August 29, 2005

Mental Health for Immigrants, ECT Information

The on-line mental health web site called "The Infinite Mind" has a number of good recordings to listen to that have become available recently, as described below.

Mental Health for Immigrants

This program explores Mental Health Care for Immigrants, with host Dr. Peter Kramer. Guests include Dr. Arthur Kleinman, professor of medical anthropology and psychiatry at Harvard Medical School and one of the world's leading experts in medical anthropology and cross-cultural psychiatry; Dr. Jane Delgado, a clinical psychologist and the president and CEO of the National Alliance for Hispanic Health; Dr. Mohamed Farrag, a psychologist and the clinical director of ACCESS: the Arab Community Center for Economic and Social Services in Dearborn, Michigan; and Dr. Yinka Akinsulure-Smith, a psychologist from Sierra Leone who works at the Bellevue /NYU Program for Survivors of Torture.

Dr. Kleinman says that culture can profoundly influence the way people experience mental illness. For example, in many cultures -- in the U.S. and abroad -- people experience depression in bodily terms (headache, trouble sleeping, stomachache, etc), which can often lead to misdiagnosis. Language issues can further complicate diagnosis. To describe sadness, a Chinese person may use a term that is often translated as "congested." A doctor who does not understand the subtleties of the expression might offer treatment for allergies or the flu, rather than depression.

Dr. Kleinman says it is critically important that doctors use professional translators. Because a person's mental illness often takes a toll on loved ones, family members should not translate. They may intensify the stress on the ill person or offer a distorted history. He adds that not all professional translators are created equal -- they, too, must be oriented toward mental health issues. He gives an example of a doctor who wanted to ask a Chinese patient if she were delusional, that is hearing voices. The translator asked, "Are you hearing voices?" and the patient responded, "Yes, you and the doctor." The translator then told the doctor, "Yes, she is hearing voices." These kinds of mistakes can have grave consequences. They then discuss the issue of stigma and how, in Asian cultures, it can extend beyond the individual to the entire family. Psychiatry, itself, also carries a strong stigma. Some mental health professionals label their clinics with names like "psychosomatic services" or "psychological medicine" or "family services" to avoid having to call themselves "psychiatric."

Click on the following link to go to the web page where you can listen to "Mental Health for Immigrants"

Another good program The Infinite Mind has, is on Electroconvulsive Shock Treatment.

There is perhaps no more polarizing topic in mental health than Electroconvulsive Therapy (ECT). Is it something out of Frankenstein, or a modern medical miracle? As heard on this week's program, the first recipient of ECT, an itinerant Italian in the 1930s, said of the treatment, “Not another one! It’s murder!” Six decades later, an Ivy League graduate says that he couldn’t have survived without it. Along the way, writer Sylvia Plath – read by actress Marsha Mason – recounts an experience of shock therapy in her novel, "The Bell Jar," Dr. Sarah Lisanby explains how the therapy works, and Marjorie, a middle-aged woman crippled by a depression, gets her first shock treatment in 30 years.

Host Dr. Peter Kramer opens the show with commentary about the conflicting attitudes regarding electroconvulsive therapy. Even as visions of the treatment call to mind Frankenstein, advanced clinical experience and practice tell an entirely different story. The one place where opposing forces on the treatment agree is this: ECT provokes memory loss in varying degrees.

For many, ECT is perceived of as the treatment of last resort. That is, in part, one reason why a middle-aged woman from greater New York – she asked that she be called Marjorie – has waited 30 years between shock treatments. In the course of this program, producer Devorah Klahr follows Marjorie through her course of therapy with Dr. Samuel Bailine at the The Zucker Hillside Hospital on Long Island. We meet her hours after her first treatment and see her with her husband after her treatment course is completed. The outcome is promising. Marjorie does experience some memory loss, but was regaining it as the segment ends.

Dr. Peter Kramer then talks with Dr. Sarah Lisanby of the Brain-Behavior Clinic at the New York State Psychiatric Institute in New York City. A researcher into the uses and effects of ECT, Dr. Lisanby explains how electroconvulsive therapy stimulates the “acute release of neurotransmitters” like dopamine in the brain and notes that the treatments can actually promote the growth of neurons or nerve cells. Dr. Kramer and Dr. Lisanby take some calls and talk about potential advances in the field – among them, techniques like Transcranial Magnetic Stimulation and Magnetic Seizure Therapy.

Click on the following link to go to a page where you can listen to the ECT (Electroconvulsive Therapy) program.


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