Psychiatrist J. Douglas Bremner has weighed in on the Melanie Blocker Stokes MOTHERS Act, an effort to provide voluntary screenings to pregnant women to help identify postpartum depression before it becomes overwhelming. I’ll let Bremner speak for himself:
The problem with this is the attitude that being a mother is a risk factor for a psychiatric disorder. First of all, there is no evidence that women without a prior history of anxiety and depression have any increased risk of getting post partum depression. So to screen all moms as if giving birth is a risk factor for depression is ridiculous.
My BS alert goes off whenever someone tries to change the argument from a reasonable effort to help increase education and information about a stigmatized mental health issue, to hyperbole, suggesting that a piece of legislation is trying to turn motherhood into a psychiatric disorder. It goes off again when a professional makes an extraordinary claim like, “there is no evidence that women without a prior history of anxiety and depression have any increased risk of getting post partum [sic] depression.” Really? Absolutely no evidence? That’s quite a strong statement, and easily proven false with a literature review.
Where shall we begin? (I have limited space and you have a limited attention span, so I’ll just highlight a few studies…)
Ross & Dennis (2009), for instance, in a literature review found that both substance use and current or past experiences of abuse are associated with increased risk for postpartum depression (PPD).
In urban South African women, Ramchandani and colleagues (2009) found the strongest predictors of postnatal depression were exposure to extreme societal stressors (e.g., witnessing a violent crime/danger of being killed) and reporting difficulties with their partner.
Robertson et al. (2004), in a large meta-analysis of research to-date, found that a previous history of depression and anxiety (not just during pregnancy) was predictive of postpartum depression. But they also found that simply experiencing a stressful life event during pregnancy or low levels of social support (e.g., not having any emotional support from your friends or family) could also lead to postpartum depression.
Beck’s (2001) meta-analysis of 84 studies found:
13 significant predictors of postpartum depression: prenatal depression, self-esteem, childcare stress, prenatal anxiety, life stress, social support, marital relationships, depression history, infant temperament, maternity blues, marital status, SES, and unplanned/unwanted pregnancy. 10 of the 13 risk factors had moderate effect sizes while 3 predictors had small effect sizes.
Look at all of those factors which are not depression or anxiety — I count 9. Even if 3 of those are small-effect size factors, that still leaves 6 factors which are not depression or anxiety.
What about the argument that if depressed women are the most at-risk, we should simply focus on them?
Ingram & Taylor (2007) found it wasn’t just a woman’s pre-birth depression severity that was important — poor emotional support and women who had more negative descriptions of their own childhood were additional risk factors that played a role in increased risk for postpartum depression. Who’s going to screen for these things, the obstetrician?
Well, no, because the obstetrician is already not doing a good job at screening for postpartum depression, even in high-risk women. Hatton et al. (2007) found that, among high-risk women, obstetric care providers may be overlooking up to one fifth of women with current major depression. Not exactly great numbers there. If obstetric care providers can’t deal with the obvious cases, I can only imagine how well they do with the more complex or less obvious ones.
Monk et al. (2008) sums the state of our knowledge on PPD:
Depression is relatively common during the perinatal period (Gavin et al. 2005; Ross and McLean 2006). Approximately 8.5 — 11% of women experience either a major or minor depression during pregnancy (Gaynes et al. 2005). Nearly 20% of women have a minor or major depression in the first 3 months following delivery (Gavin et al. 2005).
So up to 1 in 5 women have depression after giving birth, and this isn’t something worth noting or screening for? (For comparison’s sake, 1 in 10 men and women in the general population might have depression at any given time.) Giving birth doubles your risk of depression, and this isn’t an issue? Amazing.
But don’t just take my word for it. Zajicek-Farber’s (2009) study conducted on high-risk women for postpartum depression concluded that:
These findings provide additional supportive evidence that more efforts are needed to identify and assess women’s depressive symptoms to promote health and safety of young children.
These are objective researchers calling for more screenings. Not politicians. And not people (or professionals) with a political agenda.
Now, I understand Bremner’s point — let’s not medicalize and catastrophize ordinary motherhood. I agree. And of course a woman’s pre-birth depression or anxiety is strongly correlated to postpartum depression. But not exclusively, as Bremner claims.
Bremner claims, with no evidence, that all mental health screenings are simply pharmaceutical sales tactics to help increase prescriptions. That’s ridiculous. When I worked in community mental health, we ran annual mental health screenings in the clinic — with no funding from any pharmaceutical company — because it reduces stigma, decreases misinformation and increases education about mental health issues in the general population.
Sorry, but most people don’t have time to keep up with a dozen blogs or read monthly journals on the latest research in mental health. Most people know what they know about mental health largely through mainstream media, or their own first-hand experiences with an issue. How is the promotion of more information and education about mental health issues a bad thing?
Bremner uses teens as an example of screening gone wrong, but conveniently fails to mention the facts about teenagers and mental health. Teens are an “at-risk” population, hence the reason they are sometimes targeted for screenings. Teens are notorious for being limited in their treatment options (especially in the U.S., where their treatment may be covered by their family’s health insurance, meaning a talk with their parents about their mental health issues), and for peer pressure limiting their ability to accept or seek help. (Yes, sorry, if you’re seeing a therapist for depression as a teen, you’re typically not seen as a “cool” kid.)
