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Introducing the Psych Central Mood Tracker

June 25th, 2009 admin No comments

Introducing the Psych Central Mood TrackerAfter taking a look at a few of the mood trackers that have long been available online, I was very unsatisfied with both how they asked you about your mood (”How depressed are you today?”) and the results they displayed (can we say “unhelpful”?). Mood trackers are used to help you track your emotional state on a daily or weekly basis, helping you get a better grasp on your emotions. Mood trackers can also help you determine your treatment’s effectiveness over time.

Like a screening quiz for depression or anxiety, you typically can’t just ask a person, “How depressed are you?” and get any kind of answer that you can hang your hat on. People aren’t always the best judge of their own mood states — especially when they are in the downward or upward swings of mania or depression.

So we formulated a different kind of mood tracker. Introducing the Psych Central Mood Tracker!

We take a different approach to mood. We ask you 12 simple questions that can help determine your current mood state for depression, mania and anxiety. It also determines whether you may be sleeping too little or too much, which can also contribute to one’s mood. You can also leave a brief journal note for your entry.

Then we tally your results and present you an attractive, immediately useful graph of your mood states over time. They are automatically saved to your Psych Central account, so you can keep track of how you’re getting better or worse in treatment or on your own. (A free Psych Central account is required in order to use the Mood Tracker.)

We hope you enjoy! Feel free to leave us feedback in the comments below.

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5 Rules for Living with Chronic Illness and Depression: An Interview with Elvira Aletta

June 25th, 2009 admin No comments

AlettaToday I have the pleasure of interviewing one of my favorite therapists, Elvira Aletta, Ph.D., on a very important topic: chronic illness. I say important, because it now pertains to me (and thus is important), and I need to learn some coping techniques ASAP before I fall over, into the Big Black Hole of depression.

Dr. Aletta is a clinical psychologist, wife, mom to two teenagers and blogger, seeking the balance in upstate New York. She is working on a book “How to Have A Chronic Illness So It Doesn’t Have You,” and would love to hear your story about how you or someone you love thrives with chronic illness. Write to her at draletta@explorewhatsnext.com. To learn more about Dr. Aletta, check out explorewhatsnext.com.

Question: I know that you have dealt with chronic illness personally and professionally, and this is an area of specialty for you. Do you have five good rules for living with both chronic illness and depression?

Dr. Aletta: Yes, I’ve had my share of chronic illness. In my early twenties I was diagnosed with nephrotic syndrome, a rare kidney disease that usually affects young boys. Weird. Then in my thirties I came down with scleroderma. Never heard of that either. When we are young it is our God given right to take our health for granted. Chronic illness means getting sick and being told it’s not going away, and that stinks. Our bodies have suddenly freaked out on us and we’ve lost control of the one thing we thought we could count on.

It’s not depression if you are adjusting to a major loss. That’s grief, which needs time to process. Allow yourself that time to mourn, to be angry and sad about what you’ve lost. You need time to accept the new reality.

Then at some point, we need to take action. If we don’t, grief morphs into depression and that can make your physical illness worse.

Be aware that one or a combination of factors can cause lowered mood when you have a chronic illness:

  • The situation. Loss. Grief.
  • Changes in appearance, mobility, independence.
  • The illness itself may have depression as a symptom.
  • Pain and fatigue.
  • Side effects of medication and other treatments.
  • Social pressure to appear OK, especially hard if there’s no diagnosis.

My five good rules to deal with it all? OK, here we go…

1. Be confident you have the right doctor.

When you have CI your relationship with your doctor is second only to your spouse or your parents. Being honest (and you must be honest!) with that person means you need to be able to trust them to hear you. If you don’t have that kind of relationship get a second opinion. Shop around. In my CI career I fired three highly recommended specialists because they were jerks. Thankfully I’ve also had wonderful physicians who literally saved my life and my mind.

2. Define your circle of support carefully.

Isolation leads to depression and it is so easy to isolate when you feel lower then dirt. People may surprise you. Peripheral friends may step up and be terrific support while others you thought you could count on cave. If someone inside the circle asks, “How are you?” Tell them the truth. When someone outside the circle asks, lie, say, “I’m fine” and change the subject. Too often they can’t handle the truth and they suck any energy you have taking care of them. A patient of mine found her mother would get hysterical at any medical news so it was better to keep her at arms length.

