End of Summer

I spent a fabulous weekend soaking up as much sun as possible at the L.A fair and gardening and I realized- it's happened. It's getting darker sooner, colder at night (keep mind I live in Southern California so cool to me is like 70 degrees F), the children are back in school, the parks have found their quiet, and the community pool is closed. It's officially a few days into autumn, which means summer has ended. This is the saddest part of the year for me. If I could, I would have it be summer forever. So, to say goodbye to the summer of '09 I've compiled some of my favorite pictures of this summer.



Goodbye sand wiggled in my feet.



Goodbye summer flowers.



Goodbye walking the dog barefoot.



And last but not least, goodbye to practicing for the hula-hoop olympics.

Until next year.

Check out these good end of summer poems at poetry archive.org

How True is this?

Last night I watched the season premier of House, which I have been anticipating for a while because a) I love House, and b) House is going to a psychiatric facility!



I of course got very excited (maybe a little too much) comparing House's portrayal of a psych facility with reality. For those of you unfamiliar with the show, House is based around a very narcissistic albeit genius doctor (Gregory House) who has an addiction to pain killers and seems unable to love anyone (except maybe Cuddy, the hospital director). He's been slowly descending into madness (hallucinations, addiction getting worse, etc), and so he has voluntarily placed himself in a psychiatric hospital. As I watched I was surprised by how many things the writers got right, and of course noticed some things they got wrong. I thought it would be amusing to share some of those with you all who don't come in and out of a psych facility everyday.

So your wondering what's real? (or at least close to it)
1) You know how the patients (I'll say patients because that's what the show called them, but I'm used to calling them clients) used cigarettes as currency? That is extremely common. Patients place a high importance on cigarettes, almost all the patients smoke, and a lot of fights stem from cigarettes (who has them, who doesn't, who owes someone some, etc.)
2) You may have heard staff on the show call out codes. Codes are commonly used to alert other staff to danger or something that requires attention.
3) manipulation- House does a lot of it. It is very common, both to staff and loved ones.
4) you know House's roomate? There's pretty much someone exactly like that on my unit. Talks fast, always excited (in my real life case, he's bipolar)
5) quiet girl- also very real portrayal. Some of my clients don't speak. period.
6) Group therapy- vital to everyday. The nurse doesn't run all of them, but does do some. And the tantrum House threw announcing everyone's diagnoses and pushing other patients buttons, also very real portrayal
7) medication time- yes, and it happens just like on the show. Come to the nurses station, take a small cup of pills
8) talent shows- we have one next week!
9) a doctor as a patient?- possibility. I know a former social worker who is now my patient.

And what is just false? (these are more fun)
1) patients don't get seclusion simply for disagreeing. Poor House seemed to be getting dragged to seclusion for every minor thing. Seclusion is a last resort. And we don't place hands on a patient unless it is ABSOLUTELY our last resort. And when it happens, we most certainly are not wearing a mad scientist white getup while doing it (but I get it, it makes a good show)
2) this one may be the most important: Doctors and staff should NEVER challange delusions or hallucinations! This may lead to getting punched in the face. Seriously. The doctor on the show outrightly tells a patient he is not a superhero (he believes he is)
3) Patients can't just walk out and drive around a car. This is for obvious reasons. However, there are AWOLS
and last but certainly not least:
4) The nurses are not that hot, and they most certainly don't wear high heels (but one can dream)

I must say, overall the show was pretty sensitive towards mental illness and didn't stray too far from reality. Yet another reason I love this show.

Placing my Ears on the night table

I just discovered this amazing canadian poet and psychiatrist named Ron Charach who writes poetry about psychiatry and mental illness in a very simple beautiful way. His poem "Psychiatrists on the Subway" really hits home for me (its exactly how I felt today, funny enough, on the subway).

Psychiatrists on the Subway

One rarely spots psychiatrists on the subway
rubbing the haze of a long day's sessions
from their lean temples,
or thumbing through paperbacks that deal
with anything-but.

Wouldn't they like an update on who's
In the world and how they're doing?
Or would the ridership be wary of men and women
whose briefcases rattle with the tic tac
of pills, whose ears perk
like armadillos' at conversations
two seats over?

More likely we locate them in a bad joke,
in a wing-chair beside a firm couch,
a suicide statistic, a product seminar
with deli sandwiches courtesy of Pfizer or Roche
or Eli Lilly;
perhaps on the beach of a convention hotel
with a panorama of thong-clad beauties
who seldom talk revealingly

Before bed a psychiatrist sets his ears on the night-table and prays for a night of long silence from a god who prefers to listen.

You can also listen to Charach himself reading this poem, here.

So Much Yet to Learn

Tomorrow marks the one month anniversary of my job at a locked psychiatric facility and I finally feel like I'm close to getting the hang of things. On the other hand, there is so much I don't know and that does not have concrete answers. Things like, how should we be treating mental illness? Should we even think of it as "treatment" (considering that many of the disorders we deal with don't have cures)? Should we focus on rehabilitation or simply harm reduction? And, importantly, what are realistic goals? (many of the clients I've worked with have been institutionalized the majority of their lives). Today we had one of our recovery conferences in which the recovery team (which consists of me, the social worker, the charge nurse, the rehab therapist and counselor, the psychiatrist, and the psychologist) meet to discuss a few clients in depth. Today's meeting very quickly aired on the philosophical as the psychologist asked a seemingly simple question "What do we want from this client and how can we help him achieve it?" The psychiatrist put his two cents in, saying that in his ideal world we would have a completely different system that involves a reliance on behavioral interventions like a token economy (people get points or tickets or money when they perform a wanted behavior), and to some extent, forced treatment. This kind of approach was very popular in the 60's and 70's and is still used a fair amount today, but not at the facility I work in. We focus exclusively on the recovery model which gives the clients as much autonomy as possible, letting them make their own decisions (within reason), and practicing living in the community. Concretely this means that if a client doesn't want to go to a rehab group or meet with his or her doctor, or take his or her medication, he or she does not have to (the medication, if the client is a danger to self or others, can be injected however). Since starting my job, I have heard both great praise and great scorn of this recovery model. I'm still unsure how the recovery model is taken from theory to practice and next week I have a seminar on it, so I hope I learn more then. What strikes me however is the fundamentally different theoretical perspectives members of my team have with regard to mental illness and its "treatment". Some are very concerned with how the clients are feeling and with talk therapy and integration into the community, whereas others are simply concerned with severity reduction and compliance. The doc said something that stuck with me. He said that in many ways our approach to the mentally ill was better in the past than it is now, in which it is getting too radical (i.e: letting the clients do what they want).

This took me on a tangent in my head with regard to the history of mental illness. Last summer I read a great book called "Mad, Bad, and Sad: Women and the Mind Doctors" which is about the history of clinical psychology from a feminist perspective and I loved it.


It didn't really go into treatment approaches however, so I am now on a hunt for a good book that does that. I'm thinking maybe:





"Treatment and Rehabilitation of Severe Mental Illness" by William D Spaulding.


As for my history fix: "A social history of the asylum: Mental Illness and its treatment in the late 19th and early 20th Century" by Thomas G. Ebert,

or



"Reinventing Depression: A history of the treatment of depression in primary care, 1940-2004" by Chistopher Callahan, MD (since my research interests in particular lie in depression). Both sound good.



I'm thinking I'm also due to read "Toxic Psychiatry" by Peter Breggin. I've been sort of avoiding him (he's gone so far as saying mental illness is a myth and doesn't exist), but I think hearing his voice is still useful, if for nothing else, for the impact he's made on our perceptions of mental illness.

Wow, it looks like I have a lot to study up on and these books are kinda expensive (maybe the company will pay for books for enrichment?) ;) I, of course, welcome any other suggestions. Right now I think the best thing I could be is a sponge. Wish me happy reading.

*correction: I was talking about toxic psychiatry when I was really thinking about "The Myth of Mental Illness" by Thomas Szasz. Always get the two mixed up. Toxic psychiatry is also good though.

Speed Therapy?

So you know that whole concept of speed dating in which you sit down with a complete stranger for no more than three minutes at a time, hoping to find a lasting connection that may develop into a relationship? Yeah, I never much bought into that (although I'll admit, it might be fun). The folks over in New York have taken it one step further, taking the concept of speed dating and translating it to therapy. I ran into an interesting article in the NY Times that explains how this works. Basically, people who need quick advice, or whose therapists are on vacation (I kid you not), can now walk into the Housing Works Bookstore Cafe in Soho and sit down with various therapists for three minutes at a time in what the article refers to as "speed-shrinking" (sounds like some warped machine coming out of a sci-fi movie to me). The therapists are either licensed psychiatrists or psychologists.

I'm not sure how to feel about this.

On the one hand, I always promote anything that makes others feels good and is therapeutic. I don't really care what kind of therapy is used (whether it be CBT, psychodynamic, behavioral, etc). Research has shown that all therapy modes are effective because they all employ the therapist-client bond. And spending three minutes at time with various therapists does allow you to shop around and see which kind of therapy and therapist might work for you (something that would be very costly and time consuming otherwise). But how can you bond in three minutes? Is this therapy? I'm not naive enough to think that everyone can afford traditional therapy, so this does seem like a nice alternative for those who have no where else to turn. I'm not a therapist (although I do often provide talk therapy at work), but I do now this: dispensing advice, especially as a therapist, and especially to someone you've only known for three minutes, is a slippery slope. You never know how much harm you can be doing with it. The fact that these professionals are dispensing quick answers in three minutes is a little scary. It also lead me to wonder: why are the therapists risking it by doing this? And then I ran into this short sentence meant mostly as a visual in the article:

"Each of the therapists, many sitting behind piles of business cards and books they had written, hoped to achieve chemistry with their newfound clients."

Ah, now it makes a little more sense.

We are free to do what we want, and if we want some quick advice we can get it in less than a minute from our friends, acquintances, etc. But as professional therapists, we also have a responsibility to protect, and I don't think this is achieving that.

The Road Ahead

Sorry to neglect you all, yet again. I've spent the past couple of weeks mostly freaking out and partly in contemplation. You see, I've put all my energy into convincing myself I knew what I was doing. I didn't (read: quarter-life crisis: 1, Jos: 0). I've been madly (ok, half-heartedly) studying for the GRE and looking at Ph.d programs and the more I did, the more I realized I was in way over my head. Truth is, I still have work ahead of me (i.e more research experience, finding out what I really want, and actually studying for the GRE general and subject). All of these factors lead to the obvious call: wait another year. Sure my mentor had already told me this, but I guess...I don't know. I guess I was wishing this part of my life would look something like this:




You know, diving right into my future, knowing exactly what I want. Fearless, gutless, take charge woman.

Or Maybe something like this:




Taking flight, moving into the next chapter of my life.

Instead, I've come to realize that the greatest gift I can give myself is time. And maybe my life, for now, can look something like this:



I snapped that picture while on safari in Kruger National Park two years ago.

I guess what I'm trying to say is I have a road ahead of me and rushing into something isn't going to make my life any easier. Given that I usually like to follow a set of steps in my life that I at some point decided would be the end all be all, it's really scary that I'm instead choosing to be stuck in the in-between. And you know what? There's something fearless, gutless, and take charge about that, too (Quarterlife Crisis: 1, Jos: 1).

Given that, it doesn't mean that these next two years won't be full of anxieties, frustrations, and maybe some regret. I mean let's face it, yesterday I realized I'm kinda dating my mother. Yes, my mother. We do everything together these days (mostly due to the fact that all my friends have moved away and its hard to make new friends when you're working in a locked psychiatric facility part-time and the other half you're home, carless). Part of the appeal of applying to grad school was that it wasn't home. But there's something about the fact that I now don't have the safety blanket of "this is only temporary" that puts me in the drivers seat of my story. This is all very terrifying (Jos: 1, Quarterlife Crisis: 2?). And it's all a lot to think about. So, per usual, I did something to get my mind off of it. Today, I went all out and cooked a recipe I saw on real simple of Grilled Bread with Zucchini, Ricotta, and Basil. I added some garlic to the bread before grilling it and skipped on the black pepper (not my fave), and accompanied it with a nice rose. For dessert, I had a couple of dried figs. It was delicious.



Maybe I'll have a couple of things figured out tomorrow. Or hey, maybe I won't. ;)