Book review: What Is The Worst Case Scenario?

Book cover: What is the worse case scenario?

What Is the Worst Case Scenario? by Marie Abanga includes a foreword by mental health advocate and Olympian Amy Gamble. For anyone familiar with Marie’s blog, you will very much recognize her distinctive voice in this book.

Marie explains that writing this book was “my journey to a new me, a me who wants to keep facing and fighting fear, and also a me who wants to share with the world in all candidness.”  She shows her own evolution from FEAR as in Fold Everything And Run to instead Face Everything And Rise.

This memoir covers the birth of her sons, her marriage that turned out to be a sham, and her her own mental health challenges.  She shares that while pregnant with her third son things became so desperate that she picked up a knife and was ready to end her life.  It was feeling her son kicking inside her that saved her.

After her marriage ended, she left her sons at home in her native country of Cameroon and went to live in Belgium.  While living there she had to deal with the death of her brother as well as others stressors, and she became depressed and started having panic attacks.

She writes about the various fears she has had to tackle, including fear of failure, fear of love, and fear of being happy.

She explains that in Cameroon, mental illness tends to be attributed to “witchcraft, greed, or maybe a crazy lineage.”  Inspired in part by her brother’s experience of mental illness before his death, she chose to become a mental health advocate.  She writes: “Whenever I smell stigma, I spray more spirit on the open cut to burn it out and tell it to its darkness that I am an over-comer.”  She includes posts that other bloggers have shared about stigma.  Throughout the book there are also quotes included from various inspirational sources, including Maya Angelou.

This story captures Marie’s spirit and ability to persevere through adversity.  She has chosen to be vulnerable in sharing her story, and in doing so demonstrates how much strength there is in vulnerability.

 

You can find Marie on Marie Abanga’s Blog.

 

You can find my other book reviews here.

My first book, Psych Meds Made Simple: How & Why They Do What They Do, is available on Amazon as an ebook or paperback.

 

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The Pharma-psychiatry tango: necessary evil or dance with the devil?

This is a follow-up to a recent post on why I think direct-to-consumer advertising of prescription drugs is wrong. This post is going to look specifically at marketing by drug companies aimed at health care professionals.  Primarily this marketing targets physicians, since they’re doing the majority of the prescribing.

There are multiple different forms this marketing can take. One example is the drug reps that go around to medical offices. They’ll schmooze with physicians and do things like provide written information about the drug, give samples, and hand out assorted merch like pens and notepads so that their product name is in front of the prescriber’s eyeballs more often.  While drug reps receive training on their particular set of drugs, in most cases they don’t have health professional training.

Drug companies will also sponsor educational activities. They may sponsor a hospital’s departmental grand rounds, providing free lunch for an event that would have gone ahead with or without sponsorship.  A drug rep would often be there, happy for the opportunity to schmooze.

A pharmaceutical company might also bring in a speaker, typically a psychiatrist, to give a talk about the company’ drug.  This might be a local psychiatrist who the audience will already know and presumably trust, or someone who’s brought in from elsewhere and has strong credentials.  Typically there is food involved, because who doesn’t love free food, right?

Another strategy is to sponsor continuing education activities that are geared at a broader audience, which may take the form of a free webinar.  All health professionals have some form of continuing education requirements they have to meet every year, and the opportunity to get free continuing education hours can be attractive.

There are pros and cons with all of this.  Health professionals do need to learn about new drugs that are on the market.  Just because a talk is being sponsored by  a drug company does not necessarily mean that the speaker will be heavily biased.  Sometimes the featured speakers at drug company sponsored events are widely recognized as experts in their field.

Sometimes health care organizations will put restrictions on sponsored activities occurring onsite.  I remember earlier in my career going to grand rounds at the hospital I worked at and munching on drug company-funded lunch.  A few years later the healthy authority I worked at put the kibosh on sponsored events at any of the health authority’s sites.  I’ve been to a couple drug company-sponsored dinners, one with a speaker they’d brought in from elsewhere, and one with a local psychiatrist I really respected.  I fairly regularly do continuing education webinars that are free because of drug company sponsorship.  I like to think that I’m enough of an informed consumer of information to be able to evaluate what’s being given to me, and recognize that, sponsored or not, one particular talk is never going to give me the whole picture on the topic.

This is pure speculation, but I wonder if the most potential iffy part of what I’ve talked about so far is drug reps going into family doctors’ offices.  Psychiatrists are only really keeping up to date about new psychiatry meds, and the same is true with other specialties. General practitioners often have little free time, and they have to learn about a much wider range of new drugs.  Chances are, they’re going to be relying a little more on what they’re getting from drug reps.  Still, a health professional should have the background information to put new info from drug reps into a proper context, something that’s just not possible when it comes to direct-to-consumer advertising.

All of this is small potatoes compared to the potential for corruption at higher levels.  Drug companies’ primary objective is to generate profit for their shareholders.  Yes, it would be nice if they were concerned about the wellbeing of the people taking their drugs, but that’s not the reality of capitalism.  It may not be very nice, but it is what it is, and there’s no point pretending otherwise.  The problem really comes if the drug companies are getting in bed with regulators or with major medical organizations.  In an ideal world, the drug companies would be at not just arm’s length from regulators like the U.S. Food and Drug Administration (FDA), but more like football field length.  Of course, we don’t live in an ideal world, and that kind of thing can be difficult to enforce.  What if John Smith worked at the FDA for years, and decides he’s ready to make some big bucks and takes a position at a drug company.  It’s pretty tough to regulate away that influence John Smith is still going to have with all his old buddies at the FDA.  It’s the old boys’ club at its finest.

