Monday, March 28, 2011

Stay Awake


Thank you all so much for your feedback on our survey. I'm still thinking about it, but your suggestions have been excellent!

Please join our Facebook page. Again. I'm taking down the original as I didn't realize when I put it up that it would be one more thing to check and maintain and "Shrink Rap" has been a lousy Facebook friend without reciprocating. Roy put up another page, and his twitter feed populates it so that something actually happens-- on a good day, it announces new blog posts, on a bad day, Roy tweets out funny little incomprehensible tidbits. We're our own fans, so we can post to the wall, and there are some pics of real people. And the duck is there. Our page URL is: http://www.facebook.com/shrinkrapbook
Some day, we'll get it right.

We have a new post up on our Psychology Today blog. A bit more of the same, but check it out if you can stand it.

Okay, so here's the real post in honor of ClinkShrink, our caffeine addict.
It's a century since Coca-Cola went on trial for sticking that caffeine stuff in their drink. 80mg, back then. There was a trial, there was research, and here's the article in today's New York Times: A Century Later, Jury's Still Out on Caffeine Limits and Murray Carpenter writes:

Coca-Cola hired a Barnard College psychology instructor named Harry Levi Hollingworth. He mustered 16 subjects aged 19 to 39, including occasional, moderate and regular caffeine users, along with abstainers. In a Manhattan apartment rented for the research, he tested their mental and motor skills under varying levels of caffeine use and abstinence. They took caffeine capsules and placebos — double blinded, so neither they nor the researcher knew which was which — and “soda fountain” drinks with and without caffeine. The trial looming, Hollingworth did it all in just 40 days.

The subjects kept good notes. On Feb. 22, a regular user was caffeine-free: “Felt like a ‘bone head’ all day. My head was dull more than usual.” On Feb. 25, an abstainer was dosed with four grains of caffeine (260 milligrams, the approximate equivalent of a 12-ounce cup of Starbucks coffee): “Gradual rise of spirits till 4:00. Then a period of exuberance, of good feeling. Fanciful ideas rampant.”

Hollingworth found that moderate doses of caffeine stimulated his subjects’ performance on an array of tests, though some slept poorly after the highest doses. His appearance on March 27, 1911, was a high point in a four-week trial dominated by anecdotal, contradictory or sloppy testimony.

The point of the article? 100 years later and we're still asking all the same questions. Go figure.

Wednesday, March 23, 2011

Help Us Write Our Survey on the Public Face of Psychiatry!

Please Read This and Contribute Your Thoughts!

The Shrink Rappers will be hosting a workshop at this year's annual meeting for the American Psychiatric Association. We'll be talking on The Public Face of Psychiatry and of course we want to discuss the role of new media: blogs and tweets and podcasts and more. Clink will be discussing something forensic, Roy something techy.

But what is the Public Face of Psychiatry? We all believe that stigmatizing the mentally ill is a bad thing and deters people from getting care. And we all have thoughts on what helps and what hurts, but what do we actually know? There's not a lot out there on the topic. And it's not just the mentally ill, it's us Shrinks, we aren't exactly portrayed as the most regular of citizens by the media. One thing we will ask our workshop participants (thanks, Barb, for the great suggestion) is how people react at a party when the participant says they are a psychiatrist.

So what do I want from you? Well, eventually, I want you to take a survey and blast it around the blogosphere about attitudes towards psychiatry. I want it short, maybe 5 questions, so people will actually take it, and I'd like you to help me think about what those questions should be. So I'm going to start and I'd like your feedback in our comments section. Are my questions good? Should they be worded differently? Something short you might like me to add or remove or ask differently?

So here goes, and remember, this is pre-rough-draft, off the top of my head and the final questions will not look like this:


Psychiatry a) helps people b) harms people c) encourages people to use diagnostic labels as excuses for lazy or bad behavior d) is just about handing out medications

Psychiatric patients are a) regular people b) are people I'd rather avoid c) are deeper thinkers and more creative than others

Psychiatrists are a) creative, interesting people b) weirdos c) it's just another job and stereotypes don't apply d) are pawns of the pharmaceutical industry

Psychotherapy a) helps people b) encourages self-centered navel gazing c) often makes people feel or behave worse then they did before they entered treatment d) does nothing.

