Thursday, May 30, 2013

Thoughts on the Murder of Lee Rigby

5/30/13. Dr. Dalrymple, former British prison psychiatrist, comments on this brutal murder.

"A witness to the brutal hacking death of a British soldier, Lee Rigby, a few hundred yards from his barracks in London, had the presence of mind to record the explanatory statement of one of the perpetrators, Michael Adebolajo, on his phone immediately after the crime. What Adebolajo said—his hand bloody from the attack and still holding the meat cleaver with which he carried it out—was revealing, as were his manner and body language. Together, they showed him to be the product of the utterly charmless, aggressive, and crude street culture of the less favored parts of London. The intonation of his speech was pure South London, as was the resentful tone of thwarted entitlement and its consequent self-righteousness. His every gesture was pure South London; the predatory lope with which he crossed the road after speaking into the camera was pure South London..."

Wednesday, May 29, 2013

A Better Way To Treat Teens with Anxieties

5/29/13. The benefits of exposure therapy --- start will a small dose of the feared object (dogs) or event (public speaking), and gradually expose yourself to small step-wise progressions towards overcoming your fear.

Monday, May 27, 2013

'Death with Dignity' Claims Another Victim

'Death With Dignity' Claims Another Victim

Now Vermont has joined the misguided movement toward physician-assisted suicide.

In the Wall Street Journal (5/24/13)

Nearly 30 years ago, Arnold Schwarzenegger's "Terminator" character made famous the phrase "I'll be back," the implacable cyborg assassin's response to a setback. Today, similarly relentless terminators are among us, also with a deadly mission: to move America toward acceptance of physician-assisted suicide.

On Monday, the terminators gained a victory when Vermont Gov. Peter Shumlin signed into law the "Patient Choice and Control at End of Life Act." The bill had been passed by the state legislature the week before without consulting the electorate, possibly because the lawmakers had seen what happened last fall next door in Massachusetts, where voters rejected a similar initiative. Now Vermont doctors will be able to prescribe lethal medication to patients as the state joins Oregon, Washington and Montana in supporting the practice.

So the terminators are back. The reasons for opposing them and opposing physician-assisted suicide never went away. The reasons have been with us since ancient Greek doctors wrote in the Hippocratic oath that "I will neither give a deadly drug to anybody if asked for it nor will I make a suggestion to that effect." The oath is a central tenet in the profession of medicine, and it has remained so for centuries.

Dr. Leon Kass, in a brilliant essay on the Hippocratic oath in his 1985 book "Toward a More Natural Science," explains why this has been true. Medicine and surgery, he says, are not simply biological procedures but expressions, in action, of a profession given to helping nature in perpetuating and enhancing human life. "The doctor is the cooperative ally of nature," Dr. Kass writes, "not its master." It shouldn't need saying, but the exercises of healing people and killing people are opposed to one another.

Traditionally the public rests its trust in doctors on this understanding of medicine. Doctors occasionally remind the public of it when they explain why they do not participate in capital punishment or bear arms in military service.
But the terminators who champion physician-assisted suicide propose that, as seen in intensive-care units, contemporary medicine prolongs unnecessary suffering.

As a psychiatrist, I work with doctors on such units, and I can testify that all of them realize that human life itself is limited in duration and scope. These doctors regularly consider just how far they should go in sustaining a hope for recovery—cooperating with nature's resilience in treating advancing disease. They also consider when prolonging a futile effort should be replaced by comforting the person as his life naturally comes to an end. The judgment is delicate, though, and most families are justified in leaving it to skilled physicians.

Another argument for physician-assisted suicide is that many patients with cancer live too long in pain. The suffering could be reduced if their legitimate wish for death were fulfilled. These are the arguments pressed by Dr. Timothy Quill and many in the Oregon "death with dignity" group.
But scientific publications from oncologists such as Kathleen Foley, who studies patients with painful cancers, reveal that, quite to the contrary, most cancer patients want help with the pain so they can continue to live. Suicide is mentioned only by those patients with serious but treatable depressive illness, or by those who are overwhelmed by confusion about matters such as their burden on loved ones and their therapeutic options. These patients are relieved when their doctors attend to the sources of their psychological distress and correct them.

In the nearly two decades that Oregon has permitted physician-assisted suicide, I became suspicious that just such depressed and confused patients number large among those who ask for and take life-ending poisons. Why suspicious? Because the law does not demand a psychiatric assessment before they take the fatal step. Yet all efforts by psychiatrists anxious to read the medical charts of these patients after their deaths have been thwarted by the champions of their suicides, who have shrouded the patients' mental states in secrecy by raising the "privacy privilege." I believe that these doctors are killing patients of the sort that I help every day.

And then there is this talk about "death with dignity," as the Oregon and Washington laws are titled. Surely what we want is "life with dignity." Seeking life, we're ready to endure much in order to keep it going. Think of the life-saving and life-preserving colonoscopy—all dignity drops with your trousers.

The advance of the hospice movement has made a shambles of the terminators' insistence that medicine prolongs suffering and denies dignity. The doctors, nurses and social workers committed to hospice care demonstrate how an alliance with nature at life's end plays out in just the way that the medical profession intends. As hospice ways become more familiar, the public can overcome the fears that the terminators used to win over the Vermont legislature.

