Markham's Behavioral Health

Postponing Parenthood

The On Point radio show with Tom Ashbrook had a great show on Monday, January 28th, 2008, on postponing parenthood.

For the first time in human history more parents than ever are postponing child bearing and rearing into their 30s. In fact 52% of college educated women are waiting to have their first child until they are over 30.

I have noticed in my area in Western New York in Genesee, Orleans, and Wyoming Counties nestled between Rochester, NY and Buffalo, NY school enrollments in all 18 school districts in those counties has dropped between 2004 and 2007 in some districts as much as 13, 14, and 15%. Most of this drop is attributed to the shrinking demographic of fewer adults between 18 and 34 living in these counties and having children.

It's not new but it's truer than ever -- more and more young American couples are waiting later and later to start a family and have their first baby.

Fifty-two percent of college graduate first-time mothers are now thirty or older -- not just out of high school, not just out of college, but well into life and jobs and relationships and expectations.

Then come the kids. Like an earthquake -- of course.

The radio show entitled "Postponing parenthood" is about 50 minutes long and worth listening to. You can listen on line or download an MP3

Link: On Point : Postponing Parenthood.

Docs don't walk the talk in ethical practice

According to a survey of physicians in the United States a huge percentage of them don't walk the talk as far as actually acting on their ethical beliefs. The report of the survey appeared in the December 2007 issue of the journal, Annals Of Internal Medicine.

This survey of 3504 practicing physicians in the United States found that most physicians agreed with principles regarding fair distribution of resources, access to and quality of care, conflicts of interest, and self-regulation that were proposed by professional societies in 2002. Self-reported behaviors, however, showed that about one half did not follow self-regulation principles and that about one third would order unneeded magnetic resonance imaging for back pain in response to a patient's request.

According to an article in the January 4, 2008 issue of Psychiatric News about the study, less than 50% of physicians said they have or would report incompetence of a colleague even though 95% of them said they should.

However, large gaps were exposed in other responses to professional behaviors. One of the principles least applied by physicians was fulfilling professional responsibilities, including self-regulation. Forty-five percent of the respondents who knew of another impaired or incompetent physician in their hospital or group practice in the past three years did not always report the person to the institution or proper authorities, even though 96 percent had agreed, in the first part of the survey, that such colleagues should be reported.

These findings further validate the observation that professionals are not effective in policing and regulating their own professions or at least physicians are not. 

Link: Professionalism in Medicine: Results of a National Survey of Physicians -- Campbell et al. 147 (11): 795 -- Annals of Internal Medicine.

McCain's Idiotic Stance on America's Health Care Crisis

I can't decide if Presidential hopeful, Senator John McCain, is senile, psychotic, or disingenuous. According to an article in the January, 2008 issue of Clinical Psychiatry News, McCain is quoted as saying that buying health insurance is like buying a house and that it's a matter of choice whether Americans "want" to buy it or not. Apparently, he hasn't talked with the 47 million Americans without health insurance or the Americans who have been bankrupted by medical costs because they didn't "choose" to buy health insurance.

McCain's analysis of the health care crisis in the United States is scary in its simplistic naivete. It reminds me of Marie Antoinette's statement, when told that the peasants were starving to death because they had no bread, "Let them eat cake." I certainly hope McCain doesn't get elected.

“I don't think there should be a mandate for every American to have health insurance,” the Republican presidential hopeful said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.

“I think one of our goals should be that every American own their own home, but I'm not going to mandate that. … I feel the same way about health care. If it's affordable and available, then it seems to me it's a matter of choice amongst Americans,” he said.

As Sen. McCain sees it, health insurance is something many people decide they don't want. “The 47 million Americans that are without health insurance today, a very large portion of them are healthy young Americans who simply choose not to” sign up for it, he said at the forum, which was underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

Link: Clinical Psychiatry News.

Army suicides up as much as 20 percent

The Associated Press reported today, 01/31/08, that the number of suicides in the military has continued to climb and is up 20% from last year.

As many as 121 Army soldiers committed suicide in 2007, a jump of some 20 percent over the year before, officials said Thursday.

The rise comes despite numerous efforts to improve the mental health of a force stressed by a longer-than-expected war in Iraq and the most deadly year yet in the now six-year-old conflict in Afghanistan.

