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May 31, 2006
What If My Family Member Refuses Help?
QUESTION:
A relative of mine clearly needs psychiatric help, but he refuses to see a doctor about this. What should I do?
ANSWER:
Unfortunately, this is a very common problem. Sometimes people who are clearly suffering from psychiatric illness don't themselves recognize that they are having problems, even when this is readily apparent to their families. In other instances, the person may feel ashamed to acknowledge that there is a problem, or feel afraid of what treatment might entail (including fearing possible hospitalization), or feel concerned about being stigmatized because of obtaining mental health treatment. There are many instances when people really know they need help, and may even want it, but can't or won't get it without guidance and encouragement from others.
If you have a close relationship with this person, the first thing to do is to try to discuss with him your concerns, gently giving examples of what he has said or done which have made you alarmed. Try to do this in a calm, supportive, and non-accusatory manner, and suggest that he see a psychiatrist or other appropriate mental health professional for an evaluation. Try and convey that you are only suggesting this because you care about him, and be reassuring that the professionals he sees will be knowledgeable and compassionate people genuinely trying to help.
If speaking individually with him doesn't help the situation, or seems unfeasible, another approach would be to have several close family members or friends meet together with your relative to similarly express their concerns and suggest the need for evaluation and treatment. Sometimes it is helpful to offer to take the person to see a mental health professional, or to accompany him.
If you fear that your relative might be thinking of suicide, or might be violent, clearly there is much more urgency to his getting professional help. In these situations, or whenever serious psychiatric illness is suspected, one option is for you, perhaps accompanied by one or two others, to simply drive the person directly to an emergency room (where psychiatric evaluation is typically available). If you can't do this, or you fear your relative wouldn't cooperate, another option is to call the police. In Maryland and many other states, the police are legally obligated to take people with suspected mental illness who seem endangered or dangerous to a nearby emergency room so that a medical and psychiatric evaluation can be performed, and appropriate medical care can be provided.
Another option available in Maryland is to go to a district court and fill out a form called an Emergency Petition. Once this form is filled out, it is given to a judge or magistrate, and a hearing is held in which the judge may ask you some questions about your family member. If the judge/magistrate becomes convinced that your relative might have a mental illness, and might be in danger of self-harm or violence, the court official can compel the police to take him to an emergency room for a medical and psychiatric evaluation.
Sometimes, when it seems very hard to know the best way to get help for a family member, it can be extremely helpful to make an appointment with a psychiatrist (without the relative being present), explain the situation, and receive professional guidance about how best to proceed.
Going the extra mile to get a relative needed help is an expression of great concern and love; frequently, at some point the family member realizes this, and ends up feeling extremely grateful.
Do you have a question you would like to ask? Choose "Ask The Doctor" under Features in the column to the right!
Posted by admin at 11:17 AM
May 18, 2006
Film Explores Coping With Schizophrenia
The film 15 Park Avenue is the story of emotional struggles and triumphs of two sisters when one of them develops schizophrenia. The film is set in picturesque Bhutan, and is directed by the award winning Aparna Sen. This compelling and enlightening movie is marked by compassion for human frailty. There will be a discussion by Konkona Sen Sharma.
The film is a fundraiser for Chai, an organization dedicated to supporting the mental health needs of the South Asian community. It will be shown at 1:30 P.M. Saturday, May 20 at the Laurel 6 Cinemas, 371 Armstrong Ave., Laurel, MD 20724. There will be a discussion by Konkona Sen Sharma. A dinner is also being held afterwards. Advance tickets are $25 and $30 at the door. Film and dinner are $75.
Related Links:
15 Park Avenue trailer at YouTube.Com
Posted by admin at 12:07 PM
May 12, 2006
Antidepressants Not Working?
QUESTION:
I don't think my antidepressants are working. What should I do?
ANSWER:
It is important to take an antidepressant for a long enough time, perhaps a month, before deciding whether it works. In general, all antidepressants have a similar rate of effectiveness but differ in the type and degree of side effects. This is true in a statistical sense, but research and clinical experience suggest that individuals may benefit from one antidepressant but not another. Increasing the dose may be the first thing to try, and if that fails it may be useful to switch to another antidepressant. Another option is to add a second medication that may augment the therapeutic effect of the antidepressant.
Unfortunately, a significant minority of patients do not benefit, or benefit only partially, from antidepressants. Sometimes this may be because the diagnosis is incorrect, and the patient has some problem other than a clinical depression. However, even when the diagnosis is correct, the medication may not work Psychotherapy is often as effective, or sometimes more effective, than medication. The depressed patient for whom medication is not the answer should be evaluated for the type of psychotherapy that may be the most appropriate for him or her.
Posted by admin at 11:29 AM
May 11, 2006
Rebuilding: Brain Training and Schizophrenia
Lisa Halpern tells her personal story in an article in the APA Journal of Psychiatric Services April 2006. She is a woman who graduated summa cum laude and Phi Beta Kappa from Duke University with distinction in two majors. She received two merit-based fellowships: fully funded tuition and living expenses at the distinguished graduate program in Harvard's Kennedy School of Government.
But during her studies at Harvard she experienced a psychotic illness, was hospitalized at McLean Hospital and given a diagnosis of schizophrenia and was discharged on heavy doses of medication. She tells of her struggle to regain her mental functioning. She describes just how bad it was at its worst: "...as my thought disorder worsened, I lost my memory and my ability to count change, write checks, operate laundry machines, and find my way though a subway station. My IQ plummeted into the 70s. My facial expression flattened, my personality disappeared...As things got worse I limited my speech, knowing I was not making sense. I mumbled. I talked to myself. Almost mute and terribly confused, I would stare blankly at walls or, when around people, look down at the ground. I had loved reading the New York Times, but I remember when the font became too bright and the pictures jumped off the page..."
She had always enjoyed fitness activities and sports as a child, and by the age of 10 she was nationally ranked in the 400 meters and among the top 3 in the 800-meter race in her state. She applied the lessons that she learned about "training" to her recovery from her severe mental illness. When she came home from the hospital her Mother started to read to her to help her shut out other thoughts. Gradually she began to read a few lines herself from material that did not require much attention but might be of interest. She said: "familiarity and repetition helped". She began to read children's books and played card games like "Go Fish" to help her with her concentration and her memory. Playing other card games strengthened her memory and her mathematical thinking. As she writes: "Once my verbal skills increased and some of my characteristic resolve returned, I began working my memory -which meant old fashioned practice." She began to memorize passages from famous authors like Shakespeare and Eleanor Roosevelt. She continued to push herself because: "As a young competitive runner and wilderness-challenge enthusiast, I had learned the value of discipline, determination, hard work, and long-term goals. These values turned out to be equally important in reconnecting and strengthening the brain."
She was able to return to school, obtain a Masters Degree in Public Policy from Harvard, work for the Commissioner of the Massachusetts Department of Mental Health for two years, leaving to work with a community treatment team working with severely mentally ill patients. She summarizes her views as follows: "The process of rebuilding a schizophrenia-ravaged brain strikes me as analogous to rebuilding a severely injured body. Rehabilitation of the body requires daily physical therapy and a transition from being bedridden to walking in gradual stages as the body strengthens; rehabilitation of the brain requires continuing practice and adjustment as the mind strengthens. The two kinds of rebuilding - brain and body - are extremely time-consuming, humbling, and exhausting, both mentally and physically."
Related Links:
"Personal Accounts: Brain Training: An Athletic Model for Brain Rehabilitation," Halpern, Psychiatric Services, April 2006; 57: 459-460
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Posted by admin at 11:37 AM