Saturday, July 5, 2008

Help for Those Pulling Their Hair Out

Folks who suffer OCD and many other different conditions can often "pass" in society with little or no suspicion. Not so with compulsive hair-pulling (Trichotillomania), which highjacks a person's peace of mind and their looks. It also robs their pocketbooks. I can't tell you how many young women with whom I've worked spent thousands of dollars each year just to cover up the damages of Trich. But thanks to hair health expert Charlene Blacer, whose clientele is over 50% Trich-afflicted, relief is in sight. She has created a nonprofit effort,, which provides "Mane for a Year" assistance to disadvantaged folks with Trich to cover the costs of their hairpieces and replacement. Kudos, plaudits, and props to you, Charlene!
Special thanks to Michelle Dennis, a very talented artist in Melbourne, Australia, for the fabulous illustration!
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The Look of a Winner

"Eyes! Hair! Mouth! Figure! Dress! Voice! Style! Movement! Hands! Magic! Rings! Glamour!Face! Diamonds! Excitement! Image!
I came from the people,
they need to adore me,
so Christian Dior me,
from my head to my toes,
I need to be dazzling,
I want to be Rainbow High!
They must have excitement,
and so must I."
"Rainbow High," Evita, lyrics by Andrew Lloyd Webber

Okay, so it's impossible to imagine McCain or Obama being as style-conscious as Eva Peron. But they matter in a big way. So every election season brings the obligatory reminder that looks and nonverbal communications really do influence voters' choices in the polling booth. If you need a refresher course on the politics of image, try this article from the Arizona Republic, and the readers' comments on it.Sphere: Related Content

Mental Health Professional Datebook

Here are a few events to keep in mind for your calendar if you're a mental health professional:

September 4-6, 2008: American Psychotherapy Association Conference in San Diego

September 12-16, 2008: International Congress of Brief, Strategic and Systemic Therapists in San Diego

October 2-4, 2008: The 14th Annual Counseling Skills Conference in Las Vegas

October 10, 2008: National Depression Screening Day

October 30-November 2, 2008: US Psychiatric and Mental Health Congress in San Diego

March 12-15, 2009: Anxiety Disorders Association of America 29th Annual Conference in Santa Ana Pueblo, New Mexico Sphere: Related Content

Deep Brain Stimulation: A Real Hope for Help?

Over the last few months, the media has been abuzz about the promise of Deep Brain Stimulation (DBS) for the treatment of Obsessive-Compulsive Disorder, depression and maybe more. This "brain pacemaker" sends electrical stimulation to parts of the brain affected by depression and OCD, with remarkable results. The treatment has been used with stunning results in patients with Parkinson's Disease.
In a new story dated July 3, Dr. Douglas Anderson, a neurosurgeon and professor at Loyola University Chicago Stritch School of Medicine who has been among the pioneers of DBS, offered mini case studies of patients with Parkinson's, OCD, body dysmorphic disorder, and severe headaches. It's interesting to note that, according to this story, about 40,000 people worldwide have undergone this treatment and the cost can exceed $50,000. The caveat, here, is that DBS is an adjunct treatment, not a cure, and it is reserved for only those with the most severe cases that don't respond to other treatments.
The implications for this are astounding. Could this be a kind of built-in Electroconvulsive Therapy (ECT) system? It will be interesting to watch as DBS develops.Sphere: Related Content

Friday, July 4, 2008

Freedom to Marry on July 4th

On this July 4th, I've decided to post the folowing text of a letter to the editor I recently wrote and had published in an LA newspaper regarding gay/lesbian marriage rights. I couldn't think of a more appropriate, timely topic for this blog today, nor could I find a better way to write it than I already had.

