http://blogs.qc.cuny.edu/blogs/0907N_0276/004/ en-us Copyright 2007 Sun, 28 Oct 2007 16:37:59 -0500 http://www.sixapart.com/movabletype/ http://blogs.law.harvard.edu/tech/rss "Psychiatry has some of the richest yet most poorly understood diagnostic labels in medicine." This point, in my mind, is what makes labeling particularly dangerous; very often, we are not even completely sure what we are labeling patients with! I do think that it is extremely important to give a title to a disease, as that is what enables doctors to converse with one another about a particular case and provide the most suitable treatment. But, as Raj argues, in the area of mental health, labels come along with a great deal of stigma. Why would a patient, with a currently untreatable condition, want to walk around with a label attached to them? I think that the other problem with labeling is that people are often over-labeled. With the current DSM system, patients are often overloaded with labels that each account for a part of their presenting symptoms. I actually just saw an 8 year old patient who was previously diagnosed by her psychiatrist with psychotic disorder, NOS, in remission, ADHD, combined type, and a learning disorder, and mood disorder was recorded as a rule-out. When I saw this child's records I was extremely frustrated by the ease with which these highly charged labels were assigned. While it definitely gave me a sense of the type of patient who was about to walk into the office, I would hope that a psychiatrist would be more hesitant to label such a young child with all of those diagnoses. Instead of diagnosing a patient with the most troublesome of the diagnoses, attempting to treat that problem, and then seeing if the remaining symptoms lift, people want to make sure that they aren't the ones to leave off one of the possible labels. As a result, the patient is given some labels that are probably not actually present, and he/she is the one who has to live with the list of labels and their stigmas. http://blogs.qc.cuny.edu/blogs/0907N_0276/004/2007/10/lessons_from_a_label_maker.html http://blogs.qc.cuny.edu/blogs/0907N_0276/004/2007/10/lessons_from_a_label_maker.html Sun, 28 Oct 2007 16:37:59 -0500 I agree with everyone's comments that the lack of an interpreter is completely ridiculous. In this case, it isn't just a problem of consent, though. The lack of understanding also majorly impacted patient care, and seemingly, the whole reason to push for consent is to be able to provide the patient with the proper care. http://blogs.qc.cuny.edu/blogs/0907N_0276/004/2007/10/the_spirit_catches_you_and_you.html http://blogs.qc.cuny.edu/blogs/0907N_0276/004/2007/10/the_spirit_catches_you_and_you.html Mon, 15 Oct 2007 21:39:03 -0500 I understand that pulling a child out of class to receive services can make the child feel as though he/she is "not ok", but I would think that the same message comes across when that child receives special services within the classroom setting. I don't think that the answer should be that we refrain from giving children services that will improve their functioning b/c it negatively impacts their self esteem. Rather, we should provide them with services and encourage them to participate in activities in which they will experience success, acceptance, and enjoyment. Also, while it is remarkable that Kathie Snow is able to mimic the services that her child was receiving, not every parent has the time or the abilities necessary to do so. While it may indeed be best to do what she is doing, I don't think that it should be recommended for every child/parent. http://blogs.qc.cuny.edu/blogs/0907N_0276/004/2007/10/hearts_and_minds.html http://blogs.qc.cuny.edu/blogs/0907N_0276/004/2007/10/hearts_and_minds.html Mon, 15 Oct 2007 20:31:25 -0500 I find it sad that the Cassell article was published 25 years ago. Have we made any advances at all in this area over that period? http://blogs.qc.cuny.edu/blogs/0907N_0276/004/2007/10/the_nature_of_suffering.html http://blogs.qc.cuny.edu/blogs/0907N_0276/004/2007/10/the_nature_of_suffering.html Sun, 07 Oct 2007 18:07:08 -0500 "... a multidisciplinary approach should be taken to patient care, including psychosocial preparation in the preoperative phase and postoperative follow-up. This is necessary to help the patients and their entourage better anticipate and cope with unquestionable success of STN stimulation." I think that the authors' final point is extremely important and should be a necessary component in all treatment protocols. As much as patients and their caregivers want to find a cure, change is inextricably linked to the healing process, and everyone has a hard time adapting to any form of change. And, while the changes associated with a cure are supposed to be for the better, they may actually be harder to deal with. People often rise to the occasion when they/loved ones are diagnosed with an illness, but I can imagine that it is even harder to "drop" when that illness is no longer. It is hard to resume old roles once new ones have been established, especially because the relationship between the patient-caregiver can't go back to the exact way that it was prior to the illness. Also, I found it particularly interesting that there seemed to be 2 very different types of dyads: those in which the patient now had a new zest for life and the caregiver experienced some loss of identity and those in which the patient became/still felt impaired and the caregiver no longer wanted to assume that role. While people respond to these situations in a multitude of ways, it seems as though the response is almost predictable based on the patient-caregiver relationship prior to surgery (or in other cases receiving equivalent treatment). I think that it would be particulalry helpful/interesting for these people to interact in a group therapy session in which they could learn from others who are dealing with a similar situation. http://blogs.qc.cuny.edu/blogs/0907N_0276/004/2007/10/distressed_mind_in_a_repaired.html http://blogs.qc.cuny.edu/blogs/0907N_0276/004/2007/10/distressed_mind_in_a_repaired.html Sun, 07 Oct 2007 13:54:19 -0500 I'm wondering what other types of things would also remain in one's memory. Is there something intrinsic