Serious Mental Illness Blog

Official blog for LIU Post's Clinical Psychology Doctorate SMI Specialty Concentration

69 notes

Psychosis and Dissociation, Part 2: On Diagnosis, and Beyond
By Noel Hunter, M.A., M.S., Mad in America 

“You treat a disease, you win, you lose.
You treat a person, I guarantee you, you’ll win,
No matter what the outcome.”

- Robin Williams in Patch Adams

Recently I wrote an article on MIA entitled Trauma, Psychosis, and Dissociation. Several people responded privately with some very thought-provoking questions that I would like to explore and possibly answer to some extent here. Most of these questions regarded the relationship of diagnoses and treatment, which was a subject that I superficially critiqued but did not explicitly analyze. Dedicated readers of the MIA website are all too familiar with the myriad problems that exist with diagnoses in general, the stereotypical (and often untrue) assumptions associated with these various categories, and their lack of scientific validity or reliability. For those who are not as familiar with this research, there are many on this site who have tackled this issue (see: Harm ReductionDo Diagnoses InjureDoes DSM-5 MatterHow Reliable is DSM-5Psychiatry-Based Valid Science).  I do not wish to echo what has already been exquisitely written elsewhere, but I do want to address some specifics with regard to dissociation and psychosis.

First, though, I want to state that my area of experience and research is with trauma, psychosis, and dissociation. Surely, the following assertions and arguments could be said about any comparative diagnostic categories or phenomena; however, I do not have the knowledge, experience, or research to back up discussions on phenomena related to categories such as bipolar, depression, borderline personality disorder, etc. That is the only reason that I focus on the categories of Dissociative Identity Disorder (DID) and schizophrenia (and their related labels) – NOT because I believe that some other standard holds true for other categories. As a broad statement to begin with, I want to assert that above and beyond anything else, when an individual is suffering some type of distress (whether understood to an outsider or not) it should be assumed that there is a logical reason that such distress developed.

If this is the first assumption made, then there is no need to search for “what is wrong” with the person; I will repeat until the end of time that the Hearing Voices Network put it perfectly by stating we must seek to understand “what happened” to the person. Until such a time that the person is able or willing to acknowledge/remember/process/understand the complicated interpersonal, familial, and societal dynamics that may have led to the distressing experiences in the present, it should always be assumed (once real medical and nutritional factors are ruled out) that there is meaning in said experience. Placing a priority on diagnosing and categorizing prevents meaning from being made.

“But why?” many will ask; if a diagnosis is “correct” and thereby will inform targeted “treatment” then is it not best practice to proceed in such a manner? Although I recognize that we live in a society that demands immediate results, immediate answers, and immediate eradication of pain and suffering, that does not mean that science must follow suit. The following is my reasoning behind why I unequivocally answer the previous question with an emphatic “No.”

Breaking down the experience

Within the domain of the dissociative and psychotic disorder categories, the following are the most common phenomena that people subjectively and internally experience:

  • Anxiety
  • Sadness
  • Emptiness
  • Confusion
  • Hopelessness
  • Rage
  • Extreme fear
  • Overwhelming emotions
  • Lack of emotions/numbness
  • Lack of motivation or interest in anything
  • Feeling unreal
  • Feeling the world is unreal
  • Hearing voices or other auditory stimuli others cannot hear
  • Seeing/feeling/smelling stimuli that others cannot see/feel/smell
  • Identity confusion
  • Identity alteration with amnesia
  • (Note: “Dissociation” is not included here for reasons outlined in my previous post; the definition is so confused and biased at this point that there is no need to use this word to describe anything)

Now, of course, there are many other experiences that could be added to this list when looking at any individual; and that is also kind of to the point: Individual experiences are very individual. Additionally, any individual may experience any combination of the above, to different severities, at different times, and interpret these experiences in different ways. If one interprets such experiences in a manner that goes against consensus belief, then others may claim it is a “delusion,” but a “delusion” is not the internal process or experience … it is just an explanation like anything else. In this sense, even the term “psychosis” ceases to have meaning.

Seeing as how a “delusion” can be seen as a logical explanation for an incomprehensible experience, or an attempt to bring structure to a chaotic internal or external world,  then it makes no sense to me that “delusion” becomes a separate “symptom” that defines a specific “disease” that is distinct from all others. How is a person helped by being told that their internal experience is irrelevant, as is their past, because they are “delusional,” and therefore have an illness that must immediately be “treated”? I genuinely look forward to anybody responding with a constructive answer to this question.

Putting the idea of “delusion” aside (because an entire separate article could be written about that), how does diagnosis then fit in to the picture? DID is an interesting diagnosis because it is actually one of the few that has a high degree of validity and reliability when structured interviewing is utilized. Additionally, many individuals who receive this diagnosis may experience some level of relief that: 1) they are officially not “crazy” (i.e., “schizophrenic”); and 2) their trauma has been recognized. Further, trauma-informed treatments designed for DID experiences can be highly effective, validating, and rewarding … though, like any other treatment can also be incredibly harmful as well.

I might surmise, though no direct studies have been done to evaluate this, that the large portion of the harm done in this type of treatment occurs when an overzealous practitioner insists on his or her framework, pushes too hard for recognition and processing of trauma, focuses on the anomalous experiences at the expense of doing the difficult work, and the more general problems that come with relying on hospitalizations and psychotropic drugs for long periods of time. My point in stating this is to say that I come from a position wherein I believe that the dissociative disorder field has a lot to offer, but errs tremendously in its steadfast reliance on the biomedical categorical system.

On the other hand, the diagnosis piece is another story. The diagnosis of DID is based on one experience: identity alteration with amnesia. It is not surprising, then, that this category would have validity and some degree of reliability. If we took, instead, the experience of hearing voices and turned it into “Hearing Voices Disorder” it would also likely have a high degree of validity. This is because it is referring to one experience that the person has presented with: It is entirely tautological. I do not dispute that people experience identity alteration with amnesia, but this does not equate with having a disease or anything else above the experience itself.

