[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] 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.”

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 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

[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.

[Article of Interest] Hooked on the Web: Internet Addiction

By Melanie Eckhoff

Recent studies of college students begin to clarify the relationship between Internet compulsion, depression and other serious problems.

Word is spreading about the dangers of texting while driving. But what about texting and walking? Walking into someone when you’re sending a text or playing angry birds on your iPhone may be rude, but at least it’s not fatal. Walking against the light and straight into the path of a moving car is another story. Internet addiction (IA) is a disorder with symptoms similar to those found in pathological gambling and, to a lesser extent, substance abuse. Colleges nationwide are seeing the negative consequences of IA on their students. Reports estimate that 8% to 13% of undergraduates are addicted to the Internet, resulting in serious harms including impaired psychological health, family and peer relationship difficulty and lower academic performance. In addition, a link has been found between problematic Internet use and depression in college kids. There is considerable confusion about what Internet addiction is (is not). Here are answers to common questions that may get you started:

1. How does a healthcare professional spot Internet addiction?
There are eight criteria for diagnosing IA; these symptoms include preoccupation with the Internet, unsuccessful efforts to control or cut back Internet use, staying online longer than originally intended and using the Internet daily as an escape. Internet addicts can spend anywhere from 40 to 80 hours per week online, with sessions lasting up to as much as 20 hours. Some observers suggest that given the nation’s high unemployment rate over the past five years, a growing number of people are turning to online experiences to fill the empty hours and to escape the anxiety and depression of not having a job or a paycheck.

2. Does what we use the Internet for make a difference?
Certain online activities, such as cyber-relationships and online gaming, seem to be particularly potent in inducing compulsive use. A recent New York Times article reported on a study finding that in a sample of 216 undergraduates, an individual’s scores on a depression scale rose with increased levels of sharing files (movies, music, etc.) and of email usage. The authors spoke of their intention to develop a software application that could be installed on computers and smartphones to monitor your Internet activities and alert you if depressive patterns emerge. (It is far from certain that many people would consent to such an intrusion into their privacy)

3. Do Facebook and other social networking create a feeling of togetherness?
Social networking is truly changing the way people communicate and interact with one another. Facebook is the largest social networks, and “Facebooking” has practically reached epidemic proportions among the college population. In a 2009 University of Missouri survey of some 1,000 college students, more than 95% had a Facebook page and 78% of them accessed the site at least twice a day. The study also found that in terms of relatedness, Facebook use is—somewhat paradoxically—correlated with both connection and disconnection. As for addiction, the researchers suggested that their subjects were habituated to a coping device that distracts from rather than resolves everyday problems.

4. Are texting and tweeting included in the IA diagnosis?
It is an open question whether the IA spectrum should include mobile, phone-based activities such as texting and tweeting. A 2010 study of college students in Pakistan found that many texted during class lectures; the majority of their texting activity occurred during late evenings and early morning hours. Several students said that their parents have tried to stop them from texting during meals and study time. If you’re the parent of adolescents in the US, you would probably not be surprised if one child texted the other one sitting next to him or her at the dinner table rather than bothering to vocalize, “Pass the chicken.”
Texting while walking can in fact be dangerous. A recent study of 138 college students using an online test found that when listening to music, texting or having a conversation on a smartphone, they were more likely to look away from the virtual street they were crossing than were the subjects with no distraction.

5. Are colleges being “taken over” by the online universe?
Not yet. But the signs are there: for example, college professors are using Twitter as a way to encourage discussion of subject matter among students, according to a 2010 US News and World Report article. Yet abuse of the Internet on college campuses has received relatively little attention, compared to substance abuse. And given that the Internet is an increasingly integral component of the typical college curriculum, college may be a risky environment for vulnerable students.

6. What are the risks if a person engages in abuse of both substances and the Internet?
In a study I conducted of 165 undergraduates (126 women and 39 men) at the New School for Social Research, in New York City, I found that students in the control group (i.e., no problematic substance or internet use) had fewer negative outcomes than those engaged in problematic use of both substances and the Internet. However, no differences were found between the students in the control group and students who had only one of the two habits.
The negative outcomes included psychological distress and decreased satisfaction with college. Yet not all online activities were associated with the same negative outcomes—and some actually correlated with positive results. Examples: online gambling, downloading files and texting were all associated with less academic success or other negative events. High college satisfaction was associated with chatting online and using the Internet for school.
Future studies might home in on behaviors like downloading or sharing files to learn why they particularly are detrimental. Answers could help mental health professionals gain insight into how best to work with these individuals. Some observers suggest that a lack of in-person social contact initiates the depressive symptoms, which in turn are exacerbated by continued face-to-face avoidance.

7. Are those of us who are past our college years at risk?
Age doesn’t exempt anyone from the problem since most of us rely on the Internet in our jobs and our home life. Ask yourself if your use is compulsive. Do you spend more time online than you originally intended? Do you go on Facebook because you prefer it to actual face-to-face contact? If combining Internet addiction with substance abuse can lead to more negative consequences for college students, the odds are that it will have the same effect on all of us.

[Article of Interest] Psychiatry Manual Drafters Back Down on Diagnoses

By Benedict Carey

The New York Times

Excerpt: The [doctors on a panel revising psychiatry’s diagnostic manual] dropped two diagnoses that they ultimately concluded were not supported by the evidence: “attenuated psychosis syndrome,” proposed to identify people at risk of developing psychosis, and “mixed anxiety depressive disorder,” a hybrid of the two mood problems. They also tweaked their proposed definition of depression to allay fears that the normal sadness people experience after the loss of a loved one, a job or a marriage would not be mistaken for a mental disorder.

“At long last, DSM 5 is correcting itself and has rejected its worst proposals,” said Dr. Allen Frances, a former task force chairman and professor emeritus at Duke University who has been one of the most prominent critics. “But a great deal more certainly needs to be accomplished. Most important are the elimination of other dangerous new diagnoses and the rewriting of all the many unreliable criteria sets.”

Depression in Command: 

In times of crisis, mentally ill leaders can see what others don’t.

Great crisis leaders are not like the rest of us; nor are they like mentally healthy leaders. When society is happy, they toil in sadness, seeking help from friends and family and doctors as they cope with an illness that can be debilitating, even deadly. Sometimes they are up, sometimes they are down, but they are never quite well.

Source: The Wall Street Journal