Stages of Change for Weight Loss Revisited

How embarrassing.  I clicked on the link to an old post which is getting a lot of hits this week.  It's all about how diets don't work.  And I found four ads about weight loss.

Okay, maybe there is helpful information in those ads.  I hope so, because I put ads on my site to give you resources beyond what my poor brain can contrive. But I don't know, because I get paid by how often somebody looks at them, and the contract says I am not allowed to look at them myself.  I am also not allowed to encourage you to look at them.  That's up to you.  Never mind.

A Few More Holiday Survival Tips for Loonies

I know, I know.  This post is late in coming.  People have been googling prozac and holidays and bipolar and holidays for weeks.  Good for you.  You are following your therapists' advice to reduce your anxiety by thinking through your triggers and how you will handle them.

Most of what follows was first posted on November 20, 2010.  In light of recent developments in Loony Land (referring to them this time, not us) I added a section on prejudice.  Think of it as tweaking the traditional Thanksgiving fare with this year's rage for bacon and Brussels sprouts.

So here we go:


Ah, the holidays!  Time when far flung family members travel home and grow close around the turkey table.  Time to renew friendships in a round of parties and frivolity.  Time to go crazy?

Soldiers on Psych Meds

Lies, damn lies and statistics. -- It's a mantra used by people who don't accept the conclusions somebody else draws from statistics.  Today it is my mantra.

Here is a statistic:  Since 2005 there has been a remarkable eightfold increase in psychiatric prescriptions among our active duty troops.  An incredible 110,000 soldiers are now taking at least one psychotropic drug, many are on more than one, and hundreds die every year from accidental overdoses.

Saving Normal: Here I Go Again

Allen Frances uses this statistic (and I do not dispute the fact) in support of his contention, that normal people are being misdiagnosed, and hence overmedicated for mental illness.  The suggestion is that normal soldiers are put on dangerous psychotropic medications that they do not need.

Well, let's put to one side the implied accusation of nefarious, or at least incompetent conduct by medics and their commanders, and instead look at some facts.

Mental Health First Aid - So You Can Help, That's Why


Mental Health First Aid is to mental illness as CPR is to heart attack.  I discussed mental health first aid in a post a few years ago, and was pleased that a clergy colleague took the training in Iowa, to his great benefit, according to his report.  The training describes major serious mental illnesses and gives strategies for evaluating and responding to crisis situations.  It does not train people to be counselors.  It equips the general public, nonprofessionals to provide emergency assistance, in advance of professional help.

Question: Who Benefits From Mental Health First Aid

This week I attended a NAMI meeting that introduced the training to Central Oregon.  The trainer asked us, Why would somebody want to take MHFA training?  One person said he needs more tools to deal with his family member.  I said it reduces anxiety in a crisis if you know what to do.

My wife later noted our curious perspective.  We described the benefit to those who would take the course.  She countered, the reason to get the training is the same as the reason to get CPR training -- if you know what to do, you can help somebody.  The benefit is to the person who needs your help.

Loneliness is Lethal -- Ayn Rand is Wrong

This I've got mine; screw you thing we have going on in the US today is bad for our health.  John Cacioppo tells the story at a recent TED event in Des Moines, Iowa.



Here is the short version, with direct quotes in italics:

The human species is social.  We are just wired that way.

Return to the Chemistry Experiment

What is it like, this chemistry experiment, you ask.  Somebody did ask, honest.

Prozac Monologues strives to be journalism, not journaling.  I write for education (mine first, then yours), not for therapy.  So when the story turns to the Chemistry Experiment, a topic I write about so often, it gets its own label, I have tried to season my prose only lightly with my personal story.

But the Chemistry Experiment has been excruciatingly personal these last several weeks.  And nowadays, the personal story is one way that journalists frame their reporting.  So here goes.

Michael Hill and Antoinette Tuff: Lesson in Crisis Intervention

On August 20, 2013, at the Ronald E. McNair Discovery Learning Center in Decatur, Georgia
                       -- nobody died.

Tuesday, the first school shooting of the new school year

                       -- didn't happen.

It started the way these things start.  A disturbed young man went off his meds.  He decided he would die that day.  He did what others have done who wanted to die.

