A doctor’s office waiting room. (veggiesosage/flickr)
Sometimes, medical doctors view their patients only from the neck down.
But that is unwise: Over 70% of primary care visits today are related to psychosocial issues – things like anxiety or depression manifesting themselves as chronic pain, stomach aches or heart palpitations.
And, according to Dr. Russell Phillips, director of the Center for Primary Care at Harvard Medical Center, these underlying problems create all sorts of complications. “Mental health conditions complicate the treatment of everything else,” he said. “If someone has diabetes and depression, symptoms of their depression may make it harder for them to manage their diabetes.”
Of course, the problem is exacerbated by patients not even being aware that they have any underlying conditions. Doctors have to try to solve problems that “patients can’t even name,” said Phillips. He gave a quick assessment of the system today: overworked primary care physicians struggle to treat conditions in limited time and often with limited resources.
Phillips envisions a system for addressing all of these issues that would begin with mental health: Continue reading →
A couple of years ago, we wrote about an intriguing but kind of fringey therapy involving tapping different body parts as a way to treat post-traumatic stress syndrome and chronic pain.
Called “Energy Psychology,” “Emotional Freedom Technique” or simply “tapping,” the practice uses exposure and desensitization to “defuse” painful emotions associated with trauma. By tapping a series of acupuncture points on the body, and repeating certain phrases related to the negative event in an accepting way, the emotional intensity of the bad memory deflates, the theory goes, and the grip of trauma melts away.
Harvard Medical School psychiatrist Rick Leskowitz, director of the Integrative Medicine Project at Spaulding Rehabilitation Hospital and a longtime practitioner of the technique, called it “the most impressive intervention I’ve encountered in 25 years of work.”
Now, it seems, tapping is getting a bit more respect.
The influential American Psychological Association, which for years had opposed continuing education credits for programs in Energy Psychology, changed it’s position. In November 2012, the APA granted one group, the Association for Comprehensive Energy Psychology, a two-year approval to sponsor continuing education courses for psychologists. The approval will likely help boost the number of practitioners able to offer Energy Psychology, Dr. Leskowitz said.
In addition, two new research articles by Dawson Church — one an overview and another on the results of a clinical trial evaluating Emotional Freedom Techniques for PTSD in war veterans receiving mental health treatment — have been released, offering further evidence for the effectiveness of the practice. (The overview piece is scheduled for publication in August but will be available online shortly.)
And an effusive Huffington Post piece in May by Larry Burk, M.D., a certified energy health practitioner declared: “The Tipping Point for Tapping: EFT Goes Mainstream:” Continue reading →
A 1960s ad for the anti-psychotic drug Thorazine (Wikimedia Commons)
It got a bit lost in the 4th-of-July whirl, but an intriguing study came out last week in the journal JAMA Psychiatry, suggesting that for long-term recovery from psychosis, it may be better — much better — to go lighter on the anti-psychotic drugs: Your chances of recovery could double.
As a JAMA Psychiatry editorial puts it, during the remission period that follows a first episode of psychosis, when it comes to antipsychotic drugs, “less is more.”
The study immediately made me think of Robert Whitaker’s 2011 book, “Anatomy of an Epidemic,” which presented evidence that in many cases, psychiatric drugs may do more long-term harm than good. Among other points, it notes some data suggesting that schizophrenics who take anti-psychotics fare worse, long-term, than those who don’t.
From the JAMA Psychiatry press release:
Dose reduction/discontinuation (DR) of antipsychotics during the early stages of remitted first-episode psychosis (FEP) shows higher long-term recovery rates compared with the rates achieved with maintenance treatment (MT), according to a study by Lex Wunderink, M.D., Ph.D., of Friesland Mental Health Services, Leeuwarden, the Netherlands, and colleagues.
This study was a follow up study of 128 patients who had participated in a two-year open randomized clinical trial comparing MT and DR from October 2001 to December 2002. Continue reading →
Casey was diagnosed with canine compulsive disorder. He’s now on Prozac. (Courtesy)
When Casey, a 6-year-old German Shepherd, gets anxious, she chases her tail.
