While reading about adolescence and puberty this evening, I came across the Tanner Stages (NSFW—there’s an acronym I never thought I would use here), which are apparently also called Sexual Maturity Ratings. Eponyms are no longer held in high regard, you see. (Curtsey to Graham’s “Grow and Flow” post.)
I pondered the 28-day menstrual cycle. And then the twenty-something-day lunar cycle, upon which is based the calendar of my people (Got Rice?).
The menstruation article in Wikipedia suggests that there is no definitive evidence to support or deny any relationship between menstrual and lunar cycles. A quick PubMed search reveals papers that argue that women are more likely to menstruate during certain moon phases (though which moon phase is open for debate: new or full?). Cecil notes that opossums also have 28 day cycles—humans aren’t that special.
What about the oft-shared myth that people are more likely to appear in psychiatric emergency rooms around the full moon? (Lunar… lunacy….) Nope. They do not present more often at “that time of the month” and there are no more psychiatric admissions to the hospital than usual.
What about violence? Many people who are brought to the psychiatric emergency room are diverted from going to jail due to assault. Another “nay“. (Furthermore, there is no higher incidence of oral and maxillofacial emergencies during full moons. In case you were wondering.)
And then I added the “current moon phase” gadget to my iGoogle.
12 Nov 2007 | 2 comments.
The Power of Advertising.
My parents preferred Dan Rather. Sometimes they would watch Tom Brokaw deliver the news and only rarely did they settle for Peter Jennings. After dinner each night, we would retire to the main room in the house to watch the evening news. At my father’s side was a mug of steaming jasmine tea. My mother usually had a cup of hot water. I sat between them. I easily tucked my lanky nine year-old legs underneath me.
Though my eyes were fixed on the images flashing from the large metal box (”Dan Rather has nice hair”), my mind was elsewhere. I could not understand why my parents insisted on watching the news every night. I assumed it was part of a digestion ritual: Tea and TV.
The commercials, however, captured my attention.
C&R Clothiers, for many years, ran an advertisement where the camera slowly revolved around headless men wearing tailored suits. These men, visible only from the neck down, had their hands on their slim hips, adjusting their paisley neckties, and within the pockets of their pleated pants. In the background, a woman (and not Dinah Washington, who, incidentally, sounds a bit like Ella Fitzgerald) crooned
What a difference a day makes… twenty-four little hours….
Soon, my father and I began to mimic the woman with maudlin falsetto voices. That was the only line we could ever recite, as that was the only line the woman ever sang in the commercial. After those twenty-four little hours, a masculine voice provided a voiceover about the quality clothing of C&R Clothiers and how you—yes, you!—could look as good as these men in twenty-four little hours.
Google tells me that C&R Clothiers went bankrupt in 1992.
Jamie Cullum covers “What a Difference a Day Makes” on his (fun) album Twentysomething. Within the first few bars of the song, I automatically think of slim men in tweed suits. The words “C&R Clothing” in script font appear in my mind and I remember those temperate days in Southern California, President Reagan’s toothy grin, and legwarmers.
This is the power of advertising.
Janssen has released a “new” antipsychotic medication called Invega (generic name paliperidone), which is the supposedly the “new and improved” version of Risperdal (generic name risperidone). Coincidentally, risperidone is about go off patent. (Clinical Psychology and Psychiatry has covered this issue nicely, as has Dr. Carlat.)
The advertisements (and website) for Invega features a young, black male. In some ads, he is looking up, eyes closed, against a background of hand-drawn, anguished faces. The caption reads: “Do You Choose a Powerful Antipsychotic for His Mind That Also Considers His Body?” In other ads, he smiles warmly at the camera. Or is carrying a bag of groceries alongside a young, white female, who is also carrying a bag of groceries.
As far as I know, this is the only advertisement for antipsychotic medication that features a non-white person.
I wonder how this will affect prescribing practices. Will physicians and psychiatrists preferentially (and perhaps unconsciously) prescribe Invega more often to black individuals than to white people? How does this advertisement affect the stereotypes psychiatrists may hold in their minds about who has psychotic disorders? Is there a marketing scheme behind this ploy? In other branches of medicine, researchers have conducted studies about medications that may be more efficacious in black individuals (the condition that jumps to mind is high blood pressure). Because no one totally knows how antipsychotics work (there are theories, but no one knows definitively, even if he pontificates otherwise), there is no evidence to use one antipsychotic over another in a specific ethnic population…
… unless prescribers somehow associate one medication with one population through advertising and, over time, interpret this as “evidence”.
The people who know the most about human behavior and how to influence it are not psychiatrists or psychologists. They’re marketers.
10 Nov 2007 | 4 comments.
Heckler.
He was walking his dog on the other side of the street. The morning fog, silently floating underneath the street lamps and briefly glowing orange, blurred his facial features.
I ran past, hearing the soggy leaves underfoot emit a soft squash with each of my steps. I had about a mile left of my run and a stitch was beginning to develop underneath one of my ribs.
The man yelled something.
Concerned, I looked over my shoulder. The man continued his stroll. I spied a white cord sprouting from his left ear. Noting that he was not in distress, I refocused my attention on the seemingly endless sidewalk ahead.