For you see, the terminators ultimately are not merely interested in killing people who are suffering the throes of a final illness. They have even others in mind, as history tells us. The drive to allow doctors to "assist" in suicide is not recent. Its roots are in the Progressive era of the early 20th century, when many Americans placed utter confidence in reform and in technocratic elites. Then the enthusiasts for euthanasia lined up with those clamoring for government intervention in the name of eugenics and population control.

Across the decades, Americans have fought off such dire temptations with reasoned arguments about the nature of medicine. Despite Vermont's unfortunate decision, Americans elsewhere likely will continue to defeat physician-assisted suicide at the ballot box and in the statehouse. But the enemies of life are terminators—they'll be back.

Dr. McHugh, former psychiatrist in chief at Johns Hopkins Hospital, is the author of "Try to Remember: Psychiatry's Clash Over Meaning, Memory, and Mind" (Dana Press

Reading Hayek in Beijing


Bret Stephens:

"...Mr. Yang went on to make his career, first as a journalist and senior editor with the Xinhua News Agency, then as a historian whose unflinching scholarship has brought him into increasing conflict with the Communist Party—of which he nonetheless remains a member. Now 72 and a resident of Beijing, he's in New York this month to receive the Manhattan Institute's Hayek Prize for "Tombstone," his painstakingly researched, definitive history of the famine. On a visit to the Journal's headquarters, his affinity for the prize's namesake becomes clear..."

Saturday, May 18, 2013

DSM-5: A Manual Run Amok

5/18/13. Paul McHugh, MD:

"It's time for psychiatry to drop its field guide and try to learn about mental ills."

My response:

Dr. Paul McHugh (“A Manual Run Amok”, 5/18-19/2013), reminds us that psychiatrists, psychologists, and other mental health clinicians have not penetrated the secrets of human nature. The DSM-V “field guide” to psychiatric disorders, he implies, consists of a list of ingredients for many psychological disorders with no recipes for the causes or etiology of any of the increasing number of mental maladies. To ask what mental illness is --- is to get answers that often sound muddle-headed or simple-minded.

In their pioneering text, “The Perspectives of Psychiatry,” Drs. McHugh and Phillip Slavney promote  conceptual clarity when diagnosing and treating mental distress. Because we have no clue how the brain creates consciousness, psychiatric disorders, they say, must be viewed, for now, as unique combinations of diseases (e.g. schizophrenia), dimensions (e.g. personality traits, temperaments), behaviors (e.g. addictions), and life stories (e.g. traumas). No one method or approach captures the complexity of an individual’s mental life. There are no substitutes for getting to know much more than the patient’s presenting symptoms.

Over the last 100 years, mental health clinicians have learned much to help alleviate mental anguish. We know that most people who get psychological therapy feel demoralized and these people often benefit from psychological therapy. Many benefit from life-saving psychiatric medications. Even more benefit from a combination of medication and psychological therapy. Some patients get medicines they don’t need. Many more patients never get the medicines they require. It is difficult to get adults to take eight days of antibiotics to treat an infection. It is much harder to get patients to regularly take medicines for their mind if they don’t help.  

Given the million-billion or so connections between the neurons in our brains, there are ample reasons for our lags in explaining the causes of problems in our minds’ “hard-ware” and  “soft-ware.” We understand much more than we can explain.

In these days where clinicians are burdened by checklist short-cuts, insurance mandated restricted number of therapy sessions,  required quick fixes of medication without knowing the patient, to name a few, there is often a rush to a non-judgment where a diagnostic manual can run amok.

S. Ceresnie, Ph.D. 

Friday, May 17, 2013

On the Mixed Reviews of the DSM-5

5/17/13. We think we know the ingredients for psychiatric disorders --- but even this is in doubt. We for sure do not know the recipes or biological etiologies for any psychiatric disorder.

The DSM was created as a method to create reliability among clinicians and researchers --- but the validity of mental maladies has been sacrificed. The DSM was supposed to spark research to make valid categories of mental illness. Spark --- it hasn't.

Wednesday, May 8, 2013

Psychiatry's Guide is Out of Touch with Science

5/8/13. So says the Director of the National Institute for Mental Health. We should develop theories about the causes of mental maladies based on biology and genetics --- says Dr. Thomas Insel.

There are psychiatric disorders that fit the disease model such as schizophrenia, bipolar disorder, autism, and more. We don't know what causes these psychiatric diseases  We know that these diseases have a strong genetic component but as yet do not understand the complexity of the contributions of nature and nurture.

We do know that not all twisted thoughts are the result of twisted neurons in the brain. We can suffer mental distress from combinations of diseases,  life events such as death of a parent, behaviors such as addiction,  personality traits such as impulsivity and challenges of low intelligence.

What is missing from our attempts to focus on reliable and valid clusters of mental disorders (DSM-V), and begin to learn the etiology of psychiatric disorders based on understanding the brain is our answer to the following question:




We have no idea how the brain creates the sense of self-consciousness. We are the only creatures who know we have in-laws.

Saturday, May 4, 2013