EppsNet Archive: Mental Illness

What is Life Telling Me Right Now?

15 Oct 2016 /

“You married a crazy person, you got old, there are women out there hooking up with everybody and you missed it, you dumb fucker . . .”


The Savvy Clinician

8 Jan 2016 /

It’s a little hard to read the subtitle on the book cover but — “Savvy”?! I don’t think I want to work with clinicians who consider themselves “savvy.”

Being “savvy” sounds like a poor substitute for actually knowing something. I’m not fully informed but I’m “savvy.” I’m “with it.” I’m “in the know.”


A Couple of Random Thoughts on Gun Control

25 Nov 2015 /
  1. Laws don’t turn crazy people into good citizens.
  2. What reasons are there to think that gun laws would make it difficult for anyone to obtain a gun? We’ve had a War on Drugs for decades. How difficult is it to obtain illegal drugs?

25 Concepts to Facilitate Judicious Use of Psychiatric Drugs

20 Sep 2015 /

I’m not a doctor, nor do I play one on TV, but I did stay at a Holiday Inn Express last night . . . I also took a Colgate University class on medicating for mental health and judicious use of psychiatric drugs.

Pills
  1. A psychiatric medication is only one useful tool among a collection of useful tools. Remember to also consider non-drug options for therapy.
  2. The benefits of psychiatric medications are always accompanied by risk. Become familiar with the potential risk of your medication. Be alert to potential risks that might be intolerable to you.
  3. Establishing a diagnosis is a difficult and imperfect task, but it establishes the starting point for determining which treatments are appropriate.
  4. Engage your physician or a psychologist in a dialogue regarding the structure of your treatment program. Be an active participant in establishing the structure of that program. Having confidence that your treatment program will work is important for its success.
  5. Become familiar with the vocabulary of psychopharmacology and with some basic principles of psychopharmacology. It will improve your ability to communicate with your physician or therapist.
  6. Be forthcoming and candid with your physician or therapist when working to establish realistic goals for your use of psychiatric medication. These goals should include the meaningful improvement of symptoms and side effects that are acceptable to you.
  7. A treatment program should aim to not only produce meaningful improvement of symptoms but also should include a plan to prevent relapse.
  8. A psychiatric medication is limited in its effectiveness for improving a problem that has biological, psychological, and social characteristics.
  9. Ask whether the use of your recommended psychiatric medication is supported by published evidence or is an off-label prescription based upon educated guesswork. If your prescribing physician doesn’t know the answer to that question tell him or her to find out for you.
  10. Remind yourself that a psychiatric medication will alter the neurochemistry of your brain and that the effects of medication on the brain can persist and may be permanent.
  11. The ideal dosage of a psychiatric medication is the smallest dosage that is able to provide meaningful relief of symptoms.
  12. Fulfill your responsibilities for ensuring the success of your treatment program. Be fully cooperative regarding instructions for using medication and for taking the advice of the therapist.
  13. Remember that counseling, psychotherapy, or behavioral therapy may enhance the effectiveness of a psychiatric medication.
  14. Remember also that a psychiatric medication may enable counseling, psychotherapy, or behavioral therapy to be more effective.
  15. Newer psychiatric medications are often more expensive medications despite the fact that those newer drugs may not be more effective than older medications.
  16. Newer psychiatric medications have been used for a shorter period of time and by fewer people than older medications. This fact increases the likelihood that newer medications might bring unpleasant surprises.
  17. Herbal remedies and dietary supplements may or may not be effective or safe and very few of those remedies have been studied in well-designed experiments to evaluate their effectiveness and their relative safety.
  18. If possible, avoid using multiple medications in order to minimize the possibility of harmful drug interactions.
  19. Direct-to-consumer advertising of psychiatric medication is principally intended to get you to buy a product. That product may or may not be in the best interest of your own physiological, emotional and psychological well-being.
  20. Be aware that your health insurance provider may structure costs to you, the patient, in a way that provides some incentive to use one drug instead of some other drug or to use medication instead of psychotherapy. If possible, try to make the principal goal of your therapy to be the relief of symptoms, not the lowest cost of treatment.
  21. The elderly present special vulnerabilities for psychiatric medications — for example, enhanced sensitivity, likelihood of polypharmacy, or increased risk of falling.
  22. Exposing the young, still-developing brain of a child or adolescent to a potent psychiatric medication risks creating problems for those brains when they reach adulthood.
  23. The recent trend is to rely more upon psychiatric medication than upon non-drug therapies to treat psychopathology. Resist that trend when you are not convinced that medication is the best choice for you or for a member of your family.
  24. The study of brain and behavior is a frontier science. Thus the use of drugs that alter brain neurochemistry to treat psychopathology is based upon an incomplete understanding of brain and behavior.
  25. Because our current understanding of brain and behavior is incomplete, contemporary psychiatric medications are imperfect tools that are clinically useful until we learn enough to develop better tools.

