I’ve long scratched my head at one of the arbitrary political lines drawn in the sand in the world of mental health and mental illness advocacy — “serious mental illness.” (Some people refer to it as “severe mental illness,” but the correct term is “serious.”)
Focusing on this division is a lie. It is a lie told to Congress and to the public with earnest testimonials. But also with little evidence that it represents a valid — or meaningful — scientific distinction.
There’s no way to stop the rare mass shootings that occur in the United States. You may not like it, but it’s a fact no amount of laws or background checks will ever fix.
Every time a new shooting occurs, it’s a tragedy. No words can begin to describe the senseless violence of a mass shooting.
But it’s even more of a tragedy when the media — with the help of the military, in this case — is quick to report that an alleged suspect in such shootings was seeking mental health treatment for a concern. Especially when it ended up having nothing to do with the shootings.
While some media outlets are reporting that a recently published study implicates mental health stigma as one of the primary reasons for people not seeking out treatment, that’s only a part of the story.
Glossed over by most media reports of the study is that the study actually found larger barriers to treatment that pale in comparison next to the concept of “stigma” (or, more accurately, discrimination and prejudice).
Let’s take a quick look…
Assisted outpatient treatment (AOT) is a marketing term for involuntary commitment, but in an outpatient setting. AOT is like putting lipstick on a pig and calling her a princess. Experts on AOT sometimes like to pretend AOT is something different than forced treatment:
“Forcing [a person] to take medication is assisting him to make the choice we think he would make if he had a normally functioning brain.”
~ E. Fuller Torrey, MD & Jonathan Stanley, JD
Let’s delve into the twisted logic here of assisted outpatient treatment.
Last week, I wrote about how Canadian Ellen Richardson, who suffers from bouts of depression, was barred from entering the U.S. One of the outstanding question raised about that story was how U.S. customs agents were accessing Canadians’ suicide attempts and hospitalization records. A senior official for the U.S. Customs and Border Protection agency told me that they only have access to criminal and police databases, from a mutual sharing arrangement with Canada.
Well, it appears the Canadian RCMP are the ones to blame. Because for years now, the RCMP has been putting information about Canadians who attempt or even just threaten suicide into a national law enforcement database called the CPIC. Which is then shared with U.S. customs and law enforcement agencies.
Why would the RCMP want to keep track of those who threaten suicide in a law enforcement database? Is this just another example of the police discriminating against people with mental illness?
Yesterday I brought you the unfortunate story of a Canadian turned away from our borders not because she was a terrorist or criminal — but because she simply had a diagnosis of depression and, more than a year ago, was hospitalized for treatment of it.
Just to show you that the United States isn’t the only backwards country in the world when it comes to discriminating against those with a mental illness, I bring you the much sadder story of an Italian woman who had bipolar disorder, went to the UK for a training course, and wound up being forced to have a C-section without her consent. Wait, what?
Worse, this woman’s forced C-section was approved by a UK court. Apparently, in the UK, having a panic attack is sufficient to remove most of your freedoms and rights.
Could you imagine being discriminated against because you had a broken arm? Or a diagnosis of cancer? Or suffered from a concussion (like hundreds of pro sports players do every year) and were denied rights everyone else enjoys?
What if you suffered from clinical depression and have been, at past times in your life, severely depressed? Should the government be allowed to discriminate against you because of a mental health diagnosis?
The U.S. Department of Homeland Security’s agency of Customs and Border Protection apparently thinks that maybe sometimes the answer should be “yes.”
You’d think I was making this up. Sadly, I’m not.
Earlier this year, the CDC released data that showed that diagnoses of attention deficit hyperactivity disorder (ADHD) went up over the past few years. But the CDC data also showed that diagnoses went up across the board for multiple mental disorders.
Some media outlets at the time, however, only focused on the increase in the diagnosis of ADHD. This two-part article (part 1 is here) examines whether there really is an “over”-diagnosis of ADHD — or whether it’s more complicated than answering with a simple “yes” or “no.”
This Veterans Day, we honor the sacrifices made by our veterans, fighting for freedom and liberty not only for Americans, but for people everywhere.
It’s not just the veterans themselves who face mental health issues — such as post-traumatic stress disorder (PTSD) or crippling anxiety — but their families too. Families who have to cope not only with the great distances and not knowing if their soldier-husband or soldier-wife will ever return, but also with the possibly of having that person return broken. Lost. Something less-than.
And while the Veterans Administration has made great strides in providing better care for veterans in the past few years, it still has a long ways to go.
I last wrote what the Affordable Care Act (also known as Obamacare or the ACA) will mean to mental health treatment in the U.S. over a year ago. Since the Act’s passage and further analysis of it, it’s time to revisit this topic.
Some of the initial rosy predictions about the ACA are likely not to pan out quite as we had hoped. While the Act will indeed expand coverage and treatment options for millions of Americans who previously had little or no choice, it may also inadvertently take away some treatment options currently in widespread use.
Let’s find out why.
Next week marks the 50th anniversary of President John F. Kennedy signing historic legislation known as the Community Mental Health Act (back when the name of legislature plainly reflected what was in it). It was the country’s boldest attempt to bring mental health care into the modern era by moving people out of inpatient psychiatric hospitals, and put them back in the community where they belong, making mental health care affordable and readily available to all Americans.
And due to the federal government slashing funding for mental health care in the 1980s, the legislation was wildly successful in emptying out state psychiatric hospitals of old. The problem is, they had nowhere to go, because the government never bothered to come anywhere close to funding community mental health centers to make them an equivalent replacement.
John F. Kennedy’s vision here was bold but sadly unrealized. Fifty years later, our biggest providers of mental health care in the U.S.A. are not hospitals or community mental health centers at all… but prisons.
Sadly, among the 90-some-odd people who committed suicide in America on Friday, October 11, 2013, MasterChef contestant Josh Marks was among them.
People who watched the television show may remember Josh as someone who was known as a “gentle giant.” Josh, 26 and 7’2″, was known by his friends and family as someone who was kind, well-loved and thoughtful.
But the same month he lost to someone else on the final episode of MasterChef in 2012, he was also diagnosed with bipolar disorder. And just last week, he was given yet another diagnosis — schizophrenia.
After struggling with poor treatment options, the stress of the TV show, and the brand-new diagnosis, it apparently was too much for Josh to bear any longer.
Back in 2008, I met ground-breaking psychiatrist Danny Carlat. You might remember Dr. Carlat because the year before he started a blog and published an important op-ed in the New York Times about the influence that pharmaceutical companies have in marketing their drugs to physicians. (To learn more, read about it when I interviewed him here.)
What you may not have realized is that Dr. Carlat got his start with his own monthly psychiatric newsletter called, fittingly enough, The Carlat Psychiatry Report in 2003. Since its humble beginnings as a single newsletter, the Carlat Publishing empire has grown, now supporting two additional newsletters — The Carlat Behavioral Health Report, and The Carlat Child Psychiatry Report.
They’ve also just recently launched a fourth, new newsletter, The Carlat Report Addiction Treatment.
We’re pleased to be partners with Carlat Publishing in helping publish their older, past years’ archives of these newsletters over at Psych Central Professional. But we’re doubly pleased to offer our readers a special discount subscription to these independent, must-read newsletters.
Senator Roy Blunt from Missouri yesterday published an editorial in USA Today lamenting President Obama’s lack of movement on mental health legislation after the Sandy Hook Elementary School tragedy.
And while Senator’s Blunts concerns are perhaps well-intentioned, his invocation of Sandy Hook in relation to “mental health” is about as tenuous a connection one could make about two, largely unrelated subjects.
Because in his editorial, Senator Blunt glosses over one inconvenient fact — Sandy Hook’s perpetrator, Adam Lanza, had no diagnosed mental disorder, nor was he apparently ever seen by a mental health professional outside of school for specific learning-related issues.
All too often, I find myself knee-deep in discussions about language. “What do we call X?” “Wouldn’t it be better to be more ‘inclusive’ and use this other word instead?”
Nowhere is that more evident when it comes to the world of mental illness.
Finding that the word “patient” is too medically oriented, Carl Rogers — 50 or so years ago — suggested a more agnostic term, “client” (such as a lawyer or accountant might have a client). And while I agree client is a more agnostic term, Rogers unfortunately and unintentionally opened up an entire can of worms.
One that haunts us to this day and interferes with our basic ability to communicate when it comes to mental health concerns.
As I was finishing up watching last night’s presidential debate, I was about to turn off the TV when the gun control question came up. An audience member asked what each candidate would do to stem the constant gun violence our country experiences.
America has a strange but rich history with guns, since our very country was founded on every citizen being well-armed (since there was nothing close to a national army at the time). I support the 2nd Amendment and any American’s right to “bear arms.”
So I was a little taken aback when Obama said last night, in answer to the question about gun control: “Enforce the laws we’ve already got. Make sure we are keeping the guns out of the hands of criminals… Those who are mentally ill.” Wha… what?!
I agree with the first part — keeping guns out of the hands of criminals is an important (but ultimately an impossible & fruitless) goal. But why were people with a mental illness singled out for greater gun control?
I was a bit mystified at Alice G. Walton’s piece on Forbes today about the “new” mental disorder, Internet Addiction Disorder (traditionally called IAD, but the DSM-5 draft has confusingly renamed it the unfortunate Internet Use Disorder, or IUD).
As readers of World of Psychology know, Internet Addiction has been around since 1996. Indeed, we published our Guide to Internet Addiction back in 1999.
Here it is 13 years later, and there’s still no clear answer on whether this disorder actually exists.
Indeed, the DSM-5 working group on addictive disorders wasn’t convinced either. That’s why it is not going to be included as a diagnosable disorder in the new DSM 5, out next year.
Yet the Forbes piece makes just the opposite claim. So what’s going on?
Should politicians and celebrities see it as their responsibility to share the specific details of their mental illness or mental disorder diagnosis in order to help reduce the prejudice surrounding these conditions?
That’s the question Torrie Bosch asks over at Slate and arrives at this conclusion — yes, it is a politician’s duty and responsibility to offer full disclosure about their mental health concerns.
But I think Bosch is missing a key component here. When in the throes of a full-blown episode (whether it’s bipolar disorder, depression, or something else), one shouldn’t be making any life-changing decisions or decisions that could forever alter one’s future career.
While it’s easy to believe that politicians and celebrities are something special, underneath their public persona beats the heart of an ordinary person — someone who is entitled to his or her privacy. Especially for health or family concerns.
Demonstrating that the folks who are revising the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are listening to the scientific data, they have nixed two new proposed diagnoses — anxiety-depressive syndrome and attenuated psychosis syndrome. The changes were announced this week at the annual meeting of the American Psychiatric Association, the organization largely responsible for updating the reference manual used by health and mental health professionals to make diagnoses.