But it’s not the kind of endearing, once-around-and-it’s-done kind of tail-chasing we’ve all seen. Left unchecked, Casey circles around and around, pursuing her tail until she can bite it. Then, even when the blood starts flowing, the dog is driven to continue the chase.
“It’s upsetting,” says Paula Bagge, a Hopkinton, Mass. business owner who has been living with Casey since puppyhood. “And it’s damaging. She hurls herself around the house, and it’s like a big bloody paintbrush spraying the walls.” Once, Bagge tied the dog’s leash to a coffee table in an attempt to control the chasing. But Casey, who weighs about 85 pounds, just started dragging the coffee table around with her. Now, she’s on Prozac.
Dogs, it turns out, can have obsessive-compulsive disorder, just like people. And in a new study, Dr. Nicholas Dodman, a professor of clinical sciences at the Cummings School of Veterinary Medicine at Tufts University, found that structural brain abnormalities in dogs, in this case Doberman pinschers, with canine compulsive disorder (CCD) are similar to those of humans with OCD.
In an earlier study, Dodman, a leading researcher on repetitive behavior in animals, found a specific gene associated with canine OCD.
Studying anxiety disorders in dogs, Dodman says, may ultimately help scientists come up with better therapies and medications to treat OCD and related conditions in people. Current drugs for OCD, such as SSRI’s (or for dogs, a beef-flavored form of Prozac) are notoriously ineffective for many sufferers. Indeed, Dodman says, only around 43 to 60 percent of people suffering from OCD show a postive response from an SSRI; the average reduction of symptoms in people taking these drugs is only about 23 to 43 percent. “Certainly not a panacea,” he says.
So, to further this research, Dodman spends time thinking about bears who pace obsessively, for instance, or parrots unable to stop preening and picking their feathers and beagles who overeat to the point of exploding,
Dodman calls the latest dog-brain imaging study, conducted in collaboration with researchers at McLean Hospital, in Belmont, Mass., “another piece of the puzzle, another brick in the wall.”
He says while more research must be done, it’s becoming increasingly evident that dogs with OCD are a great model for exploring human psychopathology: they show similar behaviors, respond to drugs in comparable ways and now, at least in this small study, seem to have the same brain abnormalities as people with the condition. “When you know what your dealing with it’s much easier to create targeted approaches,” to treatment, Dodman says. “If you don’t know what you’re dealing with it’s just kind of like going with your sense of smell.”
OCD afflicts about 2 percent of the population and often goes untreated or undiagnosed. People suffering from the disorder, marked by intrusive thoughts and repetitive behaviors such as hand washing, locking and unlocking doors, counting, or repeating the same steps, feel these impulses as uncontrollable. And the compulsive rituals, often triggered by stress or trauma, can be incredibly time-consuming, interfering with daily life.
Famously, Lena Dunham, the star and creator of the HBO series “Girls” came out with her own OCD on air, with repetitive tics, obsessive counting and painfully compulsive use of Q-tips. Continue reading →
At first, I didn’t particularly care whether the longtime overseer of The American Academy of Arts and Sciences, a little-known Cambridge gathering place for the ultra-accomplished where Nobels are a dime a dozen, had exaggerated her credentials. Mightn’t you, if you were the only one around without a Ph.D.?
But in the eleventh paragraph of reporter Todd Wallack’s well-executed scoop, I suddenly got it: “Staff members have long complained that Berlowitz micromanages their work and that she dishes out frequent tongue-lashings. Some workers left after only a few days or weeks.”
Bullying in non-profit organizations is a serious problem. During the 15 years that I’ve been studying and writing about workplace bullying, I’ve heard countless horror stories from those who have worked in the non-profit sector, including tales of tyrannical, manipulative bosses who regularly mistreat their staff.
