It is always a privilidge to connect with those at the cliff face of mental health care.
You can heal from Depression
TMS: hope in the treatment of resistant depression
When I first heard of Transcranial Magnetic Stimulation, I must admit, I was a bit sceptical. I struggled to believe that a giant magnet held to your head could help patients struggling with Treatment Resistant Depression. But, as study after study came in, with extremely positive results in traditionally hard to treat patients, I became increasingly frustrated. Why wasn’t TMS treatment available to my patients, here in Cape Town? Depression is a horrible illness that robs people of their joy, their ability to connect, their ability to function. Antidepressants came out in the 50’s and have saved millions of lives.…
View from my office
New routes to resilience- lockdown 4 and beyond.
Day million of the lockdown and no end in sight. This week has felt particularly rough, with many of my patients really struggling. I think that part of the reason, as we settle in for the long haul, is that previous effective coping strategies have not been useful our current situation. A salient feature of my most robust and resilient patients is the sense that they can make effective future plans. They can make a adjust for any of life’s challenges. Part of my job has always been to help my patients get control in their lives, to help them…
My practice prefers visiting clients
Week one of lockdown: reflections from the couch
On 16 March President Ramaphosa declared a state of emergency. A full lockdown followed soon after. In South Africa you cannot walk your dog, nor pop out to buy alcohol or cigarettes. Psychiatrists have responded by being as freaked out as everyone. For the last 200 years, psychiatrists have used “The Container” as the boundary for their work. It is the committed time and a safe space within which my patients and I explore the hard stuff. A safe space is as important to a psychiatrist’s work, as a sterile environment is to a surgeon. It can be done in…
Anxiety myths busted
Anxiety is a cluster of psychological and physical symptoms. The psychological symptoms include feelings of dread, fear and being overwhelmed. Patients having a panic attack tell me it feels like they are going to die or go insane. Physical symptoms manifest all over the body: racing pulse, sweating, blushing, irritable bowel, irritable bladder, shaking and muscle tension. Anxiety is normal. It makes us look both ways when crossing the street. It becomes abnormal when the sufferer starts worrying and dreading everyday situations.It can start making it difficult to work, attend school or socialise. When it starts making someone’s world small, stops…
What if depression was not an illness of the brain?
At med school, I learnt that depression is an illness of the brain. When we properly treat it with the correct medication, we restore imbalances and patients get better. Depression as a brain illness is a useful model. Many of my patients come seeking help, deeply ashamed of their depression, as if it is a character flaw. When I say that the brain is an organ and can get sick like any other organ in the body, it often helps to get past all the judgemental, self-critical chatter. The longer I am in this game, the more I realise that…
Is Gaming addictive?
I put this question to a group of 12 year old boys and to a group of parents. As to be anticipated, the points of view of the two groups were passionately opposed. The boys felt that gaming was a valid hobby and that the top gamers are akin to top sportsman. (Indeed, it is proposed as a 2024 Summer Olympics gaming event). They said that gaming was a sociable stress reliever, that it kept their reflexes fast and their thinking faster. I must confess, I posed the question to a particularly nice and well-adapted group of boys. They were…
Help! My daughter (or son) has borderline personality disorder
Parenting is challenging. Every parent (hopefully) wishes to raise their child into a successful adult. Someone who can be self-reliant and live life to their full potential. Someone who can find happiness and growth in a solid relationship, and then effectively parent their children in the future. Borderline personality disorder traits can be traced back to early childhood. The disorder has a strong genetic component. There are brain abnormalities detected on neuroimaging. All of this is evidence that borderline personality disorder is a disorder of the brain, not just a psychological disorder. Salient features of this disorder are: Emotional dysregulation (extremely unstable…
The holiday blues – tinsel and tears
Summer holidays are starting. I have learnt to close my practice doors in the middle of December. Partially because of increased family commitments, but also because everybody is so out of their routines that they miss their appointments or get the times wrong. During the December holidays, routine psychiatric work falls apart and emergency work picks up. We cannot compare holiday blues and stress to clinical depression and anxiety. It’s like comparing a cold to incapacitating flu. The emergency work I handle seems to be triggered by increased alcohol and substance abuse, less sleep than usual and financial stress. There is…