Category: critique

6 Suprising Myths of In-Patient Addiction Treatment

This is straight from PsychCentral, but based on the work of Daniel Carlat, MD.  Carlat has blogged at his Carlat Psychiatry Blog (Keeping Psychiatry Honest Since 2007) for some time, paying particular attention to the shenanigans of big pharma (recommended).

Why are the myths important? Because desperate families are often willing to invest a substantial amount of time and money, in the hopes of successful treatment.

In any case, here are the 6 myths of addiction treatment, as gathered by PsychCentral. Click on their link above for further information:

1. For the price I’m paying, I’m going to get a lot of individualized attention and one-on-one counseling.

2. The counselors are all well-trained doctoral or master’s level clinicians.

3. There must be research showing that inpatient rehab centers use evidence-based techniques.

4. Inpatient residential rehab centers have been proven by research to work.

5. The reason the treatment length in rehab is 30 days is because research has shown 30 days to be the ideal length of time.

6. Residential rehab is expensive.

 

 

Is Depression Political?

“For nearly two decades, Big Pharma commercials have falsely told Americans that mental illness is associated with a chemical brain imbalance, but the truth is that depression and suicidality are associated with poverty, unemployment, and mass incarceration. And the truth is that American society has now become so especially oppressive for young people that an embarrassingly large number of American teenagers and young adults are depressed and suicidal.”

— Bruce Levine

The Godzilla Mayhem of Kids, Parents, and Family Screen Time. Tokyo is Torched.

godzillaphoto by JD Hancock (creative commons) In family therapy there’s the notion of the identified patient. A wife brings in a husband, parents a difficult child. But in our training as therapists we are taught to be skeptical of this set-up. Who else might be contributing to the problem?

The message we communicate to our kids… : “Everybody else matters more than you.” Children, she declares, “are tired of being the ‘call waiting’ in their parents’ lives.”

And from Catherine Steiner-Adair’s book, The Big Disconnect: Protecting Childhood and Family Relationships in the Digital Age:

One girl among the 1,000 children she interviewed in preparing her book said, “I feel like I’m just boring. I’m boring my dad because he will take any text, any call, any time, even on the ski lift.” A 4-year-old called her father’s smartphone a “stupid phone.”

Often we identify kids as having a problem with their devices. But let’s be real. We are all addicted to our screens. A spate of recent articles take on this issue. First, a July 6 article by Jane Brody in the New York Times, Screen Addiction Is Taking its Toll on Children fired off. Then a follow-up piece the next week: How to Cut Children’s Screen Time. Some of the assertions regarding large amounts of screen time:

  • it hinders normal development
  • older children spend over 11 hours per day on media
  • screen time offers distraction, detracting from the ability to self-soothe
  • viewing violent games creates an “immunity” to violence, in some cases a taste for violence
  • negative impact on health, behavior, school performance
  • sedentary nature and advertising promote poor diet and unhealthy weight gain
  • decrease in family conversation
  • teens send an average of 34 texts after going to bed
  • pain in fingers and wrists, narrowing of blood vessels in eyes

The anecdotal evidence that excessive screen time is problematic is everywhere. Any kind of intervention regarding children’s screen use that doesn’t include the behavior of parents is misguided and laughable at best, not to mention frustrating and fruitless. At Psychology Today, child psychiatrist Victoria Dunckley added her two cents in an article titled Wired Parent, Wired Child. Dunckley has just published (July 14)book on the topic Reset Your Child’s Brain: A Four-Week Plan to End Meltdowns, Raise Grades, and Boost Social Skills by Reversing the Effects of Electronic Screen-Time.

So what are some suggestions for reducing screen time? First, Brody:

  • Kids learn by example and modeling. Model responsible media use.
  • Keep devices out of bedrooms
  • Observe device-free moments during the day — pickup after school, mealtimes, the hour at home after school
  • Show kids they are worth your undivided attention
  • Provide alternative activities — but don’t fall into the trap of becoming their cruise director

Next, Dunckley identifies factors that help “facilitate screen management”.

  1. Education regarding the harmful physiological effects of screen-time.
  2. Realizing that interactive screen-time (video games, iPad, etc) is more problematic than passive (TV).
  3. Appreciating the quality of life improvements related to screen restriction.

If you’re interested in reading more on this topic, here a few more titles: Dwight Garner wrote a review of three books on the topic, Resisting the Siren Call of The Screen: 3 Books Offer Ways to Cut the Cord, If Only Briefly . It’s a helpful overview, though from 2013. The 3 books are listed here, as well as others mentioned in this post:

Melancholy as Heroism

Another fragment from Peter Kramer’s eloquent There’s Nothing Deep About Depression article:

Through the “anxiety of influence,” heroic melancholy cast its shadow far forward, onto romanticism and existentialism. At a certain point, the transformation begun in the Renaissance reaches completion. It is no longer that melancholy leads to heroism. Melancholy is heroism. The challenge is not battle but inner strife. The rumination of the depressive, however solipsistic, is deemed admirable. Repeatedly, melancholy returns to fashion.

I hope this taste will tease you into the article. It’s a great read.

Hamlet as the Ideal Depressive

From Peter Kramer’s There’s Nothing Deep About Depression article, which appeared a while back in the New York Times Magazine. He lays out his argument brilliantly — during Shakespeare’s time it was trendy to romanticize depression — and Hamlet is “arguably the seminal text of our culture.” His point being, romanticizing depression is ingrained in the culture to a point not often acknowledged. Interesting.

In dozens of stage dramas from the period, the principal character is a discontented melancholic. “Hamlet” is the great example. As soon as Hamlet takes the stage, an Elizabethan audience would understand that it is watching a tragedy whose hero’s characteristic flaw will be a melancholic trait, in this case, paralysis of action. By the same token, the audience would quickly accept Hamlet’s spiritual superiority, his suicidal impulses, his hostility to the established order, his protracted grief, solitary wanderings, erudition, impaired reason, murderousness, role-playing, passivity, rashness, antic disposition, “dejected haviour of the visage” and truck with graveyards and visions.

“Hamlet” is arguably the seminal text of our culture, one that cements our admiration for doubt, paralysis and alienation. But seeing “Hamlet” in its social setting, in an era rife with melancholy as an affected posture, might make us wonder how much of the historical association between melancholy and its attractive attributes is artistic conceit.