Regardless of your thoughts on this issue, I hope you'll be able to keep an open mind. And a happy Fourth of July to all of my fellow Americans. The letter is thus:

I’ve been following the self-righteous protests of whacky bigots against same-sex marriage. The entirety of their argument is based in some verses of the Bible which, many serious scholars would agree, refer to male-on-male rape and homosexual behavior in pagan rituals. Never once is there a condemnation of loving relationships between two adults of the same sex. Rather, we have a poignant exaltation of such love in the story of Jonathan and David. Never once did Jesus, the messiah to whom the fundamentalists give lip service, mention homosexuality. He didn’t even allude to it. He spoke a lot about loving others and being non-judgmental, but not one word about homosexuality.

What the fundamentalists are trying to foist onto our legal system is their interpretation of a handful of Biblical passages. Does this mean to them that their reading of scripture is more correct than that of, say, the United Church of Christ, the Episcopal Church, or Reform Judaism, all of which are among the religious organizations supportive of same-sex marriage? They are trying to win a theological debate by having their own version of religion codified into state law.

I wonder if any of these zealots arguing against same-sex marriage are fully aware of the ground on which they stand.

Of great interest to me is the number of black church leaders who are leading these protests. News flash, folks: the Bible was interpreted throughout the ages to sanction slavery, right up into the 19th century. Many arguments for slavery came from the very Biblical books these black religious folks are quoting to condemn gays and lesbians. Let us not forget the Biblical passages interpreted for years as prohibitions against interracial marriage, either.

"The hope of civilization itself hangs on the defeat of Negro suffrage,” argued one Presbyterian pastor as cited by Rev. Jack Rogers of the Presbyterian Church USA. Today, the religious fundamentalists are essentially saying, “The hope of civilization itself hangs on the defeat of same-sex marriage.”

The point is not to argue in favor of slavery or against interracial marriage. Rather, it is to say, how can you preach the Bible as the infallible word of God on one issue, then dismiss it as such on another?

Rightly foreseeing the shaky Biblical ground on which to base their opposition to same-sex marriage, others have tried to turn the debate into a pseudo-scientific one. They are obsessed about the so-called gay gene and whether it exists. One writer even challenged me for “robust” scientific evidence, although I have never once addressed the notion of a gay gene. It may or may not exist; just because researchers haven’t found it doesn’t mean it isn’t there. Ironically, on June 18, an Italian study was published in which genes that can increase a woman’s fertility were found to correlate to homosexuality in men.

Personally, I think you’ll find a lot of factors that create affectional orientation, including biology, brain structure, preverbal experiences and, dare I say it, evolutionary process. In any event, most gays and lesbians experience their orientation as something innate and immutable. It is an affectional , not merely sexual, orientation. Gays and lesbians never awakened one day and decided to fall in love with people of the same gender any more than someone else decided to fall in love with people of the opposite gender. The “choice” in homosexuality is whether to live authentically or die in secrecy.

In the final analysis, though, does it really matter whether one was born gay or not? Does it really matter whether the Bible condemns homosexuality or not? At issue is the question of the state’s interest in one’s choice of marriage partner. I would submit that if one’s affectional orientation is innate, whatever the causes, the state could not deny a marriage license to two males any more than it could to a biracial couple. If on the other hand one’s affectional orientation is chosen, it is unquestionably a very personal choice, one which must be protected as are one’s choice of religion, politics and speech. To deny either an individual’s right to express his or her nature or to exercise his or her freedom of choice is antithetical to the very foundation of this nation and a bastardization of the Constitution’s function as protector of the minority from the whims of the majority.
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Thursday, July 3, 2008

A Hard Day's Night for the Mentally Ill: Psych Patients Waiting In Emergency Rooms

In centuries past, the mentally ill were neatly locked away from public view, along with society’s other smelly unmentionables; the homeless, the unemployed, the criminally insane, and the drunkards among them. They would be herded onto ships of fools and sent out to sea, to land at some unsuspecting port, or to simply die in the blue beyond.

Many years later they were hidden behind tightly locked doors of forbidding sanitariums. In any case, society was more than happy to “treat” these unfortunates because that meant shrouding their cockeyed faces, shrill screams and endless gibberish from plain view. We as a society have a well-honed ability to simply tune them out, at least until they’re in our face.

