Holiday Shopping for True Happiness

Last minute holiday shopping -- I shop later and later every year. I even blog about it later each year. This year I have to do three  blogs in the week to get my shopping guides for the perfect Chanukah/Kwanzaa/Christmas present done. Here is the link for if you are mentally interesting and shopping for the normal in your life, here is if you are shopping for your diagnosed friend.  The second is even diagnosis specific. The most popular pick turns out to be a bluetooth phone for the one who talks back to his/her voices, but is trying to pass. Who knew.

But less than a week, people. Internet.  God bless the internet.

Another year I wrote a post on happiness. This post's holiday shopping picks (a updated rerun from 2011) gets to the heart of it -- where to get what makes for true happiness on the internet.  No, really!

People With Schizophrenia Who Recover

Among the top five factors that limit recovery for people with mental illness:

The false belief that it's all about the medication.

Medication indeed is part of mental illness recovery. It's a bigger part for some mental health issues (like schizophrenia) than others. And its effectiveness varies from drug class to drug class.

I created a bit of a twitter storm when somebody tweeted: Please quote this tweet with a thing that everyone in your field knows and nobody in your industry talks about because it would lead to general chaos.

To which I responded: Antipsychotics cause loss of brain matter.

 Last week's post described the research study that demonstrated that claim. The study was led by Nancy C. Andreasen, MD of the University of Iowa Carver College of Medicine. One should not reject antipsychotics on the basis of the study. They do what they are supposed to do. They reduce the positive symptoms (like, psychosis) that cause so much suffering. Payoffs and price tags. But they don't do the whole healing.

I continue this week with a broader picture, the what else of recovery in schizophrenia. This post was first published in 2013 with the title:

Fabulous People with Schizophrenia

Physician-Assisted Suicide for Mental Illness - It's Complicated, or Not

Two years ago, Mark Komrad attended and presented at a symposium in Belgium on physician-assisted suicide for people with mental illness. Komrad is a clinical psychiatrist, ethicist, and faculty member at Johns Hopkins. He just finished a 6-year tenure on the APA Ethics Committee and helped craft the current APA position on Medical Euthanasia for non-terminally ill patients. [That position joins the AMA to say, in a word, Don't.]

Komrad reported back on his experiences to PsychiatricTimes.com. You can read or listen to the his entire report here. This post quotes the parts that particularly struck me from a suicide prevention perspective.

In 2002 Belgium legalized euthanasia by physician (typically by injection) at the request of patients, and removed any distinctions between terminal vs. nonterminal illness, and physical vs. psychological suffering. As long as the condition is deemed "untreatable" and "insufferable," a psychiatric patient can be potentially eligible for euthanasia. There is a consultative process that basically needs a minimum of two doctors to agree about the patient's eligibility. Also, the patient gets to weigh-in on whether their condition is "treatable." Since the patient has the option to refuse treatments, this refusal may create an "untreatable" situation.

The Five Stages of Climate Change - Another View

God just tweeted this.

How did I overlook #5 for last week's post?

God

@TheTweetOfGod

· 18h

THE FIVE STAGES OF CLIMATE CHANGE 1. Denial 2. Guilt 3. Depression 4. Acceptance 5. Drowning

Stages of Grief and Climate Change

In 1969 Elizabeth Kubler Ross published On Death and Dying. It described the grief process of dying patients and how family and medical personnel could help them toward a good death.

You probably know what came to be called the stages: denial, anger, depression, bargaining, acceptance. They were never intended to describe a straight line process, more like a series of way stations to be visited on the way. They came from her work with people who were dying, and were part of the foundation of the Hospice movement, to take dying back out of the hospital where the focus is on preventing death, and put it on a more humane basis. We all die. Let's do it without the violence of extreme measures.

Kubler Ross has been on my mind lately, as it becomes clear that the planet is dying. We all are dying. But so are the polar bears, as a species, the black rhinos, the bees... And when Monsanto kills off what remains of the bees... We are facing the sixth mass extinction of the planet. Unlike the earlier five, this one is on us humans. And evidently we have eighteen months to turn it around.

