Posts tagged mental
Posts tagged mental
[Article of Interest] Mental Health Disorders among Australian Parents on the Rise
By Miriam Hall
A new study has found the number of parents with mental illness increased by three per cent every year between 1990 to 2005 [in Australia].
The study, published in the Medical Journal of Australia, is the first of its kind in Australia, based on 15 years of data from Western Australia.
Lead author of the report, Dr Melissa O’Donnell from the University of WA, said she was not surprised by the results.
”We know that welfare agencies and hospitals had recorded a rise in the number of families needing support for parents with mental health problems,” she said.
“(We know) that the cases had become more complex with co-morbidities for mental health disorders and substance use as well.
“So that, in effect, we weren’t really that surprised.”
The disorders in the study included illnesses like psychosis, substance-related abuse and stress disorders, but not post-natal depression.
Dr O’Donnell says the rise in numbers could be explained by better and more frequent diagnoses.
”We are seeing broader services available, so I guess more people are able to access services for in and out-patients,” she said.
“Therefore more parents would get a diagnosis, and that’s what we based our data on.”
But the study also found a rise in the numbers of parents with specific types of mental illness.
”We are seeing more parents in our data that had stress and adjustment related disorders… as well as an increase in parents with substance use mental health disorders,” she said.
Dr Melissa O’Donnell says the mental health of a parent can have a significant impact on families and the increasing figures highlight the need for early intervention.
“We do know that there is increase in expenditure in this area, but it’s really important that we target it to those at risk families,” she said.
”Having early intervention and treatment and support available to families, particularly when they do need respite or support in their parenting, that’s really important.”
Lead report author, Vera Morgan from the University WA, also believes there needs to be a targeted approach to providing support to mentally ill parents.
”We know a lot of these parents are subject to very poor socio-economic conditions, they have low education outcomes, low employment, and putting them close to the poverty line, and they have accommodation issues,” she said.
“They actually need support with these very specific areas as well as support in the area of raising their children.”
Ms Morgan says the Government needs to prioritise agencies.
”Although there was some support in the very recent budget, there’s always a lot more room that needs to be there for providing services,” she said.
Impact on children
Psychiatrist Dr Nick Kowalenk, from Children of Parents with a Mental Illness, says there are specific developmental issues for children who have mentally ill parents.
”Usually for kids…. who are five, six, seven, they’re affected to the extent that they can lose a bit of confidence when their parents are depressed,” he said.
”We’ve got some Australian evidence which shows that school readiness is impacted when mum or dad is depressed.
“If parents have substance abuse problems and those sorts of issues and addictions, that’s also not a good thing for kids and they tend to have a whole lot more behavioral problems and some difficulties.”
He says mental illness in parents is a hidden problem and there needs to be more support.
“The issue of kids is one that’s not always addressed that well,” he said.
“For example with Beyond Blue and in conjunction with the states, the Federal Government’s had a National Perinatal Depression Initiative, which is pretty much established Australia-wide early identification of mental health problems for mums about to give birth and for mum soon after giving birth.
”It hasn’t included dads yet, and it hasn’t really had quite enough attention to infants and making sure that their health and wellbeing is maintained even when mum or dad have a mental health problem.”
[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.”
[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.
[Article of Interest] Mental Illness a Frequent Cell Mate for Those Behind Bars
By Amanda Gardner
Former inmate describes efforts to stay emotionally healthy after his release
Eugene King ran away from home at the age of 16, the start of a lifelong pattern of drug abuse, crime and incarceration.
In retrospect, King said, he realizes he was using illicit drugs at least in part to self-medicate a variety of psychiatric conditions. But he also realizes that prison, with its lack of adequate medical treatment and what he called a generally abusive environment, only made his problems worse.
“It exacerbated [the mental illness] without a doubt,” said King, now 62.
That King’s mental health, already precarious, only worsened in prison is not an unusual story.
According to a recent study published in the Journal of Health and Social Behavior, the link between prison time and mental illness is a two-way street. Although many incarcerated people exhibit such problems as impulse control disorders — which normally first appear in childhood or adolescence — before they enter the correctional system, incarceration itself seems to cause major depression.
