Monday, March 21, 2005


Shrink Rap # 12--Marijuana and Mental Health Don't Mix

Many people believe that smoking marijuana is relatively benign health-wise, especially when compared to the long-term health problems associated with excessive alcohol use and other so-called recreational drugs. But a recent study in New Zealand suggests that smoking cannabis virtually doubles the risk of developing mental illnesses such as schizophrenia. New Zealand scientists said their study suggested this was probably due to chemical changes in the brain which resulted from smoking the drug.

The study, published in the British journal Addiction, followed over 1,000 people born in 1977 for 25 years. The researchers interviewed people taking part in the Christchurch Health and Development Study about their cannabis use at the ages of 18, 21 and 25. They were also interviewed about various aspects of their mental health. The scientists found psychotic symptoms were more common among cannabis users. They analyzed their findings to take into account the possibility illness encouraged people to use more cannabis, rather than the drug contributing to their condition.

The researchers said the link was not likely to be due to people with mental illness having a greater wish to smoke cannabis. Instead, they suggested that cannabis may increase the chances of a person suffering psychosis by causing chemical changes to the brain. They also took into account factors such as family history, current mental disorders, and illicit substance abuse.

The scientists, led by Dr. David Fergusson, said it was likely cannabis use increased the chances of a person suffering psychosis by causing chemical changes to the brain. Writing in Addiction, he added: "Even when all factors were taken into account, there was a clear increase in rates of psychotic symptoms after the start of regular use.

"These findings add to the growing body of evidence from different sources, all of which suggest that heavy use of cannabis may lead to increased risk of psychotic symptoms and disease in susceptible individuals."

It is important to mention that cannabis may have medicinal benefits for patients undergoing chemotherapy, where it is thought to alleviate nausea and stimulate appetite. It may also be beneficial to those suffering from glaucoma and multiple sclerosis. This issue is very controversial however, and use of marijuana for these specific purposes remains illegal, except in certain controlled studies.

While more study is needed to confirm the New Zealand study findings, the message is clear: Don’t take foolish chances with your mental health. Forget recreational drugs, and don’t smoke pot.

Sunday, February 27, 2005


Shrink Rap # 11--Helping Children Cope with Divorce

Divorce is a death – the death of a family unit as it was. It will never again be the same. As with any death, there are grief stages that must be experienced both by parents and children. Divorce, when children are involved, is a catastrophe. As the family unit breaks up, everyone’s foundation is shaken. This results in a loss of feelings of security in children and they may regress to earlier levels of development.

Evidence of regressive behavior include: bed wetting, temper tantrums and “acting out” their anger. Children, like adults, experience feelings of anger and sadness. Depending on the age, sex and personality of the child, their ability to articulate their feeling varies.

Every child must have the opportunity to verbalize their feelings to someone they trust. Feelings of anger and sadness do not go away-they are either internalized and become depression, or expressed externally as inappropriate, angry “acting out” and rebellious behavior.

Divorce, in and of itself, does not have to be destructive to children. If the child is treated with respect through the divorce process and afterward and given the opportunity to express their feelings, the obstacles presented by divorce can be successfully negotiated.

Professional help, i.e., psychotherapy-can provide a neutral, confidential setting which facilitates the expression of a child or adolescent’s feelings. For the younger or less verbal child, psychotherapeutic methods utilizing art or play aid in theexpression of feelings.

If a child whose family is divorcing, is showing changes in behavior that include a decline in school performance, regressed, angry and rebellious behaviors, or isolation and withdrawal indicative of depression, then professional assistance is a necessity to prevent any worsening problems and to effect a positive change.

Thursday, February 24, 2005


Shrink Rap # 10--Emotional Intimacy

More and more couples are realizing that emotional intimacy is an extremely desirable feature of a relationship. Emotional intimacy – the process of sharing thoughts, feelings, wishes, and fears – leads to a closer bond between two persons. Emotional intimacy involves free and open communication, without fear of rejection or condemnation.

