« August 2007 | Main | October 2007 »
Well, I'm leaving my office now -- last day is kinda weird. Monday I start the new gig, but the first two days are intensive orientation days, so I won't have any time to blog. But I will be publishing comments received either over the weekend or on those two days. So talk to each other! And I'll be back on Wednesday.
Heart,
Me
Okay, I haven't received an email yet saying it's okay to run the following, so I'll just say it's from an advocate for SB 226 (not a legislator). The advocate writes:
I read your blog on AOT today and was curious to understand more about your comment ... "Is Senate Bill 226 the answer? I can't say."
I honestly just want to understand - what are are your concerns about this type of legislation? The length of time? - the initial period is just six months which is not very long but might be long enough for prescribed medications to start really working. That too many people with mental illness would qualify? - statistics from Kendra's Law show less than 1%. The way it is implemented? - follow-up is in the community wherever the person lives, not in a hospital. Most hospital stays these days are barely a week, anyway, hardly enough time to stabilize and think clearly enough to continue medications when discharged.If you believe with the intent of the proposed law, that severely ill people should have treatment and SB 226 would require that they do if they have a history of hospitalizations, what is your hesitancy? Since this bill is meant only for the small minority of those whose lives are the most desperate and sad situations that yo u can imagine, (short of those who end up in jail or prison, which is often what happens with untreated mental illnesses) I don't know why you wouldn't think an assisted outpatient treatment law wouldn't be the answer. What do you think a family member should do when their loved one is psychotic, talking to themselves, following the voices in their heads, becoming parinoid and delusional - other than wait until something dangerous occurs?
People who most often are affected by AOT lack insight that they have an illness and therefore do not want any treatments, especially medications. One of the best-known experts on AOT is Dr. Xavier Amador, and if you haven't read his book, "I'm Not Sick, I Don't Need Help," it explains what this means for an individual, and for his family and friends who want to help them. Pages 31 and 32 of the latest 2007 edition of the book talk about the research about poor insight and the connection to the frontal lobe dysfunction in the brain.
HS writes:
Forced outpatient treatment is psychiatry's unique attempt to enlist patient motivation and commitment. Non-compliance is an issue in all branches of medicine but only psychiatry has been allowed to FORCE treatment on it's patients. Imagine legally requiring morbidly obese patients to comply with stomach stapling procedures to control their out of control eating which so taxes the medical system (diabetes, hypertension, worn out joints, sleep apnea, ripped pants seams.)
The hope, however, is that by forcing patients into psychiatric treatment they will "clear" and recognize the benefits of compliance with treatment. We all know forced treatment sucks, but don't many people see it as part of their growth toward understanding their illness and the utility of medication? Ultimately, doesn't it help people to avoid hurting themselves when they are really really sick?
From Susan Rogers, of the Mental Health Association of Southeastern PA:
I just saw your post about SB 226, which the Mental Health Association of Southeastern Pennsylvania will be testifying against at the Oct. 2 hearing. You may want to direct the readers of your blog to this Bazelon Center for Mental Health Law Web link . It includes position statements from a number of advocacy organizations opposing involuntary outpatient commitment (IOC) -- which SB 226 calls assisted outpatient treatment:Also, this Web site belongs to an advocacy organization in New York State. They have firsthand experience with Kendra’s law:
I would also like to quote from an article in Psychiatric Services by Michael Allen, J.D., and Vicki Fox Smith (“Opening Pandora’s Box: The Practical and Legal Dangers of Involuntary Outpatient Commitment,” March 2001): “We have the technology to provide essential services and supports, even to the hardest-to-reach people, but we have failed to fund the effort to do so. Outpatient commitment appears to be a short-sighted solution that may over time also undermine long-term treatment alliances. We believe efforts are far better directed toward fundamentally improving our public mental health system.”
In short, forced treatment doesn’t work and SB 226, if enacted, would drain vital resources from the system – resources that should be used to improve and expand much-needed services and supports.
I really suggest everyone visit the links Susan referred to. The second one, in particular, has a list of myths and facts that puts many of the issues surrounding this subject in some perspective. Plus I love that format, because I'm always like, "Oh my god -- I totally believed that!" Fun.
I just quickly want to publish a response I sent to an email fro the people who support SB 226, who asked me why I didn't wholeheartedly support it on the blog. Here's what I wrote:
I suppose my reluctance comes from my advocacy work with consumer groups, many of which are led by or composed of people who have a history of involuntary commitment and horrible abuses as a result. I have always said, as you know, that hospitals are better than prisons. But let's not kid ourselves: hospitals are terrible too. I have rarely profited from a hospital stay. There's so much incompetence and negligence, it's unbelievable. Most of the time we sat around watching TV. I could have done that at home. Nurses are burnt out and indifferent. Doctors come sporadically, and are often condescending and cruel. Patients who are "acting out" are inappropriately restrained. People are forced to have treatment that doesn't help -- that does, in fact, great harm. Is it better than prison? Of course. But this application of this legislation would not be confined to that dichotomy: prison or hospital.
Additionally, I'm uncomfortable with force or coercion being used when the health care system is so subpar and when we know so little about how some psychiatric treatments work. Also, given the influence of the pharmaceutical industry and insurance companies on type of care and quality of care, how can I have faith that forced treatment will be the right treatment?
