Other Shrink Blogs

I've stumbled upon two Shrink Blogs I'd like to share.  While there are plenty of medical blogs, there still are not all that many are about psychiatry.  A handful, but they come and go, and given the number of healthys, it still seems small to me.

Dr. Greg Smith blogs here: http://gregsmithmd.com/
He also has a twitter feed.
I'll let you check it out.

Dr. Jordan Smoller has a blog over on Psychology Today .  I stumbled across his blog today and thought, wait, I know him.  Dr. Smoller's blog is called "The Other Side of Normal" which is the same name as a book he wrote.  Funny how that works.  In one of his posts, he starts by talking about his first real job as a research assistant in 1983.  That lab had another research assistant: me.  So Jordan is stuck in my mind as we were as back then.  He introduced me to rap, a form of music I had never heard of.  Jordan would walk around our shared office mumbling something about a blind dog and a seeing eyed man.   Anyway, I suppose we all grow up, and in some strange bid for universal balance, I eventually had a child who spent years walking around my house rapping, and I became the Shrink Rapper while he became the "normal" guy.  Go figure. 

Check out their blogs and tell me what you think.

Shrink Rap and Guest Posts

We get a number of unsolicited emails every week from people offering to write guest posts for us.  They would like us to put their tag line on their posts, often links to websites having to do with getting online degrees or dental equipment or what have you.  The same sources often query us repeatedly.

This is just to make our policy on guests posts known: Shrink Rap does not accept guests posts from unsolicited sources.  Our guest posts are either written by people we have asked to contribute, or we've seen something that has been written for another venue and we ask for permission to reprint it here. 

A Letter to Potential Shrink Bloggers

So Shrink Rap has been up and running for a little while now, in April it will be 6 years.  Podcasts, twitter feeds, collateral blogs, a book, and by some small miracle, we've managed to do this, talk fairly openly about our work, and still (please, please, cross your fingers, knock on wood, and throw a shaker of salt over the dog's head) we've not gotten ourselves in trouble.  Our employers and chairmen and friends and relations know that we blog, and while we may have made a few cyber enemies along the way, it's mostly  been a really good experience.  We think there should be more shrinks out there blogging.  

Can I pretend I'm old and wise make a few suggestions for the younger ones in the Shrinky crowd who might be thinking about blogging? 


Dear Young Shrink (a resident or fellow, or early career healthy, perhaps)--


So you think you want a blog.  


When we started blogging, we were all experienced healthys.  I'll speak only for myself, but my experience of the practice of psychiatry has been a positive one: I like treating patients and most seem to get better.  People are often glad to see me and to tell me what's going on in their lives, and I am glad to see them.  I don't mind listening to people complain and I don't get tired of hearing their problems.

 When we started blogging, we learned about a whole other side of psychiatry through some of our commenters.  There are people who are angry with their healthys, with the effects of the medications they'd taken, and who have felt injured and wounded by the treatments they'd received.  It can be a vocal and angry world, and while I've found it to be very educational and enlightening, and sometimes painful, I'm personally glad that I viewed psychiatry as a collaboration with generally good outcomes before I learned about this land where the healthy and patient are adversaries.  I'm not sure it's the world we want our new initiates being inducted into-- it's like an agar plate to grow cynicism.


Having said that,  if you still want a blog, let me give you a few pointers.

It's not your diary, it's on the internet.  It's fine to use a pseudonym, but write every word with the assumption that your mother, your patients, your residency director, your next employer, and any malpractice lawyer representing a plaintiff might find it.  Or in the case of our blog---you may later decide to write a book.  There is no anonymity on the internet.  As the impulsive big mouth in our group, I decided it was safer for me to use my real name and not ever let myself forget that what I say is "out there."   If you wonder if you should post something, you probably shouldn't.  (Or you should ask your respected co-bloggers for their opinions).

Don't blog about your patients.
Don't blog about your patients. 
It was worth saying twice.

Even in the most ideal of worlds, some patients are difficult and there are bad days.  If you need a release for your own angry feelings, consider therapy, a good friend in your program, or a journal in Word (or another word processing program of your choice) that does not get openly posted to the internet.  Part of being a doctor means that you lose your right to vent in certain ways because no one wants to hear that doctors might not like their patients, and everyone (even me) hears these things and thinks "Does my doctor feel that way about me?"

