Serious Mental Illness Blog

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Posts tagged bipolar

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Making American Mental Health Care a PriorityHer Bipolar Life with Kat Dawkins, PsychCentral, April 18, 2014
In the wake of several recent violent attacks across America, including three people killed at Jewish faith and community centers, the stabbing of high school students in Pennsylvania, and the shooting of soldiers at Fort Hood, it’s that time again for the media to question and explore gun control, the root of violence, and even adequate mental health care across the country.
Last post, I discussed the unwillingness of government authorities in the state of Florida to take an educated look at the needs of patients and consumers in the mental health system.
This is an unfortunate trend, locally and federally.
While most people with mental health disorders do not engage in violence, and are actually more often the victims of violent acts, it is clear, through the nearly periodic news of deadly shootings and stabbings, family tragedies, and lost lives, that we, as a society, are failing those that are mentally troubled.
As the Washington Post says in their April 16th article about U.S. mental health care, not all of those that commit violent atrocities in America have a mental illness. But some of those people do have mental health issues.
In this country in general, can we honestly say we are doing all we can to prevent troubled people from harming themselves or others? That we are doing all that we can to make sure that those with mental disorders get the care they need?
To me, it only makes sense to fight stigma, not only by clearing up misinformation about people with a mental health condition, but by getting them medical treatment, so stigma does not in turn perpetuate, and so, most importantly, that American citizens are healthy and their quality of life increases.
Positively, the Affordable Care Act has added coverage for many U.S. citizens with mental disorders. This is not enough, though, because resources for mental health care are still, across the country, at a bare minimum.
The Washington Post article discusses some stir in Congress. Rep. Tim Murphy of Pennsylvania, for example, has a bill called  “The Helping Families in Mental Health Crisis Act”, which is considered by supporters be a reasonable way to reform the system.
This bill is hailed as a way to reorganize the way the U.S. government spends their mental health services money, prioritizing initiatives that actually matter.
Proponents say that Medicaid mental health services would be improved that mental health clinics would be better funded.
It is not a unanimously supported bill, however. One repeated criticism is the bill expands the system’s capability to hospitalize or impose treatment on patients. These critics say that money should instead be invested in community care initiatives.
One thing is constantly clear—there is much disagreement about what mental health policies and programs work, and what are a waste of time and even oppressive to patients.
It is frustrating to see much debate, but no action, and even in the wake of years of unfortunate stories and under-served consumers, we are still, as a country, at a loss of what to collectively do next.
The answer is simpler than the steps that it takes to get there.
We want people with mental illness to be a medical priority in this country, and to have better access to care, no matter who they are or what they are going through.
My psychiatrist recently retired. To get an appointment with another doctor in the same office, I have to wait nearly two months.
This kind of real-life example is paramount to understanding just how difficult it is to receive timely and quality care, in all facets of the system.
What about those that are in crisis? That can’t afford to see a doctor or receive medication? How about those that don’t know where to turn, or where to get access to services?
Just like the push of the Affordable Care Act, the U.S. government needs to step up and make mental health care a plain Jane priority.
We need to see visible evidence that we are collectively doing something to change the horrors that could be prevented, easily prevented in the richest country in the world through better mental health care services.



For more mental health news, Click Here to access the Serious Mental Illness Blog

Making American Mental Health Care a Priority
Her Bipolar Life with Kat Dawkins
, PsychCentral, April 18, 2014

In the wake of several recent violent attacks across America, including three people killed at Jewish faith and community centers, the stabbing of high school students in Pennsylvania, and the shooting of soldiers at Fort Hood, it’s that time again for the media to question and explore gun control, the root of violence, and even adequate mental health care across the country.

Last post, I discussed the unwillingness of government authorities in the state of Florida to take an educated look at the needs of patients and consumers in the mental health system.

This is an unfortunate trend, locally and federally.

While most people with mental health disorders do not engage in violence, and are actually more often the victims of violent acts, it is clear, through the nearly periodic news of deadly shootings and stabbings, family tragedies, and lost lives, that we, as a society, are failing those that are mentally troubled.

As the Washington Post says in their April 16th article about U.S. mental health care, not all of those that commit violent atrocities in America have a mental illness. But some of those people do have mental health issues.

In this country in general, can we honestly say we are doing all we can to prevent troubled people from harming themselves or others? That we are doing all that we can to make sure that those with mental disorders get the care they need?

To me, it only makes sense to fight stigma, not only by clearing up misinformation about people with a mental health condition, but by getting them medical treatment, so stigma does not in turn perpetuate, and so, most importantly, that American citizens are healthy and their quality of life increases.

Positively, the Affordable Care Act has added coverage for many U.S. citizens with mental disorders. This is not enough, though, because resources for mental health care are still, across the country, at a bare minimum.

The Washington Post article discusses some stir in Congress. Rep. Tim Murphy of Pennsylvania, for example, has a bill called  “The Helping Families in Mental Health Crisis Act”, which is considered by supporters be a reasonable way to reform the system.

This bill is hailed as a way to reorganize the way the U.S. government spends their mental health services money, prioritizing initiatives that actually matter.

Proponents say that Medicaid mental health services would be improved that mental health clinics would be better funded.

It is not a unanimously supported bill, however. One repeated criticism is the bill expands the system’s capability to hospitalize or impose treatment on patients. These critics say that money should instead be invested in community care initiatives.

One thing is constantly clear—there is much disagreement about what mental health policies and programs work, and what are a waste of time and even oppressive to patients.

It is frustrating to see much debate, but no action, and even in the wake of years of unfortunate stories and under-served consumers, we are still, as a country, at a loss of what to collectively do next.

The answer is simpler than the steps that it takes to get there.

We want people with mental illness to be a medical priority in this country, and to have better access to care, no matter who they are or what they are going through.

My psychiatrist recently retired. To get an appointment with another doctor in the same office, I have to wait nearly two months.

This kind of real-life example is paramount to understanding just how difficult it is to receive timely and quality care, in all facets of the system.

What about those that are in crisis? That can’t afford to see a doctor or receive medication? How about those that don’t know where to turn, or where to get access to services?

Just like the push of the Affordable Care Act, the U.S. government needs to step up and make mental health care a plain Jane priority.

We need to see visible evidence that we are collectively doing something to change the horrors that could be prevented, easily prevented in the richest country in the world through better mental health care services.





For more mental health news, Click Here to access the Serious Mental Illness Blog

Filed under mental health mental illness health illness healthy bipolar diagnosis disorder politics news violence gun stigma america united states usa health care shooting shootings mental mind body brain washington political news story testimonials testimonies federal state

149 notes

You are not alone: student stories of mental healthBy Libby Page and Guardian readers, The Guardian
Students share their experiences of mental health issues and reveal a common and worrying problem
When I asked students to share their experiences of mental health at university, I had no idea of the reaction it would receive. Over five days we received over 200 stories. Many entries we weren’t able to include, for legal reasons or because the experiences described were too harrowing to publish.
Originally planned to stay open for two weeks, we decided to close the project early because there wasn’t the capacity to moderate the influx of entries. Each morning we were met with more stories – from students who opened up about their anxieties and struggles.
If you are reading this and are dealing with a mental health issue yourself – you are not alone.
Students shared stories of depression, anxiety, self-harm and suicidal thoughts. Some spoke of diagnosed conditions such as obsessive compulsive disorder and bipolar disorder, and the distructive effect these conditions sometimes have on their education.
When it came to lesser-known issues such as borderline personality disorder, students spoke of a lack of understanding about what they were going through.
Others talked about the embarrassment they felt about asking for help. Some were as yet undiagnosed but clearly struggling: “I stay up all night crying” was a common phrase.
No one tells you that university might be difficult, said students. You were sold on stories from your older friends and the glossy prospectus – there are no footnotes about loneliness and disillusionment.
One anonymous student said: “As a fresher you are constantly reminded that this is supposed to be the ‘time of your life’. When it feels like the worst time of your life you feel both a sense of guilt and a pressure to keep these negative thoughts to yourself.”
Another said: “I spent the first few weeks of uni hiding in my dorm room crying my eyes out. I was homesick and wasn’t sure if I wanted to be there at all.”
Mental health issues can start in childhood, and many students spoke about a history of depression or self-harming that they carried to university. But a new life can add pressures.
"My depression and anxiety started some time before I came to university, but leaving home, being in an extremely taxing social environment and being under large academic pressure all took their toll on me," said one student.
Another said: “Getting tubes or being anywhere I didn’t know felt uncertain. I always had a burning, itching, tormenting anxiety bubbling in my chest. At the time, my boyfriend had no comprehension of mental illness and would regularly tell me panic attacks didn’t exist, that I was stupid and that I had no friends.”
Managing your studies alongside a mental health issue can be a daily struggle. “Panic attacks followed by depression meant things rapidly spiralled out of control,” said one student.
"I found I simply couldn’t think straight and my short term memory became terrible. The best description I could muster was that it felt as though the entire world had been rotated very slightly and nothing was the same anymore."
Another student said: “I’m absolutely terrified of being in social situations in which I don’t know the people I’m speaking to – seminars are a nightmare. I’ve often missed my contact hours because I’ve been up all night crying and stressing and can’t face going in.
"I don’t feel like I can tell my tutors why I’m missing their classes, because I feel like they won’t believe me as I haven’t been officially diagnosed."
Others said the stress of deadlines and feedback from tutors contributed. One student said: “I had a burn-out from the pressure of juggling nine modules. One of the triggers was some negative feedback I recieved in writing from a lecturer which included the word terrible. It was hard to get family support as they live far away.”
Students expressed a general feeling that university support services were helpful – when they could access them. After suffering from a severe anxiety attack, one student took the step to contact their university counselling service.
They said: “I’d put it off for so long, but finally I defined myself as ‘mentally ill’. It did take a few weeks for them to back to me, but nothing can describe the relief I felt when a therapist for the first time said to me, ‘that must be really hard’. Yeah, it was hard! Finally, someone who understood, who didn’t tell me to snap out of it.”
But others are still struggling. “When I started my undergraduate degree I did the responsible thing and informed my supervisor that I had depression,” said one anonymous student, who has since been diagnosed with bipolar disorder.
"He informed me that in his opinion depression was a girls issue and he didn’t know what to do with girls issues and sent me on my way."
Another student said: “My university supported me in my decision to suspend my studies and have helped me get back on track to resume my studies in September, yet I can’t help feel more could have been done to help me, before I reached breaking point.”
What do students think needs to be done? Education needs to start early. An anonymous student said: “People need to know what signs to look for in their friends. They need to understand that depression, anxiety, eating disorders, OCD and bipolar are illnesses, not character flaws.
"The support and education about them need to be on par with the education we get about other medical issues. If we learn about it in school, we will be more prepared when we get to university."
At this year’s National Union of Students (NUS) conference, a motion will be discussed that urges student unions to move “away from awareness, towards action”. It calls for training for staff, integrating mental health into the widening participation agenda, better advertising for support services, and an ensurance that academic policies do not cause additional mental distress to students who experience mental health issues.
Now is the time for action. But the response to our call to share stories shows that there are still many young people who want to talk.
What you said
"I thought everything was my fault and I was just defective and bad and that this was what I deserved from life. I missed out on social life and extra-curricular activities because I struggled with acute feelings of social anxiety, self-hatred and fear. Now I have access to support, I can support others, too, and that’s the best feeling I could ask for."
"I hope my words might help some of you to see that you really aren’t the only one. In my opinion, searching out for help in whatever small way you can manage, really is the best thing."
"Mental health issues are nothing to be ashamed of and affect almost everybody and it’s about time everyone realised this and stopped skirting round the subject and faced it head-on. "
"One thing I’ve found is that so many more people than you realise suffer from mental illnesses. As I’ve talked to friends, more and more of them have been telling me that they too suffer from the same things I do, or they have in the past."
"No matter how bad it gets and how much you think there is no hope and let your depression take over, you can always dig yourself out of that hole and find a way to manage your depression and you are not alone."
"Get help, be heard, let yourself be supported. You’re important."
Read the rest of the contributions to the GuardianWitness assignment here.



For more mental health news, Click Here to access the Serious Mental Illness Blog

You are not alone: student stories of mental health
By Libby Page and Guardian readers, The Guardian

Students share their experiences of mental health issues and reveal a common and worrying problem

When I asked students to share their experiences of mental health at university, I had no idea of the reaction it would receive. Over five days we received over 200 stories. Many entries we weren’t able to include, for legal reasons or because the experiences described were too harrowing to publish.

Originally planned to stay open for two weeks, we decided to close the project early because there wasn’t the capacity to moderate the influx of entries. Each morning we were met with more stories – from students who opened up about their anxieties and struggles.

If you are reading this and are dealing with a mental health issue yourself – you are not alone.

Students shared stories of depression, anxiety, self-harm and suicidal thoughts. Some spoke of diagnosed conditions such as obsessive compulsive disorder and bipolar disorder, and the distructive effect these conditions sometimes have on their education.

When it came to lesser-known issues such as borderline personality disorder, students spoke of a lack of understanding about what they were going through.

Others talked about the embarrassment they felt about asking for help. Some were as yet undiagnosed but clearly struggling: “I stay up all night crying” was a common phrase.

No one tells you that university might be difficult, said students. You were sold on stories from your older friends and the glossy prospectus – there are no footnotes about loneliness and disillusionment.

One anonymous student said: “As a fresher you are constantly reminded that this is supposed to be the ‘time of your life’. When it feels like the worst time of your life you feel both a sense of guilt and a pressure to keep these negative thoughts to yourself.”

Another said: “I spent the first few weeks of uni hiding in my dorm room crying my eyes out. I was homesick and wasn’t sure if I wanted to be there at all.”

Mental health issues can start in childhood, and many students spoke about a history of depression or self-harming that they carried to university. But a new life can add pressures.

"My depression and anxiety started some time before I came to university, but leaving home, being in an extremely taxing social environment and being under large academic pressure all took their toll on me," said one student.

