Posts tagged science
Posts tagged science
[Article of Interest] Unmasking the agony: Combat troops turn to art therapy
By Bill Briggs, NBC News contributor
The skull’s left corner is gone, leaving a jagged, diagonal edge drenched in red. The eyes are black and frantic. All of it resembles the Iraqi man who, in his final minute alive, stared up at Maj. Jeff Hall.
For five years, that face tortured Hall, once a sharp Army leader later shoved to his own ragged edge. Not long ago, a woman handed Hall a blank mask, brushes and paints. She asked him to see what may emerge on the surface.
“That image, seared into my mind, began leaking out of me,” said Hall, one of hundreds of active-duty troops who have created masks as part of an art therapy program at Walter Reed National Military Medical Center. “I almost needed to regurgitate it. To be honest, it helped me let it go.”
Many more masks, some resembling Hall’s violent creation, some depicting abstract demons, adorn walls at the National Intrepid Center of Excellence (NICOE) on the Walter Reed campus.
They reveal scars once carried and cloaked inside the minds of men and women back from war — troops diagnosed with mild brain injuries and secondary psychological issues, including post-combat stress.
Hall, 43, who titled his mask “The Shock of Death,” served a pair of year-long tours in Iraq spanning 2003 to 2005. Ultimately haunted by violent events he saw and survived in Iraq, including the loss of friends, Hall eventually contemplated suicide and became more isolated. His commander noticed Hall’s behavioral changes and guided him into counseling in 2008. Two years later, Hall was invited to seek treatment for a traumatic brain injury at then-new NICOE, a Department of Defense facility offering research, education and treatment focused on TBIs and psychological health.
When service members initially enter the art-therapy studio, their faces often are blank and unyielding, hiding unwelcome war souvenirs within — the mental cargo they’ve lugged home but can’t shake. On their masks, they expose that secret turmoil: vulnerabilities, anger, grief or, often, fragmented identities.
“It’s intense. They get really invested in this. It becomes very meaningful for them,” said Melissa Walker, an art therapist who coordinates the masks program at NICOE.
Participants at NICOE must be active-duty troops who are dealing with a combination of TBI and psychological health concerns. Typically, they are referred by their primary health care provider or their commander. A designated team at NICOE determines which service members are most appropriate to receive treatment there. Attendees participate for four weeks. Art therapy is just one of the tools offered and the service members usually make one mask — done during their first week at the center.
“I tell them: ‘Don’t worry about the finished product; worry about what you are symbolizing in the mask.’ That makes it more powerful to them. It gives them a way to express to us, visually, what they’re going through,” Walker said. “It’s a little less intimidating then handing them a blank piece of paper.”
Art therapy has become a staple in the treatment of a wide array of traumas, from child abuse to PTSD. Making art can help people unlock dark emotions or memories that they can’t yet vocalize, pulling those buried anxieties from their subconscious and placing them onto a canvass or into a lump of clay, said Donna Betts, a professor in the art therapy program at George Washington University.
As a patients’ pieces are taking shape, art therapists help them talk about what they believe they are trying to express in their creations, Betts said.
“It’s especially effective in the treatment of trauma in service members. When trauma is experienced, it tends to be stored in the nonverbal part of the brain,” Betts said. “This is why so many of them can’t even put into words what they’ve been through. Art therapy helps them retell their story through art. It translate that trauma from the nonverbal part of the brain to the verbal part so they can start dealing with it.
“They then become more aware of the trauma. This is where that healing starts to take place.”
After the paint is dabbed and stroked at NICOE, many of those papier-mache masks offer chilling accounts of what it is like to live inside the minds of combat veterans.
One brown face with the mouth agape and with bloodshot eyes upturned is squeezed by a metal clamp that reads “TBI” on the left and “PTSD” on the right.
Another mask is coated by small chunks of amber bark — two tiny holes remain for eyes — symbolizing the outer camouflage the maker felt is necessary to blend back into the civilian world.
