone - including yourself, or a mosquito that just landed on your arm with respect. Everyone on the same level. Since this is about psychiatry, it would be a good idea if psychiatrists did that with everybody - and with their patients too.
I try to wear long sleeves in warm weather. It gives mosquitoes a little time to think when I'm talking to them about the chemicals in my blood. I don't know if Cytoxan or Taxotere is helpful for them.

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If Dr. Last is any indicati... (Below threshold)

April 29, 2013 2:59 PM | Posted, in reply to Lori's comment, by Altostrata: | Reply

If Dr. Last is any indication, those psychiatrists who were inclined towards psychoanalysis or psychotherapy mostly have been forced into drug distribution and are very...ah...conflicted about it.

Mickey Nardo, author of the blog 1boringoldman.com (highly recommended), was one such and retired rather than doing nothing but prescribing psychiatric drugs.

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There's always a lot to unp... (Below threshold)

April 29, 2013 3:10 PM | Posted, in reply to Emilymkf's comment, by Altostrata: | Reply

There's always a lot to unpack in your comments, Emily.

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Hm.In that case, it'... (Below threshold)

April 30, 2013 3:46 AM | Posted, in reply to Altostrata's comment, by Emilymkf: | Reply

Hm.
In that case, it's probably ok that I was writing back a rather long story to you and it got lost when I stood up. Summary: I'm allergic to cats. But I have had two unavoidable encounters with a single cat recently. The first induces mild wheezing, the second produces no allergic reaction. The cat's owner is asking me to kill him painlessly in the first meeting. In the second meeting, no allergic reaction,and the cat chooses to jump up to eye level 4 inches from my face and sowly moves his nose to touch mine as we are staring into each other's eyes. This goes on for 30 seconds or 2 minutes, then he suddenly jumps off and runs away.

Very confused but hoping for an answer that is not other-worldly, I send an email to a patient who knows very much about cats. I know next to nothing. She responds with a chapter and verse explanation of what the cat's behavior meant and why my allergic response was absent. It wasn't a strange explanation, but it was quite lovely to have an experience that was puzzling turn into a story where all the pieces fell in place.

Since this is a psychiatry blog (TLP), it should have psychiatry in here someplace I think. I stepped out of a box to email a patient with a question. A lightning fast series of things ran through my mind before I made that patient contact - none of which was conscious. But first do no harm. Now as I write, I can think of all the things that made that contact good for me and for her. And for the cat.

Today I run into a print out of a summary of a study --August 29, 2005. Proceedings of the National Academy of Sciences Dr. Richard Davidson, from the University of Wisconsin at Madison, used functional MRI to determine the brain regions linking emotions with asthma flare-ups. He concludes that "In individuals with asthma and other stress-related conditions, these brain regions [the anterior cingulate cortex and insula] may be hyper responsive to disease-specific emotional and afferent physiological signals, which may contribute to the dysregulation of peripheral processes, such as inflammation." ) Now there's a mouthful.

My patient said that when cats touch noses like that with people and with each other it has a soothing effect on both parties. Blood pressure has been lowered in people during such states.

Two puzzles remain: the organization of my house would be improved if a cyclone went through it. Today I moved a book and saw a piece of paper I had printed out in 1995 about asthma and don't remember seeing since. Who can I email to answer how it turned up today?

And the other puzzle. Last week I was sent some information including a photo taken in a neuroscience lab at the same university that is cited above. In 2005, Dr. Davidson was using live people and functional MRI's. His data may or may not have value. I haven't read the article. But 8 years later the photos shown - and I'm glad I don't know where they are right now - a cat with a metal device I have seen pictures of before - machine made with technical precision - inserted into the cat's brain through his skull - it protrudes from the top of his head about an inch high and wide. It will provide information about how the cat is processing auditory signals. Who can I ask to kill him painlessly? I could only put my arms around the person who asked me that question. And then tell him later about his cat knows another way to help him. Stay alive a little longer.

You called me by my name. I was deeply touched.

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Excuse my last reply, pleas... (Below threshold)

April 30, 2013 4:08 AM | Posted, in reply to Altostrata's comment, by Emilymkf: | Reply

Excuse my last reply, please. It was not all that shorter.
Although I am glad to not be in a place where anything is required reading. Or required writing.

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Psychologist Sydney<p... (Below threshold)

May 4, 2013 4:02 AM | Posted by sarahjayne: | Reply

Psychologist Sydney

Bright Ideas is an innovative psychology and coaching clinic that provides a range of services for the prevention and treatment of mental health disorders.

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The problems in the UK seem... (Below threshold)

June 1, 2013 7:25 AM | Posted by Mark: | Reply

The problems in the UK seems to generally follow a 15 year lag to those that develop in the US. http://mrcpsychexam.com/ gives some insight into the different training that UK psychiatrists undergo.

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I know I'm late to this par... (Below threshold)

June 26, 2013 3:44 PM | Posted, in reply to Whatever's comment, by Roger G.: | Reply

I know I'm late to this party but you nailed it, my friend. We all need to step away from the Red Bull and make a logical decision that our kids and family need us more than the junk we can buy them.

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