Another said: “Getting tubes or being anywhere I didn’t know felt uncertain. I always had a burning, itching, tormenting anxiety bubbling in my chest. At the time, my boyfriend had no comprehension of mental illness and would regularly tell me panic attacks didn’t exist, that I was stupid and that I had no friends.”

Managing your studies alongside a mental health issue can be a daily struggle. “Panic attacks followed by depression meant things rapidly spiralled out of control,” said one student.

"I found I simply couldn’t think straight and my short term memory became terrible. The best description I could muster was that it felt as though the entire world had been rotated very slightly and nothing was the same anymore."

Another student said: “I’m absolutely terrified of being in social situations in which I don’t know the people I’m speaking to – seminars are a nightmare. I’ve often missed my contact hours because I’ve been up all night crying and stressing and can’t face going in.

"I don’t feel like I can tell my tutors why I’m missing their classes, because I feel like they won’t believe me as I haven’t been officially diagnosed."

Others said the stress of deadlines and feedback from tutors contributed. One student said: “I had a burn-out from the pressure of juggling nine modules. One of the triggers was some negative feedback I recieved in writing from a lecturer which included the word terrible. It was hard to get family support as they live far away.”

Students expressed a general feeling that university support services were helpful – when they could access them. After suffering from a severe anxiety attack, one student took the step to contact their university counselling service.

They said: “I’d put it off for so long, but finally I defined myself as ‘mentally ill’. It did take a few weeks for them to back to me, but nothing can describe the relief I felt when a therapist for the first time said to me, ‘that must be really hard’. Yeah, it was hard! Finally, someone who understood, who didn’t tell me to snap out of it.”

But others are still struggling. “When I started my undergraduate degree I did the responsible thing and informed my supervisor that I had depression,” said one anonymous student, who has since been diagnosed with bipolar disorder.

"He informed me that in his opinion depression was a girls issue and he didn’t know what to do with girls issues and sent me on my way."

Another student said: “My university supported me in my decision to suspend my studies and have helped me get back on track to resume my studies in September, yet I can’t help feel more could have been done to help me, before I reached breaking point.”

What do students think needs to be done? Education needs to start early. An anonymous student said: “People need to know what signs to look for in their friends. They need to understand that depression, anxiety, eating disorders, OCD and bipolar are illnesses, not character flaws.

"The support and education about them need to be on par with the education we get about other medical issues. If we learn about it in school, we will be more prepared when we get to university."

At this year’s National Union of Students (NUS) conference, a motion will be discussed that urges student unions to move “away from awareness, towards action”. It calls for training for staff, integrating mental health into the widening participation agenda, better advertising for support services, and an ensurance that academic policies do not cause additional mental distress to students who experience mental health issues.

Now is the time for action. But the response to our call to share stories shows that there are still many young people who want to talk.

What you said

"I thought everything was my fault and I was just defective and bad and that this was what I deserved from life. I missed out on social life and extra-curricular activities because I struggled with acute feelings of social anxiety, self-hatred and fear. Now I have access to support, I can support others, too, and that’s the best feeling I could ask for."

"I hope my words might help some of you to see that you really aren’t the only one. In my opinion, searching out for help in whatever small way you can manage, really is the best thing."

"Mental health issues are nothing to be ashamed of and affect almost everybody and it’s about time everyone realised this and stopped skirting round the subject and faced it head-on. "

"One thing I’ve found is that so many more people than you realise suffer from mental illnesses. As I’ve talked to friends, more and more of them have been telling me that they too suffer from the same things I do, or they have in the past."

"No matter how bad it gets and how much you think there is no hope and let your depression take over, you can always dig yourself out of that hole and find a way to manage your depression and you are not alone."

"Get help, be heard, let yourself be supported. You’re important."

Read the rest of the contributions to the GuardianWitness assignment here.





For more mental health news, Click Here to access the Serious Mental Illness Blog

Filed under mental health mental illness mental health illness healthy diagnosis disorder hope recovery story news anxiety ocd bipolar bipolar disorder bpd borderline borderline personality disorder personality emotion feeling mind body brain sad depression depressed sadness

64 notes

Autism and and Co-occurring Conditions: Bipolar DisorderBy Laurel Joss, Autism Daily Newscast
Bipolar disorder is a mood disorder characterized by extreme shifts in mood, energy, thinking and behavior. Patients suffering from bipolar disorder alternate between manic highs and devastating lows.
Everyone has their moods, but for the individual with bipolar disorder, they are exaggerated to the extreme. A patient in a manic state may go for days with little or no sleep, and may make impulsive decisions with serious consequences (ex. maxing out their credit cards or engaging in risky sexual behaviors).
Depressive phases tend to be extreme as well, with many patients lacking the energy to get out of bed and function in their daily lives. In extreme cases, some patients may even consider or attempt suicide.
People with autism can also demonstrate extreme moods, though there are differences between the two disorders. Extreme mood shifts or tantrums in patients with autism are often caused by the individual’s frustration at being unable to communicate or connect with others. This difficulty, which is a core symptom of autism, can also lead to anxiety and depression.
It is possible for both disorders to occur together, though diagnosis can be challenging. Individuals with autism may be unable to communicate their feelings, which can make it difficult for medical professionals to figure out why they are engaging in certain behaviors.
Some studies have shown that as much as 27% of individuals with autism also suffer from symptoms of bipolar disorder, though this may be exaggerated, due to overlapping symptoms between the two disorders. A 2010 study published in the Journal of Developmental and Physical
Disabilities found that many children with autism demonstrate symptoms that can also be indicators of bipolar disorder, including elevated moods, irritability, excessive talking, distractibility, and sleep disturbances.
Other studies have shown a genetic link between autism and bipolar disorder, along with other disorders such as ADHD and schizophrenia. A 2012 study from the University of North Carolina School of Medicine found that individuals with autism were more likely to have parents or siblings who had been diagnosed with bipolar disorder of schizophrenia.
One key factor in differentiating autism from bipolar disorder is to look carefully at when the symptoms appear and how long they last. An individual with autism who is high-energy, talks incessantly, and paces would not be considered bipolar, unless the symptoms appeared suddenly, along with other indicators such as lack of sleep and an increase in tantrums.
Even in a case like this, the patient should also be tested for other possible causes, including seizure disorders or exposure to food or environmental allergens. If these manic phases come and go, and if no other physical cause can be determined, then the patient may be suffering from bipolar disorder.
Bipolar disorder is often treated with a combination of psychoactive medications such a lithium and psychotherapy. Lithium can have serious side effects, and studies have shown that many individuals with autism respond well to valporic acid along with a low dose of an antipsychotic medication.
Artwork: McCarthy, M. (n.d.) A Portrait of a Lady.



For more mental health news, Click Here to access the Serious Mental Illness Blog

Autism and and Co-occurring Conditions: Bipolar Disorder
By Laurel Joss, Autism Daily Newscast

Bipolar disorder is a mood disorder characterized by extreme shifts in mood, energy, thinking and behavior. Patients suffering from bipolar disorder alternate between manic highs and devastating lows.

Everyone has their moods, but for the individual with bipolar disorder, they are exaggerated to the extreme. A patient in a manic state may go for days with little or no sleep, and may make impulsive decisions with serious consequences (ex. maxing out their credit cards or engaging in risky sexual behaviors).

Depressive phases tend to be extreme as well, with many patients lacking the energy to get out of bed and function in their daily lives. In extreme cases, some patients may even consider or attempt suicide.

People with autism can also demonstrate extreme moods, though there are differences between the two disorders. Extreme mood shifts or tantrums in patients with autism are often caused by the individual’s frustration at being unable to communicate or connect with others. This difficulty, which is a core symptom of autism, can also lead to anxiety and depression.

It is possible for both disorders to occur together, though diagnosis can be challenging. Individuals with autism may be unable to communicate their feelings, which can make it difficult for medical professionals to figure out why they are engaging in certain behaviors.

Some studies have shown that as much as 27% of individuals with autism also suffer from symptoms of bipolar disorder, though this may be exaggerated, due to overlapping symptoms between the two disorders. A 2010 study published in the Journal of Developmental and Physical

Disabilities found that many children with autism demonstrate symptoms that can also be indicators of bipolar disorder, including elevated moods, irritability, excessive talking, distractibility, and sleep disturbances.

Other studies have shown a genetic link between autism and bipolar disorder, along with other disorders such as ADHD and schizophrenia. A 2012 study from the University of North Carolina School of Medicine found that individuals with autism were more likely to have parents or siblings who had been diagnosed with bipolar disorder of schizophrenia.

One key factor in differentiating autism from bipolar disorder is to look carefully at when the symptoms appear and how long they last. An individual with autism who is high-energy, talks incessantly, and paces would not be considered bipolar, unless the symptoms appeared suddenly, along with other indicators such as lack of sleep and an increase in tantrums.

Even in a case like this, the patient should also be tested for other possible causes, including seizure disorders or exposure to food or environmental allergens. If these manic phases come and go, and if no other physical cause can be determined, then the patient may be suffering from bipolar disorder.

Bipolar disorder is often treated with a combination of psychoactive medications such a lithium and psychotherapy. Lithium can have serious side effects, and studies have shown that many individuals with autism respond well to valporic acid along with a low dose of an antipsychotic medication.

Artwork: McCarthy, M. (n.d.) A Portrait of a Lady.





For more mental health news, Click Here to access the Serious Mental Illness Blog

Filed under bipolar autism autistic mental health mental illness mental health illness healthy ill mind brain body psychology med meds medication mood mania manic depressed depression disorder diagnosis psychiatry psychiatric mood disorder doctors therapy recovery

32 notes

The Fat Lady Has SungBy Robert Whitaker, Mad in AmericaCan the field as a whole hear the fat lady sing? Or will it turn a deaf ear to her, and continue with care — the regular long-term use of antipsychotics for all — that clearly does harm?When a medical specialty develops its clinical care guidelines, the “experts” in that specialty will review the research literature, and often that evidence base may present a very confusing picture. The results from the studies may be inconsistent, or contradictory. The experts are also faced with the challenge of weighing the benefits of a treatment against its risks. However, there are also instances when the “evidence base” tells a consistent story, across decades and in studies of various types, and when that happens, the experts developing clinical care guidelines can rejoice: science has provided them with a clear picture of what is helpful and what is not.
This provides the clinical context for assessing the importance of Martin Harrow’s latest paper: It adds a new data point to a long list of research findings that all lead to the same conclusion: antipsychotics, over the long term, do not reduce psychotic symptoms, and, in fact, increase the likelihood that such symptoms will persist.
Harrow has now published a number of papers detailing the outcomes of the schizophrenia patients he has followed for more than 20 years. In previous articles, he has reported that those who stopped taking antipsychotic medications did better over the long-term than the medicated patients in every domain: recovery rates, anxiety symptoms, psychotic symptoms, cognitive function, and employment. In his newest paper, Harrow focuses more closely on medication use and psychotic symptoms, and by doing so, he is narrowing psychiatry’s focus to one critical issue: do these drugs provide any long-term benefit?Antipsychotics, of course, cause many adverse effects, and thus, in any risk-benefit assessment, these drugs need to be effective in reducing psychotic symptoms in order for there to be something on the benefit side of the ledger. If the drugs don’t do that, then there are only risks – i.e. negatives – to be tallied up. And this is why I think we can now say that, with this latest publication of Harrow’s that the fat lady has sung. The case is closed: psychiatry needs to rethink its use of antipsychotics.The Evidence Cited for Long-term Use of Antipsychotics
Psychiatry, of course, does have evidence that it can cite supporting long-term use of antipsychotics. Its evidence consists of findings from relapse studies, but, as can be easily shown, those studies do not, in fact, tell of whether the drugs reduce psychotic symptoms over the long-term.
Once Thorazine and other antipsychotics were introduced, researchers ran studies designed like this: They would take a group of patients who had stabilized well on an antipsychotic, and then half of the patients would be withdrawn from the medication, and half would be maintained on it. With great regularity, those abruptly withdrawn from the antipsychotic relapsed at a higher rate. Thus, researchers concluded that staying on an antipsychotic lowers the risk of relapse.But there are evident flaws in that relapse literature. First, most of the relapse studies involved abrupt withdrawal of the medication, which is known to increase the risk that psychotic symptoms will return. Second, the studies only tell of the return of psychotic symptoms in patients who have been on an antipsychotic; they don’t tell of the risk of relapse in patients who haven’t been exposed to the drugs. Third, they don’t tell of the risk of relapse over longer periods (two years, five years, and so forth.)
Indeed, what the relapse studies prove is this: if a person is stable on an antipsychotic, then it is a very bad idea to withdraw that drug abruptly. They don’t tell of how such treatment affects people over the longer course of their lives.The Rest of the EvidenceAlthough it is well-recognized that the relapse studies don’t provide evidence that antipsychotics are effective over the long-term, most in the field assume that that is still true. However, there is a body of evidence, stretching back 50 years, that bears on this question, and when all of it is put together, it tells a consistent story. In brief:
a) In the 1960s, the NIMH conducted a nine-hospital study that compared placebo to drug treatment, and at the end of one year, those initially treated with an antipsychotic had a higher rehospitalization rate. Thus, at this very first moment of the research literature for antipsychotics, there is the hint of a paradox: treatment that is effective over the short term may increase the risk of relapse over the long term.b) In a retrospective study that compared five-year outcomes for patients treated in 1967 with antipsychotics compared to a similar group of patients treated in 1947 without drugs (as antipsychotics had yet to be introduced), Sanbourne Bockoven found that the 1967 cohort had a higher relapse rate.c) In three studies funded by the NIMH in the 1970s, which followed patients for one to three years, relapse rates were higher each time for the medicated patients. These findings led the NIMH’s William Carpenter to ask whether antipsychotics induced a biological change that made schizophrenic patients “more vulnerable to future relapse than would be the case in the natural course of the illness.”d) At that point, two researchers from McGill University, Guy Chouinard and Barry Jones, offered a biological explanation for why the drugs would have this paradoxical long-term effect. Antipsychotics blocked dopamine receptors in the brain, and in compensatory response, the brain increased the density of such receptors. The person’s brain was now supersensitive to dopamine, and this, they wrote, could lead to “psychotic symptoms.”e) In two cross-cultural studies conducted by the World Health Organization, which compared outcomes in India, Nigeria and Colombia with outcomes in the United States and five other developed countries, the patients in India and Nigeria fared the best. In those two countries, few patients were maintained long-term on antipsychotics, and patients there were much less likely to be psychotic at the end of two and five years.e) In the 1990s, researchers conducting MRI studies of schizophrenia patients reported that neuroleptic use, at the end of 18 months, was associated with hypertrophy of the thalamus and basal ganglion structures in the brain, and that this enlargement—as University of Pennsylvania investigators reported in 1998 —was in turn “associated with greater severity of both negative and positive symptoms.” Thus, the MRI studies told of antipsychotic-induced changes in the brain that made patients more psychotic over time.f) In animal studies, researchers at the University of Toronto have reported that the reason antipsychotics “fail” over time, as a treatment for psychotic symptoms, is that they cause an increase in dopamine receptors.f) A recent randomized study by Lex Wunderink, of the Netherlands, when carefully parsed, tells a similar story. In his study, patients who had stabilized on an antipsychotic were then either maintained on the drug or withdrawn from it (or tapered to a very low dose.) After two years, the relapse rate was higher in the withdrawn/low dose group (43% versus 21%.) However, at the end of seven years, the relapse rate for the withdrawn/low dose group was slightly lower (62% versus 69%), and the key point is this: during those five years (year two to seven in the study), the group that received drug treatment as usual relapsed more frequently than the withdrawn/low-dose group. This is a result consistent with the notion that antipsychotics increase the risk of relapse over the long-term.Why the Fat Lady Has SungWe can see that this body of evidence stretches over 50 years and that it tells a consistent story. The worry that antipsychotics might increase the risk of relapse showed up in the NIMH’s very first one-year study. It showed up in Bockoven’s retrospective study. Next, it showed up in three long-term studies funded by the NIMH in the 1970s. Researchers then offered a biological explanation for why these outcomes were occurring.
The WHO’s cross-cultural studies found better outcomes in poor countries where few patients were maintained long-term on antipsychotics. MRI studies identified a drug-induced change in brain morphology that was associated with a worsening of psychotic symptoms. Researchers who developed an animal model of psychosis concluded that drug-induced dopamine supersensitivity leads to treatment failure over time. Wunderink’s randomized study revealed a higher relapse rates between years two and seven for the medicated patients. Finally, Harrow’s long-term study, which is the best such study that has ever been conducted, found that the medicated patients were much more likely to be experiencing psychotic symptoms over the long term.
Harrow’s data does not stand alone. Instead, studies of multiple types are all leading to the same conclusion. Antipsychotics do not reduce psychotic symptoms over the long term and, in fact, increase the likelihood that such symptoms will persist. And imagine if the opposite were true and all these studies showed that medicated patients had fewer psychotic symptoms over the long term. Would anyone then question the long-term efficacy of antipsychotics? Psychiatry would then proclaim that the evidence was overwhelming that the drugs had such positive effect.
In her post on this site, Sandy Steingard presents a very compelling argument for a different use of these drugs: try to avoid initial use if possible, and then, if an antipsychotic is used, see if the person can be subsequently tapered from the medication. And if a person can’t be successfully tapered, prescribe as low a dose as possible. That is a protocol that provides for selective use of the drugs, and there is clearly an “evidence base” supporting a protocol of that type. Indeed, such use could be described as a “best-use” model.
But the obvious question for psychiatry is now this: Can the field as a whole hear the fat lady sing? Or will it turn a deaf ear to her, and continue with care — the regular long-term use of antipsychotics for all — that clearly does harm?



