MENTAL HEALTH HISTORY

Mental health history is not as clear as the history of medical science. Mental problem is not primarily a physical problem that can be easily observed and visible. Even more so when it is used to the everyday behavior such as relatives or family, mental disorder has been regarded as a matter of course, not as a thing that is annoying.
Mental disorders in Indonesia still lacks focus and attention. Moreover with a low education level, the people of Indonesia is still considered a mental disorder is often associated with mysticism. Here is a history of mental health, especially in the Americas and Europe.
• In 1600 and previous
At this time, people often think mental disorders caused by the spirits near environment, and often the mediation between humans and the spirits who want to convey meaning. Therefore, they are often considered to be sick so they were not removed and still have a place in society.
• Year 1692
In America, the influence of European immigrants, who are Christians, often regarded as affected by magic or witchcraft of the evil that enters the body. Thus the fear and hate those who have magical powers. John Locke (in Siswanto, 1997) states that there are degrees of madness in people caused by the emotions that compel people to come up with any ideas and no sense a continual basis. John Locke's view is survived in Europe until the 18th century.
• Year 1724
Reverend Cotton Mather (1663-1728) broke the superstitions that exist in society by advancing physical explanations of mental illness itself. At this time, the medical approach was introduced to provide an explanation of psychiatric problems as a result of the disturbance in the body.
• Year 1812
Years 1830-1860 in the UK appear optimism in dealing with mentally ill patients due to the development of theories and techniques in dealing with mentally ill people. Psychiatrists began to emerge in 1842 and got an important role in the hospital to replace the role that lawyers play a role dealing with mentally ill at the time. However, because many have failed, it appears the pessimism therapy (therapeutic pesimism) and influenced by Darwin's statement that states that mental disorder is a developmental evolution that is innate and can not be changed anymore.
• Year 1843
There are only 24 hospitals and 2561 beds to deal with mental illness in the United States.
• In 1908
In this year, applied to the attitude of the association with the aim of which is to improve public attitudes towards mental illness and people with mental illness, improve services for people with mental illness, working for the prevention of mental illness and promote mental health.
• In 1909
Sigmund Freud visited the United States and taught psychoanalysis at Clark University in Worcester, Massachusetts.
• In 1910
Emil Kraeplin first described Alzheimer's disease and she also developed a test that can be used to detect the presence of epileptic disorders.
• In 1918
American Psychoanalysis Association made a rule that people who have graduated from medical school and practiced psychiatry that can be candidates for psychoanalytic training.
• In the 1920s
National Committee for Mental Hygiene generate a set of models of commitment laws that put in atura in some States. The committee also helped research the effect on mental health, mental illness, and treatments that bring about real change in mental health care system.
• In the 1930's
Psychiatrists began to inject insulin that causes shock and temporary coma as a treatments for patients with schizophrenia.
• In 1936
Moniz gnats publish a report on the first human frontal labotomi. Consequently in 1936 until the mid-1950s, an estimated 20,000 surgical procedures in use in American mental patients.
• In the 1940s
Electrotherapy, namely by applying electrical therapy to the brain. Was first used in American hospitals to deal with mental illness. In 1940-1950 the commencement of community care for people with mental disorders in Britain.
• In 1947
Fountain House in New York City launch of psychiatric rehabilitation of people suffering from mental illness.
• In 1950
Formed the National Association of Mental Health (NAMH) which is a merger of three organizations, namely the National Committee for Mental Hygiene, the National Mental Health Foundation, and the Psychiatric Foundation.
• In 1952
The first conventional antipsychotic drugs, ie chlorpromazine, allowed for patients to deal with schizophrenia and other major mental disorders.
• In the 1960s
British media began to reveal mental health by showing the people who have experienced mental illness to share their experiences. At this time all the taboos associated with mental disorders began to be opened and discussed in general.
• In 1961
Thomas Szasz makes writing the book The Myth of Mental Illness, which put forward the theory that states that "mental illness" is actually not really "sick", but an act of people who are mentally distressed at having to react to the environment.
• In 1962
There are 422 000 people living in the hospital for psychiatric treatment in the United States.
• Year 1970
Deinstitusional start of mass. Patients and their families back on their own resources as a result of the lack of programs for patients who have been discharged from the hospital for rehabilitation and reintegration back into society.
• In 1979
NAMH became the National Mental Health Association (NMHA).
• In 1980
The emergence of a planned treatment, with hospitalization in the short term and the public become standard treatments for mental illness treatment.
• In 1990
NMHA played an important role in eliciting Disabilities Act, which protects Americans who are mentally and physically disabled from discrimination in several areas, such as employment, public accommodations, transportation, telecommunications, and central and local government services. Meanwhile, brain describe the technology used to study the development of a major mental illness better.
• In 1994
Bpertama atypical antipsychotic drugs were introduced. This is the first new antipsychotic drugs after nearly 20 years the use of conventional medicines.
• In 1997
Researchers find genetic link to bipolar disorder who showed that the disease is inherited.