Schizophrenia, however, is quite the opposite; this category is an amalgamation of broad and varied phenomena that may or may not have anything in common at all. As I stated in my previous blog, and certainly what has been articulated numerous times elsewhere, the problems inherent in the assumptions and associations made with this diagnosis are, quite frankly, a travesty.

Even so, there are plenty of individuals who also find reassurance and comfort in formulating their experiences from a disease model and find value in this label. We learn how to explain our experiences through group-mind or society’s authoritarian dictate of accepted knowledge; even those who are deemed “schizophrenic” learn to explain their experiences through the mind of the doctor. Just as the idea that doctors’ insistence that a “delusional” patient must accept consensus reality can be incredibly harmful and completely ineffective, so too is the insistence that all people with lived experience accept the same explanation for their experiences. I do not wish to invalidate their way of making sense of things. But, that does not negate that the travesty exists, nor does it make the diagnosis a valid one.

Diagnostic Confusion

Any two individuals who experience distress that gets labeled as schizophrenia may have nothing at all in common. One may present with hearing voices, fear, rage, and overwhelming emotions, while the other has a lack of motivation, feels unreal, has a lack of emotions, and physically feels profound anxiety. The first person might have experienced significant sexual abuse, and the voices are the person’s way of making sense of this abuse while the resulting fear and extreme emotions are perfectly understandable responses to such a violation. The second individual may have experienced severe invalidation, a lack of mastery in life, and bullying. Both meet criteria for schizophrenia, and, for argument’s sake, let’s say there is no debate that this is an “accurate” diagnosis. How, then, does this diagnosis help in any way with “treatment”?

It just doesn’t.

Similarly, a person who experiences identity alteration with amnesia, thereby leading to a diagnosis of DID, may also experience hearing voices, fear, rage, and overwhelming emotions due to significant sexual abuse. Her experience is not entirely different from person #1’s experience in the preceding paragraph except for the added experience of identity alteration and amnesia. Do these two people then logically have entirely different diseases? Does “treatment” really logically flow from the diagnosis of either individual? Do these two people really need some drastically different kind of “treatment” at all?

More common within the DID realm is the person who experiences identity alteration with amnesia, fear, lack of emotion, lack of motivation, overwhelming emotion, profound anxiety, hearing voices, seeing/feeling/smelling things that others do not, feeling unreal, feeling the world is unreal, extreme fear, anxiety, hopelessness, sadness, and suicidality. This person now meets criteria for about 10 different diagnoses, DID being only one of them. When the individual does not agree with the clinician about how to explain these ever-changing symptoms, then more diagnoses may be added. Usually this will include several personality disorder diagnoses and, if the explanations sound bizarre to the clinician, then the person is said to also have schizophrenia. Again I ask; how does this help in any way with “treatment”?

It just doesn’t.

At the end of the day, any “diagnosis” or technical, medical term serves to distance everybody involved from the experience itself. It most often leads to internalization of stigma, otherness, inferiority, hopelessness, dependency, and shame. For many, it reinforces the very beliefs that contributed to the development of the distress in the first place: the person is broken and defective and deserved the mistreatment that he or she might have been victim to. It leads clinicians to fall into the trap of believing that any annoying or disturbing behaviors are indicative of disease or personality rather than an understandable response to internal or external events.

If one were to break down the seemingly incomprehensible presentation of distress into the individual experiences that may or may not include any or all of the above, then suddenly things begin to make sense. The clinician or family member might be able to relate, and the experiencer might also be able to relate to others and to his or her self in a more compassionate and humane way. There is no “othering” of the individual; rather, the experience is couched in a way that can be viewed as a very human, very understandable reaction to a very un-understandable world. Additionally, there is no disease or symptom to “cure” or “treat”; instead there is a journey to go on that includes relationship, meaning-making, healing deep wounds, coming to know one’s self, forgiveness, compassion, growth, and spirituality.

Beyond Diagnoses

The British Psychological Society published guidelines in 2011 for the use of “psychological formulation” that, in theory, could replace diagnoses in mental health treatment (Division of Clinical Psychology, 2011). Basically, and I am really simplifying this here, they  recommend that psychologists take an approach that focuses on personal meaning within familial, societal, and systemic contexts that honors collaboration and the role of trauma and chronic stress. Lucy Johnstone, MIA author and the lead author of these guidelines, has discussed this in more detailhere. Using the previously listed phenomena, it might work something like this:

A 20-something-year-old woman presented to the emergency room after family members believed that she might hurt herself or someone else. She reported having large gaps in memory, was accused of being a liar, does not trust anybody, believes the staff of the hospital is going to attack her, hears voices, sees visions, and has a history of suicide attempts.

This is not an uncommon situation, but instead of saying she is “manipulative, attention-seeking, hallucinating, paranoid, delusional, and threatens suicide” the report is just a factual recount of her actual subjective experience. The formulation might go on to say that this individual denies any trauma or abuse, she has a lot of friends, is intelligent, aims to pursue X career, and does not believe that she has anything wrong with her. The psychologist could validate this and say “you’re right, you are clearly experiencing a great deal of confusion and distress and let’s work together to try and understand what might be going on.” The psychologist assumes that some external dynamic or event slowly over time led to the extreme experience in the present and does not insist that this dynamic or event be known right away. Each behavior, statement, or outburst can be seen as an attempt to express the very confusing internal world instead of being viewed as a disease or personality problem. Everything is a clue to finding meaning and reaching the goals of pursuing X career through a focus on strengths and understanding. The person in distress and the clinician can work together to understand  what areas may need to be addressed first, how to more effectively cope with overwhelming emotions and pain, and building trust. Eventually, the meaning will come and any trauma or other painful experiences can slowly be processed. Specific techniques or activities can be planned around specific complaints of the experiencer: if she has identity alteration or hears voices … you can, together, get to know them and what they have to say. If she experiences feelings of being unreal or her surroundings being unreal, you can use grounding exercises. If she complains of heart palpitations and difficulty breathing, use relaxation exercises, if she has beliefs that the clinician does not understand or agree with, try to figure out how these beliefs are serving the individual, etc.

