Why I am against fad diets and measuring your self worth by the number on your scales

Today I spoke on 3AW with Dr Sally Cockburn about my concerns re fad diets and unhealthy messages not endorsed by experts.

As a doctor who sees many patients with eating disorders I become very concerned when fads appear that promise weight loss.

As a doctor, I am also aware about the health risks that can be caused by obesity. Of course I encourage and support healthy eating and exercise to be the body shape we are designed to be.

What I am NOT happy about are un-endorsed promotions for sale such as the 12WBT that promote weight loss and incorporate misleading information such as the importance of counting calories and regular weighing. Patients with eating disorders such as anorexia nervosa and bulimia nervosa perform these behaviours at an obsessional level. Encouraging people to weigh themselves and then to apportion their self worth to a number is dangerous and can lead to the onset and relapse of eating disorders.

Programs such as the 12WBT have not been endorsed by any regulatory health body, or have published any data about whether rapid weight loss by consuming a very low calorie diet leads to long term change. What we do know is that eating a balanced diet, watching portion size, reading labels on food packaging, and engaging in moderate regular exercise is the way to sustain the weight you should be for life. It is also the way that you can make a huge difference to many preventable diseases such as hypertension, diabetes and arthritis.

I have met quite a number of people who have enrolled in the 12WBT program with all the best intentions only to discover that the very low caloric intake in the first few weeks in unsustainable. Not because they are weak, or greedy or lack discipline, but because they are not consuming enough nutrients to sustain their daily activities.  This can then be interpreted as being a failure, and further reduce self esteem. Listening to hunger cues and eating when hungry is a normal human behaviour. Realising you are hungry and depriving yourself of food as a form of strength is pathological. And, there is no one magic number of calories that all humans must adhere to, but there are guidelines about a healthy range.

I tell my patients that they are the special unique people they are because of many factors. not one is what number they are on the scales. And I know that for many people with eating disorders, this message takes years to sink in.

By all means be healthy, happy and exercise for your physical and mental health. Just read the fine print and if you think something is too good to be true, well it probably is.

Stay well over Christmas and New Year,

Helen

A hashtag and a new style of therapy

Greetings all,

Today I write about what I experienced on social media after the passing of cricketer, brother and son, Phillip Hughes, in such a sudden and unpredictable way. I experienced a world that is different to what we see on mainstream TV most nights, full of anger and hatred against fellow humans. It was an example of how desperately people who don’t even know each other, let alone ever met each other, feel compelled to reach out to those suffering.

I often get asked by patients why they feel so affected by something they see on TV or read about in the paper. This is an extremely common experience, one I remember that occurred when Princess Diana died. In a pre-hashtag era, people in the UK left thousands upon thousands of flowers at Kensington Palace. They were dumbstruck and it felt incredulous that somebody could be alive one second and not the next. Especially somebody so famous. They had to connect with others sorrow. Humans seem to be driven to find meaning even when there is none. After all, we know life is fragile, we can’t expect to live forever yet when it happens we cannot believe it to be so. That is grief.

I also explain to patients that humans are great ‘pattern matchers’, when they say they feel silly about being affected by something that happened to somebody they didn’t know. 

When we feel grief or sadness we may be taken back to a time in our life when we experienced profound loss. Hence the pain we feel is really a combination of what we are seeing and what we are remembering. Hence we may cry about a stranger’s passing, we may want to reach out and help in any way possible. 

I feel that devising the #putoutyourbats hashtag was an incredibly therapeutic gesture that will help not only to show the families suffering that people care, but also help people who are suffering to do something with their sadness.

As for me, and because shrinks have feelings too, II was deeply affected this week as I could relate to the first on scene doctors and paramedics. I have been in a few situations where I have offered emergency assistance with groups of people watching me, knowing how bad things are and desperately trying to change what really is fate. 

My worst experience happened in 2013 and I wrote about it here. Although I pulled a toddler out of a pool in a 5 star resort and did the sloppiest CPR ever seen that resulted in him surviving, I felt total guilt that was irrational and needed lots of ‘debriefing’ to manage. The way I was treated in the US was terrible but when I got home my colleagues were fabulous to my son and I, who also witnessed the whole thing. I wasn’t hailed a hero, I wasn’t even thanked by the family, but I don’t care because I know that little boy is alive now. Yet I still remember and I still feel uneasy when I see people performing CPR, and I still question to this day whether I could have done things differently.

I write this because doctors are lousy at admitting how affected they are (including me), and that they may need some support. I can only feel for Dr John Orchard who gave Phillip the best chance of surviving what was an incredibly severe injury. He did this with the players gathered around him, with the expectation he could ‘do something’ and he did it because that’s what us doctors just do. I truly hope he is OK and does seek comfort in the fact he tried his very best. Likewise the paramedics who did arrive early but have been criticised for an apparent delay.

And to the players and cricket community, I urge you to seek help weeks or months down the track if you need it. There is no such thing as a time when you should be ‘over it’. Only you can choose when it’s time to ‘move on’. You will all be affected in your own way. Find somebody to listen and help you. People are there if you ask, way after the hashtag goes away. 

My 'prize possession". My cricket bat autographed by Dean Jones in 1992.

#putoutyourbats

Dr Helen Schultz is a consultant psychiatrist at MindAdvocacy, Richmond, Victoria, and author of "How Shrinks Think" www.mindadvocacy.com.au

Common sense prevails

Greetings all,

Like many of my medical colleagues I am celebrating today with the news that the Federal Government’s GP co-payment system is all but defunct, despite incongruent press releases throughout the day. The co-payment system is thought to affect GP visits but many don't know it was desgned to involve radiology and pathology services as well. I don’t know how this has been overturned. I hope it was because common sense and benevolence won in the end. But regardless, I care because now there is a chance my vulnerable patients will still be able to access the treatment they deserve in a country such as Australia.

I wrote about the injustice of co-payments for those with severe mental illness on Croakey in June 2014, found here. My main point was that it was inhumane to impose fees for medications and diagnostic services on an involuntary patient who was being treated under the Mental Health Act, because of the fact that they were refusing treatment or unable to consent to treatment. I wrote it at a time too when I was working in a large city and struck by the amount of homelessness and poverty even in inner urban areas. I wanted to tell those who would listen that there must always be free health care for those most unlikely to advocate for themselves or pay for it.

As I wake to this news today I am working as a psychiatrist in a rural area servicing a large population and geographical area. Many patients are indigenous, many are also kept well by the public health system. As stretched as it is, staff are genuine and truly caring of their patients. I have been able to see how medications such as clozapine have actually turned the lives around of patients with severe mental illness, keeping them out of hospital for years. 

