the future of psychiatry: the DSM and the National Institute for Mental Health

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The National Insti­tute for Men­tal Health is aban­don­ing the DSM, for what appears to be psychiatry’s pipe-​dream of prov­ing that men­tal ill­ness is bio­log­i­cal and genetic, but at least it’s not tak­ing the piece of garbage that is the DSM-​5 seriously.

women peace activists: Leymah Gbowee

Protesting_in_front_of_UN_Envoy_at_Mamba_Point_Monrovia_Liberia_180dpi_credit_Pewee_Flomoku

The soon to be released movie Pray the Devil Back to Hell— part of the Women, War, and Peace series on PBS— tells the story of the women who united to help bring an end to the Liber­ian Civil War. Leymah Gbowee, an activist who helped to bring Chris­t­ian and Mus­lim women together to wage a silent protest out­side of the Pres­i­den­tial Palace in Liberia, is a Nobel Peace Lau­re­ate for her lead­er­ship in the Liberia Mass Action for Peace fea­tured in the film.

abortion, ectopic pregnancy, and “personhood” part 2: cervical pregnancy

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Ectopic preg­nan­cies occur when an embryo implants in the fal­lop­ian tubes, ovary, cervix, or abdomen. I cov­ered fal­lop­ian preg­nan­cies in Part 1 of this series. Part 2 is about preg­nan­cies in the cervix. They are rare, only occur­ring in 0.1% of ectopic preg­nan­cies, and most of them occur after in vitro fertilization.

It’s most typ­i­cal for a cer­vi­cal preg­nancy to abort spon­ta­neously in the first trimester, but those that don’t are prob­lem­atic and dan­ger­ous, espe­cially those that are implanted in the isth­mus— between the cervix and the fun­dus (see dia­gram above)— which are the most com­mon types of cer­vi­cal preg­nan­cies. The first symp­tom of a cer­vi­cal preg­nancy is abnor­mal vagi­nal bleed­ing, but unlike ectopic preg­nan­cies in the fal­lop­ian tubes or ovaries— roughly 2/​3rds of cer­vi­cal preg­nan­cies do not cause cramp­ing or pain. For this, and other rea­sons, cer­vi­cal preg­nan­cies can be hard to iden­tify. Women who don’t go to the emer­gency room at the onset of bleed­ing are espe­cially at risk, so it’s rec­om­mended that women do go to the emer­gency room as soon as abnor­mal vagi­nal bleed­ing begins. A woman who has no med­ical insur­ance and no pain, may wait until she is clearly in cri­sis and the con­se­quences of that can be fright­en­ing— it can threaten her fer­til­ity and her life.

Before imag­ing tech­nol­ogy advances like ultra­sound, cer­vi­cal preg­nan­cies that didn’t spon­ta­neously abort couldn’t be iden­ti­fied until after the woman had been given a hys­terec­tomy to stop the bleed­ing. It was con­firmed after an exam­i­na­tion of the hys­terec­tomized uterus. Now, a cer­vi­cal preg­nancy can be dis­cov­ered even before the woman has symp­toms. If her cervix has a bluish dis­col­oration, for instance, imag­ing can be ordered so that the med­ical team can iden­tify the prob­lem and treat it.

Cer­vi­cal preg­nan­cies before twelve weeks that don’t spon­ta­neously abort and are iden­ti­fied early are the eas­i­est to treat and present less of a threat to a woman’s fer­til­ity and life than those detected and treated later. Imag­ing helps to deter­mine where the preg­nancy is in a woman’s uterus, but it can also be missed. Even with ultra­sound, it can be dif­fi­cult for a med­ical team to dis­tin­guish between a failed or threat­ened mis­car­riage and a cer­vi­cal preg­nancy, espe­cially when the fetus is located a bit higher in the uterus and only par­tially in the cervix.

There are a lot of options for early cer­vi­cal preg­nan­cies that lean toward a con­ser­v­a­tive* approach. For those that con­tinue longer there are many options for treat­ing them. A hys­terec­tomy may be required to stop the bleed­ing when the pla­centa is removed. To under­stand some of the risk of these preg­nan­cies, it’s impor­tant to under­stand that the pla­centa is not just a sack that devel­ops in the uterus— that’s the amni­otic sac that devel­ops inside the pla­centa— the pla­centa is a venous organ that can develop out­side of the uterus. Remov­ing it can cause sig­nif­i­cant and life-​threatening hem­or­rhag­ing. Not remov­ing all of it can cause infec­tion. There is not a spe­cific pro­to­col for treat­ing cer­vi­cal preg­nan­cies after the first trimester. Treat­ing one can be chal­leng­ing even for expe­ri­enced surgeons.

