July 8th, 2011 by AnneHansonMD in Opinion
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In Dinah’s post “The Chapter I Wish We Had Written” an anonymous commenter wrote about his problems finding an expert witness for his or her employment discrimination case (since I don’t know if Anonymous is male or female I’m going to use a standard male pronoun in this post—apologies if I got this wrong). Anonymous asked his doctor to help with the case, but he refused. He explained to Anonymous that he would be a biased witness and Anonymous also understood that the doctor’s involvement might affect the therapeutic relationship. Anonymous’s doctor gave her a number of referrals to forensic psychiatrists, but since he was not working with an attorney no expert would take the case. Anonymous was understandably frustrated by this situation.
I wanted to write about this because this situation comes up fairly often and I get calls from friends, colleagues and former students asking how to handle it. I’ve already written about what to do when you get served with a subpoena in my post “When Lawyers Call.”
First of all, I think Anonymous’s doctor was particularly astute to recognize the dilemma that arises when trying to help patients in situations like this. Read more »
*This blog post was originally published at Shrink Rap*
July 7th, 2011 by Peggy Polaneczky, M.D. in Health Tips
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A friend of mine had a hard time getting in to see her doctor for an urgent visit last week. Reeling from an unexpected and sudden family upset, she was depressed and anxious, unable to sleep or function, and her therapist was advising an antidepressant. She called her family doc, who works at a large hospital-based multispecialty group, and told the woman at the call center that she wanted to see the doctor on an urgent matter. She was given an appointment 6 weeks in the future.
Summoning her courage, my friend told the woman her story – and that she was really worried about herself and did not think she could wait that long.
“Sorry, that is the best I can do” was the reply.
Increasingly upset, my friend told the woman that if she had to wait that long, she just might kill herself in the interim. Read more »
*This blog post was originally published at The Blog That Ate Manhattan*
June 29th, 2011 by Dinah Miller, M.D. in Health Tips
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For those who don’t follow the comment sections of posts, there have been commenters who have been telling us about the awful experiences they have had as psychiatric patients. In particular (but not exclusively) as hospital inpatients. Commenters have used terms like “abuse” and “humiliation” and describe awful scenarios. One person asked why the mean nurses don’t get fired, everyone knows they are mean including the staff. Others throw the baby out with the bath water, one bad experience. There is implication by at least one commenter that he/she would rather die (presumably permanently) rather than face a day on a psych unit again. The suffering in these posts is palpable.
To those who feel better after leaving comments on Shrink Rap, by all means, feel free to continue, but this will not change the world. May I put in a request? If you’ve had an awful experience as a patient on a psychiatric unit, please tell the hospital. One commenter said she (/he?) complained to the hospital administration and heard that some changes were made. My thoughts? You Go Girl! (If the commenter was a male, I’m at a loss. Way to Go, Joe! perhaps?) Complain, it can’t hurt.
Oh, you say, no one listens to psychiatric patients, they just say we’re crazy so they don’t have to listen. For an isolated complaint, you may be right, Read more »
*This blog post was originally published at Shrink Rap*
June 25th, 2011 by AnnMacDonald in Health Tips, Research
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On Saturday, while thousands of Boston Bruins fans gathered at Government Center to celebrate the team’s recent Stanley Cup victory, a hundred or so true die-hards met a few blocks away at a Massachusetts General Hospital conference to talk about complementary and alternative medicine for psychiatric disorders. While I hated to miss the Bruins parade, I’m glad I attended the MGH conference.
I’ve always been a bit of a skeptic about so-called natural therapies for one simple reason: they don’t have to go through the same rigorous testing in clinical trials that medications do. At the same time, I realize that FDA-approved drugs don’t work for everyone. One in three adults with major depression, for example, can’t completely improve their mood and other symptoms even after trying multiple antidepressants.
Clearly, we need better options for treating mental health disorders. The MGH conference convinced me that some types of complementary and alternative medicine—or CAM, for short—might be worth trying. The presenters, all psychiatrists who treat patients at MGH, backed up their recommendations with scientific evidence. Several of them also contributed to the American Psychiatric Association’s recent report on CAM therapies.
We’ll be doing a story on CAM therapies for psychiatric disorders in an upcoming issue of the Harvard Mental Health Letter. For now, here are some things I learned on Saturday: Read more »
*This blog post was originally published at Harvard Health Blog*
June 25th, 2011 by AnneHansonMD in Health Policy, Opinion
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From the New York Times today we have a story entitled, “A Schizophrenic, A Slain Worker, Troubling Questions,” a horrible story about a mentally ill man who killed a social worker in his group home. The story highlights the defendant’s longstanding history of violence with several assaults in his past. He once fractured his stepfather’s skull and his first criminal offense involved slashing and robbing a homeless man. (On another post on this blog Rob wondered why the charges were dismissed in that case; from experience I can tell you it’s probably because the victim and only witness was homeless and couldn’t be located several months later when the defendant came to trial.) The defendant, Deshawn Chappell, also used drugs while suffering from schizophrenia. Before the murder he reportedly stopped taking his depot neuroleptic and was symptomatic. The news story also suggested that he knew he was committing a crime: he got rid of the body, disposed of the car and changed out of his bloody clothes. Nevertheless, he was sufficiently symptomatic to be found incompetent to stand trial and was committed to a forensic hospital for treatment and restoration. At his competency hearing the victim’s family thought that the defendant was malingering his symptoms, while the victim’s fiance was distraught enough that he tried to attack Chappell in the courtroom. The point of the Times article appears to be an effort to link the crime to cuts in the Massachusetts mental health budget.
So what do I think about this story? Read more »
*This blog post was originally published at Shrink Rap*
In Dinah’s post “The Chapter I Wish We Had Written” an anonymous commenter wrote about his problems finding an expert witness for his or her employment discrimination case (since I don’t know if Anonymous is male or female I’m going to use a standard male pronoun in this post—apologies if I got this wrong). Anonymous asked his doctor to help with the case, but he refused. He explained to Anonymous that he would be a biased witness and Anonymous also understood that the doctor’s involvement might affect the therapeutic relationship. Anonymous’s doctor gave her a number of referrals to forensic psychiatrists, but since he was not working with an attorney no expert would take the case. Anonymous was understandably frustrated by this situation.
