Please Pass the Chocolate

Ah, I didn't win the lottery.  So sad, I had such wonderful plans.


In this week's happiest of news, we learn that people who eat chocolate more weigh less.  Who know?  Yes, I went out and got me some chocolate, per the New York Times suggestion. 


Dr. Golomb’s study, published in Archives of Internal Medicine and financed by the National Institutes of Health, involved roughly 1,000 adults. The researchers looked at data on how often they exercised, the amount and type of calories they ate — including a breakdown of the types of dietary fat they consumed — and how their health and weight related to their chocolate intake. On average, the subjects were middle-aged, exercised about three times a week and ate chocolate about twice a week. There was no breakdown of the kinds of chocolate they ate, whether dark, milk or white.

The people who ate chocolate the most frequently, despite eating more calories and exercising no differently from those who ate the least chocolate, tended to have lower B.M.I.’s. There was a difference of roughly five to seven pounds between subjects who ate five servings of chocolate a week and those who ate none, Dr. Golomb said.

So nice to read something positive.  I'm still recovering from the sadness of learning that diet soda is bad for your heart (are there no guiltless pleasures?) and that red meat is also on the no-no list.  

Off to eat my chocolate....

Back to Work on Monday

So the first thing that showed up on my Twitter feed this morning was a picture of the winning lottery ticket. No, it wasn't any of our Shrink Rappers and it wasn't anybody I know personally. I can tell you that I would definitely not be tweeting my win to the entire world. Somebody is going to live to regret that.

Help Me Spend the Big Bucks.

I bought my first ever lottery ticket today.  Okay, I bought 20.  I wanted a real chance.  The Jackpot is $640 million.  That's a lot of money!  I had to go to two places: the first store was sold out, and the second was a convenience store with a long line and a clerk asking if anyone wanted anything besides lottery tickets.



Okay, when I win, how should I spend my big bucks?

Can You Ever Go Back?

Over on our Clinical Psychiatry News, ClinkShrink talks about the fate of those who have psychotic episodes at work that make national news.  You can read her thoughts Here.  She mentions the Jet Blue pilot who became combative and perhaps delusional enroute to Las Vegas and was held down by passengers, and the airline flight attendant was escorted from her plane last week.  It's bad enough to have an episode of mental illness---if that's what this was-- but to have it announced on  national news makes the recovery all the more difficult.

  I imagine that once an event is so public, an employee's stint with that particular organization may be over, though Clink thinks that if an individual makes a full recovery, s/he would be protected by the ADA.  I'm not so sure about this.  I think there are things that can happen as a result of mental illness (or drug use, or a bad reaction to a medication, or as a result of a metabolic or structural abnormality) that there is no going back from.  


Your thoughts?

Oh To Be Mentally Ill

We talk about the mentally ill as though they are a defined class of people.  The mentally ill need this or that...  The mentally ill live shorter lives.... need different resources...are dangerous...are not dangerous...smoke more...eat less chocolate... whatever....


So who are these mentally ill people?  And what do we mean when we speak of "the mentally ill?"  Community based studies showed many people-- I'm thinking the number is 56%- have a lifetime prevalence for psychiatric disorders, including anxiety disorders, phobias, and substance abuse disorders.  


If someone had a bad episode of depression that resolved years ago, are they mentally ill?  What if they remain well for years but only if they stay on medication? How sick do you have to be and for how long to enter the club? 


The NAMI website says:
Mental illnesses are medical conditions that disrupt a person's thinking, feeling, mood, ability to relate to others and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life.

Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, post traumatic stress disorder (PTSD) and borderline personality disorder. The good news about mental illness is that recovery is possible. 

I'm not so sure that does it for me.  I'll let you chime in.

Review of Crazy

No no, we're not reviewing what it means to be "crazy."  


I recently finished reading Pete Earley's book,  Crazy: A Father's Search Through America's Mental Health Madness.  Fives stars, two thumbs up, all the way.  It was a quick and engrossing read, I think I got through the whole book in three sittings. 


