When Is It a Fugue State

Everyone has been running news items about the fellow from the State of Washington who suddenly found himself in Denver and didn't know who he was. The press jumped on it and, of course, it had the ending everyone wanted -- his family saw him and came to get him. Now all is going back to normal.

Normal for this fellow, it seems, is having bouts of amnesia when under stress. This isn't very common, but it is something we do see on rare occasions. A decade or so ago, it was a very hot topic in psychiatry and people were being diagnosed with disorders that included fugue all the time. If you are a film buff as I am, you know that the first film treatment of something somewhat like this was in "All About Eve" the woman who had multiple personalities. Then we had "Sybil" who also had multiples. The debate goes on.

I did work with someone who left his home one morning to take the train into Manhattan and just disappeared. We didn't know where he was and neither did his wife until he called her from the Midwest several days later. He'd found himself on a bus and didn't know where he was going or why. That is a very disquieting feeling, I know, because when I've been driving and deep in thought, I've found myself on a familiar bridge and didn't know if I was going to work or coming home. It can shake you up pretty good for a few minutes.

I just have one question for the fellow from Washington: How is it that you had no identification in any of your pockets? If someone in my family had a disorder that could lead to fugue, I think I'd have labels in their jackets with their name and phone number on each. May seem like a trip to summer camp, but I'd be a lot happier knowing they'd be safer because of that small tag.

Related Topics: Stress Kills , What's Your Crisis Personality?

Technorati Tags: Jeffrey Alan Ingram, stress, fugue

Psychiatry Comes to the Small Screen

When TV was in its infancy, it was referred to as "the small screen" as opposed to films which were shown on "the big screen" also know as your local movie house. Everything changes and now the small screen might be an apt term for your computer monitor, if it weren't for the fact that these are now so big they rival TV screens. So much for that.

The lack of adequate mental health resources in many parts of the country and, indeed, in vast areas of the world, has finally been partially resolved through the use of computers. While the kids are having great fun with their YouTube or MySpace, the rest of us can now see another important potential of computers in healthcare. The need is now being met by telemedicine and people in the mental health field are beginning to take notice.

I remember having a graduate student who was concerned that people in her area only had one mental health professional who could offer services - her. She lived in a very rural area of the country and the nearest psychiatrist was 50 miles away. At times, she felt overwhelmed, but she was a good, caring woman who gave more to her patients than I've seen in major cities. We are fortunate to have professionals like her in the field.

I've had many people on the anxiety message board at WebMD who required specialized care and yet were unable to find a doctor in their area. Driving hundreds of miles or taking a plane wasn't an option for them and so they tried to make do the best they could.

But it's something that we should be addressing. People in need are people in need whether it's for cancer care or mental health care. Each is serious, can have life-threatening consequences and often requires sophisticated treatment.

Video hook-ups will begin to sprout around the United States and the world as the reality and the benefit of this type of mental health services becomes more widely accepted. True, not everyone is comfortable sitting in front of a camera and talking to someone on a screen, but it sure beats sitting in your home and wondering who will help you. If they can do surgery with computerized robots via video, there's no reason this can't work. The problems will inevitably come up and all of us will have to provide input, but it's worth the effort.

Related Topics: Finding a Doctor Who Will Be a Partner, Depression: Finding a Doctor or Therapist

Technorati Tags: video psychiatry, find a doctor, long-distance medicine, telemedicine

The Anxiety of the Elderly

Elderly individuals, we've come to understand, suffer from anxiety disorders just like the rest of us. Older women, in fact, may actually develop panic as they grow older, and when we consider why we begin to understand the problems here.

Advancing age means more dependence on the resources of our family, our friends, and our community. It also means needing access to healthcare professionals who have advanced training for caring for elderly patients. You wouldn't take your child to a regular General Practitioner, but rather a pediatrician. So, why would an elderly person not be taken to a physician specializing in gerontology? This is one question and it is of great importance because of the physiology and the psychology at play here.

Now a new study has found that too many communities are not ready to meet the needs of their aging populations. Access isn't provided in living spaces, buses, or restaurants. Meals needed by the shut-in elderly may be delivered sporadically, but who looks in the community for those who haven't applied because they didn't have the knowledge or the energy? Medications may be needed, but can they afford them and are they being given in the proper amounts and at the right times?

