Transcripts For CSPAN2 Book Discussion On Shrink Rap 2015011

CSPAN2 Book Discussion On Shrink Rap January 19, 2015

Psychosis, people who hear voices or see visions or have delusional beliefs from all the other symptoms blur into the realm of the usual experience. Even the psychotic experience blends into the Human Experience depending on the culture. So in some cultures you might be considered special a special if you have these issues and certainly that somebody might say i hear a voice and it is the voice of a dead relative calling and we would we would consider that a psychosis we would consider it a cultural phenomena so because the sum comes to safeco symptoms blend it is a continuum. Are you depressed or just having a bad reaction to something that lacks weve come up with ways we get medication for it so if you get it wrong, it upsets people. Does that make sense . What percentage of americans have a diagnosed Mental Illness or undiagnosed . And Community Studies when people went walking doortodoor taking history what they came up with this but 56 of americans at some point in their lifetime had some type of mental wellness. This included things like simple phobias and anxiety in an episode in the past of depression because that number seems high and it doesnt seem like 56 of people have psychiatric disorders. The figures for the National Alliance for Mental Illness puts out some weeks it is one in four were one in five americans has a mental disorder at any given time. Host how many people are being treated and how are they being treated . Guest i think a lot are not being treated. Some dont want to go because they dont want to see themselves as having a problem and they want to normalize their issues. Many people do want help and dont have access to care. Access to care is a big issue these days. How is mentalhealth treated with regards to Insurance Companies and with regard to medicare and medicaid and other Government Programs . Guest that is such a complicated question. It depends on where you are. In some areas you could be nowhere near a psychiatrist. Some people see psychiatrists and some people see therapists. Usually medications and psychotherapy and then there are other things for the more extreme conditions like that electric therapy transferring the magnetic stimulation babies are more the outliers of treatment, peer counseling is used more and more, group therapy. Host whats the approach you took in your book with your coauthors . Guest t. Want to hear the story of shrinkwrapped . Okay. So in 2006, one day i decided i wanted a blog but i didnt really know what it was. It was a fairly impulsive thing and in a couple of hours i had set up a blog that i called shrinkwrap. I am not all about technology and so i called to psychiatrists who are interested in technology and asked them if they would help me with this project so they did and they became sucked into it and i dont know if you have ever had a blog but it is something that can get very consuming. We started having meetings occasionally because when i asked the two of them, i had no idea they didnt know each other. And after a number of months, steve suddenly comes up with we need a podcast. I didnt know what a podcast was and i didnt really learn how to do it but i did that and we would meet every other sunday to put together two episodes and somehow they ended up magically on itunes. At some point i started saying we need a book thinking i dont buy how many posts they had we have done at this point but it is now april, 2006 we started so well over 2,000 posts. Its not quite going with the steam it did early on but i still post and steve doesnt post very often. And if they are in thick psychiatrist and she is the training director for the university of maryland for and Psychiatry Program so she likes to write about forensic issues and that is how shrinkwrap came to be. Host would you post on shrinkwrapped . Guest it is a lot of psychiatry related stuff. Host for the laymen or other psychiatrists . Guest it started if you go to shrinkwrap it will say on the introduction or on the banner into law by psychiatrists for psychiatrists. What was interesting is that they did come and comment, but so did other Mental Health professionals, other Health Professionals who were not necessarily in Mental Health for a number of years though we have a but we have a pediatrician who commented on every single post and patients and people would come in and write something about psychotherapy and some people would write this is why i like my psychotherapist for my first psychotherapist did this which wasnt good but then my second psychotherapist which did this was good. And so we changed from talking to psychiatrists to as the weaver talking to the general public and we got pretty good at describing our work in terms of the people could understand and i think that is what inspired the book is there seemed to be a need for an understanding of psychiatry and people just really dont understand what we do. Host what do you do . Guest have you read the book . Certainly there are psychiatrists that our administrators or researchers or academicians at the book is about the clinical practice of psychiatry. So it starts with we put in fictional characters to walk through the book. If you have a fake person to walk through the process that holds the readers a little more. We tried it without the fake people and it didnt really read that also the added people. And i say fake because it is a funny thing to write about patients under a psychiatrist. You dont want people to feel the trade. And also you want to write about specific things and you cant necessarily come up with people whove done the things he wants them to do so you can write about them in the order that you need them to and so if they are fictional, you can make them have their lives go certain way. We start by having a pediatrician that that its an episode of major depression and