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.

Loony Saints - Margaret of Cortona Edition

Every once in a while, Prozac Monologues reaches into my Roman Catholic childhood's fascination with saints, especially the ones who today might be assigned a diagnostic code in the DSM.  Twice, Lent Madness has introduced me to new ones that I share with you.

A few years ago it was Christina the Astonishing.










Today it's Margaret of Cortona.  If you're a Lent Madness regular, you'd expect Margaret to be a shoe in for the first round of voting, where her competition is a stuffy old bishop/theologian, because Margaret became a Franciscan and, more significantly, her story features a dog.  Lent Madness voters are suckers for dogs.

Bipolar and Wonky Wiring -- The Football Version

The brain is like a football team.  Go Ducks!

There are several parts, each playing its own position and fulfilling a particular function.  Together they run plays that have been rehearsed and repeated over and over, many until nearly automatic.  The behavior of the other team/environment requires adaptation of these plays, often in mid-play.  And communication among the members is essential.

Here is how they line up on the brain field.  Analysis is at the front, near the forehead.  Memory and emotion hang out together.  Coordination is at the back.  Basic life functions are at the base of the skull.  Communication runs through the middle, connecting them all to one another.

Bipolar and Mitochondria

Misfirings and mis-timings of a number of systems affecting: hormones, neurotransmitters, and immune system cycles that go off-kilter; glitches in communication between brain cells and within brain cells; and wonky wiring among the networks that connect the thinking, feeling, and evaluating parts of the brain -- that's bipolar disorder in a nutshell.  Okay, a very full nutshell.  Last week I explored one example of hormone cycles gone off-kilter, cortisol.

This week, we go inside cells to discuss my favorite little critters, mitochondria.  I first learned about mitochondria from Madeleine L'Engle, from the second of her Wrinkle in Time series, A Wind in the Door.  Charles Wallace is sick, dying, because of a problem inside his cells.  His mitochondria are not doing their job.

Mitochondria are organisms (technically, organelles) that crawled inside the cells of animals back when animals were being formed out of the ooze.  It is a beautiful relationship.  We are their hosts and meal ticket; they are the power plants that convert food into energy.  If they don't work well, neither do we.  Since the brain uses bucket loads of energy, a problem with energy production has serious consequences for anything the brain is supposed to do.

What Do Mitochondria Do?

Bipolar and Cortisol

Y'all know about Bipolar as the mood disorder of Up and Down.  You have seen the movies, watched the soap operas and dramas.  The medications promise to reduce the number of trips around the loop de loop.

That's important, because what goes up must come down, and the fall can be mighty.  But there is more to is that that.

In a person with bipolar, a whole series of mis-timings and misalignments in our internal and external cycles results in a failure to maintain balance.  The list includes: dysregulation of hormones, neurotransmitters, and immune system; irregularities in communication between brain cells and within brain cells; and wonky wiring among the networks that connect the thinking, feeling, and evaluating parts of the brain.

In other words,

Over the next few weeks, I will sample this list, especially the items that are true all the time, even when not on that roller coaster.

Dysregulation of cortisol is one of my favorites, to use the term loosely.  Cortisol is the get-up-and-go hormone.  It gets you out of bed in the morning and manages energy throughout the day in response to stress.

What Causes Bipolar -- III

No, your genes did not make you do it.

And the Prozac Monologues Tutorial on Bipolar Disorder continues, with installment #3.

Bipolar starts in the genes. But there is no smoking gun. There is no genetic defense. If you mortgaged the house, went to Vegas, lost the money, caught a disease, now you're in divorce court and maybe jail, nope.

Your genes did not make you do it.

The way the scientists put it, genes do not code for behavior. Okay, as last week's post says, it starts in your genes. But you are not doomed to end up in divorce court. You have just got some extra challenges to surmount.

Mental illnesses are developmental. They start with a brain that has certain vulnerabilities which come from genetic variations from the norm. These are vulnerabilities, not scripts.