Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for the ‘Media Coverage’ Category

Proud To Be A Psychiatrist

Posted by Dr. Vollmer on July 23, 2013

“Problems at Salinas Valley Psychiatric Program came to light in January, when nine psychiatrists wrote a letter to the facility’s then-executive director — copied to Gaither’s office — saying that high patient loads were “not safe or appropriate.” Gaither denied the allegations but overhauled the program’s leadership. Atascadero State Hospital psychiatrists also wrote a letter to that facility’s executive director this spring, citing shortages among their ranks.”

http://www.latimes.com/news/local/la-me-state-hospitals-20130723,0,2759486.story

Today’s LA Times warmed my heart. So much of the time, on this blog, I complain that psychiatrists are not doing enough to protest the poor treatment of the mentally ill. So, today when I read about psychiatrists protesting about patient care, I was relieved and proud. The psychiatrists are speaking out, leaving me to wonder why Steve Lopez, in his series of articles on the mentally ill, never mentions psychiatrists. I also learned from this article that the Department of Mental Health (DMH) has become the Department of State Hospitals, curiously leaving out the word “mental” as these “State Hospitals” are mental hospitals. Hmmm….So, I learned the following….

Welcome to the New Department of State Hospitals!

On December 7, 2011, the California Department of Mental Health announced the blueprint to establish the new Department of State Hospitals and reforms to the Department of Mental Health structure designed to improve the mental hospital system in California. Interesting.

There is still the LA County Department of Mental Health, but the State Department of Mental Health has reorganized.

State mental health services are now part of DHCS (Department of Health Care Services) and not it’s own department. I knew this change was coming, but I did not know the specifics, until this article reminded me to check it out! My impression is that this change is detrimental to mental health care, as mental health used to have it’s own budget and now it is part of the bigger health care budget. All of this will be important if the Affordable Care Act rolls out in January, 2014.

With all of that, I repeat. Today, I am basking in the glow of my colleagues standing up for patient care.

Posted in Media Coverage | 5 Comments »

Mentally Ill Are Locked Up: Where Are The Psychiatrists?

Posted by Dr. Vollmer on July 17, 2013

http://www.latimes.com/news/local/la-me-0717-lopez-twintowers-20130717,0,1637257.column

Today’s LA Times sheds light on the tragic situation in LA County, where the mentally ill are warehoused in the county jail. “3,200 people with a mental illness are behind bars (17% of the jail population),” Steve Lopez reports. Where are the psychiatrists in this discussion? We could ban together to talk about the need to rebuild our mental hospitals; the ones closed when Ronald Reagan was Governor of California. It is not clear to me why psychiatrists are not more involved in advocating for the mentally ill. The resources, in California, are so limited, and yet, what seems like a few years ago (30 or so), we had decent long-term psychiatric hospitals, such as Camarillo State Hospital, which gave the mentally ill a therapeutic community. We need to chime into this conversation so that we can remind the public that the brain influences behavior, and as such, treating brain disease, not just with medication, is a critical component to a civilized society. We need good systems of care which help people who cannot help themselves. Steve Lopez does a huge public service by bringing this to the media. Now, psychiatrists need to join him, by letting the public know that we care too.

Posted in Chronic Mental Illness, Media Coverage | 4 Comments »

Psychiatrists Don’t Care About DSM 5?

Posted by Dr. Vollmer on May 13, 2013

 

http://www.nytimes.com/2013/05/12/opinion/sunday/why-the-fuss-over-the-dsm-5.html?emc=eta1

 

