Really? Can't we be nicer? Objecting to sending those in mental health crisis directly to jail.

Hi, it's been a while.  I have been ranting in other venues, and caught up a bit in the All-Trump-All-The-Time phenomena.  

So my latest thing to rant about is hospitals that send patients to jail when they don't have beds.  I don't mean people who've committed crimes, I mean people who are in crisis, who are presumed to be a danger to themselves or others.  Here are some of my thoughts:

On Psychology Today's website, I wrote "A simple solution to the bed shortage? Unfortunately, Jail"  The link to that is Here.
Over on Clinical Psychiatry News, I did a little more research on the topic and spoke with the reporter, one of the doctors, and the Rapid City Sheriff. See "Mentally Ill? Go Directly to Jail"
The link to that is HERE.

But I've learned that it's not just in Rapid City, South Dakota where it's an issue -- oh, and the sheriff there is apparently refusing to take these patients -- but other states have these issues as well.  My friend, Pete Earley the mental health advocate has been kind enough to share my outrage HERE. 

On Facebook, I've noted:

When we submitted our book proposal for Committed, our editor told us we had to take a stance and the message had to be something more than be kind to patients. Lately, I'm thinking that "Be kind to patients" is not such an obvious thing in our crazy world. Last week, I wrote an article about a hospital in Rapid City SD that announced their overflow psychiatry patients would be held in jail (--I researched the article after I first saw it on this FB page, so thank you to the poster). Today I read that in 6 states people in mental health crises can be (and are) held in jail when there are no hospital beds available. These are not people who have committed a crime. Why, as a society, don't we think this is unconscionable? Could you imagine going to the hospital for pneumonia, being told there were no beds so you were going to jail? Why is jail ever an alternative to health care? What is wrong with us?

Colorado would outlaw using jails for mental health holds, increase services under $9.5 million proposal denverpost.com

 Mostly I've been surprised at how little outrage there is, though I hear the APA is now writing an action paper to oppose jailing psych patients. Will that help? Does anyone read APA action papers?  Commenters say, well, most mental health care is given in jail (and, sigh, we seem to accept that as okay), but this is different: these are not people who've committed a crime, these are patients going to an ER for help!  They haven't broken a law, they aren't under arrest.  Advocates want to increase laws to make it easier to force care, how about making it easier to access care in a humane and kind way?

Still More on Guns and Mental Illness

The issue with mental illness and guns is so hard to explain to people. While there have been mass shooters with mental illness, in very few cases does the "mental illness" serve to explain what happened, and statistically, you should be much more worried about being killed by your spouse, the car next to you on the highway, that extra pain pill you take (especially if you take it with a sleeping pill or a drink), than you ever should be about a mentally ill mass shooter in a public place. Where the numbers of gun deaths rise is when you mix guns with substance abuse, especially in people prone to violence, anger, and impulsive actions; suicide (where people sometimes take action within minutes of making a now-irreversible decision); or accidental deaths where people are careless (which may be higher in people with cognitive problems or who are abusing substances). 

I had an editorial on a proposed repeal of a gun law this week, and the Chicago Tribune wrote on the same issue. Note their emphasis on mass shootings (none of which pertained to this ruling as none of the shooters received Social Security Disability Payments) and it didn't explain why someone would be on disability and might need a payee. Mine was not about violence but about common sense. Obviously I like mine better, but compare and see what you think, same issue, different arguments:
 

Guns and mental illness: Don't scrap this rule

If someone has a mental illness severe enough that he cannot work or manage his own money, should he be allowed to own a gun?

chicagotribune.com|By Editorial Board

Assorted Frustrations, Plus a Book and TV Series Review

I've been finding the world to be a frustrating place, and when I'm frustrated, I write.  It could be worse.  I've written a lot this week.  

First I'll send you to a commentary piece I wrote for the Wall Street Journal asking the Senate not to repeal a ruling that prohibits those who are both disabled by chronic, severe, mental illnesses and are unable to manage their finances (often because they are cognitively impaired or have poor judgement.  I would not have concocted nor supported this original ruling under the Obama administration because I don't think mental illness and gun legislation mix, but given that it exists, it's a pretty low bar.  But mostly, I hate that the NRA has the power that it does in our country and that tens of thousands of people die from firearms each year. See: Don't Repeal Obama's Modest Gun Limit.  
If you need to get around the paywall, try going through our Facebook page to the Link: https://www.facebook.com/shrinkrapbook/

For a bit of a break, I reviewed Patrick Kennedy's wonderful memoir A Common Struggle, in the same article with the dark comedy Showtime TV series, Nurse Jackie -- an odd combination, but they are both about addiction.  See Nurse Jackie and Patrick Kennedy.

And finally, I want to rant about using jails INSTEAD of medical facilities for psychiatric patients.  I'm containing my outrage (or perhaps I'm not), but when we hear about correctional facilities being the biggest providers of psychiatric care in this country, we do assume that the people that are being housed there have either committed a crime or are suspected of committing one with pending charges.  Read my short article on Psychology Today about own hospital in South Dakota now sends their overflow psychiatric patients to the local jail.  These are not people who have committed any crime.  In what alternate universe is this okay?   So much for controlling my outrage.
See: https://www.psychologytoday.com/blog/committed/201702/simple-solution-the-bed-shortage-unfortunately-jail

 And while I'm ranting about this, please see Pete Earley's blog about a man who stole $5 worth of candy then spent 101 days in jail waiting for a bed at a state hospital.  His jail term ended when he starved to death his jail cell.  We can do so much better.  

Thanks for listening. 

