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shannendoherty-fans · 3 years

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People, November 9, 1992

Nobody's Pussycat

By Tom Gliatto. Photos by Neal Preston.

Ever Outspoken, Shannen Doherty Defends Family Values, Her Turf on Beverly Hills, 90210—and Her Rowdy Reputation in Hollywood.

THERE ARE TWO ISSUES TO BE CLEARED UP HERE. Both of them are dear to the heart of Shannen Doherty, 21-year-old star of Fox's Beverly Hills, 90210, the Aaron Spelling high school hit that is now in its third season, one in which Doherty's character, Brenda Walsh—who might be described as Gidget with attitude—will break up with that lean-hipped rebel, Dylan (Luke Perry). First issue: Why has Doherty—alone among 90210 costars and teen idols Perry, Jason Priestley, Jennie Garth, Tori Spelling, Ian Ziering, Gabrielle Carteris and Brian Austin Green—come to be regarded as "difficult"? Like, is she, in contrast to the feisty but fairly civilized Brenda, one of those women who rhyme with rich? Is she, as the tabloids have gleefully reported, impossible on the set? Is she a prima donna? Also: After hours, does she party too much? And where was she being driven, in those recent tabloid photos, by rapper Marky Mark?

Second issue: What has become of the youngest of her dogs, a rottweiler named Jake? Doherty has arrived home, at her three-bedroom house in Beverly Hills, expecting to find golden retriever Sally gone (her dad was going to slop by to take her to the vet's), but now only black Lab Penelope is here to greet her. And why is there blood around the hack patio? Unnerved, Doherty phones her parents. No luck. She calls the vet. Gets the machine. Perhaps this is not the ideal moment for Doherty to sit down with a visitor and size up that delicate first issue. She chooses an armless chair in the living room and takes out a cigarette. She smiles, but it is not a happy smile, and her fingers shake as the match reaches the cigarette. "Yeah," she says, exhaling smoke with her sigh, "you've really caught me on a good day."

"People think I'm a bitch," she says with a shrug. "There was a group of four girls at Torrance High, when; we film the show, and they walked by and said, 'Oh, what a bitch!' You can walk away from that, but you really want to turn around and say, 'Why?' " She can give you a couple of whys, actually. "The tabloids make up stuff," she says. "Somebody will call [the tabs] up and say, They're yelling at each other on the [90210] set,' and they will turn around and make it 10 times worse," Doherty says. And maybe, she reasons, the tabloids pick on her. specifically, because "I'm a strong woman. There are still some people out there who can't deal with that."

Aaron Spelling, whose company produces 90210, describes her as "the best young actress I've seen in a long time," and has no problem with Doherty or her manner. "She is a very honest person who wears her emotions on her sleeve," he says. "If you ask her a direct question, she'll give you a direct answer." For instance, Doherty isn't afraid to tell friend, costar and daughter-of-the-boss Tori Spelling if she's wearing the wrong blouse. "Of all my friends, Shannen is the really honest one," says Tori, one of the few 90210ers who talked about her. Doherty's comments are "all meant in the best way," she adds. "But I can see [her reputation] hurts her feelings a bit." If so, Doherty is not about to expose her wounded heart in public. And why should she? Her image hasn't hurt her endorsement power (she does ads for Gitano jeans). "I'm not saying I don't have my moments of bitchiness," Doherty says, not defensively at all, "because everybody has them. But it's never for no reason. I think that life is short, you should live it and be happy. I've always been a ballsy kid," she adds. "I know it pisses some people off, but isn't the end result much better?"

