Serious Mental Illness Blog

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The Play that Wants to Change the Way we Treat Mental IllnessBy Laura Barnett, The Guardian
The Eradication of Schizophrenia in Western Lapland is based on a new approach called ‘open dialogue’, and replicates the experience of having an auditory hallucination.
Can theatre offer a cure for psychosis? It’s unlikely – and it would be unwise for any theatre-maker even to try. What theatre can do, though, is convey the experience of psychosis: the hallucinations and delusions – often terrifying, sometimes comical – that define reality for those withschizophrenia and related conditions.
This, at least, is the belief shared by David Woods and Jon Haynes, co-founders of the theatre company Ridiculusmus. Their new show, The Eradication of Schizophrenia in Western Lapland, examines the effects of psychosis on several members of a fictional family, using an innovative conceit. The audience is split in two, with each half sitting on either side of a dividing wall. For the first act, each half of the audience watches one scene, while another scene is performed on the other side. Later, the audiences swap places; and in the final section, the wall becomes transparent, so that both halves of the audience are watching the same scene.
The effect, at least at first, is bewildering – and that is the point. “It’s as if you’re having auditory hallucinations,” Woods tells me when we meet during rehearsals at the Basement in Brighton, where the play is beginning a national tour. “Initially it’ll be overwhelming, chaotic. Then the audience will go out of the theatre, change sides. Slowly the voices will settle into place. In a way, it’s the same with schizophrenia. You don’t get cured, but you can recover.”
Woods and Haynes know more about schizophrenia and psychosis than most. Haynes was sectioned in the mid-80s, and spent six months as a patient in London’s Maudsley Hospital; Woods was a carer for several family members with mental health problems. It was this that first drew them towards making a show about mental illness: a series of early improvisations on the subject of family (the company devise all their work through improvisation and extensive research) threw up memories from their own pasts.
They contacted the Tavistock clinic in London, where they took part in a workshop on child carers for adults with mental health issues. It was there that they first learned about "open dialogue": a revolutionary approach to the treatment of psychosis that has, over the past few decades, virtually eradicated the condition in Western Lapland, the area of Finland where it originated.
Intrigued, Woods and Haynes travelled to the Keropudas hospital in Tornio, Finland, where Dr Jaakko Seikkula first evolved the method - and were so struck by what they found that they decided to make open dialogue the key subject of their show. “I thought: ‘Wow, this is wonderful,’” Haynes explains. “I can imagine that if we’d had this kind of approach [in the UK] years ago, things might have been very different for me. When I was ill, I remember feeling very much that I was the problem. With open dialogue, that’s not at all how the patient feels.”
Open dialogue is, as the name suggests, a treatment based on talking rather than medicating, and on intervening as early as possible in a psychotic episode. Families are directly involved in the patient’s therapy, with the aim of identifying the skewed dynamics, or other sources of emotional tension, that may have caused the patient’s crisis. “The idea,” Seikkula tells me over Skype, “is to organise the psychiatric system in a way that makes it possible to meet immediately in a crisis, and work very intensively together with the family.”
The statistics on open dialogue are startling: according to a 2003 study conducted at Keropudas hospital, 82% of patients who were given open-dialogue treatment had no, or mild, psychotic symptoms after five years, compared to 50% in a comparison group. The method has attracted international attention – in 2011, Seikkula helped found the Institute for Dialogic Practice in Massachusetts, to take open dialogue to the US. But it still remains far from the mainstream in many countries, including the UK.
The Eradication of Schizophrenia in Western Lapland has open dialogue as an underlying theme, inherent in the idea of an audience listening to a family’s experience of psychosis, much as a psychiatrist might do during an open-dialogue session. Each scene begins with a group of disembodied voices describing the principles of the method, and the psychiatrist character in the play mentions the fact that a colleague in the NHS has been struck off for using open dialogue in the place of anti-psychotic medication.
Haynes and Woods’ key aims are to raise awareness of open dialogue, and to dispel the wider stigma surrounding schizophrenia. “I would hope,” Woods says, “that people who see the show would start listening: talking to each other rather than just barging their way through life. And that they would realise that there is a lot more to schizophrenia than just the tiny minority who go out and stab somebody with a knife.”
Seikkula, too, believes that a piece of theatre such as this has a powerful role to play in expressing what he, and other practitioners of open dialogue, consider the fundamental definition of psychosis. “Psychosis belongs to life,” he says. “In my mind, we can all have hallucinations. If we are in a stressful enough situation, each of us can react in that way. This play gives people a very concrete experience of how that really is.”
The Eradication of Schizophrenia in Western Lapland is touring the UK. See ridiculusmus.com for full details.

For more information on Open Dialogue, see opendialogueapproach.co.uk

 


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The Play that Wants to Change the Way we Treat Mental Illness
By Laura Barnett, The Guardian

The Eradication of Schizophrenia in Western Lapland is based on a new approach called ‘open dialogue’, and replicates the experience of having an auditory hallucination.

Can theatre offer a cure for psychosis? It’s unlikely – and it would be unwise for any theatre-maker even to try. What theatre can do, though, is convey the experience of psychosis: the hallucinations and delusions – often terrifying, sometimes comical – that define reality for those withschizophrenia and related conditions.

This, at least, is the belief shared by David Woods and Jon Haynes, co-founders of the theatre company Ridiculusmus. Their new show, The Eradication of Schizophrenia in Western Lapland, examines the effects of psychosis on several members of a fictional family, using an innovative conceit. The audience is split in two, with each half sitting on either side of a dividing wall. For the first act, each half of the audience watches one scene, while another scene is performed on the other side. Later, the audiences swap places; and in the final section, the wall becomes transparent, so that both halves of the audience are watching the same scene.

The effect, at least at first, is bewildering – and that is the point. “It’s as if you’re having auditory hallucinations,” Woods tells me when we meet during rehearsals at the Basement in Brighton, where the play is beginning a national tour. “Initially it’ll be overwhelming, chaotic. Then the audience will go out of the theatre, change sides. Slowly the voices will settle into place. In a way, it’s the same with schizophrenia. You don’t get cured, but you can recover.”

Woods and Haynes know more about schizophrenia and psychosis than most. Haynes was sectioned in the mid-80s, and spent six months as a patient in London’s Maudsley Hospital; Woods was a carer for several family members with mental health problems. It was this that first drew them towards making a show about mental illness: a series of early improvisations on the subject of family (the company devise all their work through improvisation and extensive research) threw up memories from their own pasts.

They contacted the Tavistock clinic in London, where they took part in a workshop on child carers for adults with mental health issues. It was there that they first learned about "open dialogue": a revolutionary approach to the treatment of psychosis that has, over the past few decades, virtually eradicated the condition in Western Lapland, the area of Finland where it originated.

Intrigued, Woods and Haynes travelled to the Keropudas hospital in Tornio, Finland, where Dr Jaakko Seikkula first evolved the method - and were so struck by what they found that they decided to make open dialogue the key subject of their show. “I thought: ‘Wow, this is wonderful,’” Haynes explains. “I can imagine that if we’d had this kind of approach [in the UK] years ago, things might have been very different for me. When I was ill, I remember feeling very much that I was the problem. With open dialogue, that’s not at all how the patient feels.”

Open dialogue is, as the name suggests, a treatment based on talking rather than medicating, and on intervening as early as possible in a psychotic episode. Families are directly involved in the patient’s therapy, with the aim of identifying the skewed dynamics, or other sources of emotional tension, that may have caused the patient’s crisis. “The idea,” Seikkula tells me over Skype, “is to organise the psychiatric system in a way that makes it possible to meet immediately in a crisis, and work very intensively together with the family.”

The statistics on open dialogue are startling: according to a 2003 study conducted at Keropudas hospital, 82% of patients who were given open-dialogue treatment had no, or mild, psychotic symptoms after five years, compared to 50% in a comparison group. The method has attracted international attention – in 2011, Seikkula helped found the Institute for Dialogic Practice in Massachusetts, to take open dialogue to the US. But it still remains far from the mainstream in many countries, including the UK.

The Eradication of Schizophrenia in Western Lapland has open dialogue as an underlying theme, inherent in the idea of an audience listening to a family’s experience of psychosis, much as a psychiatrist might do during an open-dialogue session. Each scene begins with a group of disembodied voices describing the principles of the method, and the psychiatrist character in the play mentions the fact that a colleague in the NHS has been struck off for using open dialogue in the place of anti-psychotic medication.

Haynes and Woods’ key aims are to raise awareness of open dialogue, and to dispel the wider stigma surrounding schizophrenia. “I would hope,” Woods says, “that people who see the show would start listening: talking to each other rather than just barging their way through life. And that they would realise that there is a lot more to schizophrenia than just the tiny minority who go out and stab somebody with a knife.”

Seikkula, too, believes that a piece of theatre such as this has a powerful role to play in expressing what he, and other practitioners of open dialogue, consider the fundamental definition of psychosis. “Psychosis belongs to life,” he says. “In my mind, we can all have hallucinations. If we are in a stressful enough situation, each of us can react in that way. This play gives people a very concrete experience of how that really is.”

The Eradication of Schizophrenia in Western Lapland is touring the UK. See ridiculusmus.com for full details.

For more information on Open Dialogue, see opendialogueapproach.co.uk

 





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Filed under mental illness mental health mental illness health healthy wellness schizophrenia psychosis psychotic mind body brain theater play art artist creative news diagnosis disorder hallucination hallucinations recovery mad madness playwright playwriting psychology psychiatry

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Mentally Ill Patients Are More Likely to End Up in Jail Rather than a Hospital
By Justin Caba, Medical Daily
Left untreated, an individual with a serious mental illness is likely to suffer further as their symptoms worsen, and their perception of the world around them gets more and more out of touch. 
A recent survey conducted by the Treatment Advocacy Center (TAC) and the National Sheriffs’ Association has found that patients with a severe mental illness are ten times more likely to end up in a state prison rather than a state mental hospital.
“The lack of treatment for seriously ill inmates is inhumane and should not be allowed in a civilized society,” lead researcher and founder of the Treatment Advocacy Center, Dr. E. Fuller Torrey, said in a statement. “This is especially true for individuals who – because of their mental illness – are not aware they are sick and therefore refuse medication.” 
Torrey and his colleagues from both the TAC and the National Sheriff’s Association probed the records of state run prisons and mental hospitals in discovering where the majority of patients with a psychiatric illness end up. Unfortunately, jails and prisons are considered the largest institutions housing individuals with a serious mental illness. Findings revealed that only 35,000 patients with a mental illness are being kept in a hospital setting compared to 356,000 who currently reside in a prison or jail cell.
Researchers called the outcome of mistreatment experienced by some mentally ill inmates “usually harmful and sometimes tragic.” Due to their erratic or disruptive behavior, many inmates with a psychiatric disorder are at danger to being beaten, raped, self-mutilated, or suicidal. Mentally ill inmates also run the risk of being thrown into solitary confinement or having physical restraints placed on them for most of their day. Although moving inmates with a serious mental illness to a more suitable institution would be in their best interest, the research team said states and counties would also benefit from the funds that would be saved on corrections.
According to the National Alliance on Mental Illness, upward of 13.6 million adults in the United States are currently living with a serious mental illness. Many Americans may be surprised to find out what exactly is included as a serious mental illness. Major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), and borderline personality disorder all fall under the category of serious mental illness. One in four Americans experiences a mental illness in a given year. 

 

 


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Mentally Ill Patients Are More Likely to End Up in Jail Rather than a Hospital

By Justin Caba, Medical Daily

Left untreated, an individual with a serious mental illness is likely to suffer further as their symptoms worsen, and their perception of the world around them gets more and more out of touch.

A recent survey conducted by the Treatment Advocacy Center (TAC) and the National Sheriffs’ Association has found that patients with a severe mental illness are ten times more likely to end up in a state prison rather than a state mental hospital.

“The lack of treatment for seriously ill inmates is inhumane and should not be allowed in a civilized society,” lead researcher and founder of the Treatment Advocacy Center, Dr. E. Fuller Torrey, said in a statement. “This is especially true for individuals who – because of their mental illness – are not aware they are sick and therefore refuse medication.” 

Torrey and his colleagues from both the TAC and the National Sheriff’s Association probed the records of state run prisons and mental hospitals in discovering where the majority of patients with a psychiatric illness end up. Unfortunately, jails and prisons are considered the largest institutions housing individuals with a serious mental illness. Findings revealed that only 35,000 patients with a mental illness are being kept in a hospital setting compared to 356,000 who currently reside in a prison or jail cell.

Researchers called the outcome of mistreatment experienced by some mentally ill inmates “usually harmful and sometimes tragic.” Due to their erratic or disruptive behavior, many inmates with a psychiatric disorder are at danger to being beaten, raped, self-mutilated, or suicidal. Mentally ill inmates also run the risk of being thrown into solitary confinement or having physical restraints placed on them for most of their day. Although moving inmates with a serious mental illness to a more suitable institution would be in their best interest, the research team said states and counties would also benefit from the funds that would be saved on corrections.

According to the National Alliance on Mental Illness, upward of 13.6 million adults in the United States are currently living with a serious mental illness. Many Americans may be surprised to find out what exactly is included as a serious mental illness. Major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), and borderline personality disorder all fall under the category of serious mental illness. One in four Americans experiences a mental illness in a given year. 

 

 





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Panel discusses mental health care race gap
Karina Shedrofsky, The Diamondback
Even as mental health awareness and services increase, university officials said, mental health experiences vary for people of different races, a disparity they highlighted in a panel discussion last night. 
As part of Stress Less Week, an awareness campaign aimed at reducing stress and the stigma associated with mental illness, the university’s chapter of Active Minds, the Counseling Center and the Division of Student Affairs’ Diversity Advisory Council hosted a panel to address mental health resources and mental health in communities of color. A small crowd attended the event in the Benjamin Banneker room in Stamp Student Union.
Charmaine Wilson-Jones, the Diversity Advisory Council’s chairwoman, said the council wanted to host a mental health event focusing on unaddressed or underserved communities. 
“We feel like there’s a huge push for mental health right now, on campus and off,” said Wilson-Jones, a junior government and politics major. “But a lot of minority students — and people of color in general — are being left out of that discussion, and we wanted to find a way to sort of bring those two sides together.” 
Wilson-Jones connected with members of Active Minds and brought together Howard Lloyd, a doctoral intern at the Counseling Center; Na-Yeun Choi, a fifth-year psychology doctoral student; and James Houle, a Counseling Center staff psychologist. 
Wilson-Jones began the discussion by asking the speakers about their personal experiences with diversity and mental health. Each panelist identified as a different race and had different experiences but agreed that students of color face specific sources of stress and anxiety that must be combated.
“For students of color, there’s a real feeling or idea that, ‘If I go to talk to someone, they aren’t going to look like me or understand where I’m coming from. And how can someone who doesn’t look like me understand where I’m coming from?’” Lloyd said. 
Choi, a first-generation immigrant from Korea, discussed the stereotypes that can impact an individual’s mental health, such as the model minority myth surrounding Asian-American and Pacific Islander communities that creates pressure to live up to an ideal of perfectionism.
She said students of color can face numerous barriers when seeking help.   
“Maybe loss of faith and kind of bringing some shame to the families in their own community, especially in more communal and non-individual communities — they tend to look more into this concept of you really are supporting your whole community and family,” Choi said. 
Each speaker mentioned the extra emotional toll racism takes on students of color, and more specifically the idea of microaggressions — subtle and small acts of discrimination or prejudice that students who identify as white might not notice. 
“Somebody once described a million little paper cuts as a form of microaggression,” Houle said. “Over time one paper cut might not hurt, but a thousand or a million paper cuts will hurt.” 
Lloyd, who identifies as African-American, recognized that students might fear seeking help from people they don’t think they can relate to or who won’t understand their stresses and problems because of difference in race or ethnicity. 
To combat the stigma surrounding mental health issues in multiracial communities, the panelists said, talking about the issues and making students more aware of the realities of counseling — such as what psychologists and psychiatrists look like and how sessions are typically run — can go a long way.
Houle said the Counseling Center reaches out to explain the services they offer and meet people to show what psychologists look like outside of pop culture depictions, he said. The center offers Students of Color Walk-In Hour sessions during which students can see a counselor without making an appointment.
Mudit Verma, a senior psychology major and Active Minds’ fundraising director, appreciated the panelists’ advice on how to productively react when a friend or family member says something offensive that might discourage someone from seeking professional help. 
“Their responses really intrigued me,” he said. “Using objective information is really a powerful tool to sort of convince an audience.”
Josh Ratner, the Student Government Association’s student affairs vice president, said that identifying the different ways communities perceive mental health is important when trying to improve services.
“It’s really interesting to see how different communities value, stigmatize, prioritize mental health,” the junior government and politics major said. “And it’s great to see that the university has programs to try and reach out to different communities that might have more stigma associated with mental health.” 

 

 


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

Panel discusses mental health care race gap

Karina Shedrofsky, The Diamondback

Even as mental health awareness and services increase, university officials said, mental health experiences vary for people of different races, a disparity they highlighted in a panel discussion last night. 

