Serious Mental Illness Blog

An LIU Post Specialty Concentration

Posts tagged psychotherapy

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

From the related article, Sawyer, A. (2011). Let’s talk: a narrative of mental illness, recovery, and the psychotherapist’s personal treatment. Journal of clinical psychology, 67(8), 776-788: 

This article describes the author’s experience in psychotherapy, beginning as a suicidal teenager with a dismal prognosis, through 5 years of hospitalization, including shock treatment that erased most memory before age 20, through an Ivy League education, and successful professional career. Retraumatization triggered by reading her hospital records 40 years later adds a unique perspective, as the author watched, but could not control, a process within herself that she regularly addressed as therapist with her own patients. Healing aspects of relationships with three psychodynamic psychotherapists (two psychiatrists and a social worker), credited with her survival and success, are examined. A dramatic interview with Harold Searles, her psychiatrist’s supervisor, and its role in her recovery is considered. Lasting lessons concerning the healing aspects of psychotherapy, the effects of repressed early trauma encountered late in life, the need to counter stigma, and the value of personal psychotherapy are discussed.



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

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Should Mental Health Be a Primary-Care Doctor’s Job?By Suzanne Koven, who is a primary care doctor at Massachusetts General Hospital in Boston and writes the column “In Practice” at the Boston Globe.Patients occasionally ask me if I’ll be the doctor who’ll take out a gallbladder or deliver a baby. I tell them, “You deserve better.” I’m a primary-care internist, and my expertise is broader than it is deep. I manage high blood pressure and cholesterol but refer people with heart attacks to cardiologists; I perform Pap tests and prescribe birth-control pills but send pregnant women to obstetricians; and I often diagnose, but never treat, cancer.With mental illness, though, the limits of my role are less clear. I’m comfortable helping people get through life’s more common emotional challenges, like divorce, retirement, disappointing children. If you’re hearing voices, or if you walk into my office and announce that you’ve decided to kill yourself, as someone did not long ago, I know exactly what to do: escort you to a psychiatrist. But what about the lawyer who’s having trouble meeting deadlines and wants medication for attention-deficit disorder? Or the businesswoman whose therapist told her to see me about starting an antidepressant? Or the civil servant trying to shake his Oxycontin addiction? They’ve all asked me to treat them because they don’t want or can’t easily access psychiatric care.This winter, I’ll see more patients with seasonal-affective disorder than the flu, and the tissues in my exam room will dry tears more often than they muffle sneezes. The problem is, I lack the time or training to diagnose and manage many psychiatric disorders. And some studies, such as this one about low rates of detection of anxiety and depression by primary-care doctors, show that I’m probably not all that great at doing so. Still, over a third of all mental-health care in the U.S. is now provided by primary-care doctors, nurse practitioners, pediatricians, and family practitioners.One reason is that there aren’t enough psychiatrists. I recall discussions, fifteen years ago, among members of my internal-medicine group about whether it was ethical for us to prescribe antidepressants when we practiced in a hospital with dozens of mental-health professionals on staff. We no longer have those discussions. Demand by patients for mental-health care has increased such that if primary-care doctors didn’t offer it, many people would go without it. It’s estimated that seventy per cent of a primary-care doctor’s practice now involves management of psychosocial issues ranging from marriage counselling to treatment of anxiety and depression.Some argue that the increased demand is artificial, driven by overdiagnosis of mental illness and overuse of psychiatric medications. With one in four adults and one in five children currently carrying a psychiatric diagnosis—and one in five Americans taking psychiatric medications regularly, such skepticism seems warranted. Regardless, access to psychiatric care is nowhere near large enough to meet the growing demand. Fewer medical students are going into psychiatry, partly because psychiatrists, like primary-care doctors, earn among the lowest salaries of all physicians. Those who do choose psychiatry often don’t accept insurance, including Medicare and Medicaid, requiring patients to pay out of pocket. Affordable psychiatric treatment is especially limited for children and in rural states. Wyoming, for example, which has one of the highest suicide rates in the nation, had, according to one count from a few years ago, a mere twenty-seven psychiatrists—just over five per hundred thousand residents. Massachusetts, by comparison, had around over two thousand psychiatrists, or around thirty-two per hundred thousand residents.But even in Boston, where I practice, primary-care doctors are treating more mental illness. Some patients don’t have adequate insurance to obtain specialized mental-health care, despite legislative efforts, including the Affordable Care Act, to create parity between mental-health coverage and coverage for other medical conditions. Some people want psychiatric care without having to see a psychiatrist. Having finally confided a long-held secret of compulsive hand-washing or bulimia to me, some patients would rather not share it all over again with someone else. And some wish to avoid having, as one of my patients put it, “a psychiatric rap sheet”—a record that an insurance company, employer, or nosy family member might discover. They’d prefer to have their psychiatric diagnoses tucked discreetly between my notes about their heartburn and their eczema.Harvard Medical School’s Center for Primary Care recently announced a