Breaking Heroin's Grip: a documentary by Maryland's Department of Health and Mental Hygiene

Breaking Heroin’s Grip: 

Road to Recovery

Airing Saturday, February 11 at 7pm

Breaking Heroin's Grip: 
Road to Recovery is a
poignant and personal
 documentary shedding
 light on our region’s
pressing heroin problem.

 Told through the lens of adults that have
 experienced heroin’s grip first-hand, viewers
will get an authentic look inside the complexities
 of this harrowing epidemic.

The program includes a 40-minute documentary
followed by a 20-minute live phone bank offering
viewers expert information about treatment. The
documentary is produced by Maryland Public
 Television in partnership with the
Maryland Department of Health and Mental Hygiene.
The program will be simulcast by numerous broadcasters
 (both TV and radio) in Maryland, as well as surrounding states.

-->

WBAL-TV / Baltimore, MD Channel 11

WBAL-AM / Baltimore, MD Channel 1090

WJZ-TV / Baltimore, MD Channel 13

WYPR-FM / Baltimore, MD Channel 88.1

WMAR-TV / Baltimore, MD Channel 2

WJZ-FM / Baltimore, MD Channel 105.7

WNUV-TV / Baltimore, MD Channel 54

WLIF-FM / Baltimore, MD Channel 101.9

WRDE-TV / Lewes, DE Channel Comcast 9, 209, 809,
       Direct TV and Dish Network 31, Over The Air 31.1

WOLB-AM / Baltimore, MD Channel 1010

WHAG-TV / Hagerstown, MD Channel 25

WWMX-FM / Baltimore, MD Channel 106.5

WMDT-TV / Salisbury, MD Channel 47

WHFC-FM / Bel Air, MD Channel 91.1

WHUT-TV / Washington, DC Channel 32

WJEJ-AM / Hagerstown, MD Channel 1240

WUSA-TV / Washington, DC Channel 9

WPTX-AM / Lexington Park, MD Channel 1690

WITF-TV / Harrisburg, PA Channel Digital: 36 (UHF)
       Virtual: 33 (PSIP)

WITF-FM / Harrisburg, PA Channel 89.5

WTHU-AM / Thurmont, MD Channel 1450

WMPH-FM / Wilmington, DE Channel 91.7

WKHS-FM / Worton, MD Channel 90.5

WRNR-FM / Annapolis, MD Channel 103.1

WOL-AM / Washington, DC Channel 1450

WNAV-AM /Annapolis, MD Channel 1430

WPRS-FM / Washington, DC Channel 104.1

What's In Committed? So Glad You Asked....

It's Sunday night, so I'm hopeful that our new president is watching TV and not signing any new executive orders that re-shape our democracy.  Seems like a good time to tell readers a little more about Committed, and what better way then by posting the Table of Contents?  Each chapter focuses on a story, and the tales of the two patients weave their way throughout the discussion of a variety of issues.  Okay, so the topics might be boring to everyone but the most interested of readers, but we hoped that by focusing on people, that it would make this important and controversial topic more approachable.  Psychiatry? Yes, but perhaps more so ethics and patient rights.  

In a review in Psychiatric Times last week, Dr. Mark Komrad wrote:

Drs. Dinah Miller and Annette Hanson, both seasoned clinicians who have worked in a diverse range of settings, have produced one of the most important and readable contributions to this discussion that I have encountered. This is actually a book on psychiatric ethics, but it is presented in a disarming, journalistic style. The ethical tensions with which this issue is loaded are unpacked in a clear, accessible way, articulating not just the questions, but also offering sensible and realistic conclusions.

Ah, but I promised the Table of Contents, so if you'll forgive the funky colors,  pasted below:

-->

© 2016 The Johns Hopkins University Press

Foreword by Pete Earley

Before We Get Started 

 Part 1 THE PATIENTS 

1 Eleanor and the Case against Involuntary Hospitalization 

2 Lily and the Case for Civil Commitment 

Part 2 THE BATTLEGROUND 

3 In Favor of Involuntary Treatments 

E. Fuller Torrey and the Treatment Advocacy Center ; Ronald Honberg and the National Alliance on Mental Illness; Paul Summergrad and the American Psychiatric Association ;

4 Against Involuntary Treatments 

Citizens Commission on Human Rights; Celia Brown, Janet Foner, and MindFreedom International ; Daniel Fisher and the National Empowerment Center ; Ira Burnim and the Bazelon Center for Mental Health Law 

Part 3  CIVIL RIGHTS 

5 Eleanor, Lily, and the Process of Civil Commitment 

6 Christina Schumacher and the History of Civil Commitment Laws 

Part 4  THE HOSPITAL 

7 Scott Davis on Law Enforcement and Crisis Intervention Teams

8 Leonard Skivorski and the Emergency Department

9 Eleanor’s Hospital Experience

10 Ray DePaulo and Inpatient Psychiatry at a University Hospital 

11 Steven Sharfstein, Bruce Hershfield, and Free-Standing Psychiatric Hospitals 

12 Annette Hanson and the Use of Seclusion and Restraint 

13 Anthony Kelly and Involuntary Medications

14 Jim and Involuntary Electroconvulsive Therapy

Part 5 INVOLUNTARY OUTPATIENT COMMITMENT 

15 Marsha and Outpatient Civil Commitment

16 Outpatient Commitment on the Books 

17 Jack Lesser and Mental Health Courts

Part 6   A DANGER TO SELF OR OTHERS 

18 Dan, Guns, and Mental Illness

19 Bryan Stanley, Violence, and Psychiatric Illness 

20 Amy and Involuntary Treatment for Suicide Prevention 

21 Will Forcing Treatment on People with Psychiatric Disorders Prevent Mass Murders?

Part 7. FUTURE DIRECTIONS 

22 Transforming the Battleground

 

The Answer to the Problem of Violence & What I learned at #WomensMarchinWashington

Yesterday, I was among the 1% or more the US population to show up at one of the Women's Marches. These weren't just in the US, but worldwide .  



