Friday, June 27, 2008
Shrink Rap Grand Rounds: The iPhone 3G Edition
Tuesday, June 17, 2008
Anorexia Nervosa: What If!
There is a misguided belief that Psychiatry is like other branches of medicine, that we make diagnosis as if we know the definitive cause, course of treatment and prognosis.
I accept that even in other branches of medicine, what we used to know sometimes can be turned upside down overnight. We only need to look at the evolution of the understanding and treatment of Leprosy and Tuberculosis over time, and in the modern era, that of HIV/AIDS.
I was brought up to understand that “scientific truth is nothing more than what the top scientists believe in at the time.” In this modern era of “biotech” approach to medicine, new understanding is yet to be found for many conditions. In these cases, are we content to continue with empirical and symptomatic approaches?
Anorexia Nervosa comes to mind and this is one of the conditions that have for want of a better word captured the imagination of sufferers and public alike. I have already posted an earlier blog on its brief history.
Sometimes a diagnosis as powerful as Anorexia Nervosa can be a hindrance to the improvement of “sufferers”. Over my years of practice, I found that those who did well were cases where we indeed moved away from the medical/conventional psychiatric model to a somewhat paradoxical approach.
Let us consider a couple of “WHAT IF” scenarios.
What if in DSM V (the next edition of DSM), Anorexia Nervosa was voted out by the psychiatrists as a mental condition? (As they did with Homosexuality in 1973.) What if the European Court of Human Rights deemed it against human rights to forcibly treat Anorexia Nervosa? (Remember Ghandi?)
My speculations are that under these circumstances:
1:A third of the parents would take over and make sure that their bright young offsprings eat properly and stop blaming adolescent units for failing them.
2:A third would have rich enough parents who would pay for their expensive treatment in health farms.
3:Some would be snapped up by modelling agencies as the world is hungry for skinny models.
That is not 100%, you may observe.
Ah, what about mortality rate? That would be same as now or lower.
This is only one child psychiatrist’s conjecture.
The reality is that the availability of force feeding as a last resort often leads to complacency in the Psychiatric Team. Creativity is key to the resolution of many Child Psychiatric problems and the fact that Anorexia Nervosa patients can change dramatically in a split second is testament to the need for such an approach. (The Chapter “Seven Minute Cure” in The Cockroach Catcher describes such a case.) I am not advocating the declassification of Anorexia Nervosa, but would just like to encourage those of us dealing with these cases to try to understand the underlying dynamics and be innovative in their management. It could be a worthwhile experience.
Perhaps we can set up the new iPhone 3G as iAnorexphone and the Psychiatrist’s computer can watch his patients at meal time, gym and wherever else while he is busy blogging.
We need to think outside the box, and not just treat symptoms.
Grand Rounds from the South Pacific
David (as he likes to be called) of Marianas Eye hosted this weeks Grand Rounds from the South Pacific.
He has written a book called: World Peace, a Blind Wife, and Gecko Tails.
Thank you David for some interesting picks.
He has written a book called: World Peace, a Blind Wife, and Gecko Tails.
“DAVID KHORRAM, MD. As a young eye surgeon, Dr. David Khorram left the offers awaiting him in American's leading medical centers, and boarded a plane for the South Pacific, never to return. Starting in exotic Pago Pago, David has traveled, worked and lectured in villages, hospitals and huts throughout the Pacific. As a writer, he is the recipient of a Governor's Humanities Award. The founder of Marianas Eye Institute, Dr. Khorram is listed in Guide to America's Top Ophthalmologists. David, his wife Mara, and their four energetic children live on the island of Saipan, in the Marianas archipelago.”
Here is how he described my blog:
“Cool Kid Reject ADHD in Favor of Bipolar Disorder
Did you know that 500,000 children and teenagers were given at least one prescription for an antipsychotic in 2007, including over 20,000 children under age six? What I want to know is, why didn’t anyone tell me? A half-million prescriptions, and not a single one of my four kids was offered the stuff! I feel gypped. Dr. Zhang who is the author of the book, Cockroach Catcher, writes about Bipolar Disorder in Children at Cockroach Catcher Blog, "ADHD was the old black. Bipolar became the new black.”
Thank you David for some interesting picks.
Friday, June 13, 2008
Golf, Cholera and Tiger Woods
“Do what the doctors do, not what they say” has a lot of truth in life.
When it comes to replenishing energy in sports activities, we look at top athletes, and “Do what the top athletes do, not what they say.”
Annika Sorenstam Golf Channel Photos
Recently I was fortunate enough to be at the Ginn Tribute, hosted by Annika (an LPGA event). I am a firm believer that amateur men golfers stand to gain a good deal more watching top women players than top men players.
Sitting at the first Tee one got to learn the etiquette of the top players. They all shook hands with the Official Starter and the LPGA Rules Official, of course, but they also shook hands with and thanked the volunteers on the first tee. Such tournament requires a large number of volunteers – 900 in fact for the Ginn Tribute.
