Shrink Rap

Should Doctors Feel?

2012-05-27T16:12:00.000-04:00

There was an article in today's New York Times called "When Doctors Grieve." Leeat Granik mentions her mother's long battle with cancer and the family's relationship with her oncologist. She is now a health psychologist and has just published an study done by interviewing 20 Canadian oncologists. While I know nothing about the methodology she discusses, I found her conclusions, as she summarized them for the NYTimes, to be thought provoking:

We found that oncologists struggled to manage their feelings of grief with the detachment they felt was necessary to do their job. More than half of our participants reported feelings of failure, self-doubt, sadness and powerlessness as part of their grief experience, and a third talked about feelings of guilt, loss of sleep and crying.

Our study indicated that grief in the medical context is considered shameful and unprofessional. Even though participants wrestled with feelings of grief, they hid them from others because showing emotion was considered a sign of weakness. In fact, many remarked that our interview was the first time they had been asked these questions or spoken about these emotions at all.

The impact of all this unacknowledged grief was exactly what we don’t want our doctors to experience: inattentiveness, impatience, irritability, emotional exhaustion and burnout.

Even more distressing, half our participants reported that their discomfort with their grief over patient loss could affect their treatment decisions with subsequent patients — leading them, for instance, to provide more aggressive chemotherapy, to put a patient in a clinical trial, or to recommend further surgery when palliative care might be a better option. One oncologist in our study remarked: “I see an inability sometimes to stop treatment when treatment should be stopped. When treatment’s futile, when it’s clearly futile.”

I wondered if one or two (or a few) psychotherapy sessions might help doctors who deal with death or other difficult patient issues? Might brief psychotherapy give these doctors a chance to express and explore difficult emotions in way that might make them more comfortable with their feelings --even social or culturally unacceptable feelings-- and be more aware of how these feelings are impacting their work? It's just a moment of wonder. I don't want this to be read as a wish to medicalize normal emotions or to suggest that all oncologists need long-term psychotherapy, or that such a thing even be required, it's just a question of 'what if' such a venue were easily available in a non-stigmatizing environment? What do you think? Maybe it's just the sort of thing one should feel comfortable talking with colleagues, or a nice spouse, about, though I think the point of the article was that it isn't okay to talk about these things without being seen as weak or troubled.

A Pill for Alcoholism?

2012-05-23T20:50:00.001-04:00

When I was at APA earlier this month, I heard an excellent talk by Dr. Bankole Johnson on the treatment of alcoholism. I'm currently reading a book called Hooked, by Lonny Shavelson, about an effort by the San Francisco Department of Health to provide drug-treatment-on-demand to all comers in 1998. The book, a great read even if it is a bit out-of-date, talks about how drug treatment gets divided into camps of those who insist on total abstinence versus those who will settle for a decrease in use as part of the "harm reduction" model. Dr. Bankole made the point that if you look at total abstinence for alcohol, the numbers are low and one could get very discouraged trying to treat alcoholics. And he is all in favor of trying medications to reduce craving for alcohol. Which brings me to an article in the NYTimes by Douglas Quenqua called "Drugs Help Tailor Alcoholism Treatment." So Dr. Johnson is quoted in this article, and since I enjoyed his talk, I'll mention the article. It talks about medications that help some people with their cravings-- both on label and off label-- and the question of using a pill to treat an addiction.

Books and Ducks

2012-05-22T22:23:00.000-04:00

Life is quiet here as we get ready for summer. Nothing has struck me as particularly urgent to blog about, but Sarebear sent us a link to a mystery writer's blog with a post about shrinks in mystery novels, so I thought I'd share that: http://www.mysteryreaders.org/Issues/Shrinks.html#white

We haven't been able to find time to podcast, it seems we're never around all at the same time. Clink is off touring nature sites and playing with her new camera. Maybe she'll post a pic? Roy is busy with all thinks geeky, and I'm happy that I finished a grant application today-- my first ever. I've been fiddling some with my old fiction, and I'm thinking of putting one of my old novels up as an e-book on the free amazon kindle site. Has anyone done this? Do you have any wisdom to share with me? Oh, and speaking of e-books, I just got a copy of Lowell Handler's new e-book, Crazy and Proud. Do check out his website. I haven't read the book yet, but the photography is compelling.

So I thought I would check out Facebook advertising. My cousin used it to get thousands of fans for her website, Motherrr.com, about mother-daughter relationships, so I wanted to see how it worked. I ran the ad for 2 days with our book cover as the graphic and only got one click-through. I changed the graphic to a duck, and there were 6 clicks in following 24 hours. I feel like I'm turning into Roy with all this number tracking. It's just an experiment to see how it works (another Roy-type thing to do).

Finally, the graphic above was sent to me from a blogger at a site called Grass Fed Ducks, which I think is mostly about food (specifically Korean Food), but there is a duck/mental health tinge as well.

Shrink Rap Ads for NAMIWalks Donations

2012-05-18T09:57:00.002-04:00

Click image to Donate.

Shrink Rap is walking for NAMI's Donation Walk tomorrow, Saturday May 19, at Baltimore's Inner Harbor (Rash Field), at 11am. Looks like medical blogger, Dr Val Jones, will also be joining us. Roy and Dinah will be there (I think Dinah; she said she might). Clink will not be able to join us.

But, as you can see on the left, we have only hit 21% of our goal. Sure, it's $300 more than last year and I probably over-reached, but I'm not giving up yet.

Here's the deal. If anyone donates at least $200, we will donate one week of advertising on Shrink Rap, right in the header where the lime green ribbon is now. That's about 8000-10,000 pageviews and potentially 300+ click-throughs. (No pharma, no distasteful ads. Sorry if this seems cheesy but it's for a good cause.)

And, if you are in town, feel free to join us Saturday morning. Registration begins at 10am. Thank you.

(Also, thank you to our recent contributors: Lawrence, Dave, Julie, Dinah, Elise, Carol, Elizabeth, Amy, John, Colleen, Michael, Valeria, and several Anon's.)

Conversations About Bipolar Disorder

2012-05-17T17:13:00.001-04:00

Sara is a blog reader who wants to write about bipolar disorder. She's interested in talking to people who have the condition, and she's started a blog called "Conversations about our Condition."
If you wouldn't mind talking to her, do visit her site!

Fatter and Fatter

2012-05-16T17:39:00.002-04:00

I have some questions about America's obesity epidemic.

