Saturday, June 12, 2010
Friday, June 11, 2010
Simplify, Simplify
I will ponder color and design over the weekend, but here I must recommend a recent David Brooks column stoutly defending the liberal arts in education. Eschewing grand but airy pronouncements (of the kind frequently found on this blog), Brooks argued that the study of history, literature, and other domains creakily termed "the humanities" gives unique insight into "The Big Shaggy," his term for the deeply complex and wayward aspects of human nature that escape systematizing theories, whether biological, political, or otherwise ideological ("The Big Shaggy" isn't the term I would have chosen, but Brooks is writing for the New York Times, while I'm writing here).
His column nicely encapsulated what I've stood for in life and fought for in my years of clinical work, that is, resistance to the dumbing-down of human experience that is often found in diagnostic systems and, well, simple-minded approaches to minds that, rightly considered, are infinitely complicated. And yet I found myself contrasting that truth with a recent Jon Stewart routine in which he showed multiple clips of Barack Obama, with respect to situations like the gulf oil spill, health care, and the economy, pronouncing again and again to reporters, "It's complicated." Stewart followed this up with appalled exasperation: "Well simplify it!"
This usefully reminds me that human beings, while capable of appreciating complexity (to varying degrees) are alike in needing, especially in times of crisis, forceful and dramatic metaphors that are, yes, simple. So when I am tempted to disdain such words as "depression" or, even worse, "chemical imbalance," that seem to obscure a wealth of nuance with a kind of advertising slogan, I need to remember that such terms help to orient people. While a minority of folks--those who seek out psychoanalysts and English doctorates--may revel in boundless complication, most people are not wired that way. That is not to say that they're stupid or simple-minded; they merely crave contrast and direction. Leadership, whether political or clinical, is about providing these things; by breaking things down into basics, it risks dumbing-down, but the alternative risk is endless equivocation.
It seems to me that the art of medicine, like the art of life, is steering a path between over-simplification and over-complication, making use of metaphors without becoming trapped by them. Indeed, isn't language itself a kind of over-simplification inasmuch as it reduces, to paraphrase William James, the blooming, buzzing confusion of experience to a finite number of limited words? We can only grasp reality by making a narrative out of it, a narrative that necessarily distorts the stuff of experience. Just as we charge Barack Obama with constructing a narrative of the gulf oil spill that usefully but modestly apportions responsibility and possible avenues of action, we would charge a psychiatrist with drawing up a diagnostic and therapeutic narrative that is respectful of its own limitations. Whenever one tells oneself, "It's complicated," one should inwardly reply, "Simplify, simplify," and vice versa.
His column nicely encapsulated what I've stood for in life and fought for in my years of clinical work, that is, resistance to the dumbing-down of human experience that is often found in diagnostic systems and, well, simple-minded approaches to minds that, rightly considered, are infinitely complicated. And yet I found myself contrasting that truth with a recent Jon Stewart routine in which he showed multiple clips of Barack Obama, with respect to situations like the gulf oil spill, health care, and the economy, pronouncing again and again to reporters, "It's complicated." Stewart followed this up with appalled exasperation: "Well simplify it!"
This usefully reminds me that human beings, while capable of appreciating complexity (to varying degrees) are alike in needing, especially in times of crisis, forceful and dramatic metaphors that are, yes, simple. So when I am tempted to disdain such words as "depression" or, even worse, "chemical imbalance," that seem to obscure a wealth of nuance with a kind of advertising slogan, I need to remember that such terms help to orient people. While a minority of folks--those who seek out psychoanalysts and English doctorates--may revel in boundless complication, most people are not wired that way. That is not to say that they're stupid or simple-minded; they merely crave contrast and direction. Leadership, whether political or clinical, is about providing these things; by breaking things down into basics, it risks dumbing-down, but the alternative risk is endless equivocation.