Then you watched their stretching and warm-up swings, and it was interesting to watch their “energy” preparation.
I was totally surprised. Perhaps I should not have been. Apples and bananas remained the top favourites, together with plain bottled water. I must be fair, some, especially the Caddies, did pick up the proprietary drink: Gatorade. Perhaps it was because the caddies had to carry the heavy bags and the temperature was drifting into the 90s, but the lady players were probably concerned with the high glucose/fructose/sucrose content of the drinks.
Then I saw this in the New York Times:
“DR. MARK TARNOPOLSKY, a muscle physiology researcher at McMaster University in Canada and a physician, knows all about the exhortations by supplement makers and many nutritionists on what to eat and when to eat it for optimal performance. (He won the Ontario
……So might his colleague, Stuart Phillips, a 41-year-old associate professor of kinesiology at McMaster who played rugby for Canada’s national team and now plays it for fun.”
Would it surprise anyone as to what they actually do:
“……neither researcher regularly uses energy drinks or energy bars. They just drink water, and eat real food. Dr. Tarnopolsky drinks fruit juice; Dr. Phillips eats fruit. And neither one feels a need to ingest a special combination of protein and carbohydrates within a short window of time, a few hours after exercising.”
By all accounts, the first batch tasted so bad none of the scientists could stomach it, but when Cade’s wife suggested adding lemon juice, the drink that would soon become known as Gatorade was born.
According to legend, the first on-the-field tests of Gatorade came in a scrimmage between the Gators B team and the freshmen.”
According to legend, the first on-the-field tests of Gatorade came in a scrimmage between the Gators B team and the freshmen.”
Golf Posts:
Golf and Disability
Golf and Health
Autism, the Brain and Tiger Woods
The Open and The Brain
Ancient Remedy: Modern Outlook
Tiger Woods and Breathing
Golf and Health
Autism, the Brain and Tiger Woods
The Open and The Brain
Ancient Remedy: Modern Outlook
Tiger Woods and Breathing
Tuesday, June 10, 2008
Grand Rounds (4) 38
Thank you to NHS Blog Doctor for including my post about Trauma and Human Resilience in this week's edition of Grand Rounds. Grand Rounds is a weekly compilation of posts related to health care compiled by a host; NHS Blog Doctor last hosted Grand Rounds in 2006.
Sunday, June 8, 2008
Bipolar Disorder in Children
Recently a U.S. Senator uncovered something close to the Cockroach Catcher’s heart: bipolar disorder in children.
Over the last ten years or so, I kept meeting friends in the U.S. whose children seemed to progress from one psychiatric diagnosis to another with frightening regularity, the most common being from ADHD to Bipolar. One grandmother recently asked me what I thought of Bipolar illness in children.
Being an experienced and seasoned psychiatrist, I was able to bounce the question back.
“Well my grandson of five has just been diagnosed. To me he is just an imaginative bright young thing and I never really had any problems with him when he spent part of the school holidays with me. But now he is on all these medications……” she told me.
Well, a few years ago I was at an American Psychiatric Association conference, where a strong case was made for diagnosing children with Bipolar and giving them the modern anti-psychotic drug. I was impressed then.
Later I was more impressed that a single person seemed to have been able to push through a whole new agenda for the diagnosis of Bipolar disorder in children and their treatment.
ADHD was the old black. Bipolar became the new black.
Until now.
In the New York Times, the headline reads:
“Researchers Fail to Reveal Full Drug Pay”
“A world-renowned Harvard child psychiatrist whose work has helped fuel an explosion in the use of powerful antipsychotic medicines in children earned at least $1.6 million in consulting fees from drug makers from 2000 to 2007 but for years did not report much of this income to university officials, according to information given Congressional investigators.”
Who is the psychiatrist?
“By failing to report income, the psychiatrist, Dr. Joseph Biederman, and a colleague in the psychiatry department at Harvard Medical School, Dr. Timothy E. Wilens, may have violated federal and university research rules designed to police potential conflicts of interest, according to Senator Charles E. Grassley, Republican of Iowa. Some of their research is financed by government grants.”
It was Dr Biederman’s presentation I heard at the conference I mentioned earlier. This is interesting!
“Like Dr. Biederman, Dr. Wilens belatedly reported earning at least $1.6 million from 2000 to 2007, and another Harvard colleague, Dr. Thomas Spencer, reported earning at least $1 million after being pressed by Mr. Grassley’s investigators.”
The New York Times was quick to point out that these figures were most likely an under-estimate.
“Dr. Biederman is one of the most influential researchers in child psychiatry and is widely admired for focusing the field’s attention on its most troubled young patients. Although many of his studies are small and often financed by drug makers, his work helped to fuel a controversial 40-fold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder, which is characterized by severe mood swings, and a rapid rise in the use of antipsychotic medicines in children. The Grassley investigation did not address research quality…..
In the past decade, Dr. Biederman and his colleagues have promoted the aggressive diagnosis and drug treatment of childhood bipolar disorder, a mood problem once thought confined to adults. They have maintained that the disorder was underdiagnosed in children and could be treated with antipsychotic drugs, medications invented to treat schizophrenia….