The critics were worried that these new diagnoses would label millions of Americans with a mental disorder — and offering them subsequent treatment — that today wouldn’t qualify for such diagnosis or treatment.
For instance, while anxiety mixed with depression is actually quite commonly seen in the wild of clinical practices, there is no specific diagnosis for this mixed mood state. The DSM-5 sought to correct this problem — that clinicians are treating millions for a problem the DSM says doesn’t technically exist. But critics worried the new criteria were too lax and might result in over-diagnosis.
The same was true for attenuated psychosis syndrome. The proposed diagnosis was an effort to get children and young adults into treatment sooner for experiencing weird thoughts or hallucinations. But people worried that it would lead to unnecessary treatment of kids for a potentially temporary problem.
I’ve struggled to find something meaningful to say about the incident when the captain of a jetBlue flight suffered from what appeared to be a “nervous breakdown,” resulting in his eventual restraint and later, criminal charges. I think criminal charges are wholly unwarranted and an example of the double-standard and prejudice we hold against people with possible mental health issues. It shows a shocking lack of judgment on the part of the U.S. prosecutors who charged Captain Clayton Osbon. (After all, would they have charged him if he had suffered a stroke instead, which led to similar behavior? I think not.)
But outside of this prejudice shown by people who don’t treat a brain attack like a heart attack, there’s very little more to say about this unfortunate incident. No lives were lost.
And, in fact, no lives have ever been lost due to a U.S. pilot’s mental health issues, according to the Washington Post article.
Does having an abortion lead to a greater likelihood of having future mental health problems?
That’s what a study by Priscilla Coleman and her colleagues published in 2009 in the Journal of Psychiatric Research claimed. She said the data showed a direct, temporal relationship. In other words, after a woman had an abortion, they were more likely to report a serious mental health concern later in their life.
However, when other researchers (Steinberg & Finer, 2012) tried to replicate Coleman et al.’s findings, they could not do so. After conferring with the original authors and digging through the data a little more, they discovered the problem.
Coleman et al. had misrepresented a very important component of their original research. They never looked at a person’s recent or current psychiatric diagnosis. Instead, they had asked only about any diagnosis in their entire lifetime — something that meant they had no data about whether such a diagnosis was made before or after the abortion.
Benjamin Nugent believes he had Asperger’s Syndrome (a milder form of austim).
Who made this diagnosis? His mom.
His mom was so convinced that her then 17-year-old teenage son had this disorder, she put in him in an educational video about Asperger’s. Asperger’s is usually diagnosed in childhood or as a young teenager, and is characterized by a severe degree of social impairment, isolation, and what others might see as eccentric behavior.
While I commend Mr. Nugent for sharing his story with the world, I have to really question his understanding of how mental disorders are diagnosed by mental health clinicians.
Here’s his story…
A “peer” in the world of mental health and substance abuse lingo means a fellow person who has also been diagnosed with a mental health or substance abuse disorder. Peers come together on their own in self-help support groups (both in the local communities and online) to help one another with emotional support and the knowledge that can only come from having been there themselves.
Benedict Carey writing in today’s New York Times details the impact of peers who go one step farther and act as peer counselors, helping people with mental disorders or substance abuse disorders with training that exceeds that of another layperson patient.
Peer counselors are an important component of America’s fragmented mental health care system, filling in the many gaps (especially in the public mental health system). These gaps are especially prevalent in the U.S. because there are usually two different public systems: one that treat mental disorders and one that treats substance abuse disorders. Few public community mental health systems have integrated these two components in systematic, comprehensive “dual diagnosis” programs.
Today is National Depression Screening Day, so it’s time for your annual depression checkup. Are you depressed? Or are you skirting the threshold of depression, feeling low on energy and taking little pleasure out of life?
You don’t need to make an appointment or go see someone in person in order to find out the answer to these questions. Since 1995, Psych Central has offered an online interactive depression test that gives you an instant result. While nobody can diagnose a mental disorder online, it can give you a quick sense of whether it’s something to be concerned about and make an appointment with a mental health professional to examine further.
The quick depression test is just 8 questions and is an accurate screening measure for depression. It takes most people less than a minute to complete. The longer 18-question depression quiz is the oldest one online and is a more thorough screen for depressive symptoms. It’s a little more accurate, and most people complete it in under 3 minutes.
Two news stories over the long holiday weekend made the rounds about the prevalence of mental disorders in Americans and Europeans. Virtually all the news stories I’ve read completely missed important information contained within the actual reports, instead doing more reporting on the news release rather than the research itself.
I previously wrote about the CDC’s report, which contrary to headlines in newspapers such as USA Today, HealthDay, the International Business Times and others, did not report on any new data that “half of Americans will suffer from mental disorders” (data that comes from a 2004 study — 7-year old news anyone?). Approximately 25 percent of Americans may have a mental disorder — as measured by the CDC surveys — in any given year.
The European study was based upon actual research and suggested that today, up to 38 percent of Europeans may be suffering from a mental disorder — a seeming 50 percent increase over Americans. The two datasets are not directly comparable, however, since they used different methodology to arrive at their numbers.
But it appears only a few reporters bothered to read the study before reporting on it, because many simply reported on the European study with little context or understanding of its data.
The U.S. Centers for Disease Control and Prevention (CDC) released a summary report yesterday detailing how the CDC measures mental illness in the U.S., and summary statistics from those measurements. Most of the information summarized in the report is not new, since it was previously published. What the report does do is bring a great deal of this information together in a single paper.
The report notes that according to the World Health Organization, mental illness — that is, any mental disorder — accounts for more disability in developed countries than any other group of illnesses, including cancer and heart disease. Yet all we hear people talk about in the media time and time again is reducing your risk of these health problems. We rarely hear anyone talk about reducing your risk of anxiety or depression.
According to a rigorous health survey conducted by the CDC in 2004, an estimated 25 percent of adults in the U.S. reported having a mental illness in the previous year. Lifetime prevalence rates of mental illness in the U.S. were around 50 percent when measured back in 2004. That means in a family of four, one of you likely has a mental illness.
However, mental illness is greatly weighted toward our senior years, when things start looking pretty bleak.
Antidepressants have long enjoyed a reputation as being a quick and “easy” treatment for all types of depression — from a mild feeling of being a little down, all the way up to severe, life-debilitating depression.
But like all medications, they have side effects and instances where they should not be prescribed. Hence their continued need for a prescription after seeing a doctor.
So what does it mean when primary care physicians are handing them out like candy?
It suggests that your family doctor doesn’t really understand how antidepressants work, or what they are approved to treat. In short, it suggests that antidepressant medications are being over-prescribed by well-meaning doctors who are simply not using very good judgment.
Today is the American Psychological Association’s “Blog Party” in recognition of May being mental health month. The marketing effort behind designating a specific month a time to recognize and help increase awareness of a certain disease, disorder or condition is intended to help people learn more about various medical and mental health concerns.
But a few weeks ago, physician H. Gilbert Welch wrote an op-ed in the LA Times that questioned whether the pendulum has swung too far the other way. Have we become a nation of people who will get diagnosed for all sorts of sub-clinical problems at the drop of a hat?
Indeed, I think there is a very real danger of that becoming the case. And nowhere is that more likely than in mental health.
In Australia, David Jones’ publicist Kristy Fraser-Kirk is suing the company she works for and its former CEO Mark McInnes for sexual harassment. David Jones is sort of like Macy’s, except it’s based in Australia.
According to news reports, Ms. Fraser-Kirk, 27, is suing David Jones, Mark McInnes and nine directors of the company. She is seeking compensation for a number of different claims, including breach of contract, as well as punitive damages of $37 million. Not exactly chump change. But then again, maybe that’s what it takes to send a clear message about how sexual harassment will not be tolerated in the modern workplace.
But due to the publicity surrounding the case in Australia, she’s now making a new novel claim — that the publicity has led to an “adjustment disorder.” So what is an adjustment disorder? How might it impact Fraser-Kirk’s case??
All too often, I find myself writing about how mental health care fails in the U.S. It’s an easy story to write — during hard economic times, health care (especially for the poor and indigent) often takes a big hit from the government.
So it’s always refreshing to write a different story. Especially one where the feds step up and fund not just a good idea, but a great one.
The hero in this instance is the U.S. Department of Health and Human Services (HHS) and the funding mechanism is the Affordable Care Act’s Prevention and Public Health Fund. Forty-three agencies share in the $26.2 million booty (most receiving about $500,000). The goal of the funding? To help better integrate primary care into the mental health services they offer.
Yes, you heard me right — helping poor people who have a mental disorder get proper health care, sometimes in the same facility where they get their mental health treatment.
Two stories published in the past week by our news team gives me reason to be a little pessimistic about the gains we’ve made in terms of educating folks about mental health concerns.
The first article entitled, Depression Stigma Higher in Medical Students, examined mental health attitudes amongst medical students — you know, those folks who should be the most open-minded about these disorders that have significant roots in the brain. Of course, from the title of the article, you already know the study’s findings.
In a survey of 505 medical students, researchers found that not only do the future doctors have higher rates of depression than in the general population (not surprising, given the stress of medical school), but they have something a little less expected — higher rates of stigma about depression too.
Psychotherapy is a great treatment option for virtually any mental disorder or mental health concern, as well as life and relationship issues. Decades’ worth of research have proven its effectiveness, at least when you’re working with an experienced therapist who knows their stuff and uses empirically-backed techniques.
But what happens when you need to change therapists? We all need to change therapists from time to time, so how do you start over with a new therapist? Where do you begin? What do you do? And what do you look for in your new therapist?
Changing therapists can be a daunting, anxiety-inducing process. There is no “right” time to change therapists. You do it when you feel like you’re treading water with your current therapist, or you’re just not seeing the progress you’d like in therapy. With that in mind, here are 7 tips for changing therapists I recommend.
Genetic testing allows individuals to submit a genetic sample to a company, which then analyzes the genes for known anomalies or other problems. The idea is that by having that information, you may be able to be more aware of potential health problems down the road. Or even stave them off before they become a problem by changing your behaviors, diet, and exercise regimen. Companies like 23andme and Navigenics provide genetic DNA testing reports that purportedly tell you your risk factors for getting not only certain medical conditions, but also mental disorders, like bipolar or attention deficit disorder.
This may work fine for some very well-defined health issues, like heart disease (although a recent government investigation into these companies’ abilities to provide even this information reliably suggests some problems). But it doesn’t work at all for any mental disorder.
You can “malinger” — fake — virtually any mental disorder, because mental illness is defined by symptom lists that are self-reported. That is, you tell the doctor or therapist the symptoms you’re experiencing, and they simply go down the list and figure out which disorder the symptoms best fit into. Since the symptoms are self-reported, you can easily make up the symptoms to qualify for whatever diagnosis you want.