Concerns have been raised about drug companies having undue influence with the American Psychiatric Association’s committee responsible for developing the most recent edition of the Diagnostic and Statistical Manual (DSM-5).  The fact that the people on the committee have received either research funding or speaking fees from drug company doesn’t inherently mean they’re biased.  Often, prominent figures within a specialty field are particularly sought after by drug companies for that kind of thing; it doesn’t mean they’re necessarily drug company flunkies.  Yet the old boys’ club appearance is still there.

I think sometimes arguments in that area go a bit too far and throw the baby out with the bathwater, so to speak.  Sometimes GlaxoSmithKline, the makes of Paxil, are accused of inventing social anxiety disorder as a way to sell more Paxil.  Whatever role they did or did not play in the inclusion of social anxiety disorder in the DSM, there are many sufferers who would attest that social anxiety disorder is all too real and all too debilitating.

Of all of these areas, the relationships between drug companies and regulators like the FDA are most likely to cause damage, and that damage can occur on a very broad scale.  If alarming research results are being hushed up because the drug companies are too cozy with the FDA, that’s dangerous.  What is the answer, though?  I wish I knew.

 

psych meds made simple

 

My first book, Psych Meds Made Simple: How & Why They Do What They Do, is now available on Amazon as an ebook or paperback.  It’s everything you didn’t realize you wanted to know about medications!

The blogger’s guide to the basics of self-publishing

book lying on grass surrounded by leaves

I did quite a bit of research on this topic for my book that came out last week, and I’ve seen several bloggers mention that they’re also contemplating doing books at some point, so I thought I would share some of what I’ve learned.  I’m by no means an expert, but I’ve managed to get past the initial deer in the headlights phase.

Where to publish

There are multiple ways to publish a book, and you can stick to one or do a a mix of several.  Amazon is the biggest fish in the sea with their Kindle Direct Publishing (KDP) program.  They allow you to publish an ebook and/or paperback with no up front costs to you.  I’ll come back to them soon.

You can also publish directly through other book publishing platforms.  Apple’s iBooks is one option, and they have an iBook Author app that can help.  If you use Apple’s Pages word processing software, in your file menu there’s a “publish to Apple Books” option built right in  Apple’s market share is fairly small, so you probably won’t want that to be your only option.  Rakuten’s Kobo has a larger share of the ebook market than Apple, and their Writing Life platform can be used to prepare a manuscript to publish with Kobo.  Kobo ebooks can be read on Kobo ereaders or using the Kobo app.  You can set your ebook price, and it looks like typically royalties would be 70%

You can also publish through a distributor like Smashwords.  They will help you put together your book, and then distribute it to various booksellers including iBooks, Kobo, Barnes & Noble, and a few other platforms like OverDrive that sells to public libraries.  You don’t pay an upfront fee to publish your book, but they will take a cut of sales.  Your royalty on sales would depend on where the sale was made.  Your royalties are going to end up being lower than if you dealt with each of the different selling platforms directly, but that’s the price you pay for the convenience of having Smashwords do all the work.  There are a variety of similar distributors out there, but Smashwords is the only one I’ve looked into.

Ebooks on Amazon

While you have the option of publishing your book through several platforms, simplicity can be nice, especially when you’re starting out.  Amazon has a program called KDP Select, in which you agree to publish your ebook exclusively through Amazon.  They obviously would prefer if you did this, and there are two key draws.  You have to be enrolled in KDP Select for your book to be available through Kindle Unlimited, where people pay a monthly fee and can read as many books as they want.  The royalties you would get from Kindle Unlimited would depend on how much your book was read.  The other drawing point for KDP Select is that you get higher royalties on book sales (typically 70%).

There is a Kindle Create app that will help you format your book from a Word document.  You can design your book cover using Amazon’s online Cover Creator tool, or you can make your own using a site like Canva (which is what I did).  There’s also the option of paying a designer to come up with something fancier.  KDP ebooks are formatted to be read by either Kindle ereaders or the Kindle Reader app, which can be downloaded onto your desktop/laptop or mobile device.

Paperbacks on Amazon

Amazon gives you guidance on how to format your manuscript for a paperback, and they have Microsoft Word templates that you can use.  I decided to do it without using a template, and it wasn’t particularly difficult, although I use Apple Pages rather than Microsoft Word, so it took a bit of extra time to figure out how to do some of the steps.

Amazon will print paperbacks of your book on demand, i.e. when someone orders one.  They let you know how much it will cost to print the book so your book can be priced accordingly.  Because the books are printed on-demand, you don’t have to pay money up front for them to have a supply available.  You can choose the extended distribution option to make your paperback available through retailers other than Amazon, but you get a much lower royalty for books sold that way.

Paperbacks need to have an ISBN (international standard book number); this is optional for ebooks.  KDP will give you a free ISBN, and the publisher associated with that ISBN will be listed as “independently published”.  You can also purchase your own ISBN, and this allows you to designate your own publisher name.  I haven’t been able to figure out why this would be worth paying for, but in Canada we can get free ISBNs through the government, so I was officially published by Mental Health @ Home Books.  It’s kind of fun, but not so fun that I’d be willing to cough up money for it.

The actual volume of information that KDP makes available can be a bit daunting  at first.  A good place to start is their KDP Jumpstart learning series to help you get familiar with all the different aspects of self-publishing.  It takes you through everything step by step, and I found it quite helpful.

Promotion

Publishing a book also means promoting your book.  Obviously your blog is a good place to do this, as well as social media.  There are a number of bloggers out there publishing books, so watch what they’re doing and get ideas from them.  Marketing is definitely not my forte, so it’s something I’m fumbling along with and trying to figure out as best I can.