new program to improve the quality of psychiatric care offered by primary-care doctors. In its initial phases, it will place mental-health workers in six Boston-area primary-care clinics and target the treatment of depression. It will also outfit the clinics with videoconferencing technology to enable consultations with psychiatrists and other specialists.Programs like Harvard’s aren’t only responding to a shortage of psychiatrists, though. They’re part of a movement toward what’s called the “Patient-Centered Medical Home.” First conceived in the nineteen-sixties by pediatricians who were trying to provide better-coordinated care for chronically ill children, the medical-home model urges patients to receive most of their care in the offices of their primary-care doctors, with consultants coming and going. When a patient needs to see a specialist, the primary-care provider arranges and oversees the consultation. Often it occurs in the primary-care doctor’s office, or even in the patient’s actual home, via something like Skype; this modern medical home depends heavily on technology, such as electronic health records and video and digital communication between patients and their doctors—and between the primary-care team and consultants.To get a sense of how this model differs from current norms, I told Dr. Russell Phillips, director of the Center for Primary Care, about the businesswoman whose therapist had recommended that I prescribe her an antidepressant. I mentioned that I’d prescribed it, arranged to meet with the patient frequently, and crossed my fingers that the drug would be effective and wouldn’t cause side effects. If the medication didn’t work, or if she didn’t tolerate it, I’d likely have to convince her to see a psychopharmacologist—if I could find one who accepted her insurance. How would things have been different if I practiced in one of the clinics participating in his new program?Phillips said that first, my patient would fill out a PHQ-9 survey, a nine-question screener for depression. The survey isn’t perfect, but it might cut down on some of the antidepressant prescriptions written by primary-care doctors too busy to verify that a patient is clinically depressed. If she met the criteria for depression set by the PHQ-9, her name would be entered in a registry of patients in my practice who were assigned follow-up care with a psychiatric nurse, social worker, or other mental-health professional on my medical team. If appropriate, I’d prescribe an antidepressant, but with access to consultation by phone or videoconferencing with a psychopharmacologist paid to assist me.While it sounds reasonable for a primary-care doctor to get an opinion about a rash or a chest X-ray via computer, it’s less obvious that a patient’s mental health could be assessed this way. But, it turns out, “telemental health” works surprisingly well. A 2013 review of several programs in which patients received psychiatric evaluation and counselling by phone, e-mail, or video showed that telemedicine can improve symptoms, reduce length of hospital stays, and help people adhere to medication as well as face-to-face psychiatric care. For children and adolescents, telemedicine often works better than face-to-face care.Still, I confessed to Phillips that surveys, registries, and videoconferencing didn’t sound like the kind of patient interactions that made me choose primary care in the first place. He argued that, actually, the type of care he’s proposing is simply a modern version of what an old-fashioned general practitioner offered. A few generations ago, the family doctor was a one-stop resource for health care and emotional support. He might deliver you, take out your tonsils, write your college-recommendation letter, and, if he outlived you, preside over your deathbed. Phillips envisions twenty-first-century primary care as being no less inclusive. “Our patients are coming in to see us,” he told me. “They have needs. We should be able to address as many of those needs as possible. And we know behavioral-health disorders are front and center, so it should be something that primary-care doctors can manage.”He also pointed out that in the current system, in which a doctor who cares for a patient’s body often has little contact with the doctor who cares for her mind, doesn’t make much sense. Psychiatric drugs and conditions can affect physical health, and drugs for medical conditions, as well as the medical conditions themselves, have psychological effects. And people with mental illness are two to four times as likely to die from their medical conditions as people without mental illness. Several studies have shown that when primary-care doctors team up with mental-health workers, their patients’ physical health improves.The key to making team-based medical care work, Phillips said, is helping the patient feel that his or her relationship with the primary-care provider is at its center. “I’ve actually done some of this,” he told me. “And it’s very meaningful to patients to have a connection to a member of the team when they realize that the team is an extension of their physician. So it can’t be a faceless person who’s anonymous and is a robo-caller.”Not long ago, a patient of mine came to my office, accompanied by his worried family. He’d been acting peculiarly, and it wasn’t clear whether his behavior was caused by some longstanding psychiatric issues or by his many medical problems and medications. I phoned a psychiatrist at my hospital to see if I might expedite an appointment for an evaluation to complement my medical work. “Is he with you now?” the psychiatrist asked. I said that he was, and she told me that she happened to be free, and would come to my office and meet with him there.The patient and his family were greatly reassured by the psychiatrist’s visit. I have no doubt that much of that reassurance came from seeing the psychiatrist and me, even briefly, in the same room together—from a sense that I, the doctor who knows the patient best, was running the show.I thought, Wouldn’t it be great if a psychiatrist appeared in my office every time a patient needed one? In the future, one will—most likely on a screen.


