Markham's Behavioral Health

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

Women in relationship with men who gamble are 10.5 times more likely to experience Intimate Partner Violence

The Casinos are sprouting up all over, and internet gambling is on the rise. The amount of people who have problems with gambling are increasing as well. Gambling can become an addiction. Often people with gambling problems can be polyabusers of alcohol and other drugs as well as gambling. A few years ago, I remember when a fellow in the Rochester, NY area, who was engaged to marry, killed his fiancee a few days before the wedding when his gambling relapse led to an argument.

The Wager is a weekly newsletter published by Harvard Medical School and the Massachusetts Council on Compulsive Gambling. In their issue published on 02/12/03, Volume 8, number 7, they report on a study entitled "Problem Gambling and Intimate Partner Violence"

The WAGER - Back Issues

Patient Beliefs about Causes of Depression

There is an interesting article in the August, 2003, issue of the Canadian Journal of Psychiatry, reporting on a study done with 102 people surveying what they believed contributed to their depression. There were 9 possibilities which the survey offered asking the participant to score the significance of the cause for their depression on a scale of 1 -10 with 10 being the greatest importance. No item averaged more than a score of 6 and it was the item attributing depression to stress and negative life experiences. Women reported being more enamored with the biological causation than men.

The authors seem to imply that understanding to what people attribute the etiology of depression should lead to some psychoeducational activity as if we professionals could tell people for certain what causes depression. I think the best treatment would involve listening closely to what patients believe causes their depression and then crafting an individualized treatment plan accordingly. I would encourage the authors to read Barry Duncan and Scott Miller's book, The Heroic Client.

Here are the items on the survey. Maybe you would like to take it yourself if you have ever been depressed. What seems to you to have contributed to your depression?

Using the scale below, indicate on a scale of 1 - 10, with 10 being the great importance down to 1 being nonexistent, the extent to which you believe each of the following factors is responsible for causing your depression.

1. I have a biological abnormality (for example, chemical or hormonal imbalance).

2. I was born with genes that make me more prone to developing depression.

3. The way I evaluate or think about my experiences caused my depression.

4. My depression is due to my personality make-up or temperament.

5. Stress and negative life experiences caused my depression.

6. My depression stems from an imbalance in energy or flow.

7. I%u2019m depressed because I lost touch with my spiritual core or faith in God.

8. Unhealthy or dysfunctional relationships caused my depression.

9. My depression is the result of an unhealthy lifestyle (for example, poor diet and lack of exercise).

Patient Attitudes Regarding Causes of Depression: Implications for Psychoeducation

Comparing Prescription Drugs

So many prescription drugs have flooded the market accompanied by all kinds of claims of effectiveness and fewer side effects that physicians and patients have to choose whether to use older drugs or the newest drug and there is no good criteria for such a decision. It leaves patients and doctors to rely mostly on intuition, trial and error, or the salesmanship of the drug makers. The link below takes you to an editorial in the New York Times which mentions drugs for physical health problems like high blood pressure and acid reflux. The situation is even worse for antidepressants and antianxiety drugs.

Comparing Prescription Drugs

Treating hypochondria

Hypochondria is well recognized as a very difficult problem for the person suffering from it who obesses over every ache and pain, and for the physician or other health provider who is asked to provide service. Insurance companies and HMOs shudder at the thought of the word. Personal injury attorneys salivate at the very thought of the unordered test, or the missed diagnosis which could lead to damages and million dollar settlements. Every hypochondriac will eventually have something that kills him or her. So sooner, or probably later, their worst fears will come to pass and they will be proven right after all.

It's sad to see someone live in constant fear of mortal frailty and death, and to see the health care provider who is constantly being asked to investigate, come up empty handed, reassure, and live to repeat this cycle endlessly.

Years ago when I worked in the emergency room all patients had to be "medially cleared" before they could be seen by the Psychiatric Assignment Officer because most of us PAOs were nonmedical mental health professionals. I noticed that many of the people who came to the emergency room really didn't have any life threatening illness requiring this level of medical intervention. I mentioned to the Director of a large urban hospital emergency room that I could save the health insurance companies and the hospital millions of dollars if we flipped the system backwards and made everyone be "psychiatrically cleared" for medicine.

The New Yorker: Online Only

Illness and sickness: What's the difference?

Medical sociology has long made the distinction between illness and sickness. Illness is the objective diagnosis that an external impartial observer is able to make based on the constellation of symptoms which the patient presents. Sickness is the social role that the patient adopts as the patient and other concerned stakeholders, in relationship with the patient, interpret the meaning of the illness.