As I wrote earlier in the year, patients prescribed clozapine require weekly to monthly pathology tests to ensure they are not developing  life threatening side effects. They cannot pay for treatment and some are receiving treatment under the Mental Health Act, hence unable to consent to it. I know that if they had to pay $7.00 every week for 18 weeks for blood tests many would stop medications and become severely unwell, maybe even requiring months in hospital to recover. I suggest it best they receive outpatient care in an evidenced based manner rather than risk a relapse that would disrupt their lives or potentially place their lives at risk.

I was impressed to hear Dr Brian Owler, federal president of AMA, speak about the GP co-payment system today. I support his continued requests to work with the government on finding a better solution to funding care. I am not stating all patient should be bulk-billed. But I am very aware that to remove this advantage for everybody will leave an incalculable dent in the health care budget, notwithstanding poor patient outcomes and more strain for health care professionals that work in a stretched health system.

It’s Ok to make a mistake once, we all do. But if our current federal government doesn’t learn from this mistake by continuing to ignore key stakeholders such as the AMA and patient lobbying groups to my mind that would be reprehensible. 

Dr Helen Schultz is a consultant psychiatrist at 'MindAdvocacy' Richmond, Melbourne, Australia. She is the author of "How Shrinks Think" published November 2014.

Lots of talk but no action

Greetings all,

Many thanks to all of you who retweeted and replied to my blog post entitled “Not thinking before you speak”. It seems many are as outraged as I am about Mr Latham’s comments towards Lisa Pryor, and more importantly to The Financial Review for not retracting them.

As I have said, yes, all are entitled to freedom of speech but some acknowledgement that these comments are hurtful, stigmatising and lacking any credibility is still sorely missing.

The Royal Australian and New Zealand College of Psychiatrists have also replied to my post, stating via Twitter,

“Absolutely, Mark Latham’s comments are concerning and not helpful in removing stigma attached to mental illness.”

On this WhiteRibbon Day, I will keep up the fight to support Lisa Pryor, soon to be a medical colleague of mine, as well as advocate for public understanding and respect for my patients who ask for help and should not feel ashamed for receiving it. I will also continue to follow the campaign at Change.org and encourage others to do so as well. Over 1500 people have signed the petition so far.

Let's keep this going,

Best wishes,

Helen

Dr Helen Schultz is a consultant psychiatrist at MindAdvocacy in Richmond, Melbourne, Australia. She is a recent author of “How Shrinks Think” which can be purchased here.

Not thinking before you speak

Greetings all,

I begin this post by declaring that I know that in Australia we are fortunate to have the right to free speech. In particular, I am referring to Mr Mark Latham’s article published in The Financial Review last week which has caused an outrage amongst women who have mental illness or care about those who do. But what I struggle with is when those who speak from a position of influence don’t think before they speak. Or if they do and they are found to be incorrect, or indeed cause harm, don’t apologise.

I have no legal training and I am not a journalist, and don’t claim to know about tactics to sell papers or how a person is chosen to contribute to content. I am however a psychiatrist who can spend up to half her time in initial sessions with some patients reassuring them about what I can offer them and why it is a sensible and medically advised decision to seek help for mental illness. It is why I wrote my book “How Shrinks Think”. It’s where I see the most stigma. Behind closed doors, people suffering that I know we can help, but those that would be horrified if their friends or colleagues knew they were seeing a psychiatrist. Those I see get better, sometimes with medication, and still don’t want anybody to know they have a mental illness.

I can’t comprehend why Mr Latham would comment about mothers and mental illness, especially during BeyondBlue's post natal depression awareness week (16-22 November 2014). I do consider it necessary to set the record straight regarding depression and motherhood from a psychiatrist’s point of view.

If a woman is biologically predisposed to developing a mental illness they are more likely to have an episode at the time of hormonal fluctuations, i.e. during puberty, at the time of menopause, and guess what, while pregnant and after childbirth. Hence why the subspecialty of perinatal psychiatry exists. Hence the scrutiny for the emergence of post natal depression in biologically vulnerable people to protect the mother and in extreme cases the baby. See the logic there Mr Latham? The baby doesn’t force the mother onto antidepressants, the mother isn’t weak but the mother may be biologically predisposed to the development of depression, with episodes triggered by these hormonal fluctuations. Fantastic, capable, loving mothers who also have a personal or family history of depression. Thank goodness we do have effective treatments, dedicated mother‑ baby inpatient and outpatient services that care for both mother and baby while keeping them together to encourage bonding. 

Guess what else, Mr Latham, we know that we need to help the mother for the infant’s well-being as well. Something the child will not be blamed for, but the child may thank the mother for.

I have heard the notion that antidepressants are a band aid, a happy pill, something to become reliant upon or change people’s personality so many times it’s really not funny. No endocrinologist would cop the same when prescribing insulin to a 4 year old child who has type 1 diabetes. If a mother has depression she should not be made to feel ashamed if she needs to take antidepressants.

So I do concede Mr Latham has a right to freedom of speech but I would prefer it be informed and evidence based. I ask the Financial Review to accept utmost responsibility for publishing these remarks, pointed towards a successful and happy mother, by retracting the article. Remarks similar to those Mr Latham has made in the past regarding patients with mental illness. Then I can carry on working to debunk myths, educate and above all help my patients as my profession would want me to do. 

Finishing my book then having a good lie down – on the couch

Greetings all,

Well, I am very happy to say I wrote the final words of my new book “How Shrinks Think” yesterday (editors changes pending). The last word I wrote was ‘psychiatry’. The last topic I wrote about was psychiatry and social media. Who would have thought that this Facebook avoidee and Twitter ignorant person a year ago would now be embracing this great means of global communication!

It is timely for me to reflect on this change in my learning and outlook. That’s because I don’t think I would have ever finished my book (editors changes pending) if I didn’t receive all the help, support, encouragement and opportunity I have been fortunate to experience in the Twitterverse this year.

Some of my friends and colleagues in my life know I have been writing a book since August 2013. Many don’t. It does feel embarrassing I suppose to announce where ever you go that you will be an author someday. So, in the main I didn’t. But on the rare occasion that I did, people seemed generally interested. They were interested to know what I had written about and incredulous that I could be relatively easy in this era of self-publishing. But largely, I have written the book just for me. I don’t know how it’s going to be received, but regardless, I will continue to remember that.

