Tag Archives: psychology & psychiatry

Jamais vu and the hippocampus as GPS

hippocampus-as-gps

I always thought the main function of the hippocampus was to convert short-term memory into long-term memory. It’s one of the first regions of the brain damaged by Alzheimer’s. If your spouse can’t remember something you discussed 20 minutes ago, you start to worry.

The hippocampus also plays an important role in spatial memory and navigation. That’s why you unfortunately hear of Alzheimer’s patients wandering away from home and not being able to find their way back.

A recent JAMA article, Nobel Prize Winners’ Research Relates to Brain Function and Neurodegenerative Diseases, describes the hippocamcus as our inner GPS. Place cells in the hippocampus (discovered in the 1970s) are associated with locations (even if you’re just thinking about a location), and grid cells (discovered in 2005) create triangular grids that function as a positioning system in space.

Together, place and grid cells allow animals to determine their position and to navigate through their surroundings much like an inner GPS.

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RN #3: Health news: Exercise and depression. Aspirin for primary prevention. New stool sample test.

exercise-or-drugs-for-depression

Reading Notes #3: Some articles of interest I’ve come across while reading NEJM and JAMA. These items all fall into the category of health news.

Bulleted titles in the following list link to the individual items below. Under References I indicate the accessibility of articles: OA means open access, $ indicates a pay wall.

HEALTH NEWS

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The Journal of Medicine and Philosophy — August 2014

sports-doping

The August issue of The Journal of Medicine and Philosophy does not have a specific theme. The nine articles address a number of quite interesting issues, among them:

  • How existential psychotherapy can offer powerful insights to patients recovering from severe mental disorders such as psychosis
  • How a preference in athletics for natural talent over artificial enhancements (such as doping) may reflect “unsavory beliefs about ‘nature’s aristocracy’ ”
  • How rich, educated, white males may be just as, if not more, vulnerable to threats posed by physician-assisted suicide and voluntary active euthanasia than members of marginalized groups
  • When the decision is made not to administer artificial hydration and nutrition, can the responsibility for the patient’s death be attributed to the underlying pathology, even when that is not the cause of death
  • The right to procreate: Is it possible for prospective mothers to wrong prospective fathers by bearing their child

Note that the articles in this journal are not open access and that I have added the emphasis in the following extracts and abstracts. Read more

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Journal of the History of Medicine and Allied Sciences – July 2014

adelle-davis-books

In the July issue of Journal of the History of Medicine and Allied Sciences:

  • A comparison of 19th century public health measures and the contemporary approach to the AIDS pandemic
  • The conflict between the medical profession and religion in their attempts to portray habitual drunkenness
  • The understanding of dementia paralytica in the Netherlands at a time when psychiatry was attempting to establish itself as a medical profession
  • Adelle Davis’ role in creating the ideology of nutritionism.

There’s also a commentary on the Adelle Davis article, an ‘In Memoriam’ for Sherwin B. Nuland, and reviews of ten books (of which I’ve featured here only two).

Thanks to h-madness (a great blog) for bringing my attention to this new issue. Somatosphere (a most excellent blog — highly recommended) often covers this journal, but I haven’t yet seen the July issue there, so I’ll go ahead and post these abstracts. Note that all articles (other than their abstracts/extracts) are behind a paywall. (emphasis added in what follows) Read more

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A new blog on the self

new-blog-kittenI’ve started another blog called Basic research on the self. My intention is to write there about the social and cultural history of the self, aided by insights from sociology, anthropology, philosophy and psychology (especially critical psychology). This is a subject that relates to a number of topics I’ve written about here.

A while back I grouped together my interest in psychopharmaceuticals, cosmetic surgery, happiness/positive psychology, and self-help and labeled these topics “psychological and physical conformity.” When I’ve written about these subjects, I’ve talked about the way things are today. In my new blog, I’d like to step back and ask: How did the society I live in end up valuing self-actualization, self-improvement, and maximized happiness – as well as an impossibly ideal notion of physical appearance — above all else?

That question also relates to a number of my other interests here — healthism, the social determinants of health, inequality, neoliberalism. It’s much easier to convince people they’re personally responsible for their health and well-being (including their socioeconomic status) if they’ve already developed a self-concept based on the ideology of the self-contained, autonomous individual. Read more

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (4) The abnormal part

Abnormal psychologyContinued from parts one, two, and three.

