Wednesday, April 16. 2014
From a physician's report:
I have been so depressed that I have considered killing myself many times. I decided 30 years ago that I could never safely own a firearm because I knew what I would do with it someday. Even so, I have come close to buying a gun. A few years ago, I had extremely severe, treatment-resistant depression—an epoch more than an episode—that lasted several years and steadily worsened despite multiple medicines and weekly visits to my psychiatrist. Eventually, I did go shopping for a pistol. With great difficulty, I chose not to buy it and committed myself to the hospital instead.
Sunday, April 6. 2014
Dr. Joseph Pierre offers a good explanation of what Psychiatrists do: A mad world - A diagnosis of mental illness is more common than ever – did psychiatrists create the problem, or just recognise it?
A quote:
The truth is that while psychiatric diagnosis is helpful in understanding what ails a patient and formulating a treatment plan, psychiatrists don’t waste a lot of time fretting over whether a patient can be neatly categorised in DSM, or even whether or not that patient truly has a mental disorder at all. A patient comes in with a complaint of suffering, and the clinician tries to relieve that suffering independent of such exacting distinctions. If anything, such details become most important for insurance billing, where clinicians might err on the side of making a diagnosis to obtain reimbursement for a patient who might not otherwise be able to receive care.
Though many object to psychiatry’s perceived encroachment into normality, we rarely hear such complaints about the rest of medicine. Few lament that nearly all of us, at some point in our lives, seek care from a physician and take all manner of medications, most without need of a prescription, for one physical ailment or another. If we can accept that it is completely normal to be medically sick, not only with transient conditions such as coughs and colds, but also chronic disorders such as farsightedness, lower back pain, high blood pressure or diabetes, why can’t we accept that it might also be normal to be psychiatrically ill at various points in our lives?
Thursday, April 3. 2014
I am strongly opposed to death taxes of any sort. Those monies have already been taxed, and they belong to your estate which is really just a legal extension of you. You could have spent your assets when alive, but chose to conserve them. Saving is supposed to be a virtue.
(I am also opposed to gift taxes which limit how much one can give to a family member, or anyone else, without a tax penalty, but that's another topic.)
I do understand that the greedy government wants any money it can get, from any source, and I also understand that estate planning for the wealthy employs thousands of attorneys and accountants who might otherwise have little to do.
What's wrong with the idea that, over time and over generations, there would be the freedom for families to accumulate assets for the benefit of their present and future kin? The more, the better. Financial independence to some degree can be either a blessing or a curse, but, contra Teddy Roosevelt, that's not government's proper concern. I have seen family businesses, farms, and family vacation places destroyed by estate taxes, and it seems wrong to me.
Here are my poll questions - assuming you and spouse have died:
1. Do you want to leave any assets to your kids, grandkids, relatives, friends, or do you want to die broke?
2. What % of your estate would you wish to give to charities?
3. If you have one prosperous kid and two middle class or poor kids, would you write your will differently for them?
Thursday, March 27. 2014
 Isn't all sex recreational in some sense of the word? Eating is recreational too, in part, and they are both fun. Well, unless these things are dutiful chores which they can be, sometimes, for some people.
What's wrong with recreational sex (eg FB's, friends with benefits, dorm trios - meaning studly guy plus 2 playful and adventurous gal roomies, one-nighters, etc) among the uncommitted? And isn't lots of marital sex really recreational, in some sense, anyway? If not "casual" - see "kitchen table sex."
It's a serious question. In the old days, people married in their teens so that an extended period of sexual ache, longing, and loneliness was more or less taken care of. Of course, we all have our morals, scruples, religions, ethics, and considerations for the feelings of others to take into account. That's the issue, isn't it?
Frequent sexual and romantic thoughts and desires are, for better or worse, a routine part of being human. People can fall into love, lust, or desire readily. (They can fall out of those things too, fairly readily.) I am constantly reminded in my work about how prevalent, but far from universal, recreational sex is among the young, and among older singles. (No, I am not one who views sex as sacramental but more as an animal aspect of humanity with an overlay, so to speak, of a hundred other meanings. In my youth, I think I was too sentimental, religious, soulful, respectful - and controlled - to ever have been a party girl. Some regrets? Not saying. My fantasies are exciting, but private.)
A book by Psychiatrist Stephen Grosz: The Examined Life: How We Lose and Find Ourselves.
It's about peoples' life stories. Highly readable by the non-professional.
We had a good, brief post on posture last week.