Yesterday, in my psychiatrist's office, I whined to him about my most recent post on AOT. I said, "Tomorrow I predict there will be two opposing groups sending me salty emails. I feel like I'm caught in the middle." And lo, the emails came. (To be fair, neither group was salty, but I just like using that adjective that way.)
So let's clarify matters. There are two camps I'm in contact with: those who support Senate Bill 226, and those who oppose it. Both make good points. And there's clearly caring on both sides. But the bottom line is that I'm not prepared to either condone or condemn SB 226. I simply don't have enough knowledge and information to do so.
So let's play Court TV. The next post will be from one side or the other -- whoever I get a "yes, you can publish my comments" email from first. It's a random way to decide which group is the plaintiff and which group has the rebuttal. After those two groups chime in, we'll open up the floor to further discussion -- assuming there is one.
If not, I predict a Cute Fix in your future.
Drew Carey has admitted he suffered from depression and tried to commit suicide. According to MSNBC, he told Access Hollywood's Nancy O'Dell:
“I was depressed for a long time,” Carey revealed.In fact, both at 18 and in his early 20s, Carey attempted to take his own life by swallowing pills.
“Living in Hollywood, you can get disconnected from everybody. You can feel like you are the only one,” Drew explained. “So you feel it, you hold it in and you don’t let it go and you don’t try to find help because you think, ‘Oh man if I tell anybody, I’m going to seem like I’m weak. I won’t get a movie deal. I won’t get invited to…’ whatever goes through your head.”
But his experience, it seems, hasn't taught him much empathy. When O'Dell asked him what he thought of "the Owen Wilson thing," Carey said:
“It’s going to sound cold, but I wasn’t reading the paper going ‘Oh poor guy.’ I was thinking, I hope he’s learning what he is supposed to be learning from this whole experience and not wasting the opportunity to learn."
Um , yeah. It does sound cold.
You know, I never liked Drew Carey. Now I know why.
This headline popped up for my "bipolar" news alert.
Disc Of Silicates Found In Heart Of Magnificent Ant Nebula
In the article itself, there's much talk of bipolar, but having nothing to do with mental illness. Worse yet, until I read the article (or, um, some of it) I seriously thought it was about ants -- like picnic ants. Je suis idiot.
There ain't no controversy like the one surrounding Assisted Outpatient Treatment (AOT). Right now Pennsylvania is considering Senate Bill 226, which amends the act of July 9, 1976 (P.L.817, No.143), entitled "An act relating to mental health procedures; providing for the treatment and rights of mentally disabled persons, for voluntary and involuntary examination and treatment and for determinations affecting those charged with crime or under sentence," adding provisions relating to assisted outpatient treatment programs. For the full text of the bill, click here. And please do read the entire text of the bill before making any judgments, pro or con. I think people don't do that enough.
As I've said before, I have concerns about this type of legislation, but on the whole, am in sympathy with its intent, which is to get severely ill people treatment when they desperately need it -- providing enough safeguards so people's rights will not be trampled. I know it's a tall order. Is Senate Bill 226 the answer? I can't say.
Though I'm leaving the Prison Society tomorrow, my support for its mission -- to better the lives of incarcerated people -- remains. That includes making sure they have appropriate access to health care, whether for diabetes or schizophrenia. It also means recognizing that not everyone who's incarcerated needs to be there. Many, many people get caught up in the criminal justice system for years -- decades even -- merely because they did not have access to treatment for their mental illnesses. The conditions within prisons are, I assure you, much more punitive and destructive than those in psych hospitals. I have seen both sides of this, and the ugliness of incarceration -- and the incredible abuse and hostility people face behind bars -- is hard to describe. The isolation, in particular, that mentally ill inmates are forced to endure is horrible. I know I've said this before, but it's worth repeating.
The hearing for SB 226 takes place in Harrisburg on Oct. 2. I can't go -- new job, and all that -- but if you have time and are interested in learning more, it would be worth the trip.
And it said:
Recently, the Pennsylvania Medical Society's Institute for Good Medicine studied the impact of pharmaceutical television advertisements on Pennsylvanian adults. The study was conducted through "The Patient Poll," a periodic survey of Pennsylvanians on various health care issues. Pasted below is a news release on the findings.A poll of Pennsylvania adults 10 years after the first direct-to-consumer pharmaceutical television advertisement ran suggests that nearly half of the participants have asked their doctor about a specific prescription drug or medical procedure they saw advertised.
But, instead of getting upset about this situation, one physician says it's better for his colleagues to be prepared for questions.
"Most physicians are divided about whether or not pharmaceutical advertisements directed towards patients are good," said Dr. Peter Lund, founder of the Pennsylvania Medical Society's Institute for Good Medicine. "Some say it's good to have patients informed, while others say it's bad because of induced demand and incorrect self-diagnosing. Our advice to Pennsylvania physicians is to be alert to what's being advertised and be prepared to answer questions since there's a good chance they'll be asked."
Although the Institute for Good Medicine says this is the first time The Patient Poll has studied this issue and thus it has no historical data to suggest patient trends, Dr. Lund points to a study published in the August 16, 2007, edition of The New England Journal of Medicine that suggests total spending on pharmaceutical promotion grew from $11.4 billion in 1996 to $29.9 billion in 2005. Real spending on direct-to-consumer advertising increased by 330 percent during those years.