Nowhere in this formulation is there a need for diagnosis, “cure,” or an explanatory model beyond the context in which such phenomena developed. Some find comfort in diagnoses because they find comradery or normalization in knowing other people have experienced something similar. The Hearing Voices Network has shown how this same comfort can be found without diagnoses. A person who experiences mania, anxiety, depression (not in the DSM sense), identity alteration with amnesia, extreme fear and distrust of others, etc., can find that same comradery by seeking out others with that same experience; a diagnosis does NOT mean any commonality at all. Two people with the same diagnosis can have COMPLETELY different experiences and have NOTHING in common!

Alternatively, some find comfort in the diagnostic and medical explanations because they validate the lack of will or intention that the suffering individual may experience. This is a serious concern and must be addressed more sufficiently than has been thus far. Just because something is not medical, this does not insinuate the intention of one’s behavior. These experiences are very, very real. They have very real biological correlations. For instance, when one goes into a trance state (or dissociative state in some circles), every part of the brain shuts down relative to the verbal and animalistic/limbic portions of the brain. This is real, but; this is not a disease.

Lastly, using the formulation approach requires a bit more work for the professional engaging in such a practice. There is no automatic categorization, prediction, prescription, and rigid, manualized “treatment” plan, although there could be a place for all of these things based on the collaborative assessment of specific complaints. Instead, there is a need to practice an art of relating, collaborating, engaging, and dealing with really frightening, overwhelming, and uncomfortable emotions on BOTH parts. Diagnoses and medical/symptom-based approaches help the practitioner, and sometimes even the experiencer, maintain a comfortable distance from the traumatic, death-anxiety-provoking reality of life. But, we must move past this. We must do better. Again, back to the Hearing Voices movement: “Nothing about us without us.”

Indeed.

* * * * *

References:

Division of Clinical Psychology. (December, 2011). Good practice guidelines on the use of psychological formulationLeicester, United Kingdom: British Psychological Society.

For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here
 to access original SMI Blog content

Filed under mind body brain wellness health healthy recovery anxiety anxious sadness sad depressed depression confused empty hopeless hope scared emotion emotions feeling feelings trauma abuse dissociation psychosis psychotic dissociated dissociative identity disorder schizophrenia

42 notes

Mental illness and sexual abuse: The shocking linkBy Richard P. Grant, The Guardian
Violence perpetrated on the mentally ill shows that victim-blaming is nothing more than a cover-up for subhuman behaviour
Some years ago, the Mufti of Australia got into hot water when he likened women who failed to wear the hijab to “uncovered meat”, at risk of being devoured by cats. In other words, if a woman who dressed “immodestly” were to be raped then she should share, if not take all, the blame.
Sadly, despite the outcry that followed, this attitude – that of blaming the victim – is still deeply prevalent. It should be obvious, but it apparently needs stating over and over: the criminal is the offender. That is, in a rape, the rapist is at fault. No argument.
Women, for example, do not just “get raped”. Somebody has to actively perform an unwelcome act. There is no place for blaming a victim for wearing the “wrong” clothes: if you do, you justify the action. Not to mention that there is no evidence that wearing so-called provocative clothing has anything to do with whether or not someone is likely to rape someone else. Neither is being intoxicated an invitation to rape (because cultures where alcohol is banned and women must be covered up don’t have a problem with rape, right?).
It is worth repeating here that the major motive for most rapes is not sexual attraction, but power. And rapes tend not to be spur-of-the-moment: most rapes are pre-meditated, and only about 8% of rapes are perpetrated by strangers.
More than this, if you blame the victim – by saying she is like a plate of uncovered meat, say – you also remove agency from the offender. Saying “She was asking for it” is simply an abdication of responsibility: it makes you into a simpleton with no control over your actions. An animal perhaps – a feral animal who should maybe be treated like one. It’s also pretty bloody insulting to most men to imply that they are helpless animals with no self-control, but that’s by the by.
To follow victim-blaming logic, you would argue that if someone (and it doesn’t have to be necessarily a woman) does anything that is slightly outside a cultural norm then it is their own fault if someone rapes or otherwise abuses them. If that logic doesn’t immediately sound perverse to you, perhaps it would help to think of an example. Shall we consider mental illness?
There is still a stigma against mental illness. It’s a broad term covering many conditions, and it is still majorly misunderstood. You just have to look at other recent events to realise this. People suffering from severe mental illness are often stigmatised, feared even, because of the public misperception of (for example) schizophrenics as violent. But you can’t help suffering from mental illness, and you can’t always be cured of it.
Would we blame a woman who suffered from schizophrenia if someone raped her? Would we attribute the rape to her illness, and say she should have taken steps to prevent it?
Hardly.
A study by researchers at University College and Kings College London, published today in Psychological Medicine, reports that of women with severe mental illness surveyed for the study, 40% had been the victims of rape or attempted rape.* This compares with 7% of the general population (the figures for men are no less remarkable, although lower overall: 12% of men with severe mental illness had been seriously sexually assaulted, versus 0.5% in the general population).
“the reality for patients is that they are at increased risk of being victims of some of the most damaging types of violence.”
– Professor Louise Howard, Kings College London
Somebody seriously sexually abuses nearly one in every two women with severe mental illness. Although this is an association rather than a proof of causation, the study makes it clear that the illnesses being treated could not all be caused by the abuse: all participating patients had been treated for at least a year and 10% had experienced sexual assault within the past year at the time of the survey. So it looks that for at least some (and I’d wager most) of the victims, the assault would not have happened if they had not been suffering from mental illness.
Nearly half of the sexual abuse of women was classified as “domestic”, that is carried out by a partner or other family member. So again, this isn’t opportunistic rape, not a case of seeing someone “asking for it” and acting upon that notion; this is abuse by a (probably trusted) family member who is more than likely aware of the victim’s vulnerability, and who deliberately takes advantage of it.
Would you say that it is the victim’s fault for having schizophrenia that somebody abused them? Would you say that the 12% of men in the survey who were sexually abused should have done something to prevent it? Were they “asking for it”?
No? Why then say women should cover up, or not drink, or stay inside, or not take raunchy photographs of themselves with their partner? Is it simply that people with mental illness don’t have a choice, but that women do have control over their dress and their alcohol intake. If that’s what you think, then take a moment to consider what that says about you. (Hint: it’s nothing complimentary).
So why blame a woman when someone rapes or otherwise treats them like an item of property?
Shall we take the victim-blaming argument to its logical conclusion and simply say, if you don’t want to be raped, don’t be a woman?
The civil thing to do is to say no; the perpetrator of the hack; the viewer of the photographs; or the apologist for the rapist: they are the ones who poison society like a cancer, and who deserve to be publicly shamed.