In fact, Doherty, who won her first series role when she was 11 (she played Jenny Wilder on Little House: A New Beginning), thinks her "bitch" reputation started with 1989's cull black-comedy movie Heathers (in which she was one of the three nasty title teens). Doherty says she let a behind-the-cameras player on that film know, in no uncertain terms, that she didn't approve of an extramarital affair he was conducting with an extra. "It was the first time I actually saw somebody take advantage of the extras," she says. "He knew I disliked him, and he was the first person to call me a bitch." In the past year, though, she also earned the enmity of prince of sarcasm Dennis Miller when she appeared on his short-lived talk show and embarrassed him by teasing him for not being at ease. (Her photo, tacked up backstage, was subsequently defaced with a devil's horn and goatee.) And would Peter Duchow, who produced her recent TV movie Obsessed, like to work with Doherty again? "How much are you going to pay me?" he asks. He notes that she was late to the set several times ("Professionals," he says, "make an absolute effort to be on time") but then clarifies: "Like a lot of talented people, she has mood swings. Hers are perhaps a lot more exaggerated than others. And any 21-year-old is difficult to work with. She has to learn some lessons that everybody has to learn." Then there was the headline-grabbing flap at this year's Emmys show. The day before the ceremony, Doherty dropped out of presenting an award with John Stamos of Full House and 90210 costar Jennie Garth. "She was a colossal pain in the ass," says Walter Miller, who produced and directed the program. There have been numerous explanations of that pain. Initially a spokesperson said that she was suffering from bronchitis. Miller, who refers to Doherty as "a barracuda," thinks she was unhappy that Garth was given the opening line of Emmy dialogue—even though Doherty would have announced the winning name. But Doherty says she was upset that the entire 90210 cast was not given tickets to the ceremonies. "I just said, "This is ridiculous, our cast can't go,' " she explains. " 'I just don't understand that.' " Doherty's manager, Mike Gursey, says he yanked her from the telecast because "tiny" promises about her role, including what category she would present in, went unfulfilled.

Having offended the gods of Hollywood, though, the young "barracuda" arrived in tears al a luncheon the day of the Emmys, reports Aaron Spelling, "afraid even one would be mad at her." If so, it was a rare display of public insecurity from a young woman who, says her father, Tom, 48, "has always been self-assured." Shannen was born in Memphis, the younger of two children (her brother, Sean, 25, is a USC law student) and, on her mother Rosa's side, the latest in a long line of Southern Baptists. Shannen's conservative upbringing may have something to do with her public displeasure over 90210's Brenda's losing her virginity last year ("We have a whole cast that is sexually active," she complained in one interview); her disgust with that unnamed. womanizing Heathers crew member; and her August appearance at that feast of family values, the Republican National Convention, at which she led the Pledge of Allegiance. ("I don't think Clinton would be any different than Bush," says Doherty, a Jack Kemp supporter, "except maybe he'd do a hell of a lot worse.") Growing up in the male-dominated South, though, had its drawbacks. "I saw how women were treated," she says, "and I wasn't going to be treated like that." In fact, she seems to have a Scarlett O'Hara, I'll-never-go-hungry-again tenacity, developed after her family moved to the comfortable Palos Verdes neighborhood of Los Angeles when she was 6. Her father had bought a trucking firm, but within a few years the business collapsed. "Shannen has seen both sides of the coin," says her dad, now a mortgage consultant. "We lived in a prestigious area, with an ocean view. Then we had the rug pulled out from under us. There was a time when the doorbell would ring and it might be the utility man there to cut off the power." The experience seared Doherty. "People think, 'She's sitting up there in a nice house and has money,' " Shannen says of herself, suddenly irritated. "Somebody said that to me last night, and I got really pissed off. My parents went from having money to having nothing, to eating rice every single day."