EppsNet Book Reviews: Revolutionary Road by Richard Yates

29 Mar 2014 /

Richard Yates poses the question of how much reality people can stand, and the answer he comes up with is “not very much.” Alternatives to facing reality head-on are explored in Revolutionary Road: avoidance, denial, alcoholism, insanity and death.

Some excerpts:

“You want to play house you got to have a job. You want to play very nice house, very sweet house, you got to have a job you don’t like. Great. This is the way ninety-eight-point-nine per cent of the people work things out, so believe me buddy you’ve got nothing to apologize for. Anybody comes along and says ‘Whaddya do it for?’ you can be pretty sure he’s on a four-hour pass from the State funny-farm; all agreed.”

 

And all because, in a sentimentally lonely time long ago, she had found it easy and agreeable to believe whatever this one particular boy felt like saying, and to repay him for that pleasure by telling easy, agreeable lies of her own, until each was saying what the other most wanted to hear — until he was saying “I love you” and she was saying “Really, I mean it; you’re the most interesting person I’ve ever met.”

People’s inability to absorb large, unfiltered doses of reality probably explains why New Yorker fiction editor Roger Angell wrote to Yates’s agent in 1981, “It seems clearer and clearer that his kind of fiction is not what we’re looking for. I wonder if it wouldn’t save a lot of time and disappointment in the end if you and he could come to the same conclusion.”

And why at the time of his death in 1992, all of Yates’ books were out of print.

Rating: 5 stars


Japan, Day 2: Kinkakuji Temple, Nishijin Textile Center, Tea Ceremony, Bullet Train, Atami

23 Dec 2013 /

Kinkakuji Temple

Kinkaku-ji (lit. “Temple of the Golden Pavilion”), officially named Rokuon-ji (lit. “Deer Garden Temple”), is a Zen Buddhist temple in Kyoto, Japan.

The site of Kinkaku-ji was originally a villa called Kitayama-dai, belonging to a powerful statesman, Saionji Kintsune. Kinkaku-ji’s history dates to 1397, when the villa was purchased from the Saionji family by Shogun Ashikaga Yoshimitsu, and transformed into the Kinkaku-ji complex. When Yoshimitsu died, the building was converted into a Zen temple by his son, according to his wishes.

During the Onin war, all of the buildings in the complex aside from the pavilion were burned down. On July 2, 1950, at 2:30 am, the pavilion was burned down by a 22-year-old novice monk, Hayashi Yoken, who then attempted suicide on the Daimon-ji hill behind the building. He survived, and was subsequently taken into custody. The monk was sentenced to seven years in prison, but was released because of mental illnesses (persecution complex and schizophrenia) on September 29, 1955; he died of tuberculosis shortly after in 1956.

The present pavilion structure dates from 1955, when it was rebuilt.

