Psychotherapy

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There are many times I escort a patient back to my front desk Shouting things like “Never give up! Never surrender!”

I tell them how I was taught to say that when I was on active duty with the US Army Medical Corps.

“Think of whatever inspires you!” If a psychiatrist wonders if a patient is “untreatable,” then all we are really saying is that THAT patient is, at THAT moment, untreatable by THAT psychiatrist. Read more on The Untreatable Patient?…

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No, mental health care is not what it used to be.  Especially inpatient units.

Even though this is a 2014 article, and British, it may articulate the losses more clearly than anything else I have read recently. Read more on …

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At least I finished reading this article without banging the screen.

Even though the amount of psychotherapy I have time to practice is abbreviated and minimal at best, I am glad I know what I do. Read more on …

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I had never heard of ECT (Electroconvulsive Therapy) until I was about 6 years old and my Bobie, my paternal grandmother of blessed memory, was folding laundry on the living room sofa.

“Your mother thinks you are stupid, ” she told me.  “Your mother actually still thinks that you don’t know that her mother, your other grandmother, is locked up in the crazy-house and that is why you never see her and never will.”

I don’t remember yelling or making any sound at all other than bounding up the stairs to my parents where my mother of blessed memory was folding another bunch of laundry on her own bed.

I told her my grandmother had told me this “stuff” and she hadn’t, and I was not stupid and needed to know exactly what was going on.

I barely got the words out of my mouth before my mother slumped on the bed and started crying like an endless fountain, like nothing I had ever seen and told me that it was true, and she just thought I was too young to understand, and she was going to tell later, when she thought I was ready.

I ran quickly into my room and pulled a book from the shelf on my desk and brought it back to her.  As I pointed out, I was reading “All about the Human Body” which told all about sex and the horrible things men and women had to do together to have a child.

They had signed something special that I was mature enough for this so I ought to be able to hear anything about someone who was sick, especially in my own family.

She brought a photo, 9 by 7 inches or so, of her mom in elegant 1930’s clothes.  She looked well-dressed and sophisticated enough, with curly short hair.

My Mother told me then and there that I couldn’t just hear about the sickness.  I had to hear about the woman.  Her name was Sylvia Gutensky Baver.  She has a gravestone in or near Springfield, Massachusetts.  She was a founder and lifelong fundraiser for the Jewish Home for the Aged of Springfield, Massachusetts.

She wanted more education than she had, always wanting to become a nurse or to work in a clinical laboratory or something like that, but my grandfather of blessed memory always said my grandmother was “just fine,” and since he, illustrious son of a blacksmith who owned a pawn shop, would give her everything she needed and she would be fine.

He had been very limiting with her.  She loved to write songs and stories.  He decided there was no question of her becoming published.

“She would have loved you a lot,” said my mother, “because you got to do all the things nobody ever would let her do.”

My mother told me that she sad sometimes happy, with her music and poems and would dance around the house, but became sullen and withdrawn when my grandfather became home.

It had been some kind of one of those old-fashioned Jewish “arranged marriages,” and it sounded to me as if it were some kind of a recipe for a complete disaster.

My mother could only nod.  She cried another flood.  “Yeah, I guess he pretty much drove her crazy.”

She died a couple months later.  My mother took a quick train trip to Springfield for the funeral.  She didn’t tell me why until after she returned.  She didn’t want to hang around with the rest of her family, who were pretty crazy.

I don’t believe her husband could go.  He was confined, by his profound Alzheimer’s disease, to the Jewish Home for the Aged of Springfield Massachusetts, that bore both a plaque to honor her foundership and a plaque as her memorial.

The irony was not lost on me, even then.

My mother told me briefly, only after her mother’s funeral, that my “Bobie Sylvia” had thoughts about killing herself when she got really depressed and saw it really as the only way to get away from my grandfather.

My grandmother’s treatment in Northampton State Hospital of Massachusetts had precious little actual treatment.  Her “work,” my mother said, was a large gray mat, she would knit and rip out and reknit so she “always had something to do.”  She had “some kind of medicine to knock her out,” and there was, of course, the Electric Shock Therapy or “ECT.”

I read enough to know it had evolved.

I didn’t have any kind of major trauma when a senior preceptor offered to “teach” me how to do this.  I did tell my mother, for I felt a little pride the granddaughter of the shockee was going to become a “shocker.”  I was told it paid better than pharmacology, as there was really not much anyone else could think of that could pass as a “procedure” for surgeon-magnitude building in psychiatry.

I think my mother of blessed memory was more traumatized than I when I told her.  Shouldn’t have told her.

Me, I believed (and in a way still do) that this paradox of life simply confirmed that knowledge could produce power.

Here is a little about the history of the procedure.

In my grandmother’s day, the major risk of the procedure was long bone fractures.  Anesthesia is wildly improved since then.

