Transcripts For CSPAN2 Book Discussion On Shrink Rap 2015013

CSPAN2 Book Discussion On Shrink Rap January 31, 2015

[inaudible conversations] [inaudible conversations] every weekend, booktv brings you 48 hours of nonfiction authors and books on cspan2. Keep watching former television for serious readers. Considered dinah miller you write in you book shrink rap that psychiatrist is a uniquely universal medical field. Why . Guest part of it because of the history psychiatry has had. Certainly its a field that has floundered with how to diagnose how to treat, some of the treatments have not gone so well example, lobotomy phase that was very brief. I think part of the confusion even with diagnosis that spurred some controversy is that with the exception of psychosis of people who hear voices or see visions or have delusional beliefs, all the other symptoms blur into the realm of the usual Human Experience and even the psychotic symptoms sometimes blur into the realm of the usual Human Experience depending on the culture. In some cultures you might be considered special if you have these issues and certainly somebody might say i hear a voice and its the voice of a dead relative calling me. We wouldnt consider that a psychosis weapon call that a cultural we call that a cultural phenomenon. So because psychiatric symptoms blend into the realm of normal symptoms, i mean, its a continuum. Are you depressed or just having a bad reaction . When is it an illness . We have come up with ways when we call it an illness and dont. Then we give medications for it. So if you get it wrong, it upsets people. Does that make sense . Host what personal what percentage of americans have a diagnosed enemy illness or undiagnosed Mental Illness. Guest in Community Studies when people went knocking door to door and taking histories, they came up with 56 of americans at some point in their lifetime had some type of Mental Illness. This included things like simple phobias, anxiety and an episode in the past of depression because that number seems high. Doesnt seem like 56 of people have psychiatric disorders. The figures that the National Alliance for Mental Illness puts out are that, oh some weeks its one in four or one in five americans has a mental disorder in any given time. Host and how many of those people are being treated and how are they being treated . I dont have an exact answer to that. I think the thinking is that a lot arent being treated. For all sorts of ropes, some dont want to see themselves as having a problem. They try to normalize their issues. Many people do want help and dont have access to care. Access to care is really a big issue these days. Host how is Mental Health treated with regard to Insurance Companies, with regard to Medicare Medicaid other Government Programs . Guest thats such a complicated question peter. You know, some so much of this depends where you are in cities its easier to get help in rural areas you could be noy near a psychiatrist. Some supreme see psychologist, some people see therapists. Usually you ask how are Mental Illnesses treated usually medications and psych therapy and then there other are things for extreme conditions like convulsive or the these are the outliers of treatment. Peer counseling used more and morement group therapies. Host whats the approach you took in your book with your coauthors in shrink rap . Guest in 2006, one day i decided want ited a blog. I didnt really know what a blog was. It was a fairly impulsive thing and within a couple of hour is set up a blog that it impulsively called shrink rap and i called two friends who are interested in technology who are psychologists and asked them to help me with the project. So they did and they became sucked into it. A blog can get very consuming. We started having meetings occasionally because when i asked them issue had no idea they didnt know each other. And after a number of months, steve suddenly comes up with, we need podcast. I didnt know what a podcast up. I made the chili, and we would meet every a sunday, put together two episodes and somehow they ended up million include on itunes. At some point i started saying we need a book. And thinking that, well, we had already done i dont know how many posts we had done by this point. Hundreds. At this point shrink rap april of 2006 we started. So its years old. 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. He goes by roy on the blog, and goes by clink sync because she is a forensic psychiatrist and is the training director for the university of marylands foreign sick psychiatrist program. So she likes to write about forensic issues and thats how oshrink rap came to be. Host what do you post . Guest psychiatry related stuff. Host for the layman or other psychiatrists. Guest if you go to oschenk shhh rink rap it says on the banner, blog by psychiatrists for psychiatrists what was interesting is that psychiatrists did come and comment, but so did other Mental Health professionals, other Health Professionals who werent necessarily in Mental Health. For a number of years we had a pediatrician who commented on every single post. And patients and people would write something about psychotherapy and people would write, this is why i like my psychotherapist 0 my first psychotherapist did this which wasnt got but my second psychotherapist did this, which was good. So we changed from talking as though we were talking to psychiatrists to as though we were talking to the general public, and we got pretty good at describing our work in terms that other people could understand. I think that is what inspired the book. There seemed to be a need for an understanding of psychiatry, and people just dont understand what we do. Host what do you do . Guest have you read the book . We start in the book with its a broad question. The book is limited to clinical psychiatry but a certainly there are visions moore administrator0s