Archive for April, 2013

We’re Melting

April 26th, 2013

In its current state of dysfunction, immigration reform is one of several hot-button issues the U.S. Congress debates with rancor and vitriol but seemingly little view to the future and vigor of our society.

Both sets of my grandparents immigrated to the United States – the great melting pot – from Eastern Europe in the early twentieth century. My dad came to America as a 13-year-old. He spoke no English but put himself through school and became a pharmacist. Thanks to his hard work, I was privileged to attend superb universities and have tried to give back to the nation that welcomed my family.

Living on our country’s southern border for 18 years, I saw many first- and second-generation Mexican immigrants contributing in so many ways to our society, people, and cultural richness. When I came to Penn State a few years ago and visited a brilliant neuroscientist at our flagship campus in State College, I observed that almost all of his post-docs were from foreign countries, all full of scientific curiosity and drive.

From its foundation, the U.S. has prided itself on its open arms, embodied in our Statue of Liberty in New York Harbor. One generation after the next for more than two centuries have been leavened and energized by the vigor of immigrants. The success of capitalism requires creation of capital which, in turn, demands energy and new ideas. Often these emerge from the passions and restlessness of new Americans.

Today more than ever we worry about security. No one wants to open ourselves to terrorists or criminals. But if we build boundaries and barriers too high, if we stop the melting, if we no longer welcome the hungry—including those hungry to learn and create—I fear we will lose part of our souls and impoverish our future.

-Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Shively/Tan Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief, Journal of Clinical Psychiatry

Boston

April 17th, 2013

I lived and worked in Boston for almost 20 years. I raised my kids there. It’s a great city with wonderful people. I love Boston.

I have been a runner for 39 years. I love the sport: getting out on terrain familiar and exotic, feeling the breeze, my pulse race, watching walkers, other runners, dogs with their owners. I love early-morning runs—before big cities awake, along country roads and forest trails as birds are seeking their breakfast, along wharves with fishermen stringing their nets. I can’t count the number of races and fun runs I’ve participated in. I’m not very competitive—never have been. I just like the crowds and the energy, the camaraderie, the loud music, and the t-shirts.

I never ran the iconic Boston Marathon. I ran one though: the Marine Corps. And I stood and watched the Boston Marathon runners with my family when they passed near my home in Newton on Patriot’s Day.

Like people around the world, I was stunned and appalled at the carnage in Boston on Monday. What a tragedy. How sad—and senseless.

Runners are inherently can-do, optimistic, and resilient folks. It seared my heart to see them killed, maimed, and emotionally traumatized. The horror of the bombings and the reactions in the aftermath revealed some of the best in people— in runners, spectators, and the local population: heroism, compassion, generosity. There is so much that is good, so much to be proud of in the human race. But then, there is evil.

-Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Shively/Tan Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief, Journal of Clinical Psychiatry

Knee-jerk Psychiatry

April 7th, 2013

She was a young woman who’d grown up in an abusive family. Like so many others, she re-created her familiar home environment with a series of abusive partners—bearing children from a number of them. She easily grew frustrated and irritable. Feeling desperate one day, she made a life-threatening suicide attempt and was hospitalized.

 He was a middle-aged man who had built and run a successful business for decades. The business came on hard times, he went into bankruptcy, and his wife left him. He too felt desperate, made a very serious attempt on his life, and also was hospitalized.

In both cases, the serious suicide attempts resulted in a general-hospital stay, followed by transfer to a psychiatric facility. Each patient was diagnosed with a mood disorder, then treated with psychiatric medications—lots of medications. Each was discharged on multiple antipsychotics and antidepressants, a couple of benzodiazepines, gabapentin, and an antihistamine (presumably for additional sedation and anxiety relief).

Within weeks of hospital discharge, each patient showed the adverse effects of these medications: akathisia, parkinsonian signs, substantial weight gain, decreased libido, lipid and glucose abnormalities, and more. The mood-disorder diagnoses seemed questionable to me. More, the cognitive and affective side effects of these complex pharmaceutical regimens made it hard to disentangle preexisting symptoms. The out-patient doctors were challenged in their attempts to establish a therapeutic rapport and help these troubled human beings find new coping strategies in difficult circumstances.

So often what I see around the country is superficial, knee-jerk psychiatry. Harried doctors assume a serious suicide attempt must mean a mood disorder—which is often, but not always true. And a mood-disorder diagnosis (even Depression NOS) and psychiatric admission “demand” medications—often many.

How did we get to this state? Everyone loves to hate insurance companies—except their shareholders and senior executives. Most of us complain about DSM-3 and -4 (and in about a month -5). And medical educators know that Psychiatry often fails to attract the best and brightest medical-school graduates: we don’t get enough respect, our patients are stigmatized, managed care forces us to do short visits, our compensation is low among specialties, etc.

It’s all true. But somehow people in crisis deserve a little time with a knowledgeable, thoughtful professional, who can blend neuroscience with social and psychological dynamics, who brings compassion and wisdom to the clinical encounter. Psychiatry in 2013 has powerful tools. Let’s find a way to employ them with care.

-Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Shively/Tan Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief, Journal of Clinical Psychiatry