Now they’re in our emergency rooms, as they have been since Ronnie Raygun put it to the mental health system. Every now and again a news organization will run a story about all these psych patients clogging up the ERs. Today’s AP story offered a new twist: Patients are clogging psychiatric ERs because there simply aren’t enough services. This notable, albeit subtle, shift has been a long time coming. No longer are we only concerned that mentally ill patients are occupying beds that should be reserved for the “truly sick” people. In a moment of clarity, someone in the press is finally declaring the mental health system itself is sick. And it is-- severely, chronically so-- and cannot be treated with a standard regimen.

I have spent the better part of the last ten years holed up in California emergency rooms assessing, detaining, admitting and discharging psychiatric patients. Some are schizophrenics, pleasantly insane and otherwise. Some are malevolent sociopaths who wouldn’t, or didn’t, hesitate to butcher their own mother. Others are depressed and bipolar who see no recourse other than to kill themselves. And there are the kids who tried meth or some designer drug and triggered a chemical reaction unleashing heretofore dormant psychoses. There are the older drug addicts whose trips, like their dependence, won’t stop. Then, as always, you have the handful of players who come in looking for three hots and a cot and will feign absolutely any symptom for their price of admission.

During this tenure, advocating for, not just serving, the mentally ill in our society has become something of a personal mission for me. The solution is not to throw some more money at the problem, put some more services out there and hope everyone will shut up. Instead, a fundamental paradigm shift is what we need.

As with the individual, our society’s collective thought creates reality. The underfunded, broken mental health system is only an expression of our mutual fear and loathing of mental illness and, consequently, those who it affects. Change the belief and we’ll change the reality.

It wasn’t that long ago that a mysterious illness swept like a wildfire through a freewheeling slice of the gay community and a hodgepodge of IV drug abusers, two of the most marginalized populations in society. No one really cared about the carnage of AIDS until it struck middle America’s nerve when Rock Hudson sickened and died. Then Liberace. Then Freddie Mercury. The face of AIDS changed and services and funding grew accordingly. The same must be and can be done for mental illness.

Efforts like Joe Pantoliano’s Efforts like Joe Pantoliano’s No Kidding, Me Too! which seeks to remove the stigma of mental illness using star power, are on the right track. We just need more of them.

Raising awareness can raise funding. But improved policing of where the money is spent would be well worth the effort. The group I mentioned earlier, the impostors who feign mental illness for a free place to stay need to be redirected elsewhere, such as homeless shelters and case management services. This cannot be accomplished, though, until there is adequate liability protection for physicians and other professionals who dare to just say no to a malingerer, only to have the person walk out and knife themselves, just to prove a point, but unexpectedly die. It may smell of sweet justice, but it reeks in the courtroom when family members suddenly emerge from the woodwork to sue the unlucky physician.

Then there are the politicians and other stakeholders. One look at the internecine dealings behind distribution of California’s “millionaire tax” for mental health services is an embarrassing look at bureaucrats and technocrats gone wild. How long before grabby government hands are dipping into this till to fund everything but mental health in this cash-strapped state? Accountability cuts all ways.

The political will for treatment is another key issue. States like California have created legislation such as Laura’s Law, which provides for mandated outpatient treatment, but without any funding source. We can all do that kind of math: Good law+ no money=hot air. Meanwhile, many patients continue to wind through the system’s Great Revolving Door on a monthly basis, noncompliant with treatment, penniless after spending their SSI checks on drugs, and carrying “insurance” like Medicaid, which doesn’t even pay the direct costs of their care. A dollar reimbursement for $5 worth of care is a great way to devolve to no services.

Until we as a society decide if the mentally ill are really worth treating, we will continue to see ERs, general and psychiatric alike, overflowing with insanity.
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Wednesday, July 2, 2008

New Stuff Abounds

I've just uploaded the redesigned, the official website for my private practice.

Also, I've moved the advice forum on that website to a separate site, If You Want My Advice. So please visit and ask any burning questions you might have.Sphere: Related Content
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