Category Archives: medicine

Mental Health Parity discussion in the NYT

Posted on March 31, 2008 by bipolarlawyercook| 7 Comments

A detailed review of the Men­tal Health Par­ity move­ment, and the push to make health insur­ers cover men­tal ill­ness on par with phys­i­cal ill­ness.  No ques­tion where I fall on the larger ques­tion, but I’d be inter­ested in review­ing any sci­en­tific dis­cus­sion about the ways to show/prove/test for the exis­tence of hormonal/biochemical men­tal ill­nesses such as “mere” anx­i­ety and depres­sion– which respond to med­ica­tion, but which cur­rently aren’t tested for in the blood­stream, or detectable (like bipo­lar, for exam­ple) on MRI or EEG.

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Posted in bipolar, links, medicine, politics, science

What is the sound of one lawyer raging?

Posted on March 7, 2008 by bipolarlawyercook| 14 Comments

The sound of one lawyer, rag­ing, is the tippity-typety of my fin­gers tak­ing out my ire at incom­pe­tent social work­ers and inad­e­quate men­tal health hos­pi­tals by doc­u­ment­ing their idiocy and plan­ning a com­plaint to the state licens­ing board.

It is also the sound of fin­gers quickly dial­ing tele­phone num­bers, and leav­ing mes­sages that start off like this, and go down­hill from there:

“This is Bipo­lar­Lawyer­Cook, Mom’s Daugh­ter, and sis­ter to Brother, with whom you’ve been deal­ing this week dur­ing Mother’s hos­pi­tal­iza­tion.  I am also my mother’s lawyer.  I would like a return call, in order to dis­cuss why your social worker has not started paper­work for SSDI eli­gi­bil­ity on the basis of her bipo­lar; has not learned the name of the social worker who also works at your facil­ity who runs the day pro­gram she’s sup­posed to attend next week; has not called any of the medicare-accepting home health agen­cies to arrange for med­ica­tion man­age­ment, when that was what landed her in your facil­ity in the first place, and has only given my brother a list of num­bers to call.  I also want to know why your Psy­chi­a­trist is main­tain­ing her cur­rent med­ica­tion reg­i­men, when she has had four manic break­throughs with psy­chotic and delu­sional fea­tures on that regimen.”

Hon­estly, the phone book is more help­ful than their social worker.  And of course they all gave my brother the runaround, despite the pres­ence of autho­riza­tions from my Mom for them to talk to him about her care on file.  So instead, she’s being dis­charged, with­out her meds being changed (includ­ing, oh, say, a mood sta­bi­lizer that actu­ally con­trols mania, like Lam­ic­tal DOESN’T), with­out her fully sta­bi­liz­ing, with­out a ther­a­pist in place, with­out a fol­low up appoint­ment to her shrink sched­uled, and with­out a med­ica­tion man­age­ment plan in place, despite the fact that it was her lack of ade­quate med­ica­tion and her sub­se­quent mood ele­va­tion, lead­ing to non­com­pli­ance, that put her there in the first place!

You try to give peo­ple the oppor­tu­nity to do the right thing, and they f*ck it up, because she’s not vio­lently crazy and there­fore too com­plex to try to man­age.  (What?  Ther­apy?  You mean you can’t just sedate the liv­ing shit out of the cra­zies?)  And then they backpedal and hem and haw when they find out the patient is related to a lawyer, and they’re sud­denly will­ing to try all the things that I know are just stan­dard of care, not extrao­d­i­nary care.  The sound of one lawyer rag­ing?  It’s me, low­er­ing the bitch ham­mer.  Hard.  They won’t know what hit them.

Just as well I am not there, phys­i­cally.  I’dve been arrested for assault and bat­tery by now.  Attempted, my ass.  I want to stran­gle the assholes.

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Posted in bipolar, crank, lawyer, medicine, meds, mom

The drinking thing

Posted on March 5, 2008 by bipolarlawyercook| 23 Comments

My dad’s a sober alco­holic. He has been, with­out one sin­gle relapse, since I was 12. Despite his iron resolve not to relapse, and his real suc­cess in deal­ing with some of the things that caused him to start drink­ing in the first place, I’ve always been cau­tious about my drink­ing, because I know that drink­ing runs in the fam­ily, so to speak. I was there­fore inter­ested to read an arti­cle pub­lished this week in the NYT that per­sonal and cul­tural expec­ta­tions can affect our deci­sions of how much alco­hol to drink, and how to act in response to the amounts consumed.

I can count on one hand the num­ber of times I’ve con­sumed so much that I was vio­lently ill, drunk, oblit­er­ated, wasted. But the num­ber of times I’ve drunk to just short of that, to feel that mar­velous floaty feel­ing, to lose the feel­ing of being teth­ered to all my cares and woes? I couldn’t even begin to count– which is why I am try­ing to not drink much at all anymore.

