Dr. Henry Paul, MD

Psychiatrist, Author and Educator

NOT GUILTY BY REASON OF INSANITY

April 30th, 2015

In criminal trials, the insanity defense is the claim that the defendant is not responsible for his or her actions during a mental health episode (psychiatric illness or mental handicap).

The defense for mass murderer James Holmes claims the defendant was not guilty by reason of insanity in the Colorado movie theater massacre. Twelve people were killed, and 70 people injured in the 2013 shooting that stunned a nation. If the jury convicts Holmes, it would then also have to decide whether he should be executed or be sentenced to life without parole.

There are four different legal defenses for insanity. Cornell University Law School defines them quite nicely here. Depending on which defense is used the punishment could vary.

The accurate prediction of violence is a difficult area in psychiatry, so being able to predict that Holmes would do something like this is very difficult. What can we learn from Holmes? In many of these shootings, often the perpetrators are shot, or they kill themselves; not leaving the opportunity to learn what triggered them to be so violent. In this instance, crazy as it may be, we have the opportunity to observe, listen and learn from Holmes. We can learn what he was thinking and how he acted and develop possible preventive measures.

In the meantime, as this trial unfolds I want to remind parents that this can bring up a lot of scary feelings for children all again. Children will no doubt be privy to hearing the details of this shooting all again as it is discussed in the news; creating discussions that adults will have that children may overhear. I recommend that first you make sure your response is developmentally appropriate. How you discuss the trial and the shooting with a teenager is very different from how you would discuss it with a younger child. Based on their age limit the exposure to the news. Young children do not need to see it at all. Teenagers may ask questions and it may bring up some of the fears that the shooting initially triggered in 2012. Talk with your teenager about how rare it is for this to happen and emphasize safety. With young children don’t overwhelm them with details. Reassure them that they are safe. Lastly, don’t create anxiety. If you become anxious, then your children will, too.

Disclaimer This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

 

THE BRUCE JENNER INTERVIEW

April 24th, 2015

There is a lot of speculation and curiosity about the highly promoted interview between Diane Sawyer and Bruce Jenner that is running tonight on ABC.  I am sure that after the interview there will be a lot of questions.  Many Americans do not understand what a life-changing decision it is for a person to struggle with gender identity.  The lack of understanding leads to confusion, paranoia, and discrimination.  What I hope will come from the Jenner interview is a national dialog that will change the stigma surrounding transgender people in the United States.

Elliot Fukui, TransJustice Coordinator at the Audre Lorde Project,  a community organization in New York City, spoke with CBS News recently about some of the common issues and misperceptions facing transgender people today.  He says that it is important to support a person’s right to choose their identity, and he suggests a number of ways to do just that.  Click here to read the CBS story and Fukui’s recommendations.

I just wrote last week in my blog about the great job that the media is doing bringing transgender characters and actors to television. It is evident that the diversification of today’s TV characters has certainly opened up plenty of discussions.  Tonight Jenner will only add to the discussion, and that’s a good thing.  I hope tomorrow to wake up and find the national dialog has exploded on this issue.  It will only help people to understand gender identity and the need to embrace those who choose to make a change.

Disclaimer

This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

VACCINES – LEARNING THE HARD WAY!

April 22nd, 2015

I feel like I have already said a lot on my blog about the importance of vaccinating your children, but this story really drives home the importance. Who to say it better than Canadian mom of seven children, Tara Hill. Former anti-vaxxer, Hill believed that not vaccinating her children was best until all of her children came down with pertussis, better known as whooping cough.

21305347_sShe penned “Learning the Hard Way: My Journey from #AntiVaxx to Science” while in quarantine with her children and posted it on TheScientificParent.org. After a recent measles outbreak, Hill had begun to vaccinate her children. The oldest three were partially vaccinated but the youngest had not had any vaccines when they caught whooping cough.

“My youngest three children were coughing so hard they would gag or vomit. I’d never seen anything like this before,” she wrote. “Watching our youngest struggle with this choking cough, bringing up clear, stringy mucus – I had heard of this before somewhere.”

Hill said that they avoided vaccinating their children because they thought, for one thing, that vaccines were part of a large conspiracy. “We had vaccinated our first three children on an alternative schedule and our youngest four weren’t vaccinated at all,” she wrote.  “We stopped because we were scared and didn’t know who to trust.  Was the medical community just paid off puppets of a Big Pharma-Government-Media conspiracy?  Were these vaccines even necessary in this day and age? Were we unwittingly doing greater harm than help to our beloved children? So much smoke must mean a fire so we defaulted to the ‘do nothing and hope nothing bad happens’ position.”

Hill added, “For years relatives tried to persuade us to reconsider through emails and links, but this only irritated us and made us defensive.”