And this may help explain why so many inmates have trouble re-entering society when they are released, said the authors of the study.
“Prison made them depressed and that depression undermined their ability to re-enter — made it hard to find a job, hard to be motivated — and this is precisely the time they need to be motivated,” said lead author Jason Schnittker, an associate professor of sociology at the University of Pennsylvania. “We think that mood disorders are an important barrier to re-entry.”
According to background information included in the study, about 16 million people — or 7.5 percent of the U.S. population — are felons or ex-felons.
Meanwhile, people in prison have up to six times the rate of significant mental illness as the general population, said Dr. Spencer Eth, a professor of psychiatry and behavioral sciences at the University of Miami Miller School of Medicine. Eth also treats inmates at a local jail.
And although it has long been suspected that prison aggravates pre-existing psychiatric problems, experts have had trouble untangling this chicken-and-egg question, especially given that early childhood experiences are linked to both incarceration and mental illness.
For the study, Schnittker and his co-authors looked at a national database of nearly 5,700 men and women to assess both the prevalence of psychiatric disorders and any time spent in jail or prison.
Their conclusion? Incarceration was associated with a 45 percent increase in the risk of having depression.
The findings did have some limitations, namely that the authors couldn’t control for all other factors that might affect the incidence of depression. And because it’s so difficult to conduct studies in prison populations, it’s possible that the data did not pick up on worsening of conditions other than depression, said Eth, who was not involved with the study.
The data were also at least a decade old, Eth said, even though “it’s likely that if the study were to be repeated now there would be similar findings.”
Although the study authors advocate for more treatment while people are in prison and before being let out onto the streets, in reality conditions in correctional facilities are often pitiful, said Eth, echoing King’s sentiments.
“There’s very, very little treatment available to people who are in jails and prisons. At most, it’s medication, and for many conditions it’s nothing at all. It’s terrible,” Eth said. “If you didn’t have a serious mental illness going in, the conditions of jails and prisons are so deplorable, you’d have to be a hardy soul not to be depressed or worse.”
Unfortunately, psychiatric treatment for ex-offenders “on the outside” is also limited, said JoAnne Page, president and CEO of the Fortune Society in New York City, which helps individuals re-enter society after prison.
“We couldn’t get people into mental-health treatment in the community when it was available, and it’s less available than it used to be,” Page said.
In 2011, the Fortune Society, which already provided housing and other services for ex-offenders, opened its Better Living Center, which they said is the first agency in New York City to cater exclusively to individuals with a criminal history.
“Most of our people come to us after their release when we have a window of time,” Page said. “There’s a hopefulness that things could be different. It’s a wonderful time to work with people if you give them a fighting chance.”
It is through this Better Living Center that King got his chance. He now takes medication every day and sees a therapist weekly for bipolar disorder, post-traumatic stress disorder and depression.
“I have access to excellent mental-health treatment now and I’m also mindful of the fact that there are [many] prison inmates who could benefit from the same level of care, or something close to it,” King said. “Last week was my last day on parole. Over 25 years, I have been living on this cloud either in prison or on supervision. I am no longer. I am totally free.”
[Article of Interest] Side Effects of Mental Illness Drugs Cause Sudden Death
by Kerri Knox, RN
Schizophrenia is a scary and difficult chronic mental illness- both for the person and for their family who all have to live with the diagnosis. In most cases, antipsychotic medications need to be taken forever to control the disturbing symptoms. But rarely is anyone told that these medications not only double the risk of sudden cardiac death, but also put the sufferer at risk for several other chronic illnesses as well.
The severe mental condition that has been termed schizophrenia is NOT the ‘multiple personality disorder’ that many think of when they hear the term, but is a different mental illness characterized by bizarre behaviors like paranoia, hearing voices, and having hallucinations. It is often acquired after a stressful life event and occurs swiftly and unpredictably in what is known as a ‘psychotic break’. This is devastating for the patient and their family who suddenly have to live with a diagnosis of mental illness. And that is just the first step in a life filled with doctors, hospitals, medications and psychiatrists- with little hope to ever really have a normal life again.