If you ask me what I was marching for, I'd have to say it was an act of personal catharsis, a statement in favor of human rights, and an opposition to many of the things that our new president has said he intends to support.  I've long ago come to peace with the idea that many people have different political ideas than I do, and that is not what defines who I associate with (or even marry).  But what I haven't been able to come to peace with is our new president's lack of kindness.  My sign, made with every bit of knowledge I gathered from my public school art classes (thank you, Mr. Trogler), and a couple of YouTube videos on 'how to make a sign' videos, but no natural artistic talent,  simply said, "Make America Kind Again."  Please, this has no deep philosophical meaning, take it at face value. And if kindness is too much to ask, then simply the wish that we would not expend energy to be actively unkind-- the Jewish version of "Do not do unto others that which you would not have done to you."  

There are just  too many stories where our new president puts his

efforts into being unkind, towards women, towards the disabled, towards immigrants, towards minorities, and towards those with less fortunate beginnings than his own.  I'll leave it to others to talk politics, I'm putting in my vote for kindness.

So what can I tell you about the Women's March in Washington yesterday.  
--It was crowded.  It was really crowded, as was the metro.  
--There were lots of people in pink hats.
--There were lots of people with lots of issues.  While many had issues pertaining to women, and I particularly liked "Let's talk about the elephant in the womb" with a little Republican symbol elephant inside a drawing of a uterus, there were many other issues represented, including climate change, health care, education, gun control, immigration, equality for all, and the list marches on.  --There were many angry posters (sorry, I don't think F*ck Trump accomplishes much) and many posters about love.  I was a bit amused that people with angry signs or wrapped in tape that bore obscenities asked to photography my Make America Kind Again sign.  And some of my friends were wearing Nasty Women shirts; not much for consistency, but they aren't actually nasty women (in fact, they are all quite nice).
--It was civil. 
--In fact, it was kind.  On the jammed metro on the way back, I asked a friend if she had a piece of gum; when she didn't, a stranger gave me a piece.  We argued over who would take the empty seat.   ("you take it...") when one became available.  The packed people all moved for cars, for people in distress, for those with young children. 
--People jeered outside the Trump Hotel.  I didn't witness anyone throwing anything, charging the gates, or behaving badly.  Judge the jeering as you will.
--There were lots of men.
--In Baltimore, 5,000 people gathered.  I'm not aware that there was any violence.  This is a city where there are shootings at birthday parties for toddlers, and where peaceful protests have turned into full-scale riots that make national headlines.  Yet thousands of distressed people gathered to protest without event!  I wish I could tell you that no one died a violent death in Baltimore yesterday, but I can't; just not at the women's march.
--A colorful sign is a very useful way to keep a group from getting dispersed at a huge rally.

There were over 600 marches worldwide.  I don't know that there was no violence, but it seems that riots didn't make the news.  These were people who were angry about many issues and our new administration.  But they were also women, or people supporting women, and the fewer men, the less the likelihood of violence.  Obviously, the vast majority of men are not violent, and I don't want you to walk away thinking that I believe that men are violent, but for whatever reason (cultural conditioning, less testosterone?), women, as a demographic, are much less so. 

I would have said this before-- and there is no way anyone wants to hear it-- but if you want to end gun deaths and mass murder, there is a simple solution.  Stop talking about mental illness and keep guns out of the hands of men. 

I was glad I was there.  I hope our president gets a message that his plans are not as popular as he'd like them to be. And I hope he strives for kindness. 

Another Mass Murder Spurs Many Responses

Almost two weeks ago, it happened again: a man with a history of psychiatric symptoms opened fire and killed people in the Fort Lauderdale airport.  In our book, Committed, we have researched and written about mental illness and violence, guns, and specifically addressed the question of Can Forced Psychiatric Care Prevent Mass Murders?

Pete Earley, on his blog, offers the idea that it would help to change the standard for involuntary care from "dangerous" to "a need for treatment."  You can read Pete's blog, Another Mass Murder With Plenty of Warning Signs: We Need to Address the Dangerous Criteria.

But ClinkShrink doesn't agree with Pete that the issue is one of who we force into care. She says we'd be safer if we took guns from people who exhibit dangerous behaviors, not specific diagnoses. Pete's always up for a good debate, so he asked her to write about her ideas and posted them on Dr. Hanson Offers A Different View About Mass Murder and The Dangerous Criteria.  

I have my own thoughts on all of this.
In Clinical Psychiatry News, I wrote an article directed to mental health professionals in Analyses of Fort Lauderdale Shooting Need a Reset and in the  The Baltimore Sun, an Op Ed article Tragedy Again Spotlights Mental Illness.

There have been so many articles by other people attributing mass murders to everything from terrorism to mental illness to guns to  psychiatric medications. 

 One that stirred me was an article in the Sun-Sentinel by Congressman Timothy Murphy, who drafted the Helping Families in Mental Health Crisis Act (now passed as the Mental Health Reform Act of 2016) as a response to the Newtown tragedy of 2012.  In his Op Ed piece, System Failure: Not Treating The Mentally Ill Has Consequences,  Murphy makes  assumptions about the sequence of events in the Fort Lauderdale shooting that we just don't know.  I responded to his article on Psychology Today in  Laws To Force Treatment Are Not the Answer to Mass Murders.

So if you haven't had enough of us (!) we were on a local NPR

radio affiliate this morning-- Sheilah Kast's On The Record--  talking about our book and you can listen on WYPR's website HERE.

Last night we taped a segment for Forward Motion, a Montgomery County, Maryland television talk show with host Karen Allyn that will start airing at the very end of January and we'll post a link when that is up. 