To help potential readers get to know a bit more about you, you can create an author page on Amazon or whatever platform you publish on.  Goodreads is another good place to create an author page.  There are a variety of other book sites like AUTHORSdb and iAuthor that you can sign up with to help put your book out there to the world.  Booklife from Publisher’s Weekly has some good resources.

You can also check out Writers With Mental Illness (also on Twitter), which aims to support writers with mental illness and neurodiversity.

 

For my book I decided to go with Amazon and with KDP Select, in large part for the sake of simplicity.  My paperback will be available through extended distribution as well, only because I’m hoping my local library will pick it up as part of their local indie author program.  So far I’ve been happy with the Amazon experience, although the Kindle Create app didn’t do everything that I wanted it to do.

Are you thinking of publishing a book at some point?  Have you started researching options yet?

 

psych meds made simple

 

My first book, Psych Meds Made Simple: How & Why They Do What They Do, is now available on Amazon as an ebook or paperback.  It’s everything you didn’t realize you wanted to know about medications!

 

So You Know

Revenge of Eye So You Know

 

So You Know (S.Y.K.) is a new weekly challenge from Revenge of Eve.  This week’s questions are:

  • What is the soul?
  • What is religion?
  • What is spirituality?
  • What purpose do humans serve in the scheme of things?

 

What is the soul?

I conceptualize the soul as the energy that is contained within our body.  I also think of the physics law of conservation of energy, and so it makes sense to me that when we die the energy contained within us goes back into the earth.  Sort of a Lion King circle of life kind of deal.

What is religion?

When I think religion I think of organized belief systems that address broad issues like a higher power, greater purpose, and the meaning of life and death.  While this is something that can potentially give people a great deal of comfort, particularly during difficult times, rigid adherence to doctrine can cause a lot of problems.  It can also get in the way of acceptance of others, especially those with different belief systems, although that’s probably more about certain people’s interpretation than anything else.  The number of people who have been killed throughout history related to religious beliefs is truly frightening, and to me it shows that at its core religion may be about a higher power, but in practice its led by fallible humans who can become corrupted by power.

Personally the idea of an organized belief system doesn’t sit very well with me, so I am not and never will be a religious person.  My parents were atheists as well, so it’s probably not too surprising that I turned out this way.

What is spirituality?

I see spirituality as each person’s individual beliefs around the same sort of broader questions that religion addresses.  Spirituality may be based highly, somewhat, or not at all on religious beliefs.  Spiritual practices can include anything that allows us as individuals to connect with something greater than the microcosm of ourselves.

What purpose do humans serve in the scheme of things?

I’m not convinced there is a greater scheme of things, but I think if we can be compassionate towards others then we’ve done what we came here for.

 


 

If you want to join in, these are the S.Y.K. guidelines:

  • There are no right or wrong answers… Your answers = Your opinion = Your life
  • Answer a few or one, whatever you are comfortable with
  • Pingback to any S.Y.K. post
  • Use the hashtag #SYK to tag your post
  • Be real.  If you feel a certain type of way, say it.  You were asked your opinion 😉 (double dog dare)

Setting sail with the ACT life compass

ACT life compass

Image credit: Dr. John Forsyth

Acceptance and Commitment Therapy (ACT) is a type of psychotherapy that takes the stance that avoidance and resistance to internal experiences identified as negative is what causes cognitive distress.  To resolve distress, ACT suggests that we need to employ strategies like mindfulness, de-fusion from our thoughts, and recognizing the self as the context in which inner experiences occur rather than the content of those thoughts and emotions.  The commitment part of the ACT name refers to committing to actions that are consistent with out identified values.

ACT has a tool for this called the life compass.  You can find out more about the life compass and other ACT tools on the website of Dr. John Forsyth.  Dr. Russ Harris’s ACT Mindfully website also has some great resources.

The life compass looks at where you’re headed in ten key life areas: recreation/leisure, work/career, intimate relationships, parenting, education/learning, community life/environment/nature, friends/social life, spirituality, family of origin, and health/physical self-care. 

For each life domain, you’re supposed to come up with intentions that are based on your personal values and reflect the way you would like your life to look in terms of that domain.  As an example, you might consider why learning is important to you and what type of skills or knowledge that you would like to gain that would be consistent with that.  For the friends domain, intentions may include what type of friend you would like to be and what a good friendship would look like.  This process is less about specific goals or endpoints and more about valued directions.

Each direction of the life compass is rates on a scale of 1=10 for the importance (i= on the diagram above) and recent committed action (c=) towards those intentions.  You can also rate current satisfaction in each area.  Pay particular attention to areas where there is a large discrepancy between importance and either action or satisfaction.  Also identify any potential barriers you may face.  Then consider the actions that you can do now that lead you in the direction that your compass points.

Here’s a quick overview of my life compass would look like:

Recreation/leisure

Blogging is my primary leisure activity, and I hope that continues.  It’s very important to me as a form of connection and self-expression, and the amount of time I spend on it reflects that.

Work/career

My illness is a major barrier in this area, and has prompted a significant reevaluation.  My intention now is to continue to have meaningful one-on-one interactions with patients, which fits in with my value of wanting to do meaningful and fulfilling work.

Education/learning

I’m finished my formal education, but I want to continue to learn new things at any possible opportunity, and ongoing learning is a key value for me.  This area is of high importance, and I’m satisfied with how I’ve been doing.

Community life/environment/nature

I like the neighbourhood where I live.  I’ve never been particularly community-oriented in a social sense, but I do feel a sense of belonging where I am.  The natural environment is pretty spectacular, and I guess my attention would be to continue to actively appreciate and be mindful of that natural beauty.