Med­ical effects of exces­sive drink­ing aside, my con­cern is my psy­cho­log­i­cal rea­sons for drink­ing. When I am hav­ing a glass of wine or two meant to com­ple­ment my meal, I don’t worry. When I have a cock­tail or two at a social gath­er­ing, no big deal. But it’s that third drink that’s the charm. I need to watch it– because not only am I a light­weight, and that fourth will leave me feel­ing all dried out in the morn­ing, but because I’m clearly more stressed, more wor­ried, more unhappy than I though I was when the evening began.

I’m con­vinced that some of it is pure sugar crav­ings, to which I am dou­bly prone as a bipo­lar and as some­one with poly­cys­tic ovary syn­drome (PCOS). But the rest of it is more com­pli­cated. I’ve always felt that smart peo­ple do a “bet­ter” job over­think­ing, over­in­vest­ing emo­tion­ally, and crit­i­ciz­ing unnec­es­sar­ily– they do a bet­ter job at dri­ving them­selves nuts. So they need a drink, to stop that cycle. I am sure that much of this was behind my dad’s start­ing drink­ing. And I know that it’s behind mine, when I need a drink.

I try not to drink when I need a drink, but some­times I am bet­ter at rec­og­niz­ing it than at other times. That’s why I have that third drink inter­nal alarm. But now that I’m real­iz­ing that I could do a bet­ter job of calm­ing the inner critic, I’m try­ing to not drink as much at all. Bet­ter to learn to deal with that nasty inner voice with some yoga or a favorite book or going to bed early, than with a drink. I’m sure as I do a bet­ter job of tak­ing care of myself, the need for a drink will go away, but in the mean­time, I’m going to try to learn to do with­out alto­gether, in the hopes that I can con­vince that need that what it really wants is a long, hot bath, not a bourbon.

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Posted in bipolar, dad, links, medicine, meds

Should mental health providers have experience as mental health patients?

Posted on February 25, 2008 by bipolarlawyercook| 7 Comments

There’s an inter­est­ing article/column in the NYT, talk­ing about whether expe­ri­enc­ing men­tal health treat­ment (and the atten­dant suf­fer­ing dri­ving them to seek it) makes men­tal health care providers bet­ter at their jobs.  Though I wouldn’t wish men­tal ill­ness or emo­tional suf­fer­ing on any­one, I do think that a bit of prac­ti­cal expe­ri­ence pro­vides the prac­ti­tioner with some real­is­tic insight on how the patient might get out of seem­ingly per­ma­nent sit­u­a­tion.  Aca­d­e­mic knowl­edge can only go so far, and I think expe­ri­ence can help the prac­ti­tioner see neg­a­tive clin­i­cal indi­cia at an ear­lier point, so as to help head things off at the pass.

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Posted in bipolar, links, medicine, meds

Cold, hard science? Hardly.

Posted on January 17, 2008 by bipolarlawyercook| Leave a comment

The NYT pub­lished an arti­cle about drug tri­als and the under­re­port­ing of neg­a­tive and equiv­o­cal study results to the FDA and peer-approved jour­nals, data which fac­tors sig­nif­i­cantly into the FDA’s assess­ment of where a pro­posed drug falls along the risk/benefit spec­trum.  To me, it’s no sur­prise.  Despite cladding their stud­ies in impen­e­tra­ble jar­gon and cloak­ing their data in sta­tis­ti­cal regres­sions so com­pli­cated that you need a new eye­glass pre­scrip­tion to parse the num­bers, sci­en­tists are human.  They need fund­ing.  Announc­ing some big pos­i­tive find or advance is likely to be more reputation-making than another crit­i­cism with­out a solu­tion.  And drug com­pa­nies have an obvi­ous incen­tive to bury the data– if not out of con­scious greed and mali­cious dis­re­gard for the health of drug con­sumers, than out of wish­ful think­ing and the manip­u­la­tion of study results and monday-morning quar­ter­back­ing of the fac­tors under­ly­ing the neg­a­tive study and its results.  Drugs are big money.  I just wish I didn’t need mine so much.

Finally, the sad facts are this:  the FDA, like any other gov­ern­ment agency, is under­funded and under­staffed, rel­a­tive to the impor­tance of its reg­u­la­tory mis­sion.  They rely on the drug com­pa­nies to be hon­est and to dis­close good and bad infor­ma­tion. That alone, not account­ing for a revolv­ing door of researchers, study project man­agers and admin­is­tra­tors between drug com­pa­nies, the FDA, pri­vate and uni­ver­sity labs, and med­ical prac­tice, is enough to war­rant my vig­i­lance about the drugs that I take.  I don’t nec­es­sar­ily think all drug com­pa­nies are evil, or that every FDA researcher is neg­li­gent or cor­rupt.  But I do think some of them are, and the rest are only human.  So I’ll con­tinue to be the geek who reads the entire set of warn­ings with each new pre­scrip­tion, and who re-reads them every time she gets a new pill to add to the older ones.  And I’ll con­tinue to be the geek who scans the Health and Sci­ence sec­tions of the paper every Tues­day, even though I’d rather not worry about it.  But rather doesn’t enter into it.

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Posted in bipolar, crank, government, links, medicine, politics, science