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September 2003

Grace and hope - There's always tomorrow


There’s always tomorrow

Voices stirring, are they real?
Trying to maintain an even keel.

Wonder if my mind is fried
Staying sane, god knows I’ve tried

What will I do with thoughts awry?
Help me god, please, I cry.

Praying now that I will feel better
“Sleep and rest”, I imagine said her

Who are you?, I wonder, sweet angel of grace
Mother Mary, I think, who’s smiling into my face.

Dreams come and stress declines
Oblivion sweet as a grove of pines

Then new day dawns fresh and new
I remember, then, my vision of you

It’s OK now as I go on
As if life has waved a magic wand

Pharmaceutical industry out of control?

Peter Kramer, the Psychiatrist who wrote the book "Listening to Prozac" coined the term "cosmetic psychopharmacology". Dr. Kramer pointed out that we no longer use drugs to fight disease, we now use them to change people's personalities and their behavior. The Brave New World where Soma is included in the citizens daily diet is upon us.

When it comes to medications, you'd like to be able to trust your doctor, right? Well, you might want to think again. Doctors don't know much about drugs either other than what the pharmaceutical drug representatives tell them. And the drug rep seduces the doctors to prescribe their drugs with free pens, lunches, sticky notes, trips to conferences, and samples. The drug companies are underwriting professional conferences, and journal articles, and their tenacles are everywhere having metastasized into every organ of the health care industry.

You might enjoy visiting the web site below, fittingly called "No Free Lunch" which has tons of material about the ways of the pharmaceutcial industry with links to plenty of scholarly articles on the problem.

Hugs not drugs?

No Free Lunch: What's New

An Affair of Love, the movie

An Affair Of Love is a very interesting French film, with subtitles in English, done in a pseudodocumentary style, about a 40ish woman who puts an ad in a personal section of a pornographic magazine about looking for a sexual partner to fullfill a sexual fantansy. A fellow responds and they find they are attracted to each other. They meet on a regular basis without sharing any personal information and find that they are falling in love. When the woman declares her love for the man, his eyes brim with tears.

On one of their assignations in their usual hotel, an old man dies in the hallway whom they try to help. Faced with the idea of mortality, they find themselves coming to a cross roads in their relationship, and must decide if they can continue to meet just for sex, or should they, can they, explore their love for each other. The film raises interesting questions about the connection of love and sex. Can two people have ongoing enjoyable sex and not develop bonds of attachment which we usually call love? Are sex and love the same thing, or two separate things?

The movie is well done as it demonstrates two people using each other to fullfil their sexual fantasies but doing so with mutual respect, sensitivity, and at times what seems to be tenderness.

In the end the movie has a sadness to it as we realize that sex without love, while it can be enjoyable, is empty of meaning which enriches our lives bringing satisfaction and fullfilment much deeper than physical sex.

Movie Review: An Affair of Love

Open Range, The Movie

The scenery is breath taking.

Robert Duvall gives a great performance as Boss Spearman, and Kevin Costner isn't bad as Charlie Waite, but the movie dragged for me.

It's the old story about the free range cowboy moving about the prairie as a free man, and getting hemmed in by barbed wire and ranchers who want to protect their land.

It comes down to a fight and the answer, predictably American, is to kill everybody.

George W. Bush probably loved this movie and it probably speaks to the heart of Americans who support the war in Iraq who think that killing folks is the way to preserve and promote our freedom.

It didn't work for Boss Spearman and for Charlie, as they kill their nemesis, Irish immigrant and land baron rancher Baxter, and his men.

It was kind of a loose - loose proposition. But Charlie Waite gets the woman, Sue, in the end who sees some redemptive spark in Charlie's weathered body and withered soul, and Boss Spearman gets his saloon, so it ends happy. A real American folk legend.

Problem is that the evil usually isn't a one time event, its an accumlation of small things that grows over time, and its this history of killing that eats at Charlie's soul.

In his childhood, Charley explains, he used to go into the woods with his friends to innocently hunt birds and squirrels. But it wasn't long before the innocent killing of small game for his table at home graduated into vengeance killing of men. "Killed my first man in them woods. He held the paper on our farm, and after my Pa died he came 'round to get payment from my Ma any way he could. I weren't much older than Button when I shot him in the throat."

Charley is forced to leave, so he joins the Army. "Our first skirmish was pretty much like huntin' in the woods with my friends. We just sat up in some trees and they came marchin' right at us. Musta been a hundred of 'em lying dead after the smoke cleared. Went out and shot the rest who weren't."

Charley is good at killing, so he is placed in a special squadron. "Orders were pretty simple, make trouble wherever we could. With room like that it wasn't long before we was killin' men who weren't even in uniform. Seems like that went on the rest of the war."

When the war was over, he headed West to work as a hired gun for men just like that man who wounded and killed their friends. The pain of what he has done haunts him, "Every once in a while I almost get through a day without thinkin' about who I am, what I done."

Well, poor Charlie. Our heart goes out to him. Seems to have a little PTSD working there. Think a little therapy would help, or should he be medicated? Maybe the love of the good woman, Sue, will save him.