In medicine, things are a bit different. Although doctors might use your self-reported symptoms as a starting point on how to diagnose the medical problem you present with, they can usually followup by ordering a series of laboratory tests to confirm their diagnosis. There is no equivalent for mental health concerns (although there are many paper-and-pencil psychological tests have very good validity when it comes to differential diagnoses; these, however, are rarely used in daily practice).
So when I come across an article like this Associated Press one — talking about how some soldiers may be faking post-traumatic stress syndrome (PTSD) in order to gain benefits — it makes me cringe a little.
While the national mental health parity law takes effect on January 1, 2010, it does not trump existing state laws that mandate that mental disorder diagnoses are treated and covered equally as their physical health brethren. If you are covered by health insurance, come January 1, your mental health treatment cannot be any more limited than your physical health coverage. California is one such state that has had such a mental health parity law on the books since 2000, so we have nine years of lessons from that state.
Recently, a study was released that examined how the law affected people who sought out mental health treatment. Shari Roan with the Los Angeles Times has the coverage. The study, conducted by Mathematica Policy Research and the Substance Abuse and Mental Health Services Administration, looked at data from 2000 to 2005 and found some things in line with expectations:
This is not surprising, given that projections are usually based upon real-world scenarios of how mental health care is delivered and paid for.
Indeed, since it is mandated by the law, health insurance companies had little choice but to lift these limits.
This is a common, continuing problem not only with mental health providers, but general providers under health insurance plans. In fact, it’s one of the most common complaints about health insurance in the U.S.
This is nothing new. Mental health treatment providers have been choosing “covered” diagnoses for patients rather than “not-covered” diagnoses for decades (ever since managed care came on the scene). While certainly far from an ideal situation, this is forseeable outcome of having a list of approved versus unapproved and non-reimbursable diagnoses. This will remain a problem with the new law as well.
However, the study also found some things that policy makers may have not expected or planned for:
This is going to be the newest loophole used by insurance companies to refuse to pay for mental health services provided. You’d think that only your therapist or doctor could determine “medical necessity,” but leave it to insurance companies to make that determination from afar.
I believe the new parity law covers a wider range of diagnoses, so this should be as serious a concern.
This is an unexpected and unfortunate problem, in that consumers don’t necessarily know what their rights are when it comes to getting treatment that is reimbursable from their health insurer. But it is a problem that is hopefully easily solved through more outreach and education.
Mental health parity is sometimes viewed as a panacea, in that it will suddenly solve a lot of problems regarding the treatment of mental health concerns. That is not likely the case, but what it will do is make it easier for treatment providers like psychologists to see patients for as long as they need to be seen. Assuming that the “medical necessity” isn’t turned into another barrier for continuing mental health treatment, as the California study found.
Read the full article: Mental-health parity laws require oversight
On October 6, 2009, the popular television show Oprah aired a program about a 7 year old girl, Jani, who has “schizophrenia.” Schizophrenia is fairly rare within the population to begin with; it’s nearly unheard of in children as young as 7. That’s what made this an interesting and engaging program. The disorder apparently started at 2, with imaginary friends who started showing up in Jani’s life.
I can’t speak to Jani’s specific case, since I’ve never met the child, but I will say that labeling a child at this young an age with such a serious mental disorder (she was first diagnosed at age 5) is extraordinary. And of course it is easy to second-guess Jani’s experience and that of her parents from afar.
Her psychiatrist, Dr. Mark DeAntonio [from the UCLA Medical Center], says it’s very unusual for a child Jani’s age to have this kind of mental illness. “I’ve seen only really a handful of children in my 20 years that fit this kind of diagnosis,” he says. “This kind of alternate reality that she lives in — that’s very scary. That’s very disturbing.”
Disturbing indeed. Even more disturbing that Oprah would choose to highlight this kind of case with an entire show devoted to it — kind of smells opportunistic. But it wouldn’t be the first time Oprah took the sensationalistic route in portraying a mental disorder for ratings, rather than helping people truly understand people’s living with them.
I wouldn’t have written about it except that a few days ago an organization called Intervoice sent me a news release that contained an “open letter to Oprah Winfrey” regarding the episode and Jani. It’s hard for me to describe what Intervoice is, so I’ll just quote them instead:
However, there are also significant numbers of voice hearers who are overwhelmed by the negative and disempowering aspects of the experience. Many are diagnosed as having a serious mental health problem such as schizophrenia — a harmful and stigmatizing concept, in our eyes.
The experience of hearing voices prevents some people from living a fulfilled life in society (especially those in psychiatric and social care) and can lead to having a very poor quality of life. We seek to enable voice hearers troubled by their experience to change their relationship and attitude to their voices and to take up their lives again. We also want to ensure that our innovatory approach is better known by professionals, family members and friends.
We have spent the last 20 years trying to better understand why some people can cope with the experience and others can’t. We have discovered that those people who are not able to cope with their voices, on the whole have not been able to cope with the traumatic events that lay at the roots of their voice hearing experience.
I like their message — one of hope and empowerment. That hearing voices doesn’t have to be thought of as simple a “disorder” or problem that needs a fix (although many people may prefer to have the voices go away, if that’s their choice).
The organization included a long, 2,372 word letter to Oprah (sans bibliography) that emphasized these points. You can check out the entire content of the letter on their website (linked to below). But I thought this part of the letter was most interesting.
The letter, which had 95 signatories including a fair share of PhDs, MDs, and other professionals from the international community, included 10 tips for what a parent might do if they find their child is hearing voices.
In our experience, what helps children the most is a systematic approach to understanding the voices. So, in order to help we have developed an interview to help map the experience. This can be used as a way to understand the stress the child is under, and then to work together to find solutions for the problems raised by the experience of hearing voices.
We would like to offer this 10-point guide for parents, indicating what they can do if their child tells them that he or she hears voices:
- Try not to over react. Although it is understandable that you will be worried, work hard not to communicate your anxiety to your child.
- Accept the reality of the voice experience for your child: ask about the voices, how long the child has been hearing them, who or what they are, do they have names, what they say, etc.
- Let your child know that lots of children hear voices and that usually they go away after a while.
- Even if the voices do not disappear your child might learn to live in harmony with his or her voices
- It is important to break down your child’s sense of isolation and difference from other children. Your child is special – unusual perhaps, but really not abnormal.
- Find out if your child has any difficulties or problems that he or she finds very hard to cope with, and work on trying to fix those problems. Think back to when the voices first started. When did the voices arise for the first time? What was happening to your child when the voices first appeared? Was there anything unusual or stressful that might have occurred?
- If you think you need outside help, find a therapist who is prepared to accept your child’s experience and work systematically with him or her to understand and cope better with the voices.
- Be ready to listen to your child if he or she wants to talk about the voices. Use drawing, painting, acting and other creative ways to help the child to describe what is happening in his or her life.
- Get on with your lives and try not to let the experience of hearing voices become the centre of your child’s life or your own.
- Most children who live well with their voices have supportive families around them who accept the experience as part of who their child is. You can do this too!
In conclusion we would like to stress that, in our view, labelling a seven-year-old child as schizophrenic and subjecting her to powerful psychotropic medication and periodic hospitalisation is unlikely to help resolve her problems with voices. Indeed, the opposite is most probable: Jani will simply become more powerless when it comes to finding ways to cope with her voices.
Because your well respected, award winning show reaches out to so many people, we are concerned that there will be many viewers who will be left with the impression that the kind of treatment Jani receives is the only one available. If this is the case then there will be children who will be subjected to an unnecessary lifetime in psychiatric care because their families believe there are no alternatives. It is very important to recognise that hearing voices, in itself, is not a sign of psychopathology – and – voice hearers who are patients can be helped to recover from their problems by being supported in developing their own ways of coping with their emotions.
We hope you will give consideration to the possibility of making a future programme showing the other side of the story, one of hope, optimism and with a focus on recovery. Perhaps you could make a programme about a child with similar voice experiences to Jani, who has been helped to come to terms with her or his voices and to discuss with the child, parents and therapists how this was achieved?
I’d have to agree by and large with their point, hence the reason you’re reading this entry today.
Just because something is unusual — such as hearing voices — doesn’t automatically make it a symptom of a more serious disorder. While it certainly can be (and in Jani’s case, only her doctors can make such a judgment), it may be something else instead.
We would love to see Oprah tackle mental health topics with an eye toward understanding they affect everyone, rich and poor, extraordinary and ordinary, young and old. And while it’s easy to always portray them in a negative light, how interesting would it be if someone talked more about some of the positives of having a different way of looking at the world. (Some people already do, most notably Tom Wootton in his books called The Depression Advantage and The Bipolar Advantage.)
Read the full letter here (PDF).
Read more about Jani here: The 7-Year-Old Schizophrenic
A nervous breakdown refers to a mainstream and often-used term to generically describe someone who experiences a bout of mental illness that is so severe, it directly impacts their ability to function in everyday life. The specific mental illness can be anything — depression, anxiety, bipolar disorder, schizophrenia, or something else. But the reference to a “nervous breakdown” usually refers to the fact that the person has basically stopped their daily routines — going to work, interacting with loved ones or friends, even just getting out of bed to eat or shower.
A nervous breakdown can be seen as a sign that one’s ability to cope with life or a mental illness has been overwhelmed by stress, life events, work or relationship issues. By disconnecting from their regular responsibilities and routines, an individual’s nervous breakdown may allow them to try and regroup their coping skills and temporarily relieve the stress in their life.
Someone with a nervous breakdown may be seen as having “checked out” from society temporarily. They no longer maintain their social relationships with others, and find it difficult or impossible to go to work and may call in sick multiple days in a row. People with a nervous breakdown often don’t even have the coping resources available to take care of themselves, or do much more than rudimentary self-care and maintaining. They may over-eat (if it provides them comfort) or simply fail to eat altogether, not feeling the need or energy to do so.
Since a nervous breakdown is not a clinical or scientific term, it’s meaning can also vary in terms of its length and severity, as well as outcomes. Many people who suffer from a nervous breakdown usually seek out treatment (or have treatment sought out on their behalf by a loved one), and treatment is usually on the serious end of the spectrum of all the interventions available. Inpatient hospitalization for a serious nervous breakdown would not be unusual, to help a person become stabilized and find an effective treatment strategy for the mental disorder they’re affected by.
People who suffer from a nervous breakdown and seek out treatment for it will usually recover from the most extreme depths of the “breakdown” within a few weeks’ time (which may be quickened with inpatient psychiatric treatment). Longer-term recovery usually takes months of ongoing outpatient treatment with mental health specialists, such as a psychiatrist or psychologist.
A nervous breakdown is not a condition to be afraid of, as it is simply an indication of overhwelming stress and mental illness in a person’s life. Loved ones and friends of someone who is suffering from a nervous breakdown should be supportive of the individual’s efforts in seeking help for it.