are researchers academics. It starts with we put in fictional characters to walk through the book just because this is dry stuff. Who goes to a psychiatrist is a boring question. If you have a live fake person there to walk through the process, it holds the readers attention a little more. We tried without the fake people in there and it didnt read well. So we added people in. And i say fake because its a funny thing to right about patients when youre a psychiatrist. You dont want to write about your own. You dont want people to feel betrayed and you want to write about civic things and you cant come up with people who have done the things you want them to do so you can write about them so if theyre fictional you can make them have their lives go a certain way. So we start by actually having a pediatrician, who gets an episode of major depression and an electrician who becomes depressed after his wife leaves him when he is drinking heavily, and he ends up going through the jail system because he gets arrested for driving while intoxicated. And we look at how both of them access help. Then we go through, who do people go to a psychiatrist . What would be the reasons to seek help . And then we go through what kind of help there is. Somebody getting psychotherapy, how we think about when to prescribe medications. How to choo what medication to prescribe. What happens when somebody goes into the hospital, and a couple of chapters on specifically forensic issues. One of civil forensic issues, and one on criminal forensic issues. We use the same character for both help was a troubled child who grew up to become a criminal, and does well in the end, by the end of the chapter. Host dr. Miller how sophisticated are the psychotherapeutic drugs used today. Guest how sophisticated . Thats not a word i would choose. I mean, there are host effective. Guest that a better word. So if you read the New York Times or follow the news youll read stories that say that antidepressants are a little better than placebos for severe depression but for mild to moderate depression theyre really not much bert than placebo. Theyre 30240 effective which is the same you get from a sugar pill. What the studies dont tell you this is a study that looks at people given a sugar pill vs. People given a single antidepressant, and i would say thats right. I you pick somebody who walks in the door with depression and you give them one medication, chances are 30 to 40 theyll get better. The study doesnt say by the time somebody gets to a psychiatrist often they have had to try another. So yes you pick up 30 to 40 with the first medication but you pick up a little more on the next medication trial and after you have tried two or three you add them to each other. So sometimes youre using augmenting agents and by the end of the day i say most of mispatients get better. Sometimes it takes a while but that study that says theyre no better than a sugar pill doesnt take into account going into beyond an eight, week trial. Lets add psych therapy to this. Lets try different combinations add cognitive behavioral therapy. How effective . Very effective. Host are most Mental Illnesses biological environmental . Guest i think we have come to see most Mental Illnesses as biological. The problem is we dont have the biology pinpointed. A lot of people who criticize psychiatrist you say theres chemical imbalances but what are they . We dont know yet. Its because we dont know yet not because they dont exist. We have a lot of reasons to think theyre biological. For one thing they run in families and you can say that environment, too but they run in families even if you look at children separated from their parents by adoption or twins separated at birth. The probability of somebody being mentally ill or having a specific Mental Illness is higher if a parent had it or first degree relative had it. They are often treated well with medications, which alters the brain biology, even on a temporary basis which leads you to think maybe something biological was wrong. We dont think its all biology. Clearly stress precipitates episodes of Mental Illness and those who are predisposed. Host the term chemical imbalance, what does that mean . Guest thats a good question, isnt it, peter . It means something is wrong with the chemistry in your brain and i think people like the term because we do know something is wrong with the chemistry in your brain, but we decent know what that is. It takes away the blame from the patient. It takes away the blame from the family. Its not that youre a horrible mother. A schizophrenic mother. It says something is wrong with the check industry. Its not your fault. You can take something to make it bert do things to make it better. On the other hand, people who object to using medications or who have had i mean, they dont work for everybody, and they certainly a lot of them have side effects. In the best of all worlds somebody takes a medicine, they feel better and they have no side effects and thats a good day. Sort of in the median they feel better and they have side effects and have to decide which is worse. On the worst enthey have adverse effects and dont get better. Thats awful when that happens. So critics of psychiatry like to say you dont know what the chemical imbalance us, you sold us a lousy deal of goods here. You lied by saying theres a chemical imbalance when you cant point to it. I dont actually use that term very much. Host dr. Miller, u. S. President s, have they suffered from Mental Illness . Guest do you read my blog . So thats a funny question to ask. So there are historians who have gone. Looked at the behavior of u. S. President s and they have come up with Something Like half of all president s had a Mental Illness, which is about the same as youll come up with in the general public. I think so. I dont know. I think the screening nowdays for the medical