Serious Mental Illness Blog

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

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Psychiatry a Key Player in Effective Health Reform, APA SaysBy Megan Brooks, Medscape
An American Psychiatric Association (APA) work group on healthcare reform outlines key issues facing the field of psychiatry and offers recommendations for action in a report released today.
"Throughout this recent period of change, the focus on behavioral health, which includes mental illnesses and substance use disorders, has begun to shift from a compartmentalized provider approach to an integrated delivery system linking behavioral health and primary care services. This has led to a renewed awareness that mental health is critical to overall health and wellbeing," the report notes.
The work group was established by the APA board of trustees and chaired by Paul Summergrad, MD, chair of the Department of Psychiatry at Tufts University School of Medicine, Boston, Massachusetts, and president-elect of the APA. The group met numerous times during an 18-month period with input from the board of trustees, the assembly, and relevant councils and components.
Critical Role for Psychiatrists
According to the report, as healthcare reform expands insurance coverage and extends parity of benefits for behavioral health needs, it will be “critical to monitor new developments, models of care, and payment methodologies, and to enforce compliance to ensure patients and families receive the best quality of care.”
"Psychiatry must play a central role in the new patient care and delivery and payment models. These models must include an expanded emphasis on behavioral health," the report says.
The report also notes that integrated care models “hold promise” in addressing many of the challenges facing the healthcare system, but “more research is needed to build their evidence base, explore their financial impact and define the role of psychiatrists, primary care providers and other behavioral health providers.”
"Psychiatrists, alongside primary care providers, must play a major role in formulating integrated care solutions by defining their role and benefit to patients," the report recommends. It encourages the National Institutes of Health, the Centers for Medicare and Medicaid Services, and other federal agencies to continue their ongoing research and evaluation of these models.
The work group also tackled issues of financing of psychiatric care, concluding that fundamental payment issues, including implementation of parity laws, “must be addressed” to achieve the coverage, access, and new care delivery goals of the Affordable Care Act. This includes the economic impact of integration, Medicaid reimbursement policies, Medicare fee schedule distortions, fee for service payment methodologies, and the structure and management of payment.
IT Challenges Ahead
They conclude that payer and systems’ budgeting mechanisms must include management of psychiatric care within the broader medical healthcare budgets, while protecting core services for those with mental illnesses.
On the subject of quality performance and measurement, the group notes that healthcare reform has accelerated the development and use of performance indicators and recommends that the behavioral health field “become more fully engaged in the development of performance measures.”
"The field must lead on quality metrics for psychiatric care and their consistent adoption across payers and other regulatory entities. This can be accomplished by identifying a few priority areas for improvement, as well as establishing a series of goals covering various areas of practice," the group advises.
On health information technology (HIT), the group says several “challenges” lie ahead in the behavioral health field. The success of integrated care models is particularly dependent upon the deployment of electronic health records and patient registries, the report says.
The report concludes that HIT “should be a priority focus of communication and education for the psychiatric field, healthcare providers in general, patients, policy makers and the public.”
The report also addresses workforce, work environment, and medical education and training. Its key finding: “Without changes in the workforce, the field will have difficulty meeting the increased demand for specialty psychiatric physician services. Curriculum, accreditation standards, new Continuing Medical Education (CME) trainings and collaboration with primary care practitioners are needed to meet newly insured patient needs as well as provide for new care delivery models.”
The recommendations of the work group “serve as a springboard for discussion and action within the field of psychiatry,” the authors say.
APA. Integrated Care. Full article



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Psychiatry a Key Player in Effective Health Reform, APA Says
By Megan Brooks, Medscape

An American Psychiatric Association (APA) work group on healthcare reform outlines key issues facing the field of psychiatry and offers recommendations for action in a report released today.

"Throughout this recent period of change, the focus on behavioral health, which includes mental illnesses and substance use disorders, has begun to shift from a compartmentalized provider approach to an integrated delivery system linking behavioral health and primary care services. This has led to a renewed awareness that mental health is critical to overall health and wellbeing," the report notes.

The work group was established by the APA board of trustees and chaired by Paul Summergrad, MD, chair of the Department of Psychiatry at Tufts University School of Medicine, Boston, Massachusetts, and president-elect of the APA. The group met numerous times during an 18-month period with input from the board of trustees, the assembly, and relevant councils and components.