Psychotropic medications a) help people b) cause more difficulties then they cure c) are the creation of a greedy pharmaceutical industry which has deceived the public

Criminally insane patients are a) badly behaved people manipulating the system to stay out of jail b) deserving of treatment c) have the potential to return to free society d) should not live on my street

Electronic medical records (this one is potentially for Roy).... a) should exist exactly as all other medical records do in psychiatry and giving them 'special protections' increases the stigma of mental illness b) should not exist for psychiatric illnesses and treatment c) should exist but should have separate and higher protection to allow confidentiality.

A psychiatrist uses electronic medical records that can be accessed by my other physicians and I cannot restrict this: a) I would see this psychiatrist for care b) I would not see this psychiatrist for care

Direct-to-Consumer advertising (commercials/magazine ads) of medications: a) decreases the stigma associated with taking these medications and is therefore good b) scares prospective patients with the lists of side effects c) should not be used because it provides incomplete medical information and the suggestion that patients should demand specific treatments without individual consideration of the patient and their problems

Psychiatric blogs: a) are useful sources of information and I have found them to be helpful
b) are biased and unhelpful

Blogs about psychiatry in general (including those by patients and those who may be disenchanted with psychiatry) have a) encouraged me to get treatment or to recommend treatment to others b) have discouraged me from getting treatment or recommending psychiatric treatment to others.

Obviously, I need your help. Thank you so much and do let me know your thoughts!

Tuesday, March 22, 2011


Well this was really nice-- author Pete Early quoted our soon-to-be-released book on his blog in a post called
Chemical Imbalances: Real or Imagined?


Pete is the author of Crazy (and many other books), the story of his difficulties negotiating the mental health system. From his website:

Crazy: A Father’s Search Through America’s Mental Health Madness is a nonfiction book that tells two stories. The first is my son’s. The second describes what I observed during a year-long investigation inside the Miami- Dade County jail, where I was given unrestricted access. I feel more passionately about this book than any I have every written. Our nation’s jails and prisons have become our new mental asylums. I wrote this book as a wake-up call to expose how persons with mental illness are ending up behind bars when what they need is help, not punishment.

Looks like something Clink might like? Rumor has it she thought it it was wonderful.

Our thanks to Pete for the early shout-out on our book!

Sunday, March 20, 2011

Collaborative Care: Fix It And Fix Mortality




I briefly scanned the Robert Wood Johnson synthesis report on mental and medical co-morbidity so I thought I'd summarize the highlights for the blog. If you'd rather watch the recorded web seminar you can hear it here.

The report relied on systemic literature review to look at the relative risk and mortality associated with co-morbid medical and mental health conditions. The looked at studies using structure clinical interviews, self-report, screening instruments and health care utilization data (diagnostic codes reported to Medicaid).

This is what they found:

  • 68 percent of adults with a mental disorder had at least one general medical condition, and 29 percent of those with a medical disorder had a comorbid mental health condition
  • These findings support the conclusion that there should be strong integration of medical and mental health care
  • Psychiatric disorders were the most expensive conditions to treat among Medicaid beneficiaries, but also the most common when combined with cardiovascular disease
  • Medical conditions and psychiatric conditions have a reciprocal risk relationship: having one disorder increases the risk for having the other
  • Both medical and mental disorders are associated with low income, poor education, early childhood trauma and chronic stress
  • Four modifiable risk factors are responsible for high rates of co-morbidity: alcohol and drugs, tobacco, poor nutrition and lack of exercise
  • The treatments themselves may worsen co-morbidity (somatic meds cause psychiatric side effects, psychiatric meds may cause or worsen medical conditions)
  • Public mental health clients die 25 years earlier than the average life expectancy (see Figure 4 above for the relative risk of six common psychiatric conditions)
  • Multidisciplinary team approach to treatment is most effective: fully integrated medical, mental health and substance abuse services
So instead of having a public health care system that is fragmented between freestanding clinics, we should have integrated clinics that follow a collaborative care model and that provide a broad range of services. For me this means that we can no longer afford to have disjunction of care between state agencies: correctional facilities and public clinics need to coordinate care for both medical and mental health conditions. This study describes my typical clinic population: poor, poorly educated, sick, traumatized and under chronic stress. They are at greater risk of dying and the most costly to care for.