It seems to me that the art of medicine, like the art of life, is steering a path between over-simplification and over-complication, making use of metaphors without becoming trapped by them. Indeed, isn't language itself a kind of over-simplification inasmuch as it reduces, to paraphrase William James, the blooming, buzzing confusion of experience to a finite number of limited words? We can only grasp reality by making a narrative out of it, a narrative that necessarily distorts the stuff of experience. Just as we charge Barack Obama with constructing a narrative of the gulf oil spill that usefully but modestly apportions responsibility and possible avenues of action, we would charge a psychiatrist with drawing up a diagnostic and therapeutic narrative that is respectful of its own limitations. Whenever one tells oneself, "It's complicated," one should inwardly reply, "Simplify, simplify," and vice versa.
Wednesday, June 9, 2010
Happy 100?
I haven't indulged in blogging about blogging for a long time, but I will allow myself this now that Blue to Blue has inched its way to 100 posts over 11 months. However, while I have retained a few core readers (thank you!), overall the readership as reflected in both hits and comments has been smaller than in my first blog Ars Psychiatrica. Reasons?
1. I haven't been as prolific, either in frequency or ambition of posts; it has simply been a more desultory blog overall. For various reasons I haven't devoted the time and energy that I often did last year. However, some Blue to Blue posts have been, I think, every bit as decent as many in the parent blog.
2. While I would hope that most people would visit this sort of blog primarily for textual content, the cool pictures and quotes that often adorned my previous blog have generally been lacking here. All else being equal, people like pictures.
3. Considering style further, I think that the title Ars Psychiatrica, while a bit pedantic, also usefully named the blog's niche in a way that the more inscrutable "Blue to Blue" does not. Also, the midnight blue template, while appealing to me at first, has grown a bit oppressive (or maybe I'm just bored with it).
4. I haven't been as active in reading and commenting on other blogs as I used to be, which affects readership.
5. As Facebook, Twitter, etc. have continued to grow and offer further distractions, maybe fewer people take time for blogs than used to be the case. (?)
6. As compared to its predecessor blog, probably fewer posts here have offered anything like mainstream commentary on psychiatry (again, the niche is less defined).
7. Perhaps the Novalis brand, so to speak, has grown a bit stale. Just as some claim that writers tend to write the same book over and over again, one does tend to revisit the same issues, although hopefully in a spiral more than a circular fashion (theme with variations).
8. In any event, I find myself at another cusp of choosing whether to give up blogging altogether or, on the contrary, to shift gears again and approach things from a different angle. As compared to the past year, I am in a position to devote more attention to writing if desired. I have even considered returning to Ars Psychiatrica (2.0 perhaps), declaring Blue to Blue a finally unsatisfactory detour. Or perhaps I will undertake something else altogether.
1. I haven't been as prolific, either in frequency or ambition of posts; it has simply been a more desultory blog overall. For various reasons I haven't devoted the time and energy that I often did last year. However, some Blue to Blue posts have been, I think, every bit as decent as many in the parent blog.
2. While I would hope that most people would visit this sort of blog primarily for textual content, the cool pictures and quotes that often adorned my previous blog have generally been lacking here. All else being equal, people like pictures.
3. Considering style further, I think that the title Ars Psychiatrica, while a bit pedantic, also usefully named the blog's niche in a way that the more inscrutable "Blue to Blue" does not. Also, the midnight blue template, while appealing to me at first, has grown a bit oppressive (or maybe I'm just bored with it).
4. I haven't been as active in reading and commenting on other blogs as I used to be, which affects readership.
5. As Facebook, Twitter, etc. have continued to grow and offer further distractions, maybe fewer people take time for blogs than used to be the case. (?)
6. As compared to its predecessor blog, probably fewer posts here have offered anything like mainstream commentary on psychiatry (again, the niche is less defined).
7. Perhaps the Novalis brand, so to speak, has grown a bit stale. Just as some claim that writers tend to write the same book over and over again, one does tend to revisit the same issues, although hopefully in a spiral more than a circular fashion (theme with variations).