Some masks show mouths locked or sewn closed, whispering of an inability to speak of what they’ve witnessed. Many are divided down the middle — for example, one displays part of an American flag on the left and a skull on the right.
“There is a split sense of self. They feel like they’re one person when they’re deployed and one person when they return home,” Walker said. “Or, they do a really strong, warrior exterior with a vulnerable inside but they don’t feel like they can express that.”
The troops who come to NICOE for therapy can take their masks home. But many purposely leave them to hang from the walls to speak to — and perhaps even soothe — incoming troops trying to cope with the same thoughts and impulses.
The creations give service members a format “to say what they can’t say out loud — because it’s too painful or because we just don’t feel like anybody really wants to hear it,” said Hall, who remains on active duty, stationed at Rock Island Arsenal in northwestern Illinois.
“I absolutely believe it is a method to calm your mind.”
For more mental health-related news, Click Here to access the Serious Mental Illness Blog
Avatars Ease Voices for Schizophrenia Patients
By Lorna Stewart
BBC Health Check
Use of an avatar can help treat patients with schizophrenia who hear voices, a UK study suggests.
The trial, published in the British Journal of Psychiatry, focused on patients who had not responded to medication.
Using customized computer software, the patients created avatars to match the voices they had been hearing.
After up to six therapy sessions most patients said their voice had improved. Three said it had stopped entirely.
The study was led by psychiatrist emeritus professor Julian Leff, who spoke to patients through their on-screen avatars in therapy sessions. Gradually he coached patients to stand up to their voices.
“I encourage the patient saying, ‘you mustn’t put up with this, you must tell the avatar that what he or she is saying is nonsense, you don’t believe these things, he or she must go away, leave you alone, you don’t need this kind of torment’,” said Prof Leff.
”The avatar gradually changes to saying, ‘all right I’ll leave you alone, I can see I’ve made your life a misery, how can I help you?’ And then begins to encourage them to do things that would actually improve their life.”
By the end of their treatment, patients reported that they heard the voices less often and that they were less distressed by them. Levels of depression and suicidal thoughts also decreased, a particularly relevant outcome-measure in a patient group where one in 10 will attempt suicide.
Treatment as usual
The trial, conducted by Prof Leff and his team from University College London, compared 14 patients who underwent avatar therapy with 12 patients receiving standard antipsychotic medication and occasional visits to professionals.
Later the patients in the second group were also offered avatar therapy.
Only 16 of the 26 patients completed the therapy. Researchers attributed the high drop-out rate to fear instilled in patients by their voices, some of which “threatened” or “bullied” them into withdrawing from the study.
New treatment options have been welcomed for the one in four patients with schizophrenia who does not respond to medication. Cognitive behaviour therapy can help them to cope but does not usually ease the voices.
Paul Jenkins, of the charity Rethink Mental Illness, said: “We welcome any research which could improve the lives of people living with psychosis.
“As our Schizophrenia Commission reported last year, people with the illness are currently being let down by the limited treatments available.
”While antipsychotic medication is crucial for many people, it comes with some very severe side effects. Our members would be extremely interested in the development of any alternative treatments.”
A larger trial featuring 142 patients is planned to start next month in collaboration with the King’s College London Institute of Psychiatry.
Prof Thomas Craig, who will lead the larger study, said: “The beauty of the therapy is its simplicity and brevity. Most other therapies for these conditions are costly and take many months to deliver.
”If we show that this treatment is effective, we expect it would be widely available in the UK within just a couple of years as the basic technology is well developed and many mental health professionals already have the basic therapy skills that are needed to deliver it.”
For more mental health-related news, Click Here to access the Serious Mental Illness Blog
[Article of Interest] Invitation to a Dialogue: Benefits of Talk Therapy
By Larry S. Sandberg
To the Editor [of the New York Times]:
We tend to divide treatments for mental illness into “psychological” approaches and “biological” ones; the former typically involve “talk therapy” and the latter medication. But this either-or way of thinking obscures the fact that talk therapy affects the brain and is no less biological than pills.