Internal briefing papers prepared by the Army's psychiatry consultant early this month show there were 89 confirmed suicides last year and 32 deaths that are suspected suicides and still under investigation.

More than a quarter of those — about 34 — happened during deployments in Iraq, an increase from 27 in Iraq the previous year, according to the preliminary figures.

The report also shows an increase in the number of attempted suicides and self-injuries — some 2,100 in 2007 compared to less than 1,500 the previous year and less than 500 in 2002.

The total of 121 suicides last year, if all are confirmed, would be more than double the 52 reported in 2001, before the Sept. 11 attacks prompted the Bush administration to launch its counter-terror war. The toll was 87 by 2005 and 102 in 2006.

Officials said the rate of suicides per 100,000 active duty soldiers has not yet been calculated for 2007. But in a half million-person active duty Army, the 2006 toll of 102 translated to a rate of 17.5 per 100,000, the highest since the Army started counting in 1980, officials said. The rate has fluctuated over those years, with the low being 9.1 per 100,000 in 2001.

I have my own hypothesis which is that Americans are not able, in good conscience, to kill in hand to hand combat as the military has demanded in Iraq and Afghanistan in an immoral war perpetrated under deceitful rationale by their commander in chief. Guilty consciences on top of other psychosocial stressors is a deadly combination.

I am distressed as I run into young people who are considering joining the military wondering if they understand how their moral conscience may be compromised when they are asked to kill for immoral reasons.

It is interesting how the moral conflicts engendered by the activities of killing fellow human beings is never mentioned in our national policy discussions, let alone the toll it takes on the mental health of the people who are asked to kill for us in our name.

As Americans we are not only responsible for the killing done in our name, but for the mental health of the killers who kill at our behest. Apparently, an increasing number of them cannot live with themselves and hate their lives enough to end them, and not only is the blood of those they have killed for us on our hands, but now their blood is on our hands as well.

What America needs is a period of repentence as we atone for what we have done to our brothers and sisters in other countries, and what we have done to our own.

Link: Army suicides up as much as 20 percent - Yahoo! News.

Quote of the day

"The extravagant gesture is the very stuff of creation. After the one extravagant gesture of creation in the first place, the universe has continued to deal exclusively in extravagances, flinging intricacies and colossi down aeons of emptiness, heaping profusions on profigacies with ever fresh vigor. The whole show has been on fire from the word go!"

Annie Dillard, Pilgrim at Tinker Creek

Brain imaging and the criminal justice system

Justice Talking Radio program released an excellent program on 01/14/08 entitled "Neurolaw, The New Frontier" in which various experts discuss the latest brain imaging techniques and how it is being used and could be used in the future.

Some lawyers are using brain scans showing defects to argue that their clients aren’t responsible for criminal behavior. In recent years, this neuroscientific evidence has been increasingly used in our courtrooms. But some scientists argue that the imaging is still new and unreliable, while others question whether juries should be ruling on what counts as a "defective" brain. As neurolaw grows in influence, it could potentially revolutionize our notions of guilt and punishment as criminals say "my brain made me do it." Might we be, one day, just a brain scan away from a form of lie detection and prediction of criminal behavior? Tune in as we examine this new frontier of law on this edition of Justice Talking

The show lasts about 50 minutes and can be listened to on line or downloaded in MP3 format. It is well worth listening to if you are interested in the topic.

Link: Justice Talking.

Are you emotion phobic?

In the January, 20008 issue of The Sun Magazine, Barbara Platek interviews Miriam Greenspan, a Jungian therapist, about the importance of emotions. The title of the interview article is "Through A Glass Darkly: Moving From Grief to Gratitude." The whole interview is worth reading which you can access by clicking on the link below. Here is part of what Ms. Greenspan says:

By “emotion phobic” I mean that we fear our emotions and devalue them. This fear has its roots in the ancient duality of reason versus emotion. Reason and the mind are associated with masculinity and are considered trustworthy, whereas emotion and the body are associated with the feminine and are seen as untrustworthy, dangerous, and destructive. Nowhere in school, for example, does anyone tell us that paying attention to our emotions might be valuable or necessary. Our emotions are not seen as sources of information. We look at them instead as indicators of inadequacy or failure. We don’t recognize that they have anything to teach us. They are just something to get through or to control.