Mr. Earley starts with the story of his son, a young man just finishing college, who becomes delusional and disorganized.  Efforts to clarify a diagnosis and get him treatment are a bit difficult, in part because he doesn't really want help, and perhaps because these efforts span two states as the son is in school in New York but the father lives in Virginia.  Earley goes to NY to fetch his son, and alarmed that he is so delusional, disorganized, and talking about death, he takes him to an Emergency Room in Fairfax, Virginia where he is told that the son can't be committed against his will unless he has already had a suicide attempt.  The son goes home, does some strange things, then breaks into a random house where he shatters pictures, leaves water faucets running, and takes a bubble bath.  He's no longer in the voluntary psychiatric system, per se, but is now charged with felonies that will prevent him from ever being licensed in his chosen profession.  A plea bargain is reached-- for misdemeanors/probation/treatment--  but in court, the prosecutor can't cut the deal because the homeowner-victim won't allow the crime to be pled out without a felony charge.  Does the victim really get to call the shots on what a criminal is charged with?  

Earley is understandably frustrated with the system and all the roadblocks in everyone's way.  He's worried about his son's future, and a bit terrified that his son will get sick again.  Mike can't catch a break, and his diagnosis and criminal record seem to call his life to a halt for a while.  The son does well on Abilify and Earley could be their spokesman.

 The author decides to explore the system by spending a year following patients in the Dade County (Miami) jails and talks about a healthy he shadows who sees his patients for an average of 12.7 seconds.  Earley describes a whole jail unit full of really sick people who are combative, catatonic, and treatment-resistant, in a way I've never seen in nearly two decades of work in community mental health clinics.  Never....well.... Clink says this is all in a day's work for her, but it's not routine stuff for outpatient psychiatry.   The psychiatric unit he describes in the jail is disgraceful, with cold, naked prisoners lying on the floor next to the toilet, in need of blankets and kindness.  It felt like a human zoo, only in animal zoos, the creatures are treated better, I hope.   The tales Earley tells are sad ones, the people he follows end up still sick, imprisoned, or dead, and the system he describes simply doesn't work.  And the patients, some of them are so sick that there is simply no place on earth for them, and Earley faults the state mental hospitals for releasing them.  Even a well-monitored forensic patient ends up doing well, getting a job and living with his girlfriend, only to kill her.   It's all just horrible.  Real life outpatient psychiatry isn't so bleak, and while there are some awful and sad stories, there are many people who do fine.  I felt badly for Mr. Earley because he chose the most dismal of places to search for answers, and I think (or at least I hope) it's unlikely his son will end up in such devastation.  Along the way, he talks with other parents and becomes involved with NAMI.

The author does a good job of getting inside the mental health system.  I didn't agree with him on his easy separation of substance abuse and mental illness, and I don't think we know that drugs don't cause mental illness; they certainly exacerbate it, induce symptoms that mimic it, and make diagnosis and treatment nearly impossible in some settings. 

Mr. Earley is a proponent of involuntary treatment.  He talks to people while they are living on the street, eating from trash bins, victimized by rapists and robbers, and he doesn't buy that people should have the right to live this way.  Earley twice quotes Wisconsin healthy Darold Treffert as saying they get to "die with their rights on."   He wants state hospitals back and he wants them to treat patients humanely.  

If you oppose involuntary treatment under any circumstances, read this book: it will either change your mind or raise your blood pressure.  

Oh, and if you'd like, try Mr. Earley's website and blog at http://www.peteearley.com/blog/

Therapick: Match.com for Finding Psychotherapists

I read today in BusinessWeek about an L.A. startup called Therapick.com, that makes short videos of therapists being interviewed about their practice and style, and allows people to search for therapists based not only on the usual location, insurance, and gender, but also on those intangible qualities best gleaned from a video.

Here's their pitch:

Finding a therapist is a personal experience. On Therapick, you can search videos, read profiles, and email therapists you might want to work with. If you don't like the vibe of a psychologist, counselor, or healthy, move on to the next one. It's that simple. Our videos let you choose.

We've interviewed hundreds of licensed psychotherapists in Los Angeles, Chicago, New York, the Bay Area, and many other popular cities to give you the best selection for individual, couples, and family counseling in the United States. Whether you're looking for psychotherapy, marriage counseling, or even hypnosis, Therapick's videos give you a better sense of who a therapist is before going in for your first visit.

Sounds like an interesting idea. What do you all think?