A nervous breakdown, also known as a mental or emotional breakdown, is a serious and overwhelming reaction to stress that can leave a person feeling out of control and unable to function normally. Coping with a nervous breakdown requires careful and thoughtful attention to one’s physical, emotional, and mental health. Here are five different ways a person can cope with a nervous breakdown:
Depression is often viewed as the “common cold” of mental disorders, because it is so prevalent in our lives. The lifetime prevalence of depression suggests that more than 1 in 9 people could be diagnosed with the disorder at one point in their lives. And unlike some other mental disorders, depression affects virtually every aspect of what you do and how you interact with others. Every year, it wreaks havoc in millions of Americans’ lives, especially amongst those who believe it is something you should just “get over” on your own.
Here are seven common myths about depression, and the facts that answer them.
1. Depression means I’m really “crazy” or just weak.
While depression is indeed a serious mental disorder, it is no more serious than most other mental disorders. Having a mental disorder doesn’t mean you’re “crazy,” it just means you have a concern that is negatively impacting how you live your life. Left unaddressed, this concern can cause a person significant distress and problems in their relationships and life. Depression can strike anyone, at any time — whether you’re “weak” or strong, it knows no bounds. Some of the strongest people I’ve met are people who’ve coped with depression in their lives.
2. Depression is a medical disease, just like diabetes.
While some pharmaceutical-influenced marketing propaganda might simplify depression into a medical disease, depression is not — according to our knowledge and science at this time — simply a pure medical disease. It is a complex disorder (called a mental disorder or mental illness ) that reflects its basis in psychological, social, and biological roots. While it has neurobiological components, it is no more of a pure medical disease than ADHD or any other mental disorder. Treatment of depression that focuses solely on its medical or physical components — e.g., through medications alone — often results in failure. Get to know the risk factors for depression.
3. Depression is just an extreme form of sadness or grief.
In most cases, depression is not just ordinary sadness or grief over a loss. If it were ordinary sadness or grief, most people would feel better just over time. In depression, time alone doesn’t help, nor does willpower (“Pull yourself up and stop feeling so sorry for yourself!”). Depression is overwhelming feelings of sadness and hopelessness, every day, for no reason whatsoever. Most people with depression have little or no motivation, nor energy and have serious problems sleeping. And it’s just not for one day — it’s for weeks or months on end, with no end in sight.
4. Depression just affects old people, losers and women.
Depression — like all mental disorders — does not discriminate based upon age, gender, or personality. While generally more women than men are diagnosed with depression, men suffer for it all the more since many people in society believe that men shouldn’t show signs of weakness (even a man’s own upbringing may reinforce such messages). And while aging brings many changes in our life, depression is not a normal part of the aging process. In fact, teenagers and young adults grapple with depression just as much as seniors do. Some of the world’s most successful people have also had to deal with depression, people such as Abraham Lincoln, Theodore Roosevelt, Winston Churchill, George Patton, Sir Isaac Newton, Stephen Hawking, Charles Darwin, J.P. Morgan and Michelangelo. So being a loser is not a prerequisite to being depressed.
5. I’ll have to be on medications or in treatment for the rest of my life.
While some doctors and even some mental health professionals believe that medications may be a long-term solution for people with depression, the truth is that most people with depression receive treatment for it for a specific period of time in their lives, and then end that treatment. While the exact amount of time will vary from person to person based upon the severity of the disorder and how well the various treatments may work for each individual, most people who have depression do not need to be on medications for the rest of their lives (or be in treatment for the rest of their lives). In fact, a lot of research suggests that most people can be treated for depression successfully in as little as 24 weeks with a combination of psychotherapy, and if needed, medications.
6. All I need is an antidepressant to treat depression effectively.
Sorry, no, it’s not as easy as popping a pill. While certainly you can have an antidepressant medication quickly prescribed to you by your primary care physician, you’re unlikely to feel any beneficial effects from that medication for 6 or more weeks in most cases. In two-thirds of patients, that first medication won’t even work! Combined psychotherapy treatment with medication is the recommended gold standard for the treatment of depression. Anything else is going to be significantly less effective, meaning most people will suffer with their depressive symptoms longer than they need to.
7. I’m doomed! My parents (or grandparents or great uncle) had depression, and isn’t it inherited?
While in the past there’s been research to suggest the heritability of depression, more recent studies have called into question how much of depression really is genetic. The upshot? While researchers continue to explore the neurobiology of mental disorders like depression, having a relative with depression only marginally increases your risk for getting depression (10 to 15%). Remember, too, that relatives impart a lot of their own coping strategies upon us in our childhood development — strategies that may not always be the most effective when dealing with things like depression (making one more vulnerable to it).
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I hate to beat the drum of obviousness, but everything we think, feel or do has a neurobiological correlate.
If you run for 20 miles, most of us are going to be out of breath and heave air in and out of our lungs as they try and supply enough oxygen to our body. If you just found out you have to give a presentation to an audience of 4,000 people and giving presentations isn’t your livelihood, chances are you’re going to feel your palms go clammy and you may begin to sweat. If you feel intense anger or rage at another person, I bet I’ll be able to measure your blood pressure hit the roof. Even just listening to music impacts our brain’s functioning (see Koelsch, 2005 for a nice summary of this).
So why is it news that when we hook someone who has a mental disorder like depression, schizophrenia or ADHD to electrodes, or take a brain scan with fMRI or PET imaging, we’re surprised to find people’s brains with these disorders look and function differently than people’s brains without these conditions?
Yet that’s exactly what’s hailed as ground-breaking science here in this Washington Post article published earlier this week about a study looking at the brains of 53 people with attention deficit disorder (ADHD) compared to a group of healthy control subjects using PET brain imaging technology. The article discusses this JAMA study that found that people with ADHD have brains that look different than those without (Volkow et al., 2009). Specifically the researchers found that “ADHD patients had lower levels of dopamine receptors and transporters in the accumbens and midbrain — two key regions of the brain directly involved in processing motivation and reward.”
Okay. So what?
This study tells us nothing about how these dopamine receptors got the way they did. Instead, it joins the growing number of studies that analyze the brain and tell us things like, the structure of the brain may influence ADHD, or that hundreds of gene variations are linked to ADHD, or that, it’s not that people with ADHD’s brains don’t have enough dopamine, it’s that the brain pushes dopamine in the wrong direction influencing a ‘speed’ response between nerve cells. I could go on, but I hope you get the point.
Hundreds of studies have now been done analyzing the brains and genes of people with mental illness, but it doesn’t feel like we are any closer to the truth than we were 10 years ago.
One of the reasons is because none of these kinds of studies shed any light on the real problem — how did people’s brains come to have these anomalies in the first place? News articles (and sometimes even researchers themselves) subtly suggest that it’s the brain abnormality that is causing the mental disorder (in this case, ADHD). But it could just as well be the other way around — the ADHD may be causing the brain changes.
That’s why I find it interesting when researchers, like those who did the most recent JAMA study here, go out of their way to find people who haven’t taken medications for their disorder. The researchers don’t want their results contaminated by the neurochemistry of the medications.
But neurochemistry isn’t affected only by medications. It’s affected by everything we do. If you can change your very brain structure simply by driving a cab, imagine what efforts like psychotherapy can bring about. Even simple exercise can impact our brain.
Then imagine what a disorder like ADHD could do to your brain (rather than the other way around)… If ADHD is caused by some third factor, something non-neurological (say, only for the sake of argument, parenting skills), wouldn’t we still expect to see changes in the brain? Yes, we would. And we wouldn’t have any idea about this third factor if we weren’t looking for it. So while you might be technically correct in prescribing a medication to combat the brain changes, one could completely miss the underlying cause of the problem in the first place. (To emphasize, this is completely a hypothetical argument to prove a point.)
While I believe studies such as this most recent one add to our overall knowledge and understanding of conditions like ADHD (especially when it comes to pharmaceutical remedies for them), I don’t think it does much to help answer what causes ADHD. Nor does it put us any more firmly in the camp of understanding these as some sort of pure “biological brain illness.”
Having said that, I do believe that ADHD and other mental disorders have neurological correlates. And perhaps those correlates are more substantial and have a greater impact than other kinds of things in our lives. What I object to is positioning these kinds of brains scan studies as some sort of breakthrough in our understanding of these concerns when they aren’t.
Read the full article: Brain Scans Link ADHD to Biological Flaw Tied to Motivation
References:
Koelsch, S. (2005). Investigating Emotion with Music: Neuroscientific Approaches. In: The neurosciences and music II: From perception to performance. Avanzini, Giuliano (Ed.); Lopez, Luisa (Ed.); Koelsch, Stefan (Ed.); Manjno, Maria (Ed.); New York, NY, US: New York Academy of Sciences, 412-418.
Nora D. Volkow; Gene-Jack Wang; Scott H. Kollins; Tim L. Wigal; Jeffrey H. Newcorn; Frank Telang; Joanna S. Fowler; Wei Zhu; Jean Logan; Yeming Ma; Kith Pradhan; Christopher Wong; James M. Swanson. (2009). Evaluating Dopamine Reward Pathway in ADHD: Clinical Implications. JAMA, 302(10), 1084-1091.
Borderline personality disorder is a mental disorder characterized by a longstanding pattern of instability in one’s relationships with others, with a person’s own image of themselves, and their own emotions. It’s marked by impulsivity and, like most personality disorders, usually begins in early adulthood (early 20s) and pervades every aspect of a person’s life.
People with borderline personality disorder live tumultuous lives. Their romantic relationships rarely last more than a year, and their relationships with their own family tends to be unstable — some weeks they love them and want to spend all of their time with them, some weeks they hate them and won’t even talk to them (to extremes not usually experienced by the rest of us).
Traditionally, the treatment method most often recommended for people with borderline personality disorder has been a form of psychotherapy called dialectical behavior therapy (DBT). This form of psychotherapy has decades’ worth of research backing and is considered the “gold standard” for the treatment of borderline personality disorder. While DBT is effective, it requires an experienced and specially trained therapist, and long-term commitment on the client’s end. This can sometime limit a person’s ability to obtain this type of therapy. Many times it’s used as a group therapy process, which can also be scary to some potential clients.
And while DBT’s effectiveness is well accepted, it’s not as well known how it compares with other forms of treatment for borderline personality disorder over the long-term. A new research study (McMain et al., 2009) sheds some light on this issue.
Researchers studied 180 participants who were diagnosed with borderline personality disorder, of which 111 completed the year-long study. They were divided into two treatment groups — dialectical behavior therapy and general psychiatric management. What’s general psychiatric management?
