Prozac Monologues

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.

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.

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.

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?

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.

Your genes — that’s where bipolar gets started. Of all the mental illnesses, bipolar is the most heritable. That means it has the strongest genetic connection. In studies of identical twins, if one twin has bipolar, so does the other in 75% of the pairs. That compares to 60% with depression and 35% with schizophrenia.

If one parent has bipolar, a child is 13 times more likely to develop bipolar than a child with parents who do not have the disorder. If both parents have it, the child is 36 times more likely to develop it.

So you go to your doc and present symptoms of depression. Your doc will ask, Does anyone in your family have bipolar? But that's not the question you will answer. When you say No, the question you are probably answering is, Has anybody in your family ever been diagnosed with bipolar — that you know about?

While Prozac Monologues the book is on its way to publication😲Prozac Monologues the blog is being revived. I start the revival with a preview/expansion series on the chapter called Balancing Act, aka, The Science Chapter.

A friend who happens to be an academic psychiatrist reviewed The Science Chapter. He wrote, Pathophysiology of BP is really tough, even for us "bigwigs", and I hope you have some success summarizing it for a non-professional audience.

So I said, Hold my beer.

And here it is:

In a person with bipolar, a whole series of mis-timings and misalignments in our internal and external cycles results in a failure to rebalance. 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.

Okay, that will take some unpacking, which I will do over the coming weeks. Meanwhile,

it's like this:

Stay tuned...

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:

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.

Silence Kills -- The Stigma of Mental Illness Redux

It's Mental Health Month again. Out comes the stigma word, the pleas for understanding, the heart-warming whatever.

I am so done with stigma. Frankly, I am insulted that NAMI et al still use the word. Is Black Lives Matter about stigma? It's dangerous to be either in the US, and for the same reason. Prejudice, people. We are talking about prejudice.

The following was first posted in July 2013. Alas, we are still trying to get our heads out of our asses. The Affordable Care Act made some progress, a little, toward mental health parity. Insurers had to get creative to deny us coverage. But this congressional session, it's all up for grabs again, whether our illness will get covered at all. And the prejudice of doctors -- don't get me started.

So from July, 2013 --

*************************

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>.

I opened my curtain this morning, saw a brilliant blue sky, and remembered, "April is the cruelest month..." April is when suicide rates start to rise, to peak in June. Then, as is my habit, I said Morning Prayer, a spiritual discipline of prayers, psalms and bible readings. The assigned psalm for today is Psalm 20:

May the LORD answer you in the day of trouble,

the Name of the God of Jacob defend you;

Send you help from his holy place

and strengthen you out of Zion;

Remember all your offerings

and accept your burnt sacrifice;

Grant you your heart's desire

and prosper all your plans.

We will shout for joy at your victory

and triumph in the Name of our God;

May the LORD grant all your requests.

If April is the cruelest month for you, my friend, I prayed this prayer for you. Now, this sort of thing doesn't always help me. And no blame, God, no blame, if it doesn't help you. But if it does help you today, there it is. We will shout for joy, you and me and all of us who know what I am talking about, at your victory.

And while I have anybody else's attention, suicide prevention is not usually a dramatic, last minute intervention. Suicide happens when pain exceeds resources for coping with pain. Let me repeat that. Suicide happens when pain exceeds resources for coping with pain. Every day, in any little way, you are a resource. Or not. Kindness. That's the ticket. Just pay attention to someone who may be struggling. And do something, anything kind.

That's all.

Mental Illness in the Bible

Something different here -- a sermon from the batshit crazy preacher --

[When I Googled mental illness in the bible, I was, frankly, appalled by what came to the top of the page. So I hope this banal title will make a better message easier to find. If you share this post, you can do that service.]

Now to the sermon:

1 Kings 19:1-15
Psalms 42&43
Luke 8:26-39

I don't often preach about mental illness. I'm not sure I have ever heard more than a mention of it by any other preacher. But today the lectionary asks us to tell stories that are not told.

Because we are no strangers to mental illness,and neither is the Bible. There's Saul, his bipolar episodes and his suicide. There's Job and Jeremiah, hardcore depressives. There's neurotic Paul himself, though that diagnosis has gone out of fashion. And Ezekiel, well, you'll have to read him and decide for yourselves.