Suicide By Cop

The Suicide Monologue

Suicide Humor

They asked for a trigger alert. This is a humor alert. Oh, well.

I realize some people do not find suicide humor humorous. I get that. I respect this opinion and honor the feelings and experiences behind it.

If you have not read Prozac Monologues before, you need to know that it has always aspired to a bent sort of humor. And in honor of the World Health Organization's World Suicide Prevention Day, today's post, a long time coming, is The Suicide Monologue. Watch me while I attempt humor. You don't have to read it. Just know, it is what it is.

Empathy in Health Care

Medical schools are using this video in training. Watch it once just to take it in.



Watch it again.  Which one has schizophrenia?  Which one has bipolar? Which one has PTSD?  Which three are on antidepressants?

Which ones are normal?

Saving Normal - At What Cost?

Rest In Peace, John Ferguson

John Ferguson was executed by the State of Florida on Monday, August 5 at 6:17 p.m. ET.  He killed eight people thirty years ago, and many people can't get too excited about his own death.  I understand that.  As a Christian, I am grieved that my nation kills people to show that killing people is wrong.  But I get it.

The civilized world does not get it.  The United States of America is a member of an elite club, forty-three nations that have executed people in the last ten years (brown in the map below, along with China, Syria, Libya, North Korea -- our good buddies, all of them).  We bear the distinction of being the only member from among the developed nations.


We do place limitations on the death penalty.  Our constitution, since its first passage, prohibits cruel and unusual punishment, the eighth amendment.  Over the years, the Supreme Court has ruled that all forms execution are cruel and unusual, except for lethal injection, the method that Florida used to kill John.

American Medical Association on the Death Penalty

Saving Normal -- The Diagnosis Game

For readers unencumbered by the facts of the matter or any understanding of them, Allen Frances' book Saving Normal is an entertaining romp through the world of psychiatric diagnosis which will support your deepest held suspicions: that there are a few seriously wacko people out there who are very different from the rest of us, but for the most part, mental illness is a sham and you need to just snap out it.

Not to tip my hand, or anything.

The claims made without benefit of facts will take some time to sort through. And a later post will support part of Frances' agenda. In fact, support it enthusiastically. But not this one.

The APA's Cocktail Party, 2009

Farmer Wisdom - For While Waiting

Summer seems like a good time for farmer wisdom, filling in while I am filling out forms for my new psychiatrist appointment.  It's a repeat from a year and a half ago.   It has been getting a few hits lately, bringing it to my attention, and reminding me of two good therapists from my past.  Michael and Liz may or may not be on vacation right now, as they were when I first posted.  In any case, their offices are 2000 miles away, so they may as well be.  I am grateful for my time with the both of them.  I could still use double teaming.

from February 8, 2012:

For When Your Therapist Goes on Vacation

Hearts Beat As One

It is common knowledge that we can slow our heart rate by slowing our breathing. Breathe is arguably the most important tool in the whole recovery toolbox for relieving stress and staying in the here and now. The folks in Sweden have taken this data a step further, into building community for common action.

Having taken a leave of absence just as DSM-5 was published, I have a backlog of posts on diagnosis to write. But let's break it up, shall we? This one gets filed under both recovery and political action.

It would take researchers from outside of the United States to think of examining the physiology of a group activity. Swedes, with their solid background in hymn singing, did just that, using group singing as a stand-in for group action.

Doctors' Prejudice Against Mental Illness

One in four people in the United States meet the criteria for a diagnosable mental illness in any given year.  About half will develop a mental illness sometime in their life.  Allen Frances, editor in chief of DSM-IV wants fewer people, only those with the most serious illness, to be diagnosed to spare them the stigma of the diagnosis.  The chief mechanism to achieve his goal would be to change the DSM criteria, so that fewer people qualify.

This series began by introducing Dr. Frances, whose work has inspired it.  It continues to address the topic of stigma, what it means, where it comes from, how to respond.  Last week I defined terms, adding one that expands our frame.  Briefly, Merriam-Webster says that stigma is a mark of shame or discredit; while prejudice is injury or damage resulting from some judgment or action of another in disregard of one's rights.

I think it is important to distinguish between the two.  To do so, one has to clarify the context.  Stigma, when used by somebody who is the object of stigma, is the internalization of somebody else's prejudice. When it is used by somebody else, stigma is a mechanism of diversion that calls on the object of one's own prejudice to bear the responsibility of that prejudice.