For more mental health news, Click Here to access the Serious Mental Illness Blog

The Fat Lady Has Sung
By Robert Whitaker, Mad in America

Can the field as a whole hear the fat lady sing? Or will it turn a deaf ear to her, and continue with care — the regular long-term use of antipsychotics for all — that clearly does harm?

When a medical specialty develops its clinical care guidelines, the “experts” in that specialty will review the research literature, and often that evidence base may present a very confusing picture. The results from the studies may be inconsistent, or contradictory. The experts are also faced with the challenge of weighing the benefits of a treatment against its risks. However, there are also instances when the “evidence base” tells a consistent story, across decades and in studies of various types, and when that happens, the experts developing clinical care guidelines can rejoice: science has provided them with a clear picture of what is helpful and what is not.

This provides the clinical context for assessing the importance of Martin Harrow’s latest paper: It adds a new data point to a long list of research findings that all lead to the same conclusion: antipsychotics, over the long term, do not reduce psychotic symptoms, and, in fact, increase the likelihood that such symptoms will persist.

Harrow has now published a number of papers detailing the outcomes of the schizophrenia patients he has followed for more than 20 years. In previous articles, he has reported that those who stopped taking antipsychotic medications did better over the long-term than the medicated patients in every domain: recovery rates, anxiety symptoms, psychotic symptoms, cognitive function, and employment. In his newest paper, Harrow focuses more closely on medication use and psychotic symptoms, and by doing so, he is narrowing psychiatry’s focus to one critical issue: do these drugs provide any long-term benefit?
Antipsychotics, of course, cause many adverse effects, and thus, in any risk-benefit assessment, these drugs need to be effective in reducing psychotic symptoms in order for there to be something on the benefit side of the ledger. If the drugs don’t do that, then there are only risks – i.e. negatives – to be tallied up. And this is why I think we can now say that, with this latest publication of Harrow’s that the fat lady has sung. The case is closed: psychiatry needs to rethink its use of antipsychotics.
The Evidence Cited for Long-term Use of Antipsychotics

Psychiatry, of course, does have evidence that it can cite supporting long-term use of antipsychotics. Its evidence consists of findings from relapse studies, but, as can be easily shown, those studies do not, in fact, tell of whether the drugs reduce psychotic symptoms over the long-term.

Once Thorazine and other antipsychotics were introduced, researchers ran studies designed like this: They would take a group of patients who had stabilized well on an antipsychotic, and then half of the patients would be withdrawn from the medication, and half would be maintained on it. With great regularity, those abruptly withdrawn from the antipsychotic relapsed at a higher rate. Thus, researchers concluded that staying on an antipsychotic lowers the risk of relapse.
But there are evident flaws in that relapse literature. First, most of the relapse studies involved abrupt withdrawal of the medication, which is known to increase the risk that psychotic symptoms will return. Second, the studies only tell of the return of psychotic symptoms in patients who have been on an antipsychotic; they don’t tell of the risk of relapse in patients who haven’t been exposed to the drugs. Third, they don’t tell of the risk of relapse over longer periods (two years, five years, and so forth.)

Indeed, what the relapse studies prove is this: if a person is stable on an antipsychotic, then it is a very bad idea to withdraw that drug abruptly. They don’t tell of how such treatment affects people over the longer course of their lives.

The Rest of the Evidence
Although it is well-recognized that the relapse studies don’t provide evidence that antipsychotics are effective over the long-term, most in the field assume that that is still true. However, there is a body of evidence, stretching back 50 years, that bears on this question, and when all of it is put together, it tells a consistent story. In brief:

a) In the 1960s, the NIMH conducted a nine-hospital study that compared placebo to drug treatment, and at the end of one year, those initially treated with an antipsychotic had a higher rehospitalization rate. Thus, at this very first moment of the research literature for antipsychotics, there is the hint of a paradox: treatment that is effective over the short term may increase the risk of relapse over the long term.
b) In a retrospective study that compared five-year outcomes for patients treated in 1967 with antipsychotics compared to a similar group of patients treated in 1947 without drugs (as antipsychotics had yet to be introduced), Sanbourne Bockoven found that the 1967 cohort had a higher relapse rate.
c) In three studies funded by the NIMH in the 1970s, which followed patients for one to three years, relapse rates were higher each time for the medicated patients. These findings led the NIMH’s William Carpenter to ask whether antipsychotics induced a biological change that made schizophrenic patients “more vulnerable to future relapse than would be the case in the natural course of the illness.”
d) At that point, two researchers from McGill University, Guy Chouinard and Barry Jones, offered a biological explanation for why the drugs would have this paradoxical long-term effect. Antipsychotics blocked dopamine receptors in the brain, and in compensatory response, the brain increased the density of such receptors. The person’s brain was now supersensitive to dopamine, and this, they wrote, could lead to “psychotic symptoms.”
e) In two cross-cultural studies conducted by the World Health Organization, which compared outcomes in India, Nigeria and Colombia with outcomes in the United States and five other developed countries, the patients in India and Nigeria fared the best. In those two countries, few patients were maintained long-term on antipsychotics, and patients there were much less likely to be psychotic at the end of two and five years.
e) In the 1990s, researchers conducting MRI studies of schizophrenia patients reported that neuroleptic use, at the end of 18 months, was associated with hypertrophy of the thalamus and basal ganglion structures in the brain, and that this enlargement—as University of Pennsylvania investigators reported in 1998 —was in turn “associated with greater severity of both negative and positive symptoms.” Thus, the MRI studies told of antipsychotic-induced changes in the brain that made patients more psychotic over time.
f) In animal studies, researchers at the University of Toronto have reported that the reason antipsychotics “fail” over time, as a treatment for psychotic symptoms, is that they cause an increase in dopamine receptors.
f) A recent randomized study by Lex Wunderink, of the Netherlands, when carefully parsed, tells a similar story. In his study, patients who had stabilized on an antipsychotic were then either maintained on the drug or withdrawn from it (or tapered to a very low dose.) After two years, the relapse rate was higher in the withdrawn/low dose group (43% versus 21%.) However, at the end of seven years, the relapse rate for the withdrawn/low dose group was slightly lower (62% versus 69%), and the key point is this: during those five years (year two to seven in the study), the group that received drug treatment as usual relapsed more frequently than the withdrawn/low-dose group. This is a result consistent with the notion that antipsychotics increase the risk of relapse over the long-term.

Why the Fat Lady Has Sung
We can see that this body of evidence stretches over 50 years and that it tells a consistent story. The worry that antipsychotics might increase the risk of relapse showed up in the NIMH’s very first one-year study. It showed up in Bockoven’s retrospective study. Next, it showed up in three long-term studies funded by the NIMH in the 1970s. Researchers then offered a biological explanation for why these outcomes were occurring.

The WHO’s cross-cultural studies found better outcomes in poor countries where few patients were maintained long-term on antipsychotics. MRI studies identified a drug-induced change in brain morphology that was associated with a worsening of psychotic symptoms. Researchers who developed an animal model of psychosis concluded that drug-induced dopamine supersensitivity leads to treatment failure over time. Wunderink’s randomized study revealed a higher relapse rates between years two and seven for the medicated patients. Finally, Harrow’s long-term study, which is the best such study that has ever been conducted, found that the medicated patients were much more likely to be experiencing psychotic symptoms over the long term.

Harrow’s data does not stand alone. Instead, studies of multiple types are all leading to the same conclusion. Antipsychotics do not reduce psychotic symptoms over the long term and, in fact, increase the likelihood that such symptoms will persist. And imagine if the opposite were true and all these studies showed that medicated patients had fewer psychotic symptoms over the long term. Would anyone then question the long-term efficacy of antipsychotics? Psychiatry would then proclaim that the evidence was overwhelming that the drugs had such positive effect.

In her post on this site, Sandy Steingard presents a very compelling argument for a different use of these drugs: try to avoid initial use if possible, and then, if an antipsychotic is used, see if the person can be subsequently tapered from the medication. And if a person can’t be successfully tapered, prescribe as low a dose as possible. That is a protocol that provides for selective use of the drugs, and there is clearly an “evidence base” supporting a protocol of that type. Indeed, such use could be described as a “best-use” model.

But the obvious question for psychiatry is now this: Can the field as a whole hear the fat lady sing? Or will it turn a deaf ear to her, and continue with care — the regular long-term use of antipsychotics for all — that clearly does harm?





For more mental health news, Click Here to access the Serious Mental Illness Blog

Filed under psychosis psychotic psycho schizophrenia schizophrenic bipolar psychology psychiatry mental health mental illness mental health illness mind body brain healthy recover recovery med meds drug drugs therapy hallucination delusion mad madness rethinking madness symptom

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Creative inspiration associated with heightened risk of bipolar disorderBy Brooks Hays 
"People with bipolar disorder highly value creativity as a positive aspect of their condition," said Professor Steven Jones, co-director of Lancaster University’s Spectrum Center, a research facility dedicated to mental health studies.
For centuries, the link between artistic creativity and mental illness has been proffered by psychologists and intellectuals. But a new study suggests the association is more than just a romantic notion.
Researchers at Yale University and Lancaster University in the U.K. recently showed that a propensity for “inspiration” predicted a greater risk of bipolar disorder in survey participants.
Artists, musicians, poets and writers have long credited experiences of mania and depression with their moments creative inspiration. But those same experiences are also signs of bipolar disorder and other mental problems.
"It appears that the types of inspiration most related to bipolar vulnerability are those which are self-generated and linked with strong drive for success," explained Professor Steven Jones, co-director of Lancaster University’s Spectrum Center, a research facility dedicated to mental health studies.
“Understanding more about inspiration is important because it is a key aspect of creativity which is highly associated with mental health problems, in particular bipolar disorder,” Jones added.
Jones worked with Dr. Alyson Dodd, of Lancaster University, and Dr. June Gruber, of Yale, to complete the study on bipolar disorder and inspiration — the details of which are published in the latest issue of PLOS One.
The researchers found the correlation by surveying 835 undergraduate students. Participants were each given two surveys — one a trusted and much-used questionnaire aimed at gauging bipolar risk, the other a survey designed to ascertain the student’s feelings towards creative inspiration.
Those who placed a greater emphasis on incidents of personal inspiration were more likely to score higher on the 48-question bipolar survey, known as the Hypomanic Personality Scale.
“People with bipolar disorder highly value creativity as a positive aspect of their condition,” said Jones. “This is relevant to clinicians, as people with bipolar disorder may be unwilling to engage with treatments and therapies which compromise their creativity.”