"There's clear evidence that the pharmaceutical industry is spending more to promote medications," Dr. Lund, an Erie-Pa. urologist and incoming president of the Pennsylvania Medical Society, says. "If it wasn't working for them, they wouldn't be pumping more money into that budget area."
While direct-to-consumer pharmaceutical advertisements can be traced back to 1981, the debate on advertising directly to patients accelerated within the medical community 10 years ago when the Food and Drug Administration changed policy to allow television advertisements directed towards patients.
"I don't know a physician who hasn't been asked by at least one patient about a specific drug they saw advertised," Dr. Lund says.
But, Dr. Lund also says that while patients are asking for certain prescription drugs, they realize that generic drugs may be available for some, and that they should be equally effective, according to two additional questions asked by The Patient Poll.
Nearly 62 percent of participants in the poll believe that brand drugs and their generic versions are about the same. And, 53 percent have asked their doctor to prescribe a generic instead of a brand name.
"Although generics may not be available as ads are being run for newer drugs, patients know that once a generic is available, it will likely do the same trick for less money," Dr. Lund says. "Still, however, they'll ask for a specific drug based upon what they remember seeing advertised."
If you really want to feel better, check out Havidol. So funny.
About seven months ago I bought a hamster and named him Tinsel—a name I thought sounded like a Jewish accountant but that I now realize, after many confused conversations, is more closely associated with Christmas. Since I know Tinsel is going to die early—as all hamsters must—I’ve been acting like he’s a child in a hospital and I’m a visiting clown. I try to make things fun and exciting for him every day, feeding him as many delicious treats as his tiny body will allow.
The other day I went on a mission to buy more crunchy treats for Tinsel when I witnessed an interaction I haven’t been able to get out of my mind. For some reason I was especially disgusted to see it happen in a pet store. There were parakeets watching, for God’s sake!
The problem began with a white woman who was buying approximately 500 pounds of cat food. I guessed she was a shelter worker or animal rescuer, and I felt warm inside, knowing she was caring for so many whiskered, meowing faces. I thought it was cute she was also buying toys for them. I pictured her being greeted by their upturned hungry faces, and I got so into my fantasy, tears came to my eyes.
But when she went to check out, she arrived at the cashier at roughly the same time as a black guy who was buying one little bag of goldfish. Clearly, his transaction would’ve taken about 30 seconds. The fish swimming in the bag seemed happy enough, but there was more urgency to his purchase. But she went first.
That rubbed me the wrong way. I’m one of those people who goes out of their way to let other people go first. If someone has fewer items than I do, I bow awkwardly—in the manner of the 18th century—and suggest they go ahead. I just think it’s good form. The people in line with me thought so too—which is why they were shocked by the cat rescuer’s behavior. Without regard to the rest of us, she plopped her cans on the belt and the cashier began ringing her up.
This lack of decorum didn’t sit well with Goldfish Man.
“What the fuck are you buying there?” he asked her, rudely.
Uh-oh.
Because I fear conflict, I would’ve responded (probably with a bow): “I know. Can you believe this? I have, like, a bazillion cats I have to feed and I’m in a rush. I’m sorry to be such a crazy cat lady.”
And chances are he would’ve laughed.
But instead of laughing it off or—better yet—ignoring him, Cat Lady became enraged, and insisted on staying enraged for the duration. Goldfish Man was standing perfectly still, yet she took a preposterous wide-legged stance, thrust out her hand and said, “Back off!” It looked like she was demonstrating something she learned in an assertiveness class in the early ’70s.
He never raised his voice, which just made her angrier. Her face was red and she was shaking.
There was tension in the air because we all knew what was coming. And it did: She said something like, “You should learn how to speak.” She also informed him she lived in a black neighborhood, as if to suggest she was great friends with black people normally but he was too uppity. It was his fault, not hers.
When she left, we all burst out laughing. Goldfish Man seemed unfazed, as though he was immune to white people making asses of themselves. But is that really the kind of interaction that can just roll off you? Here he was, just being a garden-variety shmuck, and this woman made it all about his being black. If anything, it was more cat vs. fish than white vs. black.
Obviously, if he’d been white, she wouldn’t have reprimanded him for speaking poorly, and she certainly wouldn’t have said anything about her neighborhood. Scratch the surface of an enlightened white person, make her lose her temper, and the truth bubbles up. It was like a gentler, pet-oriented version of Michael Richards.
The reference to poor speaking habits reminded me of Joe Biden’s uncomfortable remarks about Barack Obama’s presidential candidacy. Biden told The New York Observer, “I mean, you got the first mainstream African-American who is articulate and bright and clean.”
Articulate? Clean? Obama gave Biden a pass: “We have got more important things to worry about,” Obama told CNN. “We have got Iraq. We have got healthcare. We have got energy. This is low on the list.”
So the conversation petered out. Wouldn’t it have been more productive to have serious dialogue about those remarks? What if Obama had said, “What Joe Biden’s comments represent are important for us to talk about. What powerful white people think about race matters”?
I wonder if the woman in the pet store was embarrassed after she left the store. I wonder if she said to herself, “Oh my God, where did that come from? I can’t believe I said that.” Maybe she told her white friends about it, as a confession of sorts.
Or maybe not. Maybe she didn’t care.
It doesn’t really matter. For the man holding the bag of goldfish, the damage—however slight—was done. Again.