General psychiatric management was based on the APA Practice Guideline for the Treatment of Patients With Borderline Personality Disorder and manualized for this trial. This coherent, high-standard outpatient treatment consisted of case management, dynamically informed psychotherapy, and symptom-targeted medication management. Pharmacotherapy was based on the symptom-targeted approach but prioritized treatment of mood lability, impulsivity, and aggressiveness, as presented in the APA guideline.
What did they find? Surprisingly, the researchers found that after a year’s worth of treatment for both groups, both groups significantly improved. And worse yet for DBT, there were no significant differences between the two treatment groups.
This trial demonstrated that 1 year of dialectical behavior therapy or general psychiatric management for the treatment of suicidal patients with borderline personality disorder brought about significant reductions in suicidal behavior, borderline symptoms, general distress from symptoms, depression, anger, and health care utilization, along with improvements in interpersonal functioning. Contrary to our expectations, dialectical behavior therapy was not superior to general psychiatric management with both intent-to-treat and per-protocol analyses; the two were equally effective across a range of outcomes.
One interesting data point, however, that the researchers didn’t discuss. You can see it pretty clearly in this graph:
Although this difference was reportedly not “statistically significant,” people in the general psychiatric management group had nearly 3 times the number of self-injurious episodes every month than those in the DBT group at the end of the one year treatment. That seems pretty significant, if not statistically, then at least clinically.
The other concern this article again points to is that between 38 and 39 percent of patients dropped out of treatment before the year was up. So while it’s interesting that both treatment groups benefited from the intervention, nearly 40 percent of people still aren’t helped by either (of those who returned survey about why they stopped treatment, 42 percent of subjects said that the treatment wasn’t helpful).
This is the largest trial to compare DBT against another standardized treatment and another datapoint that dispels the myth that borderline personality disorder is “untreatable.” Borderline personality disorder is treatable and this study demonstrates yet another treatment approach that appears equally effective as the “gold standard” DBT.
Reference:
McMain, S.F., Links,P.S., Gnam, W.H., Guimond, T., Cardish, R.J., Korman, L. & Streiner, D.L. (2009). A Randomized Trial of Dialectical Behavior Therapy Versus General Psychiatric Management for Borderline Personality Disorder. Am J Psychiatry.
DOI: 10.1176/appi.ajp.2009.09010039
I’ve been loathe to give any additional attention to the tiny treatment center in Washington state that says it’s treating “Internet addiction” in a “first of its kind in the US” treatment program, seeing as it’s already had over 350 media mentions in the past few days, including the one below in none other than the New York Times. Apparently when you start a media snowball rolling downhill, it’s hard to stop for a moment and do any actual reporting on the topic. It is much easier to eat up the PR and repackage it with no critical eye on the claims made.
One of the problems with the mainstream media’s reporting on the topic is that it’s acting as though this is the first treatment center to treat this mythical condition (I say “mythical” since the research is definitely mixed on its existence, and it’s not recognized by any diagnostic system nor insurance company as a legitimate mental disorder). Indeed, my good colleague whom I admire and respect, Dr. Maressa Hecht Orzack (on the Harvard Medical School faculty, no less), has been treating this condition for 15 years at the famed McLean Hospital.
Oh, but wait, you say. Dr. Orzack’s program is outpatient only. This surely must be the first inpatient treatment program for people with “Internet addiction,” no? I mean, all the media is reporting the exact same claims made in the press release by the company. Apparently, no one in the media spent 2 minutes on Google to verify the claims.
For instance, in this article entitled Internet addiction may be one click away on July 29, 2008, the reporter notes:
Coleen Moore, coordinator of resource development at the Illinois Institute for Addiction Recovery, said she has clients from college age to early adulthood who spend 14 to 18 hours a day online. […]
At the Illinois Institute for Addiction Recovery, some patients need 30 to 90 days in-patient treatment, followed by a continuing care program. But Internet addiction recovery, as any other addiction, requires lifelong treatment, experts said.
So in two minutes of Googling, I find that one of the primary components that made this story ostensibly “news” was that this was the first such inpatient program to treat “Internet addiction.” Wrong.
And one has to wonder — for 15 years, professionals have been treating this condition in outpatient settings. One hopes they’ve been treating it in outpatient settings successfully, but again, the research isn’t strong here. Why the need for more inpatient settings for something that the professional community doesn’t even recognize as a legitimate disorder?
Is the Internet like crack or heroin, where you need to seclude someone in a residential inpatient treatment center at $14,000 for 45 days while you teach them the cognitive-behavioral strategies they need to learn to better mediate their Internet use? I don’t have an answer for this question, and neither does the research, which is moot on inpatient treatment for “Internet addiction.” Without research supporting such a treatment strategy, you might as well as start selling herbal supplements to help with this concern.
Isn’t it interesting that when it came time to re-purpose an old treatment center, they settled upon an “in vogue” diagnosis?
Cosette Dawna Rae, a psychotherapist, has owned the bucolic retreat center since 1994, and was searching for a new use for it when she teamed up with Ms. Cash.
So despite the lack of any clinical evidence supporting the efficacy of inpatient treatment for a mythical condition, that doesn’t stop the press from fawning all over this slick new business. I rely on mainstream reporting to at least pretend to give equal time to the other side on controversial issues like this. And if nothing else, check out the claims made in a press release to see if they are actually true before simply reporting the claim itself. Anybody can report claims; journalism is supposed to take one additional step and see if the claim has any merit.
“Internet addiction” makes an appearance in the media about twice a year, usually for some reason like this. What doesn’t make news headlines is the actual research that calls into question this proposed diagnosis and the serious methodological flaws that exist in virtually all the research to date on this concern.
Read the full article: Center Tries to Treat Web Addicts
I was also interviewed for a segment on NPR’s “All Things Considered” on this topic, which aired yesterday evening.
People with mental illness are increasingly ending up being imprisoned, rather than in the mental health care system where many of them belong. With the down economy, states and counties — who are primarily responsible for the health of the indigent — cut social services first. And with most public psychiatric hospitals long-since closed, people who have a mental disorder end up being warehoused not in hospitals, but in prisons.
Yes, we succeeded in closing down the state mental hospitals. But we moved the population not to outpatient facilities, but to our prisons.
Now, finally, people are realizing the short-sightedness of locking people with mental illness up, as the spiraling prison costs of doing so become a burden to cash-strapped local governments.
In Philadelphia, a new mental health court has just started, meant to divert people away from prison and into mental health treatment. By doing so, the hope is that they can reduce the incidence of mental illness within prisons, and provide better care for people with a mental disorder in the process.
The new court is part of an approach called “sequential interception,” which includes programs designed to intervene so that people with mental illness don’t get caught up in the criminal justice system – or even killed by it. […]
The court and the CIT are responses to a complex problem that began decades ago when the closing of state hospitals released mentally ill people into the community without adequate support or services.
Decades later, the high numbers of mentally ill people occupying prisons – some reports put the number at 30 percent of the inmate population – suggests that in too many cases, prisons have replaced state hospitals.
Imagine that — up to 30 percent of prisoners could have a treatable mental disorder. And guess what kind of mental health care most prison systems offer? Limited, if any (federal prisons tend to do a better job in this area than state-run prisons, but none come close to offering the kinds of services one would typically find in their local community).
Human Rights Watch has called out the U.S. prison system for its warehousing of the mentally ill and giving them inadequate care:
In 1998, the Bureau of Justice Statistics reported there were an estimated 283,000 prison and jail inmates who suffered from mental health problems. That number is now estimated to be 1.25 million. The rate of reported mental health disorders in the state prison population is five times greater (56.2 percent) than in the general adult population (11 percent).
Women prisoners have an even higher rate of mental health problems than men: almost three quarters (73 percent) of all women in state prison have mental health problems, compared to 55 percent of men.
“While the number of mentally ill inmates surges, prisons remain dangerous and damaging places for them,” said Jamie Fellner, director of Human Rights Watch’s U.S. Program and co-author of a 2003 report, “Ill-Equipped: U.S. Prisons and Offenders with Mental Illness.” “Prisons are woefully ill-equipped for their current role as the nation’s primary mental health facilities.”
Prison systems are horrifying places to be in the first place. They are even more so for someone who is suffering from schizophrenia or bipolar disorder and doesn’t have access to standard treatments for them. The previous Human Rights Watch report noted:
Inmates with mental illness are often punished for their symptoms. Being disruptive, refusing to obey orders, and engaging in acts of self-mutilation and attempted suicide can all result in punitive action. As a result, the report noted, prisoners with mental illness often have extensive disciplinary histories.
Frequently, the prisoners end up in isolation units. “In the most extreme cases, conditions are truly horrific,” the report stated, adding:
Mentally ill prisoners locked in segregation with no treatment at all; confined in filthy and beastly hot cells; left for days covered in feces they have smeared over their bodies; taunted, abused, or ignored by prison staff; given so little water during summer heat waves that they drink from their toilet bowls. … Suicidal prisoners are left naked and unattended for days on end in barren, cold observation cells. Poorly trained correctional officers have accidentally asphyxiated mentally ill prisoners whom they were trying to restrain.
These are conditions one would expect in a third-world country. Not in the U.S. And not for people who are often most in need of compassion and care.
What research is there to show such mental health courts help? On Friday, a study was released that showed a 20 to 25 percent improvement in offender outcomes under the mental health court system in Minnesota.
Those who did not go through the specialized court got arrested again in less than three weeks.
Sociologist Henry Steadman, who heads the New York-based policy research group, said it’s important to view those numbers in context.
“Taking a hard-core, challenging population that has failed repeatedly in all three systems: criminal justice, substance abuse and mental health,” Steadman said, “and has cycled and is a particularly challenging group, and have come up with an intervention that is a 20 to 25 percent improvement on almost all the measures. My evaluation is that’s pretty damn good in today’s world.”
Indeed. While mental health courts don’t result in immediate cost savings, after about a year and a half, the savings start to add up. And of course, those 20 to 25 percent of people who go through such programs are leading far better lives than if they were stuck behind bars in prison.
But in the end, it’s not really about costs, is it? It’s about treating humans with basic dignity and respect, and taking care of those who need treatment and care. A society is judged in part by how they take care of their most vulnerable and sick citizens. Today, our society just got a little bit better.
For decades, scientists have been making claims about the genetic roots of mental illness, ranging from schizophrenia and depression, to bipolar disorder and attention deficit disorder (ADHD). And for decades, they’ve largely been chasing ghosts.
Eric Kandel, writing for Newsweek, makes the at-least-annual appeal that scientists are making “certain advances in genetics” which give “us new reasons for optimism” in understanding the biological basis for mental illness. As someone who’s been tracking the progress of such genetic advances over the past two decades, I have to say, I remain squarely skeptical.
