October 6th, 2010 by Dinah Miller, M.D. in Better Health Network, Health Tips, Opinion
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“I have bipolar disorder. Can I be a doctor?” One of our readers asked this. It’s one of those questions to which there is no real answer.
Being a doctor takes a long time, it requires reliability, diligence, and a willingness to learn things you may not want to learn (organic chem anyone?) and do things you may not want to do. It requires endurance and passion. You need to be tolerant of many things: Arrogant supervisors, irritable colleagues, sick people who may not be charming and who may, in their distress, be downright nasty. You have to tolerate a militaristic order and be willing to work with a system that may be very difficult, wrong, and demand your obedience in ways that may be uncomfortable. (Oh, I am so happy to no longer be a medical student or a resident in training.)
So can you do it with bipolar disorder? Can you do it with diabetes? Can you do it with attention deficit problems? Can you do it if you’re disorganized or ugly? Read more »
*This blog post was originally published at Shrink Rap*
September 24th, 2010 by Dinah Miller, M.D. in Better Health Network, News, Opinion, Research
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In psychiatry, we’ve had a hard time drawing precise links between brain pathology and psychiatric disorders. We can do it for groups of people: “Disease X” is associated with changes in brain structure of “Brain Area Y” or metabolic changes in “Brain Area Z.” But it’s groups, not individuals, and it’s an association, not a cause-and-effect, or a definite. We still can’t use this information for diagnosis, and there are still patients with any given psychiatric diagnoses who will have brains where “Area Y” is the same size as those without the disorder. We’re learning.
From what I read in this New York Times article, Owen Thomas was a bright, talented young man with no history of psychiatric disorder and no history of known concussion. In April, he committed suicide — a tragedy beyond words.
Sometime people commit suicide and everyone is left to wonder: There was no depression, no obvious precipitant, no note left behind, and every one is left to wonder why. The guilt toll on the survivors is enormous, as is the grief for their families and communities. In this case, according to the Philadelphia Inquirer, the young man was apparently struggling with the stress of difficult school work and concerns about his team and employment.
Owen’s family donated his brain to Boston University’s Center for the Study of Traumatic Encephalopathy. They discovered that Owen’s brain showed damage similar to that seen in older NFL players — he had a condition called chronic traumatic encephalopathy. Read more »
*This blog post was originally published at Shrink Rap*
September 7th, 2010 by Dinah Miller, M.D. in Better Health Network, News, Research
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The New York Times Magazine recently featured an article on preschooler depression. Pamela Paul wrote:
Diagnosis of any mental disorder at this young age is subject to debate. No one wants to pathologize a typical preschooler’s tantrums, mood swings and torrent of developmental stages. Grandparents are highly suspicious; parents often don’t want to know. “How many times have you heard, ‘They’ll grow out of it’ or ‘That’s just how he is’?” says Melissa Nishawala, a child psychiatrist at the New York University Child Study Center.
And some in the field have reservations, too. Classifying preschool depression as a medical disorder carries a risk of disease-mongering. “Given the influence of Big Pharma, we have to be sure that every time a child’s ice cream falls off the cone and he cries, we don’t label him depressed,” cautions Rahil Briggs, an infant-toddler psychologist at Children’s Hospital at Montefiore in New York. Though research does not support the use of antidepressants in children this young, medication of preschoolers, often off label, is on the rise. One child psychologist told me about a conference he attended where he met frustrated drug-industry representatives. “They want to give these kids medicines, but we can’t figure out the diagnoses.” As Daniel Klein warns, “Right now the problem may be underdiagnosis, but these things can flip completely.”
Reference: “Can Preschoolers Be Depressed?” (The New York Times Magazine, August 25, 2010).
*This blog post was originally published at Shrink Rap*