an electrician who becomes depressed after his wife leaves him when hes trending heavily and he ends up going through the jail system because he gets arrested for driving while intoxicated and we look at how they access help and then why do people go to a psychiatrist into what would be the reason to seek help and then we go through what kind of help there is how we think about when to prescribe medication, how we choose with medication to prescribe, what happens when somebody goes into the hospital and theres a couple chapters on specific legal forensics issues one on the civil forensic issues and one on criminal forensic issues and we use the same character for both. He was a troubled child who grew up to become a criminal and does well at the end of the chapter. Host how sophisticated are the drugs to the psychotherapeutic drugs used to do . Guest how sophisticated . That isnt a word that i would choose. I mean without effective . Thats a better word. If you read the New York Times or follow the news, you will read stories that did say antidepressants are a little better than placebos for severe depression but maybe mild to moderate depression but really not much better than placebo. So 30 to 40 effective which is the same as you would get from a sugar pill. What the studies dont tell you is this is a study that looks at people on a sugar pill given a single antidepressant and if i were going to take a guess i would say that is about right if you pick somebody that walks in the door with a first step of major depression and you you give them one medication the chances are 30 to 40 it will get much better. What the study doesnt go on to say is by the time somebody gets to a psychiatrist often they are not on one medicine. Theyve had to try and other try another csu pic of 30 to 40 with with the first medication that you pick up a little more on the next medication trial and after youve tried two or three you start adding them to each other sometimes you are using augmenting agents and by the end of the day im going to say most of my patients get better. Sometimes it takes a while, but that study that says they are no better than a sugar pill doesnt take into account the lets go beyond the eightweek trial. Lets add psychotherapy to this. Lets go to trying different medications and different combinations and doing things that are a little unconventional. Lets try adding cognitive behavioral therapy. So how effective . Very effective. Host are most Mental Illness is biological, environmental . Guest i think it is most Mental Illnesses are biological. The problem is that we dont have the biology pinpointed. A lot of people that criticize psychology said that this chemical analysis. But what are they . And we dont know yet but i think that its because we dont know yet, not because they dont exist. We have a lot of reasons to think that they are biological. For one thing you could say that is an environment, too but even if you look at children that are separated from their appearance parents by adoption or twins separated at birth, so the probability of somebody being mentally ill or having a specific Mental Illness is higher if the parent had firstdegree relative had it. They are often treated well with medication which alters the brain biology even on a temporary basis which leads you to think something biological is wrong. We dont think it is all biology. Clearly stress precipitate episodes of Mental Illness and those that are predisposed. Host the term chemical imbalance, what does that mean . Guest thats a good question, isnt it . It means something is wrong with the chemistry in your brain and i think people like the term because they did when something is wrong with the chemistry in your brain but we dont know what that is. It takes away the blame from the patient. It takes away the blame from the family. Its not that you are a horrible mother. Its something wrong with the chemistry. You can do things to make it better. On the other hand people that object to using medications or who have they dont work for everybody and certainly a lot of them have side effects and in the best of all worlds, somebody takes a medicine and they feel better and have no side effects and that is a good day. But then they have side side effects and they have to decide what is worse and then they have all sorts of side effects and they dont get better and that is awful and that happens. So the critics of psychiatry like to say you dont know what the chemical imbalance is. You lied by saying there is a chemical imbalance when you cant point to it. I dont use that term very much. Host u. S. President s, have they suffered from Mental Illness . Guest do you read my blog . Thats a funny question to ask. So, there are historians whove gone through and look at the behavior of president s and have come up with Something Like half of all president s have a Mental Illness which is about the same as youre going to come up with and the general public. I think so, you know, i dont know. I think the screening for the medical background in the and the president ial candidates are such that i dont think its as likely now as it was many years ago when people didnt go through the records and people didnt worry about someones Mental Health, physical health. If it is a physical Health Problem they give you the problem about being president , too. Host a lot of diagnosed Abraham Lincoln as having depression. Guest i never examined him, so if youre going to ask me im going to put you there is a rule in psychiatry that you dont diagnose people youve never met. I tried talking to mr. Lincoln that he would have nothing to do with me. Im not going to what do you think . Host it doesnt matter what i think. But you do write in your book shrinkwrap but the faa prohibits pilots from taking certain psychotherapeutic drugs. Guest i think the faa prohibits pilots from taking any psychotherapeutic drug. I believe theyve changed that