Shrink Rap

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

2005-03-21T00:46:00.000-05:00

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.

Shrink Rap # 11--Helping Children Cope with Divorce

2005-02-27T02:48:00.000-05:00

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.

Shrink Rap # 10--Emotional Intimacy

2005-02-24T23:45:00.000-05:00

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.

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

2005-02-20T11:43:00.000-05:00

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.

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

2005-02-14T13:02:00.000-05:00

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.”

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

2005-02-09T13:59:00.000-05:00

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.

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

2005-02-06T04:46:00.000-05:00

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.

Shrink Rap # 5--Helping Your Child Develop A Solid Work Ethic

2005-02-02T01:37:00.000-05:00

All of us as parents want our children to eventually become independent, productive members of society. Usually this doesn’t happen by accident; rather it is the result of years of disciplined parenting with the goal of developing a sense of responsibility
in the child. In children, the development of a work ethic begins in the school and home environments.

What is a work ethic? A work ethic is an innate sense of self-discipline and responsibility for completing assigned tasks, chores, homework, and all other duties to the best of one’s ability. It means not settling for a job done “halfway,” or
“Ah, Mom, I’ll do it later.” In the workplace, bosses won’t wait until tomorrow or that favorite TV show is over. If we as parents do not begin today to insist on a “Job well done,” it usually is too late once the teenage years are reached.

Teaching the value of a solid work ethic usually accompanies other values. For example, the concept of hard work usually goes hand-in-hand with learning the value of things by having to earn them. Many parents never think of having their child do a chore to earn a “Beanie baby,” new computer game, or new outfit.

As one of four children, I was in no position to be given things in excess and was taught two very difficult lessons at a fairly young age. First, if I wanted something, I was going to have to earn it, and second, if I did anything, do it to the best of my ability.
I credit my family for giving me the tools necessary for the completion of many years of education and private practice of medicine.

We as parents also teach children by our own behaviors--what we do is much more powerful than what we say. Guiding the development of behavior by setting an example, disciplined parenting, and teaching children to work for things, will go a long way toward helping your child develop a solid work ethic that is so important
in becoming a productive member of society.

Shrink Rap # 4--Medications Can Help Ease the Crisis, but Know the Risks

2005-01-30T03:06:00.000-05:00

Many people come for psychiatric/psychological help when the pressures and problems of life are overwhelming. Usually, life stress causes people to experience various symptoms of anxiety, depression, and insomnia. The psychiatrist can diagnose a mood or anxiety disorder and prescribe medications that are often quite effective for symptom relief. However, it is important to be aware that although a person may feel better, there is still a disease process taking place. Similarly, if a person leads an imbalanced or dysfunctionally stressful life and develops high blood pressure, medications can surely bring the blood pressure down. But the cause may continue to exist, damaging the body.

In these days of instant gratification and our extremely fast-paced lives, many people place unrealistic expectations on what psychiatric medications can do for them. Often, the prescription of one drug is insufficient for results, or causes side effects necessitating the prescription of several more drugs. People with extremely chaotic, out of control or situationally sad lives frequently expect to feel “normal” with the right combination of medications. Yes, there is the concept of chemical imbalances which medications do correct, but no medication will correct the underlying cause. And it is the correction of the cause that promotes real healing.

Sometimes, medication can “numb” reactions and reduce symptoms that are the body’s natural response to stressful situations. Without symptoms, we lose the awareness that certain situations may need to be fixed. I have seen instances where people who are medicated become complacent or resigned to life situations which can be altered. With the help of a well-trained therapist, people often find their own solutions to problems and begin to take control of their lives. Once life becomes more under control, a lot less medication is needed.

Medications can be life saving and there is often no substitute for them during a crisis. However, the long-term use can cause side effects that adversely affect quality of life. In the end, each person must make an informed decision about their treatment based on personal preferences and goals.

Shrink Rap # 3 You Come First!

2005-01-26T13:57:00.000-05:00

A selfish idea? YOU come first? Hardly. The literature of all faiths urges believers to care for themselves. For instance, the cliché “Love thy neighbor as thyself” assumes that you first are able to “love” yourself. Perhaps “love” is the wrong word these days. The concept, however, is still valid. You can only care for others as well as you know how to care for yourself.

Think for one moment. How many people rely on you? How many people are affected by how you feel every day? Spouse, children, in-laws, employees, co-workers? Even the check-out worker at the grocery is influenced by how you feel as you pass through his or her life. If you have not taken care of you, then all these interactions can be negative or even hurtful.

Somehow we have in our society come to believe that to be a good person, we must give, give, give. Time, energy, affection, money. It’s all expected to flow out from us to others. Endlessly. The more we do, the more we give, the better person we are. Or so we’ve been trained to believe.

But emotional energy is like a bank account. One cannot continue to make withdrawals and not expect the amount to shrink. What can we do if the account is emptied? Then there is nothing left for all those people who need that piece of us.