As part of Stress Less Week, an awareness campaign aimed at reducing stress and the stigma associated with mental illness, the university’s chapter of Active Minds, the Counseling Center and the Division of Student Affairs’ Diversity Advisory Council hosted a panel to address mental health resources and mental health in communities of color. A small crowd attended the event in the Benjamin Banneker room in Stamp Student Union.

Charmaine Wilson-Jones, the Diversity Advisory Council’s chairwoman, said the council wanted to host a mental health event focusing on unaddressed or underserved communities. 

“We feel like there’s a huge push for mental health right now, on campus and off,” said Wilson-Jones, a junior government and politics major. “But a lot of minority students — and people of color in general — are being left out of that discussion, and we wanted to find a way to sort of bring those two sides together.” 

Wilson-Jones connected with members of Active Minds and brought together Howard Lloyd, a doctoral intern at the Counseling Center; Na-Yeun Choi, a fifth-year psychology doctoral student; and James Houle, a Counseling Center staff psychologist. 

Wilson-Jones began the discussion by asking the speakers about their personal experiences with diversity and mental health. Each panelist identified as a different race and had different experiences but agreed that students of color face specific sources of stress and anxiety that must be combated.

“For students of color, there’s a real feeling or idea that, ‘If I go to talk to someone, they aren’t going to look like me or understand where I’m coming from. And how can someone who doesn’t look like me understand where I’m coming from?’” Lloyd said. 

Choi, a first-generation immigrant from Korea, discussed the stereotypes that can impact an individual’s mental health, such as the model minority myth surrounding Asian-American and Pacific Islander communities that creates pressure to live up to an ideal of perfectionism.

She said students of color can face numerous barriers when seeking help.   

“Maybe loss of faith and kind of bringing some shame to the families in their own community, especially in more communal and non-individual communities — they tend to look more into this concept of you really are supporting your whole community and family,” Choi said. 

Each speaker mentioned the extra emotional toll racism takes on students of color, and more specifically the idea of microaggressions — subtle and small acts of discrimination or prejudice that students who identify as white might not notice. 

“Somebody once described a million little paper cuts as a form of microaggression,” Houle said. “Over time one paper cut might not hurt, but a thousand or a million paper cuts will hurt.” 

Lloyd, who identifies as African-American, recognized that students might fear seeking help from people they don’t think they can relate to or who won’t understand their stresses and problems because of difference in race or ethnicity. 

To combat the stigma surrounding mental health issues in multiracial communities, the panelists said, talking about the issues and making students more aware of the realities of counseling — such as what psychologists and psychiatrists look like and how sessions are typically run — can go a long way.

Houle said the Counseling Center reaches out to explain the services they offer and meet people to show what psychologists look like outside of pop culture depictions, he said. The center offers Students of Color Walk-In Hour sessions during which students can see a counselor without making an appointment.

Mudit Verma, a senior psychology major and Active Minds’ fundraising director, appreciated the panelists’ advice on how to productively react when a friend or family member says something offensive that might discourage someone from seeking professional help. 

“Their responses really intrigued me,” he said. “Using objective information is really a powerful tool to sort of convince an audience.”

Josh Ratner, the Student Government Association’s student affairs vice president, said that identifying the different ways communities perceive mental health is important when trying to improve services.

“It’s really interesting to see how different communities value, stigmatize, prioritize mental health,” the junior government and politics major said. “And it’s great to see that the university has programs to try and reach out to different communities that might have more stigma associated with mental health.” 

 

 





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

Filed under race mixed race racial racism racist health mental health mental illness mental illness healthy wellness psychology psychiatry awareness news color stigma recovery treatment treat mad madness rethinking madness culture cultural society population america usa

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Mom sues psychiatric prison, alleges son isolated for 6,300 hours, shackled to bedBy ABC News
"They have criminalized his illness. That’s what they are doing," she said. "And it’s unconscionable and he’s not in a therapeutic environment. I know he is ill. I can live with that. But no one should be treated like an animal, locked in an isolation cage."
When Joanne Minich recently visited son Peter, 31, at Bridgewater State Hospital in Massachusetts, prison guards brought her to a locked cell that inmates call the “bird cage,” where he was shackled at the hands, waist and bare feet, she says.
For the past 14 months, Peter Minich has been legally committed to a legendary facility once called the state hospital “for the criminally insane” but, according to his Brookline, Mass., mother, he has never been convicted of a crime – only diagnosed with a mental illness.
Minich says her son has suffered from paranoid schizophrenia since his late teens and a court sent him to Bridgewater in January 2013, after staff members at another psychiatric hospital filed assault misdemeanor criminal charges against him. Her son had no previous criminal record or history of violent behavior, she says.
"People say it’s a hospital, but it’s not a hospital. It’s a prison," Minich, 66, said of the facility, which is administered by the state Department of Correction. "I don’t think they are helping him at all. It’s torture. It looks like a cage you put an animal in."
Minich has now filed a lawsuit in Norfolk County Superior Court against the state Department of Correction, the superintendent of Bridgewater State Hospital, the state of Massachusetts and MHM Services Inc., a national health care provider, for alleged abuses against her son.
The March 31 lawsuit, which was obtained by ABCNews.com, alleges that staff have isolated her son in a locked seclusion room at the intensive-treatment unit for at least 6,300 hours from January 14, 2013 to March 12, 2014, and restrained him to objects like his bed for 815 hours from January 14, 2013 to January 22, 2014.
She says her son’s caregivers have violated American Psychiatric Association guidelines, as well as the state’s Seclusion and Restraint law, which allows such techniques “in cases of emergency, such as the occurrence of, or serious threat of, extreme violence, personal injury or attempted suicide.”
Seclusion and restraints were ordered for incidents such as hearing voices, licking another inmate’s feet, having a seizure and being assaulted by another inmate, according to 5,000 pages of prison records cited in the lawsuit.
The lawsuit alleges that her son was offered no exercise program or outdoor activity, and his food was delivered through a “slot in the door.” His only contact with other human beings was when placed in restraints, medicated or given electro-shock treatment, according to the lawsuit.
Peter Minich’s parents have only been allowed to visit their son once a week, with a 10-minute phone call every two days. They say his condition has worsened, with more hallucinations and anxiety, and he has become more aggressive as a result of incarceration. They say their son has also lost 40 pounds.
"It’s horrible," Minich, who works in a special care nursery with premature babies, told ABCNews.com. "He’s living with this mental illness and you can’t let the system destroy him. It’s not humanitarian what they are doing to him. He is a difficult case. I am not denying that, but it doesn’t mean he should be in a prison."
Minich is demanding that her son be moved from Bridgewater. “All I want is him out of there and in a therapeutic environment,” she said. “I am afraid one day I will get the phone call saying he is dead. It’s a horrible way to live.”
The lawsuit is not seeking damages, but compliance with the seclusion and restraint statute; a treatment plan that includes individual and group therapy, and socialization and “activities of daily living” training; and a transfer to a place that is not a prison.
This is not the first time Bridgewater has come under fire for alleged abuse. In 2009, inmate Joshua K. Messier, 23, died while guards were placing him in restraints. A Boston Globe expose resulted in the discipline of six correction officials, and the state has agreed to pay the family $3 million as part of a settlement.
In 1967, Bridgewater State Hospital was the subject of a documentary, “Titicut Follies,” which showed graphic examples of physical abuse by staff and doctors. A Superior Court judge banned its public showing and ordered all copies of the film seized because of “crudities, nudities, and obscenities … eighty minutes of brutal sordidness and human degradation.”
"This is worse than anything I saw in ‘Titicut Follies,’" Minich’s lawyer, Roderick MacLeish Jr., told ABCNews.com. "At least they let them out in the yard and they had Christmas parties."
The lawsuit states that for 60 days at the end of 2013, Minich was held in seclusion for 24 hours a day, all but for eight and a half hours, including Thanksgiving and Christmas. In October of that year, he was allegedly held in mechanical restraint for more than 50 consecutive hours.
MacLeish alleges that Peter Minich, an intelligent man, has been given no reading materials when asked, nor stimulating activities while in solitary confinement, and, as a result, has deteriorated mentally.
"This is a slow death for Peter," he said. "It has evolved as part of our punitive culture." MacLeish said that Bridgewater was "cleaned up" in the 1980s. "But now we find out they are back to their old practices. … It’s a disgrace, particularly since our governor [Deval Patrick] used to be head of the Civil Rights Division at the Justice Department and has widely said that isolation should not be used."
Patrick has been outspoken on the issue, saying these measures should be used as a “last resort.”
The governor’s press secretary, Heather Nichols, responded to a request by ABCNews.com for comment by referring by citing part of a speech Patrick made last month:
"The evidence tells us that methods traditionally used to handle difficult prisoners may actually exacerbate the difficulties of those with mental illness. Solitary confinement can cause extreme disorientation that only worsens asocial behavior within a correctional institute — let alone after release. If it remains a feature of our correctional system, it should be reserved for the most exceptional situations, and only as a last resort.
"Fully restraining a mentally ill inmate carries similar risks. Unless it can be said with certainty that the inmate poses a serious and immediate physical danger to himself or his fellow inmates, he should not be tied down, limb-by-limb, in a 21st Century correctional institution. Most of our inmates — even the most difficult ones — will return to the streets of our Commonwealth. Our treatment of them must always keep that fact in mind, and preserve to the extent possible their own grip on their humanity."
Click here to read the rest of the article\

 


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Mom sues psychiatric prison, alleges son isolated for 6,300 hours, shackled to bed
By ABC News

"They have criminalized his illness. That’s what they are doing," she said. "And it’s unconscionable and he’s not in a therapeutic environment. I know he is ill. I can live with that. But no one should be treated like an animal, locked in an isolation cage."

When Joanne Minich recently visited son Peter, 31, at Bridgewater State Hospital in Massachusetts, prison guards brought her to a locked cell that inmates call the “bird cage,” where he was shackled at the hands, waist and bare feet, she says.

For the past 14 months, Peter Minich has been legally committed to a legendary facility once called the state hospital “for the criminally insane” but, according to his Brookline, Mass., mother, he has never been convicted of a crime – only diagnosed with a mental illness.

Minich says her son has suffered from paranoid schizophrenia since his late teens and a court sent him to Bridgewater in January 2013, after staff members at another psychiatric hospital filed assault misdemeanor criminal charges against him. Her son had no previous criminal record or history of violent behavior, she says.

"People say it’s a hospital, but it’s not a hospital. It’s a prison," Minich, 66, said of the facility, which is administered by the state Department of Correction. "I don’t think they are helping him at all. It’s torture. It looks like a cage you put an animal in."

Minich has now filed a lawsuit in Norfolk County Superior Court against the state Department of Correction, the superintendent of Bridgewater State Hospital, the state of Massachusetts and MHM Services Inc., a national health care provider, for alleged abuses against her son.

The March 31 lawsuit, which was obtained by ABCNews.com, alleges that staff have isolated her son in a locked seclusion room at the intensive-treatment unit for at least 6,300 hours from January 14, 2013 to March 12, 2014, and restrained him to objects like his bed for 815 hours from January 14, 2013 to January 22, 2014.

She says her son’s caregivers have violated American Psychiatric Association guidelines, as well as the state’s Seclusion and Restraint law, which allows such techniques “in cases of emergency, such as the occurrence of, or serious threat of, extreme violence, personal injury or attempted suicide.”

Seclusion and restraints were ordered for incidents such as hearing voices, licking another inmate’s feet, having a seizure and being assaulted by another inmate, according to 5,000 pages of prison records cited in the lawsuit.

The lawsuit alleges that her son was offered no exercise program or outdoor activity, and his food was delivered through a “slot in the door.” His only contact with other human beings was when placed in restraints, medicated or given electro-shock treatment, according to the lawsuit.

Peter Minich’s parents have only been allowed to visit their son once a week, with a 10-minute phone call every two days. They say his condition has worsened, with more hallucinations and anxiety, and he has become more aggressive as a result of incarceration. They say their son has also lost 40 pounds.

"It’s horrible," Minich, who works in a special care nursery with premature babies, told ABCNews.com. "He’s living with this mental illness and you can’t let the system destroy him. It’s not humanitarian what they are doing to him. He is a difficult case. I am not denying that, but it doesn’t mean he should be in a prison."

Minich is demanding that her son be moved from Bridgewater. “All I want is him out of there and in a therapeutic environment,” she said. “I am afraid one day I will get the phone call saying he is dead. It’s a horrible way to live.”

The lawsuit is not seeking damages, but compliance with the seclusion and restraint statute; a treatment plan that includes individual and group therapy, and socialization and “activities of daily living” training; and a transfer to a place that is not a prison.

This is not the first time Bridgewater has come under fire for alleged abuse. In 2009, inmate Joshua K. Messier, 23, died while guards were placing him in restraints. A Boston Globe expose resulted in the discipline of six correction officials, and the state has agreed to pay the family $3 million as part of a settlement.

In 1967, Bridgewater State Hospital was the subject of a documentary, “Titicut Follies,” which showed graphic examples of physical abuse by staff and doctors. A Superior Court judge banned its public showing and ordered all copies of the film seized because of “crudities, nudities, and obscenities … eighty minutes of brutal sordidness and human degradation.”

"This is worse than anything I saw in ‘Titicut Follies,’" Minich’s lawyer, Roderick MacLeish Jr., told ABCNews.com. "At least they let them out in the yard and they had Christmas parties."

The lawsuit states that for 60 days at the end of 2013, Minich was held in seclusion for 24 hours a day, all but for eight and a half hours, including Thanksgiving and Christmas. In October of that year, he was allegedly held in mechanical restraint for more than 50 consecutive hours.

MacLeish alleges that Peter Minich, an intelligent man, has been given no reading materials when asked, nor stimulating activities while in solitary confinement, and, as a result, has deteriorated mentally.

"This is a slow death for Peter," he said. "It has evolved as part of our punitive culture." MacLeish said that Bridgewater was "cleaned up" in the 1980s. "But now we find out they are back to their old practices. … It’s a disgrace, particularly since our governor [Deval Patrick] used to be head of the Civil Rights Division at the Justice Department and has widely said that isolation should not be used."

Patrick has been outspoken on the issue, saying these measures should be used as a “last resort.”

The governor’s press secretary, Heather Nichols, responded to a request by ABCNews.com for comment by referring by citing part of a speech Patrick made last month:

"The evidence tells us that methods traditionally used to handle difficult prisoners may actually exacerbate the difficulties of those with mental illness. Solitary confinement can cause extreme disorientation that only worsens asocial behavior within a correctional institute — let alone after release. If it remains a feature of our correctional system, it should be reserved for the most exceptional situations, and only as a last resort.

"Fully restraining a mentally ill inmate carries similar risks. Unless it can be said with certainty that the inmate poses a serious and immediate physical danger to himself or his fellow inmates, he should not be tied down, limb-by-limb, in a 21st Century correctional institution. Most of our inmates — even the most difficult ones — will return to the streets of our Commonwealth. Our treatment of them must always keep that fact in mind, and preserve to the extent possible their own grip on their humanity."