Saturday, March 19, 2011

Doctors to Go to Jail for Asking Patients About Guns in the Home

Imagine the scenario where you are an ER physician, nurse, or social worker and a person is brought to the hospital by the police for making a suicidal threat.
"I want to die. My wife left me and our house is in foreclosure."--"Do you have any plans to harm yourself?""My dad shot himself when I was little. That's how I would do it."--"Do you have any firearms at home?""OFFICER! Can you arrest this social worker? He just asked me if I have guns at home."[officer]: "Come with me sir. You have the right to remain silent..."
This is the scenario that could actually happen if Senate Bill 432 passes in Florida. The bill makes it a felony to inquire about firearms access or to include any information about firearms access in the medical record, punishable by up to 5 years in jail and/or a $5 million fine. Excuse my French, but WTF?!

An article in the Psychiatric News by Bob Guldin explains that the bill was introduced in both the House and Senate at the suggestion of the National Rifle Association (NRA) to prevent intrusion into the constitutionally protected right to bear arms.

It has been shown that removal of firearms from the home reduces the risk of a completed suicide. So you'd think such a bill would get laughed out of the legislature? Florida child psychiatrist and APA Assembly recorder said, "This bill is not a stunt... the financial power of the NRA in Florida will make it very difficult for sensible legislators to vote against this bill."

I note that a second version of the bill has been proposed, one that reduces the fine to a minimum of $10,000 for the first offense and a minimum of $100,000 for the third offense. It also reduces the offense from a felony to a "noncriminal violation" and compels the states attorney to pursue a possible violation or face professional misconduct charges. This version does permit certain health care providers to ask the question only in certain specific situations (e.g., an emergency "mental health or psychotic episode") but cannot tell anyone else other than the police. Apparently, a similar bill passed one house in Virginia five years ago before dying.

Next will be a bill that outlaws common sense.

********************

Clink comments: We've talked about issues related to guns before here, in Dinah's post "Guns and the Mentally Ill" and again when I mentioned a poster session that talked about gun ownership laws nationally. At my last American Academy of Psychiatry and Law conference I mentioned that 27 states have statutes with lifetime restrictions on gun ownership for people with mental illness. Other states have time limited restrictions on ownership, and some allow restoration of full rights contingent on a physician's documentation of recovery.

So now we have a dilemma: in states where you need a physician's certificate to buy a gun, how can that same physician then be banned from asking about ownership?? I can imagine the session in which a patient comes in to be "cleared" to buy a weapon.

MD: "Well, you're taking your medicine and your symptoms are all under control. You tell me you're feeling well and you'd like to buy that awesome weapon you've been dreaming about."

Gun buyer: "Yeah! I've done the research and I know exactly what I want."

MD: "I need to know whether you have cognitive skills and emotional stability to handle a responsibility like that. Tell me, have you ever owned a gun before?"

Gun buyer: "Awesome!! Now I can sue you for infliction of emotional distress for violating my Second Amendment rights. Those triple damages will really help me stock up my arsenal."

Bottom line: The NRA can't have it both ways. If they involve psychiatrists in restoration of gun rights, they can't ban them for asking questions about ownership.

Wednesday, March 16, 2011

Questions for Clink


One of our Psychology Today readers sent me a number of questions for our podcast, but since Dinah is away and we won't be podcasting for a week or so I thought I'd answer the questions here.

Snowtigress62 asks:

1. I am curious to know where a psychiatrist would go if they needed to seek professional help for personal problems they might be having.. would you go to a fellow psychiatrist you know or someone you don't?

---Depending on where the psychiatrist practices, the psychiatrist may not have any more choice about health care professionals than anyone else. The psychiatrist might be the only psychiatrist (literally) for hundreds of miles. When there is a choice, the psychiatrist would probably always choose to be treated by someone other than a professional acquaintance.