As Tom Doherty's company was sinking, his daughter was getting into another business—acting. Initially, Shannen tagged along when Sean tried out for a church production. In short order, she went on to play Sneezy the dwarf in Snow White, also at church ("I hammed it up"), and by age 10 she was doing commercials for Pepsi. Her big break came in 1982, when she did a voice for the animated feature The Secret of NIMH. Then Michael Landon hired her for Little House. "That show changed my life," says Doherty. "Michael Landon was the one who said to me, 'Always slick up for yourself. Never let anybody walk all over you. Be a strong woman.' " The principal of the Baptist school she attended after her stint on Little House paid the price for Landon's advice. "I hated that school," says Doherty, her voice turning sharp again. "It was very repressed. They thought that dancing was evil, and I disagreed. I organized a big dance, and the principal called me in. He wasn't pleased. He had his Bible out there on his desk and told me how God would punish me. I flipped through his Bible and found references to people dancing and rejoicing. I said to him, 'It clearly shows they danced and rejoiced. Just what the f—is wrong with you?' " Her father had reservations about Shannen and show business, but he supported her in her fight at the school, which she left alter a year. She finished her studies at the Lycée Français, a private school in L.A. (by then, the family was back on its feet financially). "Shannen believed in something," says her dad, who didn't know beforehand about the prohibition on happy feet. "She did nothing wrong." The family was less approving when she left home at 18 and moved in with a 31-year-old boyfriend (who had told her he was 28). "I wanted so much to be on my own," she says now. "I wanted to prove I could do things myself". But the boy friend turned out to be involved with drugs. "And I tried drugs and drinking," says Doherty softly. "I was drinking up a storm. Cocaine was something that I tried and didn't really like. It was more the lifestyle I was into. Every single night I was out clubbing and drinking. It was a bad scene." This went on, she estimates, for six months and ended—with a shock—the night her boy-friend struck her. "I just remember one slap across the lace." she says, "and I was out of there." She went across the street to a convenience store, phoned her parents and went home. She has since bought and moved into her own place, but remains close lo her parents. She was there for her father in 1983 and again in 1990 when he suffered strokes (his right side is now slightly paralyzed). "She has done the single most important thing lo help my recovery," he says. "She makes me laugh." It was in 1986. while playing Kris Witherspoon on her second NBC series, Our House, that Doherty first caught the attention of an influential member of the viewing audience named Tori Spelling. Tori also liked Doherty in Heathers and recommended her to her father. Doherty got the 90210 job on a Wednesday, started work on a Monday, and now she's so famous she needs a dog to protect her when she goes jogging.

(The dogs! What about those dogs? Every time the phone rings, Doherty hops up and runs off to answer, only to return with a look of dejection—no news.) Doherty doesn't deny that she may have earned her reputation for being tough in the early days of 90210. "I always stood up for the right causes, but I don't think I was always diplomatic," she says. "But recently I have learned lo be diplomatic." That hasn't prevented the occasional on-set misunderstanding—like the time recently when the day's shoot ran past midnight and Doherty announced (with the producers' permission, she says) that it was time to go home. She suspects Jennie Garth may have resented that show of authority. "I don't think Jennie was very happy," she says. At any rate, she adds, their friendship has suffered—and the Emmy business didn't help. "There's some weird tension there," she says. "We haven't really talked about what happened. But Jennie is a great girl, and this is something that can be worked on." There are no complaints from Jason Priestley, who plays Doherty's brother, Brandon. "All of the stories about Shannen are so blown out of proportion," he says. "She's a very intelligent young woman who isn't afraid to speak her mind. I really enjoy working with her. We have a good relationship on-and offscreen."

For the past year, Doherty's primary offscreen relationship has been with Chris Foufas, 25, a Chicago-based real estate manager. They met through a friend of Foufas's (in fact, she was dating the friend at the time). They announced their engagement earlier this year, but now it has been called off. "He is a wonderful man whom I love very much," says Doherty, "but I'm 21, and it's not exactly the right time to gel married. Friendship has taken over the romance.' " Marriage hasn't been completely ruled out, she says. And "if he goes out with another girl, it's [only] because he's bored." Now as to the famous night on the town with Marky Mark. Doherty maintains that they were not on a date—it was just a friendly foursome that included 90210 costars Green and Spelling. Someday, Doherty may have her own rock-and-roll groupies to distract her. A big fan of U2, Guns N' Roses and Pearl Jam (she would love to meet lead singer Eddie Vedder), she enjoys toying with the idea of having her own band. The basic career plan, of course, is to land some movie roles alter 90210, but Doherty says, "I gel into these modes of sitting in my house writing poetry that could be converted into songs."

She pauses to light another cigarette and inhales, turning her head toward the sound of a car door slamming and the scuttle of approaching paws. Sally comes bounding in, and Tom Doherty enters carrying Jake, the dog's back paws wrapped in bandages. Shannen's father explains that when he arrived to take Sally to the vet, he found Jake in the pool. The pup had fallen in and was frantically clawing the pool trying to get out. "He looks so funny," Shannen says. "I'm so relieved!" She pats him on the head, and he regards her contentedly. You will never hear a bad word from Jake about Shannen Doherty.

