mental illness

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Study: Despite Weight Gain, Quitting Smoking Improves Heart Health For Mentally Ill After A Year

(kenji.aryan/flickr)

(kenji.aryan/Flickr)

The health profile for people with serious mental illness is pretty grim. In general, they have a lower life expectancy — 25 years less than the general population — which is largely due to cardiovascular disease related to high rates of obesity and smoking.

But a new study by researchers at Massachusetts General Hospital found that after one year, seriously mentally ill patients who quit smoking — even though they gained about 10 pounds — had a lower risk of developing heart disease compared to those who didn’t quit. That’s the good news part of the research, published online in The Journal of Clinical Psychiatry. The bad news is that if those people — who already have high rates of obesity — continue to gain weight, it’s fairly likely they will develop a slew of other health problems, including cardiovascular disease, said the study’s lead author, Dr. Anne Thorndike, an assistant professor at MGH and Harvard Medical School.

“Quitting smoking is the single most important behavior change that anyone, [including] people with serious mental illness, can do to reduce their risk of developing cardiovascular disease,” Thorndike said in an interview. “But the weight gain is a red flag. The story’s not over at one year … If they continue to gain weight, all the health factors will worsen and contribute to higher rates of cardiovascular disease.”

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Commentary: Getting Off Psych Meds Was The ‘Hardest Thing’ She’d Ever Done

By Dr. Annie Brewster

By the time Laura Delano was 25, she was taking five psychiatric drugs: an anti-depressant, an anti-psychotic, two mood stabilizers and an anti-anxiety medication.

But after years entrenched in the mental health system, and defined by her psychiatric diagnoses, Laura finally got off the medications and, as she says, began “recovering from psychiatry.”

For background: Laura grew up in a wealthy Connecticut suburb in a family of high achievers. She was a nationally ranked squash player and student body president. But in her teen years, life got more complicated as she struggled with questions about her own identity.

Laura Delano weaned herself off psychiatric drugs and says she shed her identity as a “professional mental patient.” (Courtesy)

Laura Delano weaned herself off psychiatric drugs and says she shed her identity as a “professional mental patient.” (Courtesy)

She felt burdened by social and academic expectations, and started to act out. She cut herself as a way to “control” her out-of-control world, and was ultimately sent to a psychiatrist by her parents. At 14, she was diagnosed with bipolar disorder and prescribed powerful psychiatric drugs, including the mood stabilizer Depakote and Prozac.

The medication side effects led to additional problems and “symptoms,” which in turn led to more medications, Laura says, and she began to lose herself. She felt defined by the diagnoses she continued to collect: bipolar disorder, borderline personality disorder, substance abuse disorder and binge eating disorder.

Laura’s early 20s were marked by multiple psychiatric hospitalizations and ultimately a suicide attempt. Her only identity was a self-described “professional mental patient.”

But then things began to change.

Over five years ago, Laura weaned herself off psychiatric drugs and shed her diagnostic labels. For her, this has been a spiritual journey involving the cultivation of self-acceptance, self-love and honesty. “It is the hardest thing I have ever done,” says Laura, now 32. But she feels happier, more connected and more engaged in the world. Here’s a bit more from our interview:

“When you are told that your brain is broken — basically the seat of your soul, your mind, the part of you that shapes everything about who you are — when you’re taught to believe that that’s broken, and that you can’t trust yourself, you can’t trust your emotions, you can’t trust your mind, I mean it instills in you just a profound fear. Over all these years I developed this relationship of faith in the mental health system and no faith in myself, and tremendous fear of myself. And so unpacking that has been at the heart of this whole journey, realizing, ‘Wait a minute…If I’m not broken and if the struggles I’ve gone through aren’t symptoms of an illness, what are they? Maybe they are actually important and meaningful…maybe they are telling me something.’ I began to listen to my pain, and to listen to my darkness and it [has]  brought me back to this spiritual journey which I think was beginning way back when I was thirteen… Who am I? How do I fit into this world? What are the stories I have been taught to believe about how you’re meant to live your life, and what it means to be normal and worthy and acceptable…”

Personally, I’m moved by Laura’s story. As a practicing internist, I often rely on psychiatric diagnoses and medications. In my clinical practice, I have seen psychiatric medications reduce suffering and save lives. But it’s been useful to step back and reconsider my filter on these issues.