It is indeed true that our posture, along with our general comportment, attire, manners, speech, and capacity for chat are what others base their initial impressions on. Rightly or wrongly, those things matter to me too.
To stay strong and upright, I do deadlifts. Like squats, they are highly unpleasant but highly beneficial for leg strength and back strength. If we spend 15 hours per day sitting, we must do what little we can to remain vital and to delay physical decay.
Physical and mental decay begins, according to the experts, in our late 30s.
Saturday, March 22. 2014
Good posture makes people look better. It makes you look younger and inspires confidence, and it feels good.
Good posture is a habit, and so is poor posture. The military is effective at training good posture. Typical causes of poor posture are psychological, lack of training, aging, and physical weakness.
If you want to improve your posture, just imagine your Mom reminding to to sit up, or stand up, straight, all day long. Then you can work on your abdominal and back muscles, which are what make standing upright possible. Here you go: Exercises for Better Posture.
Life training matters, and can only come from home. Moms say "Stand up straight, look people in the eye, have a firm handshake and a pleasant but reserved demeanor. Nobody wants to know your natural self."
Friday, March 21. 2014
No pain, no gain? This is about gratifications and pleasures earned in the completion of things one has the impulse to avoid which require possibly unpleasant exertion, effort or discipline in contrast to easy, unearned gratifications.
The capacity to delay gratification is considered a measure of maturity and life-competence, but we all struggle with something ever day. The enemies are "I don't feel like it" or "I feel like it." In other words, self-indulgence. The enemy is us.
The earned gratifications of accomplishment tend to feel better afterwards; unearned gratifications (eg food, booze and drugs, shopping, trips and vacations, watching TV, romantic affairs, surfing the web, etc, etc.) tend to feel good while doing but often worse after because they are easy pleasures or cheap thrills which have costs which are often out of proportion to meaningful gains.
I'll confess some of my personal routine challenges, some trivial and some not:
- Getting to church - hate to dress and drag us there on Sunday morning, but always glad we went
- The gym and/or painful ("Feel the burn") exercising. No pain, no gain.
- house cleaning (I don't mind doing laundry though - thank God for electricity)
- Paperwork, paying bills, and tax prep
- Facing/doing scary or confrontational things - eg "difficult conversations"
- Dieting
- Calling Mom when I have nothing to talk about
- throwing a dinner party or cocktail party
- Studying things you need to know but aren't interested in
- giving up wine for Lent
- going to the doctor or dentist
- boat cleaning
- social events where you don't know anybody - but then you meet interesting people
- meeting with estate planners, revising the will
- getting a kid through college
- attending professional meetings
- weddings (boring except for the families) and wakes/funerals (difficult to face, for me)
What's on your list of things you feel like avoiding, but feel good after you do them?
Thursday, March 20. 2014
 For years, I have been explaining here that dietary fats are not a meaningful factor in heart disease (arterial disease). Your cholesterol level most likely doesn't matter either unless you have familial hyperlipidemia or diabetes. I believe those outliers skewed earlier studies.)
Here's more evidence: Study Questions Fat and Heart Disease Link.
The article also says this:
The smaller, more artery-clogging particles are increased not by saturated fat, but by sugary foods and an excess of carbohydrates, Dr. Chowdhury said. “It’s the high carbohydrate or sugary diet that should be the focus of dietary guidelines,” he said. “If anything is driving your low-density lipoproteins in a more adverse way, it’s carbohydrates.”
Once again, it's the carbs that are the problem. Best thing is to deal with that carb addiction.
Wednesday, March 19. 2014
Dr. Dalrymple: The Difference Between Firmness and Cruelty
Deny the dark side of human nature at your own risk. Those who deny it in others tend to be those who deny it in themselves.
Tuesday, March 11. 2014
Forever Young? 20 of the Hottest Women Over 60 Years Old. 65 is the old 45. All it takes is some care, some flair, some estrogen, some exertion, and a little cash for teeth, hair, and skin.
Re the below by Peter Arno, Are you? And is he the young man you married?
Sunday, March 9. 2014
Dalrymple begins:
In my career as a doctor in prison, I met a few swindlers in my time and on the whole I liked them. They had charm and intelligence, which perhaps is unsurprising. It isn’t easy to imagine a charmless swindler, after all; it is almost a sine qua non of the trade. Whether their charm preceded their swindling or they developed it in order to practice their swindling is hard to say, though the former is more likely. Be that as it may, their charm was their stock-in-trade and human gullibility the market in which they sold their wares.