If someone asks if they can help say yes. Accepting help is a gift to them. Trust that someday you will be on the giving end. My patient’s mother could do laundry for her and that made both of them happy. One big way someone can help is to go to doctor’s visits with you. The extra eyes and ears take the pressure off you when the news is emotionally laden and important, even if the news is good.

3. Protect your health as you would a small child.

You are more than your illness. That part of you that functions well needs you to advocate for it. Of course there are the basics of getting plenty of sleep, exercise and eating smart. In addition to all that I suggest learning a new set of signals that are your clues for when you’re wearing your health thin. For me it’s lowered ability to concentrate, tension in my neck and shoulders, irritability and loss of my usually dependable sense of humor. When those yellow lights are blinking, it’s time for me to stop, assess and make changes. When I ignored those signals I relapsed and looking back I can see where I ran the red lights. So be a fierce protector of your health. Set limits and find the courage to say ‘No’!

4. Create a new measuring stick.

Our self-esteem lies in the standards with which we measure ourselves as we go through life. To thrive with chronic illness, throw out the old and rethink your standards. If you are used to defining yourself by your 50-hour workweek, for instance, you may feel lousy about yourself because now you can’t manage it.

Finding a new standard can be tough. One technique I use with patients is to have them ask themselves what is reasonable? Is it reasonable to do it all yourself or is it more reasonable to delegate? Is it reasonable to register the kids in travel hockey or is it more reasonable to stay local? This is where a lot of courage is needed. Courage to address old pressures to be a certain way and to imagine value in doing things differently. In my own life and in my work I find that those who thrive despite chronic illness creatively find opportunity in their new reality.

5. Have dreams and strive for them!

You had ambitions to get a degree or promotion, to see the world or save it, to get married and have kids. Now you’re thinking, do I have to give that up? No, you don’t. It’s imperative for your spirit that you have goals for living, big and small.

What might change with the reality of chronic illness is the path and timing. I wanted to have kids and was told for years, ‘No.’ I had to adjust to the idea of life without kids or adopting. Then in my late thirties, my doctor said, go for it. After a scary, thrilling journey, today I have two thriving teenagers.

As we reach for the stars let’s appreciate the ground we stand on. Mindfulness has a real place in keeping depression at bay for everyone. Sometimes our dreams are right before our eyes.

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Online Mental Health Journalism Awards: 2009

June 25th, 2009 admin No comments

As we noted here, Mental Health America recently announced the winners of the “2009 Media Awards” that recognize excellence in mental health journalism. Sadly, despite the Internet’s popularity for the past 15 years, the Internet as a category is still missing from the awards. Apparently you can do good journalism online, you just won’t be acknowledged for it. (In Mental Health America’s defense, Pulitzer only began recognizing online journalism this year, too, so go figure.)

We thought we’d acknowledge some examples of outstanding online mental health and psychiatry journalism in 2008. You might argue with our broad interpretation of “journalism,” but we believe that writers or producers who can bring new insight, analysis or understanding about mental health concerns or significant issues in the fields of psychology and psychiatry are worthy of inclusion.

So without further ado, here are some of our top picks for online mental health journalism from the past year (largely based upon writing or publishing online in 2008).

Psych Central Outstanding Mental Health Journalism

Outstanding Online Mental Health Journalism: 2009

Shannon Brownlee and Jeanne Lenzer published an article in May 2008 in Slate, Stealth Marketers, that described the lack of transparency and disclosure on a particular radio show hosted by Dr. Fred Goodwin in an episode entitled, “Prozac Nation: Revisited.” Slate’s article led to additional mainstream reporting on the issue, which left a black mark on Dr. Goodwin’s otherwise stellar career. (Coincidentally, a month earlier, Philip Dawdy over at Furious Seasons focused on the same show, but zeroed in on the incorrect information and marketing slant the commentators had on the show.)

On a more positive note, one old media company published a new feature on their website that must be mentioned: The New York Times’ Patient Voices. Well-produced audio stories, Patient Voices provides a first-person and personal experience of what it’s like to live with various health and mental health concerns. I’ll just highlight their Bipolar Disorder and ADHD segments (note: self-playing audio upon clicking).

