Why I am against fad diets and measuring your self worth by the number on your scales

Today I spoke on 3AW with Dr Sally Cockburn about my concerns re fad diets and unhealthy messages not endorsed by experts.

As a doctor who sees many patients with eating disorders I become very concerned when fads appear that promise weight loss.

As a doctor, I am also aware about the health risks that can be caused by obesity. Of course I encourage and support healthy eating and exercise to be the body shape we are designed to be.

What I am NOT happy about are un-endorsed promotions for sale such as the 12WBT that promote weight loss and incorporate misleading information such as the importance of counting calories and regular weighing. Patients with eating disorders such as anorexia nervosa and bulimia nervosa perform these behaviours at an obsessional level. Encouraging people to weigh themselves and then to apportion their self worth to a number is dangerous and can lead to the onset and relapse of eating disorders.

Programs such as the 12WBT have not been endorsed by any regulatory health body, or have published any data about whether rapid weight loss by consuming a very low calorie diet leads to long term change. What we do know is that eating a balanced diet, watching portion size, reading labels on food packaging, and engaging in moderate regular exercise is the way to sustain the weight you should be for life. It is also the way that you can make a huge difference to many preventable diseases such as hypertension, diabetes and arthritis.

I have met quite a number of people who have enrolled in the 12WBT program with all the best intentions only to discover that the very low caloric intake in the first few weeks in unsustainable. Not because they are weak, or greedy or lack discipline, but because they are not consuming enough nutrients to sustain their daily activities.  This can then be interpreted as being a failure, and further reduce self esteem. Listening to hunger cues and eating when hungry is a normal human behaviour. Realising you are hungry and depriving yourself of food as a form of strength is pathological. And, there is no one magic number of calories that all humans must adhere to, but there are guidelines about a healthy range.

I tell my patients that they are the special unique people they are because of many factors. not one is what number they are on the scales. And I know that for many people with eating disorders, this message takes years to sink in.

By all means be healthy, happy and exercise for your physical and mental health. Just read the fine print and if you think something is too good to be true, well it probably is.

Stay well over Christmas and New Year,

Helen

A hashtag and a new style of therapy

Greetings all,

Today I write about what I experienced on social media after the passing of cricketer, brother and son, Phillip Hughes, in such a sudden and unpredictable way. I experienced a world that is different to what we see on mainstream TV most nights, full of anger and hatred against fellow humans. It was an example of how desperately people who don’t even know each other, let alone ever met each other, feel compelled to reach out to those suffering.

I often get asked by patients why they feel so affected by something they see on TV or read about in the paper. This is an extremely common experience, one I remember that occurred when Princess Diana died. In a pre-hashtag era, people in the UK left thousands upon thousands of flowers at Kensington Palace. They were dumbstruck and it felt incredulous that somebody could be alive one second and not the next. Especially somebody so famous. They had to connect with others sorrow. Humans seem to be driven to find meaning even when there is none. After all, we know life is fragile, we can’t expect to live forever yet when it happens we cannot believe it to be so. That is grief.

I also explain to patients that humans are great ‘pattern matchers’, when they say they feel silly about being affected by something that happened to somebody they didn’t know. 

When we feel grief or sadness we may be taken back to a time in our life when we experienced profound loss. Hence the pain we feel is really a combination of what we are seeing and what we are remembering. Hence we may cry about a stranger’s passing, we may want to reach out and help in any way possible. 

I feel that devising the #putoutyourbats hashtag was an incredibly therapeutic gesture that will help not only to show the families suffering that people care, but also help people who are suffering to do something with their sadness.

As for me, and because shrinks have feelings too, II was deeply affected this week as I could relate to the first on scene doctors and paramedics. I have been in a few situations where I have offered emergency assistance with groups of people watching me, knowing how bad things are and desperately trying to change what really is fate. 