A 23-year-old swim coach and substitute teacher committed suicide Saturday after he learned he'd be going to prison for 10-40 years because of sexual abuse against two ninth-grade girls. From the Philadelphia Inquirer:
According to court records, [Jeff] Anderson and the teens had begun a salacious online relationship via instant messaging and Facebook.com Web sites that soon turned physical.He had kissed both of the girls in a school classroom before arranging to meet with them at the home of one of the teens on a Saturday in April when the girl's parents were away. He had sexual contact with both of them there, court documents say.
While waiting for his sentence to begin, Anderson pulled an outdoor grill into his house and asphyxiated himself. He left a three-page suicide note. From the Inquirer:
In it, he acknowledged his loved ones' "unconditional love, even after the monster inside was revealed. But I cannot live with what I have done."
So many lives ruined.
Facing jail sentence, ex-teacher kills self
I have been seriously remiss of late in letting you all know what's going on at Furious Seasons -- which is a lot, as always. Please go over there now because today is the two-year anniversary of Philip Dawdy's amazing blog. That's two years of driving so-called normal people -- Big Pharma execs, say -- completely crazy. I'm on record as an admirer of the blog, so I won't get all weepy. Just, congratulations, Philip.
I think this page would be more fun that way, don't you?
I know that headline post I did earlier was a little forlorn, but man, I didn't take my Ativan last night, and it was like 8 hours of being burned at the stake. I wanted to be awake this morning, so I thought, Well, I'll just take the other stuff but not the Ativan. How bad could it be? Wrong question.
I don't think I was in any kind of proper withdrawal. I think it was rather that the OCD saw an opening -- and took it. I was really focused on every movement of my body, every sound, every little catch in my throat. I couldn't sleep. At one point, I was agonizing over whether my pillow was situated above my shoulder or below my shoulder. It's not even a distinction I could understand this morning, but last night it was of great urgency. About a half-hour after a sneezing attack, I had an asthma attack. But I was nervous about taking my inhaler, so I waited until my breathing was so shallow, I was convinced I was going to die. It was like that, for hours and hours, with intermittent sleep. In my REM moments, I had a dream that I was trapped in a horror movie called The Beloved. In the film people you were attracted to would return your interest and then turn into demons. I tried to get out of the movie and away from the demons, but I kept getting pulled in. Bette Midler was in the film. She was the only name star.
I finally gave in a couple hours ago and took a quarter pill, which is doing absolutely nothing for me. I think I'll go home and hide under the covers -- this time, after I've taken a nice, pretty white pill.
The Pennsylvania Department of Public Welfare Office of Children, Youth and Families sent out the below letter last week:
This letter is to inform you of a pattern of serious injuries that have resulted from the application of restraints at multiple facilities operated by Kidspeace National Centers, Inc. Facility staff utilized restraint techniques in managing the behavior of children, which resulted in multiple serious physical injuries that required medical attention. The injuries incurred include a spiral fracture to the left humerus; a spiral fracture to the right humerus in the elbow area; a fracture of the medial malleolus of the right ankle; a displaced right midshaft humerus fracture; a spiral fracture of the left tibia and fibula; an oblique fracture of the left distal humerus; and a fracture to the right clavicle.These incidents occurred between March 13, 2007 and August 18, 2007 at the following facilities: Athletes Center; Marconi House; Wright House; and Revere House Diagnostic Center (Kidspeace National Centers Inc) 5300 Kidspeace Drive Orefield, Pa 18069 Telephone: (610) 799-8000 County: Lehigh Region: Northeast Kidspeace National Centers Washington House (Kidspeace National Centers Inc) 1650 Broadway Bethlehem, Pa 18015 Telephone: (610) 799-8000 County: Lehigh Region: Northeast
There has also been an increased police response to complaints at KidsPeace received by local law enforcement over the past year. Many of these complaints have dealt with inappropriate sexual activity in the programs.
Based on these incidents and issues, the Department has closed the intake process for the following programs: Athletes Center; Barton House; Ross House: King House; Marconi House; Fulton House; Edison House; Wright House; Bell House; Franklin House; and Pioneer House; Revere House Diagnostic Center (Kidspeace National Centers Inc) 5300 Kidspeace Drive Orefield, Pa 18069 Telephone: (610) 799-8000 County: Lehigh Region: Northeast
Kidspeace National Centers Washington House (Kidspeace National Centers Inc) 1650 Broadway Bethlehem, Pa 18015 Telephone: (610) 799-8000 County: Lehigh Region: Northeast
What a shame.
Well, I have big news: I'm leaving my full-time job at the Pennsylvania Prison Society for a full-time job at Horizon House. Though I've enjoyed working with incarcerated people and their families -- and have learned a great deal about the criminal justice system and the evils of mass incarceration -- the Horizon House position as a Certified Peer Specialist Community Liaison will allow me to do more direct advocacy within the Wellness Alliance, a new program. Horizon House was one of three agencies selected by Philadelphia’s Department of Behavioral Health /Mental Retardation Services (DBH/MRS) to transform the agency’s partial hospital services into a recovery-oriented service. It should be interesting and challenging. And it's a position that allows me not only to be "out" about my mental illness, but depends on my sharing my recovery experience. Refreshing not to have to hide anything -- or everything.
I'll still be doing the blog, writing my column, and writing Lit Gloss for PW. But I suspect I'll have an even more nuanced understanding of mental health issues now that I'll be employed by a mental health agency.
