Enough Medical Marijuana Already

Okay, so even I'm sick of listening to me.  Here in Maryland, there were hearings on 3 proposed Medical Marijuana bills on Friday and Clink and I had an op ed piece in the Baltimore Sun opposing "medical" marijuana.   The governor announced he would veto any Medical Marijuana legislation that passed the Assembly, and while Dr. Joshua Sharfstein, the Secretary of the Maryland Department of Health and Mental Hygiene was instrumental in making recommendations for one of the bills, apparently he testified against his own bill.  So this leaves me as the only person in Maryland who is still talking about Medical Marijuana.  But I am-- I felt like I needed to address those comments on the Sun paper, and I'm going to do so over on our weekly CPN Shrink Rap News blog.  It should appear sometime on 3/15/12 around noon, editor permitting. [Here is the link. ~Roy]

I'll shut up now,  I promise, but I wanted to create this space for anyone who'd rather comment here.   

[other posts on marijuana]

The News is So Depressing Lately

Usually ClinkShrink posts about shooters.  It's really not my area of expertise, but lately I've been struck by how many shootings there have been.  I'm wondering if this is a more common occurrence lately, if it's more publicized, or if I'm just paying more attention.

In the last few weeks, it feels like there is a constant flow of tragedies in the news:
There was the teenager who killed 3 students and wounded two others at a school in Ohio.
A Florida teacher killed the head of his ex-school after being fired .
A gunman walked into a psychiatric hospital in Pittsburgh and killed one person and wounded 6 others.
A U.S. soldier in Afghanistan killed 16 civilians in their homes, including young children.

I suppose the story of the teacher is different in that it was a murder-suicide where the shooter knew the victim and had a motive-- such tragedies do happen often and their news coverage is often limited to local news-- while the other shootings sound to have random, multiple victims, and no obvious motive.  I've actually never heard of a mass shooting in a psychiatric hospital. 

Any thoughts?  Maybe ClinkShrink has some insights.  

Shrink Rapper Updates

I'm not feeling quite so popular today.  Over on the Baltimore Sun's website, Clink and I have an op ed piece talking about our views on Medical Marijuana.  Ah, most of the commenters don't agree with us, and while many of the remarks are thoughtful, many aren't.  Does smoking weed interfere with the ability to spell?    I got one phone call from a gentleman (no name, blocked number) telling me I need my head examined, that marijuana is the safest substance known to man, I shouldn't be popping my mouth off and I know nothing.  Okay, so I know what I'm going to write about for our Clinical Psychiatry News blog this week.


My favorite comment might be:
 ....who are apprantly "healthys."  Make sure next time you disclose the sources of your income for us....BIG PHARMA.  Also, how many patients would you lose if pot were lagal and you didn't have to prescribe Prozac every day?  50%?  75%?
Marijuana is plant and should not be regulated like drugs at all.  Drugs kill.
Drugs are dangerous.  Marijuana is not.

On a lighter note, we talked at Suburban Hospital on Thursday evening.  Over 80 people showed up...on a week night, at 6:30 pm, no less....to hear a bunch of healthys~!  It went well from what I could tell, lots of questions, very few people ran out of the auditorium screaming.  I felt very honored that so many people would come out to hear us.  

I did want to share with you that part of Clink's talk was to read some of the comments we got on the post What is Bipolar Disorder?  I've given talks with Clink a number of times now, but I didn't know she was going to do this and her reading of the comments was moving.  Sarebear, if you're reading this, I wanted you to know that when she was reading your description of bipolar disorder, I was thinking that you need to become a writer.

[other posts on marijuana]

Shrink Rappers at Suburban Hospital Tomorrow Evening

Clink and I will be talking (and Roy on video from the beach) at Suburban Hospital in Bethesda, Maryland tomorrow.   If you'd like to come meet us, we'd love to have you:

March 8, 2012
Suburban Hospital, in the auditorium
8600 Old Georgetown Road, Bethesda, MD 20814
Parking is free after 5 pm

Call (301) 896-3939 to register.
Open to the public

Where Did All The Psych Beds Go?

Roy likes to write about Emergency Departments and Bed Availability for psychiatric patients, but this one came to me, so I'll borrow the topic while he's away.


In the Observer-Dispatch in NY State, Andrew Coates writes in "Guest View: Psych ward closings require public discussions":


The pell-mell closures of inpatient wards at Mohawk Valley Psychiatric Center and at other Office of Mental Health (OMH) facilities around the state are unfair and unwise. The cuts will shift costs to localities even as they rob the same communities, especially Utica, of much-needed jobs.

New York state law formerly required a full year of public notification when OMH planned to close or downsize inpatient services.
But last year, Gov. Cuomo wrote into the state budget a provision that authorized ward closures on 30 days’ notice and facility closures on 60 days’ notice.
 
Coates goes on to say that the Governor has chosen "expediency over community needs." 