*** 💜♀️International Women's Day♀️💜

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blackkudos · 4 years

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Meshach Taylor

Meshach Taylor (April 11, 1947 – June 28, 2014) was an American actor. He was Emmy-nominated for his role as Anthony Bouvier on the CBS sitcom Designing Women (1986–93). He was also known for his portrayal of Hollywood Montrose, a flamboyant window dresser in Mannequin. He played Sheldon Baylor on the CBS sitcom Dave's World (1993–97), appeared as Tony on the short-lived NBC sitcom Buffalo Bill opposite Dabney Coleman, and appeared as the recurring character Alastair Wright, the social studies teacher and later school principal, on Nickelodeon's sitcom, Ned's Declassified School Survival Guide.

Early life

Taylor was born in Boston, Massachusetts, the son of Hertha Mae (née Ward) and Joseph T. Taylor, former dean of students at Dillard University in New Orleans, who was also the first dean of arts and sciences at Indiana University – Purdue University Indianapolis.

After the family moved from New Orleans to Indianapolis, Taylor graduated from Crispus Attucks High School in 1964, where he took an interest in acting, and went on to study in the dramatic arts programs at Wilmington College (Ohio) and Florida A&M University. Leaving Florida A&M a few credits shy of graduation, he worked in Indianapolis as a State House reporter for AM radio station WIFE (now WTLC), where he used the on-air name Bruce Thomas, and as the host of a community-affairs program on television station WLWI (now WTHR), as Bruce Taylor. Many years later, in May 1993, he received his bachelor's degree in theatre arts from Florida A&M.

Career

Theater and teleplays

Taylor's first professional acting gig was in a national tour of Hair. He honed his craft in repertory theater as a member of Chicago's Goodman Theatre, and the Organic Theater Company alongside Joe Mantegna, André DeShields, Dennis Franz, Keith Szarabajka, Jack Wallace, and director Stuart Gordon. While in Chicago, he appeared in David Rabe's Streamers, Native Son (1979 Joseph Jefferson Award Nomination for Actor in a Principal Role in a Play), The Island and Athol Fugard’s Sizwe Banzi Is Dead, for which he garnered the 1977 Joseph Jefferson Award for Actor in a Principal Role in a Play. He received an Emmy Award for his role as Jim in the WTTW production of Huckleberry Finn and hosted the Chicago television show Black Life. In 1998, Taylor made his Broadway debut as Lumiere in Beauty and the Beast, where he starred alongside Toni Braxton. In September, 2012, he appeared in Year of the Rabbit at Ensemble Studio Theater-LA as Vietnam veteran JC Bridges.

Television and film

In 1977, Taylor moved to Los Angeles, where he crafted a gallery of memorable characters in film and on television, including his Emmy nominated turn in the CBS sitcom Designing Women. Taylor played Anthony Bouvier, the assistant at the fictitious Sugarbaker interior design firm in Atlanta, Georgia. In 1989, he received an Emmy nomination for Outstanding Supporting Actor in a Comedy Series. In May 1981, the ninth season of M*A*S*H, he was seen as a corpsman in the final episode, "The Life You Save".

From 1993-97, he was a series regular as plastic surgeon Sheldon Baylor on Dave's World (CBS), and had a recurring role as Alastair Wright, the history teacher turned school principal, on Nickelodeon's sitcom, Ned's Declassified School Survival Guide (2004–07) and Buffalo Bill on NBC with Dabney Coleman.

Other appearances include: The Unit, Jessie, Hannah Montana as a fashion designer, All of Us as Neesee's father, The Drew Carey Show, Static Shock, Caroline in the City, Aaahh!!! Real Monsters, Women of the House, In the Heat of the Night, Punky Brewster, What's Happening Now!!, Hill Street Blues, ALF, Melba, The Golden Girls, Cagney & Lacey, Barney Miller, Lou Grant, The White Shadow, The Incredible Hulk, The Secret of NIMH 2: Timmy to the Rescue and Barnaby Jones.

In 1996, Taylor hosted his own series on HGTV, The Urban Gardener with Meshach Taylor, and in 1998, he hosted Meshach Taylor's Hidden Caribbean on The Travel Channel. He was a regular panelist on the 2000 revival of the television game show To Tell the Truth. He co-hosted Living Live! with Florence Henderson on Retirement Living TV; in 2008 until the program was revamped as The Florence Henderson Show.