— Wikipedia

Kinkakuji Temple: Golden Pavilion

Kinkakuji Temple: Golden Pavilion


Kinkakuji Temple: Golden Pavilion

Kinkakuji Temple: Golden Pavilion


Kinkakuji Temple: Golden Pavilion

Kinkakuji Temple: Golden Pavilion


Kinkakuji Temple: Golden Pavilion

Kinkakuji Temple: Golden Pavilion


Kinkakuji Temple: Golden Pavilion

Kinkakuji Temple: Golden Pavilion


Kinkakuji Temple: Golden Pavilion

Kinkakuji Temple: Golden Pavilion


Kinkakuji Temple

Kinkakuji Temple


Kinkakuji Temple: Golden Pavilion

Kinkakuji Temple: Golden Pavilion


Kinkakuji Temple

Kinkakuji Temple


Kinkakuji Temple

Kinkakuji Temple


Kinkakuji Temple

Kinkakuji Temple


Kinkakuji Temple

Kinkakuji Temple

Nishijin Textile Center

Nishijin is a district in Kamigyo-ku, Kyoto, Japan, and (by extension) a traditional textile produced there, more narrowly referred to as Nishijin-ori (Nishijin fabric).

Nishijin weaving was created in Kyoto over 1200 years ago by using many different types of colored yarns and weaving them together into decorative designs. These specialized procedures are tedious, but necessary to obtain the spectacular design needed to ensure the quality of Nishijin weaving.

— Wikipedia

What the blurb above means is that images and patterns are not dyed after the fabric has been produced, the yarn is dyed before weaving, which yields the finest quality but is much harder to create.

Kimono Show

Kimono Show


Kimono Show

Kimono Show


Kimono Show

Kimono Show

Tea Ceremony

We participated in a traditional Japanese tea ceremony, involving the preparation and presentation of matcha, a powdered green tea.

Fun fact: You don’t enter the tea room through that big opening in the front. You sort of crawl in through a small door on the right-hand side, which you can’t see in the photo. There’s a traditional reason for this, something to do with samurai not bringing swords to the tea ceremony (they won’t fit through the little door), but in modern times, it seems a bit of an unnecessary ordeal.

Tea Room

Tea Room

Bullet Train

We took the Shinkansen (bullet train) from Kyoto to Atami. These trains run on time. If the board says the train leaves at 3:12, it leaves at 3:12. Don’t show up at 3:13 and wonder where your train went.

Bullet Train

Bullet Train


Bullet Train

Bullet Train

Atami

In Atami, we enjoyed a traditional Japanese dinner, so traditional that our guide was unsure of what a couple of the items were. Atami is on the eastern coast and has a spectacular fireworks display that they shoot off over the bay.

Traditional Japanese Dinner

Traditional Japanese Dinner


Atami Fireworks

Atami Fireworks

Atami Fireworks

Atami Fireworks

Atami Fireworks

Atami Fireworks


If I Am Out of My Mind …

11 Apr 2013 /

… it’s okay with me.


Don’t Bring a Gun That Shoots Plastic Pellets to a Gunfight

9 Jul 2012 /

Man shot to death by police even though family told 911 his gun was fake

U.S. News

Two of the Strangest Mental Disorders Ever

25 Jun 2012 /

Cotard’s Syndrome – The patient believes he is dead.

Capgras Syndrome – The patient believes that a friend, spouse, parent, or other close family member has been replaced by an identical-looking impostor.

The second one reminds me of the old Steven Wright joke: “Last night somebody broke into my apartment and replaced everything with exact duplicates … When I pointed it out to my roommate, he said, ‘Do I know you?'”


Twitter: 2010-11-20

20 Nov 2010 /
Twitter
  • RT @eddiepepitone: when my shrink straps me in for electroshock therapy I know it's going to be a good day if the voltage is just right. #

Short Books

14 Aug 2010 /

My kid’s got a summer assignment for AP English — select and read two novels from a list of about 20.

I’ve been telling him since June that I’d be glad to go over the list with him and recommend books that he might enjoy reading but he’s put it off so long now that I’m limited to recommending short books that he might enjoy reading, and that leaves us with Ethan Frome, Wide Sargasso Sea and All the Pretty Horses.

He comes back from the bookstore with Frome and Sargasso, two books about men who marry crazy women.