Hill says that after six years of being frozen in fear from vaccines that she is now frozen by the disease. “My oldest two are getting better, the youngest four are getting worse and fast,” she wrote.

“Vaccination is a serious decision about our personal and public health that can’t be made out of fear, capitulation or following any crowd,” she explained. “No one was more surprised than us to find solid answers that actually laid our fears to rest.  I am confident that anyone with questions can find answers.  I would only advise them to check your biases, sources and calendar: Time waits for no parent.”

Living with misinformation and fear about vaccines is NOT making a decision. Parents need to understand that vaccinations are only given to children after extensive research has been done to make sure that the benefits out-weigh the risks. All parents want to do what is best for their children to keep them safe. You buy the perfect car seat for your newborn, the best protective gear for your teenage soccer player, sunglasses for your toddler to protect her eyes, and the list goes on. Well, vaccinations should be part of the list, too. Tara Hill wrote her story in hopes that others would learn from her experience and vaccinate their children. Click here to read her entire post. Email me at drpaul@henrypaulmd.com with your thoughts.

Disclaimer
This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

TEENS & THE LONG GOODBYE

April 17th, 2015

In the past, dying was a sudden and unexpected event. Today, living with death is an all-new experience that has families and loved ones living with death over a period of months, even years. With two-thirds of those diagnosed today with cancer living close to five years, the grieving process has begun a lot sooner and lasts a lot longer. The new process begins with a life-threatening diagnosis, proceeds through a period of treatment (or treatments) and ends eventually in death.

30026792_sOne of the more significant changes in the grieving process is the inclusion of the person who is dying. Supporting a terminally ill loved one isn’t easy; especially true for teenagers. When parents are seriously ill, or parents become caregivers to seriously ill parents (the teenager’s grandparents), many of the normal family scenarios are reversed. A teenager, experiencing the normal growing pains of adolescence, may feel that their problems are insignificant compared to those faced by their ailing family member. A teenager can feel alone during this difficult time.

Parents – healthy or sick – must realize that there is no greater blow to a child’s sense of security and safety than a mother or father who is seriously ill. Even though, teenagers are more able to understand, accept, and adhere to the adaptations the family must make to care for an ill parent; they still need to be reassured that they are loved. They need to participate in as many normal activities as they can and they need to focus on positive family activities that can be shared by everyone.

If you are a caregiver for a loved one, consider getting help with the daily household chores to cut down on family stress. Make sure that you have time to spend with your teenager. Go to an athletic event, open house, shopping or to dinner and a movie. It is important to find a routine.

Parents need to be conscious of how they react to their illness or the illness of their spouse or parent. Your teen will mimic your reaction in most cases. If you show panic and despair, they will show panic and despair. If you show understanding, patience and strength, they will show understanding, patience and strength. Be honest with your teenager about what is happening and invite them to vent their distress and anxiety openly. Help them to understand that grief is a family matter, and that the “long goodbye” is something the entire family will share.

Disclaimer

This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

 

KUDOS TO THE MEDIA FOR BRINGING THE LGBT COMMUNITY MAINSTREAM

April 15th, 2015

Despite increased societal acceptance of homosexuality, coming out for those who are gay, lesbian, bisexual or transgender is rarely an easy task. Two decades ago there were no gays on television, but that has changed. Network TV’s first gay teen came out on the soap opera “One Life to Live”. Today, network television has gone a step further and now is introducing transgender characters. Just last month the soap opera “The Bold and the Beautiful” revealed a surprising story arc that introduced the first transgender character to daytime television; Maya Avant. In a USA Today article, CBS said, “The network says B&B is the only current show on broadcast or cable TV to include a transgender character as part of the regular cast.”

23005800_sTransgender characters and actors appear in more shows with the most notable being Netflix’s “Orange is the New Black” and Amazon’s “Transparent”.

Following on the heels of B&B, Netflix and Amazon is Discovery Life’s new five-part series – a new reality show, “New Girls on the Block” that premiered last weekend. It is considered the first TV show to follow the lives of transgender women. It explores the lives of these women who are all in different phases of their transition.

It is evident that the diversification of today’s TV characters has certainly opened up plenty of discussions. Social media is abuzz with discussion groups about the characters, the shows and the issues they bring to the forefront. I welcome these shows and their diversity, and I hope that they expand the dialogue, understanding and support to LGBT individuals. Here is a link to the Huffington Post website with a good overview of how TV is changing the landscape for the LGBT community and furthering the very much needed national dialogue.

Disclaimer
This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

WHITE HOUSE CALLS FOR END TO LGBT CONVERSION THERAPY

April 13th, 2015

Very interesting call last week by the White House to end the use of “conversion” therapy on LGBT youths. ABC News reported that the Obama administration is calling for an end to the use on LGBT youth of “conversion” therapy.

