Dr. Kevorkian–Dead, But Not By Suicide

Four days ago Dr. Kevorkian (AKA Dr. Death) died and I’ve read a couple of articles about him. In yesterday’s print edition of the NY Times is this opinion, and I am linking to it because it coincides a bit with how I feel about this.

One of the things I consider part of my job description is suicide prevention. So Dr. Kevorkian’s activism for assisted suicide kind of annoys me. From everything I’ve read, there is a lot of controversy about how he proceeded to do his work. Lack of full psychiatric screenings to assess for depression or other treatable mental illnesses, significant number of patients without terminal illnesses, a few patients without any physical problems whatsoever at autopsy, and death for some patients within 24 hours of meeting with with Dr. Kevorkian for a consultation. There’s also reports of Dr. Kevorkian being interested in the very scientific process of vivisection, which is basically doing an autopsy while someone is alive. Finally, Dr. Kevorkian was not an internist, or oncologist, or psychiatrist. He was a pathologist! He practiced an area of medicine that has the least patient care. In fact, although pathologists are physicians, they really practice more like scientists–in a lab.

It’s all a little frightening, what he claimed he did, which was assist over 130 patients in suicide with a machine that he created to inject the medications. I also believe in our laws and government, and regulating such issues which are truly a matter of life and death. I’d love to hear anyone else’s thoughts on this controversial topic.

Happy Memorial Day!

This is a day that I get off of work every year, but not one I’ve necessarily appreciated in the past. Now that I work at a VA Hospital (Veteran’s Administration), I am learning what the holiday is actually about and what it means to veterans themselves. This holiday over the years has taken on meaning for many who visit cemeteries and memorials to commemorate those who have sacrificed for our country, and I believe it has created a great sense of nationalism in that way.

On a related note, because I’m kind of a tech junkie, I also wanted to highlight the new iphone app for PTSD (post traumatic stress disorder) that came out last month for veterans and their families. I have not heard from anyone who has used this app, but I would love to see how it works for people! It helps monitor symptoms for patients, allows families to understand what veterans are going through, and can direct patients directly to a source of help in times of crisis. Anyone tried this yet? I am glad to hear that the Department of Defense and Veteran’s Administration are keeping up with social media outlets to reach more veterans!

The Casey Anthony Trial

Another high profile case in the news this week! This week finally started the murder trial for Casey Anthony, accused of killing her baby daughter Caylee. The strange thing about this case is that Casey Anthony did not report her daughter missing for over a month! She was then found a mile away from the home six months later. From this article about the trial this week, it sounds like both the defense and prosecution are making accusations of murder, but the question is who did it? All I know is something seems fishy, and the allegations of sexual abuse/molestation by Casey’s father George (the baby’s grandfather) are new and unclear what part they will play in the trial. Although this may or may not be technically mental health related, it is again an interesting case and one I will continue to follow in the news–anyone else?

Jared Lee Loughner Declared Mentally Incompetent

Not a shock to have read this earlier today. This is a topic I have a lot of interest in, because it deals with people’s rights, in particular those with mental illness. As I’ve said before, it is impossible to make a diagnosis just by reading articles in the media, but the implication of this court ruling is that likely Mr. Loughner has a psychotic disorder of some kind, perhaps schizophrenia. There are laws that can force medication in order to make someone competent enough to understand the court proceedings. Once the defendant is able to understand the court proceedings, he can assist in his own defense and trial. He can still plead “not guilty by reason of insanity.” Only 1% of all pleas use this defense, making it fairly rare, as well as difficult to win. Basically the question is whether the defendant could understand right from wrong at the time of the crime. This is a difficult question to answer, and a person can be evaluated by numerous psychiatrists and get that many diagnoses and assessments. Only time will tell what the outcome will be in this case; I know I’ll be following this to see what happens. What are your thoughts–is this a fair way for Mr. Loughner to get through the legal system?

May 21st

Does anyone else get weirded out by these calls for Judgment Day? I definitely do! Sometimes there is a fine line between religious thinking, and what is termed “hyperreligiosity” in psychiatry. The term means over-religious, and is sometimes one of the things that is found in an active psychotic or manic episode. People who become hyperreligious read the Bible (or whatever other book correlates to their religion), and read special meaning into things that they read. They pray excessively, are preoccupied with religious thoughts, and may believe they have special powers that relate to their religion. When someone like this shows up in the emergency room, we tend to medicate them until they become less delusional and more in touch with reality.

I suppose what I find strange about these people who predict Judgment Day (and I feel like these are the same people who may have conspiracy theories about various political topics), is that they are not necessarily “mentally ill.” They are perhaps considered religious fanatics or zealots, but not delusional. They also have a lot of followers/believers, because if you google Judgment Day, you’ll find there is a lot of support for this coming day.

