[Article of Interest] Psychiatrists under fire in mental health battle

By Jamie Doward

British Psychological Society to launch attack on rival profession, casting doubt on biomedical model of mental illness

There is no scientific evidence that psychiatric diagnoses such as schizophrenia and bipolar disorder are valid or useful, according to the leading body representing Britain’s clinical psychologists.

In a groundbreaking move that has already prompted a fierce backlash from psychiatrists, the British Psychological Society’s division of clinical psychology (DCP) will on Monday issue a statement declaring that, given the lack of evidence, it is time for a “paradigm shift” in how the issues of mental health are understood. The statement effectively casts doubt on psychiatry’s predominantly biomedical model of mental distress – the idea that people are suffering from illnesses that are treatable by doctors using drugs. The DCP said its decision to speak out “reflects fundamental concerns about the development, personal impact and core assumptions of the (diagnosis) systems”, used by psychiatry.

Dr Lucy Johnstone, a consultant clinical psychologist who helped draw up the DCP’s statement, said it was unhelpful to see mental health issues as illnesses with biological causes.

“On the contrary, there is now overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse,” Johnstone said. The provocative statement by the DCP has been timed to come out shortly before the release of DSM-5, the fifth edition of the American Psychiatry Association’s Diagnostic and Statistical Manual of Mental Disorders.

The manual has been attacked for expanding the range of mental health issues that are classified as disorders. For example, the fifth edition of the book, the first for two decades, will classify manifestations of grief, temper tantrums and worrying about physical ill-health as the mental illnesses of major depressive disorder, disruptive mood dysregulation disorder and somatic symptom disorder, respectively.

Some of the manual’s omissions are just as controversial as the manual’s inclusions. The term “Asperger’s disorder” will not appear in the new manual, and instead its symptoms will come under the newly added “autism spectrum disorder”.

The DSM is used in a number of countries to varying degrees. Britain uses an alternative manual, the International Classification of Diseases (ICD) published by the World Health Organisation, but the DSM is still hugely influential – and controversial.

The writer Oliver James, who trained as a clinical psychologist, welcomed the DCP’s decision to speak out against psychiatric diagnosis and stressed the need to move away from a biomedical model of mental distress to one that examined societal and personal factors.

Writing in today’s Observer, James declares: “We need fundamental changes in how our society is organised to give parents the best chance of meeting the needs of children and to prevent the amount of adult adversity.”

But Professor Sir Simon Wessely, a member of the Royal College of Psychiatrists and chair of psychological medicine at King’s College London, said it was wrong to suggest psychiatry was focused only on the biological causes of mental distress. And in an accompanying Observer article he defends the need to create classification systems for mental disorder.

“A classification system is like a map,” Wessely explains. “And just as any map is only provisional, ready to be changed as the landscape changes, so does classification.”

(via artfromtheedge)

[Article of Interest] National Institute of Mental Health Abandoning the DSM
by Vaughan Bell