Friends/social life

Almost all of my social interaction is online these days.  For now at least, that’s what works.  I have valued in-person connections with people close to me in the past, but realistically depression gets in the way of that.

Spirituality

I’m not religious, nor am I particular spiritual.  I think what matters to me in this area is recognizing the shared humanity among all of us.  I’m not sure exactly what that would look like in practice, but I suppose showing compassion is part of it.

Family of origin

I would rate my satisfaction in this area a fair bit lower than the importance that I place on it (at least some of the time).  I really don’t know what my intention is, but I know my illness has been a major barrier (for me, not for them).  So all I can really come up with is a big question mark.

Health/physical self-care

I’ve accepted that I have only a limited degree of control over my life.  My intention in this area is to continue to be an active participant in my health, and to incorporate both pro-wellness and anti-illness strategies.  Sometimes it feels like I’m flailing, but overall I think I’m doing the best I can.

Not applicable

Parenting and intimate relationships are not in my life right now and may well never be, but they are also not things that are of high importance to me, so their absence doesn’t bother me.

 

What are some of the intentions that would play an important role in your life compass?

 

psych meds made simple

 

My first book, Psych Meds Made Simple: How & Why They Do What They Do, is now available on Amazon as an ebook or paperback.  It’s everything you didn’t realize you wanted to know about medications!

Weekend wrap-up

wrapping paper, ribbon, and twine

Rawpixel on Pixabay

Here’s what happened in my life over the past week:

  • I launched my book Psych Meds Made Simple.  It was very cool to get such a positive reaction from people.  Thank you! ❤️  And because of the fabulous people who bought my ebook, it’s a #1 new release in the “popular psychology psychopharmacology” category on Amazon.  Now granted, I don’t imagine there’s a whole lot of competition in that particular micro-mini-niche, but it’s still pretty darn cool.
  • As I mentioned in my post yesterday on psychomotor retardation, I’ve been really slowed down this week.  That has meant not leaving the house, not showering until I got so stinky I grossed myself out, and watching the minutes tick by with agonizing slowness.  Luckily you can get everything you need delivered these days, so I haven’t needed to leave home at all.  Thankfully there’s been an improvement as the week has gone on.  This morning I ventured past my front door for the first time in a week.  Not very far, mind you; I just took out some recycling and picked up my mail, and it was ok but I’m still walking very slowly.
  • Uncomfortable Revolution™ published my story A Venetian Romantic Getaway For Me and My Depression.  I also published Easy money-saving tricks on Vocal Lifehack.
  • I didn’t get much writing done this week (the pieces I just mentioned were written a while ago), and I definitely appreciate my system of always having 2-3 weeks worth of posts scheduled ahead of time; it keeps me from putting any pressure on myself around writing.

 

How has your week been?

 

psych meds made simple

 

My first book, Psych Meds Made Simple: How & Why They Do What They Do, is now available on Amazon as an ebook or paperback.  It’s everything you didn’t realize you wanted to know about medications!

What is… psychomotor retardation

In this series, I dig a little deeper into the meaning of psychological terms.

This week’s term: psychomotor retardation

Psychomotor retardation is one of the less common but more outwardly observable symptoms of depression, and is listed as one of the possible diagnostic criteria for a major depressive episode (in major depressive disorder, bipolar disorder, or schizoaffective disorder).  It involves a slowing of both thinking and physical movement, and often includes slowed speech with delayed responses and quiet volume.  Gaze tends to be fixed and eye contact is avoided.  Affect is often flat, meaning there is little to no facial expression of emotions.

These symptoms have been described as far back as ancient Greek times.

There is a standardized test to measure psychomotor retardation called the Salpêtrière Retardation Rating Scale.  It contains 14 items that measure walking, speed of movements in the limbs/trunk and head/neck, flow of speech, speech volume, shortness of verbal responses, limited spontaneous speech, easily fatigued, rumination, loss of interest, time perceived as painfully slow, and problems with memory and concentration.

The Motor Agitation and Retardation Scale is another test used to evaluate the extent of psychomotor retardation.  It considers abnormal gait, immobility of trunk and proximal limbs, postural collapse, slowing of movement, flat affect, downcast gaze, and speech that is soft and monotone, with delayed onset.

It’s not known exactly what causes this symptom, but it’s been suggested that changes in neural circuits in the prefrontal cortex may affect the basal ganglia, an area of the brain involved in regulating movement.  The neurotransmitter dopamine may play a role.  The hypothalamic-pituitary-adrenal axis, which connects the brain and the adrenal glands, has also been implicated.  There may also be reduced regional cerebral blood flow.

Psychomotor retardation is more common in the melancholic subtype of depression, and  also in depression with psychotic features.  One study found that a higher number of previous depressive episodes was associated with more severe psychomotor symptoms, particularly the cognitive aspects.  Electroconvulsive therapy (ECT) seems to be particularly helpful for this aspect of depression.

Slowed psychomotor activity has appeared off and on throughout the course of my illness.  It was particularly bad during my second hospitalization, which lasted two months.  As time has passed, though, there’s been a pattern of abrupt onset psychomotor retardation in response to major environmental stressors.  It generally starts when I wake up the day following the stressor, and tends to last a few weeks.  It’s always been something I’ve been quite aware of but have no control over.  I’ve come to conceptualize it as my brain’s way of trying to protect me from the world, because my thinking gets slowed down and my emotions are shoved off into a corner somewhere.

