Saturday, September 27, 2014

Dr. Ping: Con job or great job?

Eighteen months ago, Chris switched medications from Abilify to Respiridone because he didn't like Abilify (I've forgotten why).  Three months after switching he began to rapidly put on way more weight than what the Abilify did for him. I got alarmed at his out of control appetite and insisted he get a blood test, which revealed (surprise surprise) high cholesterol, for the first time in his life. So, after discussing all this with Dr. Stern, at the beginning of the year, he went back on Abilify and dropped the Respiridone all in one go. I assumed that his weight would go back to his Abilify weight. Well, it hasn't. Many months later, Chris's weight has not returned to his pre-Respiridone level.

My Internet pal, Irene, is a nurse who is quite familiar with Traditional Chinese Medicine (TCM). She suggested, based on her understanding, that TCM herbs can help with the metabolic weight gain caused by antipsychotics.

Dr. Stern, Chris's psychotherapist, wrote him a prescription for ten acupuncture sessions and I located a Dr. Ping, who runs two TCM clinics in our city.

Part of my thinking (and Dr. Stern's) was that in addition to dealing with metabolic weight gain, acupuncture would also work on Chris's ever elusive body/mind connection.  I was hoping that acupuncture could super glue or better yet "weld" Chris's intellectualizing head to the rest of his body to give him a real physical presence and "flow." Dr. Stern had previously taken up my body/mind suggestion by sending Chris to a metamorphic massage therapist. 2014 is the body/mind or bust year for Chris.

I haven't accompanied Chris to his medical appointments for several years. Once he got to the point of remembering he had them and actually getting there on time, there was no need for me to go with him. The missed appointments are a thing of the past for Chris. This time, I made an exception in the name of "research" and went with him. I had a lot of questions that I wanted to put to Dr. Ping himself. Chris had undergone 5 point acupuncture several years ago, at the suggestion of Dr. Erika, his holistic psychiatrist. At the time, I didn't think it did much for him, but he was at at different stage, and maybe being further along in the recovery process would make a difference. I really wanted to grill Dr. Ping on what exactly he might be able to do for Chris. Otherwise, this latest adventure could be a huge waste of Chris's time and our money.  I'm mustering less and less enthusiasm to keep suggesting new therapies for Chris. For much of the past two years he has been happy to just get on with his own life, his way. As it should be.

We sat down with Dr. Ping and his Chinese assistant, and he asked Chris why he was there, which got a rather lengthy philosophical reply, but eventually he got the idea that Chris was there to see if acupuncture could help him lose weight. I kept my mouth shut. Once Chris's pulse testing was done and his tongue examined, I asked about using Chinese herbs.

"No! said Dr. Ping.  "Maybe need for herbals later, but now only acupuncture. He have stagnant liver. He need to express himself more!"

"Can I see how you do the acupuncture?" I said, thinking that maybe there was something new since the last time Chris had done it. "Research," remember.

"Okay," said Dr. Ping. "Follow me."

I followed the two of them into a ward of curtained off cubicles.  I noted where Chris's cubical was and then waited down the hallway until Dr. Ping had finished. When I arrived Chris was there on the table, Saint Sebastian in his underwear, his chest stuck full of needles. Dr. Ping had left the room. There was obviously nothing new here from the last time Chris had acupuncture, so I said to Chris "I'll see you at home," and left.

Chris was a bit shaken when he got home. While I was lying on the table, Dr. Ping leaned over and hissed at me "What's your mother doing here? Be a man!"

"Well, be a man, Chris! Do what Dr. Ping says. I've been trying for ten long years, since you came back from university,  to get you out from under my apron strings. I didn't want this job in the first place. Maybe, Chris, what he's telling you is what I've been telling you, in so many words, since you were a child. You let everyone else decide for you. YOU should start establishing stronger boundaries. If you want to be a man, tell your mother she is no longer needed!"

"What else did Dr. Ping say?" I asked.

"He said I need to exercise more and not eat sugar," Chris responded.

Well, you don't need an acupuncturist to tell you that, I'm thinking.

Over the course of his treatment (number 8 and only two more to go) Chris's weight has remained more or less the same, despite his increased daily exercise routine. At his last visit, Chris challenged Dr. Ping on the lack of weight loss. "You not exercising enough. "You do MORE!" said Dr. Ping. As a parting gesture, he hammered three pins into Chris right ear. "Twist them at least four times a day," he instructed.

Dr. Ping. Well done! You are hammering home the body/mind connection by reminding Chris to use his body, to break some sweat. So, YAY! However, my response to this lack of weight loss is: Dr. Ping, then what are we paying YOU for? If we thought Chris could lose the weight by exercising or dieting, there'd be no need for acupuncture. What exactly are you selling here? Everybody knows that antipsychotics produce metabolic weight gain in most people. YOU held out the promise that acupuncture would be different.

