3 in the Key (May/June)

This months edition of 3 in the Key is special.  Previous editions of this segment focused on front line staff and will continue to do so in the future.

But this month we focus on 3 Mental Health Management members.

1 new Director, 1 new Manager and 1 well known manager who is known to be the biggest Rafael Nadal fan in the UNIVERSE!

So what does eating raw lobster on a Cuban fishing trip, tossing undergarments at a Tom Jones concert and a Car wash/detailing service for staff have in common?  

Lets find out in this months 3 in the Key….

(**Click on any of the RED underlined links for more information**)

Ping R. (Patient Care Manager for In-Patient Mental Health at the Birchmount Campus, 3B/3C/PIOU)

ping

What is your best childhood memory?

Playing with makeshift toys, nothing fancy.

Who would play you in the movie adaptation of your life?

A Chinese actress– Sylvia Chang

What do you feel most proud of?

Baked a non-deflated Chiffon cake

If you could travel anywhere, where would you go and why?

The mysterious Machu Picchu

What are your top three favorite books and why?

All books in Chinese (English links provided)

Dream of the Red Chamber

Journey to the West

Fortress Besieged

If you were prime minister, what is the first thing you would do?

Revisit the legalization and regulation of Cannabis

What is your favorite part of your job?

Opportunities to make staff proud of their work

How long have you worked at TSH?

5 months

How would your friends describe you?

Very practical and creative in getting things done

What does a perfect day look like to you?

Wake up naturally after having a good night sleep

What is a skill you’d like to learn and why?

Better cooking skill for life enjoyment

Fill in the blank: If you really knew me, you’d know________

I don’t like nonsense

What’s your favorite type of cuisine?

Chinese obviously

Who did you first see live in concert?

Some Chinese singers back home

What’s the 1 thing you’ve waited in line the longest for?

Red carpet event to get rush tickets to the Hunger Games movie

If you could choose 1 amenity to add to the workplace, what would it be?

It would have been something from staff feedback

What other languages do you know?

Mandarin & Taiwanese

Do you have any hobbies?

Go to movies and contribute to reviews

Which of your 5 senses is the strongest? Taste.

How about weakest?  Sight and hearing

What was the most incredible exotic place you’ve ever traveled to?

Eating raw lobster meat on a Cuban fishing boat 

 

Shawnna B. (Patient Care Manager for Community Services; Crisis/POP/ACTT/JAMH/ICM/ADHD & Adult Out-Patient Services)

shawnna

What is your best childhood memory?

Playing Lion King with my younger sister and reenacting the “Long live the king scene.” Obviously, I was Scar and my sister was Mufasa. I used to have her hanging off the diving board as I recited the line, and then would push her fingers off and watch her fall into the pool. I also liked playing the “Queen game,” where I would act like the Queen of England (because we share a birthday) and get my sister to run around and do things for me.

Who would play you in the movie adaptation of your life?

I can’t think of any South Asian actresses besides Mindy Kailing. We have the same pitched voice, so that works.

What do you feel most proud of?

I always wanted to pursue a career where I could help marginalized communities in some way, and be able to make meaningful changes. SRH has given me the opportunity to do this. I have been fortunate enough to be able to influence changes in the neighborhood I grew up in. I’m so proud of the achievements we have made, particularly how we have really worked to increase access to quality mental health care in Scarborough.

If you could travel anywhere, where would you go and why?

I love travelling and can’t pinpoint one place. Countries currently on my wish list include: Madagascar, Argentina, Cambodia, Vietnam, Portugal, the smaller non touristy towns of Italy and Spain, and I could really go on and on

What are your top three favorite books and why?

Pride and Prejudice

Why? Mr. Darcy, enough said. (On a side note, Colin Firth is hands down the best Mr. Darcy. Everyone should watch the 6 hour BBC version of Pride and Prejudice).

Emma

One of my favorite lines in all of literature is when Mr. Knightley says, “I cannot make speeches, Emma. . . . If I loved you less, I might be able to talk about it more.”