For more mental health resources, Click Here to access the Serious Mental Illness Blog. Click Here to access original SMI Blog content

Mental illness and sexual abuse: The shocking link
By Richard P. Grant, The Guardian

Violence perpetrated on the mentally ill shows that victim-blaming is nothing more than a cover-up for subhuman behaviour

Some years ago, the Mufti of Australia got into hot water when he likened women who failed to wear the hijab to “uncovered meat”, at risk of being devoured by cats. In other words, if a woman who dressed “immodestly” were to be raped then she should share, if not take all, the blame.

Sadly, despite the outcry that followed, this attitude – that of blaming the victimis still deeply prevalent. It should be obvious, but it apparently needs stating over and over: the criminal is the offender. That is, in a rape, the rapist is at fault. No argument.

Women, for example, do not just “get raped”. Somebody has to actively perform an unwelcome act. There is no place for blaming a victim for wearing the “wrong” clothes: if you do, you justify the action. Not to mention that there is no evidence that wearing so-called provocative clothing has anything to do with whether or not someone is likely to rape someone else. Neither is being intoxicated an invitation to rape (because cultures where alcohol is banned and women must be covered up don’t have a problem with rape, right?).

It is worth repeating here that the major motive for most rapes is not sexual attraction, but power. And rapes tend not to be spur-of-the-moment: most rapes are pre-meditated, and only about 8% of rapes are perpetrated by strangers.

More than this, if you blame the victim – by saying she is like a plate of uncovered meat, say – you also remove agency from the offender. Saying “She was asking for it” is simply an abdication of responsibility: it makes you into a simpleton with no control over your actions. An animal perhaps – a feral animal who should maybe be treated like one. It’s also pretty bloody insulting to most men to imply that they are helpless animals with no self-control, but that’s by the by.

To follow victim-blaming logic, you would argue that if someone (and it doesn’t have to be necessarily a woman) does anything that is slightly outside a cultural norm then it is their own fault if someone rapes or otherwise abuses them. If that logic doesn’t immediately sound perverse to you, perhaps it would help to think of an example. Shall we consider mental illness?

There is still a stigma against mental illness. It’s a broad term covering many conditions, and it is still majorly misunderstood. You just have to look at other recent events to realise this. People suffering from severe mental illness are often stigmatised, feared even, because of the public misperception of (for example) schizophrenics as violent. But you can’t help suffering from mental illness, and you can’t always be cured of it.

Would we blame a woman who suffered from schizophrenia if someone raped her? Would we attribute the rape to her illness, and say she should have taken steps to prevent it?

Hardly.

A study by researchers at University College and Kings College London, published today in Psychological Medicine, reports that of women with severe mental illness surveyed for the study, 40% had been the victims of rape or attempted rape.* This compares with 7% of the general population (the figures for men are no less remarkable, although lower overall: 12% of men with severe mental illness had been seriously sexually assaulted, versus 0.5% in the general population).

“the reality for patients is that they are at increased risk of being victims of some of the most damaging types of violence.”

– Professor Louise Howard, Kings College London

Somebody seriously sexually abuses nearly one in every two women with severe mental illness. Although this is an association rather than a proof of causation, the study makes it clear that the illnesses being treated could not all be caused by the abuse: all participating patients had been treated for at least a year and 10% had experienced sexual assault within the past year at the time of the survey. So it looks that for at least some (and I’d wager most) of the victims, the assault would not have happened if they had not been suffering from mental illness.

Nearly half of the sexual abuse of women was classified as “domestic”, that is carried out by a partner or other family member. So again, this isn’t opportunistic rape, not a case of seeing someone “asking for it” and acting upon that notion; this is abuse by a (probably trusted) family member who is more than likely aware of the victim’s vulnerability, and who deliberately takes advantage of it.

Would you say that it is the victim’s fault for having schizophrenia that somebody abused them? Would you say that the 12% of men in the survey who were sexually abused should have done something to prevent it? Were they “asking for it”?

No? Why then say women should cover up, or not drink, or stay inside, or not take raunchy photographs of themselves with their partner? Is it simply that people with mental illness don’t have a choice, but that women do have control over their dress and their alcohol intake. If that’s what you think, then take a moment to consider what that says about you. (Hint: it’s nothing complimentary).

So why blame a woman when someone rapes or otherwise treats them like an item of property?

Shall we take the victim-blaming argument to its logical conclusion and simply say, if you don’t want to be raped, don’t be a woman?

The civil thing to do is to say no; the perpetrator of the hack; the viewer of the photographs; or the apologist for the rapist: they are the ones who poison society like a cancer, and who deserve to be publicly shamed.