Numerous findings over the last two decades demonstrate how talk therapy alters the brain. Disabling conditions like clinical depression and anxiety can be treated effectively by understanding distorted patterns of thought, becoming aware of emotional conflicts that have not been conscious, or practicing new behaviors. Talk therapy is a potent treatment for serious mental disorders and not simply for the “worried well,” as it is sometimes characterized.
These conditions can also be treated with medication, either alone or in combination with talk therapy. Whereas the effects of medication tend to go away once the medication is stopped, the benefits of talk therapy can be enduring because of the significant changes that take place not only in the “mind” but in the “brain,” too. This is a real-life example of what the Nobel laureate Eric Kandel has discovered: learning affects the ways in which the brain forms new connections.
Why does this matter? It is important that the public know that talk therapy is an important tool in the healing process precisely because of its powerful effects on the brain. Medication, which is lifesaving for many, tends to be overprescribed. Rather than being introduced as part of a comprehensive treatment that includes psychotherapy, it is often used in its place. We should be aware of the cultural trends that devalue psychotherapy and the listening healer and the unintended consequences that may ensue.
[Article of Interest] Mental Health Disorders among Australian Parents on the Rise
By Miriam Hall
A new study has found the number of parents with mental illness increased by three per cent every year between 1990 to 2005 [in Australia].
The study, published in the Medical Journal of Australia, is the first of its kind in Australia, based on 15 years of data from Western Australia.
Lead author of the report, Dr Melissa O’Donnell from the University of WA, said she was not surprised by the results.
”We know that welfare agencies and hospitals had recorded a rise in the number of families needing support for parents with mental health problems,” she said.
“(We know) that the cases had become more complex with co-morbidities for mental health disorders and substance use as well.
“So that, in effect, we weren’t really that surprised.”
The disorders in the study included illnesses like psychosis, substance-related abuse and stress disorders, but not post-natal depression.
Dr O’Donnell says the rise in numbers could be explained by better and more frequent diagnoses.
”We are seeing broader services available, so I guess more people are able to access services for in and out-patients,” she said.
“Therefore more parents would get a diagnosis, and that’s what we based our data on.”
But the study also found a rise in the numbers of parents with specific types of mental illness.
”We are seeing more parents in our data that had stress and adjustment related disorders… as well as an increase in parents with substance use mental health disorders,” she said.
Dr Melissa O’Donnell says the mental health of a parent can have a significant impact on families and the increasing figures highlight the need for early intervention.
“We do know that there is increase in expenditure in this area, but it’s really important that we target it to those at risk families,” she said.
”Having early intervention and treatment and support available to families, particularly when they do need respite or support in their parenting, that’s really important.”
Lead report author, Vera Morgan from the University WA, also believes there needs to be a targeted approach to providing support to mentally ill parents.
”We know a lot of these parents are subject to very poor socio-economic conditions, they have low education outcomes, low employment, and putting them close to the poverty line, and they have accommodation issues,” she said.
“They actually need support with these very specific areas as well as support in the area of raising their children.”
Ms Morgan says the Government needs to prioritise agencies.
”Although there was some support in the very recent budget, there’s always a lot more room that needs to be there for providing services,” she said.
Impact on children
Psychiatrist Dr Nick Kowalenk, from Children of Parents with a Mental Illness, says there are specific developmental issues for children who have mentally ill parents.
”Usually for kids…. who are five, six, seven, they’re affected to the extent that they can lose a bit of confidence when their parents are depressed,” he said.
”We’ve got some Australian evidence which shows that school readiness is impacted when mum or dad is depressed.
“If parents have substance abuse problems and those sorts of issues and addictions, that’s also not a good thing for kids and they tend to have a whole lot more behavioral problems and some difficulties.”