Sadly, whether people want to admit it or not, mothers are another “at risk” population. Why? Because society has told mothers time and time again that giving birth is supposed to be a joyous, happy occasion. If you’re depressed after giving birth to a child, there must be something wrong with you. Don’t draw attention to yourself or your problems. Just try and deal with it, try and take care of the baby, and make it through each day. Mothers don’t know they might have something recognized as postpartum depression, much less that they can talk to someone about these feelings or that there’s treatment — psychotherapy or medication — readily available for it.
So respectfully, I disagree with Bremner’s assessment of the MOTHERS act and its need in today’s society. And if you’re not going to bother to do the legwork and just make general (false) pronouncements about what the research actually shows (or worse, suggest the all research that disagrees with you must be in pharma’s pocket), then that’s a lazy person’s argument. There are too many logical fallacies at work here to list, so I’ll just suggest that I expect more reasoned and professional arguments –based upon the actual research — about such important legislation.
Psych Central continues to support the Melanie Blocker Stokes MOTHERS Act because the research shows it would help in the efforts to increase education and correct mis-information about postpartum depression.
References:
Beck, C.T. (2001). Predictors of postpartum depression: An update. Nursing Research, 50(5), 275-285.
Hatton, D. C., Harrison-Hohner, J., Matarazzo, J., E.P., Lewy, A. & Davis .L. (2007). Missed antenatal depression among high risk women: A secondary analysis. Archives of Women’s Mental Health, 10(3), 121-123.
Ingram, J. & Taylor, J. (2007). Predictors of postnatal depression: Using an antenatal needs assessment discussion tool. Journal of Reproductive and Infant Psychology, 25(3), 210-222.
Monk, C., Leight, K.L. & Fang, Y. (2008). The relationship between women’s attachment style and perinatal mood disturbance: Implications for screening and treatment. Archives of Women’s Mental Health, 11(2), 117-129.
Ramchandani, P.G., Richter, L.M., Stein, A. & Norris, S.A. (2009). Predictors of postnatal depression in an urban South African cohort. Journal of Affective Disorders, 113(3), 279-284.
Robertson, E., Grace, S., Wallington, T., Stewart, D.E. (2004). Antenatal risk factors for postpartum depression: a synthesis of recent literature. General Hospital Psychiatry, 26(4), 289-295.
Ross, L. E. & Dennis, C-L. (2009). The prevalence of postpartum depression among women with substance use, an abuse history, or chronic illness: A systematic review (PDF). Journal of Women’s Health, 18(4), 475-486.
Zajicek-Farber, M.L. (2009). Postnatal depression and infant health practices among high-risk women. Journal of Child and Family Studies, 18(2), 236-245.
202 comments
Kimbrel wrote: NO ONE talks about cures in mental health. The cancer people get “cure cancer†the AIDS people got “cure AIDSâ€, even the fibromyalgia people get talk of a cure and that’s another one of those diseases they can’t really prove (like mental illness)… We nutcases get “take your meds (for the rest of your life) and please go away‗-
You obviously have no idea how complex the brain is, especially when injured or impaired. No clue at all. Or you wouldn’t be staying ridiculous things like this. Never in human history have people with psychiatric disorders had such opportunities for a chance at a better life. Just because some physicians can’t diagnose or prescribe correctly (can all car mechanics?) and just because some brains are severely impaired, you would throw out all pharmaceutical interventions? Selfish narcissists.
Frank lee says: ‘You obviously have no idea how complex the brain is, especially when injured or impaired. No clue at all. Or you wouldn’t be staying ridiculous things like this.’
Frank Lee’s diagnosis follows:
‘Selfish narcissists.’
You are correct, Frank lee, the brain is incredibly complex, and so is the language that goes along, (expresses itself along) with it.
It is obvious that you are not able to listen, and understand what Kimbriel is talking about, and trying to express through language, and that ‘some of us’ in turn do understand, the meaning of the words. (and which are also more complex than each individual word)
And just as I can understand what you really meant when you used the words ‘staying ridiculous’ rather than ‘saying ridiculous’.
Sometimes, it really helps to listen,and to try and relate to another person, and to try and understand a person with a complex brain and ‘complex experiences’, rather than putting them down like a ‘wise guy’, including making an immediate diagnosis like some shrinks who think like you.
Uh, Frank? I have a degree in SCIENCE. I also have a neurological disorder, and have spent numerous hours with neurologists, so I do know a thing or two about the brain.
Just do a little bit of reading up on history, and you will see that your statement is completely untrue. Even today, people in developing countries with severe mental illness (who are typically NOT treated with meds) have a much better chance at recovery than people with those same illnesses in the US. This was discovered by the World Health Organization in 1979 and verified by a second study in 1992.
