Approach, Not Author

Should I be inclined to comment on the physical or mental health of a public figure, I would need to start with a humongous disclaimer.

I suppose it is common decency that would force me to say I had never met the patient and/or had never been their doctor and/or had never had any access to their medical or psychiatric record.

A published story of a life spent largely in the public eye does not substitute for the “official” types of records “formally” listed above.  This being said, the author of the article linked here is probably at least somewhat correct in her analysis. Side effects of drugs commonly used to treat bipolar patients, as well as the generally poor physical health care generally offered psychiatric patients were probably factors.

My guess is that so were drugs that may have been taken as “substances of abuse,” or other stressors that could sometimes be omitted from “Tell All” books — which rarely do exactly that.

People in 21st century America should not die at age 60 from heart disease.

I still wonder if real “informed consent” for psychiatric medications is ever possible. I don’t know how to put the brakes on for patients (more often women) who sign my informed consents unread, often saying something charming like “You’re such a sweet lady. You wouldn’t give me anything bad.”

Obviously, they usually do not wait for me to caution them about checking “drug-drug interactions,” and they don’t often follow up with primary care or anything like that.

Working on smoking-cessation with the chronic and severely mentally ill is generally a losing proposition. Expect folks who may have trouble sitting still for very long can all too quickly induce anger and defensiveness.

I have even tried telling folks up front that cigarette smoke is like an “enzyme inducer” in the liver. It generally breaks down most psychotropics faster — so the more you smoke, the more you need. So stopping or even cutting back a bit could actually mean you need to be prescribed less!

People usually seem to already hate their psychiatrists so much they are unlikely to listen to me when I tell them this.

Of course, defibrillators should be everywhere (including airplanes) and everyone should know how to use them.

Or at the very least, one person should have passed the relatively small amount of training needed to run a defibrillator in every place (public conveyance, shopping center) that ought to have one in the first place.

I’m staying tuned on this, but I am also more than a bit fighting mad.

There are such things as preventive health protocols. Most folks never worry about their health at all until they or someone close to them has had a real scare or setback.

This is not a new idea.

“Don’t it always seem to go
That you don’t know what you got til its gone.”

Joni Mitchell, 1969, “Big Yellow Taxi.”

As for quality of medical care for the mentally ill, we are easily stuck in circuitous reasoning. I am constantly telling “real ” doctors when a problem with the mentally ill is not “all in their head” but something they have missed. I sometimes also have to tell them to do their job or else I will do my best to get their license(s) pulled.

In some perhaps minimally more subtle ways, we may be telling the mentally ill they are “worthless.”

As for this, we have to listen to consumer groups and do the best we can to make sense of things.