2. Is there stigma in the psychiatric community about a psychiatrist seeking
help from another one?

---I don't think so, at least not to the degree that one might find among the general public or among other professionals. Many psychiatrists seek out therapy as part of their training experience and this is generally accepted. Many states also have physician assistance programs affiliated with the state medical board that can help doctors with substance abuse or psychiatric problems, and the treatment is provided confidentially.

3. Do you feel in general that psychiatrists and psychotherapists are becoming too quick these days to dispense medication due to patient overload rather than working with them to deal with their problems without use of medications? what did we do before anti depressants where around?

---I don't think psychiatrists are quick to dispense medication, although this decision can be affected by the treatment setting. A doctor working on an inpatient unit will be under pressure to keep length of stay down and initiate treatment as soon as possible. The psychiatric inpatient will also generally be more ill than someone treated in an outpatient setting and may require medication sooner. Outpatient doctors, on the other hand, are more at leisure to gather more information, observe the patient for a longer time before making a diagnosis, and to wait to see if symptoms start to resolve spontaneously. As a general rule though I think people don't go to see a psychiatrist now unless they've had symptoms that are severe or longstanding. Less severe syndromes are more likely to be treated by a family doctor, internist or nurse practitioner. When people talk about psychopharmacology they often forget that most psychotropics are now prescribed by non-psychiatrists.

Regarding what people did before antidepressants were invented: they suffered. Although untreated depression can resolve spontaneously, episodes can last for months and can be extremely debilitating. In the "old days", patients were sometimes admitted purely for custodial care since there were no actual treatments available. Non-pharmacologic interventions were pretty crude: cold wet packs and insulin shock. Although electroconvulsive therapy has been around for a long time, it can still be an effective treatment for immobilizing, life threatening or treatment resistant depression.

4. What would you say to someone who is the victim of a violent crime and is furious when they find out that the person responsible for the crime is getting free psychiatric and mental health care through the prison system, and they can't get a psychiatrist for help getting dealing with their trauma from this crime due to lack of medical insurance and lack of psychiatrists?

--I don't think this reaction is limited to the victims of violent crime. Many people don't understand why prisoners get free treatment when non-criminal citizens don't (at least, not here in the United States). Prisoners don't have a right to treatment per se; the government is just barred from blocking access to care. If you incarcerate someone in a facility with no doctor, the state has effectively barred that person from seeking care on his own because he has lost his freedom. An analogous free society situation would be if the state called out the National Guard to surround your local hospital and prevent people from entering. The U.S. Supreme Court has said that it's unconstitutional to bar prisoners from access to medical care.

Fortunately, some states have something known as a victim injury compensation board. This board reviews applications submitted by crime victims, and provides limited financial support for things like therapy, medical treatment or funeral expenses. Victim assistance programs also may provide referrals for support groups for families of homicide victims.

5. Do you deal with prisoners on death row and if so how does this affect
you?

---Yes, I've treated death row inmates although the state that I work in has not carried out an execution in many years. I've seen little difference between death row inmates and other violent offenders other than differences based on age. Death row inmates are often older, calmer and more philosophical than young newly incarcerated violent offenders.

How does it affect me? I enjoy working with prisoners. In order to be a forensic psychiatrist one has to have a certain level of tolerance for hostility, impulsivity, immaturity and occasional bloodiness. It goes with the business.


Lastly, from snowtigress62:

That's all for now. I wanted to say I really enjoy your pod casts, they're
great and a lot of fun. I have recently downloaded all 55 (?) episodes and
have been enjoying them on the way to and from work. I am curious tho, I see
they are coming out less often... please tell me your not going to stop doing
them?? I loved the Dr. Phil one, your laughter cracks me up!

---Thanks! Wow, all 55---that's a lot of commuting time. We are definitely still doing the podcasts. We took a one year hiatus while writing our book "Shrink Rap: Three Psychiatrists Discuss Their Work." Now that the book is done we plan to be more regular about our podcasting schedule.


Thanks for your questions.