The New York Times has an article about a mathematician who has been looking for the causes of obesity-- In a A Mathematical Challenge to Obesity, an interview with Carson Chow, Claudia Dreifus notes that the average person weighs 20 pounds more now than in the 1970's. I was alive then and it was the hey-day of processed food back when skinny people fed their skinny kids white bread with butter and sugar. Mayonnaise (or rather Miracle Whip, what ever substance that might have been) was on everything, and oh for twinkies, ring dings, chef Boy-r-Dee, and scooter pies....those were the days.

The mathematician proclaimed that the answer is that there is more food. More is grown, more is available, it's cheaper and cheap food allows for the existence of fast food, something you can't have if the food costs a lot. What I've noticed is that food is everywhere. All the push to make school food healthier, get rid of soda machines, and encourage children to be more active (ah, the kids I know, even the heavy ones, are doing 3 hours a day of sports after school, it's no guarantee you'll be slender), but it seems that every day is a "special" day....a fund raising bake sale, someone's birthday, end of year party, weekly advisory where the kids rotate bringing baked goods, language class meal, trip to restaurant, snack parent at every sports game, followed by dinner, and when you go out, the servings are huge, and I, for one, find it hard to stop eating really good tasting food if I'm hungry and it's on my plate. So I'll believe that food availability is the reason why people are fatter.

So here's my question. Obesity researchers study obese people and how they differ from normal weight people. Why isn't everyone obese? Why are only 1/3 of Americans obese and only 1/3 are overweight? Why aren't they studying the people who remain thin despite the fact that they are surrounded by food? Okay, so some people have very fast metabolisms, but others are don't seem to have any desire to overeat. There may be lots of available food, but they don't want it, or they want it when they're hungry, but they have some and that's enough, a 'stop eating' mechanism kicks in at a point that keeps their weight low. Why don't they have the desire to eat more when food is available? And finally, there are those people who want more food, but for the sake of their health or their appearance, they limit their eating. I've heard it said, "Well, if she really wanted to be thin, she'd eat less." I don't buy it, I think there are differences between people besides a simple desire, or a weakness of character that makes self-control harder for some then for others. I want to know why some people have faster metabolisms, less desire to eat, or more will power. Okay, Dr. Carson, how does your mathematical model work for that one?

I'm not an alcoholic. It's not because alcohol isn't available-- at any given time my house is stocked with an assortment of beers (I keep dark on hand because Roy likes it) and wines. It's available, but most days, it's just not on my radar. It's not because I have great willpower. I like a drink or two, but after that I get very tired, and it's not fun to be out with people just wishing I could lie down. I'm not an alcoholic because I'm not wired to want to drink very often or very much. I tend to think it's the same with obesity: some people crave food, or the wrong food, or way too much food, and others don't. Availability may make it easier, but there are still thin people, and isn't it interesting that in more affluent socioeconomic circles, where food has always been readily available, obesity rates are lower.

As a society, we've made the statement that if you're fat, it's your fault. The obese are the last group of people that it's okay to pass judgement on. "Exercise more, Eat less." It's a simple recipe. Dr. Chow tells us there's no magic bullet. It's stigmatizing to take weight loss pills or have bariatric surgery. I've heard morbidly obese people say it's their own fault, as though they don't deserve to be thin, and they loathe themselves for eating too much. I sometimes wonder if our prejudices about obesity hinder pharmaceutical research because-- if anyone wants my vote-- there should be a magic bullet.

Crossing Over: Treatment Rights of Transgendered Prisoners

2012-05-15T21:36:00.002-04:00

Over on Clinical Psychiatry News I've put up a column on the evolving treatment rights for prisoners with gender identity disorder.

In the CPN post I cover about thirty years worth of changes in prison policies and standards, up to where we are today: individual inmates suing prisons to provide sex reassignment surgery. So far no inmate has ever been given surgery, but at this point it's just a matter of time.

I think the topic is interesting in part because it traces out how correctional standards of care develop: first the courts decide if a condition "counts" as a serious medical or mental health disorder that mandates treatment, then over time an accumulation of individual cases carve out the boundaries and limitations of that care.

So why aren't doctors the people deciding this instead of judges?

Well, they are to an extent. The institutional clinician assesses the condition and makes a determination of treatment needs. Outside clinicians acting as court consultants or correctional experts offer opinions about what the standard of care should be, and professional organizations also weigh in. Courts take in all of this information, weigh it against the interests of the facility, and issues an opinion about whether or not there is a constitutional right to treatment.

This is the same process that took place in the 90's when protease inhibitors were invented to treat HIV. Correctional facilities initially balked at giving the meds because of the cost, but now this is standard and accepted.

Feel free to post questions or comments in either place (CPN or Shrink Rap).

Kiddies!!!

2012-05-13T22:19:00.002-04:00

Happy Mother's Day, everyone. I've had an exhausting day. I asked to go hiking and spent three hours on a mountain. Oh...I'm tired.

Okay, you know that none of us are child psychiatrists, but a number of kiddy issues have hit my radar, so just a very quick recap:

Over on Clinical Psychiatry News, I did a book review of Kaitlin Bell Barnett's new book Dosed: the Medication Generation Grows Up. If you care about kids and meds, this is an excellent read, no sensational tone and she does a good job of giving a balanced presentation of the issues.

We got an email from Stuart Kaplan, a child psychiatrist at Penn State, who's written a book called Your Child Does Not Have Bipolar Disorder. I don't know Dr. Kaplan and I haven't read his book, but I wondered how he knows my child doesn't have bipolar disorder! Check out his blog (linked to the book title) and let us know what you think. I imagine that at least a few of the kids who are diagnosed with bipolar disorder might actually turn out to have it, but our readers know that I feel we need to re-think the bipolar diagnosis, especially with regard to the recommendation for lifelong treatment for those spectrum-y people. I'm thinking that Dr. Kaplan and I may be on the same page.

The New York Times has a ClinkShrink type article on Can You Call A 9 Year Old a Psychopath by Jennifer Kahn. It's an interesting article, mostly because it doesn't have any real conclusions. She talks about children who lack empathy and are behavioral nightmares, and notes that half of these disaster children grow up to normal (meaning not psychopathic) adults-- including the father of the child who was featured. She reports on an intensive program to treat these children in an 8 week-long summer camp to teach empathy and modify behavior. There's nothing about the article that indicates that the treatment is effective, though, granted it's all a research protocol and the stakes here are high. The question is raised about labeling children as 'psychopaths,' a typically stigmatizing, untreatable, and damning diagnosis, and the case is made that the diagnosis would be useful if it led to interventions that prevented these children from becoming adult psychopaths (and perhaps criminals). Personally, until there's a way to know who won't outgrow the problem, and an effective and accessible treatment to be offered, I'm voting "no" on labeling children as psychopaths. I haven't been terribly impressed by the idea that childhood extrapolates to adulthood. Won't every misbehaving teenager in foster care be given this label when there is no one around to recall that an angry/irritable/misbehaving teen was not lacking in empathy as a younger child?