Click here to read the rest of the article\

 





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Doctors’ notes on mental health shared with patients: Policy shift at Beth Israel DeaconessBy Liz Kowalczyk, The Boston Globe
At the end of every workday, psychiatrists, social workers, and other mental health providers write notes describing their patients’ visits. It is where they chronicle paranoid behavior, excessive drinking, or relationship problems. These candid comments often are available to other doctors, but they are rarely shared with patients themselves.
Now, as part of an ongoing effort to make care more transparent, clinicians at Beth Israel Deaconess Medical Center have begun posting the mental health notes in patients’ electronic medical records, allowing the patients immediate access to the summaries at home.
On March 1, about 40 providers started sharing their notes with more than 650 patients. Some are eagerly reading every word, clinicians said, while others have no interest.
“We all had some reservations,’’ said Dr. Michael Kahn, a psychiatrist who has worked at Beth Israel Deaconess for 20 years. “What about if a patient misinterpreted a note? Would they be upset about it? Would it confuse them?’’
But ultimately, he and his colleagues decided that sharing the notes could improve care by encouraging patients to more actively participate in their treatment, while inspiring providers to describe patients nonjudgmentally.
Patients can correct mistakes, such as a wrong medication dose. And rather than write a word such as “paranoid,’’ which to many people “means crazy or bad,’’ Kahn said he now uses less-loaded terms such as “persecutory anxiety.’’
Primary care providers at the Boston hospital, along with those at a handful of medical centers and physicians groups nationally, have been posting notes from medical visits in patients’ secure online medical records for several years — with mostly positive results.
But except for the Veterans Health Administration, which gives veterans online access to mental health notes, providers have hesitated to share psychiatric notes out of a belief that this approach is a minefield for patients. They worry patients will be rattled upon learning that their firm convictions are seen as delusions, or angered by diagnoses that feel harsh and stigmatizing.
Patients have a right under federal law to request their medical records, including doctors’ notes. But most patients do not ask for them, in part because the process is cumbersome and can take days or even weeks. But as electronic medical records become more widespread, it is far easier to share sensitive health information.
Stephen O’Neill, social work manager for psychiatry and primary care at Beth Israel Deaconess, said he has offered to share notes with patients informally for years. Most, including Lori, a 53-year-0ld woman who suffers from depression, have not taken him up on it. But now that he has made the summaries available online, she said she plans to read them.
On Wednesday, he showed her how the system works in his office and she read the notes from their appointment that day. “It’s not what I thought it would be,’’ she said.
Lori, who did not want her last name used because she feels mental health problems still carry a stigma, said she was surprised at the detail in O’Neill’s notes about issues she did not see as important. For example, she had discussed turning down a friend’s request for a significant favor.
After reading the entry, she understood how it related to her overall therapy. “We again reinforced. . . that she should share how she feels with her friend so that she does not internalize this,’’ O’Neill wrote.
Reading the notes is “a good way to see if you are on the same level,’’ Lori said. “Sometimes when I am in session with [him], I wonder does he understand what I am trying to get across. I get to see if he does.’’
In an opinion piece published in the Journal of the American Medical Association, Kahn and three colleagues argued that sharing notes could be particularly beneficial for patients who abuse drugs or alcohol, who are “often so used to being lectured that they tune out real-time discussions of harmful consequences.’’ Allowing them to read a doctor’s assessment in private “may diminish the need for defensive maneuvers,’’ the authors said.
Still, not all mental health providers are ready for this level of openness with patients.
Nina Douglass, who works in obstetrics and gynecology at Beth Israel Deaconess, is one of five social workers who declined to participate — for now. Some of her patients are addicted to drugs, while others are in abusive relationships. Douglass tells them at the outset that she is required to report abuse or neglect of a child to state officials. If she writes about a specific concern in a note, and the patient reads it, Douglass is worried the patient might flee rather than risk losing custody of the child.
“I absolutely share the hospital ethic of transparency,’’ she said. “But I want more time to see how this works.’’
At Geisinger Health System in Pennsylvania, where more than 1,300 providers share medical visit notes with 200,000 patients, mental health providers and pain specialists do not participate yet. The organization is planning to share psychiatric notes in the next six months, but Dr. Jonathan Darer, chief innovation officer, said doctors can exclude patients whom they feel will be harmed by easy access to visit notes, such as those with anxiety disorders who see even minor symptoms as catastrophic.
At Beth Israel Deaconess, mental health providers have identified at least 10 percent of their patients to participate in the project initially, and most are starting with those who are functioning at a high level.
“We thought, how can we find a safe place to start?’’ said Pamela Peck, clinical director for the psychiatry department. “Are there patients who would feel” upset by reading “about aspects of their psychiatric illness? That is a question that is still up for discussion.’’
Beth Israel Deaconess began encouraging providers to share medical notes nearly five years ago. Now, almost 2,300 doctors and nurse practitioners post notes for almost 225,000 patients. According to surveys done by the hospital, the vast majority want access to continue, though patients and caregivers have suggested changes.
Some patients want to approve what doctors write or to write responses. Some doctors want the option to hide notes, or portions of them, from patients or families, and want ways to communicate with colleagues privately, according to an opinion piece published in the New England Journal of Medicine earlier this year.
Partners HealthCare, the largest health care system in Massachusetts, is moving toward putting medical notes online, but is still debating whether to post mental health notes in patients’ records. One unanswered question is whether a psychiatrist’s notes are still useful and precise for other doctors, including those in the emergency room, if they are written with the knowledge that the patient can read them, said Dr. Gregg Meyer, chief clinical officer.
“One of the key points that physicians need to think about is whether the way we document care is going to fundamentally change,’’ he said. “First and foremost we have to make sure patient care is not compromised. We are watching their experience closely.’’
At Beth Israel Deaconess, doctors still have the option of putting certain notes in a locked area of the record, which patients cannot see and other doctors can access only if they provide written justification.
The hospital said it is too early to know how many patients are reading the mental health notes. Kahn spoke to one patient, a highly educated, successful woman whom he thought would jump at the chance. Kahn was surprised by her response.
“She said, ‘No, no no, I don’t want to read anything. I prefer not to look.’”

Liz Kowalczyk can be reached at kowalczyk@globe.com.

 


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

Doctors’ notes on mental health shared with patients: Policy shift at Beth Israel Deaconess
By Liz Kowalczyk, The Boston Globe

At the end of every workday, psychiatrists, social workers, and other mental health providers write notes describing their patients’ visits. It is where they chronicle paranoid behavior, excessive drinking, or relationship problems. These candid comments often are available to other doctors, but they are rarely shared with patients themselves.

Now, as part of an ongoing effort to make care more transparent, clinicians at Beth Israel Deaconess Medical Center have begun posting the mental health notes in patients’ electronic medical records, allowing the patients immediate access to the summaries at home.

On March 1, about 40 providers started sharing their notes with more than 650 patients. Some are eagerly reading every word, clinicians said, while others have no interest.

“We all had some reservations,’’ said Dr. Michael Kahn, a psychiatrist who has worked at Beth Israel Deaconess for 20 years. “What about if a patient misinterpreted a note? Would they be upset about it? Would it confuse them?’’

But ultimately, he and his colleagues decided that sharing the notes could improve care by encouraging patients to more actively participate in their treatment, while inspiring providers to describe patients nonjudgmentally.

Patients can correct mistakes, such as a wrong medication dose. And rather than write a word such as “paranoid,’’ which to many people “means crazy or bad,’’ Kahn said he now uses less-loaded terms such as “persecutory anxiety.’’

Primary care providers at the Boston hospital, along with those at a handful of medical centers and physicians groups nationally, have been posting notes from medical visits in patients’ secure online medical records for several years — with mostly positive results.

But except for the Veterans Health Administration, which gives veterans online access to mental health notes, providers have hesitated to share psychiatric notes out of a belief that this approach is a minefield for patients. They worry patients will be rattled upon learning that their firm convictions are seen as delusions, or angered by diagnoses that feel harsh and stigmatizing.

Patients have a right under federal law to request their medical records, including doctors’ notes. But most patients do not ask for them, in part because the process is cumbersome and can take days or even weeks. But as electronic medical records become more widespread, it is far easier to share sensitive health information.

Stephen O’Neill, social work manager for psychiatry and primary care at Beth Israel Deaconess, said he has offered to share notes with patients informally for years. Most, including Lori, a 53-year-0ld woman who suffers from depression, have not taken him up on it. But now that he has made the summaries available online, she said she plans to read them.

On Wednesday, he showed her how the system works in his office and she read the notes from their appointment that day. “It’s not what I thought it would be,’’ she said.

Lori, who did not want her last name used because she feels mental health problems still carry a stigma, said she was surprised at the detail in O’Neill’s notes about issues she did not see as important. For example, she had discussed turning down a friend’s request for a significant favor.

After reading the entry, she understood how it related to her overall therapy. “We again reinforced. . . that she should share how she feels with her friend so that she does not internalize this,’’ O’Neill wrote.

Reading the notes is “a good way to see if you are on the same level,’’ Lori said. “Sometimes when I am in session with [him], I wonder does he understand what I am trying to get across. I get to see if he does.’’

In an opinion piece published in the Journal of the American Medical Association, Kahn and three colleagues argued that sharing notes could be particularly beneficial for patients who abuse drugs or alcohol, who are “often so used to being lectured that they tune out real-time discussions of harmful consequences.’’ Allowing them to read a doctor’s assessment in private “may diminish the need for defensive maneuvers,’’ the authors said.

Still, not all mental health providers are ready for this level of openness with patients.

Nina Douglass, who works in obstetrics and gynecology at Beth Israel Deaconess, is one of five social workers who declined to participate — for now. Some of her patients are addicted to drugs, while others are in abusive relationships. Douglass tells them at the outset that she is required to report abuse or neglect of a child to state officials. If she writes about a specific concern in a note, and the patient reads it, Douglass is worried the patient might flee rather than risk losing custody of the child.

“I absolutely share the hospital ethic of transparency,’’ she said. “But I want more time to see how this works.’’

At Geisinger Health System in Pennsylvania, where more than 1,300 providers share medical visit notes with 200,000 patients, mental health providers and pain specialists do not participate yet. The organization is planning to share psychiatric notes in the next six months, but Dr. Jonathan Darer, chief innovation officer, said doctors can exclude patients whom they feel will be harmed by easy access to visit notes, such as those with anxiety disorders who see even minor symptoms as catastrophic.

At Beth Israel Deaconess, mental health providers have identified at least 10 percent of their patients to participate in the project initially, and most are starting with those who are functioning at a high level.

“We thought, how can we find a safe place to start?’’ said Pamela Peck, clinical director for the psychiatry department. “Are there patients who would feel” upset by reading “about aspects of their psychiatric illness? That is a question that is still up for discussion.’’

Beth Israel Deaconess began encouraging providers to share medical notes nearly five years ago. Now, almost 2,300 doctors and nurse practitioners post notes for almost 225,000 patients. According to surveys done by the hospital, the vast majority want access to continue, though patients and caregivers have suggested changes.

Some patients want to approve what doctors write or to write responses. Some doctors want the option to hide notes, or portions of them, from patients or families, and want ways to communicate with colleagues privately, according to an opinion piece published in the New England Journal of Medicine earlier this year.

Partners HealthCare, the largest health care system in Massachusetts, is moving toward putting medical notes online, but is still debating whether to post mental health notes in patients’ records. One unanswered question is whether a psychiatrist’s notes are still useful and precise for other doctors, including those in the emergency room, if they are written with the knowledge that the patient can read them, said Dr. Gregg Meyer, chief clinical officer.

“One of the key points that physicians need to think about is whether the way we document care is going to fundamentally change,’’ he said. “First and foremost we have to make sure patient care is not compromised. We are watching their experience closely.’’

At Beth Israel Deaconess, doctors still have the option of putting certain notes in a locked area of the record, which patients cannot see and other doctors can access only if they provide written justification.

The hospital said it is too early to know how many patients are reading the mental health notes. Kahn spoke to one patient, a highly educated, successful woman whom he thought would jump at the chance. Kahn was surprised by her response.

“She said, ‘No, no no, I don’t want to read anything. I prefer not to look.’”

Liz Kowalczyk can be reached at kowalczyk@globe.com.

 





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Ted Talk: “Andrew Solomon: Depression, the secret we share” Duration:29 mins 22 secs Date: Dec 18, 2013
“The opposite of depression is not happiness, but vitality, and it was vitality that seemed to seep away from me in that moment.” In a talk equal parts eloquent and devastating, writer Andrew Solomon takes you to the darkest corners of his mind during the years he battled depression. That led him to an eye-opening journey across the world to interview others with depression — only to discover that, to his surprise, the more he talked, the more people wanted to tell their own stories. 

 


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

Ted Talk: “Andrew Solomon: Depression, the secret we share” 
Duration:29 mins 22 secs 
Date: Dec 18, 2013

“The opposite of depression is not happiness, but vitality, and it was vitality that seemed to seep away from me in that moment.” In a talk equal parts eloquent and devastating, writer Andrew Solomon takes you to the darkest corners of his mind during the years he battled depression. That led him to an eye-opening journey across the world to interview others with depression — only to discover that, to his surprise, the more he talked, the more people wanted to tell their own stories. 

 





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

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57 notes

A Call to Revisit the Media’s Harmful Portrayal of the Relation between Violence and Mental Health ProblemsBy Tristan Barsky, M.S., SeriousMentalIllness.net
Recent media coverage of shootings in the United States have implied that mental health problems cause violent behavior, despite overwhelming evidence of the contrary. Here are three important pieces of that evidence and some reasons why the relationship between violence and mental health problems should be revisited.
Columbine High School, the Aurora Movie Theater, Sandy Hook, and most recently Fort Hood are a few of the sites of the most widely-covered and tragic shootings in recent American history. Another thing they have in common is that the shooters were persons apparently suffering from mental health problems. A lot of the national dialogue they prompted in the media and elsewhere revolved around the causes of, and policy responses to, mass shootings perpetrated by mental health problem sufferers. For instance, researchers analyzed a random 25% of news stories on mental health problems and gun violence from 1997 to 2012 in national and regional news sources. Most of this coverage happened after mass shootings and described them as the results of “dangerous people” rather than “dangerous weapons”. As would be expected, it’s been shown that framing mental health problems as one cause of gun violence and murder can lead the public to take on fearful, hateful, and ultimately stigmatizing attitudes towards persons suffering from mental health problems.
The problem with this kind of conversation on mental health problems and violence is that key facts are often overlooked or discounted:
1. “Mental health problems are common in the United States and internationally” (National Institute of Mental Health, 2007)
In 2007, the National Institute of Mental Health, which is the largest scientific organization in the world dedicated to the research of mental health problems, released a document called The Numbers Count: Mental health problems in America. In this census study, they show that mental health problems are “common” in the United States, where over one in four people ages 18 and older suffer from a diagnosable mental disorder in any given year. This translates to 57.7 million people, and mental health problems are the leading cause of disability in the United States and Canada. Also, many people suffer from more than one mental disorder at a given time and almost half of those with any mental disorder meet criteria for two or more mental disorders. The fact that this many people suffer from mental health problems makes it clear that having had a diagnosed illness is simply not a good predictor of violent behavior.
2. “The vast majority of people who are violent do not suffer from mental illnesses” (American Psychiatric Association, 1994)
Recent studies like this one and this one have shown not only that most people with mental health problems do not commit more violent acts than the rest of the population, but that most violent acts are not committed by people with diagnosed mental health problems. The fact is that the absolute risk of violence among this population as a group is very small and only a small proportion of the violence in the United States can be attributed to persons suffering from mental health problems. Despite the fact that sound empirical research has proven time and time again that the contribution of people with mental illnesses to overall rates of violence is small, the media continues to suggest otherwise. This has the effect of pushing this false relationship into the minds of the general public and of expanding its magnitude in the public discourse.
3. “People with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime” (Appleby, et al., 2001).
Contemporary research –some of which you can find HERE and HERE– shows that people with mental health problems not only commit less violent acts than the rest of the population, but that they are actually much more likely to be victims than perpetrators of violence in the community. A recent study showed that in the past year, almost half of a large sample of individuals suffering from mental health problems and receiving outpatient treatment were victims of a violent offence. Another large-scale study examined this phenomenon and found that people diagnosed with Serious Mental Illnesses such as schizophrenia, bipolar disorder or psychosis, have been found to be 2 ½ times more likely to be attacked, raped or mugged than the rest of the population.
Many policy approaches (this one for example) have been proposed as a result of the recent tragic shootings in the United States. They range from expanding psychological screening to further limiting the rights of individuals suffering from mental health problems, to increasing the length of Assisted Outpatient Treatment, hospitalizations, and institutionalization. Because such a large number of Americans suffer from mental health problems and because mental health problems predispose their sufferers to becoming victims of violence rather than perpetrators of it, these policies are unlikely to be effective.
By implying a link between mental health problems and violent offenses, they also suggest that people who suffer from these problems should be feared and blamed in the wake of these recent tragedies. If this harmful trend continues, it is likely that the violence towards individuals suffering from mental health problems will increase, which could compromise their sense of safety and ultimately, their recovery.

 


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

A Call to Revisit the Media’s Harmful Portrayal of the Relation between Violence and Mental Health Problems
By Tristan Barsky, M.S., SeriousMentalIllness.net

Recent media coverage of shootings in the United States have implied that mental health problems cause violent behavior, despite overwhelming evidence of the contrary. Here are three important pieces of that evidence and some reasons why the relationship between violence and mental health problems should be revisited.

Columbine High School, the Aurora Movie Theater, Sandy Hook, and most recently Fort Hood are a few of the sites of the most widely-covered and tragic shootings in recent American history. Another thing they have in common is that the shooters were persons apparently suffering from mental health problems. A lot of the national dialogue they prompted in the media and elsewhere revolved around the causes of, and policy responses to, mass shootings perpetrated by mental health problem sufferers. For instance, researchers analyzed a random 25% of news stories on mental health problems and gun violence from 1997 to 2012 in national and regional news sources. Most of this coverage happened after mass shootings and described them as the results of “dangerous people” rather than “dangerous weapons”. As would be expected, it’s been shown that framing mental health problems as one cause of gun violence and murder can lead the public to take on fearful, hateful, and ultimately stigmatizing attitudes towards persons suffering from mental health problems.

The problem with this kind of conversation on mental health problems and violence is that key facts are often overlooked or discounted:

1. “Mental health problems are common in the United States and internationally” (National Institute of Mental Health, 2007)

In 2007, the National Institute of Mental Health, which is the largest scientific organization in the world dedicated to the research of mental health problems, released a document called The Numbers Count: Mental health problems in America. In this census study, they show that mental health problems are “common” in the United States, where over one in four people ages 18 and older suffer from a diagnosable mental disorder in any given year. This translates to 57.7 million people, and mental health problems are the leading cause of disability in the United States and Canada. Also, many people suffer from more than one mental disorder at a given time and almost half of those with any mental disorder meet criteria for two or more mental disorders. The fact that this many people suffer from mental health problems makes it clear that having had a diagnosed illness is simply not a good predictor of violent behavior.

2. “The vast majority of people who are violent do not suffer from mental illnesses” (American Psychiatric Association, 1994)

Recent studies like this one and this one have shown not only that most people with mental health problems do not commit more violent acts than the rest of the population, but that most violent acts are not committed by people with diagnosed mental health problems. The fact is that the absolute risk of violence among this population as a group is very small and only a small proportion of the violence in the United States can be attributed to persons suffering from mental health problems. Despite the fact that sound empirical research has proven time and time again that the contribution of people with mental illnesses to overall rates of violence is small, the media continues to suggest otherwise. This has the effect of pushing this false relationship into the minds of the general public and of expanding its magnitude in the public discourse.