Taylor had been friends with actor Joe Mantegna since they appeared together in 1969 in the musical Hair. Taylor guest-starred in 2012 on Criminal Minds' eighth season in the episode "The Fallen", opposite Mantegna as Harrison Scott, Rossi's former Marine sergeant with whom he served in Vietnam . In January 2014, he reprised this role in "The Road Home" which aired January 22, 2014, just five months before his death. Mantegna led a Criminal Minds tenth season episode "Anonymous", to honor Taylor on January 21, 2015.

Taylor appeared in such feature films as Mannequin, Mannequin Two: On the Move, and Damien: Omen II.

Personal life

Taylor married actress Bianca Ferguson in 1983. He had four children, three with Bianca and one from a previous marriage. His children include daughters Tamar Taylor, Esme Taylor, Yasmine Taylor, and son Tariq Taylor, along with four grandchildren.

Death

Suffering from colorectal cancer, Taylor died on June 28, 2014, at his home in Altadena, California. Taylor was survived by his wife, their four children, his mother Hertha Ward Taylor (who celebrated her 100th birthday 11 days before Meshach died), two siblings, and four grandchildren. A memorial service to celebrate his life was held at Forest Lawn Memorial Park (Hollywood Hills) on July 6, 2014.

#04/11 #06/28

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ao3feed-captiveprince · 4 years

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Hangout for all fandoms!!

read it on the AO3 at https://ift.tt/2VJy9YY

by Marvelous_Stark

Just a place for everyone of every random to hang out and talk about their ships and anything they'd like! :)

This is probably a complete waste of my time, to be honest. Facebook is a thing too lol.

You can comment links to works you've made, or ones you enjoy! Honestly post anything but hate.

Have fun, make friends, and please no arguing 😓

Words: 12, Chapters: 1/1, Language: English

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Rating: Not Rated

Warnings: No Archive Warnings Apply

Categories: F/F, F/M, Gen, M/M, Multi, Other

Characters: I'll add more soon - Character

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read it on the AO3 at https://ift.tt/2VJy9YY

#IFTTT #ao3feed #fanfic #captive prince

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ao3feed-saintseiya · 4 years

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Hangout for all fandoms!!

AO3: https://ift.tt/2VJy9YY

by Marvelous_Stark

Just a place for everyone of every random to hang out and talk about their ships and anything they'd like! :)

This is probably a complete waste of my time, to be honest. Facebook is a thing too lol.

You can comment links to works you've made, or ones you enjoy! Honestly post anything but hate.

Have fun, make friends, and please no arguing 😓

Words: 12, Chapters: 1/1, Language: English

Rating: Not Rated

Warnings: No Archive Warnings Apply

Categories: F/F, F/M, Gen, M/M, Multi, Other

Characters: I'll add more soon - Character

Relationships: I'll add more soon

Additional Tags: I'll add more soon - Freeform

AO3: https://ift.tt/2VJy9YY

#IFTTT #ao3feed #fanfic #saint seiya #los caballeros del zodiaco #Hangout for all fandoms!!

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ao3feed-themanfromunclemovie · 4 years

Text

Hangout for all fandoms!!

read it on the AO3 at https://ift.tt/3f1Io2o

by Marvelous_Stark

Just a place for everyone of every random to hang out and talk about their ships and anything they'd like! :)

This is probably a complete waste of my time, to be honest. Facebook is a thing too lol.

You can comment links to works you've made, or ones you enjoy! Honestly post anything but hate.

Have fun, make friends, and please no arguing 😓

Words: 12, Chapters: 1/1, Language: English

Rating: Not Rated

Warnings: No Archive Warnings Apply

Categories: F/F, F/M, Gen, M/M, Multi, Other

Characters: I'll add more soon - Character

Relationships: I'll add more soon

Additional Tags: I'll add more soon - Freeform

read it on the AO3 at https://ift.tt/3f1Io2o

#IFTTT #ao3feed #fanfic #tmfu #the man from uncle

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ao3feed-sherlockfemslash · 4 years

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Hangout for all fandoms!!

read it on the AO3 at https://ift.tt/2VJy9YY

by Marvelous_Stark

Just a place for everyone of every random to hang out and talk about their ships and anything they'd like! :)

This is probably a complete waste of my time, to be honest. Facebook is a thing too lol.

