Empathy and Air Travel

A few days ago, I ranted about how I was detained by security at an airport, then lost my computer.  I've put an update on the bottom of the that post: My Disasters, Natural and Otherwise.

So let me talk about my new friend, whom I've never met and whom I know pretty much nothing about, Steve Silberman, blogger over on Neurotribes.  Now I've never actually read much of Neurotribes, and maybe he express opinions that would make me feel ill, but when one of our readers pointed out the post called "Dear United Airlines: I Want My Kindle and My Dignity Back", I felt like I had found a soul mate in my distress over my lost laptop and the frustration I have felt in trying to inspire some sense of caring or empathy from TSA or the airlines. 

Mr. Silberman writes:

The metaphor of frogs that don’t notice the water around them is getting warmer until it’s boiling (and they’re cooked) is only an urban legend, say the vigilant debunkers at Snopes.com — but it’s an apt image for today’s frequent flyers. Schlepping their carry-ons through security mazes, standing shoeless with arms outstretched in bleeping machines, shrugging off dramatic confiscations of shampoo and toothpaste, and frantically rejiggering carefully-plotted itineraries at a moment’s notice, we’ve come to accept the current state of affairs as just another way that life sucks in the post-9/11 era. Never mind that I’m old enough to recall when a cross-country trip on an airplane, even in economy class, offered an opportunity to unwind and feel coddled in the lap of luxury for a few hours with a stratospheric view. Now I look forward to flying about as much as I look forward to a trip to the dentist.


Okay, Steve, it was nice to meet you. 

My Disasters, Natural and Otherwise, now updated.



Podcast #61: Stay Safe

Welcome to Podcast #61. We discussed the following topics:


In the Mid-Atlantic we had an earthquake and a hurricane this week, and Clink talks about her emotional response to the earth shaking. Somehow, we ended up talking about animal reactions.  If you want to read about how the elephants at our local zoo responded, click here.  


Roy talks about continued violations of mental health parity laws by insurers, and about URAC, a group he is associated with and has talked about before.


Finally, we discuss what healthys do when patients commit crimes against them, such as stealing or manipulating prescriptions for controlled substances. Clink discussed the Menedez brothers and notes, "Once there is a threat (against the shrink), there is no confidentiality."
See also, Fully Charged Battery, a post Clink wrote in 2006.

Thank you for joining us!

*   *   *

This podcast is available on iTunes or as an RSS feed or Feedburner feed. You can also listen to or download the mp3 or the MPEG-4 file from mythreeshrinks.com. 

Thank you for listening.

Send your questions and comments to: mythreeshrinksATgmailDOTcom, or comment on this post

To review our podcast, please go to iTunes.
To review our book, please go to Amazon.

My Disasters, Natural and Otherwise

The earthquake came and went.  A little shaking, no worse for the wear, though Clink tells us in an upcoming podcast that she was a bit shaken (pun intended).  Then there was Hurricane Irene, and while the talk is now on how the media exaggerated, a quick walk around my neighborhood revealed 3 streets blocked by falling trees and two houses with trees on them.   I'm happy to report that my house is undamaged, but we've not had any power for a while now, and I'm blogging from a clinic workstation.    So much for 'natural disasters.'