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

Should Mental Health Be a Primary-Care Doctor’s Job?
By Suzanne Koven, who is a primary care doctor at Massachusetts General Hospital in Boston and writes the column “In Practice” at the Boston Globe.

Patients occasionally ask me if I’ll be the doctor who’ll take out a gallbladder or deliver a baby. I tell them, “You deserve better.” I’m a primary-care internist, and my expertise is broader than it is deep. I manage high blood pressure and cholesterol but refer people with heart attacks to cardiologists; I perform Pap tests and prescribe birth-control pills but send pregnant women to obstetricians; and I often diagnose, but never treat, cancer.
With mental illness, though, the limits of my role are less clear. I’m comfortable helping people get through life’s more common emotional challenges, like divorce, retirement, disappointing children. If you’re hearing voices, or if you walk into my office and announce that you’ve decided to kill yourself, as someone did not long ago, I know exactly what to do: escort you to a psychiatrist. But what about the lawyer who’s having trouble meeting deadlines and wants medication for attention-deficit disorder? Or the businesswoman whose therapist told her to see me about starting an antidepressant? Or the civil servant trying to shake his Oxycontin addiction? They’ve all asked me to treat them because they don’t want or can’t easily access psychiatric care.
This winter, I’ll see more patients with seasonal-affective disorder than the flu, and the tissues in my exam room will dry tears more often than they muffle sneezes. The problem is, I lack the time or training to diagnose and manage many psychiatric disorders. And some studies, such as this one about low rates of detection of anxiety and depression by primary-care doctors, show that I’m probably not all that great at doing so. Still, over a third of all mental-health care in the U.S. is now provided by primary-care doctors, nurse practitioners, pediatricians, and family practitioners.
One reason is that there aren’t enough psychiatrists. I recall discussions, fifteen years ago, among members of my internal-medicine group about whether it was ethical for us to prescribe antidepressants when we practiced in a hospital with dozens of mental-health professionals on staff. We no longer have those discussions. Demand by patients for mental-health care has increased such that if primary-care doctors didn’t offer it, many people would go without it. It’s estimated that seventy per cent of a primary-care doctor’s practice now involves management of psychosocial issues ranging from marriage counselling to treatment of anxiety and depression.
Some argue that the increased demand is artificial, driven by overdiagnosis of mental illness and overuse of psychiatric medications. With one in four adults and one in five children currently carrying a psychiatric diagnosis—and one in five Americans taking psychiatric medications regularly, such skepticism seems warranted. Regardless, access to psychiatric care is nowhere near large enough to meet the growing demand. Fewer medical students are going into psychiatry, partly because psychiatrists, like primary-care doctors, earn among the lowest salaries of all physicians. Those who do choose psychiatry often don’t accept insurance, including Medicare and Medicaid, requiring patients to pay out of pocket. Affordable psychiatric treatment is especially limited for children and in rural states. Wyoming, for example, which has one of the highest suicide rates in the nation, had, according to one count from a few years ago, a mere twenty-seven psychiatrists—just over five per hundred thousand residents. Massachusetts, by comparison, had around over two thousand psychiatrists, or around thirty-two per hundred thousand residents.
But even in Boston, where I practice, primary-care doctors are treating more mental illness. Some patients don’t have adequate insurance to obtain specialized mental-health care, despite legislative efforts, including the Affordable Care Act, to create parity between mental-health coverage and coverage for other medical conditions. Some people want psychiatric care without having to see a psychiatrist. Having finally confided a long-held secret of compulsive hand-washing or bulimia to me, some patients would rather not share it all over again with someone else. And some wish to avoid having, as one of my patients put it, “a psychiatric rap sheet”—a record that an insurance company, employer, or nosy family member might discover. They’d prefer to have their psychiatric diagnoses tucked discreetly between my notes about their heartburn and their eczema.
Harvard Medical School’s Center for Primary Care recently announced a new program to improve the quality of psychiatric care offered by primary-care doctors. In its initial phases, it will place mental-health workers in six Boston-area primary-care clinics and target the treatment of depression. It will also outfit the clinics with videoconferencing technology to enable consultations with psychiatrists and other specialists.
Programs like Harvard’s aren’t only responding to a shortage of psychiatrists, though. They’re part of a movement toward what’s called the “Patient-Centered Medical Home.” First conceived in the nineteen-sixties by pediatricians who were trying to provide better-coordinated care for chronically ill children, the medical-home model urges patients to receive most of their care in the offices of their primary-care doctors, with consultants coming and going. When a patient needs to see a specialist, the primary-care provider arranges and oversees the consultation. Often it occurs in the primary-care doctor’s office, or even in the patient’s actual home, via something like Skype; this modern medical home depends heavily on technology, such as electronic health records and video and digital communication between patients and their doctors—and between the primary-care team and consultants.
To get a sense of how this model differs from current norms, I told Dr. Russell Phillips, director of the Center for Primary Care, about the businesswoman whose therapist had recommended that I prescribe her an antidepressant. I mentioned that I’d prescribed it, arranged to meet with the patient frequently, and crossed my fingers that the drug would be effective and wouldn’t cause side effects. If the medication didn’t work, or if she didn’t tolerate it, I’d likely have to convince her to see a psychopharmacologist—if I could find one who accepted her insurance. How would things have been different if I practiced in one of the clinics participating in his new program?
Phillips said that first, my patient would fill out a PHQ-9 survey, a nine-question screener for depression. The survey isn’t perfect, but it might cut down on some of the antidepressant prescriptions written by primary-care doctors too busy to verify that a patient is clinically depressed. If she met the criteria for depression set by the PHQ-9, her name would be entered in a registry of patients in my practice who were assigned follow-up care with a psychiatric nurse, social worker, or other mental-health professional on my medical team. If appropriate, I’d prescribe an antidepressant, but with access to consultation by phone or videoconferencing with a psychopharmacologist paid to assist me.
While it sounds reasonable for a primary-care doctor to get an opinion about a rash or a chest X-ray via computer, it’s less obvious that a patient’s mental health could be assessed this way. But, it turns out, “telemental health” works surprisingly well. A 2013 review of several programs in which patients received psychiatric evaluation and counselling by phone, e-mail, or video showed that telemedicine can improve symptoms, reduce length of hospital stays, and help people adhere to medication as well as face-to-face psychiatric care. For children and adolescents, telemedicine often works better than face-to-face care.
Still, I confessed to Phillips that surveys, registries, and videoconferencing didn’t sound like the kind of patient interactions that made me choose primary care in the first place. He argued that, actually, the type of care he’s proposing is simply a modern version of what an old-fashioned general practitioner offered. A few generations ago, the family doctor was a one-stop resource for health care and emotional support. He might deliver you, take out your tonsils, write your college-recommendation letter, and, if he outlived you, preside over your deathbed. Phillips envisions twenty-first-century primary care as being no less inclusive. “Our patients are coming in to see us,” he told me. “They have needs. We should be able to address as many of those needs as possible. And we know behavioral-health disorders are front and center, so it should be something that primary-care doctors can manage.”
He also pointed out that in the current system, in which a doctor who cares for a patient’s body often has little contact with the doctor who cares for her mind, doesn’t make much sense. Psychiatric drugs and conditions can affect physical health, and drugs for medical conditions, as well as the medical conditions themselves, have psychological effects. And people with mental illness are two to four times as likely to die from their medical conditions as people without mental illness. Several studies have shown that when primary-care doctors team up with mental-health workers, their patients’ physical health improves.
The key to making team-based medical care work, Phillips said, is helping the patient feel that his or her relationship with the primary-care provider is at its center. “I’ve actually done some of this,” he told me. “And it’s very meaningful to patients to have a connection to a member of the team when they realize that the team is an extension of their physician. So it can’t be a faceless person who’s anonymous and is a robo-caller.”
Not long ago, a patient of mine came to my office, accompanied by his worried family. He’d been acting peculiarly, and it wasn’t clear whether his behavior was caused by some longstanding psychiatric issues or by his many medical problems and medications. I phoned a psychiatrist at my hospital to see if I might expedite an appointment for an evaluation to complement my medical work. “Is he with you now?” the psychiatrist asked. I said that he was, and she told me that she happened to be free, and would come to my office and meet with him there.
The patient and his family were greatly reassured by the psychiatrist’s visit. I have no doubt that much of that reassurance came from seeing the psychiatrist and me, even briefly, in the same room together—from a sense that I, the doctor who knows the patient best, was running the show.
I thought, Wouldn’t it be great if a psychiatrist appeared in my office every time a patient needed one? In the future, one will—most likely on a screen.



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

(Source: newyorker.com)

Filed under new news psychology psychological psychologist therapist therapists psychotherapy medical medicine health illness mental mental health mental illness mental disorder disorder primary care primary care doctor doctors boston massachusetts united states united states usa america internist