You can comment links to works you've made, or ones you enjoy! Honestly post anything but hate.

Have fun, make friends, and please no arguing 😓

Words: 12, Chapters: 1/1, Language: English

Rating: Not Rated

Warnings: No Archive Warnings Apply

Categories: F/F, F/M, Gen, M/M, Multi, Other

Characters: I'll add more soon - Character

Relationships: I'll add more soon

Additional Tags: I'll add more soon - Freeform

read it on the AO3 at https://ift.tt/2VJy9YY

#IFTTT #ao3feed #fanfic #sherlock

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douglasbergerpsychiatristto-blog · 7 years

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Tests, testing, and tested – we need to critically evaluate the meaning of tests in psychiatry

Douglas M. Berger Meguro Counseling Center, Tokyo, Japan

A recent article entitled, “Perils of Newborn Screening”[1] led me to think of how we in psychiatry and our patients also have some perilous ideas about screening and testing. The article describes testing initiated in 2006 in New York State for Krabbe disease of the nervous system. Krabbe disease is a rare inherited disorder where lack of the enzyme galactocerebrosidase causes the myelin coating on the nerves to break down. Mental and motor development are affected, and muscle weakness, deafness, and blindness may occur.[2]

Out of the total one-million babies tested, 24 tested positive and out of 24, 4 developed symptoms. One family refused treatment and subsequently the child died; another child died from complications of the treatment; another’s illness is progressing despite treatment, and one baby who had been treated successfully has recently lost his ability to walk. Parents of babies who test positive, are described to be in a constant state of worry, some pursue risky tests, and the emotional trauma (not to mention the cost) incurred is likely to outweigh the benefits.

This example illustrates how one kind of test may have pros and cons. The pros and cons of ‘testing’ can also be seen in one’s daily practice of psychiatry. The following are personal experiences of my practice in Tokyo.

CLINICAL EXAMPLES

“My 8-year-old child is depressed, should they have psychological (psych) testing to determine if antidepressants are warranted?” A woman I have been treating for a few years for major depression told me about her 8-year-old son who is irritable, has been crying more, and has written some notes contemplating suicide. She first brought her son to a large local counseling center where they recommended in-person counseling with their staff psychologist, school observations, and psych testing (costing about $4,500), and told the mother that they could not recommend starting antidepressants until the psych testing was complete. The son could not finish the testing because he was unable to maintain concentration.

The mother eventually decided she couldn’t wait anymore and asked me to evaluate the child who clearly looked depressed. I explained that if the psych testing assessed the son having a depression, this affirms the obvious. If the psych testing assessed the son without a depression, we are still left with a depressed-looking child who is writing suicide notes, and with an anti-depressant responsive depression in his mother. Neither family dynamics nor school issues could explain the child’s depression.

We agreed that there was no logic for psych testing in terms of, ‘to treat’ or ‘not to treat’; and in tandem to a medical work-up for depression, we initiated 2.5 mg of escitalopram a day with a good response. Scales and tests for depression may indeed provide some helpful information; however, predictive value, sensitivity, and specificity are still far from perfect,[3] and the National Institute of Mental Health (NIMH) guidance only mentions medical examination and history of symptoms in the evaluation of depression.[4]

While no test can fully prove a psychiatric diagnosis, we understood that the medication can be construed to be both a treatment as well as a kind of diagnostic test, i.e., improvement on administration, and relapse on discontinuation would support the diagnosis of a major depression.

In addition, while the son was ill with depression, the other aspects of psych testing, i.e., personality or intellectual testing, would not properly reflect these areas of functioning. It would be like asking a person with pneumonia to run around a track, time them, and then make an interpretation of this person’s ability to run (not to mention the cost saving of the psych testing).

The next peril is the way the school authorities may use the results of his psychological testing, which may have a negative impact on the child’s education in the future. I opined that the school only needed to know that the son would get help, but did not need to know the diagnostic or treatment details.