Aside from this, I have had my own technologic demons.  Twelve days ago I took a quick flight to visit a family member.  On the way back, I placed my belongings on the security belt.  A guard popped out and told me to put my laptop in a separate bin, and I did.  I then walked through the body scanner.  It wasn't the usual metal detector devices, but one of those new strip-you/radiate-you body scans, and I'm not sure I've been through one before-- I usually manage to go through the 'other' line, but that day there was no other line.  A sign offers the option of a 'pat down' but I'll be scanned and go, thank you.  So I raise my hands like the picture shows, I hear a click, and thinking the "xray" is over, I put them down.  Oh, it takes long than that, and now I've "moved" in the scanner.  A security guard jumps in front of me, blocks my way and there is a call for a female security guard.
    "My stuff!" I say, starting to head towards the belt.
    "Don't go near your stuff," he barks.  Oh, it's not like I could walk through him anyway.   "Did you move in the scanner?" he asks.  Yes.  That's why.  Can't I walk through again?  No.  I'm now a potential terrorist.  A female guard in purple latex (?) gloves shows up and recites her poetry about the pat down and how she uses the back of her hands over certain body parts.  Do I want a private room?  No, just let me move on with my life.  I'm molested and cleared, and pointed in the direction of my stuff sitting on the belt.  I grab my suitcase, purse and shoes and move on.   After an unremarkable flight, I arrive home eager to check my email.  Where is my computer?  Oh, no, I last remember seeing it when I placed it on the security belt. Because the battery had died, I had no intention of using it on the plane, but I don't remember ever putting it back in my carry-on suitcase after security.  I call the airport and it's not there.  I call again in the morning and there is a laptop, found at the same  checkpoint, around the same time, but it's a different make and would be hard to confuse with my Macbook, especially given that I left a couple of USB chargers plugged in. 
     I rant.  I rave. (Roy says I do this well).  And somewhere in there, my wireless at home zorks and I can't access the internet from my desktop.  Verizon says it's the computer.  The next day, another tech and other evening on the phone (thank you to my husband) and they decide it's the modem, not the computer.  A new modem comes and things are back on line, an hour or so before we shut down for the hurricane which knocks out the power. 
     So ranting and raving and many calls to TSA, and five days later they review the security tapes.  There I am, but the table where the items items are placed as they come through the scanner is a white blotch, completely obscured by way the sun's glare.  There is no way of seeing if my computer came through or if someone picked it up. 
     In the meantime, I remember that my computer has anti-theft software on it.  I call to have it activated, and I see my own path with the computer, but there is nothing to indicate that it has been turned on since the battery died the morning of my flight.  Friends assure me that anti-theft software can be de-activated.
     And then there is the issue of the computer that was left around the same time.  Isn't that weird?  Someone left a computer at a security checkpoint and no one has called, 12 days later, to ask about it.  I keep thinking this has to be related, that someone grabbed the wrong computer, stuck it in their bag, went on vacation, and either hasn't noticed, or hasn't thought to link it to the airport security process.  I ask TSA to turn it on and see who owns it.  The battery is dead (what is it with these travelers and their dead laptop batteries) and they are looking for a charger.  If they will tell me the make and model of the laptop, I offer, I will send them a charger.  It does feel like a series of unfortunate and unlikely events. 
     Apparently they have a bunch of laptops and somehow TSA doesn't have the sense of urgency that I do.  Plus, my TSA agent assures me, the laptop was logged in 45 minutes after I went through the security scanner, and there is no way a computer can sit there for that long without the TSA agents noticing it.  I just can't find another story that would easily explain the disappearance of my Macbook, unless I put my laptop back in my suitcase and don't remember this (I was a little distracted after the whole security event) and someone on a full flight took my suitcase out of the overhead bin in the hopes of finding something valuable?  Other than the TSA belt, and placing my suitcase in the overhead bin for the flight, it was never out of my sight.  I usually keep the laptop in a separate bag, but since the battery was dead, that bag was in the suitcase and made it home. 
     It's time to buy a new computer and 'move on' but I'm concerned that the moment I do that, the old one will show up.  One friend says I must have tremendous faith in people to think that might happen, and I do.  Seems to me that if you set out to steal computers, you wouldn't do it on an airport security line in front of agents and a camera.  I'm feeling very unplugged!
----
Update on Wednesday 8/31:
After 12 days, TSA turned on the laptop that was left at the security checkpoint shortly after they ascertained that I was not carrying a bomb anywhere too obvious.  On day 13, they located the owner, a college student who had no idea where her computer had gone and she did not have my missing MacBook.  I believe my relationship with my personal TSA agent is now over.  I'm not sure if I should be annoyed about the whole process, or after reading about Steve Silberman's unsuccessful attempts to get his Kindle back from United Airlines, if I should be grateful that at least I had a live person to talk to, one who answered his cell phone while he was taking his daughter to college, and who responded to email messages and was eventually moved by my incessant nagging (who, me?). 