Wednesday, March 5. 2014
A new study: High suicide rates for soldiers in, out of war
A while ago, Junk Science put in a well-deserved plug for Dr. Paul McHugh and Dr. Sally Satel in his piece, in which he notes that the majority of military suicides have never been near combat.
I could discuss the topic of suicide and suicidality for days. Suicide is not one thing. It is endlessly complex, and definitely not always accompanied by clinical depression or other mental illness. Shame, guilt, loss, or anger are often prominent components, along with personality disorders, Bipolar, psychosis, and other things.
PTSD? Readers know that I tend to think that it is not a "disorder" but a normal variant. The people who put the DSM together can't tell the difference.
Here's the article by Elise Cooper to which he was reacting: Suicide in the Armed Forces: Not a Disgrace
Tuesday, March 4. 2014
Some of our readers enjoy Allen's movies. I do. My first date with the future Mrs. BD was to see Sleeper. Does the man have any moral foundation? I doubt it. Talent? Undoubtably. What is wrong with the people in the film biz?
A shrink friend sent me this comment:
“Woody Allen, Mia Farrow, Dylan and Truth or truth” (Or, “Would you read this if the title didn’t say “Woody Allen.”)
“Truth is truth,” Paddy Chayefsky stated. If only analysts could have that certitude, lost in the past few decades. Truth is relative, “constructed” in the present (transference), not historically accurate. Historical truth doesn’t exist or doesn’t matter at least. Except if a child was sexually molested: then truth matters, the real thing, what happened, was she or he seduced, assaulted. No “relative” here (for truth).But not a simple matter. Let’s listen to Jean Piaget (more neutral than Woody Allen).
Piaget said that for much of his childhood, he “remembered” that when he was in the pram with his nurse as an infant, he was kidnapped. Then, some years later, his nurse revealed that he had not been kidnapped; she simply hadn’t paid attention and his pram rolled away. He still “felt” that he was kidnapped, even as he learned the historical truth that he hadn’t been.
Now, Allen and Farrow (for this is mostly a tragedy that results from their stunning animosity); their children suffer from what the U.S. Army would call “friendly fire” (about nothing which is friendly when your shot dead). Their young adult adopted daughter is cited by a columnist as an example of someone molested by her father in childhood and the aftereffects into adulthood. But, Allen cites an extensive evaluation at Yale Child Study Center at the time of the alleged molest, that showed that she was likely not molested by father. If they are to believed, if our Yale colleagues are to be trusted to some degree, then we learn at least three things.
First, the now young adulthood victim believes that she was molested; she is a victim of animosity between her parents. Second, we learn respect for the adherence between love and hate (as Freud suggested); how love turns to hate when a “divorce” occurs.
Second, Farrow, married at nineteen to Andre Previn, has such animosity to Allen that she would make enduring accusations at the expense of her children’s well-being (her older son confirms that mother told the children to turn against their father).
And third, perhaps Allen’s last word on this may be dismissed by some.
Perhaps all that is left to us at this point is to recognize that some “truths” are not so relative; ain’t important. Truth about life events can really count. When we work with children molested, helping them recognize the true events of their, to explain why they feel and live the way they do, is one significant factor in this work.
Two parents rain animosity at each other over the decades; their children are shot down in this crossfire.
"What it comes down to is that the mystery of joy does not pose a problem for me. I treat it as a constant rather than a fleeting experience."
Taki is a blessed human being; one of the fortunate ones for whom life itself is a blessing and who can spread it to others.
Saturday, March 1. 2014
Psychiatric Times retracts essay on “satanic ritual abuse”
Psychiatry has seen its share of damagingly-erroneous fads over the years: multiple personality, satanism, "recovered memories." It's important to learn from such fads and errors, not to hide them in embarrassment.
Every branch of medicine, and of science in general, experiences erroneous fads and false enthusiasms. Only a few years ago, the climate scientists were going nuts about global cooling, and soon, perhaps, they will do so again.
The only cure is chronic skepticism.
Sunday, February 23. 2014
From Paul Bloom, (author of Just Babies: The Origins of Good and Evil), The War on Reason - Scientists and philosophers argue that human beings are
little more than puppets of their biochemistry. Here's why they're
wrong.
In a contemporary, and often unacknowledged, rebooting of Freud, many psychologists have concluded from such findings that unconscious associations and attitudes hold powerful sway over our lives—and that conscious choice is largely superfluous. “It is not clear,” the Baylor College neuroscientist David Eagleman writes, “how much the conscious you—as opposed to the genetic and neural you—gets to do any deciding at all.” The New York University psychologist Jonathan Haidt suggests we should reject the notion that we are in control of our decisions and instead think of the conscious self as a lawyer who, when called upon to defend the actions of a client, mainly provides after-the-fact justifications for decisions that have already been made...
