Friday, March 23, 2018
Pre-Anorexia Nervosa & Pre-Raphaelites: A Profound Secret!
In life one should value chance encounters.
Earlier in June we spent some time with our friends in Dorchester
In a chance encounter with Andrew Lloyd Webber, Josceline Dimbleby asked him bluntly if she could go and see the portrait he had of her great-aunt, Amy Gaskell.
“Ah, that wonderful dark picture,” Andrew said. “Yes, please come……Well, I think she looks rather like you......”
“Did you know that she died young?” Josceline asked Andrew.
“Of a broken heart.”
She told Andrew that she would try to find out more. This led her to start researching into the life of Amy, her mother May and the famous Pre-Raphaelite painter Edward Burne-Jones and the result was the book A Profound Secret.
I looked at the book cover and thought the portrait reminded me of the Picasso I used for my Anorexia Blog.
Leighton House Museum 2004/Andrew Lloyd Webber
Girl in a Chemise Picasso
Tate
It is said that as a young man Picasso admired the pre-Raphaelites and Edward Burne-Jones so much that in 1900 he would have gone to London rather than Paris
“There was a hint in the book that she might well have died of Anorexia!” My hostess said.
It was a fascinating book, like good family biographies are, as long as you accept that it is not going to be as organised as fiction. A good writer helps and Josceline Dimbleby is a well established food and travel writer.
For a psychiatrist, it is especially interesting as he is allowed glimpses into the various personalities, their psychiatric problems and the resulting family dynamics, without the interference of the usual psychiatric labelling or coding. Unfortunately self medicating with alcohol, opium and other fancy substances was rife in that era and the result could often be tragic.
Indeed Josceline thought at one point in the book that Amy might have suffered from Anorexia although it was not a known condition at the time. She left it till the end of the book to let us into the final secret. You will have to find out for yourself.
Without the effect of drugs that would double the bodyweight, we have in the end one of the most beautiful portraits of the Pre-Raphaelites. Burne-Jones’ life is of course another psychiatric book: his mother died when he was six days old and many felt that all his life he was searching for the perfect mother he so missed. It is indeed ironical that the art world has been much enriched by what was essentially untreated bereavement.
Psychiatry may need to look again at what we have been doing, as we do not seem to have found another Burne-Jones.
Reference: "There had been a considerable vogue in Barcelona
........"Picasso assured me, when he was staying in London in 1950, that for him his [1900] trip to Paris was merely a halt on a journey that would take him further north to London England
Other References:
Related Posts:
The Book: The Cockroach Catcher
Read more:
NHS: The Way We Were! Free!
FREE eBook: Just drop me a line with your email.
Email: cockroachcatcher (at) gmail (dot) com.
A Brief History of Time: Anorexia Nervosa
In life one should value chance encounters.
Earlier in June we spent some time with our friends in Dorchester
In a chance encounter with Andrew Lloyd Webber, Josceline Dimbleby asked him bluntly if she could go and see the portrait he had of her great-aunt, Amy Gaskell.
“Ah, that wonderful dark picture,” Andrew said. “Yes, please come……Well, I think she looks rather like you......”
“Did you know that she died young?” Josceline asked Andrew.
“Of a broken heart.”
She told Andrew that she would try to find out more. This led her to start researching into the life of Amy, her mother May and the famous Pre-Raphaelite painter Edward Burne-Jones and the result was the book A Profound Secret.
I looked at the book cover and thought the portrait reminded me of the Picasso I used for my Anorexia Blog.
Amy Gaskell by Edward Burne-Jones
Leighton House Museum 2004/Andrew Lloyd Webber
Girl in a Chemise Picasso
Tate
It is said that as a young man Picasso admired the pre-Raphaelites and Edward Burne-Jones so much that in 1900 he would have gone to London rather than Paris
“There was a hint in the book that she might well have died of Anorexia!” My hostess said.
It was a fascinating book, like good family biographies are, as long as you accept that it is not going to be as organised as fiction. A good writer helps and Josceline Dimbleby is a well established food and travel writer.
For a psychiatrist, it is especially interesting as he is allowed glimpses into the various personalities, their psychiatric problems and the resulting family dynamics, without the interference of the usual psychiatric labelling or coding. Unfortunately self medicating with alcohol, opium and other fancy substances was rife in that era and the result could often be tragic.