I had to do a last sweep before I move on.  I realized that I'd called the local airport twice and left messages at baggage claim, and that both messages had been returned by someone saying they had not found a computer.  I'd left two messages for the airline--AirTran, with details about my flight, and I had never heard back.  Before I spring for a new computer, I thought I would try again, because you never know if my computer could have slithered its way out of my suitcase and been found in an overhead cabin just sitting there.  I was determined to speak with a human.

After a number of phone calls and a little surfing, I did eventually find a human at both airports that I went through.  No computer.  Only no one knows where else the plane may have gone.  Is there a centralized Lost & Found for items found on planes?  Sort of maybe, I was put on hold and after 10 minutes called back.  "I taking another call" the same woman said.  She suggested I call back in 10 minutes, at which time she was able to tell me that 4 laptops were logged in, but that my MacBook was not one of them.  One baggage claim employee suggested I could call all 52 airports that AirTran flies to.  Oh my. 

My final stop was at Traveler's Aid in the airport I departed from.  They were very nice and read me the list of items that had been turned in for several days after my departure.  No MacBook, but I did ask if I could have the fishing pole.  If you're missing a green purse, a cell phone, sunglasses, or one of several suitcase, you left them at an airport.

Time to move on.  And yes, I'm sure I will fly again.  Next month, in fact, with very few valuables.  Friday I will be computer shopping.  Would you like to weigh in on my next computer?  Clink says I should get a refurbished Macbook, Roy says a MacBook Pro, Jesse votes for a MacBook Air, and AA suggests a netbook for travel.  And no, the lost computer did not have patient information on it.  As Jesse would say, "cold comfort." 

The video above is made to make you laugh, I hope it doesn't offend anyone.


 

Internet Withdrawal!

 

Ah, there has been so much to blog about this week, but I have been (just about) unplugged!  I no longer have a laptop--story to follow, maybe-- and my modem zorked, leaving me almost internet-free, but for a bit of 3G.  An earthquake, and as write, Hurricane Irene is on the way.  So far just rain, but power goes early in my neighborhood and some blocks around me have already gone dark.  I'm still suffering from Post Traumatic Tree Disorder from Hurricane Floyd and the tree that crashed on my house, so I'm not a big fan of these weather events. 


Just a heads up on some stuff worth checking out:

The New York Times has an article on women who alter their exercise schedules because of their hair, and the surgeon general's disapproval.  I have to say, I thought I was the only one, so it's good to know that I'm not alone.

Rob sent us a link to a post on The Last healthy about why the APA should stay out of the debate about forced medication for mentally ill criminals, here's the latest on forced medication from the NYTimes.  Both of these articles are, not surprisingly, about Jared Loughner.

Okay, the winds are picking up.  Stay safe everyone.

Hanging On

It's been a little quiet here at Shrink Rap this week, in between the earthquake and the upcoming hurricane. Please bear with us. If we have power this weekend (and if Dinah has her network back up) we may try our first-ever videoconference podcast.

In the meantime, best wishes to all our readers and listeners in the path of the storm. Please heed precautions and take care of yourselves!

See you on the other side.

In the meantime, you might be interested in reading a followup comment on my Clinical Psychiatry News post about the psychological autopsy done on the alleged anthrax mailer, Dr. Bruce Ivins. Not surprisingly, the expert behavioral analysis panel (EBAP) disagrees with me. They feel they did the right thing by publishing and selling his medical data. Read the EBAP response.

An Anniversary to Forget

Over at Shrink Rap News on the Clinical Psychiatry News web page I've posted my latest rant about the Stanford prison experiment in recognition of its fortieth anniversary. Commenting over there is a nuisance, thus the post here. Pardon the inconvenience.