He says mental illness in parents is a hidden problem and there needs to be more support.
“The issue of kids is one that’s not always addressed that well,” he said.
“For example with Beyond Blue and in conjunction with the states, the Federal Government’s had a National Perinatal Depression Initiative, which is pretty much established Australia-wide early identification of mental health problems for mums about to give birth and for mum soon after giving birth.
”It hasn’t included dads yet, and it hasn’t really had quite enough attention to infants and making sure that their health and wellbeing is maintained even when mum or dad have a mental health problem.”
[Article of Interest] National Institute of Mental Health Abandoning the DSM
by Vaughan Bell
In a potentially seismic move, the National Institute of Mental Health – the world’s biggest mental health research funder, has announced only two weeks before the launch of the DSM-5 diagnostic manual that it will be “re-orienting its research away from DSM categories”.
In the announcement, NIMH Director Thomas Insel says the DSM lacks validity and that “patients with mental disorders deserve better”.
This is something that will make very uncomfortable reading for the American Psychiatric Association as they trumpet what they claim is the ‘future of psychiatric diagnosis’ only two weeks before it hits the shelves.
As a result the NIMH will now be preferentially funding research that does not stick to DSM categories:
Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system. What does this mean for applicants? Clinical trials might study all patients in a mood clinic rather than those meeting strict major depressive disorder criteria. Studies of biomarkers for “depression” might begin by looking across many disorders with anhedonia or emotional appraisal bias or psychomotor retardation to understand the circuitry underlying these symptoms. What does this mean for patients? We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system.
As an alternative approach, Insel suggests the Research Domain Criteria (RDoC) project, which aims to uncover what it sees as the ‘component parts’ of psychological dysregulation by understanding difficulties in terms of cognitive, neural and genetic differences.
For example, difficulties with regulating the arousal system might be equally as involved in generating anxiety in PTSD as generating manic states in bipolar disorder.
Of course, this ‘component part’ approach is already a large part of mental health research but the RDoC project aims to combine this into a system that allows these to be mapped out and integrated.
It’s worth saying that this won’t be changing how psychiatrists treat their patients any time soon. DSM-style disorders will still be the order of the day, not least because a great deal of the evidence for the effectiveness of medication is based on giving people standard diagnoses.
It is also true to say that RDoC is currently little more than a plan at the moment – a bit like the Mars mission: you can see how it would be feasible but actually getting there seems a long way off. In fact, until now, the RDoC project has largely been considered to be an experimental project in thinking up alternative approaches.
The project was partly thought to be radical because it has many similarities to the approach taken by scientific critics of mainstream psychiatry who have argued for a symptom-based approach to understanding mental health difficulties that has often been rejected by the ‘diagnoses represent distinct diseases’ camp.
The NIMH has often been one of the most staunch supporters of the latter view, so the fact that it has put the RDoC front and centre is not only a slap in the face for the American Psychiatric Association and the DSM, it also heralds a massive change in how we might think of mental disorders in decades to come.
[Article of Interest] The Problem With How We Treat Bipolar Disorder
By Linda Logan
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] 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.
EARTH DAY 2013
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!
[Article of Interest] In Gun Debate, No Rift on Better Care for Mentally Ill
By Jeremy W. Peters
While the Senate has been consumed with a divisive debate over expanded background checks for gun buyers, lawmakers have been quietly working across party lines on legislation that advocates say could help prevent killers like Adam Lanza, the gunman in the Newtown, Conn., massacre, from slipping through the cracks.
Proponents say the plans, which stand a good chance of being included in any final gun-control bill, would lead to some of the most significant advancements in years in treating mental illness and address a problem that people on both sides of the issue agree is a root cause of gun rampages. Unlike the bitter disagreements that have characterized efforts to limit access to guns, the idea of improving mental health unites Republicans and Democrats, urban and rural, blue state and red state.