Schizophrenia and a handful of medications forever
There is no ‘cure’, in traditional medicine, for Psychosis; and a prescription for one or more ‘antipsychotics’ with names like Haldol and Risperdal, along with a cocktail of other drugs often prescribed for anxiety, depression and sleep are frequently on the menu. But what these people are rarely, if ever, told about are the long term side effects of these drugs. While doctors are ever prescribing anticholesterol ‘statins’, aspirin and blood pressure medications in order to achieve a 1 - 2% reduction in heart disease, they are knowingly giving schizophrenic individuals, who generally get their first psychotic break as a teenager or young adult, a shortened lifespan from the medications that they are prescribing.
In the research available on these drugs, it is well known that Sudden Cardiac Death is a ‘side effect’ of antipsychotic medications. In fact, these medications DOUBLE the risk of sudden cardiac death. In the beginning, however, it does not give them the “heart disease” of clogged arteries that we associate with heart attacks. The immediate risk of antipsychotics is that they give sufferers a high risk for a very specific disorder called ‘Prolonged Q-T interval’.
Prolonged Q-T Interval gets its name from the prolonged time that it takes for the electrical activity of the heart to return to normal after each heartbeat. But this extra time isn’t measured in minutes or seconds, but in hundredths of a second- making it difficult to diagnose. But this extra millisecond can have the devastating consequence of putting the taker of these medications into an abnormal cardiac rhythm called Ventricular Fibrillation- which will quickly lead to death without immediate emergency care. And this will come on without pain, shortness of breath or any of the other ‘warning signs’ of a heart attack because it is not clogged arteries that are the problem, but the electrical system that is the primary problem.
Even worse, antipychotics don’t just put people into your vanilla, standard everyday Ventricular Fibrillation that generally responds well to the dramatic ‘paddles on the chest, everybody get away from the patient and shock them’ type of defibrillation that you see on television. It actually puts them into a very specific TYPE of Ventricular Fibrillation called Torsades de Pointes, that doesn’t change to a normal rhythm with the shocks and heart starting medications that are the ‘standard protocol’ for restarting the heart. Instead, ‘Torsades’ requires an immediate infusion of intravenous magnesium. As hospitals and emergency rooms have magnesium at hand, this shouldn’t be such a hard thing to do; but unfortunately, Torsades de Pointes is fairly rare and is difficult to recognize, so in many cases it is not even considered until the shocks and CPR are not working- and by then it is often too late for the magnesium to be effective.
But wait, there’s more…
Not only do antipsychotics double the risk of deadly heart rhythms, but they ALSO increase the risk of getting diabetes, high blood pressure, high cholesterol and obesity- which are risk factors for ‘regular’ heart disease complete with clogged arteries, angioplasty and open heart surgery. Fortunately, true psychosis is rare- so doctors don’t prescribe these dangerous medications unless they are absolutely necessary… right?
Unfortunately, this is not the case at all. In fact, over 200,000 people in the US are newly diagnosed each year and hundreds of thousands of prescriptions for antipsychotics are written every year. They are being given to adolescents, children and even preschoolers as young as two years old. Most of these are prescribed by primary physicians without the child having even had an evaluation by a psychiatrist. And almost half were written, not for schizophrenia as they are intended, but for ADD and ADHD for which the drugs have never even been tested!
“Rates of (doctor’s office) visits that resulted in a psychotropic prescription increased from 3.4 percent in 1994-1995 to 8.3 percent in 2000-2001. By 2001, one out of ten office visits by adolescent males resulted in a prescription for a psychotropic medication.” Trends in the use of psychotropic medications among adolescents, 1994 to 2001.
So, while researchers who study the cardiac death risk profile of antipsychotic drugs are advocating “sharp reductions” in the use of these agents- doctors are ignoring this advice and are steadily increasing the number of antipsychotic drugs prescribed each year. These patients, who are often children and teens without true schizophrenia, will somehow have to deal with several chronic health conditions that will not only shorten their lives, but decrease the quality of a life already made more difficult by mental illness.
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.