It has long been recognized that health care providers can play an iatrogenic function by making sickness worse by focusing on symptoms and interpreting them in certain ways. We now see pharmaceutical companies doing this very thing in their drug advertisements convincing people that they may be sick, when in fact, they previously were unaware that they had a problem. To what extent is this "patient education" early detection that prevents further progression of serious illness, and to what extent is this "patient education" the creation of sickness?

I had a male friend one time tell me that it was a blessing to turn 50 because he was no longer horney all the time. Now the Viagra commercials would have us believe that the diminishment of libido is a medical problem that can be managed with medication. Even ex Senator Bob Dole, and Presidential Candidate, married to another prominent politician, Elizabeth Dole, advocates for the use of Viagra. I always wondered what Elizabeth thought of this.

At any rate, the link below points to an editorial in the British Medical Journal which raises this whole issue of the meaning of symptoms. Symptoms mean one thing to one person, and other things to other people, and who is to finally say what the meaning of symptoms should mean? The patient, the physician, the drug company, the family, the HMO or payor?

bmj.com Ogden 327 (7412): 409

This is the week to see Mars

Mars will be closer to earth this week than ever before in human history. If you want to see it, this would be the week to take a peak. You might wonder what this has to do with Behavioral Health? I think that part of good mental health is the capacity to experience awe. How can you look up into the midnight sky and not be awed? Haven't done it for awhile? See if you can see Mars this week. If you do, post a comment and let us know how it made you feel.

North Coast Cafe

Do kids suffer from PTSD?

PTSD, Post Traumatic Stress Disorder, is one of those new Psychiatric Diagnoses, that has been created after the Viet Nam War, when many of the soldiers were returning from Viet Nam and acting "nuts" with flashbacks, depression, isolating behaviors, temper outburts, and abuse of substances. In other wars, these symptom constellations were called other things. For example, after World War I, it was referred to as "shell shock".

As the diagnosis, PTSD, came into usuage in the 80s, 90s, and into the new millenium, it began to be used for similar symptoms after people experienced other kids of traumatic incidents like car crashes, murders, rapes, etc. There was a growing awareness that traumatic incidents, especially if prolonged and intense, can lead to psychic distress with lasting consequences. Now there is growing awareness that children, too, can suffer from PTSD, and a recent survey found that 4% of boys, and 6% of girls between the ages of 12 -17 have symptoms of PTSD.

What can be done about it? Usually supportive counseling, individually and in groups, to process the thoughts, feelings, and behaviors associated with the incident seems to have a way of objectifying the experience so that it is perceived as being external to the person rather than intrinsic to their personality. Being able to objectify it, allows a person to manipulate it in ways to their benefit.

As the bumper sticker says, "Shit happens!". I saw one one time which said "Mega shit happens!" The fact that shit happens is not really the point. It's how we handle the shit, when it happens, that can make the difference for our future mental health.

TIME.com: Violent Aftershocks -- Aug. 18, 2003

Clinical research on children discussed

One of the sections of the National Academy of Science is the Institute On Medicine. The Institute of Medicine has a Committee on Clinical Research With Children, and in July, 2003, the Committee had hearings regarding the policies and procedures that should be created and implemented when research grants and projects are funded and designed which involve children. (You read about this in your local newspaper right? :-)

Nowadays, the drug companies, ever looking for new markets, are pushing all kinds of psychotropic medications for children so this has become a bigger issue as Americans, always looking for simple and quick fixes to complex situations, increasingly are tempted to medicate the problems with their kids away with a silver bullet.

And so CHADD (Children and Adults With Attention Deficit Disorder), a large group of parents, kids, and professionals (0ver 20,000 members) concerned about ADD and its affect on individuals and families, stepped up to the plate and testified. I found CHADD's presentation very enlightening and reasonable. You can read the 8 page statement by clicking on the link below and when you get to the web page of the Institute on Medicine you will find an icon there to download the CHADD statement.

Basically what the statement says is that ADD and ADHD are misunderstood and there are many myths and much stigma attached to this diagnosis. CHADD attempts to provide information and recommend services and practices that are evidence based. CHADD believes that current policies and procedures in place have served youth well. CHADD further outlines the areas in which it believes further research should be done.

I recommend downloading and reading their statement if you are at all interested in ADD, and if you are concerned about research practices involving children.

IOM Clinical Research Involving Children: Statement of Child and Adults with Attention-Deficit Hyperactivity Disorder