Doctors have known for years that antipsychotic drugs, sometimes called major tranquilizers, can quickly subdue children. But youngsters appear to be especially susceptible to the weight gain and metabolic problems caused by the drugs, and it is far from clear that the medications improve children’s lives over time, experts say.
What is the number of children involved?
“Some 500,000 children and teenagers were given at least one prescription for an antipsychotic in 2007, including 20,500 under 6 years of age, according to Medco Health Solutions, a pharmacy benefit manager.”
Under 6 years of age!!! Take a look at this tragedy in The Boston Globe.
A girl of 4 died. These are the words in The Boston Globe;
“Finally, it's sad but true -- the field of child psychiatry is afraid of Biederman. One can hear the worries and fears whispered in the academic halls and clinics over where Biederman has taken the profession. Yet to politely challenge Biederman in public is to risk public retribution and ridicule from him and his team. Also academic researchers in child psychiatry risk losing their funding if they criticize this darling of the pharmaceutical industry, which provides most of the money these days for psychiatric research.” Dr. Lawrence Diller
Looking back at my career as child psychiatrist for over 30 years, I can count six bipolar cases, one at age 11, three between 13 and 16 and two over 16. All of them responded extremely well to Lithium.
Although the Grassley investigation did not address research quality, the New York Times article reported dissenting voices from other top psychiatrists:
“The group published the results of a string of drug trials from 2001 to 2006, but the studies were so small and loosely designed that they were largely inconclusive, experts say. In some studies testing antipsychotic drugs, the group defined improvement as a decline of 30 percent or more on a scale called the Young Mania Rating Scale — well below the 50 percent change that most researchers now use as the standard.
Controlling for bias is especially important in such work, given that the scale is subjective, and raters often depend on reports from parents and children, several top psychiatrists said.”
This is why I have always argued that reports from parents, teachers and children cannot entirely replace direct clinical observation.
“More broadly, they said, revelations of undisclosed payments from drug makers to leading researchers are especially damaging for psychiatry.”
Money corrupts.
Over the last ten years or so, I kept meeting friends in the U.S. whose children seemed to progress from one psychiatric diagnosis to another with frightening regularity, the most common being from ADHD to Bipolar. One grandmother recently asked me what I thought of Bipolar illness in children.
Being an experienced and seasoned psychiatrist, I was able to bounce the question back.
“Well my grandson of five has just been diagnosed. To me he is just an imaginative bright young thing and I never really had any problems with him when he spent part of the school holidays with me. But now he is on all these medications……” she told me.
Well, a few years ago I was at an American Psychiatric Association conference, where a strong case was made for diagnosing children with Bipolar and giving them the modern anti-psychotic drug. I was impressed then.
Later I was more impressed that a single person seemed to have been able to push through a whole new agenda for the diagnosis of Bipolar disorder in children and their treatment.
ADHD was the old black. Bipolar became the new black.
Until now.
In the New York Times, the headline reads:
“Researchers Fail to Reveal Full Drug Pay”
“A world-renowned Harvard child psychiatrist whose work has helped fuel an explosion in the use of powerful antipsychotic medicines in children earned at least $1.6 million in consulting fees from drug makers from 2000 to 2007 but for years did not report much of this income to university officials, according to information given Congressional investigators.”
Who is the psychiatrist?
“By failing to report income, the psychiatrist, Dr. Joseph Biederman, and a colleague in the psychiatry department at Harvard Medical School, Dr. Timothy E. Wilens, may have violated federal and university research rules designed to police potential conflicts of interest, according to Senator Charles E. Grassley, Republican of Iowa. Some of their research is financed by government grants.”
It was Dr Biederman’s presentation I heard at the conference I mentioned earlier. This is interesting!
“Like Dr. Biederman, Dr. Wilens belatedly reported earning at least $1.6 million from 2000 to 2007, and another Harvard colleague, Dr. Thomas Spencer, reported earning at least $1 million after being pressed by Mr. Grassley’s investigators.”
The New York Times was quick to point out that these figures were most likely an under-estimate.
“Dr. Biederman is one of the most influential researchers in child psychiatry and is widely admired for focusing the field’s attention on its most troubled young patients. Although many of his studies are small and often financed by drug makers, his work helped to fuel a controversial 40-fold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder, which is characterized by severe mood swings, and a rapid rise in the use of antipsychotic medicines in children. The Grassley investigation did not address research quality…..
In the past decade, Dr. Biederman and his colleagues have promoted the aggressive diagnosis and drug treatment of childhood bipolar disorder, a mood problem once thought confined to adults. They have maintained that the disorder was underdiagnosed in children and could be treated with antipsychotic drugs, medications invented to treat schizophrenia….
Doctors have known for years that antipsychotic drugs, sometimes called major tranquilizers, can quickly subdue children. But youngsters appear to be especially susceptible to the weight gain and metabolic problems caused by the drugs, and it is far from clear that the medications improve children’s lives over time, experts say.
