Archive for January, 2008

From Salon: Doctors need to be aware of widespread health misinformation on the Web, because patients are going to find it.  Although the article is pitched as “Internet information is good for patients and doctors”, the misinformation aspect it its major point.

And a good point.  This is a basic tenet among the people who study end users of software and web applications, who do user-centered design, human-computer interaction, usability studies, etc:  You have to design your approach for what people are going to do.  Designing (whether it be software/web applications or any kind of information delivery) for what you think they ought to do is an approach destined for failure.

And you can’t stop the Internet.  It spreads information, and misinformation, like nothing else.

(On the other hand, calling doctors who don’t get this – like the article does – ow.  Good way to piss people off.  Doctors are end users of information, too, and starting off your approach with an insult, maybe not so effective.)

I didn’t realize this until I’d spent a summer around dogs, but they’re like people in some very relevant ways.  They get enthusiastic, they get angry, they feel down and icky, they misbehave and know it, they understand a small English vocabulary, and they look up at you adoringly whenever you have control over who gets chicken scraps and who doesn’t.

Let’s say you have a dog (let’s make him a mutt) named Barky (your six-year-old named him, not you).  You’ve had him for five years, you love him and your kid does too, and you know quite well that lying in one place, resisting going out into the sunshine for walks, and eating very little is not at all normal behavior for rambunctious, cheerful Barky.  He’s more than unhappy and you know him well enough to know that this is well outside the normal.  You take him to the vet and nothing’s physically wrong, but the vet suggests that he’s depressed and might benefit from Reconcile, the Prozac for dogs.

What do you do?  Your options include (this is not a complete set): reject the option because he’s a dog, not a human, and only humans feel real emotional pain and/or deserve treatment; reject the option because you ask about the side effects and decide they would be worse for Barky than how he appears to feel now; or accept the suggestion because you think that reducing pain, even animal pain, is desirable, and can be helped by medication. You can also go home and make fun of it. I know what I’d choose to do for someone I cared about, even if they weren’t human, or weren’t adults, or whatever we choose as the boundary line between living beings whose pain matters, and those whose pain we don’t consider real enough to matter.  It wouldn’t necessarily be to give them psych meds (that really would depend on the expected benefit and side effects), but I wouldn’t reject it based on the notion that dogs cannot have serious problems or painful emotional experiences.

The availability of Prozac for dogs is unquestionably an attempt for Eli Lilly to expand their market.  This is not different from other companies.  When you see an ad for life-saving drugs, it’s because they want more people to get those drugs.  When you see an ad for a new sports drink, it’s because they’re trying to get more people to buy it.  And so on.

The question here isn’t whether drug companies are exploitative – we already know they are, so that’s not really a question – but whether we want to use their products to reduce suffering.

Some therapists do not “get” the difference between having life problems, and having mental illness (plus, often, life problems).  My suggestions for dealing with this, if you are mentally ill and seeking therapy, are:

1) Look for therapists affiliated with hospitals, they tend to have more experience with psych patients.

2) Be leery of anyone who makes a big deal out of “situational” versus “chemical” depression.  It’s all chemical; it all happens in your brain and body.  Peter Kramer, a psychiatrist who is pro-therapy and writes books about therapy and books about medication, argues that research shows that depression triggered by repeated situational events comes to look no different from depression with a heavier genetic component.  It’s just that some people start higher or lower down the slope.

Those who start further down the slope – who some people would say have “chemical” depression – can still be helped by therapy.  For example, people who are more prone to depression following negative life events can learn to better anticipate and/or avert those events, and cognitive therapy can help people interpret those events in ways that are less damaging.  It’s not always enough, but it can be very helpful.

Continue reading ‘Situational versus chemical depression, and what it (doesn’t) mean for treatment’ »

I have taught mentally ill college students, given advice to mentally ill college students, and been one myself. Based on those experiences, here is a guide to not tanking your exam / your class / your degree while you’re having a meltdown. This is probably most applicable to college students at universities in the United States, but there’s generally applicable stuff in here too.

None of this is easy to do when things get rough, but many of these suggestions are minor time commitments that can make a huge difference.

1. Decide on your major goal

If you are clear on what you want, it will be easier to decide what to do while things are going south. If your major goal is to get a good education, get a good job, or go to graduate school, your top priority should be using relevant resources (including those related to mental illness). If your major goal is to avoid treating your mental illness (or using accommodations, extensions etc), evaluate what you are willing to sacrifice (grades, time, extracurricular activities, your job, future salary, etc) and plan what you will sacrifice when.

See the bottom of this entry for my opinionated take on this.

2. Know your available resources

If your school has a students with disabilities service, a counseling center, or a health services, and you are not already using them, look them up and find out what they offer.

3. Know your course policies

Take time out of your day to go over your syllabuses with a fine-tooth comb. You need to know your teachers’ policies about emergencies, grade appeals, accommodations, and extensions/make-ups. Plan to make use of these where they can help you.
Continue reading ‘A college instructor’s guide to not tanking your grades while having mental illness issues’ »