My worst experience happened in 2013 and I wrote about it here. Although I pulled a toddler out of a pool in a 5 star resort and did the sloppiest CPR ever seen that resulted in him surviving, I felt total guilt that was irrational and needed lots of ‘debriefing’ to manage. The way I was treated in the US was terrible but when I got home my colleagues were fabulous to my son and I, who also witnessed the whole thing. I wasn’t hailed a hero, I wasn’t even thanked by the family, but I don’t care because I know that little boy is alive now. Yet I still remember and I still feel uneasy when I see people performing CPR, and I still question to this day whether I could have done things differently.

I write this because doctors are lousy at admitting how affected they are (including me), and that they may need some support. I can only feel for Dr John Orchard who gave Phillip the best chance of surviving what was an incredibly severe injury. He did this with the players gathered around him, with the expectation he could ‘do something’ and he did it because that’s what us doctors just do. I truly hope he is OK and does seek comfort in the fact he tried his very best. Likewise the paramedics who did arrive early but have been criticised for an apparent delay.

And to the players and cricket community, I urge you to seek help weeks or months down the track if you need it. There is no such thing as a time when you should be ‘over it’. Only you can choose when it’s time to ‘move on’. You will all be affected in your own way. Find somebody to listen and help you. People are there if you ask, way after the hashtag goes away. 

My 'prize possession". My cricket bat autographed by Dean Jones in 1992.

#putoutyourbats

Dr Helen Schultz is a consultant psychiatrist at MindAdvocacy, Richmond, Victoria, and author of "How Shrinks Think" www.mindadvocacy.com.au

Common sense prevails

Greetings all,

Like many of my medical colleagues I am celebrating today with the news that the Federal Government’s GP co-payment system is all but defunct, despite incongruent press releases throughout the day. The co-payment system is thought to affect GP visits but many don't know it was desgned to involve radiology and pathology services as well. I don’t know how this has been overturned. I hope it was because common sense and benevolence won in the end. But regardless, I care because now there is a chance my vulnerable patients will still be able to access the treatment they deserve in a country such as Australia.

I wrote about the injustice of co-payments for those with severe mental illness on Croakey in June 2014, found here. My main point was that it was inhumane to impose fees for medications and diagnostic services on an involuntary patient who was being treated under the Mental Health Act, because of the fact that they were refusing treatment or unable to consent to treatment. I wrote it at a time too when I was working in a large city and struck by the amount of homelessness and poverty even in inner urban areas. I wanted to tell those who would listen that there must always be free health care for those most unlikely to advocate for themselves or pay for it.

As I wake to this news today I am working as a psychiatrist in a rural area servicing a large population and geographical area. Many patients are indigenous, many are also kept well by the public health system. As stretched as it is, staff are genuine and truly caring of their patients. I have been able to see how medications such as clozapine have actually turned the lives around of patients with severe mental illness, keeping them out of hospital for years. 

As I wrote earlier in the year, patients prescribed clozapine require weekly to monthly pathology tests to ensure they are not developing  life threatening side effects. They cannot pay for treatment and some are receiving treatment under the Mental Health Act, hence unable to consent to it. I know that if they had to pay $7.00 every week for 18 weeks for blood tests many would stop medications and become severely unwell, maybe even requiring months in hospital to recover. I suggest it best they receive outpatient care in an evidenced based manner rather than risk a relapse that would disrupt their lives or potentially place their lives at risk.

I was impressed to hear Dr Brian Owler, federal president of AMA, speak about the GP co-payment system today. I support his continued requests to work with the government on finding a better solution to funding care. I am not stating all patient should be bulk-billed. But I am very aware that to remove this advantage for everybody will leave an incalculable dent in the health care budget, notwithstanding poor patient outcomes and more strain for health care professionals that work in a stretched health system.

It’s Ok to make a mistake once, we all do. But if our current federal government doesn’t learn from this mistake by continuing to ignore key stakeholders such as the AMA and patient lobbying groups to my mind that would be reprehensible. 

Dr Helen Schultz is a consultant psychiatrist at 'MindAdvocacy' Richmond, Melbourne, Australia. She is the author of "How Shrinks Think" published November 2014.

Lots of talk but no action

Greetings all,

Many thanks to all of you who retweeted and replied to my blog post entitled “Not thinking before you speak”. It seems many are as outraged as I am about Mr Latham’s comments towards Lisa Pryor, and more importantly to The Financial Review for not retracting them.