How can you help? Each of us has to look in our area for the gaps and the things overlooked. It's not just a service we owe to our older citizens, we owe it to ourselves, so it meets two needs.

Related Topics: Long-term Antidepressants for Elderly?, Anxiety Often Missed in the Elderly

Technorati Tags: anxiety, elderly, aging, gerontology

Threats and Terrorism: Conquering Fear

[Update: With the news of today's small plane crash of a plane belonging to pitcher Cory Lidle, Dr. Farrell's reminder to keep things in perspective has been republished.

- WebMD Blog Editor]

The events of 9/11 seemed to be vanishing as time does its work on these things, but now we have been reminded that things really haven't changed. The foiled terrorist planned attacks on three major American airlines in Great Britain have, once again, stressed all of us, but we can and will get through this, too.

Life is a series of our managing events in our lives and the way we manage distressing personal events can be used in this instance. Remember the famous words of President Franklin D. Roosevelt's first inaugural address where he said the "only thing we have to fear is fear itself."? Those are words for all of us now.

First, remember that life goes on and that we need to maintain our daily activities and the structure of our lives. Structure and activities help provide focus and stability for us. If we were to be totally wrapped up in the idea of this latest plot, we would make ourselves victims time and again because these fellows will keep hatching plots. Do you want to have a life of your own choosing? Then, keep on with your goals, work, go to school, have fun with family and friends. These things will help you maintain your mental and physical health.

Second, limit your exposure to news. By that I don't mean that we should all stick our heads in the sand, but don't permit excessive news coverage to raise your level of anxiety. Journalists, unfortunately, have a tendency to try to raise our blood pressure over the events they are covering and this one will be prime for that treatment. Gluing yourself to the TV or radio isn't going to do anything for you in terms of how you need to lead your life. Of course you need to be informed, but you need to decide how much is too much news.

Third, let this be a reminder of the things you hold precious in your life and reach out to those you love and enjoy their company tonight or this week. These latest culprits have helped us to see what is important, so do something that will allow you to share your joy with those around you.

If you need a place to share your concerns, leave a comment here. I'll be checking in throughout the day and will be glad to answer.

Related Topics: Anxiety in Uncertain Times, Trump Stress With Your Thoughts

Technorati Tags: NYC plane crash, terrorism, stress

School Shootings

The spate of school shootings in the last three weeks has to be a terribly upsetting thing for parents and more so for children. How does a child go to school when they hear about so many students being killed by students and adults? It is almost an epidemic and we don't seem to have the vaccine for this one.

What you say to your kids and how you say it also has to be on the minds of parents and school authorities. Do you turn schools into fortresses with doors being monitored or closed circuit TV to the local police station? How could anyone possibly man all these posts? The task seems daunting.

One thing we find in common in all these shootings; guns. All the perpetrators used firearms and the latest used an automatic handgun. Do we need to consider who has access to guns and whether or not a license has to be issued yearly along with evidence of mental stability for a gun? This is one thought.

The sad fact is that anyone is potentially capable of this type of an attack and our schools, for the most part, are vulnerable. Our children, therefore, require more attention right now and parents need to come together with school authorities to formulate a plan for each school district. No one wants to do this, but our children need more of a sense that there is a plan in place.

I have always been in favor of children having either cell phones or pagers with which they can contact their parents or get help. I do understand that schools currently feel this is an impediment to classroom order, but that doesn't mean kids shouldn't have them. The school rules need to be clearly defined and kids need to be asked for their cooperation. Asking kids to cooperate is decidedly different from telling them they can't have these devices.

It's also the time now to offer more comfort and continue dialoguing with your kids on their concerns. Talk to your children about what to do if something happens at school. Remember that schools, the environment within the school and the administration are very powerful forces for safety. Rules about who may or may not come into a school, how angry outbursts will be dealt with and how to better manage anger are all important.

One thing we've seen and we may see it in the Lancaster, PA shooting is kids being made fun of or bullied. Some of these wounds go deep and last a long time. There has to be zero tolerance for violence, bullying or anything else that makes a child feel insecure.


Related Topics: Portrait of a Psychopath, Bullying Increasing: First Boys, Now Girls

Technorati Tags: school shootings, school violence, guns