For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here
 to access original SMI Blog content

Filed under abuse abused trauma traumatized ptsd victim blaming mental health healthy mind body brain recovery recover stigma stigmatized mental illness mental health rape raped trigger triggered wellness assault sexual assault violence violent psychology psychiatry

13 notes

Selling Prozac as the Life-Enhancing Cure for Mental WoesBy Clyde Haberman, The New York Times
When it came to pharmacological solutions to life’s despairs, Aldous Huxley was ahead of the curve. In Huxley’s 1932 novel about a dystopian future, the Alphas, Betas and others populating his “Brave New World” have at their disposal a drug called soma. A little bit of it chases the blues away: “A gramme” — Huxley was English, remember, spelling included — “is better than a damn.” With a swallow, negative feelings are dispelled.
Prozac, the subject of this week’s video documentary from Retro Report, is hardly soma. But its guiding spirit is not dissimilar: A few milligrams of this drug are preferable to the many damns that lie at the core of some people’s lives. Looking back at Prozac’s introduction by Eli Lilly and Company in 1988, and hopscotching to today, the documentary explores the enormous influence, both chemical and cultural, that Prozac and its brethren have had in treating depression, a concern that gained new resonance with the recent suicide of the comedian Robin Williams.
In the late 1980s and the 90s, Prozac was widely viewed as a miracle pill, a life preserver thrown to those who felt themselves drowning in the high waters of mental anguish. It was the star in a class of new pharmaceuticals known as S.S.R.I.s — selective serotonin reuptake inhibitors. Underlying their use is a belief that depression is caused by a shortage of the neurotransmitter serotonin. Pump up the levels of this brain chemical and, voilà, the mood lifts. Indeed, millions have embraced Prozac, and swear by it. Depression left them emotionally paralyzed, they say. Now, for the first time in years, they think clearly and can embrace life.
Pharmacological merits aside, the green-and-cream pill was also a marvel of commercial branding, down to its market-tested name. Its chemical name is fluoxetine hydrochloride, not the most felicitous of terms. A company called Interbrand went to work for Eli Lilly and came up with Prozac. “Pro” sounds positive. Professional, too. “Ac”? That could signify action. As for the Z, it suggests a certain strength, perhaps with a faint high-techy quality.
(X is a pharmacological cousin to Z. Both letters are somewhat unusual, worth many points in Scrabble. It is surely not a coincidence that a striking number of modern medications contain either Z or X, or both, in their names, like Luvox, Paxil, Celexa, Effexor, Zantac, Xanax, Zoloft, Lexapro and Zocor, to name but a few. Not surprisingly, confusion can set in. Zantac or Xanax — remind me which one is for heartburn and which for panic disorder?)
Pendulums, by definition, swing, and the one on which Prozac rides is no exception. After the early talk about it as a wonder pill — a rather chic one at that — a backlash developed, perhaps unsurprisingly. Grave questions arose among some psychiatrists about whether the S.S.R.I.s increased chances that some people, notably teenagers, would commit suicide or at least contemplate it. No definite link was confirmed, but that did not end the concern of some prominent skeptics, like a British psychiatrist, Dr. David Healy. He has dismissed the notion of S.S.R.I.s as saviors as “bio-babble.”
If some users deem Prozac lifesaving, others consider it sensory-depriving. A loss of libido is a common side effect. Some writers and artists, while often relieved to be liberated from depression’s tightest grip, also say that Prozac leaves them mentally hazy. In his 2012 book, “Antifragile: Things That Gain From Disorder,” Nassim Nicholas Taleb offered this: “Had Prozac been available last century, Baudelaire’s ‘spleen,’ Edgar Allan Poe’s moods, the poetry of Sylvia Plath, the lamentations of so many other poets, everything with a soul would have been silenced.”
Then, too, S.S.R.I. critics express doubts that these drugs have proved themselves significantly more effective than placebos. Some among them question the very concept that serotonin levels, on their own, cause depression or prevent it. One psychotherapist in that camp is Gary Greenberg, an author of several books on mood disorders. Writing in The New Yorker last year, Dr. Greenberg said that scientists had “concluded that serotonin was only a finger pointing at one’s mood — that the causes of depression and the effects of the drugs were far more complex than the chemical-imbalance theory implied.”
“The ensuing research,” he continued, “has mostly yielded more evidence that the brain, which has more neurons than the Milky Way has stars and is perhaps one of the most complex objects in the universe, is an elusive target for drugs.”
More broadly, this retrospective on Prozac introduces a discussion of whether the medical establishment, and perhaps society in general, has gone too far in turning normal conditions, like sadness, into pathologies. And have we paved a path — shades of soma — toward wanton reliance on drugs to enhance life, not to conquer true illness?
This is what a prominent psychiatrist, Dr. Peter Kramer, has called “cosmetic psychopharmacology,” a Botox approach, if you will, to matters of the mind: Why not take Prozac and its S.S.R.I. mates even if you are not clinically depressed but believe that they can boost your confidence, or maybe help you make a stronger pitch at the sales meeting?
A response from others in Dr. Kramer’s field is that we are taking traits that are normal parts of human nature and casting them as diseases simply because remedies now exist. For instance, shyness is now regarded by some as a condition in need of treatment. In its more severe form, it is placed under the heading of social anxiety disorder. Then there are those much-heralded life enhancers, Viagra and its erection-aiding cousins. They are marketed not only to men with sexual dysfunction but also to those whose aging bodies are enduring normal wear and tear.
One area of shyness that the S.S.R.I. class has helped overcome is discussion of depression. Decades ago, Hollywood stars and other celebrities dared not touch the subject. Now they routinely go public with their anguish. Robin Williams was an example.
Of course, there are those in other realms of society for whom the topic remains taboo. Take one man who confesses to his wife that he is on Prozac but cautions her to tell no one. “I’m serious,” he says. “The wrong person finds out about this and I get a steel-jacketed antidepressant right in the back of the head.” This is Tony Soprano talking to his wife, Carmela. An extreme example from a work of fiction? Sure. But in all likelihood many Americans have similar fears about what others might think, and keep depression to themselves.
The video with this article is part of a documentary series presented by The New York Times. The video project was started with a grant from Christopher Buck. Retro Report has a staff of 13 journalists and 10 contributors led by Kyra Darnton. It is a nonprofit video news organization that aims to provide a thoughtful counterweight to today’s 24/7 news cycle.
For more mental health resources, Click Here to access the Serious Mental Illness Blog.Click Here to access original SMI Blog content

Selling Prozac as the Life-Enhancing Cure for Mental Woes
By Clyde Haberman, The New York Times

When it came to pharmacological solutions to life’s despairs, Aldous Huxley was ahead of the curve. In Huxley’s 1932 novel about a dystopian future, the Alphas, Betas and others populating his “Brave New World” have at their disposal a drug called soma. A little bit of it chases the blues away: “A gramme” — Huxley was English, remember, spelling included — “is better than a damn.” With a swallow, negative feelings are dispelled.