So is Allen Frances trying to protect those whom he calls the worried well from being marked with shame or discredit?  Or is he creating a diversion that calls on people who are suffering to bear the responsibility for somebody else's prejudice?

Silence Kills - The Stigma of Mental Illness

I don't use the s-word.  I hate this title.  I use it only because people who need this post will use it when they google.

I don't use the s-word.  But here it is.

First from Google:

Definition of STIGMA

Noun
  1. A mark of disgrace associated with a particular circumstance, quality, or person: <the stigma of mental disorder>.

DSM-5 - Passé Before Published

Most of Allen Frances' ranting against DSM-5 bounces back to hit his own DSM-IV just as well.  He acknowledges this in the preface of Saving Normal, which he says is part mea culpa.  You could sum his argument against DSM-5 as It's DSM-IV, only more so!  We could all find some consensus around that line.

So while I am not pleased with this man's rants [did you pick up on that last week?], I do not come to praise DSM.  To keep us all on the same page, I am reposting my piece from November, 2011.  What I wrote below referred to DSM-IV.  Most of it applies to DSM-5, as well.  The differences between the two do not a difference make in my own critique.  The fatal flaw in DSM-5 is that it is DSM-IV's little brother.  That's what Thomas Insel is talking about...

Introducing Allen Frances

Allen Frances was the editor of the DSM-IV, first published in 1990.  He is now the fiercest critic of its next major revision, the DSM-5.  For over three years, he has been blogging weekly to this end at Psychology Today.  This week I will summarize his steady drumbeat.  I hope soon to publish an open letter to him.

Frances' complaint in a nutshell is that the DSM-5 creates fad diagnoses and changes criteria of older diagnoses to medicalize a whole range of normal behavior and miseries.  The link lists these problem diagnoses and a number of the following points, in an article published all over town last December.

These issues have been discussed widely, in public and private circles.  I am not qualified to address each point, though I did give a series over to one of them, the bereavement exclusion.  The best of the batch, if I do say so myself, is Grief/Depression III - Telling the Difference, which got quoted in correspondence among the big boys.

Looking Under the Hood - A Better Depression Diagnosis?

Corrected July 7, 2013

Maybe my writer's block is an Ecclesiastes issue.  There is nothing new under the sun.

But finally, there is.  No, not the DSM.  Keep reading.

The DSM. Sigh.

But regarding the DSM, and it makes no difference at all which edition, you have to wonder when somebody who is suicidal, losing weight, irritated at the drop of a hat and can't sleep gets the same diagnosis as somebody else who is immobile, gaining weight, couldn't be bothered about anything anymore and sleeps the night and day away.  It's all depression -- the DSM's junk drawer.

Finally, somebody thought to sort the junk drawer, by looking inside the brains of these two sorrowful souls, both taking the same meds for God's sake.

PET Scans - Looking Under the Hood

Helen Mayberg and her team at Emory University School of Medicine used PET scans to look under the hood (to use John McManamy's favorite metaphor).  PET scans use a radioactive tracer to determine where glucose is being used in the brain, i.e., what part of the brain is busy.

The Power of Apology

First, a nod to our excrutiatingly polite neighbors to the north, on the Power of Apology from Scott Stratton:



Next, inspired by Scott and in honor of Magna Carta Day - a rerun of last year's Entitled to an Apology?

Perhaps because a central feature of both hypomania and depression is irritability, and because a characteristic of the "bipolar temperament" is a certain tendency toward an attitude of entitlement, interpersonal disputes tend to be common in this patient population. -- Ellen Frank, Treating Bipolar Disorder

Landfill Harmonic

I promised a series --



If the world sent you garbage, send back music.

Rx for Joy - Joanne Shortell

Joanne Shortell took me up on my call for guest bloggers.  I am glad she did, as I learned of a blogger and mental health advocate I'd like to introduce to you.  Joanne has three websites.  Strongly Bipolar is a blog similar to Prozac Monologues.  Maevetour.blogspot.com/ is the source of the following piece.  And Servicepoodle.com gives more information about the issue it discusses.  