What is the number of children involved?
“Some 500,000 children and teenagers were given at least one prescription for an antipsychotic in 2007, including 20,500 under 6 years of age, according to Medco Health Solutions, a pharmacy benefit manager.”
Under 6 years of age!!! Take a look at this tragedy in The Boston Globe.
A girl of 4 died. These are the words in The Boston Globe;
“Finally, it's sad but true -- the field of child psychiatry is afraid of Biederman. One can hear the worries and fears whispered in the academic halls and clinics over where Biederman has taken the profession. Yet to politely challenge Biederman in public is to risk public retribution and ridicule from him and his team. Also academic researchers in child psychiatry risk losing their funding if they criticize this darling of the pharmaceutical industry, which provides most of the money these days for psychiatric research.” Dr. Lawrence Diller
Looking back at my career as child psychiatrist for over 30 years, I can count six bipolar cases, one at age 11, three between 13 and 16 and two over 16. All of them responded extremely well to Lithium.
Although the Grassley investigation did not address research quality, the New York Times article reported dissenting voices from other top psychiatrists:
“The group published the results of a string of drug trials from 2001 to 2006, but the studies were so small and loosely designed that they were largely inconclusive, experts say. In some studies testing antipsychotic drugs, the group defined improvement as a decline of 30 percent or more on a scale called the Young Mania Rating Scale — well below the 50 percent change that most researchers now use as the standard.
Controlling for bias is especially important in such work, given that the scale is subjective, and raters often depend on reports from parents and children, several top psychiatrists said.”
This is why I have always argued that reports from parents, teachers and children cannot entirely replace direct clinical observation.
“More broadly, they said, revelations of undisclosed payments from drug makers to leading researchers are especially damaging for psychiatry.”
Money corrupts.
Saturday, June 7, 2008
Review on Amazon
The Cockroach Catcher has a full review on Amazon.
Here is the full review:
BOOK REVIEW, by Peter Chang.
Reading this book was truly a trip down memory lane for me.
Not only was I in the same medical school as the author (hereinafter referred to as "Zhang"), he and I were assigned to the same study group in our 5-year sojourn at the University of Hong Kong. I too caught cockroaches in my matriculation years in order to practice the dissection of their salivary glands and digestive system, just as Zhang describes in the book. After we graduated in 1968 with the degree of M.B.,B.S. (Bachelor of Medicine and Bachelor of Surgery, we served as "housemen" (known as "interns" in North America) for one year in different hospitals. In 1969, Zhang and I, together with several other classmates, went into Castle Peak Hospital, the only mental hospital in Hong Kong at the time, to work as "medical officers", which was essentially an apprenticeship in psychiatry. We both took the examinations of the Royal College of Physicians in London, England, to obtain the D.P.M. (Diploma in Psychological Medicine) around 1972.
Although Zhang settled in the United Kingdom, and I in Canada, I can identify with much of his experience as a psychiatrist. This book helps to demystify mental illness and humanize the doctor-patient relationship. I am very impressed by Zhang's down to earth approach to problem solving. The secret to his success in therapy is the respect that he gives to his patients, their families and his colleagues. Just by listening to his patients and believing in their stories, Zhang is able to perform miracles, such as the "Seven Minute Cure" (Chapter 1), Ping Pong (Chapter 24), and "Bullying" (Chapter 23).
Zhang has a special talent for engaging difficult patient in therapy, as exemplified in "Wrong Foot" (Chapter 12), "Hiccup Boy" (Chapter 13), "Failure" (Chapter 34), and "Yellow Card" (Chapter 46). As Zhang finds coercive treatment distasteful, such as force feeding an anorexic patient, he is good at negotiating with patients so that they would voluntarily eat again to achieve their own individual goals. For instance, the patient in Chapter 34 started to eat again because she did not want to be "sectioned" (meaning certified under mental health laws) which would prevent her from going to the United States to pursue higher education.
While most doctors are content with taking a medical history, Zhang would listen to his secretary and cleaning staff to learn about the milieu, thus gleaning useful information that can help his patients. It reminds me of Confucian humility. Confucius says: "When three men walk together, I have a teacher among them".
As Western trained psychiatrists with Chinese heritage, Zhang and I are not confined to particular schools of thought. Neither of us has felt the compunction to subscribe to a particular theory, such as being Freudian, Jungian or a behaviorist. We aim to be "eclectic", that is, to use whatever that works. In 1970's, psychoanalysis dominated training institutions for psychiatrists in U.K. as well as in Canada. I can see in the book that while Zhang is educated in psychoanalysis, he is not bound by it in his practice. His creative and innovative approaches to clinical problems remind me of the now popular "C.B.T." (cognitive behavior therapy).
Zhang laments the dawning of the age of red tape in psychiatry, which is the same all over the world. The emphasis on "guidelines", also known as "evidence based medicine", and artificial restraints on access to services, have changed the landscapes of our practice. If everyone practices cookie cutter type of medicine, where will we find new thinking and new treatments?