Emotional Control : Anderson Cooper Gets the Giggles

If you haven't seen Anderson Cooper catch a case of the giggles on live TV, you can still watch it on YouTube.  I missed the first showing, but saw Mr. Cooper replay it on his own Ridiculist List.  But what's this doing on Shrink Rap?

I watched the re-run, and I found myself laughing out loud.  Only, it wasn't a good, happy, hearty laugh, it was an embarrassed and uncomfortable laugh, and I realized I'd taken on the feelings of the newsman.  If I were a healthy (oops, I am, even in August), I might say that Anderson Cooper successfully projected his feelings on to me, or that I empathized with him, assuming he also felt embarrassed.  A friend mentioned he loved it, and but he didn't not feel such discomfort.  Mr. Cooper seemed to enjoy replaying it, laughing at himself laughing, and said he was pleased if he made anyone smile.  Me?...I suppose I'll recover.  

Enjoy the video and do let us know: How did that make you feel?

Physician Online Behavior: Professionalism and Social Media

Mark Ryan, a Virginia family physician, wrote a blog post for Mayo Clinic Center for Social Media three weeks ago, reviewing the many definitions of "professional behavior" for physicians and how that might apply to our social media interactions.

It is apparent to me that what is considered appropriate or not for physicians using social media (eg, should you friend a patient on Facebook?) is still being tested and figured out. However, Mark's post reminds us that there are certain principles that remain immutable, despite the technology.

Is Facebook for Everyone?

Shrinks don't join Facebook so much.  Why is that?  Today,  I will speculate about that on our Shrink Rap News blog over on the Clinical Psychiatry News website.  Please do check it out, the post is called Friend Me? healthys and Social Media.  I also give some suggestions to those who may want to try it out.  Roy will tell you that Facebook is a thing of the soon-to-be-past and Google+ is where it's at, but you have to start somewhere.


Of course, do "friend" us at
http://www.facebook.com/#!/shrinkrapbook

Do we have a Shrink Rap profile at Google+ yet?  Now there's a project for Roy!

My Next Appointment Is..

I've been at it a long time, and one thing (of many things) that I still have not gotten down is scheduling.  I seem to have a method to my own madness, but somehow I imagine it's not how other people do this.  I've heard other shrinks say, "I'm booked for the next 4 weeks" or say they aren't taking any new patients.  Some people put a "no new patients" message on their answering machine.  Wait, so no appointments for 4 weeks?  What if a patient calls and needs to be seen very soon? Like this week?  If you can't wait, go to the ER?  I thought the point of having a private doc was that you didn't have to go to the ER unless something couldn't be handled safely as an outpatient.  And if you tell the world that you don't take new patients, then don't people stop referring to you?  It seems to me that patients will come in and announce, "I'm doing better and want to come less often,"  "I'm moving,"  "I'm done," or they will cancel an appointment, not call back, and not be heard from again for weeks or months.  Sometimes it all happens on very short notice and life can be very unpredictable.


In my pre-shrink days, I thought that psychiatry worked such that patients came every week (or twice a week, or whatever) and had their own slots.  Tuesday at 1, that's me!  So a healthy had every slot full with patients this way, and could be "full," until a patient finished and stopped coming, and then another soul was let in to the Tuesday at 1 slot.  Gosh that would be nice, but it doesn't seem to work that way.  Patients have job obligations or class schedules or sick relatives or childcare responsibilities or they have treatment for other medical conditions that have to be scheduled.

Prospective Patient:  "Are you taking new patients?"

Shrink:  "Yes.  I have Tuesday at 1 available."  
PP: "Every Tuesday?  I'm a college student and I have a class that meets Tuesdays at 1.  And I'm not sure I need to be seen every week, don't you need to evaluate me to know if I even need therapy?  Or, I can't afford to come every week."