For more mental health news, Click Here to access the Serious Mental Illness Blog

Creative inspiration associated with heightened risk of bipolar disorder
By Brooks Hays 

"People with bipolar disorder highly value creativity as a positive aspect of their condition," said Professor Steven Jones, co-director of Lancaster University’s Spectrum Center, a research facility dedicated to mental health studies.

For centuries, the link between artistic creativity and mental illness has been proffered by psychologists and intellectuals. But a new study suggests the association is more than just a romantic notion.

Researchers at Yale University and Lancaster University in the U.K. recently showed that a propensity for “inspiration” predicted a greater risk of bipolar disorder in survey participants.

Artists, musicians, poets and writers have long credited experiences of mania and depression with their moments creative inspiration. But those same experiences are also signs of bipolar disorder and other mental problems.

"It appears that the types of inspiration most related to bipolar vulnerability are those which are self-generated and linked with strong drive for success," explained Professor Steven Jones, co-director of Lancaster University’s Spectrum Center, a research facility dedicated to mental health studies.

Understanding more about inspiration is important because it is a key aspect of creativity which is highly associated with mental health problems, in particular bipolar disorder,” Jones added.

Jones worked with Dr. Alyson Dodd, of Lancaster University, and Dr. June Gruber, of Yale, to complete the study on bipolar disorder and inspiration — the details of which are published in the latest issue of PLOS One.

The researchers found the correlation by surveying 835 undergraduate students. Participants were each given two surveys — one a trusted and much-used questionnaire aimed at gauging bipolar risk, the other a survey designed to ascertain the student’s feelings towards creative inspiration.

Those who placed a greater emphasis on incidents of personal inspiration were more likely to score higher on the 48-question bipolar survey, known as the Hypomanic Personality Scale.

People with bipolar disorder highly value creativity as a positive aspect of their condition,” said Jones. “This is relevant to clinicians, as people with bipolar disorder may be unwilling to engage with treatments and therapies which compromise their creativity.”





For more mental health news, Click Here to access the Serious Mental Illness Blog

Filed under virginia woolfe woolfe bipolar bipolar disorder mania manic depression depressed diagnosis disorder mind body brain health healthy happy happiness recovery creative creativity art artist artistic painter writer author artists inspired inspiration mental

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What Does It Feel Like to Have Bipolar Disorder?By Quora ContributorThis question originally appeared on Quora.Answer by Mills Baker, in fairly successful treatment for 12-plus years:I have bipolar disorder, as does my mother and as did her mother. I am the sort of person who “seems” bipolar to people—that is my energy, creativity, instability, mercuriality, and easy gregariousness confirm many of the popularly imagined stereotypes about bipolar people.That said, I think only in their extremes are mania and depression actually unintelligible to ordinary folks. That is: At their utmost intensity, they are unlike anything a normal person ever experiences (mania is, in particular, qualitatively different at the end than any healthy mood state), but at most times, they are not at all different from the maximally intense moods everyone knows—just more so, longer-lasting, and disconnected from normative causes.
To understand what having bipolar disorder “feels like,” keep in mind the following:
First, bipolar is less about short-term mood instability than about long-term mood cycles, which can last months, years, or in rare cases even decades. (See F.M. Mondimore for more on cycles and durations.) Instability is part of it, but not the only part.
Second, the cumulative effect of these cycles on the formation of a personality is significant. After a childhood of radically changing interests and attitudes on such a timeline, one develops a certain excitability, flightiness, distractibility, or perhaps that’s just me. But this is a major part of bipolar: the personality that is shaped by a lifetime of intense, fluctuating moods.
Third, cycles grow in intensity over time. This means that at first in mania, for example, you’re simply in a great mood. Then you’re really in an extraordinarily creative, kinetic, charming mood. Then you’re the life of all parties, and you’re feeling pretty libidinous. Then you’re doing irresponsible things and fleeing a pursuing psychosis. Then you’re in psychosis, tortured by acousticovisual hallucinations, paranoia, and your own penchant for completely unacceptable reactions and behavior. This progression can take days, weeks, months, or years. The same progression tends to hold for depression.
Kay Redfield Jamison is a psychiatrist at Johns Hopkins University who suffers from, treats, and writes about bipolar disorder. About mania, she writes:

The ideas and feelings are fast and frequent like shooting stars, and you follow them until you find better and brighter ones. Shyness goes, the right words and gestures are suddenly there, the power to captivate others a felt certainty. There are interests found in uninteresting people. Sensuality is pervasive and the desire to seduce and be seduced irresistible. Feelings of ease, intensity, power, well-being, financial omnipotence, and euphoria pervade one’s marrow. But, somewhere, this changes. The fast ideas are far too fast, and there are far too many; overwhelming confusion replaces clarity. Memory goes. Humor and absorption on friends’ faces are replaced by fear and concern. Everything previously moving with the grain is now against— you are irritable, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of the mind. You never knew those caves were there. It will never end, for madness carves its own reality.

Mania (and hypomania, to an obviously lesser extent) are truly hard to describe; I attempted my own description of a brief manic experience here.In the blackness of myself, I could see that my thoughts were not myself at all: My self is only a nothingness that exists in a state of pure terror and hatred, and my thoughts rotate around it as debris in a tornado. My thoughts were imbecilic, disgusting, vicious, superficial, detestable, but by this point I could no longer stay with them long enough to hate them. They distracted me, but I couldn’t attend to them. I said in my mind: Oh God, oh God, oh God, nothing, nothing, nothing. Oh God, nothing, nothing. Oh God, I’m nothing, it’s nothing, there’s nothing, God, God.Periodically I would see what I assume was a phosphene, and it would transform into something real. I saw a glowing purple shape become the sun, and the sun became the blond hair I had in childhood. And I realized that I had murdered that boy, had murdered my own boyhood self, had destroyed this innocent child, and I ground my teeth to silence myself, as I wanted to scream so loud that I would tear myself apart, would explode in a bloody spray. I was sick with guilt and fear. I had nothing inside myself any longer. I felt I had betrayed myself, had orphaned myself when I needed someone most. I heard in my mind: Why did I kill him? Oh God, he needed someone, he needed someone, why did I kill him? I’ve killed him, oh God, I’ve killed him.I was seized with a desire to gain physical access to and destroy my brain, an urge I felt in childhood when I had severe headaches. I grasped my hair and attempted to pull it out; I wanted to rip my scalp over and reach into my skull and destroy my mind, scramble and tear apart this malevolent and pathetic apparatus with my fingers, rip out the guts of my who nightmare self. I couldn’t get my hair out, hated myself for it, lost the thread of this thought, and resumed my silent shrieking and sobbing.
About depression, Jamison writes in Night Falls Fast:

In its severe forms, depression paralyzes all of the otherwise vital forces that make us human, leaving instead a bleak, despairing, desperate, and deadened state… Life is bloodless, pulseless, and yet present enough to allow a suffocating horror and pain. All bearings are lost; all things are dark and drained of feeling. The slippage into futility is first gradual, then utter. Thought, which is as pervasively affected by depression as mood, is morbid, confused, and stuporous. It is also vacillating, ruminative, indecisive, and self-castigating. The body is bone-weary; there is no will; nothing is that is not an effort, and nothing at all seems worth it. Sleep is fragmented, elusive, or all-consuming. Like an unstable gas, an irritable exhaustion seeps into every crevice of thought and action.

Jamison is well-known, too, for her research on the link between bipolar disorder and creativity, which leads me to my conclusion:To know what it “feels like” is to know the qualia, the phenomenological experiences a bipolar person encounters that an unaffected person does not. I don’t think there are many of these. Going berserk, being creative, having an awful temper, not being able to trust my own emotional reactions: These have a certain weight when I list them out, discuss them as individual tragedies. They can even sound unique.But everyone loses it. Everyone has his moments of charisma, creativity, success, strength, achievement, and everyone struggles with himself. You may not hallucinate, but I bet you can understand what it’s like for your mind to misbehave, react insanely. If you haven’t yet lost control of yourself in life, wait.We bipolar people have a tendency to comfort ourselves by saying that our more intense experience of typical phenomena constitutes an election: We are elite, more alive, deeper! Jamison’s own excellent research on bipolar artists has amplified this: The popular Western conflation of insanity, artistic talent, and melodrama permits a kind of sentimental self-regard: Yes, I’m crazy, but I’m also probably in some difficult-to-establish way deeply brilliant!Perhaps this is true for some, but it seems mostly to me to be a consolatory story, the sort of inversion that Nietzsche describes as resentiment: To say this illness is really a kind of health, a kind of deeper seeing, is a lie. I like my life a lot, but I am uncomfortable with this persistent meme, largely because I’m sometimes confused into believing it myself. Indeed, one of bipolar disorder’s chief symptoms is often that a patient confuses herself with an artist. (Or more generally: an exception. Mondimore notes that throughout history, “grandiosity” has changed in its expressions. An important symptom of bipolar, grandiosity was once expressed by women saying they were pregnant with kings or the messiah, men believing they were kings or the messiah; presently, our insanity is less monarchical and religious; we all instead believe we special exceptions of one sort or another).I’ve been in treatment now for 12 years, on the same cocktail of medications for years and years. For me, the most enduring way that bipolar “feels” different is in how I cannot trust my reactions. When someone says something to you and you recognize it as an insult, as abuse, your reactive anger is appropriate and you can commit to it, or you can make some determination based on your values, your reason, and choose a different course of action. I can’t even trust that the person insulted me. I can’t trust my emotional perceptions or reactions.That’s the strangest thing about how it feels, after the dust of the actual disorder settles, more than a decade in: the open insanity has abated and visits only briefly, the idea that I’m a secret artist is absurd, and what’s left is a more or less normal life in which I have to emphasize “mental hygiene” (prioritizing regular sleep, for example) and in which I always feel doubt about what I think and feel, as we all probably should anyway.Note: As Anne Zieger helpfully noted, this answer is not fully comprehensive: Phenomena such as rapid-cycling, which I’ve experienced only from SSRIs, aren’t discussed, and the variations of bipolar disorder aren’t either. How it “feels” to be bipolar naturally varies widely from person to person, just as how it feels to be sane must, so I should emphasize that this answer is how it feels for me alone. Most bipolar people will have significant variations in their experiences.



For more mental health news, Click Here to access the Serious Mental Illness Blog

What Does It Feel Like to Have Bipolar Disorder?
By Quora Contributor

This question originally appeared on Quora.

Answer by Mills Baker, in fairly successful treatment for 12-plus years:

I have bipolar disorder, as does my mother and as did her mother. I am the sort of person who “seems” bipolar to people—that is my energy, creativity, instability, mercuriality, and easy gregariousness confirm many of the popularly imagined stereotypes about bipolar people.
That said, I think only in their extremes are mania and depression actually unintelligible to ordinary folks. That is: At their utmost intensity, they are unlike anything a normal person ever experiences (mania is, in particular, qualitatively different at the end than any healthy mood state), but at most times, they are not at all different from the maximally intense moods everyone knows—just more so, longer-lasting, and disconnected from normative causes.

To understand what having bipolar disorder “feels like,” keep in mind the following:

  • First, bipolar is less about short-term mood instability than about long-term mood cycles, which can last months, years, or in rare cases even decades. (See F.M. Mondimore for more on cycles and durations.) Instability is part of it, but not the only part.
  • Second, the cumulative effect of these cycles on the formation of a personality is significant. After a childhood of radically changing interests and attitudes on such a timeline, one develops a certain excitability, flightiness, distractibility, or perhaps that’s just me. But this is a major part of bipolar: the personality that is shaped by a lifetime of intense, fluctuating moods.
  • Third, cycles grow in intensity over time. This means that at first in mania, for example, you’re simply in a great mood. Then you’re really in an extraordinarily creative, kinetic, charming mood. Then you’re the life of all parties, and you’re feeling pretty libidinous. Then you’re doing irresponsible things and fleeing a pursuing psychosis. Then you’re in psychosis, tortured by acousticovisual hallucinations, paranoia, and your own penchant for completely unacceptable reactions and behavior. This progression can take days, weeks, months, or years. The same progression tends to hold for depression.


Kay Redfield Jamison is a psychiatrist at Johns Hopkins University who suffers from, treats, and writes about bipolar disorder. About mania, she writes:

The ideas and feelings are fast and frequent like shooting stars, and you follow them until you find better and brighter ones. Shyness goes, the right words and gestures are suddenly there, the power to captivate others a felt certainty. There are interests found in uninteresting people. Sensuality is pervasive and the desire to seduce and be seduced irresistible. Feelings of ease, intensity, power, well-being, financial omnipotence, and euphoria pervade one’s marrow. But, somewhere, this changes. The fast ideas are far too fast, and there are far too many; overwhelming confusion replaces clarity. Memory goes. Humor and absorption on friends’ faces are replaced by fear and concern. Everything previously moving with the grain is now against— you are irritable, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of the mind. You never knew those caves were there. It will never end, for madness carves its own reality.

Mania (and hypomania, to an obviously lesser extent) are truly hard to describe; I attempted my own description of a brief manic experience here.
In the blackness of myself, I could see that my thoughts were not myself at all: My self is only a nothingness that exists in a state of pure terror and hatred, and my thoughts rotate around it as debris in a tornado. My thoughts were imbecilic, disgusting, vicious, superficial, detestable, but by this point I could no longer stay with them long enough to hate them. They distracted me, but I couldn’t attend to them. I said in my mind: Oh God, oh God, oh God, nothing, nothing, nothing. Oh God, nothing, nothing. Oh God, I’m nothing, it’s nothing, there’s nothing, God, God.
Periodically I would see what I assume was a phosphene, and it would transform into something real. I saw a glowing purple shape become the sun, and the sun became the blond hair I had in childhood. And I realized that I had murdered that boy, had murdered my own boyhood self, had destroyed this innocent child, and I ground my teeth to silence myself, as I wanted to scream so loud that I would tear myself apart, would explode in a bloody spray. I was sick with guilt and fear. I had nothing inside myself any longer. I felt I had betrayed myself, had orphaned myself when I needed someone most. I heard in my mind: Why did I kill him? Oh God, he needed someone, he needed someone, why did I kill him? I’ve killed him, oh God, I’ve killed him.
I was seized with a desire to gain physical access to and destroy my brain, an urge I felt in childhood when I had severe headaches. I grasped my hair and attempted to pull it out; I wanted to rip my scalp over and reach into my skull and destroy my mind, scramble and tear apart this malevolent and pathetic apparatus with my fingers, rip out the guts of my who nightmare self. I couldn’t get my hair out, hated myself for it, lost the thread of this thought, and resumed my silent shrieking and sobbing.

