Crazy Talk

Where's the Answer?

I've been struggling a little more than usual the past few months in giving my patients (and myself) solid advice about a variety of health topics.  As a doctor I want to be able to slog through all of the noise and fluff and get to a reliable piece of advice.  Yesterday, I had a bit of a revelation as to why I've been struggling more and more.  

There is no longer any clear authority on topics related to health.  I can't even read the New York Times anymore and I think even 60 minutes has lost its compass.  Major universities have been hit by scandal after scandal and the governmental agencies seem to be pawns of the highest bidder. 

I think there are two main reasons for this.  First, there has been an erosion of trust.  Government officials, researchers and doctors have ties to many of the billion dollar companies that profit from health care, so patients don't know if they are getting objective advice or a testimonial that's been paid for.

Second, even if there is a legitimate trustworthy authority on a given topic, you won't know it when you find it.  With the access to information that the internet has provided have come a proliferation of news sources, organizations, and, of course, bloggers.  Often the ones with the best branding and search engine optimization but not necessarily the best information are the ones that get listened to. 

I usually like to offer a solution when writing these posts, but as I said, I've been struggling.  What I can say is to maintain a healthy dose of suspicion when evaluating any source of information and when vetting a source, look for sincerity and an absence of conflict of interest.  There are people out there who sincerely want to help.  You've just got to figure out how to find them.

The Relationship Formula

In my work as a therapist, I've noticed that the relationship problems that my clients come in with often boil down to problems in communication.  Well, this is not an amazing revelation, but what I noticed is that people don't know what to do to fix the communication breakdown. 

I've developed a very simple formula for my clients to use and I've been amazed at how universal and how successful it is.  When consistently applied, it never fails.  And I'm going to share it with you.

Step 1 - Figure out what you feel

Step 2 - Figure out what you need from the other person

Step 3 - Communicate both of these things as clearly as you possibly can

Step 4 - Observe the other person's reaction and listen to what they say

Step 5 - Repeat

(note: the results of Steps 1 and 2 may be different when repeated as a result of a properly executed Step 4, which is why repeating for a few cycles is so important)

It may sound overly simple but that's part of what makes it useful.  When things get emotional, as they often do in our important relationships, and you feel stuck, you can refer to this simple easy-to-remember formula.  Like I said, it always works.

Vet the advisor BEFORE taking the advice

I'm not thrilled with the title but since it's been a while since I've posted I thought I'd get to the point instead of stressing over it.

In this age of information overload, time management is essential and I have been encountering a huge waste of time in my practice and in my life in general.  It has to do with coming across some piece of new information and springing into action only to find that the information was misleading or just plain wrong.  Sometimes looking back, I realize that the original source of the information may not have been the most reliable.  This can be a frequent occurrence when dealing with the internet.

But whether online or on TV (or in a blog), we have to get into the habit of considering the source before considering the information.  By actively seeking out trusted sources or at least having a basic method to evaluate sources, we can save an enormous amount of time otherwise wasted chasing "false leads". 

Advertisers want to sell you a product and they're getting more and more sneaky.  Product placements and "news" items that are actually promoting a specific product or service are everywhere. I'm not saying that anything that is advertised is of no use, but you have consider the source before you use the information to make a purchasing or consumption decision.

Psychiatry Needs Jargon

I read an article this week that compared diseases in psychiatry to diseases in other areas of medicine.  The article pointed out that other medical specialties have medical-sounding words to describe many of their conditions.  In other words, jargon.  In psychiatry we treat "depression" and "anxiety", words that have every day meaning that is related (but NOT equivalent to) the illness.  This creates a lot of confusion about what it means to be depressed versus suffering from Major Depressive Disorder as defined by the DSM IV. 

This problem has only been made worse by the increased coverage of mental health in the media.  Now people describe themselves as "having OCD"or "being ADD", or even "being Bipolar". 

It's great that there is a growing awareness of the existence of these various conditions.  The next step needs to be the recognition that these conditions are medical illnesses that are best treated by a doctor (and not the guy behind the counter at Vitamin Shoppe).

Don't be Arbitrary - Dosing

I've had a surge of this in my practice to decided to post about it.  What is "this"?  The "this" is patients arbitrarily deciding what dose of medication is their maximum.  Of course we want to use the minimum effective dose and of course side effects need to be addressed, but I'm talking about arbitrarily deciding not to go above a certain number.  If a recipe called for you to put something in the oven for 30 minutes at 400 degrees, you wouldn't just declare that 15 minutes was plenty and that you wouldn't go above 250 degrees.  You wouldn't do this because you know that the outcome of the dish wouldn't be the same.  It just wouldn't cook properly and would lead to a bad outcome.  The same is true with medication doses.  You can't cut the dose in half without likely reducing its effectiveness.  If you are worried about side effects, talk this over with your doctor.  Sometimes the side effects are independent of dose and sometimes they can be minimized by going slowly. 

It's a difficult decision to consider going on medications for any condition but once you've made that difficult leap, don't deprive yourself of relief by sabotaging the treatment by not taking the full dose.

Who are you calling "Bipolar"?

Over me lifetime, mental health and psychiatry have emerged from the shadows and into mainstream media.  From Dr. Melfi in The Sopranos to Hannibal Lechter in the Silence of the Lambs series to Gabriel Byrne in In Treatment on HBO, people are being exposed to the concepts and the terminology of psychiatry.