From day one of medical training, we are taught to fit our patients into neat diagnostic categories whenever possible. The goal of our patient interactions, we learn, is to sift through and distill all that we see and hear in order to home in on a diagnosis. This categorization can be helpful in directing our care, of course, but it can also be limiting, and even dangerous. Rarely does a diagnosis fit perfectly, yet all too often in our culture one’s diagnosis becomes indistinguishable from one’s identity.

Labels have power. With mental illness, diagnostic criteria are particularly difficult to define and identify. Truthfully, our current understanding of the brain and the biochemistry behind mental illness is limited. There are no clear markers to measure and quantify. Instead, we must rely on subjective interpretation of behavior.

And yet, psychiatric labels abound. It is estimated that one in four adults, or approximately 61.5 million individuals, and one in five teens between the ages of 13 and 18, meet criteria for a diagnosis of mental illness within a given year.  Continue reading

Landmark Gene Discovery Cracks Open ‘Black Box’ Of Schizophrenia

Sydney and her mother Lori look into the bedroom mirror where Sydney experienced her first symptoms of schizophrenia. Now 20, Sydney has had no symptoms for almost two years now. (Jesse Costa/WBUR)

Sydney and her mother Lori look into the bedroom mirror where Sydney experienced her first symptoms of schizophrenia. Now 20, Sydney has had no symptoms for almost two years now. (Jesse Costa/WBUR)

One November day in her senior year of high school, Sydney accidentally broke the full-length mirror leaning up against the wall of her bedroom.

She felt a gust of superstitious dread: “Oh my God, I have to put this mirror together or I’m going to have bad luck.” Then, it escalated oddly into religious terror: “The devil’s coming to get me!”

Something inside her seemed to snap, she said. She sensed demons invading through the broken glass.

Not long afterward, President Obama spoke to Sydney inside her head: “OK, this is how the world is now,” he told her. “Everyone is so in love with each other, we can hear each other in our heads.”

The menacing voices of demons started to torment her, especially at night. She became convinced that she was going out with the pop star Justin Bieber, that he was chatting with her on her phone and sending her hidden messages in his Twitter feed. She thought he set up paparazzi in her backyard on Boston’s North Shore, that he was sending planes over her house to let her know he cared.

“Is this really happening?” She would ask the voices in her head. “Is this?” Yes, they told her. Yes.

What was really happening? How does a sunny girl who’d never had psychiatric problems before, who grew up loving dance and Disney princesses, a good student who was rich in family and friends, how does that girl suddenly lose her hold on reality?

Schizophrenia affects about 1 in every 100 people, and one thing is clear: Genetics plays a role. Sydney’s uncle had schizophrenia, and scientists have identified more than 100 genes that can raise the risk for it.

Now, researchers based at the Broad Institute in Cambridge and Harvard Medical School have pinpointed the gene that is the biggest risk factor for schizophrenia discovered so far, and figured out how it does its damage: It makes the brain prune away too many of the connections between neurons.

“[I]t may be like you have an over-energetic gardener who prunes back so much that the bushes die off…”

– Bruce Cuthbert, of the National Institute of Mental Health

That finding, just published in the journal Nature, may also explain why schizophrenia tends to hit at such an odd age, in the late teens and early 20s. That pruning of connections is a normal process that ramps up during adolescence, but this genetic culprit may make it go overboard.

Pruning may sound bad, said Bruce Cuthbert, the acting director of the National Institute of Mental Health, but actually, it’s helpful: “It’s like clearing away the underbrush so your brain can function more efficiently.”

But, he said, “in people with this overactive version of the gene, it may be like you have an over-energetic gardener, who prunes back so much that the bushes die off because they don’t have enough branches.”

Cuthbert called the paper a “genetic breakthrough” and “a crucial turning point in the fight against mental illness.” Eric Lander, director of the Broad Institute, said it means we’re finally starting to understand what causes schizophrenia at the level of brain biology.

“For the first time,” Lander said, “we’re opening up the black box and looking inside and seeing, how does the disease really arise? That makes this, in my opinion, perhaps the most important paper in schizophrenia since the disease itself was ever defined,” over a century ago.

This scientific excitement does not mean, however, that the findings will lead to new treatments for schizophrenia any time soon, Lander and others said. It takes years for such basic science to translate into treatments — if it ever does.

But the new paper does suggest some promising new targets for drug development, some already being worked on for other diseases, said Harvard Medical School’s Steve McCarroll, who led the research team. Continue reading

Ted Stanley, Who Donated Hundreds Of Millions For Mental Illness Research, Dies

Ted Stanley is seen in a YouTube video screenshot from the Broad Institute. Stanley has died at the age of 85.