The Merchant of Venice

This isn’t my favorite play by Shakespeare. King Lear, Macbeth, and Titus Andronicus all surpass The Merchant of Venice for me. But, I fell in love with Shylock’s soliloquy the first time I read it, and it still moves me.

I am a Jew. Hath not a Jew eyes? Hath not a Jew hands,
organs, dimensions, senses, affections, passions; fed with the same
food, hurt with the same weapons, subject to the same diseases,
heal’d by the same means, warm’d and cool’d by the same winter
and summer, as a Christian is? If you prick us, do we not bleed? If
you tickle us, do we not laugh? If you poison us, do we not die?
And if you wrong us, do we not revenge? If we are like you in the
rest, we will resemble you in that.

 If you were prime minister, what is the first thing you would do?

Meet Nadal. We should really work on strengthening our ties with Spain.

 What is your favorite part of your job?

Refer to question 3!

How long have you worked at TSH?

5 years

How would your friends describe you?

Ambitious, loyal, compassionate, hardworking, determined, directionally challenged, and undomesticated.

What does a perfect day look like to you?

Sleep in, go for brunch with friends, grab a flight to watch the French Open in Paris, the end.

What is a skill you’d like to learn and why?

How to fight. Refer to question 1. My sister is taller and stronger than me now, and for some reason she wants revenge.

Fill in the blank: If you really knew me, you’d know

I absolutely hate Jack Armstrong. And everyone knows my number one nemesis is Djokovic.

 What’s your favoThairite type of cuisine?

Currently, it’s .

 Who did you first see live in concert?

My mom took me to see Tom Jones when I was a kid. I was confused as to why so many older women were throwing their undergarments at him.

What’s the 1 thing you’ve waited in line the longest for?

Food. Toronto loves lining up for food.

If you could choose 1 amenity to add to the workplace, what would it be?

Large screen TV for Grand Slams and playoff times.

What other languages do you know?

Tamil, kind of. At times it may just be me speaking in English, but with an accent…

 Do you have any hobbies?

I joined a pottery class, I wasn’t good at it. I joined ball hockey, flag football, dodgeball, volleyball, and softball. I wasn’t good at those.

Does watching sports, drinking wine, and travelling count as hobbies? Because then yes, I have hobbies.

 Which of your 5 senses is the strongest? How about weakest?

Strongest – taste

Weakest – sight

What was the most incredible exotic place you’ve ever traveled to?

Again, I can’t pick. I love travelling and try to go on one big trip each year. I’m fortunate to have friends with similar interests, and parents who took me all over the world from a young age. Some of my favorite “exotic” places have been Oman, South Africa, Israel, Egypt, Ghana, and Sri Lanka.

 

Sari G. (New Director for Mental Health, Seniors Health and Family Medicine Teaching Unit for SRH)

Sari_Greenwood_crop

What is your best childhood memory?

I have always loved animals, especially dogs. I was that kid that went up to every dog I saw despite the warnings from my parents so my best childhood memory was the day I got my very own, not stuffed, puppy for my 7th birthday.

Who would play you in the movie adaptation of your life?

Jennifer Lopez

What do you feel most proud of?

Being the mother of two fantastic amazing kids.

If you could travel anywhere, where would you go and why?

I’d love to go to Spain and Portugal and all around the Mediterranean. Sounds exotic.

What are your top three favorite books and why?

A Man Called Ove

Cutting for Stone

When Breath Becomes Air

If you were prime minister, what is the first thing you would do?

I would never want the job as prime minister so I’d probably resign.

What is your favorite part of your job?

Working with amazing people and contributing to making positive differences in the lives of so many patients, families and staff.

How long have you worked at TSH?

20 years!!

How would your friends describe you?

I think fun to be around, a bit competitive (or maybe extremely competitive), and someone who would do anything for them

What does a perfect day look like to you?

In the summer, a round of golf with my husband and kids followed by lunch, a swim, and then spending time with friends in the evening in the backyard, enjoying a BBQ dinner and some great wine. In the winter, I’d probably exchange the round of golf for a day of skiing, and then dinner in front of the fire…also with some great wine!

What is a skill you’d like to learn and why?

I’d really love to perfect my short game in golf. I need to be able to win.