This was triggered again for me this past weekend after the stigmatized cluster-f*ck I experienced when I went into ER (twice) for physical reasons but they decided I was just a psych patient.  When I woke up the next morning, even walking to the bathroom was a challenge.  For me at least it’s not the same feeling as lack of energy; it’s more like my body is trying to resist the movement.  The rating scale described above mentions slowing of time; I don’t always experience that, but this time around it was pretty painful for a few days.  I didn’t feel like doing anything, even watching tv, and of course that made the time go by even slower.  Putting words together to speak out loud can be challenging.

Is psychomotor retardation a symptom you’ve experienced with your illness?  Have you noticed any patterns with it?

 

You can find the rest of my What Is series on my blog index.

Sources:

 

psych meds made simple

 

My first book, Psych Meds Made Simple: How & Why They Do What They Do, is now available on Amazon as an ebook or paperback.  It’s everything you didn’t realize you wanted to know about medications!

Should pharmaceutical advertising be banned?

In many countries, direct to consumer advertising (DTCA) of prescription drugs is either prohibited or tightly restricted.  The United States is a notable exception, along with New Zealand.  For tv ads, the standard pattern is to talk about the illness, talk about the amazing benefits of the drug, and then provide the required long list of side effects in an upbeat tone of voice while cheerful music plays and people are shown happily living their wonderful lives.  The ad closes with something along the lines of “ask you doctor if _____ is right for you”.  If you haven’t seen one of these ads before, there are a couple of examples at the end of this post.

Drug company marketing to health care providers is a related but distinct issue that’s deserving of its own post, so I’ll set it aside for the sake of this post and focus solely on issues around DTCA.

Wikipedia cites a study that reported expenditures in the U.S. grew from $1.1 billion in 1997 to $4.2 billion in 2005.  In the last ten years, four major pharmaceutical companies have reached settlements of greater than $1 billion with the U.S. Food and Drug Administration (FDA) over allegations of illegal marketing.  Psychiatric medications were among the drugs involved in all of these settlements.  Prescription drug ads do not need to be pre-screened by the FDA before they can be printed or broadcast, so even if an ad is later found to be in violation of the laws, it will have already been seen by large numbers of consumers.

In Canada there’s a loophole of sorts that allows marketing of drugs as long as there’s no mention of what medical condition the drug is used for.  In 2006 the independent Health Council of Canada published a report looking at at the public health implications associated with direct to consumer advertising of prescription drugs.  They recommended closing this loophole and prohibiting all DTCA of prescription drugs.

What are the potential benefits?

Clearly the winner here is the drug companies themselves.  But what are the supposed benefits to consumers from this kind of advertising?  According to the Health Council of Canada report, some of the benefits that are claimed are consumer education, increased autonomy in health care decision making, earlier diagnosis of illnesses, and increased medication compliance.

Public service announcements may be educational, but commercial advertisements are not.  Whether its drugs or laundry detergent, the purpose is to sell a product.  Any information that is gained through commercial advertising is only to support the primary sales purpose and will likely heavily biased.

In terms of autonomy, I’m not sure that going to the doctor and requesting drug X truly represents autonomous decision making.  In fact, if patients are forming spurious judgments about the state of their health and the treatment they need, they lose the true autonomy that comes from getting a well-reason diagnosis and being presented with appropriate treatment options in a way that allows them to make informed decisions.

As for earlier diagnosis, this brings to mind issues with misleading Paxil advertising that essentially claimed that everyone (and probably their dog too) had social anxiety disorder and needed to be medicated.  Social anxiety is a very real and potentially debilitating condition, but the makers of Paxil were casting a much wider net than that.  People who are unwell will make their own decisions about whether or not to seek medical help, but there’s no need for the masses to go rushing to their doctor asking for drugs because pharmaceutical marketing campaigns told them they were most likely sick.

I fail to see how compliance could be improved, unless the line of thinking goes that if a patient asks their doctor for drug X (whether they need it or not), they’re more likely to take drug X?  Or does seeing a Pristiq ad on tv remind someone that they forgot to take their medication that morning?  It all seems like a rather flimsy argument.

What are the potential harms?

According to studies cited in the Health Council of Canada report, direct-to-consumer advertising influences both patient demand and physician prescribing.  A study of general practitioners in New Zealand found that almost 70% felt pressured by their patients to prescribe medications.  A study conducted in the U.S. and Canada found that when patients went into an appointment requesting a drug, they were 17 times more likely to be prescribed a drug by the end of that appointment.

Pharmaceutical ads that claim Drug X is wonderful for condition Y are targeting consumers who likely don’t have the medical knowledge base to determine whether Drug X is in any way appropriate for them, and may have no idea if they actually have condition Y or not.  If they go to their doctor requesting Drug X, a prescriber may order Drug X rather than the more appropriate Drug Z in order to appease the patient, or they may try to appease the patient by giving them Drug X even though they don’t actually meet the full diagnostic criteria for condition Y.  While this may seem like poor practice on the part of physicians, it’s certainly not unheard of.  As an example, overprescribing of antibiotics is driven in part by patients who are going in to see their doctor and demanding antibiotics even though they most likely have a viral illness that antibiotics will do nothing for.  Doctors are busy enough without having to spend time trying to re-educate patients who have been misinformed by drug company ads.

 

Decisions about an individual’s medication treatment should be made by that person and their healthcare providers based on their specific health concerns.  Pharmaceutical companies should not have the opportunity to interfere in that process.  The whole reason drugs are prescription only is that medical professionals need to determine whether or not they are appropriate for a given patient.  If patients are going into their medical appointments having actually researched treatment options, that’s great, but watching a pharmaceutical ad is not research.  It’s a sales pitch.

A 2013 opinion piece in the New York Times says that “biased pill-pushing messages are a public health menace.”  I agree, and it would be nice to see regulators in the U.S. and New Zealand stand up to the powerful pharmaceutical lobby and put an end to direct to consumer advertising.  Sales tactics have no place in mental health care.

