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

By Jamie Doward

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

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

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

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

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

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

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

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

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

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

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

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

(via artfromtheedge)

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

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

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.

Successful and Schizophrenic

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Article of Interest] Mind-Pops More Likely With Schizophrenia

By Ia Elua, Keith R. Laws, Lia Kvavilashvili

Excerpt: Mind-pops are those little thoughts, words, images or tunes that suddenly pop into your mind at unexpected times and are totally unrelated to your current activity. These involuntary ‘mind-pops’ have become a topic of scientific study only recently even though they were described long ago by novelists such as Vladamir Nabokov.

Almost everyone reports experiencing mind-pops at some time or another, but some experience them more than others according to research conducted by the University of Hertfordshire. In the paper to be published in Psychiatry Research, findings suggest that mind-pop experiences are related to hallucinations in those people suffering from schizophrenia.

[This study] found that all 100% schizophrenia patients reported experiencing mind-pops, compared to 81% of the depressed patients and 86% of the mentally healthy individuals. In addition, schizophrenia patients experienced mind-pops significantly more frequently than depressed patients and mentally healthy people. Professor Laws added: “Mind-pops were more common both in patients who had experienced hallucinations in the past and in those who were currently experiencing hallucinations.”

[Article of Interest] Recent developments in borderline personality disorder

By Anthony P. Winston

Excerpt: Despite many unanswered questions, recent developments give grounds for optimism. It is now difficult to sustain the view that all borderline patients are untreatable. Psychoanalysis, cognitive therapy and empirical research are converging, and a coherent aetiological model of the disorder is beginning to emerge. The outlook for this challenging group of patients may be starting to improve.

The apparent success of brief therapies is somewhat at odds with the view held by many clinicians that borderline patients benefit from a relatively prolonged relationship with a therapist or therapeutic team. This view is consistent with the evidence for disordered attachment in BPD, which suggests that a stable therapeutic attachment may be helpful in allowing patients to develop psychologically in a more functional way.

[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. 

Dopamine: Duality of Desire

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.

[Article of Interest] Mental illness link to art and sex

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.

[Article of Interest] “Families and First Break: An Evolving Role” – Ron Bassman, Karyn Baker & Connie Packard

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.