Fill in the blank: If you really knew me, you’d know_____

I hate losing at any game.

What’s your favorite type of cuisine?

Sushi

Who did you first see live in concert?

Madonna

What’s the 1 thing you’ve waited in line the longest for?

A ride at wonderland

If you could choose 1 amenity to add to the workplace, what would it be?

Car wash service – interior and exterior

What other languages do you know?

A bit of French

Do you have any hobbies?

Golfing, anything that keeps me active. I love to run.

Which of your 5 senses is the strongest? How about weakest?

Smell is my strongest sense; and I think hearing may be my weakest.

What was the most incredible exotic place you’ve ever traveled to?

A week-long sea kayak trip down the Baja peninsula

 

Mental Notes would like to thank Ping, Shawnna and Sari for participating in this months 3 in the Key installment.  You are key players in our department.

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Reading of the Week: Is Psychoanalysis Relevant? Paris vs. Ravitz

From the Editor

“Today, psychoanalysis has been marginalized and is struggling to survive in a hostile academic and clinical environment. This raises the question as to whether the paradigm is still relevant in psychiatric science and practice.”

This week, we consider the relevance of psychoanalysis.

Drawing from the May issue of The Canadian Journal of Psychiatry, we look at two papers.

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Freud and analysis: debating his relevance

In a Perspectives piece, Dr. Joel Paris argues that psychoanalysis is part our legacy – but not much more. In an Editorial, Dr. Paula Ravitz responds. She opens by writing: “My concern is that by unnecessarily pitting psychiatry against psychoanalysis, we may throw out the baby with the bathwater.”

It’s a great and important debate.

DG

 

Paris on Therapy

“Is Psychoanalysis Still Relevant to Psychiatry?”

Joel Paris

The Canadian Journal of Psychiatry, May 2017

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http://journals.sagepub.com/doi/full/10.1177/0706743717692306

 

“Psychoanalysis is a theory of psychopathology and a treatment for mental disorders. Fifty years ago, this paradigm had great influence on the teaching and practice of psychiatry. Today, psychoanalysis has been marginalized and is struggling to survive in a hostile academic and clinical environment. This raises the question as to whether the paradigm is still relevant in psychiatric science and practice.

 

“In a difficult climate for the theory and practice of psychoanalysis, several responses have emerged, either by attempting to bridge the gap with science or by redefining the field as lying outside of science. Thus, some analysts have supported revised paradigms, such as attachment theory, that are better supported by evidence. Others have taken the view that Freud’s ideas concerning the unconscious mind are compatible with modern neuroscience. Still others have moved in the opposite direction, arguing that it is sufficient to offer a coherent interpretation of psychological phenomena. This review will briefly examine all these attempts to revive psychoanalysis.”

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Joel Paris

So opens McGill’s Joel Paris in his paper. He predicts a “continued and lingering decline” for psychoanalysis. In a sweeping essay that draws heavily from the literature, he makes several points.

 

  • Psychoanalysis has been undermined by a lack of scientific study. “The absence of solid and persuasive evidence for the theory may be the consequences of self-imposed isolation from the empirical sciences.” (He notes that attachment theory is the “notable exception.”)
  • Even psychoanalysts, he writes, concede there is limited evidence. “Peter Fonagy, a psychoanalyst who is also a respected researcher, has acknowledged that ‘the evidence base for psychoanalytic therapy remains thin.’”
  • Though there is evidence for time-limited dynamic psychotherapies, Dr. Paris argues that this isn’t generalizable to psychoanalysis. With psychoanalysis, “a few reports have attempted to examine” outcomes, but there have been serious limitations.
  • Attempts to tap brain imaging to confirm analytic theories – such as using REM activity – have been “incompatible with empirical data.” Some, like Norman Doidge, have argued that the “brain can change itself” – but Doidge’s books are bestsellers, but “have had little impact in medicine.”

 

“Whatever its limitations, psychoanalysis left an important legacy to psychiatry. It taught a generation of psychiatrists how to understand life histories and to listen attentively to what patients say. In an era dominated by neuroscience, diagnostic checklists, and psychopharmacology, we need to find a way to retain psychotherapy, whose basic concepts can be traced back to the work of Freud, as part of psychiatry.”