Dr. Daniel Carlat, blogging over at The Carlat Psychiatry Blog, did more than his fair share of citizen journalism exposing the corrupt continuing medical education (CME) system, too often bought and paid for by pharmaceutical companies pushing their specific medications. His entries in 2008 brought light to many such biased practices (and the resulting changes made in the industry as a result of efforts like his). Perhaps it’s not “mental health” enough, but CME is what provides education to psychiatrists and other professionals. This education is part of the basis they then use to make clinical judgments in the office treating patients for their mental health concern.

The mysterious CL Psych blogging at Clinical Psychology and Psychiatry: A Closer Look often breaks down complex research findings and puts them into more clear and understandable terms. He explains how researchers skew the data and their results to get to their intended goals (regardless of what the data actually show). Since research informs practice and practice trends, biased or poor research can influence how clinicians end up treating people.

One year ago, Jeremy Dean blogging at PsyBlog described the limited research behind “brain training programs” that have become all the rage on devices such as the Nintendo DS and iPhone. He described in the article how many different types of strategies promoting cognitive enhancement are often no more than marketing hype.

We often enjoy the insightful writings of The Last Psychiatrist, as he provides a witty and interesting outlook on news, cultural trends, human behavior and research that would be difficult to find anywhere else. One of his most popular entries of 2008 was an analysis of the modern manufacturing of pop musical hits like Katy Perry’s “I Kissed a Girl”, not for teenagers, but for middle-aged men. Or this entry that looked at why you probably wouldn’t want the widespread use of neuroimaging scans (like fMRI or MRI scans) in court. Or the three-part series about the apparent rise of narcissism in college students. Thought-provoking and always interesting.

Like him or hate him (he tends to be polarizing), Philip Dawdy also often provides the first public look into court documents, court trials and other information surrounding drug research (perhaps best known for making the Zyprexa court documents available for download on his site). You may never know quite what to expect from his blog, but he is a prime example of mental health journalism online.

Dr. Vaughan Bell at Mind Hacks found a pre-print of the “Voodoo” neuroimaging fMRI study which leveled significant criticisms at much of the fMRI research published in the field in the past 20 years. The final paper and responses to it were just recently published in the May 13, 2009 issue of Perspectives on Psychological Science. Bell’s finding of the pre-print set off a controversy online about the limits of fMRI brain imaging studies — which eventually affects our understanding of mental disorders.

And you can’t really leave 2008 without an honorable mention to U.S. Senator Charles E. Grassley. He has single-handedly led to the exposure of dozens of discrepancies between the monies researchers claimed they made from drug companies, and the monies they reported as a conflict of interest to their universities. Such disclosures have led to a fundamental change in how such disclosures are made, including at organizations such as the National Alliance on Mental Illness.

?Did we overlook someone who provided independent reporting or journalism online in the past year on a mental health, psychology or psychiatry topic? Please leave us feedback and we’ll add them to our list to review for next year’s entry.

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The Age of Innocence

June 25th, 2009 admin No comments

You know, I can still remember being very young and how much fun it was. Or at least I think I remember it being fun. I felt safe, lacking stress or pressure, and was interested in what the great outdoors had to reveal.

Now, you have to know that I lived in a pretty nice neighborhood, where the family ate dinner together, we all went to church on Sunday, and where it was OK to play in the street, ride your bicycle, climb trees and build forts. If you skinned your knee, the neighbor called your mom, and by the time you got home she had the bandage and tincture of iodine ready.

I did my homework, the dishes, and played. Period. Oh, yeah, I had my sports (I rode horses), played golf, figure-skated, bowled, played badminton and croquet, and was on the rifle team. But did I run from activity to activity, requiring an appointment book for scheduling “play dates” with my friends? Absolutely not.

What did I have? A “normal” childhood for the time. You see, I grew up in the 1950s and ’60s in the U.S. It was post-World War II and Korea, the America I knew was booming, and we had a revival of the happy days that you see on Andy Griffith, Leave it to Beaver, and Superman. This was an era where we were taught that life was fair, that the good guys win and that if you followed the rules, you would be safe and happy. And, oh yeah, everything was resolved in less than an hour. Remember Bonanza? Even the most awful circumstances were fixed by the end of that show.