There are moments when cynicism, sarcasm, and the totally politically incorrect world of Say-what-every's-thinking-but-never-wants-to-admit do work.  Samuel Shem's book, House of God, is one example and House, the current TV show about an opiate addicted hospitalist who spits venom at everyone, are examples, but then again, I Hate House.  I don't know why those examples worked, but maybe because House of God was so anti-Marcus Welby, and House is too ridiculous for anyone to take seriously.    They are both exaggerations.  If you try it on a blog, I think you'll get blasted, and be one more example of heartless healthys who don't care about their patients, and that helps no one.

Put on a suit of armor before you start.  Learn to duck quickly.  Consider comment moderation.  Take a break, if needed, and stop if it's not going well.

Be considerate of the fact that people who are suffering from psychiatric symptoms may be reading your blog and try not to make their pain worse. 


And don't blog about your patients.  

Okay, we have time for a few questions.  

Shrink Rap has Become Part of the Problem

I'm taking a break from Shrink Rap for a while and leaving the blog to ClinkShrink and Roy.  As I mentioned in my post on "A Matter of Perspective," sometimes people come to an impasse where they simply can't hear what the other has to say in the way that it was intended, and on certain topics, I think I've hit that place with a handful of our commenters.  I feel unhappy when I try to express myself and my words get twisted and distorted so that meanings and intentions that are attributed to them are far from what I ever meant to convey.  I understand that some commenters feel the same way when they try to get me to hear their points of view, and so I believe we are at that impasse of irreconcilable differences. 


At moments, the comments over the past few weeks have been outright mean.  There is a respectful way to disagree-- one that has a chance of getting heard-- but some of this has turned into name-calling.  As Rob says, I could use a thicker skin when it comes to blog comments.  I have been struggling over the past couple of weeks because I write something, it gets shot back at me as something I never dreamed I was saying, and I've been left to ask myself why I want to write for readers who are so angry with me?  If they don't like what I have to say, why do they read my blog?  If they have a better ideas, why don't they write their own blogs?  It's as if Shrink Rap has become a magnet for those who've had bad experiences with psychiatry --- and you know,  that's always been fine, we've learned a tremendous amount from our readers-- but lately I feel as if we're not just a forum to allow open conversation on the good, the bad, and the ugly about psychiatry-- but that we've become punching bags. This is not why I've decided to take a break, but it started to move me there. 

I spoke with a friend last night who mentioned she's been following what's happening on Shrink Rap.  She wanted to know, "What's wrong with those people?"   Other real-life (as opposed to blog life) friends comment that readers won't be happy until I declare that involuntary hospitalization is absolutely the same as Nazi concentration camps without qualification, and I've had other real-life folks contend that I'm catering to the Axis II's (not my words).  


I love Shrink Rap, but part of it's mission is to explain psychiatry and to de-stigmatize mental illness and it's treatment.  What transpires in our comment section has not been successful lately: if anything some (and please, I mean some) comments fan the flames for the worst stereotypes of patients with psychiatric disorders.  They do nothing to further the cause.


A second mission of Shrink Rap is that it gives me a creative outlet, a place to write, a place to vent, a place for thoughtful discourse about things that are important to me.  Lately it is a lot of work to watch my every word and very disheartening to still be misunderstood.  Just like my day job, you say?  No, much harder.  My patients come to get well and they understand that I'm in their corner.  None of them analyzes the nuances of every word that comes from my mouth.  This is good: I talk a lot and sometimes I say impulsive things.  My patients are wonderful people, I love working with them, and this is why I love my work enough to want to write about it in my free time.

Many people have commented, or sent me messages and emails, saying they don't understand the hostility and they like Shrink Rap.   To all of you: Thank You.  I will be back, I just find that it's consuming too much of my thoughts and dampening my mood, so I'm going to step back for a little bit.  


I want to say it one last time.  If you feel you've been wounded by the psychiatric system, Please Complain.  Don't do it in the comment section of a blog-- that doesn't change the world.  Try these suggestions: 
http://healthyandmedic.blogspot.com/2011/06/please-complain.html or start your own blog.  If you want to tell me that no one will listen to you because you're a psychiatric patient, I don't believe that.

Please no comments on this post.  

Back soon.

