Monday, December 30, 2013

Best in Mental Health (weeks of 12/16 - 12/28/13)

Well, to end the year with referrals (it is always nice to refer to others), inspired by another blogger's online research, you're getting a link-full of articles and information some about changes in provisions to mental health care in only the past two weeks, but mostly a dozen or so blogger thoughts, old and new. We probably need to keep up with the new ones, refresh the old.

There are links to social work and psychology sites, nonprofit and private practice sites.

So if you have some time, maybe while thinking up those New Year resolutions, cruise my new best friend Dorlee's suggestions. They might make good reading. Or make you angry.

That depends, as always, upon your politics, for some of these bloggers have strong opinions. One, for example, takes issues with the new DSM, a fairly long read, caveat emptor.

Happy New Year, drive safe or preferably not at all, and as you obviously already know, it really isn't cool anymore to drink excessively on New Years Eve.

therapydoc :

Here are a few of Dorlee's suggestions: Social Work Career Development: Best in Mental Health (weeks of 12/16 - 12/28/13)

From her long list, I recommend the following:
How Bullied Children Grow Into Wounded Adults
Avoidance in Trauma
Child Protection Lessons
Able Road  Ways to get around disability, really get around.
What a Shrink Thinks (nice to know the thoughts of other docs on anger)

By the way, not everyone agrees with the DSM-5 boycott. (one of the links)

Thursday, December 26, 2013

Internet Gaming Addictions and the DSM-5

Were it not for my practice, and now, the last section of the remarkable DSM-5, I wouldn't be blogging about this. It feels like such a scrooge-thing to do. A kid finds this awesome present, an X box 360 under the tree, and his mom reads ENT and warns. . .
Enjoy. But remember. It is a starter drug.
Like our first flip phone was a starter drug, too, right?

We can laugh, but couples do present in therapy, meaning they are in therapy because they disagree (fight) about one of them having a compulsion to play games online with friends. He isn't finishing his second shift responsibilities, and worse, isn't coming to bed at night. Every night is Christmas, up late waiting for an online Santa to lose.

Competition rocks, really raises those endorphins.

At the end of the DSM-5, page 795, we find a new disorder proposed for further study. Internet Gaming Disorder. No code yet.

Interestingly, Persistent Complex Bereavement Disorder is among these disorders under consideration. I have seen it in practice, had no proper way to diagnose the syndrome, other than to slap on Major Affective Disorder, Single Episode, Moderate. The patient's depressive episode felt severe, but different. Hopefully there will be a DSM-5 TR (text revised) or a DSM-6 coming up soon that includes Persistent Complex Bereavement Disorder, and provides an actual code, or number.

As you know, proper diagnosis has implications for treatment.

Not to get too distracted, sorry, but Internet Gaming Disorder, is among the conditions that haven't quite made it to prime time, are merely under consideration. But that is a big thing, implies we are certainly within our rights to warn kids, friends, co-workers about devices as starter drugs.

Here are the proposed criteria, paraphrased, for IGD, Internet Gaming Disorder.

Persistent and recurrent use of the Internet to engage in games, often with other players, leading to clinically significant impairment or distress as indicated by five or more of the following within a year:
1.  Preoccupation with online games, even past and upcoming games. Internet gaming is the dominant daily life activity.
2.  Withdrawal when Internet gaming is taken away, meaning irritability, anxiety, or sadness.
3.  Developed Tolerance-, needing to spend increasing amounts of time in play online.
4.  Unsuccessful attempts to control Internet game participation.
5.  Loss of interest in previous hobbies.
6.  Knowing it is creating problems in self and relationships, yet continuing to play excessively.
7. Has deceived others about the amount of time gaming online.
8. Uses Internet gaming to escape a negative mood.
9. Loss of relationships, jobs, or academic opportunity and success, due to Internet gaming.

Note: The above applies to nongambling Internet games, and does not include required professional use and is limited to gaming, not other recreational or social, sexual sites.

We will be asked to specify the severity, mild, moderate, or severe.

I, for one, am grateful that my particular obsession, blogging here, is back. Only yesterday Simon and Schuster sent me a book that is likely to roast everything we therapists do, Promise Land, My Journey Through America's self-help Culture, (note the grammar), written by a woman who has been through many different types of therapy none of them good. and probably is going to tell us that Everyone Does Not Need Therapy. Could be, but it sure feels that way.