It doesn’t help that Kandel’s own arguments are exercises in circular logic:
One major advance has been the discovery that there is much more variability in the genome than had been anticipated, and that this takes the form of copy number variation (CNV). These are duplications or deletions of segments of a chromosome, often involving several or tens of genes, that enhance or depress the actions of specific genes. A well-known example of a CNV is the extra copy of chromosome 21 resulting in Down syndrome. It has recently been discovered that this type of variation is extremely common in everyone’s genome.
If there’s “much more variability in the genome,” guess what? That means finding specific meaningful, predictable variations is all the more challenging. If the extra copy of chromosome 21 is “extremely common,” how come Down syndrome isn’t so much more common?
We’ve highlighted previously altered genes that may increase the risk of schizophrenia, for example. But not a year goes by where more such research highlights other genes or other gene variations. I mean, we’ve been talking about this for years. What’s changed recently?
Nothing. If anything, new research shows just how complicated gene research is. If hundreds of gene variations could be indicted in a “simple,” less-serious mental disorder like attention-deficit disorder, imagine the complexity of more debilitating disorders like depression or bipolar disorder.
Kandel also makes this claim you’ve probably heard before:
Scientists are also making progress in finding the biological markers for depression, anxiety, and obsessive-compulsive neurosis. Markers are essential to understanding the anatomical basis of mental disorders, diagnosing them objectively, and following their response to treatment, as well as perhaps preventing psychosis in those at high risk.
Progress? Well, if you call understanding how extraordinarily complex the human genome is, compared to what we thought it was 10 years ago, yeah, I guess you could call that “progress.” But honestly, researchers are not significantly closer to finding genetic markers for depression, anxiety and OCD than they were a decade ago. Think of our understanding of brain disorders and genetics similar to that of unpeeling an onion. The size of a giant watermelon. Or the moon.
But the strangest point made by Kandel is that the effectiveness of psychotherapy is now “proven” because of brain imaging studies which have been called into question:
The most convincing scientific progress in psychiatry in the past decade has had little to do with genomics. It is the rigorous, scientific verification that certain forms of psychotherapy are effective. […] Insofar as psychotherapy works and produces stable, learned changes in behavior, it can cause stable anatomical changes in the brain. We are now beginning to measure such changes with brain imaging.
Who cares? We don’t need brain imaging to understand that psychotherapy works. I guess all those decades of psychology research showing the effectiveness of psychotherapy were for naught until we had the sheer magic of brain imaging.
While I believe understanding human genetics and the neurological basis of mental disorders is important, invaluable work, I think articles like Kandel’s sort of miss the point. This work is slow and arduous, and for every one step forward, we take two steps back. Indeed, we are making progress, but it is not progress one can easily track or summarize in a mainstream news article of this nature.
In the treatment of mental disorders, we have plenty of approaches that work just as well as (and, in fact, work better than) any medical treatment for a medical disease. (Honestly, Kandel should look at the research behind the vast majority of surgical procedures to see the lack of rigorous scientific data that he’s demanding for mental illnesses.)
Genetics may one day hold some sort of key to our understanding of mental disorders. But that’s a line that’s been repeated hundreds of times over the past two decades, and one that seems no truer today than it did in 1989.
Read the full entry: A Biology of Mind
Bipolar disorder has been the focus of attention in recent years, as a new slew of psychiatric medications have been developed to help treat it. Such medications drive pharmaceutical marketing and increased educational efforts surrounding bipolar disorder (for better or worse).
But many myths surround bipolar disorder — what it is, what it means, and how it’s treated. Here’s to busting a few of the most common ones.
1. Bipolar disorder means I’m really “crazy.”
While bipolar disorder is a serious mental disorder, it is no more serious than most other mental disorders. Having a mental disorder doesn’t mean you’re “crazy,” it just means you have a concern that is negatively impacting how you live your life. Left unaddressed, this concern can cause a person significant distress and problems in their relationships and life.
2. Bipolar disorder is a medical disease, just like diabetes.
While some marketing propaganda might simplify bipolar disorder into a medical disease, bipolar disorder is not — according to our knowledge and science at this time — a medical disease. It is a complex disorder (called a mental disorder or mental illness ) that reflects its basis in psychological, social, and biological roots. While it has significant neurobiological and genetic components, it is no more of a pure medical disease than ADHD or any other mental disorder. Treatment of bipolar disorder that focuses solely on its “medical” components often results in failure.
3. Manic depression is different than bipolar disorder.
Manic depression is simply the old name for bipolar disorder. The name was changed to more accurately describe the type of mood disorder it is — someone who experiences swings between two poles of mood (or emotion). Those two poles are mania and depression.
4. I’ll have to be on medications for the rest of my life.
While the default assumption by most mental health professionals is that most people with bipolar disorder will need to be on medications for the rest of your life, nobody can predict how exactly you, as an individual, will react to such medications or what the future holds for your specific needs. So it is a myth to say that all people with bipolar disorder will absolutely be on medications for the rest of their lives. As many people age with this disorder, they find their swings between mania and depression lessen significantly, and the need for medication may decrease, and may even be discontinued without any harmful repercussions.
5. I’m feeling better since taking my medications, which means I probably don’t need them any more, right?
Wrong. Once a person starts feeling better because of the medication, they often discontinue taking the medication, leading to an eventual relapse. This is a common problem in the treatment of bipolar disorder and is something professionals like to call “treatment compliance.” This is just a fancy way of saying that a person needs to continue taking their medication as prescribed, no matter how good they may be feeling. It is perhaps one of the most insidious issues in the treatment of bipolar disorder, and leads many people to greater distress than if they just kept taking their medications.
6. There’s no need for psychotherapy in bipolar disorder.
This varies from person to person (just as the need for taking medications does), but this is a myth insomuch that many people and professionals believe that psychotherapy doesn’t help much in the treatment of bipolar disorder. Psychotherapy can be very helpful and effective in the treatment of bipolar disorder, since medications alone can’t teach a person new coping skills or how to deal with feelings of an impending manic or depressive episode. Psychotherapy can help a person with bipolar disorder learn to live with the disorder in their lives without as much stress or upset. While many people with bipolar disorder forgo psychotherapy, it is usually a helpful treatment to consider when first diagnosed.
7. Atypical antipsychotics are only for schizophrenia.
In the U.S. in 1990, a new class of medications was introduced called “atypical antipsychotics.” These newer medications are not used to treat only psychosis (such as that found in schizophrenia), but also a wider range of psychiatric symptoms. One of their approved uses is in the treatment of bipolar disorder in adults. They may also be approved in short time for use in teenagers and children 10 years and older (although they are already sometimes prescribed by doctors for “off label use” in teens and children). So don’t let the name of the class of medications fool you — they treat far more than just psychosis.
8. Atypical antipsychotics have little to no side effects.
Atypical antipsychotics are often the primary drug doctors use to treat bipolar disorder. In the U.S., the Food and Drug Administration has determined that such drugs are both safe and effective for this use. However, like all medications, atypical antipsychotics have their own set of risks and side effects.
These medications have a different side effect profile than the medications they replace. While initially marketed as a “better” side effect profile, research since 1990 has shown that the side effects they do produce in many people can be just as worrisome as older medications. Chief among the typical side effects are weight gain and metabolism problems, which can be precursors to type 2 diabetes, increased risk of stroke, and heart problems (including an increase in cardiac arrhythmias which can lead to sudden death).
9. I may just have depression.
Many times, bipolar disorder mimics clinical depression, because one of the primary symptoms of bipolar disorder is clinical depression. Up to 25 percent of people who have bipolar disorder are initially misdiagnosed with depression. Why does this occur? Because many people first go to their primary doctor for a diagnosis, and primary doctors do not always ask enough questions to make the proper diagnosis. This can occur with mental health professionals who also fail to probe enough when a person presents with clinical depression in their office.
An incorrect initial diagnosis can lead to incorrect treatment, such as the prescription of antidepressant. Generally, antidepressants are not used in the treatment of bipolar disorder, and in fact, can make the disorder worse in the person. So if you’ve ever had an episode of increased energy for no particular reason (not because you just drank a liter of Coke), make sure you share that information with your mental health professional.
Want to learn more?
Stay up-to-date on the latest bipolar news, research, information and opinions over at our bipolar blog, Bipolar Beat!
The end of the psychotherapy relationship is a difficult phase of therapy. Perhaps the second most difficult one, next to actually making the decision to try out psychotherapy in the first place and pour your heart out to a complete stranger (albeit a professional).
Therapists call the end of therapy “termination,” which doesn’t help in the “let’s give this a warm, fuzzy-feeling name to make it sound as least scary as possible” department. In everyday society, we typically “terminate” bugs or contracts, not relationships. But that’s psychology for you, always promoting psychobabble when simply calling it “ending therapy” would’ve sufficed.
Ending any relationship for most of us is not something that comes easily, or is second nature. In fact, ending a relationship may be one of the most difficult things we do in our lives. Many people simply don’t know how to handle the feelings accompanying the loss, and so it can be a very trying and stressful time even under the best of circumstances.
Most psychotherapy relationships end mutually, however, which makes them a little bit easier to handle. But not much. No matter what reason the relationship may be ending — the natural end of a course of therapy for a specific mental disorder, you or your therapist moving, a change in insurance coverage — here are some tips to make the transition easier for you.
1. Understand The Process.
While many therapists are good about explaining the termination process, some are not. Termination starts with a discussion about whether it might be a good time to end therapy. Although it’s usually begun by the therapist, sometimes clients will get the ball rolling too (especially if they feel like they’re no longer “getting anything” from therapy).
After the discussion, if both parties have agreed to end therapy, a date is chosen, usually many weeks out. In the sessions between the initial decision and the chosen end date, the therapist spends time discussing how the client is feeling about the end of psychotherapy. Goals of therapy are discussed, and the progress made on those goals. The therapist will also often review the techniques learned in therapy, and strategies to ensure the client can rely on those techniques and tools in the future without the therapist’s help. A final session ends the process.
2. Bring It Up Early.
Most experienced psychotherapists are trained to start the termination process early — far earlier than most clients are probably used to or even comfortable with. Some therapists may start talking about it as far out as 10 or 12 sessions from the end (especially for longer-term therapy). This is a good thing. It gives you time to get comfortable with the idea, and it gives your mind time to get anxious — anxiety that can then be dealt with in your continuing psychotherapy sessions.
3. Pick A Final Session Date.
This is connected to bringing it up early: Your therapist should work with you on picking the date of your last session. It’s best to choose this date together, to ensure it’s not too early (for you) or that it doesn’t interfere with some other commitment either one of you may not know about. Such a date also acts as a mutual goal the both of you will work toward in your remaining sessions.
4. Let It Out.
Ending a psychotherapy relationship is just as difficult as ending any relationship in your life. That means you’re likely going to experience mixed emotions about the end of your relationship with your therapist. That’s fine, but it’s even better if you find a way to express those feelings to your therapist. Sometimes the end of therapy brings up a new issue that hasn’t yet emerged in session. This gives you time to work on these things — if work is needed — while there’s still time.