A year ago, when I decided to call my declining rate of blogging a ‘sabbatical,’ I wrote down some questions to explore while I took time off to read.

How did we find our way into the dissatisfactions of the present – the commercialization of medicine, the corporatization of health care, the commodification of health? Does understanding the path we followed offer any insight into finding a better direction? Was the increasingly impersonal nature of the doctor-patient relationship inevitable once medicine became a science? Or was it only inevitable once health care emphasized profits over patients and the common good?

At the time I thought I would read primarily in the history of medicine, and that was how I started. Appreciating the historical context of medicine is important for understanding both how medicine ended up where it is today and what medicine could become. “The texture and context of the medical past provide perspective, allowing us to formulate questions about what we can realistically and ideally expect from medicine in our own time,” I wrote.

Now that I’ve become more familiar with the social determinants of health, I’m less optimistic about the future. The problem is not simply that the corporatization of health care has increased dissatisfaction among both doctors and patients. The problem is that our focus is so narrowly limited to health care systems that we fail to see the larger issue. As one metaphor puts it, doctors are so busy pulling diseased patients out of the river, there’s no time to look upstream and ask who’s throwing the bodies into the water. Read more

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (3) Connections

Continued from parts one and two, where I defined the terms used in the following diagram of my blogging interests. Click on the graphic for a larger image.

Blog topics and their connections

If I had written the previous two posts a year ago, I would have realized how much my interests were intertwined. I guess I wasn’t ready to do that. Anyway, in this post I catalog some of the connections.

Healthism

~ Healthism and psychological and physical conformity: Healthy lifestyle campaigns promote an ideal way of life that encourages individuals to alter their behavior and appearance. Although it’s true that we would all be better off if we didn’t smoke, that doesn’t make anti-smoking laws any less authoritarian, i.e., requiring conformity (see the section on anti-authority healthism in this post). The fitness aspect of healthy lifestyles promotes the desirability for both men and women of acquiring (i.e., conforming to) specific body images.

“Self-help is the psychiatric equivalent of healthism.” That’s a slogan I made up. I’m not sure yet if it will stand up to scrutiny. Certainly the self-help industry encourages self-criticism, which leads to a preoccupation with those aspects of personality currently considered undesirable. Read more

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (2) Economics & the socio-political

Continued from part one, where I discussed the first three of my six interests: healthism, medicalization, and psychological and physical conformity. Click on the graphic below to see a larger image.

Blog topics and their connections

The social determinants of health

Social determinants of health (often abbreviated SDOH) refers to unequally distributed social and economic conditions that correlate with unequal and inequitable distributions of health and disease. Presumably there is a causal relationship between the two, not merely a correlation. Definitively identifying the causal mechanisms, however, is difficult. A great many things influence our health (including things we’re not even aware of yet), and it can be difficult to isolate and scientifically study some of the ones we strongly suspect, like poverty, isolation, or a sense of being socially inferior.

The medical model is the preferred framework in modern westernized societies for explaining the distribution of health and disease. It emphasizes risk behavior (smoking, diet), clinical risk factors (blood pressure, blood sugar, cholesterol levels), genetics, health care access and quality, behavioral change, and patient education. One common characteristic of the medical model’s explanation of health and disease is that causes are located in the individual (behavior, genes), not in the individual’s economic and social environment. Read more

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (1) Bodies, minds & medicine

It’s always hard to be sure about these things, but I think the reason I decided to take a ‘sabbatical’ from blogging last July was that I was interested in too many seemingly unrelated topics. Writing about all of them left me feeling like I never got to the ‘meat’ of any one of them. And I couldn’t convince myself to focus on just one or two things, since that would mean abandoning the others, which I was unwilling to do.

Now that I’ve taken the past year to read and reflect, I find – duh! – that my interests are not as unrelated as I’d assumed. In hindsight, I should have realized this long ago, but, alas, I did not. I’m writing this post to clarify to myself what I now see as the common threads that connect my interests.

Here is a diagram that groups my interests into six categories. (Click on the graphic to see a larger image.)