What happened to those times? Were the good old days actually better? No. They weren’t. We were just naive, didn’t have the stuff that is now on the news 24/7 (that began by televising the Vietnam War with nightly body counts and gruesome images), and didn’t have to worry about terrorist attacks, bioterrorism, cyberspies or identity theft.

But we did dive under our silly desks at 1:00 every Monday afternoon as the air raid drill was sounded. We were afraid of Russia dropping The Bomb on us (er, just like we had done to Japan. Twice).

We had only two antibiotics, and my doctor used to come down the drive to give me a shot of penicillin once a day when I was sick. I was, and am, allergic to the other one, sulfa. I remember taking the Salk vaccine for polio, since it was still a problem in the United States. We also took paregoric (ohh, gag!) for nearly everything from tummy aches to sleep problems. What did that mean? Only the physically tough survived. The flu was expected; so were measles, mumps, and even whooping cough (although that was on the way out). Our parents feared polio and scarlet fever. My fourth grade buddy died of pleurisy (look it up!). I still remember that.

Why am I talking about this? Well, I reflect back on the “good old days” and they weren’t so good for adults. Just for kids. And the kids lived completely in a fantasy world that had nothing to do with the cigarette smoke-filled, boozy happy hours that our parents enjoyed. My parents remembered the Great Depression, they knew about war, and they had often lost family members to disease and disaster.

Mental health was never spoken about, barely whispered. Depression was seen as a weakness, and never treated, unless you became so depressed that you couldn’t function, but could afford going into a sanatorium. I live near one of the most famous private mental hospitals in the country, where Zelda Fitzgerald and Jonathan Winters recovered from depression (or bipolar disorder, in Winters’s case). Only the rich could go there, and only the rich were treated fairly.

Just down the freeway from my home is a state hospital that was shown on TV in 1961 as still being cruel to the insane, as we used to call those poor people who suffered from delusions and hallucinations. I remember the show very clearly and it shocked even my youthful mind. They were strapping people down, or to the hospital room walls, naked. It was easier to clean them if they didn’t have soiled clothes. Imagine that. Only 48 years ago, and they were still treating humans more poorly than they were treating their own pet dogs.

We didn’t get the Civil Rights Bill signed until 1964. At least my generation fostered some of the change we wanted. This bill fostered change for everyone; men, women, children, black, white, red, or yellow. The mentally ill, and those unable to care or protect themselves. Everyone.

Life was a fantasy for kids, but not for adults back then. But how do you think your kids are going to look back on their childhood, especially because instead of playing with a large cardboard box (that could be anything from a castle to a fire house), riding bikes, fishing, and playing miniature golf, they are watching movies like “Dragged Into Hell” and playing video games where you blow things up and murder people (or androids, same thing). These kids are isolated and getting more depressed and angry as the days go by.

Maybe your childhood wasn’t as “magical” as I thought mine was. Perhaps it was. But you have the power to change your kid’s childhood (or even your own, if you’re still a kid) by getting out there and doing things. Riding a bike (where it’s safe), going to the playground (with supervision) and playing Wii with others can foster truly great memories, no matter how accurate. Get up, get out there, and have fun. Childhood is gone as quickly as your breath. This is the time that you can build a great adult.

I invite others to write about the goodness in their own childhood, or talk about how they are helping to build positive memories for their children. There’s always time. But it is time to make that difference, take that step, for better mental and social functioning for our kids and ourselves.

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6 Steps to Serenity

June 25th, 2009 admin No comments

seren.jpegI don’t know how many times I utter the Serenity Prayer in a day, but it’s well into the double digits. In fact, the words penned by the late theologian Reinhold Niebuhr may very well be imprinted on my plastic brain because its message is so central to my mission of chasing after sanity. I want so desperately to be able to let go of all the stuff I can’t change, to take charge of the things in my life that are under my control, and to distinguish, once and for all, the difference between laziness and illness, between persistent and stupidity, and between doable and “leave it the hell alone.”

Here are just a few ways I “do” the Serenity Prayer in my life: techniques that help me separate the unchangeable from the changeable … a half-dozen steps I regularly take toward serenity.