Last week a friend told me she had just been diagnosed with bipolar. I remember eight years ago when she told me she was finally getting treatment for depression. I didn't say it at the time, but for the next several days my brain was screaming it: Really? In 2016 people are still being misdiagnosed, and mis-treated, mistreated with meds that make them worse. I mean,

F*cking Really?!!

Lives are at stake here, people. Careers, families, credit, and yes, lives. That is what people lose when their doctors get this call wrong.

Today is Vincent Van Gogh's birthday. Some people give him a post-mortem diagnosis of bipolar disorder, and take the occasion to declare World Bipolar Day. Healthcentral.com contributor John McManamy says for him, every day is bipolar day.

As for the world in World Bipolar Day, precisely which world are people talking about? In my memoir, I note:

Maybe someday, aliens will kindly abduct me and return me to the planet of my birth.

In the meantime, I'm stuck on this one, not a planet of my own choosing, performing my own stunts, learning as I go along. As I like to joke: We're peanut butter people stuck in a tofu world governed by Vulcans.

World Suicide Prevention Day - Keeping It Simple This Year

Two things I wish everybody knew:

No matter how you package it, shaming suicide does not prevent it, and

Understanding never pushed anybody over the edge.

photo of candles by Nevit Dilmen, used under the GNU license.

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.

It amazes me how many research scientists seem to have flunked statistics. Or ought to have. Me, I majored in the liberal arts. But at Reed, even those who took Science for Poets would be required to rewrite some of the scientific papers I have read on the subject of antidepressants.

So the vocabulary terms for the week are observer bias and confounding variables. No worries -- lots of pictures.

Clinical Experience in Defense of Prozac

Let's say you are a doctor treating 100 patients with severe depression. You give them all antidepressants. It seems irresponsible not to, doesn't it. Thirty of them get better. Fifteen do not make a follow-up appointment. You switch the fifty-five who are still trying to another antidepressant. Another fifteen get better. And another fifteen do not make a follow-up appointment.

Over the course of a year, you get up to fifty whose depression is remission and ten who are still struggling. You don't know what happened with the forty who are no longer seeing you. They couldn't afford treatment; they didn't like your face; they couldn't find parking; they got worse on your medication. You have no idea. But you have fifty patients who think you saved their lives. You feel pretty good about yourself, don't you.

Antidepressants and Suicide: A History

Do antidepressants prevent suicide, or do they cause it?

Yes.

Well, maybe.

It's a no-brainer, right? People who commit suicide are depressed. Take away the depression, and how better than with an anti-depressant, and you decrease the risk of suicide.

So what's with the question? Here is the story:

History of Antidepressants

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.

Richie Cox, Rest Easy Now

Any story worth telling is worth improving.

Richie had a fisherman's philosophy when it came to story telling. He inspired, or provoked, or was co-conspirator in many of the Bar Tales of Costa Rica. The following excerpt is my tribute to this cowboy/hippie/mystic who will be sorely missed.

Apology

There is one particular table at the Pato Loco where deals get made over American breakfast. Mama, who has overheard a lot of deals being made, said, “It gets so you can tell the real ones from the ones who are all talk. Paul, he never talks about his deals. He’s one of the real ones. But that Jerry who reneged on the house, you could tell he was all blow.”

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…

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.

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.

Andrew Solomon on Depression

I want to be Andrew Solomon when I grow up. Only briefer. And funny.

In the absence of blood tests, people with depression have words. And Solomon has a lot of them.

Solomon's book The Noonday Demon: An Atlas of Depression sits by my bedside. I'll get through it someday soon, because I want to tell potential publishers that Prozac Monologues is Noonday Demon, only briefer. And funny.

Solomon went around the world to report how the world experiences depression. Yes, he found it everywhere.

Last week when I told my doctor I was going to Costa Rica, he asked if I would feel better there. You know what? People in Costa Rica get depression, too. Hard to imagine, I know. But it's true. They have psych wards and therapists and ECT and everything in Costa Rica. I have a card for a psychiatrist in San Jose, just in case.

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 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.

Ruby Wax Fills In For Mental Illness Awareness Week

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

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.

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

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

Definition of STIGMA

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