This book is a "must read" for all professionals in the mental health field, and for all interested individuals. It is a kaleidoscope of life seen from the eyes of the therapist who genuinely cares about his patients as people. Zhang provides an in-depth understanding of the human condition.
In my view, this book gives us a glimpse into the soul of psychiatry, into holistic medicine at its best.
Here is the full review:
BOOK REVIEW, by Peter Chang.
Reading this book was truly a trip down memory lane for me.
Not only was I in the same medical school as the author (hereinafter referred to as "Zhang"), he and I were assigned to the same study group in our 5-year sojourn at the University of Hong Kong. I too caught cockroaches in my matriculation years in order to practice the dissection of their salivary glands and digestive system, just as Zhang describes in the book. After we graduated in 1968 with the degree of M.B.,B.S. (Bachelor of Medicine and Bachelor of Surgery, we served as "housemen" (known as "interns" in North America) for one year in different hospitals. In 1969, Zhang and I, together with several other classmates, went into Castle Peak Hospital, the only mental hospital in Hong Kong at the time, to work as "medical officers", which was essentially an apprenticeship in psychiatry. We both took the examinations of the Royal College of Physicians in London, England, to obtain the D.P.M. (Diploma in Psychological Medicine) around 1972.
Although Zhang settled in the United Kingdom, and I in Canada, I can identify with much of his experience as a psychiatrist. This book helps to demystify mental illness and humanize the doctor-patient relationship. I am very impressed by Zhang's down to earth approach to problem solving. The secret to his success in therapy is the respect that he gives to his patients, their families and his colleagues. Just by listening to his patients and believing in their stories, Zhang is able to perform miracles, such as the "Seven Minute Cure" (Chapter 1), Ping Pong (Chapter 24), and "Bullying" (Chapter 23).
Zhang has a special talent for engaging difficult patient in therapy, as exemplified in "Wrong Foot" (Chapter 12), "Hiccup Boy" (Chapter 13), "Failure" (Chapter 34), and "Yellow Card" (Chapter 46). As Zhang finds coercive treatment distasteful, such as force feeding an anorexic patient, he is good at negotiating with patients so that they would voluntarily eat again to achieve their own individual goals. For instance, the patient in Chapter 34 started to eat again because she did not want to be "sectioned" (meaning certified under mental health laws) which would prevent her from going to the United States to pursue higher education.
While most doctors are content with taking a medical history, Zhang would listen to his secretary and cleaning staff to learn about the milieu, thus gleaning useful information that can help his patients. It reminds me of Confucian humility. Confucius says: "When three men walk together, I have a teacher among them".
As Western trained psychiatrists with Chinese heritage, Zhang and I are not confined to particular schools of thought. Neither of us has felt the compunction to subscribe to a particular theory, such as being Freudian, Jungian or a behaviorist. We aim to be "eclectic", that is, to use whatever that works. In 1970's, psychoanalysis dominated training institutions for psychiatrists in U.K. as well as in Canada. I can see in the book that while Zhang is educated in psychoanalysis, he is not bound by it in his practice. His creative and innovative approaches to clinical problems remind me of the now popular "C.B.T." (cognitive behavior therapy).
Zhang laments the dawning of the age of red tape in psychiatry, which is the same all over the world. The emphasis on "guidelines", also known as "evidence based medicine", and artificial restraints on access to services, have changed the landscapes of our practice. If everyone practices cookie cutter type of medicine, where will we find new thinking and new treatments?
This book is a "must read" for all professionals in the mental health field, and for all interested individuals. It is a kaleidoscope of life seen from the eyes of the therapist who genuinely cares about his patients as people. Zhang provides an in-depth understanding of the human condition.
In my view, this book gives us a glimpse into the soul of psychiatry, into holistic medicine at its best.
Tuesday, June 3, 2008
Trauma and Human Resilience
Mental Nurse alerted us to the results of some new research in the US on coping with collective Trauma.
University of Buffalo News Release:“It's Okay to Keep Those Feelings Inside, New Study Suggests”
“……Contrary to popular notions about what is normal or healthy, new research has found that it is okay not to express one's thoughts and feelings after experiencing a collective trauma, such as a school shooting or terrorist attack.
[The author] points out that immediately after last year's tragic shootings at Virginia Tech University there were many ‘talking head’ psychiatrists in the media describing how important it is to get all the students expressing their feelings.
‘This perfectly exemplifies the assumption in popular culture, and even in clinical practice, that people need to talk in order to overcome a collective trauma,’ he said……”
In The Cockroach Catcher, Dr Zhang remembered attending a lunch time talk at his hospital: “What have we learnt from King’s Cross?”
“By rights possibly one of the most damaged psychologically and physically. She underwent no fewer than seventeen operations. The photo of her running down the street of Saigon naked probably changed the course of the Vietnam War and the world’s perception of good and bad. Then came her dramatic escape in 1992 to Newfoundland and her eventual settling down in Canada. Human resilience is not to be underestimated and the imposition of psychological intervention could represent a great under-estimation of our genetical endowment. At one of her public lectures, one of the war veterans who was a helicopter gunner broke down.”