No, that BBC report was written last month. Make that seventeen months. The rest of the planet is addressing that deadline, while the US is set to spend the last months we have to make a difference locked in our own coming storm. We have one last chance to prevent a white nationalist totalitarian regime. The issues are tied, fascism and climate change, since the regime is doubled down on a nineteenth century energy policy. So, there we have it. We are screwed.

I am seeing those stages play out in social media and every day interactions. How about you?

Denial

I don't mean the old white guys who have a financial interest in denying climate change. I mean the determined optimism of those who still believe in the last minute reprieve. "Science will solve it." Science did solve it, years ago. We ignored them.

Do you think maybe Marvel Comics has tapped into the denial zeitgeist? Our obsession with comic book heroes testifies to our continued expectation that just when the game appears lost, somebody else will save us. Maybe that girl from Norway...

Anger

Ouch - right? You don't have to read the nightly body count. Look no further than your Facebook feed.

Somebody started a thread with Birdcage gifs. Here was my contribution:

What I think I sound like on Facebook:

What I really sound like on Facebook:

Do you have people who pre-irritate you? I do. Before they open their mouths, I already feel irritated. Maybe we have eighteen - no, seventeen months on climate change. But have we already passed the tipping point on anger? Angry at all the angry people around us - how do we reverse that one?

Depression

A quarter of us in the US are on psychotropic meds. That doesn't count all the self-medicators out there. This is the golden day for legal marijuana.

Bargaining


I think this is what the straw fetish is about. We sit in our SUVs at the fast food drive-through, motors running, and berate the poor kid who handed us our beverage with a plastic straw. Like, if we give up our plastic straws, we will dodge the bullet.

Acceptance

In Kubler Ross's original idea, with acceptance comes peace. I don't really see any peace about the death of the planet out there, nor in here. The closest I come is acknowledgement. That's the word I substituted years ago in the Serenity Prayer, when acceptance carried just too much baggage. God, grant me the serenity to acknowledge what I cannot change.

But these predictions of demise are not for the short term. The seventeen month deadline is for the tipping point. After that, carbon levels will be so high there's only one direction to go. The melted polar caps don't freeze up again, (90° in Anchorage on the 4th of July this year), the icebergs disintegrate, releasing more carbon into the atmosphere, raising the temperature more rapidly, causing ocean levels to rise. Salt water is already infiltrating fresh water aquifers, destroying arable farm land and causing water shortages...

What with environmental refugees, starvation, and the inevitable military responses, civilization is finished thirty years from now. Some say twenty. The thing about these predictions, the only mistakes the predictors make is to predict we have more time than turns out to be the case.

Even so, in the face of environmental refugees, starvation, water shortages, and military intervention, twenty years is a long time to stand on one foot, pulling off that serenity thing about a good death.

We need another stage.

David Kessler, Kubler Ross's coauthor on a later book provides one in Finding Meaning: The Sixth Stage of Grief.

I walked into my therapist's office last week after a month's absence and caught her up. "The book is going great. If it weren't for my existential despair, my life would be terrific." This was pure gift to her. My issues are usually cognitive therapy issues. But she says she does existential therapy. "Maybe ultimately there is no meaning. Maybe you have to find your own."

Finding Meaning

Well, there's plenty of that going around. From Trump as the Second Coming to Paul Ryan's blatant embrace of Ayn I-don't-owe-anybody-anything Rand (he's a Catholic of all things!), to Spiritual-but-not-Religious, to tattoos, to My Family is Everything and the Only Thing, to...

I just took this photo on a walk which included a sample of CBD tincture (self-medicating) and a swing by my favorite shoe store. They're red! They're mine! What does it matter that my portfolio is predicted to carry me to my end-of-retirement date, when my end-of-retirement date is anticipated to be later than the end-of-civilization date? Life is short, buy shoes.

So I choose a meaning. The family of God. As we all go down the tubes, I want to go down together, loving my neighbor as myself, welcoming the stranger, protecting the widows and children. Not the new-fangled heretical Christianity. Give me that old-timed religion, the Biblical Judeo-Christian thing that the Muslims embrace, too. It's not about power. It has stood up to Pharaoh, to Caesar, to Hitler. It will stand up to what comes next.