REFERENCES

Siswanto. , 2007. mental health, Yogyakarta: Yogyakarta andi,

Sarwono, Sarlito. 2010.pengantar general psychology, Jakarta: eagle release

One Of Us: Physicians Who Kill

"I have already said that if you kill a doctor, all the doctors are instantly on your neck. But what if the man who does the killing is a physician himself? That complicates the situation most damnably..."

---Foursquare: The Story of a Fourfold Life by John Oliver

I've been reading, along with everybody else, the story of the Army major and psychiatrist Dr. Nidal Hasan who killed thirteen people in a spree shooting at Fort Hood yesterday. Let me say first that I've never met Dr. Hasan and know nothing about him; I have no particular information or insights about this offense beyond what I've read in the media.

The CNN article today interviewed two of Dr. Hasan's patients, who both said nothing but glowing things about him and his care. I've blogged about spree killers before ("Shooter Psychology") but this case is different. It got my thinking about the general issue of physicians who kill.

Physician killers are certainly a relative rarity, but they are not unknown. Dr. Jack Kevorkian is probably the most famous here in the United States, but in the United Kingdom there was the case of Dr. Harold Shipman. Dr. Shipman forged the will of, and then killed, several elderly female patients. Then there was Michael Swango, a serial poisoner who killed his patients specifically so that he could take credit for his heroic "resuscitation" efforts. As far back as 1920 Dr. John Oliver wrote about an anonymous psychiatrist colleague who killed another physician and was found legally insane. The quote at the start of this post is from Dr. Oliver's autobiography were he discussed the case. For anyone really fascinated by the topic, I refer you to the book Demon Doctors: Physician Serial Killers. I haven't read it myself so I can't vouch for it; feel free to write in reviews.

But I digress. Getting back to what happened at Fort Hood, the news reports don't indicate anything to suggest that Dr. Hasan was psychotic, motivated by greed or financial gain or out of a need to be a hero. He wasn't an infantryman who had been exposed to combat and who might have been terrified of going back to a traumatic environment. He was educated and presumably in a better financial and social situation than most of the patients he treated, unlike many of my murderer patients who have burned multiple social bridges prior to the killing.

Regardless, a killing by a physician---particularly by a psychiatrist---creates a bizarre aftermath. The military is sending mental health professionals to counsel the victims and witnesses; I'd be willing to bet those military mental health professionals will be required to check their weapons at the door.

My Three Shrinks Podcast 51: Vegan Gingerbread Cookies

For this podcast I brought some homemade vegan gingerbread cookies that I baked using a recipe from the Steph Davis blog. I'm also looking for a good sugar cookie recipe that doesn't use refined sugar or all-purpose flour. If you've got one, send it along.

We discuss my post Is it malpractice to lie? which involves a surgeon sued for malpractice for allegedly lying to a patient regarding his professional background. We wonder how much, if any, information physicians may some day be obliged to disclose to their patients prior to treatment.

There is a new type of research being done, called "in silica" research, in which people write computer programs to model behavior. We talked about computer models of suicide and how this can replicate suicide epidemics in real life. Roy is inspired to talk about a computer program that models how guys choose urinals in public restrooms, and how people stand in elevators.

We never got to the FAA policy discussion or the cell phones in therapy topic. That was saved for our next podcast.

Last but not least, Dinah takes her dog Max to the new office. Who knew that dogs could be terrified of elevators??