About depression, Jamison writes in Night Falls Fast:

In its severe forms, depression paralyzes all of the otherwise vital forces that make us human, leaving instead a bleak, despairing, desperate, and deadened state… Life is bloodless, pulseless, and yet present enough to allow a suffocating horror and pain. All bearings are lost; all things are dark and drained of feeling. The slippage into futility is first gradual, then utter. Thought, which is as pervasively affected by depression as mood, is morbid, confused, and stuporous. It is also vacillating, ruminative, indecisive, and self-castigating. The body is bone-weary; there is no will; nothing is that is not an effort, and nothing at all seems worth it. Sleep is fragmented, elusive, or all-consuming. Like an unstable gas, an irritable exhaustion seeps into every crevice of thought and action.


Jamison is well-known, too, for her research on the link between bipolar disorder and creativity, which leads me to my conclusion:
To know what it “feels like” is to know the qualia, the phenomenological experiences a bipolar person encounters that an unaffected person does not. I don’t think there are many of these. Going berserk, being creative, having an awful temper, not being able to trust my own emotional reactions: These have a certain weight when I list them out, discuss them as individual tragedies. They can even sound unique.
But everyone loses it. Everyone has his moments of charisma, creativity, success, strength, achievement, and everyone struggles with himself. You may not hallucinate, but I bet you can understand what it’s like for your mind to misbehave, react insanely. If you haven’t yet lost control of yourself in life, wait.
We bipolar people have a tendency to comfort ourselves by saying that our more intense experience of typical phenomena constitutes an election: We are elite, more alive, deeper! Jamison’s own excellent research on bipolar artists has amplified this: The popular Western conflation of insanity, artistic talent, and melodrama permits a kind of sentimental self-regard: Yes, I’m crazy, but I’m also probably in some difficult-to-establish way deeply brilliant!
Perhaps this is true for some, but it seems mostly to me to be a consolatory story, the sort of inversion that Nietzsche describes as resentiment: To say this illness is really a kind of health, a kind of deeper seeing, is a lie. I like my life a lot, but I am uncomfortable with this persistent meme, largely because I’m sometimes confused into believing it myself. Indeed, one of bipolar disorder’s chief symptoms is often that a patient confuses herself with an artist. (Or more generally: an exception. Mondimore notes that throughout history, “grandiosity” has changed in its expressions. An important symptom of bipolar, grandiosity was once expressed by women saying they were pregnant with kings or the messiah, men believing they were kings or the messiah; presently, our insanity is less monarchical and religious; we all instead believe we special exceptions of one sort or another).
I’ve been in treatment now for 12 years, on the same cocktail of medications for years and years. For me, the most enduring way that bipolar “feels” different is in how I cannot trust my reactions. When someone says something to you and you recognize it as an insult, as abuse, your reactive anger is appropriate and you can commit to it, or you can make some determination based on your values, your reason, and choose a different course of action. I can’t even trust that the person insulted me. I can’t trust my emotional perceptions or reactions.
That’s the strangest thing about how it feels, after the dust of the actual disorder settles, more than a decade in: the open insanity has abated and visits only briefly, the idea that I’m a secret artist is absurd, and what’s left is a more or less normal life in which I have to emphasize “mental hygiene” (prioritizing regular sleep, for example) and in which I always feel doubt about what I think and feel, as we all probably should anyway.

Note: As Anne Zieger helpfully noted, this answer is not fully comprehensive: Phenomena such as rapid-cycling, which I’ve experienced only from SSRIs, aren’t discussed, and the variations of bipolar disorder aren’t either. How it “feels” to be bipolar naturally varies widely from person to person, just as how it feels to be sane must, so I should emphasize that this answer is how it feels for me alone. Most bipolar people will have significant variations in their experiences.





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Residual depression has lasting impact on bipolar patientsBy Eleanor McDermid, Senior medwireNews ReporterIn bipolar disorder, depressive symptoms are not only negatively associated with the outcome, but also affect verbal memory performanceA prospective study confirms the detrimental effect of subthreshold depressive symptoms on the outcomes of patients with bipolar disorder.
The findings, published in the Journal of Affective Disorders, also suggest that the effect is partly mediated by cognitive impairment.Researcher Anabel Martínez-Arán (University of Barcelona, Spain) and colleagues say that most studies have been cross-sectional, whereas they followed up 111 patients for 1 year. The patients were aged an average of 40 years and 78.4% had bipolar I disorder; all were euthymic at inclusion.
The team assessed verbal memory (using the California Verbal Learning Test), because impairment in this neurocognitive function is thought to be a core feature of bipolar disorder. Along with subsyndromal depressive symptoms (≤8 on the Hamilton Depression Rating Scale), patients’ composite verbal memory score explained 19% of the variance in their baseline scores on the Functioning Assessment Short Test (FAST).
Subthreshold depressive symptoms and verbal memory were associated with each other, such that patients with more depressive symptoms had larger memory impairments. They were also individually associated with baseline functional status.
“Thus in bipolar disorder, depressive symptoms are not only negatively associated with the outcome, but also affect verbal memory performance,” say the researchers.
Verbal memory had a significant indirect effect on outcome, partly mediating the relationship between depressive symptoms and functional status.
During 1 year of follow-up, patients’ functional status remained fairly stable overall, with average FAST scores of 29 at baseline and 27 at follow-up. Baseline functional status explained 44% of the variance in 1-year functional outcomes.
As baseline functional status was, in turn, partly dependent on depressive symptoms and verbal memory, these variables therefore contribute to follow-up functional outcomes, explain Martínez-Arán et al.The researchers note, however, that the study only assessed verbal memory, and impairments in this domain could be partly caused by other neurocognitive deficits.
“The identification of mediators in the prediction of functional outcome may help to disentangle the complex network of variables that contribute to functional outcome, since many variables with direct and indirect effects might be involved,” they conclude.


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Residual depression has lasting impact on bipolar patients
By Eleanor McDermid, Senior medwireNews Reporter

In bipolar disorder, depressive symptoms are not only negatively associated with the outcome, but also affect verbal memory performance

A prospective study confirms the detrimental effect of subthreshold depressive symptoms on the outcomes of patients with bipolar disorder.

The findings, published in the Journal of Affective Disorders, also suggest that the effect is partly mediated by cognitive impairment.
Researcher Anabel Martínez-Arán (University of Barcelona, Spain) and colleagues say that most studies have been cross-sectional, whereas they followed up 111 patients for 1 year. The patients were aged an average of 40 years and 78.4% had bipolar I disorder; all were euthymic at inclusion.

The team assessed verbal memory (using the California Verbal Learning Test), because impairment in this neurocognitive function is thought to be a core feature of bipolar disorder. Along with subsyndromal depressive symptoms (≤8 on the Hamilton Depression Rating Scale), patients’ composite verbal memory score explained 19% of the variance in their baseline scores on the Functioning Assessment Short Test (FAST).

Subthreshold depressive symptoms and verbal memory were associated with each other, such that patients with more depressive symptoms had larger memory impairments. They were also individually associated with baseline functional status.

“Thus in bipolar disorder, depressive symptoms are not only negatively associated with the outcome, but also affect verbal memory performance,” say the researchers.

Verbal memory had a significant indirect effect on outcome, partly mediating the relationship between depressive symptoms and functional status.

During 1 year of follow-up, patients’ functional status remained fairly stable overall, with average FAST scores of 29 at baseline and 27 at follow-up. Baseline functional status explained 44% of the variance in 1-year functional outcomes.

As baseline functional status was, in turn, partly dependent on depressive symptoms and verbal memory, these variables therefore contribute to follow-up functional outcomes, explain Martínez-Arán et al.
The researchers note, however, that the study only assessed verbal memory, and impairments in this domain could be partly caused by other neurocognitive deficits.

“The identification of mediators in the prediction of functional outcome may help to disentangle the complex network of variables that contribute to functional outcome, since many variables with direct and indirect effects might be involved,” they conclude.





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After I Was Diagnosed With Bipolar Disorder, I Decided to Move ForwardBy Cooper Moll; Mental health advocate, psychology student
Arianna Huffington has invited her Facebook followers to share their wake-up calls — the moments they knew they had to make changes in their lives in order to truly thrive and not just succeed — as part of a series produced in conjunction with the release of her book Thrive: The Third Metric to Redefining Success and Creating a Life of Well-Being, Wisdom, Wonder and Giving. You can read all the posts in the series here.
When I was 17 years old, I was diagnosed with Bipolar Disorder, something that came as no surprise, as my life prior to my diagnosis was fraught with behavioral challenges. At 21 years old, after years of battling uncontrollable moods, fits of rage, a myriad of body image issues, addiction and frustration with finding adequate medication I found myself in my first psychotic episode. This was no way to live, I knew I was capable of so much more as an articulate young woman with big dreams. At 5 o’clock in the morning on July 7, 2011, after driving through the night with a head full of racing thoughts in a mind that possessed zero ability to cope, I found myself collapsed on the porch of my father’s home manic, enraged and inconsolable. I was surrendering, I could no longer fight the battle my life prior to that summer had felt so unrelenting and inhibiting. After a brief rest early that morning, the first few hours of sleep I had experienced in days, is when made my decision to thrive. For years prior to that hazy morning, I had been urged by loved ones to receive intensive clinical psychological treatment in a formal setting, but I believe part of me was always resisting in denial and arrogance. It was at the end of my rope where I found my desire to change the trajectory of my life. On July 11, 2011, I made the first imprints in the path toward my new way of being in the world. I spent 90 days in intensive psychological care and healing treatment where I acquired invaluable “tools” that allowed me to move forward in the world, the woman I was on my father’s porch that July morning became a shadow of my former self and an unwelcome stranger in my future. 
Almost three years later not a day goes by where I don’t draw on the lessons learned through my decision to thrive. I am currently finishing my Bachelor’s degree in clinical psychology and work as a peer counselor to youth experiencing their first onset of mental illness in Los Angeles, California. Everything I do comes from a place of gratitude for my demons and experiences that catalyzed my decision to forge the path I am on today. For I would be nothing without them just as I would be nothing without the boundless compassion, patience and support of the loved ones in my life who have championed all of my efforts.
I used to think the notion that people could change was a farce … until I did it myself. I am changing everyday, creating a more authentic self with every opportunity to do so, and within the beautiful chaos of it all — I am thriving.
(Image credits: Bipolar Disorder 1 by chi-of-ink)


For more mental health news, Click Here to access the Serious Mental Illness Blog

After I Was Diagnosed With Bipolar Disorder, I Decided to Move Forward
By Cooper Moll; Mental health advocate, psychology student

Arianna Huffington has invited her Facebook followers to share their wake-up calls — the moments they knew they had to make changes in their lives in order to truly thrive and not just succeed — as part of a series produced in conjunction with the release of her book Thrive: The Third Metric to Redefining Success and Creating a Life of Well-Being, Wisdom, Wonder and Giving. You can read all the posts in the series here.

When I was 17 years old, I was diagnosed with Bipolar Disorder, something that came as no surprise, as my life prior to my diagnosis was fraught with behavioral challenges. At 21 years old, after years of battling uncontrollable moods, fits of rage, a myriad of body image issues, addiction and frustration with finding adequate medication I found myself in my first psychotic episode. This was no way to live, I knew I was capable of so much more as an articulate young woman with big dreams. At 5 o’clock in the morning on July 7, 2011, after driving through the night with a head full of racing thoughts in a mind that possessed zero ability to cope, I found myself collapsed on the porch of my father’s home manic, enraged and inconsolable. I was surrendering, I could no longer fight the battle my life prior to that summer had felt so unrelenting and inhibiting. After a brief rest early that morning, the first few hours of sleep I had experienced in days, is when made my decision to thrive. For years prior to that hazy morning, I had been urged by loved ones to receive intensive clinical psychological treatment in a formal setting, but I believe part of me was always resisting in denial and arrogance. It was at the end of my rope where I found my desire to change the trajectory of my life. On July 11, 2011, I made the first imprints in the path toward my new way of being in the world. I spent 90 days in intensive psychological care and healing treatment where I acquired invaluable “tools” that allowed me to move forward in the world, the woman I was on my father’s porch that July morning became a shadow of my former self and an unwelcome stranger in my future. 

Almost three years later not a day goes by where I don’t draw on the lessons learned through my decision to thrive. I am currently finishing my Bachelor’s degree in clinical psychology and work as a peer counselor to youth experiencing their first onset of mental illness in Los Angeles, California. Everything I do comes from a place of gratitude for my demons and experiences that catalyzed my decision to forge the path I am on today. For I would be nothing without them just as I would be nothing without the boundless compassion, patience and support of the loved ones in my life who have championed all of my efforts.

I used to think the notion that people could change was a farce … until I did it myself. I am changing everyday, creating a more authentic self with every opportunity to do so, and within the beautiful chaos of it all — I am thriving.