to music that makes it completely different from everything else? Or is it that in his particular case and with his training, music became encoded differently? If it is that he retained some memories of things that he really loved, maybe this is the way to help patients retain some sense of self as they their AD diagnoses are becoming more severe- tap into what it is that still speaks to them. http://blogs.qc.cuny.edu/blogs/0907N_0276/004/2007/10/clive_2.html http://blogs.qc.cuny.edu/blogs/0907N_0276/004/2007/10/clive_2.html Mon, 01 Oct 2007 22:47:15 -0500 Anyone see "50 First Dates"? I can't claim that I have, but from what I heard about the movie, it's a story about a similar experience (I think post TBI) and very similar approaches to managing the disorientation that results on a moment to moment basis. http://blogs.qc.cuny.edu/blogs/0907N_0276/004/2007/10/clive.html http://blogs.qc.cuny.edu/blogs/0907N_0276/004/2007/10/clive.html Mon, 01 Oct 2007 22:34:27 -0500 I found this reading to be particularly interesting, as I typically think of children/spouses as the caregivers who are struggling to adjust to their family member's diagnosis of AD rather than medical staff members attempting to deal with their patients. Oftentimes, a parent/spouse is sent to a home assuming that the staff members are more capable of managing the patient, resulting in a better enviornment in which the patient can reside. It seems as though more people would think twice before sending the patient to a home if they were to realize these issues in the patient-staff relationship, especially because it comes at the cost of aspects the patient's independence and happiness. If this then results in increased anxiety and frustration, the demands on the staff becomes even greater than they would have been on the family member, which then increases the likelihood that the patient will be infantilized further. Seems like quite the downward spiral to me. http://blogs.qc.cuny.edu/blogs/0907N_0276/004/2007/09/managing_stress_by_medicalizin.html http://blogs.qc.cuny.edu/blogs/0907N_0276/004/2007/09/managing_stress_by_medicalizin.html Wed, 26 Sep 2007 11:48:15 -0500 "The chance for heroic rescue is there at least..." Why is the goal to rescue? Shouldn't it be to treat? And, if the presenting illness is not treatable, than the task should becoming providing comfort and recommendations that will improve the quality of the patient's life with the illness. The search for an alternate diagnosis that would be curable can be detrimental to the patient. I have witnessed this first hand: I had a patient who was referred for a neuropsych assessment as part of a work-up to determine if Deep Brain Stimulation would be an appropriate treatment. The patient's history revealed that he had previously had 21 different brain surgeries, 15 of them in the past 7 years! Seemed a little excessive. Sure enough, his MMPI-2 profile had questionable validity b/c he tended to over report the presence and severity of symptoms, and even so, the general pattern produced revealed a tendency to respond to psychological distress with physical symptoms. This patient would surely benefit from CBT before cutting his head opened, again. But each time, the doctors that he went to decided that their surgery would be the one to rid him of his presenting complaint. While I recognize that it may have seemed, at each time point, that the surgery would be successful, the overall patient (and his medical history) seems to have gotten lost somewhere along the way. A little less heroism would probably have been a good thing in this case. http://blogs.qc.cuny.edu/blogs/0907N_0276/004/2007/09/the_desert.html http://blogs.qc.cuny.edu/blogs/0907N_0276/004/2007/09/the_desert.html Mon, 24 Sep 2007 15:29:34 -0500 http://www.wnyc.org/shows/radiolab/episodes/2006/05/05]]> http://blogs.qc.cuny.edu/blogs/0907N_0276/004/2007/09/link.html http://blogs.qc.cuny.edu/blogs/0907N_0276/004/2007/09/link.html Tue, 18 Sep 2007 14:18:11 -0500 Towards the end of her essay, Nancy Mairs discusses the effect that she believes MS, or similar currently untreatable conditions, has on doctors. She expresses, as we did in class last week, that doctors often treat patients as less than whole human beings; however, she adds that the opposite is also true. I found her statements about treating doctors gently, because of their bruised egos, to be fascinating. While I believe that there is definitely validity to the thought, I would assume that it is the rare patient who espouses such a belief, as the authors of the other readings, and Mairs herself, describe points at which a patient is indeed diminished or even defeated by a disease. Mairs has clearly learned to adapt to her illness, or at least to its state at the time that she wrote the essay. To be able to show such sensitivity to another person, who is not directly impacted by the disease, is truly remarkable and seems to surpass the transcendence of self that Charmaz describes. The topic reminded me of a patient whom I tested last year. On both days of the assessment, the patient commented about how bad she felt for me because my profession requires me to work with people, such as herself, on a continuous basis. I remember thinking that her comments were quite odd; wouldn’t one consider the patient’s position to be worse than that of the treating professional? But the patient did not pity herself at all. In light of this week’s readings, I would venture to say that she already worked through her struggles with her illness. I happened to meet her at a time in which she wasn’t frustrated with her state. I can’t imagine that she would think that my position was pitiful if she were more aggravated with hers. Had I met her even a few weeks before, she may never have made such comments, as she may have been too consumed with her own grief. To me, Mairs’s statements highlight the need to consider the particular point at which one meets the patient, as the specific constellation of symptoms at that moment is not the only thing that is in flux. http://blogs.qc.cuny.edu/blogs/0907N_0276/004/2007/09/illness_and_identity.html http://blogs.qc.cuny.edu/blogs/0907N_0276/004/2007/09/illness_and_identity.html Tue, 11 Sep 2007 09:35:36 -0500