Saturday, March 12, 2011

The Gulag


Dinah is away this week so Roy and I are filling in. Here's a quick blog post (more to come). I stumbled over the Center for History and New Media web site this morning and found a video tour of an old Soviet gulag. In addition to the video, there's an accompanying audio tour (in Russian, with an English text translation). The camp is better than most, from what I gathered from the description, because it eventually housed formerly high-ranking prisoners. The thing that struck me most was this comment by the tour guide, about transfers out of the gulag to other facilities:

"If one could leave a camp or a jail, a mental institution meant a life sentence, because the effect of mind-altering drugs could not be reversed."
I wonder how many tourists have gone away from that tour thinking that psychiatrists are equivalent to political persecutors. I've seen this attitude about psychiatric medications reflected in some legal opinions here in the United States as well, thankfully in cases a couple decades old, but present nonetheless---the idea that psychiatric medications are "mind-altering" rather than "mind-correcting."

Of course, there are people who have been hurt by psychiatric medications or who feel that they have been permanently damaged by them and I'm not dismissing or ignoring those experiences. I was just struck by the international nature of the stigma about meds.

Friday, March 11, 2011

Roy is Driving Me Crazy!



I'm at my office today and I turn on my phone between patients. There's a text and a message, both from the same person. "Where is Roy, he's supposed to be here at a meeting? Can you contact him?"

Interesting. I scratch some body part or the other. Am I Roy's mother? Did someone forget to tell me? I forward the text to Roy, and welcome in the next patient. After that session, I check messages again. Roy has texted me, "I can't talk, I'm in a meeting." I guess he got there. Oh good.

And the blog. We have a rule about the sidebar: Dinah doesn't touch it. It's Roy's rule, but I've had a few problems, so mostly it's okay. But then, I decided I wanted a duck on the side bar. I put one up. That I can do. Roy took it down, because if I say Earth, Roy says Mars. Duck> No duck. No duck> Duck. Should I start reverting to reverse psychology? What was wrong with the duck? I liked it. Roy put up a link to our book's Facebook page---you remember, that book we've been writing for about a zillion decades that never actually materializes. I promise (I hope) that it isn't just a pipe dream. So the book's Facebook page has a whopping 8 fans and their photos are shown on our sidebar. Does Jesse the Chinchilla Lover want his photo on Shrink Rap? Do we want to advertise our 8 fans? I take it down. And Roy tells me he's frustrated that I undo things he does without talking to him first. But my duck-- he took down my duck! And he didn't talk to me first.

Why does Roy want the Facebook page up anyway? Does it matter? How will our Shrink Rap Book FB page change the world? Oh, we had tried a Shrink Rap friend page, but that was too hard to manage. I had to sign out of my own account and confirm new friends, and interact with them, and I'm a bit on overload (in case you couldn't tell!). We tried a "fan" page and that was fine. Only it was linked and combined with the
friend page and who knew what was what. I was pretty confused and I created them! So Roy made us a FB book page, only the book's not out, so he doesn't want anyone to know. But he does want 25 people to be fans so he can reserve a specific URL for it. HuH? And then he put his twitter feed in to it which would be good---Shrink Rap posts would populate the wall, but then he had a twitter conference and all sorts of random tweets went twitting away on the wall and in my News Feed. I think I'm way too old for this. Anyway, Roy is driving me crazy.

Please join our Shrink Rap Book page so Roy can drive you crazy, too.

And Clink has a new "old" post up on Shrink Rap Today over at Psychology Today.


Wednesday, March 09, 2011

Guest Blogger Dr. Robin Weiss on Stigma and Health Insurance Parity




I'm borrowing this from Robin, who wrote it a while back when she was our state psychiatric society's prez. A little background: Robin was a pediatrician, turned health policy expert, turned psychiatrist. I'm guessing that she didn't do her second residency training in psychiatry so that she could write prescriptions for 40 patients a day, but I could be wrong. Except that I'm not.