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[Article of Interest] “Stigma” of Mental Illness a Setback for Patients, Society
As posted on CBSnews.com
We don’t know what drove the gunman in Newtown to kill, and the fact is 95 percent of violence is committed by people who are not mentally ill. Even so, the shooting has put a spotlight on mental illness. All too often, the stigma attached to it keeps people from getting diagnosed and treated.
Four years ago, Zac Pogliano was a fun-loving teenager. He had plenty of friends and played in a rock band. His mother Laura remembers when he suddenly became paranoid.
“I would come home and bang on my own door after work every day, ‘Please let me in. It’s your mom. It’s your mom.’ And finally, I would crawl through my window,” she says.
“He would lock me out. And then one day, horribly, literally, he opened the door to me and I could tell by the look on his face that he did not know who I was.”
Eventually, Zac made a confession.
“He said, ‘Did you know I’ve been hearing voices for a year?’ … I said ‘My darling, why would you not tell your own mother? I would never turn away from you.’ He said, ‘Because no one wants a crazy person.’”
Zac’s fear of telling anyone about the voices delayed his diagnosis. He had schizophrenia. He still loves music, but the disease has forced him to put his life on hold. He’s been hospitalized several times.
Zac says the voices were criticizing him. “I can tell you it was a man voice and woman voice, picking on me,” he says.
Schizophrenia usually strikes young adults between the ages of 16 and 30. Not only can they hear voices, they may also suffer from visual hallucinations, delusions and extreme paranoia.
Zac can appear robotic and emotionless. Those are symptoms of the disease. The medication he takes can worsen those symptoms and also cause weight gain.
Zac agrees that there is a stigma attached to mental illness. “People will judge you, especially after someone gets assaulted by a crazy guy. I could be that crazy guy,” he says. Zac has never been violent.
While about 95 percent of violence is committed by people with no serious mental illness, those with schizophrenia are two to four more times more likely to commit violence than the average person. Studies have shown that proper treatment significantly lowers that risk.
Five days a week, Zac goes to an outpatient treatment program at Johns Hopkins Bayview Medical Center in Baltimore.
“We need to look at Zac every single day, we need to make sure that he’s taking medicine because that makes him think clearly,” says Krista Baker, his therapist. “The longer that we can get Zac to be doing well, the better the prognosis he has.”
Zac says he feels like he’s on the right track.
”I’m a 21-year-old man and I would like to have a steady life with a job and maybe a family some day.”
His mother, Laura, says her biggest misconception was that she could “fix it. That if I tried hard enough, he would regain his health. And he would be exactly like he was; and that’s very hard to accept.”
The stigma attached to mental illness continues to be a huge barrier and delay to early diagnosis and treatment.
The creators of the Serious Mental Illness blog invite you to submit your visual art, music, photography, crafts, video work, poetry, collage, or short fiction to Art from the Edge.
Art from the Edge, a virtual gallery and resource center, is dedicated to art created in and about extreme mental states. It is an open and public world wide forum for artists to share their visual and written works and their personal stories with all those interested in the connection between creativity and “edge” states.
Much like art, which exists in a multitude of mediums and forms of expression, there are a plurality of “edge” states that inspire the artists who harbor them. For this reason, we leave the term completely open to our community’s interpretation, knowing from research and experience that this state could be driven by psychosis or trauma, or an altered state induced by drugs. It could be the offshoot of extreme depression or grief, or the aftermath of a spiritual or mystical state of consciousness.
Ultimately, we are interested in the artist’s individual experience and in his or her sense of what it is that drove the creative act.
[Article of Interest] I’m Elyn Saks and this Is What It’s Like to Live with Schizophrenia
By George Dvosky
Elyn Saks first started noticing that something was wrong when she was 16. One day, and without reason, she suddenly left her classroom and started walking home. It turned into an agonizing journey in which she believed all the houses in her neighborhood were transmitting hostile and insulting messages directly into her brain. Five years later, while attending law school at Oxford, she experienced her first complete schizophrenic break. Saks struggled over the course of the next decade, but she came through thanks to medication, therapy, and the support of friends and family.