Blog topics and their connections

Four of the six categories relate to all five of the others. The two outliers (neoliberalism and medicalization) are not as directly related as I feel the others are. Read more

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Guest post: Is the prevalence of depression related to the modern empowerment of the individual?

Alain-Ehrenberg_Das_erschoepfte_Selbst_Depression_in_der_GesellschaftPierre Fraser is an author, essayist, and (currently) a PhD candidate in sociology at Université Laval. Just as his most recent book (Tous Malades !: Quand l’obsession pour la santé nous rend fous) was being published, I met Pierre on Twitter, where we discovered our mutual interest in the subject of healthism. Pierre blogs at Pierre Fraser and tweets as @pierre_fraser.

This translation would have been impossible without the invaluable assistance of Jan Henderson (PhD in the history of science and medicine from Yale). Her work allowed me to revisit the original French text and enhance it, and in this sense, we followed the injunction of Karl Popper : the duty of clarity. I hope our collaboration will continue, because Jan and I are particularly concerned about the healthization of society, and we try to understand how health has become a social value. Feel free to send us your comments (Jan Henderson, Pierre Fraser).

Pierre Fraser, 2012

When a medical clinician examines a patient, she first determines the presenting symptoms, considers which bodily functions might account for those symptoms, arrives at a diagnosis, and provides the most appropriate treatment. But what if the presenting symptom is depression? As Alain Ehrenberg points out, “depression, like any mental illness, is not a disease that can be assigned to a part of the body.” [1] In fact, as Ehrenberg goes on to say: “when psychiatry can discover the cause of a mental illness, as happened with epilepsy, it is no longer a mental illness.” [2] Such has been the dilemma of the history of psychiatry. Read more

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Recommended (online) reading

Woman reading computerI’m still on “sabbatical.” Mostly reading. Thinking about what I most want to write about. I know what my interests are — the problem is, I have too many. Meanwhile, here are some blogs I enjoy reading.

Thought Broadcast by Dr. Steve Balt

Psychiatry is a controversial topic these days. We (speaking for myself, anyway) love to criticize the overprescription of psychopharmaceuticals, the medicalization of the slightest deviation from “normal,” and those psychiatrists who are eager to take “gifts” from the drug companies whose products they subsequently prescribe and promote.

I suspect people relate to psychiatry more readily than to the science of medicine. We’ve all known moments of slippage along the spectrum of mental health. We’d all like to understand ourselves better, something psychiatry used to promise before it tried to reduce us to the chemical interactions inside our brains.

Dr. Balt writes about all of this. What I especially like about his blog is his compassion for patients and his honest assessment of the psychiatric profession. His writing has a quality like Gawande’s: He maintains a strong personal presence without straying too far into the overtly personal.

To get a sense of Thought Broadcast, read Dr. Balt’s My Philosophy page. A recent post I’d recommend: How to Retire at Age 27. It’s on psychiatric qualification for disability. His point is that labeling (and medicating) someone as disabled does nothing to solve underlying social problems. It concludes:

Psychiatry should not be a tool for social justice. … Using psychiatric labels to help patients obtain taxpayers’ money, unless absolutely necessary and legitimate, is wasteful and dishonest. More importantly, it harms the very souls we have pledged an oath to protect.

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Bruckner on the good life, money, and the unequal world of work

Consumer Society by Barry SmartOnce more, from Perpetual Euphoria: On the Duty to Be Happy. This time on our relation to wealth.

Why is it American conservatives deplore European social democracy? Could it be that it doesn’t stimulate consumerism enough to satisfy a free market economy? (emphasis added in the following quotations)

[T]he power of the great upheavals of the preceding century in France, including those of 1936 and 1945, consisted not only in redistributing the social pie, but also in creating new kinds of opulence for the majority of the people: free time, poetry, love, the liberation of desire, the sense of everyday transfiguration. Not being content to manage penury, but discovering everywhere new goods that are unquantifiable and escape the rule of profit, prolonging the old revolutionary dream of luxury for everyone, of beauty made available to the most humble. Today, luxury resides in everything that is becoming rare: communion with nature, silence, meditation, slowness rediscovered, the pleasure of living out of step with others, studious idleness, the enjoyment of the major works of the mind – these are all privileges that cannot be bought because they are literally priceless. Then we can oppose to an involuntary poverty a voluntary poverty (or rather a voluntary self-restriction) that is in no way a choice to be indigent but rather a redefinition of our personal priorities. This may involve giving up things, preferring freedom to comfort, to an arbitrary social status, but for a larger life, for a return to the essential instead of accumulating money and objects like a ludicrous barrier set up against fear and death. In the end, true luxury is the invention of one’s own life, master over one’s destiny; “but everything that is precious is as difficult as it is rare” (Spinoza).