What will save America? The myth of the lone, tragic, hero cowboy is alive and well on the Cinema screen in the summer of 2003, and on the deck of an Air Craft Carrier in May, 2003. Will Laura Bush, like Sue, make it all better?

Movie Ministry | Open Range

Laurel Canyon (2002)

Sam is a psychiatric resident, and his live in girlfriend, Alex, is a MD working on her dissertation for her Ph.D. They move to Laurel Canyon, California, to live in Sam's mother's house from Boston when Sam gets his residency there. Problem is that Mom, Jane, is a hedonistic record producer who is a big source of embarrassment to Sam, and who winds up corrupting Alex, and winds up with a weak apology towards the end of the movie to Sam about being a bad mother.

There is a confusing tension about Sam thinking his mother is "sick" because of her loose pot smoking, promiscuous behavior, when she seems a likable woman even if she behaves in ways that most people would think of as unconventional, if not immoral. Does psychiatry have anything to offer even if it comes in the form of a disapproving son who is entering the profession? Apparently not. The message of the film seems to be that the hard working overachieving young professionals need to loosen up and enjoy the illicit pleasures of the pop culture.

There are other tensions too. Apparently, Sam and Alex are living together with the intention of getting married. It really isn't clear. Both are seriously tempted to having affairs, Alex with the musician whose music Jane is producing, and a three way with Jane herself, and Sam with a second year psychiatric resident, Sara. Sam tells Sara that they should "sublimate", but Sara says they should "satisfy".

There is a scene where the psychiatric residents are together drinking and watching a video after a hard day of working on an inpatient psychiatric floor where Sam has been caring for a kid who was cranked up on too much crack (it's interesting that the residents use mood altering chemicals as they treat patients who use mood altering chemicals). Following this Sam and Sara are attempting to get into Sara's car, both drunk, arguing about who is less drunk to drive. It's never clear how they get home, but the scene is played in a humorous and romantic way.

The moral befuddlement and immaturity does not reside with Jane alone and it seems only a matter of time before Sam and Alex sink to her level. Overall this movie sends a bad message and has little socially redeeming value other than to raise some interesting questions about the differences between the generations of the 70s and the 90s, and whether ambitious high achieving young professionals are any better (emotionally intelligent and moral) than loose living musicians who manifest the values of the decadent pop culture. As likable as she is, Jane is a bad mother, and Sam's embarrassment is probably legitimate, and this point, as well as the confusion over infidelity, drunk driving, and spoiled professional identities, is never clearly brought to resolution in this film.

Life has consequences and as Phil McGraw says "Some people get it, and some people don't." It is not clear whether Sam and Alex are getting it.

Laurel Canyon (2002)

Patient compliance

The North Coast Cafe blog has a cartoon posted August 30th, by Callahan, of a doctor telling a patient to "heal!"

Us collaborative therapist types might find this funny or irritating depending on the mood we are in. However, I think Callahan intends to paradoy the expert, top down, attitudes which some health care providers, who consider themselves experts, take.

North Coast Cafe

Male MD/female RN or Female MD/Female RN - Professional and Gender Power in health care settings

I haven't given a lot of thought before to power relationships and how they are influenced by a mix of professional status and gender power. This is an interesting study, done in Canada, about the relationships between male doctors and female nurses, and female doctors and female nurses. There are many interesting observations in this study. For example, persistent sex-role stereotypes influenced the relationship between female nurses and physicians. Nurses were more willing to serve and defer to male physicians. They approached female physicians on a more egalitarian basis, were more comfortable communicating with them, yet more hostile toward them.

I really don't know what to make of this in terms of managing work environments or choosing health care providers myself. If I was to be in a hospital staffed with predominantly female nurses would I be better off with a male doctor or a female?

IJEqH | Full text | Gender and power: Nurses and doctors in Canada

Eating disorders - Psychotherapy or medications? Medications don't work

Dr. Phillipa J. Hay, a Senior Lecturer at the University of Adelaide in Australia, and Senior Consultant Psychiatrist to the Royal Adelaide Hospital, authors an article in the July, 2002, issue of the Psychiatric Times, which basically says that the research to date finds that medications do not help with eating disorders such as Anorexia and not much with Bulimia. Psychotherapy and interpersonal therapies do seem to help. She describes the "serotonin hypothesis" and muses about why SSRIs don't work.

However, there are some things that do seem to help with eating disorders and I have been interested in some of the Narrative Therapy approaches such as the development of "anti-anorexia leauges" where the eating disorder problem is externalized, and people band together in leagues to fight it with the support of people willing to stand in solidarity with people afflicted by the problem. You might want to check out the Narrative Approaches web site and the archived anti anorexia materials they have there.

Teach our children well

In the June 2, 2003, issue of the New Yorker, on page 42, there is a cartoon depicting a man, the father, casually dressed, shoes off, sitting on a sofa with feet up on a coffee table watching TV. In the background we see a women, presumably his wife, in the kitchen looking into the refrigerator. In the center of the cartoon we are looking up a stairway to the second floor and we see a small child, about 3, in pajamas, holding a teddy bear, and rubbing her or his eyes and the father says:

"A story? Honey, wouldn't you rather a mild sedative?"