Rx for Joy Can Be Written by any Therapist in the U.S.


My current therapist is a nurse practitioner who can prescribe psychiatric drugs.  My previous therapist was an MSW who could not.  Both, however, could write a prescription for an emotional support animal (ESA).  A short, simple letter (see sample below) from a doctor (any medical doctor, not just a psychiatrist) or any therapist will allow a person with a psychiatric disability or a chronic pain condition to have pets in no-pets housing, to avoid any pet deposit or pet fee, and to avoid size limitations or species restrictions.  The person with the disability gives this to their landlord or co-op/condo board as a request for a reasonable accommodation.  (See link: How to Get an Emotional Support Animal.

Why should I prescribe ESAs?

Thomas Insel - Toward a New Understanding of Mental Illness




Cutting this guy's budget is like telling Orville and Wilbur Wright to take the month off.

Jill Bolte Taylor's Stroke of Insight



Dr. Bolte Taylor's story is told in greater detail, both her stroke and her recovery in her book.  You can link to it in the column to the left under Fabulous Books.

Calling All Guest Bloggers

That little box of words is empty. Day after day, replacements do not arrive.  It is time for Prozac Monologues to go on sabbatical. I'm thinking -- two months might do it.

But I hate it!  I can't do it!  Help!

Calling all bloggers -- this space is vacant and available.

So here's the deal.  I am open to publishing your poem, blog piece, article, ruminations, if:

  • It is on topic (reflections and/or research on the mind, the brain, mental illness and/or society);
  • It is educational and/or entertaining;
  • It is not hateful nor wildly inaccurate;
  • It strikes my fancy.

Oh, My Aching Neurons!

Having a hard year?

Fiscal Cliff, Sandy Hook, Sequester, you can take your Swiss Army knife on the plane with you, no you can't, North Korea, ricin -- not to mention your own life...

And then there was Boston.

If you are exhausted, you don't need to blame your meds.  Your mind has been stretched to the limit.

How's your brain doing?

Minding My Mitochondria

I don't know if this is related, but it sure seems timely.  One of my posts has gone viral - well, within the context of Prozac Monologues viral.  I have been working up to over 100 hits a day.  Nice progress -- thank you to all who have helped spread the word.  Suddenly one day this week, my hits jumped to 530.  Almost all of them were one post, a review of Terry Wahl's book, Minding My Mitochondria.

This post was already one of my most read, a cross-over hit with people who have multiple sclerosis.  Last month it got mentioned in an MS chat group, which drove a spike in hits out of Poland.  [The blogger.com software enables bloggers to track aggregate statistics.  I can't tell who is reading, but I can tell how many, what country, and to a limited extent, how readers found my blog.  This week's traffic seems to come from Facebook.]

Wahls' book is about brain cell health, and how what we eat sustains or starves our brain cells -- in particular, mitochondria, the little power plants inside our nuclei that turn what we eat into energy.

Hence, the relevance to your current state of exhaustion.

Why the Poor Give More

The article that inspired this post is titled Why the Rich Don't Give to Charity.  But I figure, language has power, and why reinforce behavior that I would rather see changed?

Before you go off in a huff, let me tip my hand -- I acknowledge and will discuss both the exceptions and free will.

The short answer to any of these questions, why the poor give more, why the rich don't give, and why some rich do is -- mirror neurons.  Three weeks ago I reported on these in Mirror Neurons - They Change Everything, along with a youtube featuring V.S. Ramachandran.  Here is the promised expansion on the theme.

Statistics on Giving

Ken Stern reports in The Atlantic Magazine that the top 20% of Americans donate 1.3% of their income.  The bottom 20% donate 3.2%.  He asks, What's up with that?

Paul Piff - Higher Social Class Predicts Increased Unethical Behavior

We Are On Our Own


Last week I was part of a group that was confronted with a psychiatric crisis in a visitor.  This group had never been called upon in this way.  But among our ranks we had enough experience of psychiatric crisis that:


1) We were determined we would help a stranger; and
2) We knew how to do it.

Part of the story was that inevitable series of telephone calls to offices in 24 hour institutions that were closed.  When flesh and blood was finally located, the response was rude, ineffective and dismissive.