And now, for the Most Depressing Headline of the Day: US Suicide Rates for Young Girls, Boys Up
Interesting -- we're medicating and treating more kids than ever. There's something wrong with that picture.
For some reason, I've been reluctant to write about Owen Wilson's suicide attempt. I just feel sorry for him and don't want to get into it -- which makes no sense, I know, given that he's a public figure.
Thankfully, the New York Times' Daphne Merkin is more eloquent than I'd ever be on the subject, so (thanks Masale.Wallah), click here.
Thanks to Herb S. for sending me a link to Maria Luisa Tucker's Village Voice article about so-called experimental treatments for depression. I can't begin to describe how much I relate to the woman who's profiled in the article, who, like me, is chronically suicidal. Her experience with ECT also resonated for me, though her memory loss is more devastating than my own (I had fewer treatments):
Kelley began getting three treatments a week. Her suicidal depression was replaced by a mindless stupor. After the first treatment, a nurse wheeled Kelley out looking disheveled and disoriented. She was sent to the cafeteria, where she sat "drooling milk out the sides of her mouth," [her partner] Deb said. At home, Kelley couldn't empty the dishwasher because she couldn't remember where the dishes went. The only thing she was able to do was veg out on the couch watching football.After 33 sessions, Kelley pulled the plug on the treatment when it was apparent that the side effects were lasting. She had lost 20 years of memory. Everything she knows about her life from the years 1979 to 1999 comes from photographs, medical records, and overheard conversations. After her mother died last year, friends and family tried to console her by saying that she would always have her memories, but she wasn't able to admit to them that she actually couldn't remember much about her mother. "I have a photograph of the two of us, but I can't emotionally connect," Kelley says. "I don't recognize my mother, and I don't recognize myself."
Nevertheless, she was alive and no longer suicidal. "When you get knocked senseless by a two-by-four, you're not thinking about how depressed you are," Kelley wrote. "At this level of depression, most doctors are elated that you are still alive after they treat you. They congratulate themselves on saving another [void-of-quality of] life" (her aside).
Kelley stopped the ECT in April 1999. By November of the same year, she was already searching for something else.
Senate Passes "Mental Health Parity"
Mental Health America commends Senators for moving to end insurance discrimination and calls on the House to now pass S.558
ALEXANDRIA, Va. (September 19, 2007)—Mental Health America commends the United States Senate for passing critical legislation to end mental health insurance discrimination, and its sponsors, Senators Pete Domenici (R-N.M.), Michael B. Enzi (R-Wyo.) and Edward Kennedy (D-Mass.) for their leadership. The bill – S. 558, the Mental Health Parity Act of 2007 – will ensure that Americans with employer-sponsored health insurance and their families receive mental health care coverage at the same level as coverage for general health problems.
"The support of this legislation is overwhelming as it should be," said David Shern, president and CEO of Mental Health America. "The science is clear. Tomes of research demonstrate the interconnectivity of mental and general health. Public policy is finally catching up with science through passage of this important legislation."
S. 558 has a wide range of supporters that, for the first time, includes business and insurance leaders, as well as mental health advocates. For details on the legislation and more information, go to www.equitycampaign.net.
"With passage earlier this summer of legislation that would provide parity in mental health coverage under both Medicare and the State Children's Mental Health Program, Congress has a historic opportunity this year to end discrimination against people with mental health disorders in both private plans and federal health program," said Shern. "As we celebrate this first step, we urge House and Senate leaders to make history."
Mental Health America and its national network of affiliates now looks to members of the House to pass S. 558 and make history.
From U.K. Business Weekly:
[Using MRI], the researchers found that when certain areas of the patients’ brains developed a greater volume of grey matter, or greater activity was recorded in the front of the brain, they were able to predict whether a patient would present a more rapid or even complete improvement during antidepressant treatment.“This study shows that the rate of symptom improvement in depressed patients treated with antidepressant drugs can be predicted by brain scanning before treatment begins. The results add new evidence in favour of the view that we may be able in future to personalise treatment for depressed patients.”
The UK government is excited about this because it might save them money; they won't have to spend as much on pharmaceuticals. In the U.S., I'm guessing this same research will be suppressed, since saving people money is exactly what pharmaceutical companies don't want you to do.
Thanks to Sally for sending in the below letter to the Ethicist -- and his answer -- from the New York Times. She says, "The idea that people who have had emotional problems in their past are more likely to be violent or harm children is absurd and common."
My nanny recently told me that she takes antipsychotic medication for a bipolar disorder. I’ve been happy with her for the past two years. She seldom spends long hours alone with my children because I am a stay-at-home mother, and she would never knowingly harm them, but people with psychosis can’t always control themselves. You don’t fire someone for a disability, and I feel a particular sense of obligation because she is a young undocumented Haitian, but should I dismiss her to protect my children? — K.V., BrooklynYou should not fire your nanny. Your anxiety stems more from lurid notions of mental illness — “Psycho” and “The Snake Pit” are not documentaries — than any real risk to your children. Your nanny has never endangered them; you’ve long admired her work.
You are restrained not only by ethics but also by the spirit of the Americans with Disabilities Act. An attorney I consulted says that if you ran a larger business, “to fire her would be illegal.” Were she to stop taking her medication or otherwise display dangerous behavior, a business could dismiss her. Fortunately, as a stay-at-home mother, you can see if her condition deteriorates before anyone is imperiled.