Lastly, when did I say that I would throw out all pharmaceutical interventions? If I had that attitude, do you think I would have ever let them medicate me for a year? People should be allowed to CHOOSE- yes, CHOOSE- whatever method they want to help them with their mental illness. The problem is that too much focus is being put on pharmaceutical interventions right now- and if you look at the statistical data, it’s not improving things. Not by a long shot.
Never understand why blog authors allow their sites to become chat room clatter like the above has become. Go to your email sites and debate away this spurious dialogue on your turf, please.
It demeans the topic at hand, ie how to intervene in diagnosing and treating postpartum depression.
Remember?
We don’t have each other’s email to discuss this elsewhere. If you don’t want to read it, don’t.
skillsnotpills wrote:
“…It demeans the topic at hand, ie how to intervene in diagnosing and treating postpartum depression.”
Well, no, it isn’t… We (I), changed the objective, above, and it is now “let’s cure mental illness.” It’s easy enough to get rid of depression: just stick around somebody who isn’t depressed, and copy what they do… Funny thing, communication…
Anyway, we’re not “engaging in spurious dialogue,” we’re having a deeply philosophical discussion, in keeping with the sombre nature of the subject matter.
Matt
I do believe that the reason Psychiatry and Religion hate each other so much is, because they are just so much alike.
Now, it’s not that I worship surgeons, but this is what happened with me about a year ago.
I saw a surgeon who specifically requested that all the original tests, (i.. MRI, CT scans, etc) were sent to him so he could view them for himself rather than go by someone else’s report.
Although the MRI was negative for further pathology, he told me he didn’t quite trust the report and that he was concerned, and therefore scheduled three hours for the Operating Room, just in case. Then he injected a dye into the area that would tell him if anything had spread, but from the dye’s behavior, this was unlikely, and which in this case also confirmed the MRI report.
But the surgeon once again was suspicious and so he started looking further around only to find that that his suspicion was confirmed.
The pathology had dangerously spread beyond and he, and his team and the pathologist spent every last second of the three hours operating.
Had the surgeon been a novice and uninterested in all his affairs, and trusted the MRI and Ultrasound results,I would be dead by now.
But instead he used his caring and skill and competence to treat and cure me. he went beyond.
I hardly think that most Psychiatrists are just as diagnostically accurate, and skillful, when they stuff huge parma into any patient just so he shuts up.
I love surgeons- never had one steer me wrong, yet (and I’ve had 12 surgeries).
Anyway, I wanted to note that I stand corrected: I found a website that is actually talking about cures for mental illness: http://www.imhro.org/
And it says, from the website: “The International Mental Health Research Organization is a leading mental health charity committed to supporting research to help people with brain disease, and, ultimately, find CURES for schizophrenia, depression and bipolar disorder.”
MUCH appreciated. Yes, I understand the brain is complex, but that doesn’t mean a cure should not be the goal.
kimbriel wrote:
“…Yes, I understand the brain is complex, but that doesn’t mean a cure should not be the goal.”
Absolutely. And we know the brain is complex, because each of us has one, which we may analyse at length and at our leisure.
I’ll tell you what the cure for depression is: not being depressed. The question is, what does “not being depressed” amount to? I can’t remember whether it was you or Katrin who wrote something to the effect that “mental illness is a list of symptoms”. “Not mental illness,” then, must also amount to a list, which directly contradicts the definition.
Presumably, then, when one is happy, enjoying some activity and feeling involved, one cannot be, by definition, depressed. Should one avoid being sad, bored and isolated, for fear that one is going to be labelled “depressed”? Well, that’s probably a question for the individual – there’s nothing objective about it, as far as I can tell.
So, we’re now left with another question: if one is exhibiting the moods/behaviours that amount to “depression,” how does one switch to the behaviours/moods that amount to “not depression”? Serendipity is the answer, I think: go and do something else, and let one’s brain work on the problem, in the background/unconscious! Give it a problem, and it’ll work it out, every time.
Matt
Matt, could you give an example? kat
Re Dr. Grohol’s statement: Are you honestly suggesting that a person’s mental health is somehow worth less money and value than their physical health??
The point is really that if a person’s physical health deteriorates enough they will die.
If a person’s mental health deteriorates, they aren’t necessarily headed for death.
But if toxic drugs deteriorate a person’s physical state they can die sooner than they would have without them. If you want to try to convince people that a mental state causes deteriorating physical damage you can do that, but it would be very difficult to validly prove how that actually occurs. And nobody can say it actually occurs because it is scientifically unprovable with a valid test or clinical research.
And yet the experts still maintain that it happens even though they have no way of proving that it happens. The label expert allows these folks to say things a normal person wouldn’t believe if said to them by a normal person.
Interesting chain, I have to say. Can’t believe I forgot to check this back out after I submitted a comment up at the very beginning. Anyway, I had to re-join the discussion, though it seems to have veered off the topic at hand. Totally in agreement with skillsnotpills @ 12:17 pm 7/27 (speaking of skillsnotpills, I agree w/your comments @ 5:24 pm 7/16). If you read these comments from the bottom up, you’d never think we were having a discussion about PPD. Especially the deeply philosophical–and circular–points of this guy Matt which fail to reverberate with me, probably due to the fact that he’s not talking about women and PPD at all, or the Mother’s Act for that matter. Michael Elder’s comments are irrelevant in this particular discussion.