In a potentially seismic move, the National Institute of Mental Health – the world’s biggest mental health research funder, has announced only two weeks before the launch of the DSM-5 diagnostic manual that it will be “re-orienting its research away from DSM categories”.
In the announcement, NIMH Director Thomas Insel says the DSM lacks validity and that “patients with mental disorders deserve better”.
This is something that will make very uncomfortable reading for the American Psychiatric Association as they trumpet what they claim is the ‘future of psychiatric diagnosis’ only two weeks before it hits the shelves.
As a result the NIMH will now be preferentially funding research that does not stick to DSM categories:
Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system. What does this mean for applicants? Clinical trials might study all patients in a mood clinic rather than those meeting strict major depressive disorder criteria. Studies of biomarkers for “depression” might begin by looking across many disorders with anhedonia or emotional appraisal bias or psychomotor retardation to understand the circuitry underlying these symptoms. What does this mean for patients? We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system.
As an alternative approach, Insel suggests the Research Domain Criteria (RDoC) project, which aims to uncover what it sees as the ‘component parts’ of psychological dysregulation by understanding difficulties in terms of cognitive, neural and genetic differences.
For example, difficulties with regulating the arousal system might be equally as involved in generating anxiety in PTSD as generating manic states in bipolar disorder.
Of course, this ‘component part’ approach is already a large part of mental health research but the RDoC project aims to combine this into a system that allows these to be mapped out and integrated.
It’s worth saying that this won’t be changing how psychiatrists treat their patients any time soon. DSM-style disorders will still be the order of the day, not least because a great deal of the evidence for the effectiveness of medication is based on giving people standard diagnoses.
It is also true to say that RDoC is currently little more than a plan at the moment – a bit like the Mars mission: you can see how it would be feasible but actually getting there seems a long way off. In fact, until now, the RDoC project has largely been considered to be an experimental project in thinking up alternative approaches.
The project was partly thought to be radical because it has many similarities to the approach taken by scientific critics of mainstream psychiatry who have argued for a symptom-based approach to understanding mental health difficulties that has often been rejected by the ‘diagnoses represent distinct diseases’ camp.
The NIMH has often been one of the most staunch supporters of the latter view, so the fact that it has put the RDoC front and centre is not only a slap in the face for the American Psychiatric Association and the DSM, it also heralds a massive change in how we might think of mental disorders in decades to come.

[Article of Interest] Mental Illness a Frequent Cell Mate for Those Behind Bars

By Amanda Gardner

Former inmate describes efforts to stay emotionally healthy after his release

Eugene King ran away from home at the age of 16, the start of a lifelong pattern of drug abuse, crime and incarceration.

In retrospect, King said, he realizes he was using illicit drugs at least in part to self-medicate a variety of psychiatric conditions. But he also realizes that prison, with its lack of adequate medical treatment and what he called a generally abusive environment, only made his problems worse.

“It exacerbated [the mental illness] without a doubt,” said King, now 62.

That King’s mental health, already precarious, only worsened in prison is not an unusual story.

According to a recent study published in the Journal of Health and Social Behavior, the link between prison time and mental illness is a two-way street. Although many incarcerated people exhibit such problems as impulse control disorders — which normally first appear in childhood or adolescence — before they enter the correctional system, incarceration itself seems to cause major depression.

And this may help explain why so many inmates have trouble re-entering society when they are released, said the authors of the study.

“Prison made them depressed and that depression undermined their ability to re-enter — made it hard to find a job, hard to be motivated — and this is precisely the time they need to be motivated,” said lead author Jason Schnittker, an associate professor of sociology at the University of Pennsylvania. “We think that mood disorders are an important barrier to re-entry.”

According to background information included in the study, about 16 million people — or 7.5 percent of the U.S. population — are felons or ex-felons.

Meanwhile, people in prison have up to six times the rate of significant mental illness as the general population, said Dr. Spencer Eth, a professor of psychiatry and behavioral sciences at the University of Miami Miller School of Medicine. Eth also treats inmates at a local jail.

And although it has long been suspected that prison aggravates pre-existing psychiatric problems, experts have had trouble untangling this chicken-and-egg question, especially given that early childhood experiences are linked to both incarceration and mental illness.

For the study, Schnittker and his co-authors looked at a national database of nearly 5,700 men and women to assess both the prevalence of psychiatric disorders and any time spent in jail or prison.

Their conclusion? Incarceration was associated with a 45 percent increase in the risk of having depression.

The findings did have some limitations, namely that the authors couldn’t control for all other factors that might affect the incidence of depression. And because it’s so difficult to conduct studies in prison populations, it’s possible that the data did not pick up on worsening of conditions other than depression, said Eth, who was not involved with the study.

The data were also at least a decade old, Eth said, even though “it’s likely that if the study were to be repeated now there would be similar findings.”

Although the study authors advocate for more treatment while people are in prison and before being let out onto the streets, in reality conditions in correctional facilities are often pitiful, said Eth, echoing King’s sentiments.