Ted Stanley is seen in a YouTube video screenshot from the Broad Institute. Stanley has died at the age of 85.

Ted Stanley, a billionaire businessman and philanthropist who donated more than $825 million to support research on mental illness, has died at his home in Connecticut. He was 85.

Stanley’s 2014 donation of $650 million to the Broad Institute of MIT and Harvard was billed as “the largest ever donation toward psychiatric research.”

At the time, WBUR’s Curt Nickisch reported that Stanley’s donation to find and treat the genetic underpinnings of mental illness had a personal side: Stanley’s son, Jonathan, suffered from bipolar disorder.

Here’s a bit of Nickisch’s story:

CURT NICKISCH: Ted Stanley founded a company whose first product was a series of medals commemorating the biggest scientific achievement of its time – the moon landing in 1969. While his collectibles business grew, his son Jonathan Stanley grew up a normal Connecticut kid, until, at age 19, Jonathan came down with bipolar disorder with psychosis, which got worse over the next three years.

JONATHAN STANLEY: We’ll call it the epiphany from my dad’s standpoint at least. I went three days straight running through the streets of New York – no food, no water, no money, running from secret agents. And not surprisingly – after I stripped naked in a deli – ended up in a psychiatric facility.

NICKISCH: Jonathan was a college junior.

J. STANLEY: My dad came to visit and got to see his beloved son in a straitjacket.

NICKISCH: The Stanleys were lucky. Jonathan responded well to the drug lithium. He went on to graduate from college and then law school too. Meanwhile, his father had met other fathers whose sons did not respond to treatment – other families who had to keep living with uncontrolled mental illness. Ted Stanley says that gave him a focus for his philanthropy.

TED STANLEY: There was something out there that our son could take and it made the problem go away. And I’d like to see that happen for a lot of other people and that’s why I’m doing what I’m doing.

NICKISCH: The $650 million donation represents the bulk of his fortune. The Broad Institute is a partnership of Massachusetts Institute of Technology, Harvard University and Harvard’s five teaching hospitals. Its head, Eric Lander, wants to begin using Ted Stanley’s money to catalog all the genetic variations that contribute to severe psychiatric disorders. He says the Broad has already collected the DNA from 100,000 psychiatric patients.

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From 2014:

How Trauma Brings Fear, Yes, But Also More Nuanced Reactions

A woman breaks down while paying her respects at a makeshift memorial near the Inland Regional Center Friday in San Bernardino, California, where several people were shot and killed by two shooters on Dec. 2. (Jae C. Hong/AP)

A woman breaks down while paying her respects at a makeshift memorial near the Inland Regional Center Friday in San Bernardino, California, where several people were shot and killed by two shooters on Dec. 2. (Jae C. Hong/AP)

By Mary C. Zeng, MD
Guest Contributor

November and December have been months of trauma.

The Paris terror attacks and the American shootings in San Bernardino and Colorado Springs have taken a heavy toll on both survivors and witnesses. Media coverage depicting scene after scene of carnage has also generated painful and lingering emotional reactions by secondhand exposure. A recent New York Times article describes “a creeping fear of being caught in a mass rampage has unmistakably settled itself firmly in the American consciousness.”

It’s true that trauma breeds fear. Those who were directly victimized in the attacks are, of course, likely to develop both short- and long-term fear reactions. But even indirect victimization, such as through the media, can be psychologically damaging. One study of New Yorkers after Sept. 11 found that people who watched more news coverage were over three times more likely to develop post-traumatic stress disorder (PTSD), a hallmark disease of fear.

However, if we are to truly understand and appreciate each other’s emotions during these troubling times, we must talk beyond fear. Failure to do so would be a disservice to those who are suffering.

A variety of responses is expected, and normal, in the aftermath of trauma. Fear is only one of several emotions that may arise — one of a cluster of experiences collectively known as peri-traumatic distress. Other feelings in this cluster include helplessness, sadness, grief, guilt, shame, anger and horror. Certain cognitive responses, such as a worry about fainting or dying, are also common, as are physical sensations such as loss of bowel or bladder control and shaking, sweating or a racing heart.

Another common response immediately following a trauma is peri-traumatic dissociation: a state of disconnectedness from oneself or from reality, memory loss, reduced awareness or time distortion that is triggered by a traumatic event.