What does it take to achieve emotional intimacy?

First, there must be a significant level of trust in the relationship. Trust is necessary because of the gradually increasing self-disclosure of one’s innermost thoughts and feelings. As each person becomes more and more “exposed”, vulnerability increases, as does the risk of being hurt. Therefore, trusting one’s partner to be sensitive to your vulnerability is critical.

Often, pain accompanies the process and is an indication of the degree and depth of exposure of oneself to their spouse, or significant other, in areas which are extremely sensitive. Such sensitive areas include: expressing personal needs and desires, exposing flaws and weaknesses, and conveying to your partner satisfactions as well as dissatisfactions with life’s everyday problems and concerns.

There must be honesty in verbalizing one’s feelings and a true dedication to this process of establishing closeness and a finely developed system of communication. Each person must be able to disagree, experience anger, and express anger in words without attacking the other person. It is impossible to communicate openly when one fears encountering a judgmental or confrontational partner. Ideally, some resolution must follow the inevitable misunderstandings that arise.

Another requisite in achieving emotional intimacy is having a non-destructive environment where a couple can routinely share quiet time together. Finding quiet time requires special effort with the many responsibilities couples have including the demands of children, stressful work schedules of one or both partners, and other pressures.

Lastly, methods of communication are significant in this process. It is necessary to proceed with fairness, admissions of error and forgiveness. Most of all, there must be a basic fundamental caring, consideration and respect for the other person and their feelings. Achieving emotional intimacy is certainly not easy, but it can be one of life’s most rewarding endeavors.

Sunday, February 20, 2005


Shrink Rap # 9-- The Stigma of Mental Illness: Why the Movie “As Good as it Gets” Can Teach Us a Lesson

As a physician specializing in psychiatry, I know that many emotional conditions such as depression and anxiety disorders are true medical illnesses with a biologic (physical) origin. Psychiatry has become more and more "biological" in its diagnosis and treatment approaches during recent years, but a very significant stigma still exists against those who are seeing a therapist. This has become increasingly difficult to understand, but it is a social stigma that is so very important to eliminate.

Why does an embarrassment or stigma still exist associated with those who are seeking psychiatric treatment? Why do people wait so long before come for help - to the point of becoming nearly non-functional with their families, children and work environment?

First, many people have a picture in their mind of movies in which psychiatrists are ineffective listeners of problems of patients who are lying on psychoanalytic couches. It is important to remember that psychoanalysis preceded our modern treatment approaches which now have a much higher success rate. We currently have many safe and effective medications, which when used with or without psychotherapy, help many people fully recover.

Another reason for the stigma is in the use of the term "mental illness". The field of psychiatry has undergone many changes in the past twenty years. Research into the functioning of the brain and nervous system has led to the concept of a "chemical imbalance" as the cause of illnesses such as Major Depression and Panic Attacks. In addition, Obsessive Compulsive Disorder, a condition portrayed so well by Jack Nicholson in the 1997 movie As Good As It Gets, is also caused by a chemical imbalance. Medications were used to help treat the "Obsessive Compulsive" character being played by Nicholson. Many psychiatric illnesses are not "mental" or "emotional,” but are now understood to be "neurochemical illnesses".

Many people are told, "You can do this on your own, be strong,” as if a person can easily will themselves out of depression or anxiety. Can someone "Be Strong" and make their diabetes or bronchitis just go away? These types of suggestions only result in a delay in seeking treatment or feelings of failure in the individual who finally does seek help. The stigma of psychiatric treatment also leads many people to seek help at the health food store, or other types of self-diagnosis and self-medications.

Men in particular have to overcome an additional obstacle. It may seem "Un-Macho Like" to seek professional psychiatric help when one fails to understand or see their condition as an illness, and instead view it as a weakness in their character. Thus, injury to a man's ego often contributes to their long delays in seeking treatment.