As I have said, yes, all are entitled to freedom of speech but some acknowledgement that these comments are hurtful, stigmatising and lacking any credibility is still sorely missing.

The Royal Australian and New Zealand College of Psychiatrists have also replied to my post, stating via Twitter,

“Absolutely, Mark Latham’s comments are concerning and not helpful in removing stigma attached to mental illness.”

On this WhiteRibbon Day, I will keep up the fight to support Lisa Pryor, soon to be a medical colleague of mine, as well as advocate for public understanding and respect for my patients who ask for help and should not feel ashamed for receiving it. I will also continue to follow the campaign at Change.org and encourage others to do so as well. Over 1500 people have signed the petition so far.

Let's keep this going,

Best wishes,

Helen

Dr Helen Schultz is a consultant psychiatrist at MindAdvocacy in Richmond, Melbourne, Australia. She is a recent author of “How Shrinks Think” which can be purchased here.

Not thinking before you speak

Greetings all,

I begin this post by declaring that I know that in Australia we are fortunate to have the right to free speech. In particular, I am referring to Mr Mark Latham’s article published in The Financial Review last week which has caused an outrage amongst women who have mental illness or care about those who do. But what I struggle with is when those who speak from a position of influence don’t think before they speak. Or if they do and they are found to be incorrect, or indeed cause harm, don’t apologise.

I have no legal training and I am not a journalist, and don’t claim to know about tactics to sell papers or how a person is chosen to contribute to content. I am however a psychiatrist who can spend up to half her time in initial sessions with some patients reassuring them about what I can offer them and why it is a sensible and medically advised decision to seek help for mental illness. It is why I wrote my book “How Shrinks Think”. It’s where I see the most stigma. Behind closed doors, people suffering that I know we can help, but those that would be horrified if their friends or colleagues knew they were seeing a psychiatrist. Those I see get better, sometimes with medication, and still don’t want anybody to know they have a mental illness.

I can’t comprehend why Mr Latham would comment about mothers and mental illness, especially during BeyondBlue's post natal depression awareness week (16-22 November 2014). I do consider it necessary to set the record straight regarding depression and motherhood from a psychiatrist’s point of view.

If a woman is biologically predisposed to developing a mental illness they are more likely to have an episode at the time of hormonal fluctuations, i.e. during puberty, at the time of menopause, and guess what, while pregnant and after childbirth. Hence why the subspecialty of perinatal psychiatry exists. Hence the scrutiny for the emergence of post natal depression in biologically vulnerable people to protect the mother and in extreme cases the baby. See the logic there Mr Latham? The baby doesn’t force the mother onto antidepressants, the mother isn’t weak but the mother may be biologically predisposed to the development of depression, with episodes triggered by these hormonal fluctuations. Fantastic, capable, loving mothers who also have a personal or family history of depression. Thank goodness we do have effective treatments, dedicated mother‑ baby inpatient and outpatient services that care for both mother and baby while keeping them together to encourage bonding. 

Guess what else, Mr Latham, we know that we need to help the mother for the infant’s well-being as well. Something the child will not be blamed for, but the child may thank the mother for.

I have heard the notion that antidepressants are a band aid, a happy pill, something to become reliant upon or change people’s personality so many times it’s really not funny. No endocrinologist would cop the same when prescribing insulin to a 4 year old child who has type 1 diabetes. If a mother has depression she should not be made to feel ashamed if she needs to take antidepressants.

So I do concede Mr Latham has a right to freedom of speech but I would prefer it be informed and evidence based. I ask the Financial Review to accept utmost responsibility for publishing these remarks, pointed towards a successful and happy mother, by retracting the article. Remarks similar to those Mr Latham has made in the past regarding patients with mental illness. Then I can carry on working to debunk myths, educate and above all help my patients as my profession would want me to do. 

Finishing my book then having a good lie down – on the couch

Greetings all,

Well, I am very happy to say I wrote the final words of my new book “How Shrinks Think” yesterday (editors changes pending). The last word I wrote was ‘psychiatry’. The last topic I wrote about was psychiatry and social media. Who would have thought that this Facebook avoidee and Twitter ignorant person a year ago would now be embracing this great means of global communication!