Schizophrenia as a health condition is as neglected as it’s misunderstood. People tend to get squeamish when it comes to mental illness, convincing themselves that it’s not a wide scale problem, or that people who suffer from it are lost causes. At the same time, many people cling to outdated notions about the disorder.
Indeed, schizophrenia is not as rare as some people think. It has been estimated that anywhere from 0.3 to 0.7 percent of the population is afflicted with it. For a country like the United States, that’s anywhere from 940,000 to 2,200,000 people. And the costs are enormous, estimated at $62.7 billion per year in the U.S. alone. Yet, schizophrenia receives only a small fraction of the amount of medical research dollars that go into other serious diseases and disorders.
It’s also commonly mistaken for multiple personality disorder, what’s now referred to as dissociative identity disorder (DID). These two conditions are distinct, though some crossover exists; DID patients sometimes exhibit psychotic symptoms. Also, both DID and schizophrenia can be triggered by traumatic experiences. But that’s where the similarities end.
Another common misconception about schizophrenia is that people who suffer from it are extremely violent.
“And that’s just not true,” says Saks. “Most people with schizophrenia are less violent, but are more likely to be victimized.” The big, violent folks, added Saks, tend to be teenage males and substance abusers.
There’s also a misconception that all people with schizophrenia can’t hold down a job, and that they lose the ability to work in any kind of meaningful way. Or that they can’t live independently, that they need some kind of supervised living arrangement.
Like many other psychological disorders, schizophrenia follows along a spectrum in terms of its severity. While many people can become incapacitated by their symptoms, Saks argues that most of them could benefit from drugs and therapy.
And indeed, Saks is convinced that there are more “high functioning” people with schizophrenia than is typically assumed. To that end, she, along with her colleagues at UCLA and USC, designed a study to recruit high functioning people with schizophrenia in the LA area. Specifically, they were looking to study professionals, a group that included MDs, PhD candidates, teachers, CEOs, and full-time students.
“I mean, we got 20 subjects fairly quickly,” she told me, “I started to suspect that I wasn’t unique, that there were many other people like me. It would interesting to know what the stats are on how many people with schizophrenia are so-called “high functioning” professionals.”
Moreover, Saks is convinced that, with proper resources, nearly everyone can live up to their potential — regardless of their situation or status.
“There are going to be some people who you do everything for and they still won’t be able to thrive,” she says, “But I think many more people can do better than we give them credit for — but instead, we prematurely tell people to lower their expectations.”
Indeed, antipsychotic medications have revolutionized the treatment of schizophrenia — and they work startling well. “A lot of people get on medication and they completely recover and never require therapy,” says Saks. But there are some people who don’t respond to medication — and that, she argues, is where therapy and social support could potentially help.
“The best evidence with major mental illness shows that the most effective strategy is to use a combination of meds and a therapy for choice,” says Saks. “For me, I know I need the therapy and the medication. I need both of them. If one of them were to go away I would probably be really compensated.”
Saks is currently in psychoanalytic treatment, where she attends sessions five days a week. And by doing so, she’s going against the grain; conventional wisdom says psychoanalytic treatment shouldn’t work for people with psychosis. But she’s convinced it’s helping.
Saks told me about several aspects of psychoanalytic treatment that have been tremendously beneficial for her — and they’re not typical things that psychoanalysts do.
For example, because stress is particularly bad for psychiatric illnesses, Saks has been taught to identify her stressors and avoid them. Or cope with them at the very least. She has also learned to bolster her “observing ego” — that part of her brain which allows her to step back and observe her mind, feelings, and thoughts in order to understand them and not get swept up.
“It’s also a place where you can bring your thoughts,” she says. “A lot of therapists have a rule where their patients cannot articulate their delusions or hallucinations — but to me you need to have a place where you can do that, where it’s safe. It’s sort of like a steam valve. I don’t have to do it in my outside world, I have a place where I can do it in therapy.”
Another important thing, says Saks is insight.
“People have different theories about psychotic symptoms,” she says. “Some people think they’re just the random firing of neurons that don’t have any meaning. But I think they have meaning and that they tell you some truth about your psychological reality. So, when I say I’ve killed hundreds of thousands of people, it’s really an archaic way of saying I feel like a very bad person. But even though it’s meaningful in this sense, it doesn’t help patients in the moment of the psychotic symptoms that they interpret.”
