A Newsletter from www.MentalMeds.org

Issue 9

Dear Reader,

Yes, we are celebrating Halloween here at MentalMeds! You'll find several treats, and one trick, in this newsletter.

The treats are the jokes in the humor section. I tried to compile a list of Halloween jokes involving psychiatrists, but this doesn't seem to be a popular combination. If you know of any I haven't listed, send them to me, and I'll include them in the next issue! In the meantime, feel free to laugh at the jokes below, even the ones that are not seasonal.

The trick is not a joke, but an article about a serious problem, namely, what happens if you have an illness that makes you think you are not ill? That question is the subject of this newsletter's article, about a fascinating and disturbing condition known as anosognosia.

Kevin Thompson, Ph.D.
Editor

P.S. As always, if you do not wish to receive email from me, please let me know, and I will remove your name from my list.

Table of Contents

Calling for Articles
Humor
Anosognosia: The Most Devastating Symptom of Mental Illness
Are You Looking for Writers?

Calling for Articles

Do you have experiences you would like to share about how you have coped with mental illness? Uplifting stories? Educational stories? Email me with your idea, and if it makes sense, I will be happy to include it in a future issue.

Humor

Funny stuff from around the Internet.

The Monstrous Psychiatrist, from Sabrena's Madness Mansion

Why did Frankensteins' monster go to the psychiatrist?
He thought one of his screws were loose!

A Halloween Psychology Joke, from PyschLinks Online

I walked into a coffee shop on Halloween to find the woman behind the counter with a bunch of sponges pinned to her uniform.
"I'm assuming this is a costume, but just what are you supposed to be?" I asked.
The waitress responded proudly, "I'm self-absorbed."

The Ex-Girlfriend, from Summer Rain

My wife and I were sitting at a table at my high school reunion. I kept staring at a drunken woman swigging her drink, as she sat alone at a nearby table.
    My wife asks, "Do you know her?"
    "Yes," I sighed. "She's my old girlfriend. I understand she started drinking right after we split up those many years ago, and I hear she hasn"t been sober since."
    "My God!" says my wife, "Who would think a person could go on celebrating that long?"

The Nun and the Fig Leaf, from RunningForums.com

A nun, badly needing to use to the restroom, walked into a local Hooters. The place was hopping with music and loud conversation and every once in a while the lights would turn off. Each time the lights would go out, the place would erupt into cheers.
    When the revelers saw the nun the room went dead silent.
    She walked up to the bartender, and asked, "May I please use the restroom?"
    The bartender replied, "OK, but I should warn you that there is a statue of a naked man in there wearing only a fig leaf."
    "Well, in that case I'll just look the other way," said the nun.
    So, the bartender showed the nun to the back of the restaurant, and she preceded to the restroom. After a few minutes, she came back out, and the whole place stopped just long enough to give the nun a loud round of applause.
    She went to the bartender and said, "Sir, I don't understand. Why did they applaud for me just because I went to the restroom?"
    "Well, now they know you're one of us," said the bartender, "Would you like a drink?"
    "But, I still don't understand," said the puzzled nun.
    "You see," laughed the bartender, "every time the fig leaf on the statue is lifted up, the lights go out. Now, how about that drink?"

Obsessions, from RunningForums.com

A Licensed Counselor was conducting a group therapy session with four young mothers and their small children.
    "You all have obsessions," he observed. To the first mother, he said, "You are obsessed with eating. You've even named your daughter Candy."
    He turned to the second Mom. "Your obsession is with money. Again, it manifests itself in your child's name, Penny."
    He turns to the third Mom. "Your obsession is alcohol. This too manifests itself in your child's name, Brandy."
    At this point, the fourth mother gets up, takes her little boy by the hand and whispers, "Come on, Dick, we're leaving."

A Second Opinion, from the Canonical List of Psychiatrist and Psychologist Jokes

Man goes to a psychiatrist; psychiatrist sez, "You're crazy!"
Man sez, "I want a second opinion!"
Psychiatrist sez, "OK, yer ugly, too!"

Hoist by his own Petard, from the Canonical List of Psychiatrist and Psychologist Jokes

Hypnotist: "Okay, Mr. Henry, when I say wake up you will no longer be shy but full of confidence and be able to speak your mind... Wake up!"
Patient: "Right, you! How about giving me a refund, you money-grabbing old skinflint!"