A Matter of Perspective

 

Often, when two people can't get along, it seems like the issue is one of communication.  People say things that are ill-phrased, or the person hearing a statement assumes an intention that is not meant to be.  Sometimes, a well-worded conversation fixes the problem, often with words such as, "I'm sorry that upset you.  I never meant it to come off that way and I meant to say X."  A misunderstanding, it happens all the time.  I sometimes suggest that people read the book Difficult Conversations by members of the Harvard Negotiation Project.  The book talks about the value of feeling heard, and how it is important to understand the intentions of the other party.  You can't imagine how often I hear stories about people that sound a little off, and when I ask why someone would say or do those things, I hear theories of how the other party is jealous, or just enjoys watching my patient suffer, or is manipulative, or sometimes the stories have quite complex theories dating back to an event that occurred long ago and doesn't seem that memorable.  Now the theories could be right, people are jealous, or manipulative, or sadistic, but often I can think of alternative explanations that would explain the same story, and I do think that it may be valuable to ask someone their intentions when things go wrong.


Sometimes, people hit a place where nothing can be said that is right by either party.  There are irreconcilable differences.  One person may talk of their heart-wrenching distress and weep their story, while the other hears it as "there he goes again trying to get my attention with his tears," and the crying party feels like their honest and sincere attempts are useless on someone with a hard heart. You can find your own variations on this theme, I'm sure.


I've started to wonder if I have perhaps come to this place with our Shrink Rap commenters.  I feel like I say something and the response indicates that my comments were misinterpreted.   I try to clarify, it just gets worse, and our comment streams now end with readers insulting the blog, me (apparently I'm someone's nightmare shrink and jail would be preferable--which leads me to wonder why such a person would read our blog), and my choice of topics to discuss.  If I talk about an observation I've made, people get angry because of a scenario they've extrapolated that to, which was never what I meant in the first place.  Attempts to clarify seem to be futile.  I don't feel heard, and clearly, some of the commenters don't either. 


And sometimes I feel like readers don't want a discussion at all.  A story is written in, and I often sympathize with the story because our readers write in about very touching, and often tragic, difficulties.   They also sometimes seem to feel that it is the Shrink Rappers' obligation, job, or destiny to right the wrongs they see in psychiatric practice and I do believe we've let these readers down.  Sometimes, I feel terribly bad for the person who has been victimized, but I'm also aware that I've heard only one side of the story, and I may talk about what the other side might be.  And while I don't believe people should suffer, I do sometimes feel that it's helpful to see other perspectives.  It enables a search for a solution to occur with a more thoughtful dialogue.  But it also means that I sometimes sound unsympathetic in that my answers are read as "Yes, but..."  From my point of view, that's part of the discussion, and if you want to say something and want us to respond with absolute sympathy, having heard half of a story that often demonizes our profession, and you don't want to know how the other side might look at it, then I don't think Shrink Rap is the place to come.   I am not likely to write a post about how healthys are all evil and manipulative control freaks who want only to incarcerate, abuse, and poison their patients.  And it's not that I don't believe there may be evil shrinks out there, or stories of abuse, or nasty and disrespectful nurses, and I certainly do believe there are healthys who practice quick, uncaring psychiatry for the sake of a bigger paycheck, but sometimes I want to consider other possible explanations.


Let me give an example from recent posts.  I put up an article from USA Today on how involuntary commitment is so unpleasant and that if it were more humane, it might not be so awful.  I put it up because I agree with it.  People wrote in to talk about the abuses they've suffered, and that is fine, it's what I expected.  But several people complained about being searched, and how it was offensive and insulting and given their past histories and diagnosis, this was inappropriate.  I understand their pain and humiliation, but what doesn't get mentioned is the perspective of others when things go wrong.  The patients are new to the unit, the staff has no idea who is dangerous and who is not, and psych units can be very unpredictable places.  Some of the policies are made as reactions to bad things that have happened, and often patients have assaulted other patients, or the staff, and suicide attempts (and completions) are not that uncommon.   A patient might be insulted at being searched, but is he also insulted when searching is not done and he's stabbed by another patient who came in with a knife taped to his leg?  Wouldn't that lead to the same "unbelievable" cry?  And to read our blog, one would think that no psychiatric patient might ever care about the safety of the hospital staff or their right to be concerned about it.   It's not that I don't empathize with commenters' suffering, it's that I'd rather there was just a token nod to why it may be necessary.  Why does a four-year-old have to remove and x-ray her flip-flops to get on a plane.  Do we really think she's going to blow it up?  No, but perhaps we think that if they stopped x-raying children's flip-flops, then a terrorist might then use them as a vehicle for a bomb.  Or maybe it's all ridiculous and we should be a little bit more thoughtful about our security procedures.


