The upside of overdiagnosing

From Reuters Group plc on the proposed revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM)

Citing examples of new additions like “mild anxiety depression,” “psychosis risk syndrome,” and “temper dysregulation disorder,” they said many people previously seen as perfectly healthy could in future be told they are ill.

“It’s leaking into normality. It is shrinking the pool of what is normal to a puddle,” said Til Wykes of the Institute of Psychiatry at Kings College London.

Labeling everybody as mentally ill kind of puts schizophrenia into perspective, then, doesn’t it? The ever elusive “normal” is becoming a shrunken pool.

Progress report from Chris

In the cranial-sacral therapy I have been doing for a few weeks, comfort is key, the therapy is intimate, you are placing your body into the therapist’s hands so it’s best to make the most of your time and listen to your feelings. At our last session the therapist stressed the importance of “mind-body dialogue,” keeping our thoughts firmly grounded in our real-world self. Strong feelings and judgments have their effect on the physical body and during the sessions I am encouraged to notice how certain thoughts are received, if they manifest themselves as tension.

Sound therapy continues to be a source of wonder and amazement. I’d never pay as much attention to a teacher at school or my GP, probably because my ST has all these cool gadgets, a lakefront view and a portrait from the adult version of “The Little Mermaid.” At each session after he plays his kaleidoscopic mix tape we share our impressions of what happened. I say this allows me to see clearly into my past, and he says each sound has with it a certain feeling associated with it. The channel of time is opened up.

Dr. Stern, my psychiatrist has all but said “reduce Serdolect at your own rate.” She genuinely supports my coming off this particular medication and is leaving it up to me. I’m down to about six milligrams from eight, and I could be as low as four by now if I paid more attention to the schedule for reduction prescribed online. Despite the lazy days of summer I’m more than willing to go for a jog in the morning or swim in the evening, partly as an effort to keep my weight down which has shot up again even over the past month.

I wish I’d paid more attention to my brother’s advice to find a job or a course to pass the summer because I don’t have anything to look forward to from one week to the next. Like many other hopefuls to the job market I’m throwing in my lot with a local technical school for computer training in the fall. It will be tough; I’ll have to work with younger people in a non-native language for me, learning something I’m not absolutely crazy about, but it will hopefully lead to better things. Thankfully there’s someone working with me who better grasps the language and the school’s policies. One of my goals is to find someone who wants to learn English to do things together and share language skills.

Chris Forbes

My sweet Lord

The week-end was a whirlwind of consecutive but separate dinners out with two sets of friends who we haven’t seen for a while. The first couple also have three sons like us and their youngest is now officially depressed, seeing a psychiatrist and having problems with his course work at university. In his younger years he was given therapy for some kind of learning related disabilities (dysgraphia being one.) This pattern of ending up with a new diagnosis beyond learning disabilities around the age of eighteen seems to be not uncommon.

This young man has been seen as “having problems,” something not quite right most of his life. I wonder how this image feeds into his sense of well-being and prevents him from being who he is.

Our next set of visiting friends brought their two teenagers with them to the dinner. They are both very bright and engaging. The sixteen year old daughter casually mentioned she was seeing a psychiatrist, so of course, we got talking. Since she seemed so engaged I was trying to figure out the nature of her needing to see a psychiatrist. She was very au courant with her problems, with the jargon, with the limitations of her treatment. She suffers from anxiety. Well, how exactly does this play out, I asked?

What her brother and her agreed on was that there are hours on end when she completely freaks out and makes everyone’s life miserable. Still, I was puzzled because she seemed so aware and self-confident. Then it got interesting. She is a very, very religious Christian. Just talking about her passion for Christ was whipping her more and more into a sort of religious ecstasy and about then I decided to switch topics to diffuse a possible melt-down.

Her parents are very religous, especially her father. Her father is the anxious sort, but, like most of us, age has given him some coping skills. His daughter doesn’t have that filter. A reasonable guess is that her anxiety is related to being afraid to venture out beyond parental control. I don’t believe in Deepak Chopra she said, because he teaches that it’s all about happiness. (I think that’s a misinterpretation of Chopra.) I don’t believe we should live in the now. I want to be with Christ. And, you could tell, she really wanted to be one with Christ. Intense religiosity, in my opinion, is an internal destabilizing force.

From my more pan-Buddhist perspective, I would say a little yoga would temper her fixations.

Waxing philosophical

I made a quick trip to our local drop-in medical clinic this morning before work. My right eardrum was vibrating and I figured it was ear wax. I didn’t want to leave it as long as the last time when I was in real pain and had to get my ear flushed out with water. The doctor had a young medical student with him so spent a long time mapping out the problem for his benefit. According to the doctor, the wax was superficial and dragging a hose in wasn’t necessary.

For the student’s benefit, the old doctor drew some diagrams of the ear with “corridors” leading to the eustachian tube and to the nasal passages. The drawings reminded me of a plumber showing me the cause of the leak or where the wedding ring is lodged. According to the doctor, my nose is a perfect pyramid shape and the narrow bridge can lead to these sorts of problems. “Just take some nose spray and ear drops and have a good day.” This is a my long winded way of saying this is what doctors are good at, the mechanics of your body. The doctor is a technician, like your plumber, like your car mechanic.

You can’t map out the mind like this and say with any confidence where the blockages are.

TED

My day job is seriously getting in the way of my real passions. (Three more years!) The Internet has done some amazing things. Not only am I slowly getting up to speed on Twitter, but I also now regularly run my English through a German translator and vice versa. I can get the gist of what Germans are writing to me. Google Translate, for German at least, keeps getting better and better. You just move the verb from the end of the sentence and jam it somewhere back in the middle until it all makes sense.