This is not to say that Bruckner fails to appreciate the situation of the poor. Written in 2000, way before the financial crisis, this comment is even more relevant today:

[P]overty in developed countries may never be overcome, simply because the rich no longer … need the poor to get rich. … The misfortune of being exploited has been succeeded by the still worse misfortune of no longer being exploitable.

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Bruckner on the family, being gay, and AIDS activism

The perfect familyI recently read and very much enjoyed Pascal Bruckner’s newly translated book, Perpetual Euphoria: On the Duty to Be Happy (originally published in 2000). Here’s a passage from the chapter “The Fat, Prosperous Elevation of the Average, the Mediocre.” (emphasis added in the following quotations)

[W]hat a contradiction to see in civil unions or in gay marriage with adopted children the forerunners of the disintegration of the family! It is exactly the reverse: it is the familial order that is triumphing over all of us, no matter what group or belief we subscribe to, and it is hard to see any argument, anthropological or other, that we could make against it.

Good point. Lost on conservatives, unfortunately. The new normal in family formation is resisted by those who cling to traditional values, while the traditional value of family prevails.

The paragraph continues with a discussion of conformity and anticonformity, and includes the following footnote:

According to Lucien Sfez, in 1995, 45 percent of literature majors at Stanford said they were gay, a figure that has little to do with reality. The author sees three reasons for this phenomenon: it is cool to say you’re gay and not to have the brutal image of the heterosexual; gays being a minority are protected by labor unions; and finally, gays cannot be accused of sexual harassment. La Santé parfait, p. 65.

The first reason makes sense, the second is irrelevant today, and the third certainly isn’t true in the US.

The footnote appears in connection with a critique of identity politics. “People state their identities only to make others yield, and display them noisily, perhaps out of fear that without them they would not exist.” Later on, however, in a chapter on suffering, Bruckner does not fault those who go public with an identity that features an incurable disease or disability.

The impact of AIDS activism on attitudes towards illness

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The emotional burdens of patient care

The emotional pain of doctorsIn a recent issue of JAMA, Dr. Michael Stillman writes about the emotional pain of delivering bad news to a patient he has known through the best and worst of times.

Earlier in my career, delivering bad news seemed like a technical challenge. I would methodically seat patients and their family members facing one another, pause for a moment after reporting that there was an “unexpected finding” on a scan, and search for an opportunity to say that I “wish things were different” and that I would be there to help until the very end. This routine, though slightly stiff, helped anchor me in whatever emotional swell was to come.

Now, however, these conversations just make me sad. …

Patients suffer and die, and a physician must find the balance being feeling her own humanity and maintaining the professional stance that allows her to move on. There are no simple guidelines, although Dr. Stillman suggests remembering the good times his patients have had and focusing on those moments.

Emotional hazards of practicing medicine

I wonder just how aware patients are of the psychological burden of being a doctor. Dr. Stillman writes:

I love practicing medicine. Unequivocally. Yet it sometimes seems as much a burden as a privilege. We begin our careers in the anatomy room, a ghoulish lab in which many “civilians” would faint. We cut our teeth in bloody operating rooms and intensive care units from which few people leave intact. We spend our lives bearing witness to the sufferings and diseases of troubled souls. We are well paid, intellectually stimulated, and, if we are lucky, trusted and maybe even loved by our patients. Yet on certain days, when our patients do not do well, the trade-off seems untenable.

How are we to protect ourselves from the emotional hazards of the practice of medicine? How are we to stand with our patients through the very worst while avoiding depression, significant stress reactions, and even substance abuse or addiction? …

There is simply no way to be a good but distant physician.