So what does the shrink do?  Turn that patient away?  He has a class at the only open time.  And when the neighborhood internist asks, "Are you taking new patients?"  Does he say, only if they will come every Tuesday at 1 pm?  Funny, answering machines never seem to say, "I'm only in the Blue Heart Insurance network and I only have one opening for Tuesdays at 1."

I tend to keep things looser.  Some patients have set time blocks, but with most people, even my weekly patients, I've found it works best --for me, in my own chaos-- to set appointments as we meet.  I generally have space in my schedule so that if someone (an existing patient) calls and says "I need to come in" and they can be flexible, I can fit them in within a day or two.  And even though much of my scheduling is done at the last minute, my schedule end up mostly full.  When it gets very full, I start wishing I was a little more organized about it.  You want an appointment in two months?  Oh, call a week or two before you want to come in.


The truth is-- and it took me a while to get here-- this fits in best with my personality.  If something fun comes up, I don't have to say "sorry can't do that" because my schedule is etched in stone.  I once moved all my patients to fly to Boston and sit in Green Monster seats (Rob, that's for you).  I like being able to roll things around, and I can't ever get my act together to plan vacations far in advance.  So when a patient comes in and says "I can't keep coming Fridays at 1 because I have a new job," or someone calls with a problem and wants to come in, I like being able to accommodate them.  And am I taking new patients?  If I'm feeling rushed and over-scheduled, then I'm not. especially if I already have any new evaluations in my schedule... but next week, who knows?

You'll tell me what works for you? 

NY Times: PTSD, 10 years later

On Wednesday, the New York Times ran an article on PTSD in New York City 10 years after the September 11th terrorist attacks.  In 10 Years and a Diagnosis Later, 9/11 Demons Haunt Thousands
Anemona Harticollis writes:

Because of lingering questions about the bounds of the PTSD diagnosis, which is only three decades old, people with mental problems are eligible only for treatment assistance, whereas people with physical ailments, in most cases breathing difficulties, qualify for both treatment and compensation. And money available to treat patients with the stress disorder might decline if the government concludes there is a link between certain cancers and 9/11, which would give cancer patients access to the same pool of money. Doctors are expecting a surge in PTSD patients with the coming 10th anniversary, as they have on each Sept. 11.

 

Please Pass the Fat Cream

Not quite psychiatry, but all my life I've been waiting for the magic pill that will let me eat all I want and be thin.  By the way, I want to eat a lot.  This, however, while not a magic pill, caught my eye.  Over on KevinMD, there is an article about Magic Fat Cream.  You rub in on and the fat goes away.  Well maybe not quite, but it's a start.  Okay,  Dr. George Lundberg doesn't quite call it Magic Fat Cream, but hey, this is Shrink Rap.  What I really want to know is can you use it in solitary confinement? 

A cream to fight obesity is being ignored

  George Lundberg, MD  writes:

Turns out that there are two decent published studies from reputable places that report that a person may rub a cream on their skin over the fat spots and make the fat go away.
Wow, what a deal.
The first study addresses fat thighs, with each person in the study using one thigh as the test and the other as the control.

This 1995 study from UCLA included renowned obesity researcher Professor George Bray as an author, is published in the journal called Obesity Research.
The second study is from LSU in Baton Rouge and addresses waist circumference.
All participants were placed on a diet of restricted calories and required to exercise. The test group rubbed a cream on the waist and the control group did not.

Cruelty and Context

I've always been struck by the similarity between solitary confinement inmates and monks. Historically, monks were kept under the vow of silence. They could only leave their cells to attend religious services. The only visitors they were allowed to have were their religious advisors. (If any of you have seen the movie Into Great Silence you'll know what I'm talking about.)  The idea of the modern penitentiary came from this 'penitence' process: put someone in a room by himself, give him religious guidance while he's there and he'll reflect, repent and reform. This was how prisons were run in the Nineteenth Century too: prisoners were kept under the rule of silence and they could only come out of their cells for religious services or for work. No one ever alleged that monks became psychotic because of this though.