Her immigration status already restricts her other employment prospects, and her limited options, as you imply, impose an additional ethical burden on you. If she can do the job, she should be allowed to keep it.
He handled it well, but this is a perfect example of stigma when you least expect it. I'm sure after two years the nanny felt she could confide in the woman she spent every day with, and whose children she loved and cared for. It's the kind of story that makes me reluctant to tell people what I do.
There's an interesting first-person account in the Belfast Telegraph today by Naomi Hooke (not pictured), a woman who has suffered with anorexia since she was 11. Part of her message is that sufferers should be provided more psychological counseling and understanding. She doesn't want people to think eating disorders are all about wanting to be models or celebrities. She writes:
Anorexia has often been perceived as a quest for model-like beauty, as a teenage fad or as a diet gone wrong. It has even been described as a lifestyle choice. Seldom is anorexia acknowledged as the life-threatening medical condition that it is. Many anorexics detest their bodies, refusing even to pose for family holiday snaps. I, like many of the eating disorder patients I have met, never sought beauty; instead, I spent years trying to make myself look as ill as possible in order to avoid male attention.
In England a young pregnant woman, Fran Lyon, is going to have her baby taken away from her as soon as she gives birth -- simply because she has a psychiatric history. Her problems began when she was 14 and was raped. For the next three years she was in and out of psychiatric institutions. But when she was 18 she turned her life around and has seen been working with mental health charities and has been completely functional. Yet within 30 minutes of her baby's birth, it will be taken away from her and put into foster care, partly because of what social services says is a risk of Munchausen By Proxy. A liberal MP in Fran's corner says:
'What does Fran's case tell us? That no woman who has been raped or had mental health problems can be allowed to have a baby, even years later?'What could be more traumatic than for a mother to have her baby taken away at birth? It's monstrous. That, in itself, can cause mental health problems, which is then used by social services against the mother as a reason not to return the baby. It becomes a self-fulfilling prophesy.
Fran Lyon's website, Asking for a Chance
Bartonella is not the ugly stepsister of Barbarella, but an illness that comes as a result of a tick bite. A recent article in the Archives of General Psychiatry suggests that along with physical symptoms, it can possibly cause psychiatric symptoms, including agitation, depression and panic attacks. Veddy interesting. The below title is about as long as the abstract, but I can't get the full text.
Do Bartonella Infections Cause Agitation, Panic Disorder, and Treatment-Resistant Depression?
Not about mental health, unless you consider lipstick therapy a valid form of healthcare.
![20021218_Satel[1].gif](http://trouble.philadelphiaweekly.com/archives/20021218_Satel%5B1%5D.gif)
Thanks to Kent for sending along a link to this New York Times editorial. I didn't look at the byline before I read it, so I had no preconceived notions about the author, but I found myself agreeing with basically everything that was said. When I saw it was Sally Satel, I was slightly frustrated. I worry that given how controversial she is, people will be unable to read what she wrote without prejudice. But it's a solid piece, and especially attractive to someone like me: I believe the DSM-IV can be valuable, but I also believe it's deeply flawed. She seems to feel the same way, and expresses herself with moderation.
Am I really saying this about a Republican? I must have a fever.
Thanks to Susan S. for letting me know that Meg White is suffering from acute anxiety and that's the reason the White Stripes have canceled a bunch of tour dates. The article says she's unable to travel. Acute anxiety results most often in panic attacks. So it's no surprise she can't travel in that condition. Poor thing! It's nice of her to be so candid, though. None of that "exhaustion" crap for a hardy rock 'n' roller.
Get better soon, Meg.
I have literally been reading John Grohol since the earliest days of my diagnosis. He was an early voice of sanity and moderation in the online mental-health wilderness. Whenever I had a question about an element of treatment, I turned to him, and was always rewarded with good information.
Now I'm honored that John and crew have chosen me as one of the 10 best bipolar blogs on the web. If someone told me back then that I'd one day be honored on his website, I'd never have believed it. I wasn't even convinced I'd live another year, let alone accomplish anything that someone I so respected would want to pay tribute to. Sometimes it's hard to remember how far we come in recovery. This has been a pleasant reminder.
Plus, the description of The Trouble With Spikol is so nice, I plan to have it framed as well as tatooed across my stomach.
Please do visit this link to see it -- and to learn who the other honored bipolar bloggers are.
I was fresh out of the shower, maybe 72 seconds or so, and I was already drenched with sweat. It confused me. I couldn’t tell if the water was dripping or my sweat was dripping, and I actually considered licking myself to figure it out. Instead I put my hair up in its least flattering style: in a green ponytail holder, grabbed from a junk drawer, with a purple headband, grabbed from a junk drawer—both grabbings, obviously, done without looking.
I looked in the mirror. I was clearly a maniac. My pupils were the size of blueberries, I was wet and flushed, and because I was alarmed by the sight of myself looking alarmed, even my nostrils looked shocked.
It was 6:15, and the dinner guests were due at 6:30. I had to get out of my apartment.
My anxiety takes many forms, but often—and we needn’t get into why this is, because then my shrink wouldn’t have any fun—it’s about pregnancy. What if I’m pregnant? Practically speaking, of course, there are only two answers to this boring refrain: 1) have a baby, or 2) have an abortion. That’s it. One or two, A or B, eeney or meeney. There is no mo.
