Posts tagged diagnostic
Posts tagged diagnostic
For some people their psychoses or nervous breakdowns come at the transition between youth and adulthood. It may be in the final years of school or the moving away from home to go to university or a new job in the big city. It was like this for many members of my family although not for me. My psychoses were to do with hormones and body transitions. But there could be a similarity I suppose, in terms of moving from one mind/body state into another.
I’ve heard from other parents who describe similar altered mind states for their sons and daughters which are translated into disorders by psychiatrists who are keen to pin the tail on the donkey or the diagnosis on the psychotic. Quickly followed up by anti-psychotics, forcibly given if resistant, then if refusing the schizo disorders label, seen as anosognosia or lacking insight. A no-win situation whatever way you look at it. I got away with it in 1978 and 1984, after painful induced childbirth blew my mind, because back then there wasn’t perinatal psychiatry or drug cocktails to hand. A narrow escape.
But it’s got harder and harder I think to get out of a psychosis without being tied in to the system and tied up with psychiatric drugs. Especially if you have resisted the label and challenged the system on behalf of others. In 1995 my oldest son had a transitional breakdown or psychosis, after leaving home to go to university. He went into the local acute psychiatric ward voluntarily and wasn’t looked after well. We lived at that time very near the hospital, in fact on the farm that used to belong to the asylum. I kept a close eye on my son and made complaints about his treatment when necessary.
I had head-to-head disagreements with my son’s psychiatrist who wanted to pin a disorder label on him, something to do with “cyclical depression”. This was because the anti-psychotic, as with me, depressed my son. I advocated on behalf of my son, we resisted the labels, he recovered after a year, got back on with his life and has never looked back. I joked at the time that if ever I had to engage with them as a psychiatric patient then they’d have me straitjacketed. Then in 2002 I found myself going in voluntarily to the same psychiatric hospital, in a menopausal psychosis, to be chemically straitjacketed.
I knew that the game was up when I tried to leave and was detained for 72 hours. The “heavy” (large male nurse with arms folded) at the emergency door meant I wasn’t going to be able to make a run for it. I’d have to swallow the drugs and did so under duress, inwardly defiant. Within 24 hours the drugs started to take effect and I was entering never never land. A place I never did want to go back to.
I had enjoyed my childhood but didn’t want to return there. I had no choice. The psych drugs entered my brain and psyche, gradually taking away my decision-making abilities, maturity and life experience. Some folk might like to be free from responsibility but I really don’t like the feeling of infantilisation. Having to rely on psychiatric “professionals” and be dependent. It made me depressed and resulted in psych drug cocktails, my continued resistance giving way to disorder labels. I didn’t like being Peter Pan and preferred to get back to being Wendy.
“All children, except one, grow up. They soon know that they will grow up, and the way Wendy knew was this. One day when she was two years old she was playing in a garden, and she plucked another flower and ran with it to her mother. I suppose she must have looked rather delightful, for Mrs Darling put her hand to her heart and cried, ‘Oh, why can’t you remain like this for ever!’ This was all that passed between them on the subject, but henceforth Wendy knew that she must grow up. You always know after you are two. Two is the beginning of the end.”
― J.M. Barrie, Peter Pan
As a mother of 3 sons who have experienced psychoses and psychiatric treatment at transition between youth and adulthood, I didn’t want them to be caught up for too long in the Peter Pan effect of psychiatric treatment. I’d been there, got the tee-shirt, and had known other folk in the past who’d got stuck on the psych drugs which, to my mind, were to be avoided if possible, if not then tapered when possible. I didn’t ask psychiatrists about tapering and did it myself when I could, although there was a community psychiatrist in 1985 who supported my coming off psych drugs.
I’ve found out though that my sons have to make their own journeys through never never land in the way that suits them. I’d prefer if they got out quick. Easier for me I suppose because I really don’t like having to engage with psychiatry in any shape or form. Never did. Ironically I now find myself in a continual engagement, up to my neck in it, on groups and committees, sitting next to them at events.
Even last week I attended an event and a female psychiatrist chose to sit next to me and tried to advise and direct at every opportunity. At one point, when I was tweeting, she said that she hoped I wasn’t tweeting about her. I wondered if she thought that my world revolved around her? Godlike. I soon put her right. But I couldn’t put her off and she stuck like glue. I just had to ignore her and get on with my own agenda. I’m used to doing this with psychiatrists.
And now we have psychiatrists who are also neuroscientists and claim to have found the holy grail, the proof of mental illness by examining the brains and eyes of people who have been on psychiatric drugs for many years and been forcibly labelled with schizophrenia. There’s a group doing this at Aberdeen University in Scotland. I sent an Email to them the other week but I haven’t had a response and likely won’t get one. I’d read some of their research a while back and their “guinea pigs” are people who have been in the psychiatric system for some time. It’s obvious, to me anyway, that the psych drugs will have caused brain and eye changes. It stands to reason.
If they could scan our brains when we first enter a psych ward with a psychosis and show us the broken bits then I might believe them. When I broke my fibula in 3 places in 2005, not long after coming off maximum doses of venlafaxine, which causes bone loss, I was shown the X-ray of my fractured bone by the consultant. Not a pretty sight but proof of the damage and justification of the 6 inch metal plate insertion and screw going through the ankle at right angles. About 6 weeks in plaster and in a wheelchair followed. I had to get the plaster changed when my foot swelled up.