1. Go to a happy place.

What do you do with the stuff you can’t control, with the gunk that is keeping you from peace and happiness? Try to swap it–the bad memories and phobias and fears from your past–with some snapshots from your childhood or adolescence where you felt loved, whole, even sane!

In his bestseller “Home Coming: Reclaiming and Championing Your Inner Child,” John Bradshaw explains that our lives are filled with old anchors, the result of neurologically imprinted experiences that we keep replaying when a situation resembles our childhood. However with some meditation and what he calls “anchoring,” “we can change the painful memories from childhood by putting them together with actual experiences of strength acquired in our adult lives.”

To do this we have to create a happy place, where we re-experience those moments in our lives when we were accepted, welcomed, and loved, and we swap them for the bad memories. Most of my happy places are outside. There I greet my inner child, give her some snacks, and strongly nudge her to release her fears so that she can grow up to be normal.

2. Don’t go to an unhappy place.

After you’ve made a visit to your happy place and emerged as a balanced and centered person, you will better know what kinds of events and things to avoid next time … um, supposedly.

After twelve years of therapy and 21 years of hanging out in twelve-step groups, I think I have finally located my triggers: Irish bars loaded with inebriated folks, super-sized Wal-marts with over 100 aisles of products manufactured in China, Chuck-E-Cheese restaurants with life-sized rodents singing melodies to screaming children, and conversations with people who think mental illnesses are like mermaids–not real–and that absolutely every health condition can be fixed with the right thoughts plus a little acupuncture.

I have compiled a list of these places, persons, and things in my mind that I can’t change (like the life-sized rodent) so that I know to keep away in the future, because we don’t want more bad memories, do we? That would require another session in the happy place.

3. Hunt down unrealistic expectations.

You’re never going to be able to distinguish between the unchangeable and the changeable unless you hunt down unrealistic expectations. These bad boys are the obnoxious cousins of perfectionism–which can disable your body, mind, and spirit faster than anything else I know because perfectionism ensures that your self-esteem and self-confidence stay down where the submarines are: below sea level.

I identify unrealistic expectations every week in therapy. There I will jot down irrational goals like “penning a New York Times bestseller in my half-hour of free time in the evening,” “being homeroom mom to 31 kids and chaperoning every field trip while being the primary breadwinner for the family,” and “training for a triathlon with a busted hip.” Then my therapist and I arrive at some realistic options, like “aiming to chaperone two field trips a year” and “working out a few times a week but saving the triathlon for after retirement.”

4. Color in the zebra.

Not only does perfectionism hand out unrealistic expectations, but it blinds you to color, so that you’re left with black and white vision. Like many people who struggle with depression, I have to pull out my palette of colors to remind myself that just because something didn’t turn out the first time, doesn’t mean that it’s destined to fail every time I try it. David Burns offers 15 ways to untwist distorted thinking in his “Feeling Good” that can add oodles of shades to your perspective. The result is that you take several situations out of the “can’t control” category and you place them into the “I’ll give it a good shot” file.

5. Take baby steps.

By now you might have a better idea of what you can, indeed, change. You can see it in the distance. But how do you get there?

Break the job down.

Start small.

Tackle one task at a time.

For example, as I was beginning to ascend out of the abyss of my severe depression, I was overwhelmed by everything–a sink full of dishes, a menacing diaper, a doctor’s appointment. Decision-making was especially painful: for me and for the person asking the question. And I didn’t have a clue as to how to restart my career. Every time I thought about it, I began to shake with anxiety.

My great aunt Gigi, who had suffered her own nervous breakdown at age 35, coached me along the way. “Itsy-bitsy steps,” she’d remind me. So I signed up to be a writing tutor at the Naval Academy for three hours a week, just to see if I could manage my emotions for that long.

I succeeded! Except for the morning I burst into tears because I couldn’t concentrate long enough to read a midshipman’s boring paper about history of the Tripoli Monument.

Then I asked my editor at the news outlet where I had worked pre-breakdown if I could resume my biweekly column. That step was harder, especially on the weeks where I’d sit at a blank computer screen for an hour or more, waiting for my words to come out from hiding. But I forged on. I continued to write, a little article here and there, which eventually lead to Beyond Blue, a leap, but one I was able to take because of the smaller steps that came before it.