Sally Satel MD, writes her opinion about the upcoming release of DSM 5. Apparently former President Bill Clinton will announce the release this coming weekend in San Francisco. The book has been fourteen years in the making, and with all due respect to Dr. Satel, I think psychiatrists care a lot about this new publication, attempting to pronounce who has a mental illness. I am not sure how one can care about the mentally ill and not care about the labels which shape patient’s identity. As one of my commenters said recently, in response to my post about distinguishing ADHD from Asperger’s Disorder (now called Autism Spectrum Disorder), she did not understand herself because she was told that she had issues which made no sense to her. This confusion, brought on by clinicians, not meticulous about diagnostic classification, causes harm to patients and their families. DSM 5 is likely to cause more patients to believe they have a mental illness, when, in fact, they are struggling with issues of powerful family dynamics, causing symptoms which potentially disable them. This uptick of diagnosis brings more business to psychiatric facilities, mental health practitioners and disability offices, but it also changes the patient’s understanding of what ails them. Likewise, the promise of quick treatment, can lead patients to feel very discouraged that they are not obtaining symptom relief. It would be as if yoga promised patients flexibility, instead of promising them the journey towards deep breathing. The depth of the problem is often not captured in our diagnostic manual, and as such, patients with means, are left to seek treatment from practitioners willing to take the time and the thoughtfulness to tolerate the messiness and uncertainty of exploring an interior landscape which is varied and constantly changing. DSM 5, like DSM IV, encourages a hastiness which is destructive to training new psychiatrists, and hence destructive to patients understanding the complexity of their experience. Dr. Satel is wrong, in my opinion, that DSM 5 is a non-event to clinicians. DSM 5 dashes our hopes for a field which promotes depth and breath, rather than checklists which look at static experiences. DSM 5 is an outrage. That is the fuss.

Posted in DSM 5, Media Coverage | 1 Comment »

Is The ‘Self’ Lost in Psychiatry?

Posted by Dr. Vollmer on April 29, 2013

http://www.nytimes.com/2013/04/28/magazine/the-problem-with-how-we-treat-bipolar-disorder.html?pagewanted=all

Linda Logan talks says ” for many psychiatrists, mental disorders are medical problems to be treated with medications, and a patient’s crisis of self is not very likely to come up in a 15 minute session with a psychopharmacologist.” She goes on to say that non-medical professionals are taking on the task of understanding the self, but “new therapies and treatment philosophies, founded mostly by clinical psychologists and other practitioners who are not medical doctors, recognize the role of the self in people with mental illness.” This is my rant and so I will continue to both understand that my professional world is changing and, at the same time, attempt to push back and bring the “self” back to psychiatry, in my own way, through my work and through this blog.

Many in my cohort went into psychiatry because we felt that the patient had the disease, as opposed to our medical colleagues who treated patients like they were the disease. This personal aspect of psychiatry was the draw. The “liver patient in room one,” was the inspiration for leaving a field in which people were defined by what organ system failed, and not their social histories, their occupational histories, or their contributions to society. As psychiatry becomes more “medical,” patients are now a “disease” and there seems to be little value in understanding how the person copes with their illness, but rather the value, is in getting rid of symptoms. Clearly both are important. Moreover, it is important, in my mind, that one clinician be able to look at both symptom relief and coping styles. When these two issues are bifurcated, the patient is left to feeling misunderstood and frustrated, as Linda Logan articulates clearly in this article.

Of course there are exceptions, but the trend in psychiatry is towards this medicalization, which means towards a depersonalization of care. This trend crushes my soul. If we, as psychiatrists, do not carry the banner of knowing our patients, for the human beings they have worked hard to become, then who is going to provide comprehensive care to those with crippling neuroses and/or psychoses? Who is going to see the big picture of medication management within the context of defense mechanisms and family dynamics? Who is going to understand that to lean too much towards nature or nurture is to rob the patient of the complexity of their condition? We, as psychiatrists, must embrace both complexity and uncertainty. If we do not do this, then patients will suffer, and as they are, by definition, compromised, and hence  mostly unable to advocate for themselves. This is my rant, one which bears repetition, and so I will continue to post on this topic. Thank you, Linda Logan for triggering my continuous outrage.