I’d like to acknowledge and applaud Dr. Grohol (esp. comments @ 2:45 pm 7/15, 6:52 am 7/17, 12:42 pm 7/17 and 5:25 pm 7/17), Gina Pera (esp. comments @12:03 pm 7/15 and 2:35 pm 7/15), and Power is Knowledge.
These are by far my fav:
1. Dr. Grohol, thank you for saying the following…I couldn’t agree more!
“I don’t think or see women as “voiceless victims†just because some are trying to empower them with information and more data — data that comes from screening measures. A woman’s choice about what she does with that information and data is just that — her choice. I would never imagine it is my right to come between a doctor and their patient and their right to choose any treatment they want (or no treatment at all). It’s their choice, not yours, not mine. Screening provides women with more data to make an informed decision. Lack of screening keeps women in the dark. Since this bill only provides for voluntary screenings (and doesn’t mandate any sort of treatment whatsoever), I will very much continue to support it.â€
“I think we have to realize that our knowledge and ability to understand the complexity of the human body and the mind has a long way to go. I understand that, as do most researchers and clinicians. But what are we to do in the meantime, as our we try and increase our knowledge? Stop trying to help people in emotional pain who want treatment?? Or do the best we can with the tools and treatments we have available? There’s no doubt nor argument that treatment can harm as well as help. The question then becomes, How do we minimize likelihood of harm and increase the likelihood of help? And this is true of any treatment, psychotherapy too.â€
2. Gina, thank you for saying this…I couldn’t agree more!
“Overly focusing on mothers and PPD or depression seems a real danger here. The problem isn’t medication or the Internet-based self-medicating-with-opposition crowd’s favorite boogie man, Big Pharma. The problem is poorly trained clinicians who do not know how to screen for a wide variety of mental illness and often treat the wrong thing. We have them to thank, in my opinion, for the medication backlash.”
“Hate to see you defend yourself against such spurious attacks, Katherine. It’s not that the people who make such attacks trouble themselves to read your blog and to perceive your intentions accurately. Such deliberations are beyond them. People who have not one mirror neuron in their brains distrust those who do; it is simply a foreign concept to them. The fact that they see craven motives behind every advocate or volunteer speaks more to what motivates them than what motivates those whom they criticize.”
_ _ _ _ _ _ _ _
Kimbriel, how the heck do you think an OB/GYN would foster an open, trusting relationship if they don’t necessarily do what they’re supposed to do which is to ensure the new mother is feeling alright after having just given birth without asking a few questions which, if a woman feels uncomfortable answering, she can just pass on? Since when does a doctor jam questions down a patient’s throat? I personally have never experienced it in my lifetime. If my OB/GYN or GP had spent a few minutes asking me questions to try to get to the bottom of what was wrong with me when I had PPD, I would’ve been so lucky. If I had been asked relevant questions–or in other words screened for PPD–as soon as I indicated I had insomnia (rather than just been prescribed Ambien to help me sleep because he thought I had the blues), I could’ve been spared the painful experience that ensued, panic attacks and all.
I have to disagree with many of the anti-Mothers Act opponents in this chain….PPD is absolutely under-diagnosed and under-treated in this society. Every time I talk to a bunch of women, they share with me that they suffered miserably and unnecessarily from PPD without any treatment at all, depriving them of their ability to enjoy motherhood the way that they would’ve liked. Why did they suffer? Because they didn’t know what they had and were afraid to speak up and seek treatment due to the myths out there about motherhood and mental illness. We as a society have a truly long way to go to overcome all that. This country needs to provide education so that every last person is aware of what PPD is. I would’ve loved to have enjoyed my motherhood experience, but I didn’t. I was caught unaware and uneducated about PPD and what to look out for. No one told me anything. Had I known then what I know now, things would’ve been so different, so much better. This is what so many PPD survivors and others interested in the wellbeing of mothers are hoping to finally achieve in this country. Until then, what do all anti-pharma people propose? Be the change that makes a difference for mothers once & for all? That would be great, because it is so desperately needed!
If this bill passes, which I hope it does, it should be up to the individual woman whether she wants to answer questions at 6 weeks postpartum intended to make sure she is okay. If I were asked, I would answer, knowing what I know today.
I agree with many in the chain that the underlying problem and barrier to progress lies in the fact that medical professionals need to be trained to properly detect, diagnose and treat PPD. They also need the right resources/tools to do so.
My doctor’s office voluntarily screens for PPD. This is relatively new. I have had five children and it was not until this last child (born 8 weeks ago) that this screening took place. It took place at my six-week follow-up and there was nothing “invasive” about it.
I have read one commenter here who said he/she was a psychiatrist and that this sort of screening should only take place if the patient is known to be “at risk.” I ask, how is an OB/GYN
Sorry, hit a wrong button…continued from previous comment at 9:24am
I ask, how is an OB/GYN supposed to know which patients are at risk? Most doctors do not know their patients personally. To assess which patients are at risk would require, well, some type of screening at some point.