Ring a bell? We’ve all heard the old joke about how academic politics get so nasty because the stakes are so low. Is there, I asked him, something similar happening in non-profits? Our conversation, edited:
So are non-profits like academia? Are they notorious for managerial nastiness? Continue reading →
Ariel Castro appears in Cleveland Municipal court on Thursday. Castro was charged with four counts of kidnapping and three counts of rape after three women missing for about a decade and one of their young daughters were found alive at his home earlier in the week. (Tony Dejak/AP)
The news out of Cleveland this week of three young women held captive for a decade of physical, sexual and psychic abuse horrified the world. For parents, the news provoked perhaps a more targeted kind of fear, and raised one of the most fraught questions in parenting: How can we instill in our kids street smarts and an instinct to detect danger without leaving them terrified and fearful of the world? For some answers, we paged child psychiatrists Gene Beresin and Steven Schlozman, both at Massachusetts General Hospital and Harvard Medical School. Here is their professional response:
Every parent has said it: “Now, kids…don’t talk to strangers.”
It’s good advice. However, given the recent horrific events in Cleveland, some parents might very appropriately worry that this particular bit of wisdom is due for re-evaluation. After all, it appears all three young women kidnapped and held hostage for the past decade got into a car with their tormenter. He was known in the neighborhood, after all, and his own daughter was friends with one of the victims.
This is, of course, an extreme example of a particular narrative that we hear repeatedly these days. “We can’t let our kids play outside like we used to — the world has changed too much.”
But where does that leave us? What do we say to our children as we struggle to maintain the shaky balance between ensuring safety and also teaching independence and reasonable trust in the world and in our communities?
This is among the most vexing questions of modern parenthood. We certainly don’t want our kids to see a trusted uncle or coach as a potential villain – that would create an emotionally untenable world where all individuals, no matter how well known, are deemed potentially dangerous.
And yet, the alleged perpetrator in Cleveland was the father of one of the prisoner’s close friends. How do we deal with this dilemma?
There is of course no perfect or straightforward answer. Events like those in Cleveland are indeed extremely rare. Understandable media attention can create the impression that the world is in fact far worse than it actually is. At the same time, though, we have to find a way to increase awareness among our children of the potential dangers inherent in our world.
Know Your Child
So, for children of all ages, what can we do to?
Remember that every child is different; the way you present your words of safety needs therefore to be tailored to your individual child. So, the first principle is to know your child. Parents are good at this. In most cases, no one knows a kid better than the kid’s parents. There are 8-year-olds who will not be particularly bothered that even a well-known neighbor might have somewhat sketchy “issues.” And there are 12-year-olds who will freak out, have nightmares and feel that he or she can never trust anyone ever again. Continue reading →
This combination of undated photos shows Tamerlan Tsarnaev, 26, left, and Dzhokhar Tsarnaev, 19. (AP)
From the moment the two Boston bombing suspects were identified, acquaintances and strangers alike have speculated that the older, ex-boxer brother had dragged the younger, mellower brother into badness. The Boston Globe’s Deborah Kotz offers a round-up today of such psychological theorizing, including a comparison to the 2002 Washington sniper case in which 17-year-old Lee Boyd Malvo fell under the influence of an older father figure.
Personally, my favorite theory comes in this Huffington Post diatribe: “Are The Boston Bombers Just Douchebags?” But epithets, however satisfying, cannot stem curiosity. And one of the more interesting possible elements of emotional explanation comes from Harvard psychiatrist Harold Bursztajn, who raises the possibility of a psychiatric diagnosis called “Shared Delusional Disorder” — long known in literature as a “folie à deux,” French for madness shared by two.
The diagnosis is not new to the upcoming DSM-5, the psychiatric “bible” of diagnoses. But it is, Dr. Bursztajn said, the only diagnosis in the official compendium that is, at base, “relational.” He defines Shared Delusional Disorder as a situation in which one person in a close relationship, usually the dominant one, develops a delusion and pulls the weaker person into it. It is considered rare, but is probably under-diagnosed, he said, because it tends to involve paranoia and concealment.