8. In any event, I find myself at another cusp of choosing whether to give up blogging altogether or, on the contrary, to shift gears again and approach things from a different angle. As compared to the past year, I am in a position to devote more attention to writing if desired. I have even considered returning to Ars Psychiatrica (2.0 perhaps), declaring Blue to Blue a finally unsatisfactory detour. Or perhaps I will undertake something else altogether.
Monday, June 7, 2010
On the Perpetuation of Species
Spanning the gamut of online wisdom, advice columnist Carolyn Hax and philosopher Peter Singer weigh in on the advisability of adding to the sum total of humanity. I've long been curious about the ways in which people choose (when they do have a choice, which they usually do) whether or not to have children.
Hax, responding to a letter-writer who asks if her anxiety disorder may be too severe for her to attempt parenthood, replies, in effect, that wanting to be a parent is no justification for becoming one. She advises the inquirer to consider, in light of her own knowledge of what it is to be a child, whether she would want herself as a parent. How drastically different human history would be if this were a precept that were followed with any consistency! Isn't the presumption of fitness for parenthood pretty much wired into the human organism? Indeed, it may be only the seriously depressed or demoralized, like the letter-writer in this instance, who even consciously consider the matter (which isn't to say that most people who choose not to have children do so for reasons of pathology).
Singer reminds us that creating a child is, of course, a portentous act of either good or ill. He alludes to recent philosophical writing that argues that, well, life often isn't the unqualified good we take it to be (I envision The Onion article: "Philosophers discover that life isn't worth living."). And all joking aside, one does occasionally encounter lives that are so chock full of misery and degradation that, really, not only the moral universe as a whole, but also the possessors of the lives in question, would seem to have been better without them.
Half tongue-in-cheek, Singer wonders whether it would be reprehensible for the species to decide that we will in fact be the final generation. After all, there is no categorical duty to procreate; we do not hold the childless to be guilty of some existential failure or infraction. We cannot be held to have a responsibility for vague beings of the future who may or may not exist; we have duties toward the living, that is all. And yet...one could argue that the presumption of a future for humanity, even if one does not have biological children oneself, is so deeply ingrained in the human organism that the horror of apocalypse far exceeds one's own demise. The future of humanity is not an obligation, but it is a hope, or perhaps a faith.
If one were to genuinely doubt the chance for a worthwhile life of one's offspring, then one would implicitly have to question one's own as well. I am surprised that Singer didn't mention The Children of Men, the movie a few years back that showed the depression and desperation of a world without reproduction. Arguably the final generation, whenever its grim day may come, whether in years or in millenia, will be the saddest one of all.
Hax, responding to a letter-writer who asks if her anxiety disorder may be too severe for her to attempt parenthood, replies, in effect, that wanting to be a parent is no justification for becoming one. She advises the inquirer to consider, in light of her own knowledge of what it is to be a child, whether she would want herself as a parent. How drastically different human history would be if this were a precept that were followed with any consistency! Isn't the presumption of fitness for parenthood pretty much wired into the human organism? Indeed, it may be only the seriously depressed or demoralized, like the letter-writer in this instance, who even consciously consider the matter (which isn't to say that most people who choose not to have children do so for reasons of pathology).
Singer reminds us that creating a child is, of course, a portentous act of either good or ill. He alludes to recent philosophical writing that argues that, well, life often isn't the unqualified good we take it to be (I envision The Onion article: "Philosophers discover that life isn't worth living."). And all joking aside, one does occasionally encounter lives that are so chock full of misery and degradation that, really, not only the moral universe as a whole, but also the possessors of the lives in question, would seem to have been better without them.
Half tongue-in-cheek, Singer wonders whether it would be reprehensible for the species to decide that we will in fact be the final generation. After all, there is no categorical duty to procreate; we do not hold the childless to be guilty of some existential failure or infraction. We cannot be held to have a responsibility for vague beings of the future who may or may not exist; we have duties toward the living, that is all. And yet...one could argue that the presumption of a future for humanity, even if one does not have biological children oneself, is so deeply ingrained in the human organism that the horror of apocalypse far exceeds one's own demise. The future of humanity is not an obligation, but it is a hope, or perhaps a faith.