6. Rip the tags off.

Here’s another way to change the things you can: rip off all the (figurative) sales tags in your life.

By that I mean getting involved and investing yourself into something–your family, your passion or career, your vision–moving yourself from the sidelines into the game. And positive psychologists such as Martin Seligman purport that getting involved and dedicating our time and energy to a higher purpose or cause is one of the strongest antidotes of depression and paths to happiness or SERENITY.

I try to rip off as many tags as I can today because I know, by experience, that having a cool wardrobe of never-worn skirts–of blowing off invitations to socialize with and meet fellow moms, neighbors, bloggers–further propels me down the depression hole. When I want so badly to isolate and build a nice, comfy fort in life like the ones out of chairs and blankets David and Katherine build in our family room, I’ve got to get out the scissors, cut the tags off, and show up for that coffee hour that I committed to. I’ve got to take a chance on the dress and invest myself into my community.

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Cultural differences

June 25th, 2009 admin No comments

We have four female partners. They are all part time.

One was on maternity leave. One was on holiday. One was not on that afteroon. The other had finished her early afternoon sugery and was off doing the school run. So, as occasionally happens, there were only male doctors available. I was “duty doctor”. A female patient phoned to say that she had been in an RTA that morning. A car had driven into the side of her car. Not hurt. A bit shaken up. She was 29 weeks into her second pregnancy. No pain. No bleeding. She felt that the baby was “more active than usual”.

Does not sound too serious, but you have to be sure. I offered her an appointment within the hour. She asked if I would want to examine her abdomen. I said I would. She said she was not prepared to be examined by a male doctor and that she usually saw the female doctor who was on the school run. Would she not be back at work later? I wish.

We ended up with her having an appointment with her female doctor tomorrow morning. She was happy enough with that, but I was not. It is not ideal. She could go up to the hospital, but there is no guarantee of a female doctor there, and seeing a midwife out of hours is next to impossible unless you are fully dilated and, these days, even then it is not easy.

What can you do? Why do I feel bad about it?

Still, soon it will not be a problem because before long, all doctors will be female. If you are male, and that bothers you, best get your scrotum checked now.

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Summer solstice : the Druids & the Chiropractors

June 25th, 2009 admin No comments


Thanks to Planet Chiropractic for the photograph above. Good to know that the American chiropractors recognise that they are visiting from a different planet. Meanwhile, for us Earthlings, it is the Summer Solstice, the longest day. For those of us with sub-clinical SAD syndrome, this is the harbinger of longer nights, shorter days and the long, hard haul to the winter solstice on 21 December (for those as anal as Dr Crippen about this, at exactly 17.47)

The sun-worshippers and Druids are even now gathered on Salisbury Plain. Dr Crippen pauses awhile to wonder why Planet Chiropractic is so interested in sun-worship. Mr Justice Eady has decreed that one should not use words like “bogus” when discussing the …er interesting claims made by British chiropractors. I wonder if even now our chiropractors, dressed in ancient robes, are prancing round Stonehenge with the Druids. It would seem appropriate.

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Darzi Wars : the end of the NHS

June 25th, 2009 admin No comments

A lunchtime phone call from a godson.

He qualified as a doctor last year. He has just coming to the end of his F1 year. He wants to be a surgeon. A properly trained surgeon. There are a total of 41 F1s in the region in which he works. Twenty of them (he knows for certain, there may be more) are applying for jobs in Australia. He is one of them.

Australia is enthusiastically welcoming our newly qualified doctors. In fact, it is actively recruiting them. It will not pay them as much as they will get paid here, but it will treat them decently, train them properly, and offer them a stimulating career. Many are going. Doctors.net is full of adverts such as this.

Why is it happening? What is to be done?

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This brilliant take on NHS bureaucracy gives some of the answers : Kafka’s NHS

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"The State of ME" by Nasim Marie Jafry

June 25th, 2009 admin No comments

(velo = bike, gubbed = exhausted, velo-gubbed legs = the way your legs feel when you have M.E, as if you’ve been doing the tour de france, except you haven’t been near a velo)
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What I like about The State of ME is that it is refreshingly free of cod-science.