“There’s very, very little treatment available to people who are in jails and prisons. At most, it’s medication, and for many conditions it’s nothing at all. It’s terrible,” Eth said. “If you didn’t have a serious mental illness going in, the conditions of jails and prisons are so deplorable, you’d have to be a hardy soul not to be depressed or worse.”

Unfortunately, psychiatric treatment for ex-offenders “on the outside” is also limited, said JoAnne Page, president and CEO of the Fortune Society in New York City, which helps individuals re-enter society after prison.

“We couldn’t get people into mental-health treatment in the community when it was available, and it’s less available than it used to be,” Page said.

In 2011, the Fortune Society, which already provided housing and other services for ex-offenders, opened its Better Living Center, which they said is the first agency in New York City to cater exclusively to individuals with a criminal history.

“Most of our people come to us after their release when we have a window of time,” Page said. “There’s a hopefulness that things could be different. It’s a wonderful time to work with people if you give them a fighting chance.”

It is through this Better Living Center that King got his chance. He now takes medication every day and sees a therapist weekly for bipolar disorder, post-traumatic stress disorder and depression.

“I have access to excellent mental-health treatment now and I’m also mindful of the fact that there are [many] prison inmates who could benefit from the same level of care, or something close to it,” King said. “Last week was my last day on parole. Over 25 years, I have been living on this cloud either in prison or on supervision. I am no longer. I am totally free.”

[Film of Interest] “Running from Crazy”
Mariel Hemingway Tackles Family History of Suicide, Mental Illness in New Doc

The new documentary “Running from Crazy” chronicles the life of actress Mariel Hemingway, the granddaughter of the great novelist Ernest Hemingway. The film focuses on Mariel’s family history of mental illness and the suicides of seven relatives, including her grandfather and her sister, Margaux.

iThe film is directed by the two-time Academy Award-winning filmmaker Barbara Kopple, whose documentary “Harlan County U.S.A.” has become a classic and won an Oscar in 1977.

Successful and Schizophrenic

By Elyn R. Saks, law professor at the University of Southern California and the author of the memoir “The Center Cannot Hold: My Journey Through Madness.”

Thirty years ago, I was given a diagnosis of schizophrenia. My prognosis was “grave”: I would never live independently, hold a job, find a loving partner, get married. My home would be a board-and-care facility, my days spent watching TV in a day room with other people debilitated by mental illness. I would work at menial jobs when my symptoms were quiet. Following my last psychiatric hospitalization at the age of 28, I was encouraged by a doctor to work as a cashier making change. If I could handle that, I was told, we would reassess my ability to hold a more demanding position, perhaps even something full-time.

Then I made a decision. I would write the narrative of my life. Today I am a chaired professor at the University of Southern California Gould School of Law. I have an adjunct appointment in the department of psychiatry at the medical school of the University of California, San Diego, and am on the faculty of the New Center for Psychoanalysis. The MacArthur Foundation gave me a genius grant.

Although I fought my diagnosis for many years, I came to accept that I have schizophrenia and will be in treatment the rest of my life. Indeed, excellent psychoanalytic treatment and medication have been critical to my success. What I refused to accept was my prognosis.

Conventional psychiatric thinking and its diagnostic categories say that people like me don’t exist. Either I don’t have schizophrenia (please tell that to the delusions crowding my mind), or I couldn’t have accomplished what I have (please tell that to U.S.C.’s committee on faculty affairs). But I do, and I have. And I have undertaken research with colleagues at U.S.C. and U.C.L.A. to show that I am not alone. There are others with schizophrenia and such active symptoms as delusions and hallucinations who have significant academic and professional achievements.

Over the last few years, my colleagues, including Stephen Marder, Alison Hamilton and Amy Cohen, and I have gathered 20 research subjects with high-functioning schizophrenia in Los Angeles. They suffered from symptoms like mild delusions or hallucinatory behavior. Their average age was 40. Half were male, half female, and more than half were minorities. All had high school diplomas, and a majority either had or were working toward college or graduate degrees. They were graduate students, managers, technicians and professionals, including a doctor, lawyer, psychologist and chief executive of a nonprofit group.