Dr. Harold Bursztajn (Courtesy)
“The delusions are concealed, and can be concealed more successfully because there’s someone else to share them,” said Dr. Bursztajn, co-founder of Harvard Medical School’s Program in Psychiatry and the Law. “You have company in your delusion, so you don’t need to tell anyone else. Good psychodynamic training is all the more vital to treat a disorder that is fundamentally relational and which involves concealment, because if you don’t know how to help people overcome their shame and defensiveness and fear about how crazy they are, then people won’t show you.”
Shared Delusional Disorder commonly shows up as Munchausen by Proxy, in which a parent becomes delusionally concerned that their child has an illness, and the child begins to believe it as well.
“One person has the delusion,” Dr. Bursztajn said, “and the other person is dependent, emotionally or physically. The dependent person feels that a condition for being loved is to buy in to the delusion, so they buy in to it and then the two of them have a system going…The two people lose touch with reality and form a bond against either a common enemy or, in the case of Munchausen by Proxy, it’s against nature itself and against the human condition, which is that we’re all fragile.”
It was back to school today after a week of “vacation” and I must say I am relieved.
The routines and clear parameters are a gift after a week of chaos, uncertainty and fear. My kids, ranging in age from 6-16, are processing the marathon bombings in different ways, and with varying amounts of information. I tried to shelter the younger two (six and eight) as much as possible from the gory details, but a day of “lockdown” two miles from Watertown made it impossible to avoid the basic facts. Bad guys. Bombs. Killings. Wounds. Terror.
Dr. Annie Brewster and her daughter Hannah, age 6.
The questions have been endless, especially from my six-year-old.
“Why did the bad guys want to hurt people?”
“Why did the police kill the first bad guy?”
“Why didn’t they kill the second bad guy?”
“What if the bad guy gets out of jail?”
“What if there are more bombs?”
“How do bombs hurt people?”
“How many bad guys are there in the world?”
I have been bumbling along, trying my best to instill my kids with a sense of security and hope, guided by expert advice on how to talk to kids about such atrocities. My parenting experience and the fact that I am a physician myself hasn’t helped me much. For the younger two, I know that I have to keep things simple and as black and white as possible: good guys and bad guys, scary events and now safety — but I am struggling with this, feeling vaguely deceitful. The truth is, I don’t feel safe. I can’t promise that there won’t be any more bombs. I don’t really know what makes a “bad guy” become a “bad guy.” But I have heard these words coming out of my mouth as I snuggle in bed with my children at night and try to soothe them into sleep.
“You are safe.”
“There will be no more bombs, I promise.”
“There are at least 100 good people for every one bad person.” (??)
“I won’t let anyone hurt you.”
Lies, really, or at the very least, partial truths. But is this wrong?
I don’t know.
My six-year-old sees through it. The “bad guy/good guy” dichotomy doesn’t hold for her, and last night as I lay with her and rubbed her back she threw me a curve ball.
A girl looks out the window of her family’s home as a SWAT team drives through her neighborhood while searching for a suspect in the Boston Marathon bombings in Watertown, Mass., Friday, April 19, 2013. (AP Photo/Charles Krupa)
Over the course of this harrowing, surreal week, Dr. Gene Beresin offered some very useful professional advice on how to explain the terrible events to kids while still trying to make them feel safe and secure.
Beresin, a child psychiatrist and director of the Massachusetts General Hospital Center for Mental Health and Media, also shared this advice for stressed-out grownups struggling with Friday’s city-wide lockdown, which kept millions trapped in their homes and on edge for the day.
As one Boston-area mom put it on Facebook Friday night: “So many feelings — relief its over, sadness that it all happened, grief at the losses and injuries, anger that my kids are growing up in a world of violence and just plain tired from being on high alert all week.”
Now that the remaining Marathon bombing suspect has been captured, the question is: will the trauma linger on? And if so, what form will it take? In a continuing attempt to help parents mitigate any residual stress, Beresin offers these tips on trouble signs to watch for as children and families return to “normal” life and daily routines.