Both of these sets of responses are normal short-term reactions to trauma. They may be experienced with varying levels of intensity, depending on how directly or indirectly someone was exposed to the trauma. They are expected to phase out, or extinguish, for many people over a course of weeks after the traumatic event.

It is when these reactions do not extinguish that the long-term and potentially crippling effects of trauma begin to show in individuals with a genetic predisposition. Peri-traumatic responses then turn into PTSD, a psychiatric illness affecting 7-8 percent of all Americans over their lifetimes. The classic signs of PTSD, aside from exposure to a traumatic event, include intrusive memories of the event; avoidance of people, places and situations associated with the event; negative mood and cognitions; and hypervigilance and hyperarousal.

In the same way that a veteran who saw IEDs in Iraq now sees IEDs everywhere, the mass shooting survivor forgets how to feel safe even on the home front. The world turns into a permanently dangerous, uncontrollable place.

Besides peri-traumatic distress, peri-traumatic dissociation and PTSD, which are widely researched because they can lead to psychological disability down the line, a whole range of emotions is possible in light of the recent tragedies. Numbness, bewilderment, resignation — there is no one right way to react to trauma. Traumatized individuals are also at higher risk of developing psychiatric disorders other than PTSD, such as major depression and substance abuse.

But positive adaptations to trauma have also started to receive research attention. Continue reading

Is It Possible To Prevent Suicide? 2 Psychiatrists Map Out The Ways

By Gene Beresin and Steve Schlozman

Suicide is awful, more common than you’d think and, in many cases, highly preventable.

Perhaps most important, in virtually every culture and every ethnic group on the planet, suicide is highly stigmatized. It therefore makes sense for the international health community to designate a day when we stop to actively contemplate this potent cause of misery and death. That’s today: World Suicide Prevention Day, though the harsh facts surrounding suicide are so much bigger than a single day.

The statistics, from the International Association for Suicide Prevention, are staggering:

*There are an estimated 800,000 deaths every year throughout the world that are directly attributable to suicide.

*This number is probably under-reported, given the stigma associated with suicide, and the fact that deliberate, self-harming behavior is often misclassified as an accident. The teen that drives into a street lamp at 100 mph could very well be attempting suicide, and not be the victim of an automobile mishap.

*Suicide is the 15th leading cause of death on the planet.

*Suicide is more common among older people (70 years of age and up), but also occurs in middle-aged and younger individuals at alarming rates.

*Lower income nations endure more suicides, but suicide remains a major cause of death in developed nations as well.

*Suicide has been tied to numerous psychiatric illnesses (mostly mood disorders), to difficult economic or traumatic situations and environments, to substance use disorders (both with and without addiction), to the loss of loved ones, and to a lack of good follow-up care following suicide attempts.

*The number one predictor of death by suicide is a previous attempt.

2013 U.S. suicide rate by age group, via CDC

Why So Common?

In other words, we know a lot about suicide. So if we know so much, why does suicide remain so stubbornly common?

The answer to this question is actually much less concrete than we might think. Studies on post-suicide-attempt intervention are lacking and under-represented. Studies on pre-suicide-attempt intervention are also insufficient in generating a simple and generalizable prevention methodology. Moreover, the likelihood of creating a one-size-fits-all approach is minimal. This might be why we know less than we’d like to.

There are studies that show that email, phone and in-person communication following an attempt can make a positive difference, but these studies have relatively low numbers of participants and clearly need follow-up. We also have studies that show we can increase the understanding of suicide and its risk factors in high schools and colleges, but it isn’t clear whether this understanding leads to decreased suicide rates. We do know that treatment as usual — that is, telling someone to go to an appointment with a yet-to-be-met clinician following his or her discharge from an emergency room or hospital — falls short of other more personal interventions.

All of this points to a common flaw in the understanding of suicide.

Suicide isn’t a formal disease. We don’t treat suicide itself. We treat the causes of suicide.

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Related:

Stressed-Out Undergrads And The College Mental Health Crisis

In case you missed it this morning taking your possibly stressed-out kids to school, check out On Point’s excellent segment about the mental health crisis among college students.

The bottom line: undergrads are struggling, many of them suffering from mild, moderate and severe mental illness. And colleges are scrambling to figure out ways to cope, from setting up automated counseling kiosks to launching campaigns promoting the message that it’s all right to ask for help.

A special report, “An Epidemic of Anguish,” published in The Chronicle of Education is featured on the show:

“Colleges are trying to meet the demand by hiring more counselors, creating group-therapy sessions to treat more students at once, and arranging for mental-health coordinators who help students manage their own care. A couple of colleges have even installed mental-health kiosks,which look like ATMs and allow students to get a quick screening for depression, bipolar disorder, anxiety, and post-traumatic stress.