Critical Role for Psychiatrists

According to the report, as healthcare reform expands insurance coverage and extends parity of benefits for behavioral health needs, it will be “critical to monitor new developments, models of care, and payment methodologies, and to enforce compliance to ensure patients and families receive the best quality of care.”

"Psychiatry must play a central role in the new patient care and delivery and payment models. These models must include an expanded emphasis on behavioral health," the report says.

The report also notes that integrated care models “hold promise” in addressing many of the challenges facing the healthcare system, but “more research is needed to build their evidence base, explore their financial impact and define the role of psychiatrists, primary care providers and other behavioral health providers.”

"Psychiatrists, alongside primary care providers, must play a major role in formulating integrated care solutions by defining their role and benefit to patients," the report recommends. It encourages the National Institutes of Health, the Centers for Medicare and Medicaid Services, and other federal agencies to continue their ongoing research and evaluation of these models.

The work group also tackled issues of financing of psychiatric care, concluding that fundamental payment issues, including implementation of parity laws, “must be addressed” to achieve the coverage, access, and new care delivery goals of the Affordable Care Act. This includes the economic impact of integration, Medicaid reimbursement policies, Medicare fee schedule distortions, fee for service payment methodologies, and the structure and management of payment.

IT Challenges Ahead

They conclude that payer and systems’ budgeting mechanisms must include management of psychiatric care within the broader medical healthcare budgets, while protecting core services for those with mental illnesses.

On the subject of quality performance and measurement, the group notes that healthcare reform has accelerated the development and use of performance indicators and recommends that the behavioral health field “become more fully engaged in the development of performance measures.”

"The field must lead on quality metrics for psychiatric care and their consistent adoption across payers and other regulatory entities. This can be accomplished by identifying a few priority areas for improvement, as well as establishing a series of goals covering various areas of practice," the group advises.

On health information technology (HIT), the group says several “challenges” lie ahead in the behavioral health field. The success of integrated care models is particularly dependent upon the deployment of electronic health records and patient registries, the report says.

The report concludes that HIT “should be a priority focus of communication and education for the psychiatric field, healthcare providers in general, patients, policy makers and the public.”

The report also addresses workforce, work environment, and medical education and training. Its key finding: “Without changes in the workforce, the field will have difficulty meeting the increased demand for specialty psychiatric physician services. Curriculum, accreditation standards, new Continuing Medical Education (CME) trainings and collaboration with primary care practitioners are needed to meet newly insured patient needs as well as provide for new care delivery models.”

The recommendations of the work group “serve as a springboard for discussion and action within the field of psychiatry,” the authors say.

APA. Integrated Care. Full article





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

Filed under psychiatry psychiatric psychology health healthcare mind body brain healthy news apa health reform medicine diagnosis disorder reform politics dsm mental illness mental health mental illness american us unites states america patient doctor psychiatrist therapist