3. “People with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime” (Appleby, et al., 2001).

Contemporary research –some of which you can find HERE and HERE– shows that people with mental health problems not only commit less violent acts than the rest of the population, but that they are actually much more likely to be victims than perpetrators of violence in the community. A recent study showed that in the past year, almost half of a large sample of individuals suffering from mental health problems and receiving outpatient treatment were victims of a violent offence. Another large-scale study examined this phenomenon and found that people diagnosed with Serious Mental Illnesses such as schizophrenia, bipolar disorder or psychosis, have been found to be 2 ½ times more likely to be attacked, raped or mugged than the rest of the population.

Many policy approaches (this one for example) have been proposed as a result of the recent tragic shootings in the United States. They range from expanding psychological screening to further limiting the rights of individuals suffering from mental health problems, to increasing the length of Assisted Outpatient Treatment, hospitalizations, and institutionalization. Because such a large number of Americans suffer from mental health problems and because mental health problems predispose their sufferers to becoming victims of violence rather than perpetrators of it, these policies are unlikely to be effective.

By implying a link between mental health problems and violent offenses, they also suggest that people who suffer from these problems should be feared and blamed in the wake of these recent tragedies. If this harmful trend continues, it is likely that the violence towards individuals suffering from mental health problems will increase, which could compromise their sense of safety and ultimately, their recovery.

 





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

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60 notes

Real Men Talk About Their Feelings — For Real
By Josh Rivedal, professional actor, author, playwright, speaker on suicide prevention
Posted on The Huffington Post Healthy Living
Men are willing to talk about the size of their prostate glands, or how much Viagra they’re allowed to take, but they’re still not willing to be open about their mental health.
If men want to live long, healthy and productive lives it’s absolutely crucial that the dialogue surrounding men’s mental health has to change.
I lost my father Douglas to suicide in 2009. Douglas lost his father Haakon to suicide in 1966. Each suffered from undiagnosed mental disorders and each suffered in silence because of the stigma surrounding men talking about and getting help for mental illness.
Haakon was dealing with post-traumatic stress disorder after having been shot down in Hamburg, Germany, in 1941. Douglas may have been clinically depressed for a very long time, but my mother filing for divorce was a catalyst (not the cause) for his action in taking his own life.
There’s a relatively new case study in The Journal of Men’s Health that says that men are affected tremendously by divorce. They have higher rates of alcohol and drug abuse, depression and detach themselves from personal relationships and social support.
In 2011, I had several catalysts for my own near-suicide attempt: the dissolution of a relationship with a long-term girlfriend (similar to a divorce), a lack of work, and fallout from my mother’s betrayal. I was in terrible emotional pain and unknowingly suffering from clinical depression.
Standing at the ledge of a fourth floor window, I realized I didn’t want to die. I just wanted to end my inner torment. And I needed to break the familial cycle. So I came back inside, took a risk and asked for help by calling my mother.
Over the next few months I continued to take more risks. I called old friends to tell them I needed their support. I got into therapy. And no one ever told me I was crazy, stupid or a bad person. They told me they loved me and wanted to help me.
While recovering from clinical depression, I wanted to help youth and other men like me. So I used a biographical one-man play, The Gospel According to Josh, about my foray into show business along with my father’s suicide and took it to high schools, colleges and community centers all across the U.S. and Canada. With it, I talk about the importance of mental health and suicide prevention. Most of my audiences were and still continue to be women. One of the things I’ve found is that men have a difficult time talking about and getting help for their mental health or if they’re feeling suicidal. There seems to be some societal pressure that says “You’re not a true man if you don’t have it all together, all the time.”
But I have a message for men everywhere that’s simple yet profound. There’s always hope and help out there for you. As a man who has suffered from clinical depression, I can say from personal experience that this is not a character flaw or a weakness. It doesn’t make you any less of a man. In fact, by asking for help it makes you a stronger man. It gives you a fighting chance to improve your life and become the person you want to be. Reach out to your family and friends and ask for help. Nip it in the bud before it can turn into a crisis.
And while I’m not a mental-health professional, here are several resources to where you can ask for additional help from a professional if you need it: ManTherapy.org — an interactive tool to learn about men’s mental health; MentalHealthAmerica.net — find your local chapter of Mental Health America, a place where you can find information to help you live mentally well; SuicidePreventionLifeline.org — a general crisis line where you can reach out 24/7 to speak with someone if you’re feeling suicidal.



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

Real Men Talk About Their Feelings — For Real

By Josh Rivedal, professional actor, author, playwright, speaker on suicide prevention

Posted on The Huffington Post Healthy Living

Men are willing to talk about the size of their prostate glands, or how much Viagra they’re allowed to take, but they’re still not willing to be open about their mental health.

If men want to live long, healthy and productive lives it’s absolutely crucial that the dialogue surrounding men’s mental health has to change.

I lost my father Douglas to suicide in 2009. Douglas lost his father Haakon to suicide in 1966. Each suffered from undiagnosed mental disorders and each suffered in silence because of the stigma surrounding men talking about and getting help for mental illness.

Haakon was dealing with post-traumatic stress disorder after having been shot down in Hamburg, Germany, in 1941. Douglas may have been clinically depressed for a very long time, but my mother filing for divorce was a catalyst (not the cause) for his action in taking his own life.

There’s a relatively new case study in The Journal of Men’s Health that says that men are affected tremendously by divorce. They have higher rates of alcohol and drug abuse, depression and detach themselves from personal relationships and social support.

In 2011, I had several catalysts for my own near-suicide attempt: the dissolution of a relationship with a long-term girlfriend (similar to a divorce), a lack of work, and fallout from my mother’s betrayal. I was in terrible emotional pain and unknowingly suffering from clinical depression.

Standing at the ledge of a fourth floor window, I realized I didn’t want to die. I just wanted to end my inner torment. And I needed to break the familial cycle. So I came back inside, took a risk and asked for help by calling my mother.

Over the next few months I continued to take more risks. I called old friends to tell them I needed their support. I got into therapy. And no one ever told me I was crazy, stupid or a bad person. They told me they loved me and wanted to help me.

While recovering from clinical depression, I wanted to help youth and other men like me. So I used a biographical one-man play, The Gospel According to Josh, about my foray into show business along with my father’s suicide and took it to high schools, colleges and community centers all across the U.S. and Canada. With it, I talk about the importance of mental health and suicide prevention. Most of my audiences were and still continue to be women. One of the things I’ve found is that men have a difficult time talking about and getting help for their mental health or if they’re feeling suicidal. There seems to be some societal pressure that says “You’re not a true man if you don’t have it all together, all the time.”

But I have a message for men everywhere that’s simple yet profound. There’s always hope and help out there for you. As a man who has suffered from clinical depression, I can say from personal experience that this is not a character flaw or a weakness. It doesn’t make you any less of a man. In fact, by asking for help it makes you a stronger man. It gives you a fighting chance to improve your life and become the person you want to be. Reach out to your family and friends and ask for help. Nip it in the bud before it can turn into a crisis.

And while I’m not a mental-health professional, here are several resources to where you can ask for additional help from a professional if you need it: ManTherapy.org — an interactive tool to learn about men’s mental health; MentalHealthAmerica.net — find your local chapter of Mental Health America, a place where you can find information to help you live mentally well; SuicidePreventionLifeline.org — a general crisis line where you can reach out 24/7 to speak with someone if you’re feeling suicidal.





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

Filed under mental health mental illness mental health illness healthy mind body brain men man masculine Josh Rivedal suicide suicidal disorder diagnosis psychology depression depressed recovery hope pain emotional major depression major depressive disorder news therapy recover help

148 notes

You are not alone: student stories of mental healthBy Libby Page and Guardian readers, The Guardian
Students share their experiences of mental health issues and reveal a common and worrying problem
When I asked students to share their experiences of mental health at university, I had no idea of the reaction it would receive. Over five days we received over 200 stories. Many entries we weren’t able to include, for legal reasons or because the experiences described were too harrowing to publish.
Originally planned to stay open for two weeks, we decided to close the project early because there wasn’t the capacity to moderate the influx of entries. Each morning we were met with more stories – from students who opened up about their anxieties and struggles.
If you are reading this and are dealing with a mental health issue yourself – you are not alone.
Students shared stories of depression, anxiety, self-harm and suicidal thoughts. Some spoke of diagnosed conditions such as obsessive compulsive disorder and bipolar disorder, and the distructive effect these conditions sometimes have on their education.
When it came to lesser-known issues such as borderline personality disorder, students spoke of a lack of understanding about what they were going through.
Others talked about the embarrassment they felt about asking for help. Some were as yet undiagnosed but clearly struggling: “I stay up all night crying” was a common phrase.
No one tells you that university might be difficult, said students. You were sold on stories from your older friends and the glossy prospectus – there are no footnotes about loneliness and disillusionment.
One anonymous student said: “As a fresher you are constantly reminded that this is supposed to be the ‘time of your life’. When it feels like the worst time of your life you feel both a sense of guilt and a pressure to keep these negative thoughts to yourself.”
Another said: “I spent the first few weeks of uni hiding in my dorm room crying my eyes out. I was homesick and wasn’t sure if I wanted to be there at all.”
Mental health issues can start in childhood, and many students spoke about a history of depression or self-harming that they carried to university. But a new life can add pressures.
"My depression and anxiety started some time before I came to university, but leaving home, being in an extremely taxing social environment and being under large academic pressure all took their toll on me," said one student.
Another said: “Getting tubes or being anywhere I didn’t know felt uncertain. I always had a burning, itching, tormenting anxiety bubbling in my chest. At the time, my boyfriend had no comprehension of mental illness and would regularly tell me panic attacks didn’t exist, that I was stupid and that I had no friends.”
Managing your studies alongside a mental health issue can be a daily struggle. “Panic attacks followed by depression meant things rapidly spiralled out of control,” said one student.
"I found I simply couldn’t think straight and my short term memory became terrible. The best description I could muster was that it felt as though the entire world had been rotated very slightly and nothing was the same anymore."
Another student said: “I’m absolutely terrified of being in social situations in which I don’t know the people I’m speaking to – seminars are a nightmare. I’ve often missed my contact hours because I’ve been up all night crying and stressing and can’t face going in.
"I don’t feel like I can tell my tutors why I’m missing their classes, because I feel like they won’t believe me as I haven’t been officially diagnosed."
Others said the stress of deadlines and feedback from tutors contributed. One student said: “I had a burn-out from the pressure of juggling nine modules. One of the triggers was some negative feedback I recieved in writing from a lecturer which included the word terrible. It was hard to get family support as they live far away.”
Students expressed a general feeling that university support services were helpful – when they could access them. After suffering from a severe anxiety attack, one student took the step to contact their university counselling service.
They said: “I’d put it off for so long, but finally I defined myself as ‘mentally ill’. It did take a few weeks for them to back to me, but nothing can describe the relief I felt when a therapist for the first time said to me, ‘that must be really hard’. Yeah, it was hard! Finally, someone who understood, who didn’t tell me to snap out of it.”
But others are still struggling. “When I started my undergraduate degree I did the responsible thing and informed my supervisor that I had depression,” said one anonymous student, who has since been diagnosed with bipolar disorder.
"He informed me that in his opinion depression was a girls issue and he didn’t know what to do with girls issues and sent me on my way."
Another student said: “My university supported me in my decision to suspend my studies and have helped me get back on track to resume my studies in September, yet I can’t help feel more could have been done to help me, before I reached breaking point.”
What do students think needs to be done? Education needs to start early. An anonymous student said: “People need to know what signs to look for in their friends. They need to understand that depression, anxiety, eating disorders, OCD and bipolar are illnesses, not character flaws.
"The support and education about them need to be on par with the education we get about other medical issues. If we learn about it in school, we will be more prepared when we get to university."
At this year’s National Union of Students (NUS) conference, a motion will be discussed that urges student unions to move “away from awareness, towards action”. It calls for training for staff, integrating mental health into the widening participation agenda, better advertising for support services, and an ensurance that academic policies do not cause additional mental distress to students who experience mental health issues.
Now is the time for action. But the response to our call to share stories shows that there are still many young people who want to talk.
What you said
"I thought everything was my fault and I was just defective and bad and that this was what I deserved from life. I missed out on social life and extra-curricular activities because I struggled with acute feelings of social anxiety, self-hatred and fear. Now I have access to support, I can support others, too, and that’s the best feeling I could ask for."
"I hope my words might help some of you to see that you really aren’t the only one. In my opinion, searching out for help in whatever small way you can manage, really is the best thing."
"Mental health issues are nothing to be ashamed of and affect almost everybody and it’s about time everyone realised this and stopped skirting round the subject and faced it head-on. "
"One thing I’ve found is that so many more people than you realise suffer from mental illnesses. As I’ve talked to friends, more and more of them have been telling me that they too suffer from the same things I do, or they have in the past."
"No matter how bad it gets and how much you think there is no hope and let your depression take over, you can always dig yourself out of that hole and find a way to manage your depression and you are not alone."
"Get help, be heard, let yourself be supported. You’re important."
Read the rest of the contributions to the GuardianWitness assignment here.



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

You are not alone: student stories of mental health
By Libby Page and Guardian readers, The Guardian

Students share their experiences of mental health issues and reveal a common and worrying problem

When I asked students to share their experiences of mental health at university, I had no idea of the reaction it would receive. Over five days we received over 200 stories. Many entries we weren’t able to include, for legal reasons or because the experiences described were too harrowing to publish.

Originally planned to stay open for two weeks, we decided to close the project early because there wasn’t the capacity to moderate the influx of entries. Each morning we were met with more stories – from students who opened up about their anxieties and struggles.

If you are reading this and are dealing with a mental health issue yourself – you are not alone.

Students shared stories of depression, anxiety, self-harm and suicidal thoughts. Some spoke of diagnosed conditions such as obsessive compulsive disorder and bipolar disorder, and the distructive effect these conditions sometimes have on their education.

When it came to lesser-known issues such as borderline personality disorder, students spoke of a lack of understanding about what they were going through.

Others talked about the embarrassment they felt about asking for help. Some were as yet undiagnosed but clearly struggling: “I stay up all night crying” was a common phrase.

No one tells you that university might be difficult, said students. You were sold on stories from your older friends and the glossy prospectus – there are no footnotes about loneliness and disillusionment.

One anonymous student said: “As a fresher you are constantly reminded that this is supposed to be the ‘time of your life’. When it feels like the worst time of your life you feel both a sense of guilt and a pressure to keep these negative thoughts to yourself.”

Another said: “I spent the first few weeks of uni hiding in my dorm room crying my eyes out. I was homesick and wasn’t sure if I wanted to be there at all.”

Mental health issues can start in childhood, and many students spoke about a history of depression or self-harming that they carried to university. But a new life can add pressures.

"My depression and anxiety started some time before I came to university, but leaving home, being in an extremely taxing social environment and being under large academic pressure all took their toll on me," said one student.

Another said: “Getting tubes or being anywhere I didn’t know felt uncertain. I always had a burning, itching, tormenting anxiety bubbling in my chest. At the time, my boyfriend had no comprehension of mental illness and would regularly tell me panic attacks didn’t exist, that I was stupid and that I had no friends.”

Managing your studies alongside a mental health issue can be a daily struggle. “Panic attacks followed by depression meant things rapidly spiralled out of control,” said one student.

"I found I simply couldn’t think straight and my short term memory became terrible. The best description I could muster was that it felt as though the entire world had been rotated very slightly and nothing was the same anymore."

Another student said: “I’m absolutely terrified of being in social situations in which I don’t know the people I’m speaking to – seminars are a nightmare. I’ve often missed my contact hours because I’ve been up all night crying and stressing and can’t face going in.

"I don’t feel like I can tell my tutors why I’m missing their classes, because I feel like they won’t believe me as I haven’t been officially diagnosed."

Others said the stress of deadlines and feedback from tutors contributed. One student said: “I had a burn-out from the pressure of juggling nine modules. One of the triggers was some negative feedback I recieved in writing from a lecturer which included the word terrible. It was hard to get family support as they live far away.”

Students expressed a general feeling that university support services were helpful – when they could access them. After suffering from a severe anxiety attack, one student took the step to contact their university counselling service.

They said: “I’d put it off for so long, but finally I defined myself as ‘mentally ill’. It did take a few weeks for them to back to me, but nothing can describe the relief I felt when a therapist for the first time said to me, ‘that must be really hard’. Yeah, it was hard! Finally, someone who understood, who didn’t tell me to snap out of it.”

But others are still struggling. “When I started my undergraduate degree I did the responsible thing and informed my supervisor that I had depression,” said one anonymous student, who has since been diagnosed with bipolar disorder.

"He informed me that in his opinion depression was a girls issue and he didn’t know what to do with girls issues and sent me on my way."

Another student said: “My university supported me in my decision to suspend my studies and have helped me get back on track to resume my studies in September, yet I can’t help feel more could have been done to help me, before I reached breaking point.”