A Second Opinion, from the Canonical List of Psychiatrist and Psychologist Jokes
A man walks into the psychiatrists office with a pancake on his head, fried eggs on each shoulder, and a strip of bacon over each ear. The shrink, humoring him, asks, "What seems to be the problem?"
The guy answers, "Doc, I'm worried about my brother."

Checking Out, from the Canonical List of Psychiatrist and Psychologist Jokes

A man calls the psychiatrist at a mental hospital and asks who's in room 24.
"Nobody" comes the reply.
"Good" says the man, "I must have escaped."

The Halloween Party, from Humor Matters

A young couple was invited to a swanky masked Halloween party. The wife came down with a terrible headache and told her husband to go to the party and have a good time. Being the devoted husband he was, protested. But she argued and said she was going to take some aspirin and go to bed. She told him there was no need for him to miss the fun. So he took his costume and away he went.

The wife, after sleeping soundly for one hour, awakened without pain, and as it was still early, she decided to go to the party. Because hubby did not know what her costume was, she thought she would have some kicks watching her husband to see how he acted when she was not around. She joined the party and soon spotted her husband cavorting around on the dance floor. He was dancing with every nice chick he could, and copping a feel here and taking a little kiss there. His wife sidled up to him and being a rather seductive babe herself, he left his partner high and dry and devoted his time to the new "action". She let him go as far as he wished; naturally, since he was her husband. Finally he whispered a little proposition in her ear and she agreed, so off they went to one of the cars and had a little bang.

Just before unmasking at midnight, she slipped out, went home and put the costume away and got into bed, wondering what kind of explanation he would have for his notorious behavior. She was sitting up reading when he came in, and she asked him what he had done. He said, "Oh, the same old thing. You know I never have a good time when you're not there." Then she asked, "Did you dance much?" He replied, "I'll tell you, I never even danced one dance. When I got to the party, I met Pete, Bill and some other guys, so we went into the den and played poker all evening. But I'll tell you... the guy that I loaned my costume to sure had one helluva time!"

Confession is Good for the Soul

A retiring parish priest was being honored at a big dinner. When the local mayor, who was to give a speech honoring the priest, was late to arrive, the organizer asked the priest to fill time by saying a few words to everyone.

"I've had a great fifty years in this parish," Fr. Smith began. "And although it's been fifty years, I'll never forget my first day here.

"I was an unworldly young man from the country, of very humble origins. The other seminarians used to kid me about how shocked I would be at all the sinning that goes on in big cities. I would laugh, and assume they were joking.

"So there I was, fresh out of the seminary, hearing my first confession in the big city, and the man says to me,

'Father, I have sinned. I drink way too much, and often pass out in the bar. I have successfully coveted my neighbor's wife, and his neighbor's wife, and her brother's wife. I have embezzled $50,000 from the police retirement fund, and spent it all on bribes to get myself into a position of power. I'm a sad, sorry wretch, and I'll probably go and do it all over again next week, but I need forgiveness for last week. Can you help me?'

"Well, let me tell you, I was shocked. Shocked! But I counseled him, gave him his penance, and forgave him in the Lord's name.

"And that was my introduction to this parish! I tell you, I almost begged the Bishop for another parish, but I stuck it out, and I'm glad I did. It's been wonderfully satisfying to serve you all over the years, even if I was nervous about hearing confession for the first few years!"

The diners laughed and applauded. Just then, the mayor came in, and was directed to the podium to give his commemorative speech.

"Good evening, everyone," the mayor began, "and please accept my apologies for being late tonight. I want to tell you all how proud I am to be here to commemorate Fr. Smith's fifty fine years as our parish priest. I have to say that time sure flies. Why, it seems only yesterday when I met him. In fact, I had the honor of being the very first person whose confession he heard at this parish!"

Send me your favorite joke, funny story, or amusing picture, as long as it is related to mental illness. Keep it upbeat, please! Jokes involving mental illness are welcome, but jokes that demean mental illness are not. If it's appropriate, I'll put it up on the humor page.

Anosognosia: The Most Devastating Symptom of Mental Illness

by Kevin Thompson, Ph.D.