“My 4-year-old has been tested and diagnosed with Asperger’s Disorder, can you counsel him?” This has been a more frequent inquiry in recent years. Some parents or adult patients almost seem to be proud to have this diagnosis, thinking that it portends high intelligence, but it may actually be a way to avoid a more uncomfortable mental illness diagnosis. Most of these parents do not realize that there is no test to prove that someone has Asperger’s, (the criteria for Asperger’s includes: Marked impairment in social relations, often with stereotyped motor movements, and a vast knowledge of some topic of esoteric or impractical value),[5] and that the incidence of Asperger’s is thought to be extremely low (about three in 10,000)[6] when compared with other disorders whose symptoms overlap with Asperger’s (i.e., attention deficit disorder/ attention deficit hyperactivity disorder (ADD/ADHD), which may affect up to 10% of children.[7]) Few of the patients who come in with a supposed diagnosis of Asperger’s actually fulfill the criteria for Asperger’s.

On examination, most of these children have symptoms suggesting ADD or ADHD; some have depression or anxiety, and others a shyness or awkwardness that may be normal or may evolve into social anxiety disorder later in life. On rare occasion some do look like high-functioning autistic children, although it seems parsimonious and logical to assume that these children have the far more common diagnosis rather than a rare diagnosis if the symptoms overlap significantly.

The peril here is when the parents or an adult patient does not accept having a diagnosis or treatment other than that for Asperger’s. If a child also seems to have a comorbid ADD or ADHD, it needs to be treated first; to ascertain what Asperger’s symptoms may be left. Otherwise, it would be like making a diagnosis of asthma in a child with pneumonia (i.e., it is impossible to see if Asperger’s is there while the person is clearly impaired with ADD or ADHD).

In addition, once a child gets a diagnosis in their educational record, it tends to have a life of its own as definitive, and neither parents, educators, nor even psychologists or psychiatrists, endeavor to change the record.

“Cognitive behavioral therapy has been tested and proven to be effective for depression; can you give it to me?”

This is another situation where the use of the word ‘tested’ comes in and is an inquiry that can be a challenge for the psychiatrist to handle when the patient has vegetative symptoms, a strong family history, and a chronic course of depression because these patients usually require antidepressant medication in addition to any therapy.

Cognitive behavioral therapy (CBT) aims at repairing negative thoughts that are thought to cause depression.[8] Clinically, it is easy to observe; however, that negative cognitions improve when depressed mood improves, be it with antidepressants or the natural cycling course out of depression.[9] This is analogous to delusions improving, when one is given an antipsychotic, so that negative thoughts are more likely the result of depression rather than the cause, just like a runny nose and a cough are the result of a cold. If negative thoughts were the cause of depression, then this would be the only Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis I condition where the symptoms are also construed to be the cause.

However, it can often be seen that CBT may help persons with depression function better. Degree of depression is usually evaluated by a rating scale that assesses both neuro-vegetative symptoms as well as misery (i.e., cognitive symptoms such as despair and helplessness). Giving persons hope and support can alleviate some of the misery symptoms decreasing depression scores. Allowing some time to pass where the persons improve by themselves or cycle out of depression can also decrease scores. In either case, the person functions better and their depression scores decrease over time. Even a few points lower on a depression test can result in a call of a “statistically significant difference” compared to a supportive therapy control group, but that does not mean the illness is really treated. For example, I broke my arm by falling on the ice. I had real pain and also misery because I couldn’t do things I normally liked to do. When my orthopedist told me, “I see many fractures like this, you will be fine in a few months,” all my misery disappeared, but the fracture did not change. Patients in misery can respond well to an authority figure which gives them hope.