Sounds nice, but it's not about being nice, is it. For at least two thousand years, choosing a meaning that goes deeper than the embrace of power, choosing to stand with the dispossessed, the meek in the language of Jesus, has given people something to die for. Not kill for. Die for. To pull that off is going to take the energy I have left, and more. It will take a community of people to support such a decision - to be willing to die. I don't know what you call it. In my shop we call it the Body of Christ. It will take the Body of Christ to be the Body of Christ, broken together. Together with our nonChristian sisters and brothers, too.

Damn, this ended up a sermon. Well, here's the bottom line. If we're all going to die, I don't want to be an asshole.

Captain Marvel image from pyramidinternational.com

Birdcage gifs from giphy.com and tenor.com

dove icon in the public domain

flair from Facebook.com

photo of shoes by author

Doctors as Priests, Providers and Protectors - Part 4

In Priests, Providers, and Protectors: The Three Faces of  the Physician, Ron 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.

Demi Lovato -- Bipolar Warrior

The news story caught my ear.  I don't usually follow celebrity news.  But I had just read an article about Demi Lovato in a NAMI magazine.  I listened for some report of who she is and what she represents.  I wondered about a recent depression, a suicide attempt, perhaps.

Nope, not a word.  Celebrity drug overdose.  That's the story.  I swear they wrote this story thirty years ago, periodically pull up the file, change the name, and post.

She deserves better.  I'll just have to write my own post.

Lovato has long been open about her mental illnesses, bipolar, bulimia, self harm, drug abuse, and alcoholism.  Her celebrity as a pop star is significant to the story in one way.  It has given her a voice to advocate for those who have no voice.

Celebrity is not a risk factor for substance abuse.  But an alcoholic father is.  She has the genetic load to develop the condition.

Celebrity is not a risk factor for substance abuse.  But childhood trauma is.  She was bullied as a child, to the point of resorting to home schooling.

Celebrity is not a risk factor for bipolar, either.  But substance abuse and bipolar do often go together.  56% of people with bipolar struggle with addiction.  Why so many?  There are three potential explanations:

On Surviving - I Wish Robin Williams Had

Nearly a week's worth of reporting on Robin Williams' death, some of it heartfelt, some of it educational, some of it ignorant bloviating -- even if you have been living under a rock and not heard any coverage at all, you can name the bloviators, can't you.  By now, my readers surely wonder, What is the Prozac Monologues take on his untimely death?

I have written reams on suicide and suicide prevention.  Click on those two links and take your pick.  But skip the Suicide Monologue, at least for another week.  It is inappropriate for another week.  And if you do go there, then mind the humor alert.  I am serious -- about the humor alert, that is.  Some of you won't find it funny. It wasn't written for you.

But before we abandon the suicide conversation in favor of the next thing, let's expand the frame.  Here's the deal.  Of all the people alive on the planet today, 50,000,000 will, at some point in their lifetimes, struggle with suicide.

I can't say we will think about suicide.  Those of you who think about it in passing seem to think that the seriously suicidal think.  There is lots going on inside our burning brains.  But thinking doesn't really describe it.

How To Tame Your Mind -- Ruby Wax

It's like training a dragon, only harder.

Ruby Wax nails depression: when your personality leaves town, and suddenly you are filled with cement.

She nails the problem: our brains don't have the band width for the 21st century.  Nobody's brain does.  Yours doesn't, either.

And she nails the solution: learning how to apply the brakes.

Christina the Astonishing!

Basil the Great vs. Christina the Astonishing – Lent Madness begins.

Saints and Lent – is Prozac Monologues straying from its mission, reflections and research on the mind, the brain, mental illness and society?  Hardly.  First, note the Madness in Lent Madness.  Then wait ‘til you see the saints.

Lent Madness

The forty days before Easter are traditionally a time to focus on one’s spiritual growth.  But there is a looniness built in from the start.  Ash Wednesday to Holy Saturday – count them – 46 days.  Oh yeah, Sundays don’t count.  Does that mean I can smoke and eat chocolate on Sunday?  Opinions vary.

And once you are debating whether you can smoke on Sunday (does it depend on what you’re smoking?), you have already leaned in the direction of madness.  Leaning, leaning…

Ruby Wax Fills In For Mental Illness Awareness Week

Just perk up! -- 'Cuz I didn't think of that.

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

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.

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

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.

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.