Crazy Talk

Psychiatry Needs Jargon

I read an article this week that compared diseases in psychiatry to diseases in other areas of medicine.  The article pointed out that other medical specialties have medical-sounding words to describe many of their conditions.  In other words, jargon.  In psychiatry we treat "depression" and "anxiety", words that have every day meaning that is related (but NOT equivalent to) the illness.  This creates a lot of confusion about what it means to be depressed versus suffering from Major Depressive Disorder as defined by the DSM IV. 

This problem has only been made worse by the increased coverage of mental health in the media.  Now people describe themselves as "having OCD"or "being ADD", or even "being Bipolar". 

It's great that there is a growing awareness of the existence of these various conditions.  The next step needs to be the recognition that these conditions are medical illnesses that are best treated by a doctor (and not the guy behind the counter at Vitamin Shoppe).

Want to learn about mental illness?

I know this posting is overdue and was intended to review exercise tips but I wanted to write a quick post to let people know about a series appearing on public television and available online that provides basic information about various mental illnesses.  I haven't watched the series yet myself but I'm hopeful that it provides impartial information that can be a starting point for understanding various mental conditions including autism, schizophrenia, bipolar disorder, depression, PTSD, obsessive-compulsive disorder, and others.  In short, it covers most major mental illness.  I hope that it takes a step toward demystifying and destigmatizing mental illnesses.

Here's the URL: http://www.wliw.org/productions/local/healthy-minds/season-two-overview/164/

It is on WLIW21 and channel 13 in NY.  The hours are early AM and later in the evening so perhaps best to watch online.

Are we overmedicating kids with "ADHD"?

It pains me to have entitled this post as I did, but I chose to because I know that this is the kind of thing people want to believe.  I'm not sure why, but I have repeatedly encountered this preconception among many different individuals outside of psychiatry.  People love to hear ANY hit of evidence that supports the idea that children are being over-medicated.

I have had to experience being interviewed by reporters on this topic.  I treat no children and very few adolescents and I am by no means an ADHD expert, but like all psychiatrists, I am familiar with the diagnosis and the role of stimulants and other medications in the management of ADHD symptoms.  I have very little if any investment in supporting the use of medications outside of my belief that patients may benefit from their use.  So when the reporters asked me questions about this diagnosis, I was baffled by their absolute giddiness at anything that made it seem that too many prescriptions were being written and their almost depressed-like state when I described the appropriate use of medications.  In both cases, they opted not to pursue the story because, in my view, my expert commentary did not support what they wanted to believe.

Are some children prescribed medications inappropriately?  Absolutely.  Does this necessarily mean that all prescriptions are inappropriate?  Obviously not, but that is the conclusion people gravitate towards.  This simply defies logic.  To make a conclusion like this, you need to have all the facts, not just a hunch.

In Treatment

There is series on HBO that started this week called In Treatment starring  Gabriel Byrne as a psychiatrist.  It airs Monday through Friday, and each half-hour episode is of a session, three individuals each day Monday, Tuesday, and Wednesday, a couple on Thursday, and Gabriel Byrne's session with a supervisor on Friday. 

Because the nature of therapy and the nature of entertainment are different in certain ways, it has been difficult to capture what happens in therapy on TV.  Well, I think this series actually does a pretty good job.  There are some details of the way the doctor interacts with the patients (and with his supervisor) that are not true to life, but overall I think it's pretty good.

For those of you who do not have HBO, the episodes are available on iTunes and for some reason they are being offered for free.  For anyone who hasn't been in therapy and is curious about it, I think it's worth a look.  Even if you have been in therapy, I think the episodes this first week have been entertaining.  I'm curious to hear what others, therapists and patients, think about the show.

Curious About Therapy?

Well, Hollywood and television are catching on to this fact more and more.  Most people know about Tony Soprano's therapy and lots of people in the mental health field like to talk about how realistic it was (or wasn't).  I didn't decided to start this new category (separate from my Psychiatry in the News) category until now because I've been watching more TV lately and have noticed that references to mental health and therapy are cropping up everywhere.

Recent examples include an episode of Numbers (a crime show in which the younger brother of an FBI agent who is a math genius helps his brother by using math to solve cases).  In that episode, the FBI agent brother is coping (or not coping) with having shot and killed an assailant and a side story is his hesitation about getting help with it.  My hat goes off to the writers and director for ultimately having him go to see the psychologist for help.

The other example that comes to mind is a new series about a therapist that focuses on her own life while including some of her clients and their issues.  This is more of a comedy/drama but highlights to me that the entertainment industry is recognizing that people are interested in their mental lives. 

Do I have hope that this will help encourage more people to seek treatment?  I sure do.  Things on TV get people talking and that is the first step to helping people open up to possibilities.  (also the reason for this blog)