Vivian Rakoff, the chair of the University of Toronto’s Department of Psychiatry during the 1980s and one of the legends of Canadian psychiatry, used to say that psychiatry was both a science and an art, and the essence was to balance the two. More than four decades later, his words ring as true as ever.
So begins Dr. Paul Garfinkel in the chapter “Science and Care” of his newly released autobiography, A Life in Psychiatry: Looking out, Looking in.
It has the feel of a bad movie.
When the BBC goes to interview psychiatrist Dr. Egip Bolsane in his native Chad, they find a man in a small office with a small wooden desk. Dr. Bolsane speaks enthusiastically about his work, wiping sweat from his forehead (he can’t afford an air conditioner) as he talks about the challenges of practice in a country where mental illness is often confused with possession.
When was the last time you recommended exercise to one of your depressed patients?
Too often, we tend to be too selective with our patients, choosing to talk up the drugs, and choosing not to talk about the other things that can help.
It’s a problem not confined to clinicians: 2014 seems to be the Year of the Obscure Depression Treatment. The American Journal of Psychiatry has published papers on ketamine and NSAIDs. The New York Times ran an op ed suggesting that mushrooms may be the future of treatment (citing the British Journal of Psychiatry, no less).
And with such attention-grabbing remedies, exercise seems so much less dazzling.
Case study: Bryan is a 57 year old male who is employed as a graphic designer. He has Bipolar Affective Disorder and has frequent episodes. “Being bipolar is like jumping out of an airplane knowing you don’t have a parachute on. You know you’re going to be hurt, but the high is so euphoric that it’s worth the risk. You can deal with the consequences later.”
Question: Can technology help this patient stay healthy and out of hospital?
http://www.wired.com/2014/11/mental-health-apps/
(Because of firewall issues, this link may not work. The article follows.)
This week’s Reading isn’t from a peer-reviewed journal, it’s from Wired. Continue reading
If the extent of human suffering were used to decide which diseases deserve the most medical attention, then depression would be near the top of the list. More than 350 million people are affected by depression, making it one of the most common disorders in the world. It is the biggest cause of disability, and as many as two-thirds of those who commit suicide have the condition.
“But although depression is common, it is often ignored.
http://www.nature.com/news/medical-research-if-depression-were-cancer-1.16307
First published in 1869, Nature is one of the most cited scientific publications. It is also one of the most read (Nature claims an online readership of 3 million unique readers a month).
This special issue of Nature is dedicated to Depression.
To our knowledge, the current study is the first report to demonstrate a potential effect of these psychosocial interventions on telomere length (TL) among distressed breast cancer survivors.
http://onlinelibrary.wiley.com/doi/10.1002/cncr.29063/full
(Because of browser and firewall issues, this link may not work. The paper is attached in PDF format.)
My impression of this paper in two words: seriously cool. Continue reading
An estimated 11% of adolescents have an episode of depression by age 18 (Merikangas et al. 2010) and depressed youth are at greater risk of suicidality (Hawton, Saunders & O’Connor 2012), physical health problems including obesity (Goodman & Whitaker 2002), and high-risk behaviors (Armstrong & Costello 2002). However, only 60% of depressed adolescents receive treatment (Costello et al. 2014).
(Because of firewall issues, this link may not work. The article follows.)
With that strong introduction, a recent blog posting on The Mental Elf summarizes a major new JAMA paper on collaborative care for adolescents with depression. Continue reading
I have plenty of acquaintances, and a couple hundred ‘friends’ on Facebook. But real friends, mostly family, I can count on one hand. For me, making friends is like climbing a vertical rock wall with no ropes, requiring a degree of thrill-seeking, and a good deal of risk.
http://well.blogs.nytimes.com/2014/10/23/living-with-schizophrenia-coffee-and-friends/
(Because of firewall issues, this link may not work. The article follows.)
This short New York Times essay describes the burden of living with Schizophrenia. Though just over 1,000 words, I think it explains the challenges of severe, persistent mental illness better than whole books written on the topic. Continue reading
By the 1880s, there were 75 psychiatric hospitals in the United States, and a survey estimated that less than 1% of prisoners had mental illness. For the next 90 years, it was widely accepted in the United States that people with mental illness belonged in hospitals rather than prisons.
Then it all came undone.
http://ajp.psychiatryonline.org/article.aspx?articleid=1911272
(Because of firewall issues, this link may not work. A PDF version of this article is attached.)
In this editorial in the current issue of the American Journal of Psychiatry, University of North Carolina’s Dr. David Rubinow considers the unintended consequences of de-institutionalization, the decades long push for the mentally ill to be moved out of hospitals and into the community – and often into the forensic system. Continue reading
I attended the funeral, albeit awkwardly. I told myself not to feel defensive. I could learn from this, but that didn’t make it right. I didn’t recover for a very long while.
http://www.thestar.com/news/insight/2014/10/03/a_patients_suicide_a_doctors_devastation.html
(Because of browser and firewall issues, this link may not work. The article follows.)
Dr. Paul Garfinkel has had a storied career — psychiatrist, prolific researcher, administrator. There’s even a street named after him in downtown Toronto.
He can now add to the resume: published author of a moving and thoughtful memoir. Continue reading
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