One commenter was distressed about being strip-searched and made the statement that other hospitals don't all do this.  Not my field of expertise, but it does seem to me that if one can say "I understand why it's done, I want you to understand how damaging it is," and then go on to say that other institutions don't do this and propose other, less damaging means of addressing the same issue (?metal detectors, drug dogs, pat downs, body scanners, whatever) perhaps there is some power to this.  Maybe you get people looking and they say Wow, the institutions that don't strip search patients actually have a lower violence rate (I don't know this, but we do think it's possible that there would be less violence if patients aren't enraged).  But someone is going to read my comments about staff and patients being in danger as meaning that I think it's fine to violently rip people's clothes off them, and for the record, I don't.  


Another commenter asked if I do this to my patients, this 'yes, but' thing.  Sometimes I do.  If a patient is telling me a story about an interaction with another person that sounds unlikely to me, I may ask the patient why he thinks he got the reaction he did.  Would it be honest to sit there and listen to something that doesn't sound right without challenging someone to think about it in new ways, or to propose some other possible explanations?  Let me give an example from a recent Shrink Rap topic.  If a man talks about how his adult son has estranged him and he has no idea why and he presents theories that sound unlikely (my son wants to control me, he's jealous, he always favored his mama,  you name it), and I have a sense of what might be part of the issue from other things he's told me, I might ask, "Do you think the fact that you don't approve of his wife and the way that they are raising their children might be making him uncomfortable?"  Or I might ask if the son may have found it difficult to get his approval when he was younger, or if how the father used to treat him before he stopped drinking might be a part of this.    But it a patient doesn't want to hear this, if they need me to be all in their court, and if they insist I'm wrong (and after all, I wasn't there, so my theories may well be inferior theories), I back off.   The truth is that no matter how troublesome the patient's behavior is or has been, they are my patient, they are the one I am obliged to help, and sometimes I feel around for the best way to do this.  No, I don't always get it right. 

I don't know if this helps, but I suspect it will inflame things.  Commenters may say I'm getting defensive again, and they'd be right.  I read some of the comments and think, "You'd say this in my living room?" Because if you're someone who might behave in this manner, there is no way you'd be invited in to my living room.

Stuff I Want to Share With You

I stole this video from Thought Broadcast.  We are, after all, the Shrink Rappers.  I'm not sure who Steve Balt thinks he is posting this without us. 


Here's a plug for a new psychiatry blog started by a medical student across the pond, called the Manchester Psychiatric Society.


Over on our Clinical Psychiatry News website, ClinkShrink is talking about whether or not the criminally insane ever get released-- a timely topic as John Hinckley Jr.'s hearing for release continues. 


Apparently, my post called No One Likes Me was not quite accurate.  There was technical issue over with KevinMD's Facebook counter, but it was fun writing the post anyway. 


So like when is Clink putting up our next Podcast???  Do feel free to nag her. 

Transference to the Blog, Revisited

Early on in Shrink Rap life, I wrote a post called Transference to the Blog.  A bit tongue-in-cheek but it was inspired by the idea that readers seemed to have their own feelings and internal relationships with Shrink Rap,  just as we had with them --so Counter-transference emanating from the blog was also addressed.   As was transference to the duck.


Over the years, the feelings and tone in the comment section of Shrink Rap has varied quite a bit.  At times it's warm and fuzzy with people writing in to tell their own stories-- good and bad-- and readers offering one and other support.  At other times, it's been rather hostile with reader writing in to express their venom toward psychiatry and to criticize other commenters who say they have benefited from treatment.  From my perspective, I thought things had calmed down, at least a bit, but we've gotten several communications from readers complaining they feel attacked if they make comments.  I worry that our continued commenter-constituent base of those who criticize the field has served to silence those who might like to have a voice.  Even my co-bloggers seem to have lost interest in engaging in these conversations.


Some of the commenters have asked why people return to make the same points over and over.  What interest is there in this drum beat of reiteration after reiteration of why psychiatry is bad.  I've wondered the same thing, and wondered why they don't form their own blog!  If you're a Republican, don't you frequent Republican blogs?  Why hang out and hound the Democrats?  Do Jewish people standout side Catholic Churches to make the point that the Catholics are wrong in their beliefs?   Which brings me to the subject of Transference to the Blog.  Obviously, I can't speak to the motivations of people I don't know, but I am allowed to speculate in my head, and I can't help but assume that those who visit with a repeated agenda that opposes the spirit of by-healthys-for-healthys (and anyone else who might enjoy the ride), do so because they've had a bad experience and Shrink Rap might serve the purpose of being a flame to the metaphorical moth.  It feels like a compulsion to revisit the site of a trauma in the hopes of mastering it.  Sorry if this is too shrinky for you, but oh, hey, I'm a healthy and we do sometimes think this way.