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Interview: Borderline Personality Disorder, Fear Of Abandonment, And RelationshipsBy Richard Zwolinski, LMHC, Casac & C.R. ZwolinskiToday we’re talking with therapist Lisa Bahar about Borderline Personality Disorder and how it can affect relationships.Welcome, Lisa. BPD makes it difficult to be involved in a stable, healthy relationship. What are some kinds of behaviors that people with BPD have that are a challenge to a relationship?A person with BPD desires and responds to structure, predictability and communication. When there is lack of predictability, anxiety or fear of abandonment can potentially set in, and disruptive and unstable behavior can escalate into controlling and aggressive reactions.These reactions can occur when their partner’s behavior even slightly differs from what is expected. For example, if a partner, who is “always” on time is 15 minutes late, breaking a pattern of predictability, feeling of anxiousness increase. These feelings trigger feelings of abandonment, which can then lead to disproportionate reactions. These feelings are all rooted in fear.For example, when the partner shows up, the person with BPD might accuse them of cheating, leaving or have a plan to leave them. Or the person with BPD might act out with behaviors used as a way to give the message that the other is being “punished”. These might include not speaking, slamming doors, pouting, and so on. They all communicate I am angry.Tell us more about what this type of manipulative behavior looks like?Manipulation is a way to create control. If it is unconsciously motivated through a conscious act, such as an outward behavior like tantrums, crying, threatening, and attacking, it is what I call sloppy manipulation.Or, it can be sophisticated manipulation. When manipulative behavior takes the form of crafty questions which are intended to trap the other person into saying something that they really did not know mean to say, or give an answer that they really didn’t realize they were giving.The individual with BPD does not always use direct and healthy communication skills and instead acts out behaviorally and/or communicates indirectly.Are people with BPD consciously manipulating others? Sometimes, it seems like these manipulative behaviors are habits or knee jerk reactions rather than conscious emotional manipulation. Can you explain what is really going on?Exactly, these behaviors can be habits. Generally until awareness sets in, the individual may not know that they are unconsciously motivated. Once awareness sets in, and insight is gained, usually through various mindfulness practices, then there can be an opportunity for behavior change.Behavioral change is the real test of insight. Of course, the individual with BPD needs to actually know how to change and that is where the Dialectical Behavior Therapy skills become helpful.What are the underlying reasons and/or mechanisms driving manipulative behavior in someone with BPD?Fear of abandonment. Also, a feeling of disconnect particularly with a sense of self. This happens when an individual feels they don’t have an identity without the other there to define them. When the partner demonstrates behaviors that are interpreted as “leaving” by an individual with BPD it can feel like a loss of identity.Fear of abandonment can feel almost like death to the individual with BPD since it is a kind of “death of self.” That is why some people with BPD have a pattern of jumping from relationship to relationship—they do this in order to sustain sense of self.How does Dialectical Behavior Therapy help those with BPD resolve these issues?Dialectical Behavior Therapy is a set of skills that are very concrete and clear. They allow the individual to decrease emotionally intense reactions by providing a way to decrease the symptoms.DBT teaches a set of skills including:Core Mindfulness skills which help to calm the mind.Interpersonal Effectiveness skills which are designed to help you effectively communicate what you want, express feelings and say no clearly.Emotional Regulation skills which help you manage and deal with emotions rather than emotions controlling you.Distress Tolerance skills which help you be able to handle crisis situations more effectively and deal with reality and it’s terms, as opposed to resisting what reality is.What are some suggestions for people who want to overcome manipulative behaviors that drive people away?The first part is that the person has to want the change—they have to be the one to do the work! Of course, someone else such as the person the client is in a relationship might also want the change, and that is fine—but it can’t be the primary motivation.Next, there must be a willingness and dedication to learning skills that can help. For example the client must be willing to practice the skills he or she learns from DBT. They have to understand: This is a not a quick fix, but the development of a pattern of life skills.What advice do you have for family, friends and colleagues who are trying to cope with these behaviors and who, understandably, don’t want to feel attacked or manipulated?Education is key.Significant others must be aware of their part in interactions and reactions and must learn how best to respond. DBT is most effective if all family members are involved. Each person involved should practice a self care plan. It is so important for clients and family members to not point the finger at any one person.Thanks for speaking to this topic.


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

Interview: Borderline Personality Disorder, Fear Of Abandonment, And Relationships
By Richard Zwolinski, LMHC, Casac & C.R. Zwolinski

Today we’re talking with therapist Lisa Bahar about Borderline Personality Disorder and how it can affect relationships.

Welcome, Lisa. BPD makes it difficult to be involved in a stable, healthy relationship. What are some kinds of behaviors that people with BPD have that are a challenge to a relationship?
A person with BPD desires and responds to structure, predictability and communication. When there is lack of predictability, anxiety or fear of abandonment can potentially set in, and disruptive and unstable behavior can escalate into controlling and aggressive reactions.
These reactions can occur when their partner’s behavior even slightly differs from what is expected. For example, if a partner, who is “always” on time is 15 minutes late, breaking a pattern of predictability, feeling of anxiousness increase. These feelings trigger feelings of abandonment, which can then lead to disproportionate reactions. These feelings are all rooted in fear.
For example, when the partner shows up, the person with BPD might accuse them of cheating, leaving or have a plan to leave them. Or the person with BPD might act out with behaviors used as a way to give the message that the other is being “punished”. These might include not speaking, slamming doors, pouting, and so on. They all communicate I am angry.

Tell us more about what this type of manipulative behavior looks like?
Manipulation is a way to create control. If it is unconsciously motivated through a conscious act, such as an outward behavior like tantrums, crying, threatening, and attacking, it is what I call sloppy manipulation.
Or, it can be sophisticated manipulation. When manipulative behavior takes the form of crafty questions which are intended to trap the other person into saying something that they really did not know mean to say, or give an answer that they really didn’t realize they were giving.
The individual with BPD does not always use direct and healthy communication skills and instead acts out behaviorally and/or communicates indirectly.