If the woman’s preg­nancy is mis­di­ag­nosed as a threat­ened or failed spon­ta­neous abor­tion, and the woman is sent home to watch and wait, then the woman is at risk of hem­or­rhage. If a woman finds her­self in a Catholic hos­pi­tal that does not allow the use of methotrex­ate or any pro­ce­dure that threat­ens the fetus, she may need to go to another hos­pi­tal for treat­ment, if her future fer­til­ity is impor­tant to her.

As an aside, I found this rec­om­men­da­tion in this article

CAUTION ! In some soci­eties a woman who does not men­stru­ate is not accept­able as a wife, and if this is so in your com­mu­nity, don’t sac­ri­fice her uterus unless her life is in danger.”

A soci­ety that pri­mar­ily val­ues women accord­ing to their abil­ity to pro­duce chil­dren, doesn’t value infer­tile women enough for their part­ner to remain loyal to them. If you think that that doesn’t have any­thing to do with the beliefs at the root of the “per­son­hood” move­ment, then maybe you’re not pay­ing atten­tion to their implicit mes­sage. We’re get­ting into seri­ous A Handmaid’s Tale ter­ri­tory with “per­son­hood” leg­is­la­tion that defines “per­son­hood” as begin­ning at con­cep­tion and women as incu­ba­tors who are of less value than a life-​threatening mass of cells that has no or astro­nom­i­cally low chances of ever becom­ing viable.
Con­tinue read­ing

cartoon: a response to an early exhibit of prehistoric reptiles

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The Effects of a Hearty Din­ner after Vis­it­ing the Ante­dilu­vian Depart­ment at the Crys­tal Palace”, a car­toon pub­lished in the mag­a­zine Punch in 1855 (image in pub­lic domain). An unsus­pect­ing vis­i­tor of the Crys­tal Palace exhi­bi­tion is haunted in his night­mares by the mon­strosi­ties emerg­ing from the dis­tant (and not so dis­tant) past.

May 1, 1851: The First Dino­ma­nia (and Dinosaur Night­mares) at the Sci­en­tific American

The life sized mod­els of Crys­tal Palace inspired the very first “Dino­ma­nia“- hun­dreds of thou­sands of peo­ple vis­ited the Crys­tal Palace crea­tures, dinosaurs were dis­cussed in pop­u­lar mag­a­zines and mod­els, posters, poems and nov­els of pre­his­toric beasts were widely dis­trib­uted and appre­ci­ated – to the great delight of cartoonists…

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health care reform and a 2 billion dollar experiment

OHSU_gondola
Ore­gon picks 33 cri­te­ria to mea­sure health as part of $2B health­care reform experiment

This exper­i­ment looks to be start­ing out with some sen­si­ble approaches. It’s money well spent. Ore­gon is smart with money, OHSU is an excel­lent research hos­pi­tal, and Ore­gon is the first state in the U.S. to have in-​home care­giv­ing, which saves money and allows thou­sands of dis­abled peo­ple to live in com­fort and dignity.

I would like to see all HMOs encour­aged to oper­ate as well and as effi­ciently as Kaiser Per­ma­nente. As an in-​home care­giver who has had four clients in Ore­gon, I must say that the clients who chose Kaiser got great care and per­sonal atten­tion. I enjoyed work­ing with Kaiser staff and felt like part of the care team, because they made me part of it, they truly get team work. The other HMO I know of requires patients to play phone tag for a week to get any­thing done; and the other— for those on MEDICARE/​MEDICAID— I call “the place where patients go to die.”

Since the SEIU has orga­nized care­givers, they’ve pro­vided plenty of dif­fer­ent kinds of train­ing, so that the care­givers can learn what they need to to take care of their patients indi­vid­u­ally, and care­givers who work enough hours to qual­ify can get very afford­able health insur­ance through Kaiser Per­ma­nente— care­givers not hav­ing health care is a BAD idea, for obvi­ous rea­sons. I’ve no doubt that care­givers and the SEIU will have a lot of good input in this process of look­ing for ways to improve our health care sys­tem in mean­ing­ful ways. It would not sur­prise me if Ore­gon man­aged to lead the way for the U.S. on qual­ity health care that our nation can afford and be proud of.

There are two ser­vices I’d like to see added for home-​care in Ore­gon— wheel­chair repair/​pick-​up, and occa­sional help with deep clean­ing, re-​organizing, and haul­ing things off. The lat­ter would help to reduce falling haz­ards and make homes more liv­able and spa­cious. At this time, care­givers only get paid for light house­keep­ing as far as the por­tion of their hours that are ded­i­cated to housework.

And, of course, I’d like to see all states imple­ment home-​care for their dis­abled pop­u­la­tion. It’s smart. It’s human­iz­ing. It’s per­son­al­ized. And it’s nice.

Thanks for the 2 bil­lion dol­lars, Mr. President!

articles on BigPharma

on the history of drug regulation and prohibition in the U.S.

war on drugs

In the arti­cle Kath­leen Frydl on the drug war: ‘Here we have total and com­plete fail­ure.’ by Dylan Matthews in the Wash­ing­ton Post, he inter­views Kath­leen Frydl, who has just pub­lished a book The Drug Wars in Amer­ica, 1940 – 1973. In the book, and in the inter­view, she sketches the his­tory of drug addic­tion in the U.S. fol­low­ing the devel­op­ment of new nar­cotics and wars in which many sol­diers became addicted to nar­cotics that were used to man­age pain. She also traces the evo­lu­tion of U.S. drug poli­cies from the Har­ri­son Nar­cotic Act which reg­u­lated the dis­tri­b­u­tion and use of nar­cotics used for med­i­c­i­nal pur­poses, to a focus on illicit drug use and pros­e­cu­tion, to the fail­ure of Con­gress to reg­u­late and tax pre­scrip­tion drugs like amphet­a­mines and bar­bi­tu­rates in the fifties (though they were known at the time to be extremely addic­tive), to “the war on drugs” that was started by Nixon.

As an exam­ple of how inef­fec­tive the drug war has been, she gives this example

It’s time to step back and look at the for­est. In 1968, a dime bag of heroin cost $5 and was about 15 – 40 per­cent pure. Today, with­out adjust­ing for infla­tion, it costs $5 and it’s 15 – 40 per­cent pure. That’s a crude mea­sure, but that’s the def­i­n­i­tion of fail­ure, right there.

and after giv­ing addi­tional insight concludes

The thing I have been sug­gest­ing, at the top of my list, is some kind of National Acad­emy of Sci­ences study to for­mally model dif­fer­ent approaches to the reg­u­la­tion of illicit drugs, includ­ing the way that we used to do it under Har­ri­son, and also to address how costly the tran­si­tion between one regime and another would be. We’re at the point where we want the hard social sci­ence and for­mal mod­el­ing to come in.
For exam­ple, if you’re nego­ti­at­ing trade agree­ments, as we are doing right now, what would it mean to include illicit nar­cotics reduc­tion in those talks rather than requir­ing crop dust­ing for erad­i­ca­tion? Which is more effec­tive? There’s a lot of things I sug­gest that are tra­di­tional tac­tics of agri­cul­ture and trade pol­icy, that I’d like to see assessed by neu­tral scholars.

Con­tinue read­ing

competitive philosophy and it’s wonder

from Opini­a­trety: Missed Oppor­tu­nity

If I had known about the Twitter-​length phi­los­o­phy con­test, I would’ve entered “All con­ver­sa­tional impli­ca­tures are can­ce­lable, and I am the Queen of Roma­nia. I mean it lit­er­ally.” Only 99 char­ac­ters, and not only is it an orig­i­nal argu­ment I actu­ally got it pub­lished (with some addi­tions). Oh well.

com­ment: Was Dorothy Parker the orig­i­nal source of “and I am the Queen of Roma­nia (if mem­ory serves, I think actu­ally “and I am Marie of Roma­nia”) or was she quoting?

blog host’s response: I had thought of it as some­thing of a ready-​made phrase but maybe she orig­i­nated it. I actu­ally changed it from “Marie” so it wouldn’t be a ready-​made phrase or idiom, because those mess up impli­ca­tures — in this case you actu­ally do have to do the cal­cu­la­tion that I’m obvi­ously not the queen of Roma­nia, and so I’m flout­ing a maxim of qual­ity, and so I’m try­ing to say that “all con­ver­sa­tional impli­ca­tures are can­ce­lable” isn’t true either.

Huh. Don’t know what he said, but now I’m kind of wor­ried about using a ready-​made phrase or idiom and mess­ing up an impli­ca­ture somewhere.