It is timely for me to reflect on this change in my learning and outlook. That’s because I don’t think I would have ever finished my book (editors changes pending) if I didn’t receive all the help, support, encouragement and opportunity I have been fortunate to experience in the Twitterverse this year.

Some of my friends and colleagues in my life know I have been writing a book since August 2013. Many don’t. It does feel embarrassing I suppose to announce where ever you go that you will be an author someday. So, in the main I didn’t. But on the rare occasion that I did, people seemed generally interested. They were interested to know what I had written about and incredulous that I could be relatively easy in this era of self-publishing. But largely, I have written the book just for me. I don’t know how it’s going to be received, but regardless, I will continue to remember that.

In all sorts of ways the interrelationship between my experiences on social media and my writing journey have been closer than I would have imagined. I began to ‘play’ with the concept of writing about modern day psychiatry from the ‘inside’ on January 1 2014. I started my blog “How Shrinks Think” to sort out my own thoughts as well as gauge others impressions of what I had to say. I was scary at first but then a whole lot of fun. Then I gained the courage to use my voice as blogger and writer of “How Shrinks Think” in order to enter the world of campaign building. I was very involved in @AHPRAaction in May, and then wrote about the federal government proposed Medicare Co-payment and the effect it would have on those with severe mental illness. This propelled me into re-connecting with colleagues from the past, particularly from my AMA days, including Mukesh Haikerwal, and Amit Vohra. Opportunities arose from this including the privilege of being a speaker at the inaugural AMA(Vic) DiT conference.

I also discovered the talent and experience other doctors in Australia had when it came to writing. Although we have never met face to face, I consider Edwin Kruys in Queensland and Jacquie Garton-Smith in Western Australia to have really inspired me to keep writing and ultimately ending the journey that is the first draft of a book. I was fortunate enough to have some blog posts picked up by Croakey, and managed to connect with psychiatrists in Australia and around the world.

It is no coincidence that I will launch my book at @SoMebythesea on November 15^th 2014. I am organising this workshop amongst incredible people, many  I would never have met were it not for Twitter. It is amazing that virtually all of the organisation and promotion for @SoMebythesea has occurred via the amazing network opportunities of social media. Now I have Dionne Kasian-Lew, Marie Bismark, Mary Freer and Jen Morris coming along to speak at @Somebythesea. All people I have met via networking.

Of course, I have not forgotten my friends from the beginning and pre SoMe. Some are also growing and expanding their social media presence, like the sleep guru David Cunnington. Brad Mckay has been a great mate all along and a wonderful mentor for me in this new foray. My journey did begin with Andrew Griffiths and Kylie Bartlett, and I will always be grateful for their teachings and guidance. And all my friends who have been there, offering advice and encouragement.

So, the next 6 weeks are now in the hands of my editor, Roy Mazucco, and designer, Carly Goodwin. Incredible to believe but if all goes to plan, I will have my book in my hand in 6 weeks. May need to see a psychiatrist to process it all.  

Shrinks and Social Media

I don’t ever remember learning about social media at medical school back in the '90s. Social media was reading the newspaper or a magazine before uni started. In the olden days, merely 20 years ago, we had no idea the www was coming.  Dr Google was somewhere in the lecture theatre but we didn’t recognise him/her, and we couldn’t imagine that there would be communal platforms like Facebook around to unite strangers and label them friends.

Lecturers teaching ethics in medicine did not fathom a world where doctors would live within social media, and have to work their way through the twists and turns of setting up and maintaining Facebook personal pages, doing their best not to be found on social media by their patients, yet really wanting to share photos of recent holidays, and remain in touch with colleagues.They certainly wouldn't have envisaged doctors embracing socila media as an effective means of building communities, promoting evidenced based helath messages and influencing for change. 

Regulatory bodies such as AHPRA and professional associations such as the AMA have tried to keep up with the growing trends of what was considered a fad and considered absolutely not relevant to professionals, certainly doctors, but then had to begrudgingly accepted social media as something here to stay. Unfortunately the regulatory bodies, not the medical profession have advocated for the way social media should be used in medicine, and many doctors remain unaware that they need to know more about social media in medicine.