Are people with BPD consciously manipulating others? Sometimes, it seems like these manipulative behaviors are habits or knee jerk reactions rather than conscious emotional manipulation. Can you explain what is really going on?
Exactly, these behaviors can be habits. Generally until awareness sets in, the individual may not know that they are unconsciously motivated. Once awareness sets in, and insight is gained, usually through various mindfulness practices, then there can be an opportunity for behavior change.
Behavioral change is the real test of insight. Of course, the individual with BPD needs to actually know how to change and that is where the Dialectical Behavior Therapy skills become helpful.

What are the underlying reasons and/or mechanisms driving manipulative behavior in someone with BPD?
Fear of abandonment. Also, a feeling of disconnect particularly with a sense of self. This happens when an individual feels they don’t have an identity without the other there to define them. When the partner demonstrates behaviors that are interpreted as “leaving” by an individual with BPD it can feel like a loss of identity.
Fear of abandonment can feel almost like death to the individual with BPD since it is a kind of “death of self.” That is why some people with BPD have a pattern of jumping from relationship to relationship—they do this in order to sustain sense of self.

How does Dialectical Behavior Therapy help those with BPD resolve these issues?
Dialectical Behavior Therapy is a set of skills that are very concrete and clear. They allow the individual to decrease emotionally intense reactions by providing a way to decrease the symptoms.
DBT teaches a set of skills including:
Core Mindfulness skills which help to calm the mind.
Interpersonal Effectiveness skills which are designed to help you effectively communicate what you want, express feelings and say no clearly.
Emotional Regulation skills which help you manage and deal with emotions rather than emotions controlling you.
Distress Tolerance skills which help you be able to handle crisis situations more effectively and deal with reality and it’s terms, as opposed to resisting what reality is.

What are some suggestions for people who want to overcome manipulative behaviors that drive people away?
The first part is that the person has to want the change—they have to be the one to do the work! Of course, someone else such as the person the client is in a relationship might also want the change, and that is fine—but it can’t be the primary motivation.
Next, there must be a willingness and dedication to learning skills that can help. For example the client must be willing to practice the skills he or she learns from DBT. They have to understand: This is a not a quick fix, but the development of a pattern of life skills.

What advice do you have for family, friends and colleagues who are trying to cope with these behaviors and who, understandably, don’t want to feel attacked or manipulated?
Education is key.
Significant others must be aware of their part in interactions and reactions and must learn how best to respond. DBT is most effective if all family members are involved. Each person involved should practice a self care plan. It is so important for clients and family members to not point the finger at any one person.

Thanks for speaking to this topic.





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

Filed under bpd borderline borderline personality borderline personality disorder personality disorder personality disorder recovery education news research psychology psychiatry therapy sad sadness depression dsm character cbt cognitive cognitive behavioral cognitive behavioral therapy behavioral behavior brain mind body mental health mental illness

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Children who have lots of nightmares at risk of suffering hallucinations and psychosis as teenagersBy Daily Mail Reporter
At 12, nightmares tripled occurrence of psychotic symptoms later in life
For those between two and nine, psychosis was 56 per cent more likely
If they persist ‘they can be a sign of something more significant later in life’
Children who have lots of bad dreams and nightmares are at a greater risk of suffering psychosis, a study has shown.Research showed that for 12-year-olds, nightmares more than tripled the occurrence of psychotic symptoms such as hallucinations and delusions.And children aged between two and nine who were most plagued by bad dreams were 56 per cent more likely to experience later episodes of psychosis than those whose sleep was undisturbed.However, scientists have moved to reassure parents that nightmares are common in young children, and that they usually grow out of them.Lead researcher Professor Dieter Wolke, from the University of Warwick, said: ‘We certainly don’t want to worry parents with this news; three in every four children experience nightmares at this young age.'However, nightmares over a prolonged period or bouts of night terrors that persist into adolescence can be an early indicator of something more significant in later life.'The study, part of a wide-ranging health investigation called the Avon Longitudinal Study of Parents and Children (Alspac), recruited more than 6,700 children.By the age of 12, around a quarter of the group reported having nightmares in the previous six months.Fewer than one in 10 experienced night terrors, which are often signified by a loud scream and the individual sitting upright in a panicked state, though unaware of any of the involuntary action. Nightmares and night terrors are often confused but very different forms of sleep disturbance.The former tend to occur during the shallower REM (rapid eye movement) part of the sleep cycle, when most dreaming takes place.Night terrors happen during deep sleep, causing the unaware sleeper to sit bolt upright in a panicked state, thrash about or scream.The children were assessed six times between the ages of two and nine. Higher rates of nightmares during this period were found to increase the likelihood of psychosis.Children who reported persistent nightmares at only one of the assessment time points were 16 per cent more likely to experience adolescent psychotic episodes than those who had no nightmares.Three or more nightmare periods were associated with a 56 per cent increased risk.At 12 years of age the risk of psychosis was more than tripled by having nightmares and almost doubled by night terrors.Lucie Russell, from the charity YoungMinds, which campaigns to improve the mental health of children and young people, said: ‘This is a very important study because anything that we can do to promote early identification of signs of mental illness is vital to help the thousands of children that suffer.'Early intervention is crucial to help avoid children suffering entrenched mental illness when they reach adulthood.'


