Posts tagged dsm 5
Posts tagged dsm 5
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
For more mental health news, Click Here to access the Serious Mental Illness Blog
Avatars Ease Voices for Schizophrenia Patients
By Lorna Stewart
BBC Health Check
Use of an avatar can help treat patients with schizophrenia who hear voices, a UK study suggests.
The trial, published in the British Journal of Psychiatry, focused on patients who had not responded to medication.
Using customized computer software, the patients created avatars to match the voices they had been hearing.
After up to six therapy sessions most patients said their voice had improved. Three said it had stopped entirely.
The study was led by psychiatrist emeritus professor Julian Leff, who spoke to patients through their on-screen avatars in therapy sessions. Gradually he coached patients to stand up to their voices.
"I encourage the patient saying, ‘you mustn’t put up with this, you must tell the avatar that what he or she is saying is nonsense, you don’t believe these things, he or she must go away, leave you alone, you don’t need this kind of torment’,” said Prof Leff.
”The avatar gradually changes to saying, ‘all right I’ll leave you alone, I can see I’ve made your life a misery, how can I help you?’ And then begins to encourage them to do things that would actually improve their life.”
By the end of their treatment, patients reported that they heard the voices less often and that they were less distressed by them. Levels of depression and suicidal thoughts also decreased, a particularly relevant outcome-measure in a patient group where one in 10 will attempt suicide.
Treatment as usual
The trial, conducted by Prof Leff and his team from University College London, compared 14 patients who underwent avatar therapy with 12 patients receiving standard antipsychotic medication and occasional visits to professionals.
Later the patients in the second group were also offered avatar therapy.
Only 16 of the 26 patients completed the therapy. Researchers attributed the high drop-out rate to fear instilled in patients by their voices, some of which “threatened” or “bullied” them into withdrawing from the study.
New treatment options have been welcomed for the one in four patients with schizophrenia who does not respond to medication. Cognitive behaviour therapy can help them to cope but does not usually ease the voices.
Paul Jenkins, of the charity Rethink Mental Illness, said: “We welcome any research which could improve the lives of people living with psychosis.
"As our Schizophrenia Commission reported last year, people with the illness are currently being let down by the limited treatments available.
”While antipsychotic medication is crucial for many people, it comes with some very severe side effects. Our members would be extremely interested in the development of any alternative treatments.”
A larger trial featuring 142 patients is planned to start next month in collaboration with the King’s College London Institute of Psychiatry.
Prof Thomas Craig, who will lead the larger study, said: “The beauty of the therapy is its simplicity and brevity. Most other therapies for these conditions are costly and take many months to deliver.
”If we show that this treatment is effective, we expect it would be widely available in the UK within just a couple of years as the basic technology is well developed and many mental health professionals already have the basic therapy skills that are needed to deliver it.”
For more mental health-related news, Click Here to access the Serious Mental Illness Blog
[Article of Interest] Good Marriage Can Buffer Effects of Dad’s Depression On Young Children
Story reprinted from materials provided by University of Illinois College of Agricultural, Consumer and Environmental Sciences
What effect does a father’s depression have on his young son or daughter? When fathers report a high level of emotional intimacy in their marriage, their children benefit, said a University of Illinois study.
“When a parent is interacting with their child, they need to be able to attend to the child’s emotional state, be cued in to his developmental stage and abilities, and notice whether he is getting frustrated or needs help. Depressed parents have more difficulty doing that,” said Nancy McElwain, a U of I professor of human development.
But if a depressed dad has a close relationship with a partner who listens to and supports him, the quality of father-child interaction improves, she noted.
“A supportive spouse appears to buffer the effects of the father’s depression. We can see it in children’s behavior when they’re working with their dad. The kids are more persistent and engaged,” said Jennifer Engle, the study’s lead author.
In the study, the researchers used data from a subset of 606 children and their parents who participated in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development.
When their child was 4½ years old, parents ranked themselves on two scales: one that assessed depressive symptoms and another that elicited their perceptions of emotional intimacy in their marriage. Parents were also observed interacting with their child during semi-structured tasks when the children were 4½, then 6½ years old.
“At this stage of a child’s development, an engaged parent is very important. The son’s or daughter’s ability to focus and persist with a task when they are frustrated is critical in making a successful transition from preschool to formal schooling,” Engle said.
Interestingly, depressed mothers didn’t get the same boost from a supportive spouse.
That may be because men and women respond to depression differently, she added. “Men tend to withdraw; women tend to ruminate. We think that high emotional intimacy and sharing in the marriage may encourage a woman’s tendency to ruminate about her depression, disrupting her ability to be available and supportive with her children.”
Depressed men, on the other hand, are more likely to withdraw from their partners. “This makes emotional intimacy in the marriage an important protective factor for fathers,” McElwain said.
The study emphasizes the need for depressed parents to seek support, if not from their spouses, from friends, family, and medical professionals, she added.
[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.”
[Blog Post of Interest] The Big Chill: Psychiatric Medications Now Are on Trial For Murder
By Michael Cornwall, Ph.D. on Mad in America
Excerpt: The Canadian judge in the first North American criminal trial to find Prozac the sole cause of a murder ruled – “There is clear medical evidence that the Prozac affected his (defendant’s) behavior and judgment, thereby reducing his moral culpability.” Will those chilling words cause a small tremor in the writing hand of every prescriber of Prozac and other psychiatric medications from now on?
That Prozac verdict which is not going to be appealed by the District Attorney changes everything. The upcoming Utah Supreme Court trial where the court has already ruled that prescribers of psychiatric medications can be held responsible for the actions of their patients, adds to the huge shift in the landscape for anyone who prescribes.
[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.”