It may be politically expedient to turn a deaf ear and a blind eye to needs of patients with serious mental illness. (Patients who are not exactly known for lavish campaign contributions!)
Yet cutting services to vulnerable patients with no serious public discussion of the impact on our communities, with no regard for the human hardship upon patients and their families, is as irresponsible as it is outrageous.


 In the next day's (2/29) Times Union, Dr. Coates then shared a patient's perspective on the bed closures.  The patient wrote:


For many individuals in Mohawk Valley, no one is really sure where they are going. But they are leaving maybe the only home they ever knew. Maybe the only place they ever felt safe.

Mohawk Valley is not perfect but it’s certainly better than the streets. And now the system has failed them – the system itself is failing. The mental health system is stretched to the breaking point already in NYS. Closings are just going to make it worse. People are going to end up on the street.

 I'll leave the comments to you.  I probably would have found the patient's opinion to be more powerful if she had been previously hospitalized in the facility that is being closed.  


Thanks to Meg for the shout out on this issue!

Does Botox Change The Shrink?

So I'm a little older than I used to be and recently when I look in the mirror, I've noticed some lines in my forehead when I make specific expressions.  I'm not so sure I like them; when they show up in photos, they definitely make me look older.  And yet, I know that these lines aren't just from aging, they are an occupational hazard.  Part of attentive listening in psychotherapy involves using your face to convey, in non-verbal ways, obviously, feelings and expressions and interest and even questions.  These are my quizzical lines.  Really?  Don't you think you're kidding yourself there?  Give me a break.  Not a word gets uttered, but oh so much gets communicated in silence, with the movement of just a few muscles.  Yes, Clink, here and there I have a moment of silence.   A short moment, but still.  Wrinkles as an occupational hazard.  


Every now and then I have the thought that maybe I should Botox those lines away, but my first thought is always, will it interfere with my work?  Who am I as a healthy without the Quizzical Look?  Will my patients relate to me differently?  Will they have worse/different/better therapeutic outcomes if my facial muscles are paralyzed?   Oh, and since they came from my work, can I tax deduct the cost of botox treatments?  


No worries, I'll stay wrinkled....or quizzical....as long as Clink continues to be a nun look-a-like and Roy remains a geek. 

T for Two and Two for T.

Today's New York Times has an article about couple's therapy and how difficult this is to do.  The piece is by Elizabeth Weil and is titled, "Does Couples Therapy Work?" 


I don't do couples work.  I didn't plan it that way, but very early in my career, I realized I'd had minimal training in couples therapy and people with marital problems deserved to be treated by someone who had experience in this area.  


I do sometimes see my patients with their spouses,  or even significant others, and it's always an interesting experience.  I also hear from my patients that they will see their partner's therapist for couples therapy, and I'm never sure how that really works--- to me it seems that the allegiance, or agency, of the therapist needs to be clear.  You're either working for the couple, or you're working for an individual.  I don't know how you do both.


Since I only do individual work, it's very clear to me: I'm aiming for what's in the best interest of my patient.  While I may like or respect or wish the best for their parent/child/spouse/or roommate, my goal is to help my patient.  Sometimes it's a single goal: It's never in the best interest of my patient to do something that will cause physical harm to anyone-- if for no other reason than I think my patients are happier when they live in a setting where they get treated by me, and not by ClinkShrink (--meaning, not in jail or prison). 


Sometimes I ask people to bring in a family member.  Usually this is because either I need more information about the history, the current situation,  or about what symptoms the patient may be exhibiting in their natural environment.  More often, I ask people to bring in a family member because I need to enlist their help in either caring for a patient or monitoring them.  Perhaps someone wants to go off a medication and past attempts have been unsuccessful-- it may be helpful to educate a family member as to what the symptoms of a recurrence are and an extra set of eyes may help catch problems earlier than I would be able to alone.  Perhaps a patient needs more help in negotiating the day-to-day issues in life, like getting to a doctor to evaluate that mass, or to evaluate a memory problem.  


More often, people ask me if they can bring their spouse, and it's not my idea.  I often ask what the agenda is to be, why they want their person to come.  Here are some reasons why people bring others to therapy sessions:
--They want me to fix the other person. (I can't do this).
--They want to confront the other person about a problem in a place where they feel safe (Can I go home now?...This is never fun).
--They just want me to meet the person they talk about a lot.  (I often like meeting them and having a face and live person to put to the stories).
--They want me to explain what's wrong with them to someone who cares but doesn't seem to understand (I'm happy to try).  


In a clinic setting where I see people for medication management, it's not unusual for people to bring family members into every session.  The patient may not be someone who talks about their emotions or feelings, or even has any interest or ability to relay to me stories from their lives.  Perhaps they have a brain disorder (like mental retardation or a history of a disabling stroke) and the medications are targeting disruptive behaviors or psychosis, and the person who comes is often the one to identify whether things are going well or not, in conjunction with the patient.

What are your thoughts on bringing significant others to sessions with a healthy?