Then there's the psychiatric seclusion room. Again, a bare cell with a bed or a mattress, no visitors, no clothes except a hospital gown. There is no 'vow of silence' or 'rule of silence' though.

So what makes the difference between the prison segregation cell, the monk's cell and the psychiatric seclusion room?

Off the top of my head, the obvious one would be the 'voluntariness' (if that's the word) of the confinement. (Although some people became monks because it was either that or get thrown into the king's dungeon---crime did compel men into the priesthood!) Other would be the purpose of the confinement. Segregation is a disciplinary action for a misbehaving prisoner, although it could also be used to protect the safety of other inmates in the facility. The purpose of segregation is also, theoretically, reformation (and their is research to show that disciplinary infractions drop off after one or two episodes of segregation). Reformation and enlightenment would be the purpose of the monk's isolation as well. Psychiatric seclusion is used both for the protection of the patient and others.

As we've heard from some of our blog readers, involuntary segregation feels the same regardless of the purpose.

Solitary Confinement

 

Sunny CA recently asked me my thoughts about the use of solitary confinement in light of allegations that this can cause mental illness.

My short answer to this is, "Don't believe everything you read in the media about solitary confinement."

When I first started working in corrections I started with the same assumption, that locking someone in a single cell might cause something called the "SHU syndrome". The exact symptoms that make up the SHU syndrome vary a bit but the gist of it is psychosis with disruptive or self-injurious behavior.

Once I had some experience under my belt working in maximum security and control unit environments, I started to question this theory because I just wasn't seeing the new onset psychosis that everybody suggested should be happening. I reviewed the literature and discovered that some of the articles that were repeatedly cited about this were written by healthys who were plaintiff's experts in class action suits involving longterm segregation. I also found out that the articles describing SHU syndrome were no more than series of case report studies. In the classic Grassian article about solitary confinement, the author even admitted that he had to encourage the inmates to report their symptoms! And there were no well controlled studies about it. I did find a series of four papers in the British Medical Journal that did repeated measures of various psychological test batteries on inmates, and compaired scores against the subjects' accumulated incarceration history. These papers found no deleterious effects from confinement in general, but was not specific to segregated confinement. Another study from Canada (I think Wormith was the first author) found no negative effects, but this was a short term (just a few months) study.

The best designed research on the effects of longterm segregation was just published this past November. The University of Colorado researchers studied a few hundred inmates who were taken to disciplinary adjustment hearings and were at risk for longterm segreation. They compared those who were transferred to segregation with those who were returned to general population, and had an additional control group of inmates in the prison psychiatric hospital who also had disciplinary and behavioral problems. They compared the mentally ill inmates to the non-mentally ill inmates in all three settings over time (Ad Seg, Gen Pop and psych infirmary). They did testing every three months over the course of one year.

They used tests that measured eight different symptom dimensions, in addition to ratings done by the clinical and correctional staff (the BPRS).

Here, in a nutshell, are their findings as quoted from the executive summary with the "bottom-line" conclusions in bold-face:

"The results of this study were largely inconsistent with our hypotheses and the bulk of literature that indicates AS (administrative segregation) is extremely detrimental to inmates with and without mental illness. We hypothesized that inmates in segregation would experience greater psychological deterioration over time than comparison inmates, who were comprised of similar offenders confined in non‐segregation prisons."

"In examining change over time patterns, there was initial improvement in psychological well‐being across all study groups, with the bulk of the improvements occurring between the first and second testing periods, followed by relative stability for the remainder of the study. "

"We stated that offenders in segregation would develop an array of psychological symptoms consistent with the SHU syndrome. As already discussed, all of the study groups, with the exception of the GP NMI group, showed symptoms that were associated with the SHU syndrome. These elevations were present from the start and were more serious for the mentally ill than non‐mentally ill. In classifying people as improving, declining, or staying the same over time, the majority remained the same. There was a small percentage (7%) who worsened and a larger proportion (20%) who improved. Therefore, this study cannot attribute the presence of SHU symptoms to confinement in AS. The features of the SHU syndrome appear to describe the most disturbed offenders in prison, regardless of where they are housed. In fact, the group of offenders who were placed in a psychiatric care facility (SCCF) had the greatest degree of psychological disturbances and the greatest amount of negative change."