Meanwhile, the Boston Globe reports that MIT, a well-known hotbed of stress, is enhancing its mental health services for students:

Starting this academic year, the Cambridge school will provide more mental health counselors, create a drop-in center for students to talk with professionals, and make it easier for students to seek professional services off campus.

The changes come after campus officials reviewed the results of a survey administered to students in April and May, which found that 24 percent of undergraduate respondents have been diagnosed with one or more mental health disorders by a health professional.

Alli Stancil/Flickr

Alli Stancil/Flickr

The reality that many college students suffer from mental illness isn’t exactly new. Earlier this year, for instance, researchers at UCLA surveyed 150,000 college freshman and found an increase in the number of students who report they were “frequently depressed.”

I asked child psychiatrist Dr. Steve Schlozman, associate director of The MGH Clay Center for Young Healthy Minds and an assistant professor of psychiatry at Harvard Medical School, about the UCLA report back in February and whether depression among college-age kids is getting worse, and he said: “We are reaping what we sow.” He added:

The pressure we put on high school kids to get into college and the pressure then that college follows up with is highly correlated with increased rates of emotional distress that can become full-blown depression. Also, the age of onset of depression is the exactly the age of onset of college — there’s a perfect storm of stressors. Finally, there’s a greater willingness to come forward, which is good. So, despite the fact that we’re using the word ‘depression’ a little more glibly, I’d rather have that and then rule out clinical depression through appropriate channels, like college health services, than miss cases that can lead to real suffering and possibly even death.

Now, Schlozman says, it makes sense for colleges to boost their efforts to make mental health services more accessible. In an email, he writes:

It makes sound ethical, medical and common sense for colleges and universities to increase their surveillance for mental health challenges as the school year begins, and to provide easy and unfettered access for ongoing care. Ideally, a comprehensive plan that has multiple and coordinated entry points and multiple and coordinated means by which care is delivered is the best way to provide the essential help that the last two decades have shown us is sorely needed on college campuses.

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Dr. Mark Vonnegut: On Creativity, Being ‘Crazy’ And Getting Help

By Mark Vonnegut, M.D.
Guest Contributor

Being related to a famous person is somewhere between a cruel joke and a minor distraction. My father was immensely talented and worked very hard at his writing, but the degree of his success was a fantastically unlikely bit of luck. There are lots of talented, hard-working artists who don’t make it.

The important thing in overcoming mental illness, whether or not you have a famous last name, is to want things to be better — and being willing to get help to make that happen.

Dr. Mark Vonnegut (Courtesy)

Dr. Mark Vonnegut (Courtesy)

Both of my parents’ families advised them to stay away from one another, as mental illness was rumored to be in each other’s family. The rumors were true, but it wasn’t like anyone then or now comes with any guarantees. It makes us feel more alive to be able to see, listen to and read great art, partly because great art is often the result of great struggle. The idea that artists and “the mentally ill” have inner demons while the rest of us do not is part of what has made it — and continues to make it — so hard to come to terms with mental illness.

The reason the arts and craziness run in families is because crazy people who can sing and dance and paint pictures and write well do a much better job of convincing others to have babies with them than if they’re just plain crazy. Thus has it ever been.

In my career as a mental patient, I started with schizophrenia, worked my way up through manic depression, and have now settled at bipolar disorder. I can joke about it because I recovered sufficiently to get into and through medical school, internship and residency, and have had the enormous honor and privilege of being trusted by parents to help them and their children. I make no bones about it; I make mistakes just like everyone else, but am very proud of how well I do my job.

I’m also very aware of how easily I could have ended up otherwise — a suicide statistic or just another broken young man who never got well enough to have a life. Continue reading

The Upside Of Admission To The Psych Unit: A Doctor’s Inside View

By Helen M. Farrell, M.D.
Guest Contributor

I met J in the Emergency Department. Dark red blood was oozing out of self-inflicted deep lacerations to her forearms. The surgical team was consulted and the cuts were debrided, cleaned, stitched and neatly bandaged. J was patched up. But she was not healed. Her wounds ran deeper than a surgeon’s instruments could access.

Together, we had a thoughtful conversation that included a review of her suicidal thoughts, intermittent hallucinations and innermost feelings. These vacillated unpredictably between anger and worthlessness. I informed J that she was going to be admitted to the psychiatric unit for her safety and treatment.