Scenes from APA's Annual Meeting

2012-05-09T09:22:00.001-04:00

I always find APA a bit overwhelming. There's so much going on at once, so many people to catch up with. Invariably all the stuff I want to go happens at the same time and invariably it's the same stuff everyone else wants to go to so I end up sitting on the floor in the backs of rooms-- I can't find who or what I'm looking for, and I stay out late every night and eat and drink more than I normally do. I always find it fun to give a presentation or two, but even if I'm only talking for a few minutes, there's something very draining about public speaking. Monday morning I ended up in the hotel gym and by late afternoon, I thought maybe I'd go home at lunch on Tuesday.

Fortunately, I did remember that I was presenting on a panel on Tuesday afternoon, so I didn't leave until after our workshop! We did a four-hour seminar on Sunday morning (Thank You to those who came out at 8 AM to hear us!), went straight to a book signing, and then Tuesday we did a new media workshop with Steve from Thought Broadcast and Dr. Bob. It was a lot of fun and it was great to meet some or our blog commenters, including William, Synergysta, and Tigermom! My one regret was that I didn't go to see Dianne Wiest, the actress who plays the psychiatrist on In Treatment.

The protesters were their own story. On Saturday, there were people with signs that said things like "Human Emotions aren't Diseases." I tweeted out: "Is it a problem that I agree with most of the protesters?" From what I could tell, they were calm and pleasant. On Sunday, the crew was more aggressive. They were chanting, "Stop Drugging and Shocking Our Children." As we walked through this line of chanting protesters, thrusting pamphlets at us, one man followed us screaming. My friend said she felt like she was walking into an abortion clinic. On Monday I didn't see any protesters, but there was a giant jumbo-tron set up blaring out information about the DSM, interviews with people saying it wasn't scientific. I only watched for a few moments, but I just thought, "yup." The sign about the Psychiatry drugging our troops caught my attention because we hear so much in psychiatry about how their aren't enough psychiatrists to treat the troops and especially the returning vets. While the suicide rates and use of psychotropics have both risen, their is nothing about the sign that indicates that the soldiers taking the medicines are the ones committing suicide, and I wondered how the troops feel about protesters picketing on their behalf.

Some pics: The protesters of course. One of Clink's slides as she explains "What is Twitter," the Hopkins Press sign from our booksigning (The duck is bigger than ever!), Dr. Steven Hyman, former director of NIMH, giving a very thoughtful talk on the pros and cons of the DSM and his thoughts about the DSM-V.

Blame the DSM?

2012-05-02T21:02:00.000-04:00

In the Washington Post, April 27, 2012, "Psychiatry's Bible, the DSM, is doing more Harm than Good," Paula J. Caplan writes:

About a year ago, a young mother called me, extremely distressed. She had become seriously sleep-deprived while working full-time and caring for her dying grandmother every night. When a crisis at her son’s day-care center forced her to scramble to find a new child-care arrangement, her heart started racing, prompting her to go to the emergency room.

After a quick assessment, the intake doctor declared that she had bipolar disorder, committed her to a psychiatric ward and started her on dangerous psychiatric medication. From my conversations with this woman, I’d say she was responding to severe exhaustion and alarm, not suffering from mental illness.

Caplan goes on to express her concerns with psychiatric diagnoses, the DSM, the problems with these labels that lead to the use of dangerous medications. Oh, we've been here on Shrink Rap before, see "Diagnostic Labels That Change Lives".

Caplan continues

In our increasingly psychiatrized world, the first course is often to classify anything but routine happiness as a mental disorder, assume it is based on a broken brain or a chemical imbalance, and prescribe drugs or hospitalization; even electroshock is still performed.

According to the psychiatrists’ bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM), which defines the criteria for doling out psychiatric labels, a patient can fall into a bipolar category after having just one “manic” episode lasting a week or less. Given what this patient was dealing with, it is not surprising that she was talking quickly, had racing thoughts, was easily distracted and was intensely focused on certain goals (i.e. caring for her family) — thus meeting the requisite four of the eight criteria for a bipolar diagnosis.
When a social worker in the psychiatric ward advised the patient to go on permanent disability, concluding that her bipolar disorder would make it too hard to work, the patient did as the expert suggested. She also took a neuroleptic drug, Seroquel, that the doctor said would fix her mental illness.

Caplan goes on to say that because of the existence of a psychiatric label-- one she contends is wrong-- the patient lost her friends, her marriage, her home, her self-confidence, her wealth, was forced to move across the country to somewhere she was isolated, and the six weeks she spent on medication (presumably Seroquel) left her with a condition that may someday leave her blind.

Mental health professionals should use, and patients should insist on, what does work: not snap-judgment diagnoses, but instead listening to patients respectfully to understand their suffering — and help them find more natural ways of healing. Exercise, good nutrition, meditation and human connection are often more effective — and less risky — than drugs or electroshock.

Caplan, a Harvard psychologist, goes on to discuss a complaint she is helping to file against the DSM editors on behalf of 10 patients who were misdiagnosed. "Psychiatric diagnoses," she concludes, "are not scientific and they put people at risk."
-------------

Where do I even begin? Please, please, I don't know the patient, I only know the presentation given, and I'm going to be very sarcastic, because the way it was presented struck me a ridiculous and it distracted from some valid points that might have been made if there wasn't the Evil, Idiot Psychiatrist Theme with a sensationalist tone. Shame on the Washington Post for printing this.

Okay, so I couldn't quite follow the case she presented, at first it sounds like the patient went to the ER with symptoms of a cardiac problem, or exhaustion, or a maybe a panic attack. Perhaps, but some imbecile ER doc did a check list of symptoms, told her she had Bipolar disorder, and without even listening to her, weighing other options, or taking into consideration the context of her life, sent her off with Seroquel and a recommendation for therapy. This misdiagnosis then destroyed her life, because why would her husband and friends stick with her if she's got bipolar disorder? What better time to leave your wife then when her grandmother is dying, she's stressed out and sick? So she went to the ER because she was tired and her heart was racing. I think they see this all the time...I think they do an EKG and perhaps make sure the patient isn't having a heart attack or arrhythmia, and if they think it's anxiety, the patient gets a dose of a benzodiazepine, and gets sent home. Okay, but it's an ER and the docs are rushed and focused on what the patient needs now. They make wrong diagnoses all the time, and it's not just psychiatry, and it's not just because the doctor is sitting there with the DSM or has memorized the hundreds of possible diagnostic criteria.