 And we are enjoying our 15 minutes of fame, even if it's on disturbing, but very important, topic.  As somber as this all is, one thing I don't think we get across is that Committed is about people and their stories, it's not just research and facts, and the book is meant to be accessible and compelling to anyone interested in the topic, not just psychiatrists.

Looking Ahead to APA in San Diego

This May, the American Psychiatric Association's Annual Meeting will be in San Diego.  I'm thinking ahead here, but people often make their travel plans in January, so I'd like to tell you about the talks we'll be involved in and invite you to come listen and participate. 
--------------------
To search for sessions by topic or presenter, go to this link:
http://s4.goeshow.com/apa/annual/2017/itinerary_planner.cfm
 
Session ID: 3019 Symposium
 Outpatient Commitment: A Tour of the Practices Across States
Date: Tuesday, May 23
Time: 8:00 AM–11:00 AM

Speakers:
Chair: Dinah Miller (Maryland)
Presenter: Ryan C. Bell, M.D., J.D. (New York State)
Presenter: Kimberly W. Butler, L.C.S.W., M.S. (New York State)
Presenter: Adam Nelson, M.D. (California)
Presenter: Erin Klekot, M.D. (Ohio)
Presenter: Mustafa Mufti, M.D. (Delaware)
Discussant: Marvin S. Swartz, M.D. (North Carolina)

                           ______________________________

Session ID: 2284  Workshop

Are You a Sitting Duck Online? What You Can (and Can’t or Shouldn’t) Do About—and Avoid in the First Place—Negative Reviews by Patients

Date: Tuesday, May 23

Time: 1:30 PM–3:00 PM

 

Speakers:

Chair: Robert Hsiung, M.D.

Presenter: Paul S. Appelbaum, M.D.

Presenter: Dinah Miller, M.D.

                 _____________________

Session ID: 3010 Symposium

 The Battle Over Involuntary Psychiatric Care

Date: Wednesday, May 24

Time: 2:00 PM–5:00 PM

 

Speakers:

Chair: Dinah Miller, M.D.

Presenter: Roger Peele, M.D. (in favor)

Presenter: Paul S. Appelbaum, M.D. (APA's views)

Presenter: Elyn R. Saks, J.D. (Saks Institute for policy, law, and ethics)

Presenter: Al Galves, Ph.D. (MindFreedom International)

Discussant: Annette Hanson, M.D.

--------------------------
Measurement-Based Care: Using Multidimensional Assessments to Drive Improvements in Outcomes in Integrated Care Settings 
Rapid Fire Talks Focused on Behavioral Care
 May 22, 2017  Room 27
1:30 PM - 1:50 PM

Presenter: Steven R. Daviss, M.D.

Honoring Carrie Fisher

10. On not being defined by your mental illness:

Rene Macura / ASSOCIATED PRESS / Via bphope.com

 

This was my favorite of the 13 things.  If you'd like to read them all on Buzzfeed, go Here.

Helping Doctors Get Help

Every year, roughly 400 doctors and medical students die from suicide.  To put this in perspective, there are roughly 100 medical students in a medical school class, and schooling takes four years: each year in the United States, we lose an entire school worth of doctors to suicide.  For more perspective: there are 141 medical schools and 31 osteopathic schools in the country; educating students takes time, money, and a tremendous amount of resources, and we have a doctor shortage.  Losing a school worth of physicians each year is an awful thing.  Furthermore, surveys have shown that about 30% of medical students have significant symptoms of depression, a percentage notably higher than the general population.

This seems a bit odd: medicine is still a profession that is held in esteem.  People work for years to get into medical school and it's a very competitive process.  Those who have made it are, for the most part, lucky.  Academically, they are the cream of the crop: motivated, hardworking, organized, driven, and among the few who get the privilege of working in a field where you help people and earn good money.  And as someone who treats patients, I will tell you that it truly is an honor to be a doctor and a psychiatrist; I am grateful for the career I've been able to have and for the flexibility and diversity it has afforded me as both a healer and writer. 

So why the high rates of suicide and depression?  The blame has been put on the rigors of training, the demoralization of doctoring, the disappointments and the tremendous stress.  And doctors are people, they  get psychiatric illnesses for the same reasons others do: genetic predispositions, personal losses, stress and a fear of failure, sleep deprivation, or devastation over a bad personal or professional event.  We still don't know why some people are resilient in the face of difficulties and others are not.

And doctors hesitate to get help: after all, mental illness is stigmatized and doctors may be asked about their mental health issues for licensing and for jobs.  I knew one medical student who took Prozac-- it helped with anxiety and irritability, though she never had a full blown episode of disabling depression-- and said so on health forms when she started residency. She had to explain and get documentation that she was capable of working.  Obviously, we don't want someone in the throes of a disabling psychiatric episode treating patients, but we also don't want people to avoid getting care because they might be called out on it, or even lose their license when they have treatable conditions.  It seems it might be better to encourage people with psychiatric and substance abuse disorders to get help rather than to have them treating patients when they aren't at their best or to have them die from suicide. It's a mixed bag, because many psychiatric and substance abuse problems can be hidden, especially by someone who is able to show up at work and function reasonably everyday, and treatment is generally available to this group of professionals in that they have insurance and resources.

The 'stigma' of quiet mental illness is still a bit odd to me.  As a medical student in New York City in the 1980's, psychiatry wasn't just about being mentally ill, it was, to some extent, about self-examination.  Psychiatrists who did psychotherapy were expected to have psychotherapy, and psychoanalysts were required to undergo an analysis.  