Indeed Josceline thought at one point in the book that Amy might have suffered from Anorexia although it was not a known condition at the time. She left it till the end of the book to let us into the final secret. You will have to find out for yourself.
Without the effect of drugs that would double the bodyweight, we have in the end one of the most beautiful portraits of the Pre-Raphaelites. Burne-Jones’ life is of course another psychiatric book: his mother died when he was six days old and many felt that all his life he was searching for the perfect mother he so missed. It is indeed ironical that the art world has been much enriched by what was essentially untreated bereavement.
Psychiatry may need to look again at what we have been doing, as we do not seem to have found another Burne-Jones.
Reference: "There had been a considerable vogue in Barcelona
........"Picasso assured me, when he was staying in London in 1950, that for him his [1900] trip to Paris was merely a halt on a journey that would take him further north to London England
Other References:
Related Posts:
The Book: The Cockroach Catcher
Read more:
NHS: The Way We Were! Free!
FREE eBook: Just drop me a line with your email.
Email: cockroachcatcher (at) gmail (dot) com.
FREE eBook: Just drop me a line with your email.
Email: cockroachcatcher (at) gmail (dot) com.
A Brief History of Time: Anorexia Nervosa
: Yo Yo Ma
You may also want to read about Amanda.
Anorexia Nervosa Posts
May 22, 2012
She had been hospitalised for Anorexia Nervosa. She was cured. She got married. Then she had Chris. If she did not tell me, I never would have guessed she had Anorexia Nervosa. At first I did not even know how I knew
Mar 01, 2008
Jun 17, 2008
FREE eBook: Just drop me a line with your email.
Email: cockroachcatcher (at) gmail (dot) com.
Monday, March 19, 2018
Child Psychiatrist: Just doing his job!
It is Spring, despite the snow, the Oak Tree is trying:
All photos ©2014 Am Ang Zhang
Spring reminded me of my adolescent patient, it was her spring too.
Rachel
Rachel could not get to school. She was having such bad back pain. Her family doctor wrote an urgent referral. As she would not see the psychologist at school, school was considering taking mother to court.
There was a change in managing school refusal. Education Authorities suddenly turned trigger happy and all over the country parents were taken to court. I did wonder if this was due to a shortage of Educational Psychologists who were now too busy dealing with Formal Assessments as a result of the new Education Act, or whether it was due to years of public criticism of the inadequacy of the softly softly approach to the problem. There is some truth that there is a hard core of children whom no teacher really wants to see at school and the authorities are quite happy they are absent. These are children who are entitled to free meals and the hidden saving of them not attending school adds up to a pretty substantial sum. To assess them would take up precious Psychologist time and also may generate expenses in terms of ferrying these children by taxi to special tutorial units or schools.
But Rachel came from a professional family. Mother was a lawyer and father an insurance executive commuting to London
Clinical judgment is indeed a kind of “profiling”. We judge our patients from a variety of information and we “profile” them. It may not be correct but we do.
I had my suspicion that the Educational Psychologist never got to see her record to realise that she was not really the type anyone should ever dream of prosecuting.
The family doctor thought that I should be given a shot before anyone should have a go. Mother was told in no uncertain term that she needed to get Rachel to see me.
“But she was in such pain!” mother said. She did protest but in the end succumbed. With the help of a neighbour, they managed to get her to the clinic and she was lying down in our waiting area.
I had one look at Rachel, perhaps 6 ft tall, lying flat in the waiting area and asked my secretary to call an ambulance whilst I talked to the Radiology Consultant. An X-ray examination was ordered and if necessary an MRI scan.
How could I come to such a decision without even spending half a minute with mother or the patient? Was I being over dramatic? Or was it what we have been trained for? Was it why psychiatrists are trained as doctors first?
I could of course have been entirely wrong and the girl might really have been school phobic. Would I have subjected her to an unnecessary X-ray examination? Would my reputation suffer as a result?
The ambulance came. The paramedics were excellent. They treated it as potential spinal injury and transported her that way. I accompanied her onto the ambulance. You had to see her face to know you were right. She was grateful someone believed her. For me it was worth all the drama. My only wish was we were not too late that she might not be able to walk.