 

 

Ravitz Responds

“Contemporary Psychiatry, Psychoanalysis, and Psychotherapy”

Paula Ravitz

The Canadian Journal of Psychiatry, May 2017

http://journals.sagepub.com/doi/full/10.1177/0706743717704762

“In his Perspective, ‘Is Psychoanalysis Still Relevant to Psychiatry?’ Paris presents a critical perspective on psychoanalysis in the context of evidence-based care. Scientific discourse demands critical dialogue, and so in this editorial, I provide alternative perspectives on some of Paris’s arguments and further thoughts on psychoanalytic training, research, and treatment. My concern is that by unnecessarily pitting psychiatry against psychoanalysis, we may throw out the baby with the bathwater.”

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Paula Ravitz

So responds the University of Toronto’s Dr. Paula Ravitz to the Paris paper. She forwards several arguments.

 

  • She notes that psychoanalytic thought is traced to various theories – and that a typical scientific consideration isn’t necessarily appropriate. “[C]urrent psychoanalytic thought is informed by theory of mind, feminist theory, queer theory, sociology, cognitive psychology, nonlinear dynamics, evolutionary biology, political science, anthropology, Buddhism, evolutionary psychology, and ethology. Many aspects of this rich interdisciplinary landscape of influences lie outside the domain of science and its standards of evidence, but not all.”
  • That said, she observes “the strength of evidence” for different psychotherapies. “Canadian position papers and working group papers on psychotherapy published over the past 4 decades highlight that psychotherapy treatments are integral, core components of psychiatric practice.”
  • And she taps the literature, “Although there are fewer controlled studies of psychoanalytic treatment, there is in fact evidence for the efficacy of both short- and long-term psychodynamic psychotherapy (LTPP). Leichsenring and Rabung’s systematic review of 23 studies conducted between 1984 and 2008 identified 11 prospective RCTs and 12 observational studies of >1000 patients receiving LTPP in which there was a large within group effect size of 0.96… for pre- to posttreatment overall outcomes, and for the 8 studies that included a comparison group, the overall between-group effect size was even larger at 1.8…”

 

“Psychotherapy treatments can effectively address suffering and enhance outcomes and the quality of care of mental illnesses across a spectrum of health care settings. As evidence-based practitioners and psychiatrists, we must use what is best for our patients and be trained in a broad range of effective treatments, including psychotherapies and psychoanalytic principles. Based on 40 years of outcome and process research, it is clear that psychotherapy treatments are helpful for patients with psychiatric disorders and therefore a critical component to be preserved in the training and practice of psychiatrists of the 21st century.”

 

A few thoughts:

  1. What a terrific exchange.
  1. Congratulations to the authors – and to The Canadian Journal of Psychiatry for publishing this debate. (And I would encourage readers to look at the papers themselves, since this summary is just that – a summary.)
  1. Though these two psychiatrists take different positions, there is clearly common ground. Note, for instance, that they both acknowledge the contribution of psychoanalysis to current care, including attachment theory. And both acknowledge the incredible importance of psychotherapy in terms of evidence-based care.

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  1. A past Reading considered this topic, drawing on a clever Guardian essay, and then discussing an American Journal of Psychiatry paper that showed that CBT helped patients with bulimia achieve symptom relief faster than those treated with analysis – though the study did show that neither psychotherapy was particularly effective.

 

You can find the Reading here:

ROTW: Freud is Dead are his Ideas Dead Too?

 

  1. In a publicly-funded system, there are larger questions. Does analysis justify its cost given the system’s limited resources? Is it problematic to think in these terms, with government officials then trying to pick winners and losers in treatment, potentially micro-managing patient care?

 

  1. These two selections, then, touch on a broader discussion – the relevance of psychoanalysis has implications for education, clinical practice, and health care financing. I’ll close the way I started: by noting that it’s a great and important debate.

 

 

Reading of the Week. Every week I pick articles and papers from the world of Psychiatry. 

 

-Dr. David Gratzer