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Guy Kawasaki recently worked with us to ink a humorous spoof "How to Tell If Your Boss is Crazy" and just posted it on his blog with the full text on the American Express Open Forum. We used the DSM-IV criteria for Narcissistic Personality Disorder, Paranoid Personality Disorder, Obsessive-Compulsive Personality Disorder, and Anti-Social Personality Disorder to play off popular sterotypes of problematic managers. We originally pitched an idea to Guy on psychoanalyzing Steve Jobs, but his comment was on that plan was merely "not interested."

Guy has a bunch of really cool materials out there including a whole bunch of books, a new blog network called Alltop, and of lots of inspirational speaking about early stage technology companies including my all-time favorite from TIECon 2006, below.

For people who encounter mental health issues, a perennial question must be answered, namely 'should I think about meds or psychotherapy.' Often, that question is answered for them based on which type of health care provider they see such as a psychologist or therapist vs. a psychiatrist or internist. At Mindsite, we hope to provide tools and features going forward that better educate people about what is best for them when making this critical decision.

Recently, a new study published in the Archives of General Psychiatry found that for people who seek help from a psychiatrist, the emphasis on medication is increasing. Denise Gellene from the LA Times reports that this trend may be driven by insurance reimbursement:

Psychiatrists who said they provided psychotherapy to all of their patients declined to 10.8% in 2004-2005 from 19.1% in 1996-1997, according to the report. Consistent with previous studies, researchers found that patients who paid out-of-pocket, generally the wealthiest patient group, were more likely to receive psychotherapy.

Financial incentives were weighted against psychotherapy, the report said. Reimbursement for a 45- to 50-minute outpatient psychotherapy session was 40.9% lower than reimbursement for three 15-minute medication management visits, the report said, citing a 2003 study. Anticipated changes in Medicare reimbursement are expected to bring payments into closer balance, experts said.

Another interesting section from the article noted:

The report found evidence of a cultural preference for psychotherapy in the Northeast, which Olfson said might be attributable to the influence of Yale University School of Medicine and the University of Pennsylvania School of Medicine, whose faculties are strong proponents of psychotherapy.

Has anyone seen The Dark Knight? We were thinking of checking it out this week. Looks like a solid review on Rotten Tomatoes. Interesting excerpt including DSM-IV references from another review on TimeOut Chicago:

Nolan’s sequel to 2005’s Batman Begins internalizes the schism between serious aims and summer-movie duties. The problem isn’t the admittedly jaw-dropping Sturm und Drang—this is Batman, not Bergman—but how the pummeling action rarely informs the psychological angst. Still wrestling with a DSM-IV’s worth of disorders, the Caped Crusader (Bale) now has to contend with Harvey Dent (Eckhart), a district attorney with a transformative face-lift coming his way, and the Joker (Ledger). Thankfully, an origin story isn’t offered for the grinning archnemesis; he simply appears like the Ebola virus, armed with an appetite for destruction and John Wayne Gacy’s makeup manual. What the late actor accomplishes with little more than a nurse uniform and a Groucho Marx waddle makes the various set pieces—never mind Bale’s raspy, remote characterization—pale in comparison.

This week, there are two very interesting stories posted on Mindsite that I'd like to highlight. The first story is from User 99 who inks "Depression, Meditation and Chi - perhaps not a good cocktail." The author starts by explaining that:

"I am 32, and have suffered from major depression since age 20. It has not ruined my life, but nothing has ever been the same. I believe Zen meditation and various Chi Gung exercises made things worse near the start, and I'm wondering if anybody else has experienced this."

User 99 goes on to write about the overlap between their spritual practice and a worsening depressive episode. Ultimately the author finds that Zoloft is an effective antidepressant for them and concludes:

"Somebody experiencing the first symptoms of depression while meditating might find their diagnosis camoflauged, or be dissuaded from taking drugs or going to therapy, because of a belief that they just need to "work through it." Therefore, for me it's sort of moot whether meditation actually contributed to the *onset* of my depression or not - because the bigger problem was that it delayed diagnosis. And that I had the poor judgment to keep these problems secret for too long."

In another story, User 240 writes about a personal battle with alcohol in "Stopping drinking with the assistance of AA" detailing some frustration and elation with the AA program, which was ultimately successful in helping them cope with their condition.

"I spent many years drinking from age 15 to age 38. There were many days where I told myself 'never again' but invariably, later that day, I'd have my first of several/many beers. While much of my drinking felt social in nature, it was always quite different than what I saw other people doing. I never understood how they could just stop at 1 or 2 drinks. I always wanted #3 and #4, 5 and 6 always seemed like even better ideas. Calling it a night was always a drag for me.

My drinking ended after a final binge -- I woke up sitting in the driver's seat of my car. That day was pretty much of a blur. Had to call in sick, and then just walked around slightly disoriented/depressed, asking myself why I was doing what I was doing. I knew that my drinking had progressed to a point where I know 'craved' drinking, and I couldn't stop -- in fact, many days I'd lie to myself and say I'd just have 1 or 2 and then see myself slip to 3 and 4 and then consume 12+ on my own. I also saw more time drinking alone."

We don't have a bias at Mindsite about influencing the direction of any diagnostic or treatment related discussion - in time, we hope to objectively add to the discussion of what does and doesn't work for treating or coping with common mental health issues like these. If you have experience in any diagnostic group, help us work to figure it out by sharing your story and joining our community!

Finally, we are actively adding additional features as we type. Let us know what you want to see at feedback AT mindsite.com. Thanks!

We are finally out of the initial Mindsite soft launch! Matt Kenison, Director of Engineering, flipped the switch over this last weekend and took us live with some substantial improvements to our platform. We've incorporated quite a bit of feedback from friends of Mindsite over the last 2 months and we hope that this new version of the site solves a number of problems associated with our prior release. In addition to ditching our previously pouty stock photography on the homepage, noteworthy updates include:

• New diagnostic surveys. We've added diagnostics surveys for Posttraumatic Stress Disorder (PTSD), Alcohol abuse and dependence, and a number of substance abuse surveys (see the full list). PTSD was a particularly difficult survey to implement and lead product manager Joshua Walker made a heroic effort wrestling with the complicated algorithms necessary to support this diagnosis. We hope that the PTSD feature will be helpful to anyone, worldwide, wondering if they meet the criteria for this increasingly common mental health condition given the chaotic state of the world. In time we hope to support more than just an English version of the survey…
• Question and Answer. With little effort you can now ask a quick question to the Mindsite community as well as help other Mindsite users by answering their questions. We’ll be improving this feature in the future so please pipe up with any further recommendations.
• New information architecture and design. Navigation and interaction on Mindsite is now based around specific mental health conditions. In our prior release, users liked our diagnostic surveys but found the site very confusing in terms of community participation. Hopefully, the new format will make interacting with Mindsite easier, leading to better information about strategies for treating and coping with various mental health issues. Moreover, we have a cleaner user interface and design in place now.

We are moving to a more frequent release schedule now that we have shipped our v2. If you have any ideas for how we can improve the site, please let us know in the comments, or send us a note at feedback AT mindsite.com. Thanks.