Okay, but it turns out that she was on a psychiatric ward. You can't get admitted to a psychiatric ward because you're tired, with racing thoughts, a fast heartbeat, talking fast and being distracted. Pretty much, you need to be a danger--, suicidal, or having severe hallucinations or delusions, or be in extreme distress in some way. This was a wealthy patient who could afford outpatient care. All I'm sure of, is there is something more to the story.

Finally, the patient was admitted to a psychiatry unit, so presumably there was a second doctor who met with the patient and a treatment team that observed her behavior for a few days. Okay, I've stories of really lousy inpatient care, and I do believe the diagnosis could still be wrong and the treatment that was recommended might be wrong, or helpful at the moment but not necessary for the long-term, but I don't buy that a misdiagnosis let to the complete demise of this patient's life and a need to move across the country. These are the types of problems one sees as a result of the behaviors a person might have because they have a mental illness, perhaps one such as bipolar disorder.

So I don't know the patient, or the diagnosis. But I do know that the entire premise for this article is based on the idea that the patient was simply tired and stressed and perfectly normal and did not have a psychiatric disorder (the author tells us this) and this label alone destroyed her life. The reader is not allowed to even entertain the idea that the patient had a psychiatric disorder-- that maybe the psychiatrist did get some history and make reasonable observations, and the patient really did have bipolar disorder? (Obviously, I don't know this). There's no mention of a review of the records, discussion with family, interview of the doctor, Caplan is telling us her impression based on the patient's report only.   Maybe the patient had panic disorder, or a personality disorder, or even an adjustment disorder (perfectly possible given the stresses involved). Oh, but then she took a bum recommendation to go on disability, and she got it! I've seen really sick people not get disability. It takes a lot of documentation and the government looks for ways to avoid paying this-- you don't get disability for having a psychiatric diagnosis, you have to be disabled by it. So, somehow, this patient who was simply exhausted and stressed, with No Psychiatric Disorder, per Dr. Caplan, managed to get admitted to a hospital and get disability benefits.

There were some valid points Caplan could have made. The DSM is not a 'scientific manual.' Personally, I don't find it terribly helpful in clinical practice. I don't keep a copy in my office (I bought one to use while writing Shrink Rap), and I'm not planning to buy the DSM-V. The overall concept is good, and it's very helpful to researchers to be certain that the groups they study have some diagnostic reliability, otherwise there is no way if knowing if a certain treatment addresses a specific group of people who can reliably be classified as having a specific illness. This isn't all bad, but I don't need 370-400 diagnosis for my work (predicted in the new DSM-V). And Caplan makes the statement that the editor, Allen Frances, says the work is based in science but has spread it's net too far. If you read Dr. Frances' blog, you'll note that he is quite skeptical and opposed to many of the proposed changes for DSM-V.   It's not like the psychiatrists aren't thinking hard about these diagnostic categories and the ramifications they have. Still, I'm skeptical about how we think about these disorders, especially Bipolar Disorder.

I agree with Caplan that psychiatrists should listen more. Fifteen-minute med checks have made a mockery of our profession. I also tell all of my patients to exercise, eat healthy, and look for ways to solve their problems. But to imply that these things are the answers for the majority of people who are suffering (and often too distressed, depressed, and unmotivated, to just pull up their bootstraps, get up and exercise and cook a healthy meal )-- is an insult. You know, sometimes those things really do work, but if people are able to do those things, they've often tried them before seeking psychiatric opinions. To read Caplan's piece, you'd think everyone is an idiot. And finally, ECT: it still in use because some people find it helps.

Okay, I am ranted out.

APA 2012 Shrink Rap Feedback

2012-05-01T22:05:00.000-04:00

I'm setting this space up a few days in advance as I finish up my slides for our APA presentations.

If you come to hear any of speak, please visit here and let us know what you liked and what you didn't.

For a list of when and where we will be talking, please go HERE.

Please note that not all of the sessions involve all of the Shrink Rappers.

Please let us know which session you attended, and feel free to tell us if there are topics you'd like to hear us speak on next year.

Slides from our seminar are here: http://mythreeshrinks.com/apa12

Come Meet The Shrink Rappers in Philadelphia

2012-04-30T23:55:00.000-04:00

We will all be at APA in Philadelphia next weekend and we'd love to meet you. Click HERE for a complete list of our presentations.

First, the age-old Philadelphia question: Jim's or Pat's for the best cheesesteak?

Where we will be:

Sunday, 8 AM- 12 Noon (no, we didn't choose this time), we are giving a seminar on Blogging, Podcasting, and Writing Books for the Public. We actually know something about these topics. I believe the seminars are listed with the courses on the main schedule, and ours will be held at the Marriott.

Sunday, 12:15-1 Find us in the Exhibition Hall at the Johns Hopkins University Press booth, we'll be signing copies of Shrink Rap.

Tuesday, 1:30-3 We will be doing a workshop on Psychiatrists and New Media: Gaining Control of our Specialty's Image. Steve from the Thought Broadcast blog and Dr. Bob Hsuing ("Dr. Bob") will be with us for a panel discussion.

I will be putting up a spot on the blog for participants to give us some feedback on the sessions.

19 days left...

2012-04-30T00:00:00.000-04:00

CLICK to go to Tribute page thanking donors... and Roy is winning... you know you want to give in Dinah's name.

Psychotherapy as a Model for Positive Relationships

2012-04-29T10:59:00.001-04:00

One of our regular readers wrote in a comment that she's read how the psychotherapeutic relationship is supposed to model a healthy relationship for the patient. I hope I got this right, I can't seem to find the comment.

So I think I missed that lecture in residency. It seems to me that while psychotherapy is about having an honest, trusting relationship (and that is usually a good thing), it is very different from the relationships we have in our real lives.

Psychotherapy is about the patient's life. In some ways, it's a rather narcissistic endeavor (and I don't mean that in a pejorative way, but it just is). Mostly it goes one way, and aside from the patient asking "How are you?" and perhaps a polite exchange about the therapist's life if the relationship lends itself to that, the session focuses on the problems and concerns of one person, without the expectation that the patient listen patiently or provide support, kindness, insights, or interpretation to the other party.

Healthy real-life relationships are two-way streets. And real life people have issues, demands, and problems. The psychotherapist is a little bit actor, who doesn't generally volunteer his own distress, and who may certainly have his own very screwed up life!