A friend recommends TED Ideas worth spreading and raved about Ethan Zuckerman “listening to global voices.” I haven’t watched it yet, but thought you might want to get a jump start.

Sure, the web connects the globe, but most of us end up hearing mainly from people just like ourselves. Blogger and technologist Ethan Zuckerman wants to help share the stories of the whole wide world. He talks about clever strategies to open up your Twitter world and read the news in languages you don’t even know.

Our mission: Spreading ideas.

We believe passionately in the power of ideas to change attitudes, lives and ultimately, the world. So we’re building here a clearinghouse that offers free knowledge and inspiration from the world’s most inspired thinkers, and also a community of curious souls to engage with ideas and each other. This site, launched April 2007, is an ever-evolving work in progress, and you’re an important part of it. Have an idea? We want to hear from you.

Lame misuse of antipyschotics

There is a sad storyin the New York Times today of an abused, neglected boy. What caught me eye was this:

About age 12, Mr. Harris-Moore was determined to have several psychiatric conditions, including depression, attention deficit disorder and intermittent explosive disorder, according to a later psychiatric report. He was prescribed antidepressant and antipsychotic drugs.

So he was prescribed antipsychotics, but psychotic wasn’t one of his labels. This practice is so widespread it’s hard believe in what it is exactly that antipsychotics do. If the drugs are supposed to be needed, what is an antipsychotic supposed to do for someone who doesn’t have psychosis? What does an antipsychotic do for people who do have psychosis?

NAMI’s ties with the pharmaceutical industry

Today’s post is simply a placeholder so I can refer to it in future posts if challenged to “prove” that NAMI cannot be an unbiased source of information about the medications your relative is taking.

Check out the NAMI Corporate Contributions page for the first quarter of 2010. Seeing all those pharmaceutical companies on the list doesn’t look like there is much incentive for NAMI to find other sources of funding.

The NAMI webpage states: The list reflects contributions only to the national organization. NAMI state organizations and affiliates are separate entities and where appropriate are established independently as non-profit 501c3 organizations.

All a-twitter

I feel like I am back in junior high. Anything Gianna Kali posts, I want to copy. If she wore leopard skin jackets and smoked cigarettes from a cigarette holder, I’d want to copy that. By posting really interesting articles, her Beyond Meds blog gives me lots of fuel for my own daily post.

I have been meaning to write Gianna to ask her how Twitter works, because I know she Twitters a lot, and I am in the Twitter slow lane. I know she isn’t responding to e-mail so I am delighted to read her latest postings about Twitter to get a sense of what I am supposed to do. Now if she would only answer the question: How do I condense my blog link into the least amount of characters, and is it bad form to post my own blog link at all?

Akathisia – so that’s what it was!

When Chris was home after his first three month stint in the hospital, and while he was enrolled at the day program, he would pace our small apartment constantly. Round and round he went, round the dining room table, then into the living room, then back out to the dining room, round and round and round. Sit down, we would yell, but he couldn’t sit down. He was extremely agitated. His eyes also sort of rolled back into his head, giving him that “zombie” look. Chris was on the antidepressant Effexor as well as the antipsychotic Respirdal at that time.

There’s the gold standard where doctors, patients and family members know and share what is going on,

From the Family Dysfunction and Mental Health blog
But yes, antidepressants per se can indeed cause increased suicidal ideation, suicidal behavior, and completed suicides. However, I believe this only happens in three very specific situations, all of which can be managed by a competent psychiatrist.

The first situation is when a patient develops a side effect known as akisthesia (sic), which is extreme agitation in which a patient can barely sit still. Milder agitation can also be a side effect. Studies clearly show that a mix of depression and anxiety greatly increases the risk for suicide. The psychiatrist can warn patients about this side effect and tell them to call the doctor if it develops. Tranquilizers usually take care of this problem, but some patients must be switched to a different antidepressant, which may or may not cause that particular side effect.

and then there is the reality:

We just put up with the pacing. Now I find out that there is name to it, “akathesia” and that a competent psychiatrist can manage this. We put up with it because we just figured it was part of the diagnosis. Chris ended up back in the hospital after one month at the day program while they switched his meds. Seems now that all they really needed to do was to get him off the Effexor.

The popping and whistling sounds that Chris made went on much longer. Again, Ian and I figured it was just part of the weird territory of psychosis that we had wandered into. Surely, we figured, Chris was popping and whistling at the day program, and if it was okay with the doctors then it was okay with us. I think this may have been a symptom of tardive dyskinesia, but what do I know? Eventually, he just stopped popping and whistling.

$538,320.20

And the insurance company didn’t even bat an eye. . . This staggering figure is what was billed* to our insurance company for my son between December 2003 and July 2010, for:

1. hospitalizations (three, totalling nine months)
2. Day program (two years)
3. private psychiatrists (two)
4. medications
5. blood tests
6. occupational therapy
7. Tomatis Method (reimbursed under alternative medicine component)

Why doesn’t the insurance company make a fuss about this outrageous amount, I naively wonder. I could have saved them thousands by insisting on one drug for no more than three months of each hospitalization. I am convinced we could have avoided the hospitalizations and day program altogether if I had known about and had access to alternative treatments from day one. Had we (and the doctors) not over-reacted at the beginning, had we been told that schizophrenia was an understandable coping mechanism, things would have been different.

This figure does not include the thousand of dollars we paid out of pocket for vitamins, nor does it include sound therapy, the assemblage point shift and cranial-sacral massage. (The Tomatis Method, which I approve of, costs about $5000.) Heck, if the insurance company had agreed to pay for the alternative therapy, and refused to pay for medications, things would have been very different. As it stands, both my husband and I are embarrassed that my son, a relatively normal, intelligent guy who had a huge existential crisis, has cost the system so much money.

__________________
The figure actually represents three different currencies, which I am treating at par.