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Pharmaceutical branding: building “the perfect beast” 02/28/2011

Posted by ALT in Pharmaceuticals, Treatments.
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Each word has an entire volume of history attached to it.  Where does it come from?  How was it used in other places, other times?  Tracing the ancestry of a word through etymology reveals ancient understandings of the need for and role of such a word in a culture and tracks philosophical shifts over time on a societal level [exhibit A: compare the ancient, etymological meaning of “psychiatry” to current uses]. 

A word with no history, springing up “full-grown” and pregnant with meaning, is an anomaly with a specific function: it serves, not a culture attaching meaning to its life-world, but the sole purposes of its creator.  It delivers a very specific message — cut out of context, simplified, compelling — from its master to all who invoke its power. 

PROZAC.  SEROQUEL.  ZYPREXA. 

We’re talking about branding.

Pharmaceutical companies have inserted new words into the language of mental wellness, words with no etymological ancestors.  Words that are designed, above all else, to sell. 

What effect does this have our culture’s conversation about mental health?

  

The perfect name = “the perfect beast”

Pharmaceutical companies start working with branding consultants as early as 3 years out, searching for that perfect name, the one that will:

find a fresh way into the hearts and minds of customers … redefine and own the conversation… ignite the passions of customers… propel itself through the world on its own, becoming a no-cost, self-sustaining PR vehicle.

(from pharmaceutical branding consultant IGOR International’s handbook: “Building the Perfect Beast; The IGOR Naming Guide”).  

WHOA.  Let’s process for a moment:  that “hearts and minds” phrase is a clear reference to LBJ’s counter-insurgency efforts in the Vietnam War (though it, too, has an interesting history which long predates American imperial activities).  “Beast,” too, is an interesting word choice – slightly apocalyptic to my ears – though an appropriate description of a self-propelled, insentient thing doing the PR bidding of its masters.

Costly research has shown that:

  • hard letters with an edge (P,T, and K) convey effectiveness
  • X is perceived as scientific
  • L,R, and S are calming
  • Z means speed

Additionally, the name is most effective if it contains some pre-existing elements of meaning; then there is less of a need to create a new meaning through marketing and advertising.

All this points towards the fact that drug companies are marketing directly to consumers, and they’re not doing it from an evidence-based point of view (ie, presenting information from clinical trials proving the effectiveness of the drug).  It’s all about symbolism, emotion, and the sub-conscious.

Dettore and Piergrossi point to the brand Invega for a Johnson & Johnson anti-psychotic.

The word Vega, the brightest star in the constellation Lyra, is imbedded in it. Any imagery related to the stars or space carries a positive connotation.

It almost offers the patient hope through the name,” Piergrossi said.

(from this recent news article; emphasis added)

So let’s have a look at a few common drug names.  What kind of beast was this drug intended to be?  How is it meant to propel itself directly into our hearts and minds?  AND, how do the emotions and symbolism invoked compare to the actual evidence surrounding the effectiveness of the drug?

PROZAC

Pro – Positive, affirmative.  Additionally, we have the “p” sound, which conveys “effectiveness.”

Zac – “speed.”

Given that research has shown that antidepressants are only marginally (at best) more effective than placebo, and usually take about 3-5 weeks to begin “working,” this name is a bit misleading. 

May I suggest TRIAPLACEBOFIRST instead?

SEROQUEL

SER – the “s” sound is soothing, and this seems to imply “serenity.” 

QUEL – calm, quell. 

Despite the calming sound of its name, research has shown that acute akathisia (maddening restless energy which can cause pacing, twitching, and even violence) is a common side effect of Seroquel. 

Perhaps the name JUMPOUTTAURSKIN would better convey this “side effect”/main effect of the drug?

Anyone else out there have a suggestion for a better name for a particular “beast?”  I’m anxious to hear your ideas… Language change is a powerful force, a way to re-define and reframe.  It can work for you.

Will the real soul healers PLEASE STAND UP 02/23/2011

Posted by ALT in Philosophy/Spirituality.
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 “A word is a promise; a failure to deliver a kind of betrayal.  What does the language of mental health promise?”

I said that.  I said that because we’ve been promised something by psychiatry – namely, soul-healing – and we haven’t gotten it.  We’ve gotten pain, poison, suppression, denial, defamation, and death.

