Wednesday, January 16, 2008

Anxiety, Ethics, and Blogging

Mi emailed me after reading comments and said, "I think it's so nice that people see themselves in your blog."

Well, yes. And no.

FD brings home throw-away medical journals and will occasionally cut out an article of interest. "Read this," he says, tossing me a shiny, neatly-folded page. "Tell me what you think."

This one's from Family Practice News.
Point/Counterpoint: Do physician bloggers compromise patient privacy?

I'm not a physician, of course, but all mental health professionals have an obligation to protect patient privacy . So the article is of interest. And it's about blogging.

Two docs, one a neonatologist, ( and one a psychiatrist with a private practice, face off.

The psychiatrist believes that physicians should not blog. She argues that when medical bloggers write, they swing the power to expose patients, breach confidentiality. She cites an extreme case, a blogger MD who tells of an 18 year old patient who birthed her third child on Xmas day. The tone of the post is heavy on the musar (criticism or value judgement in Yiddish).

She is right about that case, for sure. Clearly the age of the patient and date of birth of a third child are identifiers, and it is likely that the young mother, albeit blessed, would be embarrassed and distressed had she read the doctor's judgmental words about her on the Internet.

Closing argument?
Patients should not have to ask their doctors if they blog before they feel safe to agree to treatment.

The neonatolgist, Tales from the Womb, counters nicely, making the point that he blogs under his real name because being anonymous would dilute his authority. That implies, to me, that what he's teaching really is important, and blogging is a way of disseminating that information to the public for the public good. It's not so simple, physicians should not blog.

Authority, by the way, is something Psychotoddler, also an MD, told me I would lose when I took my name off this blog, fearing home-invaders more than anything else. It's an anxiety thing.

Tales feels that using methodology that carefully disguises detail in the enactment of a case adequately addresses the psychiatrist's complaints. Teaching begs examples and good teachers find them. So he takes snippets of old case material, changing every identifier including, but not limited to (a) biological sex, (b) time, (c) gender, (d) age, (e) race, (f) marital status, (g) political preferences (h) sexual preferences, (i) geographical region, (j) occupation, and (k) socioeconomic status. We have MANY demographic qualifiers to play with.

Family therapists can manufacture fictional demographics for everyone in an example, changing great-grandparents into adoptive gay uncles if necessary to make a point. It's not too hard to do a rewrite with a little imagination and still not sacrifice verisimilitude.

Writers enjoy this effort and professionals who blog, face it, are writers. We're professionals first, however. It's in our blood to protect you. Ethics are mother's milk. We spend hours of classtime digesting them.

So. You can see whose side I'm on. And to reiterate, when you read a case on this blog, it's never a real situation except perhaps when I talk about myself and my family, and even that can be hyperbole except for me liking a good sandwich. And who doesn't?

To teach a decent class about health or mental health, however, we need more than our families of origin in the credits. There's just so much pathology in any one clan.

The point though, is that you have and will continue to have many good professional blogs out there to choose from. But when it comes to this one

. . . even if a situation feels VERY familiar to you

. . .even if it feels I'm speaking TO you

. . . even if it feels that surely I have written a post BECAUSE of you . . .

It's not about you.

And on that note, can we please get back to work?

About six months ago a publicist sent me Dancing with Fear, a book by psychologist Paul Foxman. I agreed to post on it only if I liked it, but warned her that a book like this is at the very bottom of my list of things to read. Like I want to read another book on anxiety when I could be drooling over Vogue? Come on.

So for months the book occupied a place in a heap of journals and books on the floor next to my bed. And every time I looked at it I felt guiltier and guiltier. It got to the point that the guilt just got to me.

What could I do? What would you do? I sucked it up and gave it a good skim, enough to recommend DWF to those of you who need more on those cognitive-behavioral techniques that I feel are so key to emotional management.

Dr. Foxman has lovely discussions on anticipatory anxiety and the must have coping strategies that you need to cope with excruciating anxiety. And he's not afraid to talk about sex, the natural tranquilizer.

You'll find those shoulds and what ifs, the obsessive thoughts that undermine your rational thinking, and pages and pages on proper breathing, yoga, diet, and muscle contraction/relaxation. Some of these things (breathing and muscle contraction for sure) should be taught in elementary school. How are kids supposed to get through test anxiety without them?

Dr. Foxman takes on everything from the biological events that define our anxiety, to psychological defense mechanisms, sleep, food, and drugs. He may discuss visualization, too, but I could be imagining it. And if you like self-disclosure from your therapydoc, you'll like his candor about his own disorders.

I didn't see What Goes Up, Must Come Down, my theme song for anxiety, but maybe it's in there, too. Coasting through a panic attack, just breathing normally is the way to go, rather than fighting it. Knowing that you'll eventually resume your regular programming is the key.

But I'm pretty sure he does emphasize that therapydocs are not so into control, to quote the psychiatrist in the movie, Ordinary People, because needing control makes us more anxious, and it's elusive.

Enough about fear and the movies. Check out the book next time you're spilling coffee at Borders.

If you also want a book that's truly gripping, a page turner that scares you yet keeps you in it because you know it just has to have a happy ending, read Lori Schiller's biography about her struggle with schizophrenia, The Quiet Room, written with Amanda Bennett.

I couldn't put it down. Here's a link to a blurb from Lori that she wrote while working on the book.