now. I believe they have needed that if youve gone for 12 months without an episode of depression that you can fly. Its not an issue that the medication impairs your ability to play. Fly. Certainly some medications that impair your ability to fly but you would think that if pain medicines or muscle relaxers. Its not limited or even allergy medicines make people sleepy. But i think the fear is that if somebody could potentially be mentally unstable they shouldnt be flying an airplane. Host is addiction and Mental Illness . Guest it depends on whether you are an Insurance Company. So, if you are the diagnostic and statistical yes addiction is a Mental Illness. If youre an Insurance Company who, somehow the treatment of addiction has been parsed out separately so you cannot be admitted to psychiatric a psychiatric unit with a primary diagnosis of a addiction come a Substance Abuse disorder typically goes to someone in a detox unit or rehab unit. You have to have another illness like depression or bipolar disorder or some type of anxiety and usually Anxiety Disorders cant get admitted to inpatient units. Host due to think personally that addiction is a Mental Illness . Guest s. Its some type of illness. I dont think its a selfcontrol issue completely. Obviously there is an issue of selfcontrol but certainly some people seem to be more driven to crave certain things. Some people dont drink at all and they dont drink at all because they dont like the taste of alcohol or they dont like how it makes them feel and other people just really struggle to not have a drink. So i think there are some biological underpinnings to any kind of craving like that. Host over the years, theres been legislation passed or debated to bring Mental Health into parody with physical health. Has that happened from your perspective . Guest i think it is trying to get there. Im not that familiar with the daytoday injured and issues but its an insurance question is Mental Illness reimburse the same way that physical illnesses are and i know some people have concerns about it but it gets very funny and technical because it will be things like one of the raise ways the Insurance Companies can get around it is to reimburse a percentage of their usual customary rates for something for a procedure and i think they are reimbursing the same way that they reimburse medical illness. However they said the usual customary rate as nobody as usual customary rate. They just pay less. So, they set the rate that isnt a reasonable community rate. If they are not good of the people in their network. I think people worry about being seen as crazy or having their thoughts and feelings and opinions dismissed. People worry about what i do want to be a pilot and then you have to worry that your pilot is depressed wouldnt you rather he got therapy and took a pill then felt fearful of giving up so he went out in a plane having not told anybody is depressed . Psychiatry is a doubleedged sword we want people to get help when they are ill and its hard to sometimes guarantee that there wont be consequences that are troubling. We send the message of up constantly and its gotten worse recently. Its gotten to legislation for example. And in the new york state act as there is a whole comprehensive Gun Legislation that includes your therapist is obligated to report to the fbi registry if youre if you might be a danger to someone else. And inpatient if you are voluntarily committed you get reported to these registries. So there is a doubleedged sword of do you tell somebody that youre feeling suicidal or if you know that you were a gun owner and youre worried that means that somebodys going to find out . Most states do not have that requirement and im not aware i think the hospitals have to report but im not aware of individual therapists reporting but its a funny issue with confidentiality and get help but if you get help there might be repercussions. Host from your perspective as a private psychotherapist or private psychiatrist, do you think that you have a duty to report your patience to the list to the fbi if they are a danger or if they are going to endanger some of the elses life . Guest i havent had that happen. So if you belief somebody has expressed and intended wish to harm somebody and attention to harm a specific victim you are obligated to do one of three things in the state. You are obligated to hospitalize them and protect them and everybody involved or to call the police were or to call the victim but there is that there is not a provision in maryland to call an fbi registry and have their guns taken away or have them put on a list to prevent them from having their guns. Theres just not a mechanism to do that and i dont think that psychiatrists would. We feel that people should be able to come in and talk confidentially. Its never in my patients best interests best interest until somebody even if im not looking at the society as a whole but just my patients best interest dont want him killing himself or anybody else. That doesnt make your life unfold in a happy way. Host what is the role of the National Institute of Mental Health, the National Institute of Mental Health . Guest i dont know. That is a good question. Their focus lately has been very biological very much on brain initiatives and i dont have a lot of contact with the nih and i know the director has a blog that i patiently look at. But they Fund Research is so not necessarily something im following that closely. Host with all of the information out there and people self diagnose . Guest of course. Why wouldnt they be. Sometimes they are self diagnosing right. I dont think it is a bad thing. Somebody looks and says yes ive been feeling that way i think i do have depression or my anxiety has had a point it is interfering with my life and maybe i should go get some help. We look at the list of symptoms which is what what the psy

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