Psychiatric Annals

EDITORIAL 

Here's to a Taste of Lemonade

Jan Fawcett, MD

Abstract

The articles in this issue of Psychiatric Annals deal with such issues as dual diagnosis, integration of treatments in dual-diagnosis patients, and model-integrated treatment systems, and address the economic benefits of the integrated treatment of substance abuse disorders.

Given the prevalence of comorbid substance abuse disorders, these articles address important issues for today's practicing clinicians. One theme that is continually sounded in these articles is the common comorbidity of drug abuse/addiction and psychiatric disorders. In such dually diagnosed patients there may be honest disagreement on the relative role of each entity in mamtaining and advancing pathology, and it may well vary from patient to patient. The issue of appropriate treatment of dualdiagnosis patients is still debated. For instance, it has been pointed out that alcohol abuse may be accompanied by depressive symptoms that remit after several months of abstinence. In other instances, treatment of comorbid depression may be necessary to help reestablish function or reduce suicide risk. The appropriate mix and coordination of treatments of dually diagnosed patients still needs improvement. Usually a depression or anxiety disorder can be treated by an individual clinician, whereas addressing a substance abuse/addiction problem requires a team approach. Integrating these approaches still remains a goal that is often not reached, to the detriment of the patient. A balanced patient-centered, rather than theory-centered, approach is important to deal with multiple patient scenarios. Models for diagnosis and integrated treatment of dually diagnosed patients are presented in this issue.

This is our last issue of 1998. With a new year approaching, I am always led to evaluate how I spent my life the past year and how I want to spend whatever precious time is allotted me over the next. The goal is to enhance life awareness, meaning, and happiness as long as health wfll allow. It's been a good year punctuated by some "tests" created by a cluster of stresses these past few months, what I would call a "Job" experience. I hope to be through these by the New Year. Whether or not this is the case, I have to remind myself that these episodes create an opportunity to test and hopefully enhance my ability to not let external storms distract me from the meaningful experiences life has to offer, the things that really matter and will continue to matter.

I am reminded of the series of short essays by Roger Bone, MD, published in JAMA a few years ago under the title "A Taste of Lemonade." Roger was trying every available treatment to stem the progression of a metastatic carcinoma that made itself known out of the blue, at the height of his career. A handsome, enormously talented, and nationally known critical care internist in his early 50s, Roger was driven to produce and did so with self-discipline that was difficult to match. Inspired by his struggle to live, this highly motivated and successful academic physician wrote several articles about his recognition of what was really important in his life. He described his acute appreciation of his loving relationships and the enjoyment of nature around him. He described this awareness with the experiential metaphor of enjoying a glass of lemonade brought to him by his wife one evening as they looked out over the river flowing by their home in the South. His message was similar to that expressed in "Tuesdays With Morrie" by Mitch Albom. Roger fought, tried every possible treatment, and made rounds on terminal cancer patients in his white coat when he was finally bald from his chemotherapy, before his body (but not his spirit) finally succumbed to his malignancy. His…

The articles in this issue of Psychiatric Annals deal with such issues as dual diagnosis, integration of treatments in dual-diagnosis patients, and model-integrated treatment systems, and address the economic benefits of the integrated treatment of substance abuse disorders.

Given the prevalence of comorbid substance abuse disorders, these articles address important issues for today's practicing clinicians. One theme that is continually sounded in these articles is the common comorbidity of drug abuse/addiction and psychiatric disorders. In such dually diagnosed patients there may be honest disagreement on the relative role of each entity in mamtaining and advancing pathology, and it may well vary from patient to patient. The issue of appropriate treatment of dualdiagnosis patients is still debated. For instance, it has been pointed out that alcohol abuse may be accompanied by depressive symptoms that remit after several months of abstinence. In other instances, treatment of comorbid depression may be necessary to help reestablish function or reduce suicide risk. The appropriate mix and coordination of treatments of dually diagnosed patients still needs improvement. Usually a depression or anxiety disorder can be treated by an individual clinician, whereas addressing a substance abuse/addiction problem requires a team approach. Integrating these approaches still remains a goal that is often not reached, to the detriment of the patient. A balanced patient-centered, rather than theory-centered, approach is important to deal with multiple patient scenarios. Models for diagnosis and integrated treatment of dually diagnosed patients are presented in this issue.

This is our last issue of 1998. With a new year approaching, I am always led to evaluate how I spent my life the past year and how I want to spend whatever precious time is allotted me over the next. The goal is to enhance life awareness, meaning, and happiness as long as health wfll allow. It's been a good year punctuated by some "tests" created by a cluster of stresses these past few months, what I would call a "Job" experience. I hope to be through these by the New Year. Whether or not this is the case, I have to remind myself that these episodes create an opportunity to test and hopefully enhance my ability to not let external storms distract me from the meaningful experiences life has to offer, the things that really matter and will continue to matter.

I am reminded of the series of short essays by Roger Bone, MD, published in JAMA a few years ago under the title "A Taste of Lemonade." Roger was trying every available treatment to stem the progression of a metastatic carcinoma that made itself known out of the blue, at the height of his career. A handsome, enormously talented, and nationally known critical care internist in his early 50s, Roger was driven to produce and did so with self-discipline that was difficult to match. Inspired by his struggle to live, this highly motivated and successful academic physician wrote several articles about his recognition of what was really important in his life. He described his acute appreciation of his loving relationships and the enjoyment of nature around him. He described this awareness with the experiential metaphor of enjoying a glass of lemonade brought to him by his wife one evening as they looked out over the river flowing by their home in the South. His message was similar to that expressed in "Tuesdays With Morrie" by Mitch Albom. Roger fought, tried every possible treatment, and made rounds on terminal cancer patients in his white coat when he was finally bald from his chemotherapy, before his body (but not his spirit) finally succumbed to his malignancy. His message, like Morrie's, is one I think of especially as a new year approaches. I try to remember the lessons of Roger and Morrie: There are important things in life to be appreciated and there are many distractions that can blunt our appreciation of the health, loving relationships, and beauty around us we are so privileged to have. Life is too transient and unpredictable to let the distractions interfere.

Enjoy the coming holiday season with your loved ones, and here's to a New Year focused on appreciating what really matters. As the Gershwin song goes, masterfully recorded by singer Shirley Home, "Here's to Life."

10.3928/0048-5713-19981201-03

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