While I do not know for certain that I agree with legislating screenings, I do believe they should be given. Having suffered PPD without detection following previous pregnancies I can only imagine how much easier my life would have been, and the lives of those around me, if it had been identified and dealt with early on.
Pls remember there is nothing in the bill that states screening will be mandatory.
2 Replies to the above:
1. Sara: I sense I was the one you note as mentioning “at risk”, and that is my point, that an OBGYN is not trained to make such a determination based on their interactions with a post partum patient. So, if a patient comes in and makes questionable comments that reflect a mood disorder issue, the patient should be advised to see a mental health professional to determine if the problem is one of PPD. Not necessarily a psychiatrist first, perhaps better if it was a therapist if the issues at hand were coping or psychosocial problems related to being a new parent or overwhelmed multi-child parent. But, let the expert make the determination, not a doc who will be writing a script, or worse, reaching for a sample pack that a pharma company has prepared once this sick legislation has metastisized into the process. You really think OBs are going to implement an appropriate treatment process for PPD? Think again!
By this rationale being repeated by the advocates to this bill, can’t anyone with an MD after their name treat any medical problem that presents in their office? Can’t psychiatrists treat diabetes? Can’t cardiologists treat multiple sclerosis? Can’t surgeons treat psoriasis?
Again, think again!
2. Ivy: thank you for the supportive comment. I said it then (7/16), and I say it now above again to Sara, one of the sizeable reasons that psychotropics are causing problems is due to the fact that non-psychiatrists who have prescription access too eagerly write prescriptions. Every one is quick to attack psychiatry, yet I know that a majority of the suicidal patients this develops from being placed on meds is due to PCPs/internists/nurse practitioners/OBgyns starting these people on meds and then sloughing it off on psych MDs to pick up the pieces, if the patient even gets to a psych MD door by then.
“everyone thinks they are a psychiatrist until the crap hits the fan, and then everyone has left the room to leave the patient and psychiatrist to get it full force.” Said to me in my training by a supervising Psych MD, and oh how accurate an assessment to the state of affairs it has been.
If it is so easy to practice mental health care, why is psychiatry still a profession in this millenium? I’ll tell you in one sentence repeated to me by multiple non psychiatric physicians for decades now: “I don’t have time to talk to the patient and hear their problems I can’t treat as a somatic doc, so that’s your expertise.”
And yet, still 70% of antidepressant prescriptions written in the US are by non-psychiatrists. Seems people just don’t know better. Eh?
Ivy’s comments are so disingenuous.
One, she knows the Mothers Act is modeled after the New Jersey law that REQUIRES women to be screened during and after pregnancy. They have NO choice.
The screening language was finally removed last year only after they all realized that they would never get the Act passed if it stayed in.
Senator Menendez said as recently as May, 2009, that once the federal legislation is passed, they hope the individual states will pass screening laws like New Jersey’s.
Ivy’s statement below really got me going because I tried to post a response to the twisting of my words by Grohol and it was not accepted.
Ivy said, “These are by far my fav: 1. Dr. Grohol, thank you for saying the following…I couldn’t agree more! “I don’t think or see women as “voiceless victims†just because some are trying to empower them with information and more data — data that comes from screening measures.”
I never said women were the voiceless victims. This is what I wrote on another site:
Over on Grohol’s site, my statements about the voiceless, unprotected victims of the Mothers Act disease campaign, the fetus and nursing infants, were basically ignored.
Grohol himself switched my term “voiceless” into meaning the women and never addressed the victims I was talking about.
Dr David Healy, the famous psychopharmacologist and historian on psychiatry from the UK has said, that only 1 out of 10 pregnant women will be helped by antidepressants even if they do have true depression, which means the fetus of nine women will be put at risk for the one mother who may be helped.
As Dr Fred Baughman points out, years ago, doctors would never have considered giving pregnant women drugs unless it was absolutely necessary.
Today, in the midst of the psych drug peddling for profit schemes, the safety and health of the unborn fetus is no longer the priority concern in providing health care to pregnant women. In fact, it seems to have fallen to the bottom of the list.
Being that the medical profession as a whole is now dominated by the pharmaceutical industry’s best interest, women themselves had better start thinking about the responsibility they have to the unborn children they chose to bring into this world, who have no voice of their own in this drugging matter.
The health and safety of the fetus needs to return to the number one position on the list of concerns for pregnant women.
As a women, mother and grandmother, it’s difficult for me to understand how they ever lost that priority position in the first place.
Evelyn Pringle
Hi doc (skillsnotpills),
I read you loud and clear and especially “And yet, still 70% of antidepressant prescriptions written in the US are by non-psychiatrists. Seems people just don’t know better. Eh?â€
Some do and I’ll include me in that category and since I’ve been a support person and caregiver to my spouse for more than 46 years and reasonably educated in my proactive mental health advocacy and activism and having collaborated with many in your profession as well as the other medical disciplines I’ll politely throw the ball back into your court as I have done with a number of my spouse’s practitioners.