5. Anger And Anxiety Are Normal.
It’s perfectly normal to feel anger, anxiety, or a host of other emotions after your therapist has suggested it might be time to end the relationship. Express them. Write them out. Twitter them, or post them on your Facebook page. Whatever works for you, find a way to share these things with your therapist (and if not your therapist, some other outlet that gives you a sense of relief).
6. Ask Questions If You Have Them.
Sometimes the end of therapy brings up questions about the future. What if I relapse? Who do I call? Can I start therapy with you in the future if the need arises? Any books or support groups you recommend to help me with everyday coping? Can you give me a referral to another psychotherapist you recommend? Sometimes we get flustered or feel embarrassed to ask such questions at the end of therapy. Try to find a way to ask any questions you might have, since this may be the last chance you have to have a mental health professional’s opinion or help with them.
7. Knowing If You’re Not Ready.
Some people may not be ready to end therapy. You should talk to your therapist sooner rather than later if this is the case for you. You also have to try to separate out the feelings of “I’m not ready to do this” vs. “This is making me very anxious, but it feels like it’s the right time.” Just because talking about ending the relationship makes you feel anxious or uncomfortable doesn’t mean it isn’t right. But if you’re not ready to end it — because, for instance, you believe you have more work to do or more to learn — say so. Most therapists will respect your sense of whether it’s “right” or not and continue working with you.
8. It’s Done Face-To-Face.
The final session, as with most psychotherapy, is done face-to-face. Although some clients end up canceling their last session (with the sentiment of, “Why bother? We’re done, so let’s be done with it already”), it’s best to stick with it and attend the last session even if you don’t feel like it. Like ending any (hopefully!) positive relationship, it’s usually best to have one last final goodbye. It helps with “closure,” as therapists like to say.
9. The Final Session.
There is no “normal” way a final session goes — each therapist has his or her own way of doing it. It may involve a sort of encapsulating the months (or years) of therapy spent together, and ensuring the client is ready to move on in his or her life. Especially long-term or close therapeutic relationships may end with tears and a hug (if both parties agree). Shorter-term, solution-focused therapy will often end more business-like, with a handshake and best wishes.
10. Termination Is Not The End.
Although the word suggests an ending, termination really is the start of a new beginning for you. You are once again on your own in the world without the comfortable and safe weekly check-in with your therapist. And while that initially may be a little scary or sad, it marks another stage or transition in your life that you can embrace if you choose.
As the old saying goes, all good things must come to an end, and that includes psychotherapy too. Rest assured, however, that if you need to return to therapy in the future, a good therapist will be waiting for you.
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At the American Psychiatric Association’s annual meeting last week, a presentation covered some of the likely major changes that will be incorporated into the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders, commonly referred to as the DSM by mental health professionals. The DSM provides professionals with the symptom checklists that allow for a mental disorder diagnosis to be made.
The most significant change proposed has to do with the inclusion of dimensional assessments for depression, anxiety, cognitive impairment and reality distortion that span across many major mental disorders. So a clinician might diagnose schizophrenia, but then also rate these four dimensions for the patient to characterize the schizophrenia in a more detailed and descriptive manner.
Despite the PR spin that “no limits” were placed on this revision of the DSM, the reality is that there will be very few significant changes from the existing edition of the DSM-IV. While virtually all disorders will be revised, the revisions will, for the most part, be incremental and small. Why? Because the APA recognizes that you can’t retrain 300,000 mental health professionals (not to mention the 500,000 general physicians) in the field to completely relearn their way of diagnosing common mental disorders such as depression, bipolar disorder, ADHD and schizophrenia. Changes are always incremental and tweak the existing system, nothing more.
Some disorders are on the chopping block, just as others were for the DSM-IV revision. This time around, schizoaffective disorder will likely be replaced by a general schizophrenia diagnosis that includes the previously mentioned dimensional assessments. This might be termed schizophrenia with a strong mood component. Gender identity disorder will likely be renamed and placed under a different category, to reflect the modern reality that it is rarely considered a sexual dysfunction.
There will likely be the addition of some new disorders as well, just as in the DSM-IV. Many, if not most, new disorders are placed into an appendix called “Criteria Sets and Axes Provided for Further Study.” These are not disorders that can be diagnosed, but the proposed criteria are used to help researchers communicate with one another. For instance, premenstrual dysphoric disorder (PMDD) is listed in the current DSM-IV as such a disorder, but is already commonly diagnosed by many professionals.
Amongst the new disorders proposed, hoarding may be added to the category of obsessive-compulsive illnesses as its own disorder. Another new disorder is apparently being proposed for children and teens:
And the group was leaning heavily toward proposing a new risk syndrome for individuals — especially young people — that research has suggested are strongly predisposed to schizophrenia and other psychotic conditions.
The DSM-V is scheduled for publication in 2012 and will be the result of 13 years’ worth of literature reviews, independent research, and countless meetings amongst the 160 professionals in the 13 working groups organized by the American Psychiatric Association. Next steps?
The 13 working groups in charge of DSM’s major subsections must still reach decisions on proposed language defining conditions and disorders. Field tests of revised diagnostic criteria are scheduled to begin this summer, with results ready for analysis in mid-2010.
Looking forward to its publication in 2012, but that’s still 3 years away. We still have a long wait ahead of us!
Read the full article: Major Changes Loom for Bible of Mental Health
What is the difference between having a short-term, emotional crisis, an adjustment disorder, and long-term clinical depression? Well, in the hands of a sloppy mental health professional, the answer might be “nothing” — all three might be diagnosed as “major depression.” But is this really sloppy diagnosis (or, as researchers would call it, a “diagnostic challenge”), or a simple result of how mental health is typically reimbursed in the U.S.?
Researchers Monroe & Reid (2009) argue that clinicians and researchers need to do a better job in evaluating depression in context of a person’s life stress. Without doing so, they argue “one cannot determine whether or not the presenting condition represents an understandable response to adversity, an adjustment disorder, or a clinical syndrome indicative of a true psychological disorder.”
Not everyone develops depression after experiencing life stress. The researchers note there are many possible explanations for this, ranging from social support (having a good network of friends and family around you), personality characteristics, and genetic predisposition to suffer from the ill effects of stress. The last factor suggests a strong genetic-environmental interaction. It’s not enough just to have the genes that may predispose you to depression, you also need the life stress as well.
While life stress may indeed be importantly related to how depression forms in some people, I’m not sure it matters as much when helping a person deal with a depressive episode. It’s fine to recognize life stress as a potential necessary but not sufficient trigger for future episodes, but it generally is unhelpful for the current episode.
That’s because clinicians don’t get paid due to the accuracy of their diagnoses, I hate to say. They only get paid if they diagnose a mental disorder that’s reimbursable (under most people’s insurance plans). Many of those plans only cover “major” mental disorder, not minor ones such as “adjustment disorder,” and definitely not someone who comes into therapy and only wants to talk about their “understandable response to adversity.” So clinicians will most often err on the side of the most reimbursable diagnosis, even if they know it may not be the most accurate diagnosis.
So while researchers can debate such finer points until the cows come home, this kind of differentiation illustrates why there can exist a gap between academicians/researchers and clinicians. Researchers sometimes appear to live in a world where theoretical accuracy models and distinct differentiation between disorders is a Holy Grail to be pursued.
Clinicians, however, live in the trenches — trying to help their clients with appropriate diagnoses (which may not always be the most accurate), but also needing to be paid for their services (since most people aren’t willing to pay out of pocket the $80 to $180/hour fee most clinicians charge). This is a far messier world where nice little well-defined diagnostic categories can so readily break down. But it’s the real world where science is put into use.
Accurate mental illness diagnosis is important in both research studies and clinical psychology, although for different reasons.
In research studies, accurate mental illness diagnosis is critical for ensuring that participants are appropriately selected and matched for comparison, and for ensuring the validity and generalizability of the results. Accurate diagnoses allow researchers to study specific mental illnesses and compare results across different studies, and also provide a common language for communication between researchers.
In clinical psychology, accurate mental illness diagnosis is important for providing effective treatment. A correct diagnosis allows a clinician to choose the most appropriate treatment approach based on evidence-based practices, which in turn can improve patient outcomes. An accurate diagnosis can also help a patient understand their condition, reduce stigma, and improve their ability to access appropriate care and support.
Overall, accurate mental illness diagnosis is important in both research and clinical psychology as it provides a common language for communication and a basis for effective treatment and understanding.
The accuracy of mental illness diagnosis between two sets of clinicians can vary. A number of factors can influence the accuracy of diagnosis, including the type of mental illness being diagnosed, the training and experience of the clinicians, the use of standardized diagnostic tools, and the availability of information about the patient’s history and symptoms.
Research suggests that diagnostic agreement between clinicians can range from fair to good, depending on the mental illness and the type of diagnostic evaluation used. For example, some mental illnesses, such as major depressive disorder and bipolar disorder, tend to have higher levels of diagnostic agreement than others, such as personality disorders.
The use of standardized diagnostic tools, such as structured diagnostic interviews or symptom rating scales, can improve the accuracy of diagnosis by providing a common language and set of criteria for evaluating patients. In addition, obtaining a comprehensive patient history and gathering information from multiple sources, such as family members or previous treatment providers, can provide a more complete picture of the patient’s symptoms and improve diagnostic accuracy.
Overall, while some level of diagnostic variability is expected, efforts to improve the accuracy of mental illness diagnosis, such as the use of standardized tools and a comprehensive evaluation process, can help to reduce variability and improve patient outcomes.
Reference:
Monroe, S.M. & Reid, M.W. (2009). Life stress and major depression. Current Directions in Psychological Science, 18(2), 68-72.
Unbelievably, we reported earlier this week that 1 in 12 teens may be addicted to video games. I say “unbelievably” because the research that comes to this stunning conclusion lacked a certain… validity.
As Dr. Cheryl Olson noted succinctly on Game Politics:
The concern here is labeling normal childhood behaviors as “pathological” and “addicted.” The author [Iowa State University’s Prof. Douglas Gentile] is repurposing questions used to assess problem gambling in adults; however, lying to your spouse about blowing the rent money on gambling is a very different matter from fibbing to your mom about whether you played video games instead of starting your homework.
So in other words, you can create your own Instant Mental Disorder ™ by simply repurposing the criteria for pathological gambling for any behavior you find might be potentially “addicting.” Don’t believe me? This is exactly how “Internet addiction” was created nearly 13 years ago (and it still is no closer to being valid despite the passage of time because of its conflicting diagnostic criteria and poor sampling).
We’ve made it easy for you to create your own Instant Mental Disorder ™ — just like real researchers do! — by printing and filling out the below form. Try words or phrases like “reading” or “socializing with friends/family” or “watching TV” or “following favorite sports team” to see how effectively this IMD applies to so many people in your life!