Kim Phuc never had any therapy.
We have to be aware that a whole industry has sprung up based on very inexact theories and it is nice to know that the earlier findings in England have now been confirmed across the pond. In cases where mental conditions are entangled with compensation claims it becomes especially difficult to be truly objective.
On the matter of psychotherapy, a good deal of current blog comments are hostile to therapists and their methods. A good therapist is hard to come by, and should be like a wise aunt or uncle to whom one turns to for advice that one may or may not accept or act on. A good therapist needs to be intelligent and broad-minded, and mature with rich life experience. A bad therapist, on the other hand, takes over and does not allow for any leeway on how one should continue with life.
We may forget too that good therapy is for life, and may be more useful for the mentally healthy than for the mentally sick. What government or insurer would allow for that?
Here I will have to quote my Guru again:
“A Therapist is like a toilet really: some may need it three or five times a week; others once in a while. Some patients may have a sort of mental diarrhoea and require therapy sessions more often.”
University of Buffalo News Release:“It's Okay to Keep Those Feelings Inside, New Study Suggests”
“……Contrary to popular notions about what is normal or healthy, new research has found that it is okay not to express one's thoughts and feelings after experiencing a collective trauma, such as a school shooting or terrorist attack.
[The author] points out that immediately after last year's tragic shootings at Virginia Tech University there were many ‘talking head’ psychiatrists in the media describing how important it is to get all the students expressing their feelings.
‘This perfectly exemplifies the assumption in popular culture, and even in clinical practice, that people need to talk in order to overcome a collective trauma,’ he said……”
In The Cockroach Catcher, Dr Zhang remembered attending a lunch time talk at his hospital: “What have we learnt from King’s Cross?”
The speaker was a Senior Registrar from the Maudsley."......He was a Registrar at the time of the King’s Cross fire. He was just coming out of the station when the accident happened, and so was at the front line so to speak not just as a pedestrian but also as a psychiatrist. He became interested in PTSD (Post Traumatic Stress Disorder) and did a fair bit of research on King’s Cross and other disasters.
He quoted a number of cases, including the Herald of Free Enterprise disaster. There were those who despite help of all kinds would commit suicide. Many were heroes in that they saved many lives. Yet the feeling that they did not deserve to live eventually overtook them and they committed suicide.
What was most surprising was how the group that had counselling generally fared worse, much worse than those without any counselling. The group that did best were the ones that drank, and drank a fair amount.
It was not his intention to promote vodka but he thought we could not be kept from the truth……
His research showed that talking about the incident seemed to make things worse, much worse than anyone ever imagined……”
Then he remembered Kim Phuc:
He quoted a number of cases, including the Herald of Free Enterprise disaster. There were those who despite help of all kinds would commit suicide. Many were heroes in that they saved many lives. Yet the feeling that they did not deserve to live eventually overtook them and they committed suicide.
What was most surprising was how the group that had counselling generally fared worse, much worse than those without any counselling. The group that did best were the ones that drank, and drank a fair amount.
It was not his intention to promote vodka but he thought we could not be kept from the truth……
His research showed that talking about the incident seemed to make things worse, much worse than anyone ever imagined……”
Then he remembered Kim Phuc:
“By rights possibly one of the most damaged psychologically and physically. She underwent no fewer than seventeen operations. The photo of her running down the street of Saigon naked probably changed the course of the Vietnam War and the world’s perception of good and bad. Then came her dramatic escape in 1992 to Newfoundland and her eventual settling down in Canada. Human resilience is not to be underestimated and the imposition of psychological intervention could represent a great under-estimation of our genetical endowment. At one of her public lectures, one of the war veterans who was a helicopter gunner broke down.” Kim Phuc never had any therapy.
We have to be aware that a whole industry has sprung up based on very inexact theories and it is nice to know that the earlier findings in England have now been confirmed across the pond. In cases where mental conditions are entangled with compensation claims it becomes especially difficult to be truly objective.
On the matter of psychotherapy, a good deal of current blog comments are hostile to therapists and their methods. A good therapist is hard to come by, and should be like a wise aunt or uncle to whom one turns to for advice that one may or may not accept or act on. A good therapist needs to be intelligent and broad-minded, and mature with rich life experience. A bad therapist, on the other hand, takes over and does not allow for any leeway on how one should continue with life.
We may forget too that good therapy is for life, and may be more useful for the mentally healthy than for the mentally sick. What government or insurer would allow for that?
Here I will have to quote my Guru again:
“A Therapist is like a toilet really: some may need it three or five times a week; others once in a while. Some patients may have a sort of mental diarrhoea and require therapy sessions more often.”
My only gripe is that where money is involved, one needs to be cautious: the best advice in life is free, like those from your wise aunt or uncle, if you are lucky enough to have one.