How’s about getting of your ass and high horse and along with the Bremner’s, Carlat’s and other professionals with your viewpoint influencing your societal organizations to educate and/or change the practices of the AMA and the other medical associations and their memberships from dispensing these drugs and your specialty and then washing their hands (dumping) of these serious cases by the time it reaches you and your associates.
It’s wonderful you share your thoughts on these forums but the problems do not necessarily lie with screenings for medical and/or mental health problems but as far as I’m concerned and not necessarily with you per se but certainly with many in the medical profession.
You guys (maybe not you as I don’t know your age) screwed up the health care system so that we ended up with the abomination called managed care (technically managed profits and little to no care) so instead of talking, do something to educate and improve the delivery systems for proper mental health care within the medical establishment. And while you’re at it, where were you all these years fighting for parity in health insurance coverage for mental health?
That was a very long hard fought battle so how’s about you guys starting a movement for a more appropriate delivery system for mental health?
The concepts and idealism of medical screenings for illnesses are in and of themselves not bad but rather the misapplications and squirreled up delivery systems needs to be addressed.
Warmly,
Herb
VNSdepression.com
Hey Herb, long time, no read. I am the formerly therapyfirst, as I shed that alias about 3 months ago once I came to the painful conclusion that not only patients have no real investment to pursue therapy as an intervention, but I am finding more and more ‘therapists’ are equally not invested to offer the service in the first place! So, I have gone to this alias as it was offered by a colleague who does take her job seriously and puts the patient directly in the cross hairs when the patient is meds only focused and wastes hers and my time.
I’m under the age of 50 and have watched my older colleagues sell out to the managed care beast 20 years ago as my field is one of whores and cowards. Note not all, but too many that justifies my use of that phrase. I left the APA in 1995 after the Eist/Sharfstein election when 48% voted for Dr Sharfstein’s unspoken “managed care is here to stay, so deal with it” campaign slogan, so the writing was on the wall. And the parity issue only still validates insurance intrusions in the end, so that is not an honest and effective goal to strive for.
As far as impacting on the hierarchy of the AMA and APA, it is death and retirement that will make the difference, and that is not going to happen too soon, eh? I am as direct and honest about this issue, and as long as entrenched, soulless, selfish bastards who have lost the oath they read outloud at their medical school graduations 30 or more years ago and just focus on their wallets and prestige/power among their cronies are still in charge, nothing will change.
So, as the Carlats, Bremners, and I feel Mr Dawdy at Furious Seasons is a prime time player to some degree, speak out but are not empowering the masses who are missing the point, they will do little. And that is not meant to be demeaning to them, it is just you can’t negotiate with narcissism and antisocial personalities. And that is what is basically running the show.
Getting it back to this post, political legislation does not help things in the end, and I truly do not understand why Dr Grohol does not see this instinctively. Fame fucks you up, that is why I like what I do. I treat people who are looking for help, and I do it because it is right and I have the skills to do it for the most part. I am not interested in prestige or accolades, but thank yous from patients are truly appreciated.
Glad to read you are around. Hope you can bring some healthy, responsible, and challenging viewpoints to the debate!
Have a good weekend!
FYI, another comment lost to the spam machine. Personally, while you, Dr Grohol, have emailed me to tell me it is the system that messes with me, I have to say I do not think it is coincidence. And if it is this inconsistent, I offer you find another service, if able, to handle your volume.
skillsnotpills
Are Evelyn Pringle’s posts being blocked, again. By blocking them, it makes it seem she is unwelcome on this blog especially to the lady who questioned whether she ever worked as a journalist at a credible newspaper. People usually hate Evelyn because they don’t like to hear what she has to say and or what her sources say. And by blocking her from posting, you give her a bit of credibility if for no other reason than if people can’t stand to hear the truth, there must be some truth in what gets blocked out.
Larry Bone
Skills…this has happened to me, though, as well, like three times.
Once the comment that was lost showed up about seven hours later, and which was not so great either.
The other two just ‘puffed into thin air.’
I find this frustrating as well.
Katrin
All the comments on this blog break down into.women who are comfortable with taking psychiatric drugs no matter how toxic over the long run to themselves or their unborn. There are those women who do not want anything legislatively introduced that would subject them to being forced to take drugs that they feel are toxic to themselves or to their unborn. If informed consent was a part of this bill, the comments on this blog would not be anywhere near as toxic as they have been. If 1 out of 10 women feels comfortable taking toxic psychiatric drugs, the other 9 should not be forced to consent to being drugged through legislative coersion. A mother not worried about these drugs is free to take them although the rights of an unborn child would be respected if she refrained from taking such drugs until after her baby was born.
Larry Bone
There is nothing in the bill that mandates screening or drugs, for that matter.
Are Evelyn Pringle’s posts being blocked again? People hate Evelyn Pringle such as the lady who questioned whether she ever worked for a credible newspaper, because she says what people don’t want to hear or quotes sources people don’t want to hear. Either way when people read a blog and someone like Evelyn is blocked from posting, it tends to make people believe there must be some truth either in what they say or their sources say. Such lack of transparency becomes suspect in the eyes of blog readers.