Oh, wait. There's just one technique that Dr. Foxman's encyclopedic paperback forgets to mention. This coping strategy really does quiet the brain, requires no meds, but is quite psychologically addictive, caveat emptor, so I recommend it in small doses, one or two games at most (sure, start 'em over again until you win).

Yes, it's that computer game, Spider Solitaire. Before you reach for the stupid Tylenol PM or whatever garbagey over-the-counter sleep medication you use,

Go to the Start menu. Find Accessories. Click on Games.

OR go out and buy a couple of books. Go to bed, lie flat so the blood flows to the reticular formation in the back of your brain, and read.

You'll never look back.



Midwife with a Knife said...

All great observations. The only "true" thing that I blog about is me. The situations are all either common enough (there are probably a million babies born each day!), or are changed, or the dates are changed. My life, my feelings, my actions are all parts of my story that belong to me. My patients babies don't belong to me, so I can't give out identifying details, which in some cases can even include the diagnosis, when the diagnosis is rare.

Actually the one reason I blog semi-anonymously (only semi, because I think that people who know me who read my blog would know who I am) is primarily because it protects the anonymity of my patients. The midwest is a big place. There are babies delivered here all the time. If I were to tell everybody, say, that I was in St. Louis or Cleveland, it might be a clue to who my patients are.

Also, the anxiety tips are great! When ever I'm about to do a surgery and I'm anxious about it (actually happens more frequently than patients would like to know), I take a deep breath and hum the Sun song to myself (you know.. "The sun is a mass of incandescent gas, a giant nuclear furnace! It burns really hot at millions of degrees and it's 93 million miles away!").

April_optimist said...

LOL! Nice to know I'm not the only one who uses Spider Solitaire that way...

Unknown said...

Hi. I've been reading your blog for a while, but this post I just had to comment on! Spider solitaire should come with a 'warning, this game may be addictive' notice. I am currently writing up my phd thesis, and just this week I had my husband remove spider solitaire from my computer so that I could finish the damn thing. One game would turn into two would turn into 17, you know how it goes. Not surprisingly, my productivity has gone through the roof this week! So I think I'll stick to the reading option as a coping strategy...

therapydoc said...

LOU, I honestly didn't know what the word addictive meant until I met that game.

Unknown said...

This is a very interesting post on Anxiety attack! This website has helped me a lot on axiety attacks and it’s very useful. They have many great tips to guide to. Do check it out at

Jay said...

Aside from the fact that your solitaire suggestion is Windows-centric (I play Solitaire Until Dawn on my Mac), I loved this post. You've got me writing about both anxiety and blogging ethics tonight.

Anonymous said...

Oh my yes. An amazing, okay, startling and deeply disturbing, realization for me during early blogging stages was how many folks projected every. word. I. typed. was referring to them in some clandestine fashion. You don't want to know the fallout. Jeepers it transcended creepers.

Ya know, the only reason I kept the moniker "the psycho therapist" was because so many cyberfolk knew me under this nom de plume before I started a blog I felt it best to carry on for continuity's sake. But it cost me, it has definitely cost me. Declaring my self to be a mental health practitioner opens all kinds of cans of worms and informs an impression/expectation of behavior/beingness before anything I offer enters the gray matter. It is what it is. I accept it and move on.

There is a part of me that would LOVE to discourse on the patient adventures experienced over the course of a day and I know many are voyeurs at heart. This, however, is so far removed fro what I feel like doing in cyberland.

I know it must be odd/hard for some folks to read a therapist rambling about bullshit, their need to keep me safely "pedastaled",n'all. Well, tough nuggies to that, is what I say. This time, I ain't here for you. I'm off work. Deal.

Okay so I'm rambling. Thanks for the heads up and the advice. Next time I want to review the interesting material I hear all day I'll repress the desire and keep my impulses in check.

No matter what anyone says, being a psychotherapist is one of the most incredible jobs on the planet. So interesting, we bipeds be.

Nightie night.

Jack Steiner said...

Anonymity and blogging- oh the stories I could tell. It has been quite a ride.

therapydoc said...

Oh, Jack, just one!

Radical Reminders said...

Great post! Protecting clients is crucial when working in any mental health or social services feild. Problem is, i don't think anyone considered the internet when developing all the rules on personal identifiers. I mean, each disclosure is a piece to the puzzle of identity. Maybe i just write an anecdote, indicate gender, maybe race and it's no big deal? Paired with the time/date stamp on my blog it may actually be a big deal, especially to anyone who reads my blog and knows me outside the "blog world."

What an interesting feild for professionals to navigate! there should be research on blogging and the effects of therapy given by those who do and do not blog :)

Anonymous said...

"Windows-centric" - LOL!

I (Heart) My Trazodone!


Anonymous said...

And then there's the great benefit of feeling that you're not alone....not to be underestimated.

Anonymous said...

Husband plays a game of Spider. If he loses he goes on to start a new game. He also gets some amazingly low scores for playing one time. Me? Not so much into low scores, unless I am deliberately trying to get a better score than he did! But I am the type who will play the same game over and over again until I win it, regardless of the score. And what's even more weird, I find I enjoy the game more when I don't win it on the first round!

therapydoc said...

So addicting.

Unknown said...

I am The assistant editor with I really liked your site and I am interested in building a relationship with your site. We want to spread public awareness. I hope you can help me out. Your site is a very useful resource.

Please email me back with your URl in subject line to take a step ahead and to avoid spam.

Thank you,

therapydoc said...

Sure, Kathy. But your email address didn't work!

Better Things-- Seeing Ghosts