I'm looking forward to reading Jessica Lamb-Shapiro's amazing read. The reviews so far are amazing.

Light reading, as opposed to the DSM. And let's talk. Until you've been to six AA meetings and hate them all, can you really say that AA isn't for you? Same thing with therapy.

Six therapydocs and you have the right to complain.

I'll get to it this weekend.


Saturday, December 21, 2013

Blogging (Writing) and Reading, Even When You are Grieving

First, I apologize for blogging so rarely the past six months. We say that writing can be therapeutic, but you do need a certain amount of neuro-transmitters, endorphins, serotonin, zipping around upstairs to put out. 

But that's going to change. After all, I've studied the new DSM 5
and there's much to say about diagnosis.

 Yeah, it was expensive.

But mainly because time heals.  I'm beginning to notice things again, like in the old days, when something, any random thing, would happen and I would tell FD: I must blog about this. That's happening again.

The job, when a parent passes away, as any therapist will tell you, is to grieve, but also, to get out there, be in the world .When you're running on empty, that can be hard. So for some of us the best therapy is to sit around and read, preferably in some yoga posture, learn new things. Or listen to the radio, watch TV.

Listening to NPR last week I heard two journalists talking about books that might make nice holiday gifts. Below are a few of my own suggestions. If any of you have others, chime in. They don't have to be all that educational. Nothing too violent, and really, no gratuitous sex. Emphasis on gratuitous.

My thinking, read to yourself or maybe even better, to someone else. A personal favorite, The Ugly Duckling.

If alone, and you're choosing from the the National Public Radio lists, be careful about the late night thrillers.
Where'd You Go, Bernadette?
The books below won't keep you up, guarantee, with the exception perhaps of  
Where'd You Go, Bernadette: A Novel Maria Semple's novel is wonderful, you'll read it in one sitting.

Blind Spot and the Harvard Racism Test
Just in case you don't think you're a racist, think again. This book not only teaches you everything you need to know about improv, but about our unconscious biases. Blind Spot

We've talked about John Elder Robison's book, but if you're new here, check it out. A man realizes he has Asperger's Syndrome and rises to success in spite of it. Asperger's is now officially on the autism spectrum, no longer a disorder unto itself.
Look Me in the Eye

Look me in the eye 

 Mr. Robison's brother, Augusten Burroughs writes about everyone's favorite drug, alcohol in DRY.

 Product Details

And because you can never read enough about BPD . . .

Borderline Personality Disorder in Adolescents

A patient just the other day asked me, literally, "Is happiness just a myth?"  I had to flash the book at him and say, "Unfortunately, yes. But it is a nice myth."
 The Myths of Happiness

The Myths of Happiness

Men on Rape 
What you'll find fascinating about this book, and you may only get it used, is the treatment of language, how men talk about women, how they talk to women. Talking tends to be something we don't think about nearly enough.Timothy Beneke's book has been on my shelf for years. I won't lend it out.

Monkey Mind
Daniel Smith's (300.02 DSM-5) struggle with a different disorder, what some of us call screaming anxiety.
Product Details
That's what it is like to have a Monkey Mind. Not fun.

Language of flowers

 There are so many languages, but until this book, who knew that sending yellow roses means something entirely different than sending red or white roses. This book is worth buying for the glossary alone. It is an amazing story about foster care. As you might suspect, being punted around as a child from one home to another isn't always the best thing for a person. But some survive, and thankfully, they know how to either tell their story, or write about it themselves.
The Language of Flowers


Wednesday, December 11, 2013

Ten Survival Tips for that Family Reunion

Well, it isn't over until it's over, but as the first snowfall blankets Chicago, most of us are settling in for the holidays, glad to see 2013 go.
First snow, not so great

A patient asked me only yesterday when it occurred to her:
"Wait! If Chanucha is over early this year, then what do you guys do during the Xmas season. And what will you do on Xmas?"
She did look worried.
Poker on Xmas

On the day of, many of us eat Chinese food, play poker, or go to the movies, which sounds good to me.

And while others are making cookies, decorating the tree, and wrapping gifts in preparation, I'll probably do what I'm doing now, wrapping up therapy with sad people. Really, confused people. The holidays are tough on everyone.