Larry Bone
In New Jersey, screening is mandatory as an example for other states to follow. If women don’t want a law like the one in New Jersey in their state, who can blame them for not supporting the Mother’s Act? Both bills originated from the same sponsor so how can anyone claim screening and therefore enforced drugging in not the truthful purpose behind passage of these bills?
Larry Bone
An interesting day here at PsychCentral, I must say. This posting certainly has had its number of comments, maybe not a record, but the issue has generated volume. I just hope in the end that the author here has the interest of the public at hand, and if he really has a strong feeling that this legislation will benefit more than harm, then I hope he is right. But, I don’t think he is right. Because, in the end per history of what politicians do, it is what is convenient or serves special interests, and I leave you all with this metaphor I ask of patients who struggle with choices that I sense have more obvious outcomes than not:
If you are presented with two doors to exit to get to your needs/desires, and door one has an 80% likelihood of getting you there, and door two has a 20% likelihood of getting you there, what door will you choose?
This legislation is behind door number two, folks. And if I am wrong, we are all happy, because patients get what they need, and they get better. Or, if I am right, pharma and politicians are appeased, at the expense of the public.
You figure out what door to exit, people, I made my choice, and door one looks damn good to me!!!
It was NJ Gov Corzine that passed the NJ law. There are many supporters of the law in NJ, including me.
I never said the fetus isn’t important. It sure is. Your implication that I wouldn’t think a fetus is important is insulting. The NJ law is a postpartum one, where healthcare professionals are required to screen their POSTPARTUM patients (fetuses no longer part of the equation) that you say the Mother’s Act is modeled after. Anyway, everyone has a right to their own position with regard to this potential legislation. I and many other supporters remain such, just as the opponents will remain such. As I’ve told Amy before, I respect others for their positions…everyone has a right to their own beliefs which they arrive at from their own experiences. However, resorting to insults only shows the nature of the person providing such negative comments. Period.
You damn right I get negative when I see the health and safety of voiceless children, whether it be the fetus’ or nursing infants, get delegated to the bottom of the heap.
And I am going to keep right on being negative towards anyone involved in any profiteering scheme that leads to the forced drugging of these helpless victims.
As I’ve said previously, investigating and reporting on the Mothers Act disease mongering campaign is not some kind of pleasurable hobby for me. In fact, it’s an utterly disgusting task.
My sole purpose is to protect children who in no way can protect themselves.
And with the psycho-pharmaceutical industry brainwashing women of child bearing years with these types of campaigns, it’s obvious that they need all the help they can get.
And my interest lies in the women with PPD who continue to slip through the cracks because their doctors do not properly detect, diagnose and treat PPD. They have a right to be asked simple questions to gage how they are faring after childbirth. They have a right to know before they get it what exactly to look for in terms of PPD. As a PPD survivor, I have firsthand experience of falling through the cracks, and that is not a good experience by any means. I also knew well enough about the risks of meds being fed to my daughter, so I moved to formula. I am not in this for profiteering by any means.
Fine Ivy – you keep looking after the mothers, who by your own admission, are not voiceless and have mouths of their own.
As a woman, mother, and grandmother, my interest will remain focused on the helpless children who never asked to be born, just as it has since I gave birth to my own children beginning some 40-odd years ago, and as my 7 grandchildren entered the world beginning 17 years ago.
You women need to quit acting like childbearing is some brand new experience, any different than it was for the rest of us, who somehow managed to make it through without drugging our infants in the womb or through nursing, every time mood changes occurred that we knew came with the territory.
By now, the risks and harms that can be done by psych drugs to the fetus and nursing infants is well documented and easily found on the internet.
Unless a drug is absolutely necessary for some life-threatening condition, in my opinion, a decision to take it, with knowledge that any possible harm could come to the child, is selfish.
The few women who experience true postpartum depression or psychosis are easy to spot and they can get help. Train doctors to be on the look-out if there are none out there competent enough to see it.
Screening the entire 4 million women who give birth each year in the US is totally unnecessary and amounts to nothing but a recruitment dragnet for the new “reproductive psychiatry” industry.
People need to look at the whole picture here. This disease mongering campaign is by far not solely for the financial benefit of Big Pharma.
Easy to spot, not so easy for all mothers with PPD to get the right treatment. You don’t know what I went through, so suggesting that I’m a wimp for not sucking it up like everyone else has the thousands of years women have been giving birth is ridiculous. Did you survive anything other than the hormonal shifts that cause the majority of mothers out there to be tearful or irritable for the first couple of weeks postpartum? Don’t presume to know what I or any other PPD survivor has gone through unless you’ve been through it yourself (sordid physical symptoms ranging from insomnia, not knowing what was happening to me, feeling completely unable to function, suffering from God-awful panic attacks)–and worse yet, have your own OB/GYN fail to even recognize that I had PPD at 6 weeks postpartum. Who’s to say that if I hadn’t sought treatment, I wouldn’t have wanted to end it all out of sheer fear and desperation. Yeah, I’m selfish alright for wanting to get help so I could function and take care of my daughter.
Don’t waste your time, Ivy. Evelyn Pringle is never interested in reality- or sane-based points of view. She has her agenda, and she barrels ahead over everyone in her way, all the while claiming how much she cares. Weird-o.
Can’t you read, Evelyn? These mothers don’t want your help. And to keep insisting that they do is doing violence to them. If their babies could talk, they’d say the same thing.
As for “Concerned Reader”, I’m done responding to bloggers who don’t even have the decency or guts to use their real names.
As for Ivy, I have read your story and it is not much different than many I have seen over my life-time.
Aside from the use of terms like “panic attack” instead of simply describing how new mothers often get extremely fearful and overwhelmed while taking care of newborns.
Absolutely nothing new there. I remember it well myself and thinking I was crazy. But the good thing was that 40 years ago, people assured me I was not and that it was normal to get fearful and overwhelmed.
Nobody taught me how to cope with having or taking care of a tiny little baby. It was a learning process – like everything else in life.
But thank God, nobody even mentioned drugs, or I probably would have been conned into taking them just like the women are now.
As far as depression, the answer would not be to start dosing a woman with antidepressants because they don’t even start to work (if at all) for 3 to 6 weeks.
That’s a lot of time that could be spent on getting to the core issue of what is really going on with the new mother.
Insomnia goes with the territory and the common sense thing to do is to find someone to help out with the child to make sure you can get some uninterrupted time to sleep.
The bottom line is there are umteen things that could and should be tried before a woman even thinks of taking drugs while pregnant or nursing.
But that’s not the way it works today. The doctor, who does not provide therapy, prescribes the drugs first and the woman is lucky if she ever gets referred for any type of therapy.
Also, in the 15-minute office call, the doctor does not ask anything about what might be going on in the woman’s life other than having a baby.
And 9 chances out of 10 there are plenty of issues that should be looked at and dealt with before a woman is drugged.
Again, until you’ve been in my shoes and experienced real insomnia and real panic attacks, you cannot assume that all that equates to is sleep deprivation and anxiety from being a new mother. It was way beyond that, and obviously you didn’t experience what I experienced, otherwise you’d understand what I’m saying. I’m done trying to explain to someone who thinks she knows it all.
Don’t tell me what I have or have not been through. I lost a planned baby at 5 months and after another planned pregnancy, my 3-day-old infant died.
As much as you would like to believe they are, you’re experiences are not unique in the history of childbearing.
You’ve simply been brainwashed into believing they are by the profiteers running this show, who want to lock in life-long customers.
After reading over the various postings on your website Ivy, I believe that to be true because you come across as very sincere in your wanting to help other women.
I do not think you are a “knowing” participant in the Mothers Act disease mongering campaign in the same category as say Katherine Stone and Lauren Hale, and that’s why I’ve never written anything derogatory about you or your website in my articles.
I’m not about to fault somebody for being duped by quite possibly the most rapid gang of disease mongers that I’ve come across in my 5 years of investigating these types of profiteering schemes.
Thanks, Evelyn, for sharing your personal experiences, at least these particular ones.
You are right, we can never, ever assume anything about another person, and who has won the suffering contest.
Evelyn,
I am very sorry to hear about your experience.
I had the Queen Bee of all postpartum disorders- postpartum psychosis- and I STILL don’t think that justifies screening ALL women for what happened to me. It’s 1 out of 1000 who gets this. They caught it two weeks postpartum and I was committed and drugged (and separated from the baby for three days). I am thankful for the two weeks I had with him and that I was able to breastfeed during that time- something I lost when they gave me drugs that weren’t safe for breastfeeding.
Thanks for you post.
Katrin wrote:
“Matt, could you give an example? kat”
Sorry, I’ve kinda lost the thread a bit… An example of the brain solving a problem via “background processing,” for wont of a better description? Or serendipity? Bear in mind, of course, that I use these words as near-facsimiles of the concepts that I’m trying to explain – they may mean something different to you.
Anyway, for most people, the issue is in identifying what the problem actually is. You’d be surprised how few have even the vaguest idea. Or perhaps you wouldn’t.
To answer your question (by not answering it!), I could give an example from my own experience, but it would be largely meaningless to you – something that I had regarded as insurmountable and massively problematic might present itself as trivial, to you.
Matt
Ivy wrote:
“…If you read these comments from the bottom up, you’d never think we were having a discussion about PPD. Especially the deeply philosophical–and circular–points of this guy Matt which fail to reverberate with me, probably due to the fact that he’s not talking about women and PPD at all, or the Mother’s Act for that matter…”
Not circular… It’s a spiral – we may return to the same place, but it looks different, the second time around, because it’s viewed from a slightly different perspective.
Anyway, if you want something other than circularity, or the semblance thereof, then you would have to have an objective, because if you don’t have a reference point, how will you know whether or not you’re progressing in the right direction? And if you can’t be sure that you’re headed in the right direction, there seems precious little point in moving off the spot.
Matt
PS Unless somebody’s going to reveal that they have experienced what they take to be PPD, then it would be difficult for any of us to discuss it, given that we would have no knowledge of it, and nobody to ask.