But each month I freak out—despite the fact that I’ve freaked out the month before, despite the fact that I take the pill more regularly than the pope takes communion, despite the fact that some women can’t even get pregnant at my age.
And at 6:15 on a Monday night before the arrival of dinner guests, I was freaking out yet again—I had to know. Right now.
I burst out of the bathroom, looking as though I’d just had an unpleasant encounter with a fire hydrant.
“OhmygodIhavetogotocvsrightnowitsreallyimportantitlljusttakeafewminutes,” I said to my boyfriend, who looked afraid.
“Just go,” he said.
In the car I panicked in a different way, fostered in part by the dispassionate delivery of NPR. Didn’t the people at National Public Radio understand what was going on? What if CVS didn’t have any pregnancy tests left? Oddly enough, that had happened to me twice earlier in the day. Both Walgreens and Hahnemann Hospital’s pharmacy were sold out of them. For an anxious person prone to magical thinking, it was like the Hindenburg.
But at CVS, as always, everything was right with the world. I felt like a hero in a Western striding into a saloon, one hand on my keychain with my CVS card, the other on my wallet.
The automatic doors parted for me. The air conditioning chilled my sweat and shower water so I was crisp and cool. I pushed my cart down the aisle—well known, of course, from prior frenzied visits—and felt like patting it fondly on the rump, as though it were my horse. It was the kind of elation a true panic sufferer knows and loves: the edge of relief.
But when I saw how many pregnancy tests CVS had to offer, the edge of relief receded. I literally watched it go. Goodbye, my sweet edge! How could I pick the right test?
There’s the early- results test and the stick test and the cup test and the digital readout test and the plus-sign test and the test shaped like the state of Texas and the one that smells like peaches and the test that says, “You’re screwed!” when it gives you your results. There’s the test that plays checkers with you while you wait for the
results and the test that brews coffee and eats a scone and the test that just turns into a baby and starts wailing and pooping in its diaper.
Which do you buy?
If you’re in the midst of a panic attack, you buy them all.
I knew it was insane to buy 20 pregnancy tests, but I couldn’t control myself. I had the whole conversation you’d have with a rational person, but the irrational person always wins.
Rational person: “Buying all this is crazy.”
Irrational person: “But you are crazy.”
Game, set, match.
I was hoping the cashier might save me, but she was on her cell phone. It seemed she was able to do everything—discuss her relationship, give herself a manicure, plan her retirement fund—except pay attention to me and the $85 I was spending. I could’ve been wearing an electric cat on my face, and she wouldn’t have noticed me. I slunk away with my enormous bag, ashamed in front of myself.
When I got home, the guests still hadn’t arrived. I had time to do the cup test, which seems the most reliable. You pee into the cup, then use the little dropper to place three droplets into the felt-like panel. Then you stand and watch it for three minutes while you twirl your hair and hum nervously and say, “Come on, stupid-stupidface.” After
you’ve washed your hands, of course.
I don’t have to tell you how this ends. I wasn’t pregnant. But I was relieved. The edge of relief became a ledge, and then my apartment. It was delightful not to be pregnant—again. And after a major anxiety attack, that’s really all you can ask for.
[Illustration by Alex Fine]
This week (tomorrow night, actually) marks the beginning of the High Holy Days in Judaism (and Ramadan, BTW), so I wanted to honor that not by going to synagogue, but by posting a video by gestalt therapist Yaron Ziv about forgiveness -- done entirely in Hebrew. I listened to most of it, but couldn't understand a thing. For all I know, he could be the idiot Israeli brother to Deepak Chopra. But I loved to listen to him; it almost made me fall asleep, as though I were in synagogue. If he had broken out the Kol Nidre, that really would've rocked. Or the Sh'ma -- that, too, makes me feel warm inside. I guess it makes George Bush feel warm inside too, and that's why he started celebrating a week early.
I do so miss smoking, but I'm lucky my asthma got the better of me and I had to stop. I'm surprised to learn 1 in 10 pregnant women still smoke, given everything we know, but researchers are trying to figure out if depression has something to do with it. From the AP:
"These ladies all know, I promise you, about the health risks. That's not what it is," says Dr. Jan Blalock of the University of Texas M.D Anderson Cancer Center, which has begun a first-of-a-kind study, Project Baby Steps, to test whether non-drug depression therapy helps pregnant smokers quit."We should at least understand more about why these ladies don't quit. We should be looking more carefully instead of just saying, 'Whoop, got this group of hard-core smokers.'"
Doesn't Jan sound kind of sassy?
Thanks to Rebecca for letting me know about "A Day in the Life" contest, which I think we should all enter, if only to represent, yo. Here's the press release:
Sometimes we just want people to understand what a day in the life living with bipolar disorder or schizophrenia is like! AstraZeneca Pharmaceuticals wants to help you tell that story... and a lucky winner will even win $1000 for their submission!"A Day in the Life..." is a competition aimed at raising awareness of what it is like to live with bipolar disorder or schizophrenia. Submissions are being accepted until September 14, 2007 and can include essays, drawings or paintings, music, video or audio.
Download the files here for more information.
So says Masale Wallah:
If you listen to los ricos in Venezuela -- or los ricos in the U.S., for that matter -- they'd say yes. But there may be a clinical diagnosis, actually.
President Chavez on Prozac to help cope with bouts of clinical depression?