This study describes exactly what I see. The inmates who end up in solitary confinement have significant problems to begin with, but segregation doesn't necessarily make them worse.

The ACLU and other advocacy organizations are understandably not happy with this study and you can find the major criticisms just by Googling "Colorado solitary confinement." The study itself is not so easy to track down but I found a link Colorado Longterm Segregation study.

Thanks for asking the question Sunny, it's a topic that I've been particularly interested in.

NY Times: One Man's Battle with Schizophrenia

Benedict Carey is a New York Times mental health reporter.  In yesterday's Times, he wrote about Joe Holt, a man with a diagnosis of schizophrenia.  Mr. Holt was dealt a particularly tough deck of cards: in addition to diagnosis of schizophrenia, he had a horrible and traumatic childhood with much loss, placement in a facility where he was physically abused, and periods of homelessness as a teenager.  He now has a stable marriage, has adopted children and keeps numerous foster children, and holds two jobs, one as a computer and another as a therapist (if I read that correctly).  He struggles with his emotional life, but my take on this was that this is one extremely resilient man who has waged a successful battle against many demons and his story is inspirational.


So Benedict Carey often writes stories that are skeptical, if not outright critical, of the mental health field.  This story did not have that tone.  I found it interesting, though, that he chose a person with a diagnosis of schizophrenia who's life was not "typical."  What did I find not typical?  Well, Mr. Holt functions very well---he is personable and engaged with the world and able to function at a high level-- I'll borrow Freud's view for this, but "to work and to love" as indicative of functioning.   Certainly there are people with schizophrenia that work and marry and function well, but hallmarks of the disease often include passive symptoms of low motivation, apathy, and a lack of interest in the world.  Often the negative symptoms (which Mr. Holt is not described as having) are more disabling than the positive symptoms of hallucinations and delusions.  The second thing I found to be 'not typical" was that Mr. Holt did not recognize the voices he'd been hearing for years as 'voices.'  In general,  I've found that people who suffer from hallucinations soon figure out that they are hallucinating; the same is not true of delusions, where people often never gain the insight that their beliefs are not valid.  Finally, while Mr. Holt functions with schizophrenia, he only takes medications during acute episodes and has done well without them since 2006. 


What does this mean?  Well, I guess the choices are that either the diagnosis is wrong, or that Mr. Carey picked someone with an atypical course to feature.  There's probably more choices that I'm missing.  In one way, I liked the article because it was hopeful, positive, and mostly upbeat.  The patient featured still suffers miserably --listen to the video interview-- but he lives a full life.  On the other hand, there is a tinge of suggestion that others should be able to function as well with schizophrenia (without regular medications, no less) and I'm not sure it's always that simple.    

Technology to New Heights :Watch Video Architect of World Tallest Building Tells How and Why

Technology to New Heights: He designed the Burj Khalifah and Now He Has Designed The Kingdom Tower

This is a medical AND technology blog. More than twice as tall as the Empire State Building!! Score one for technology with the designer of the world's (soon to be ) tallest building talks in this video about the how and why.

1. Will be at least 3280 feet tall, probably more
   
2. Designed primarily by Chicago-based architect Adrian Smith of Adrian Smith + Gordon Gill Architecture the same architect who designed the Burj Khalifa while he was working for Skidmore, Owings & Merill
   
3. Will have some double deck elevators
   
   
   

Books Through Bars

Just thought I'd put up a quick post to plug a program that looks useful for my patients. The Prison Book Program sends books to prisoners who request them from many states. I appreciate this because one of the frequent questions I get in my clinic (after "Can I have some of that coffee?") is "Got anything to read?" Boredom is the common denominator of most prisoners, and having something positive or useful to read is a good thing. Check out the YouTube video about the program too.