Mental illness comes in many forms. Depression, bipolar disorder, schizophrenia, and the anxiety disorders all have the potential to be crippling, and ruin lives. Yet as terrible as depression, mania, psychosis, and the other symptoms of these disorders can be, there is one that stands out as the most damaging of all:

Anosognosia

This obscure word, which is pronounced "uh-no-sog-no-zha," means "denial of illness," and is more serious than you might think.

Most people understand the psychological concept of denial, which is a refusal to believe an uncomfortable truth. Who hasn't heard heard a heavy drinker, eater, smoker, or drug user say, "I can quite any time I want," or someone with a chronic cough (which may indicate a serious illness) say, "It's not important--It's just a cough." Pressing the denier on the obvious gap between reality and his belief typically yields a flurry of thin excuses that support his position, and can provoke an outburst of anger if continued long enough.

Denial serves a useful purpose in helping people cope with sudden change, and is harmless as long as it is not maintained too long. Denial becomes harmful when it interferes with a person's ability to cope effectively with the challenges he faces. Fortunately, denial is temporary in most cases, and even chronic deniers can can learn better over time.

Anosognosia is quite different. It is not simply denial of a problem, but the genuine inability to recognize that the problem exists. It is a common consequence of brain injuries, and occurs to varying degrees in such disorders such as schizophrenia, bipolar disorder, and Alzheimer's disease. (I hasten to add that "common" does not mean "universal!" Most people who suffer from these illnesses are quite aware that they are sick.)

Someone who has anosognosia isn't being difficult, or refusing to face the truth. He is literally unable to believe that his illness is, in fact, an illness. As a result, he does not see any reason to take medication that can control his illness. Many people who have anosognosia will refuse to take medication for schizophrenia or bipolar disorder, because they do not believe they are ill. If pushed, they may give the appearance of cooperation, while secretly discarding their medication.

In the case of paranoid schizophrenia, where the patient believes others are conspiring to harm him or control his life, the combination of anosognosia and paranoia can provoke the him to violent action in an attempt to escape his "persecutors." (Sadly, the often debilitating side effects of antipsychotic medication, which, unlike his illness, are all too apparent to the patient, provide supporting evidence for his beliefs.)

For a symptom with such an obscure name, anosognosia plays a prominent role in both law and medicine. Treatment for most illnesses is taken at the discretion of the patient, who is free to seek, select, or decline treatment, as he considers appropriate. However, there are times when the individual's right to control his medical treatment conflicts with other important principles, namely, the sanctity of life, and the protection of others from harm. A person who is in the grip of a severe psychotic episode, who is judged likely to harm himself or someone else, may legally be committed to a psychiatric hospital for evaluation and treatment, on an involuntary basis. Such treatment usually consists of antipsychotic or mood-stabilizer medications, observation, and possibly restraint.

Most patients who are prone to psychosis (primarily, those with schizophrenia) do not have any particular desire to harm other people. The danger comes not from a desire to harm, but from hallucinations and delusions that can drive violent actions. (For example, a patient may sincerely believe he is fighting for his life against an evil force, when in reality he is attacking an innocent person.) So it is not surprising that patients who are aware of the nature of their illness, and the risk of such harm, generally do prefer treatment to prevent violent incidents. Similarly, patients who have anosognosia about their psychotic symptoms, but whose behavior is harmless, may not have a need for medication that justifies removal of their right to make decisions about their treatment

However, those psychotic patients who are at risk for committing violent acts, and also have anosognosia, are both dangerous, and unable to believe that anything is wrong with them. Because of this belief, they will refuse treatment, and remain dangerous. These are the patients whose right to control their own treatment conflicts with the right of others to safety.

In the end, each case must be handled on its own merits, and someone must make the difficult calls--and be prepared to live with the consequences. It is because of anosognosia that such calls must be made.

Kevin Thompson, Ph.D. is the author of Medicines for Mental Health: The Ultimate Guide to Psychiatric Medication. You can find information about treatments for depression, bipolar disorder, schizophrenia, and sexual problems on his Web site at www.MentalMeds.org

Are You Looking for Writers?

If you are looking for articles on mental-health and medication issues, for an online or printed publication, send me a note. I write for various publications, and may be able to help.