I have a new column in PW. It's a book review column called Lit Gloss, and it's weekly. I love doing it so much. Generally, I hate writing, which is a funny problem for a writer. But I look forward to doing this every week, and feel like I could do it every day if I had to. I love books, so maybe that's why. If you'd like to take a look at it, go here for the latest one and scroll down for past columns. As a practice, it's a cure for depression. I'm not sure reading it will have the same effect, though.
1. Sleep late
2. Go to a cafe and read something smart while sipping coffee
3. Listen to Radio Times, WHYY's show hosted by Marty Moss Coane, about current affairs. A description of today's show:
A new study shows a 40-fold increase in bipolar diagnosis in children over 10 years. Is this a case of overdiagnosis or have psychiatrists been underdiagnosising the disorder in the past? We are joined by the author of the study, MARK OLFSON a professor of psychiatry from Columbia University and psychiatrist ELLEN LEIBENLUFT from the National Institutes of Mental Health to talk about the alarming rise in bipolar diagnosis in children.
I hope Moss-Coane points to the flaws in this study, which John M. Grohol does a nice job of explicating. Also, the Wall Street Journal's Health Blog notes that Mark Olfson has financial ties to the pharmaceutical industry, which Moss-Coane should question.
To listen live to the program, or to learn more, go here.
Last day in Paris. Quelle domage! Have I sufficiently mangled the French language? I just called to order a taxi for tomorrow morning to take us to the airport, and it'll be a miracle if it arrives on time. Or even tomorrow. Or ever. I might have called and said, "I'd like a hansom cab for 1920, SVP." It was that bizarre on my end. I heard her giggle.
![brad_pitt[1].jpg](http://trouble.philadelphiaweekly.com/archives/brad_pitt%5B1%5D.jpg)
Here I am autre fois. I took some amazing photos of street art in Belleville today. I was losing my mind from all the cool grafitti. I have to go back there sometime and bring a tripod.
Terry wrote a lovely piece for us, which I would paste in for us if I could get my PW email account to work. From now on, if you have submissions, please send them to lspikol@gmail.com, which is more reliable.
Now, for the MISUNDERSTOOD HEADLINE OF THE WEEK:
Volunteer Sought Pitt for Anxiety Study
Which I understood as an organization soliciting celebrity involvement in scientific research. As they say en Francais, le duh.
That means "I am crazy" in French. Yes, the language acquisition is moving right along. Ou sont les toilettes? Today I went to the Museum of Decorative Arts and ate an enormous strawberry tart. Oui!
In my absence, some of you have really been taking up the gauntlet -- which I don't think is the right expression, but c'est la vie, you know, I'm thinking en Francais. TTWS reader EVS, in particular, has been going a little nuts with the link-sending-in-ing, which I truly appreciate. So we'll let him take it from here:
'The Inked Shrink'
With his tattoos, interesting past and Web site, Richard Gear and his "life coach" approach appeal to young Portlanders seeking counseling
Scientists Test New Bipolar Remedies
Scientists are casting a wide net to find better treatments for the crushing depression and uncontrolled manias of bipolar disorder, and some approaches they're testing seem pretty surprising.
Mental Problems Rising in Poor Countries
Poverty, Diseases Add Cases Of Depression, Schizophrenia; Experts
Urge More Money, New Strategies
Well, here I am in Paris, and it's predictably beatiful and all that yadda yadda. My anxiety has mostly gone away, though not entirely. My mood is always good on vacation in Europe because I do nothing but walk all day, after a good night's sleep and several good meals. I'm staying in my own little apartment within an apartment on the Ile St. Louis, thanks to the incredible good will of my mother's friend and business associate, and sleeping in a large bed with the best linens I've evern known. The comfort of the bed, and the cozy room, and the fact that I can sleep a full 10 hours, which is what my body really requires for maximum functionality, means I wake up recharged and ready to go. I have felt zero fatigue since I've been here, and in Philly I limp along like a noodle. Today we walked and walked and walked for five hours, and I plan to go out and walk some more in another hour. I've been to Paris several times, so it's not just the newness of a place. It's the sleep!
Plus, I'm not torturning myself about food and weight while I'm here. I'm eating what I want to, but finding that I'm not having wild cravings. It's so important to get out of your everyday patterns to realize what is and isn't non-negotiable. I think stress makes me obsess about eating, and I'm going to fight back. The migraines, on the other hand, have not gotten the memo that we're on vacation. One a day, right one schedule, my dear headache friends. See? If I anthropomorphize them, it'll make them seem cute.
Other thoughts: Air France might as well be Aeroflot, which I flew when Russia was still the USSR. It sucks, and I don't care how much frommage they throw at me. CNN Europe version is better than American CNN. I miss my hamster.
But as far as mental health news, well, I got an email from Philip Dawdy about some astronomical numbers from a Harvard researcher, basically claiming that something like half of the population has a mental illness. Obviously, Philip has some thoughts on this. Moi? Not right now. I'm too busy being someone else.
[Photo of a Paris scene by Delgoff]
Liz Spikol is senior contributing editor of Philadelphia Weekly. She writes the award-winning column The Trouble With Spikol, which began as a chronicle of her struggle with mental illness, and has since expanded into humorous musings on everything from graphic novels to how to use a mop. She also writes the paper's book review column, Lit Gloss. This blog -- named one of the Top 10 Bipolar Blogs of 2007 by PsychCentral -- is about mental illness policy, news, personal journeys and more.