Prozac, the subject of this week’s video documentary from Retro Report, is hardly soma. But its guiding spirit is not dissimilar: A few milligrams of this drug are preferable to the many damns that lie at the core of some people’s lives. Looking back at Prozac’s introduction by Eli Lilly and Company in 1988, and hopscotching to today, the documentary explores the enormous influence, both chemical and cultural, that Prozac and its brethren have had in treating depression, a concern that gained new resonance with the recent suicide of the comedian Robin Williams.

In the late 1980s and the 90s, Prozac was widely viewed as a miracle pill, a life preserver thrown to those who felt themselves drowning in the high waters of mental anguish. It was the star in a class of new pharmaceuticals known as S.S.R.I.s — selective serotonin reuptake inhibitors. Underlying their use is a belief that depression is caused by a shortage of the neurotransmitter serotonin. Pump up the levels of this brain chemical and, voilà, the mood lifts. Indeed, millions have embraced Prozac, and swear by it. Depression left them emotionally paralyzed, they say. Now, for the first time in years, they think clearly and can embrace life.

Pharmacological merits aside, the green-and-cream pill was also a marvel of commercial branding, down to its market-tested name. Its chemical name is fluoxetine hydrochloride, not the most felicitous of terms. A company called Interbrand went to work for Eli Lilly and came up with Prozac. “Pro” sounds positive. Professional, too. “Ac”? That could signify action. As for the Z, it suggests a certain strength, perhaps with a faint high-techy quality.

(X is a pharmacological cousin to Z. Both letters are somewhat unusual, worth many points in Scrabble. It is surely not a coincidence that a striking number of modern medications contain either Z or X, or both, in their names, like Luvox, Paxil, Celexa, Effexor, Zantac, Xanax, Zoloft, Lexapro and Zocor, to name but a few. Not surprisingly, confusion can set in. Zantac or Xanax — remind me which one is for heartburn and which for panic disorder?)

Pendulums, by definition, swing, and the one on which Prozac rides is no exception. After the early talk about it as a wonder pill — a rather chic one at that — a backlash developed, perhaps unsurprisingly. Grave questions arose among some psychiatrists about whether the S.S.R.I.s increased chances that some people, notably teenagers, would commit suicide or at least contemplate it. No definite link was confirmed, but that did not end the concern of some prominent skeptics, like a British psychiatrist, Dr. David Healy. He has dismissed the notion of S.S.R.I.s as saviors as “bio-babble.”

If some users deem Prozac lifesaving, others consider it sensory-depriving. A loss of libido is a common side effect. Some writers and artists, while often relieved to be liberated from depression’s tightest grip, also say that Prozac leaves them mentally hazy. In his 2012 book, “Antifragile: Things That Gain From Disorder,” Nassim Nicholas Taleb offered this: “Had Prozac been available last century, Baudelaire’s ‘spleen,’ Edgar Allan Poe’s moods, the poetry of Sylvia Plath, the lamentations of so many other poets, everything with a soul would have been silenced.”

Then, too, S.S.R.I. critics express doubts that these drugs have proved themselves significantly more effective than placebos. Some among them question the very concept that serotonin levels, on their own, cause depression or prevent it. One psychotherapist in that camp is Gary Greenberg, an author of several books on mood disorders. Writing in The New Yorker last year, Dr. Greenberg said that scientists had “concluded that serotonin was only a finger pointing at one’s mood — that the causes of depression and the effects of the drugs were far more complex than the chemical-imbalance theory implied.”

“The ensuing research,” he continued, “has mostly yielded more evidence that the brain, which has more neurons than the Milky Way has stars and is perhaps one of the most complex objects in the universe, is an elusive target for drugs.”

More broadly, this retrospective on Prozac introduces a discussion of whether the medical establishment, and perhaps society in general, has gone too far in turning normal conditions, like sadness, into pathologies. And have we paved a path — shades of soma — toward wanton reliance on drugs to enhance life, not to conquer true illness?

This is what a prominent psychiatrist, Dr. Peter Kramer, has called “cosmetic psychopharmacology,” a Botox approach, if you will, to matters of the mind: Why not take Prozac and its S.S.R.I. mates even if you are not clinically depressed but believe that they can boost your confidence, or maybe help you make a stronger pitch at the sales meeting?

A response from others in Dr. Kramer’s field is that we are taking traits that are normal parts of human nature and casting them as diseases simply because remedies now exist. For instance, shyness is now regarded by some as a condition in need of treatment. In its more severe form, it is placed under the heading of social anxiety disorder. Then there are those much-heralded life enhancers, Viagra and its erection-aiding cousins. They are marketed not only to men with sexual dysfunction but also to those whose aging bodies are enduring normal wear and tear.

One area of shyness that the S.S.R.I. class has helped overcome is discussion of depression. Decades ago, Hollywood stars and other celebrities dared not touch the subject. Now they routinely go public with their anguish. Robin Williams was an example.

Of course, there are those in other realms of society for whom the topic remains taboo. Take one man who confesses to his wife that he is on Prozac but cautions her to tell no one. “I’m serious,” he says. “The wrong person finds out about this and I get a steel-jacketed antidepressant right in the back of the head.” This is Tony Soprano talking to his wife, Carmela. An extreme example from a work of fiction? Sure. But in all likelihood many Americans have similar fears about what others might think, and keep depression to themselves.