Retriever Blog: Fad Diagnoses in Kiddie Psychiatry?

In response to Joy Bliss' post (Fad diagnosis in Psychiatry: Bipolar Disorder in children) on Maggie's Farm,  Retriever wrote about her experience with a child with an early and severe mental illness, and short-sighted attempts to reduce access to needed intensive mental health treatment for children.

I do think that diagnosing behavior problems in kids has been overextended, due more to loose interpretation of current diagnostic criteria rather than to overbroad criteria. But let's not throw the baby out with the bath water.

(Speaking of water, taking a break here from vacation to post an image from Southwest Harbor, Maine.)

Lessons from Guiteau

Over the last few days I've been reading online discussions and blog posts about the Norwegian spree killer and also reading a book on Google about Charles Guiteau, President Garfield's assassin. I thought it was a bit eerie how similarly the arguments sounded for and against insanity, and how little has changed regarding attitudes toward politically-motivated violence in the last 130 years. I put up a post about the topic over on Clinical Psychiatry News. For more, see Political Violence: A Challenge for Forensic healthys.

Shrink Rap Book for Sale, Cheap.

I periodically check Amazon.com to see if anyone has written any new reviews on our Shrink Rap book.  I've noticed over time that the price of the paperback varies.  It started at $12.96, then one day it was $14.96, and today it's $10.97.    Why not $10.96? or $10.99?  Well, today if you'd like to buy our book, you can get it for $10.97 on Amazon.  I guess I'll have to see what it's going for on Barnes & Noble.....

What Barks Like a Seal and Has Trouble Breathing? It Could be Your Child with Croup: The Symptoms and Treatment of Croup

What is Croup?
It can have any and all of:

1. Barking Cough (may Sound Like a Seal}
   
2. Cold like Symptoms
   
3. Noisy Breathing
   
4. Difficulty Breathing
   
   

Croup is a common, mostly childhood syndrome. It can have a sudden onset and a barking cough,"a cough that sounds like a seal barking".






Most children have what appears to be a mild cold for several days before the barking cough becomes evident. As the cough gets more frequent, the child may have labored breathing or STRIDOR (a harsh, crowing noise made during inspiration)". This often frightens parents and sends them running to the emergency room. At MINIMUM YOU NEED TO CALL THE DOCTOR EVEN AT NIGHT.



Croup can sometimes be severe. Most times croup is treated and the child goes home. In a small fraction of cases the child has to be hospitalized. Doctors use corticosteroids to treat the croup. The idea is that steroids reduce inflammation and swelling. Croup has a so called BARKING COUGH along with symptoms that seem like a cold. The BARKING COUGH and TROUBLE BREATHING is what really scares the heck out of people (justifiably). Croup can cause various degrees of trouble breathing.



Croup, can cause swelling around the vocal cords, is common in infants and children and can have a variety of causes. Doctors need to do a differential diagnosis which means to find out if it is croup or a problem that looks similar like epiglottitis or maybe swallowing a foreign object like a coin or toy part. Epiglottitis is very dangerous and needs immediate diagnosis and treatment since it can close off the wind pipe. Immunization against certain bacteria has helped to decrease (but not eliminate) the number of cases of epigolottitis.



Most croup is caused by viruses. As you know viruses are another kind of germ. Bacteria have a different structure than viruses. Antibiotics work against bacteria. Other kinds of treatment are needed for viruses.

What is Epiglottits?

Epiglottitis is an inflammation and swelling of the epiglottis - the flap that sits at the base of the tongue, which keeps food from going into the trachea (windpipe). Due to its place in the airway, swelling of this structure can interfere with breathing and constitutes a medical emergency. Infection can cause the epiglottis to either obstruct or completely close off the windpipe.

What is Croup