In all sorts of ways the interrelationship between my experiences on social media and my writing journey have been closer than I would have imagined. I began to ‘play’ with the concept of writing about modern day psychiatry from the ‘inside’ on January 1 2014. I started my blog “How Shrinks Think” to sort out my own thoughts as well as gauge others impressions of what I had to say. I was scary at first but then a whole lot of fun. Then I gained the courage to use my voice as blogger and writer of “How Shrinks Think” in order to enter the world of campaign building. I was very involved in @AHPRAaction in May, and then wrote about the federal government proposed Medicare Co-payment and the effect it would have on those with severe mental illness. This propelled me into re-connecting with colleagues from the past, particularly from my AMA days, including Mukesh Haikerwal, and Amit Vohra. Opportunities arose from this including the privilege of being a speaker at the inaugural AMA(Vic) DiT conference.

I also discovered the talent and experience other doctors in Australia had when it came to writing. Although we have never met face to face, I consider Edwin Kruys in Queensland and Jacquie Garton-Smith in Western Australia to have really inspired me to keep writing and ultimately ending the journey that is the first draft of a book. I was fortunate enough to have some blog posts picked up by Croakey, and managed to connect with psychiatrists in Australia and around the world.

It is no coincidence that I will launch my book at @SoMebythesea on November 15^th 2014. I am organising this workshop amongst incredible people, many  I would never have met were it not for Twitter. It is amazing that virtually all of the organisation and promotion for @SoMebythesea has occurred via the amazing network opportunities of social media. Now I have Dionne Kasian-Lew, Marie Bismark, Mary Freer and Jen Morris coming along to speak at @Somebythesea. All people I have met via networking.

Of course, I have not forgotten my friends from the beginning and pre SoMe. Some are also growing and expanding their social media presence, like the sleep guru David Cunnington. Brad Mckay has been a great mate all along and a wonderful mentor for me in this new foray. My journey did begin with Andrew Griffiths and Kylie Bartlett, and I will always be grateful for their teachings and guidance. And all my friends who have been there, offering advice and encouragement.

So, the next 6 weeks are now in the hands of my editor, Roy Mazucco, and designer, Carly Goodwin. Incredible to believe but if all goes to plan, I will have my book in my hand in 6 weeks. May need to see a psychiatrist to process it all.  

Shrinks and Social Media

I don’t ever remember learning about social media at medical school back in the '90s. Social media was reading the newspaper or a magazine before uni started. In the olden days, merely 20 years ago, we had no idea the www was coming.  Dr Google was somewhere in the lecture theatre but we didn’t recognise him/her, and we couldn’t imagine that there would be communal platforms like Facebook around to unite strangers and label them friends.

Lecturers teaching ethics in medicine did not fathom a world where doctors would live within social media, and have to work their way through the twists and turns of setting up and maintaining Facebook personal pages, doing their best not to be found on social media by their patients, yet really wanting to share photos of recent holidays, and remain in touch with colleagues.They certainly wouldn't have envisaged doctors embracing socila media as an effective means of building communities, promoting evidenced based helath messages and influencing for change. 

Regulatory bodies such as AHPRA and professional associations such as the AMA have tried to keep up with the growing trends of what was considered a fad and considered absolutely not relevant to professionals, certainly doctors, but then had to begrudgingly accepted social media as something here to stay. Unfortunately the regulatory bodies, not the medical profession have advocated for the way social media should be used in medicine, and many doctors remain unaware that they need to know more about social media in medicine.

More and more, doctors want to influence debates on health matters, and nowhere is this more real than in psychiatry and mental illness. In 2014 we must realise that stigma is rife and campaigns such as ’@RUOKday’ and days dedicated to suicide prevention are popular because there still exists a fundamental belief that to be depressed is weak and something to suffer in silence. Large NGO’s with stacks of cash  have departments that run social media campaigns, driving their messages home, influencing the debate and keeping the radar on the topics. But what about doctors? Why do we believe others can pledge our plights and we can be taken as read, without being read, that we support or refute an argument or counterargument without making our own unique and collective point of view known? How do doctors, particularly psychiatrsts feel about campaigns such as @RUOKday, and what are they saying about it?

In Australia, the ABC is running a campaign called 'Mental As' to coinicide with national Mental Health week in October 2014. Great to use high profile celebrities to 'raise awareness', but what does a psychiatrist feel about a campaign being labelled "Mental As?" How do psychiatrists feel about raising awareness for a most valuable area of health, yet with limited funding to provide care when patients seek help?  How do psychiatrists feel about being labelled as those that treat 'mental patients, a most derogatory and stigma enhancing term. Isn't that where psychiatrists can have a say? In summary, advocacy about mental illness on social media is one sided, lacking a robust evidence base and not informed and influenced by experts in the field - psychiatrists themselves.

In the last 5 years it is pleasing to see medical colleges such as RANZCP and RACGP join social media, tweet regularly and highlight very important policy decisions they are making regarding such critical issues as the mental health issues facing asylum seekers and offshore detainees. In recent times we have seen doctors unite over issues they are passionate about such as #AHPRAaction, #ScrapTheCap and #CoPayNoWay. Because the fact is this. Social media is not for posting what you ate for lunch or where you spent your holidays. Social media is for connecting, uniting and advocating as a mass of people from so many walks of life that would never have been able to come together so quickly in any other way. Campaigns on social media work quickly, they pack a punch and they influence.

I write as a novice to social media, coming on board in January 2014 as a naysayer and critic. It was because I didn’t know about this side of social media. I learnt from other professional bodies, dipped my toes in the twitter universe and discovered to my amazement there were people I could find and follow who felt like me. People who admired what I did and followed me back. I quickly joined an amazing campaign called #AHPRAaction and stood up to our regulatory body to defend our rights in the context of social media. Four months after I opened my twitter account. Now I blog regularly, have a company Facebook page, tidied up my LinkedIn profile, set up a psychiatrist’s and registrars group on Linkedin (PARA) which is gaining membership, and have almost finished my first book.

And what about me as a doctor, passionate about psychiatry, and with my experience as a writer and learning the ropes about being a shrink? Well, now I have a voice and a brand. I have stepped forward and claimed my identity that is authentic to me, before others can post about who they think I am. I have bought my domain name www.drhelenschultz.com, and claimed the @Drhelenschultz  twitter handle before somebody else does and pretends to be me. Not a narcissistic thing to do, but a sensible thing to do, as the real estate space in social media gets clogged, people find new ways to influence and may wrongly do so by purporting to be somebody else. And because I want to guarantee my future both in the business and medical world as well as the social media world. The two are intertwined. I love the feeling that I can write what I think and own it, and others can truly decide whether they admire me or not because they know the real me.