Though notionally about “Helen”, Nasim Jafry’s carefully titled book is unashamedly autobiographical. It tells the story of a fit, intelligent modern languages student who, part way through her university course, is stricken with a chronic, disabling and undiagnosable illness. So often, books about myalgic encephalomyitis are written by the militant wing of the “ME brigade” and are angry, self-indulgent, outspoken and intolerant. One of the most eminent ME militants, and certainly one of the most preposterous proponents of cod-science, is “Jodi Hummingbird” (really) who believes that:

M.E. is similar in a number of significant ways to illnesses such as multiple sclerosis, Lupus and Poliomyelitis (polio).

the brain stem…is always damaged in M.E.

ME…is primarily neurological, but also involves cognitive, cardiac, cardiovascular, immunological, endocrinological, metabolic, respiratory, hormonal, gastrointestinal and musculo-skeletal dysfunctions and damage. M.E. affects all vital bodily systems and causes an inability to maintain bodily homeostasis.

causes a list of symptoms so numerous as to cover just about any serious illness you care to mention

…the hearts of M.E. patients only pump barely pump enough blood for them to stay alive. Their circulating blood volume is reduced by up to 50%.

A Hummingbirds’ (sic) guide to ME

I didn’t know that hummingbirds bark. Poor old Jodi. She doesn’t understand apostrophes either. Before I bought the State of ME, I read Jodi Hummingbird’s review. When Jodi isn’t barking, she is being a characteristic militant ME pompous git. You are not entitled to your opinion unless you agree with Jodi. Only Jodi understands ME and if you don’t agree with Jodi, she has no time for you. Heaven forbid that Nasim Jafy, who has suffered from ME for over twenty years, should have her own opinion.

3/10 for the quality of the information given about M.E. It was almost entirely inaccurate. Almost all of the medical information given related to ‘CFS’ rather than M.E., and these are two very different entities!

Jodi Hummingbird’s review of The State of ME

It is people like Jodi who give ME sufferers a bad name. Thank goodness there are some, like Nasim Jafry, who do not share her views. Nasim Jafry writes with wit and gentle good humour about her illness. It is a long illness and it is a long book, perhaps a little too long. She does not burden us with too many medical details. Her family doctor is none too sympathetic but then Helen/Nasim comes under the care of a sympathetic consultant, a rheumatologist I suspect. He takes Helen/Nasim through a number of treatments including plasmaphoresis and “kick the television” ACTH therapy. None of the treatments is successful. There is the suggestion that the “diagnosis” was made on the basis of a muscle biopsy. If only it were as simple as that.

Helen/Nasim is spared the endless suggestions of graduated exercise programmes that are now Nicely in vogue. Any doctor who is contemplating recommending such treatment to patients with ME would do well to read the State of ME first. It is far more persuasive than Jodi Hummingbird’s pseudo-science about cardiac output.

Those doctors from the Simon Wessely school of thought might well ask if Helen/Nasim was clinically depressed and thus might have benefited from treatment with anti-depressants. There is nothing to suggest that Helen/Nasim was depressed before the onset of the illness. Her account is transparently honest and convincing, and I do not believe that she is suppressing details of any pre-existing psychiatric condition. A more interesting question is whether, during the course of her illness, she develops a secondary depression which might have benefited from psychological or pharmaceutical intervention. I reached a conclusion on that. You must reach your own.

We must assume that Helen/Nasim was never offered CBT (thank God!). Maybe it had not been invented then. (It had, but it wasn’t trendy). She has a supportive family but she does not seem to have been offered outside psychological support and there is nothing in the narrative to suggest that she would not have accepted that sort of help or indeed any sort of help from someone sympathetic. She does dabble occasionally with the quacktitioners but to no avail.

The State of ME is also a story of young love told around an increasingly intrusive illness. Jafry’s account of Helen’s various relationships are, notwithstanding some self-consciously twee descriptions of oral sex, convincing and, like all good love stories, one wants to finish the book to see with whom, if anyone, Helen settles down. The end may surprise you.