More and more, doctors want to influence debates on health matters, and nowhere is this more real than in psychiatry and mental illness. In 2014 we must realise that stigma is rife and campaigns such as ’@RUOKday’ and days dedicated to suicide prevention are popular because there still exists a fundamental belief that to be depressed is weak and something to suffer in silence. Large NGO’s with stacks of cash  have departments that run social media campaigns, driving their messages home, influencing the debate and keeping the radar on the topics. But what about doctors? Why do we believe others can pledge our plights and we can be taken as read, without being read, that we support or refute an argument or counterargument without making our own unique and collective point of view known? How do doctors, particularly psychiatrsts feel about campaigns such as @RUOKday, and what are they saying about it?

In Australia, the ABC is running a campaign called 'Mental As' to coinicide with national Mental Health week in October 2014. Great to use high profile celebrities to 'raise awareness', but what does a psychiatrist feel about a campaign being labelled "Mental As?" How do psychiatrists feel about raising awareness for a most valuable area of health, yet with limited funding to provide care when patients seek help?  How do psychiatrists feel about being labelled as those that treat 'mental patients, a most derogatory and stigma enhancing term. Isn't that where psychiatrists can have a say? In summary, advocacy about mental illness on social media is one sided, lacking a robust evidence base and not informed and influenced by experts in the field - psychiatrists themselves.

In the last 5 years it is pleasing to see medical colleges such as RANZCP and RACGP join social media, tweet regularly and highlight very important policy decisions they are making regarding such critical issues as the mental health issues facing asylum seekers and offshore detainees. In recent times we have seen doctors unite over issues they are passionate about such as #AHPRAaction, #ScrapTheCap and #CoPayNoWay. Because the fact is this. Social media is not for posting what you ate for lunch or where you spent your holidays. Social media is for connecting, uniting and advocating as a mass of people from so many walks of life that would never have been able to come together so quickly in any other way. Campaigns on social media work quickly, they pack a punch and they influence.

I write as a novice to social media, coming on board in January 2014 as a naysayer and critic. It was because I didn’t know about this side of social media. I learnt from other professional bodies, dipped my toes in the twitter universe and discovered to my amazement there were people I could find and follow who felt like me. People who admired what I did and followed me back. I quickly joined an amazing campaign called #AHPRAaction and stood up to our regulatory body to defend our rights in the context of social media. Four months after I opened my twitter account. Now I blog regularly, have a company Facebook page, tidied up my LinkedIn profile, set up a psychiatrist’s and registrars group on Linkedin (PARA) which is gaining membership, and have almost finished my first book.

And what about me as a doctor, passionate about psychiatry, and with my experience as a writer and learning the ropes about being a shrink? Well, now I have a voice and a brand. I have stepped forward and claimed my identity that is authentic to me, before others can post about who they think I am. I have bought my domain name www.drhelenschultz.com, and claimed the @Drhelenschultz  twitter handle before somebody else does and pretends to be me. Not a narcissistic thing to do, but a sensible thing to do, as the real estate space in social media gets clogged, people find new ways to influence and may wrongly do so by purporting to be somebody else. And because I want to guarantee my future both in the business and medical world as well as the social media world. The two are intertwined. I love the feeling that I can write what I think and own it, and others can truly decide whether they admire me or not because they know the real me.

As for psychiatry, I will continue to have a presence and a voice on social media, finish my book “How Shrinks Think” and be a thought leader when it comes to our treatment of those with mental illness, and what we can all do better. I’ll stand aside NGO’s and colleges as somebody who works within the system and has a right to have a say. That say will be shouted on social. 


Dr Helen Schultz is a consultant psychiatrist based in Melbourne, Australia. She is also founder of CPD Formulations, a medical education company that creates medical education programs written for doctors by doctors. Her new workshop is called @SoMebythesea, to be held on 15th November 2014, in Torquay, Victoria. It will be the inaugural social media workshop for the medical profession.