As for psychiatry, I will continue to have a presence and a voice on social media, finish my book “How Shrinks Think” and be a thought leader when it comes to our treatment of those with mental illness, and what we can all do better. I’ll stand aside NGO’s and colleges as somebody who works within the system and has a right to have a say. That say will be shouted on social. 


Dr Helen Schultz is a consultant psychiatrist based in Melbourne, Australia. She is also founder of CPD Formulations, a medical education company that creates medical education programs written for doctors by doctors. Her new workshop is called @SoMebythesea, to be held on 15th November 2014, in Torquay, Victoria. It will be the inaugural social media workshop for the medical profession. 

Healing the scars from registrar training

Greetings all, 

The title bears no need for explanation. We all know what I am talking about. Those horrific nights on call we thought would never end, the continual feelings of being out of our depth. The feeling of total inadequacy and a longing to go home.

Now I am a consultant psychiatrist and have run away again from reality to work on the last revisions on my first ever book, How Shrinks Think. Not bad given I have wanted to be a writer since I was 12 and I am now 46. Still, I have built up more to write about and feel more confident about what I want to say. 

My warts and all account of psychiatry from my perspective began taking shape about a year ago. The first draft was finished in about a month. 1000 words a day for 30 days. Then I stopped, struck with fear because I presumed I would be criticised by my peers for saying what I wanted to say about how psychiatry is according to me the most exciting speciality of medicine, but also the one that is most controversial and misunderstood. So it sat with my editor, Roy, until about 2 months ago. 

Now, I feel I have confidence, so have continued in earnest to achieve my deadline for my book launch of 15th November 2014.

As part of all of this, and to stop myself being distracted by my pantry that needs cleaning, weeds that need removing from the garden, the need to concoct the most difficult recipe from Australian Women's weekly all-time favourites cookbook when home alone, pay attention to the cat, do my nails, organise my home office and watch crap on Foxtel, I have started getting into these 'writer in residence’ weekends where I simply run away to a beautiful hotel, languish by the fire and look all mysterious with my laptop. I love it when the check in staff ask me if I am on a holiday, and I can quickly retort, oh no, I am a WRITER and here to work. I'm sure they laugh as I drag my luggage, my snacks and my books up to my hotel room. 

So here I am, at writers retreat number 2.

I have checked into the newest Art series hotel, The Schaller, in Bendigo. Not just in Bendigo but on the grounds of the Bendigo hospital. Not only on the grounds of the Bendigo hospital but where the nurses accommodation used to be. Not only where the nurse’s accommodation used to be  but where I stayed for 6 months (3 as a medical student and 3 as a psychiatry registrar). Ok. Big breath. This has to be for a reason. The walls ain’t talking because they are all new, but hey if they could, they’d remember me as a scared medical student, homesick, much older than my peers so didn't fit in, then returning as a psychiatry registrar for 3 months. I remember my great mate Carlos, another psych registrar who walked in after our first day on rotation here in psych to say, “lets' celebrate, it's only 11 weeks 6 days and 5 hours to go, we’re practically half way there!!”. And that was what it was like. 

Some nights I was called back to the ward so often I gave up getting changed and went to the ward in my pyjamas. Nobody seemed to notice. Many nights I couldn’t leave the emergency department as I tried to help staff calm down violent patients. Most nights there was no room for admission to the psych ward so I admitted them to the 'Rad ward' which was the radiology department that closed at 5pm. The patients laid in temporary beds. We are talking about 2005 not 1925. Many days I had no sleep and was expected to drive to Echuca to start clinic at 9am the next day. Not conducive to good learning, not conducive to me or my patients. But the way it was. These walls would know I went to the lake here in Bendigo one day, called my best friend, told her I was quitting and drove home. I did go back on Monday but gee it was on a knife edge.

So here I am, in this most salubrious hotel, uber chic, and the total opposite of what I was given while up here as a doctor. No lino on the floors, no rats, no shared bathrooms with cold water. In fact truth be told I begged to stay here in the nurse’s accommodation as psychiatry registrars were placed in old houses on the outskirts of Bendigo and we were too frightened to travel back and forth overnight in our cars to the ward. We begged to live within the derelict nurses accommodation because there was security on site and we could walk to the ward. 

I am stronger than ever to write my book because despite how totally awful it can be at times to be a doctor in training, we do get through and life gets better. Recently, a psychiatrist contacted me out of the blue. She was a registrar I coached during her training and she rang to tell me she gained her fellowship with the RANZCP. She was so grateful. The one thing she remembered me saying and that kept her going probably on nights when she was pyjama clad, sleep deprived and slave to her pager was I told her just get thought your training and it will get better. They were her words to me, yes, Helen, just like you said it did get better....

And as I finish my book in this place of 360 degrees growth and experience, 10 years later, I also know like I never believed back then, it does get better. 

Feeling connected

Doctors are extremely busy people. So are many professionals. We go about our day attending to our patients, reduce our ever increasing pile of administration, run our practices and juggle our personal lives. When our patients need us in an emergency they have no idea there may be quite a few with similar needs on the same day. And nor should they. We are quite skilled at triaging, attending to the problems at hand and delivering as much as needed for our patients. But there does come a time when we would like to raise the white flag and say, STOP! Just for a minute, so we have a chance to breathe and an opportunity to recharge.

I have taken myself away for a weekend of solitude and reflection, a moment to take stock and assess where I currently am in my career and where I am heading. Giving my all, as doctors do, can lead to needs to escape and energise. And so here I am in a coastal location, remembering who I am and what is important to me. 

This is no new revelation. Doctor’s mental health and wellbeing relies on the notion that we all need a break, we all need to listen to our bodies and minds, and pro-actively manage our needs for our own health and the health of the patients we are responsible for. So, why do we find it hard to get away?

Part of it is the realisation that at the end of the day, many of us are small business owners, managing staff, and scrutinising cash flow. We are not only responsible for our patients but also for our staff and our obligations under tax law. We work to pay our college fees, medical indemnity and other professional liabilities we incur as doctors. We juggle our time amongst our clinical duties and our business requirements. We can, quite easily, forget that we are like other doctors, feel isolated and overwhelmed, and before we know it, consumed by worry and insecurity.

Medical training does not equip us with business skills, yet many of us are small business owners. At times I truly believe that learning all the branches of the facial nerve was inconsequential when compared to learning how to pay the BAS on time or service overdrafts. But this is real life post fellowship. The answer? Becoming and staying connected to your peers, and asking and receiving help.

