Category: Reading of the Week

Reading of the Week: The New Yorker Essay on De Troyer (and Carter v. Canada)

In her diary, Godelieva De Troyer classified her moods by color. She felt “dark gray” when she made a mistake while sewing or cooking. When her boyfriend talked too much, she moved between “very black” and “black!” She was afflicted with the worst kind of “black spot” when she visited her parents at their farm in northern Belgium. In their presence, she felt aggressive and dangerous. She worried that she had two selves, one “empathetic, charming, sensible” and the other cruel.

She felt “light gray” when she went to the hairdresser or rode her bicycle through the woods in Hasselt, a small city in the Flemish region of Belgium, where she lived. At these moments, she wrote, she tried to remind herself of all the things she could do to feel happy: “demand respect from others”; “be physically attractive”; “take a reserved stance”; “live in harmony with nature.” She imagined a life in which she was intellectually appreciated, socially engaged, fluent in English (she was taking a class), and had a “cleaning lady with whom I get along very well.”

So begins this week’s reading, an essay by writer Rachel Aviv that was just published in The New Yorker.

It’s a moving and tragic story of a woman who struggles with low mood. If she dreams of fluent English and a cleaning lady, her life takes a turn for the worse: after a breakup, she “feels black again.” Loss and estrangement replace hope and love. After years of struggling, the near elderly woman ultimately chooses to end her life. But she doesn’t die by her own hand; she dies in a clinic at the hands of a physician. To us Canadians, this is a story that is both familiar – involving psychiatry and medications – and unfamiliar – euthanasia and state-sanctioned doctor-assisted suicide.

De Troyer’s life and death occurs an ocean away, in Belgium. But, in light of a recent Supreme Court of Canada ruling in Carter v. Canada, a question to ask: how will doctor-assisted suicide reshape psychiatry in this country? Continue reading

Reading of the Week: My lovely wife in the psych ward

There’s no handbook on how to survive your young wife’s psychiatric crisis. The person you love is no longer there, replaced by a stranger who’s shocking and exotic. Every day I tasted the bittersweet saliva that signals you’re about to puke. To keep myself sane I hurled myself at being an excellent psychotic-person’s spouse. I kept notes on what made things better and what made things worse. I made Giulia take her medicine as prescribed. Sometime this meant watching her swallow, then checking her mouth to confirm that she hadn’t hidden the pills under her tongue. This dynamic led us to become less than equals, which was unsettling.

I’ve been a physician now for nearly a decade and a half. Much of everything has become routine. It wasn’t always like this. I remember the first night on call as a medical student doing my Internal Medicine rotation – the angst and confusion, as I received page after page. As a resident, I remember my first few “observed” psychiatric interviews, with the entire team present, so many people watching me. I remember the first few months of being an attending, trying to pace myself and navigate everything from dictations to the parking lot. But those days are behind me. Practicing day after day, week after week, year after year, routine sets in.

For patients and their families, though, health care is so often not routine – and that’s especially true with mental illness. It’s a world of first appointments, unexpected side effects and complications, recovery and relapse. Continue reading

Reading of the Week: Lithium

http://www.nytimes.com/2014/09/14/opinion/sunday/should-we-all-take-a-bit-of-lithium.html?_r=1

(Because of browser and firewall issues, this link may not work. The article follows.)

Should We All Take a Bit of Lithium? So asks Dr. Fels in this provocative and clever New York Times essay.

This we know: Lithium is an incredible mood stabilizer for people with Bipolar Affective Disorder. Lithium has anti-suicidal properties; Lithium slows cell apoptosis (programmed cell death) in the brain; Lithium works as an antidepressant. As Dr. Fels notes: “its efficacy in mood disorders and suicide prevention has been documented as well as or better than virtually any other psychotropic medication.”

So… should we all be taking it? Continue reading