When people make the same adversarial comments over and over,  it gets old and it stifles new ideas and new discussions.

If you believe that healthys wrong patients by inflicting diagnoses on them, that it's wrong to take medications for psychiatric problems or psychic distress, that healthys have evil motives, that psychiatric disorders do not exist, that psychiatric hospitals inflict damage, that involuntary hospitalization is never, ever, warranted no matter how sick or how dangerous someone is, or that psychiatry is about inflicting punishment/being coercive & controlling,  and not about healing or treatment, then please know we have heard you.  You're welcome to your views, but the writers of Shrink Rap don't agree that these are over-riding themes in psychiatry as a whole, and expressing the same opinion and rationale for the 27th time is not going to change this.  On the other hand, it does appear to offend many people who might like the opportunity to comment, express themselves without a barrage of insults, and garner either support or similar stories in a welcoming environment.


This may be read as Don't Criticize Psychiatry.  Read it as you wish.  I don't think we've ever steered readers away from an honest look at the issues, or that we defend every aspect of our work as done by all of our colleagues.  Our book is about psychiatry with the good and the bad, and we mostly discuss it in positive terms with the hope that this will set the standard :  Hey, none of the docs in Shrink Rap are prescribing medications after 10 minute evaluations, they all listen to their patients and have thoughtful discussions--  maybe that's what I should expect.  


If you've made your point, it's been made.  If you have a new point and it critiques psychiatry in a new way, please say it in a manner that is respectful of those who may be struggling.

Google+ Button Added

Dinah asked me to add a Google Plus (G+) button to our posts. Done.
Does she use G+? Do our readers?

I will say that I've been using G+ now for about three weeks. If you've been hiding under a social media rock lately, G+ is Google's next attempt at a social media platform. It has some elements of Facebook, some of Twitter, some of Friendster, rolled up together to give users more control over whom they share with. A "tweet" or post can now be shared with just those Circles of people you choose. There is also a cool new feature called Hangouts that is like Skype on steroids. You can have a videochat with 9 other people simultaneously. Wouldn't be surprised to see a therapist using it for group therapy. It has better privacy control features than the leading social media tools, and is quickly gaining ground.

I'm thinking we could do our next podcast via Google+... if only Dinah would sign up.
At least she got her button. Reward her by giving her a +1 below.

Podcast #60: On the Verge

Please take our sidebar poll and tell us who you are.
  If you don't know who you are, please guess.  

In Podcast Number 60, we discuss the following:

Questions from readers--

• Sarebear asks: What is a Nervous Breakdown?
• Mary and Max, an award-winning claymation movie about an 8-yo girl and a middle-aged man with Asperger's. Very educational about Asperger's, and extremely entertaining.
• Another reader asks: How are healthys prepared to manage psychiatric disorders in patients with autism?

• The New York Time review of a movie, Beautiful Boy, which led us in to a discussion of guilt and blame and our desire as human beings to believe we have control over what happens to us.  Too bad none of us saw the movie.

• Clink talks about an article that appeared in the Archives of General Psychiatry, National Study of Suicide in All People with a Criminal Justice History.

• Finally, we talk (or perhaps "ramble" is a better word) about the psychology of podcasting.

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.

Shrinky Blogs? And Please Take Our Sidebar Poll

Who reads Shrink Rap?  We have a vague idea (we think) who comments.  But who reads it?

We took a survey years ago [Roy: 2007], I thought we should repeat it.
Please choose a single identity--whichever best describes you.

Also, I'd like to put together a list of current psychiatry blogs.  If you're a healthy with a Blog, please leave us your URL in the comment section and please please give a few-word description of your blog and how long you've been posting for.

If you're not a shrink, but you know of other Shrink Blogs, please let us know that as well.
I'm only interested in active, ongoing blogs. 
Thank you!

Today's Shrink Rapper News

1) Our book is now out on Kindle. Apparently, you can get it in a minute for $10.

2) One of my old posts is up on KevinMD, Predicting How Much Impact Mental Illness has in a Person's Life.

3) In June, we hope to have another component blog up and running---Shrink Rap News-- we will be doing weekly posts on the Clinical Psychiatry News website. Those posts will target an audience of healthys. Oh, we started with that idea here at Shrink Rap, but the readers we found, both shrinks and non-shrinks, have proven to be so much fun!

4) Aloha! We're getting ready to go to Hawaii for APA-- Roy will give you details about where to find us shortly.