Tuesday, February 11. 2014
Editor's note: Dr. Azeff will be a regular contributor on medical topics
"Surviving Anxiety" was the cover story of The Atlantic magazine for January/February written by its editor, Scott Stossel.
One is a little flabbergasted when reading this man's story. While portraying himself as virtually crippled by anxiety in all of its forms, generalized anxiety, post traumatic stress, panic disorder and multiple phobias, he functions as the editor of a prestigious magazine which means likely conflicts with aggressive publishers and super-sensitive, if not querulous, writers. He is a writer himself and therefore a person expected to show up for promotional talks and for lectures. How does he do it? He begins his article, excerpted from his book, by describing his drug regimen for public speaking; xanax, inderal and scotch or vodka. As a clinician one is immediately tempted to take the bait and challenge the doses of his medication and balk at his use of ethanol which he acknowledges is risky at best, dangerous more honestly. From there we are led on a trip through his life and through the evolution of psychiatric treatments over the past thirty years, the good the bad and the ugly.
His first doctor who started treating him at age eleven and saw him twice a week for 25 years is roughly of my generation, I'll be 75 in a few months, Dr. L as he is called is probably in his early eighties. Analytically oriented therapy mixed with play therapy mixed with pharmacotherapy at the outset, progressing over decades to everything as it came along including EMDR and self-actualizing therapy whatever that means. One can appreciate the changes over the years as a picture of the evolution of a modality seeking a scientific framework. Just as edema was initially seen as a unitary "disease" called dropsy until science deconstructed the multiple causes of this symptom, so many of our psychiatric illnesses may be no less than psychological dropsy. I'll wager in the next ten years "schizophrenia" will be at least four different conditions of different etiology, and anxiety may follow suit as well.
But what I take away from this verbose, sometimes wry, sometimes antic, sometimes prolix piece is the transgressions of some of his caretakers. Well into Scott's treatment, Dr. L takes his father into treatment as well and uses Scott's sessions to get information about Stossel senior. The porous boundary is something we all grapple with but this is a destruction of the boundary that calls the treatment into question, perhaps from the start. After all, we may change course with a patient but usually with caution and discussion. I hope we are beyond the point of arguing that one cannot do both psychotherapy and psychopharmacology, but can one start with a classic dynamic model and wander into EMDR? Then there is the behavioral psychologist, Dr.M (both of these caretakers are "Boston" and Harvard trained and perhaps even faculty so we all must be clear that they definitely and unimpeachably know what they are doing) who determined his core problem was emetophobia, fear of vomiting, which she would treat with exposure therapy. Using the emetic ipecac which had cured other emetophobes, Stossel attempts the exposure with two doses of ipecac that produce retching and gagging but no vomiting in the course of four hours.
The next day he speaks to Dr. M who eventually relates that she was so shaken by his experience she cancelled all of her afternoon patients and spent the day at home nauseated and vomiting and taking to bed. Once again a transgression of questionable purpose. That treatment was fractured and collapsed fairly soon afterwards. We all have seen patients who are difficult to treat, who have disabling symptoms of anxiety or depression or psychosis, which are not easily medicated. How often do we ask ourselves about the possibility that the patient is consciously or unconsciously engaged in an attempt to make us feel as helpless and demoralized as he feels? Is it "blaming the patient" to weigh this possibility as a cause of intractable symptoms?
There is nothing glaringly obvious pointing to this in the story Stossel tells us and his brave walking through fire story is to be admired, but I'm just saying . . .
Friday, February 7. 2014
An annual re-post, but re-posted again because we seemed to help a number of people with this:
Forget the "Obesity Crisis." That's a crock. Abundant, good food is a blessing and a rarity in human history so it is a great privilege and luxury to be overweight. It certainly is true that, when tasty food is cheap, people will eat a lot of it and their bodies will kindly store what they don't need to survive today, to the detriment of our knees, hips, appearance, comfort, and general vigor. Trouble is, we won't need that storage tomorrow - or ever. It's like hoarding.
We can all be as fat or fit as we wish to be. It's a free country, and being fat (but not obese) isn't terrible for your health unless you are diabetic or want to be able to get around energetically. But don't listen to the Dieticians and Nutritionists. They will want you to get in shape slowly and in a "sustainable" way. In your heart, you know that will never happen. If you are bothering to read this, you just want to get in shape as quickly as you can without liposuction or use of the vomitorium.