The RANZCP strongly advises we form peer review groups post training in order to discuss clinical cases and obtain feedback and support. Obviously very important but way too narrow for most of us in private practice. In my time since fellowship I have forged and cherished some very strong relationships with peers that have nothing to do with discussing complex cases of schizophrenia, or the latest views on using antidepressants in bipolar depression. As a small business owner and sole director, my most valuable mentors are those who have done it before me, who are honest enough to admit their mistakes and can tell it like it really is. They have helped me understand how to run a practice in ways my training did not prepare me for.

And now, through social media I feel connected to other health professionals including doctors who have similar creative pursuits to mine. I have discovered a group of doctors who have a passion for writing, as do I. Now that registrar days are over I have pursued other areas of learning that matter to me. This has transpired into a feeling of connectedness, contribution to a community, asking for help and truly learning. 

As I embark upon my weekend of solitude and throw myself into finishing my first novel, I thank those who I have met and who have supported me to learn how to take a break, how to follow my passions, and how to actually make it happen. You know who you are. See you when I get back to reality.

If a doctor's practice ran the way Dutton is running health..

Boy, has it been a turbulent time in health lately. And for all the wrong reasons. Yet the federal government plough on, resisting communication or negotiation while they stick to their mantra – their proposed changes for health and necessary for the good of the country.

I keep trying to define what can be good for patients in all of this, but can only see a trail of negativity, a loss of services and values in healthcare for patients and fears of a diminishing medical workforce if education and health cuts are passed.

Then I thought about another way. Try for one or two minutes, just try to see the government’s point of view. Really, really try, maybe not be so ‘pessimistic’. Maybe see if it would make sense if I try and apply Dutton’s principles to a busy medical practice and see if these policies have any merit. Or are they simply something to apply on a grand scale rather than in a practical situation?

So, here’s my take on applying these changes to a real world setting;, what doctors and I work in every day,

A new world scenario for a busy medical practice:

Imagine this for a while and see how it fits. Doctors in this busy private practice hold a meeting behind the staff’s back and announce in unison that the situation at the practice is worse than anybody imagined. They have had some external auditors in and had no idea things were this bad when they signed the lease.

The principal doctors announce that due to the crisis left by previous tenants, there will no longer be a tea room, toilet facilities or any basic staff amenities. The principal doctors agree these measures will be tough but necessary. They did not appreciate how the previous tenants had left the premise. Hence they cannot be held accountable for what would be tough but fair changes for all.

The principal doctors inform the staff that there will be a 30% reduction in staffing commencing in 2 weeks. As a gesture of goodwill, the principal doctors will take a 2% pay cut, because, after all ‘we’ve ALL inherited this MESS’. There will be limited access to services such as Medicare or the Australian Tax Office. They were just superfluous services anyway, not really required by a busy medical practice.

Beginning in a week’s time, cash registers will be installed at reception and all staff will instruct patients to pay up before they have any chance of seeing a doctor. Even if presenting with chest pain, acute shortness of breath or other life threatening symptoms. The doctors understand that there will be ‘casualties’ due to this blanket measure but nevertheless it will work for the good of most who need health care. And it’s important for practice staff to remind patients that each and every dollar raised will go to curing their health problems via a medical research fund, so they will no longer experience chest pain or shortness of breath in the future. After all, the new breed doctors know, there is nothing in this ‘acute health care’ it costs too much and there is no return on investment.

The doctors warn the practice staff that this will be a very difficult time, but to remind patients that it is difficult for all, not just those who have recently lost their job,  have a mental illness, perhaps a physical disability or find themselves homeless of late. TOUGH. FOR. ALL. In fact, the principal doctors announce they will spend $250,000 to rebrand the practice with this telling and sage message. Staff will wear this logo on their new uniforms and doctors will add it to the business cards. Everybody will assume their rightful role in where they now fit in the practice and the greater community.  At the bottom.

When doctors finally get to see their patients, suddenly stricken with low self esteem and self worth, they will turn off their listening ears and preach to their heart’s content. They will fail to miss the tidal wave of patients surging the wrong way out of the practice door (or perhaps the right way), there will be serenity in the waiting room, but no place for reflection.

At least these radical but necessary changes will only need to be in place for three years. After that the practice lease will be up for renewal, and the new team of doctors can inherit the mess, seeing fit to do with it what they want.

Imagine this in the real world? What doctor would stand for this on behalf of their patients or their own professional lives?

Thoughts?

The dominoes are starting to tumble

A few weeks out from the State budget and one week out from a Federal Budget, we are beginning to see the direct effects of winding back health care for all, but especially for those with mental illness.

Yesterday The Age in Melbourne reported the State Government would no longer fund St Mary’s house of welcome in Fitzroy, as well as many other institutions that genuinely support and care for those with severe mental illness.  

I remember St Mary’s house of welcome from my training days. Back then it was a bustling place, a care and respite space for many inner urban patients with a mental illness. It provided a community, a haven, hot meals, clothing, shelter and love. Nowadays, it is even busier, and would have been full to the brim for years to come had it not received the news it would no longer receive government funding the day after the state government budget was delivered.

Many of the patients we knew within our service would feel safe going to St Mary’s when unwell, rather than calling a crisis team or attending an emergency department. In fact, most patients experiencing a relapse of severe mental illness avoid psychiatric services. St Mary’s provided a bridge between patient and service, our service could be alerted by their staff if somebody was unwell. They would do this in discreet and compassionate way, and would discourage psychiatric services from attending at St Mary’s to keep it as a safe place. However, services could follow up after hours and ensure treatment was provided.

There is no doubt that such wonderful facilities never come to the attention of politicians except as a cost on a piece of paper, to be cut when needed. There is no human element to the decision making. Where will these people go as these services break down? What will happen to their mental health? And if they can’t afford meals how will they afford to pay their GP’s $7.00?

Little is known about taking payments from patients in public hospitals. This seems to have been pushed to the State Government’s discretion. Will an acutely mentally unwell patient lost from services be asked to pay? Even when extremely paranoid and actively avoiding services? What is the point of newer medications and modalities of care if we are actively discouraging patients from seeking help, by taking away their places of refuge and charging them for care that they have no insight they need.

What will be the next domino to fall?

Choosing to play 'win-lose' in negotiation and how it applies to #budget2014

Greetings all,

As promised, here is another key learning from my WMA caring physicians of the world conference at INSEAD this month.

During a very busy timetable we immersed ourselves in understanding negotiation skills and multi party coalitions. The same day, I watched the Commission of Audit report and discussions fill twitter feeds. I could see what was happening, the Federal Government’s strategy behind #budget2014 was clearly win-lose negotiation tactics, where the tool of choice is power not communication.