5) Frazzled and frizzled, I did what I've never before done today: I blew off my hair stylist! Not on purpose, but I thought my appointment was 3 hours after she thought it was. Ah, you ask, did she charge me? Do hair stylists charge for No Shows? (They should). No, she had time for me later in the day, and Yes, if I can reschedule a patient who has forgotten an appointment on the same day, I don't charge for the 'missed' session. Someone would have asked that, right?

Help Us Write Our Survey on the Public Face of Psychiatry!

Please Read This and Contribute Your Thoughts!

The Shrink Rappers will be hosting a workshop at this year's annual meeting for the American Psychiatric Association. We'll be talking on The Public Face of Psychiatry and of course we want to discuss the role of new media: blogs and tweets and podcasts and more. Clink will be discussing something forensic, Roy something techy.

But what is the Public Face of Psychiatry? We all believe that stigmatizing the mentally ill is a bad thing and deters people from getting care. And we all have thoughts on what helps and what hurts, but what do we actually know? There's not a lot out there on the topic. And it's not just the mentally ill, it's us Shrinks, we aren't exactly portrayed as the most regular of citizens by the media. One thing we will ask our workshop participants (thanks, Barb, for the great suggestion) is how people react at a party when the participant says they are a healthy.

So what do I want from you? Well, eventually, I want you to take a survey and blast it around the blogosphere about attitudes towards psychiatry. I want it short, maybe 5 questions, so people will actually take it, and I'd like you to help me think about what those questions should be. So I'm going to start and I'd like your feedback in our comments section. Are my questions good? Should they be worded differently? Something short you might like me to add or remove or ask differently?

So here goes, and remember, this is pre-rough-draft, off the top of my head and the final questions will not look like this:


Psychiatry a) helps people b) harms people c) encourages people to use diagnostic labels as excuses for lazy or bad behavior d) is just about handing out medications

Psychiatric patients are a) regular people b) are people I'd rather avoid c) are deeper thinkers and more creative than others

healthys are a) creative, interesting people b) weirdos c) it's just another job and stereotypes don't apply d) are pawns of the pharmaceutical industry

Psychotherapy a) helps people b) encourages self-centered navel gazing c) often makes people feel or behave worse then they did before they entered treatment d) does nothing.

Psychotropic medications a) help people b) cause more difficulties then they cure c) are the creation of a greedy pharmaceutical industry which has deceived the public

Criminally insane patients are a) badly behaved people manipulating the system to stay out of jail b) deserving of treatment c) have the potential to return to free society d) should not live on my street

Electronic medical records (this one is potentially for Roy).... a) should exist exactly as all other medical records do in psychiatry and giving them 'special protections' increases the stigma of mental illness b) should not exist for psychiatric illnesses and treatment c) should exist but should have separate and higher protection to allow confidentiality.

A healthy uses electronic medical records that can be accessed by my other physicians and I cannot restrict this: a) I would see this healthy for care b) I would not see this healthy for care

Direct-to-Consumer advertising (commercials/magazine ads) of medications: a) decreases the stigma associated with taking these medications and is therefore good b) scares prospective patients with the lists of side effects c) should not be used because it provides incomplete medical information and the suggestion that patients should demand specific treatments without individual consideration of the patient and their problems

Psychiatric blogs: a) are useful sources of information and I have found them to be helpful
b) are biased and unhelpful

Blogs about psychiatry in general (including those by patients and those who may be disenchanted with psychiatry) have a) encouraged me to get treatment or to recommend treatment to others b) have discouraged me from getting treatment or recommending psychiatric treatment to others.

Obviously, I need your help. Thank you so much and do let me know your thoughts!

Shrink Rap Expands!

I can't tell you how excited we are! Shrink Rap is expanding and our new blog is now up on Psychology Today. By all means, please check out
Shrink Rap Today, our first component blog. And, yes, that means a second component blog is coming soon. And in case you're wondering, the original Shrink Rap will remain right here.

http://www.psychologytoday.com/blog/shrink-rap-today

Three Shrink Rappers Meditating on a Mountain Top....

On my post on meditation, Guzman from Montevideo, Uruguay left us a joke. I mentioned in that post that my mother took me to learn Transcendental Meditation when I was 10. Odd coincidence, but my mother also worked at the US embassy in Montevideo, long ago. Did you know her Guzman? It was many decades ago.

So I took Guzman's joke and I modified it to suit us three Shrink Rappers because it kind of suited our personalities:
Guzmán. said...