Oh, but you want to say that the therapist, by listening attentively and being supportive is modeling good listening skills, empathy, and kindness. Ideally, that's true. But the therapist is modifying his reactions based on the fact that he's learned a particular style of listening, understands that being non-judgmental is part of the deal, and responds in a way that is therapeutic for the patient. So he doesn't argue about politics, doesn't get indignant if the patient makes a degrading remark about something the therapist values, and when he confronts the patient with behaviors or thought patterns that need to be changed, he does it from a place that is gentle, respectful, and he backs down if the patient gets upset and can't hear it. In other words, the therapist sometimes quashes his own emotions and reactions for the sake of the patient. Real life people in two-way relationships just aren't wired to be 'all about you' all of the time. While a friend may see that you are upset and let you go off ranting (and thank you to my friends who do this for me) and listen nicely and therapeutically for a bit, this is too much to ask from anyone all of the time in a long-term relationship. People disagree, they argue, they have their own opinions, and they show it when they get offended or angry. One should not expect the people in their lives to react as their therapists do, in measure ways. Nor should they hold themselves to that standard when engaged in a relationship with others. It's nice if you can do it for a little while for a friend/spouse/relative in distress who needs a comforting ear. But don't go home and try to be your shrink. It's hard and you won't have any friends.

Ideally, a psychotherapist is very responsive and reliable. There are exceptions (oh for the shrink with ADD, or who runs overtime with an emergency, or who is just a bit disorganized), but generally, the doctor shows up. Probably a good thing to expect in one's important relationships, but it doesn't always work out that way, and there is some motivation for the shrink in that this is "Work" (and many people who are irresponsible in their private lives do prioritize "work") and the shrink gets paid.

On the positive side, in real life intimate relationships, you get to be together for more than an hour, it doesn't cost you big bucks to talk, there's some possibility that you aren't being pushed to talk about things you'd rather not, a hug or a kiss or a reciprocal statement of love can be very wonderful things, as can a card or a gift (chocolate is often good) or an offer to go out for coffee or a drink or a walk, when you're feeling distressed.

Therapists generally don't throw plates against the wall when they get upset with a patient, so if you need that type of adaptive behavior and restraint to be modeled for you, then I agree, the therapeutic relationship does show some healthier ways of responding.

Tell me what you think? What have your patients said they've learned from you, and what have you learned from your therapist?

Raising Poochie Right

2012-04-26T22:52:00.001-04:00

Okay, psychiatrists know about mental illness, but we are called on to comment all different types of issues regarding relationships, development, what transactions are likely to lead to mental health or mental distress. I'm expanding our area of so-called expertise even further, and feel inspired to comment on an article in today's New York Times, "Should Your Dog Be Watching TV?"

Regarding new TV programming made especially for dogs, Douglas Quenqua writes:

If your dog does show interest, it probably can learn from what it sees on a television, Ms. Anderson said. Exposing a pet to muted versions of everyday irritants like vacuum cleaners and doorbells, for example, is a time-tested method for reducing the animal’s fear of them. But an important aspect of the technique is amping up the volume as the dog grows comfortable — so, depending on how quickly a dog learns, the owner may want to hover nearby to turn up the DogTV volume.

But — of course — dog owners shouldn’t mistake TV time for quality time, animal behaviorists cautioned. “It definitely isn’t a substitute for play time with your dog,” Ms. Anderson said. “Exercise can solve a lot of behavioral problems.

Oh my, programming includes grassy fields, bouncy balls, quiet vacuum cleaners, scenes to comfort, entertain and teach dogs, and to address anxiety, agitation, and decrease separation anxiety. It just makes me think that raising children is hard enough and you have to worry about what you expose your children to, how much time they spend in front of screens, whether you're using your TV as a babysitter, how you're going to schedule piano lessons so they don't conflict with tennis team, homework, and religious school. The nice thing about having a dog is that it just gets to be a dog. You walk the dog, pet the dog, feed the dog, be with the dog. Until now, you didn't have to worry about all the influences on the dog: how much TV is the right amount of TV? Is it okay to go for a walk in the woods or will Rover miss an important learning segment on TV? What if the dog finds some segments soothing (is he just transfixed? Is this healthy?) but finds other segments over-stimulating? Look, yet more things to worry about, as if life wasn't complicated enough.

I may have to trade in the dog for a gerbil and hope they don't invent Rodent TV.

Shrink Rappers Set Bar High for NAMI Walks

2012-04-25T01:00:00.002-04:00

4/24: $250 ~ 4/25: $295 ~ 4/28: $330

Click on image to donate!
See which Shrink Rapper has attracted the most donations.
4/28 (7%): thank you, Carol!
4/25 (6%): thank you Christina, Jesse, Abhishek!

The National Alliance on Mental Illness is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. They provide education and training programs for consumers, family members, providers, and the general public. Their Family-to-family and Peer-to-peer programs have won awards for providing education, insight, and support to people and families affected by mental health problems. They have hundreds of state and local affiliate organizations to provide grassroots support to communities.

NAMIWalks, NAMI's annual fundraiser, raised charitable contributions to support their work. The Shrink Rappers are working to raise money for the NAMIWalks fundraiser on May 19 at the Baltimore Inner Harbor. All of the money goes to support the Anne Arundel County NAMI affiliate. We did this last year 3 days before the event and managed to still raise $750. We're shooting for $5000 this year.

Anne Arundel county has a population of 588,000 people. Anne Arundel county has 14 psychiatric beds to treat the portion of that 588,000 who require intensive inpatient psychiatric treatment. That comes to 2.4 inpatient beds per 100,000 people. The average number of psychiatric beds in the U.S. is 36 per 100,000 (most recently available data; see other psych beds posts for details). The average number of psychiatric beds in Africa is 3.4 beds per 100,000 population. Anne Arundel county has fewer inpatient resources per capita than Africa. They need our help.

So... I'm asking our dear readers to help out and pitch in. In the last month, we've had 22,000 unique visitors. If only one-fourth of you Shrink Rap visitors gave $1 to our fund-raising campaign, we'd have $5000 for the Anne Arundel county NAMI chapter, which they can put to good use. Please consider clicking the picture above to donate to this cause. Give $1, $10, $25, $50, or even $100... whatever you can. And it's all tax-deductible. (4/25: Sarebear said it won't take less than $10.)

To really sweeten the deal, we will give an autographed copy of our book to any person or organization that donates $250 or more. (Yeah, I know, big deal. Still, it's a token of our appreciation.)

And, if we manage to get any SUPER donations of $1000 or more (!!), we will place an image of your choice (tasteful only) for one month in a prominent place on our blog to celebrate your generous donation (or to advertise your organization), including a link back to your website, as well as four signed copies of our book. Note that we get about 40,000 page views and over 20,000 unique visitors per month -- that's ~2.5 cents per impression! (If we get more than one of these donations, we'll give each one it's own month, in order of receipt of donation, starting with June.)