If one were to genuinely doubt the chance for a worthwhile life of one's offspring, then one would implicitly have to question one's own as well. I am surprised that Singer didn't mention The Children of Men, the movie a few years back that showed the depression and desperation of a world without reproduction. Arguably the final generation, whenever its grim day may come, whether in years or in millenia, will be the saddest one of all.
Maxim
A nice poem by Carl Dennis (already online at The New Yorker website):
To live each day as if it might be the last
Is an injunction that Marcus Aurelius
Inscribes in his journal to remind himself
That he, too, however privileged, is mortal,
That whatever bounty is destined to reach him
Has reached him already, many times.
But if you take his maxim too literally
And devote your mornings to tinkering with your will,
Your afternoons and evenings to saying farewell
To friends and family, you'll come to regret it.
Soon your lawyer won't fit you into his schedule.
Soon your dear ones will hide in a closet
When they hear your heavy step on the porch.
And then your house will slide into disrepair.
If this is my last day, you'll say to yourself,
Why waste time sealing drafts in the window frames
Or cleaning gutters or patching the driveway?
If you don't want your heirs to curse the day
You first opened Marcus's journals,
Take him simply to mean you should find an hour
Each day to pay a debt or forgive one,
Or write a letter of thanks or apology.
No shame in leaving behind some evidence
You were hoping to live beyond the moment,
No shame in a ticket to a concert seven months off,
Or, better yet, two tickets, as if you were hoping
To meet by then someone who'd love to join you,
Two seats near the front so you catch each note.
A Maxim
To live each day as if it might be the last
Is an injunction that Marcus Aurelius
Inscribes in his journal to remind himself
That he, too, however privileged, is mortal,
That whatever bounty is destined to reach him
Has reached him already, many times.
But if you take his maxim too literally
And devote your mornings to tinkering with your will,
Your afternoons and evenings to saying farewell
To friends and family, you'll come to regret it.
Soon your lawyer won't fit you into his schedule.
Soon your dear ones will hide in a closet
When they hear your heavy step on the porch.
And then your house will slide into disrepair.
If this is my last day, you'll say to yourself,
Why waste time sealing drafts in the window frames
Or cleaning gutters or patching the driveway?
If you don't want your heirs to curse the day
You first opened Marcus's journals,
Take him simply to mean you should find an hour
Each day to pay a debt or forgive one,
Or write a letter of thanks or apology.
No shame in leaving behind some evidence
You were hoping to live beyond the moment,
No shame in a ticket to a concert seven months off,
Or, better yet, two tickets, as if you were hoping
To meet by then someone who'd love to join you,
Two seats near the front so you catch each note.
Saturday, May 29, 2010
Really?
"Fortunately analysis is not the only way to resolve inner conflicts. Life itself still remains a very effective therapist."
Karen Horney
Alan Schatzberg, M.D., outgoing president of the APA, has presented a solution for what he sees as a major problem besetting the DSM-5 process, that is, excessive coziness with the common folk and their darned opinions:
"One thing we ought to consider is using more technical language. Our cardiology colleagues don't talk about heart attacks but use the term myocardial infarction. Hematologists are not attacked for including leukemia in their nomenclature, and they wouldn't think of giving it up for "way too many white cells disorder" (WTMWCD)! Why shouldn't we follow their lead? To my view, bulimia would be a better term than binge eating disorder. The latter was attacked by a prominent psychiatric critic as suggesting he could be diagnosed with the disorder after a heavy Thanksgiving dinner. Our language should indicate the severity of the possible impairment. Simiarly, temper dysregulation in children sounds too much like temper tantrums. They are not the same, but the use of the language is problematic. We need to be more serious about our terminology. In the end, we will get it right."