Saks believes that extreme and exaggerated ideations are a defense mechanism — which in some circumstances can make a person feel better or safe.
Saks closed our conversation by noting that, outside of medications and drugs, it’s people who can make the greatest impact.
“It’s so important to have a benign, smart, caring, non-judgmental person that accepts you — not only for the good — but for also the bad and the ugly,” she said, “That is incredibly empowering.”
[Video of Interest] Simon Kyaga - Genius and Madness
Simon Kyaga, MD, of the Karolinska Institute in Stockholm, and colleagues conducted a nested case-control study that included 1,173,763 participants enrolled in the Swedish total population registries. The researchers compared patients diagnosed with psychiatric disorders and their healthy relatives to the general population. Scientific and artistic occupations were defined as creative professions. These included dancers, photographers, researchers and authors, for example. Diagnoses of psychiatric disorders were based on the International Classification of Diseases.
In this study, those in overall creative professions were not more likely to have psychiatric disorders, with the exception of bipolar disorder. However, authors were more than twice as likely as controls to have schizophrenia (OR=2.09; 95% CI, 1.35-3.23) and bipolar disorder (OR=2.21; 95% CI, 1.50-3.26). This population was also more likely to be diagnosed with unipolar depression (OR=1.54; 95% CI, 1.30-1.81), anxiety disorders (OR=1.38; 95%CI, 1.03-1.86), alcohol abuse (OR=1.47; 95% CI, 1.25-1.74), drug abuse (OR=1.53; 95% CI, 1.09-2.16) and to commit suicide (OR=1.49; 95% CI, 1.08-2.05).
Consistent with their earlier research, Kyaga and colleagues found that first-degree relatives of patients with schizophrenia, bipolar disorder, anorexia nervosa and, to a lesser degree, autism were significantly overrepresented in creative professions.
According to the researchers, the results have important clinical implications: “If one takes the view that certain phenomena associated with the patient’s illness are beneficial, it opens the way for a new approach to treatment,” Kyaga said in a press release. “In that case, the doctor and patient must come to an agreement on what is to be treated, and at what cost. In psychiatry and medicine generally there has been a tradition to see the disease in black-and-white terms and to endeavor to treat the patient by removing everything regarded as morbid.”
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.
[Special Announcement] The 2013 Psychological Therapies for Psychosis International Conference
Mission: ISPS is an international organization promoting psychotherapy and psychological treatments for persons with psychosis. We are committed to advancing education, training and knowledge of mental health professionals in the treatment and prevention of psychotic mental disorders. We seek to achieve the best possible outcomes for service users by engaging in meaningful partnership with health professionals, service users, families and carers.
Throughout the world the cycle is turning more and more towards exploring the multitude of ways in which psychology is relevant to psychosis, from understanding early experiences and their effects on mind and brain, to trauma, to the psychology of stigma, and we could add here a very long list but emphasise our particular conference focus on the psychological therapies of many kinds relevant to psychosis.
We encourage you to come and participate, to consider offering a paper of your own, or organize a symposium and join in the lively discussions and we guarantee you will return home enriched and enthused.
Having visited Warsaw, we can both vouch for the excellence of the conference facilities in the old University which is alongside the beautifully rebuilt 13th - 15th century historical centre of Warsaw which truly deserves its UNESCO heritage site status. As well as beautiful buildings, the area is packed with street cafes, restaurants and musical entertainment and there is plenty of accommodation at this time of year.
We look forward to welcoming you alongside our Polish hosts.
[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.
By Lynda Tait, PhD; Max Birchwood, DSc; Peter Trower, PhD
Excerpt of the Article: In contrast to earlier views of recovery style as a stable trait characteristic, recent evidence suggests that recovery style can change over time […] Recovery style has been identified as an important factor in adjustment to psychosis.
This [study] supports the view that a functional sense of self or identity is an important resilience factor in recovery from psychosis, and in facilitating coping efforts.
[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.”