To live here, in this Eurocentric, industrialized, dehumanized society is to be traumatized.  The soul wounding is inflicted, as a matter of course, on just about everyone, all to the mantra of for your own good.  For your own good.  Trust me – it’s for your own good.

Yanked from the womb with forceps or a vacuum (when gravity will do much better) * fed on soy and synthetic “formulas” (when mother’s milk was what our very souls craved) * rudely awakened by a clanging alarm clock at 5:40am every weekday morning so that we can go sit in windowless jail cells [aka schools] and be fed useless, oversimplified bits of information (not knowledge)… having the creativity and individuality in us slowly squeezed out, to be replaced with a gray uselessness (when the truth – that the pursuit of knowledge is the greatest and most joyful quest imaginable – was right in front of us) * to negotiate, as green, trusting, innocent, teenagers,  a culture tremendously oversexed by the media, steeped in the ideas of abusive, vampire love, women as objects, men as mere accessories to their penises (when what we wanted was to be held, loved, respected) * to go to college, to get more “education,” but mainly to be told that we all are destined to become “productive members of society” – all the while accruing soul-crushing, lifelong debts of unimaginable sums (these debts making the “productive member of society” path the ONLY choice available) * then, to enter the “job market” only to find that there’s no use for whatever shreds of self-respect, intellect, and purpose remain after years of intellectual abuse.  To find that what’s expected is inactivity, lack of thought, unprofessionalism… (when what we wanted was TO MAKE A DIFFERENCE) * Violence – everywhere, even in beautiful suburbia – a seemingly unavoidable scream echoing down the corridors of your life, only to be silenced with willful ignorance, copious amounts of alcohol, or perhaps a bit of both * Evidence of “lives of quiet desperation” all around us; a trembling hand reaching for Coca-Cola ™ in aisle 15 at the grocery store (slogan- “Life begins here”), a crumpled and forlorn cigarette package in a tarred pothole, a solitary figure clutching an illuminated cell phone; a poor substitute for the presence of another human being, don’t you think?

Is it really all for our own good?

Purely anecdotal: I’ve noticed that a common trigger for mental unwellness in children is school—disbelief that such a place can exist, that children are condemned to spend a great deal of time there (for no easily understandable reason).  And in adults, it’s a growing recognition of how anti-human our mad society really is.

The self-proclaimed and professionally certified “soul healers” (again, I am referring to psychiatrists here…) aren’t helping; instead, I would argue that they are making things infinitely worse, by suggesting that their patients wish it all away with chemicals instead of addressing that which causes them so much pain.

But to be anti-psychiatry is to be “anti-soul healing.”  No good; because soul healing is clearly what we need.

So here is what I propose:

Each and every human being dedicated to SOUL HEALING needs to STAND UP.  Online, in “real life,” in their communities, in their homes… to their families, to their friends, to complete and total strangers.  To politicians, religious leaders, even mental health professionals.

Stand up and say (or sing, or shout, or write): I AM IN FAVOR OF HUMANITY.  I am in favor of the soul (soul power).

I LOVE YOU!

And then to live that; every day.  Demonstrating it in each moment of your life.

Some technical considerations

You don’t need to be “certified” to be a soul healer.  It probably hurts more than it helps, actually, because certification is – in most cases – just another word for “industrial indoctrination.”  But here’s what you do need [taken mostly from Eduardo Duran’s excellent book Healing the Soul Wound]:

  • The soul healer must have a real and deep understanding of who he is; this means that he must know spiritually where he stands and where he comes from (who his ancestors are).  “The importance of spiritual identity starts to become clear as the soul healer begins to understand that a relationship with spiritual entities is an important part of the work of healing.”
  • “The soul healer must embody the healing energy in her life in all that she does.  Western healers have a way of compartmentalizing their role as a healer from what they do in ‘real life.’”  This does not work; soul healing is an all-or-nothing pursuit.

It’s time to take the very important business of soul healing back from the professionals; they’ve had their chance (and they blew it!).  Now let humanity take a new path – no longer “productive members of society,” let us be simply “human beings with SOUL.”

 

On the dehumanization of Sylvia Plath… 02/22/2011

Posted by ALT in Uncategorized.
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Sylvia Plath was a human being. She lived and breathed, she feared, she loved, she picked daffodils.

Skipping around in her unabridged journals this morning, I had that revelation. Why should it be a revelation? Because the mental health field has made her an ICON; something entirely separate from humanity. According to them, she IS clinical depression, suicide; she IS tortured genius. 