Only one person can make deposits in that emotional energy bank. You! That is why YOU come first. You are responsible for keeping that emotional bank full. Only you.

“YOU COME FIRST” urges a new concept: mental wellness. Most people think of psychiatry as an experience to be had after a crisis. That’s wrong. These days we eat healthy and exercise to avoid a heart attack. We lose weight and stop smoking to prevent the stroke. We should also exercise our emotions to determine how we can be as emotionally healthy as possible. If we truly recognize how important we are in our families and our communities, then we will take the steps to examine the emotional side of our lives. Counseling, massage, relaxation therapy, sleep assistance and other tools are all a part of helping you understand that you come first. This is not selfish a thought. It is, in fact, the way you can guarantee that you will always be there to give to those who need you.

Shrink Rap # 2--What’s the Latest on Suicide Risk and Antidepressants for Children?

2005-01-22T16:57:00.000-05:00

FDA confirms some antidepressants increase suicide risk in some children. In February of 2004, two advisory committees of the U.S. Food and Drug Administration recommended that the FDA warn practitioners about the possible risk of suicide potential associated with antidepressant treatment in children. The information was obtained from clinical trials of medications with children, expert witnesses on suicide research, testimony from families of suicide victims, as well as from those whose children had benefited from antidepressant medication.

At a second meeting last year, improvement on antidepressant study designs and monitoring for suicide risk was discussed. Now, federal officials are preparing stronger warnings giving some antidepressants to children after new analyses back a suspected link to suicidal thoughts and behavior. FDA and Columbia University psychiatric specialists have re-evaluated 25 studies involving more than 4,000 young people and eight antidepressants. When all the results were lumped together, young antidepressant users were about 1.8% times more likely to have suicidal thoughts or behaviors than patients given dummy pills. Risk varied widely from drug to drug and among studies of the same drug, but studies of Effexor showed particular risk.

At present, changes have been made in the labels for Effexor, Serzone,Wellbutrin, Celexa, Lexapro and Paxil indicating warnings which apply to both adults and children with major depressive disorder. The warnings recommend that patients be observed closely for clinical worsening and the emergence of suicidal ideation and behavior, particularly when they begin treatment and when the dose is changed. The warnings also advise families and caregivers of patients to be alert to those and other symptoms, including agitation and irritability, and to immediately let health care providers know about them.

Despite the warnings and possible risks, it should be noted that Major Depression is a serious mental illness which often responds favorably to medication, in both children and adults.

Shrink Rap's First Rap

2005-01-20T14:03:00.000-05:00

Dear Reader,

Hello, and welcome to Shrink Rap, my first venture into the brave new world of blogging. For those of you who don't know me, I'm a psychiatrist located near Fort Lauderdale, FL. I've been in private practice (General Psychiatry) for more than sixteen years. I received my MD from the University of Miami and am board-certified by the American Board of Psychiatry and Neurology. If you're interested, more information is available on my website: www.doctorgorin.com.

The purpose of Shrink Rap is to provide topical and useful information on a variety of mental health issues. It's my hope that you find this weblog both informative and helpful. I plan to update the information on this site as frequently as time allows, and I encourage feedback, questions, and suggestions for new topics.

So, here goes rap #1...

Food for Thought

Depression is a disorder marked by sadness, low energy, impaired concentration, and feelings of dejection. Some people believe that depression is normal. Hectic daily activities and the conflict between family and career cause constant stress. Yet depression and anxiety as a response to stress are not normal. They can be signs of illness, which may worsen and result in physical symptoms or an inability to function.

Life was much simpler for the last two generations. Father worked; mother stayed home. This is no longer the model. Some now view families as an “endangered species.” There are more single mothers working than ever before. There is greater stress and competition for well-paying jobs. The result: long hours at work, away from the family. Children are raised with limited supervision. Thus we see more children with emotional problems derived from a lack of knowledge as to who they are and what their role is in today’s society. Similarly, adults suffer from the loss of nurturing that family time should provide.

Until recently, mental health was not discussed openly. However, there is a growing awareness that choosing therapy can be helpful, even necessary, to cope with today’s life. Psychiatric help is often sought for the entire family. Today, being healthy means not only having a sound body, but also a sound mind and spirit.

People exercise their bodies daily, yet they neglect to “exercise” their feelings and emotions. Young men are taught to hide and deny emotions. Women are reluctant to seek help in coping with their depression, anxiety, or distressed relationship. The same fitness fanatic who exercises daily, eats right and has two physicals a year will neglect the mind until a crisis is reached. Emotional problems don’t just happen, but are cumulative and they can be avoided at times with the same “daily fitness” and “annual physical” approach we use when caring for our bodies.

The Chinese say “the journey of a thousand miles begins with a single step.” Just like it’s better to maintain a healthy heart than recover from a heart attack, dealing with emotional issues is easier before the chaos of a crisis breaks. Think about “exercising your emotions" and give your mental health professional a call.