Highly placed military officers would of course be sacked if they made that sentiment public… unless an unassailable number of them did it at the same time. My guess is that there would be considerably more than five that way…

Highly placed military officers would of course be sacked if they made that sentiment public… unless an unassailable number of them did it at the same time. My guess is that there would be considerably more than five that way…

from Chris Floyd’s Empire Burlesque – High Crimes and Low Comedy in the Bush Imperium

Iraq withdrawal a defeat: UK press: “An admission of defeat dressed up as a victory was how many sections of the British press today summed up Prime Minister Tony Blair’s decision to pull troops out of Iraq.” (news.com.au)

Google Search compares the current insurgent attacks in Iraq to the 1968 Tet Offensive. The congruities go beyond recent fears voiced by McCain.

“…[For] the first time since the resignation of Richard M. Nixon, Americans have reason to doubt the future of their democracy. ” — Joe Conason (Salon), in an excerpt from his new book It Can Happen Here: Authoritarian Peril in the Age of Bush

In an installment of Slate‘s “Hot Documents” series, a 2001 memo from Lilly’s marketing department lays out the battle plan for marketing the antipsychotic medication Zyprexa (Lilly’s brand of olanzapine). It is commonplace to observe that the health of the American people is hostage to Big Pharma these days; several important aspects of just how this has been brought about are highlighted here.

The major therapeutic advances in psychopharmacology during my professional career in psychiatry have been the development of new types of two classes of medications, antidepressants and antipsychotics, the rationale for developing which has been the notion that they are less prone to cause side effects than older antidepressants or antipsychotics, and thus far more tolerable and less complicated for our patients to take. Eli Lilly has been at the forefront of these developments with its products Prozac (fluoxetine), the first of the SSRI antidepressants, and Zyprexa (olanzapine), one of the first two new-generation “atypical” antipsychotics.

I have long ranted about prescribing trends in psychiatric medications which follow from these developments. The vast expansion in prescribing of these classes of drugs, often for inappropriate or marginal indications, and decreasing intensity of followup and supervision of their use, leads to rampant problems. These have included the highly-publicized seeming association between antidepressant prescribing and suicidality and (to a lesser extent) incidents of violence and rage; the discomfort associated with discontinuing antidepressants too rapidly; and, as the current article highlights, the epidemic of serious and supposedly unanticipated metabolic complications emerging with the use of the atypical antipsychotic medications.

A more pervasive and perhaps more serious complication than these has been the changing message we are giving our patients — that reaching for the prescription pad can replace the careful crafting of a relationship with an afflicted individual that allows them to come to grips with their life problems; that people do not need to be seen as individuals but rather merely instances of a diagnostic class; that an external agent (a doctor; a medication) can fix them with little effort on their part; that they are passive witnesses rather than active agents in their recovery and, by extension, in their lives; that there is less and less room for personal responsibility in life; that there is little value to careful diagnosis and little distinction between diseases requiring treatment and “cosmetic” personality variants one must either accept or modify slowly and painstakingly.

The leaked memo confirms what I have assumed — that Big Pharma has had deliberate and explicit strategies to persuade less qualified practitioners to prescribe these medications; to prescribe them with less care and supervision; to prescribe them for a broader range of conditions for which they are less appropriate; and to disregard the serious complications they can cause.

All of these, of course, have one goal and one goal only — to maximize profit and commodify already horribly disenfranchised patients with mental health problems. And, when the medications rather than the marketing practices are blamed for the complications and adverse outcomes that follow, mental health treatment is vilified, psychiatric illnesses further stigmatized, and suffering individuals dissuaded from seeking appropriate care that could alleviate their serious distress.

Havidol is “the first and only treatment for Dysphoric Social Attention Consumption Deficit Anxiety Disorder (DSACDAD)…” [via boing boing]

Jan Morris: “The American swagger has become bombast, the cocky GI a bully. But with luck the pendulum may be ready to swing back…” (Guardian.UK)

I am not sure if the napping is the independent variable here. It may be that people who take naps take better care of themselves in general, are less driven and more relaxed, etc. Correlation is not causation.