Yes, this is what ails contemporary psychiatry, the lack of abstruse terminology that will mystify and impress the hoi polloi (which wouldn't be a bad term for a mental disorder, come to think of it). Time to haul out the Latin and German dictionaries. American psychiatry's cardinal sin has been false modesty, and an unwillingness to stick its fingers into as many pies as possible. We need to be more aggressive in educating the purblind populace about the grave severity of their mental states, crying out for the local psychiatrist. We need to exaggerate the degree of our actual knowledge, for the good of our patients of course.
What is noteworthy about myocardial infarction, though, and countless other terms from other disciplines, is the useful work that the names do in indicating specific and potentially modifiable pathophysiology (in this case, the death of cardiac muscle cells). Unfortunately it's hard to think of a single psychiatric diagnostic term that has that level of specificity. Are neurologists wringing their hands over the term stroke, which seems to enjoy both wide general use and a meaningful clinical designation?
This sounds like the kind of throat-clearing that might lead a psychiatrist to wear a white coat, which is about as useful on a shrink as it is on an accountant. Not really, of course, as perhaps a white coat would helpfully accentuate the placebo effect, as would the casual use of dumbfounding (if insignificant) expressions like amygdalar aberration, or hippocampal ischemia, or limbic encephalopathy. (Unless the patient starts laughing). Yes, melancholia sounds way cooler than depression, but apart from those of us who enjoy cool words, what would the former accomplish beyond self-importance?
Karen Horney
Alan Schatzberg, M.D., outgoing president of the APA, has presented a solution for what he sees as a major problem besetting the DSM-5 process, that is, excessive coziness with the common folk and their darned opinions:
"One thing we ought to consider is using more technical language. Our cardiology colleagues don't talk about heart attacks but use the term myocardial infarction. Hematologists are not attacked for including leukemia in their nomenclature, and they wouldn't think of giving it up for "way too many white cells disorder" (WTMWCD)! Why shouldn't we follow their lead? To my view, bulimia would be a better term than binge eating disorder. The latter was attacked by a prominent psychiatric critic as suggesting he could be diagnosed with the disorder after a heavy Thanksgiving dinner. Our language should indicate the severity of the possible impairment. Simiarly, temper dysregulation in children sounds too much like temper tantrums. They are not the same, but the use of the language is problematic. We need to be more serious about our terminology. In the end, we will get it right."
Yes, this is what ails contemporary psychiatry, the lack of abstruse terminology that will mystify and impress the hoi polloi (which wouldn't be a bad term for a mental disorder, come to think of it). Time to haul out the Latin and German dictionaries. American psychiatry's cardinal sin has been false modesty, and an unwillingness to stick its fingers into as many pies as possible. We need to be more aggressive in educating the purblind populace about the grave severity of their mental states, crying out for the local psychiatrist. We need to exaggerate the degree of our actual knowledge, for the good of our patients of course.
What is noteworthy about myocardial infarction, though, and countless other terms from other disciplines, is the useful work that the names do in indicating specific and potentially modifiable pathophysiology (in this case, the death of cardiac muscle cells). Unfortunately it's hard to think of a single psychiatric diagnostic term that has that level of specificity. Are neurologists wringing their hands over the term stroke, which seems to enjoy both wide general use and a meaningful clinical designation?
This sounds like the kind of throat-clearing that might lead a psychiatrist to wear a white coat, which is about as useful on a shrink as it is on an accountant. Not really, of course, as perhaps a white coat would helpfully accentuate the placebo effect, as would the casual use of dumbfounding (if insignificant) expressions like amygdalar aberration, or hippocampal ischemia, or limbic encephalopathy. (Unless the patient starts laughing). Yes, melancholia sounds way cooler than depression, but apart from those of us who enjoy cool words, what would the former accomplish beyond self-importance?
Friday, May 28, 2010
The Unnameable
After almost twenty years in my mind, the syllabic cornucopia of psychotropic drug names has made its case for a celebratory post. What has taken so long? And would I want the job of coming up with a moniker for Lilly's next miracle?