When a party or individual chooses to play win lose, they use their power to influence and win. They need to be very aware of the risk and believe the reward will be great enough to set off the risks. Win lose negotiations fall down when such parties overestimate reward and underestimate resistance.

So what does this mean in the context of the last few days? Well, choosing to deliver a budget that is harsh, hits the most vulnerable that a society should protect, doesn't contain a lot of information about how these measures could even be implemented, and then states that it will help Australia out of a perceived economic mess, may be overestimating reward.

I don't see reward when it comes to the $7.00 copayment. I have spoken to a patient who takes warfarin, who told me that if the copayment for pathology services go through, they will take their chances rather than have twice weekly blood tests. 

As a psychiatrist, I may no longer be able to prescribe lithium as often, a fantastic medication for bipolar disorders, as lithium monitoring is crucial with weekly blood tests needed to avoid kidney and thyroid disturbance. The ridiculous aside to this is that lithium is much cheaper than newer atypical agents and more cost effective for government. But, if my patient doesn't return, doesn't have regular monitoring, and develops renal dysfunction, they will then be knocking on the bulging doors of the emergency department. For the sake of making a GP or pathology centre claim $7.00 from a patient, because, after all, they have lost $5.00 per consult, costs and burden of disease will only but rise.

What will we see playing out in the next few days? Parties that choose win-lose and underestimate resistance will feel they have won for a little while until key stake holders form coalitions and lobby to block changes. Key stakeholders that have been shut out of any discussion about this most important budget, and all important patient groups will lobby via all channels available. Let's see what win-lose really looks like in a few weeks, and at the next election.

Then, a word of advice for all, using 'win-win' in negotiation requires communication. How about Government communicate with RACGP, GPRA, AMA,  and  include doctors rather than just rule them, or reduce them to workers of another branch of the ATO.

Thoughts?

Helen

Availability Bias and delivering messages that change

Greetings all,
I have just arrived home after attending the World Medical Association 'Caring Physicians of the World' Leadership Course, at INSEAD Singapore. Over the next few posts, I plan to share some of the most amazing insights I learnt in a jam packed 5 days, surrounded by doctors and leaders from all over the world.
Today, I'm posting about the first concept that hit me between the eyes and taught me how best to communicate and influence with impact. And it stems from the concept of availability bias.

In a nutshell, availability bias is how news stories are shaped and how we are touched by events that occur around the world. News events are largely made up of stories of tragedies and disasters, or one in a million good luck stories. This shapes our understanding of issues for good or not, far greater than being presented with facts and statistics. Take for example, the horror of a plane crash. An absolute tragedy for all concerned and well worthy of headline news. Availability bias results in the decision we make to take that information and decide whether or not it is safe to fly. Because, after all, there is no report of how many planes landed safely and without incident on any given day. The information available to us leads to a bias in our thinking.

In addition, good leaders tell stories, rather than just present facts. Once the human element is lost and we can't connect on an emotional level, the impact to change is reduced, and the message gets lost within the debate.

As leaders of health debates, we must remember to tell stories and share the personal element of every issue we aim to influence. And as doctors we see and hear first hand these stories every day. As I continue to try and influence issues that impact on patients with mental illness, I will remember to embrace the impact of a human story, an experience or a tragedy rather than just present facts or statistics. We were told "statistics are humans with the tears washed off''. Such an important point of view, and one you can use when delivering powerful messages.

So, next time you are presented with facts about a healthcare issue, perhaps that you disagree with or can't relate to, remember the concept of availability bias. Hear the presenter as a journalist at the airport commenting on all the places that landed safely, and influence with your own personal, authentic story (de-identified of course), for the good of your patients and to really make change.
Best wishes,
Helen

Leading from the Couch - Psychiatry and Leadership

In just under a week, I will be attending the World Medical Association (WMA) Caring Physicians of the World Leadership Program at the INSEAD business school in Singapore. I will be one of a number of delegates from around the world representing our respective local medical associations. I am attending as a psychiatrist and will be learning and engaging as much as I can to become a better leader in this most challenging and important area of medicine.

Although a terrific honour, this is also confronting, and has led me to ponder what it is to be a psychiatrist and a leader? And even more importantly, can we still call ourselves leaders in debates around mental health or mental illness?

In a world that is post de-institutionalisation, over time more and more non-government organisations, consumer lobby groups and front line services such as Lifeline do an amazing job at helping people in crisis, enhancing the awareness of mental illness and attempt to reduce stigma. Government funding is directed at large organisations so that they can fund projects and inform the metal health debate. Office bearer positions within these organisations are not reserved for psychiatrists but a range of mental health clinicians. In fact WE are largely being labelled 'mental health clinicians' when we are Psychiatrists with medical degrees and post graduate training. And although funding and awareness is all important, I should not be at the expense of evidenced based care that psychiatrists are trained to deliver.

Today on Twitter, SANE posted a comment from their CEO, Jack Heath. In a recent comment in the Age he stated that more than 2500 people died by suicide in this country in 2012. He described this as deeply concerning, not least because it is the highest number of suicide deaths in the past 10 years. He called for collaboration between clinicians, NGO’s and Government. He believes mental health clinicians need more skills in recognising and managing suicidal tendencies. But what about psychiatrists, who are trained in this and can do this work being engaged in this debate. Actually, why aren’t we leading it?  

I am concerned about the ‘dumbing down’ of a profession I am very proud of. When I have a patient in crisis and need to call crisis services, I rarely get to speak to a medical colleague. Imagine a cardiologist sending in a patient to an emergency department with chest pain only to be told he cannot speak to the admitting officer, another doctor. And psychiatrists are largely losing traction as leaders in hospital multidisciplinary teams. Policy is often informed and determined by others.

Two ways I see that psychiatrists will continue to experience challenges as becoming leaders in the mental health debate:

1.    The Monash University Medical School now offers a course titled 'Medicine of the Mind' rather than psychiatry. I can only imagine the outcry if they offered orthopaedics as ‘Medicine of the Bones’. Not only is this a watering down of our skills and abilities, it may discourage medical students becoming future psychiatrists. Medical students need to be educated that psychiatry covers more than just the mind.