When I debriefed with my therapist, she expected my frustration at calls for help that did not yield help.  That is one of my therapy themes -- a cognitive schema, as a former cognitive therapist called it.  I surprised my new therapist and surprised myself with my response.  No, I didn't expect help.  We are on our own.

In the Beginning -- Four Years Out

Four years ago I had lost my voice.  Literally.


How does a psych patient get help without a voice?  Too many times shamed into silence, when I quit my therapist I went to a Chinese Practitioner who did energy work, so I wouldn't have to speak.  When I had no choice but to find a new psychiatrist, I had to whisper.

How does a preacher preach without a voice?  Too long in the dark night, I had nothing to say.  When the pension fund required I not work at all for a year as a condition of disability, it was a relief.


How does a writer write when the words disappear?  Again I had no choice but to return to the Chemistry Experiment, this time with Lamictal. -- They tell you all about this exceedingly rare rash.  Sure it could kill you.  But you just stop taking the med, the rash goes away.  Meanwhile, they forget to mention the very common side effect -- your words disappear.  I didn't complete a sentence for months, forgetting in the middle what I intended to say.  Four books languished on my laptop.

Prozac Monologues

But I am a psych patient.  I am a preacher.  I am a writer.  I need my voice.  Enter http://prozacmonologues.blogspot.com/.

Mirror Neurons - They Change Everything

Blow your mind in the seven minutes and forty-four seconds:



You just watched V.S. Ramachandran, Director for the Center of Brain and Cognition at the University of California Sand Diego, cross the mind/brain barrier in his description of mirror neurons.  These neurons, a subset of the command neurons in the frontal cortex, are the neurobiological basis for imitation, culture and empathy.  What we see another do or feel causes mirror neurons in our own brains to fire, so that we understand or feel the same.

This week's blogpost is published late because I kept trying to explain what mirror neurons explain.  They explain everything.

They explain why rich people are not as generous as poor people.  (That may get its own post soon.)  They explain why religious people give more than nonreligious people, more time, more money, more blood.  (My source for that one is sociological, not neurobiological.  So I may not blog it, though mirror neurons would explain it.)  They explain why people who own guns are more afraid than people who do not, and why people who watch tv overestimate the crime rate.  They explain pornography.  They explain Congress.

Fabulous People With Schizophrenia

People With Schizophrenia Who Recover

My guess is you don't know people with schizophrenia who have jobs, own their homes, are married and join clubs and congregations.  My guess is, even if you work in the field or volunteer in homeless shelters, you do not count among your friends, your real friends, the ones you invite to your house for dinner, anybody with schizophrenia.

My guess is you do not know that such a thing is possible.

Lionel Aldridge decided to change that.  Lionel Aldridge played defense for the Green Bay Packers and won two Super Bowl rings.  (Go Cheeseheads!)  He lost them when schizophrenia took his life out of control.  Literally, his ring fell off his hand; he couldn't find it in the gutter.

But he came back.  He got treatment.  He vowed that if he got better, he would not remain silent, so that other people with schizophrenia would know they are not alone, so they would know they could recover, and so you would know that, too.  His story is in this link.

Inductive Research

Schizophrenia -- Taming the Dragon

Imagine you have a dragon in the house.

It has been there a long time.  When it was little, you could hide it.  You knew your parents didn't like it when you talked about it.  So you guarded it as a secret for the longest time, even with its nasty habit of singeing your fingers.  But when the couch caught fire, they knew, and insisted you get help.

They want you to get rid of the dragon.  Some of them think you can.  Others think you can tranquilize it, and the couch will never catch fire again, and nobody need ever know you have a dragon in the house.

Iron Rule #1:  You cannot get rid of the dragon.  It is here to stay.

Missing My Friends With Voices


I sat next to the young man as he told his story in Peer to Peer.  Honestly, he scared me.  I was new to the loony world.  I was getting less scared of people like me (and through them, eventually less scared of me).  But I was still scared of people with schizophrenia.  And this one, especially.  The others had a grip.  My young man had missed a session or two, not yet stable, like, able to tolerate a large room with twenty people stretched around big tables.

He whispered.  They asked him to speak up, but the longer he talked, stretching the three-minute limit to ten or fifteen, the softer his voice got.  I strained to hear him.  I was the only person in the room who could.  The story rambled, hitchhiking around obstacles and through obscure events.  If he hadn't whispered, if I hadn't strained so hard to hear the words, I would have missed it.  I would have missed him.