It is incredible that the dysadministration be allowed to get away with this yet again. First of all, the proportion of the IED-related casualties arising from the supposedly-Iranian devices is miniscule. Secondly, even if the devices in question originate in Iran, there is no evidence that Iranians have brought them into Iraq or that their use is state-sponsored. They may just as well have been bought on the black market. And wouldn’t it be in the interests of at least some of the Iraqi insurgents to turn the US’ attention in the direction of Iranian meddling? Encouraging the extension of armed conflict to Iran would further diffuse American power, bog us down even more severely and create the opportunity for a humiliating American defeat an even more humiliating American defeat than we are undergoing now.

This is one in my continuing series of posts objecting to the medicalization of everyday life, which is particularly rampant in the mental health field. Psychiatrists are taught, as the writer above alludes to, to avoid passing moral judgment on others’ souls, but what if the only other way to validate your perceptions of or reactions to the way someone does business with you is to diagnose them with a disorder?

One of my particular interests in my work is the treatment of irritability and interpersonal violence, some of which is attributable to personality disorders and some to brain pathologies. Some, but not most…

The duty of the psychiatrist is as much to know when not to treat as to treat. We have to be very careful not to contribute to the epidemic of erosion of personal responsibility for behavior in modern society. Giving someone a diagnosis can serve to let them “off the hook”; this is a relief and a service when it is appropriate but a travesty when it is not, as it often is not. How many times have I heard a patient say, “I can’t help it. They tell me I’ve got a chemical imbalance” or the like?

An essay such as Friedman’s is a bold affront to a worrisome facet of the medical status quo, to be heartily welcomed from one curmudgeon to another.

Point well-taken, but shouldn’t we be hearkening at least as far back as The X-Files and Millennium, if not Twilight Zone and Kolchak, with such concerns?

I am addicted to this stuff (although never a lover of American Southern fried chicken…).

The Army lieutenant who refused to deploy to Iraq did not fully understand a document he signed admitted to elements of the charges, the judge ruled. Watada was charged with conduct unbecoming and missing movement for staying behind when his brigade shipped out last June, as covered here. (I think war resisters deserve broad coverage, as I have explained.) Watada asserted that, because the war was illegal, his responsibility as an Army officer was to disobey his deployment order. Does any reader know if, under military law, he can face a second court-martial after the mistrial?

Should cut down on the incidence of brain tumors in New York as well as pedestrian-vehicle accidents [grin]…

“It’s a sad fact of military aviation that helicopters flying in combat are accidents waiting to happen.” They are slow, they fly low, and they have lots of external vulnerable targets. They can be brought down by small-arms fire. Most of the downings that the Pentagon is quick to assert did not result from hostile fire actually turn out indeed to have been shot down. The role of copters in the upcoming ‘surge’ remains to be seen… (Time)

Also: 

Copter Crashes Suggest Shift in Iraqi Tactics: “American officials say the streak strongly suggests that insurgents have adapted their tactics and are now putting more effort into shooting down the aircraft….Some aspects of the recent crashes indicate that insurgents have become smarter about anticipating American flight patterns and finding ways to use old weapons to down helicopters, according to military and witness reports. The aircraft, many of which are equipped with sophisticated antimissile technology, still can be vulnerable to more conventional weapons fired from the ground.” (New York Times )

I am puzzled by what I think is a specious distinction here. There are many ways to be a problem drinker. Alcoholism is an imprecise term that has little utility and serves to make people either defensive or self-satisfied. It is a common occurrence for people entering treatment for alcohol-related problems to bolster their denial with the assertion that, after all, they are “not alcoholic”. It is true, not all problem drinkers are alcohol-dependent, by which we mean physiologically addicted, needing to drink daily, going into withdrawal if deprived of access to alcohol, and requiring a medical detox to become sober. DSM-IV, the ‘bible’ of official psychiatric diagnoses, makes a distinction between alcohol dependence and alcohol abuse, but IMHO both qualify as “alcoholism”. Just my .02.