---------------------


Psychiatry has always seemed to me to be the most fundamental and inclusive medical specialty. What psychiatrists understand is this: Human illness is a dynamic function of genetics and environment, and genetics and environment are further influenced and changed by each other. So we understand that existential angst, psychodynamics, family structure, goodness of fit between parent and child, inborn temperament, neurotransmitters, brain structure and function, and more, are all part of the illness mix -- just as true listening, various forms of psychotherapy, and psychopharmacology are all part of the treatment. It is this understanding that elevates psychiatry to a model for all medical specialties. Furthermore, mental illness disrupts and damages those very human capacities that we value most -- our thinking, our emotional lives, and our behavior. I don’t mean to create a competition among the organs (pancreas, liver, kidney vs. mind/brain), but certainly those functions executed by the brain underlie all else. In light of all this, what could possibly account for psychiatric treatment’s peripheral, holding-on -by-the-skin-of-our-teeth insurance coverage status?

Dr. Myrna Weissman, in JAMA, wrote an editorial titled Stigma. She describes the experience of her friend’s fourteen year old son as he struggled with first, serious mental illness, and later, leukemia. What his mother encountered first was her insurance company’s refusal to authorize a comprehensive evaluation; a useless three day hospitalization leading to an episode with the legal system; blame for her son’s behavior; and more care provided by the education system than by the medical care system. What she encountered when he developed symptoms of leukemia was prompt diagnosis and full treatment; an expectation that there would be relapses; compassion and support; and full insurance coverage for hospitalizations, partial hospitalizations, and home care. Dr. Weissman concludes that the stigma associated with mental illness leads to lack of insurance parity, which leads to heartbreakingly bad care -- this, at a time when each week brings breathtaking new research findings about the etiologies of mental illnesses and their treatment.

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So what do you think? This paper was written in 2001. Has much changed? We hear a lot about psychiatry being under-funded because the research and the proof aren't there. It seems it can always be done with less (less time, less therapy, less hospital beds --okay, fewer hospital beds--, less expensive medications, less education) or so we're told. I personally think the insurance companies simply want to part with as little money as possible, and that certain illnesses garner more sympathy than others. Can you imagine the uproar if an insurance company refused to pay for a child's treatment for leukemia? And with all the push for parity, is it getting any better for psychiatry? Or is just getting worse for the other specialties?

Monday, March 07, 2011

Shrink Rap Expands!




I can't tell you how excited we are! Shrink Rap is expanding and our new blog is now up on Psychology Today. By all means, please check out
Shrink Rap Today, our first component blog. And, yes, that means a second component blog is coming soon. And in case you're wondering, the original Shrink Rap will remain right here.


http://www.psychologytoday.com/blog/shrink-rap-today

Saturday, March 05, 2011

Talk Doesn't Come Cheap



Gardiner Harris has an article in today's New York Times called "Talk Doesn't Pay So Psychiatrists Turn to Drug Therapy." The article is a twist on an old Shrink Rap topic--Why your Shrink Doesn't Take Your Insurance. Only in this article, the shrink does take your insurance, he just doesn't talk to you.

With his life and second marriage falling apart, the man said he needed help. But the psychiatrist, Dr. Donald Levin, stopped him and said: “Hold it. I’m not your therapist. I could adjust your medications, but I don’t think that’s appropriate.”

Ah, Dr. Levin sees 40 patients a day. And the doc is 68 years old. This guy is amazing, there is no way I could see 40 patients a day for even one day. He's worried about his retirement, but I wouldn't make it to retirement at that pace. Should we take a bet on whether Dr. Levin has a blog?

So the article has a whimsical, oh-but-for-the-good-old-days tone. In-and-out psychiatry based on prescribing medications for psychiatric disorders is bad, but the article doesn't say why. In the vignettes, the patients get better and they like the psychiatrist. Maybe medications work and psychotherapy was over-emphasized in the days of old? The patients don't complain of being short-changed, and if Dr. Levin can get 40 patients a day better for ---your guess is as good as mine, but let's say-- $60 a pop and they only have to come every one to three months, and there's a shortage of psychiatrists, then what's the problem? Why in the world would anyone pay to have regular psychotherapy sessions with the likes of someone like me?