Overall, I think this is a good thing.  I believe that education about psychiatry and psychiatric illness will ultimately make appropriate treatment more accessible to us all. 

However, along with  the greater visibility comes the natural adoption of certain psychiatric terminology into mainstream language.  Psychiatry is especially susceptible to this because our technical terms can sound like everyday emotions that people are familiar with (depression, anxiety) or descriptive in such a way that people think they understand what the words refer to (bipolar, obsessive-compulsive).  The problem is that people's impressions of what the words mean are not always correct.  For a field in which stigma and irrational fear is a hallmark, this can create serious problems.

I am not about to tell people what words they can and cannot use, but I am hoping that people will think carefully about what certain labels mean depending on where they originate.  You can refer to your moody neighbor as seeming "bipolar" but understand that this does not mean that he necessarily has a mental illness or needs to be put on medications (though you might want him to be evaluated)

The First Step

When talking about substance abuse, we often hear people remark that the first step toward recovery is admitting that there is a problem.  Because of denial, people have to "hit rock bottom" before they'll seek help.

While we don't usually think about it this way, often the same is true for depression and anxiety or any problem that may call for treatment with a psychiatrist or psychologist.  Largely due to stigma, I think, people do not want to face the possibility that they can be helped by a psychiatrist or other mental health professional.  The resistance is so strong that people will go to great lengths to deny that there is a problem and avoid seeking help.

To these people I just want to point out that the point of getting an evaluation is to get help and feel better.  It's not necessarily a question of needing medication or a specific treatment but exploring the possibility that one can feel better or that life can be easier.

Ultimately, some of the patients I have worked with decide to deal with things without medications, but even these individuals are glad that they found out what was available to them.  And for each person who chooses to forgo medications, many more wonder why they held off considering medications for so long because they have made such a difference in their lives.

I am not at all on a crusade to get people to take medications but my main professional frustration is how many people suffer because they can't get past what it means to have a problem and ask for help.  People don't have to admit they have a problem, but rather consider that there may be helpful treatment.

Want to learn about mental illness?

I know this posting is overdue and was intended to review exercise tips but I wanted to write a quick post to let people know about a series appearing on public television and available online that provides basic information about various mental illnesses.  I haven't watched the series yet myself but I'm hopeful that it provides impartial information that can be a starting point for understanding various mental conditions including autism, schizophrenia, bipolar disorder, depression, PTSD, obsessive-compulsive disorder, and others.  In short, it covers most major mental illness.  I hope that it takes a step toward demystifying and destigmatizing mental illnesses.

Here's the URL: http://www.wliw.org/productions/local/healthy-minds/season-two-overview/164/

It is on WLIW21 and channel 13 in NY.  The hours are early AM and later in the evening so perhaps best to watch online.

Some Quick Tips (Sleep)

Here are some quick sleep tips (tune in next time for exercise):

Sleep
1)    Quantity, quality, and consistency.  These are the aspects of sleep to pay attention to if you feel like you aren't sleeping "enough".  The first one is obvious, you need a certain amount of sleep and if you are deprived, you'll feel tired.  The second points to the fact that it's not just spending time in bed that's important but getting good quality sleep.  Paying attention to the sleep environment (comfort, noise level, temperature) can help ensure good quality sleep.  Consistency means having a relatively stable bedtime and wake-up time.  Our brains are used to habits and we get thrown off when we don't have a stable routine (think jet lag).

2)    Don't ignore things the effects of things that can interfere with sleep.  Again, this one is pretty simple but people manage to overlook it.  I'm talking about things like caffeine, food, alcohol, and other substances that can make you groggy or too peppy to sleep.  Most people know that caffeine makes you stay awake but will often overlook their post-dinner espresso as a possible reason they can't sleep.

3)      Sleep helps consolidate memory.  There is a good reason to read before bedtime.  There is data that shows that memories can consolidate while we're sleeping.  We might assume that it is better to study early in the morning while we are fresh but in terms of retaining information, it is often better to study new material at night and then sleep on it.  (Remember, this doesn't justify the all-nighter because then you're not actually getting the sleep)

Some Quick Tips (Diet)

Here are some quick diet tips (tune in next time for tips about sleep):

Diet
1) Don't let others choose your portion sizes.  One key to controlling calorie intake is to be thoughtful about what and how much you put in your body.  Seems simple enough but we often get derailed and overeat because we let the portion size served to us determine how much we eat.  Start paying attention to the point at which you get satisfied during your meal.  Once you have an idea of how much is enough, get into the habit of setting aside just that amount before you start eating.  You won't get needless calories and will avoid that discomfort of having eaten a bit too much.

2) Put hunger in perspective.  If you're trying to lose weight, you should expect to feel hungry sometimes because hunger is your brain's signal that it is starting to burn stored calories.  Also, remember that you don't have to eat a lot to stop feeling hungry.  Even if you're very hungry, a little bit of food should take care of the hunger.  The best strategy is to not let yourself get overly hungry in the first place by eating small amounts throughout the day.

3) Don't reward exercise with food/drinks if you're trying to control weight.  Some people follow exercise by indulging in a treat rationalizing that they've just burned some calories so can afford to take in some extra.  If you're trying to lose weight, then at the very least you are preventing your exercise from working.  What's worse is that there is a tendency to overshoot or take in even more calories than you burned so you're actually better off in terms of weight on the days you don't exercise!