“This administration supports efforts to ban the use of conversion therapy for minors,” Valerie Jarrett, a senior adviser to President Obama, wrote in a post on the White House website last week. This was triggered by the suicide of Josh “Leelah” Alcorn back in December.

Alcorn was born a boy who was dealing with an inner-struggle since he was four years old that he felt more like a girl. “To put it simply,” he said in a suicide note that posted to Tumblr after he died, “I feel like a girl trapped in a boy’s body, and I’ve felt that way ever since I was 4.” Josh felt his parents were never going to accept him transitioning, and he wrote how as time went on he felt more-and-more isolated. In the end, Alcorn took his life in December by stepping in front of a tractor-trailer on an Ohio Interstate.

In the note, he said, “Please don’t be sad, it’s for the better. The life I would’ve lived isn’t worth living in … because I’m transgender. I could go into detail explaining why I feel that way, but this note is probably going to be lengthy enough as it is. To put it simply, I feel like a girl trapped in a boy’s body, and I’ve felt that way ever since I was 4. I never knew there was a word for that feeling, nor was it possible for a boy to become a girl, so I never told anyone and I just continued to do traditionally ‘boyish’ things to try to fit in.”

Stock photo 124RF

Stock photo 123RF

This is a sad situation, but we have to be careful not to be too quick to blame anyone. Sexual transitioning is being discussed more by mainstream media, and that is a good thing, but there is a long way to go. Thanks to social media, there are communities and groups that have formed to support those dealing with gender identity. These groups have also been educating society in general about gender identity and the struggles and hurdles that these individuals face.

Actress Hilary Swank who, 15 years ago, won an Oscar for playing murdered transgender teen Brandon Teena in “Boys Don’t Cry,” said last week on the Meredith Viera show, “I think we have taken strides since that movie……. But we still have a long way to go! ….”

The firestorm on social media set off by the death of Alcorn has called for an end to “transphobia”. The national dialogue has started and that’s a good thing. Let’s remember that “coming out” is a controversial issue and is not easy, especially for adolescents. Despite that you may have trouble accepting it, you should provide emotional support to your loved one. Click here for a list of guidelines for dealing with LGBT teens.

Here is a link to Slate.com with Josh “Leelah” Alcorn’s entire note.

Disclaimer
This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

ABOUT THAT PILOT

April 7th, 2015

Most of the news coverage of the recent airplane crash has described the co-pilot, Andreas Lubitz, as a depressed person; one with suicidal tendencies who had recently researched suicide and cockpit security on his computer. He apparently sought medical help for an undisclosed mental health issue. It is also suggested by the news media and law enforcement that the co-pilot might have been on medication recently for a mental health issue.

25869324_sAlthough suicide does happen more frequently in the depressed population, we should remember that it is not that common, and violence is rare. To understand this co-pilot you have to go beyond the criteria for diagnosing the usual major depressive episode and consider that some people become so depressed that they develop psychotic depression sometimes with delusions. Delusions can convert a person’s perception of the world so dramatically that it becomes a very bad place, even a place that one should leave. Sometimes taking others with you is not perceived as a murderous act but as one of saving them from suffering in such a terrible world. On occasion, you will see this in suicide notes left by parents who kill their children and then commit suicide so that everyone is “safe and together” in a better place. As bizarre as all this might sound it might explain what happened in this horrendously destructive act and decrease our perplexity to a degree.

It would not be the first time that the mental health of a pilot has been called into question. Alpo Vuorio, MD, PhD, an aviation specialist in occupational medicine at the Mehiläinen Airport Health Centre in Finland, led a study in 2014 that had researchers looking at the last 20 years of data for “aircraft assisted suicide”. What they discovered was reported in the Journal of Aviation, Space and Environmental Medicine. The study found that from 1993-2012, 24 of 7,244 plane crashes were thought to be deliberately caused by a pilot.

In TIME magazine last month, Vuorio said in response to the study, “I really wish that we had some kind of deeper thinking about this issue, because it’s one of the most difficult in aviation medicine.”

Screening pilots and cabin crew of commercial airlines for mental health issues is tricky. I just wrote last week about the fear of disclosing a mental illness to your employer. In this particular case, declaring that you have a mental illness, however temporary, could be a career-ender for a pilot. Disclosing your disorder to your employer raises questions not only about pilots disclosing their mental health issues but also how do you treat them and what is the criteria for deciding if they are capable of flying. Many people in many high-profile professions work while being treated for their mental illness. There certainly is a lot to consider here. The good thing is that the dialogue has started, and the discussion needs to include all professions and not just airline pilots. So let’s remember, this case of possible depression should not warrant any great worry that suicide and homicide are frequent outcomes of this disorder. The majority of depressed people can receive treatment and recover without tragedy.

Disclaimer
This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.