Showing posts with label Ronald Pies. Show all posts
Showing posts with label Ronald Pies. Show all posts

Gratitude - The Prozac Monologues Publication Edition

Fifteen years! From the hypomanic first draft of Prozac Monologues on a yellow legal notepad to a published book, and the nail file that inspired it all.

The book was officially released into the wild this week and will be celebrated in two launches, one sponsored by Paulina Springs Books in Sisters, OR, and the other sponsored by Prairie Lights in Iowa City, IA.

It's a good time to talk about gratitude. Forgive my self-indulgence. It is a day to reflect.

First, people have asked whether it was hard to write about such dark times in my life, if it retriggered some of those emotions. Occasionally, it did. Occasionally I would have a sleepless night remembering, in particular, difficult encounters in treatment. One can forgive sincerely. One can forgive over and over. Still, the brain remembers. I don't harbor resentments, but I can't always hop off the time travel machine that is my brain, how it repeats the tracks laid down by past traumas.

Care of the Soul and COVID-19

Ronald W. Pies is a psychiatrist, bioethicist, and professor emeritus at SUNY and Tufts. His writings often tend to the philosophical, which keeps me reading his work and occasionally engaging with him in cross conversation between Prozac Monologues and PyschiatricTimes.com, where he served as editor-in-chief 2007-2010.

Pies' recent post is one such example where our respective disciplines come along side each other, Care of the Soul in the Time of COVID-19. He identifies five assaults on the soul made by the pandemic: impotence, grief, loneliness, mistrust, and displacement. While underlining that one solution will not work for all, he proposes cognitive therapy, gratitude, and the arts as strategies for healing.

Therapy and Spiritual Direction

As a physician, it is natural that Dr. Pies would write of problems and solutions. I too have been thinking about the larger implications of the COVID pandemic. However, I do less pastoral care these days. My thinking has been more in the realm of spiritual direction. Spiritual direction is as likely to trouble the mind as soothe it, raising questions to ponder rather than soothing manifestations of distress. So my care of the soul focuses on the questions that COVID raises about identity, values, and purpose. 

Identity

Misconceptions about Antidepressants

What do you think are the most common misconceptions about antidepressants?


Prozac Monologues: A Voice from the Edge is at the press kit stage with Q&A in development. My publicist wants me to answer questions that interviewers might ask. My responses should be in the three to seven sentence range, she says.

Three to seven sentences are not my forte. I am doing my best and taking comfort that in an interview format, there might be a follow-up when I can say more.

They are good questions and worth a blog series, I think, where I can expand to three to seven paragraphs. Mostly seven. Maybe more. Plus, you know, pictures. So that's what you get for a few weeks.

No, antidepressants are not happy pills

Major Depression and World Bipolar Day

Your diagnosis is major depression. So what does World Bipolar Day have to do with you?

I mean, what a relief to just have major depression, right? Isn't bipolar another level of crazy? Well. . .

First, a reality check. Whatever level of crazy you are now, you can call it whatever you want, your mental health struggles will not get worse if your diagnosis changes. Actually, you might get better. I'll get back to that.

Doctors as Priests, Providers and Protectors - Part 4

In Priests, Providers, and Protectors: The Three Faces of  the PhysicianRon Pies proposes a third way to view physicians, not exalting them to the grandiose position of Priest nor demoting them to mere Provider. In the role I call the Protector, the physician's chief obligation is that of  the safeguarding of the patient's physical, emotional, and spiritual well being.

This is a role that acknowledges the patient's autonomy, while recognizing the physician's expertise and the ethical imperative to use that expertise to express foundational principles of the medical field: beneficence, nonmaleficense, and justice. Do good, don't do harm, and I'm not sure what he means by justice, though I have some ideas. The examples below are mine, not his.

Doctors as Priests -- The Look

Several years ago I took Prozac for what was then thought to be Major Depression.  The hypomanic episode it precipitated gave me a book.  But before that, it gave me the runs.  Since my first doctor thought the runs would go away on their own, but I was about to leave for Costa Rica and wanted them to go away faster, I sought a second opinion.  The new patient form asked for my full history, and I told the truth about my depression, as well as the runs.