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Don’t drink and judge: Bitter tastes and moral disgust

Tasting something bitterDisgust is an emotion experienced – either actually or in the imagination – through the senses. Charles Darwin, for example, wrote: “I am disgusted by the stench and sight of that rotting viscera.” Some anthropologists suggest that feeling disgust was an adaptive survival mechanism in the course of our evolution. It may be maladaptive today, however, as it can result in fears of those who are different from us, sexual prejudices, and other irrational behaviors. Says anthropologist Dan Fessler:

We often respond to today’s world with yesterday’s adaptations. … That’s why, for instance, we’re more afraid of snakes than cars, even though we’re much more likely to die today as a result of an encounter with a car than a reptile.

Do bitter tastes increase moral disgust

Psychologists have asked whether there’s a connection between feelings of physical disgust and a sense of moral disgust. In an experiment designed to explore that question, test subjects were given three different drinks – one sweet, one bitter, and water. They were then shown morally questionable scenarios (ranging from second cousins engaging in consensual sex to a man eating his dead dog) and asked to rate how morally questionable they found these scenarios. Participants were also asked about their political orientation.

The results? Those who drank something bitter rated the scenarios 27 per cent more disgusting than those who drank water. In addition, political conservatives were more strongly affected by bitter tastes than liberals.

The psychologists’ conclusion: “[E]mbodied gustatory experiences may affect moral processing more than previously thought.” Or, as New Scientist relates:

Although the mechanisms linking taste and behaviour are not yet clear, the authors [of the study] ask whether jurors should avoid bitter tastes and whether food preferences play a role in shaping political ideals.

Hmmm. Maybe we could create more political harmony by feeding conservatives more cake. Read more

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Overdiagnosed and overprotected children

Helicopter parentsThere’s been much discussion for years now on whether children are overmedicated for behavioral problems. A very thoughtful report was just published by The Hastings Center: “Troubled Children: Diagnosing, Treating, and Attending to Context.” It asks the underlying question: Are increased rates of diagnosis and treatment with drugs appropriate or are healthily children simply being labeled as sick and given drugs to alter their moods and behavior? (The report is available online as a PDF file.)

With that on my mind, I was struck by a comment from Tanya Byron, an English psychologist, writer, and child therapist,

[W]e have to really listen and think about why a child is telling us something. The behaviour of children and young people is fundamental to a well-functioning society, because they can tell us what is going on more honestly than we tell ourselves.

If there really is an increase in mental disorders among children, what does this tell us? If there isn’t, what does giving psychopharmaceuticals to four-year-olds tell us about ourselves? And could we be honest about what it says?

Stigma: We are afraid to lose the competition of life

Byron also made a good point about the stigma of mental health: (emphasis added in the following quotations)

[I]t would be helpful if we could accept that mental illness and physical illness all lie on a continuum, and sometimes bits of our physical body don’t work very well, and sometimes bits of our mental body don’t work very well – and that that’s OK, and it’s actually not an indication of failure. If you break your leg, you are not going to suddenly be seen as less successful than you were before you had broken your leg. So why do we have this stigma around mental health?

… We are scared of people seeing us as somehow not the person they thought we were, as if life is a competition and the only way that you win it is by being completely invincible and robust and never being fragile or vulnerable. That is just ludicrous. That is why I like kids: because they remind us that life really isn’t like that.

On not letting children be children

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What the Internet does to the mind and self

Internet addictionOne of the best things I’ve read on the subject of what the Internet does to our mental processing and social interactions is Adam Gopnik’s The information, How the Internet gets inside us. It was published in The New Yorker and is currently not behind a pay-wall.

Gopnik discusses the work of a number of writers, including the books Cognitive Surplus, Is the Internet Changing the Way You Think?, The Shallows, Hamlet’s BlackBerry, Alone Together, and Too Much to Know. He divides the thinking of these writers into three categories: Never-Better, Better-Never, and Ever-Waser.

The Never-Betters believe that we’re on the brink of a new utopia, where information will be free and democratic, news will be made from the bottom up, love will reign, and cookies will bake themselves. The Better-Nevers think that we would have been better off if the whole thing had never happened, that the world that is coming to an end is superior to the one that is taking its place, and that, at a minimum, books and magazines create private space for minds in ways that twenty-second bursts of information don’t. The Ever-Wasers insist that at any moment in modernity something like this is going on, and that a new way of organizing data and connecting users is always thrilling to some and chilling to others—that something like this is going on is exactly what makes it a modern moment.