The video with this article is part of a documentary series presented by The New York Times. The video project was started with a grant from Christopher Buck. Retro Report has a staff of 13 journalists and 10 contributors led by Kyra Darnton. It is a nonprofit video news organization that aims to provide a thoughtful counterweight to today’s 24/7 news cycle.

For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here
 to access original SMI Blog content

Filed under prozac ssri drug drugs med meds medication medications suicide suicidal robin williams depression depressed psychology psychiatry counseling chemical xanax celexa mind body brain wellness health healthy effexor zantac zoloft lexapro zocor

64 notes

Missy Douglas: Visualizing bipolar disorder through artBy David Keller, BBC News
Fed up with keeping her mental health a secret, bipolar disorder sufferer Missy Douglas spent a year creating a painting each day to express her feelings. Controversially, she decided not to take her medication during this time, in the hope that paintings demonstrating her highs and lows would raise awareness of her condition.
Waking up each morning, Missy Douglas has no idea how the day will go. She may feel invincible, or she may be hit by a bout of depression.
Battling the emotional extremes in life has become second nature to the 37-year-old artist, who has lived with bipolar disorder for most of her adult life.
Last year she chose to do what she does best. Every day, for a year, she picked up her paintbrushes and painted exactly how she felt.
She decided to give up her medication while she carried out the project.
"I wanted it to be as pure a view of the disorder as possible," she said.
"Painting every day didn’t make me feel more stable or increase my sense of wellbeing," she said Douglas. "In fact, trying to look inside and express raw emotion or psychological distress everyday was very difficult.
"It sometimes exacerbated the depression or mania I was experiencing at the time. However, when I look back I can recognize the patterns and rhythms of my own ‘brand’ of the disorder."
Bipolar disorder brings about strong mood swings that can last for several weeks.
It can leave people unable to form relationships or cope with the day-to-day routine of work and - in extreme circumstances - lead to a feeling of worthlessness.
Douglas, who is originally from Northampton but now lives in New York, said living with the condition could be “extremely exhausting”.
For more mental health resources, Click Here to access the Serious Mental Illness Blog.Click Here to access original SMI Blog content

Missy Douglas: Visualizing bipolar disorder through art
By David Keller, BBC News

Fed up with keeping her mental health a secret, bipolar disorder sufferer Missy Douglas spent a year creating a painting each day to express her feelings. Controversially, she decided not to take her medication during this time, in the hope that paintings demonstrating her highs and lows would raise awareness of her condition.

Waking up each morning, Missy Douglas has no idea how the day will go. She may feel invincible, or she may be hit by a bout of depression.

Battling the emotional extremes in life has become second nature to the 37-year-old artist, who has lived with bipolar disorder for most of her adult life.

Last year she chose to do what she does best. Every day, for a year, she picked up her paintbrushes and painted exactly how she felt.

She decided to give up her medication while she carried out the project.

"I wanted it to be as pure a view of the disorder as possible," she said.

"Painting every day didn’t make me feel more stable or increase my sense of wellbeing," she said Douglas. "In fact, trying to look inside and express raw emotion or psychological distress everyday was very difficult.

"It sometimes exacerbated the depression or mania I was experiencing at the time. However, when I look back I can recognize the patterns and rhythms of my own ‘brand’ of the disorder."

Bipolar disorder brings about strong mood swings that can last for several weeks.

It can leave people unable to form relationships or cope with the day-to-day routine of work and - in extreme circumstances - lead to a feeling of worthlessness.

Douglas, who is originally from Northampton but now lives in New York, said living with the condition could be “extremely exhausting”.

For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here
 to access original SMI Blog content

Filed under art artist artistic creative creativity fine artist paint painting painter bipolar bipolar disorder mind body brain wellness health healthy mental health mental mental illness recovery treatment hope psychology psychiatry counseling life life story feelings feeling

45 notes

Living With Schizophrenia: The Importance of RoutineBy Michael Hedrick, The New York Times
Michael Hedrick is a writer in Boulder, Colo. He blogs at http://thehedrick.com and his book Connections is available at https://www.createspace.com/3426326
I can remember the early days of having schizophrenia. I was so afraid of the implications of subtle body language, like a lingering millisecond of eye contact, the way my feet hit the ground when I walked or the way I held my hands to my side. It was a struggle to go into a store or, really, anywhere I was bound to see another living member of the human species.
With a simple scratch of the head, someone could be telling me to go forward, or that what I was doing was right or wrong, or that they were acknowledging the symbolic crown on my head that made me a king or a prophet. It’s not hard to imagine that I was having a tough time in the midst of all the anxiety and delusions.
Several months after my diagnosis, I took a job at a small town newspaper as a reporter. I sat in on City Council meetings, covering issues related to the lowering water table and interviewing local business owners for small blurbs in the local section, all the while wondering if I was uncovering some vague connections to an international conspiracy.
The nights were altogether different. Every day, I would come home to my apartment and smoke pot, then lay on my couch watching television or head out to the bar and get so hammered that I couldn’t walk. It’s hard to admit, but the only time I felt relaxed was when I was drunk.
I eventually lost my newspaper job, but that wasn’t the catalyst for change.
It all came to a head one night in July. I had been out drinking all night and, in a haze, I decided it would be a good idea to drive the two miles back to my apartment. This is something I had done several times before, but it had never dawned on me that it was a serious deal. I thought I was doing well, not swerving and being only several blocks from my house, when I saw flashing lights behind me.
What started as a trip to the bar to unwind ended with me calling my parents to bail me out of jail at 3 a.m.
The next year of my life would mean change. I’m not entirely clear on the exact point at which my routine drinking and drug use turned into healthier pursuits. Maybe it was the shock of meeting with a D.U.I. lawyer, or the point after sentencing when I realized I’d be forced to make a daily call, first thing in the morning, to find out if I would have to pee in a cup that day. Maybe it was the fact that I’d need someone else, mainly my mom, to drive me anywhere for the next year. Or perhaps it was the consistent Saturday morning drug and alcohol therapy group or Wednesday and Thursday afternoons of community service that kicked me into a groove.
The groove of it eventually turned into a routine, one that wasn’t marked by indulgence but instead by forced commitment that eventually I would grow to respect.
During that time, I quit smoking pot, I quit drinking and I got some of the best sleep I’d gotten since my diagnosis. Trips to the bar on Monday afternoons turned into extended hours at coffee shops where I finished my first novel.
For some reason, it gave me joy to recite my routine to whoever asked. I would wake up at 7, get coffee and a bagel with plain cream cheese, check Facebook, write until I had 1,000 words, get lunch, do errands in the afternoon, return home, get dinner, take my pills (with food), watch TV and get to bed around 9.
It might all sound tremendously boring. But this regimented series of events was always there; they’d always carry over. And with time, it gave me great comfort to not have to deal with the unexpected. I had a set plan for most days, and there was already too much chaos in my head.
I found that I never forgot to take my medicine. I always had at least eight hours of sleep. And I felt much more relaxed and was able to finally wrap my head around my diagnosis. I began to see the world as a mostly random series of events, rather than an overarching conspiracy plot. The healthy routine was integral.
My story, as with so many stories of recovery, isn’t over. The biggest things in my life are now my friends and family, my work and my daily routine. I take my meds faithfully, and although I no longer attend regular therapy sessions, I find eight years of living with schizophrenia has made me well equipped to deal with future problems. I still get up early, do my work for the day, hang out with my mom or my friends in the afternoon and then ease into the evening. Most important, I still get to bed by 9 every night. I’m more stable, much healthier, and I’m happy.
The routine of things set a stable foundation for recovery by providing me with familiarity. That familiarity was more than welcome when my mind was unrecognizable.
For more mental health resources, Click Here to access the Serious Mental Illness Blog.Click Here to access original SMI Blog content.