It actually made sense.  There was a flow.  The connections were loose, granted.  But if I got in the canoe with him, I could ride the river as he paddled through his quest to make sense of it.

That was my introduction to the inner world of schizophrenia.  My life is richer for it.  Yours could be, too.

Caveat -- Mental Illness is Real

Untangling Redemption

Kelly Flanagan is a psychotherapist who blogs.  I think that is brave of him.  Most mental health professionals keeps a decidedly low profile online.  Boundaries, you know.

Flanagan not only blogs -- he puts it right out there.

[I have been sick as a dog this week, and will share him with you, instead of churning out my own stuff.  Thanks, Kelly, for doing the heavy lifting.]

Flanagan's blog is called Untangled, and his theme is redemption: Tell a redemptive story with your life.  Now.

Immediately, he is asking for trouble in this bizarre world where meanness has become the measure of ones Christianity, and all those Christian words are distorted to stand for the opposite of what they intend.

In this Orwellian world, (where entitlement means something to which you are not entitled) Redemption means that you have paid whatever price somebody else has decided you ought to pay in mental gymnastics and conformity to their way of life.

Flight of Ideas

Pride of lions
Fleet of ships
Host of angels...

Flight of ideas.

It's a lovely phrase.  Isn't that what ideas do -- fly?

I think so.  But evidently, not everybody.


A Visit from the Goon Squad

I was looking to meet new people in my new home town, and went to the library's book club.  The selection for my second meeting was Jennifer Egan's A Visit from the Goon Squad.  Sex, drugs, rock and roll, and, oh yes, suicide -- these characters were my tribe!  No, I haven't lived their lives.  More to the point, I have asked their questions.

I wasn't sure how Egan's characters would be received in this group of middle-aged and older women.  I didn't know the book club members yet, but they seemed pretty respectable.  Then again, I can seem pretty respectable, too.  I expected a lively discussion.

Nope.  No lively discussion.  No discussion at all.  They were so dismayed, they were speechless.  The librarian resorted to reading reviews.

Defending DSM-5 -- Sort Of

Good mental health reporting takes research, careful analysis, nuance and a whole lot of work.  And in the end, it doesn't sell newspapers.  Which is why you see so much bad mental health reporting, even where you thought you'd find better.


[I like to think that opening sentence explains why I post no more often than once a week.  I work to provide a quality product.  But that is for you to judge.]

The long awaited publication of the Diagnostic and Statistical Manual, Edition V has generated a blizzard of easy-to-whip-off articles with sensationalist headlines, just the thing for you to share on Facebook on a boring weekday afternoon, and get a nice Ain't it awful rant going among your friends when, really, you should be doing your life.

The Spectre of the Butterfly Net

Most of these articles follow the same tired theme, Psychiatrists are out to diagnose half the population, turning normal human conditions into mental illnesses, because they are in cahoots with the pharmaceutical industry to put the nation on medication.

These articles write themselves.  Pick any diagnosis that the DSM-V has dared to update from a work last revised nineteen years ago, add a quote from the disgruntled old man who was editor-in-chief of said nineteen-year-old document, which only barely tinkered with the 1980 edition anyway, plug in a statistic on drug sales, and there you have it.

Next, pick another diagnosis, substitute a humanistic psychologist for the disgruntled old man, and you are good to go with next week's article.

I, who love links, am not going to link to any of this trash.

Now I have my problems with the DSM.  But I do have some sympathy for its revisers, caught in the middle of a sea change, trying to update a system that will be tossed into the deep within the decade, and would have been already, if we spent any halfway reasonable amount of money on research.

For now I will do my own op ed piece and offer for your consideration the following assertion, based on my own experience in the system and reports of friends who have been at this a whole lot longer:

There are no psychiatrists running around on the streets, chasing toddlers with temper tantrums, trolling funeral parlors for grieving widows, whipping up business.  People!  There are not enough psychiatrists to deal with the loonies already identified.  They do not need you!