As students, we were told that the school had a mental health service which provided an evaluation and 10 visits with a private practice psychiatrist (and then the student could pay for more if they wanted), or treatment with a psychiatry resident for very low fees.  Many of my classmates were very open about being in treatment, and people went because they were stressed, disturbed about relationships, or having more serious psychiatric issues.  During my psychiatry rotation, the chief resident wrote his analytic hours on the board in the nursing station so he would not be disrupted, and I sat in a class where one resident said to another, "Hey Bob's not here because he's starting therapy today."  One of my classmates had a serious suicide attempt and was treated in the ICU.  It wasn't someone I knew very well and I know none of the details.  What I do know is that this classmate graduated and went on to a prestigious residency program.  Google let me learn that my classmate is now, over 25 years later, a physician at a top academic institution.  Today, I'm not sure if that outcome could happen.  

This month, I saw an article in one of the psychiatric newspapers calling on licensing boards not to require doctors to report past episodes of psychiatric illness, only present episodes, in an effort to encourage doctors to get treatment.  Really? Why single out psychiatric disorders?  Shouldn't reporting requirements encompass all disabling disorders?  Do you want your surgeon seizing while he's operating on you?  Or having his blood sugar drop?  Do we really care about the fact of an illness?  Shouldn't we care more about whether it impairs a physician?

So I was pleased to read this month's newsletter from the Maryland Board of Physicians: there was a specific discussion on mental health/substance abuse treatment that noted that Maryland's licensing board asks only about current conditions (including physical conditions) that impair a physician's ability to practice.  It lists some resources for getting care, and notes that this is not the same as mandated treatment in the case where it's come to the attention of the Board that someone has a health issue which obviously impairs them-- one that has been reported by a third party to the Board as being a risk to patient safety.  

So Maryland docs, if you are quietly depressed, anxious, suicidal, or wonder if those happy blips in your mood mean you have bipolar tendencies -- go for it and get help.  Tell who you want, and don't tell who you don't want.  Will decreasing stigma or reporting requirements lower suicide rates?  I hope so.  And finally, if you're in Maryland and need a private practice psychiatrist to see you quickly, don't forget our resource at MarylandPsychiatrists.net where psychiatrists with availability within two weeks may list their practice.  It's a free service for both shrinks and patients.

Home Inspection and Double Billing: Two Kindle Novels for Free, and Happy Holidays to Our Shrink Rap Readers

Happy Holidays!

At this time of year, I like to set up free downloads to two of my novels. You can get these books for free on your Kindle from Sunday to Thursday.

Double Billing is the story of a woman whose life changes when she discovers she has an identical twin. It's a quick read with a little  psychiatry sprinkled in.  One reviewer said:

 The book was a page-turner because of elegant structure and pacing.  I really cared about the author’s take on things –because she is a psychiatrist? because I’ve followed  her blog for a while?– which meant that I was interested in the protagonist’s thoughts, feelings and actions.  At times I ached for the mess her life was in, at others I wanted to shake her into action, and then she’d find her backbone again, just in the nick.  

Home Inspection is a story told through psychotherapy sessions in a format that is similar to the HBO series In Treatment. Dr. Julius Strand is a psychiatrist who plods along in his already-lived life until two of his patients inspire him through their own struggles to find meaning.  One reviewer wrote:

 I like to read all sorts of books, but books where there's something in it that reflects a part of me, a part of my life, a part of my experiences, are something I go out of my way to find. I have not found any fiction book that does nearly as much to show what psychotherapy is like.

There is is a single link to my Amazon page with all my books here. 

If you don't own a Kindle reader, you can install a free Kindle app on your computer, tablet, or cell phone by going here and then you can read any Kindle book. You don't need to buy a Kindle to read on your computer, tablet, or smartphone.

 Both novels are also available as as paperbacks from Amazon, but not for free.  And our two non-fiction books can also be found on that page, but again, not for free.

I'm more than happy to have people download my novels at no cost -- I'll be keeping the doctor day gig -- so please tell/tweet/blog/share the free promotions to anyone you think might be interested.

Finally, If you do read any of the books, please consider putting a review on Amazon.   
 

It Happened! Link to Yesterday's NPR Diane Rehm Show on Involuntary Psychiatric Care

The third time scheduled was a charm and we had a wonderful time going in to Washington to be on Diane Rehm's talk show.  Okay, so the car wouldn't start at first, and I missed a turn, but we got there without event.  The show included our friend, Pete Earley, and two people who had experienced involuntary psychiatric hospitalizations, Lily and Jaime -- they both did a great job of talking about their experiences.  Pete, the author of Crazy: A Father's Search Through America's Mental Health Madness and more recently co-author of the novel Treason,  added a lot of life to the issue by talking about how hard it was to get his son care during a psychotic state years ago.  The nice thing: Pete's son is doing great, as are the two women who called in.  

If you'd like to listen, the link is here:

https://thedianerehmshow.org/shows/2016-11-29/the-debate-over-involuntary-psychiatric-treatment

And Pete Earley wrote more about the show, including some of the Facebook Q&A after, on his blog.
As far as the photo goes, we took a vote and Diane Rehm definitely looks the best.  What a great host and what a privilege to be on this marvelous radio show before she retires.

Involuntary Psychiatric Care-- a Discussion on NPR's Diane Rehm Show on Tuesday : the Third Time's a Charm

I've posted twice about how we will be discussing our new book, Committed, on the Diane Rehm Show on National Public Radio.  Well, national politics have gotten in the way, and we've been rescheduled for more time-sensitive issues.  

So I'm excited to tell you that we will be on the Diane Rehm Show this Tuesday, November 29th, during the second hour of the show -- 11 AM if you're listening on WAMU, 88.5 FM.  Only it's gotten better -- while the show was originally supposed to be just the two authors, the programming has changed: Pete Earley, who wrote the foreword, will be joining us in the studio, and two people who have been hospitalized involuntarily will be participating by phone, including one of the wonderful women we traced through the book -- Lily.  