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[Article of Interest] The Problem With How We Treat Bipolar Disorder
By Linda Logan
Excerpt:
The last time I saw my old self, I was 27 years old and living in Boston. I was doing well in graduate school, had a tight circle of friends and was a prolific creative writer. Married to my high-school sweetheart, I had just had my first child. Back then, my best times were twirling my baby girl under the gloaming sky on a Florida beach and flopping on the bed with my husband — feet propped against the wall — and talking. The future seemed wide open.
I don’t think there is a particular point at which I can say I became depressed. My illness was insidious, gradual and inexorable. I had a preview of depression in high school, when I spent a couple of years wearing all black, rimming my eyes in kohl and sliding against the walls in the hallways, hoping that no one would notice me. But back then I didn’t think it was a very serious problem.
The hormonal chaos of having three children in five years, the pressure of working on a Ph.D. dissertation and a genetic predisposition for a mood disorder took me to a place of darkness I hadn’t experienced before. Of course, I didn’t recognize that right away. Denial is a gauze; willful denial, an opiate. Everyone seemed in league with my delusion. I was just overwhelmed, my family would say. I should get more help with the kids, put off my Ph.D.
When I told other young mothers about my bone-wearying fatigue, they rolled their eyes knowingly and mumbled, “Right.” But what they didn’t realize was that I could scarcely push the stroller to the park, barely summon the breath to ask the store clerk, “Where are the Pampers?” I went from doctor to doctor, looking for the cause. Lab tests for anemia, low blood sugar and hypothyroidism were all negative.
Any joy I derived from my children was now conjoined with grief. I couldn’t breathe the perfume of their freshly shampooed hair without being seized by the realization that they would not always be under my roof. While stroking their backs, I would mentally fast-forward their lives — noses elongating, tongues sharpening — until I came to their leave-taking, until I reached my death and, ultimately, theirs.
I lost my sense of competence. If a colleague remarked on my intelligence, I mentally derided him as being too stupid to know how dumb I was. If someone asked what I did for a living, I would say, “Nothing” — a remarkably effective conversation stopper. I couldn’t bear the thought of socializing; one night I jumped out of the car as my husband and I were driving to a party.
Despite having these feelings in my mid-30s, when my kids were 8, 5 and 3, I was thriving professionally: I had recently completed my Ph.D. in geography, had just finished co-teaching a semester at M.I.T. as a lecturer and was revising my dissertation on spec for a respected university press. Yet several nights a week, I drove to the reservoir near my home, sat under a tree and, as joggers and their dogs ran past, thought about ending it all. There was a gun shop on the way to my poetry group; I knew exactly where to go when the time came.
My day, once broken by naps, gradually turned into lengthy stretches of sleep, punctuated by moments of wakefulness. My husband and I didn’t explain to the kids that I was depressed. “Mommy’s a little tired today,” we would say. A year or so earlier, a therapist told us to tell the children. “But they’re just kids,” we said. “What do they know?” “They know,” she said. When we eventually spoke to them, my oldest daughter came to me and asked: “Why did you keep it a secret? I thought all mothers were like you.”
After a few weeks of stopping at the reservoir, as suicide eclipsed all other thoughts, I finally told my husband about my worsening psychic pain. The next day I was hospitalized. It was June 1989. Even though we were living in Boston, we decided I should go to Chicago to work with the psychopharmacologist who, 15 years earlier, restored the health of my father, who had also been hospitalized for depression. As the cab pulled away from our house, I turned and saw three children’s hands pressed against the screen of an upstairs window. This is the way the world breaks.
The moment the psych-unit doors locked behind me, I was stripped of my identity as wife, mother, teacher and writer and transformed into patient, room number and diagnosis. I couldn’t open a refrigerator without permission. If I were on suicide watch, I had to ask before going to the bathroom. I was told when to sleep and when to wake, when to eat and when to go to group. My routine, which at home had cleaved so closely to my children’s, now revolved around the clattering sounds of the food trays being brought three times each day from the service elevators into our unit. With my husband and children nearly 1,000 miles away, I was severed from my fixed stars. I missed my children’s smells, the way they used to wrap their bodies around my legs when I was on the phone. I brought my son’s comforter to the hospital for my bed. I remembered him with one leg thrown across the covers, a small foot peeking out from his pajamas.
When my children visited, I had to resuscitate my maternal self, if only for an hour. I dragged myself to the shower, pulled on a pair of clean sweat pants and a fresh T-shirt and ran a streak of lipstick across my lips, hoping to look like a reasonable facsimile of a mother.
My doctor used my first hospitalization as a so-called washout, a period during which he planned to take me off the medication I was on and introduce several drugs in several different combinations. The prospect of polypharmacy — taking many drugs at once — seemed foreboding. I read about Prozac’s giving some people entirely new personalities: happier, lighter, even buoyant. “Who are you going to turn me into?” I asked my doctor.
“I’m not turning you into anyone,” he said. “You’ll be yourself, only happier.”
“I don’t think I even have a self anymore.”
“We’ll find your self.”
I was wary. “Just don’t turn me into Sandy Duncan.”
How much insult to the self is done by the symptoms of the disorder and how much by the drugs used to treat it? Paradoxically, psychotropic drugs can induce anxiety, nervousness, impaired judgment, mania, hypomania, hallucinations, feelings of depersonalization, psychosis and suicidal thoughts, while being used to treat the same symptoms. Before getting to the hospital, my daily moods ranged from bad to worse, each state accompanied by a profound depth of feeling. The first drug I was given was amitriptyline (Elavil), which, in the process of reducing my despair, blunted all my other emotions. I no longer felt anything. It was like going from satellite TV to one lousy channel.
[…]
For many people with mental disorders, the transformation of the self is one of the most disturbing things about being ill. And their despair is heightened when doctors don’t engage with the issue, don’t ask about what parts of the self have vanished and don’t help figure out strategies to deal with that loss.
Some in the mental-health field are beginning to recognize this need. Janina Fisher, a psychologist and the assistant director of the Sensorimotor Psychotherapy Institute in Broomfield, Colo., told me that there has been a “sea change” in the role the self plays in the therapeutic dialogue since the decades when I was sick. New therapies and treatment philosophies, founded mostly by clinical psychologists and other practitioners who are not medical doctors, recognize the role of the self in people with mental illness. Patients tell her, “I just want to be that person I used to be.” Fisher encourages her patients to recognize that their mental trauma is a part of their life, but shouldn’t dominate it.
In my own experience with Scheftner, whom I began seeing after my father’s doctor moved away, we talk about the self but only when I bring it up. That’s why I have enjoyed helping to run a support group for people with mental disorders, something I’ve been doing for the last three years. There are usually 8 of us, sometimes 12. We sit in the basement of a local library every Wednesday afternoon. Though we know one another’s innermost thoughts, we are intimate strangers, not friends. Like A.A. and other self-help groups, we’re peer-led: run by and for people with mental disorders. We talk one by one about the past week — small achievements, setbacks, doctor appointments, family conflicts. While the self is not always an explicit topic, the loss of self — or for those doing better, the reconstruction of the self — is a hovering presence in the group.
One day, not long ago, a middle-aged man came to our group. He told us that he spent the past year attending different grief groups, but none of them were right. “Why not?” someone asked. The man said: “Because everyone there was grieving over the loss of another person. I was grieving for myself. For who I used to be before I got sick and who I am now.”
During the 20-odd years since my hospitalizations, many parts of my old self have been straggling home. But not everything made the return trip. While I no longer jump from moving cars on the way to parties, I still find social events uncomfortable. And, although I don’t have to battle to stay awake during the day, I still don’t have full days — I’m only functional mornings to midafternoons. I haven’t been able to return to teaching. How many employers would welcome a request for a cot, a soft pillow and half the day off?
One morning, about five years ago, my husband and I were talking on the family-room sofa. I was still wearing my pajamas and had wool hiking socks on. As he rubbed my feet, he told me he was leaving. It was, at once, a scene of tenderness and savagery. A little later, he threw some clothes into a suitcase and moved out. But my self — devastated, grieving, angry — remained intact.
Today, my mind is nimble. Creative writing has crept back into my life. I’ve made a couple of close friends in Chicago. My greatest pleasure is still my children — they’re starting careers, marrying, on the brinks of their lives. I’m looking forward to grandchildren, to singing the 1950s favorite “Life Is but a Dream” while spinning those babies under the stars of a falling night on a Florida beach. This June, I’m turning 60. I’m having a small party to celebrate my ingathering of selves. My old self was first to R.S.V.P.

[Article of Interest] The Problem With How We Treat Bipolar Disorder

By Linda Logan

Excerpt:

The last time I saw my old self, I was 27 years old and living in Boston. I was doing well in graduate school, had a tight circle of friends and was a prolific creative writer. Married to my high-school sweetheart, I had just had my first child. Back then, my best times were twirling my baby girl under the gloaming sky on a Florida beach and flopping on the bed with my husband — feet propped against the wall — and talking. The future seemed wide open.