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This podcast is available oniTunes or as an RSS feed orFeedburner feed. You can also listen to or download the .mp3or the MPEG-4 file frommythreeshrinks.com.

Thank you for listening

Send your questions and comments to: mythreeshrinksATgmailDOTcom

I Am Not 'One Of Them'

Since the Fort Hood shooting I've been hearing and reading a lot in the media about 'compassion fatigue' and 'vicarious trauma'. I feel compelled to blog after reading yesterday's New York Times article on the topic, which I'm sure won't be the last.
The idea is that any mental health professional who spends their days listening to patients tell their stories of traumatic events will eventually end up having emotional difficulties from it as well. The other term for this is 'compassion fatigue', in other words losing the ability to empathize with others or becoming numb to trauma due to exposure to patients' traumatic stories. The Times article is careful to point out that vicarious trauma and compassion fatigue will not automatically lead one to become a killer.
Well, I'm relieved to hear that.
Over the years as both a forensic and correctional psychiatrist I've heard plenty of trauma-related stories. I've reviewed autopsy photos and crime scene photos and read police reports of violent offenses and watched videotapes of violent offenses. I've heard people talk about
their crimes and talked to victims of violent crimes (if they survived). People who have read my "What I Learned" posts know that the annual conference of the American Academy of Psychiatry and Law regularly features presentations about serial murderers, psychotic killers, crime scene investigation techniques and other topics that can be a bit gruesome.
If all 1700 forensic psychiatrists in this country are exposed to this regularly that's a whole lot of vicarious trauma. It's good to know I won't automatically become a spree killer.
Frankly, I wasn't worried.

Academy for Film and Psychiatry

There's nothing quite like blogging in a blizzard. My house, by the way, is the one with the gutters torn off one side and draped across the front with the disconnected downspouts. You will notice that our flat roofs have been shoveled off-- makes for a fine family project in the snow-- after having the insight that another 20 inches could well cause their collapse.

So I thought I'd give a plug to Dr. Fred Miller and his Academy for Film and Psychiatry. His 'filmosophy' reads:

FILM IS NOTHING SHORT OF OUR STRUGGLE TO UNDERSTAND PEOPLE, CULTURE AND OURSELVES. FILM ENGAGES ALL OF OUR SENSES AND IN THAT WAY IS LIKE NO OTHER MEDIUM. THE PARALLELS BETWEEN THE FILMMAKER AND THE PSYCHOTHERAPIST ARE MANY. EACH IS ACUTELY AWARE (OR SHOULD BE) THAT HE OR SHE IS PRESENTING AN UNDERSTANDING OF THE HUMAN CONDITION AND ALSO THAT THE PROCESS OF UNDERSTANDING IN AND OF ITSELF IS HEALING AND FULFILLING. BOTH ARE SUBJECTS OF INTENSIVE STUDY AND ENDLESS DEBATE. ENJOY!

Film seems like as a good a thing as any to do today, so long as the power holds. Brrrr from Maryland, hon!

Am I Normal?

Paperdoll commented that ?she (?he-- do paperdolls have gender?) likes posts about "normal."

The quick answer is: No, you're not normal! Normal people don't call themselves "paper doll." Normal people also don't write blogs called "Shrink Rap" or post photos of their feet all over the internet.

I'm a psychiatrist and people ask me all the time "Is that normal?" or worse, "Am I normal?"
And we start with a semantic disconnect here: I equate "Normal" with "Booooring!" and would gladly wear a pin that says "Why Be Normal?" Like Why? What is normal? Why would anyone aspired to that. Normal is an IQ of 100, corn flakes for break fast and tuna fish for lunch (ok, I like tuna)..normal entails conforming to some exact mediocre standard. Why would you want to be Normal. Please don't call me normal (I think I don't have too worry too much here).

To my patients, however, "Am I normal?" doesn't mean Am I normal, it means "Please tell me I'm not crazy." You're not crazy. Okay, Paperdoll, I don't know you, and I don't know what crazy means to you, but there's probably a good shot you're not crazy. And I am definitely not crazy. Oh, yeah, I'm a psychiatrist and I'm not supposed to use the word crazy. Okay, you're normal.