(Image credits: Bipolar Disorder 1 by chi-of-ink)



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[Film of Interest] Here One Day

In 1995, Nina Williams Leichter, the brilliant wife of a New York state senator, committed suicide by jumping from the 11th floor of her apartment building. Though she had struggled with manic depression, Williams had always been an energetic figure who tried to bring public attention to mental health issues. Her suicide shattered the lives of her family: her husband and two children, Josh and Kathy. Sixteen years later, Kathy Leichter, now a filmmaker, returns to stay in her parents’ apartment. Amid the collected letters, clothes and empty medication bottles, Leichter makes a discovery. In a plastic case, she finds dozens of audio cassettes made by her mother, emotional often rambling messages attempting to understand the madness overwhelming her. Over time, Leichter begins to chronicle, then come to terms with the full depth of her mother’s mental anguish. Here One Day is a powerful personal statement, threading together the disparate strands of Williams’ sorrow, ultimately becoming a moving evocation of life itself.

Here One Day attempts to educate and reduce stigma around mental illness and suicide, to link audiences to support, and to teach how mental illness and suicide impacts families. The film is available for DVD purchase and for community screenings facilitated by the film’s award-winning director, Kathy Leichter. For more information go to: http://www.hereoneday.com or contact her at info@hereoneday.com.



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[In the News] The Violence in Our Heads
By T. M. Luhrmann
Stanford, California. — The specter of violence caused by mental illness keeps raising its head. The Newtown, Conn., school killer may have suffered from the tormenting voices characteristic of schizophrenia; it’s possible that he killed his mother after she was spooked by his strange behavior and tried to institutionalize him. We now know that Aaron Alexis, who killed 12 people at the Washington Navy Yard on Monday, heard voices; many observers assume that he, too, struggled with schizophrenia.
To be clear: a vast majority of people with schizophrenia — a disease we popularly associate with violence — never commit violent acts. They are far more likely to be the victims of violence than perpetrators of it. But research shows us that the risk of violence from people with schizophrenia is real — significantly greater than it is in the broader population — and that the risk increases sharply when people have disturbing hallucinations and use street drugs. We also know that many people with schizophrenia hear voices only they can hear. Those voices feel real, spoken by an external, commanding authority. They are often mean and violent.
An unsettling question is whether the violent commands from these voices reflect our culture as much as they result from the disease process of the illness. In the past few years I have been working with some colleagues at the Schizophrenia Research Foundation in Chennai, India, to compare the voice-hearing experience of people with schizophrenia in the United States and India.
The two groups of patients have much in common. Neither particularly likes hearing voices. Both report hearing mean and sometimes violent commands. But in our sample of 20 comparable cases from each country, the voices heard by patients in Chennai are considerably less violent than those heard by patients in San Mateo, Calif.
Describing his own voices, an American matter-of-factly explained, “Usually it’s like torturing people to take their eyes out with a fork, or cut off someone’s head and drink the blood, that kind of stuff.” Other Americans spoke of “war,” as in, “They want to take me to war with them,” or their “suicide voice” asking, “Why don’t you end your life?”
In Chennai, the commanding voices often instructed people to do domestic chores — to cook, clean, eat, bathe, to “go to the kitchen, prepare food.” To be sure, some Chennai patients reported disgusting commands — in one case, a woman heard the god Hanuman insist that she drink out of a toilet bowl. But in Chennai, the horrible voices people reported seemed more focused on sex. Another woman said: “Male voice, very vulgar words, and raw. I would cry.”
These observations suggest that local culture may shape the way people with schizophrenia pay attention to the complex auditory phenomena generated by the disorder and so shift what the voices say and how they say it. Indeed, that is the premise of a new patient-driven movement, more active in Europe than in the United States, which argues that if you treat unsettling voices with dignity and respect, you can change them.
The Hearing Voices movement encourages people who hear distressing voices to identify them, to learn about them, and then to negotiate with them. It is an approach that flies in the face of much clinical practice in the United States, where psychiatrists tend to assume that treating such voices as meaningful encourages those who hear them to give them more authority and to follow their commands.
Yet while there is no judgment from the scientific jury at this point, there is evidence that at least some people find that when they use the Hearing Voices approach, their voices diminish, become kinder and sometimes disappear altogether — independent of any use of drugs.
This evidence is strengthened by a recent study in London that taught people with schizophrenia to create a computer-animated avatar for their voices and to converse with it. Patients chose a face for a digitally produced voice similar to the one they were hearing. They then practiced speaking to the avatar — they were encouraged to challenge it — and their therapist responded, using the avatar’s voice, in such a way that the avatar’s voice shifted from persecuting to supporting them.
All of the 16 patients who received a six-week trial of that therapy found that their hallucinations became less frequent, less intense and less disturbing. Most remarkably, three patients stopped hearing hallucinated voices altogether, even three months after the trial. One of those three patients had heard voices incessantly for the prior 16 years.
The more we know about the auditory hallucinations of schizophrenia, the more complex voice-hearing seems and the more heterogeneous the voice-hearing population becomes. Not everyone will benefit from the new approaches. Still, they offer hope for those struggling with a grim disease.
Meanwhile, it is a sobering thought that the greater violence in the voices of Americans with schizophrenia may have something to do with those of us without schizophrenia. I suspect that the root of the differences may be related to the greater sense of assault that people who hear voices feel in a social world where minds are so private and (for the most part) spirits do not speak.
We Americans live in a society in which, when people feel threatened, they think about guns. The same cultural patterns that make it difficult to get gun violence under control may also be responsible for making these terrible auditory commands that much harsher.


For more mental health news, Click Here to access the Serious Mental Illness Blog

[In the News] The Violence in Our Heads

By T. M. Luhrmann

Stanford, California. — The specter of violence caused by mental illness keeps raising its head. The Newtown, Conn., school killer may have suffered from the tormenting voices characteristic of schizophrenia; it’s possible that he killed his mother after she was spooked by his strange behavior and tried to institutionalize him. We now know that Aaron Alexis, who killed 12 people at the Washington Navy Yard on Monday, heard voices; many observers assume that he, too, struggled with schizophrenia.

To be clear: a vast majority of people with schizophrenia — a disease we popularly associate with violence — never commit violent acts. They are far more likely to be the victims of violence than perpetrators of it. But research shows us that the risk of violence from people with schizophrenia is real — significantly greater than it is in the broader population — and that the risk increases sharply when people have disturbing hallucinations and use street drugs. We also know that many people with schizophrenia hear voices only they can hear. Those voices feel real, spoken by an external, commanding authority. They are often mean and violent.

An unsettling question is whether the violent commands from these voices reflect our culture as much as they result from the disease process of the illness. In the past few years I have been working with some colleagues at the Schizophrenia Research Foundation in Chennai, India, to compare the voice-hearing experience of people with schizophrenia in the United States and India.

The two groups of patients have much in common. Neither particularly likes hearing voices. Both report hearing mean and sometimes violent commands. But in our sample of 20 comparable cases from each country, the voices heard by patients in Chennai are considerably less violent than those heard by patients in San Mateo, Calif.

Describing his own voices, an American matter-of-factly explained, “Usually it’s like torturing people to take their eyes out with a fork, or cut off someone’s head and drink the blood, that kind of stuff.” Other Americans spoke of “war,” as in, “They want to take me to war with them,” or their “suicide voice” asking, “Why don’t you end your life?”

In Chennai, the commanding voices often instructed people to do domestic chores — to cook, clean, eat, bathe, to “go to the kitchen, prepare food.” To be sure, some Chennai patients reported disgusting commands — in one case, a woman heard the god Hanuman insist that she drink out of a toilet bowl. But in Chennai, the horrible voices people reported seemed more focused on sex. Another woman said: “Male voice, very vulgar words, and raw. I would cry.”

These observations suggest that local culture may shape the way people with schizophrenia pay attention to the complex auditory phenomena generated by the disorder and so shift what the voices say and how they say it. Indeed, that is the premise of a new patient-driven movement, more active in Europe than in the United States, which argues that if you treat unsettling voices with dignity and respect, you can change them.

The Hearing Voices movement encourages people who hear distressing voices to identify them, to learn about them, and then to negotiate with them. It is an approach that flies in the face of much clinical practice in the United States, where psychiatrists tend to assume that treating such voices as meaningful encourages those who hear them to give them more authority and to follow their commands.

Yet while there is no judgment from the scientific jury at this point, there is evidence that at least some people find that when they use the Hearing Voices approach, their voices diminish, become kinder and sometimes disappear altogether — independent of any use of drugs.

This evidence is strengthened by a recent study in London that taught people with schizophrenia to create a computer-animated avatar for their voices and to converse with it. Patients chose a face for a digitally produced voice similar to the one they were hearing. They then practiced speaking to the avatar — they were encouraged to challenge it — and their therapist responded, using the avatar’s voice, in such a way that the avatar’s voice shifted from persecuting to supporting them.

All of the 16 patients who received a six-week trial of that therapy found that their hallucinations became less frequent, less intense and less disturbing. Most remarkably, three patients stopped hearing hallucinated voices altogether, even three months after the trial. One of those three patients had heard voices incessantly for the prior 16 years.

The more we know about the auditory hallucinations of schizophrenia, the more complex voice-hearing seems and the more heterogeneous the voice-hearing population becomes. Not everyone will benefit from the new approaches. Still, they offer hope for those struggling with a grim disease.

Meanwhile, it is a sobering thought that the greater violence in the voices of Americans with schizophrenia may have something to do with those of us without schizophrenia. I suspect that the root of the differences may be related to the greater sense of assault that people who hear voices feel in a social world where minds are so private and (for the most part) spirits do not speak.

We Americans live in a society in which, when people feel threatened, they think about guns. The same cultural patterns that make it difficult to get gun violence under control may also be responsible for making these terrible auditory commands that much harsher.



For more mental health news, Click Here to access the Serious Mental Illness Blog

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[Article of Interest] The Problem With How We Treat Bipolar Disorder
By Linda Logan
Excerpt:
The last time I saw my old self, I was 27 years old and living in Boston. I was doing well in graduate school, had a tight circle of friends and was a prolific creative writer. Married to my high-school sweetheart, I had just had my first child. Back then, my best times were twirling my baby girl under the gloaming sky on a Florida beach and flopping on the bed with my husband — feet propped against the wall — and talking. The future seemed wide open.
I don’t think there is a particular point at which I can say I became depressed. My illness was insidious, gradual and inexorable. I had a preview of depression in high school, when I spent a couple of years wearing all black, rimming my eyes in kohl and sliding against the walls in the hallways, hoping that no one would notice me. But back then I didn’t think it was a very serious problem.
The hormonal chaos of having three children in five years, the pressure of working on a Ph.D. dissertation and a genetic predisposition for a mood disorder took me to a place of darkness I hadn’t experienced before. Of course, I didn’t recognize that right away. Denial is a gauze; willful denial, an opiate. Everyone seemed in league with my delusion. I was just overwhelmed, my family would say. I should get more help with the kids, put off my Ph.D.
When I told other young mothers about my bone-wearying fatigue, they rolled their eyes knowingly and mumbled, “Right.” But what they didn’t realize was that I could scarcely push the stroller to the park, barely summon the breath to ask the store clerk, “Where are the Pampers?” I went from doctor to doctor, looking for the cause. Lab tests for anemia, low blood sugar and hypothyroidism were all negative.
Any joy I derived from my children was now conjoined with grief. I couldn’t breathe the perfume of their freshly shampooed hair without being seized by the realization that they would not always be under my roof. While stroking their backs, I would mentally fast-forward their lives — noses elongating, tongues sharpening — until I came to their leave-taking, until I reached my death and, ultimately, theirs.
I lost my sense of competence. If a colleague remarked on my intelligence, I mentally derided him as being too stupid to know how dumb I was. If someone asked what I did for a living, I would say, “Nothing” — a remarkably effective conversation stopper. I couldn’t bear the thought of socializing; one night I jumped out of the car as my husband and I were driving to a party.
Despite having these feelings in my mid-30s, when my kids were 8, 5 and 3, I was thriving professionally: I had recently completed my Ph.D. in geography, had just finished co-teaching a semester at M.I.T. as a lecturer and was revising my dissertation on spec for a respected university press. Yet several nights a week, I drove to the reservoir near my home, sat under a tree and, as joggers and their dogs ran past, thought about ending it all. There was a gun shop on the way to my poetry group; I knew exactly where to go when the time came.
My day, once broken by naps, gradually turned into lengthy stretches of sleep, punctuated by moments of wakefulness. My husband and I didn’t explain to the kids that I was depressed. “Mommy’s a little tired today,” we would say. A year or so earlier, a therapist told us to tell the children. “But they’re just kids,” we said. “What do they know?” “They know,” she said. When we eventually spoke to them, my oldest daughter came to me and asked: “Why did you keep it a secret? I thought all mothers were like you.”
After a few weeks of stopping at the reservoir, as suicide eclipsed all other thoughts, I finally told my husband about my worsening psychic pain. The next day I was hospitalized. It was June 1989. Even though we were living in Boston, we decided I should go to Chicago to work with the psychopharmacologist who, 15 years earlier, restored the health of my father, who had also been hospitalized for depression. As the cab pulled away from our house, I turned and saw three children’s hands pressed against the screen of an upstairs window. This is the way the world breaks.
The moment the psych-unit doors locked behind me, I was stripped of my identity as wife, mother, teacher and writer and transformed into patient, room number and diagnosis. I couldn’t open a refrigerator without permission. If I were on suicide watch, I had to ask before going to the bathroom. I was told when to sleep and when to wake, when to eat and when to go to group. My routine, which at home had cleaved so closely to my children’s, now revolved around the clattering sounds of the food trays being brought three times each day from the service elevators into our unit. With my husband and children nearly 1,000 miles away, I was severed from my fixed stars. I missed my children’s smells, the way they used to wrap their bodies around my legs when I was on the phone. I brought my son’s comforter to the hospital for my bed. I remembered him with one leg thrown across the covers, a small foot peeking out from his pajamas.
When my children visited, I had to resuscitate my maternal self, if only for an hour. I dragged myself to the shower, pulled on a pair of clean sweat pants and a fresh T-shirt and ran a streak of lipstick across my lips, hoping to look like a reasonable facsimile of a mother.
My doctor used my first hospitalization as a so-called washout, a period during which he planned to take me off the medication I was on and introduce several drugs in several different combinations. The prospect of polypharmacy — taking many drugs at once — seemed foreboding. I read about Prozac’s giving some people entirely new personalities: happier, lighter, even buoyant. “Who are you going to turn me into?” I asked my doctor.
“I’m not turning you into anyone,” he said. “You’ll be yourself, only happier.”
“I don’t think I even have a self anymore.”
“We’ll find your self.”
I was wary. “Just don’t turn me into Sandy Duncan.”
How much insult to the self is done by the symptoms of the disorder and how much by the drugs used to treat it? Paradoxically, psychotropic drugs can induce anxiety, nervousness, impaired judgment, mania, hypomania, hallucinations, feelings of depersonalization, psychosis and suicidal thoughts, while being used to treat the same symptoms. Before getting to the hospital, my daily moods ranged from bad to worse, each state accompanied by a profound depth of feeling. The first drug I was given was amitriptyline (Elavil), which, in the process of reducing my despair, blunted all my other emotions. I no longer felt anything. It was like going from satellite TV to one lousy channel.
[…]
For many people with mental disorders, the transformation of the self is one of the most disturbing things about being ill. And their despair is heightened when doctors don’t engage with the issue, don’t ask about what parts of the self have vanished and don’t help figure out strategies to deal with that loss.
Some in the mental-health field are beginning to recognize this need. Janina Fisher, a psychologist and the assistant director of the Sensorimotor Psychotherapy Institute in Broomfield, Colo., told me that there has been a “sea change” in the role the self plays in the therapeutic dialogue since the decades when I was sick. New therapies and treatment philosophies, founded mostly by clinical psychologists and other practitioners who are not medical doctors, recognize the role of the self in people with mental illness. Patients tell her, “I just want to be that person I used to be.” Fisher encourages her patients to recognize that their mental trauma is a part of their life, but shouldn’t dominate it.
In my own experience with Scheftner, whom I began seeing after my father’s doctor moved away, we talk about the self but only when I bring it up. That’s why I have enjoyed helping to run a support group for people with mental disorders, something I’ve been doing for the last three years. There are usually 8 of us, sometimes 12. We sit in the basement of a local library every Wednesday afternoon. Though we know one another’s innermost thoughts, we are intimate strangers, not friends. Like A.A. and other self-help groups, we’re peer-led: run by and for people with mental disorders. We talk one by one about the past week — small achievements, setbacks, doctor appointments, family conflicts. While the self is not always an explicit topic, the loss of self — or for those doing better, the reconstruction of the self — is a hovering presence in the group.
One day, not long ago, a middle-aged man came to our group. He told us that he spent the past year attending different grief groups, but none of them were right. “Why not?” someone asked. The man said: “Because everyone there was grieving over the loss of another person. I was grieving for myself. For who I used to be before I got sick and who I am now.”
During the 20-odd years since my hospitalizations, many parts of my old self have been straggling home. But not everything made the return trip. While I no longer jump from moving cars on the way to parties, I still find social events uncomfortable. And, although I don’t have to battle to stay awake during the day, I still don’t have full days — I’m only functional mornings to midafternoons. I haven’t been able to return to teaching. How many employers would welcome a request for a cot, a soft pillow and half the day off?
One morning, about five years ago, my husband and I were talking on the family-room sofa. I was still wearing my pajamas and had wool hiking socks on. As he rubbed my feet, he told me he was leaving. It was, at once, a scene of tenderness and savagery. A little later, he threw some clothes into a suitcase and moved out. But my self — devastated, grieving, angry — remained intact.
Today, my mind is nimble. Creative writing has crept back into my life. I’ve made a couple of close friends in Chicago. My greatest pleasure is still my children — they’re starting careers, marrying, on the brinks of their lives. I’m looking forward to grandchildren, to singing the 1950s favorite “Life Is but a Dream” while spinning those babies under the stars of a falling night on a Florida beach. This June, I’m turning 60. I’m having a small party to celebrate my ingathering of selves. My old self was first to R.S.V.P.