You don't get to see a psychiatrist and submit to trial by DSM until

  • denial
  • snapping out of it
  • hiding
  • behavioral modification
  • herbal remedies
  • and prayer

have not worked, and there is no choice but to go where you do not want to go, in the face of your drinking buddies who all tell you, You'd have to be crazy to see a psychiatrist.

Well, maybe you are.  Maybe you are on the knife's edge.  Be prepared to stay there a while longer.  It will take three months to get an appointment.  Longer, if you don't have insurance.

Seriously, they don't need you.

Diagnosis is Your Best Friend

Do you know anybody who has suffered for years with some unidentified illness, bouncing from doctor to doctor, treatment plan to treatment plan, feeling crazy and out of control, because there is no reasonable explanation for these vague, though debilitating symptoms that come and go, and your friend begins to think that you all think he/she is crazy and not really sick at all?  Lyme Disease, Fibromyalgia, TBI, MS, ALS, Lewy Bodys...

The day that person receives a diagnosis, even a difficult one, is a day of rejoicing.  Now he/she knows, can make plans, can learn about the illness, follow a course of treatment, maybe even find one that helps.

Diagnosis, if it is the right diagnosis, even if it is more serious than the previous diagnosis, even if you really, really don't like the diagnosis, is the first step toward recovery.

I mean, think about it.  If you get out of breath climbing a flight of stairs, do you listen to your friends tell you to rest mid-flight?  Or do you go to a doctor who might tell you that you have a blocked artery?  Is the doctor drumming up business?  Or is he/she saving your life?

Mental Illnesses are Made of Normal Experiences

Let's break out some dialectical thinking.  I know, it's hard.  That is why mental health reporters for USAToday and even the New York Times don't ask you to do it.  Prozac Monologues does ask you to do it.  But we can take it slow.

First, what is dialectical thinking?  It is when you hold two truths that seem to contradict each other in your mind at the same time.  Truth is not about either/or.  It is mostly both/and.

So our first statement is this:

Mental illnesses are made of normal experiences.  Everybody gets sad.  Everybody gets angry.  Everybody gets up in the morning sometimes and just can't get started on the day.  Everybody who walks by a group of scary people thinks they are saying bad things.  Everybody catches something out of the corner of the eye that isn't really there.  Everybody throws something against the wall.  Everybody persists in believing something that is false.  Everybody has an occasional impulse to jump off the bridge.

The symptom lists of the DSM are filled with behaviors that everybody does.

News Flash:  Us loonies inhabit the same planet as everybody else.

That is the first truth in our venture into dialectical thinking.  And it is the source of all those headlines about how the DSM is turning normal behavior into mental illness.  How is this for a thought -- mental illness really is not that weird after all.

The Suffering of Mental Illnesses is not Normal Suffering

But.  Here is the other statement to hold in your mind while remembering the first one:

There is a difference.  You get a diagnosis of some sort of mental illness when a whole lot of normal experiences and a whole lot of normal suffering pile up beyond your ability to function in a normal world.

That's it.  If you are not at the end of your rope, you do not have a mental illness.  Rather you are having a bad day, or week, or year.  If you are functioning well in the world, you do not make an appointment with a psychiatrist, and do not receive a diagnosis.  And the psychiatrist is just fine with that, because he/she doesn't have time to see you anyway.  The DSM is not about you, and does not try to be about you.  So leave it alone and let it help those of us who need its help.

When your loved one dies, you will not be diagnosed with depression just because you are going through a normal grieving process.  A normal grieving process looks like depression, but only on the surface.

If what you have is Major Depressive Disorder, then you don't go through a normal grieving process.  You don't think about your loved one; you don't remember the good times; you don't share those scandalously funny pokes in the ribs during the funeral; you don't cling to your sister; you don't even get mad at the person who deserted you by dying.  You just sit under a black cloud and think about how miserable you are.  So you do not get better, and -- get this -- you do not do normal grieving, until you get treated for your depression.

Grieving widows are in no danger from the DSM, if their grieving really is normal.

When your child throws a temper tantrum, you don't run out for a diagnosis of Disruptive Mood Dysregulation Disorder.  A badly behaved child has good days and bad days.  If the parents are consulting with school and other resources and genuinely working on the issue, things get better.  When they have tried every recommendation in the book, when they fear for their lives, when the child is out of control and scared and miserable about his/her own behavior, and this has gone on for years...

then it is insulting, it is cruel and it is simply not helpful to tell these parents that there is nothing wrong with their child and that the doctor's attempts to figure it out are part of some grand conspiracy that threatens to medicalize normal behavior.  If you don't know, if you have not walked in their shoes, then shut the hell up.