Diane Rehm makes a point of saying: 

 One of her guests is always you 

So do feel free to call in or email questions, and we will be staying for a little while after the show for a continued discussion on Facebook.

While we hope you can listen live, we'll publish a link to the show after it airs. 

While I'm here, please let me mention that Committed was listed on Scientific American's Books to Read in December!

Link to information about our segment on the Diane Rehm Show Here.

Tune in to Tell Me Everything with John Fugelsang on Sirius XM #121

You're invited to tune in tomorrow, 

Monday Novermber 21st,

 when we join radio host 

John Fugelsang on his show

Tell Me Everything

3PM on SiriusXM, #121

We will be talking about our book,

Committed: The Battle Over Involuntary Psychiatric Care

My Neverending iPhone 7+ Fiasco

If you've already read the beginning of this, you can scroll down to the Addendum added on 1/17/17, or to Addendum #2 added on 1/26/17, or Addendenum #3 added on January 29, 2017

Please note that while this is usually a psychiatry blog, today I am using it to vent for my own personal psychotherapy.  Please feel free to offer words of support, to make helpful interpretations to improve my insight, or if you know CBT techniques that may help me, I'm open to that.  Is there a 12 step group for iPhone users?  Medications to treat Post Traumatic iPhone Seven Disorder? 
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Dear Mr. Jobs,
I know you've died and left the job and I should leave you to your death in peace, but I imagine you are spinning in your grave at a mind-boggling rate where there is no peace to be had.  You used to run an amazing company with great products and great service, and since you've left, it's gone to hell.  I don't know where you are but  perhaps you might know this?

Let me tell you my iphone 7 story.
~First I'll start from way back: I loved my iPhone 4.
~At some point I upgraded to an iPhone 5s, it had terribly short battery life of 3-4 hours.  I thought I'd cracked the screen (it was a plastic protector) so it looked pathetic.  Touch voicemail didn't work, and since this is my only phone and I run a medical practice from it, it was often difficult to retrieve messages, and I spent about an hour on the phone with support figuring out how to change my greeting for vacations.  Simply put, it was time for an upgrade many months ago, but I waited for September for the latest model: the iPhone 7 which came with many promises.
~I went to the Apple store to buy my iPhone 7, which is constantly advertised on TV.  Ha!  No such product.  Order it, the color I want will be available in 3 months, I opted not to.
~There were ways to order it online, but I really wanted a live person to help with set up, oh, and what I want still wouldn't be available for months.
~I gave up on the color and began calling Apple every few days.  They repeatedly told me to check on line at 8 AM everyday for availability, but I could not figure out how to do that on the website (all those Ivy League degrees for nothing).
~One day, I was told that a gold (meh) phone was available at a mall 30 minutes from me and I could reserve a time to come get it.  Yes! I arrived at 5:30 to get my iPhone 7, I brought my MacBook Pro because my phone was not backing to the cloud. They got me the phone, backed my phone to the computer, erased my phone (despite my suggestion that they wait until the new one was set up) and handed me off to the next guy to set up the new phone; I was told this would take a few minutes.   I was able to cash in my old phone for $90. The new phone with Apple Care plan cost over $1,000.
~I remained at the store until 9:30 when it closed.  My 4 year old MacBook Pro has Lion and it was incompatible with the new phone, and try as they may, 2 set up guys and 3 geniuses could not get the information transferred.  At one point, the genius just vanished for half an hour (maybe on break, but he could have said so?).  The geniuses were helping several people at once.  There was little sympathy for my plight, but occasionally, my genius offered a reassuring word that it would eventually work. My operating system could not be updated because I was not sure if the computer was fully backed up, and when I suggested they use an external drive to do this, they said they I could buy one.  No one suggested that I pay 99 cents to get enough storage space in the cloud to back up there.
~At 10 AM the next morning, I arrived at an Apple store closer to my home with my new phone, my old phone which I had purchased back, my MacBook Pro, and an external drive so the computer could be backed up. Now a new operating system could be installed that would compatible with the new phone.  I was told to come back at noon because there was a wait.  I did so and was told to come back at 3 PM because there was still a wait, at which point I asked to see a manager and be given special consideration since I had been trying to get the phone set up for many hours and was on day 2 now.  They did expedite me, and by 5 PM, my phone was set up and my computer upgraded to Sierra.  I also learned that I needed more RAM on the computer, which Apple does not do, but they suggested outside business which could help me.  Really, they can't add RAM to their own computers? In all, 11.5 hours including an entire business day in Apple's stores for a process I expected to take 30 minutes.  And no, I would not have purchased the phone if I was aware that it would be this difficult. And that was the beginning of the story.
~The new phone has good battery life.  I'm told it has a better camera.  The fingerprint unlock sometimes works, I finally turned it off.  I can now back to the cloud for 99 cents a month.  
~The phone itself does not work -- people are constantly telling me I am breaking up.  At first I thought it was a connection issue, but then I realized it happened everywhere, on every call.  I'd touch the phone and it would get better.  But every call is stressful and people often hang up on me frustrated that they can't hear me.  
~I called Apple support, the technician immediately knew I was on the phone that didn't work because she couldn't hear me breaking up. Diagnostics revealed a problem that would take 40 minutes to fix.  I had to go to work and arranged for a call back time later.  They had me re-hook to my own network, but the phone doesn't work even when I'm not on my home network.  Still, it was better: fewer people complained I was breaking up, but in the middle of almost every call, people continued to tell me that they've lost me.  "I can't hear you, can you hear me?"  (Yes I can hear you).  Have I mentioned that I run a doctor's office off this phone, and that I have a new book out and planned to be doing a live radio interview from it on Monday for a Sirius XM show --Ah, I will stay near a landline.
~I tried to make a Genius Bar appointment on the website.  There used to be an option for Get Help and Make A Genius Bar Appointment.  No more.  It took clicking through many many screens, some repeatedly, to get to that point where you can actually schedule and I would not be able to find it again.  The contact info all wanted me to chat or call, which I'd done.  At this point, I now dream my Apple Password because I've entered it roughly 100 times in my many hours of iPhone 7 hell.  Appointments were all 4-5 days away during times when I have patients scheduled.  Plus, I know that if I enter the store, I may never leave, so I am scheduling an unpredictable amount of time.  I was later told that if I had the Apple App it would be much easier to make the appointment -- I suppose I should have magically known that?  It does not suggest that on the website.
~Yesterday I prepared myself: I went to the iPhone store steeled for however long it might take. The next technician could see me as a walk-in in 3 and a half hours, at 6 PM.  Too long to sit in the store, but I could buy some groceries, run them home, and come back, no problem.  I talked to him about what if they called me earlier, he said they probably wouldn't, and said I would have the option to delay the appointment. I said I would return by 5:30.
~Forty-five minutes later, I'm checking out of Sam's Club with  space heaters and a rotisserie chicken, among other perishables when my phone texts me that they are ready.  I try to delay the appointment by pressing the button for 60 more minutes, but after repeated texts to me, they cancel my appointment.
~Perishables in the car, I return to the mall where I'm told the wait is 3.5 hours.  I rant about how they told me that and then called me after 45 minutes, and oh by the way, I spent 11.5 hours having the phone set up over 2 days.  There is no sympathy, I'm told there is a line, but I'll be moved forward, have a seat. 
~I sit.  I'm soon texted to check in.  I check in with the guy with the gray cap and am told to have a seat.
~I sit.  I'm soon texted to check in.  I check in with the guy with the green cap and am told to have a seat.  I sit.  Maybe an hour since I've been back, maybe not quite.
~I rant at the guy sitting next to me.  Then I get the guy with the green cap and the gray cap together and see if they can help me.  These employees are robots.  They have a line and a procedure.  No one apologizes, no one empathizes with the frustration, no one thinks it's odd that I keep getting to texted to check in after I've checked in.  I see other people in the very crowded store with 3-4 slow moving 'geniuses' and other people also rant at the intake guys.  I know I am getting distraught as well, and I apologize to the young men because I realize that neither the system nor the problematic phones are their fault, they are just the messengers.  I just want my thousand dollar phone to hold a call.  I think they hire Apple store employees from the poker tables at the local casinos.
~I ask to speak with a manager and they say yes, then send over a security guard.  The security guard listens to my saga, he actually expresses a degree of kindness and sympathy. I feel sorry for the man across from me (his phone heats up to the point where it's untouchable then goes blank), who has now heard the tale four times.
~A manager comes over.  She apologizes (much appreciated) and gets a technician who asks what would make me happy.  I tell him I want my phone to make calls without going silent in the middle.  He offers to exchange the phone for a new one.  I ask if mine can be fixed.  He runs diagnostics and says there is a problem with the phone.  So a new phone it is,  but they don't have another phone in stock.  He'll order it.  He doesn't know when it will come-- a few days-- and he doesn't know if it will take 11.5 hours to transfer my information but he says the usual is 10 minutes.  I ask if I can have a different color since gold was never my preference and I've been through a lot.  I can't, it has to be the same phone.  And for some reason I had believed there was a 30 day return policy--- since I still have my old iPhone 5s which I repurchased from the store when they couldn't transfer the information.  Nope 14 days, I can't just return it and buy an Android.