If anyone has a good explanation for this phenomenon, I’d love to hear it!

Whitney Houston Back in Rehab

One of the first songs I ever sang karaoke was “I Wanna Dance With Somebody.” Whitney Houston really had some great hits back then and I am sad for her that she’s back in rehab. While I wouldn’t say I looked up to her as a role model, I did feel she was somewhat respectable as an actress and singer. Unfortunately her life has been riddled with drugs, violence, and chaos. She has been in and out of rehab over the years and is still having trouble staying sober. I know that addiction is extremely difficult to overcome. It is especially difficult for those that have little to lose, i.e. no job, no money, no family. Think about it, what’s the point of quitting, it’s not like they have something to look forward to. So you would think intuitively that it would be easier for celebrities to stay sober–they have a lot to lose, right? However, for celebrities, they have almost too much of a cushion to sustain their drug and alcohol use. Additionally the more trouble they get into, the more fame it brings. They’re also not used to being told no, and find the structure needed for sobriety almost impossible to sustain.

I think it’s important not to put too much hope into others’ sobriety; if our expectations are too high, they will almost surely be crushed. I wish Whitney Houston luck in her latest efforts, but I also won’t be surprised if the next time she’s in the news is for her latest relapse.

Will Whitney Houston stay clean this time?Market Research

Big Pharma Still Advertising at Medical Conferences

I recently came across this interesting article. The quick summary is that although hospitals and medical schools are limiting how much doctors can come in contact with pharmaceutical advertising, the same advertising is still running rampant at medical conferences. I found this article personally intriguing because I will be leaving for Honolulu this week to attend the American Psychiatric Association (APA) annual meeting. The last meeting I went to was two years ago, and I recall the meeting being littered with advertising for various antipsychotics and antidepressants. I have already received advertising in the mail from various companies inviting me to their events at the meeting. The reason this is such a big deal is because the APA considers itself the “voice and conscience of modern psychiatry.” Quite a large undertaking.

The most laughable quote for me in the attached article is when Dr. Jack Lewin, chief executive of the American College of Cardiology, says, “I don’t buy a soft drink just because of the advertising… I buy it because I like it.” I find this quote to be so indicative of the cognitive dissonance that exists with doctors–advertising affects everyone else except for me. Advertising is a multi-billion dollar industry for good reason, because it works, on doctors and patients. The commercials on TV encourage patients to “ask your doctor if this medication is right for you,” which creates additional pressure on physicians to prescribe drugs that may not be the best choice. We’d like to think this is not the case, but I see examples of this on a daily basis.

Anyway, I’m very curious about the upcoming meeting. I have already taken a personal stance and stopped attending “educational” dinners sponsored by big pharma. Hopefully I won’t have to start boycotting the APA too.

The Phoebe Prince Case Is Finally Over–Did She Get Justice?

Over the past two days, the Phoebe Prince case finally came to its conclusion. Phoebe Prince was a 15-year-old teenage girl who immigrated to Massachusetts from Ireland with her mom and sister. She later committed suicide in January 2010, after several months of bullying and cyberbullying. Initially nine teenagers were charged with various offenses, ranging from stalking to criminal harassment to statutory rape. Some of the charges were eventually dropped, and the case was finally resolved just this week with punishment of probation and community service, and after a year, ending up with clean records. Interestingly, Phoebe’s mother gave an emotional statement to the court, but agreed with the resolution. What she wanted more than anything, was an acknowledgment of contribution to Phoebe’s death.

Sadly, Phoebe Prince had a history of psychiatric problems prior to arriving at her new high school. She was bullied at her school in Ireland, cut herself, and was taking medication for depression. She had also had a suicide attempt after her boyfriend (one of the accused bullies) broke up with her. Even more sadly, some of the teenagers in the case made comments that if she was truly suicidal, why hadn’t she already done it? Although I cannot make a diagnosis about someone I’ve never met, the cutting behavior, suicidal gestures, and chaotic relationships, sound like the making of borderline personality disorder. This diagnosis cannot be made until someone turns 18, but people certainly show signs of it during adolescence. The reason I bring this up is because although people with borderline personality disorder often make suicidal threats and gestures without actually killing themselves, a percentage of them actually do. Unfortunately it is hard to tell who will and who won’t.

It is hard to say how much the bullying contributed to Phoebe’s eventual suicide. It is also hard to say how much responsibility her school had to try to prevent this. From what it sounds like, everyone could have done a better job, but that is always easier to say in hindsight. The fact of the matter is that it happened, and while it is truly a sad case of a life cut short, the good is that the teenagers in the case sound as if they are truly sorry for the way they behaved, and her high school has begun to take real measures to address bullying. The media attention her case has gathered has hopefully also led other schools around the nation to do the same. While we cannot prevent every suicide in every child, we sure have the obligation to give our best to try.