Naughty children are not diagnosed in the DSM, if they can get better without it.

Diagnosis of Mental Illness is Not Easy

The DSM V does not make diagnosis easier.   Yeah, well -- diagnosis of any sort got more complicated when they threw over the four humours theory.

There is more to say in the DSM's defense.  I will get to it.  It will make me work and make you think.  And I don't imagine you will share it on Facebook.

Oh well.  My ad revenue never did pay the mortgage.

flair from Facebook.com

The Brain on Tetris

What happened to that hour?  That other hour?  The one after that?  Where did they go?

My son's best friend from childhood, whom I haven't seen in ten years, sent me a message with this link to a BBC story, The Psychology of Tetris.  When he saw it, did he remember that I used to ask my son to hide the Gameboy?

More Guns = More Suicides


Compare states to states.  Compare regions to regions.  Compare states within regions to other states within the same region.  Compare people of the same age group, in any age group, men to men and women to women.  Compare unemployed people to unemployed people, working folk to working folk.  Compare city dwellers to city dwellers, country folk to country folk.

Compare people with depression to other people with depression; people who are suicidal to other people who are suicidal; people who have a plan to other people who have a plan; people who have a past suicidal attempt to other people who have a past suicidal attempt, for God's sake!

More Guns = More Suicides.

Get it?

Homicide and Firearms - Some Facts

While I was researching this post, a Facebook friend posted this  picture.  I commented, giving information I discovered and found surprising.  The stats are below, under domestic violence.  A friend of my friend then commented, Dearest Willa......useless, worthless statistics.  Lies, damn lies and statistics.  Go back to class and learn forgiveness, and while you're at it....drop dead!

Well.  That was disturbing.  To my knowledge, I do not know the person who called me Dearest Willa, said I need to learn forgiveness, and then told me to drop dead.  It occurs to me that facts have power, if they evoked this response.

My facts come from the Centers for Disease Control, Bureau of Justice and Federal Bureau of Investigation, from reports and data bases that count people who died and how they died.  That is all these sources did -- they counted.  They made no policy recommendations.

I make no policy recommendations in this series, either.  I am reporting their numbers.  I do hope they are not useless numbers.  I offer them to you to help you weigh the costs and benefits of gun ownership.

How Many Killed Since Newtown?

Technical difficulties have delayed my research on homicide and firearms.  I can't figure out how to make the story not tedious.  So I will skip it.  Maybe next week...

Until then, here is a resource to keep you up to date.  Slate Magazine and the Twitter feed @GunDeaths are crowd sourcing data to answer the question:

How Many People Have Been Killed by Guns Since Newtown?

The answer is not easy to find.  Coroners do not publish this information in real time.  Perhaps you noticed that my statistics last week were from 2009 and 2010.  The tally is collected only at the end of the year, and it is not official for some months after.  Suicides, in particular, are underreported, even in official statistics.  They get caught up in investigations that take months beyond the reporting date.  Eventually the numbers for 2011 will be corrected, when these investigations are completed.  Meanwhile, the smaller number has been published in places that will not be corrected and will nonetheless be repeated (including Prozac Monologues, if I try to publish the most current sources.)


Guns and Death, Death and Guns

I have a friend, a young mother of two toddlers, whose New Years resolution is to get her license to carry.  This series is for her.  Live long and prosper, dear one!

My Next Series -- Facts About Firearms

I have a plan.  No, not that kind of plan.  Well, yes, I do.  But that is not the plan I mean right now.  I plan to do a series about firearms.  It is my intent to provide facts, just facts.  There are a lot of facts out there about firearms.  A lot of nonsense is disguised as facts.  But genuine facts are available, and more useful than our impressions for making sound decisions.

I am not going to write about my opinions about firearms, because, well really, who cares about my opinions.

Keeping Track of How People Die

Firearms are a cause of death, which means that the US Centers for Disease Control keeps track of them.  Wait, wait -- it doesn't keep track of the firearms, just the deaths.

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