What do students think needs to be done? Education needs to start early. An anonymous student said: “People need to know what signs to look for in their friends. They need to understand that depression, anxiety, eating disorders, OCD and bipolar are illnesses, not character flaws.

"The support and education about them need to be on par with the education we get about other medical issues. If we learn about it in school, we will be more prepared when we get to university."

At this year’s National Union of Students (NUS) conference, a motion will be discussed that urges student unions to move “away from awareness, towards action”. It calls for training for staff, integrating mental health into the widening participation agenda, better advertising for support services, and an ensurance that academic policies do not cause additional mental distress to students who experience mental health issues.

Now is the time for action. But the response to our call to share stories shows that there are still many young people who want to talk.

What you said

"I thought everything was my fault and I was just defective and bad and that this was what I deserved from life. I missed out on social life and extra-curricular activities because I struggled with acute feelings of social anxiety, self-hatred and fear. Now I have access to support, I can support others, too, and that’s the best feeling I could ask for."

"I hope my words might help some of you to see that you really aren’t the only one. In my opinion, searching out for help in whatever small way you can manage, really is the best thing."

"Mental health issues are nothing to be ashamed of and affect almost everybody and it’s about time everyone realised this and stopped skirting round the subject and faced it head-on. "

"One thing I’ve found is that so many more people than you realise suffer from mental illnesses. As I’ve talked to friends, more and more of them have been telling me that they too suffer from the same things I do, or they have in the past."

"No matter how bad it gets and how much you think there is no hope and let your depression take over, you can always dig yourself out of that hole and find a way to manage your depression and you are not alone."

"Get help, be heard, let yourself be supported. You’re important."

Read the rest of the contributions to the GuardianWitness assignment here.





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

Filed under mental health mental illness mental health illness healthy diagnosis disorder hope recovery story news anxiety ocd bipolar bipolar disorder bpd borderline borderline personality disorder personality emotion feeling mind body brain sad depression depressed sadness

126 notes

Shooting Unfairly Links Violence with Mental Illness — AgainBy Joseph Shapiro, Shots: Health News from NPR
Experts in mental health say (even as more facts about Lopez emerge) that it’s highly unlikely the violence could have been predicted. Just raising that question, psychologists and psychiatrists say, shows how much Americans misunderstand the link between mental illness and violence.
With the Army’s disclosure that Army Spc. Ivan Lopez was being evaluated for post-traumatic stress disorder before he went on a shooting rampage Wednesday, there were once again questions about whether the Army could have prevented the violence at Fort Hood.
Experts in mental health say (even as more facts about Lopez emerge) that it’s highly unlikely the violence could have been predicted. Just raising that question, psychologists and psychiatrists say, shows how much Americans misunderstand the link between mental illness and violence.
One national survey in 2006 found that most Americans — 60 percent — believed people with schizophrenia were likely to be violent. But the vast majority of people with psychiatric disorders are not violent. In fact, another study found they are far more likely to be the victims of violence, and that 1 in 4 experience violence every year.
Dr. Carl Bell, a psychiatrist at the University of Illinois at Chicago, says being able to predict who will be violent in advance “is impossible.”
"The reality," Bell says, "is that prediction of violence is only useful in an immediate clinical situation: Someone comes in and says, ‘I’m going to kill myself.’ Then you take their word for it, and can predict violence in the short term. But you cannot use that to predict violence in the long term."
Army officials said Thursday that Lopez had seen a psychiatrist in the past month, but there were no indications that he was suicidal.
Dr. Thomas Grieger, a clinical and forensic psychiatrist who worked in military hospitals for three decades, says that one reason violence is so hard to predict is because it is so rare. “Acts of extreme violence and acts against yourself — suicide attempts — are so infrequent that it really becomes almost impossible to predict when any individual or situation is going to escalate to that,” Grieger says. “So many factors come to play: interpersonal relationships, difficulty in the workplace, issues at home, career issues and true mental health issues like depression, bipolar disorder or psychosis.”
Medications are another complicating factor — which ones and whether a soldier was taking them. For many troops back from deployment, multiple medications are prescribed to deal with pain, mental health issues and other problems. Army officials say Lopez had been prescribed Ambien, a drug to help him sleep, and other medications to treat anxiety and depression.
Still, there are a few factors that are more likely than others to be present among people who do become violent. The best predictor of future violence is whether a person with a psychiatric illness has been arrested or acted violently in the past. And people with substance abuse problems, on top of mental illness, are also at a greater risk of committing violence.
Bell says there’s growing study of “mass murder preceding suicide.” In these cases, someone who goes on a shooting spree wants to die, but wants to do so in a way that gets a lot of attention.
"There’s a huge dynamic in suicide where people get angry because they’re hurt," Bell says. "They say, ‘I’ll fix you. I will kill myself and I’ll get even with you.’ What better way to get even (and make a big splash) than to kill a bunch of people before you kill yourself?" It’s been reported that Lopez shot himself, bringing his shooting spree to an end, after he was confronted by a police officer.
This was the second mass shooting at Fort Hood in less than five years. Last year, Maj. Nidal Hasan, an Army psychiatrist, was sentenced to death for killing 13 people and wounding 32 others in the November 2009 shooting that remains the worst mass murder at a military installation.
It’s more reasonable to question whether the Army could have prevented Hasan’s violence — but not because of mental illness. The FBI had seen email that Hasan had sent to the website of terrorist Anwar al-Awlaki, expressing his own sympathy toward suicide bombers.
And, as my NPR colleague Daniel Zwerdling reported, Hasan’s supervisor at Walter Reed Army Medical Center was so concerned about Hasan’s “pattern of poor judgment and a lack of professionalism” that he wrote a memo sharply criticizing the doctor. That kind of document could have ended a military career.
But instead, the Army — with a shortage of psychiatrists and a flood of soldiers returning from Iraq and Afghanistan with mental health problems — kept Hasan working.
After the 2009 shootings, the Pentagon commissioned a report on how to prevent a repeat of the shootings. The report made 47 recommendations for how to improve security. One was to improve training so that military personnel could better “identify contributing factors and behavioral indicators of potentially violent actors.” Another was simply to realize that its own soldiers could be a threat. Another was to find ways to restrict the carrying of personal firearms on military bases. Lopez, it’s been reported, died of a self-inflicted gunshot wound from a .45-caliber Smith & Wesson semiautomatic pistol. The gun, according to media reports, was purchased at the same Killeen, Texas, store where Hasan bought his pistol.



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

Shooting Unfairly Links Violence with Mental Illness — Again
By Joseph Shapiro, Shots: Health News from NPR

Experts in mental health say (even as more facts about Lopez emerge) that it’s highly unlikely the violence could have been predicted. Just raising that question, psychologists and psychiatrists say, shows how much Americans misunderstand the link between mental illness and violence.

With the Army’s disclosure that Army Spc. Ivan Lopez was being evaluated for post-traumatic stress disorder before he went on a shooting rampage Wednesday, there were once again questions about whether the Army could have prevented the violence at Fort Hood.

Experts in mental health say (even as more facts about Lopez emerge) that it’s highly unlikely the violence could have been predicted. Just raising that question, psychologists and psychiatrists say, shows how much Americans misunderstand the link between mental illness and violence.

One national survey in 2006 found that most Americans — 60 percent — believed people with schizophrenia were likely to be violent. But the vast majority of people with psychiatric disorders are not violent. In fact, another study found they are far more likely to be the victims of violence, and that 1 in 4 experience violence every year.

Dr. Carl Bell, a psychiatrist at the University of Illinois at Chicago, says being able to predict who will be violent in advance “is impossible.”

"The reality," Bell says, "is that prediction of violence is only useful in an immediate clinical situation: Someone comes in and says, ‘I’m going to kill myself.’ Then you take their word for it, and can predict violence in the short term. But you cannot use that to predict violence in the long term."

Army officials said Thursday that Lopez had seen a psychiatrist in the past month, but there were no indications that he was suicidal.

Dr. Thomas Grieger, a clinical and forensic psychiatrist who worked in military hospitals for three decades, says that one reason violence is so hard to predict is because it is so rare. “Acts of extreme violence and acts against yourself — suicide attempts — are so infrequent that it really becomes almost impossible to predict when any individual or situation is going to escalate to that,” Grieger says. “So many factors come to play: interpersonal relationships, difficulty in the workplace, issues at home, career issues and true mental health issues like depression, bipolar disorder or psychosis.”

Medications are another complicating factor — which ones and whether a soldier was taking them. For many troops back from deployment, multiple medications are prescribed to deal with pain, mental health issues and other problems. Army officials say Lopez had been prescribed Ambien, a drug to help him sleep, and other medications to treat anxiety and depression.

Still, there are a few factors that are more likely than others to be present among people who do become violent. The best predictor of future violence is whether a person with a psychiatric illness has been arrested or acted violently in the past. And people with substance abuse problems, on top of mental illness, are also at a greater risk of committing violence.

Bell says there’s growing study of “mass murder preceding suicide.” In these cases, someone who goes on a shooting spree wants to die, but wants to do so in a way that gets a lot of attention.

"There’s a huge dynamic in suicide where people get angry because they’re hurt," Bell says. "They say, ‘I’ll fix you. I will kill myself and I’ll get even with you.’ What better way to get even (and make a big splash) than to kill a bunch of people before you kill yourself?" It’s been reported that Lopez shot himself, bringing his shooting spree to an end, after he was confronted by a police officer.

This was the second mass shooting at Fort Hood in less than five years. Last year, Maj. Nidal Hasan, an Army psychiatrist, was sentenced to death for killing 13 people and wounding 32 others in the November 2009 shooting that remains the worst mass murder at a military installation.

It’s more reasonable to question whether the Army could have prevented Hasan’s violence — but not because of mental illness. The FBI had seen email that Hasan had sent to the website of terrorist Anwar al-Awlaki, expressing his own sympathy toward suicide bombers.

And, as my NPR colleague Daniel Zwerdling reported, Hasan’s supervisor at Walter Reed Army Medical Center was so concerned about Hasan’s “pattern of poor judgment and a lack of professionalism” that he wrote a memo sharply criticizing the doctor. That kind of document could have ended a military career.

But instead, the Army — with a shortage of psychiatrists and a flood of soldiers returning from Iraq and Afghanistan with mental health problems — kept Hasan working.

After the 2009 shootings, the Pentagon commissioned a report on how to prevent a repeat of the shootings. The report made 47 recommendations for how to improve security. One was to improve training so that military personnel could better “identify contributing factors and behavioral indicators of potentially violent actors.” Another was simply to realize that its own soldiers could be a threat. Another was to find ways to restrict the carrying of personal firearms on military bases. Lopez, it’s been reported, died of a self-inflicted gunshot wound from a .45-caliber Smith & Wesson semiautomatic pistol. The gun, according to media reports, was purchased at the same Killeen, Texas, store where Hasan bought his pistol.





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

Filed under news shooting violence mental illness mental health mental health illness healthy mind brain body psychology psychiatry ivan lopez lopez army military disorder diagnosis ptsd post traumatic stress disorder trauma traumatic anxiety depression ambien drug drugs med

63 notes

Autism and and Co-occurring Conditions: Bipolar DisorderBy Laurel Joss, Autism Daily Newscast
Bipolar disorder is a mood disorder characterized by extreme shifts in mood, energy, thinking and behavior. Patients suffering from bipolar disorder alternate between manic highs and devastating lows.
Everyone has their moods, but for the individual with bipolar disorder, they are exaggerated to the extreme. A patient in a manic state may go for days with little or no sleep, and may make impulsive decisions with serious consequences (ex. maxing out their credit cards or engaging in risky sexual behaviors).
Depressive phases tend to be extreme as well, with many patients lacking the energy to get out of bed and function in their daily lives. In extreme cases, some patients may even consider or attempt suicide.
People with autism can also demonstrate extreme moods, though there are differences between the two disorders. Extreme mood shifts or tantrums in patients with autism are often caused by the individual’s frustration at being unable to communicate or connect with others. This difficulty, which is a core symptom of autism, can also lead to anxiety and depression.
It is possible for both disorders to occur together, though diagnosis can be challenging. Individuals with autism may be unable to communicate their feelings, which can make it difficult for medical professionals to figure out why they are engaging in certain behaviors.
Some studies have shown that as much as 27% of individuals with autism also suffer from symptoms of bipolar disorder, though this may be exaggerated, due to overlapping symptoms between the two disorders. A 2010 study published in the Journal of Developmental and Physical
Disabilities found that many children with autism demonstrate symptoms that can also be indicators of bipolar disorder, including elevated moods, irritability, excessive talking, distractibility, and sleep disturbances.
Other studies have shown a genetic link between autism and bipolar disorder, along with other disorders such as ADHD and schizophrenia. A 2012 study from the University of North Carolina School of Medicine found that individuals with autism were more likely to have parents or siblings who had been diagnosed with bipolar disorder of schizophrenia.
One key factor in differentiating autism from bipolar disorder is to look carefully at when the symptoms appear and how long they last. An individual with autism who is high-energy, talks incessantly, and paces would not be considered bipolar, unless the symptoms appeared suddenly, along with other indicators such as lack of sleep and an increase in tantrums.
Even in a case like this, the patient should also be tested for other possible causes, including seizure disorders or exposure to food or environmental allergens. If these manic phases come and go, and if no other physical cause can be determined, then the patient may be suffering from bipolar disorder.
Bipolar disorder is often treated with a combination of psychoactive medications such a lithium and psychotherapy. Lithium can have serious side effects, and studies have shown that many individuals with autism respond well to valporic acid along with a low dose of an antipsychotic medication.
Artwork: McCarthy, M. (n.d.) A Portrait of a Lady.



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

Autism and and Co-occurring Conditions: Bipolar Disorder
By Laurel Joss, Autism Daily Newscast

Bipolar disorder is a mood disorder characterized by extreme shifts in mood, energy, thinking and behavior. Patients suffering from bipolar disorder alternate between manic highs and devastating lows.

Everyone has their moods, but for the individual with bipolar disorder, they are exaggerated to the extreme. A patient in a manic state may go for days with little or no sleep, and may make impulsive decisions with serious consequences (ex. maxing out their credit cards or engaging in risky sexual behaviors).

Depressive phases tend to be extreme as well, with many patients lacking the energy to get out of bed and function in their daily lives. In extreme cases, some patients may even consider or attempt suicide.

People with autism can also demonstrate extreme moods, though there are differences between the two disorders. Extreme mood shifts or tantrums in patients with autism are often caused by the individual’s frustration at being unable to communicate or connect with others. This difficulty, which is a core symptom of autism, can also lead to anxiety and depression.

It is possible for both disorders to occur together, though diagnosis can be challenging. Individuals with autism may be unable to communicate their feelings, which can make it difficult for medical professionals to figure out why they are engaging in certain behaviors.

Some studies have shown that as much as 27% of individuals with autism also suffer from symptoms of bipolar disorder, though this may be exaggerated, due to overlapping symptoms between the two disorders. A 2010 study published in the Journal of Developmental and Physical

Disabilities found that many children with autism demonstrate symptoms that can also be indicators of bipolar disorder, including elevated moods, irritability, excessive talking, distractibility, and sleep disturbances.

Other studies have shown a genetic link between autism and bipolar disorder, along with other disorders such as ADHD and schizophrenia. A 2012 study from the University of North Carolina School of Medicine found that individuals with autism were more likely to have parents or siblings who had been diagnosed with bipolar disorder of schizophrenia.

One key factor in differentiating autism from bipolar disorder is to look carefully at when the symptoms appear and how long they last. An individual with autism who is high-energy, talks incessantly, and paces would not be considered bipolar, unless the symptoms appeared suddenly, along with other indicators such as lack of sleep and an increase in tantrums.

Even in a case like this, the patient should also be tested for other possible causes, including seizure disorders or exposure to food or environmental allergens. If these manic phases come and go, and if no other physical cause can be determined, then the patient may be suffering from bipolar disorder.

Bipolar disorder is often treated with a combination of psychoactive medications such a lithium and psychotherapy. Lithium can have serious side effects, and studies have shown that many individuals with autism respond well to valporic acid along with a low dose of an antipsychotic medication.

Artwork: McCarthy, M. (n.d.) A Portrait of a Lady.