The person lies still and with one or another position or strength of electrode a “grand mal,” seizure, the kind that can make a body shake largely all over, is induced.  Not physically, for the body remains artificially paralyzed, but it is discretely recorded by a little EEG (electroencephalograph) meant to measure the same.

It is still used — and still works amazingly well — for something nobody seems to understand as well as they think they do.  Here is a modern discussion of the procedure from the Mayo Clinic.

Although depression, bipolar illness, and even psychosis can be treated with this, it is usually necessary to show resistance to pharmacology before getting insurance to pay for this.  Even more of a deterrent is patient mythology and fear.  I have not done this for many, many years, mainly because most patients run like crazy when you mention it.  I would not consider it “controversial,” but there are a few side effects and some folks still think it controversial.

As for the illness, my grandmother Sylvia Gutensky Baver was probably bipolar, as were both my parents and my brother, may all of their memories be blessed.

At one time, I kneeled before the Torah on the sacred Jewish altar, thanking God for having spared me from the effects this illness wrought on their lives.

I have used whatever it is I have got to fight this monster.

I think this is a really big piece of how I became the Renegade Doctor.

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I’m on my way to shoot a video with my dear friend Christelle Tachon that will end up on my new podcast site.  This is actually the second time I will have filmed with Christelle, and the first episode with her is nearly completed in the editing process.

Read more on New Podcast Is Available — Mona Jones, Part 2…

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Too many Americans can’t afford to and simply do not–take their medicines as prescribed. That estimate is based on information from the (American!) Centers for Disease Control). I have had patients come into my office who take their medications –in both cases, for life-threatening infectious diseases — only every other day, simply because that is all they can afford. I explained to each one individually the idea of the half-life of a drug. They only stay in your body for a certain length of time, then they leave your body in waste products.  That is why taking a drug every other day is not really effective. They both gave me almost exactly the same response — It was all they could afford, and it was probably better than nothing. Read more on Big Pharma Is Capitalism Out Of Control…

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Back in the days before Noah’s flood, a psychiatrist would take care of both the medical and the psychotherapeutic needs of a patient. Of course, we all knew that it took “a different kind of doctor.”  In the old days they said it had to be a Jewish doctor who was afraid of the sight of blood. Of which I am not — I mean, I used to be a surgeon so I put that one to sleep.

Read more on You Are The Boss of Your Therapy Sessions…

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Back in the days before Noah’s flood, a psychiatrist would take care of both the medical and the psychotherapeutic needs of a patient. Of course, we all knew that it took “a different kind of doctor.”  In the old days they said it had to be a Jewish doctor who was afraid of the sight of blood. I am not.  I mean, I used to be a surgeon so I put that one to sleep.

Read more on You’re the Boss…

Filed under Doctors, News, Psychiatrists, Psychotherapy by on . Comment#

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In my previous blog post, I talked about “Keeping Up With The Kardashians” — and asked some fans for advice for aspiring reality TV stars. If you got drawn in by that, I continued the topic in my private opt-in newsletter.  If you haven’t followed that, you can register for free by filling in that little form up in the top right-hand corner.  It’s a no-spam non-commercial commentary blog and you can opt-out at any time. But there is more to say — and this time, I’m reaching deep into the psychology of those who are in the spotlight and want to be in the spotlight.

The tie between the popularity of reality TV shows and celebrity worship was not immediately evident. But it is obvious that our American society is clearly increasing in — Narcissism. In Greek mythology, Narcissus was a handsome young man who was sitting on a stone precipice, admiring his own reflection in the water, when he fell in and drowned.  The spot where this happened was allegedly marked by the first Narcissus flower. In modern times — like at dinner last night — the narcissus is a wonderful edible flower that is often served as garnish with sushi. Go figure. The queen of the current American psychology of narcissism in unquestionably Jean Twenge, PhD., a professor at the University of California San Diego, who has written a couple of books and lots of articles on the phenomenon of modern narcissism, and has been much interviewed in the public media. In a recent article, she is defending her own research and findings. Frankly, my non-systematic review of clinical data suggest she is right on. She has been criticized — a badge of boldness and popularity, think I — for attributing narcissism somehow to children having been brought up to believe they are special. Once again, I personalize.  My parents filled my head with feelings of being special.  Comparing me to Wonder Woman” and, when I was very young, telling me that I was “smarter than the average bear” like Yogi.

But they also told me this gave me a terribly heavy responsibility,  They impressed this on me mainly through religion — most especially, making sure that I read parts of the (Jewish) prayer book before the service at all holidays and Sabbath.  And we got to temple early, long before services started, because my father of blessed memory had to “warm up” the organ. (He also directed the choir) They never failed to remind me that I was named after Queen Esther, the woman who saved the Hebrew people. In the Book of Esther, she did this by winning a (Royal) beauty contest.  I can’t have been older than 6 or so when I explained to her that if we were waiting for me to save the people by winning a beauty contest, then the people are in trouble. She told me I could maybe do this by working hard in school. I guess the rest is history.  Many have told me I must have been “raised right.”