I don’t think there is a particular point at which I can say I became depressed. My illness was insidious, gradual and inexorable. I had a preview of depression in high school, when I spent a couple of years wearing all black, rimming my eyes in kohl and sliding against the walls in the hallways, hoping that no one would notice me. But back then I didn’t think it was a very serious problem.

The hormonal chaos of having three children in five years, the pressure of working on a Ph.D. dissertation and a genetic predisposition for a mood disorder took me to a place of darkness I hadn’t experienced before. Of course, I didn’t recognize that right away. Denial is a gauze; willful denial, an opiate. Everyone seemed in league with my delusion. I was just overwhelmed, my family would say. I should get more help with the kids, put off my Ph.D.

When I told other young mothers about my bone-wearying fatigue, they rolled their eyes knowingly and mumbled, “Right.” But what they didn’t realize was that I could scarcely push the stroller to the park, barely summon the breath to ask the store clerk, “Where are the Pampers?” I went from doctor to doctor, looking for the cause. Lab tests for anemia, low blood sugar and hypothyroidism were all negative.

Any joy I derived from my children was now conjoined with grief. I couldn’t breathe the perfume of their freshly shampooed hair without being seized by the realization that they would not always be under my roof. While stroking their backs, I would mentally fast-forward their lives — noses elongating, tongues sharpening — until I came to their leave-taking, until I reached my death and, ultimately, theirs.

I lost my sense of competence. If a colleague remarked on my intelligence, I mentally derided him as being too stupid to know how dumb I was. If someone asked what I did for a living, I would say, “Nothing” — a remarkably effective conversation stopper. I couldn’t bear the thought of socializing; one night I jumped out of the car as my husband and I were driving to a party.

Despite having these feelings in my mid-30s, when my kids were 8, 5 and 3, I was thriving professionally: I had recently completed my Ph.D. in geography, had just finished co-teaching a semester at M.I.T. as a lecturer and was revising my dissertation on spec for a respected university press. Yet several nights a week, I drove to the reservoir near my home, sat under a tree and, as joggers and their dogs ran past, thought about ending it all. There was a gun shop on the way to my poetry group; I knew exactly where to go when the time came.

My day, once broken by naps, gradually turned into lengthy stretches of sleep, punctuated by moments of wakefulness. My husband and I didn’t explain to the kids that I was depressed. “Mommy’s a little tired today,” we would say. A year or so earlier, a therapist told us to tell the children. “But they’re just kids,” we said. “What do they know?” “They know,” she said. When we eventually spoke to them, my oldest daughter came to me and asked: “Why did you keep it a secret? I thought all mothers were like you.”

After a few weeks of stopping at the reservoir, as suicide eclipsed all other thoughts, I finally told my husband about my worsening psychic pain. The next day I was hospitalized. It was June 1989. Even though we were living in Boston, we decided I should go to Chicago to work with the psychopharmacologist who, 15 years earlier, restored the health of my father, who had also been hospitalized for depression. As the cab pulled away from our house, I turned and saw three children’s hands pressed against the screen of an upstairs window. This is the way the world breaks.

The moment the psych-unit doors locked behind me, I was stripped of my identity as wife, mother, teacher and writer and transformed into patient, room number and diagnosis. I couldn’t open a refrigerator without permission. If I were on suicide watch, I had to ask before going to the bathroom. I was told when to sleep and when to wake, when to eat and when to go to group. My routine, which at home had cleaved so closely to my children’s, now revolved around the clattering sounds of the food trays being brought three times each day from the service elevators into our unit. With my husband and children nearly 1,000 miles away, I was severed from my fixed stars. I missed my children’s smells, the way they used to wrap their bodies around my legs when I was on the phone. I brought my son’s comforter to the hospital for my bed. I remembered him with one leg thrown across the covers, a small foot peeking out from his pajamas.

When my children visited, I had to resuscitate my maternal self, if only for an hour. I dragged myself to the shower, pulled on a pair of clean sweat pants and a fresh T-shirt and ran a streak of lipstick across my lips, hoping to look like a reasonable facsimile of a mother.

My doctor used my first hospitalization as a so-called washout, a period during which he planned to take me off the medication I was on and introduce several drugs in several different combinations. The prospect of polypharmacy — taking many drugs at once — seemed foreboding. I read about Prozac’s giving some people entirely new personalities: happier, lighter, even buoyant. “Who are you going to turn me into?” I asked my doctor.

“I’m not turning you into anyone,” he said. “You’ll be yourself, only happier.”

“I don’t think I even have a self anymore.”

“We’ll find your self.”

I was wary. “Just don’t turn me into Sandy Duncan.”

How much insult to the self is done by the symptoms of the disorder and how much by the drugs used to treat it? Paradoxically, psychotropic drugs can induce anxiety, nervousness, impaired judgment, mania, hypomania, hallucinations, feelings of depersonalization, psychosis and suicidal thoughts, while being used to treat the same symptoms. Before getting to the hospital, my daily moods ranged from bad to worse, each state accompanied by a profound depth of feeling. The first drug I was given was amitriptyline (Elavil), which, in the process of reducing my despair, blunted all my other emotions. I no longer felt anything. It was like going from satellite TV to one lousy channel.

[…]

For many people with mental disorders, the transformation of the self is one of the most disturbing things about being ill. And their despair is heightened when doctors don’t engage with the issue, don’t ask about what parts of the self have vanished and don’t help figure out strategies to deal with that loss.

Some in the mental-health field are beginning to recognize this need. Janina Fisher, a psychologist and the assistant director of the Sensorimotor Psychotherapy Institute in Broomfield, Colo., told me that there has been a “sea change” in the role the self plays in the therapeutic dialogue since the decades when I was sick. New therapies and treatment philosophies, founded mostly by clinical psychologists and other practitioners who are not medical doctors, recognize the role of the self in people with mental illness. Patients tell her, “I just want to be that person I used to be.” Fisher encourages her patients to recognize that their mental trauma is a part of their life, but shouldn’t dominate it.

In my own experience with Scheftner, whom I began seeing after my father’s doctor moved away, we talk about the self but only when I bring it up. That’s why I have enjoyed helping to run a support group for people with mental disorders, something I’ve been doing for the last three years. There are usually 8 of us, sometimes 12. We sit in the basement of a local library every Wednesday afternoon. Though we know one another’s innermost thoughts, we are intimate strangers, not friends. Like A.A. and other self-help groups, we’re peer-led: run by and for people with mental disorders. We talk one by one about the past week — small achievements, setbacks, doctor appointments, family conflicts. While the self is not always an explicit topic, the loss of self — or for those doing better, the reconstruction of the self — is a hovering presence in the group.

One day, not long ago, a middle-aged man came to our group. He told us that he spent the past year attending different grief groups, but none of them were right. “Why not?” someone asked. The man said: “Because everyone there was grieving over the loss of another person. I was grieving for myself. For who I used to be before I got sick and who I am now.”