Mother too shook my hand as the ambulance got ready to go. I always told my juniors. “Trust them, most of the time.”
I left a message for the radiologist to call me.
The call came back from the radiologist. She had two collapsed vertebrae, a common condition among very tall children who have just had a growth spurt. The Orthopaedic Surgeon was preparing for an emergency operation.
“Good work.” The radiologist said.
I knew. He meant: “Good work for a psychiatrist, and a child psychiatrist at that.”
Some time later mother arranged to see me to tell me in detail what was done.
“She wants to thank you for believing her.”
I was just doing my job.
From another doctor:
Absolutely riveting! Brings me back to working (in NHS psychiatry) when work was really interesting! The tone is quite conversational; it is like hearing you telling stories. I ordered more copies for my family and friends.
I knew it would be very special and it sure is. To us your trainees it is like going back on the rotation to have the joy of working with you again. The difference is that l can now learn at leisure from this book. Congratulations.
The book is very well written and makes very easy and interesting reading even for the laymen. You learn a lot about the Health System, a lot about child psychiatry and a lot about the growing up and development of the author.
Fascinating account of child psychiatry cases, including some creative yet effective treatments. Anyone who is a parent or around children or really anyone at all actually will find the book surprising, entertaining, thought-provoking, funny and moving.
The book makes me realize the difficult decisions with which a doctor is so often faced, the need for him to have faith in himself and, coupled with that, the need for continued idealism and enthusiasm. These don't, of course, apply only to doctors but are particularly important for them.
Great book. I have bought one to give to my son on his birthday.
Tuesday, March 13, 2018
Photography: The Old Days!
It was a rather somber day when I gave away all the chemicals that I have accumulated over the years of dark room work. As it happened the couple that got them were both medical doctors. Hopefully they can make good use of them.
There is indeed much that modern day software can do to duplicate the work of the traditional dark room. Yet there is something magical seeing your print wet and perfect in the dark room.
I have often been asked about some of my photos:
Here are some of the technical details.
Both are taken with Nikon FM2 180/2.8 ED lens. The lens was probably the best of the hand held pre-digital lens Nikon ever produced and I still use it with my Digital Body.
Mademoiselle
Film: Kodak Tmax100 Kodak developer.
Paper: Oriental Seagull (3) FB.
Developed using diluted Kodalith Developer. Further toning using Kodak Selenium toner for enhanced tones.
Sharp-eyed photographers would notice Pan Am sign thus dating the picture.
Film: Ilford 400 developed by pushed Rodinal developer to get the sharp and huge grains.
Paper: Oriental Seagull (3) FB.
Developed using diluted Kodalith Developer. Further toning using Kodak Selenium toner for enhanced tones.
It is vital to get the sharp focusing of the grains.
Photoshop can in the quadtone mode assign different tones to different levels at will and the level adjustment will enhance what is often a gamble on Lith. Modern printers cannot quite produce the exhibition quality of good Fibre Base Paper of old.
Saturday, March 10, 2018
Bright Young Doctors & Rainbow: Answer to Prayers!
In Medicine, it is amazing what the Bright Young Doctors can offer. In my day and now!
Thirty years ago, a patient of mine was unconscious for 23 days and it was mother's belief that it was through prayer that her daughter was saved. I did not argue with her then.
The Bright Young Doctor in my days:
" A good doctor is one who is not afraid to ask for help but he must also know where to ask.
“Get me Great Ormond Street
“I already did.”
She is going to be a good doctor.
“Well, the Regional unit said that they had no beds so I thought I should ring up my classmate at GOS and she talked to her SR who said “send her in”.”
Who needs consultants when juniors have that kind of network? This girl will do well.
“Everything has been set up. The ambulance will be here in about half an hour and if it is all right I would like to go with her.”
But perhaps God works through his people in his own way. Discoveries in Medicine should therefore enhance our faith rather than the other way round.
It took nearly 30 years for the real answer to her prayers to really emerge.