Related Posts:
Monday, June 2, 2008
Picasso, Medicine and Lloyds
Photo © Am Ang Zhang/Bauhinia Press 2008 Trivia question: What is the link between Picasso, medicine and Lloyds (of London)?
Here is the answer.
Retinitis Pigmentosa – latest advance in Medicine
Retinitis Pigmentosa is the name given to a group of hereditary disorders of the retina, a sort of sensor like those on digital cameras that is responsible for transmitting images formed by the lens to the brain for interpretation. The disorder can affect different receptor cells and some sufferers may have a slower rate of deterioration than others. There is often a gradual loss of peripheral vision which makes sufferers more vulnerable to knocking things around them.
(In case you are wondering – no, Picasso did not suffer from retinitis pigmentosa.)
Very recently London’s Moorfield Hospital did a trial of an artificial eye device (called Argus II) developed by a US firm Second Sight for such sufferers. A tiny camera and transmitter is attached to a pair of glasses, powered by a wireless microprocessor and battery pack that can be worn on the belt. An ultra-thin electronic receiver and electrode panel is implanted in the eye
Exciting news indeed, though it is too late to prevent the damage to one famous Picasso painting.
Le Rêve by Picasso
There were many women in Picasso’s life, and a number of them have been immortalized in his paintings, giving the proud owners a highly valuable asset and of course in some cases a very pleasant picture to look at.
Picasso: Woman in White Metropolitan Museum of Art
“Although the model was always thought to be the artist's Russian wife Olga Khokhlova, it has recently been suggested that Picasso's muse was actually an American beauty, Sara Murphy, wife of the painter Gerald Murphy, with whom Picasso was infatuated between 1921 and 1924.
We may never know the true identity of the sitter, but since Picasso frequently fused the features of different people into a single idealized portrait, it is possible that this is just such a case. If so, the features of Olga and Sara are integrated here into a masterful and striking composition, full of tenderness and classical beauty.”
Metropolitan Museum of ArtThis painting really shows that Picasso could truly paint and draw. We cannot say the same of some modern artists who should perhaps remain nameless.
Could you however imagine how Picasso’s style evolved from this to Le Rêve?
This is a painting of Picasso’s 24-year old mistress, Marie-Thérèse Walter.
“Le Rêve” by Picasso
Christie's file photo via AP
Le Rêve was first bought for $7,000 in 1941 by Victor and Sally Ganz of New York City. It was sold at Christie's auction house on
November 11, 1997 for an unexpectedly high $48.4 million, apparently to Wolfgang Flöttl, an Austrian born financier who later sold it to casino magnate Steve Wynn for an undisclosed sum, estimated to be about $60 million.On October 9th 2006, news first broke on the pages of the New York Post:
Cubist Killer was the headline and apparently the painting had suffered a six-inch tear.Two weeks later the New Yorker revealed the full story in The $40-Million Elbow.
Nora Ephron, who wrote Heartburn (inspired by the affair of her second husband, Carl Bernstein of Watergate fame, with Margaret Jay, daughter of Jim Callaghan), When Harry Met Sally, Sleepless in Seattle, etc. wrote about the episode after the New York Post let the cat out of the bag. As you might expect, her account was most entertaining.
“The buyer of the painting, Wynn told us, was a man named Steven Cohen. Everyone seemed to know who Steven Cohen was, a hedge fund billionaire who lived in Connecticut in a house with a fabulous art collection he had just recently amassed. ‘This is the most money ever paid for a painting,’ Steve Wynn said. The price was $4 million more than Ronald Lauder had recently paid for a Klimt. Oh, that Klimt. It had set a bar, no question of that, and Wynn was thrilled to have beaten it. He invited us to come see the painting before it moved to Connecticut, never to be seen again by anyone but people who know Steven Cohen.
There, on the wall, were two large Picassos, one of them Le Reve. Steve Wynn launched into a long story about the painting -- he told us that it was a painting of Picasso's mistress, Marie-Therese Walter, that it was extremely erotic, and that if you looked at it carefully (which I did, for the first time, although I'd seen it before at the Bellagio) you could see that the head of Marie-Therese was divided in two sections and that one of them was a penis. This was not a good moment for me vis a vis the painting. In fact, I would have to say that it made me pretty much think I wouldn't pay five dollars for it.”
My sentiment completely. On the other hand, I would have the Woman in Whilte hanging all the time in my best room.
“He raised his hand to show us something about the painting -- and at that moment, his elbow crashed backwards right through the canvas.
There was a terrible noise.
Wynn stepped away from the painting, and there, smack in the middle of Marie-Therese Walter's plump and allegedly-erotic forearm, was a black hole the size of a silver dollar - or, to be more exactly, the size of the tip of Steve Wynn's elbow -- with two three-inch long rips coming off it in either direction.”
Steve Wynn has retinitis pigmentosa.
For further detail I urge you read Nora’s full account.
The Lloyds of London Connection
Where did Lloyds of London come into this drama?