 

What are your thoughts?

 

Sample ads posted on Youtube:

 

psych meds made simple

 

My first book, Psych Meds Made Simple: How & Why They Do What They Do, is now available on Amazon as an ebook or paperback.  It’s everything you didn’t realize you wanted to know about medications!

Book review: Searching For The Truth

Book cover: Searching For The Truth

Searching For The Truth: Poems & Prose Inspired by our Inner Worlds by Maranda Russell begins with the dedication: “For everyone who isn’t afraid to search for the truth, even if it means looking outside your comfort zone.”

The book takes a very personal look at difficult topics like death, uncertainty, pain, and fear.  In the intro Maranda describes her writing style as “short, blunt, and to the point”; personally I found that strengthened the poems rather than weakening them.  Descriptors are concise but meaningful, like “emotional sewage” and “their heads sloshing over with tough questions.”

One short, powerful poem focuses on all-consuming bitterness.  Another talks about forgiving someone who only saw the worst in her.  One of my favourite poems was On Opinions, and I think it needs to be put on a sign and waved around vigorously as needed:

Everyone has opinions,
but not everyone
should share theirs.

I’m sorry to tell you,
but your opinions –
no matter how closely held,
do not override
scientific fact.

 

Book cover: Stories Behind My Art

You should also check out Stories Behind My Art, in which Maranda shows that being an artist is more about staying true to yourself than doing what others might think you’re supposed to do. The book includes several pieces of her art, along with descriptions of the meaning behind each one. I found having the combination of visual art and words allowed me to see things in the art that I wouldn’t otherwise have seen. There was a good mix of pieces that contained profound messages and others that captured some of the simple beauties and pleasures of life.

 

These are both short books that are easy to read, and I would definitely recommend that you check them out!

 

You can find Maranda on her blog Maranda Russell.

 

You can find my other book reviews here.

My first book, Psych Meds Made Simple: How & Why They Do What They Do, is available on Amazon as an ebook or paperback.

 

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Please don’t see me…

Last week I was in a grocery store outside my neighbourhood. I was feeling physically lousy that day, and had greasy hair and was wearing the previous day’s clothes that I’d slept in.

In the produce section, I spotted a former coworker. This was someone I used to really like working with, and a very kind person. My first reaction, though, was to hide, so I took a detour on my way to grab celery for the guinea pigs. Then I spotted him again in the bakery section, this time about to walk right by me. I did a quick 180 to keep my face hidden, and I think chances are he was preoccupied or else he would’ve noticed the weirdo doing the evasive manoeuvre.

It’s not as though this was someone who I had any negative associations with, so what was going on? I looked like crap, but that wasn’t the issue either – or at least, it wasn’t a major factor.

I think the biggest factor was embarrassment. My level of functioning career-wise has tanked over the last few years. There’s a very good reason for that (my illness) and I’ve made the most of what I’ve been dealt, so most of the time it’s not an issue. But when I’m faced with the possibility of talking to former colleagues, I start to feel inadequate.

This colleague I avoided in the grocery store wouldn’t have judged (or if he did, he would have kept it very much to himself). He was always really supportive when it came to my illness. So if the judgment wasn’t going to come from him, that meant that it was firmly rooted in my head.

I think part of the issue is that when seeing former colleagues, naturally the first topic of conversation that’s going to come up is work. That’s just the way it is, and there’s no way around it.  And if it doesn’t happen to be the first thing that comes up, it’s guaranteed to be the second. And I don’t want to talk about work, but really in that context there’s no way to avoid it.

I suppose it’s sort of an identity thing too. I used to be a nurse, then that shifted to nurse with a side of patient, then straddling nurse-patient, and now patient with a side of nurse. And that is what it is, but it does change who I am in relation to my old colleagues.  My identity has evolved over time, but for colleagues who I haven’t seen for several years, they know me from a few different identities ago and to them this would look like a large shift.

I don’t know if my weird explanation makes any sense, but I suspect I’m not alone in wanting to avoid or hide from certain people. Is that something you’ve experienced?

3.2.1 Quote me! – Creativity

paints, brushes, and paper

It’s season 3 of the 3.2.1 Quote Me! game created by Rory at A Guy Called Bloke and K9 Doodlepip.  Today’s topic is creativity, and thank you  to Beckie at Beckie’s Mental Mess for tagging me.

The rules (which I’m not going to follow entirely):

Rules: 3.2.1 Quote Me!

Thank the Selector

Post 2 quotes for the dedicated Topic of the Day.

Tag 3 bloggers to take part in ‘3.2.1 Quote Me!’

Note: Although this is the topic for today there is no specific deadline to it, meaning you can answer as and when.

Please Note l will be reblogging your responses unless you wish for me to NOT do so.

 

This one clearly comes from a fellow introvert:

“Solitude is creativity’s best friend, and solitude is refreshment for our souls.” – Naomi Judd

The second one seems to capture the creative process particularly well:

“Creativity is a spark. It can be excruciating when we’re rubbing two rocks together and getting nothing. And it can be intensely satisfying when the flame catches and a new idea sweeps around the world.” – Jonah Lehrer

It’s book release day!

psych meds made simple

My first book, Psych Meds Made Simple: How & Why They Do What They Do, is available today on Amazon as an ebook or paperback.  It’s everything you didn’t realize you wanted to know about medications!

So, what’s this book about?  People living with mental illness are often left out of the loop when it comes to understanding how exactly medications work.  This book explains pharmacology in a simplified, accessible way to help you understand the effects, both positive and negative, of psychiatric medications and why these effects occur.