What follows is an excerpt from Prozac Monologues, the book to be published next year.  It describes that appointment.  I offer it as an example of a doctor functioning as priest.  [See last week's commentary on Ron Pies' article, Priests, Providers, and Protectors: The Three Faces of the Physician.]  Not the Father kind of priest, but the more ancient healer/witch/shaman kind.  It's tricky to handle the power of the priesthood.  But I want doctors to manage that power responsibly, not give it up on account of its ambiguity.  It is the power of relationship.  We need doctors to use every power at their disposal to heal.  Priesthood is one of those powers.

The Look

...When the doctor looked at the piece of paper with all those words circled on it, she didn't smile at my weak attempt at humor.  Oh well.  What she was most concerned about for my trip to Costa Rica was how I would manage my depression as the Prozac was leaving my system -- which I could tell it was, because the dark suffocating cloud was coming back.

Doctors as Priests, Providers, and Protectors - Part 2

Ron Pies and I ask similar questions.  Well, I never asked Is Suicide Immoral?  But maybe I should let that one go...  In addition to being Professor of Psychiatry at SUNY and Tufts, Pies is a bioethicist and Editor in Chief Emeritus at Psychiatrictimes.com.  So while he writes books like Clinical Manual of Psychiatric Diagnosis and Treatment: A Biopsychosocial Approach, his philosopher, poet, and novelist vocations are expressed in other works, including The Myeloma Year: And Essays on Mind and Spirit.

The kind of guy I'd love to meet for coffee and conversation, Pies added to my fascination an article reflecting on his role as a doctor, Priests, Providers, and Protectors: The Three Faces of the Physician.  See, my senior thesis reflected on my own future role as priest, the ordained kind, Is the Holy Spirit an Equal Opportunity Employer?  Both of us take on the notion of priest as Father.

"Yes, Father, I've been taking my medicine."  A patient's slip of the tongue led Pies to recall the ancient connection between the roles of healer and holy person.  It's a natural connection, if you consider the divine will to be for healing.  It doesn't matter what faith tradition you examine.  The two roles were originally one.

Doctors as Priests, Providers, and Protectors - Part 1

The Three Faces of the Physician is the subtitle of a recent article in Psychiatric Times by Ronald L. Pies, MD, Professor in Psychiatry at SUNY and Tufts, Editor in Chief Emeritus at said e-zine, bioethicist, and aspiring mensch.  Dr. Pies and I have been allies on a certain DSM revision.  We once butted heads over the nature of suicide.  And he has provided valuable assistance in the science chapters of my soon to be published book Prozac Monologues: Are You Sure It's Just Depression?  His (typically) thoughtful examination of the shifting role of physician calls for a response from the side of the relationship, the confessant, consumer, and cared for, aka patient.  My (typically) thoughtful response will be in three parts, starting in the middle of this alliterative stew.

Pies has many problems with the title provider.  It blurs the distinctions among the various health care team members, their roles, responsibilities, and contributions.  It obscures the dignity of a highly educated, hard working and dedicated profession.  It compromises the relationship with its counterpart, the consumer who comes to the exchange overvaluing what she has learned from her internet searches and trying to tell the doctor what to prescribe.

Consumer Movement

Pies traces the origins of the provider usage to two things, the consumer movement in medicine and the encouragement of the insurance industry.  There are good things to be said about the consumer movement, he acknowledges.  I will list a couple of them here.

World Bipolar Day and the Color Red

Prozac Monologues -- the book -- is coming!  It really is.  Well, a chapter and a half still to go.


Here is a sneak peak that may answer the burning question,

Why are you wearing red on World Bipolar Day?  

It's called:
Three

Have you ever noticed -- flight of ideas, distraction, talking fast/pressure to keep talking -- these are symptoms of a serious mental disorder (we're talking the manic phase of bipolar here) and also kind of -- fun.

Suicide Is Not a Choice

I peered over this very overpass on the Eisenhower Expressway. Years ago, there was no the fence along the top, just a rail. It was pie that brought me there. Yes, pie. It was Thanksgiving night, and the holiday was ending without pie.

Of course, it wasn't a reason to commit suicide. Of course, suicide is a permanent solution to a temporary problem. Don't treat me like an idiot with your clever lines.