Even worse, she is entertainment. This poem was written by Ms. Plath’s daughter, Freida Plath, in response to the 2003 film Sylvia, starring Gwenyth Paltrow.

My Mother (by Freida Plath)

They are killing her again,
She said she did it
One Year in every ten,
But they do it annually, or weekly,
Some do it daily,
Carrying her death around in their heads,
And practicing it. She saves them
The trouble of their own;
They can die through her
Without ever making
The decision. My buried mother
Is dug up for repeat performances

Now they want to make a film
For anyone lacking the ability
To imagine the body, head in oven,
Orphaning children. Then
It can be rewound
So they can watch her die
Right from the beginning again.

The peanut eaters, entertained
At my mother’s death, will go home,
Each carrying their memory of her,
Lifeless — a souvenir.
Maybe they’ll buy the video
Watching someone on TV
Means all they have to do
Is press ‘pause’
If they want to boil a kettle,
While my mother holds her breath on screen
To finish dying after tea.

The filmmakers have collected
The body parts.
They want me to see.
But they require dressings to cover the joints
And disguise the prosthetics
In their remake of my mother.
They want to use her poetry
As stitching and sutures
To give it credibility.
They think I should love it-
Having her back again, they think
I should give them my mother’s words
to fill the mouth of their monster,
Their Sylvia Suicide Doll.
Who will walk and talk
And die at will,
And die, and die
And forever be dying.

They – mental health activists, feminists, moviemakers – leave little room for her to have been Sylvia. But she was! She was — vividly, starkly, truly.  

There’s a lesson here for each and every one of us that has been dehumanized in one way or another by this society that doesn’t leave much room for human beings to just be.  Don’t let them convince you that it is better to be the “action figure” version of yourself; that plastic is better than living flesh; that 144 characters are sufficient to say your peace; that a a sound byte represents the multitude of your thoughts.  Don’t let them turn you into a Doll, ever.

    

Sylvia Plath with children Freida and Nicholas:

   

 

 

 

 

 

 

 

 

 

    

     

   

New advertising for antipsychotics forecasts another change in the language 02/21/2011

Posted by ALT in Mental Health News, Treatments.
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 The Internet wants me to take drugs.

I know this, because nearly every site I visit subtly whispers things like “Seroquel…” “Abilify…”  “Adderall, for adult ADHD…” to me from the sidebars.  It shows me pictures of a perfect life, happy smiling people trendily going about their business as “productive members of society” – everything, in short, that a well-trained, successfully socialized member of the system should be wanting by now. 

Targeted advertising can often be a bit misguided.

This one kept cropping up when I was doing the research for last week's Twilight article. Charming, isn't it? (Also, note the "Ads by Google" in the bottom right)

Note to Google – you can track my keystrokes and correspondence if you like, but you need to work on interpreting those keystrokes better.  The reason I’m searching things like “antipsychotics side effects” is NOT because my doctor recently recommended them to me and I am doing a bit of Internet research.

[Note to people doing said research: be forewarned – pharmaceutical companies can and do manipulate search results so that their preferred websites come up first.  You’re going to have to dig deep to find unbiased information about these drugs and the possible side effects.]

These sidebar ads are designed to slip in under the radar (IE, your conscious mind).  They’re not meant to be the center of attention—so turning an attentive eye to them can yield some incredibly interesting results. 

   

Name changes; a new name = an untarnished reputation

As previously discussed, antipsychotics (the older class) were originally marketed in the United States as “neuroleptics,” and are still known by that name in Europe.  The neuroleptic label (literally meaning “brain seizure”) was dropped in favor of, first “anti-schizophrenics” and, later, “antipsychotics.”

In other words, the name for the class of drugs represented by chlorpromazine and all its relatives changed over time, and the change in name was a direct reflection of how drug companies wanted the drugs to be perceived.  Obviously, a name that implies the drug causes seizures isn’t too good for business; and “antipsychotic” is preferable to “anti-schizophrenic” because it allows for usage amongst other populations beyond schizophrenics (for example, those diagnosed with “bipolar disorder”). 

If it weren't highly illegal (false advertising, you see), they probably would've switched to "happy pills" next.

Drug classification is kind of unique amongst scientific systems of classification in this regard; a drug is assigned to a specific class based on either active ingredient or the condition it is meant to counteract.  This allows the same drug to belong to several different classes; for example Wellbutrin is both an “antidepressant” and a “smoking cessation agent.”  This also makes it possible for the same drug to be reassigned to new categories as new usages are approved.

