Showing posts from September, 2019
March Madness; April Fools Consider the title. Both terms indicate we are now in a season marked by much fun and frivolity. But both terms also suggest a darker side of this season as well: they hint at a time of loss of normal self controls, which can make this season one of considerable unrecognized dangers as well. Many cultures recognize and sanction the loosening of our restraints in early Spring. In the U.S., Mardi Gras is perhaps the most vivid example of raucous behaviors, including wild costumes and dancing, laced with ample doses of imbibing and licentious behaviors. Germans, characteristically(at least in popular imagination) staid and predictable, celebrate the end of Fasching at this time with   days of permissible loss of restraint. Holi in India is celebrated with vividly colored costumes, throwing colored water, dirt and balloons at others, and even gals kissing selected guys. On Purim, in March, the rabbis have instructed us to drink to such an extent that we c
Further Elaboration on Social Security Disability System In response to Christine Michaels’ recent rebuttal of my article on the dysfunctional   Social Security Disability system, I would like to add several clarifications. Firstly, I did do not believe all mental health patients are scamming the system. Certainly, there are chronically ill individuals who cannot function normally no matter the treatments they receive. Perhaps this is the population Ms. Michaels deals with exclusively. However , to suggest she has never seen people “game” the system can only indicate one of two possibilities, and I have just indicated the more benign of the two. Since my article, I have heard from physicians, nurses, social workers, and, yes, some attorneys whose feedback has been a throaty “Right on! It’s about time someone gave voice to this issue.” One nurse who worked extensively with the chronically mentally ill in the hospital setting, where patients would be expected to be most impaired, e
The True Lesson from Anthony Bourdain’s Suicide        The media have been replete with articles extolling the life, liveliness, and productivity of Anthony Bourdain. His death is surely a tragedy, a major loss to all who admired his spunk, energy and creativity. Most articles express shock and bewilderment that a man so successful, who achieved heights he’d not dreamed of, could have taken his life. His death has also spawned a wrenching postmortem which has included frequent calls for those ridden by suicidal thoughts to reach out for help, and for significant others to ask when suicidal thoughts are suspected.       These recommendations are welcome, but they are thin soup. General education is massively deficient in providing even the most basic knowledge about a subject we all deal with 24/7: behavioral health. In my op-ed article “Teach the Three R’s…and P for Psychology”(Pittsburgh Post-Gazette, July 2014),   I noted that half of our population carry diagnosable psychi
How to Navigate the (Broken) Behavioral Health/ Mental Heath System Attaining good mental health treatment is an odyssey unto itself. Many shoals and barriers exist along the way to appropriate care. These can be broken down into two large categories: knowledge of behavioral health symptoms and knowledge of the behavioral health system. I am concerned with both sets of issues, as both serve as major weak links in the treatment chain. I have elsewhere written about the appalling lack of knowledge on the part of most individuals regarding mental health issues and mental health problems, made all the more astonishing by the evident fact that most of us are dealing with mental health issues, if not problems, 24 hours a day,  seven days a week. I have argued previously for a mental health track to be included in all educational grades from kindergarten through college as a major step forward to reducing the incidence of behavioral health problems and behavioral health dangers such as su
Patients are gaming the disability system - at high cost to themselves and society     As a practicing psychiatrist in Pittsburgh, I have become all too aware of a disturbing and potentially dangerous way in which Social Security Disability is now being deployed for psychiatric patients. In years past, a person who applied for SSI/Disability would have his or her psychiatric records requisitioned from a treating psychiatrist. The applicant would then also be evaluated by a second psychiatrist contracted to the Social Security Administration and not linked to the patient. In addition, the applicant was required to be seen by a contracted psychiatrist annually to ensure that he or she indeed remained disabled and qualified for the subsidy. In recent years, however, I am finding patient after patient placed on disability, often after an initial evaluation with me, without any attempt made to check if that individual remains disabled, even years after the initial determination. For inst
Choosing a Mate? Follow This Prescription February 14, 2016 12:00 AM By Marnin E. Fischbach Our dishwasher broke and flooded part of our kitchen floor. My wife researched high and low online for the best deal on the best replacement available, with great success. When my daughter was in high school, she did extensive research on the universities she might wish to attend and happily selected Washington University in St. Louis. It was a match made in heaven, one which helped her mature and develop into a knowledgeable and appropriately assertive young woman. The recent lapse of our access to UPMC physicians prompted me to seek the best internists available in my remaining network. Most of my own patients tell me that they also selected me based on a careful review of local psychiatrists and their patient evaluations. We learn to research nearly every minor and major purchase of goods and services. But when it comes to choosing our permanent mates, we often turn off our research skills
Psychology and Education Teach the three Rs ... plus P for psychology Children need to know how their minds and feelings operate, explains a Pittsburgh psychiatrist By Marnin E. Fischbach The goal of our education system is to equip us with the skills and information essential to living an enjoyable and worthwhile life. To this end, we are exposed early on to the three basic disciplines of reading, writing and arithmetic — all of which are vital for us to cope in society and to continue learning. In my experience, one educational track just as vital as the “three Rs” has been omitted from our educational system: psychology — a basic understanding of how the mind and emotions work. It is estimated that half of Americans suffer from diagnosable and potentially treatable mental, emotional or behavioral symptoms. But only half of these individuals ever seek help and, of those who do, 70 percent are treated by nonbehavioral physicians whose net effect is estimated, unfortunately, to h
Treat the Whole Patient: Bring in the Psychiatrist By Marnin E. Fischbach, M.D. Psychiatry and other behavioral specialties need to be made far more available to the primary care patient. This would bring the appropriate expertise to help treat the inseparable medical and behavioral problems, and would lower the stigmatization of behavioral treatment through its medicalization . Consider the following: It is estimated that up to half of the population have symptoms consistent with one of the recognized psychiatric diagnoses described in DSM-5. Of those patients in whom psychiatric illness has been diagnosed, fewer than half have their symptoms treated by a physician. Of the half who receive psychiatric treatment, approximately 70% are treated by primary care physicians (PCPs) and only 30% ever see a behavioral therapist or a psychiatrist (1, 2). Consider also that PCPs often see patients whose behavioral problems “masquerade” as physical symptoms, which can cause—or signi
Do I need a Psychiatrist? You Do Need a Shrink After All Or didn’t you know it? Consider the following: It is estimated that up to half of the population suffer symptoms consistent with one the recognized psychiatric diagnoses described in the official Diagnostic and Statistical Manual. Of those diagnosed, fewer than half ever have their symptoms treated by a physician. Of the half that receives treatment for psychiatric symptoms, a full 70% are treated by their primary care physicians, while only 30% ever get before a therapist or a psychiatrist. Now, primary care physicians are generalists. They are not expected to go into great depth in regard to their patients’ behavioral symptoms, nor do they have the time(7 minutes per patient?) nor the expertise to do so. Having seen many patients who have experienced either partial or full treatment failures with their PCPs, I can relate the following highly common scenarios that routinely present to me: 1-The patient is treated