During the 20-odd years since my hospitalizations, many parts of my old self have been straggling home. But not everything made the return trip. While I no longer jump from moving cars on the way to parties, I still find social events uncomfortable. And, although I don’t have to battle to stay awake during the day, I still don’t have full days — I’m only functional mornings to midafternoons. I haven’t been able to return to teaching. How many employers would welcome a request for a cot, a soft pillow and half the day off?

One morning, about five years ago, my husband and I were talking on the family-room sofa. I was still wearing my pajamas and had wool hiking socks on. As he rubbed my feet, he told me he was leaving. It was, at once, a scene of tenderness and savagery. A little later, he threw some clothes into a suitcase and moved out. But my self — devastated, grieving, angry — remained intact.

Today, my mind is nimble. Creative writing has crept back into my life. I’ve made a couple of close friends in Chicago. My greatest pleasure is still my children — they’re starting careers, marrying, on the brinks of their lives. I’m looking forward to grandchildren, to singing the 1950s favorite “Life Is but a Dream” while spinning those babies under the stars of a falling night on a Florida beach. This June, I’m turning 60. I’m having a small party to celebrate my ingathering of selves. My old self was first to R.S.V.P.

Filed under Science History News bipolar bipolarity antipsychotic isps psychiatric psychiatry psychoanalysis psychological psychology psychopathology psychopharmacology psychosis psychotherapy psychotic Crime Extreme america documentary med medication meds mental mental illness pharmacy hospital dsm dsm 5

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[Article of Interest] Childhood Depression May Be Tied to Later Heart Risk

For these kids, obesity, smoking and inactivity more likely in adolescence, preliminary research showsTeens who were depressed as children are more likely to be obese, to smoke and to be sedentary, a new study finds.The findings suggest that depression during childhood can increase the risk of heart problems later in life, according to the researchers.The study included more than 500 children who were followed from ages 9 to 16. There were three groups: those diagnosed with depression as children, their depression-free siblings and a control group of unrelated youngsters with no history of depression.Twenty-two percent of the kids who were depressed at age 9 were obese at age 16, the study found. “Only 17 percent of their siblings were obese, and the obesity rate was 11 percent in the unrelated children who never had been depressed,” study first author Robert Carney, a professor of psychiatry at Washington University School of Medicine in St. Louis, said in a university news release.The researchers found similar patterns when they looked at smoking and physical activity.”A third of those who were depressed as children had become daily smokers, compared to 13 percent of their nondepressed siblings and only 2.5 percent of the control group,” Carney said.Teens who had been depressed as children were the least physically active, their siblings were a bit more active and those in the control group were the most active, according to the study, which is scheduled for presentation Friday at the annual meeting of the American Psychosomatic Society in Miami. Although the study showed an association between childhood depression and obesity, smoking habits and inactivity later in life, it did not prove a cause-and-effect relationship.These findings are cause for concern because “a number of recent studies have shown that when adolescents have these cardiac risk factors, they’re much more likely to develop heart disease as adults and even to have a shorter lifespan,” Carney said.”Active smokers as adolescents are twice as likely to die by the age of 55 than nonsmokers, and we see similar risks with obesity, so finding this link between childhood depression and these risk factors suggests that we need to very closely monitor young people who have been depressed,” he said.
Note: Data and conclusions presented at meetings are typically considered preliminary until published in a peer-reviewed medical journal.

[Article of Interest] Childhood Depression May Be Tied to Later Heart Risk


For these kids, obesity, smoking and inactivity more likely in adolescence, preliminary research shows

Teens who were depressed as children are more likely to be obese, to smoke and to be sedentary, a new study finds.
The findings suggest that depression during childhood can increase the risk of heart problems later in life, according to the researchers.
The study included more than 500 children who were followed from ages 9 to 16. There were three groups: those diagnosed with depression as children, their depression-free siblings and a control group of unrelated youngsters with no history of depression.
Twenty-two percent of the kids who were depressed at age 9 were obese at age 16, the study found. “Only 17 percent of their siblings were obese, and the obesity rate was 11 percent in the unrelated children who never had been depressed,” study first author Robert Carney, a professor of psychiatry at Washington University School of Medicine in St. Louis, said in a university news release.
The researchers found similar patterns when they looked at smoking and physical activity.
A third of those who were depressed as children had become daily smokers, compared to 13 percent of their nondepressed siblings and only 2.5 percent of the control group,” Carney said.
Teens who had been depressed as children were the least physically active, their siblings were a bit more active and those in the control group were the most active, according to the study, which is scheduled for presentation Friday at the annual meeting of the American Psychosomatic Society in Miami. Although the study showed an association between childhood depression and obesity, smoking habits and inactivity later in life, it did not prove a cause-and-effect relationship.
These findings are cause for concern because “a number of recent studies have shown that when adolescents have these cardiac risk factors, they’re much more likely to develop heart disease as adults and even to have a shorter lifespan,” Carney said.
Active smokers as adolescents are twice as likely to die by the age of 55 than nonsmokers, and we see similar risks with obesity, so finding this link between childhood depression and these risk factors suggests that we need to very closely monitor young people who have been depressed,” he said.

Note: Data and conclusions presented at meetings are typically considered preliminary until published in a peer-reviewed medical journal.

(Source: Childhood Depression May Be Tied to Later Heart Risk)

Filed under antipsychotic isps psychiatric psychiatry psychoanalysis psychological psychology psychopathology psychopharmacology psychosis psychotherapy psychotic News Science Neuroscience teen teenager child children smoke smoking cig cigarette cigarettes History Major Depression depressed depression depressive health

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EARTH DAY 2013
Could a Different Approach to “Mental Health” Be Part of Solving the Climate Crisis?
By Ron Unger