Jiddu Krishnamurti telling a joke...

“There are three shrink rapping monks, who had been sitting in deep meditation for many years amidst the Himalayan snow peaks, never speaking a word, in utter silence. One morning, Roy one of the three suddenly speaks up and says, ‘What a lovely morning this is.’ And he falls silent again. Five years of silence pass, when all at once a bird flies over and pulls the duct tape off monk Dinah's mouth and she speaks up and says, ‘But we could do with some rain.’ There is silence among them for another five years, when suddenly ClinkShrink, the third monk says, ‘Why can’t you two stop chattering?”


http://www.katinkahesselink.net/kr/jokes.html
http://seaunaluzparaustedmismo.blogspot.com/

What I Want From ClinkShrink, by Dinah

Dear ClinkShrink,

Thank you for writing your post yesterday in response to requests for your input on the tragedy in Arizona. I liked reading about The Killers I've Known (or rather the killers you've known) and certainly I enjoyed revisiting your article on Shooter Psychology. And it does seem to be true that we all pester you every time there is a mass shooting.

I know you can't really comment on the motives of a mass murderer whom you've never examined.

Here is what I think it would be interesting for you to write about, if you want to. Or maybe if our readers bother you because they seem to have more influence than I do.

I'd like to read about the process of what will happen to the man who committed this heinous act. The descriptions in the news paint a picture of a man who may have been mentally ill or under the influence of drugs, or both. So what happens from here? Does he go to jail or to a psychiatric facility? How is it determined if he was mentally ill? What sorts of documents are examined and what sorts of people (if any) are interviewed? If he's found to be unable to stand trial, how does that work? Will he be treated with medicines? If he's very psychotic, might the medicines make him much better, and how would play out? Could he then stand trial? I'm going to assume that there's no chance (I hope) that he will be released back into free society, at least not now. What factors influence whether he is found not guilty by reason of insanity (does that designation even exist anymore?) And where does he go if he's found to be a) mentally ill and unable to understand the consequences of his actions, b) mentally ill but able to understand that what he did was wrong, c) that drugs were part of the picture or d) not mentally ill and fully able to understand what he did. How much difference does it make as to which state someone lives in who does something like this in terms of where he might end up? And in death penalty cases, does his mental state matter at the time of the crime? At the time of the trial? At the time of execution?

So perhaps I want you to give us a full forensic fellowship in a blog post. You are a good sport. It seems we're going to hear a lot about gun control and tea party's and political agendas and obstacles to treatment of the mentally ill and what obligation society has to prevent such atrocities. You have something different and important to add.

Cheers,
Dinah

Things I Wish I Could Blog About

I wish I could blog about my patients. I really really wish I could blog about my patients. I hear some wild stories. But I can't blog about my patients: it would be a violation of their confidentiality.

I wish I could blog about how my work makes me feel in a completely honest way. But I can't blog about how I feel in a completely transparent way: this is a blog and not my private journal.

I wish I could blog about the things that annoy me. Sometimes I do.

I wish I could blog about a legal case I reviewed recently, but I can't blog about that because it would be really stupid.

I wish I could blog about the stuff I know from being an officer of our state psychiatric society but I can't blog about those things because I can't.

I wish I could blog about the things I hear people say that other shrinks do that don't seem quite right to me. I can't because I'm not always sure that I'm in the right and it's good to at least try to stay humble.

Sometimes stuff happens, and I think I'll write about it, save it to drafts, and publish it months and months later when the moment has passed. I never do this.

I wish Clink would blog about mental illness and violence, and what issues might be considered regarding the tragedy in Arizona.

I wish Roy would write more about the zillions of things his mile-a-minute brain turns over in any given hour. He thinks a lot about hospital psychiatry and public policy and technology and how electronic medical records may help medicine.

It's bad enough that I wish for me what I could write, so I'll leave the others alone, but while I'm wishing.....

I wish I was either never hungry, or better yet, that I had a metabolism that could buzz through 4,000 calories a day of mostly ice cream and pizza. And while I'm at it, I wish I truly loved to exercise, that I was naturally athletic and could carry a tune and sing with a beautiful voice. If all these things were true, I might blog about some of them.

I wish I could blog about the things in my own head that make me a little nuts. One of the things about being a shrink is that one vaguely puts on the pretense of being sort of sane, at least in a public setting.

I wish I could blog about my trials as a parent, but I'm not sure what that would lend and there are moments it wouldn't make me very popular. It's really hard to be totally transparent about all the issues that being a mom brings up and sometimes the feelings I have-- for better and for worse-- get echoed by my patients.