Posted in Media Coverage, Psychiatry in Transition | 4 Comments »

Allan Arbus

Posted by Dr. Vollmer on April 24, 2013

http://www.nytimes.com/2013/04/24/arts/television/allan-arbus-mash-actor-dies-at-95.html?adxnnl=1&adxnnlx=1366824116-sVw9Zw5sh1end8MEUpK1KA

Years ago, a psychiatrist friend of mine were going to small theatre and we ran into “Dr. Freedman” from M*A*S*H*, and with great enthusiasm said “we are psychiatrists too.” It took a few minutes for us to realize the absurdity of our comment, and yet, we felt so comfortable with him, as a colleague. He was gentle with us, but, of course, we felt foolish. All these years later, Alan Alda is quoted as saying a similar sentiment about the late Allan Arbus. Moreover, to learn today that he was married to the talented, but tragic, Diane Arbus, is all the more riveting. I imagine his sensitivity was innate, making him a great actor, photographer, and, in my mind, a great listener, as well. It is so rare that my profession is portrayed well in the media. Thank you, Allan Arbus.

Posted in Media Coverage, obituaries | 1 Comment »

Crowd-Sourcing

Posted by Dr. Vollmer on April 23, 2013

 

You can evaluate your psychiatrist, as with any service provider, online. Drug addicts being told they can’t get refills can rant about their physician’s poor bedside manner and lack of empathy. Patient satisfaction evaluations are being used to determine physician salaries, as test scores are now tied to teacher’s pay in some school districts. Technology has made it such that the consumer has a voice, and although one does not know to trust the consumer’s opinion, in an uncertain world, internet evaluations through crowd-sourcing, give information which guides the client through the confusing maze of choosing a trusted professional. As Sandy Banks stated in the LA Times, yesterday, http://www.latimes.com/news/local/la-me–banks-yelp-backlash-20130423,0,7103175.column?page=2 , those with negative complaints tend to be more detailed and hence get put higher up in the algorithms, than those with flowery, complimentary feedback. Hence, negative reviews tend to float to the top, and in the case of businesses, if they advertise, then they can change the algorithm such that more positive feedback floats to the top. So, how much anxiety should a new psychiatrist feel when a patient calls and says “I was given your name by another doctor, but I googled you and found some negative reviews, so I am not sure if I should see you or not, but I thought I would give you a call  to see what you sound like on the telephone.” “The best way to see if I can help you, is to come in and meet me and form your own opinion” would be my advice to this young psychiatrist. The personal nature of this relationship makes it such that it is not “one-size fits all,” it is not “fungible”. As such, I would suggest this new psychiatrist say, “the question is not whether I am a good psychiatrist, but rather, the question is am I the right psychiatrist for you?” Crowd-sourcing has no way to address this “goodness of fit” approach to this very personalized service. On the one hand, this is terribly obvious, but on the other hand, it is hard not to flip out over a negative written evaluation, as the internet gives a certain permanence to words. Psychiatry is in transition. As such, psychiatrists need to cope with negativity on the internet. My suggestion-we all need to blog to remind folks out there that crowd-sourcing, when it comes to a psychiatrist, is out of  context. We need to promote this doctor/patient relationship without sounding defensive or paranoid. Once again, this is a new world for my profession. We are learning as we are going. The challenge of the internet continues. We, psychiatrists,  used to worry about protecting patient privacy, and of course, we still do, but now we also worry about protecting our privacy, as well. I think there is little hope for the latter. I can live with that.

Posted in Crowd Sourcing, Media Coverage, Psychiatry in Transition | 2 Comments »

Social Isolation Is Not Good For Your Health-Proving What We Know Intuitively!

Posted by Dr. Vollmer on March 26, 2013

http://www.latimes.com/news/science/la-sci-social-isolation-health-20130326,0,7160788.story

Without connection, we die sooner. So, today’s article in the LA Times, tells us, as it reports from a published study in the Proceedings of the National Academy of Sciences. Sure, we want science to support what makes sense, so sure I support the study. I just hope it comes as no surprise. Emotional needs, like physical needs, are needs, and as such, when deprived, poor mental and physical states ensue. Without nutrition we die. Food is life-sustaining, and so are friends and family, if one feels that these friends and family can provide reciprocity and respect. This latter comment, is, of course, speculation. The study only shows in a gross way, how important people are to other people. I speculate further, that the interactions necessary to sustain life are those which bolster self-esteem and worthiness. Without these, the mind tells the body that life is less important and so there is less of a push for self-care. In other words, as we age, this mind/body connection is even more important, as the body becomes more vulnerable, the need for the mind to “fight” for the body’s survival is more critical. This “fighting mind” is fueled by feeling loved and valued by people deemed important. Some would argue that elderly people in communal living situations live longer because the support of the community helps them wake up each day and look forward to seeing their “friends’ whereas elderly folks who live alone have less incentive to push themselves towards activities. All this to say that “behavioral medicine,” as some call the specialty of mental health, really promotes the obvious-friendship. As I say many times in my posts, the answer is easy. The difficulty is in the execution.