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

Filed under bipolar autism autistic mental health mental illness mental health illness healthy ill mind brain body psychology med meds medication mood mania manic depressed depression disorder diagnosis psychiatry psychiatric mood disorder doctors therapy recovery

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People with psych labels suffer discrimination: Mental health professionals are often guilty of such prejudiceBy Monica Cassani, Beyond Meds
People with psychiatric labels suffer discrimination that is not only demeaning but can also be dangerous.
A 2007 UK study by the Royal College of Psychiatrists revealed that prejudicial treatment of mentally ill patients extends to physical medical care; they receive poorer quality of care and doctors spend less time with them possibly leading to higher rates of death and preventable disease. Though tragic, the more scandalous aspect of the phenomena is the fact that mental health professionals apply the same prejudices to those whom they attempt to treat. The worst thing someone in mental distress can experience is dehumanizing treatment from other human beings who are supposed to be caring for them. I suppose as long as we continue to label people as ill and abnormal due to mental distress this will continue. We create a class of people who aren’t quite like everyone else.
I’ve written about my experience, as a mental health professional and as a person labeled with a serious mental illness quite often on Beyond Meds. I can attest to the fact that depending on how I choose to identify myself with other professionals, I am treated radically different. Generally speaking, when I identify as a social worker, rather than the author of Beyond Meds, – which is identified commonly as a “patient” blog, – I am received with respect by mainstream and alternative professionals both. I am also engaged more deeply and with more interest. On the other hand, when I identify primarily as the author of the blog but also a mental health professional, I am more likely to be treated dismissively. Because those professionals who profess to share my interest in radically changing the system or using alternatives to psychiatry exhibit this bigotry as well, it only reinforces how deeply entrenched these prejudices are across all sectors of society. Clearly what professionals across the board remember once it’s disclosed is that I was a user of psychiatry: a mentally ill person. I don’t consider myself as such — not anymore, but that doesn’t seem to matter even, quite often, among those professionals who profess not to believe in mental illness!
My online experience of identifying as patient vs. social worker, therefore, offers me a unique perspective. The sad fact is that the majority of those in mental distress are subject to the care of mental health professionals who consider them inherently less than equal. This is not generally recognized because on a conscious level people believe they really care. But well-meaning and acting with prejudice are unfortunately not mutually exclusive. I don’t know how one extracts this insidious form of bigotry. People don’t see it in themselves. How do we help them see? One way, of course, is to begin to courageously find and root out our own bigotries. All human beings have them.
Peer counseling, too, is a concept that may help bridge the divide between clinician and patient. When we meet those we are helping from a place of vulnerability and equality, we can bring about healing. I’ve noted that once I publicly acknowledged my frailty, my humanity, the healing relationship often became much stronger. Some of the connections and healing relationships I’ve made via my work at Beyond Meds have been astonishingly deeper and more honest than any work I ever did as a social worker when I relegated parts of myself as off limits to my clients. I was taught to separate myself this way as a professional.
Authenticity is trained right out of mental health professionals and instead a vague and subtle superiority replaces it. How do I know this? Because I too was tainted and saw it in myself, as a professional, even as I saw it in my colleagues around me. I also experienced it as a patient/client, I was actively made ‘other’ by the people I saw professionally. These parts – that of the knowing superior vs the ignorant inferior – are in all of us too, regardless of training! I suggest those in mental health circles who have taken up the mantle of helper become acutely conscious of this so that they might minimize the harm it can cause in relationship with others.
Also, I think that the concept of being a peer can be embraced by professionals. As human beings we are all peers. We are all, every one of us, in this wonderful and mysterious thing called life. And all of us are struggling in various ways to make sense of it. Is there really such a difference between someone trained as a clinician and a client? I think not!  If those trained to help were also trained to remember that their role as helper was because they have much more in common with their patients/clients than not, then we will start to see a flattening of hierarchy.
The fact is, we all have incredible capacities and learn very particular things in our own individual idiosyncratic ways. Most of it is not learned in school or training regardless of level of education.
This begs the question: Is it possible that identifying with a client might actually be a good thing? This is surely exactly why ”peer counselors” are effective.
Clinicians are trained to never, ever identify with the client. Why? What is wrong with recognizing shared humanity, even a weakness or flaw, and bonding in that? In providing a safe container from that understanding? The mere instruction to avoid such intimacy at all costs seems like a violent denial of oneself and clients both. It seems indicative of a deep fear of ones own dark parts. How do we help others find their way out of the dark if we hide from our own darkness? Such identification may not always be appropriate to share, no doubt, it may also not be present with many clients. But when it is present and appropriate to share from such a place, with adequate boundaries in place, it can be an incredibly healing experience for both parties. I believe that all our psyches contain a full spectrum of the content of the human psyche within it… Some people experience more or less of this or that, but we’ve all got it in there. Healing ourselves and others both require deep familiarity with all its parts. This is not understood particularly well among most mental health professionals, in my opinion.
Most mental health professionals not only know next to nothing about the deepest part of the psyche, they are terrified of it, adding another layer of obfuscation to the problem. When people in mental distress are terrified the last thing they need is to be met by a “healer” who is equally terrified of the clients thoughts and behavior.
Changing our system of care for those in mental distress requires deactivating the knee-jerk response of professionals and non-professionals alike towards those in psychic pain. Where we start with this is not always clear. I suppose I’m doing my bit here and all those conscious of these issues do what makes sense in their lives. There are schools of psychology that are very adept at thinking about these issues, but most training dwells on “abnormal psychology” thus the sense of “other” becomes a conditioned process as students learn about what is not normal in the human psyche. There are other ways of understanding unusual behaviors without considering it grossly pathological. For example in cases of trauma and abuse unusual behaviors may be highly adaptive. Then healing involves coming to understand how these behaviors or thinking patterns might have once served someone and how one might let them go now that they do not.
Needless to say, I’ve made some sweeping generalizations here and thus must add that there are indeed many wonderful healing people in the world. Ultimately what is at stake here is becoming conscious of the nature of our humanity. I am blessed to know many such people, lay and professional both, who are conscious of these issues. Still, it’s very hard for people lost in mental distress to find resources that include deeply healing professionals and so the people who need healing the most often do not find them. How do we change that? I suppose it starts with us going ever deeper into ourselves and lovingly, with compassion, helping others do the same.
Right now our system of psychiatric care is very toxic. Educating people by example is where we must start.



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

People with psych labels suffer discrimination: Mental health professionals are often guilty of such prejudice
By Monica Cassani, Beyond Meds

People with psychiatric labels suffer discrimination that is not only demeaning but can also be dangerous.

A 2007 UK study by the Royal College of Psychiatrists revealed that prejudicial treatment of mentally ill patients extends to physical medical care; they receive poorer quality of care and doctors spend less time with them possibly leading to higher rates of death and preventable disease. Though tragic, the more scandalous aspect of the phenomena is the fact that mental health professionals apply the same prejudices to those whom they attempt to treat. The worst thing someone in mental distress can experience is dehumanizing treatment from other human beings who are supposed to be caring for them. I suppose as long as we continue to label people as ill and abnormal due to mental distress this will continue. We create a class of people who aren’t quite like everyone else.

I’ve written about my experience, as a mental health professional and as a person labeled with a serious mental illness quite often on Beyond Meds. I can attest to the fact that depending on how I choose to identify myself with other professionals, I am treated radically different. Generally speaking, when I identify as a social worker, rather than the author of Beyond Meds, – which is identified commonly as a “patient” blog, – I am received with respect by mainstream and alternative professionals both. I am also engaged more deeply and with more interest. On the other hand, when I identify primarily as the author of the blog but also a mental health professional, I am more likely to be treated dismissively. Because those professionals who profess to share my interest in radically changing the system or using alternatives to psychiatry exhibit this bigotry as well, it only reinforces how deeply entrenched these prejudices are across all sectors of society. Clearly what professionals across the board remember once it’s disclosed is that I was a user of psychiatry: a mentally ill person. I don’t consider myself as such — not anymore, but that doesn’t seem to matter even, quite often, among those professionals who profess not to believe in mental illness!

My online experience of identifying as patient vs. social worker, therefore, offers me a unique perspective. The sad fact is that the majority of those in mental distress are subject to the care of mental health professionals who consider them inherently less than equal. This is not generally recognized because on a conscious level people believe they really care. But well-meaning and acting with prejudice are unfortunately not mutually exclusive. I don’t know how one extracts this insidious form of bigotry. People don’t see it in themselves. How do we help them see? One way, of course, is to begin to courageously find and root out our own bigotries. All human beings have them.

Peer counseling, too, is a concept that may help bridge the divide between clinician and patient. When we meet those we are helping from a place of vulnerability and equality, we can bring about healing. I’ve noted that once I publicly acknowledged my frailty, my humanity, the healing relationship often became much stronger. Some of the connections and healing relationships I’ve made via my work at Beyond Meds have been astonishingly deeper and more honest than any work I ever did as a social worker when I relegated parts of myself as off limits to my clients. I was taught to separate myself this way as a professional.

Authenticity is trained right out of mental health professionals and instead a vague and subtle superiority replaces it. How do I know this? Because I too was tainted and saw it in myself, as a professional, even as I saw it in my colleagues around me. I also experienced it as a patient/client, I was actively made ‘other’ by the people I saw professionally. These parts – that of the knowing superior vs the ignorant inferior – are in all of us too, regardless of training! I suggest those in mental health circles who have taken up the mantle of helper become acutely conscious of this so that they might minimize the harm it can cause in relationship with others.

Also, I think that the concept of being a peer can be embraced by professionals. As human beings we are all peers. We are all, every one of us, in this wonderful and mysterious thing called life. And all of us are struggling in various ways to make sense of it. Is there really such a difference between someone trained as a clinician and a client? I think not!  If those trained to help were also trained to remember that their role as helper was because they have much more in common with their patients/clients than not, then we will start to see a flattening of hierarchy.

The fact is, we all have incredible capacities and learn very particular things in our own individual idiosyncratic ways. Most of it is not learned in school or training regardless of level of education.

This begs the question: Is it possible that identifying with a client might actually be a good thing? This is surely exactly why ”peer counselors” are effective.

Clinicians are trained to never, ever identify with the client. Why? What is wrong with recognizing shared humanity, even a weakness or flaw, and bonding in that? In providing a safe container from that understanding? The mere instruction to avoid such intimacy at all costs seems like a violent denial of oneself and clients both. It seems indicative of a deep fear of ones own dark parts. How do we help others find their way out of the dark if we hide from our own darkness? Such identification may not always be appropriate to share, no doubt, it may also not be present with many clients. But when it is present and appropriate to share from such a place, with adequate boundaries in place, it can be an incredibly healing experience for both parties. I believe that all our psyches contain a full spectrum of the content of the human psyche within it… Some people experience more or less of this or that, but we’ve all got it in there. Healing ourselves and others both require deep familiarity with all its parts. This is not understood particularly well among most mental health professionals, in my opinion.

Most mental health professionals not only know next to nothing about the deepest part of the psyche, they are terrified of it, adding another layer of obfuscation to the problem. When people in mental distress are terrified the last thing they need is to be met by a “healer” who is equally terrified of the clients thoughts and behavior.

Changing our system of care for those in mental distress requires deactivating the knee-jerk response of professionals and non-professionals alike towards those in psychic pain. Where we start with this is not always clear. I suppose I’m doing my bit here and all those conscious of these issues do what makes sense in their lives. There are schools of psychology that are very adept at thinking about these issues, but most training dwells on “abnormal psychology” thus the sense of “other” becomes a conditioned process as students learn about what is not normal in the human psyche. There are other ways of understanding unusual behaviors without considering it grossly pathological. For example in cases of trauma and abuse unusual behaviors may be highly adaptive. Then healing involves coming to understand how these behaviors or thinking patterns might have once served someone and how one might let them go now that they do not.

Needless to say, I’ve made some sweeping generalizations here and thus must add that there are indeed many wonderful healing people in the world. Ultimately what is at stake here is becoming conscious of the nature of our humanity. I am blessed to know many such people, lay and professional both, who are conscious of these issues. Still, it’s very hard for people lost in mental distress to find resources that include deeply healing professionals and so the people who need healing the most often do not find them. How do we change that? I suppose it starts with us going ever deeper into ourselves and lovingly, with compassion, helping others do the same.

Right now our system of psychiatric care is very toxic. Educating people by example is where we must start.





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

Filed under stigma mental health mental illness mental health healthy fitness mind brain body label labels psychology psychiatry prejudice med meds medication medications blog tumblr patient recovery recover respect justice equality heal healing therapy

32 notes

The Fat Lady Has SungBy Robert Whitaker, Mad in AmericaCan the field as a whole hear the fat lady sing? Or will it turn a deaf ear to her, and continue with care — the regular long-term use of antipsychotics for all — that clearly does harm?When a medical specialty develops its clinical care guidelines, the “experts” in that specialty will review the research literature, and often that evidence base may present a very confusing picture. The results from the studies may be inconsistent, or contradictory. The experts are also faced with the challenge of weighing the benefits of a treatment against its risks. However, there are also instances when the “evidence base” tells a consistent story, across decades and in studies of various types, and when that happens, the experts developing clinical care guidelines can rejoice: science has provided them with a clear picture of what is helpful and what is not.
This provides the clinical context for assessing the importance of Martin Harrow’s latest paper: It adds a new data point to a long list of research findings that all lead to the same conclusion: antipsychotics, over the long term, do not reduce psychotic symptoms, and, in fact, increase the likelihood that such symptoms will persist.
Harrow has now published a number of papers detailing the outcomes of the schizophrenia patients he has followed for more than 20 years. In previous articles, he has reported that those who stopped taking antipsychotic medications did better over the long-term than the medicated patients in every domain: recovery rates, anxiety symptoms, psychotic symptoms, cognitive function, and employment. In his newest paper, Harrow focuses more closely on medication use and psychotic symptoms, and by doing so, he is narrowing psychiatry’s focus to one critical issue: do these drugs provide any long-term benefit?Antipsychotics, of course, cause many adverse effects, and thus, in any risk-benefit assessment, these drugs need to be effective in reducing psychotic symptoms in order for there to be something on the benefit side of the ledger. If the drugs don’t do that, then there are only risks – i.e. negatives – to be tallied up. And this is why I think we can now say that, with this latest publication of Harrow’s that the fat lady has sung. The case is closed: psychiatry needs to rethink its use of antipsychotics.The Evidence Cited for Long-term Use of Antipsychotics
Psychiatry, of course, does have evidence that it can cite supporting long-term use of antipsychotics. Its evidence consists of findings from relapse studies, but, as can be easily shown, those studies do not, in fact, tell of whether the drugs reduce psychotic symptoms over the long-term.
Once Thorazine and other antipsychotics were introduced, researchers ran studies designed like this: They would take a group of patients who had stabilized well on an antipsychotic, and then half of the patients would be withdrawn from the medication, and half would be maintained on it. With great regularity, those abruptly withdrawn from the antipsychotic relapsed at a higher rate. Thus, researchers concluded that staying on an antipsychotic lowers the risk of relapse.But there are evident flaws in that relapse literature. First, most of the relapse studies involved abrupt withdrawal of the medication, which is known to increase the risk that psychotic symptoms will return. Second, the studies only tell of the return of psychotic symptoms in patients who have been on an antipsychotic; they don’t tell of the risk of relapse in patients who haven’t been exposed to the drugs. Third, they don’t tell of the risk of relapse over longer periods (two years, five years, and so forth.)
Indeed, what the relapse studies prove is this: if a person is stable on an antipsychotic, then it is a very bad idea to withdraw that drug abruptly. They don’t tell of how such treatment affects people over the longer course of their lives.The Rest of the EvidenceAlthough it is well-recognized that the relapse studies don’t provide evidence that antipsychotics are effective over the long-term, most in the field assume that that is still true. However, there is a body of evidence, stretching back 50 years, that bears on this question, and when all of it is put together, it tells a consistent story. In brief:
a) In the 1960s, the NIMH conducted a nine-hospital study that compared placebo to drug treatment, and at the end of one year, those initially treated with an antipsychotic had a higher rehospitalization rate. Thus, at this very first moment of the research literature for antipsychotics, there is the hint of a paradox: treatment that is effective over the short term may increase the risk of relapse over the long term.b) In a retrospective study that compared five-year outcomes for patients treated in 1967 with antipsychotics compared to a similar group of patients treated in 1947 without drugs (as antipsychotics had yet to be introduced), Sanbourne Bockoven found that the 1967 cohort had a higher relapse rate.c) In three studies funded by the NIMH in the 1970s, which followed patients for one to three years, relapse rates were higher each time for the medicated patients. These findings led the NIMH’s William Carpenter to ask whether antipsychotics induced a biological change that made schizophrenic patients “more vulnerable to future relapse than would be the case in the natural course of the illness.”d) At that point, two researchers from McGill University, Guy Chouinard and Barry Jones, offered a biological explanation for why the drugs would have this paradoxical long-term effect. Antipsychotics blocked dopamine receptors in the brain, and in compensatory response, the brain increased the density of such receptors. The person’s brain was now supersensitive to dopamine, and this, they wrote, could lead to “psychotic symptoms.”e) In two cross-cultural studies conducted by the World Health Organization, which compared outcomes in India, Nigeria and Colombia with outcomes in the United States and five other developed countries, the patients in India and Nigeria fared the best. In those two countries, few patients were maintained long-term on antipsychotics, and patients there were much less likely to be psychotic at the end of two and five years.e) In the 1990s, researchers conducting MRI studies of schizophrenia patients reported that neuroleptic use, at the end of 18 months, was associated with hypertrophy of the thalamus and basal ganglion structures in the brain, and that this enlargement—as University of Pennsylvania investigators reported in 1998 —was in turn “associated with greater severity of both negative and positive symptoms.” Thus, the MRI studies told of antipsychotic-induced changes in the brain that made patients more psychotic over time.f) In animal studies, researchers at the University of Toronto have reported that the reason antipsychotics “fail” over time, as a treatment for psychotic symptoms, is that they cause an increase in dopamine receptors.f) A recent randomized study by Lex Wunderink, of the Netherlands, when carefully parsed, tells a similar story. In his study, patients who had stabilized on an antipsychotic were then either maintained on the drug or withdrawn from it (or tapered to a very low dose.) After two years, the relapse rate was higher in the withdrawn/low dose group (43% versus 21%.) However, at the end of seven years, the relapse rate for the withdrawn/low dose group was slightly lower (62% versus 69%), and the key point is this: during those five years (year two to seven in the study), the group that received drug treatment as usual relapsed more frequently than the withdrawn/low-dose group. This is a result consistent with the notion that antipsychotics increase the risk of relapse over the long-term.Why the Fat Lady Has SungWe can see that this body of evidence stretches over 50 years and that it tells a consistent story. The worry that antipsychotics might increase the risk of relapse showed up in the NIMH’s very first one-year study. It showed up in Bockoven’s retrospective study. Next, it showed up in three long-term studies funded by the NIMH in the 1970s. Researchers then offered a biological explanation for why these outcomes were occurring.
The WHO’s cross-cultural studies found better outcomes in poor countries where few patients were maintained long-term on antipsychotics. MRI studies identified a drug-induced change in brain morphology that was associated with a worsening of psychotic symptoms. Researchers who developed an animal model of psychosis concluded that drug-induced dopamine supersensitivity leads to treatment failure over time. Wunderink’s randomized study revealed a higher relapse rates between years two and seven for the medicated patients. Finally, Harrow’s long-term study, which is the best such study that has ever been conducted, found that the medicated patients were much more likely to be experiencing psychotic symptoms over the long term.
Harrow’s data does not stand alone. Instead, studies of multiple types are all leading to the same conclusion. Antipsychotics do not reduce psychotic symptoms over the long term and, in fact, increase the likelihood that such symptoms will persist. And imagine if the opposite were true and all these studies showed that medicated patients had fewer psychotic symptoms over the long term. Would anyone then question the long-term efficacy of antipsychotics? Psychiatry would then proclaim that the evidence was overwhelming that the drugs had such positive effect.
In her post on this site, Sandy Steingard presents a very compelling argument for a different use of these drugs: try to avoid initial use if possible, and then, if an antipsychotic is used, see if the person can be subsequently tapered from the medication. And if a person can’t be successfully tapered, prescribe as low a dose as possible. That is a protocol that provides for selective use of the drugs, and there is clearly an “evidence base” supporting a protocol of that type. Indeed, such use could be described as a “best-use” model.
But the obvious question for psychiatry is now this: Can the field as a whole hear the fat lady sing? Or will it turn a deaf ear to her, and continue with care — the regular long-term use of antipsychotics for all — that clearly does harm?