My hope is that the shame and secrecy associated with obtaining professional psychiatric help will gradually diminish and eventually cease to exist. If we understand how the social stigma was established in the first place - the media lack of medical knowledge, societies' understanding or ignorance, etc., then we should realize there is no need to "stay in the closet." Let's wipe out the term "mental illness" and view many of these conditions as "neurochemical illness,” with the same non-prejudicial attitude as we do toward diseases such as diabetes or hypertension.

Monday, February 14, 2005


Rap # 8--Saying “No” Means Good Parenting

Among the most common presenting problems in our practice involving children and teenagers are “behavioral problems.” Certainly no child or teen behaves perfectly and there are degrees of unacceptable, rebellious and disrespectful behaviors. But how much negative behavior should a parent allow? Also, how do such behaviors develop and what can be done about them?

Our job as parents is to raise our children to be able to survive on their own in the world. This means that all our interactions with our children will involve molding and shaping their behaviors, with the intentions of giving them the tools to function successfully and independently some day. We are supposed to give them good values, an education and help them develop a sense of right and wrong. As adults, they will need to rely on their own self-discipline to succeed in the school and in the workplace. This is why disciplining children is so very important – it enables children to have self-discipline as adults.

Disciplining children, setting limits and saying “No” is difficult for many parents. Why is it that so many parents of this generation are unable to say “No?” Parenting styles often are related to our upbringing and our own childhood experiences. Many people who were harshly disciplined and felt controlled and restricted as children, become lenient, overly permissive parents who feel they should never deny their children anything. But living in the real world means knowing that we can’t have everything we want. And the sooner we begin to teach our children that lesson, the better.

Often, after working in therapy with children and their parents, we see that a lack of consistent discipline has been present since the child was very young. Spoiling a child, giving in to their demands and failing to say “No” when appropriate and set limits, leads to disrespectful, angry and increasingly uncontrollable and undesirable behaviors later on. As the child gets older, running away, smoking, promiscuity, verbal or physical fighting with parents and truancy with failing grades are see. The best time to begin molding behavior constructively, disciplining and saying “No” when necessary is when a child is young. But it is never too late to become a stronger, more effective parent and better disciplinarian. Often, some parenting guidance can go far to turn a rebellious child or teenager around. Just remember, it may be very good for your kids if you say “No.”

Wednesday, February 09, 2005


Shrink Rap # 7--Is Just Taking a Pill the Total Answer?

Many emotional problems are diagnosed as physical illnesses that can be effectively treated with medications. This fact should help to de-stigmatize mental health therapy and encourage more people to seek treatment from a therapist without feeling embarrassed. However, there are limitations to the use of medications alone and the most effective treatment for emotional disorders is often the combination use of medication and therapy.

It is known that there are direct interactions between “the mind” and the physical aspects of “the brain”- the mind being a person’s thoughts, feelings and emotions, reactions to stress, etc. It is the interaction between the mind and the organic brain that can stress the nervous system as well as the rest of the body. This interaction can result in a “chemical imbalance”. Chemical imbalances present as illnesses including depression, panic attacks, and obsessive-compulsive disorders, to name just a few. Thoughts, feelings, emotions, losses, job changes, deaths, divorces and other stressful life events can also stress our bodies and immune systems resulting in a variety of illnesses.

People with a family history of emotional disorders may have a greater tendency to develop chemical imbalances. Pills work on the chemical imbalance quite effectively, reducing or virtually eliminating the clinical symptoms. However, the medications do not address the “mind” part of the mind/brain interaction. Therapy helps people cope with their problems, feelings, and emotions, going hand-in-hand with the use of medications to speed up a person’s recovery. Many people, particularly women, suffer from long-standing feelings of low self-esteem. Low self-esteem can be a symptom of depression and improves along with the other symptoms as the depression is adequately treated. However, in the case of deeply ingrained low self-esteem, good quality psychotherapy is the only effective treatment.