I considered a top ten list, but let us consider them by class:
1. Antidepressants: The meat and potatoes of psychiatry, these names are sure to be written with hand-numbing repetition, so it is a good thing that for the most part these drugs are happily named. A linguistic and pharmaceutical titan, Prozac is an arresting amalgam of the soothing, almost soporific Proz- followed by the hard "ack" that provokes comparison with another very popular drug of the 1980's. As the drug itself is meant to do, the name both calms and enlivens.
Zoloft and Paxil, completing the original SSRI trifecta, are also remarkably mellifluous names, although the former's buoyancy wafts dangerously close to corniness. Paxil follows flattery of Latinate pedantry (Latin pax=peace) with the relaxing -il evoking dutiful memories of Elavil, grandaddy of them all.
After these, antidepressant inspiration was spent in both chemistry and name. Celexa, its knock-off Lexapro, and Luvox? Not memorable. Effexor showed a lack of subtlety (Get it, "affects her," the majority of depressed patients being women?), regrettably dubbed "Ineffexor" when failing to work or causing dismaying withdrawal symptoms. Wellbutrin is a name simply rebarbative and without redeeming qualities, and it has been painful to hear a few concretely-minded patients over the years refer to it dismissively as "Badbutrin," which is a crime against both wit and alliteration.
2. Anxiolytics: It is a shame that Librium, lifted whole from a pleasing state of balance, did not prevail as a popular benzodiazepine. Similarly, Valium, connoting valiant equanimity, has largely fallen by the wayside. Instead we have Klonopin, which brings to my mind some kind of blunt instrument; Ativan, which seems to me a very gray sort of word, summoning nothing whatsoever; and the always suspect Xanax, whose pernicious influence may draw somewhat from its palindromic potency. A drug used for panic attacks should not end in -ax. But then again, I have heard that the color red, which tends to make people feel agitated and uncomfortable, sells best in grocery stores. Appropriately an afterthought, Buspar is a drug that eminently deserves its lame designation.
3. Mood-stabilizers: With the exception of lithium, which enjoys the elegant purity of being plucked right from the periodic table, the third lightest element in the universe, this group is composed of referential failures. Depakote. Tegretol. Lamictal. Whatever their pharmacological effects (which may be considerable), these names do not inspire confidence, and can be the insult on top of the injury of a diagnosis of bipolar disorder.
4. Antipsychotics: The hoary first generation of "major tranquilizers" could not be topped in dignity. Thorazine summons a compound of Nordic power with neuropsychiatric precision, a hammer brought down with pinpoint accuracy. Haldol conveys both majesty and trustworthiness, as of a respected elder. Navane is a name both implacable and imperious, sounding as if it should have been given by injection only. The contemporary offspring suffer from a failure of ingenuity. While Seroquel suggests a certain sophistication, Risperdal and Geodon are vaguely boorish in tone, while Abilify is simply an embarrassment. The unfortunate progeny of ability and fortify, it is a name that can't be taken seriously, which is a shame, because it isn't at all a bad drug. "Have you ever taken Abilify?" is a bit like asking, "Have you ever drunk Kool-Aid?" Please.
5. Stimulants: Provigil is sort of cool, evoking the steadily tenacious all-nighter, but maybe a bit too ominously. Compared to Ritalin, which is vaguely reassuring but forgettable, Adderall was a triumph of shameless audacity. The name is a naked directive: add this drug to all the patients you can, period. Why simplify or streamline your life when you can, in fact, add more? Add what? Adderall! You can have it all. At this point we are beyond subtlety, the closest possible thing to the drug name "Takethis."
A note on generics: Chemical drug names, with very few outliers, are infelicitous and afford little pleasure, except to the most self-righteous who refuse to pay their respects to brand names. Fluoxetine, carbamazepine, and thiothixene are flashbacks from Organic Chemistry. The only exceptions would be haloperidol and valproic acid, which are stimulatingly, sinisterly(?) decadent, sounding akin to something like absinthe.
In the world of medication management, we take our gratification where we can. (Note: this spoof concerns names and not the medical value of any of the medications mentioned. Ask your doctor).
