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Some Patients Feel That Mental Health Diagnostic Labels Are Stigmatizing

From time to time, our readers comment that they are distressed with a diagnosis a psychiatrist has given. They’ve met with a doctor, talked for a while (half an hour, an hour, maybe two hours) and based on whatever information the psychiatrist has, a diagnosis is made. Maybe it’s right, maybe it’s not, and maybe the diagnosis will change over time. Some readers have commented that they object to the idea that psychiatrists must assign a diagnosis to be paid, when in fact there is no diagnosis, and they think that’s wrong. The psychiatrist should work for free?

Since I don’t accept insurance, I’m not obligated to make a diagnosis, but if I don’t put one on the statement, the patients won’t get reimbursed. Some tell me that they aren’t submitting psychiatric claims to an insurance company, others don’t have insurance, and many do submit claims. I’m left to wonder why someone with no psychiatric diagnosis would consult a psychiatrist to begin with, especially since some diagnoses (Adjustment Disorder, for example, or Anxiety Not Otherwise Specified) are not particularly stigmatizing. Read more »

*This blog post was originally published at Shrink Rap*

Psychotherapy And Humor

Awhile back I put up a YouTube audio that I thought was funny. A commenter didn’t like it and felt it promoted stigma. So I took a vote, and while most people were fine with it, a number did not like it, and I took the post down. We received this note, and I thought it was substantial enough to be its own guest post (with permission, of course).

Hi. I am a practicing psychiatrist based in New York City. I find your blog interesting, informative, and, at times, funny. Now, can you guess which entry I’d like to comment on?

Mel Brooks once said (paraphrased) that if you slip on a banana peel and land on your butt, it’s comedy. If I fall down a flight of stairs, it’s tragedy. I’ve had a long-term interest in humor, and a brief career as an unpaid stand-up comic in L.A. (Brief because my bombing to “killing” ratio was about 15 to one.) With respect to my experience as a therapist, I now occasionally utilize humor in my treatment, but only extremely judiciously once I have gotten to know my client. I learned my lesson early.

At the beginning of my residency training, during my second session with a client, I commented that perhaps he felt like Groucho Marx when Groucho said that he “wouldn’t want to be a member of any club with standards low enough to accept [him].” I sat back, feeling as if I had made the interpretation of the century, and waited for a reaction. I got one. Read more »

*This blog post was originally published at Shrink Rap*

Mental Illness And The Right To Vote

Back in the 1970s, Kansas passed a law that could prevent people with mental illness from voting. The law was never used, but advocates were successful in getting an amendment passed that revoked that law.

This law was passed at a time when stigma against mental illness was much higher than now. I’m guessing it was presumed that folks with a mental illness could not reason enough to exercise an informed vote, which is not true, of course. If 1outta5 have a psychiatric illness, including anxiety, depression, and substance abuse, then there could have been a huge swath of disenfranchised voters.

And there already exists, to a degree, a basic cognitive test for voting: Navigating the whole ballot process. In Maryland, ours was electronic and no harder to use than an iPad, but I could still imaging some with severe dementia unable to navigate the system. But there should never be a cognitive bar one must pass to vote. The challenge would be where to draw the line.

*This blog post was originally published at Shrink Rap*

Patient Privacy In Haiti: “She Has AIDS” Via A Secret Note

I can’t get the stories of Haiti out of my mind. A patient showed up at the Port au Prince hospital ward with a massive left sided paralysis: an obvious stroke. This 48-year-old woman had collapsed the day before and was now accompanied by her three grown daughters, who were most attentive and worried. I examined her in the bed with other patients and families gathered around. (There is no sense of privacy and even an exam seems to be everyone’s business in Haiti). One daughter spoke broken English, but I had a good translator that helped me get the information I needed. It was a sad story. Read more »

*This blog post was originally published at EverythingHealth*

HIV, Stigma, And The Media

Last November, the National Football League devoted the entire month to breast cancer awareness. Players like Reggie Bush wore pink gloves, armbands, even shoes, to promote efforts to fight the disease.

There were some heartwarming moments. Players brought their mothers, grandmothers, and other women who’d battled breast cancer to the games, all of them wearing attractive pink game-day jerseys. Announcers told their own stories of “courageous” battles against the disease waged by friends and family members.

It’s powerful and inspiring, these overpaid hulks of manhood showing they’re secure enough in their masculinity to don feminine-ish garb to support their sisters and mothers.

But try to imagine the NFL — or any sports league — launching a similar campaign to fight HIV and AIDS. Which player would trot out a brother, sister, or father who’s HIV positive? Which television announcer would proudly point to the afflicted and speak of their “inspirational” battle with HIV?

In an NPR interview last week, Theresa Skipper talked about why she concealed her HIV diagnosis for 19 years: Read more »

*This blog post was originally published at The Daily Monthly*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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