Mr. Jobs: You need a better product.  And please don't constantly advertise a product that is so unavailable.  You need more employees.  You need to train them to express some sympathy and kindness to those who have unexpected delays and waits and poor quality products.  You need to tell them not to tell people to come back in many hours, then call them in 45 minutes.  It's a mall, if I knew it would be a 45 minute wait, I wouldn't have sushi in my trunk, I'd have wandered around or gotten a cup of coffee.  You need to instruct them to be kinder to people who've already had problems with the product and service and to have a mechanism to put people to the front of the line who have been there multiple days and have had  hours of frustration.  A restaurant would have offered a free dessert, and not that I want dessert or that that makes things all better, but it does acknowledge that the customer is right in expecting something for their money.  Your staff acts like they are doing me some great favor in providing their expensive, malfunctioning product, with no concern about customer satisfaction.  Given my awful experiences, some empathy and a willingness to provide timely service and to change the phone color would have been appreciated.  And yes, we sold our Apple Stock this week.

I still don't have a fully functional phone, let's hope I'm not back venting about problems picking up my new iPhone.

Thank you for your attention to this matter, Mr. Jobs, and I hope you are in a better place.
Dinah

 -----Addendum to my iPhone 7 + fiasco 
(please note I am ranting as therapy.)
The story above began in November, and I was soon provided with a new phone and an easy transfer of data --I was in the Apple Store for under an hour.  End of Story?  No, the second phone didn't work either. The reception was poor and calls went in and out for no reason.  I called Apple, they said to call my carrier.  I called my carrier, they said there was in fact an issue and they did something that made things better: my reception was better, but phone calls still went to mute periodically so that the other party was left to say, "Are you there? Are you there?"  I was there. I'd touch the screen or push a button, and things would improve.  In the meantime, since the Apple folks had backed up my phone to my computer and had to upgrade my system from Lion to Sierra, I lost access to iPhoto, and the newest version doesn't seem to exist.  And my MacBook is now more wonky than ever.  