2.    On 16 April 2014, Dr Murray Patton, current President of the Royal College of Australia and New Zealand Psychiatrists (RANZCP) spoke on ABC Radio National about addressing community misunderstanding about psychiatry. He reported results from a survey of 1500 members of the public in Australia and New Zealand, which will be released shortly. Perhaps the most staggering finding was that more than half of Australians (56%) are unaware that psychiatrists have undertaken medical training as a doctor, and 15% of the community incorrectly thinks a psychologist has medical training. This would be unthinkable in other specialities in medicine, and one ponders how this has happened? If patients don’t know what we do, they may not feel comfortable being referred to us. Hence the barrier to effective evidenced based treatment widens.

So, I will be heading to off to Singapore, as a medical doctor, passionate about psychiatry and willing to work out how I can become involved as a leader in this very important debate. The incidence of mental illness is a global concern, a local issue, and we need a strong empowered medical workforce for generations to come.

Should we be banning Stilnox?

It is call to action that has been mentioned on a regular basis. There is a drug on the market that despite repeated requests from the public and medical profession continues to be available. It's called Stilnox, the chemical name being Zolpidem. It's a newer type of sleeping tablet, and has been linked to a number of adverse events, usually related to amnesia after taking it, and has been reported to have led to patients performing acts they have no recollection of the next day.
This I don't refute, and, just as an aside, other sleeping tablets can lead to the same adverse effects. The risk of these events occurring seem to be increased when patients combine Stilnox with alcohol, which is against the recommendations of the manufacturer.
The NRL have raised concerns that Stilnox use is rampant among rugby players, and they feel the medication is being used to achieve a 'high' in players that are subjected to random drug tests, because it is not seen as a performance enhancing drug, hence goes undetected during routine drug screening. Perhaps they are referring to the adverse effects as outlined above. But Stilnox does not act on the same chemicals in the brain as amphetamines, so I am not sure about this.
What really annoys me about this whole debate associating athletes and sleeping tablet use is that we are not addressing the underlying question. Why do elite athletes need to use sleeping tablets like Stilnox at all?
As a clinician who specialises in sleep disorders, I am aware of the high rates of anxiety and sleep problems in elite athletes. While there will always be a temptation for some to misuse substances, by and large elite athletes have sleeping problems because of unrealistic expectations placed on them by their clubs. Athletes become sleep deprived as they attempt to adhere to match timetables, early morning training and jet lag when travelling to and from international events.
What is more rampant within the sporting profession than Stilnox use is a lack of understanding of the impact of 'cheating sleep'. Sleep is often seen as something to trade off against late nights and early morning obligations. This is despite the growing body of evidence which demonstrates convincingly that chronic sleep deprivation leads to a range of health problems, including obesity and cardiac disease.
Take for example the way the AFL match fixture runs in 2014 compared to when I started watching about 30 years ago. Matches can run untill 11pm on a Friday or Saturday night, players travel interstate on a regular basis and must attend early morning training sessions. Or, what about Olympic athletes that travel to other countries and are in the pool or on the track well before jet lag has dissipated, expected to do their very best during hours when they would normally be asleep. Sleep is 'cheated' at the very times that they are under scrutiny to do well. And this is without the added effects of performance anxiety which may also cause temporary insomnia.
So do we ban a drug or educate the sporting profession about the need for restorative sleep? I don't advocate that we use sleeping tablets on anything more than a temporary basis, and always in conjunction with psychological and behavioural strategies. But if external pressures mean physically less time in bed, how do athletes cope? Is this really why the use of sleeping tablets is rife within the sporting profession? And why label an athlete as a drug user when they have legitimate sleep disturbance and need professional help?

Taking it for the team

It is always hard to stick your head up and fight for a cause. Or so I hear. I have always been a crusader thats is passionate and controversial. I don't always conform but often question, looking for solutions where possible. As a result, I dont always 'fit in'. That can be tough, and I know I can polarise, but it's all I know, even if it creates personal angst at times. 

The recent @AHPRAaction debate has fuelled passion and outrage within me from the get go. I have watched the argument intently, and yesterday, I added my name to a petition that will be delivered to my governing body as a doctor and psychiatrist. Many of my colleagues agree with my views on this assault on free speech but are too concerned of potential backlash, and as such resist from adding their name to the petition. It doesn't mean they don't care but they fear consequences. 

Do I fear consequences? Of course I do. Do I fear my potential vulnerabilities as we move to a society focused on social media? Resoundingly, yes. I felt comforted today as I checked the list and found doctors I admire adding their names to the petition. Today, Dr Mukesh Haikerwal threw his support behind #APHRAaction that counter proposed regulations by AHPRA regarding social media. If there is one doctor I would state cares about his peers, its Mukesh. I was priveliged to have an office bearer position within AMA when he was involved at state level, then as federal president. I am reassured that I am actively supporting a cause with no certain conclusion, and involves a body that can de-register me, but I am one of many including Mukesh. I can state vehemently that this is not fair, encourage lively debate and influence a decision that can only become more relevant as we move towards a future intertwined with social media. 

I have been reflective during this debate. Why do we fear backlash as doctors? It begins as medical students and interns.  We learn not to show weaknesses or vulnerabilities, or ask for help. We work hard but don't make it into our chosen specialty. We fail our college exams a few times and we keep fronting up for work. We struggle with the challenge of entering private practice while distracted by the intricacies of small business, while feeling we are alone. We learn somewhere in medical student training it's not OK to say we are struggling, and as such, human. But when we feel we are being treated unjustly? Why do we find it so hard to stand up for our rights?

The @AHPRA debate has been one sided largely because of lack of comment from the body that has imposed the regulations. I am proud I am on the side that has united doctors that are fearful of governing bodies, but more fearful of living in a world where all that is said about us publicly is negative. I know I am not alone when stating I am not a doctor for the notoriety. I don't need testimonials. My patients thank me behind closed doors, and on a difficult day that is all I need to keep going. But what of the next few years and social media trends? Did I sign up for a calling that is gruelling, challenging, terrifying yet rewarding only to see criticism about me? The balance might tilt and the tweets, posts and updates may shatter me on a difficult day. That's why I am fighting now. And being surrounded by the likes of Mukesh, I know I am doing the right thing by myself and my profession. And I am so proud to be one of my colleagues that has put their fears aside recently and exposed themselves as campaigners against these regulations. 

Let's hope we tip the balance in our favour. 

So what really is the difference between a psychiatrist and a psychologist?

Greetings all, 

I bet as fellow psychiatrists you are asked this all the time, or maybe not. I always start my session with new patients targeting this to attempt to and debunk any stigma and myths they invariably have about us. The stock standard answer from the new patient is that 'you prescribe drugs, psychologists don't'.