©2012 Am Ang Zhang
The Bright Young Doctor now:
I was staying at our resort in Boquete and was having dinner with three friends all of them with medical connections. One was in hospital administration and one a nurse. The husband of the nurse was a pharmacist. Somehow the conversation drifted into medical topics and knowing that I am a Child Psychiatrist the pharmacist started talking about his nephew who was nearly sent to a mental institution as he suffers from catatonia and doctors eventually diagnosed schizophrenia and put him on antipsychotics. Luckily the catatonic symptom probably saved him as some bright young thing just read the book Brain On Fire and gave him the Clock Test. That led to the NMDAR antibody testing that proved positive. He responded well to the treatment regime that has been developed and is off all antipsychotic medication.
My Teratoma patient was lucky as she belong to that group that improved without further treatment once the Teratoma was removed. She eventually had a baby.
The Power of Prayers & Teratoma: Brain & NMDA!
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Anti-NMDA Receptor Encephalitis
NEW ORLEANS — A mysterious, difficult-to-diagnose, and potentially deadly disease that was only recently discovered can be controlled most effectively if treatment is started within the first month that symptoms occur, according to a new report by researchers from the Perelman School of Medicine at the University of Pennsylvania. The researchers analyzed 565 cases of this recently discovered paraneoplastic condition, called Anti-NMDA Receptor Encephalitis, and determined that if initial treatments fail, second-line therapy significantly improves outcomes compared with repeating treatments or no additional treatments (76 percent versus 55 percent). The research is being presented at the American Academy of Neurology's 64th Annual Meeting in New Orleans
565 cases! Not so rare!
The condition occurs most frequently in women (81 percent of cases), and predominately in younger people (36 percent of cases occurring in people under 18 years of age, the average age is 19). Symptoms range from psychiatric symptoms, memory issues, speech disorders, seizures, involuntary movements, to decreased levels of consciousness and breathing. Within the first month, movement disorders were more frequent in children, while memory problems and decreased breathing predominated in adults.
My patient was under 18 and presented with catatonia symptoms. She later lose consciousness and was ventilated.
"Our study establishes the first treatment guidelines for NMDA-receptor encephalitis, based on data from a large group of patients, experience using different types of treatment, and extensive long-term follow-up," said lead author Maarten Titulaer , MD , PhD, clinical research fellow in Neuro-oncology and Immunology in the Perelman School of Medicine at the University of Pennsylvania
The disease was first characterized by Penn's Josep Dalmau, MD, PhD, adjunct professor of Neurology, and David R. Lynch, MD, PhD, associate professor of Neurology and Pediatrics, in Annals of Neurology in 2007. One year later, the same investigators in collaboration with Rita Balice-Gordon, PhD, professor of Neuroscience, characterized the main syndrome and provided preliminary evidence that the antibodies have a pathogenic effect on the NR1 subunit of the NMDA receptor in the Lancet Neurology in December 2008. The disease can be diagnosed using a test developed at the University of Pennsylvania
Teratoma: finally!
In earlier reports, 59 percent of patients had tumors, most commonly ovarian teratoma, but in the latest update, 54 percent of women over 12 years had tumors, and only six percent of girls under 12 years old had ovarian teratomas. In addition, relapses were noted in 13 percent of patients, 78 percent of the relapses occurred in patients without teratomas.
As Anti-NMDA Receptor Encephalitis, the most common and best characterized antibody-mediated encephalitis, becomes better understood, quicker diagnosis and early treatment can improve outcomes for this severe disease.
The study was presented in a plenary session on Wednesday, April 25, 2012 ET at 9:35 AM at the American Academy of Neurology's annual meeting.
[PL01.001] Clinical Features, Treatment, and Outcome of 500 Patients with Anti-NMDA Receptor Encephalitis
Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies
Of 100 patients with anti-NMDA-receptor encephalitis, a disorder that associates with antibodies against the NR1 subunit of the receptor, many were initially seen by psychiatrists or admitted to psychiatric centres but subsequently developed seizures, decline of consciousness, and complex symptoms requiring multidisciplinary care. While poorly responsive or in a catatonic-like state, 93 patients developed hypoventilation, autonomic imbalance, or abnormal movements, all overlapping in 52 patients. 59% of patients had a tumour, most commonly ovarian teratoma. Despite the severity of the disorder, 75 patients recovered and 25 had severe deficits or died.
Related paper:
Anti-NMDA Receptor Encephalitis: Diagnosis, Psychiatric Presentation, and Treatment
I remember my early days of psychiatry in a mental hospital in
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