Unless, unless, I say to myself, a great part of TCM is the doctor applying psychological pressure on top of the needle pressure. Dr. Ping may be doing a great job. The acupuncture may simply be a distraction, a side show. What may be more important than the needles is the psychology.

The Chinese physician, in contrast, directs his or her attention to the complete physiological and psychological individual. All relevant information, including the symptom as well as the patient's other general characteristics, is gathered and woven together until it forms what Chinese medicine calls a "pattern of disharmony." This pattern of disharmony describes a situation of "imbalance" in a patient's body. Oriental diagnostic technique does not turn up a specific disease entity or a precise cause, but renders an almost poetic, yet workable, description of a whole person.*

Will Chris be able to lose weight caused by metabolic weight gain through acupuncture? I have no idea. It's either a con job or a great job.
Kaptchuk, Ted J., The Web That Has No Weaver, McGraw-Hill, 2000, page 4.

Thursday, September 4, 2014

Practical things you can do for anxiety

Hope for Everyone

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Kjetil Mellingen

September 3, 2014

I am a very optimistic psychologist, but with reason. For 25 years I’ve been working with people who have had psychological problems in every conceivable area. Many psychologists have problems with burnout, especially early in their careers. For me, this has been very different. By using the treatment techniques that I do, I feel anti-burned out. It is so gratifying to see people get out of their serious problems, that I look forward to every day of clinical work.
The reason why many in the mental health field get burned out may be that they are not able to make changes in people’s lives as they had hoped.
I often get frustrated when patients come to me after a treatment career with four or five previous psychologists. The clients have been very close to giving up, but they often give it a last try, especially in the anxiety clinic where I work. Having failed in many therapies, having been made very pessimistic, I really admire them for not giving up completely.
Usually these patients have been to psychologists who are very concerned with childhood experiences. For years they have been talking to the psychologists about all kinds of bad things that have happened to them, in an attempt to find out what may have caused their psychological problems.
The problem is that even if we could reliably find exactly what caused the problems, this does not give us any direction about how to help cure the problem. The sad fact is that we cannot change people’s childhoods.
Another sad effect, is that doing psychotherapy that is not working may be very demotivating and give people the feeling that there is no hope for their condition.
What makes more sense, especially to clients, is to look at their everyday situation, and find out what problems they have within their daily lives. In technical terms, this is called formulation.Many British psychologists see this as a very useful alternative to diagnosis. The formulation would describe in everyday language what triggers your  problems, how you react, what  makes the problem worse or better, and eventually what may be done with this in the here and now.
Read this rest of the article here. There is a very good video in it for learning to handle the anxiety associated with drug withdrawal.

Tuesday, September 2, 2014

Life goes on

I'm still here. Life goes on at its decidedly slower pace now that Chris is becoming a self. I haven't blogged about him in a while, but recently I've been getting a flurry of e-mails from mothers seeking my advice about what to do about their own sons and daughters who've been recently diagnosed. I can't just tell them to read my blog (all 912 posts) and expect them to get a handle of how to help their relative NOW. Years ago, an Internet pal told me that the best way to be influential is to write a book, so yes, that memoir I've been talking too much about and doing too little to finish, will take precedent over  regular blog posts once again, beginning this month.

I've been looking over some of my earlier posts and wince at how garbled some of them are. What was I possibly thinking when I wrote THAT? I wonder. A future project for me will be to clean up some of the language to make the posts more readable. (Ref. Weird Al Yancovic's Word Crimes, "Saw your blog post. It was fantastic! (I'm being sarcastic.) Cause you write like a 'spastic.") . . . Better book some quality time with my book editor beginning this month.

Monica Cassani has started a weekly blog post about psychiatric drug withdrawal called It Gets Better. Seeing her post today reminded me that an important part of my blog is to also show people from my own experience with Chris, how it does get better. The person you thought you knew at eighteen or twenty, was probably not a personality, not a cohesive self. The person you see ten years later may the person he or she has been struggling to be all along, defining themselves in surprising ways. Given the right conditions, the caterpillar eventually becomes a butterfly, the seedling becomes a plant. The building up of a personality is for patient people. The results are gratifying.

Chris has been wonderfully productive recently. He's taken two intensive French language courses and passed his language proficiency exam, which he will need to show to a potential employer. One step at a time. He just got back from a week's technical training in sound and light for theater productions. Since he dropped out of university at age twenty, he has not wanted to/not been able to, take a course involving assignments and grades and he hesitated to venture far from the nest. What he has done recently should give anyone struggling under the diagnosis of schizophrenia, cause for hope. I don't see "schizophrenia" anymore. Haven't seen it for a long time. I prefer to talk in terms of spiritual crisis, maturation, and a finding one's self.