"Roy, you've talked me into it. Enough already; where do I click!?"

Click right HERE to take you to our team donation page. Or click on the image at the top of the post. I will change this image daily to update the progress you are making. You will be able to choose which Shrink Rapper you want to honor with your donation (a little friendly shrink competition).

I'll throw in one more thing. Whomever donates the most will get to also have a Guest Post on Shrink Rap, and we'll bring you on as a guest on our podcast, My Three Shrinks. (Can you tell I listen to a lot of public radio?)

Thank you for considering this worthy cause.
~Roy out.

PS: You can also JOIN our Shrink Rappers Team and raise funds yourself. We have room for 27 more "walkers", and you can either walk in person on May 19, or just in spirit (you don't have to be present to raise money, but I must tell you that Clink will be out of town, and Dinah is at best a maybe).

Endless Therapy...and some other stuff, too.

2012-04-23T14:50:00.001-04:00

Yesterday's New York Times appears to be dedicated to psychiatric bloggers. I got a head start with the article on SSRI's, but it's going to take me a while to catch up. Jesse-- can't I get you to post about Richard Friedman's article, "Why Are We Drugging Our Soldiers?" You're my military buddy!

So I'll start with "In Therapy Forever? Enough Already." Oh my. By Psychotherapist Jonathan Alpert who authored Be Fearless; Change Your Life in 28 Days. Excuse me, Mr. Alpert, but when is your next opening? I got me some issues that could use a quick fix.

Alpert writes:

Talk to friends, keep your ears open at a cafe, or read discussion boards online about length of time in therapy. I bet you’ll find many people who have remained in therapy long beyond the time they thought it would take to solve their problems. According to a 2010 study published in the American Journal of Psychiatry, 42 percent of people in psychotherapy use 3 to 10 visits for treatment, while 1 in 9 have more than 20 sessions.

For this 11 percent, therapy can become a dead-end relationship. Research shows that, in many cases, the longer therapy lasts the less likely it is to be effective. Still, therapists are often reluctant to admit defeat.

He goes on to say:

Therapy can — and should — focus on goals and outcomes, and people should be able to graduate from it. In my practice, the people who spent years in therapy before coming to me were able to face their fears, calm their anxieties and reach life goals quickly — often within weeks.

Why? I believe it’s a matter of approach. Many patients need an aggressive therapist who prods them to face what they find uncomfortable: change. They need a therapist’s opinion, advice and structured action plans.

Okay, so I'm all in favor of goals and structure and action plans. But a lot of people come for longer than 10 visits, they aren't all "failures" or stuck in a bad place (some, granted, are), and putting into words what happens in therapy and why it is helpful is really, really hard. The psychoanalysts invented their own language for what happens in therapy, and it's not one I was ever able to master.

Okay, so why would therapy take more then 10 appointments, in bullet points:

Most people don't come to see me to fix a discrete problem. They usually come because they are uncomfortable with their feelings or behavior patterns --and screaming really loudly "STOP DRINKING" does not seem to work for me, maybe Jonathan Alpert has a better style. These problems, like depression or anxiety or irritability or mood lability or panic attacks or being really stressed out, come and go. The problems don't get 'fixed' with an action plan. They sometimes get fixed with medicines and therapy often provides some tools for better coping.
Therapy offers a place to talk about feelings and behaviors that people are not comfortable talking to their friends about. Sometimes the issues are on-going and a single "dump" isn't enough. In these cases, therapy offers comfort. Insurance companies don't want to hear that: we need measurable goals that can be achieved in 3 sessions. Comforting those who are suffering is not allowed. (Please forgive my sarcasm)
People usually can generate their own list of action plans and they come to treatment because fixing the problem is complicated and often they have stuff to work through before they can leave the lousy husband, or feel good enough about themselves to quit the job, or perhaps they shouldn't quit the lousy job because while they want to, it pays the bills and they can't find another job.
Psychiatric problems wax and wane and people need more support when their symptoms are more intense, and less when all is well. It's not uncommon for people to come in more often during difficult times and less often during the good times.
Some people have problems such that they drive people away and have trouble with intimacy. The therapeutic relationship may fill that void or be a place to examine those patterns. Sometimes people who don't have problems with intimacy still find the therapeutic relationship to be really useful.
For people with behavioral issues, therapy provides a degree of accountability that can be very helpful.

Some people come for a few sessions, they feel better, and that's great. Some people have an on-going mental disorder and regular therapy sessions provides a safety net: a means to monitor moods, anxiety, delusions, hallucinations, or the stresses in life, and to talk about relationships, all as part of an ongoing process of coping with a chronic disorder and keeping the symptoms in check or catching relapses early. Some people find it helpful to go to therapy and talk about the thoughts that go round in their heads, and that's about as scientific as I can get for them. And finally, some people find that the therapeutic relationship adds a level of comfort, introspection, meaning, and focus to their lives that helps them siphon their emotional energies into creative and productive outlets. (There, I made up my own language).

So if you're a chronic patient and it feels useful, don't worry about it. You may not even be a failure. If you're frustrated that therapy isn't helping you to fix what you wanted fixed, go see someone else for a consult and second opinion.

Lucy!

2012-04-22T10:42:00.001-04:00

Yesterday I was on a speaker on a panel at The Annapolis Book Festival. There were a few glitches--one of the panelists had a family emergency and couldn't make it (--oh, I still have to meet Pete Earley, I was looking very forward to this after all the wonderful things I've heard about him), and the A-V equipment didn't fly and part of my talk begins with a slide show set to music called The Public Face of Psychiatry, that I like to use as a set up for why psychiatry needs blogs and books and an image re-do. It all went fine despite the missing panelist and AV issues--I showed the slideshow on my computer and it was worked fine.

The most notable part of the event, however, was that my Co-panelist, Joani Gammill, author of The Interventionist, came with her emotional support chihuahua, Lucy. What a sweet little dog! She also came with her beautiful, charming, and very mature 13-year-old daughter, but the daughter remained in the audience, in charge of the never-used dog carrier. Lucy, however, was front and center on the panelist's table. And to think, I actually ironed my shirt that morning. If I knew there would be a dog to focus all the attention, I would gone wrinkled.