Psych Meds Made Simple begins with the essentials of pharmacology and then moves on to cover all the major classes of psychiatric medications.  You’ll learn why one medication in a particular class might be a better fit for you than another.  Are you having weight gain from your medication?  You’ll find out why, and what other medications might be less likely to have the same side effect.

I’ve pulled together what I’ve learned in my training as a nurse and (former) pharmacist and years of clinical experience, added in my personal perspective from having taken many of these medications, and distilled it all down to the essential elements you need to know.

Chapter list:

  • Neurotransmitters and receptors
  • Pharmacology fundamentals
  • Antidepressants
  • Mood stabilizers
  • Antipsychotics
  • Anxiolytics and sedatives
  • Stimulants
  • Putting the pieces together

I’ve written this book from the perspective that medications can be a powerful tool against mental illness, but they’re not a cure and they should never be the only tool in your toolbox.  The more you know, the better position you’re in to make decisions about your own health and illness.

A huge thank you to the people that have pre-ordered Psych Meds Made Simple!!!!

 

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Adventures in stigma in the ER

I mentioned in yesterday’s post that a few days ago my family doctor had sent me into hospital because of worsening shortness of breath.  It seemed like the ER doc took one look at my list of psych meds and decided to write me off as a psych patient.  He barely listened to anything I said, and kept asking what the point was of my GP sending me in.  All he wanted to do was repeat the tests my GP had already done and refer me to an outpatient clinic.  I was upset with being dismissed like that, and there was no need for me to be in ER to do what my doctor had already done, so I left.

Then yesterday comes along.  From the time I woke up, I was extremely dizzy, to the point where even walking around my apartment was difficult.  I checked my blood pressure a few times, and it was very high.  My heart rate was also high.  On one recheck of my blood pressure it was 170/118, which is extremely high.  I still didn’t really want to go back to ER after the experience I had a couple days before, but I called the provincial Healthlink phone line and talked to a nurse, who thought I should definitely go in to ER.

I was too busy to make it to my building’s front entrance to catch a taxi, so I called an ambulance.  The paramedics showed up a short time later.  When they loaded me in the ambulance, they rechecked my blood pressure.  It was still high, but not dangerously so.  At that point I was freaking out, thinking that ER was going to brush me off as a psych patient and not take the physical stuff seriously.  I was upset and started crying, and told the paramedics there was no point in me going to ER.  They assured me that my physical issues were concerning and they would advocate for those to be taken seriously.  After several minutes of cry-fest, I decided to go ahead and go to ER, mostly because I didn’t think I could walk back to my apartment from the ambulance.

After waiting for a while in the waiting room with paramedics, a triage nurse directed me to a chair in the triage area to wait in.  I had no further contact with ER staff until 3 hours later when the psychiatric triage nurse came to talk to me.  The initial triage nurse had entered into their system that my presenting complaint was depression.

I was so upset with this, and I wish I hadn’t had such a strong emotional reaction because it made me less able to stand up for myself.  I asked to talk to the nurse who had triaged me, and she was defending her decision, saying I was in ER for a mix of things and she had to pick one so she had picked depression.  She showed me the triage form she had completed for me based on what ambulance had said, and based on that my presenting concerns were shortness of breath, dizziness, and hypertension, and depression was part of my history.  Yet when entering me into the hospital system, it was depression.  I told her that had nothing to do with why I was there, but she kept insisting that yes, it was.  She minimized all of my physical concerns, to the point of being really offensive.  She told me that my vital signs were stable, even though it had been three hours since my vital signs were last checked.  One of the things she brought up was that I didn’t make eye contact during the two seconds that she directed me to a chair, as if that right there decided things.  I told her that this was typical of the stigma around mental illness, and she said she didn’t have stigma, and she has friends with mental illness.

I asked to speak to a manager, but with it being a weekend there wasn’t a manager on duty, so she brought in the ER charge nurse.  Of course the charge nurse backed the triage nurse, minimized my physical concerns, and was disgustingly patronizing.  Any time I swore she shushed me and told me not to swear because there were senior citizens around.

At that point I was just done, so I left.  No marching confidently out; I was still extremely dizzy, so my walking was slow, tentative, and wobbly.  But who gives a crap about that, right?  I’m JUST a psych patient.

This hospital is part of Vancouver Coastal Health, an organization that has traumatized me before, both when I have been a patient and when I was an employee (I’m a nurse) being bullied.  While they proudly claim to have processes in place for dealing with complains, I know from experience that what they actually do is brush things under the rug rather than acknowledging and dealing with them.  They steadfastly refused to admit that the workplace bullying I experienced actually happened.  Their modus operandi seems to be making the whole ordeal as stressful as possible for the person making the complaint.  So I emailed their Patient Care Quality Office to express my concerns, but I asked them not to contact me to follow up, and instead pass on to the ER manager that some anti-stigma training is called for.  I also sent in a complaint about the paramedics who transported me to hospital for telling me one thing and telling the triage nurse something entirely different.  I’m also going to call out Vancouver Coastal Health on Twitter.

Unsurprisingly, this has set me back in terms of my depression.  I’m prone to developing psychomotor retardation (a depressive symptoms involving slowing of movement and thoughts) in response to overwhelming stressors.  Combine that with ongoing dizziness and moving around is quite the challenge.

This kind of thing is not okay.  There is more than enough stigma to go around without health care providers hopping on board.  Just because someone has a mental illness does not mean that it’s always to primary issue or that their physical concerns are trivial.