“This is a place where people can come together,” said Senator Debbie Stabenow, Democrat of Michigan, who has worked with some of the Senate’s most conservative Republicans on a piece of mental health legislation. “As we’ve listened to people on all sides of the gun debate, they’ve all talked about the fact that we need to address mental health treatment. And that’s what this does.”
The issue also appeals to members of Congress in another important way: it serves as a political refuge for Republicans and more conservative Democrats who are eager to offer a federal response to the shootings in Connecticut and Aurora, Colo., but have no interest in taking any action that could be seen as infringing on constitutional gun rights.
Senator John Cornyn of Texas, the No. 2 Senate Republican, who has not wavered in his opposition to tighter gun laws, met with families of Newtown victims and said he came away believing they wanted to attack mental health problems above all else.
“This is actually something we can and should do something about,” Mr. Cornyn said. “We need to make sure that the mentally ill are getting the help they need.”
Advocates for better mental health services said that many of them were initially uneasy about seizing on an event as tragic as the Connecticut school shootings to win improvements in care. And many have noted that very few violent crimes are committed by mentally ill people. But they came to believe that the current time was the best opportunity for real change, and that they might not get another one for a while.
“This is our moment,” said Linda Rosenberg, the president of the National Council for Community Behavioral Healthcare. “I hate the connection between gun violence and the need for better mental health care, but sometimes you have to take what you can get.”
The emerging legislation would, among other things, finance the construction of more community mental health centers, provide grants to train teachers to spot early signs of mental illness and make more Medicaid dollars available for mental health care.
There would be suicide prevention initiatives and support for children who have faced trauma. The sponsors of one of the bills estimated that an additional 1.5 million people with mental illness would be treated each year.
Ms. Stabenow’s measure has attracted backing from some of the Senate Republicans who are strongly backed by the National Rifle Association, including Marco Rubio of Florida and Roy Blunt of Missouri. Both of those lawmakers opposed the successful effort on Thursday to overcome a Republican filibuster and begin debate on a gun measure.
One of the proposals being negotiated, which has the support of Senators Tom Harkin, Democrat of Iowa, and Lamar Alexander, Republican of Tennessee, unanimously passed a Senate committee this week, something that could hardly be said about any of the gun legislation.
President Obama has also joined the effort. His budget includes $130 million for programs that would help detect mental illness in young children, train educators to spot those signs and refer the students to treatment.
Treatment for mentally ill people is but one of many issues before Congress, and it lacks not only headline-grabbing elements like semiautomatic weapons and gun-show loopholes, but also a backer like Mayor Michael R. Bloomberg of New York who can bankroll a multimillion-dollar advertising campaign to remind voters to contact their senators.
Nevertheless, the issue has moved rapidly through the Senate, because of the efforts of the mental health lobby and because many legislators have a personal connection to mental illness. Senator Harry Reid, the majority leader, spoke the other day about his father’s suicide by gun.
Senate Democratic aides said that there is likely to be at least one mental health bill offered as an amendment to the larger gun package. The problem will be accommodating all of the additions.
Democrats have to agree to allow Republicans the same number of amendments as they give themselves. To reduce the likelihood that Republicans will offer multiple amendments that could water down and even torpedo the gun bill, it is in Democrats’ interest to limit their amendments.
“It’s very difficult to come up with a system that’s foolproof,” [Ronald S. Honberg] said. “The bigger point is if you really want to improve mental health care in this country, then let’s improve mental health care.”
[Documentary of Interest] Coming Off Psych Drugs: A Meeting of the Minds
Description: In June of 2012, twenty-three people came together to discuss the subject of coming off psychiatric drugs. We were psychiatric survivors, therapists, mental health consumers, family members, and activists, united by a passion for truth-telling. More than half of us had successfully come off psych drugs, including cocktails of antipsychotics and mood stabilizers. What resulted from our three-day gathering was an unforgettable meeting of the minds.