The screw got taken out about 2 months later, by local anaesthetic, and the consultant prior to the op showed me the foot long screwdriver that he said had been made in Sweden. He recommended I let him know if I could feel any pain and they would give me more anaesthetic. During the procedure he told me he was having a bit of difficulty finding the end of the screw. I trusted that he would eventually get a grip. And so he did. The screw came out, the plate stayed in. I got physiotherapy and got back to walking and driving again. A collaborative relationship with the consultant doctor from start to finish. If only it could be like that with consultant psychiatrists.
I did wonder how I managed to shatter my fibula when only walking downstairs, after a job interview in a library. I got the job and started after getting back on my feet. Fortunately a test for osteoporosis was negative. The mystery of the leg break was solved recently when I read some information online about venlafaxine and bone loss:
“Bone Fractures: Epidemiological studies show an increased risk of bone fractures in patients receiving serotonin reuptake inhibitors (SRIs) including venlafaxine. The mechanism leading to this risk is not fully understood.” Medsafe NZ, page 10
“Conclusion: The increased bone loss associated with high dose venlafaxine may possibly be a result of synaptic inhibition of serotonin uptake” Journal of Negative Results in Biomedicine, June 2010
I want to see alternative ways of working with people in and through a psychosis that don’t involve psychiatric drugs and coercive treatment towards those of us who are unbelievers in the biomedical model of mental illness. Help us transition through our psychoses with our psyches intact or restored. Whatever trauma or crisis brought us to the point of emotional collapse please don’t retraumatise us, replacing new pain with old. Let us come to terms with our humanity and human frailty.
“Peter was not quite like other boys; but he was afraid at last. A tremor ran through him, like a shudder passing over the sea; but on the sea one shudder follows another till there are hundreds of them, and Peter felt just the one. Next moment he was standing erect on the rock again, with that smile on his face and a drum beating within him. It was saying, “To die will be an awfully big adventure.”― J.M. Barrie, Peter Pan
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From the related article, Sawyer, A. (2011). Let’s talk: a narrative of mental illness, recovery, and the psychotherapist’s personal treatment. Journal of clinical psychology, 67(8), 776-788:
This article describes the author’s experience in psychotherapy, beginning as a suicidal teenager with a dismal prognosis, through 5 years of hospitalization, including shock treatment that erased most memory before age 20, through an Ivy League education, and successful professional career. Retraumatization triggered by reading her hospital records 40 years later adds a unique perspective, as the author watched, but could not control, a process within herself that she regularly addressed as therapist with her own patients. Healing aspects of relationships with three psychodynamic psychotherapists (two psychiatrists and a social worker), credited with her survival and success, are examined. A dramatic interview with Harold Searles, her psychiatrist’s supervisor, and its role in her recovery is considered. Lasting lessons concerning the healing aspects of psychotherapy, the effects of repressed early trauma encountered late in life, the need to counter stigma, and the value of personal psychotherapy are discussed.
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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.
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] 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.”
[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.
Being an ex-drug-addict turned neuroscientist brings a unique insight into the physiological and phenomenological realities of addiction.
Excerpt: For 10 years I spun in and out of an addiction to opiates (and other drugs) that led to despair, crime, and the loss of everything I valued most—including my place in graduate school. After many failed attempts, I finally quit taking addictive drugs 30 years ago. I reentered grad school, got my PhD in developmental psychology, and became a professor at the University of Toronto, focusing on emotional and personality development. I studied these topics for 13 years, but I never quite understood my own personality development. I came to believe that my theories needed help from neuroscience, and that’s why I switched to research on the emotional brain—my focus for the past decade.
When I was in the throes of intense psychological addiction, my thoughts were continuously (and unpleasantly) drawn to drug imagery. It would be so great to have some now! How can I get some tonight?! But attraction to something you are just about to get feels marvelous. Dopamine-induced engagement turns into a headlong rush of triumph when the goal is finally accessible.
This perspective on the dual nature of attraction helps make sense of addiction. Unsated attraction can be a kind of torture, and addicts may seek drugs to put an end to that torture, more than for the modicum of pleasure drugs actually bestow.
Excerpt: Creativity of some artists is fuelled by the unique world view mental illness can provide, but without the completely debilitating aspects of the condition. Instead, the artists are able to direct their creativity into artistic projects.
ABSTRACT: The changing role of the family and how the family unit may help or harm a disturbed and/or disturbing member is examined. The authors use their personal experiences as mental health professionals, user/survivors and family members to inform their critique. A brief history of family involvement – how the family has been perceived and worked with by mental health professionals – is followed by a description of present day practices. The paper concludes with speculation about alternatives in which quality of life for all of the family members may be more possible.
"Our study suggests that if people have a single genetic risk factor alone or a traumatic environment in very early childhood alone, they may not develop mental disorders like schizophrenia," says Guo-li Ming, M.D., Ph.D., professor of neurology and member of the Institute for Cell Engineering at the Johns Hopkins University School of Medicine.
"But the findings also suggest that someone who carries the genetic risk factor and experiences certain kinds of stress early in life may be more likely to develop the disease."
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.
Excellent Blog offering up-to-date Mental Health, psychiatry and psychology articles/news/research from around the web. Highly recommended!
The International Society for the Psychological Treatments of the Schizophrenias and Other Psychoses's list of the Top 20 papers on the psychological treatments of the schizophrenias and other psychoses:
Psychodynamic psychotherapy lasting for at least a year is effective and superior to shorter-term therapy for patients with complex mental disorders such as personality and chronic mental disorders.