 What a shame that after over a hundred years, post collaborations between Freud and Jung who later parted ways as the genesis of psychiatry and psychology was forming, we still have to explain to patients who we are and what we do. In stark contrast, if a patient presented with a broken leg to an emergency department, they would demand to see a doctor, not an allied health professional fully qualified to assist with rehabilitation. Yet for some reason psychiatry is not recognised as a medical specialty amongst lay people in 2014, and we still need to 'sell' ourselves to those who are referred to us. For those of you reading this and disagree, I suggest you begin your sessions the same way and see what they reveal. Reality ain't pretty. 

There are so many reasons why psychiatry and psychology are two different disciplines that share similarities and should complement each other. Go read a standard text and work it out. In clinical practice, although I incorporate my own mix of pharmacological and psychotherapeutic approaches, I have a niche of psychologists whom I refer to constantly to request their guidance, and deliver their expertise for patients we share. In private practice it is a lovely nurturing model that the public hospital system with all its rhetoric and useless catch phrases never accomplish when they refer to the use of a multidisciplinary team. Where would I have ever learnt about schema focused therapy in my training, yet how many patients have I referred to psychologists for this expert type of therapy that have resumed their lives, better than before with a collaborative approach between psychiatrist, psychologist and GP? Any patient, for which there are so many, with childhood trauma, benefit so beautifully with this approach and I have learnt so much from my psychology colleagues.

But here is the disparity. Last week, I met a psychologist who was keen to work 'collaboratively' with me. After about 10 minutes he was keen to impart his ideas that in about 20 years, psychiatry would be a dying profession, and by then psychologists would be able to prescribe medications. In his eyes, psychiatry was the path of last resort for patients with mental illness, as psychologists were much more expertise when it came to understanding the mind and brain. He had little time for doctors in general and psychiatrists in particular who prescribed medications indiscriminately, and didn't seem to appreciate what psychiatrists could offer. Yet he wanted to work with me and share patients. If I could refer them to him. Gee, thanks, but I chose politely to decline the offer. However, I was left thinking, was his view reality based on his interactions with our specialty or was it skewed? It's easy to argue the latter when defensive. We ain't surgeons, we don't fix almost AMI's and death amongst our patients is taken on as personal failure. Our work is not glamorous, but was he frustrated about our resistance to work together collaboratively, or was he trying to claim our turf bestowed with our medical registration and specialty training?

And then the second disparity. A new patient referred to me and in the throes of engagement with our fortnightly sessions. Towards the end of the second session she felt compelled to talk about her conflict. Not about her life, her family, her chronic illness or her existence. No, her conflict was she didn't see me as a psychiatrist. She asked me to label what was wrong with her and I replied by saying that labels were not always useful, getting to know people was much more helpful. I reassured her that I was still getting to know her and for her to feel comfortable with me. But her feedback was compelling; she stated I acted more like a psychologist as I was more down to earth and easy to talk to. How did she form that opinion? Where did that come from? In her early 20's and without any formal psychiatric history, this was her opinion. 

What is psychiatry getting wrong? Why do we have to constantly defend what we do? Are we going to be obsolete? I welcome you unabashed, candid views...

As always,

Helen

Please tell me this is not happening...

Ok, I haven't worked in the public mental health system since 2009. OK I might be misinformed. But I am hearing more and more from colleagues that a reduction in staffing in public hospitals is leading to increased use of major antipsychotic medications to sedate patients, so they require less intensive support and care. Known as 'chemical restraint', this method is being used over safer methods during the acute period a patient may be agitated and require transportation. Now, anybody who has not witnessed first hand how unwell and distressed patients with acute mental illness can be may find this diffiicult to comprehend. But doctors and nurses are duty bound to ensure they keep patients safe from themselves and others until better. The safest way is to use trained staff to calm patients, proivde one on one support and supervision, in a low stimulus environment. The same goes for patients who are agitated and distressed from head trauma or brain infection as well. Hospitals should be able to rely on teams of trained staff to use their expert skills to contain patients, thus minimising the need to use antipsychotic medications to achieve this.
However, the word on the street is because of staff shortages and more acuity in patients, the use of chemical restraint is becoming more routine in situations where patients need to be transported or contained. Chemical restraint is achieved by injecting medications used for illnesses such as schizophrenia.
So, what happens to patients when they are given cumulative doses of major antipsychotic medications? Well, they may experience respiratory depression, ie unable to breathe effectively, and may end up with pneumonia. They may experience severe side effects of potent medications, particulalrly if already on regular doses of medications. And when chemically sedated, they can't alert anybody that they may be experiencing symptoms of this.
In no way am I blaming the staff who do a superb job working with patients who are very unwell. I am blaming a public health system that looks at dollars, cuts brutally and without consideration, and I feel for the vulnerable patients with acute mental illness that suffer as a result.

Fame is not a vaccine for depression

This week has been confronting for most who watch popular or social media. We have woken to the news that celebrity olympian, Ian Thorpe, has declared he is being treated for depression and other conditions, and whether due to depression or not, the world has lost Philip Seymour Hoffman, who, most importantly, was a father of 3 young children. In a society so accustomed to perceive we know people we have never met, to 'follow' and to 'like' complete strangers we seem to be affronted that we are not aware celebrities are in pain or struggling. How many of my patients tell me they would not consider informing friends they are seeing a psychiatrist, let alone reveal they are depressed, anxious and perhaps entertaining suicidal thoughts? If they don't feel comfortable, then how can we expect those in the spotlight can until it is way too late?
Is it living in the spotlight that makes those vulnerable to mental illness fall victim to it? Or is it that they are just like everybody else, with the same chances of developing what are common disorders such as anxiety and depression? And surely, as a society we must remember we don't really know anybody very well, particularly those we like to think we know because we follow them.

Ahhhh, families...

It must be January. Not because it's so hot, the tennis is on, and the traffic is slightly better in Melbourne at the moment. Because my patients tell me so. Because they have endured Christmas, and now feel the pain. They have spent time with their families, and this hasn't always been a great thing.
Why do we feel compelled to 'celebrate' with those who push our buttons and trigger our vulnerabilities? It's common for some patients to strengthen throughout the year, resolve to rise above  dysfunctional dynamics, be confident in their decisions, only to undo this on 25 December. They feel obligated, emotional blackmail is unleashed and they spend time with those they avoid for 364 days of the year. The in-law, the grandparent, the cousin, somebody who has caused pain in the past is bestowed way too much power, and all is unleashed as if it was yesterday.
Somebody once told me that Psychiatrists invented Christmas to ensure there was plenty of work to do in a slow, cold European winter. More than just a joke. Time to roll up my sleeves and offer some healing for the next few months.