Gopnik’s writing is inspired, as in the end of this passage:

[T]he Ever Wasers smile condescendingly at the Better-Nevers and say, “Of course, some new machine is always ruining everything. We’ve all been here before.” But the Better-Nevers can say, in return, “What if the Internet is actually doing it?” The hypochondriac frets about this bump or that suspicious freckle and we laugh—but sooner or later one small bump, one jagged-edge freckle, will be the thing for certain. Worlds really do decline. “Oh, they always say that about the barbarians, but every generation has its barbarians, and every generation assimilates them,” one Roman reassured another when the Vandals were at the gates, and next thing you knew there wasn’t a hot bath or a good book for another thousand years.

I found this next observation insightful. It relates to the offensive behavior so common on the Internet. Read more

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It’s better not to have children

A research article in the journal Think enumerates the reasons it’s better not to have children.

Most people assume that having children is a rewarding exercise, even a necessary ingredient of a complete and happy life. But a cold hard look at the facts suggests otherwise.

Children rarely make a net contribution to a parent’s (self-assessed) levels of happiness (and remember, people tend to overestimate their happiness levels). In anonymous surveys, most parents report regretting having children. Seventy percent of people would not have had children if they knew what it would be like …. Only five percent of men and a third of women said having children improved their happiness levels ….

Studies have shown that while people’s happiness goes up when they are expecting a baby it sharply declines once the child is born. And the evidence is, the more children you have the more unhappy you are likely to be …. Happiness levels only start going back up after the last child leaves home ….

Some might think that after a lifetime of offspring-induced unhappiness you can at least look forward to an old age where your children care for you. But in the West the number who care full-time for their elderly parents is comparatively small. Not having children is probably a much better pension plan. When they reach old age ‘[t]he childless are more financially secure and in better health [than parents]’ ….

None of this makes child creation and rearing sound like a recipe for flourishing. It sounds like a major obstacle to a happy life, at least in the majority of cases.

Happy mother and child Read more

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The duty to be happy

Pascal Bbruckner Perpetual EuphoriaThe French intellectual Pascal Bruckner casts a critical eye on happiness in his newly translated book, Perpetual Euphoria: On the Duty to Be Happy. Much of what he has to say about happiness applies equally to health.

In the first post on this blog I asked: How did health, which used to be something we were born with, become something we believe we can personally control. Today most people in developed countries assume they can avoid certain diseases and prolong their lives by practicing a “healthy lifestyle.” How did this happen? When did the change occur? What does it mean that – unlike earlier generations — we’re so preoccupied with our health?

Attitudes towards both health and happiness changed in the sixties. In an interview in The Guardian, Bruckner comments: (emphasis added)

After the 60s, there is no more distance between one’s happiness and oneself. … One becomes one’s own main obstacle. To overcome this obstacle a huge market opened: medicine to modify your mood, surgery to modify your body, and it also includes the spread of therapy and new or reformed religions. So Jesus is no longer this transcendent God, but a life coach who helps you overcome addiction and so on. …

We should wonder why depression has become a disease. It is a disease of a society that is looking desperately for happiness, which we cannot catch. And so people collapse into themselves. …

[P]eople are very unhappy when they try hard and fail. We have a lot of power in our lives but not the power to be happy. Happiness is more like a moment of grace.

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The unavoidable and burdensome responsibility to be happy

Victoria Huggins American IdolI came across this photo of Victoria Huggins, of American Idol fame, while searching for an image of an annoyingly cheerful person. It was on a relatively new blog called Media Studies, written by Andover media student (I presume) Kristina.

Kristina describes Victoria as “Possibly the most annoyingly loud, optimistic, cheerful person you will ever encounter. With an incredibly high-pitched, overly exaggerated Southern accent and a specialty in church music, she is the poster child for America.”

Fortunately, I missed the episode of American Idol when Victoria appeared and was promptly eliminated.