Well, Mr Wynn would not have the painting worth $139m uninsured, would he? What is interesting is that he then tried to make a claim for $54 million in lost value due to damage, and not surprisingly, Lloyds was not exactly forthcoming.
USA Today on Jan,13th 2007 reported:
“A day after filing a lawsuit against Lloyd's, Wynn on Friday attacked the insurance industry as a whole, accusing insurance companies of ‘irresponsible, careless, inconsiderate and deliberate evasive behavior’ that too often works for them.
He said insurers play ‘dirty tricks’ and habitually delay responding to claims, hoping to wear down those making claims and get them to settle for much less than what they are owed.
‘Most folks that have insurance can't afford the legal fees, so they take what they get,’ Wynn said in a telephone interview. ‘There's only one way to stop this kind of thing, and that is to go to court.’”
Guess what, Lloyds eventually settled for an undisclosed sum. Perhaps Nora could find out for us how much he got. Steve Wynn can certainly afford his legal fees. Hopefully Argus II will be ready soon enough before another painting gets damaged.
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Sunday, June 1, 2008
Did you catch the May Blogs
Nature
It’s a Bird, a Reptile, a Mammal: It’s Platypus
Enron, South Africa and Carbon Trading
Fish “shepherding” in the Virgin Islands
Child & Adolescent Psychiatry
Another “Ribena Girl”
Asperger's Syndrome, Libel and Thalidomide
ADHD, Heart Risks, Kinko and Jetblue
Abuse Abuse Abuse
Adoption Adoption Adoption
Medicine & Psychiatry
Senator Kennedy, Gliomas and Vesicular Stomatitis Virus (VSV)
Care in the Community
Loquat and Medicine
Multiple Sclerosis Treatment – an Update
Lithium Bipolar and Nanking
Cockroaches Hiroshima and Health Maintenance
Leisure Pursuits & Health
Picasso Medicine and Lloyds
Illness and Morality
Dry Falls-Thinking Outside The Box
Vacation in the Evergreen State
It’s a Bird, a Reptile, a Mammal: It’s Platypus
Enron, South Africa and Carbon Trading
Fish “shepherding” in the Virgin Islands
Child & Adolescent Psychiatry
Another “Ribena Girl”
Asperger's Syndrome, Libel and Thalidomide
ADHD, Heart Risks, Kinko and Jetblue
Abuse Abuse Abuse
Adoption Adoption Adoption
Medicine & Psychiatry
Senator Kennedy, Gliomas and Vesicular Stomatitis Virus (VSV)
Care in the Community
Loquat and Medicine
Multiple Sclerosis Treatment – an Update
Lithium Bipolar and Nanking
Cockroaches Hiroshima and Health Maintenance
Leisure Pursuits & Health
Picasso Medicine and Lloyds
Illness and Morality
Dry Falls-Thinking Outside The Box
Vacation in the Evergreen State
Did you catch the earlier Blogs
Here is an update of the posts so far.
Nature
Passion and Easter
Cats Going Insane
Anhinga in Costa Rica - Faking Is Not All Bad
Bauhinia blakeana and other health warnings
Elephant and teenage pregnancy
Lunar Eclipse
Mother Nature should be ecstatic
The Cockroach Catcher in Costa Rica
Turtles in Barbados
Yunnan
Food
Wine, Media and The Mind
Antioxidants and cooking
Chinese New Year and the Goose
Papaya and Nobel Prize
Quinoa: the super grain
The secret is out: recipe for Teochiu Braised Goose
The sliced Goose and a natural dose of Glucosamine
Child & Adolescent Psychiatry
Medicine & Medication
Seroxat and Ribena
Leisure Pursuits & Health
The Cockroach Catcher and Pompano
Nature
Passion and EasterCats Going Insane
Anhinga in Costa Rica - Faking Is Not All Bad
Bauhinia blakeana and other health warnings
Elephant and teenage pregnancy
Lunar Eclipse
Mother Nature should be ecstatic
The Cockroach Catcher in Costa Rica
Turtles in Barbados
Yunnan
Food
Wine, Media and The Mind
Antioxidants and cooking
Chinese New Year and the Goose
Papaya and Nobel Prize
Quinoa: the super grain
The secret is out: recipe for Teochiu Braised Goose
The sliced Goose and a natural dose of Glucosamine
Child & Adolescent Psychiatry
A Brief History of Time: Anorexia Nervosa
Child Psychiatry, Ping Pong, Paper Planes and Toys
Please don't poison our children with stimulants
Religious Fanaticism and the Ice Maiden of Peru
This Child Psychiatrist also uses the Stethoscope
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Seroxat and Ribena
More Expensive Placebos Bring More Relief
Alaska, Good Friday Earthquake and Zyprexa
Autism, the Brain and Tiger Woods
Che Kung Temple (che gong miao) and the Power of Prayers
Multiple Sclerosis, Iguanas and Wrong Foot
Sadness medicated to extinction
Leisure Pursuits & Health
The Cockroach Catcher and Pompano
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