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

The Fat Lady Has Sung
By Robert Whitaker, Mad in America

Can the field as a whole hear the fat lady sing? Or will it turn a deaf ear to her, and continue with care — the regular long-term use of antipsychotics for all — that clearly does harm?

When a medical specialty develops its clinical care guidelines, the “experts” in that specialty will review the research literature, and often that evidence base may present a very confusing picture. The results from the studies may be inconsistent, or contradictory. The experts are also faced with the challenge of weighing the benefits of a treatment against its risks. However, there are also instances when the “evidence base” tells a consistent story, across decades and in studies of various types, and when that happens, the experts developing clinical care guidelines can rejoice: science has provided them with a clear picture of what is helpful and what is not.

This provides the clinical context for assessing the importance of Martin Harrow’s latest paper: It adds a new data point to a long list of research findings that all lead to the same conclusion: antipsychotics, over the long term, do not reduce psychotic symptoms, and, in fact, increase the likelihood that such symptoms will persist.

Harrow has now published a number of papers detailing the outcomes of the schizophrenia patients he has followed for more than 20 years. In previous articles, he has reported that those who stopped taking antipsychotic medications did better over the long-term than the medicated patients in every domain: recovery rates, anxiety symptoms, psychotic symptoms, cognitive function, and employment. In his newest paper, Harrow focuses more closely on medication use and psychotic symptoms, and by doing so, he is narrowing psychiatry’s focus to one critical issue: do these drugs provide any long-term benefit?
Antipsychotics, of course, cause many adverse effects, and thus, in any risk-benefit assessment, these drugs need to be effective in reducing psychotic symptoms in order for there to be something on the benefit side of the ledger. If the drugs don’t do that, then there are only risks – i.e. negatives – to be tallied up. And this is why I think we can now say that, with this latest publication of Harrow’s that the fat lady has sung. The case is closed: psychiatry needs to rethink its use of antipsychotics.
The Evidence Cited for Long-term Use of Antipsychotics

Psychiatry, of course, does have evidence that it can cite supporting long-term use of antipsychotics. Its evidence consists of findings from relapse studies, but, as can be easily shown, those studies do not, in fact, tell of whether the drugs reduce psychotic symptoms over the long-term.

Once Thorazine and other antipsychotics were introduced, researchers ran studies designed like this: They would take a group of patients who had stabilized well on an antipsychotic, and then half of the patients would be withdrawn from the medication, and half would be maintained on it. With great regularity, those abruptly withdrawn from the antipsychotic relapsed at a higher rate. Thus, researchers concluded that staying on an antipsychotic lowers the risk of relapse.
But there are evident flaws in that relapse literature. First, most of the relapse studies involved abrupt withdrawal of the medication, which is known to increase the risk that psychotic symptoms will return. Second, the studies only tell of the return of psychotic symptoms in patients who have been on an antipsychotic; they don’t tell of the risk of relapse in patients who haven’t been exposed to the drugs. Third, they don’t tell of the risk of relapse over longer periods (two years, five years, and so forth.)

Indeed, what the relapse studies prove is this: if a person is stable on an antipsychotic, then it is a very bad idea to withdraw that drug abruptly. They don’t tell of how such treatment affects people over the longer course of their lives.

The Rest of the Evidence
Although it is well-recognized that the relapse studies don’t provide evidence that antipsychotics are effective over the long-term, most in the field assume that that is still true. However, there is a body of evidence, stretching back 50 years, that bears on this question, and when all of it is put together, it tells a consistent story. In brief:

a) In the 1960s, the NIMH conducted a nine-hospital study that compared placebo to drug treatment, and at the end of one year, those initially treated with an antipsychotic had a higher rehospitalization rate. Thus, at this very first moment of the research literature for antipsychotics, there is the hint of a paradox: treatment that is effective over the short term may increase the risk of relapse over the long term.
b) In a retrospective study that compared five-year outcomes for patients treated in 1967 with antipsychotics compared to a similar group of patients treated in 1947 without drugs (as antipsychotics had yet to be introduced), Sanbourne Bockoven found that the 1967 cohort had a higher relapse rate.
c) In three studies funded by the NIMH in the 1970s, which followed patients for one to three years, relapse rates were higher each time for the medicated patients. These findings led the NIMH’s William Carpenter to ask whether antipsychotics induced a biological change that made schizophrenic patients “more vulnerable to future relapse than would be the case in the natural course of the illness.”
d) At that point, two researchers from McGill University, Guy Chouinard and Barry Jones, offered a biological explanation for why the drugs would have this paradoxical long-term effect. Antipsychotics blocked dopamine receptors in the brain, and in compensatory response, the brain increased the density of such receptors. The person’s brain was now supersensitive to dopamine, and this, they wrote, could lead to “psychotic symptoms.”
e) In two cross-cultural studies conducted by the World Health Organization, which compared outcomes in India, Nigeria and Colombia with outcomes in the United States and five other developed countries, the patients in India and Nigeria fared the best. In those two countries, few patients were maintained long-term on antipsychotics, and patients there were much less likely to be psychotic at the end of two and five years.
e) In the 1990s, researchers conducting MRI studies of schizophrenia patients reported that neuroleptic use, at the end of 18 months, was associated with hypertrophy of the thalamus and basal ganglion structures in the brain, and that this enlargement—as University of Pennsylvania investigators reported in 1998 —was in turn “associated with greater severity of both negative and positive symptoms.” Thus, the MRI studies told of antipsychotic-induced changes in the brain that made patients more psychotic over time.
f) In animal studies, researchers at the University of Toronto have reported that the reason antipsychotics “fail” over time, as a treatment for psychotic symptoms, is that they cause an increase in dopamine receptors.
f) A recent randomized study by Lex Wunderink, of the Netherlands, when carefully parsed, tells a similar story. In his study, patients who had stabilized on an antipsychotic were then either maintained on the drug or withdrawn from it (or tapered to a very low dose.) After two years, the relapse rate was higher in the withdrawn/low dose group (43% versus 21%.) However, at the end of seven years, the relapse rate for the withdrawn/low dose group was slightly lower (62% versus 69%), and the key point is this: during those five years (year two to seven in the study), the group that received drug treatment as usual relapsed more frequently than the withdrawn/low-dose group. This is a result consistent with the notion that antipsychotics increase the risk of relapse over the long-term.

Why the Fat Lady Has Sung
We can see that this body of evidence stretches over 50 years and that it tells a consistent story. The worry that antipsychotics might increase the risk of relapse showed up in the NIMH’s very first one-year study. It showed up in Bockoven’s retrospective study. Next, it showed up in three long-term studies funded by the NIMH in the 1970s. Researchers then offered a biological explanation for why these outcomes were occurring.

The WHO’s cross-cultural studies found better outcomes in poor countries where few patients were maintained long-term on antipsychotics. MRI studies identified a drug-induced change in brain morphology that was associated with a worsening of psychotic symptoms. Researchers who developed an animal model of psychosis concluded that drug-induced dopamine supersensitivity leads to treatment failure over time. Wunderink’s randomized study revealed a higher relapse rates between years two and seven for the medicated patients. Finally, Harrow’s long-term study, which is the best such study that has ever been conducted, found that the medicated patients were much more likely to be experiencing psychotic symptoms over the long term.

Harrow’s data does not stand alone. Instead, studies of multiple types are all leading to the same conclusion. Antipsychotics do not reduce psychotic symptoms over the long term and, in fact, increase the likelihood that such symptoms will persist. And imagine if the opposite were true and all these studies showed that medicated patients had fewer psychotic symptoms over the long term. Would anyone then question the long-term efficacy of antipsychotics? Psychiatry would then proclaim that the evidence was overwhelming that the drugs had such positive effect.

In her post on this site, Sandy Steingard presents a very compelling argument for a different use of these drugs: try to avoid initial use if possible, and then, if an antipsychotic is used, see if the person can be subsequently tapered from the medication. And if a person can’t be successfully tapered, prescribe as low a dose as possible. That is a protocol that provides for selective use of the drugs, and there is clearly an “evidence base” supporting a protocol of that type. Indeed, such use could be described as a “best-use” model.

But the obvious question for psychiatry is now this: Can the field as a whole hear the fat lady sing? Or will it turn a deaf ear to her, and continue with care — the regular long-term use of antipsychotics for all — that clearly does harm?





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

Filed under psychosis psychotic psycho schizophrenia schizophrenic bipolar psychology psychiatry mental health mental illness mental health illness mind body brain healthy recover recovery med meds drug drugs therapy hallucination delusion mad madness rethinking madness symptom

278 notes

Recovery from Borderline Personality Disorder May Be AttainableBy Ashley Brown, MA, PhDRecovery from Borderline Personality Disorder (BPD) may be possible, and the roots lie in understanding the biosocial model. This model originated with Marsha Linehan’s theory, which argued that there were both social and biological reasons that BPD develops.
Borderline Personality Disorder is often considered one of the most difficult diagnoses with which to work. But in my many years of experience working with individuals with BPD, I found that there are reasons behind their actions which, when understood, can help lead to empathy, acceptance, and ultimately change.
According to the biosocial model, people with BPD frequently have differences in their neurotransmitter and neurological functioning. Research has shown that they many have neurotransmitter issues that make them more emotional, aggressive, or reactive to stimuli – making them more prone to emotionally intense experiences.
People with BPD have usually been invalidated throughout life which leads to emotional sensitivity. For example, imagine a child who is hungry or frustrated trying to communicate this to his or her parents but being told that their feelings don’t matter over and over again. The feelings may be cast aside with statements such as “there’s nothing to cry about” or through cultural stereotypes such as “little girls don’t get angry” or “big boys don’t cry”. And environments of emotional, psychological, and physical abuse are extremely invalidating.
Invalidation serves to demonstrate to children that their feelings are wrong and that somehow they need to look externally, to other people, to know what they are feeling and if their feelings have value. Being told their emotions were wrong led them to believe that emotions were bad things, to be avoided whenever possible. This creates a chronic, internal tension where the person feels that they have to live up to others’ expectations and not experience negative feelings. Yet they also feel anger and worthlessness for having those unavoidable negative feelings, or on a deeper level, for not being able to authentically express themselves.
This tension builds up and causes an emotional explosion. In fact, the individual who has had their emotions invalidated repeatedly growing up will feel that if they don’t demonstrate their emotions through large displays, that no one will believe them. They believe that their emotions are not worthy of being considered, so may in fact subconsciously overemphasize their emotional expression in order to ensure that other people “believe” that what they are feeling is real.
This is one reason BPD results in so many emotional outbursts. People with BPD have been invalidated for so long that they don’t trust what they feel unless their feelings are overflowing and taking over the room. It’s only then that the individual with BPD can relax and say “see, I told you I was upset”.
Having emotions ignored by others for so long also leads to black and white behaviors and beliefs. For someone with BPD, behaviors may swing like a pendulum from distancing themselves from their emotions and other people to feeling needy and dependent on someone else. Although the individual looks for love and approval from others, they have difficulty accepting that love due to the low regard they have for themselves. Chronic invalidation has caused them to feel overwhelmed by distressing emotions. Sometimes their behavior becomes self-sabotaging and self-destructive when they can’t cope with these emotions. Frequently, social relationships merely reinforce these negative patterns.
As children, people with BPD learned these skills to survive in their dysfunctional environment. But these skills no longer serve them. Many people with BPD find the notion of “change” to be invalidating in itself because it implies that there is something wrong with them that needs to be purged. This is why the most successful and well-researched therapy for BPD, Dialectical Behavior Therapy (DBT), focuses on balancing radical acceptance and non-judgment of oneself while recognizing the need for change.
The biosocial model reveals keys to recovery from Borderline Personality Disorder and tells us that this diagnosis does not have to be the horrible life-sentence that many people and medical professionals make it out to be. Marsha Linehan, the inventor of DBT, revealed in a 2011 New York Times article that she had Borderline Personality Disorder when she was younger. Yet, she’s found ways to cope with and grow from the issues that at one point institutionalized her. If she can get through it, anyone can.



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

Recovery from Borderline Personality Disorder May Be Attainable
By Ashley Brown, MA, PhD

Recovery from Borderline Personality Disorder (BPD) may be possible, and the roots lie in understanding the biosocial model. This model originated with Marsha Linehan’s theory, which argued that there were both social and biological reasons that BPD develops.

Borderline Personality Disorder is often considered one of the most difficult diagnoses with which to work. But in my many years of experience working with individuals with BPD, I found that there are reasons behind their actions which, when understood, can help lead to empathy, acceptance, and ultimately change.

According to the biosocial model, people with BPD frequently have differences in their neurotransmitter and neurological functioning. Research has shown that they many have neurotransmitter issues that make them more emotional, aggressive, or reactive to stimuli – making them more prone to emotionally intense experiences.

People with BPD have usually been invalidated throughout life which leads to emotional sensitivity. For example, imagine a child who is hungry or frustrated trying to communicate this to his or her parents but being told that their feelings don’t matter over and over again. The feelings may be cast aside with statements such as “there’s nothing to cry about” or through cultural stereotypes such as “little girls don’t get angry” or “big boys don’t cry”. And environments of emotional, psychological, and physical abuse are extremely invalidating.

Invalidation serves to demonstrate to children that their feelings are wrong and that somehow they need to look externally, to other people, to know what they are feeling and if their feelings have value. Being told their emotions were wrong led them to believe that emotions were bad things, to be avoided whenever possible. This creates a chronic, internal tension where the person feels that they have to live up to others’ expectations and not experience negative feelings. Yet they also feel anger and worthlessness for having those unavoidable negative feelings, or on a deeper level, for not being able to authentically express themselves.

This tension builds up and causes an emotional explosion. In fact, the individual who has had their emotions invalidated repeatedly growing up will feel that if they don’t demonstrate their emotions through large displays, that no one will believe them. They believe that their emotions are not worthy of being considered, so may in fact subconsciously overemphasize their emotional expression in order to ensure that other people “believe” that what they are feeling is real.

This is one reason BPD results in so many emotional outbursts. People with BPD have been invalidated for so long that they don’t trust what they feel unless their feelings are overflowing and taking over the room. It’s only then that the individual with BPD can relax and say “see, I told you I was upset”.

Having emotions ignored by others for so long also leads to black and white behaviors and beliefs. For someone with BPD, behaviors may swing like a pendulum from distancing themselves from their emotions and other people to feeling needy and dependent on someone else. Although the individual looks for love and approval from others, they have difficulty accepting that love due to the low regard they have for themselves. Chronic invalidation has caused them to feel overwhelmed by distressing emotions. Sometimes their behavior becomes self-sabotaging and self-destructive when they can’t cope with these emotions. Frequently, social relationships merely reinforce these negative patterns.