But despite our fear, there is something in us that wants to feel all these emotional energies, because they are the juice of life. When we suppress and diminish our emotions, we feel deprived. So we watch horror movies or so-called reality shows like Fear Factor. We seek out emotional intensity vicariously, because when we are emotionally numb, we need a great deal of stimulation to feel something, anything. So emotional pornography provides the stimulation, but it’s only ersatz emotion — it doesn’t teach us anything about ourselves or the world.

Link: The Sun Magazine | Through A Glass Darkly.

Quote of the day

"He...treats his emotions like mice that infest our basement or the rats in the garage, as vermin to be crushed in traps or poisoned with bait."

Marge Piercy

Subtle manipulation of celebrity images sells to gullible Americans lacking media literacy skills

I have increasingly enjoyed the blog, The Last Psychiatrist. It is thoughtful, relevant, and stimulating. The current article has to do with how People Magazine treats the personality of Heath Ledger, the star of Brokeback Mountain, who suddenly died recently on 01/22/08.

I, of course, can't speak for The Last Psychiatrist, but I think his point is that People Magazine wants to hook readers and sell magazines and is not necessarily interested in the truth. Therefore, the reader should beware that he/she is reading a spin that may not provide information that is entirely accurate. I have long been interested in media literacy which are skills rarely taught in schools, even colleges, any more. The Last Psychiatrist makes a good case for readers to get out their media literacy skills and apply them to People's schlock.

Here is part of what The Last Psychiatrist writes:

All of this is subtle, I'll admit. But that's why it's so important to see it.  If it was blatant, we'd be arguing it; subtle is a virus, it's unconscious.  Individually none of these photos or phrases mean anything, but taken together they signify something; like the use of the green filter in the movie The Matrix.

If you ask, "are you saying People thinks he is gay?" you've misunderstood.  People has no interest in the truth; it is inviting speculation, it is causing confusion.

In order for you to understand what I'm saying, you'll have to accept that the media doesn't just select the "best" photos or quotes for their stories, but carefully selects ones that fit their story-- story that's not necessarily explicit.

Link: The Last Psychiatrist: People Magazine Has Something To Tell You About Heath Ledger.

U.S. abortion rate at lowest level since '74

The abortion rate and actual number of abortions are down in the U.S. according to an article  published by Reuters on January 17, 2008 based on a study which will be published in the journal Perspectives on Sexual and Reproductive Health in March of 2008.

The U.S. abortion rate continued its long-term decline in 2005, falling to its lowest level since 1974, according to the latest census of all known abortion providers in the U.S. conducted by the Guttmacher Institute in New York.

In 2005, the U.S. abortion rate fell to 19.4 abortions per 1,000 women aged 15 to 44 years, continuing the downward trend that started after the U.S. abortion rate peaked in 1981 at 29.3 per 1,000 women.

The number of abortions also declined, to a total of 1.2 million in 2005. This is 8 percent fewer than in 2000 and 25 percent below the all-time high of 1.6 million abortions performed in 1990.

It appears that more abortions are now done with medication since the pill RU- 486 is available. Medication rather than surgical intervention can be done up to the 9th week of pregnancy.

A "key finding" from this survey is that "mifepristone matters," Jones said. "Mifepristone is having an impact on abortion services although we aren't sure at this point whether it is increasing access to abortions."

The latest census shows that 57 percent of all known abortion providers in the U.S. now offer early termination of pregnancy with RU-486, up from 33 percent in early 2001. Medication abortion accounted for 13 percent, or 161,000, of all abortions performed in 2005, and 22 percent of all abortions eligible for RU-486 - that is, those performed up to nine weeks' of pregnancy.

A recent study from the Centers for Disease Control and Prevention looking at abortion in 2004 found that there has been a "gradual but notable increase in very early abortions and we think in part that can be attributed to the availability of mifepristone," Jones noted.

"We knew that (mifepristone use) had increased and had become better integrated into abortion services; this survey just gave us an actual figure to work with," Jones said.

Mifepristone, she added, "provides women who are terminating their pregnancies with more options; in many cases they now have an option as to whether they want surgical abortion or medication abortion."

Link: MedlinePlus: U.S. abortion rate at lowest level since '74.