Related: 

Bush’s Resumé

Here’s a wonderful illlustration of the value of the web for social networking. (Reddit)

The Cognitive Neuropsychiatry of Religious Belief and Experience — Ryan McKay [.pdf]

Related:

Psychiatrists are the least religious medical specialty overall; and the more religious a physician is, the less likely s/he is to refer a patient to a psychiatrist. (Psychiatric Services)

Professor of Law and Psychiatry Discusses Her Battle with Schizophrenia, depicted in her recent memoir, The Center Cannot Hold, with a weblogger. As FmH readers know, one of my ongoing concerns in my work as a psychiatrist is the stigma attached to mental illness and how my patients suffer for it. Saks has much to say about that. My curiosity, simply put, is whether she rises above the stigmatization because she is exceptional, or whether she is exceptional because she has somehow managed to rise above the stigmatization. Her story reinforces my impression, from years of working with schizophrenics, that one’s IQ score helps. While intellect is by no means protective against the devastation of a psychotic illness (in some cases, quite the contrary, because of greater insight into what is being lost!), those with the most rehabilitative potential are usually those with the greatest intellectual capacity either premorbidly or at least retained . In Saks’ case, as well, some questions about whether she truly had the devastating disease of schizophrenia arise.

On Being Asked To Write A Poem Against The War In Vietnam

Well I have and in fact
more than one and I’ll
tell you this too

I wrote one against
Algeria that nightmare
and another against

Korea and another
against the one
I was in

and I don’t remember
how many against
the three

when I was a boy
Abyssinia Spain and
Harlan County

and not one
breath was restored
to one

shattered throat
mans womans or childs
not one not

one
but death went on and on
never looking aside

except now and then
with a furtive half-smile
to make sure I was noticing.

When I Wrote A Little

poem in the ancient mode for you
that was musical and had old words

in it such as would never do in
the academies you loved it and you

said you did not know how to thank
me and in truth this is a problem

for who can ever be grateful enough
for poetry but i said you thank me

every day and every night wordlessly
which you really do although again

in truth it is a problem for how can
life ever be consonant with spirit

yet we are human and are naturally
hungry for gratitude yes we need it

and never have enough oh my dear i
think these problems are always with

us and in reality have no solutions
except when we wash them away on

salty tides of loving as we rock in
the dark sure sea of our existence

ADHD Drug Tested as Treatment for Crack Addiction. Atomoxitine, a nonaddictive medication used for ADHD, may be enough of a mild mimic of the pharmacological effects of cocaine in the CNS that it might substitute for it, the reasoning goes. When used in cocaine rehab, however, patients often relapse. So the efffects and dangers of mixing atomoxetine and cocaine were investigated in a study to be published in Drug and Alcohol Dependence but available online in pre-print. The verdict was that there was mild additive cardiovascular danger and no consistent blockade of the pleasurable effects of the cocaine. In other words, the combination was “safe but of questionable effectiveness”, investigators concluded.

This illustrates a longstanding fallacy in the treatment of drug addiction, IMHO. All too often, no matter what the drug is, addicts are given a medication that produces a mild version of the pharmacological effects of their drug of choice in hopes it will satisfy their cravings or block the stronger effects of the drug and make it less rewarding. Examples include another medication, the antidepressant bupropion, for cocaine; and buprenorphine for opiate addiction. Similar (but even more thoughtless) is the medically contraindicated but widespread practice of maintaining ex-alcohol abusers on tranquilizers for sleep or anxiety. I have rarely seen these work and usually see users begin using their drug of abuse again while still on the supposed treatment, with additive effects. The fallacy lies in the reductionistic pharmacological materialism that equates the reward of the drug entirely with its (poorly-characterized) physiological effects in the CNS. This ignores the psychological needs the drug and its use provide. The habitual and compulsive nature of drug abuse comes from its being a powerful reinforcer in far more ways than just its stimulation of the “pleasure center” of the CNS, as it has become fashionable to describe it. From this point of view, it is not puzzling that patients will revert to their drug of abuse instead of, or on top of, the supposed relapse-preventing medication therapy.

A related phenomenon occurs when other drugs which themselves have abuse potential are used to substitute for the supposedly more damaging street drug, as in the case of methadone for opiate addicts. I’m not arguing about the merits of legalizing addiction here, but if that is what we are doing, let us be honest about it. Not only is there a street trade in diverted methadone itself (as well as suboxone) — more to get high than to self-detox — but the methadone clinics are often vehicles to maintain or even enhance clients’ addictions, in effect diverting addicts’ payments from the drug dealers into the clinic coffers. Call me cynical, but few of the methadone clinics I have seen do what would be medically prudent: (a) carefully assess the patient’s level of tolerance and maintenance need; (b) place the patient on a dose of methadone at or slightly below that level; (c) and embark on a medically prudent and tolerable but inexorably progressive taper of the methadone.