This 75-minute documentary (directed by Daniel Mackler) offers a rare glimpse into the world of coming off psych drugs through the eyes of those who have done it. The film presents, among others, Will Hall, author of the world-renowned “Harm Reduction Guide to Coming Off Psychiatric Drugs,” Oryx Cohen, director at the National Empowerment Center, Laura Delano, blogger at www.madinamerica.com, and Daniel Hazen, noted psychiatric survivor and human rights activist.
Although this documentary is not medical advice, it intends to offer something even better: hope. In a world where increasing numbers of people are put on psychiatric drugs every day, where more than 20 percent of Americans already take them, and where so many are told they need to stay on them for life, COMING OFF PSYCH DRUGS offers proof that another way is possible.
Available at www.wildtruth.net
HAVE YOU CREATED ART IN OR ABOUT AN EXTREME STATE?
The creators of the Serious Mental Illness blog invite you to submit your visual art, photography, video work, poetry, collage, or short fiction to Art from the Edge.
Art from the Edge, a virtual gallery and resource center, is dedicated to art created in and about extreme mental states. It is an open and public world wide forum for artists to share their visual and written works and their personal stories with all those interested in the connection between creativity and “edge” states.
Much like art, which exists in a multitude of mediums and forms of expression, there are a plurality of “edge” states that inspire the artists who harbor them. For this reason, we leave the term completely open to our community’s interpretation, knowing from research and experience that this state could be driven by psychosis or trauma, or an altered state induced by drugs. It could be the offshoot of extreme depression or grief, or the aftermath of a spiritual or mystical state of consciousness.
Ultimately, we are interested in the artist’s individual experience and in his or her sense of what it is that drove the creative act.
[Article of Interest] Mental Illness a Frequent Cell Mate for Those Behind Bars
By Amanda Gardner
Former inmate describes efforts to stay emotionally healthy after his release
Eugene King ran away from home at the age of 16, the start of a lifelong pattern of drug abuse, crime and incarceration.
In retrospect, King said, he realizes he was using illicit drugs at least in part to self-medicate a variety of psychiatric conditions. But he also realizes that prison, with its lack of adequate medical treatment and what he called a generally abusive environment, only made his problems worse.
“It exacerbated [the mental illness] without a doubt,” said King, now 62.
That King’s mental health, already precarious, only worsened in prison is not an unusual story.
According to a recent study published in the Journal of Health and Social Behavior, the link between prison time and mental illness is a two-way street. Although many incarcerated people exhibit such problems as impulse control disorders — which normally first appear in childhood or adolescence — before they enter the correctional system, incarceration itself seems to cause major depression.
And this may help explain why so many inmates have trouble re-entering society when they are released, said the authors of the study.
“Prison made them depressed and that depression undermined their ability to re-enter — made it hard to find a job, hard to be motivated — and this is precisely the time they need to be motivated,” said lead author Jason Schnittker, an associate professor of sociology at the University of Pennsylvania. “We think that mood disorders are an important barrier to re-entry.”
According to background information included in the study, about 16 million people — or 7.5 percent of the U.S. population — are felons or ex-felons.
Meanwhile, people in prison have up to six times the rate of significant mental illness as the general population, said Dr. Spencer Eth, a professor of psychiatry and behavioral sciences at the University of Miami Miller School of Medicine. Eth also treats inmates at a local jail.
And although it has long been suspected that prison aggravates pre-existing psychiatric problems, experts have had trouble untangling this chicken-and-egg question, especially given that early childhood experiences are linked to both incarceration and mental illness.
For the study, Schnittker and his co-authors looked at a national database of nearly 5,700 men and women to assess both the prevalence of psychiatric disorders and any time spent in jail or prison.
Their conclusion? Incarceration was associated with a 45 percent increase in the risk of having depression.