So sometimes I'm told that I'm too normal to be a psychiatrist. Oh, all the Shrink Rappers---believe it or not--- kind of "look" normal....except for ClinkShrink who has started acting like Spiderman while she repels off steep cliffs. Apparently-- or so I'm told-- psychiatrists don't look normal.

Where am I going with this? And why? Is this kind of bloggy discourse normal?

Obama Mama it's Health Care Reform!

In case you haven't heard, we've got ourselves health care reform.
What do you think?
Will this be a good thing for psychiatric patients?
Will this be a good thing for psychiatric docs (the shrinks among us?)

Personally, it's been so much commotion and so many pages, it's been way too much to follow (and no one asked my opinion anyway). I think I'm happy for movement, we've been stuck for so long with a system that just doesn't make sense. I'm told most people are happy with their health insurance. Are you?

Go for it, write in our comment section!

Guest Blogger Dr. Darell on Not Being Funny in Psychotherapy

A while back, I put up a YouTube video that I thought was funny. A commenter didn't like it and felt it promoted stigma. So I took a vote, and while most people were fine with it, a number did not like it, and I took the post down. We received this note, and I thought it was substantial enough to be it's own guest post (with permission, of course).
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Hi. I am a practicing psychiatrist based in New York City. I find your blog interesting, informative, and, at times, funny. Now, can you guess which entry I'd like to comment on?

Mel Brooks once said, (paraphrased), that if you slip on a banana peel and land on your butt, it's comedy. If I fall down a flight of stairs, it's tragedy.

I've had a long-term interest in humor, and a brief career as an unpaid stand-up comic in L.A. (Brief because my bombing to "killing" ratio was about 15 to one.)

With respect to my experience as a therapist, I now occasionally utilize humor in my treatment, but only extremely judiciously, once I have gotten to know my client.

I learned my lesson early. At the beginning of my residency training, during my second session with a client, I commented that perhaps he felt like Groucho Marx when Groucho said that he wouldn't want to be a member of any club with standards low enough to accept him. I sat back, feeling as if I had made the interpretation of the century, and waited for a reaction. I got one. The client stormed out of my office and never returned. My supervisor later told me that, as I suspected, I had screwed up royally.

This memory resonates with Dinah's statement that it's the recipient's reaction to a joke or a comment that counts. So know thy audience, and know thyself. You're obviously on much safer ground if you make a joke about a community or an ethnic group that you belong to. We do, however, live in an era of enhanced sensitivities and political correctness, and need to be extra careful not to anger or offend.

With respect to the Youtube audio, I, like a number of your readers, have heard other versions and have become desensitized to it. Ironically, I read about a version of it being told by a psychiatrist moonlighting as a standup comic years ago. My immediate reaction was, "Keep your day job, doc!"

Since "Psychiatry Hotline" is available to a large and varied audience, including people suffering from mental illness, I would not personally have posted it. Although it appears comparatively innocuous, I voted for it as offensive from a psychiatrist's point of view because it trivializes mental illness and is potentially hurtful to many.

Warmest regards,

Edward W. Darell, M.D.

Blog: ShrinqueRap (on Wordpad). Very soon to be updated. Please do not sue me. I registered the domain name before hearing of your blog, and my pockets are extremely shallow. (just short of being inside-out).

URL: www.shrinqerap.com

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And while we're on the subject of humor---- a nice break before I start writing about In Treatment tonight--- Sarebear sent us a link on A Proposal to Classify Happiness as a Psychiatric Disorder. Hmmm...it's a joke, right?
And don't worry, Dr. Darell, we're not going to sue you, but do keep your day job.

National Strategy to Reduce Prescription Drug Abuse

Nearly 500 people have taken our Attitudes about Psychiatry survey so far. If you haven't yet, [please do.]

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The White House released its plan last week entitled "Epidemic: Responding to America's Prescription Drug Abuse Crisis" [LINK to pdf of this 10-page plan]. Below are some of the elements in this plan that is part of the National Drug Control Strategy (like that has worked so well :-/).