At the same time, most were unmarried and childless, which is consistent with their diagnoses. (My colleagues and I intend to do another study on people with schizophrenia who are high-functioning in terms of their relationships. Marrying in my mid-40s — the best thing that ever happened to me — was against all odds, following almost 18 years of not dating.) More than three-quarters had been hospitalized between two and five times because of their illness, while three had never been admitted.

How had these people with schizophrenia managed to succeed in their studies and at such high-level jobs? We learned that, in addition to medication and therapy, all the participants had developed techniques to keep their schizophrenia at bay. For some, these techniques were cognitive. An educator with a master’s degree said he had learned to face his hallucinations and ask, “What’s the evidence for that? Or is it just a perception problem?” Another participant said, “I hear derogatory voices all the time. … You just gotta blow them off.”

Part of vigilance about symptoms was “identifying triggers” to “prevent a fuller blown experience of symptoms,” said a participant who works as a coordinator at a nonprofit group. For instance, if being with people in close quarters for too long can set off symptoms, build in some alone time when you travel with friends.

Other techniques that our participants cited included controlling sensory inputs. For some, this meant keeping their living space simple (bare walls, no TV, only quiet music), while for others, it meant distracting music. “I’ll listen to loud music if I don’t want to hear things,” said a participant who is a certified nurse’s assistant. Still others mentioned exercise, a healthy diet, avoiding alcohol and getting enough sleep. A belief in God and prayer also played a role for some.

One of the most frequently mentioned techniques that helped our research participants manage their symptoms was work. “Work has been an important part of who I am,” said an educator in our group. “When you become useful to an organization and feel respected in that organization, there’s a certain value in belonging there.” This person works on the weekends too because of “the distraction factor.” In other words, by engaging in work, the crazy stuff often recedes to the sidelines.

Personally, I reach out to my doctors, friends and family whenever I start slipping, and I get great support from them. I eat comfort food (for me, cereal) and listen to quiet music. I minimize all stimulation. Usually these techniques, combined with more medication and therapy, will make the symptoms pass. But the work piece — using my mind — is my best defense. It keeps me focused, it keeps the demons at bay. My mind, I have come to say, is both my worst enemy and my best friend.

That is why it is so distressing when doctors tell their patients not to expect or pursue fulfilling careers. Far too often, the conventional psychiatric approach to mental illness is to see clusters of symptoms that characterize people. Accordingly, many psychiatrists hold the view that treating symptoms with medication is treating mental illness. But this fails to take into account individuals’ strengths and capabilities, leading mental health professionals to underestimate what their patients can hope to achieve in the world.

It’s not just schizophrenia: earlier this month, The Journal of Child Psychology and Psychiatry posted a study showing that a small group of people who were given diagnoses of autism, a developmental disorder, later stopped exhibiting symptoms. They seemed to have recovered — though after years of behavioral therapy and treatment. A recent New York Times Magazine article described a new company that hires high-functioning adults with autism, taking advantage of their unusual memory skills and attention to detail.

I don’t want to sound like a Pollyanna about schizophrenia; mental illness imposes real limitations, and it’s important not to romanticize it. We can’t all be Nobel laureates like John Nash of the movie “A Beautiful Mind.” But the seeds of creative thinking may sometimes be found in mental illness, and people underestimate the power of the human brain to adapt and to create.

An approach that looks for individual strengths, in addition to considering symptoms, could help dispel the pessimism surrounding mental illness. Finding “the wellness within the illness,” as one person with schizophrenia said, should be a therapeutic goal. Doctors should urge their patients to develop relationships and engage in meaningful work. They should encourage patients to find their own repertory of techniques to manage their symptoms and aim for a quality of life as they define it. And they should provide patients with the resources — therapy, medication and support — to make these things happen.

“Every person has a unique gift or unique self to bring to the world,” said one of our study’s participants. She expressed the reality that those of us who have schizophrenia and other mental illnemesses want what everyone wants: in the words of Sigmund Freud, to work and to love.