Living With Schizophrenia: The Importance of Routine
By Michael Hedrick, The New York Times

Michael Hedrick is a writer in Boulder, Colo. He blogs at http://thehedrick.com and his book Connections is available at https://www.createspace.com/3426326

I can remember the early days of having schizophrenia. I was so afraid of the implications of subtle body language, like a lingering millisecond of eye contact, the way my feet hit the ground when I walked or the way I held my hands to my side. It was a struggle to go into a store or, really, anywhere I was bound to see another living member of the human species.

With a simple scratch of the head, someone could be telling me to go forward, or that what I was doing was right or wrong, or that they were acknowledging the symbolic crown on my head that made me a king or a prophet. It’s not hard to imagine that I was having a tough time in the midst of all the anxiety and delusions.

Several months after my diagnosis, I took a job at a small town newspaper as a reporter. I sat in on City Council meetings, covering issues related to the lowering water table and interviewing local business owners for small blurbs in the local section, all the while wondering if I was uncovering some vague connections to an international conspiracy.

The nights were altogether different. Every day, I would come home to my apartment and smoke pot, then lay on my couch watching television or head out to the bar and get so hammered that I couldn’t walk. It’s hard to admit, but the only time I felt relaxed was when I was drunk.

I eventually lost my newspaper job, but that wasn’t the catalyst for change.

It all came to a head one night in July. I had been out drinking all night and, in a haze, I decided it would be a good idea to drive the two miles back to my apartment. This is something I had done several times before, but it had never dawned on me that it was a serious deal. I thought I was doing well, not swerving and being only several blocks from my house, when I saw flashing lights behind me.

What started as a trip to the bar to unwind ended with me calling my parents to bail me out of jail at 3 a.m.

The next year of my life would mean change. I’m not entirely clear on the exact point at which my routine drinking and drug use turned into healthier pursuits. Maybe it was the shock of meeting with a D.U.I. lawyer, or the point after sentencing when I realized I’d be forced to make a daily call, first thing in the morning, to find out if I would have to pee in a cup that day. Maybe it was the fact that I’d need someone else, mainly my mom, to drive me anywhere for the next year. Or perhaps it was the consistent Saturday morning drug and alcohol therapy group or Wednesday and Thursday afternoons of community service that kicked me into a groove.

The groove of it eventually turned into a routine, one that wasn’t marked by indulgence but instead by forced commitment that eventually I would grow to respect.

During that time, I quit smoking pot, I quit drinking and I got some of the best sleep I’d gotten since my diagnosis. Trips to the bar on Monday afternoons turned into extended hours at coffee shops where I finished my first novel.

For some reason, it gave me joy to recite my routine to whoever asked. I would wake up at 7, get coffee and a bagel with plain cream cheese, check Facebook, write until I had 1,000 words, get lunch, do errands in the afternoon, return home, get dinner, take my pills (with food), watch TV and get to bed around 9.

It might all sound tremendously boring. But this regimented series of events was always there; they’d always carry over. And with time, it gave me great comfort to not have to deal with the unexpected. I had a set plan for most days, and there was already too much chaos in my head.

I found that I never forgot to take my medicine. I always had at least eight hours of sleep. And I felt much more relaxed and was able to finally wrap my head around my diagnosis. I began to see the world as a mostly random series of events, rather than an overarching conspiracy plot. The healthy routine was integral.

My story, as with so many stories of recovery, isn’t over. The biggest things in my life are now my friends and family, my work and my daily routine. I take my meds faithfully, and although I no longer attend regular therapy sessions, I find eight years of living with schizophrenia has made me well equipped to deal with future problems. I still get up early, do my work for the day, hang out with my mom or my friends in the afternoon and then ease into the evening. Most important, I still get to bed by 9 every night. I’m more stable, much healthier, and I’m happy.

The routine of things set a stable foundation for recovery by providing me with familiarity. That familiarity was more than welcome when my mind was unrecognizable.

For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here
 to access original SMI Blog content
.

Filed under schizophrenia schizophrenic psychosis psychotic hallucination delusions delusion recovery recover trauma traumatized treatment hope mind body brain wellness health healthy mental health mental mental illness diagnosis psychology psychiatry counseling routine life daily life story