Narcissism is a concept that originated with Freudian psychiatry.  It was believed to originate in a man when his relationship with his mother was overly close.  Other theorists have suggested in may be related to excessive closeness or neglect from either parent. Here is a good summary of the evolution of the concept, as well as the currently accepted diagnostic criteria. There seem to be biological and/or genetic factors, as well as psychological reasons that people can end up diagnosed as the full blown “Narcissistic Personality Disorder.” A personality disorder is a way of dealing with the world that a human “develops” during adolescence that is dysfunctional, causing pain to the individual and/or to the people in the world who deal with this person. Estimates of prevalence (frequency) of this disorder in the general population is estimated at about 6%.  If you know more than 20 people (you do), chances are you know at least one. They come across as egotistical, to put it mildly.  They are not particularly empathic, blame other people for their problems.  Their self-esteem is inflated. Their attitude toward themselves fluctuates between feeling “omnipotent” and feeling “devalued.” Curiously enough, I seem to be more likely to meet people with this disorder as colleagues or associates than I am to see them as patients.  I believe that to be because when they have troubles in life, they invariably believe the difficulties that caused them are other people’s problems, and not theirs. So it is no surprise that folks with these problems don’t usually show up in a psychiatrist’s office seeking treatment. I can think immediately of a couple of technically excellent surgeons who would meet criteria, as well as a couple of psychologists and psychotherapists.  Especially one who believes herself so gifted in application of a certain psychotherapeutic method that nobody else should perform psychotherapy in any other way.  Of course, it just ain’t so. I shall avoid discussing narcissism in presidential candidates for now, although it is not hard to imagine another posting about that one. When people note there is an increase in narcissism, they do not usually mean the same full-blown personality disorder we are discussing above.  Very often we diagnose narcissistic “traits” for people who have some aspects of narcissism in their personality. There is a fair amount out there. In case you are curious, there is an online test (with a bunch of disclaimers that it should not be used for a clinical diagnosis) to see if you are in any way a little narcissistic. Narcissism seemed historically to be just a little more frequent in men than in women.  However, most of the followers of the Kardashians known to me are women. Some statistics suggest that the growth in narcissism that has taken place in our generation comes mainly from women. Remember, they want to be admired, but may also feel “devalued.” While all these changes in the world have been going on, I have been aging.  I do look at objective research findings to confirm observations whenever I can. Still, I think the page indexed below is correct when it infers more people will look at a woman’s physical appearance than at her character development. Put this into the context of the age of the internet and most particularly, Facebook.  It is possible for a woman who craves more admiration and self-esteem than she has got, to vicariously live the life of someone with the ascribed status that comes with wealth, fame, and physical attraction. This page adopts Twenge’s work and associated studies into a set of directions to help men avoid “hooking up” with narcissistic women. By this time, I have pretty much made up my mind that I am not terribly likely to get a Kardashian-type status in any social context known to me. But I am still wondering — what do I really know about the people, the women who make up a non-negligible amount of people I know either casually or as folks on a professional staff? What do I know about them if they like and follow the Kardashians? Yes, the obligatory formal academic type psychological studies do exist, and have been reviewed. Note that this article focuses on “celebrity worshipers,” who have taken a scale relevant to that entity, which seems to be far from having 100% consistency with the designation of “narcissist,” although I suspect there may be more than a little overlap. This paper specifically cites a fairly large study (343 folks) where 4 of 5 scales on the inventory for narcissism correlate with the Celebrity Attitudes scale for “celebrity worship.” Aspects of psychopathology (that is, mental illness) that are found in the population of celebrity worshipers more frequently than in the population at large include a “proneness” to fantasy and a “tendency” toward addiction, and criminality, depression and anxiety. This particular combination sounds like more than a few of my “dual-diagnosis” patients — that is, folks being treated simultaneously for addictions and mental illness. As for me, I have at least decided that I am not suited for Kardashian-type celebrity worship.  Given the above psychopathology, I am very glad I do not encourage such psychopathology, for I was imprinted with the notion that with great power comes great responsibility (many years before the popular Spiderman movies picked up this slogan). Somehow, I still want to believe that every human has the capability of elevating the entire human race by elevating individuals to higher moral situations. I will cling to these beliefs of my childhood, as anachronistic as they may seem. I feel somehow noble that I have put this effort into explaining what is going on.

The End

 

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Like many others, I am of the type who has been made to feel less.  Less than healthy, less than human; whatever, the kind of feeling that sells diet food and diet plans. Read more on A Few Extra Pounds Might Not Be So Bad…