Joani and Lucy spoke first while four men worked on the projector on my behalf. After I spoke, I asked for questions. The first question, influenced I'm sure by Lucy-- was from someone who wanted to know how I used animals in my practice of psychiatry. Oh my. I really can't compete with a chihuahua. I thought of my dogs, Kobe, the incredibly high strung Pomeranian who appeared in my back yard two-and-half years ago, and Max, the wonderful mutt-from-the-pound who hated closed spaces and died of cancer last year. I told what few pet stories I had: I'd brought Max to my office once on a weekend. He panicked in the elevator (we left by the stairs). He couldn't even sleep in a bedroom with us, he scratched at closed doors. No therapy for Max. And Kobe doesn't sit still and would be an amazing distraction. Kobe, sad to say, is all about Kobe. And once upon a time I was medical director of a clinic. One day I looked outside my first floor office window and there was a man on the sidewalk outside the clinic with a 10-foot-long albino python wrapped around his neck. He wasn't a patient, and I asked him A) what does it eat and B) to leave. Snakes and community psychiatry clinics don't mix. A patient once brought a dog to a session with another psychiatrist in her handbag (I don't recall this being a problem). And another patient brought his pet ferret in. I asked him not to because there were children in the waiting room petting the ferret and I didn't think it was fair for some poor mom to have to explain to the pediatrician that her kid got bitten by a ferret while she was waiting to see her psychiatrist. The member of the audience suggested I get a fish tank-- not a bad idea, my dentist has an amazing one--but I struggle to keep the plants alive, arrange separate coverage for them while I'm away, and....well, I'll think about the fish idea.

Okay, so Joani has been to rehab compliments of Dr. Phil, and has continued to work with him in her own role as an interventionist. You can see why she'd be good, and I put a Dr. Phil clip with her up above. The Shrink Rappers have an funny fondness for Dr. Phil after ClinkShrink and Roy tricked me into believing we were talking to him on the phone during a podcast. And while, I'm plugging other people, I hope all is well with our missing panelist, Pete Earley, and do check out his wonderful book Crazy: A Father's Search Through America's Mental Health Madness.

It was a very fun morning. They gave me a nice gift bag for speaking and told me to take two for my co-authors, so Clink and Roy, I have gifts for you (note to Clink, includes T-shirt and coffee...) We even sold a few books and I got to be on a panel with a chihuahua.

And if you've never listened to the Dr. Phil prank that my co-bloggers played on me, you can find it here. Hard to believe I'm advertising how gullible I am.

Do SSRI's Even Work? And if so, How?

2012-04-20T09:50:00.001-04:00

Just in case you feel like reading Sunday's New York Times Magazine before it come out, over on "Post-Prozac Nation: The Science and History of Depression," Siddhartha Mukherjee will be writing about the history and efficacy of antidepressants. Dr. Mukherjee writes:

Fast forward to 2012 and the same antidepressants that inspired such enthusiasm have become the new villains of modern psychopharmacology — overhyped, overprescribed chemicals, symptomatic of a pill-happy culture searching for quick fixes for complex mental problems. In “The Emperor’s New Drugs,” the psychologist Irving Kirsch asserted that antidepressants work no better than sugar pills and that the clinical effectiveness of the drugs is, largely, a myth. If the lodestone book of the 1990s was Peter Kramer’s near-ecstatic testimonial, “Listening to Prozac,” then the book of the 2000s is David Healy’s “Let Them Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and Depression.”

He talks about depressed people in the 1950's being cured as a side effect of their treatment for tuberculosis (isoniazid was one of the first medicines to elevate mood in the depressed) and hyptertensive patients becoming depressed on Raudixin.

Mukherjee goes on:

In 2011, Hen and his colleagues repeated these studies with depressed primates. In monkeys, chronic stress produces a syndrome with symptoms remarkably similar to some forms of human depression. Even more strikingly than mice, stressed monkeys lose interest in pleasure and become lethargic. When Hen measured neuron birth in the hippocampi in depressed monkeys, it was low. When he gave the monkeys antidepressants, the depressed symptoms abated and neuron birth resumed. Blocking the growth of nerve cells made Prozac ineffective.

Hen’s experiments have profound implications for psychiatry and psychology. Antidepressants like Prozac and Zoloft, Hen suggested, may transiently increase serotonin in the brain, but their effect is seen only when new neurons are born. Might depression be precipitated by the death of neurons in certain parts of the brain?

He finishes off with the ideas:

The differences in responses to these drugs could also be due to variations in biological pathways. In some people, neurotransmitters other than serotonin may be involved; in yet others, there may be alterations in the brain caused by biological factors that are not neurotransmitters; in yet others, there may be no identifiable chemical or biological factors at all. The depression associated with Parkinson’s disease, for instance, seems to have little to do with serotonin. Postpartum depression is such a distinct syndrome that it is hard to imagine that neurotransmitters or hippocampal neurogenesis play a primary role in it.

Nor does the theory explain why “talk therapies” work in some patients and not in others, and why the combination of talk and antidepressants seems to work consistently better than either alone. It is very unlikely that we can “talk” our brains into growing cells. But perhaps talking alters the way that nerve death is registered by the conscious parts of the brain. Or talking could release other chemicals, opening up parallel pathways of nerve-cell growth.

But the most profound implications have to do with how to understand the link between the growth of neurons, the changes in mood and the alteration of behavior. Perhaps antidepressants like Prozac and Paxil primarily alter behavioral circuits in the brain — particularly the circuits deep in the hippocampus where memories and learned behaviors are stored and organized — and consequently change mood.

Over on Clinical Psychiatry News....

2012-04-18T23:18:00.000-04:00

Check out our CPN site where Roy is talking about Stage 2 Meaningful Use, and I've put down my final words (I hope!) on strip searching psych patients. Do Check It Out if you'd like to see what we have to say, and to all those who helped me with this article, please accept my gratitude! Roy and I would both love your feedback.

Lately, I feel like a moving obsession...I was preoccupied with medical marijuana legislation for a bit, then with how body searches are conducted of our patients, at the moment I'm reading Kaitlin Bell Barnett's new book Dosed: The Medication Generation Grows Up....my review is forthcoming. What next?

EHRs & Privacy: Am I The Only One Who Cares About This Stuff?

2012-04-17T10:16:00.001-04:00

Electronic Health Records are a wonderful thing. They allow for the easy access of information from one doc to another. Now when the patient takes the white pill for that bump, I can go in to the records and see what the bump was and what the white pill is. Once in a great while, it has meaning for their psychiatric care, and it's good for general curiosity, too, and periodically, I may help with the education process if it seems important that the patient should have a greater understanding of their bumps. Roy likes EHRs and President Obama will pay you tens of thousands of dollars to implement one in just the right way (too many hoops for me). As a doctor, it's mostly nice. I still see a lot of people who get portions of their health care in another system and I can't access their labs-- labs I actually need to have to safely monitor how their bodies are tolerating their psych meds, but I'm doing my best. When I run labs on a patient who gets their primary care outside of our system, I hand them a copy to give to their doctor, hoping that I will spare them a needle stick and spare the 'system' (usually Uncle Sam) the cost of repeating the same blood work. Who knows if that ever happens.