As children, people with BPD learned these skills to survive in their dysfunctional environment. But these skills no longer serve them. Many people with BPD find the notion of “change” to be invalidating in itself because it implies that there is something wrong with them that needs to be purged. This is why the most successful and well-researched therapy for BPD, Dialectical Behavior Therapy (DBT), focuses on balancing radical acceptance and non-judgment of oneself while recognizing the need for change.

The biosocial model reveals keys to recovery from Borderline Personality Disorder and tells us that this diagnosis does not have to be the horrible life-sentence that many people and medical professionals make it out to be. Marsha Linehan, the inventor of DBT, revealed in a 2011 New York Times article that she had Borderline Personality Disorder when she was younger. Yet, she’s found ways to cope with and grow from the issues that at one point institutionalized her. If she can get through it, anyone can.





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

Filed under borderline borderline personality borderline personality disorder bpd disorder personality disorder diagnosis psychology mind brain body health healthy recovery hope mental health mental illness mental illness cutting self harm self help dbt dialectical behavior therapy linehan marsha linehan news research hopeful study

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What Does It Feel Like to Have Bipolar Disorder?By Quora ContributorThis question originally appeared on Quora.Answer by Mills Baker, in fairly successful treatment for 12-plus years:I have bipolar disorder, as does my mother and as did her mother. I am the sort of person who “seems” bipolar to people—that is my energy, creativity, instability, mercuriality, and easy gregariousness confirm many of the popularly imagined stereotypes about bipolar people.That said, I think only in their extremes are mania and depression actually unintelligible to ordinary folks. That is: At their utmost intensity, they are unlike anything a normal person ever experiences (mania is, in particular, qualitatively different at the end than any healthy mood state), but at most times, they are not at all different from the maximally intense moods everyone knows—just more so, longer-lasting, and disconnected from normative causes.
To understand what having bipolar disorder “feels like,” keep in mind the following:
First, bipolar is less about short-term mood instability than about long-term mood cycles, which can last months, years, or in rare cases even decades. (See F.M. Mondimore for more on cycles and durations.) Instability is part of it, but not the only part.
Second, the cumulative effect of these cycles on the formation of a personality is significant. After a childhood of radically changing interests and attitudes on such a timeline, one develops a certain excitability, flightiness, distractibility, or perhaps that’s just me. But this is a major part of bipolar: the personality that is shaped by a lifetime of intense, fluctuating moods.
Third, cycles grow in intensity over time. This means that at first in mania, for example, you’re simply in a great mood. Then you’re really in an extraordinarily creative, kinetic, charming mood. Then you’re the life of all parties, and you’re feeling pretty libidinous. Then you’re doing irresponsible things and fleeing a pursuing psychosis. Then you’re in psychosis, tortured by acousticovisual hallucinations, paranoia, and your own penchant for completely unacceptable reactions and behavior. This progression can take days, weeks, months, or years. The same progression tends to hold for depression.
Kay Redfield Jamison is a psychiatrist at Johns Hopkins University who suffers from, treats, and writes about bipolar disorder. About mania, she writes:

The ideas and feelings are fast and frequent like shooting stars, and you follow them until you find better and brighter ones. Shyness goes, the right words and gestures are suddenly there, the power to captivate others a felt certainty. There are interests found in uninteresting people. Sensuality is pervasive and the desire to seduce and be seduced irresistible. Feelings of ease, intensity, power, well-being, financial omnipotence, and euphoria pervade one’s marrow. But, somewhere, this changes. The fast ideas are far too fast, and there are far too many; overwhelming confusion replaces clarity. Memory goes. Humor and absorption on friends’ faces are replaced by fear and concern. Everything previously moving with the grain is now against— you are irritable, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of the mind. You never knew those caves were there. It will never end, for madness carves its own reality.

Mania (and hypomania, to an obviously lesser extent) are truly hard to describe; I attempted my own description of a brief manic experience here.In the blackness of myself, I could see that my thoughts were not myself at all: My self is only a nothingness that exists in a state of pure terror and hatred, and my thoughts rotate around it as debris in a tornado. My thoughts were imbecilic, disgusting, vicious, superficial, detestable, but by this point I could no longer stay with them long enough to hate them. They distracted me, but I couldn’t attend to them. I said in my mind: Oh God, oh God, oh God, nothing, nothing, nothing. Oh God, nothing, nothing. Oh God, I’m nothing, it’s nothing, there’s nothing, God, God.Periodically I would see what I assume was a phosphene, and it would transform into something real. I saw a glowing purple shape become the sun, and the sun became the blond hair I had in childhood. And I realized that I had murdered that boy, had murdered my own boyhood self, had destroyed this innocent child, and I ground my teeth to silence myself, as I wanted to scream so loud that I would tear myself apart, would explode in a bloody spray. I was sick with guilt and fear. I had nothing inside myself any longer. I felt I had betrayed myself, had orphaned myself when I needed someone most. I heard in my mind: Why did I kill him? Oh God, he needed someone, he needed someone, why did I kill him? I’ve killed him, oh God, I’ve killed him.I was seized with a desire to gain physical access to and destroy my brain, an urge I felt in childhood when I had severe headaches. I grasped my hair and attempted to pull it out; I wanted to rip my scalp over and reach into my skull and destroy my mind, scramble and tear apart this malevolent and pathetic apparatus with my fingers, rip out the guts of my who nightmare self. I couldn’t get my hair out, hated myself for it, lost the thread of this thought, and resumed my silent shrieking and sobbing.
About depression, Jamison writes in Night Falls Fast:

In its severe forms, depression paralyzes all of the otherwise vital forces that make us human, leaving instead a bleak, despairing, desperate, and deadened state… Life is bloodless, pulseless, and yet present enough to allow a suffocating horror and pain. All bearings are lost; all things are dark and drained of feeling. The slippage into futility is first gradual, then utter. Thought, which is as pervasively affected by depression as mood, is morbid, confused, and stuporous. It is also vacillating, ruminative, indecisive, and self-castigating. The body is bone-weary; there is no will; nothing is that is not an effort, and nothing at all seems worth it. Sleep is fragmented, elusive, or all-consuming. Like an unstable gas, an irritable exhaustion seeps into every crevice of thought and action.

Jamison is well-known, too, for her research on the link between bipolar disorder and creativity, which leads me to my conclusion:To know what it “feels like” is to know the qualia, the phenomenological experiences a bipolar person encounters that an unaffected person does not. I don’t think there are many of these. Going berserk, being creative, having an awful temper, not being able to trust my own emotional reactions: These have a certain weight when I list them out, discuss them as individual tragedies. They can even sound unique.But everyone loses it. Everyone has his moments of charisma, creativity, success, strength, achievement, and everyone struggles with himself. You may not hallucinate, but I bet you can understand what it’s like for your mind to misbehave, react insanely. If you haven’t yet lost control of yourself in life, wait.We bipolar people have a tendency to comfort ourselves by saying that our more intense experience of typical phenomena constitutes an election: We are elite, more alive, deeper! Jamison’s own excellent research on bipolar artists has amplified this: The popular Western conflation of insanity, artistic talent, and melodrama permits a kind of sentimental self-regard: Yes, I’m crazy, but I’m also probably in some difficult-to-establish way deeply brilliant!Perhaps this is true for some, but it seems mostly to me to be a consolatory story, the sort of inversion that Nietzsche describes as resentiment: To say this illness is really a kind of health, a kind of deeper seeing, is a lie. I like my life a lot, but I am uncomfortable with this persistent meme, largely because I’m sometimes confused into believing it myself. Indeed, one of bipolar disorder’s chief symptoms is often that a patient confuses herself with an artist. (Or more generally: an exception. Mondimore notes that throughout history, “grandiosity” has changed in its expressions. An important symptom of bipolar, grandiosity was once expressed by women saying they were pregnant with kings or the messiah, men believing they were kings or the messiah; presently, our insanity is less monarchical and religious; we all instead believe we special exceptions of one sort or another).I’ve been in treatment now for 12 years, on the same cocktail of medications for years and years. For me, the most enduring way that bipolar “feels” different is in how I cannot trust my reactions. When someone says something to you and you recognize it as an insult, as abuse, your reactive anger is appropriate and you can commit to it, or you can make some determination based on your values, your reason, and choose a different course of action. I can’t even trust that the person insulted me. I can’t trust my emotional perceptions or reactions.That’s the strangest thing about how it feels, after the dust of the actual disorder settles, more than a decade in: the open insanity has abated and visits only briefly, the idea that I’m a secret artist is absurd, and what’s left is a more or less normal life in which I have to emphasize “mental hygiene” (prioritizing regular sleep, for example) and in which I always feel doubt about what I think and feel, as we all probably should anyway.Note: As Anne Zieger helpfully noted, this answer is not fully comprehensive: Phenomena such as rapid-cycling, which I’ve experienced only from SSRIs, aren’t discussed, and the variations of bipolar disorder aren’t either. How it “feels” to be bipolar naturally varies widely from person to person, just as how it feels to be sane must, so I should emphasize that this answer is how it feels for me alone. Most bipolar people will have significant variations in their experiences.



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

What Does It Feel Like to Have Bipolar Disorder?
By Quora Contributor

This question originally appeared on Quora.

Answer by Mills Baker, in fairly successful treatment for 12-plus years:

I have bipolar disorder, as does my mother and as did her mother. I am the sort of person who “seems” bipolar to people—that is my energy, creativity, instability, mercuriality, and easy gregariousness confirm many of the popularly imagined stereotypes about bipolar people.
That said, I think only in their extremes are mania and depression actually unintelligible to ordinary folks. That is: At their utmost intensity, they are unlike anything a normal person ever experiences (mania is, in particular, qualitatively different at the end than any healthy mood state), but at most times, they are not at all different from the maximally intense moods everyone knows—just more so, longer-lasting, and disconnected from normative causes.

To understand what having bipolar disorder “feels like,” keep in mind the following:

  • First, bipolar is less about short-term mood instability than about long-term mood cycles, which can last months, years, or in rare cases even decades. (See F.M. Mondimore for more on cycles and durations.) Instability is part of it, but not the only part.
  • Second, the cumulative effect of these cycles on the formation of a personality is significant. After a childhood of radically changing interests and attitudes on such a timeline, one develops a certain excitability, flightiness, distractibility, or perhaps that’s just me. But this is a major part of bipolar: the personality that is shaped by a lifetime of intense, fluctuating moods.
  • Third, cycles grow in intensity over time. This means that at first in mania, for example, you’re simply in a great mood. Then you’re really in an extraordinarily creative, kinetic, charming mood. Then you’re the life of all parties, and you’re feeling pretty libidinous. Then you’re doing irresponsible things and fleeing a pursuing psychosis. Then you’re in psychosis, tortured by acousticovisual hallucinations, paranoia, and your own penchant for completely unacceptable reactions and behavior. This progression can take days, weeks, months, or years. The same progression tends to hold for depression.


Kay Redfield Jamison is a psychiatrist at Johns Hopkins University who suffers from, treats, and writes about bipolar disorder. About mania, she writes:

The ideas and feelings are fast and frequent like shooting stars, and you follow them until you find better and brighter ones. Shyness goes, the right words and gestures are suddenly there, the power to captivate others a felt certainty. There are interests found in uninteresting people. Sensuality is pervasive and the desire to seduce and be seduced irresistible. Feelings of ease, intensity, power, well-being, financial omnipotence, and euphoria pervade one’s marrow. But, somewhere, this changes. The fast ideas are far too fast, and there are far too many; overwhelming confusion replaces clarity. Memory goes. Humor and absorption on friends’ faces are replaced by fear and concern. Everything previously moving with the grain is now against— you are irritable, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of the mind. You never knew those caves were there. It will never end, for madness carves its own reality.

Mania (and hypomania, to an obviously lesser extent) are truly hard to describe; I attempted my own description of a brief manic experience here.
In the blackness of myself, I could see that my thoughts were not myself at all: My self is only a nothingness that exists in a state of pure terror and hatred, and my thoughts rotate around it as debris in a tornado. My thoughts were imbecilic, disgusting, vicious, superficial, detestable, but by this point I could no longer stay with them long enough to hate them. They distracted me, but I couldn’t attend to them. I said in my mind: Oh God, oh God, oh God, nothing, nothing, nothing. Oh God, nothing, nothing. Oh God, I’m nothing, it’s nothing, there’s nothing, God, God.
Periodically I would see what I assume was a phosphene, and it would transform into something real. I saw a glowing purple shape become the sun, and the sun became the blond hair I had in childhood. And I realized that I had murdered that boy, had murdered my own boyhood self, had destroyed this innocent child, and I ground my teeth to silence myself, as I wanted to scream so loud that I would tear myself apart, would explode in a bloody spray. I was sick with guilt and fear. I had nothing inside myself any longer. I felt I had betrayed myself, had orphaned myself when I needed someone most. I heard in my mind: Why did I kill him? Oh God, he needed someone, he needed someone, why did I kill him? I’ve killed him, oh God, I’ve killed him.
I was seized with a desire to gain physical access to and destroy my brain, an urge I felt in childhood when I had severe headaches. I grasped my hair and attempted to pull it out; I wanted to rip my scalp over and reach into my skull and destroy my mind, scramble and tear apart this malevolent and pathetic apparatus with my fingers, rip out the guts of my who nightmare self. I couldn’t get my hair out, hated myself for it, lost the thread of this thought, and resumed my silent shrieking and sobbing.

About depression, Jamison writes in Night Falls Fast:

In its severe forms, depression paralyzes all of the otherwise vital forces that make us human, leaving instead a bleak, despairing, desperate, and deadened state… Life is bloodless, pulseless, and yet present enough to allow a suffocating horror and pain. All bearings are lost; all things are dark and drained of feeling. The slippage into futility is first gradual, then utter. Thought, which is as pervasively affected by depression as mood, is morbid, confused, and stuporous. It is also vacillating, ruminative, indecisive, and self-castigating. The body is bone-weary; there is no will; nothing is that is not an effort, and nothing at all seems worth it. Sleep is fragmented, elusive, or all-consuming. Like an unstable gas, an irritable exhaustion seeps into every crevice of thought and action.


Jamison is well-known, too, for her research on the link between bipolar disorder and creativity, which leads me to my conclusion:
To know what it “feels like” is to know the qualia, the phenomenological experiences a bipolar person encounters that an unaffected person does not. I don’t think there are many of these. Going berserk, being creative, having an awful temper, not being able to trust my own emotional reactions: These have a certain weight when I list them out, discuss them as individual tragedies. They can even sound unique.
But everyone loses it. Everyone has his moments of charisma, creativity, success, strength, achievement, and everyone struggles with himself. You may not hallucinate, but I bet you can understand what it’s like for your mind to misbehave, react insanely. If you haven’t yet lost control of yourself in life, wait.
We bipolar people have a tendency to comfort ourselves by saying that our more intense experience of typical phenomena constitutes an election: We are elite, more alive, deeper! Jamison’s own excellent research on bipolar artists has amplified this: The popular Western conflation of insanity, artistic talent, and melodrama permits a kind of sentimental self-regard: Yes, I’m crazy, but I’m also probably in some difficult-to-establish way deeply brilliant!
Perhaps this is true for some, but it seems mostly to me to be a consolatory story, the sort of inversion that Nietzsche describes as resentiment: To say this illness is really a kind of health, a kind of deeper seeing, is a lie. I like my life a lot, but I am uncomfortable with this persistent meme, largely because I’m sometimes confused into believing it myself. Indeed, one of bipolar disorder’s chief symptoms is often that a patient confuses herself with an artist. (Or more generally: an exception. Mondimore notes that throughout history, “grandiosity” has changed in its expressions. An important symptom of bipolar, grandiosity was once expressed by women saying they were pregnant with kings or the messiah, men believing they were kings or the messiah; presently, our insanity is less monarchical and religious; we all instead believe we special exceptions of one sort or another).
I’ve been in treatment now for 12 years, on the same cocktail of medications for years and years. For me, the most enduring way that bipolar “feels” different is in how I cannot trust my reactions. When someone says something to you and you recognize it as an insult, as abuse, your reactive anger is appropriate and you can commit to it, or you can make some determination based on your values, your reason, and choose a different course of action. I can’t even trust that the person insulted me. I can’t trust my emotional perceptions or reactions.
That’s the strangest thing about how it feels, after the dust of the actual disorder settles, more than a decade in: the open insanity has abated and visits only briefly, the idea that I’m a secret artist is absurd, and what’s left is a more or less normal life in which I have to emphasize “mental hygiene” (prioritizing regular sleep, for example) and in which I always feel doubt about what I think and feel, as we all probably should anyway.

Note: As Anne Zieger helpfully noted, this answer is not fully comprehensive: Phenomena such as rapid-cycling, which I’ve experienced only from SSRIs, aren’t discussed, and the variations of bipolar disorder aren’t either. How it “feels” to be bipolar naturally varies widely from person to person, just as how it feels to be sane must, so I should emphasize that this answer is how it feels for me alone. Most bipolar people will have significant variations in their experiences.





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

Filed under bipolar bipolar disorder bi polar disorder diagnosis mind body brain health healthy mental mental illness illness mental health mania manic depression depressed sad emotion feelings feeling psychology psychiatry counseling therapy treatment recovery hope quora