There is so much about which Helen/Nasim could be angry and yet this book is free of anger and free of bitterness. It is a balanced, non-didactic account of a young person grappling with a dreadful illness. All doctors will benefit from reading the State of ME. It may make those doctors who are not “believers” pause awhile before calling in the psychiatrists.

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A list of NHS BLOG DOCTOR articles on myalgic encephalomyelitis may be found here

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Health care "rationalisation" : the cruellest cut

June 25th, 2009 admin No comments

When you go to the hairdresser you know there are going to be cuts. Sometimes the cuts may be savage; a short, back and sides. You would not tell the hairdresser to choose the cuts. You would not believe a hairdresser who said he could shorten your hair without cutting it.

There are going to be cuts in public services. Of that there is not the slightest doubt. There is only one person in the country who says there will not be any cuts, and that is our discredited Prime Minister. His performance at today’s PMQs was dishonest. He lied. Like the barber purporting to shorten your hair without cutting it, he fools no one. Balls is lying. Liam Bryne, the Chancellor’s rotweiller, is lying. Look at this glorious double speak:

“You’ve got to separate two kinds of spending here. You’ve got to separate current spending, that is the day-to-day cash in hand. In real terms that grows by 0.7%…

It is a bit of a red herring, I think, to try and mix up capital spending and current spending. You know, if you put the two things together you get the numbers that you talk about. Because of course once you’ve got a school, you’ve got a school. Once you’ve got a hospital, you’ve got a hospital. The thing that really matters is what happens in the day-to-day current spending. The overall envelope rises by 0.7%.”

Liam Byrne, the Chief Secretary to the Treasury.

Neither party dare admit that some of the impending cuts will be in health care. But, behind the scenes, the government has already appointed the health care barber. He is none other than Matthew Swindells. Swindells used to work within the NHS. Now, as so many others have discovered, he can make far more money by working for the NHS as an independently contracted management consultant.

Matthew Swindells, managing director of the health division of Tribal and former special adviser to then health secretary Patricia Hewitt, said GP services would not face cuts if practices took on more secondary care work.

‘Some 30%-40% of patients in hospital don’t need to be there. There is a huge gain to be made. It needs a step change, not to replace primary care services, but extend what they are doing.

PULSE

What a c.v.! Patricia Hewitt’s spad turns into a management consultant and sells his dubious wares back to the NHS. He now works for TRIBAL, a super smooth, slick, top of the second divsion management consultancy which makes its money advising the public sector how to improve thier efficiency. Swindells is not medically trained and has no experience of primary health care. But he wants to force GPs to take on work much of which they are not trained to do. And if they refuse? He will pass it down the food chain to the pharmacists.

Tribal, appointed as one of the Government’s key advisers on healthcare spending, warned PCTs were ‘remarkably tolerant’ of variations in GP referral rates, and said a clampdown could bring ‘very substantial benefits’. It also warned GP services could face ‘rationalisation’ if practices did not take on complex hospital work, with ‘more cost-effective’ providers such as pharmacists to be commissioned to take on a greater proportion of frontline work.

Don’t you love the use of the word “rationalisation”? And when the pharmacists make a mess of it, what then? Pass it down to the nurses? Then to the auxilliaries? Then to the cheapest and most ignorant of all the independent health care providers, the “expert patients” If they could take over, the NHS would cost nothing.

Do not despair. There are ways of making cuts. My colleague, the Jobbing Doctor, shows how £350,000,000 could be saved at a stroke, and I am with him on that. I too have a simple ploy. A front end charge of £20 each and every time you wish to see a doctor. That charge would, at a stroke, reduce waste and would generate a vast amount of money. But it will not happen. Every time I suggest it, there are howls of anguish. Utterly wrong and utterly misplaced but demonstrating so clearly why no political party dare make the suggestion. Instead, they will stealthily dumb down the service. You can have two pharmacists for the price of one doctor (that figures – four to five years to train as a pharmacist, nine to ten years to train as a GP).

You, the common folk, may continue to celebrate your “right” not to have to pay a front-end charge to see the new, stealthily dumbed-down, untrained, health care professional. But do not expect to find Gordon Brown, or Margaret Thatcher, or Patrician Hewitt, or Mark Swindells or Dr Crippen queuing behind you. We will all be elsewhere, seeing a doctor.

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