Another post on Kristina’s blog caught my attention, as the subject is close to my heart: How media/advertising images of the ideal body have … how shall I put this … messed us up. She comments on how her college-age contemporaries found the cast of MTV’s Skins so ugly they couldn’t watch it, when these young people are in fact – Kristina says — uniquely attractive. I agree. (Click here for image.) Kristina’s comment:

What is beauty anymore, anyway? What have you done to our standards? You have raised them to an impossible high that will never be met without a computer unless eating disorders and cancer-causing beauty products become common practice.

Precisely.

Anyway, all this by way of introducing the following video. It’s been around for a year, but I just discovered it (thanks to Psychiatric Times). It comes from The Onion and has had a million and a half viewers on YouTube. Production level is high, as is the humor level. Read more

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Reluctant patients: The mental health of doctors

Mental health of doctorsThe British medical journal The Lancet surveyed a number of studies that discuss troubling statistics on suicide and depression among American physicians. The subject is not new, but the studies attempt to provide a few new insights.

A 2004 analysis in The American Journal of Psychiatry found that male doctors were 1.41 times more likely to commit suicide than other men. The statistic for female doctors was significantly higher, 2.27.

The cause of the increased rates is not known, but the problem seems to start in medical school.

At medical school, competitiveness, the quest for perfection, too much autonomy coupled with responsibility, and the fear of showing vulnerability have all been cited as triggers for mental ill health.

The stigma of not being able to cope

A study in JAMA published last year looked at the fear of showing vulnerability. It found that 53% of medical students who had high levels of depressive symptoms were concerned about revealing their state of mind. They felt such honesty would be risky for their careers. Many saw the mere act of asking for help as an acknowledgment that their coping skills were inadequate.

Medical students are under extraordinary demands. They feel they are making life and death decisions and that they can never be wrong. There is such tremendous pressure to be perfect that any sense of falling short makes them very anxious.

If medical students are critical of each other about depression, how does that transfer to patients? We don’t want the medical education experience to make them less tolerant of mental illness. Stigma seems to be lessening among the general public. But it is possible the medical professional is lagging behind.

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Love and marriage in China

Chinese weddingPrevious articles on the “second wives” of well-to-do Chinese men have focused on how unfair it is that mistresses of corrupt officials become exorbitantly wealthy. Or on the government’s foot-dragging in putting marriage databases online. But in an article ostensibly about the branding of luxury goods, Tom Doctoroff, a leading authority on marketing in China, offers a cultural analysis of the phenomenon. (emphasis added)

Because China has never had a humanist revolution, sex and marriage have always been relatively divorced. That is why many Asian cultures have an immensely commercialised and categorised [sex industry]. … [I]f a husband is a man of means, and has a significant income, then he can take on a second wife without violating his obligation to his first wife. …

Second Wife culture is just one part of a much bigger and more interesting area which is the difference between love and marriage in China and the West. Marriage in the west is rooted in romantic passion, and although that passion evolves over time we basically assume that if it’s is [sic] gone from marriage it’s a shallow marriage. Yes, there are other concerns that surround it – children, money – but it’s not the core of the relationship.

In China it’s fundamentally true that a marriage is not between two individuals, it’s between two clans. Marriage is a way that people connect into a broader society in which the individual is not the basic productive unit. This has always been the case.

In China, a romance is not ideal unless it is also accompanied by commitment. In Chinese, when we translate “a diamond is forever”, we don’t mean that passion lasts forever. It translates as “he will do anything for you, forever”. And that’s why people buy a lot of things for their mistresses – that affection needs to be demonstrated, too. Read more

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Mental illness in college students: Overdiagnosed

Mental health college students overdiagnosisThe New York Times ran an article in December about the declining mental health of college students. The focus of the article was actually on how difficult it is for understaffed counseling centers to cope, but the problem was framed with some disturbing statistics: “44 percent [of students] in counseling have severe psychological disorders, up from 16 percent in 2000, and 24 percent are on psychiatric medication, up from 17 percent a decade ago.”

The article offered two possible explanations for these statistics: More students are able to attend college because effective psychiatric medicine is available and/or counselors are now better at recognizing a serious illness than they used to be.

Experts say the trend is partly linked to effective psychotropic drugs (Wellbutrin for depression, Adderall for attention disorder, Abilify for bipolar disorder) that have allowed students to attend college who otherwise might not have functioned in a campus setting.