[Article of Interest] The Problem With How We Treat Bipolar Disorder

By Linda Logan

Excerpt:

The last time I saw my old self, I was 27 years old and living in Boston. I was doing well in graduate school, had a tight circle of friends and was a prolific creative writer. Married to my high-school sweetheart, I had just had my first child. Back then, my best times were twirling my baby girl under the gloaming sky on a Florida beach and flopping on the bed with my husband — feet propped against the wall — and talking. The future seemed wide open.

I don’t think there is a particular point at which I can say I became depressed. My illness was insidious, gradual and inexorable. I had a preview of depression in high school, when I spent a couple of years wearing all black, rimming my eyes in kohl and sliding against the walls in the hallways, hoping that no one would notice me. But back then I didn’t think it was a very serious problem.

The hormonal chaos of having three children in five years, the pressure of working on a Ph.D. dissertation and a genetic predisposition for a mood disorder took me to a place of darkness I hadn’t experienced before. Of course, I didn’t recognize that right away. Denial is a gauze; willful denial, an opiate. Everyone seemed in league with my delusion. I was just overwhelmed, my family would say. I should get more help with the kids, put off my Ph.D.

When I told other young mothers about my bone-wearying fatigue, they rolled their eyes knowingly and mumbled, “Right.” But what they didn’t realize was that I could scarcely push the stroller to the park, barely summon the breath to ask the store clerk, “Where are the Pampers?” I went from doctor to doctor, looking for the cause. Lab tests for anemia, low blood sugar and hypothyroidism were all negative.

Any joy I derived from my children was now conjoined with grief. I couldn’t breathe the perfume of their freshly shampooed hair without being seized by the realization that they would not always be under my roof. While stroking their backs, I would mentally fast-forward their lives — noses elongating, tongues sharpening — until I came to their leave-taking, until I reached my death and, ultimately, theirs.

I lost my sense of competence. If a colleague remarked on my intelligence, I mentally derided him as being too stupid to know how dumb I was. If someone asked what I did for a living, I would say, “Nothing” — a remarkably effective conversation stopper. I couldn’t bear the thought of socializing; one night I jumped out of the car as my husband and I were driving to a party.

Despite having these feelings in my mid-30s, when my kids were 8, 5 and 3, I was thriving professionally: I had recently completed my Ph.D. in geography, had just finished co-teaching a semester at M.I.T. as a lecturer and was revising my dissertation on spec for a respected university press. Yet several nights a week, I drove to the reservoir near my home, sat under a tree and, as joggers and their dogs ran past, thought about ending it all. There was a gun shop on the way to my poetry group; I knew exactly where to go when the time came.

My day, once broken by naps, gradually turned into lengthy stretches of sleep, punctuated by moments of wakefulness. My husband and I didn’t explain to the kids that I was depressed. “Mommy’s a little tired today,” we would say. A year or so earlier, a therapist told us to tell the children. “But they’re just kids,” we said. “What do they know?” “They know,” she said. When we eventually spoke to them, my oldest daughter came to me and asked: “Why did you keep it a secret? I thought all mothers were like you.”

After a few weeks of stopping at the reservoir, as suicide eclipsed all other thoughts, I finally told my husband about my worsening psychic pain. The next day I was hospitalized. It was June 1989. Even though we were living in Boston, we decided I should go to Chicago to work with the psychopharmacologist who, 15 years earlier, restored the health of my father, who had also been hospitalized for depression. As the cab pulled away from our house, I turned and saw three children’s hands pressed against the screen of an upstairs window. This is the way the world breaks.

The moment the psych-unit doors locked behind me, I was stripped of my identity as wife, mother, teacher and writer and transformed into patient, room number and diagnosis. I couldn’t open a refrigerator without permission. If I were on suicide watch, I had to ask before going to the bathroom. I was told when to sleep and when to wake, when to eat and when to go to group. My routine, which at home had cleaved so closely to my children’s, now revolved around the clattering sounds of the food trays being brought three times each day from the service elevators into our unit. With my husband and children nearly 1,000 miles away, I was severed from my fixed stars. I missed my children’s smells, the way they used to wrap their bodies around my legs when I was on the phone. I brought my son’s comforter to the hospital for my bed. I remembered him with one leg thrown across the covers, a small foot peeking out from his pajamas.

When my children visited, I had to resuscitate my maternal self, if only for an hour. I dragged myself to the shower, pulled on a pair of clean sweat pants and a fresh T-shirt and ran a streak of lipstick across my lips, hoping to look like a reasonable facsimile of a mother.

My doctor used my first hospitalization as a so-called washout, a period during which he planned to take me off the medication I was on and introduce several drugs in several different combinations. The prospect of polypharmacy — taking many drugs at once — seemed foreboding. I read about Prozac’s giving some people entirely new personalities: happier, lighter, even buoyant. “Who are you going to turn me into?” I asked my doctor.

“I’m not turning you into anyone,” he said. “You’ll be yourself, only happier.”

“I don’t think I even have a self anymore.”

“We’ll find your self.”

I was wary. “Just don’t turn me into Sandy Duncan.”

How much insult to the self is done by the symptoms of the disorder and how much by the drugs used to treat it? Paradoxically, psychotropic drugs can induce anxiety, nervousness, impaired judgment, mania, hypomania, hallucinations, feelings of depersonalization, psychosis and suicidal thoughts, while being used to treat the same symptoms. Before getting to the hospital, my daily moods ranged from bad to worse, each state accompanied by a profound depth of feeling. The first drug I was given was amitriptyline (Elavil), which, in the process of reducing my despair, blunted all my other emotions. I no longer felt anything. It was like going from satellite TV to one lousy channel.

[…]

For many people with mental disorders, the transformation of the self is one of the most disturbing things about being ill. And their despair is heightened when doctors don’t engage with the issue, don’t ask about what parts of the self have vanished and don’t help figure out strategies to deal with that loss.

Some in the mental-health field are beginning to recognize this need. Janina Fisher, a psychologist and the assistant director of the Sensorimotor Psychotherapy Institute in Broomfield, Colo., told me that there has been a “sea change” in the role the self plays in the therapeutic dialogue since the decades when I was sick. New therapies and treatment philosophies, founded mostly by clinical psychologists and other practitioners who are not medical doctors, recognize the role of the self in people with mental illness. Patients tell her, “I just want to be that person I used to be.” Fisher encourages her patients to recognize that their mental trauma is a part of their life, but shouldn’t dominate it.

In my own experience with Scheftner, whom I began seeing after my father’s doctor moved away, we talk about the self but only when I bring it up. That’s why I have enjoyed helping to run a support group for people with mental disorders, something I’ve been doing for the last three years. There are usually 8 of us, sometimes 12. We sit in the basement of a local library every Wednesday afternoon. Though we know one another’s innermost thoughts, we are intimate strangers, not friends. Like A.A. and other self-help groups, we’re peer-led: run by and for people with mental disorders. We talk one by one about the past week — small achievements, setbacks, doctor appointments, family conflicts. While the self is not always an explicit topic, the loss of self — or for those doing better, the reconstruction of the self — is a hovering presence in the group.

One day, not long ago, a middle-aged man came to our group. He told us that he spent the past year attending different grief groups, but none of them were right. “Why not?” someone asked. The man said: “Because everyone there was grieving over the loss of another person. I was grieving for myself. For who I used to be before I got sick and who I am now.”

During the 20-odd years since my hospitalizations, many parts of my old self have been straggling home. But not everything made the return trip. While I no longer jump from moving cars on the way to parties, I still find social events uncomfortable. And, although I don’t have to battle to stay awake during the day, I still don’t have full days — I’m only functional mornings to midafternoons. I haven’t been able to return to teaching. How many employers would welcome a request for a cot, a soft pillow and half the day off?

One morning, about five years ago, my husband and I were talking on the family-room sofa. I was still wearing my pajamas and had wool hiking socks on. As he rubbed my feet, he told me he was leaving. It was, at once, a scene of tenderness and savagery. A little later, he threw some clothes into a suitcase and moved out. But my self — devastated, grieving, angry — remained intact.

Today, my mind is nimble. Creative writing has crept back into my life. I’ve made a couple of close friends in Chicago. My greatest pleasure is still my children — they’re starting careers, marrying, on the brinks of their lives. I’m looking forward to grandchildren, to singing the 1950s favorite “Life Is but a Dream” while spinning those babies under the stars of a falling night on a Florida beach. This June, I’m turning 60. I’m having a small party to celebrate my ingathering of selves. My old self was first to R.S.V.P.

Filed under Science History News bipolar bipolarity antipsychotic isps psychiatric psychiatry psychoanalysis psychological psychology psychopathology psychopharmacology psychosis psychotherapy psychotic Crime Extreme america documentary med medication meds mental mental illness pharmacy hospital dsm dsm 5

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[Video of Interest] An Interview with Jaakko Seikkula

Dr. Seikkula talks about the Open Dialogue approach to psychiatric interventions, in which he describes how this approach was developed, as well as the basic principles of the approach which have emerged from analysis of the results.

Open Dialogue is a Finnish alternative to the traditional mental health system for people diagnosed with “psychoses” such as “schizophrenia” is “Open Dialogue.” This approach aims to support the individual’s network of family and friends, as well as respect the decision-making of the individual

Find out more about Open Dialogue HERE.

