"What sort of patient has a disease..."

This is an affecting, and effective, post by someone who was responding to the "I am Adam Lanza's mother" article by detailing his own struggles with mental health. I appreciate when he says he has a "disorder" but I prefer to focus on his obvious strength. To follow the dictum of the physician William Osler:

It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has. 

This author seems okay.

11Cards available on Kobo

The 11 Cards book has launched on the Kobo store.  This also means it is available at Indigo in Canada (may not be useful in Canada, but it's nice to know my home and native land can get it).

A mapping effort to provide assistance to seniors

An excellent resource map for services and volunteer opportunities for seniors. There are still seniors stuck without their normal support networks in communities devastated by Sandy. This kind of crowdsourcing application can help.

Coney Island and the Rockways are still in really bad shape three weeks after Sandy.

Update: dsm5.org walled up

On 11/15, access to dsm5.org, the site for the revisions process of the Diagnostic and Statistical Manual, was substantially blocked by its management. At first, the links from the main page to the revisions material were removed, but with a link to an inside page, say from Google, it was possible to still read the revisions. But later in that day, almost everything was put behind a password screen. The reason, according to the front page, was that the comment period was over and it was time to prepare for publication in May 2013.

So much for science, open discussion, and intellectual history. Turns out (what many critics have been saying all along) the DSM is a commercial product with a thin veneer of science, and the American Psychiatric Association considers the information its "intellectual property". I'm not totally clear on what they are achieving by taking the material offline, since it isn't going to affect sales of the books much, and it has driven a big hole in scholarship. It smells like censorship.

Update: the dsm.org site is back up. Same walled condition as above.

Bad enough. But now things seem somehow worse. At this point (Sunday 11/18), the entire dsm5.org site seems to have gone offline. Ping and traceroute both show the site as non-responsive. Sometime on Saturday evening, it just went away. I hope it's merely some technical glitch, because there is still important information available, including links to critical documents, and its always possible that they could drop the wall again.

By the way, Google has cached the pages as of early November, which may still provide researchers the opportunity to continue to download and "review and comment" (in the terms of use of the site) on the various changes. I'm not certain how long they will stay in the cache, so storing a copy locally might be helpful.

One small way to overcome the pettiness of the APA.

Anxiety in Athletes

Interesting New York Times article on golf pro Charlie Beljan's panic attack during his win at a PGA Tour event. This situation-specific anxiety is probably vastly more wide-spread than we think. Our world is awash in idolatrous jock-worship and so much sports writing focuses on drive, work, physical prowess and, when the athlete is successful, their mental toughness. I wonder how many physically gifted people have stepped away from competition because, frankly, it can be emotionally fraught.

Personally, I think I know what Beljan might be experiencing. As a teenager, I was a modestly-talented skier (back when Jean-Claude Killy ruled), skied regularly as a ski patrolman with a coach for the Olympic B team (very helpful to my skills) and a small New England college talked to me about joining their team. Given my limited interest in athletics overall, I gave it all a pass. Even at the time, I had what I think was a fair understanding of how competition wasn't going to be good for me. First, attention and concentration issues meant that maintaining 100% focus in a race course was tough (disastrous in slalom, deadly in downhill). But the killer was anxiety, something I had experienced much younger in chess matches. If you suffer from the smallest imbalance in the sympathetic nervous system, competition (effectively the fight side of fight-flight-freeze) can be way too charged. Skiing is not a risk-averse sport in general, with lots of speed, height and danger. For me, that was peachy (after all, I had an adolescent brain)—it was the competing that sucked. Maybe an anxiolytic could have helped, and apparently the World Anti-Doping Agency (WADA) doesn't include them on the banned substances list. (Ah, what might have been.)

Also intriguing is how Beljan managed to make it this far in his career without his anxiety overwhelming him. One player interviewed in the article wondered why such scenes don't happen more often. I suspect, from my experience, that nearly all people select themselves out of sports fairly early. Take it from me, the body and mind send signals starting at a young age that you aren't suited for this kind of stress, no matter if you are capable physically.

11 Cards: Quick Start Guide

I work in a mental health clinic in New York City. The patients are great, the staff are great. The darkest challenge, though, is the management of treatment plans. The Office of Mental Health for the State of New York (all bow before its name) requires that every patient get a treatment plan written within 30 days of admission and reviewed at least every 90 days thereafter. So, with 50 patients (active or inactive), that's in excess of 200 plans/reviews handled a year per clinician, effectively 4 per week. Time management is a bear. 

With that in mind, I needed a way to manage this relentless schedule and not let the management overwhelm my care for my patients (or my natural ADD). I found an elegantly simple solution, so I wrote a short e-book describing it. Buy it if you're an overworked, overstressed clinician (or know one). Let me know what you think.

Finally, the patients get flowers

No matter how sane you tell yourself you are, when the door closes behind you as a visitor on the psychiatric ward, you feel a shudder. These are sterile, hard-edged environments. Nice to see this art project by Anna Schuleit at the closing Massachusetts Mental Health Center, one of the old school hospitals. Schuleit covered the facility in fresh flowers because flowers were off-limits when it was a functioning facility. 28,000 plants for 28,000 estimated patients for the 91 years of operation.

Don't try this at home

This is an amusing way to deal with the perfect storm of 100% Internet and ADHD: hire someone to slap you if you start wandering off task. The serious message may be the aspect of subtle social pressures to maintain focus. I spend most of my day (when I'm not seeing patients) alone in front of my computer. I have to use intrinsic rather than extrinsic motivators.