“Locked up?!” These are typical words expressed by patients who learn that they are going to be admitted involuntarily to the psychiatric unit. When J heard this news, her own tear-stained face scrunched up in an expression of horror. After several minutes of pleading, she finally resigned herself to the plan.

A nurse came into the room and took J’s phone. She took her sweater, her belt and the laces from her shoes. J stripped down into a standard hospital gown. It is common for patients to make one last plea and many have told me that they fear the psychiatric unit is analogous to prison.

J is representative of the many patients whom I treat on a day-to-day basis. She is a composite of those actual people who suffer from serious mental illnesses ranging from psychotic and mood disorders to personality disorders that require hospital level care.

Not Your Mother’s Psych Ward
The days of psychiatrists wantonly locking up patients like J against their will are long gone. They have been replaced by a legal process called civil commitment that firmly puts patients’ rights first. Yes, J was being admitted against her will, but she would retain her power to make treatment decisions, summons legal counsel, and even have a hearing with a judge. These safeguards apply to patients like J who are mentally ill and at risk of harm to themselves or others as a direct result of mental illness.

We know about the extreme cases of mental illness — those who involuntarily get locked on a psychiatric unit. An estimated one-quarter of the United States population will suffer from mental illness. But what about those people whom we never hear about? Far too many people, victims of stigma, neglect treatment and suffer in the isolating silence of darkness. They are compelled to withdraw because of fear and shame.

Beyond Shock Therapy

Driving much of that stigma is the fantasy of what happens behind that infamous locked door. Images from “One Flew Over the Cuckoo’s Nest” fill people’s imaginations, as do fantasies of the “shock therapy” room, which many incorrectly think is a place of punishment and not treatment. Continue reading

More resources:

Predicting The Next Mental Health Crisis: Sometimes We Just Can’t Know

Chris/flickr

Chris/flickr

By Steve Schlozman, M.D.

When tragedies hit, it is in our nature to ask why. The co-pilot in the horrific Germanwings crash had serious mental health problems, according to reports. How could no one have known how serious his challenges were? How could no one have predicted this terrible outcome?  On its surface this line of questioning seems even a bit ludicrous.  After all, even in the murky face of mental illness, the potentially deliberate and fatal nose-dive of a commercial aircraft seems impossible to imagine.  Nevertheless, this is exactly the question that we’re seeing over and over in the coverage of the crash.

How could we not have known?

The fact is, however, that this particular question glosses over a profoundly uncomfortable quandary that is by no means unique to psychiatry. For all of modern medicine, predictions are surprisingly fraught with difficulty.  For all of medicine’s miracles, for all of its technological wonders and advances, medicine remains a quintessentially human endeavor.  You might even argue that phrases like “medical miracle” are indeed part of the problem.  This more we grant medicine undue and mystical prowess, the more resistant we grow to the grueling trial and error that characterize everyday medical practice.  Doctors are wrong all the time.  That’s a fact.

Nevertheless, physicians are asked to prognosticate. That’s the verb form of “prognosis.” As patients and families, we look to our doctors daily for prognostic estimates.  (Emphasis on estimates.)  These estimates are really hypotheses necessarily based on incomplete data. Rare complications and twists of fate befuddle even the best.

For psychiatry this truth can be especially hard to swallow.  A neurologist might not be able to predict every migraine, but it is the rare migraine that results in tragedy.  Still, remember that psychiatrists cannot read minds. Like all physicians, psychiatrists will try their best to understand what is the cause of suffering.  And, as with all clinicians, psychiatrists will sometimes be right and sometimes not.  Medicine remains an art even as the science continues to improve.

The fact that someone suffers a psychiatric disorder, even a recurrent psychiatric disorder, is not remarkable when compared to the rest of medicine.  The same occurs with ulcers, asthma, allergies, orthopedic injuries, sinus infections and so forth. Most medical illnesses are chronic and many are intermittent. No medical professional can predict with absolute certainty when an episode is going to occur or how severe it may be. To be fair, physicians can and do identify triggers, but the intensity of a presumed reaction is outside anyone’s ability to predict.

And this is where society gets especially flummoxed. No one would argue that the art of medicine is infallible. No one would suggest that medical practice is right 100% of the time. But faced with tragedy, we are much more comfortable as a species pretending that our predictions are foolproof and that our mishaps are exceedingly rare.

Why can’t we always know? Medicine is post-modern. We cannot know because we can’t. Continue reading