I considered a top ten list, but let us consider them by class:
1. Antidepressants: The meat and potatoes of psychiatry, these names are sure to be written with hand-numbing repetition, so it is a good thing that for the most part these drugs are happily named. A linguistic and pharmaceutical titan, Prozac is an arresting amalgam of the soothing, almost soporific Proz- followed by the hard "ack" that provokes comparison with another very popular drug of the 1980's. As the drug itself is meant to do, the name both calms and enlivens.
Zoloft and Paxil, completing the original SSRI trifecta, are also remarkably mellifluous names, although the former's buoyancy wafts dangerously close to corniness. Paxil follows flattery of Latinate pedantry (Latin pax=peace) with the relaxing -il evoking dutiful memories of Elavil, grandaddy of them all.
After these, antidepressant inspiration was spent in both chemistry and name. Celexa, its knock-off Lexapro, and Luvox? Not memorable. Effexor showed a lack of subtlety (Get it, "affects her," the majority of depressed patients being women?), regrettably dubbed "Ineffexor" when failing to work or causing dismaying withdrawal symptoms. Wellbutrin is a name simply rebarbative and without redeeming qualities, and it has been painful to hear a few concretely-minded patients over the years refer to it dismissively as "Badbutrin," which is a crime against both wit and alliteration.
2. Anxiolytics: It is a shame that Librium, lifted whole from a pleasing state of balance, did not prevail as a popular benzodiazepine. Similarly, Valium, connoting valiant equanimity, has largely fallen by the wayside. Instead we have Klonopin, which brings to my mind some kind of blunt instrument; Ativan, which seems to me a very gray sort of word, summoning nothing whatsoever; and the always suspect Xanax, whose pernicious influence may draw somewhat from its palindromic potency. A drug used for panic attacks should not end in -ax. But then again, I have heard that the color red, which tends to make people feel agitated and uncomfortable, sells best in grocery stores. Appropriately an afterthought, Buspar is a drug that eminently deserves its lame designation.
3. Mood-stabilizers: With the exception of lithium, which enjoys the elegant purity of being plucked right from the periodic table, the third lightest element in the universe, this group is composed of referential failures. Depakote. Tegretol. Lamictal. Whatever their pharmacological effects (which may be considerable), these names do not inspire confidence, and can be the insult on top of the injury of a diagnosis of bipolar disorder.
4. Antipsychotics: The hoary first generation of "major tranquilizers" could not be topped in dignity. Thorazine summons a compound of Nordic power with neuropsychiatric precision, a hammer brought down with pinpoint accuracy. Haldol conveys both majesty and trustworthiness, as of a respected elder. Navane is a name both implacable and imperious, sounding as if it should have been given by injection only. The contemporary offspring suffer from a failure of ingenuity. While Seroquel suggests a certain sophistication, Risperdal and Geodon are vaguely boorish in tone, while Abilify is simply an embarrassment. The unfortunate progeny of ability and fortify, it is a name that can't be taken seriously, which is a shame, because it isn't at all a bad drug. "Have you ever taken Abilify?" is a bit like asking, "Have you ever drunk Kool-Aid?" Please.
5. Stimulants: Provigil is sort of cool, evoking the steadily tenacious all-nighter, but maybe a bit too ominously. Compared to Ritalin, which is vaguely reassuring but forgettable, Adderall was a triumph of shameless audacity. The name is a naked directive: add this drug to all the patients you can, period. Why simplify or streamline your life when you can, in fact, add more? Add what? Adderall! You can have it all. At this point we are beyond subtlety, the closest possible thing to the drug name "Takethis."
A note on generics: Chemical drug names, with very few outliers, are infelicitous and afford little pleasure, except to the most self-righteous who refuse to pay their respects to brand names. Fluoxetine, carbamazepine, and thiothixene are flashbacks from Organic Chemistry. The only exceptions would be haloperidol and valproic acid, which are stimulatingly, sinisterly(?) decadent, sounding akin to something like absinthe.
In the world of medication management, we take our gratification where we can. (Note: this spoof concerns names and not the medical value of any of the medications mentioned. Ask your doctor).
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