Another example is Attention Deficit/Hyperactivity Disorder (ADHD). Pills may help a child focus and/or calm their hyperactive behavior, but they do not address the secondary problems such the low self-esteem that often affects ADHD children. Nor do pills teach a child the proper social skills or work with parents to help them with the necessary discipline and consistency so important with ADHD children.

In addition to psychotherapy and the taking of medications, exercise, good nutrition, vitamin supplements, and the avoidance of excessive amounts of alcohol, nicotine and caffeine are part of the treatment of psychiatric illnesses. Simply taking a pill can often be easier than modifying lifestyle habits for some people. I often tell patients “Exercise can often be the best antidepressant-it has no side effects.”

I wish it were that easy to treat low self-esteem with a pill or to help a partner in a troubled marriage suffering with Major Depression by the taking of a pill alone. But the effective combination of the right medication, psychotherapy and better health habits can help most people experience a significant improvement in their quality of life.

Sunday, February 06, 2005


Shrink Rap # 6 -- You Are Getting Very Sleepy...The Truth about Hypnosis

A hypnotic “trance” is not something that is foreign to us--we’ve all been so absorbed in thought while reading a book or watching a movie that we fail to notice what is happening around us. These focused states of attention are similar to hypnosis. Simply put, when our minds are concentrated and focused, we are able to use them more powerfully. In this condition, we can tap into normally unused mental powers to create new possibilities of experience.
People typically experience both mental tranquility and physical relaxation under hypnosis. Various changes in perception are also common under hypnosis. Some people feel great heaviness coming over their bodies, others feel very light or numb. Subjective feelings of floating, sinking, spinning, and tingling sensations are also reported.

Contrary to a popular belief, people under hypnosis are neither captive nor spellbound. For the most part, a subject can resist direct instructions that he or she feels will undermine their wishes or compromise his or her moral standards. Still, there are rare cases of misconduct in which hypnosis is deliberately misused by a skilled hypnotist. This is one of several good reasons to seek a reputable professional when it comes to choosing a hypnotherapist. A good guideline for finding a qualified clinical professional is this fact---the only people qualified to treat your mental or physical problems with hypnosis, are those who are also qualified to treat the same problems without hypnosis.

Psychiatrists use hypnosis in treating patients to overcome negative habits, anxiety, phobias and other fears, and depression. They use hypnosis for exploration of the unconscious, to better understand underlying motivations or identify whether or not past events or experiences are associated with causing a problem. Psychiatrists have also had positive results in helping patients control appetite and reduce the levels of drugs necessary in the treatment of chronic illnesses.

Hypnosis, while effective, may not be for everyone. It appears to be of the greatest benefit when a patient is highly motivated to overcome a problem and when the hypnotherapist is well trained in both hypnosis and in general considerations relating to the treatment of the particular problem. Also, some patients seem to have higher native hypnotic “talent” (increased suggestibility) and capacity which may allow them to benefit more readily from hypnosis.
Hypnosis can be a powerful tool for healing—so powerful that it can completely remove or distract people from feeling pain. For this reason it is important that a physician or other state-licensed medical or psychological specialist assess the underlying medical or psychological condition prior to hypnosis. Also, because there is no medical degree required for the practice of hypnotherapy, persons wishing to undergo hypnosis should make certain that the therapist is well trained. This bears repeating: it is safest to look for a hypnotherapist who is a licensed professional in a field where hypnotherapy is part of their normal practice, such as psychiatrists (MD’s) and psychologists. It is essential to check credentials and background when choosing a hypnotherapist.

Finally, it is important to keep in mind that hypnosis is like any other therapeutic treatment: it is of major benefit to some patients with certain problems, and it is helpful with many other patients, but it can fail, just like any other clinical method. For this reason, trained clinical hypnotherapists emphasize that they are not "hypnotists,", but instead health care professionals who use hypnosis along with the other tools of their professions.

For a more comprehensive look at hypnosis, click here.

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