No, pie brought me there, but that was not why I would jump. Pie was a match, a tiny little three letter match. My problem was a brain filled with gasoline. And one tiny match, that I should have been able to snuff with my fingers, threatened to ignite it and send me over the edge. The shame of being powerless over one tiny match poured on more gasoline.

Suicide Immoral? WTF?

Guilty pleasure: Eavesdropping on psychiatrists talking with each other about us loonies. Like many guilty pleasures, it is not always good for my well-being. But I am endlessly curious. And it has yielded a number of blogposts in the OMGThat'sWhatTheySaid thread.

My go-to source for blog material is Psychiatric Times. It reports the latest news and research in Loony Land. It reflects on the practice of psychiatry. Sometimes it turns to mud wrestling. Oh, the good ol' DSM days!

A couple months ago, one of the editors, Ron Pies wrote a brave (foolhardy?) editorial inspired by Jennifer Michael Hecht's book, Stay: A History of Suicide and the Philosophies Against It. Intending to provoke, he titled it, Is Suicide Immoral?  Let the rumble begin.

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.

Grief/Depression IV - Not the Same/Maybe Both

So a woman goes into the doctor's office, three weeks after her husband died. I got through the funeral just fine. But now I feel awful. There is this ten ton weight on my chest. I'm exhausted; I don't have the energy to wash the dishes. I'm trying to pack up my husband's things, and I am too weak to pick up his shoes. I can't eat. Sometimes I get hit so hard with this wave of anxiety, I think I'm going to throw up.

What are the chances the doctor will say, Of course you feel awful. These are all very natural symptoms of grief. You just need time. But if you still feel like this a month from now, call my nurse and set up an appointment. What are the chances the doctor will not pull out the stethoscope and listen to her chest?

Answer: It depends on whether the doctor is stupid.

Or a psychiatrist.

These are classic symptoms of heart disease. There is significant overlap between the symptoms of heart disease and the experience of grief. But there is no Bereavement Exclusion for a diagnosis of heart disease. Instead, family physicians and cardiologists take the time to examine whether the person presenting these symptoms may have both.

Grief/Depression III - Telling the Difference

Once, when I was seriously under and still headed down, a friend said to me, There have been times in my life when I was sad, so sad I couldn't imagine being any sadder. But it seems that what you and others with depression are describing is a whole different level that I know nothing about.

See, that's what would be helpful, instead of, I know just how you feel. I remember when [fill in the significant loss]... I knew that he knew times of deep sadness, because I knew some of those times, and because he is a person is thinks and feels deeply. And listens deeply. Everyone should have such a friend.

It was Social Hour. We were in a corner to protect me from all those people being social. I leaned against a wall, because I was very tired. I guess the wall gave me the idea. I said, Yes, there are times I have been so sad I couldn't imagine being sadder. It's like the sadness became a wall I could lean against, because I was so tired. But Depression IS different. Imagine if the wall gives way. Imagine there isn't a limit. You lean and the wall gives way.

Grief/Depression II - Rise in Rates of Mental Illness

Are we really getting sicker?

A New York Times article, When does a broken heart become a diagnosis? sells papers with its usual technique - latch onto a fringe element and substitute good writing skills for substantive analysis.

I am all for good writing skills, and perhaps stumble in the same direction at times. But depression is my beat. So God willing and the brain permitting, I am going to beat this bit to the ground. Two weeks ago I discussed three contexts for the discussion, the cost of health care, the scientific value of the DSM and the hobby horse of the author featured in the Times article. I promised more contexts to come.

Are We Getting Sicker? - Context IV

James Wakefield's thesis is that we are turning natural human emotions, (the ones we want to get rid of, because they are unpleasant), into a diagnoses. His beat is depression, as well, but the Times is on this bandwagon with autism and no doubt other diagnoses to come.

Well, I grant some validity to the concern in general. Is it shyness or Social Anxiety Disorder? Is it artistic nonconformity or Attention Deficit Hyperactivity Disorder? Is it the sleep disruptions of normal aging or Overactive Bladder Disorder? Was it all those wings, doritos and beer you guzzled Superbowl Sunday (and most Sundays), or Gastroesophageal Reflux Disease?

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