Weekend wrap-up

wrapping paper, ribbon, and twine

Rawpixel on Pixabay

Here’s what happened in my life over the past week:

  • The difficulty breathing that started last week has just gotten worse. Since further testing wasn’t going to be available any time soon in the community, my doctor decided to send me in to emergency. The waiting room was horrible – way over-stimulating.  Unfortunately, it only got worse from there.  The ER doc had clearly decided by the time he met with me that he wasn’t going to take me seriously.  He barely listened to a word I said.  He kept asking what the point was of my doctor sending me in.  He thought I had asthma, which is total BS.  I ended up walking out in tears after meeting with him.  It was only afterwards that it clicked that he had asked if I was taking all my medications regularly (I’d told the triage nurse about all the psych meds I take).  Suddenly it made sense.  He had seen my long list of psych meds and made his decision based on that.  He was probably a jackass in general, but anti-mental illness stigma kicked up the jackass factor a few notches.
  • This week has been a bit of a write-off since I haven’t been feeling well.  I’ve spend an inordinate amount of time aimlessly clicking back and forth among the various tabs and windows I have open on my computer, which would be fine except it’s not the least bit relaxing.
  • I has a post I’d previously published on my blog about the difference between trauma and PTSD accepted by The Mighty.  It was almost 2 months ago that I had submitted it and I had pretty much given up hope.
  • I found some very good cookies and hot chocolate mix at a grocery store I don’t usually shop at, so  that’s been my indulgence for the week.

How has your week been?

What is… transference & countertransference

In this series, I dig a little deeper into the meaning of psychological terms.

This week’s terms: transference & countertransference

The idea for this post came from Meg at Why does bad advice happen to good people?

The concept of transference was first proposed by Sigmund Freud.  In therapy, it occurs when a client unconsciously redirects feelings associated with one person, often an important figure in the earlier part of their life, onto the therapist.  Transference may occur outside of therapy as well, when feelings relating to one relationship are projected onto another relationship, such as feelings someone has experienced toward a parent being transferred onto a significant other.

Countertransference happens when the client triggers an emotional reaction in the therapist, which may be related to unresolved issues within the therapist.

The way that transference is viewed in therapy depends on one’s theoretical perspective.  In Adlerian psychotherapy, transference is treated as an obstacle that stands in the way of therapeutic progress.  Some forms of therapy do not address transference at all in the therapeutic model, such as cognitive behavioural therapy.  That’s not to say that it’s not possible for transference or countertransference to arise, but it’s not something that’s used as part of the therapy model.

Transference plays a starring role in psychoanalysis and related therapies like psychodynamic psychotherapy, in which it is seen as an important way to gain access to the unconscious mind.  Wikipedia describes it as a process by which “patients relive their infantile conflicts by projecting onto the analyst feelings of love, dependence and anger”.  The therapist points out and interprets any transference that arises, and this is used to identify and resolve old conflicts and problematic defense mechanisms.  Interpretation of the countertransference that arises can offer the therapist insight into elements of client’s experience that have gone unspoken.

Transference-focused psychotherapy is a type of psychodynamic therapy aimed at people with borderline personality disorder.  Transference is used to identify distorted perceptions of self, others, and object representations.  It is seen as a way to gain direct access into the client’s internal world, and inconsistent perceptions of shared reality are addressed in therapy.  This wasn’t a type of therapy that I had heard of before. Based on what Wikipedia had to say, it looks like there hasn’t been a lot of research on it yet, but it does show some promise.

Infatuation can be one potential product of either transference or countertransference.  The infatuation may be directed either from the client towards the therapist, or vice versa.  Any therapist worth their professional license would recognize this early on and deal with it, either by ending the therapeutic relationship or doing their own work in therapy or supervision.

Freud also described a “transference neurosis”, which occurs when the relationship with the therapist because the most important relationship in the client’s life, and infantile feelings are directed at the therapist as a sort of parental figure.  Interpretation is seen as the key therapeutic intervention.

Borderline personality disorder (BPD) is one of the conditions that can be particularly likely to trigger countertransference reactions on the part of the therapist.  Adequate supervision is necessary to allow therapists to work through this countertransference with peers and prevent it from impacting the therapeutic relationship.  Supervision in a therapy context doesn’t usually mean a supervisor sitting in on a therapy session; rather, it’s an opportunity to discuss afterwards how sessions went and identify what was difficult and what could have been done differently.  This sort of supervision is built into the dialectical behaviour therapy approach developed by Dr. Marsha Linehan.

In my career as a mental health nurse, I don’t think transference hasn’t really come up, probably because of the types of settings I’ve worked in.  I have both witnessed and experienced countertransference though.  The countertransference has mostly been stirred up by clients with BPD.  I think part of this is that people with BPD tend to be highly perceptive, and if the individual with BPD sees the mental health professional as being unhelpful or making things more difficult for them, the angry outbursts that are a symptom of BPD can be targeted straight at the weaknesses the healthcare provider may already feel insecure about.

Most colleagues I’ve worked have been able to recognize this and keep it from having a negative impact on the therapeutic relationship with the client, but a few didn’t keep a lid on it as much as I think they should have.  My take on the matter is that countertransference at some point is inevitable to some extent for most mental health professionals, but it’s the professional’s responsibility to recognize it and deal with it so that it doesn’t become the client’s problem.

Psychoanalytic or psychodynamic therapy has never appealed to me as something to do to manage my own illness, and the idea of projecting my own emotional crap onto a therapist feels kins of icky.  I’m not trying to say that it’s not a valid form of therapy, and I’m sure for some people it can be very helpful, but for me it just doesn’t feel like a good fit.

Have transference and countertransference come into play in therapy work that you have done?

 

You can find the rest of my What Is series on my blog index.

Sources: