Posted by: thealienist | October 23, 2014

In Defense of Coercion

I know that I addressed this issue in an earlier post on involuntary hospitalization, and this post may be redundant.  Still, I have been reading more posts complaining about the use of coercion in mental health treatment and especially by psychiatrists.  In these posts, and in the comments on my previous post on involuntary hospitalization, it seems that many of the comments by many (though not all) of the writers are addressing particular misuses of coercion rather than a general consideration of whether coercion has a legitimate place in the role of a mental health provider.

To begin with, I acknowledge that there is clear potential for misuse of coercive methods in all forms of health care but particularly in mental health care.  Therefore, an important question is whether it is so dangerous as to be eliminated from use.  Next, if one agrees that there is some role for coercion, we would need to decide what circumstances would permit it.  We would also need to consider what methods would be appropriate if coercion were allowed and if the situation permitted it.

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Posted by: thealienist | October 20, 2014

Who is the Monster in “Frankenstein”?

My wife and I were wanting to read a book for Halloween and decided to read Mary Shelly’s Frankenstein.  For those of you who have never read the book, it is NOTHING like you might expect from seeing most of the movies supposedly based on the book.  I highly recommend the book to those of you who have an interest in Gothic horror (though it is not that scary) and especially those who have an interest in the personal and social psychologies of evil.  Please continue below the fold for further discussion (spoilers ahead).

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It seems to me that some games are better than others.  Some are trivial.  Some are boring.  Others are fascinating, fun, and profound.  Given that it is possible that all of life is a game (a given that I am not convinced of yet), what makes a game “good”?  Is it merely a matter of taste?  Are there some criteria that we can apply to judge the quality of the games we play?  If indeed it is true that live is a game from top to bottom, then it seems essential to me that we be able to choose what games we play and what role we play within them.  I wonder if this is not a great part of what mental health care is all about.  We help people to find their game and to remain suitable for effective participation in it.  We are part coach and part team physician.  Let’s think some more about this.

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Posted by: thealienist | October 14, 2014

The Game(s) of Life

I have been interested in games and game theory for a long time.  I think that play is an important part of life.  I also think that I see our modern western culture trying (ironically) to squeeze play out of the average person’s life while trying to get more and more people to play their particular type of game.  I have read with interest the works of many authors who emphasize the role of play in human experience, but I have found no agreement among them as to what constitutes “play” or what the essential components of a “game” are.

I am going to use this category to explore (perhaps only for myself) what constitutes “play” and how much of our lives are taken up by games – either intentional or unintentional.  In addition to defining these abstract terms, I plan to comment on and analyze (to the extent of my ability and aided by any who would like to help) how the idea of “games” enriches or impoverishes our lives.  I expect that the posts in this category will be more rambling than usual and may take me (us?) down some blind alleys.  Overall, however, I hope that in our wanderings we will see interesting, beautiful, and revealing sights.

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Posted by: thealienist | October 13, 2014

The Depression Trap

Just as in anxiety and bipolar disorders (see previous posts), major depression has its own traps.  If seen far enough in advance, they are usually easily avoidable.  Unfortunately, many patients do not recognize these traps until they are neck-deep in them.  Let’s examine them in more detail.

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Posted by: thealienist | October 10, 2014

The Bipolar Traps

In the same spirit as I wrote previously in “The Anxiety Traps,”  I see some common traps faced by those who suffer from bipolar disorder.  Some of the traps occur most often in those who find themselves frequently stuck in depressive episodes.  Other traps are built for those in frequent (and especially mild) manic or hypomanic episodes.  Let’s see what it is best to avoid.

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Posted by: thealienist | October 7, 2014

The Anxiety Traps

When it comes to mental illness, I see several “traps” that my patients fall in. How they fall for these traps and how they are lured into these traps are easy to understand. Avoiding them is usually fairly straightforward, though it may be difficult. Let’s talk about the traps that the anxious need to avoid.

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Posted by: thealienist | October 2, 2014

The Psychiatrist as Scout

When I was in residency, my attending psychiatrists sometimes described psychotherapy as two people walking together. The patient is in the lead, and the psychiatrist has a flashlight with which he can point out and illuminate interesting or useful objects or processes. I like this image, though I prefer the image of the old west scout who was hired to guide explorers and settlers through the mountain passes and wilderness paths of America’s frontiers.  Still, this image brings up some questions.  How did this unlikely pair come together?  Where are they walking?  What does the psychiatrist bring that is of value to this pair?  Who is in control?

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Posted by: thealienist | September 29, 2014

Treatment with Antidepressants for Anxiety Disorders

Some of my patients get very confused with they are diagnosed with an anxiety disorder and are prescribed antidepressants.  It is not uncommon for them to have mixed feelings about this and to delay starting medications.  They look on the internet and see that their medications are made to treat depression, and they forget our discussion about how antidepressants are also good treatments for most kinds of anxiety.  Because of this, I want to take a moment to discuss the role of antidepressants in comprehensive treatment for anxiety.

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Posted by: thealienist | September 25, 2014

What Is “Mental Health”?

People often talk of “mental health,” but I wonder if many have given much thought to just what that is.  I know that in my practice, my patients often have very different ideas about mental health than I do.  Some of the things that I often discuss with them is how I define mental health, how I see them deviating (if they do) from my standard of mental health, and how treatment is supposed to restore them to a healthy state.  Although the idea of mental health seems very elementary, I fear that very few have considered what it really means.  Many arguments in blogs between mental health care consumers (I really don’t like that term — sounds to impersonal), mental health care professionals, and others outside the day-to-day mental health area seem to hinge on a failure to agree on just what “mental health” is and its role in society.

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