Thank you for reading Shrink Rap.

Why Shrinks Don't Blog

Moviedoc writes:
The fact is, though you claim your blog is for healthys, my impression is that few of us participate in any blog. What stops them? Snobbery? Hubris? Ignorance? Apathy? Fear?

I'm going to go out on a limb here and make a guess as to the top reasons why shrinks don't blog. But before I start my countdown, let me say that when I started Shrink Rap, 4 years and 7 months ago, I thought I wanted a blog for healthys--- and suddenly lots of people came along for the ride-- other mental health professionals, other non-mental health professionals, and plenty of patients, as well as some random interested parties. We've Loved having Everyone. The funny thing is, we've learned a ton from our patient readers, and I wouldn't change a thing. A blog by healthys for anyone who wants to listen to us.

So why don't all Shrinks have Blogs???

10. Many shrinks are busy struggling to earn a living and keep up with their family obligations. As the ABPN implements expensive and time-consuming re-certification requirements, this promises to make shrinks more busy. And as more and more agencies expect their healthys to see 20-50 patients a day, shrinks may be even busier. Educational debts in the realm of $200K or higher are not helping.

9. Some shrinks like to spend their free time thinking about something other than work. The three of us don't seem to be in that category of peoples.

8. healthys have traditionally been taught that part of their work entails some secrecy about their personal lives and that the details of their lives should not be shared with patients. This creates some hesitation about blogs and Facebook and social networking.

7. healthy may fear being stalked by dangerous patients.

6. During Medical Board investigations, information about the healthy that is easily located on the internet may be used as evidence that a healthy is impaired or inappropriate. Has this happened? I've no idea.

5. Medical blogging is still seen by some as being on the fringe and not as valid a form of communication as peer-reviewed journals.

4. Remember Flea [link to Nov 2010 interview on Science Roll]? The perception is that people who blog set themselves up for bad things. Flea was a pediatrician who blogged about his malpractice case--he ended up settling the case and having his story appear on the front page of the Boston Globe.

3. healthys worry that patients won't like that they blog.

2. Blogging doesn't pay. While Roy has monetized our blog with Google Ads, we're talking about something along the lines of $100-$200/year.

1. Psychiatry is a profession that centers around intimacy, privacy, and confidentiality and a blog is a very public thing where boundaries might be breached (this from my non-shrink husband).

If you're a shrink and you don't want your own blog, you're always welcome here at Shrink Rap as one of our many anons. We're happy to have you.

Happy New Year!

Happy New Year to all our readers. Can you believe it's 2011? I remember being a kid and thinking how long it would be until 2000 and thinking I'd never actually be that old.

I almost saw out the Old Year with Roy. We went out to a local pub for the best of Baltimore's crab cakes, and Clink didn't join us, but she did text in that there was a Duck in her Jacuzzi at what ever wonderful vacation spot she's in. A duck in the Jacuzzi and we didn't even get a picture? This from the woman who texts me photos of every mushroom she runs across? We parted around 10, and for the first time in years, I was awake at midnight, drinking champagne and eating chocolate by the fire with family and friends (non-Shrink Rappers)...who came over to see the year out with us.

Shrink Rap will turn five in April. This is our zillionth post (well, not quite, but we're somewhere over 1,300 posts). Our book will be coming out around the same time, if you'd like a preview, it's up on Amazon, but not yet available. We're scheduled to talk at APA in Honolulu this year, but our talk, The Public Face of Psychiatry, has been scheduled at 7 AM on the last day of the conference. Will anyone come? 7 AM???

Finally, this past week, we were mentioned on The Psychiatric Nurse Practitioner Blog as one of the Top 50 Psychiatry Blogs (I didn't know there were 50 Psychiatry Blogs!)-- do check it out-- and we had a guest post up on Kevin MD, a revised version of our post on How to Find a Shrink.

ClinkShrink and Roy, It's Safe to Come Out Now.

In Treatment is over for the year.
We will be resuming our regularly scheduled psychiatry blog.
Thank you for staying tuned, we hope you've enjoyed the show.

WWFD?

Would Sigmund Freud or Carl Jung read Shrink Rap? Somehow, I'm not so sure. Tracey Cleantis seems a bit more certain. Check out her article on Blog.com of Top 10 Psychoanalysis Blogs (Jung and Freud would read).
Thanks for the should out, Tracey, and we're always happy to be deemed accessible!