Filed under open dialogue open dialogue antipsychotic isps psychiatric psychiatry psychoanalysis psychological psychology psychopathology psychosis psychotherapy psychotic schizophrenia schizophrenic abilify biology bipolar bipolarity med medication meds alternative health Neuroscience Science News crazy mad

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SMI Spotlight:
Fountain House425 W 47th St, New York, NY
Fountain House is about the power of community. It was created to relieve the loneliness and stigma that affect so many people who are living with serious mental illnesses, like schizophrenia, bipolar disorder, and major depression. Serious mental illness disrupts lives - people lose their jobs, they drop out of school, they alienate their families and friends, and they end up alone.
Employment: In the 50 years that Fountain House has been supporting members on the job, they have developed innovative methods to help them overcome these challenges and deliver outstanding performance. Working within some of the most prestigious corporations in New York City, they tailor their services to the needs of each member and their employer. This ensures that members have a solid foundation from which to launch their professional success, and that their corporate partners have great employees.
Wellness: Fountain House’s Wellness initiative, created in 2004, in response to the tragic deaths of four members under 40 within a month, is incorporated throughout the center. It includes nutritional counseling and healthy food offerings, personal training and access to on-site fitness equipment, and education on a range of topics from preventative testing to stress management. They offer an extensive smoking cessation program, one of three pilot projects in New York City grant-funded by The New York City Department of Health and Mental Hygiene. Additionally, they provide integrated psychiatric and primary medical care for members at The Storefront, an off-site clinic operated in partnership with St. Luke’s-Roosevelt Hospital.
Education: Fountain House has developed an array of supports that enable students not only to return to school but to excel. As one of the largest education programs of its kind, they assist an average of 133 students each semester in a variety of academic settings – GED classes, technical schools, colleges, and graduate studies.
Housing: Fountain House is committed to offering safe, affordable and dignified housing to as many members as possible. They have been helping our members create homes since 1958, and today they have one of the largest supported housing networks in New York State, serving some 500 men and women. Recognizing that every person wants and needs something different in their living situation, each home is unique – from 24-hour staffed supported buildings to single room hotels, to shared and single apartments with mobile support teams.
Young Adults: The Young Adult Program at Fountain House reaches out to young men and women and provides a community of people who recognize their unique challenges while providing the support and expertise to help them pursue their dreams.
Visit the Fountain House Blog

SMI Spotlight:

Fountain House
425 W 47th St, New York, NY

Fountain House is about the power of community. It was created to relieve the loneliness and stigma that affect so many people who are living with serious mental illnesses, like schizophrenia, bipolar disorder, and major depression. Serious mental illness disrupts lives - people lose their jobs, they drop out of school, they alienate their families and friends, and they end up alone.

  • Employment: In the 50 years that Fountain House has been supporting members on the job, they have developed innovative methods to help them overcome these challenges and deliver outstanding performance. Working within some of the most prestigious corporations in New York City, they tailor their services to the needs of each member and their employer. This ensures that members have a solid foundation from which to launch their professional success, and that their corporate partners have great employees.
  • Wellness: Fountain House’s Wellness initiative, created in 2004, in response to the tragic deaths of four members under 40 within a month, is incorporated throughout the center. It includes nutritional counseling and healthy food offerings, personal training and access to on-site fitness equipment, and education on a range of topics from preventative testing to stress management. They offer an extensive smoking cessation program, one of three pilot projects in New York City grant-funded by The New York City Department of Health and Mental Hygiene. Additionally, they provide integrated psychiatric and primary medical care for members at The Storefront, an off-site clinic operated in partnership with St. Luke’s-Roosevelt Hospital.
  • Education: Fountain House has developed an array of supports that enable students not only to return to school but to excel. As one of the largest education programs of its kind, they assist an average of 133 students each semester in a variety of academic settings – GED classes, technical schools, colleges, and graduate studies.
  • Housing: Fountain House is committed to offering safe, affordable and dignified housing to as many members as possible. They have been helping our members create homes since 1958, and today they have one of the largest supported housing networks in New York State, serving some 500 men and women. Recognizing that every person wants and needs something different in their living situation, each home is unique – from 24-hour staffed supported buildings to single room hotels, to shared and single apartments with mobile support teams.
  • Young AdultsThe Young Adult Program at Fountain House reaches out to young men and women and provides a community of people who recognize their unique challenges while providing the support and expertise to help them pursue their dreams.

Visit the Fountain House Blog

Filed under fountain house community Science History News research stigma schizophrenia schizophrenic mental illness bipolar Major Depression depressed depression diagnosis dsm psychology psychosis psychotherapy psychotic psychoticism nutrition nutritous health healthy ged education therapy

77 notes

[Article of Interest] I’m Elyn Saks and this Is What It’s Like to Live with Schizophrenia
By George Dvosky

Elyn Saks first started noticing that something was wrong when she was 16. One day, and without reason, she suddenly left her classroom and started walking home. It turned into an agonizing journey in which she believed all the houses in her neighborhood were transmitting hostile and insulting messages directly into her brain. Five years later, while attending law school at Oxford, she experienced her first complete schizophrenic break. Saks struggled over the course of the next decade, but she came through thanks to medication, therapy, and the support of friends and family.
Excerpt:
Often Misunderstood
Schizophrenia as a health condition is as neglected as it’s misunderstood. People tend to get squeamish when it comes to mental illness, convincing themselves that it’s not a wide scale problem, or that people who suffer from it are lost causes. At the same time, many people cling to outdated notions about the disorder.
Indeed, schizophrenia is not as rare as some people think. It has been estimated that anywhere from 0.3 to 0.7 percent of the population is afflicted with it. For a country like the United States, that’s anywhere from 940,000 to 2,200,000 people. And the costs are enormous, estimated at $62.7 billion per year in the U.S. alone. Yet, schizophrenia receives only a small fraction of the amount of medical research dollars that go into other serious diseases and disorders.
It’s also commonly mistaken for multiple personality disorder, what’s now referred to as dissociative identity disorder (DID). These two conditions are distinct, though some crossover exists; DID patients sometimes exhibit psychotic symptoms. Also, both DID and schizophrenia can be triggered by traumatic experiences. But that’s where the similarities end.
Another common misconception about schizophrenia is that people who suffer from it are extremely violent.
"And that’s just not true," says Saks. "Most people with schizophrenia are less violent, but are more likely to be victimized.” The big, violent folks, added Saks, tend to be teenage males and substance abusers.
There’s also a misconception that all people with schizophrenia can’t hold down a job, and that they lose the ability to work in any kind of meaningful way. Or that they can’t live independently, that they need some kind of supervised living arrangement.
Like many other psychological disorders, schizophrenia follows along a spectrum in terms of its severity. While many people can become incapacitated by their symptoms, Saks argues that most of them could benefit from drugs and therapy.
And indeed, Saks is convinced that there are more “high functioning” people with schizophrenia than is typically assumed. To that end, she, along with her colleagues at UCLA and USC, designed a study to recruit high functioning people with schizophrenia in the LA area. Specifically, they were looking to study professionals, a group that included MDs, PhD candidates, teachers, CEOs, and full-time students.
"I mean, we got 20 subjects fairly quickly," she told me, "I started to suspect that I wasn’t unique, that there were many other people like me. It would interesting to know what the stats are on how many people with schizophrenia are so-called "high functioning" professionals."

More than Meds
Moreover, Saks is convinced that, with proper resources, nearly everyone can live up to their potential — regardless of their situation or status.
"There are going to be some people who you do everything for and they still won’t be able to thrive," she says, "But I think many more people can do better than we give them credit for — but instead, we prematurely tell people to lower their expectations.”
Indeed, antipsychotic medications have revolutionized the treatment of schizophrenia — and they work startling well. "A lot of people get on medication and they completely recover and never require therapy," says Saks. But there are some people who don’t respond to medication — and that, she argues, is where therapy and social support could potentially help.
“The best evidence with major mental illness shows that the most effective strategy is to use a combination of meds and a therapy for choice,” says Saks. “For me, I know I need the therapy and the medication. I need both of them. If one of them were to go away I would probably be really compensated.”
Saks is currently in psychoanalytic treatment, where she attends sessions five days a week. And by doing so, she’s going against the grain; conventional wisdom says psychoanalytic treatment shouldn’t work for people with psychosis. But she’s convinced it’s helping.
Saks told me about several aspects of psychoanalytic treatment that have been tremendously beneficial for her — and they’re not typical things that psychoanalysts do.
For example, because stress is particularly bad for psychiatric illnesses, Saks has been taught to identify her stressors and avoid them. Or cope with them at the very least. She has also learned to bolster her “observing ego” — that part of her brain which allows her to step back and observe her mind, feelings, and thoughts in order to understand them and not get swept up.
"It’s also a place where you can bring your thoughts," she says. "A lot of therapists have a rule where their patients cannot articulate their delusions or hallucinations — but to me you need to have a place where you can do that, where it’s safe. It’s sort of like a steam valve. I don’t have to do it in my outside world, I have a place where I can do it in therapy.”
Another important thing, says Saks is insight.
"People have different theories about psychotic symptoms," she says. "Some people think they’re just the random firing of neurons that don’t have any meaning. But I think they have meaning and that they tell you some truth about your psychological reality. So, when I say I’ve killed hundreds of thousands of people, it’s really an archaic way of saying I feel like a very bad person. But even though it’s meaningful in this sense, it doesn’t help patients in the moment of the psychotic symptoms that they interpret.”
Saks believes that extreme and exaggerated ideations are a defense mechanism — which in some circumstances can make a person feel better or safe.
Saks closed our conversation by noting that, outside of medications and drugs, it’s people who can make the greatest impact.
“It’s so important to have a benign, smart, caring, non-judgmental person that accepts you — not only for the good — but for also the bad and the ugly,” she said, “That is incredibly empowering.”

[Article of Interest] I’m Elyn Saks and this Is What It’s Like to Live with Schizophrenia

By George Dvosky

Elyn Saks first started noticing that something was wrong when she was 16. One day, and without reason, she suddenly left her classroom and started walking home. It turned into an agonizing journey in which she believed all the houses in her neighborhood were transmitting hostile and insulting messages directly into her brain. Five years later, while attending law school at Oxford, she experienced her first complete schizophrenic break. Saks struggled over the course of the next decade, but she came through thanks to medication, therapy, and the support of friends and family.

Excerpt:

  • Often Misunderstood

Schizophrenia as a health condition is as neglected as it’s misunderstood. People tend to get squeamish when it comes to mental illness, convincing themselves that it’s not a wide scale problem, or that people who suffer from it are lost causes. At the same time, many people cling to outdated notions about the disorder.

Indeed, schizophrenia is not as rare as some people think. It has been estimated that anywhere from 0.3 to 0.7 percent of the population is afflicted with it. For a country like the United States, that’s anywhere from 940,000 to 2,200,000 people. And the costs are enormous, estimated at $62.7 billion per year in the U.S. alone. Yet, schizophrenia receives only a small fraction of the amount of medical research dollars that go into other serious diseases and disorders.

It’s also commonly mistaken for multiple personality disorder, what’s now referred to as dissociative identity disorder (DID). These two conditions are distinct, though some crossover exists; DID patients sometimes exhibit psychotic symptoms. Also, both DID and schizophrenia can be triggered by traumatic experiences. But that’s where the similarities end.

Another common misconception about schizophrenia is that people who suffer from it are extremely violent.

"And that’s just not true," says Saks. "Most people with schizophrenia are less violent, but are more likely to be victimized.” The big, violent folks, added Saks, tend to be teenage males and substance abusers.

There’s also a misconception that all people with schizophrenia can’t hold down a job, and that they lose the ability to work in any kind of meaningful way. Or that they can’t live independently, that they need some kind of supervised living arrangement.

Like many other psychological disorders, schizophrenia follows along a spectrum in terms of its severity. While many people can become incapacitated by their symptoms, Saks argues that most of them could benefit from drugs and therapy.

And indeed, Saks is convinced that there are more “high functioning” people with schizophrenia than is typically assumed. To that end, she, along with her colleagues at UCLA and USC, designed a study to recruit high functioning people with schizophrenia in the LA area. Specifically, they were looking to study professionals, a group that included MDs, PhD candidates, teachers, CEOs, and full-time students.

"I mean, we got 20 subjects fairly quickly," she told me, "I started to suspect that I wasn’t unique, that there were many other people like me. It would interesting to know what the stats are on how many people with schizophrenia are so-called "high functioning" professionals."

  • More than Meds

Moreover, Saks is convinced that, with proper resources, nearly everyone can live up to their potential — regardless of their situation or status.

"There are going to be some people who you do everything for and they still won’t be able to thrive," she says, "But I think many more people can do better than we give them credit for — but instead, we prematurely tell people to lower their expectations.”

Indeed, antipsychotic medications have revolutionized the treatment of schizophrenia — and they work startling well. "A lot of people get on medication and they completely recover and never require therapy," says Saks. But there are some people who don’t respond to medication — and that, she argues, is where therapy and social support could potentially help.

The best evidence with major mental illness shows that the most effective strategy is to use a combination of meds and a therapy for choice,” says Saks. “For me, I know I need the therapy and the medication. I need both of them. If one of them were to go away I would probably be really compensated.”

Saks is currently in psychoanalytic treatment, where she attends sessions five days a week. And by doing so, she’s going against the grain; conventional wisdom says psychoanalytic treatment shouldn’t work for people with psychosis. But she’s convinced it’s helping.

Saks told me about several aspects of psychoanalytic treatment that have been tremendously beneficial for her — and they’re not typical things that psychoanalysts do.

For example, because stress is particularly bad for psychiatric illnesses, Saks has been taught to identify her stressors and avoid them. Or cope with them at the very least. She has also learned to bolster her “observing ego” — that part of her brain which allows her to step back and observe her mind, feelings, and thoughts in order to understand them and not get swept up.

"It’s also a place where you can bring your thoughts," she says. "A lot of therapists have a rule where their patients cannot articulate their delusions or hallucinations — but to me you need to have a place where you can do that, where it’s safe. It’s sort of like a steam valve. I don’t have to do it in my outside world, I have a place where I can do it in therapy.”

Another important thing, says Saks is insight.

"People have different theories about psychotic symptoms," she says. "Some people think they’re just the random firing of neurons that don’t have any meaning. But I think they have meaning and that they tell you some truth about your psychological reality. So, when I say I’ve killed hundreds of thousands of people, it’s really an archaic way of saying I feel like a very bad person. But even though it’s meaningful in this sense, it doesn’t help patients in the moment of the psychotic symptoms that they interpret.”

Saks believes that extreme and exaggerated ideations are a defense mechanism — which in some circumstances can make a person feel better or safe.

Saks closed our conversation by noting that, outside of medications and drugs, it’s people who can make the greatest impact.

It’s so important to have a benign, smart, caring, non-judgmental person that accepts you — not only for the good — but for also the bad and the ugly,” she said, “That is incredibly empowering.”

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