I had to let it rest; my $1,000+ phone was driving me crazy and I felt like I was in a feedback loop that was always my fault.  Make a genius appointment: how? The website used to be so clear.  If you had the app it would be easier.  I downloaded the app.  It took 50 clicks to get to "Make a genius bar appointment" and it was always a week away with the ability to set it for one device only.  I had to take a break for my own sanity.  

Today, after a conversation the other day that dropped three times, I decided I had the time and resilience to deal with my iPhone issue again.  And I want to see my photos.  Three months ago they were on iPhoto and I could see them for free.  When I got the new phone, I figured out the cloud and paid 99cents/month for storage.  Today, if I want to try to see my photos in whatever app is on my computer, it will cost me $2.99/month. Whatever, I clicked yes. Have I mentioned that I can't always access my voicemail? Or reliably change my outgoing message? The battery life is much better, the screen is bigger, but otherwise, I hate this phone.  And the touch unlock doesn't reliably work -- I use the password and still find myself swiping to turn it on.  Also, no jack-- you need to hook it to a separate thing through the charging port to use headphones: one more thing to keep track of and you can't listen and charge at the same time.  But for $159 they'll sell you new Apple bluetooth earbuds (another thing to lose).

I tried to schedule a genius bar appointment.  None until Sunday, but I have time on Thursday, and after all I've been through, can't they be accommodating? -- I'm on phone #2 with 16 hours logged sitting at the iPhone store.  I call Apple Support.  Oh, the diagnostics run in November showed a software problem that had transferred to the second phone.  Really? They didn't want to mention that then? They could restore my setting to store bought and walk me through this if I have a reliable internet connection and another phone to talk on, but my Macbook does NOT reliably connect to the internet, it's iffy and comes in and out and is very slow, and if I didn't hate Apple at this point, I'd gladly buy a new MacBook.  Is it funny that I'm worried about what I could lose?  Option #2 is they can charge me for a third new phone, send it to me, and refund me when I send the second phone back and  I'm on my own for transferring my information.  I don't trust me either with this.

I ask for a supervisor. I rant some more.  What would be helpful?  I'd like her to make a genius bar appointment for me.  She can do that on Saturday.  I'd like her to call one of my local Apple stores (there are two within 25 miles) and schedule an appointment for me on Thursday, and know they'd have another phone available, and that they could look at my Macbook  at the same time.  She can't do that, I can't be moved because other people have scheduled appointments to have their screens replaced and have issues dealt with.  That I'm on my second poorly functioning device, have spent 16 hours in Apple Stores over this, and have had many conversations with Apple Support doesn't matter.  She's sorry, but obviously, she's not.  Ah, and the call ended when my phone dropped it.  She didn't call back.

In therapy, it's not unusual for people to talk about their frustration with technology.  By this point, you probably think I'm a madwoman (I think I've lost it, so feel free) but I bet you aren't surprised to know that I'm rather sympathetic to my patients who are frustrated with their devices.  

So I don't know where Mr. Jobs is, but I do know that Apple has gone to hell. Mr. Cook, please do feel free to contact me. 
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26 January 2017.  The saga continues: I decided I needed to be able to talk on the phone, and I made a Genius Bar appointment for yesterday at 4:30 pm.  It was a short wait and I a very pleasant young genius named Jeff who felt that the problem had to be a transfer in a software issue from the first phone to the second phone because it would not make any sense for two phones to have the same problem. The solution, to reset the phone to factory settings and start fresh, individually downloading my apps. My calendar is on google, the contacts and voicemail remained, but I lost all my texts (I often use them to track when I've called in medications, to find pharmacy phone numbers, and to keep track of communications, but oh well). Set the phone up from scratch. Log another hour at the Apple Store and a couple in set up.  Trying to find the Contacts App, which shows up in the search window but not on the Screen.  Trying to figure out why some people are in the Contacts App but not in my contacts within the Phone App.  Oh, well, I'm managing, but everything is just a little different.   And I wish I could tell you the phone works reliably, but it doesn't, still having people say, "Are you there? Are you there?  Can you hear me?"  Yes I can hear you. No clue where to go from here. Yes, yes, I know I should have gotten an android, and No, apple feedback does not respond. 
I think the count: 17 hours in the Apple Store.
Not sure how long on the phone with Apple Support: I'm going to guess 2 hours.  And countless hours of aggravation.  Aren't you glad you asked? 
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Inspired by the inability to hold a cohesive conversation with one of my kids calling from out of town, I tried a new format for reaching out to Apple Support: Text.  Dan couldn't help me but he passed me along to Janae.  We chatted for one hour and she had me reset some phone/cellular options on the phone, but she was convinced the problem was with my carrier, AT&T.   I then called AT&T and talked to Uba in the Phillipines for some time.  Because the problem is intermittent, Uba insisted the issue was with my phone, not the carrier.  But Janae had wanted AT&T to open a case number and thought the issue could be with my SIM card.  Uba first said she'd send a new SIM card, then she insisted the phone was fine (right, tell that to my kid who cut out 6 times over 2 calls in a matter of minutes) and said she couldn't.  She sent me to a supervisor in Kansas who had me make a voice recording, "because if the voice recording is muffled, then it's the phone."  The voice recording was not muffled so a new SIM card is on it's way and there is a case open to be resolved (whatever that means) by 1/31.  And actually, since I was told to alter the settings to WiFi ON and Data Only (remember, the phone was swiped clean a few days ago), I have been able to have 3 conversations without anyone yelling "I can't hear you !".
The nice thing: when I reset the phone I picked much nicer wallpapers than I've been using: A photo through an arch at a castle overlooking the beautiful parliament building in Budapest for my lock screen, and the Grand Tetons in Jackson Hole for my home screen background. Makes losing all records of all my texts worth it?