Earth Day 2013 is a good time to reflect on how problems in our mental health system reflect deep flaws in “normal” conceptions of what it means to be a human being.  These flawed conceptions then contribute in a critical way to the climate crisis that threatens us all.
In noticing the connection between flawed ideas about “normality” and the environmental crisis that threatens to bring down our civilization, I’m following in the footsteps of David Oaks, director of MindFreedom, who would likely be writing about this himself if he wasn’t too busy working in rehab, trying to get back functioning after breaking his neck last December.  (By the way,  MindFreedom really needs donations right now to take it through a period of financial crisis:  read why here , or go to http://www.mindfreedom.org/join-donate to make donations.)
A key problem is that within most of the mental health system, individuals are seen as healthy when they “fit in” or adjust to the overall society.  To the extent that they don’t adjust, they are seen as “having issues,” and those most out of adjustment are seen as “psychotic.”
At times, it seems to make sense to look at things this way:  adjustment seems to solve problems, and not fitting in, or being maladjusted, gets in the way of solving them.  People who are severely maladjusted may endanger their own lives or those of others.
Unfortunately, humanity is finding out that in the absence of wisdom, people can fit in with each other and be socially “well adjusted” and yet be causing catastrophic problems, such as by undermining the health of the ecosystems they live within and depend on for survival.   Or, as David Oaks likes to put it, “normal people are destroying the planet!”
R.D. Laing once said “It is of fundamental importance not to make the positivist mistake of assuming that because a group’s members are in formation this means that they’re necessarily on course.”  Of course, those who break from formation are not necessarily on course either, but if the crowd is heading over a cliff, it is important at some point to break away and start experimenting with other directions.  Unfortunately, in our society, young people who experience trouble while they experiment with new directions are simply labeled as “ill” and are seen as in need of being drugged back to some semblance of what is “normal” within the culture, even though the culture itself is headed straight for environmental catastrophe.
It seems we need a more complex idea about what constitutes health, and sickness.  I think the notion of “creative maladjustment” as described in Sophie Faught’s previous Mad in America post, “Taking Martin Luther King Jr’s Call For Creative Maladjustment Seriously” is exactly what we need as the foundation for a definition of “mental health” that would lead us towards both a functional mental health system and a functional society.
There seems to be little question that being maladjusted to something that is healthy is problematic.  So for example the person who has healthy food but thinks it is all poisoned will have difficulties.  But being adjusted to something that is not healthy is also problematic, and can be a much bigger problem.  The notion of “creative maladjustment” addresses both sides of this dilemma, suggesting the use of creative discretion in when and how to be maladjusted, rather than either supporting either blind conformity and adjustment, or reckless and undiscriminating maladjustment.
When mental health workers become able to recognize the possible value of maladjustment, they become less sure they have complete answers, and become able to relate to those they intend to help from a position of being fellow human beings searching for positive approaches to life rather than from a role of being authorities in what it means to be “sane.”   Mental health workers who recognize the value of searching, and of being maladjusted, can see possible value in “mad” experiences, and can connect on a peer level even when they are relating to people who have experiences that are very different from their own.  Being able to connect in this way is, I think, a precondition to being able to be genuinely helpful.
Of course, if one talks about seeing something positive in psychotic experiences, one can expect to be accused of “romanticizing madness.”  But somehow, those who worry that people will go too far in seeing something positive in mad experience never worry about the opposite, the possibility that people will “awfulize” madness, that they will see only the negative in it, and so will increase fear of madness and mental health stigma.  (It’s actually pretty bizarre that our mental health system will work so hard to convince people that mad experience is nothing but bad, and then turns around and tries to run “anti-stigma campaigns”!)
Recognizing “creative maladjustment” as a better definition of mental health allows mental health workers to honor the spirit of mad rebellion as being of potential value, even if not every manifestation of that spirit is helpful, and even if some manifestations can be highly dangerous!  Young people need to know that their efforts to be maladjusted to much of what is going on makes sense, even as they also need to know that it typically takes work and reflection to refine that maladjustment into something that is usefully creative.
Another part of making maladjustment creative is finding ways to come together with others in carrying it out.  This need to reconnect with others can seem paradoxical, because there is always the danger that if one connects too much, one will be right back “in formation” with a dysfunctional way of being organized, and a dysfunctional society!  The trick is to find a way to be autonomous enough to find a direction based on something deeper than just fitting in or being normal, while also being connected enough to cooperate with others in getting support and in sharing ideas and perspectives.  This is much easier to do when the culture, or at least a subculture, supports the idea of something like creative maladjustment.
When I was an alienated young man, it helped me greatly to find others who were maladjusted in their own ways and to find that we could work together in ways that were a lot of fun!  It was extremely helpful for us to support each other’s ability to move and create independently, even when the creativity was more silly than serious.  A long time friend of mine, John Law, coauthored a book coming out in May on the Cacophony Society, an organization closely related to the Suicide Club, which was the group he and  participated in together back in the 1970’s.  For me, it was the coordinated maladjustment in the events we created that helped me reconnect with the larger world, and I think we need to give greater recognition to the value of such ways of connecting.
MindFreedom’s current promotion of a “Creative Maladjustment Week” can be seen as just one small step toward the creation of a new ideal in our culture, the ideal of always aiming to be maladjusted toward what is destructive, rather than the flawed idea of mental health as “adjustment.”  Communicating the ideal of creative maladjustment to the public can also be a way of increasing awareness about how the process of being “mad” may be part of exploration toward new ways of being, with some of those new ways being possibly that which may ultimately save us from catastrophe.
It will be of little long term use to reform society and the mental health system if the ecological crisis then completely undermines civilization, leading to massive famine, die offs, migrations and wars.  Any mental health reforms would likely get lost in the chaos.  But I believe mental health reform is still worth working toward at this point, because changing the aim of mental health work, from adjustment to creative maladjustment, could shift the mental health system toward actually supporting exploration in new ways of thinking and being instead of always attempting to suppress it.  We need such exploration at this time more than perhaps any other.
I also want to point out that a key part of creative maladjustment is balancing personal fun, joy, and humor with activism and attention to the larger realities.  E.B. White is famous for having said ““I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult.”  David Oaks helped me learn how to approach life this way, and I think it is key to being an activist and not burning out.  It is true that finding the balance can be difficult, but each step of the way can also be incredibly rewarding, and every other way of being in the world makes a lot less sense.
I’m hoping in the near future to write about how to create public events or spectacles that communicate to the public both about the role of creative maladjustment in cultural evolution and renewal, and about the vital necessity of doing something different before the climate crisis escalates into something that kills most all our possibilities.
Till then, I hope you persist in your own forms of creative maladjustment, and in connecting with others on that wavelength, and I also hope that you support MindFreedom International in continuing to do its work of linking together groups all over the planet which working to support people’s access to  human rights and to creative maladjustment.  Like I said earlier, it is a tricky period financially for MindFreedom as it copes with David being in rehab, but it’s vital we keep this group going that has done so much for keeping these issues alive all over the world.  Again, you can read why here , or go to http://www.mindfreedom.org/join-donate to make donations.
Thanks for all that you do to support mental health reform, creative maladjustment, groups like MindFreedom, and all the actions you take in support of insuring a future for the human race on this beautiful planet of ours!

EARTH DAY 2013

Could a Different Approach to “Mental Health” Be Part of Solving the Climate Crisis?

By Ron Unger

Earth Day 2013 is a good time to reflect on how problems in our mental health system reflect deep flaws in “normal” conceptions of what it means to be a human being.  These flawed conceptions then contribute in a critical way to the climate crisis that threatens us all.

In noticing the connection between flawed ideas about “normality” and the environmental crisis that threatens to bring down our civilization, I’m following in the footsteps of David Oaks, director of MindFreedom, who would likely be writing about this himself if he wasn’t too busy working in rehab, trying to get back functioning after breaking his neck last December.  (By the way,  MindFreedom really needs donations right now to take it through a period of financial crisis:  read why here , or go to http://www.mindfreedom.org/join-donate to make donations.)