After my post last week about The Patient Who Didn't Like the Doc. On Line , I'm a bit skeptical about on-line reviews. Still, I Googled the psychiatrist in the story, and the on-line reviews are not as uniformly positive as those given by the patients who spoke to Mr. Harris. Some were scathing, and they complained about how little time he spends with them. In all fairness, others were glowing.

The article makes psychiatrists sound like money-hungry, unfeeling, uncaring, sociopaths. Either they're charging $600 a session (...oh, can I have that job?) or the financial aspect is so important that they're completely compromising their values for the sake of a buck. This doctor believes that patients get the best care when they receive psychotherapy, and the rendition Mr. Harris gives is that it's understandable that he's compromised his values to maintain a certain income. I don't buy it and I don't think it portrays psychiatrists accurately or favorably. If the doctor felt that it was the high ground to give treatment to 40 patients a day who otherwise couldn't get care, then this portrayal wouldn't be so bad. And that may be the case---I don't know him and I don't know Mr. Harris and I do know that an occasional reporter has been known to slant a story. I found it odd that there were no other options here aside from 4 patients/hour, 10 hours/day, not to mention the 20 emergency phone calls a day that he manages in the midst of all the chaos. Why hasn't this doctor left the insurance networks and gone to a fee-for-service model with a low volume practice if psychotherapy is what he enjoys and what he feels is best? Or why doesn't he devote an hour or two a day to psychotherapy? Okay, I shouldn't rag on the poor doc, I only know him through a newspaper portrayal, but I don't think this article showed psychiatry at its finest hour. And yes, I know there are psychiatrists out there who have very high volume practices.

Thursday, March 03, 2011

i before e, except after w?


I mean we're shrinks, we deal with the weird everyday. If anyone knows weird, it's us.

So I get this email from Roy.
Stop spelling it "wierd" it's "weird" you have it stuck in your head wrong. He's right and he gave me a long list of places on Shrink Rap where weird is misspelled as 'wierd.' Only they weren't all me. Clink did it a couple of times. Sarebear did it in our comment section. I did it a bunch. This is weird. But it is "i before e except after c"...right? Why is weird spelled weirdly?

Maybe I need a new word. Strange. Unusual. Unconventional. Odd. That's a good one, even I can't spell "odd" wrong.

From Wikipedia:

Old English wyrd is a verbal noun formed from the verb weorþan, meaning "to come to pass, to become". The term developed into the modern English adjective weird. Adjectival use develops in the 15th centrury, in the sense "having the power to control fate", originally in the name of the Weird Sisters, i.e. the classical Fates, in the Elizabethan period detached from their classical background as fays, and most notably appearing as the Three Witches in Shakespeare's Macbeth. From the 14th century, to weird was also used as a verb in Scots, in the sense of "to preordain by decree of fate".

The modern spelling weird first appears in Scottish and Northern English dialects in the 16th century and is taken up in standard literary English from the 17th century. The regular modern English form would have been wird, from Early Modern English werd. The substitution of werd by weird in the northern dialects is "difficult to account for".[1]

The now most common meaning of weird, "odd, strange", is first attested in 1815, originally with a connotation of the supernatural or portentuous (especially in the collocation weird and wonderful), but by the early 20th century increasingly applied to everyday situations.[2]

Enough. It's all too weerd. The chinchilla is for Jesse because his preoccupation with the little rodents is kind of ....different.

Wednesday, March 02, 2011

We Still Don't Say



It's been nearly 5 years of Shrink Rap posts--this is post number 1,402. I've rambled and ranted so much, I don't know what I've said and what I haven't said, much less what the other Shrink Rappers have talked about.

So Meg asked ClinkShrink to comment on this article about Bernie Madoff's psychotherapy in prison. Mary Jo says we could have a field day with Charlie Sheen (it was a joke, as evidenced by the : ) in the comment...at least I think it was a joke).

Instead, I thought I'd write about the Goldwater Rule and how shrinks can't talk to the media about people they haven't examined. This feels familiar. Maybe ClinkShrink already posted about it? A quick search, and I 'remembered' that I wrote a post called We Don't Say just about two years ago.

Regarding Bernie Madoff and Charlie Sheen, I think we'll stick to "No Comment."