Recommended Resource: NIH’s master list of ~ 500 neurological disorders, neurological symptoms and neurological diseases
Compiled by the National Institute of Neurological Disorders and Stroke

The list links out to comprehensive neuroscience-focused definitions, treatment options, research endeavors, organizations, and more.

[Article of Interest] Schizophrenia: When Hallucinatory Voices Suppress Real Ones, New Electronic Application May Help
By Elin Fugelsnes/Else Lie; translation by Glenn Wells/Carol B. Eckmann.

Excerpt from the article: “Every one of us hears inner voices or melodies from time to time. The difference between non-afflicted individuals and schizophrenia patients is that the former manage to tune these out better,” the professor points out.

If patients could learn to stifle inner noise it could have a huge impact on our ability to treat schizophrenia, he states. To this end, Professor Hugdahl’s research group has developed an application that can be used on mobile phones and other simple electronic devices, to help patients improve their filters.

Wearing headphones, the patient is exposed to simple speech sounds with different sounds played in each ear. The task is to practice hearing the sound in one ear while blocking out sound in the other. The application has only been tested on two patients with schizophrenia so far. The response from these patients is promising, Dr Hugdahl relates.

“The voices are still there, but the test subjects feel that they have control over the voices instead of the other way around. The patient feels it is a breakthrough since it means he can actively shift his focus from the inner voices over to the sounds coming from the outside,” the professor explains.

[Article of Interest] Death with Honors: Suicide among Gifted Adolescents

By James R. Delisle, Ph.D.

Department of Teacher Development and Curriculum Studies, Kent State University, Kent, Ohio.

Abstract: The incidence of suicide and suicide attempts among adolescents has increased markedly during the past two decades. Gifted adolescents, often perceived by others as being immune from problems of depression and emotional upheaval because of their high intelligence, have also shown increases in suicidal behaviors. On the basis of current research, the author contends that gifted young people are especially susceptible to suicide attempts. 

[Article of Interest] Enhanced creativity in bipolar disorder patients: A controlled study

By Nancy C. Andreasen, M.D., Ph.D. 

Chair of Psychiatry and Director of its Neuroimaging Research Center and the Mental Health Clinical Research Center at The University of Iowa Carver College of Medicine

Excerpt from the article: People have wondered whether there is a relationsip between creativity and mental illness, or “genius and insanity” in popular parlance, at least since classical times […]The following are only some of the writers who have died by suicide during the twentieth century: Ernest Hemingway, Sylvia Plath, John Berryman, Anne Sexton, and Virginia Woolf […] In the twentieth century this association has been supported by several techniques commonly used to examine familial transmission of various illnesses, including evaluation of first-degree relatives of creative individuals and examination of biological and nonbiological adoptive relatives of creative individuals adopted at birth 

[…]

Eighty percent of the writers [examined in this study] had had an episode of affective illness at some time in their lives, compared with 30% of the control subjects. A surprising percentage of the affective disorder was bipolar in nature; 43% of the writers had had some type of bipolar illness, in comparison with 10% of the control subjects. Both of these differences were statistically significant. In addition, the writers had significantly higher rates of alcoholism (30%, compared with 7% in the control subjects). 

Spread the Word: Inquiry into the ‘Schizophrenia’ Label

The  Inquiry into the ‘Schizophrenia’ Label Inquiry Panel would like to hear about your experience and thoughts about ‘schizophrenia’ or similar labels such as ‘psychosis’. We are particularly interested in hearing from:

• people affected by the label ‘schizophrenia’ (or similar labels such as ‘psychosis’)

• people given other ‘mental illness’ diagnoses

• families, carers and friends of people diagnosed with ‘schizophrenia’ or ‘psychosis’

• mental health workers and professionals, and

• people interested in mental health issues

  For more information, Click Here. 

Psychiatry’s bible, the DSM, is doing more harm than good

Excerpt from the Washington Post article: In our increasingly psychiatrized world, the first course is often to classify anything but routine happiness as a mental disorder, assume it is based on a broken brain or a chemical imbalance, and prescribe drugs or hospitalization; even electroshock is still performed.