He ruled out All the Pretty Horses because it’s 300 pages long and “I read the first sentence and it had like six adjectives.”


Twitter: 2010-03-10

10 Mar 2010 /
Twitter
  • RT @eddiepepitone: Zagat's guide: best mental institution is Creedmore. Their chicken a la king will drive you nuts-great game room as well. #

Dad Is Not Nuts

14 Dec 2009 /

As part of a family discussion, my mom names the three members of our extended family whom she considers to be nuts.

My sister adds two more people to the list, including my dad.

“No, Dad is not nuts,” my mom says, “although he gets along well with the nuts.”

My dad says to me, “That’s the best compliment I’ve ever had from this family.”

“That you’re not nuts?” I ask.

“That’s right.”


Microblog: 2009-04-20

20 Apr 2009 /
  • Carrie Fisher on her core audience: Alcoholics, addicts, gay (both sexes), mentally ill & people named Erica – http://twurl.nl/hvswww #
  • You know my motto: I never metacognitive I didn’t like. #
  • Temps are soaring in the OC. Treated myself to an ice-cold lemonade at lunch… #
  • @NoReinsGirl That’s why I stockpile rum, coke and ice. Emergency preparedness! in reply to NoReinsGirl #

Core Audience

19 Apr 2009 /

Carrie Fisher on her core audience:

Alcoholics, addicts, gay (both sexes), mentally ill & people named Erica……


Really Crazy

17 Dec 2008 /

I had an office visit with my doctor, who is also my wife’s doctor . . .

We always spend a few minutes talking about my wife, who, to use the medical terminology, is “really crazy.”

“She is really crazy,” the doctor says. “I don’t know how you keep your sanity. You always seem so calm. I bow to you.” And she stretches both arms out and actually bows.

I’m glad someone is able to get a laugh out of it.

Then she refills my Paxil prescription so I can make it through the next six months . . .


More People I’m Sick Unto Death Of

1 Dec 2008 /

Diagonal Jaywalkers

I don’t mind if you want to cut across the middle of the road. I do that myself.

But when I do it, I take a straight line perpendicular to the street and I walk briskly, maybe even jog a little bit. I don’t take a diagonal path into oncoming traffic and refuse to speed up when I see a car coming.

Why do I not do it that way, you ask?

Two reasons:

  1. The person driving the car may not be paying attention and may run me over and kill me.
  2. The person driving the car may be a crazy person looking to run over anybody who gets in his way. YOU DON’T THINK SO?! There’s a lot of nuts out there! Read the news! I swear to god, some days I feel like I’m just hanging on by a thread myself.

Think about that the next time you try to walk in front of my car.


You Don’t Say

10 Sep 2008 /

One of our exercises in Crucial Conversations training was to “think of a person who is really frustrating to work with,” and to describe in writing a recent interaction with that person in terms of what was actually said, and what you were thinking or feeling but didn’t say.

My responses included the following:

What I Actually Said
This project presents some unique challenges.
What I Didn’t Say
I have a lot of experience managing IT projects, but not in running a day care center or a mental institution, which is what this project requires.
What I Actually Said
That’s not quite the way I would have phrased it.
What I Didn’t Say
Everyone else in these meetings seems to feel constrained by a sense of professionalism and decency that you appear not to possess.

One of my colleagues at our table of four claimed that based on those responses, she could identify the person I was writing about.

Since she and I and the person in question have never worked on anything together, I said she couldn’t, but much to my amazement, she did.


He Didn’t Go Crazy

23 Apr 2008 /

JACKSON, Mississippi (AP) — Paul Davis, a singer and songwriter whose soft rock hit “I Go Crazy” stayed on the charts for months after its release in 1977, died Tuesday. He was 60.

CNN.com

That’s disappointing.

Not the fact that he died, because who cares, really, but the fact that he didn’t actually go crazy and kill himself in some bizarre fashion . . .


Miyamoto Musashi

11 Jul 2007 /

On second thought, we have a family member who perceives things that cannot be seen, so #7 may be more indicative of mental illness than enlightenment . . .


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