The findings did have some limitations, namely that the authors couldn’t control for all other factors that might affect the incidence of depression. And because it’s so difficult to conduct studies in prison populations, it’s possible that the data did not pick up on worsening of conditions other than depression, said Eth, who was not involved with the study.
The data were also at least a decade old, Eth said, even though “it’s likely that if the study were to be repeated now there would be similar findings.”
Although the study authors advocate for more treatment while people are in prison and before being let out onto the streets, in reality conditions in correctional facilities are often pitiful, said Eth, echoing King’s sentiments.
“There’s very, very little treatment available to people who are in jails and prisons. At most, it’s medication, and for many conditions it’s nothing at all. It’s terrible,” Eth said. “If you didn’t have a serious mental illness going in, the conditions of jails and prisons are so deplorable, you’d have to be a hardy soul not to be depressed or worse.”
Unfortunately, psychiatric treatment for ex-offenders “on the outside” is also limited, said JoAnne Page, president and CEO of the Fortune Society in New York City, which helps individuals re-enter society after prison.
“We couldn’t get people into mental-health treatment in the community when it was available, and it’s less available than it used to be,” Page said.
In 2011, the Fortune Society, which already provided housing and other services for ex-offenders, opened its Better Living Center, which they said is the first agency in New York City to cater exclusively to individuals with a criminal history.
“Most of our people come to us after their release when we have a window of time,” Page said. “There’s a hopefulness that things could be different. It’s a wonderful time to work with people if you give them a fighting chance.”
It is through this Better Living Center that King got his chance. He now takes medication every day and sees a therapist weekly for bipolar disorder, post-traumatic stress disorder and depression.
“I have access to excellent mental-health treatment now and I’m also mindful of the fact that there are [many] prison inmates who could benefit from the same level of care, or something close to it,” King said. “Last week was my last day on parole. Over 25 years, I have been living on this cloud either in prison or on supervision. I am no longer. I am totally free.”
[Article of Interest] Study Links Immigrating at Young Age and Higher Risk of Psychosis
By Nicholas Bakalar
A new study has found that among immigrants, younger age at the time of migration predicts a higher incidence of psychotic disorders.
The study, published last month in The American Journal of Psychiatry, was conducted from 1997 to 2005 in The Hague, Netherlands, where there are detailed records on almost everyone who has sought care for a possible psychotic disorder. The researchers found 273 immigrants, 119 second-generation citizens and 226 Dutch citizens who fit the criteria.
In four groups — people from Suriname, the Netherlands Antilles, Turkey and Morocco — the risk of psychosis was highest among those who immigrated before age 4. There was no association of psychosis with age among Western immigrants.
The researchers, led by Dr. Wim Veling of the Parnassia Psychiatric Institute, investigated various possible explanations — that social factors are involved, that people migrate because they are prone to psychosis, and that a decision to migrate is influenced by early appearance of psychosis, among others. But the correlation persisted.
“We don’t know the reason,” said Dr. Ezra Susser, the senior author and a professor of epidemiology at Columbia University, “but it might be related to early social context, which we know has an important influence on later health and mental health.”
[Article of Interest] People with Mental Illness at Highly Increased Risk of Being Murder Victims
Risk highest among those with substance use disorders
People with mental disorders have a highly increased risk of being victims of homicide, a large study published today on bmj.com suggests. The perpetration of homicide by people with mental disorders has received much attention, but their risk of being victims of homicide has rarely been examined. Yet such information may help develop more effective strategies for improving the safety and health of people with mental illness.
So a team of researchers from Sweden and the USA assessed mental disorders and homicides across the entire population of Swedish adults between 2001 and 2008. Mental disorders were grouped into the following categories: substance use disorder; schizophrenia; mood disorders including bipolar disorder and depression; anxiety disorders and personality disorders. Results were adjusted for several factors such as sex, age, marital status, educational level, employment status and income. Of 7,253,516 adults in the study, 141 (22%) out of 615 homicidal deaths were among people with mental disorders.