It was only when he continued to yell that I understood (1) what he was yelling and (2) that he was yelling at me.
“TRIP!” he had shouted.
“FALL DOWN!”
I cocked an eyebrow.
“FALL ON YOUR FACE!”
“GET FAT!”
“BECAUSE YOU’RE WEARING BLACK, I HOPE YOU GET FAT!”
I kept running, mildly disturbed and grateful that I would soon be out of his view. I smothered a smile—here was a man who was heckling me before dawn for running.
I soon turned a corner, relieved that he had stopped yelling at me. I mused about the event: Was he psychotic? I shook my head—he was likely a jerk. Obnoxious behavior need not be pathological; often, it’s just annoying. I silently gave thanks that I hadn’t fallen down—I had yet to stumble since adopting this cardiovascular habit.
Refocusing on my breathing in an attempt to assuage the stitch in my side, I cruised down the hill, eagerly approaching the flat ground that lay before me. I turned the corner—
—and my foot caught on an uneven tile of sidewalk. My body lurched forward and my limbs flew into the air in an attempt to maintain my balance—
—and a few steps later, I realized that I had tripped. And had nearly fallen on my face.
8 Nov 2007 | 6 comments.
Green is for ‘Go’.
Yesterday, a good friend of mine (the same one who insisted that I get a running skirt if when I move to New York) left a book for me, along with a note that enthusiastically cheered my anticipated relocation to Manhattan.
The book, New York Detail: A Treasury of Ornamental Splendor, is essentially a picture book. Photographs of architectural details cover the pages. It’s lovely. I’ve overlooked many of these details when I’ve been in New York City in the past. There’s just way too much to see in that city.
I received the official offer for a fellowship position in consult-liaison psychiatry from my first choice today.
It was nice. And a relief.
My friends here in Seattle were all abuzz with excitement—I’ve never received so many e-mails with so many exclamation marks per e-mail in my life. My friends are an enthusiastic, warm, and buoyant bunch. They’re wonderful.
And though I am absolutely tickled to be heading to New York City, I am also sad that I will be leaving my friends in the Pacific Northwest. (… though, admittedly, many of them have already invited themselves to stay with me in New York City. Funny how that happens. “Do you want to sleep in my closet or out on the fire escape?”)
… and, of course, I haven’t left yet.
There’s a lot to do between now and then:
- Just how does one move across the country?
- Should I drive my car to New York City? I’ve always wanted to take a transcontinental road trip. Man, I can’t wait to get rid of my car.
- How much stuff can I sell or give away here before I go?
- I have to pay a hefty sum to get my medical license for New York State.
- I am dreading looking for a place to live in New York City. It seems like a highly aversive process.
- June is going to be a crazy busy month: I’ve got to take my psychiatry board exams, make arrangements for graduation, and move across the country. What am I getting myself into?
On the door of my office is a map of New York City. In October, a friend and I were discussing the different programs in the city. I was scanning the map to point out my top choices for programs.
“Why haven’t you put push pins onto the map?” he asked.
“I don’t know,” I answered. “I figured they wouldn’t stay?”
He laughed at me. “Here—give me some pins. Show me where your first choice is.”
I quickly pointed out the site.
“What color should the pin be?” he asked. I dug through the pin container and found a green pin.
Green is for growth, I thought. I didn’t even come up with that—that’s something a guy I went to medical school with once said. It’s stuck, for whatever reason.
I handed the pin to my friend.
“Green is for ‘go’,” he said as he firmly pushed the pin into the map. “Okay, where’s choice number two?”
He pushed the yellow pin in.
“I see that we are following the ‘traffic light’ model of ranking,” he joked. “And number three?”
I waffled. There were two programs that tied for third. I hesitated before pointing out the location with a clear pin. (I didn’t have a red pin.)
We both then stood back and looked at the map.
“Wow. That green pin really sticks out,” he remarked. “It’s very clear now where you want to go. The yellow pin is less obvious and that clear pin—you can hardly even see it.”
Tomorrow, I shall remove the yellow and clear pins.
Green is now definitely for “go”.
6 Nov 2007 | 13 comments.
Three-Sentence Stories.
1. I asked him what he wanted in life. He paused, fighting back tears. “To be in love,” he eventually whispered.
2. “This is Mr. Smith in room 15,” he said, his voice full of static over the nurses’ speakerphone. “I need help… with my life!” The psychotic man’s name was actually Mr. Jones, he was in room 19, and the nurses couldn’t help but giggle.
3. “A patient grabbed my boob—can you assure me that my breast isn’t broken?” she jested. The nurse lifted up her shirt and pulled away her bra. The skin on her breast was red, raw, and tender.
4. A bag of candy slouched on the countertop. Walking past, I suddenly stopped, shyly looked around, and asked, “May I have one?” A nurse brushed past and said, “Yes, I believe that is public domain.”
5. A ring of clouds encircled the waist of Mt. Rainier. The setting sun cast a rosy glow over the snowy mountain. It soon faded into the midnight blue darkness of seven o’ clock.
4 Nov 2007 | 3 comments.