The areas of this plan involve education of prescribers and users, monitoring programs, making it easy to dispose of controlled dangerous substances (CDS for short), and enhancing enforcement. The plan establishes thirteen goals for the next five years, and also creates a coordinating body, the Federal Council on Prescription Drug Abuse, to oversee and coordinate it all.

If any of our readers have comments on specific items (I've numbered them for ease of reference), including unintended (or even intended) consequences, please chime in.

1. EDUCATION
1. require training on responsible opiate prescribing
2. require Pharma to develop education materials for providers and patients
3. require professional schools and organizations to include instruction on balancing use of opiates for pain while reducing abuse
4. require state licensing boards to include relevant ongoing education in their licensure requirements
5. help ACEP develop guidelines for opiate prescribing in the Emergency Department [this should be a big help]
6. increased use of written patient-provider agreements
7. facilitate public education campaigns, especially targeting parents
8. encourage research on low-abuse potential treatments, epidemiology of substance abuse, and abuse-deterrent formulations
2. TRACKING AND MONITORING
1. encourage effective PDMP (Prescription Drug Monitoring Programs) in every state, including use of HIEs and connecting with federal health care systems (VA, DOD, IHS, DOJ), and expanding interstate operability of PDMPs
2. support reauthorization of NASPER, which funds PDMPs
3. explore provider insurance reimbursement for checking the PDMP database before writing CDS prescriptions [interesting...might work]
4. reduce "doctor shopping"
5. issue Final Rule on electronic CDS prescribing [finally!]
6. increase use of SBIRT programs, including via EHRs (Electronic Health Records)
3. DISPOSAL
1. expand on "take-back" programs (eg, allowing pharmacies to accept unwanted pills for disposal)
2. develop DEA regs on CDS disposal and educate public on it
3. get Pharma involved
4. ENFORCEMENT
1. increase training for law enforcement personnel and prosecutors
2. aggressive action against "pill mills" and inappropriate prescribers
3. establish a Model Pain Clinic Regulation Law for states to use
4. increase surveillance of prescription drug trafficking
5. use PDMP data to identify "doctor shoppers" and do something about it

This is long enough, so I won't list the plan's thirteen goals; these begin on page 9.

While I am concerned that the enforcement aspects will continue to criminalize actions against people with addictions (which should be viewed more as a health problem rather than a criminal problem, IMO), the increased use of Prescription Drug Monitoring Programs to increase identification of and assistance for people with prescription drug abuse problems should be helpful. Recent articles about the diversion of opiates, even by elderly folks who are supplementing their fixed income by selling their Percocets to neighbors, make it clear how deep this problem is. Some of these interventions have a decidedly Big Brother feel to them. But people are dying, so something must be done.

In Electronic Health Information, Who Decides Which Info is "Sensitive"?

I participate in a committee that establishes policies for our state's health information exchange (HIE). The HIE is the electronic infrastructure that permits hospitals, physician groups, labs, imaging companies, pharmacies, and others to share information about patients. The idea behind the sharing is to make it easier for your primary care doctor to share your health data (ideally, with your permission) with your cardiologist and your dermatologist. The potential benefits to this sharing include:

• quicker exchange of information than with faxing or mailing
• less likely for papers to get misfiled or lost (eg, think Hurricane Katrina)
• better tracking of who accessed what information
• less duplication of tests ("I know you had a CAT scan at the other hospital last week but I can't wait for the results to be sent to me so I'm getting another one.")
• improved coordination of care
• fewer medical errors due to more information available
• decreased liability due to sharing of important information with other providers

The potential risks include:

• decreased privacy due to potential for data breach, identity theft
• loss of data due to technical problems (viruses, hardware failure, etc)
• failure to secure data due to inadequate authentication, authorization, encryption, etc
• more errors in health record due to automated data collection processes
• increased liability due to sharing of sensitive information with other providers

I wanted to talk briefly about this notion of "sensitive health information." Our committee has spent many hours discussing what this might mean and how to define it. One view is that all health information should be treated as "sensitive," while another is that only certain categories of health information, such as mental illness, substance abuse, HIV status, domestic violence, abortion history, and genetic data, should be treated with additional safeguards against inadvertent access or disclosure. This latter viewpoint promotes the stigma about mental illness that we have been trying to erase.  It wasn't so long ago that epilepsy and cancer might have been on this list. My viewpoint is that patients should be the one to decide which elements of their health information should be treated with extra precautions and which should be considered routine.