A more important problem with using the word ‘tested’ is that it is not easy to study psychotherapy as a modality of treatment because the studies cannot be double blinded like a drug study that has a placebo arm—an extremely crucial point. A study on bias in treatment outcome studies concluded that the results of unblinded randomized clinical trials (RCTs) tended to be biased toward beneficial effects if the RCTs’ outcomes were subjective (as they are in psychotherapy studies) contrary to being objective.[10]

Patients and even professionals assume that the words “randomized and controlled” mean that the studies looking at a therapeutic modality are fully evidence based, even if they are not double blind. They may be single blinded, i.e., the rater may not know the treatment the patient received, but the patient themselves cannot be blinded to the type of therapy, thus potentially biasing the results. Depression studies notoriously have large random errors due to the wide variety of subjects many of which have mild forms of low mood, investigator and patient preference and economic incentive, or non perfect rating instruments, etc. Bias can lead to a result very far from the true value.[11]

A recent meta analysis[12] examined how effective CBT is when placebo control and blindedness are factored in. Pooled data from published trials of CBT in schizophrenia, major depression, and bipolar disorder that used controls for non-specific effects of intervention were analyzed. This study concluded that CBT is no better than non-specific control interventions in the treatment of schizophrenia and does not reduce relapse rates, treatment effects are small in treatment studies of major depression, and it is not an effective treatment strategy for prevention of relapse in bipolar disorder.

This does not mean that CBT has no value, it only means that we need to consider CBT as an adjunctive modality to help functional impairment and suffering vs. an illness course-changing intervention. It is imperative that our field does not allow studies that are unblinded to be called “evidence based tests.” They need to be in a different category, i.e., “uncontrolled clinical data”, or “clinical impressions” (of CBT practitioners and/or their patients).

CONCLUSION

To the lay-person, the word “test” implies some absolute truth. The value of a test or a diagnosis given by an authority is very hard to evaluate by the average lay-person, and when it comes to testing of a therapeutic intervention, even most mental health professionals do not understand why it is crucial to control bias by double-blinding in a clinical trial of an intervention, whether psychotherapy or drug. The words “controlled” or “randomized” seem to carry more weight than they are worth if there is no placebo or double blind to back them up. We must also not avoid a critical discussion of the economic incentive to do a test or to “prove” the evidence base of a certain therapy.

{Ed.: Dr. Berger is in private practice in Japan and consultant on pharmaceutical clinical trials. Web page is at: www. japanpsychiatrist. com. This article is intended as a personal opinion piece and not a scientific analysis.}

REFERENCES

1. Bleicher A. Perils of newborn screening: Doctors may be testing infants for too many diseases. Sci Am 2012;307:16-7.

2. Pastores GM. Krabbe disease: An overview. Int J Clin Pharmacol Ther 2009;47(Suppl 1):S75-81.

3. Rivera CL, Bernal G, Rossello J. The Children’s Depression Inventory (CDI) and The Beck Depression Inventory (BDI): Their validity as screening measures for major depression in a group of Puerto Rican adolescents. Int J Clin Health Psychol 2005;5:485-98.

4. Available from: http://www.nimh.nih.gov/health/publications/men-anddepression/diagnostic-evaluation-and-treatment.shtml. [Last Accessed on 2013 Mar 30].

5. F84. Pervasive developmental disorder. International Statistical &ODVVL¿FDWLRQRI’LVHDVHVDQG5HODWHG+HDOWK3UREOHPVth (ICD-10) ed. World Health Organization (2006).

6. Fombonne E. Epidemiological surveys of pervasive developmental disorders. In: Volkmar FR, editor. Autism and Pervasive Developmental Disorders. 2nd ed. Cambridge: Cambridge University Press; 2007. p. 33-68.

7. Centers for Disease Control and Prevention. Summary Health Statistics for U.S. Children. National Health Interview Survey, 2002. March 2004, Series 10, No. 221.

8. Burns, David. Feeling Good, The New Mood Therapy. Avon Books; 1980.

9. Fava M, Davidson K, Alpert JE, Nierenberg AA, Worthington J, O’Sullivan R, et al. Hostility changes following antidepressant treatment: Relationship to stress and negative thinking. J Psychiatr Res 1996;30:459-67.

10. Wood L, Egger M, Gluud LL, Schulz KF, Jüni P, Altman DG, et al. Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: Meta-epidemiological study. BMJ 2008;336:601-5.

11. Steven Piantadosi. Clinical Trials: A Methodologic Perspective. 2nd ed. Hoboken: Wiley-Interscience; 2005.

12. Lynch D, Laws KR, McKenna PJ. Cognitive behavioural therapy for major psychiatric disorder: Does it really work? A meta-analytical review of well-controlled trials. Psychological Medicine 2010;40:9-24.

#psychiatry #psychiatric testing

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