There is also greater awareness of traumas scarcely recognized a generation ago and a willingness to seek help for those problems, including bulimia, self-cutting and childhood sexual abuse.

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DSM-5: A “wholesale imperial medicalization of normality”

The psychiatrist is inThe American Psychiatric Association (APA) is in the process of revising its bible of mental disorders, the Diagnostic and Statistical Manual of Mental Disorders (DSM). Research planning for the new version, called DSM-5, began in 1999. The release date has now been extended until 2013.

The revision process has been contentious. Daniel Carlat, on his psychiatry blog, described the exchange between opposing psychiatrists as a bar room brawl that had “degenerated into a dispute that puts the Hatfield-McCoy feud to shame.”

The latest history of and update on the warring factions comes from an article in Wired magazine by Gary Greenberg, author of Manufacturing Depression: The Secret History of a Modern Disease. He interviews Allen Frances, lead editor of the manual’s previous version (DSM-IV). Frances came out of retirement to voice his objections to the upcoming revisions. Read more

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Why the increase in mental health problems for college students?

Depressed college studentIn a recent NY Times article on the rising number of college students with mental health problems, there’s an interesting comment on why the numbers are increasing.

Experts say the trend is partly linked to effective psychotropic drugs (Wellbutrin for depression, Adderall for attention disorder, Abilify for bipolar disorder) that have allowed students to attend college who otherwise might not have functioned in a campus setting.

There is also greater awareness of traumas scarcely recognized a generation ago and a willingness to seek help for those problems, including bulimia, self-cutting and childhood sexual abuse.

The greater awareness of trauma doesn’t surprise me, but the first explanation hadn’t occurred to me. I’d like to see the evidence. My first take on psychotropic drugs for children is that they’re overdone, but I’m willing to be convinced otherwise. If this is true – that more students can attend college because of the drugs they take — then that’s good news.

This particular article has very little information on the students themselves. It’s mostly about how difficult it is for understaffed college counseling centers to cope with the increase. Read more

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Updates: Commercialization of infidelity, medical rivalry, conservatives on climate change, football concussions

Ashley Madison websiteAs a practicing pediatrician, I, too, feel the nobility and privilege of my profession, and count myself lucky every day that I am able to do what I do. But to denigrate lawyers and journalists as somehow less valuable to society is beneath us as a profession. Read more

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Should psychiatrists go to med school?

Psychiatry and big pharmaOne of the problems Carlat readily acknowledges is that psychiatry is excessively focused on psychopharmaceuticals at the expense of other effective treatments. Not only is there too much focus when it comes to treatment. There’s so much money flowing from the pharmaceutical industry to psychiatrists that one has to seriously question the profession’s ability to be objective. Read more

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Should grief be labeled and treated as depression?

GrievingThe American Psychiatric Association (APA) is in the process of revising the Diagnostic and Statistical Manual of Mental Disorders (DSM) – the psychiatrist’s bible. Its last incarnation — known as DSM IV — was published in 2000. The new version will be DSM V. … One item in dispute is whether bereavement – the grieving process that follows the loss of a loved one – might qualify a patient for the DSM label Major Depressive Episode. Read more

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Negative knowledge: Remembering Alfred Schutz

In practice there’s no reason to suspect that any particular piece of information is inadequate before it is revealed to be otherwise. But in theory there’s no reason to exclude anything from suspicion. It is characteristic of all interpretations, meanings, and values that they are never the last word. They are all potentially obsolete. Reality is not just occasionally precarious – it has no permanent foundations whatsoever. It is the nature of knowledge to be fragmentary and partial. This is the first and final, the ultimate source of anxiety.
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Cultural differences: Emoticons

And what’s the significance of the need to tilt your head to read western QWERTY emoticons, but the eastern ones are looking straight at you? Not what I’d expect culturally. But perhaps the difference here is that the western versions require fewer keystrokes – we’re in more of a hurry.

The Geographic points out that emoticons date back to 1881, when the American magazine Puck published “Typographical Art” for melancholy, indifference, astonishment, and joy. Emotions a bit more subtle than the ubiquitous smiley face, no? Read more

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