This was ultimately agreed upon by the other committee members, but it still didn't help us much because the technology for patients to review their health information and mark which bits should be tagged as sensitive is not yet built into nearly any of the electronic health record products or the HIE systems. There is no standard for doing so nor is there even any agreement about how or whether it should be done. Groups like healthdatarights.org and speakflower.org have promoted these ideals, but we are not much closer to achieving them.

Anyway, I discussed this topic in my Shrink Rap News blog post this week over on Clinical Psychiatry News. Read more about it over there. If you are a psychiatrist, log in or register on CPN and join the discussion (my mistake -- other professionals and also consumers are allowed to register over there).

Hanging On

It's been a little quiet here at Shrink Rap this week, in between the earthquake and the upcoming hurricane. Please bear with us. If we have power this weekend (and if Dinah has her network back up) we may try our first-ever videoconference podcast.

In the meantime, best wishes to all our readers and listeners in the path of the storm. Please heed precautions and take care of yourselves!

See you on the other side.

In the meantime, you might be interested in reading a followup comment on my Clinical Psychiatry News post about the psychological autopsy done on the alleged anthrax mailer, Dr. Bruce Ivins. Not surprisingly, the expert behavioral analysis panel (EBAP) disagrees with me. They feel they did the right thing by publishing and selling his medical data. Read the EBAP response.

How to be a Successful College Student

It's Labor Day and kids are getting ready to go back to school.  The Shrink Rap duck pictured here is getting in his last moments of holiday relaxation, and I am so happy to be up and running on my new Macbook pro.

Here at Shrink Rap, we don't offer medical advice, so this is not medical advice.  It's not based on anything even vaguely resembling evidence-based medicine, but I have treated many college students over the years and I have been impressed by those things that seem to make or break the college experience.  Back-to-School, but none of us treat the under-18 crowd, so my bullet point suggestions are limited to college students.  If you're a parent, feel free to send this to your college student, and if you're a student, feel free to ask "Who are those blogging shrinks with the duck? They must be quacks." 

Here are my quick & dirty pointers for how to succeed in college:

1) Show Up.
Being present in class, on time, in a state that vaguely resembles conscious is most of the battle.
If you don't go to class, with the exception of the unanticipated onset of a febrile or gastrointestinal illness, then you should know well in advance that you're not going to go and have a strategy for how you are going to make up the work.  By these criteria, "I don't want to get out of bed" doesn't work.  But "The professor doesn't speak English and lectures straight from the book, so it's a better use of my time to read the book and get notes from my roommate who takes great notes," may be a valid reason to skip class.

2) Don't smoke weed.
This is a tricky one-- many college students smoke weed (or at least those who end up my office almost all do).  Some people smoke marijuana regularly and still seem to live fully productive lives.  Some people seem to find it very "beneficial" to them even though it appears to be killing their motivation and decreasing their anxiety to the point where they have no ambition, barely move,  and don't do the things it's necessary to do in order to succeed, for example #1 above: Show Up.  Oddly enough, marijuana smokers do not see the connection between their  low motivational level and their low success status and they are absolutely sure their consumption of marijuana has nothing to do with their problems.  They become very skilled at telling others why weed isn't part of the problem and many are quite well versed on the rhetoric of NORML and how the it's a political agenda to keep marijuana illegal.   If you're not successful and you smoke weed, stop and see if your life gets better.  Oh, and by the way, two weeks off is not a 'trial.'  Don't smoke at all, ever, for 6-12 months and see if you're in a better place.  If you are successful and you smoke weed, you're probably not reading this article, but even in the best scenarios, it increases your risk of lung cancer and it causes the munchies which can make you fat, and if you get caught and arrested it's a lot of explaining to do for a very long time.   