backgrounds of president ial candidates is such that i dont think its as likely now also it was many years ago when people didnt go through the records, people didnt worry about someones Mental Health, physical health. If you have a physical Health Problem they give you a rough time about being president , too. Oo a lat of armchair psychiatrists have diagnosed Abraham Lincoln as having depression. Guest i never examined him. Theres a rule in psychiatrist that you dont diagnose people you have never met. I tried talking to mr. Lincoln but we ooh have nothing do with me. Im not going to that do you think . Host well, doesnt matter what i think. But dinah miller, you write in your book that 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 theyve made it that if you have gone for 12 months without an episode of depression, that you can fly. Its not an issue that the medication impairs your ability to fly. Certainly some medications impair your ability to fly but you would think that of pain medicines or muscle relaxanted. Its not limited to even allergy medicines make people sleepy. But i think the fear is that if somebody could potentially be mentally unstable they should not be flowing flying an airplane. Host is addiction a Mental Illness. Guest depends whether or not youre an insurance company. If youre the diagnosic statistical manual yes. If youre an insurance company, somehow treatment of addiction has been parsed out separately. So you cannot be admitted to a psychiatric unit with a primary diagnosis of a an addiction. A Substance Abuse disorder typically goes to someone a detox unit or a rehab unit. You have to have another illness, like depression or bipolar disorder or anxiety and usually anxiety disordered cant get admitted to inpatient units but host do you think permanently, that addiction is a Mental Illness . Guest well, yes. Its some type of illness. Die think its i dont think its a selfcontrol issue completely. Obviously theres some issue of self control but certainly some people seem to be more more driven to crave certain things. Some people dont drink at all because they Development Like the taste of alcohol or how it makes them feel. Other people who struggle to not have a drink. And i think theres some biological underpinnings to any kind of craving like that. Host dinah miller over the years theres been legislation passed or debated to bring Mental Health into parity with physical health. Has that happened from your perspective . Guest i think its trying to get there. I may be the wrong foreign ask the wrong person to ask that. Im not that familiar with the daytoday insurance issues of because its an insurance question. Is Mental Illness reimbursed the same way that physical illnesses are . I know there are still people who have concerns about it but it gets very funny and technical because it will be things like one way the Insurance Companies get around it is that they reimburse a percentage of their usual and customary rates for something, for a procedure, and i think they are reimbursing the same way they reimburse medical illnesses. However, they set the usual and customary rates at nobodys usual and customary rates. Its not a reasonable rate and then pay the same amount they would it still leaves the patient sometimes to flounder if they good out of network and if the rates arent good they dont have people in their network. Host what are some of the stigmas attached to Mental Illness. Guest i think people worry about being seen as crazy or having their thoughts and feelings and opinions dismissed because, oh, you must be manic again. No no, im just excited about something. I think at times it just leaves people feeling discredited, and people worry about what if i do want to be a pilot . And then you have to worry, what if your pilot is depress inside wouldnt you rather he got therapy and took a pill and felt fearful of doing that and went off in the plane having not told anybody he is depressed . Psychiatry is this enormous doubleedged sword. We want people to get help when theyre ill, but its hard to sometimes guarantee there wont be consequences for that are troubling. We send this message out constantly. And its gotten worse recently. Gotten legislation, for example. In new york theres the new york safe act, which is a whole comprehensive Gun Legislation includes that your therapist is obligated to report to the an fbi registry if youre you might be a danger to someone else. So inpatients if you get involuntarily committed you get reported to the registries. So so theres the doubleillinoised do you tell somebody youre feeling suicide and if youre a gun owner that means somebody will find out. Most states do not have that requirement, and im not aware that i think the hospitals have to report im not aware of individual therapists reporting but its a funny issue between confidentiality and get help but if you get help there might be repercussions. Host from your perspective as a private psychiatrist or psychotherapist, do you think that you do have a duty to report your patients to a list to the fbi if theyre a danger to somebody . If you feel they are going endanger somebody elses life . Guest well, i havent had that happen so let hope um if you think theres a theres a law call that if you believe somebody has expressed an intended wish to harm somebody and an intention to harm a specific named victim, youre obligated to do one of three things in this state. Youre obligated to hospitalize them to protect everybody involved, or to call the police or to call the victim, the intended victim. But theres 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 not a mechanism to do that. And i dont think psychiatrists would welcome that. We feel people should be able to come and talk confidentially but truly its never in in my patients best interests to kill someb

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