A key problem is that within most of the mental health system, individuals are seen as healthy when they “fit in” or adjust to the overall society.  To the extent that they don’t adjust, they are seen as “having issues,” and those most out of adjustment are seen as “psychotic.”

At times, it seems to make sense to look at things this way:  adjustment seems to solve problems, and not fitting in, or being maladjusted, gets in the way of solving them.  People who are severely maladjusted may endanger their own lives or those of others.

Unfortunately, humanity is finding out that in the absence of wisdom, people can fit in with each other and be socially “well adjusted” and yet be causing catastrophic problems, such as by undermining the health of the ecosystems they live within and depend on for survival.   Or, as David Oaks likes to put it, “normal people are destroying the planet!”

R.D. Laing once said “It is of fundamental importance not to make the positivist mistake of assuming that because a group’s members are in formation this means that they’re necessarily on course.”  Of course, those who break from formation are not necessarily on course either, but if the crowd is heading over a cliff, it is important at some point to break away and start experimenting with other directions.  Unfortunately, in our society, young people who experience trouble while they experiment with new directions are simply labeled as “ill” and are seen as in need of being drugged back to some semblance of what is “normal” within the culture, even though the culture itself is headed straight for environmental catastrophe.

It seems we need a more complex idea about what constitutes health, and sickness.  I think the notion of “creative maladjustment” as described in Sophie Faught’s previous Mad in America post, “Taking Martin Luther King Jr’s Call For Creative Maladjustment Seriously” is exactly what we need as the foundation for a definition of “mental health” that would lead us towards both a functional mental health system and a functional society.

There seems to be little question that being maladjusted to something that is healthy is problematic.  So for example the person who has healthy food but thinks it is all poisoned will have difficulties.  But being adjusted to something that is not healthy is also problematic, and can be a much bigger problem.  The notion of “creative maladjustment” addresses both sides of this dilemma, suggesting the use of creative discretion in when and how to be maladjusted, rather than either supporting either blind conformity and adjustment, or reckless and undiscriminating maladjustment.

When mental health workers become able to recognize the possible value of maladjustment, they become less sure they have complete answers, and become able to relate to those they intend to help from a position of being fellow human beings searching for positive approaches to life rather than from a role of being authorities in what it means to be “sane.”   Mental health workers who recognize the value of searching, and of being maladjusted, can see possible value in “mad” experiences, and can connect on a peer level even when they are relating to people who have experiences that are very different from their own.  Being able to connect in this way is, I think, a precondition to being able to be genuinely helpful.

Of course, if one talks about seeing something positive in psychotic experiences, one can expect to be accused of “romanticizing madness.”  But somehow, those who worry that people will go too far in seeing something positive in mad experience never worry about the opposite, the possibility that people will “awfulize” madness, that they will see only the negative in it, and so will increase fear of madness and mental health stigma.  (It’s actually pretty bizarre that our mental health system will work so hard to convince people that mad experience is nothing but bad, and then turns around and tries to run “anti-stigma campaigns”!)

Recognizing “creative maladjustment” as a better definition of mental health allows mental health workers to honor the spirit of mad rebellion as being of potential value, even if not every manifestation of that spirit is helpful, and even if some manifestations can be highly dangerous!  Young people need to know that their efforts to be maladjusted to much of what is going on makes sense, even as they also need to know that it typically takes work and reflection to refine that maladjustment into something that is usefully creative.

Another part of making maladjustment creative is finding ways to come together with others in carrying it out.  This need to reconnect with others can seem paradoxical, because there is always the danger that if one connects too much, one will be right back “in formation” with a dysfunctional way of being organized, and a dysfunctional society!  The trick is to find a way to be autonomous enough to find a direction based on something deeper than just fitting in or being normal, while also being connected enough to cooperate with others in getting support and in sharing ideas and perspectives.  This is much easier to do when the culture, or at least a subculture, supports the idea of something like creative maladjustment.

When I was an alienated young man, it helped me greatly to find others who were maladjusted in their own ways and to find that we could work together in ways that were a lot of fun!  It was extremely helpful for us to support each other’s ability to move and create independently, even when the creativity was more silly than serious.  A long time friend of mine, John Law, coauthored a book coming out in May on the Cacophony Society, an organization closely related to the Suicide Club, which was the group he and  participated in together back in the 1970’s.  For me, it was the coordinated maladjustment in the events we created that helped me reconnect with the larger world, and I think we need to give greater recognition to the value of such ways of connecting.

MindFreedom’s current promotion of a “Creative Maladjustment Week” can be seen as just one small step toward the creation of a new ideal in our culture, the ideal of always aiming to be maladjusted toward what is destructive, rather than the flawed idea of mental health as “adjustment.”  Communicating the ideal of creative maladjustment to the public can also be a way of increasing awareness about how the process of being “mad” may be part of exploration toward new ways of being, with some of those new ways being possibly that which may ultimately save us from catastrophe.

It will be of little long term use to reform society and the mental health system if the ecological crisis then completely undermines civilization, leading to massive famine, die offs, migrations and wars.  Any mental health reforms would likely get lost in the chaos.  But I believe mental health reform is still worth working toward at this point, because changing the aim of mental health work, from adjustment to creative maladjustment, could shift the mental health system toward actually supporting exploration in new ways of thinking and being instead of always attempting to suppress it.  We need such exploration at this time more than perhaps any other.

I also want to point out that a key part of creative maladjustment is balancing personal fun, joy, and humor with activism and attention to the larger realities.  E.B. White is famous for having said ““I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult.”  David Oaks helped me learn how to approach life this way, and I think it is key to being an activist and not burning out.  It is true that finding the balance can be difficult, but each step of the way can also be incredibly rewarding, and every other way of being in the world makes a lot less sense.

I’m hoping in the near future to write about how to create public events or spectacles that communicate to the public both about the role of creative maladjustment in cultural evolution and renewal, and about the vital necessity of doing something different before the climate crisis escalates into something that kills most all our possibilities.

Till then, I hope you persist in your own forms of creative maladjustment, and in connecting with others on that wavelength, and I also hope that you support MindFreedom International in continuing to do its work of linking together groups all over the planet which working to support people’s access to  human rights and to creative maladjustment.  Like I said earlier, it is a tricky period financially for MindFreedom as it copes with David being in rehab, but it’s vital we keep this group going that has done so much for keeping these issues alive all over the world.  Again, you can read why here , or go to http://www.mindfreedom.org/join-donate to make donations.

Thanks for all that you do to support mental health reform, creative maladjustment, groups like MindFreedom, and all the actions you take in support of insuring a future for the human race on this beautiful planet of ours!

Filed under antipsychotic isps psychiatric psychiatry psychoanalysis psychological psychology psychopharmacology psychosis psychotherapy psychotic News Science History earth day earth day schizophrenia schizophrenic climate crisis mental mental illness serious mental illness treatment Mad mad pride madness rethinking madness unger