Indeed, it was a crazy pre-Thanksgiving. The games began in October, well before Halloween. People worried about Thanksgiving in November. The family reunion head games.

Every year during this season to be happy and jolly, peaceful and thankful, at the top of the list of things to talk about in therapy is the question, a conundrum really:
"How In the h__(world) am I going to deal with my (extended) family and still manage to stay sane?"
We have stress without family reunions, to be sure. Some of us would rather skip the whole thing, use the time off of work as mental health days.

But invisible loyalties are very powerful, as is the guilt that drives our compliance, our trek across town, across the country to see family, perhaps to go to church like in the old days, visit old friends. We go, brave the stress. Even if the family isn't a particularly warm and fuzzy family, it feels right being a family. And we have so much to talk about. If only we could find a way.

There could be a fairly simple (not) protocol to consider, a humble strategy. Ten points.

(1) Begin by considering what you have, as not the absolute worst thing to have. At least there is something to complain about when we have family.

I tell people to think of children who survived the Holocaust who have no memories of their parents, or very few left, and grandchildren who never met their grandparents. Nothing to complain about there. And millions, face it, lose family in one way or another. No reunion. No stress. Would you trade? Perhaps, and nobody would blame you, certainly not me. But sometimes this shoe fits.

(2) Assuming this is a non-negotiable, you are going to see family in the next few weeks and you do hold significant grudges, see if it is at all possible to forgive and forget. You may need to air those grudges out loud to many people before you go, or in therapy, or even make a list. It is good to let go of the baggage, at least try, and talking is one way of letting go.

(3) Think of it, that inventory, that list of grievances based upon real life events, as a bad dream, many bad dreams, and file the memories.  File the angry memories full of hurts into mental envelopes that represent a stuck part of childhood, when the ego was too immature to handle the stress. You're older now.

(4) If you a sibling or a parent has spurned you, reconnect with others, or maybe an old friend in the neighborhood. It would be a shame to let the past wreck the precious few days off ruin a chance to see people you like. Latch onto your allies and make believe it never happened (see above about bad dream), whatever it is you're angry about, if only for a week or so. Give yourself a break. (Talk to your therapist about ways to cope with obsessive thoughts. Or Google it.)

(5) Think. It isn't good to judge people. Human error is a part of life. We don't know the whole story, can't understand, not what happened then, maybe not even now. The motivations of others are a mystery unless we ask, and even then sometimes. The family reunion is the best opportunity to ask about those motives, to get new information, to understand people who share our DNA.

It is a small handful, that group we consider family, and they tend to be the subject of therapy. So get more information. We'll  use it. Think of it as an informational interview.

(6) The informational interview may not be possible, obviously. Being in the same room does not mean that everyone is going to just open up and talk to one another. Best to script a few conversations ahead of time. The time together will surely be more fun, if we make the effort to ignore the past and pretend everything is okay.  Make small talk. Prepare a list of things to talk about ahead of time.
"Have you tried the sushi?  It is amazing."  "How about those Bears!"
 (7) If it is possible, if time together with family does miraculously become something of an extended family encounter group, then listen more, talk less. It is likely there is a vast amount of knowledge that you do not know about the person you wish wasn't coming to Grandma's this year. For all you know, this person has been through chemo three times. Still feel the rage? If yes, get therapy.

(8) To engage someone in a conversation of the past, difficult moments in childhood, it is best to keep it general. Rather than say,
"What were you thinking when you threw me down the stairs and when you hung me out the window?"
Best to ask, 
"How was it for you in that house thirty years (whatever the number) ago?  I was so miserable. I thought you hated me."
 Even that could be too specific. Start with the first sentence, see where it goes.

(9) To avoid any conversation about the past, if that suits you better, stay busy, help out, and bring a book or a tablet. It is likely that all of the above will be mute because everyone will be glued to an electronic gizmo anyway. We live in a wonderful age.

(10) Cater to those who have personality disorders. Resistance is futile. If someone is narcissistic, you won't be fixing this. Let this person have control, flatter to the degree that is necessary, and you might be able to hear some fabulous stories, a spin on what happened that year(s) Mom forgot her birthday.

That can be difficult when the negativity, the jealousy, the anger, is palpable. Refer to all above and bring out a deck of cards, or play checkers with someone. Or if necessary, Solitaire.

Better yet, join us for poker and Chinese.