After adjusting for several factors, the results show that people with any mental disorder were at a fivefold increased risk of homicidal death, relative to people without mental disorders. The risk was highest among those with substance use disorders (approximately ninefold), but was also increased among those with personality disorders ((3.2fold), depression (2.6fold), anxiety disorders (2.2fold), or schizophrenia (1.8fold) and did not seem to be explained by substance use.
One explanation for the findings may be that those with mental disorders are more likely to live in high deprivation neighbourhoods, which have higher homicide rates, say the authors. They may also be in closer contact with other mentally ill people and be less aware of their safety risks owing to symptoms of the underlying illness. They suggest that interventions to reduce these risks “should include collaborations between mental health clinics and the criminal justice system to develop personal safety and conflict management skills among people with mental illness.” Improved housing, financial stability, and substance abuse treatment may also reduce vulnerability to violent crime, they add. A key implication of these new findings is that clinicians should assess risk for the full array of adverse outcomes that may befall people with mental health problems, say Roger Webb and colleagues at the University of Manchester, in an accompanying editorial. This would include being a victim of violence as well as committing it, abuse and bullying, suicidal behaviour, accidental drug overdoses, and other major adverse events linked with intoxication or impulsivity.
These risks go together, and people with mental illness, as well as their families, should receive advice on avoiding various types of harm, they suggest. They acknowledge that some important questions remain unanswered, but suggest that national mental health strategies “should reflect the broad nature of safety concerns in mental healthcare, while antistigma campaigns among the public should aim to counter fear of mentally ill people with sympathy for the risks they face.”
“Mental disorders and vulnerability to homicidal death: Swedish nationwide cohort study”, Casey Crump et al. BMJ. 2013;346:f557 doi:10.1136/bmj.f557
Editorial: “Risk of people with mental illnesses dying by homicide”, Roger Webb et al. BMJ. 2013;345:f1336 doi: 10.1136/bmj.f1336
[Article of Interest] Edward Deeds, Outsider Artist, Leaves Behind Hauntingly Innocent Drawings From Mental Institution
By Priscilla Frank
”The artist really should be lost to history, and certainly these drawings should,” said curator Tom Parker of his upcoming exhibition. The works in question are by Edward Deeds, a mental patient at Missouri State Hospital for almost 40 years. The show, entitled, “Talisman of the Ward: The Album of Drawings by Edward Deeds,” presents 30 works by the outsider artist.
Deeds, who was diagnosed with dementia praecox and schizophrenia, was committed to a mental institution in 1936. Beyond this fact we know little about his condition, personality or life, although the curator sees all he needs to in Deeds’ artwork. “The images have one fabulous clue on every page,” Parker explained to the Huffington Post. “State Lunatic Asylum, written on the paper by the hospital. One poetic detail which encapsulates everything you need to know about the artist and his circumstance.”
The artist’s drawings, crafted on the official hospital stationary, radiate a remarkable innocence given the circumstances of their creation. Whimsical lions, wide-eyed characters and vintage vehicles comprise a pictorial land far beyond the mental facility walls. The only reminder of Deeds’ dark reality is recurrence of the letters “ECT,” a likely acronym for the controversial shock treatment known as electroconvulsive therapy.
At the time of Deeds’ death he gave his collection of drawings to his mother, who then passed them to her other son, who stored them in his attic. Years later, the drawings were tossed out to a curbside junk pile and were discovered by a 14-year-old boy who became fascinated with them. He kept the works safe for 36 years.
The precious drawings, both unpretentious and cryptic, present an idyllic vision from a mysterious perspective. The story of their creation and survival is as magnetic as the raw emotion in his innocent crayon strokes.
“Talisman of the Ward: The Album of Drawings by Edward Deeds” will show from January 10 until February 9, 2013 at Hirschl & Adler Modern.