In order to be diagnosed, you only need to match 5 or more of the following criteria:
1. Preoccupation:
The person is preoccupied with ________________ and has frequent thoughts about ________________, planning the next time spent doing ___________________, or thinking of ways to do more of ____________________, etc.
2. Tolerance:
Similar to drug tolerance, the person needs to ________________ with increasing amounts of (time/effort/money) in order to achieve the desired excitement or “rush.”
3. Loss of Control:
The person has made repeated unsuccessful efforts to control, cut back, or stop __________________.
4. Withdrawal:
The person is restless or irritable when attempting to cut down or stop _________________.
5. Escape:
The person ______________ as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression).
6. Chasing:
After losing (time/money/something else) _______________, the person often returns another day to get even.
7. Lying:
Lies to family members, therapist, or others to conceal the extent of involvement with __________________.
8. Illegal Activity:
The person has committed illegal acts such as forgery, fraud, theft, or embezzlement to finance __________________.
9. Risked Relationships:
The person has jeopardized or lost a significant relationship, job, or educational or career opportunity because of _________________.
10. Bailout:
Relies on others, such as friends or family, to provide (money/excuses/help) to relieve a desperate situation caused by _________________.
11. Mania:
The behavior isn’t better explained by a manic episode.
Scored 5 or more on this? Congratulations! You now meet the diagnostic criteria for being Addicted to _________________. Get thyself to a Center for Treatment of ______________ Addiction today!
For decades, thousands of people in dozens of organizations have fought tirelessly to reduce the stigmatization and ignorance associated with mental health issues and mental disorders. Mental illness is not something you can just “get over,” nor is it an invention of the pharmaceutical companies (although I’m sure there are some who believe that).
Even within this dedicated group of people who are all fighting for the same things — recognition that mental illness is just as real as physical illness — they is within-group stigmatization. Some mental disorders get the short shrift, or are thought to be less “real” or serious than other disorders. The National Alliance on Mental Illness (NAMI), for instance, only lobbies and advocates for what it considers to be biologically-based mental disorders, such as schizophrenia and bipolar disorder. They have historically had far less interest in other disorders, such as anxiety or personality disorders.
This saddens me. And it saddens me even further to see people knock something like postpartum depression, a very real mental disorder that affects thousands of mothers every year who have just given birth to their child, and then feel overwhelmed with depression. They often are unable to do even basic child care for their newborn baby, and feel hopeless, despondent, and listless, without motivation or energy.
Moms are in need of being taken seriously, of having their concerns heard. You’d think nobody would be against mothers seeking to get proper diagnosis, treatment and care for something that is at the very core of having a healthy family.
But you’d be wrong.
Senator Robert Menendez of New Jersey introduced the Melanie Blocker Stokes MOTHERS Act in the Senate to try and reduce the stigmatization that goes on around postpartum depression, increasing funding for education and screening programs to catch more mothers in need. But one senator — an obstetrician no less — doesn’t like “disease-specific” legislation, and has used a senatorial hold to stop the legislation from moving forward, according to Katherine Stone’s entry over at Postpartum Progress:
Senator Menendez indicated that much of the strong opposition to this bill continues to come from Senator Tom Coburn of Oklahoma who refuses to pass any of what he calls “disease-specific” legislation. Here’s the part that absolutely kills me: Dr. Coburn specializes in family medicine and obstetrics. Dr. Coburn has personally delivered more than 4,000 babies, according to his bio.
Thanks Dr. Coburn! What a great way to show your forward-thinking efforts, at the very same time the e-patient movement is gaining steam and people are looking to replace the old paternalistic doctor who “always knows best” with empowered, educated patients who work as true partners with their doctors.
And why is this legislation so controversial? I have no idea. The legislation under consideration would increase federal efforts to combat postpartum depression by:
It is estimated that postpartum depression (PPD) affects from 10 to 20 percent of new mothers. In the United States, there may be as many as 800,000 new cases of postpartum conditions each year. The cause of PPD isn’t known but changes in hormone levels, a difficult pregnancy or birth, and a family history of depression are considered possible factors.
Sounds good to me. But Philip Dawdy over at Furious Seasons remains skeptical:
Here’s the thing that makes my scratch my head, however: women have given birth for many thousands of years and many have experienced “baby blues,” until recently without mental health screenings or psych meds of any kind and without a bunch of arm waving about post-partum depression (the advocacy on this issue is a phenomenon of the last decade). Broadly speaking, the lack of such supposed benefits does not seem to have harmed society a bit, although there are obviously individual exceptions.
With that same logic, Philip could be scratching his head about a lot of disorders where, prior to their “invention,” people seemed to get along just fine in society — attention deficit disorder (ADHD), PTSD, panic attacks, autism, Asperger’s syndrome, etc. It’s no surprise to anyone who’s studied women’s history to understand how repressed their voices have been in society until the past few decades. So is it any wonder that history isn’t filled with their accounts of grappling with postpartum depression? A woman would be an outcast from their own family for admitting such a thing even 50 years ago. Even possibly disowned or institutionalized. It just wasn’t said or discussed much.
Perhaps the saddest thing of all, though, is that people — in this day and age of instant connectivity and all of the wonders the Internet has brought us — are still against basic, simple things like education and information about these concerns. “What? You want us to spend money educating future moms on postpartum depression!??! Ridiculous!” I just don’t get it.
Postpartum depression is real, it affects thousands of lives every year, and is one of those quiet disorders that have flown under the radar for far too long, while mothers lived in quiet desperation that someone would listen to them and believe them when they said they were depressed after just giving birth. To be listened to, to be understood, to be heard. That’s all these mothers ask.
Read the full entry: Senator Blocking MOTHERS Act Is Obstetrician (Seriously).
In a fluff piece Parenting magazine recently published (and which was picked up by CNN below), moms are apparently “at risk” for a non-existent mental health concern. How one can be at risk for something that doesn’t exist and that no doctor can diagnose is beyond me. But Rachel Mosteller apparently glosses over that point in suggesting that using the Internet while trying to keep your sanity as a stay-at-home mom can amount to “Internet addiction.”
Look, you have to start getting alarmed:
These moms are contributing to a growing global addiction. There’s a movement among psychiatrists to recognize Internet addiction as an official mental disorder (just like alcohol dependency). And a recent Stanford University national survey found that 14 percent of Internet users find it hard to stay away from it for several days at a time; 9 percent try to hide their “nonessential Internet use” from their loved ones; 8 percent admit they use the Web as a way to escape problems.
That’s right folks… this is a growing global addiction! There’s absolutely zero evidence to support this hyperbole, but it makes for the urgency needed to make the story sound relevant and timely. The next DSM isn’t due out until 2012 (yes, that’s still 3 years away), and if you substituted “cell phone” or “telephone” or even “television” or “watching sports” with “Internet” in the above paragraph, you’d see the ridiculousness of the claims.
In fact, the article relates many stories, including this one:
“When my husband got home from work, I was clingy and dying for someone to talk to. I started to feel like a crazy person. I was becoming depressed without any interaction,” she says.
Desperate, she went online and found the community she needed. “I’d talk to people in chat rooms for hours.” But not about babies or parenting. “I needed to feel like a normal person who could have normal conversations that weren’t about breastfeeding or how many ounces my son gained.” Soon, she was spending as many as eight hours online every day.
Wow, so actually it sounds like going online helps reduce social isolation and improve one’s overall functioning and mood levels. How can this sort of positive behavior be labeled an “addiction?”
How about this scary one?
Online, you can pay bills, order diapers, upload photos, and look up possible causes of your kid’s constipation. In fact, you can almost accomplish too much online.
“Ticking items off a to-do list is intoxicating when you feel like you don’t have much control over other parts of your life,” says Parker
Wow, that is indeed scary! Imagine, a tool that actually lets you socialize with your friends, find emotional support with other moms, and get tons of stuff done throughout the day, all the while still watching your children at home. Any other article might note that these all sound like positives, as long as one isn’t ignoring the children in order to do them.
And if you spend time on the Internet and neglect your child? Well, let’s see, soap operas have been around for how long…? Did we ever have a “Soap Opera Dysfunctional Addiction (SODA)?” And child neglect is indeed a serious problem, but not one you need to blame on any specific technology or distraction, is it?
Well, let’s ask an expert… who just happens to make his living from seeing people who have this non-existent disorder:
“Being a mom of young children can be very solitary,” agrees Jay Parker, cofounder of Internet/Computer Addiction Services in Redmond, Washington. So it’s easy for them to turn online, he explains, to find other parents and create a world there where they are not alone. Once that world is created, it becomes an escape that moms may turn to whenever they’re stressed, lonely, bored, or sad. In addiction, they become dependent on that escape.
So where does one draw the line between being in a positive, prosocial world where you can keep in touch with your friends and family on Facebook and Twitter, and gain emotional support from other moms just like you in support groups , to it suddenly being a dark “escape” that people turn to whenever they feel like — when they’re stressed, lonely or just bored? Well, of course there is no line because this is a completely arbitrary and artificial distinction.
When I was lonely or bored 10 years ago, I picked up the phone (as I imagine many mothers did), and called a friend. So how is that any different than going online and chatting with your friends via email or Twitter? It is, of course, no different, except that if you do too much of the latter, we can now call it an “addiction.”
In a timely bit of luck, Byun and colleagues (2009) just published a “metasynthesis” (a review and analysis) of all the Internet addiction research for the past decade. It was not a positive review:
The analysis showed that previous studies have utilized inconsistent criteria to define Internet addicts, applied recruiting methods that may cause serious sampling bias, and examined data using primarily exploratory rather than confirmatory data analysis techniques to investigate the degree of association rather than causal relationships among variables.
In other words, the research has been characterized by sloppiness by the researchers — sloppiness in definition, sloppiness in subject recruitment, and sloppiness in statistical analyses. This review — not the first to question the validity of the body of research on “Internet addiction” — adds further evidence that the disorder has little chance of making it into the DSM-V in 2012.
Look, I understand a magazine called Parenting needs to try and publish sexy stories to keep their subscribers, but articles like this one continue to push misinformation onto the unsuspecting public. And when CNN republishes such tripe in its “Health” section, it suggests that the story actually has some objective health reporting in it (which it doesn’t).
Indeed, some moms might spend too much time on the Internet. I imagine also that some moms spend too much time watching soaps, or get too involved in their child’s social life or extracurricular activities as well. The key is to not demonize something as positive and helpful as the Internet to most moms. Articles like this make it sound like that if you’re a mom and you spend time online paying bills or clipping coupons, you’re a bad mother.
You’re not — you’re normal. So relax and go twitter this article to your friends!
Read the full article: Why moms are at risk for Internet addiction.