Posted in Geriatrics, Loneliness, Media Coverage, Mind/Body | 8 Comments »

The Family Narrative: Essential-How About That!

Posted by Dr. Vollmer on March 18, 2013

 

 

http://www.nytimes.com/2013/03/17/fashion/the-family-stories-that-bind-us-this-life.html?src=me&_r=0

 

Bruce Feiler writes that for good health, a family narrative, one that “oscillates” between happy and sad times is the telling, pun intended, point to happy families. As someone who considers themselves to be in the business of personal narratives, Mr. Feiler’s article makes sense to me. Understanding history, both personal and family, gives a solid foundation towards moving forward; no matter how challenging, or upsetting this history may be. It seems that the human brain does better with context, and creating a narrative, helps to develop a setting in which the current situation arises. Knowledge is power, as the saying goes. Personal knowledge, family knowledge is perhaps the best kind.

Posted in Media Coverage | 4 Comments »

Who Is Paying For Content?

Posted by Dr. Vollmer on February 23, 2013

Geneva Overholser,  Professor and Director of the USC School of Journalism said that we, the consumers, have to pay for content we do not agree with. We have to stop reading what we know. So agreed, Kai Ryssdal, host and senior editor of Marketplace, public radio’s program on business and the economy. As far as I understand human nature, this is not likely to happen. Paying for content that goes against our grain seems so far from our basic motivation to agree with ourselves; our basic tendency to stay put, both physically and mentally. As someone who loves newspapers, I am saddened by this development, although I do appreciate the internet for so many things, this is not one of them. The loss of print journalism is going to change how much we expand our perspectives on the world. Professor Overholser, I respectfully disagree.

Posted in Media Coverage | 6 Comments »

Talking Back To The Talkback

Posted by Dr. Vollmer on February 10, 2013

 

So, I studied CS Lewis. I reviewed Freud’s life. I watch the PBS Special entitled “The Question of G-d.” When it came down to the last few days, I mostly worried about my hair. This was a new and exciting experience for me, and as such, I felt like I had to narrow the field into one particular anxiety. In an odd way, that seemed to calm me down. Speaking to professionals is comfortable for me. I have a sense of why they come and what they want to hear to make their time feel well spent. This opportunity presented different challenges. I did not have a grasp as to who was in this audience. Some, a few, came to support me, and for that I was very grateful. Yet, the majority, I assume, were West Los Angeles theater goers who came to be entertained, but their idea of enjoyment was not so clear to me. How much did they know about Sigmund Freud or CS Lewis before they entered into this ninety minute sword fight? I made my best guess, as I approached the play as a drama which illustrated the conflict of ideas, as opposed to action. The mental game, if you will, provided the action in the mind. My five minutes on stage before the actors came on, felt long and short at the same time. I had a lot of ideas, but I also felt braced for the transition from speaker to moderator. The actors did arrive on stage, and I reminded myself that my job is to repeat the question, which sounds much easier than it actually is. No worries though, since the actors repeated the question they wanted to answer, and so I was left to hold my tongue from my urge to make the discussion linear. The actors exerted their charm. I was, as I expected, mostly a tree at this point. The evening concluded and then I could relax. Yet, like ending a good book, or leaving a good movie, I was left bereft. I so enjoyed the intense focus of trying to understand the life and work of two great thinkers in the twentieth century. Of course, I could continue my quest, but without the thought of standing up in front of five hundred strangers, the push to learn more has dissipated. My début is complete. I am open to more opportunities…..hint, hint!

 

Posted in Freud, Media Coverage, Teaching, Teaching Psychoanalysis | 9 Comments »

 
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