3) College Students and Drinking.
This is even trickier because while there are college students who don't smoke weed, the role of alcohol in college life is huge and the pressure to drink is immense.  It's not legal if you're under 21, it seems to lead to all sorts of problems, but it seems to be an impossible sell to college students, so let me make suggestions based on the assumption that there is nothing I can say that would stop anyone from drinking:
--Don't drink on any night when you need to be somewhere the next morning.
--Don't drink enough that you vomit, pass out, or black out.
--Don't drive after you've had anything to drink: being dead is a lot worse than not finishing college.
--Keep your total consumption under 15 drinks a week for a man and 8 drinks a week for a woman.
--If you can't keep abide by the above suggestions, you have a problem and should get help.
NPR had an interesting show on Why College Students Drink So Much and Party So Hard about a book by Thomas Vander.
Add to the How to Stay Alive Issue :  Before you go out drinking, Eat.  If your friends pass out, roll them on their side and don't ever leave someone who is passed out alone.  If they really can't be aroused to at least push you away and groan, call an ambulance.  Don't do shots.  Beer pong is more fun and much safer. Don't drink in settings where you may be sexually vulnerable.

4) Get enough sleep.
If this means not scheduling early classes or taking naps during the day, then consider those things when you set your schedule, but sleep is really important.

5) If you have a psychiatric disorder, don't stop your treatment.
It's not unusual for kids to try this when they go off to college and don't have the 'rents handing them medications or driving them to therapy appointments.  It's a really bad idea.  Particularly bad times to cease treatment are first semester Freshman year and any year during mid-terms or finals.    I'll add: if you have a psychiatric disorder, don't drink, it makes everything worse.

6) Take a large, heavy brick and throw it through your Nintendo/PlayStation/XBox.
  Ditto for online fantasy games.  Anything outside of school work or employment that captures you for more than two hours a day may be a problem.  Reading psychiatry blogs is fine.

7) If you're a sensitive or problem child, don't have a roommate who shares the same bedroom with you, it adds to the stress of college and it's helpful to have space you can escape to.

8) If you're having a rough time, get help.
If you're struggling in class, talk to the professor and consider getting a tutor.  If you're very depressed, call the counseling center.  If you're feeling sick, go to the health center.  College is not the time to suffer alone.

9) Know the final drop date for your classes and if you're failing, drop the class.  Remember to turn in the form.

Anyone want to add to the list?
Best wishes for a happy, fun, and educational school year.

What Makes Mental Illness Bad?

So why is it that some people have a psychiatric disorder and they bounce back and it's not a big deal, while others struggle terribly? For the unlucky ones, mental illness defines them.

Here are some factors that affect how much impact psychiatric illness has in a person's life:
(Note to Roy: did I get the effect/affect thing right here?)
1) The severity of the symptoms.
Any way you dice it, mild-to-moderate anxiety can often be hidden and isn't as disruptive as an episode of psychosis with hallucinations and paranoid delusions.
Just to give an example.

2) The duration of the episodes.
So a chronic depression or severe obsessive compulsive disorder may be more disabling than a brief episode of psychosis.

3) The form of the symptoms.
Some symptoms are intrinsically more public than others, or more difficult to bounce back from. In terms of "Can I be a doctor if I have bipolar disorder?," one episode of walking around the hospital naked may be all it takes to get sent home.

Form and severity of symptoms, and the duration of the episodes, are likely to be intrinsic to the disease and not something the individual controls.

4) How responsive the illness is to treatments.
Some people have very severe symptoms that are very responsive to treatment.

5) External support systems: access to good care, chicken soup, and TLC. Job flexibility may enable some people to quietly take time off when the going gets rough. Understanding friends & family-- these are all good things.

6) Individual personality features that support good coping. This is vague and I just made it up, but it's the best I can do--- maybe 'resilience' is another term for it.

7) Individual special features which help a person compensate. So being extremely intelligent, or extremely efficient and diligent, or very charming and charismatic, may make everything else a bit easier.

8) Stress load. This is hard to say for all people--- many people really struggle when things go wrong, and not all people with psychiatric illnesses relapse under severe stress, but all things being equal, it's probably better to not have a lot of loss and stress in life if one is trying to cope well with mental illness.

9) Co-morbid substance abuse. People with psychiatric disorders and drug or alcohol addictions just don't do as well. Often, it's a toxic combination.

10) Co-morbid medical disorders.

11) A willingness to devote time, energy, money and resources to a healthy lifestyle.
(It can't hurt)

What'd I miss?