Eliminating carbs reduces or eliminates carb craving in most overweight people over several weeks.
This can be a one- to three-month program as desired. Maintenance is another topic.
Details below -
Continue reading "The Official Maggie's Farm Get-Back-in-shape before Summer Plan"
Thursday, February 6. 2014
 I never expect honest answers from questions about sex, substance use, or money, so I won't expect perfect honesty here.
However, in an effort to warm up this frigid winter season, here's my scientific Maggie's Farm poll question for today:
How often during a normal day out and about in the world do you think "Hmmm, that's appealing; I think I wouldn't mind having some sex with that guy or gal"?
Honest answers most appreciated.
Sunday, January 26. 2014
We go back to Arthur C. Brooks' 2007 What Really Buys Happiness? Not income equality, but mobility and opportunity
Most of the studies he discusses avoid defining happiness, and just let people report. At issue, of course, is that as long as one is not in dire straits, happiness and contentment in life depend on non-economic factors: temperament and personality, relationships, family, hobbies and interests, etc.
There is no one "happiness." Some are most happy when taking risks, others more comfortable when they feel more secure. Material gain is not a universal goal.
Saturday, January 25. 2014
I am a fan of online dating, especially for those who are out of school. There is just no other way to interview so many available candidates efficiently, with the advantage of screening them in advance.
When people get divorced, I usually recommend that a person have a coffee with at least 25-30 candidates, at minimum, before deciding to get involved with anyone. That's because the recently-divorced are usually lonely, unhappy, sex-starved; often hurt or angry or worried about the future, and generally prone to poor judgement and poor choices. However, those things may apply to many single people.
Because of this, I found this fellow's love story interesting: How a Math Genius Hacked OkCupid to Find True Love
Do guys just want sex? That's a topic for another day. That guy wanted true love, whatever that is.
Wednesday, January 22. 2014
The friendship paradox is the empirical observation that your friends
have more friends than you do. Now network scientists say your friends
are probably wealthier and happier, too.
Back in 1991, the sociologist Scott Feld made a surprising discovery while studying the properties of social networks. Feld calculated the average number of friends that a person in the network has and compared this to the average number of friends that these friends had.
Against all expectations it turned out that the second number is always bigger than the first. Or in other words, your friends have more friends than you do.
Researchers have since observed the so-called friendship paradox in a wide variety of situations. On Facebook, your friends will have more friends than you have. On Twitter, your followers will have more followers than you do. And in real life, your sexual partners will have had more partners than you’ve had. At least, on average.
I always figured that it was because my friends are friendlier than I am.
Monday, January 20. 2014
 Antidepressants fail to help around 70% of depressed patients on the first try.
Antidepressants are now the treatment of choice for anyone with acute or chronic symptoms of "major depression," ie anxiety, disturbed sleep, hopelessness and helplessness, self-hatred, appetite loss, irrational guilty feelings, loss of sex drive, inability to concentrate, sometimes suicidal feelings, and inability to find pleasure or interest in things. In my experience, the vast majority of patients with a fair number of those symptoms feel better with antidepressants, but, in my view, medicine should never be given without psychotherapy of some sort.
Where it gets complicated is that 1. there are many kinds of depression besides major depression; 2., the personality type, and personal strengths and weaknesses can effect the way depression occurs, and whether it occurs at all, and, 3. life circumstances have a real impact on the ability to improve depression with medicine (if your business is going bust, or your child dying with cancer, no antidepressant will make you merry).
I'll try to keep it brief. The generic term "depression" runs the gamut from the heavily-inherited form that occurs in Bipolar Disorder (which is probably a brain-wiring abnormality), to the grief-like depressive reactions to life-events, especially loss, which occur in vulnerable people. In between are sad-sack people with chronic mildy depressed mood, and many people with chronic mood problems due to personality disorders or neurotic problems. My point is that there is not one "depression". The word refers to a group of symptoms, not a diagnosis.
Because depression is not a unitary phenomenon, different forms require different treatment approaches, whether psychotherapeutic or chemical, but the research says preferably both for severe depression.
It is not widely understood that the new SSRI antidepressants are not "mood elevators." They have no effect whatsoever on people without depression, which is why they are never abused.
I will have to follow-up with a Part 2 later, because this is getting too long, according to our blog rules. "Short and sweet." But some subjects are complex and nuanced, as our esteemed French Senator likes to say.
Image is Durer's Melancholia.
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