I've mentioned before that my gripe with this system is that any healthcare professional in the system can access information. Now everyone I work with, and approximately 10% of my neighbors (wild guess here), and even some of my patients, have access to this system. The only thing that stops someone from looking up a friend's medical history is the knowledge that you will get in trouble-- and likely fired-- if you get caught. But you have to get caught, which means that someone has to look up who accessed the information and track down if it was a legitimate accessing of information. Now they do it, and people have been fired, and the prohibition is real, but we don't think that in a system of many thousands of people, there isn't a sociopath here or there?

Let me give you an theoretical example: what if a young nurse (he has access) starts dating a pretty young hospital worker (she does not have access to the records; also these people can be old and/or ugly if you'd like....just enjoying my fiction here). He's curious about her; in fact, he's prone to a bit of pathological jealousy. He decides to take his chances and look up her records and he notices that someone has run an HIV test on her (it was negative) and she's had a miscarriage a couple of years ago, one she never mentioned to him. Oh, and psych records aren't in the system (yet, coming soon) but her primary care doc mentioned that she's on Prozac for depression and Seroquel for sleep. Isn't Seroquel the big guns, maybe she's crazy. So if he tells her he looked at her records, and she wants to report him, he's toast. But maybe she doesn't want to get him fired, so she eats it. Also, once he's fired, he's just fired, not dead. He can then tell whoever he likes, I suppose, especially if he loses his license. And the saying goes that there are random "flags" that go up to catch wrong-doers, but this is a big system, so I am skeptical.

I've mentioned my concern about this to a few people, especially since the system is about to be overhauled. I've suggested that each patient have a card or an identifier that the provider should get from the patient to authorize access to the information. I've asked that this be brought up at planning meetings. I get looks like I'm from Mars. Obviously, all health care providers should have access to their patient's records, and in this system, there is no absolute guarantee that your neighbor won't be curious and you don't have the right to not tell the dermatologist that you had a vasectomy three years ago, or to keep your internist from making a note that your antibiotic was started in jail. Okay, I will say that all of the records I've read (it's been years, that's a lot) are very professional, but still, sometimes the facts are the facts and they aren't all that savory. I asked if the topic came up at the planning meeting and was told no one else was concerned. My boss has agreed with me that I watch too much 24.

So I went to schedule a routine screening exam the other day. I have no reason to be concerned about this, but I am generally uneasy about being in the massive data bank that is the system's records and I avoid it. I called for the appointment, and the office had been taken over by my hospital system, something new! I asked if my results would go into the main hospital computer. Of course they will! Thank you, I said, I will get my test elsewhere, and I hung up.

Why doesn't anyone else care about this stuff?

Come Meet Dinah!

2012-04-14T17:01:00.000-04:00

Dinah will be speaking with Pete Earley and Joani Gammill at

The Annapolis Book Festival on April 21st.

MATTERS OF THE MIND: MENTAL ILLNESS AND ADDICTION
10:30 a.m. Room 3 - Barn Commons

Mental illness and addiction take many forms. How do we cope as sufferers, as family members, as mental health professionals? Moderated by Joan Gillece, a diverse panel featuring Pete Earley, Joani Gammill and Dinah Miller looks at matters of the mind from their varied perspectives.

The Incarcerated Mentally Ill

2012-04-14T13:06:00.000-04:00

Ah, it's a ClinkShrink topic but she's off for the weekend answering a call to the opera, so I'm filling in and posting an article from The New York Times. Abby Goodnough writes in "Deal to Reduce Isolation of Mentally Ill Inmates,"

The settlement results from a lawsuit filed in 2007 by an advocacy group. It sought to stop Massachusetts from placing mentally ill inmates with disciplinary problems in small isolation cells for up to 23 hours a day, saying that doing so violated their constitutional rights against cruel and unusual punishment as well as the Americans with Disabilities Act.

Poll Results and the Limelight...

2012-04-13T15:51:00.000-04:00

Over on Clinical Psychiatry News, Roy is writing about using the color Lime for mental illness awareness...do check it out. Apparently it works for Lyme Disease, Lymphoma, and Muscular Dystrophy, too, but here in psych we like to be inclusive and co-morbidity is always an issue.

If you took my poll on patient searches or helped with comments I can use for quotes, thank you so much. The survey results are here, please remember these are not science, not even a little, and I left it to the reader to define "strip search" so it's really just a snapshot:

Were you Strip Searched upon admission?

Yes		27	42%
No.		38	58%

If you answered YES: Were you a voluntary patient at the time of admission?

Yes		20	31%
No		9	14%

If you answered YES: What type of hospital were you in?

Private Psychiatric Hospital	11	17%
A Psychiatric Unit of a Community Hospital	14	22%
A State Psychiatric Hospital	6	9%
A State Hospital specificially for Forensic/ court-ordered patients	0	0%

If you answered Yes, did you find the experience of being strip searched to be very distressing?

I hope no one is offended that I discussed two things in one post. I know people were offended in the past, but late on a Friday, you only get two posts when my salary for this goes up. If I'm not back, have a great weekend.

Tell Me Your Psych Unit Search Stories

2012-04-10T00:01:00.005-04:00

I'm planning to write an article on strip search policies at psychiatric hospitals and that's why I asked anyone who has been hospitalized in a psychiatric unit in the last three years to take my Strip Search Survey. Roy pointed out to me that I didn't define 'strip search' and that his hospital does not do this---they ask patients to change into a gown and search their clothes, but not their bodies. I did assume that people would define strip search as the visual inspection of the skin after the removal of all clothes, and that being told to change with some sort of privacy --in a bathroom, behind a curtain, while a nurse of the same gender holds up a gown or a sheet but isn't looking-- is not a strip search.

Will you help me with my article? Can you tell your stories in the comment section and let me quote you? I will not use 'names' but quote "one commenter said," and you are welcome to give your feedback as "Anonymous." I would like to know what state the hospital you're talking about is in, and if you are a patient, a psychiatrist, a nurse, a family member. I'm interested in stories of how being searched was handled well and how it was handled badly, stories by hospital personnel. I know some of you have told your stories here before, but I didn't ask for permission to quote, so feel free to repeat yourself here if you don't mind being quoted. Also, if you were strip searched, I'd like to know if it was because of a blanket policy at the hospital versus a specific concern the staff had about you and any danger you might pose to yourself or others.