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

Children who have lots of nightmares at risk of suffering hallucinations and psychosis as teenagers
By Daily Mail Reporter

  • At 12, nightmares tripled occurrence of psychotic symptoms later in life
  • For those between two and nine, psychosis was 56 per cent more likely
  • If they persist ‘they can be a sign of something more significant later in life’


Children who have lots of bad dreams and nightmares are at a greater risk of suffering psychosis, a study has shown.
Research showed that for 12-year-olds, nightmares more than tripled the occurrence of psychotic symptoms such as hallucinations and delusions.
And children aged between two and nine who were most plagued by bad dreams were 56 per cent more likely to experience later episodes of psychosis than those whose sleep was undisturbed.
However, scientists have moved to reassure parents that nightmares are common in young children, and that they usually grow out of them.
Lead researcher Professor Dieter Wolke, from the University of Warwick, said: ‘We certainly don’t want to worry parents with this news; three in every four children experience nightmares at this young age.
'However, nightmares over a prolonged period or bouts of night terrors that persist into adolescence can be an early indicator of something more significant in later life.'
The study, part of a wide-ranging health investigation called the Avon Longitudinal Study of Parents and Children (Alspac), recruited more than 6,700 children.
By the age of 12, around a quarter of the group reported having nightmares in the previous six months.
Fewer than one in 10 experienced night terrors, which are often signified by a loud scream and the individual sitting upright in a panicked state, though unaware of any of the involuntary action.
Nightmares and night terrors are often confused but very different forms of sleep disturbance.
The former tend to occur during the shallower REM (rapid eye movement) part of the sleep cycle, when most dreaming takes place.
Night terrors happen during deep sleep, causing the unaware sleeper to sit bolt upright in a panicked state, thrash about or scream.
The children were assessed six times between the ages of two and nine. Higher rates of nightmares during this period were found to increase the likelihood of psychosis.
Children who reported persistent nightmares at only one of the assessment time points were 16 per cent more likely to experience adolescent psychotic episodes than those who had no nightmares.
Three or more nightmare periods were associated with a 56 per cent increased risk.
At 12 years of age the risk of psychosis was more than tripled by having nightmares and almost doubled by night terrors.
Lucie Russell, from the charity YoungMinds, which campaigns to improve the mental health of children and young people, said: ‘This is a very important study because anything that we can do to promote early identification of signs of mental illness is vital to help the thousands of children that suffer.
'Early intervention is crucial to help avoid children suffering entrenched mental illness when they reach adulthood.'



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

Filed under mental illness mental health mental illness health healthy unhealthy dream dreaming sleep diagnosis disorder dsm psychology psychiatry blog tumblr knafo psychosis psychotic schizophrenia bipolar depression child kid children teen teenager mind body

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The Peter Pan Effect of Psychiatric TreatmentBy Chrys Muirhead, Mad in America: Science, Psychiatry and Community
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



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

The Peter Pan Effect of Psychiatric Treatment
By Chrys Muirhead, Mad in America: Science, Psychiatry and Community

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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Annita Sawyer - Is Diagnosis Destiny?
Posted on the Yale University Youtube Channel

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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Filed under serious mental illness serious mental illness mental illness mental health health psychology psychologist psychoanalysis treatment psychotherapist therapist therapy psychotherapy psychiatrist psychiatry diagnosis diagnostic dsm dsm 5 dsm iv clinical psychology clinical psychological research science news suicide suicidal