Flowers sit at a police barrier near the finish line of the Boston Marathon in Boston Tuesday, April 16, 2013. (AP Photo/Winslow Townson)
By Gene Beresin, MD
What a week. From Monday’s Marathon bombing to Friday’s city-wide “stay at home” order to, finally, the dramatic capture of the bombing suspect, the people of Boston have had an intensely stressful and emotional few days. That includes the kids.
Parents are understandably worried about the impact these events have had on their children (and themselves). We remember how long it took to recover from other tragedies.
Fortunately, kids and families tend to be incredibly resilient. However, there may be a range of emotions and behaviors that parents could notice in the short run that would tip them off about a problem.
Here are some things to look for, and even more importantly, if you do see them, things you could do to fend off longer term problems:
• Remember that kids observe your behaviors and react to your feelings and actions.
• Parents need to take care of themselves first. It is much like the statement on airplanes, if the pressure drops, put the oxygen mask on yourself first, then help the child next to you. Parents are best able to help kids of any age if they have a means of processing the tragedy. The more you can obtain support from others, calm yourself down and present yourself in a supportive way, the better this is in allowing you to help your kids. This usually means having nurturing family members and/or a community to help you.
• Kids need a few basic things:
Reassurance things are going to be OK
Assurance their daily needs will be met
Presence of caring adults who are paying attention to them
Hope for the present and future.
How can parents and caregivers distinguish normal reactions to trauma from those that are worthy of concern and perhaps professional attention? Let’s look at kids in different age groups. And remember that a change in the short run may simply be a phase and can disappear with a brief response. So don’t jump to conclusions that things are going to be terrible at the first signs of problems. Continue reading →
So far this morning my kids have watched two movies and an old episode of “Glee.” We read “Oliver Twist.” We packed for a weekend trip we may not be able to take. Now we’re snacking. And there’s still no telling when the Boston “stay at home” order will be lifted. Stressful? Umm, just a bit.
We’ve been getting excellent advice from child psychiatrists about how to talk to children about this week’s events — from the horrific Marathon bombing Monday to today’s scary, surreal manhunt around our neighborhoods: MIT, Memorial Drive, Cambridge Street at Norfolk and as friends say, H2O-town. But what about the grown-ups? We’re on-edge too and wondering how to cope. (I tried to go to yoga this morning but it was cancelled.) Here, again from our expert mental health team at MGH is a list of top coping strategies when you are trapped at home during a massive police manhunt:
By Gene Beresin, M.D. and Steven Schlozman, M.D.
As adults we always think of our children first. Maybe this is human nature, survival of the species or just plain love.
But adults have their own share of fears, anxieties, and needs during massively stressful times. What are some of the ways disasters and war-like situations affect us and what can we do to help ourselves?
Humans respond to life and death situations with the fight or flight response – that is they experience normal fear, physical symptoms of anxiety (stomach upset, jitteriness, rapid heart rate, extreme vigilance) and a wish to be in a safe place. But even if safe, excessive fear verging on panic can feel awful. Physical symptoms such as headache, muscle spasm, tremor, heartburn, or even chest pain are not uncommon. We startle at the slightest sound or change in the environment.
Some feel depressed, hopeless, and develop a kind of pessimistic, catastrophic thinking in which most things are taken as signs of doom and gloom. Others long for getting outside, feeling trapped, isolated. Still others cannot remember things, keep track of time or just feel lost. In these moments, it is sometimes hard to function – to do daily activities, take care of kids, or focus on work.
So, what can adults do to cope with our current stress:
1. Adults need support from other close adults, e.g., spouse, family member, friends
2. Family cohesion: stay close to others, kids, spouses. Do things together — play, especially cook!
3. Community cohesion: This includes religious, spiritual or other community groups. Try to stay connected even at a distance, calling, texting, using your social media.
4. Ability to process events, both emotionally and cognitively: Techniques may be specified for each. We need to specify the techniques a bit: Get in touch with your emotions, and think of ways you have settled them in the past; and be careful of exaggerated or catastrophic thinking. This will be over soon. In general use logic over emotion!
5. Self-reflection and awareness is key. Be aware of your current state. Monitor yourself.
6. Self-care that is physical: sleep, good diet, exercise