Four-year old Rebecca Riley was found dead on the floor of the family home in Hull on December 13. Prosecutors are charging her parents with first-degree murder for allegedly “regularly giving her drug overdoses, ostensibly to keep her calm and help her sleep”. (Boston Globe)

Rebecca had been diagnosed at age 2 1/2 [sic] with attention deficit hyperactivity disorder and bipolar disorder and was being medicated by a Tufts-New England Medical Center psychiatrist who was also prescribing nearly identical drug regimens for her older brother and sister. The medical center rushed to stand behind their clinician, stating

With the caveat that of course I don’t know the clinical details of Rebecca Riley’s case, I would have to say that there is at least one psychiatric colleague here in Massachusetts who questions the appropriateness of the care little Rebecca received. I find it difficult to imagine how any 2 1/2-year old could possibly be diagnosed with these disorders in the first place. As readers of FmH know, I think the field suffers from rampant overmedicalization of variant behaviors. In particular, I have vented my spleen about the irresponsible epidemic of diagnosing ADHD — there is not an epidemic of ADHD; there is one of diagnosing it! (Perhaps we ought to have a psychopharmacological treatment for disordered diagnostic practices among caregivers…) And childhood bipolar disorder, a controversial diagnosis which seems defined, Alice-in-Wonderland fashion, by little more than the fact that it does not present anything like the adult bipolar disorder with which we are familiar, is the newest abused diagnosis in child psychiatry. Then consider for a moment, even granting the validity of the diagnoses, whether one should ever medicate small children so heavily, or medicate them at all. The only possible consolation from this horrendous travesty of medical care will be if Rebecca’s death becomes a cause celebre that leads to earnest reform. Whatever aspersions one might cast on the parents’ role in their daughter’s death, this entire family should be considered poster children for the affront to human dignity that mental health diagnosis and treatment have become.

Your thoughts?

Hmm, sounds like it should be right up my alley, and in fact I find cognitive dissonance a psychological concept of crucial importance. We change our beliefs to avoid the distress of conflicting thoughts. Is it to salve our egos or to avoid agonizing over past mistakes, as the New York Times birthday appreciation poses the question? I actually think there is not much of a distinction. A sense of certainty allows us to have confidence in our minds, our ability to decipher the world and to act decisively. It is one of the foundations of effective functioning. As a mental health clinician, I see every day how devastating it is to lose confidence in the reliability of one’s own thought processes and the lengths to which people will go to avoid doing so.

Debra J. Dickerson, author of The End of Blackness and An American Story, argues that Obama is “black” rather than black, as he cannot claim ancestry from African slaves.

I have written before, here (“A New Way to be Mad”; scroll down or use your browser’s search function to find ‘apotemnophilia’) (2000) and here (“Costing an Arm and a Leg”; ditto) (2003), about apotemnophilia. It is back in the news because of this Guardian article, but it seems it has a less tongue-tying name now — BIID or body identity integrity disorder. Here are a spate of recent references (Google) under the new name. [“Squick!” — acm]

This Vancouver office building is less than 6′ wide [via digg]

“Insomniacs can take heart from a new drug that makes the brain enter a state similar to narcolepsy.” In narcolepsy, people suddenly fall asleep, probably because neurons that normally release orexins, proteins that promote the waking state, are defective. Swiss researchers have developed an orexin-receptor blocking drug which, in preliminary tests, promotes sleepiness in laboratory animals and human subjects. As opposed to current sedative-hypnotic drugs, this sleep would be more physiological, i.e. natural: “Unlike other sleeping pills, the drug also increases the time spent in REM sleep, when the brain is thought to organise memories, so it may not cause the forgetfulness and memory disruption linked to regular sleeping pill use.” (New Scientist)

“This is a list of lists of unsolved problems in various subjects” (Wikipedia). Just choose your discipline, devote the major part of your creative years to one of these questions, and retire on your Nobel Prize proceeds.

From Cognitive Daily via kottke

My family and I never tire of these, having visited a number of such sites (Roadside America ) in the US (as well as abroad). I always detour if one is within reach of our road trip route. (By the way, I subscribe to the theory that these are not-very-mysterious optical illusions.)

A weblog about mental healthcare from an investigative journalist who has been a mental health consumer.

The test is not yet commercially available, and take note that the detection rate is only around 2/3 although there is a negligible false positive rate. But it is far safer than amniocentesis as a first screen.

And: