PsychSense: Sensible Psychological Solutions

Be Prepared

We have all been reading about the floods in the midwest, the tornados and the wild fires in California. While we feel for those affected there is always relief that it did not happen to us or someone we love. While this is understandable, don’t put your head in the sand, or use denial.  Perhaps its time to review the things you need to do  to deal with a weather  emergency. Remember the first thing is to take a deep breath, try to remain calm and get your list of things to gather or do. Use the skills you have learned at this site to remain calm and help others stay calm.

You can print this off this page and keep it handy. Collect the suggested items (and any others you think you need)  and put them in all one place.

  Remain Calm by talking to yourself, slowing your breathing, and forcing yourself to speak and move deliberately. This will help you think clearer. Next assess the situation and make a plan. Avoid minimizing and denial. Better to overreact then underreact.

Know what the signs of a approaching storm are, keep a radio( a weather radio may be worth buying in certain parts of the country)  on and listen for alerts. Have a fire escape plan from every room.

Plans should be made ahead of time and every family member should have a task to do and should know what it is and how to do it. Make them practice even if they roll their eyes. A meeting place is critical incase you get separated.

Sustinance:

• 3 days of supplies & food
•  Water / hydration   minimum 1gal per day per person
• 2 gal collapsible water containers
• Water purification tabs or water purification system, or make your own pure water with an eyedropper and iodine or chlorine bleach.  Iodine works, doesn’t taste so good, 20 gtts per gallon of clear water, 40 gtts for cloudy water. 5 % chlorine bleach (usual strength of household bleach use plain bleach unsented)- Add 2 drops of bleach/ gallon of water
• Food 2000 cal. per day per person  
• Can opener 

Shelter / Protection

•  Blankets / pillow
•  Toilet paper
• Non-cotton clothing (fast drying synthetics or wool)
•  Duct tape
• Emergency thermal blankets
•  Leather gloves / rubber gloves
• Rain Poncho
•  Face mask / N-95 respirator
• Moist Towelettes                       
•  1 roll plastic sheeting
• Garbage bags 
• Hand sanitizer
• 12 hour light sticks / flashlights/wind up flashlight
• Extra batteries

Communication

•  Cell phone & charger 
•  Whistle  
• Important papers
•  Wind- up radio

Other important items

•  Multi-function tool 
•  Cash / change / travelers checks
• Prescription medication / other meds 
• Bleach
• Pet food / extra water for pet 
• Pet meds
• Waterproof container 1 large 1 small
• Paper and pencil 
• First Aid Kit & Book
• Entertainment (cards, small games (many games come in travel size, pick up sticks, dominos, etc)
• Favorite Book, religious/ spiritual books that you use

Being prepared will help you feel in control, calmer and improve your decision making under stress. Here’s hoping you never need to test your preparedness.

Well the  mental health parity  laws are again in the news.  Should insurance companies be required  to give equal coverage for psychiatric illness as they do for physical illness?  Here’s the rub, no one can agree on what a psychiatric illness is.  

Most (but not all) will agree that a person with Schizophrenia has a psychiatric illness (a severe one at that) But what about Substance abuse?  Is this a psychiatric illness or a behavioral problem? 

 Ok what is the difference between Psychiatric and Behavioral?  Behavioral became the preferred  jargon to replace psychiatric when the HMOs came into vogue.  In my humble opinion,  calling a psychiatric illness “behavioral”,  puts the expectation on the patient to fix it (change their behavior.)  Oh the power of words!

 I never liked the “behavioral” word, but I too felt pressured to use it in the title of my own book  Behavioral First Aid  because it was the jargon of the day.   I really wanted title the book Psychological First Aid but copped out because Behavioral was more accepted at the time.  (This actually  may be changing again.)

Ok, so the question now becomes which psychiatic Illnesses should be recognized  as ones that cannot be controlled by the patient.  I think  for the most part  this is pretty clear with illness like Schizophrenia.  But what about depression? To be painfully honest,   I am pretty  tired of trying to convince people that clinical depression is VERY different then what many people call depression ( and take medicine for) like stress, grief and just normal downs of life.  Clinical depression has many physical signs and symptoms and people cannot talk themselves out of it.  With a major Clinical depression patients can be psychotic (out of touch with reality)  More about all of this in future posts.

What about Bi-Polar illness ( the diagnosis de jure). Don’t get me started on that!

For today lets just have a reasonable informed discussion about  mental health parity.  I know the insurance companies cannot (and should not) pay for years of therapy for someone who has made no attempts to change the things they can, and uses therapy as a cruch. (granted this is a tough call but I believe we can do it).

People with major mental illness need and deserve insurance coverage. It is the responsibility of the professional community ( not insurance companies ) to draw these lines no matter how difficult it is. Mental health professionals of all disciplines need to put their own interests aside to band together and come up with a logical solution to this long standing issue.

An article in today’s NY times about a doctor who offered to pray with a patient brought a variety of responses that covered the entire gamet from  suggestions of  taking his  license away to nominating him for sainthood.

I thought about this because the use of prayer,  religion or other spiritual practices has been a topic of many conversations by patients in my psychotherapy practice over the years.  I usually say something like “if it helps you or brings you comfort  its fine”. However,  no one has ever asked me directly to pray with them.  I can imagine this could happen especially during a crisis or emergency.  As a matter of fact, it is a wonder I have avoided it so far.  This article made me wonder what my answer would be to such a request. 

 As I have no objection to prayer  (even do it myself)  I imagine I could pray with a patient. However it goes so much against my training, it would  make me uncomfortable, so what would I say?  Well truthfully, I don’t know and I hope nobody ever asks. But just in case,  I am practicing a few responses…..  ” I would like to sit with you while you pray”,  or “Why don’t we sit quietly together and each pray in our own way”. 

I hope to avoid this issue, but if it does comes up I know I will do what feels right at the time. One thing I know for sure (this seems to be my answer to more and more  things the older I get) is there is no right answer. Darn!

I felt compelled to respond to  some of the misinformation  in a NY Times book review this morning of A Brief History of Anxiety by Patricia Pearson.

•  To start the reviewer calls Mrs Pearson a “neurotic”. This is  very old term with no true meaning. It is not in use in  modern psychiatry.

• Mrs Pearson is said to have anxiety.  There are quite a few anxiety disorders on a continium that range from mild  (generalized anxiety disorder) to very severe such as Obsessive compulsive disorder  (OCD) and Phobias.

• The symptoms of dread and multiple debilitatinging fears Mrs. Pearson describes are signs of severe OCD. I haven’t read the book but I would expect that she would also have some compulsive symptoms also. (excessive cleaning, rituals, etc.)

• Effexor is not addictive!!!  Heroin, alcohol, codine, valium, ( an antianxiety drug ), xanax( an antianxiety drug),  and many others are addictive; antidepressants are not. ( a drug is addictive if it causes a chronic  condition of compulsive drug seeking for the pleasent state or relief  it brings. It’s effects on the  brain lead to tolerance, physical dependence, uncontrollable craving and, all too often, relapse.)

• The return of symptoms after stopping antidepressants are simply the return of depression. (If you stop your insulin your blood sugar goes back up.)  Stopping antidepressants can sometime result in mild symptoms of muscle aches and headaches. This does not qualify as withdrawal!

•  Mrs Pearson complains of “anti-anxiety medications, which dulled the static in her brain but left her “in an emotional half-light,” secure but disengaged.” (drug addicts actually seek this feeling)  This does occur with Valium and Xanax type drugs (these are intended for situational crisis and NOT for long term use, just because they are addicting.  In my opinion these drugs  are way overused. )

• Very Ocasionally patients will complain of  a Zombie like feeling from an antidepressant, usually a switch to a different drug will relieve this feeling.

Patients with severe OCD need treatment with high doses of antidepressants and expert behavioral therapy. (this is hard to come by) This combined treatment can do wonders for people suffering with this  horrendous condition.

Don’t get me wrong I don’t believe in pushing pills but OCD is debiliting and very serious. If untreated it tends to get worse. It is painful  for the patient but for everyone around her.

Of course it may make a great story!  I loved “As Good as It Gets,” with Jack Nicholson.  If you are interested in OCD and haven’t see this DO !

This blog is an extension and elaboration of the concepts in my book Behavioral First Aid: Managing Emotions during Emergencies.  Here we will discuss how to use words to calm others (and ourselves), mental health issues in general, and  communication related topics.  I love to talk about talking and here is my favorite quote reminding us how hard this really can  be.

“I know that you believe you understand what you think I said, but I’m not sure you realize that what you heard is not what I meant.” - Robert McCloskey

I will post on Sunday, Wednesday and Friday. Please join the discussion.

Virginia Duffy PhD RN Psychiatric Nurse Practitioner