Contrast this to the biological system of classifying life: once you are assigned to a specific category, that’s it.  If cats were both “mammals,” along with being “mice-eaters” and “milk-drinkers,” you wouldn’t really be classifying them; you’d be describing them.  Classification is definitive (one, unchanging label); description is much more subjective (what once was an “adorable kitty” becomes a “snarling furball” under certain circumstances). 

Only one label for this cat: "kittykatus furious"

So the pharmaceutical drug classifcation system isn’t a classification system at all; it’s a descriptive system.  And this is what pharmaceutical companies are really doing when they change the name of a drug class, or reassign a drug to a new class: they’re describing it differently, in order to affect the way it is perceived by potential consumers (or even the FDA).   Aside from being useful in avoiding patent expiration dates, this maneuver is a great way to escape bad press for a particular chemical in a particular context.

   

When I say “bad press,” you say “antipsychotics!”

That’s right… the past couple months have been one bit of bad news after another for antipsychotics.  Several recently published studies show that they cause brain shrinkage, weight gain, Parkinson’s-like symptoms, diabetes, seizures, heart problems – a whole laundry list of incredibly undesirable side effects.  And this is national news (though a few tenacious “researchers” – funded by pharma, of course – are still courageously arguing that brain shrinkage might not be so bad, after all.  Good one, guys.). 

Could it be that consumers are going to be a little wary when they hear the word “antipsychotic”?  Might they be a bit more apt to do some research, and not just click on the pharma-funded hits at the top of Google, but delve into the blogosphere, survivor testimonies, or perhaps some of the clinical literature?

Maybe, and that’s certainly a risk to the billions of dollars of profits these drugs bring in every year. 

I think it’s time for a name change, folks.

  

And that was my long-winded way of getting to the point, which is…

This is what I saw in my sidebar today:

Accompanied by this text [excerpt]:

Antidepressants have increased the risk of suicidal thoughts and actions in some children, teenagers, and young adults.  Patients of all ages starting treatment should be watched closely for worsening of depression, suicidal thoughts or actions, unusual changes in behavior agitation and irritability.  Patients, families, and caregivers should pay close attention to any changes, especially sudden changes in mood, behaviors, thoughts, or feelings.  This is very important when an antidepressant medicine is started or when dose is changed.  Report any change in these symptoms immediately to the doctor.  SEROQUEL XR is not approved for patients under the age of 18 years.

(from online SEROQUEL XR advertisement; emphasis added)

Wait, Seorquel?  The one classed as an “atypical antipsychotic”?  The one that is not and has never been classed as an antidepressant, nor has it been approved for use as an antidepressant?

[Note: it can be used as an augmentor, ie prescribed alongside another antidepressant if that antidepressant is not effective, and it can also be prescribed for “bipolar depression.” But it CANNOT be prescribed as sole therapy for clinical depression, and IS NOT an antidepressant.]

Seroquel, made by Astra-Zeneca, which just paid literally the biggest fine in the history of corporate America [$520 million] for deliberately marketing a drug for off-label uses?  And that drug was…

SEROQUEL?

Check it:

Seroquel is AstraZeneca’s second best-selling pharmaceutical and made sales of $4.87 billion in 2009, up 12% on 2008. The drug was first granted FDA approval in 1997 for the treatment of manifestations of psychotic disorders. Three years later FDA proposed narrowing the approval to the short-term treatment of schizophrenia only. In January 2004, U.S. approval was also given for the short-term treatment of acute manic episodes associated with bipolar disorder. Finally in 2006, the drug was sanctioned by FDA for the treatment of bipolar depression.

The government’s investigation was brought about as a result of a whistleblower lawsuit. The resulting allegations stated that between 2001 and 2006 AstraZeneca promoted Seroquel to psychiatrists and other physicians for disorders not covered by FDA approval. These off-label indications spanned a broad range of conditions including aggression, Alzheimer disease, anger management, anxiety, ADHD, bipolar maintenance, dementia, depression, mood disorder, post-traumatic stress disorder, and sleeplessness. Moreover, it is claimed, AstraZeneca promoted Seroquel to physicians who don’t normally treat patients with schizophrenia and bipolar disorder, the two approved disorders for the drug.

(from a recent news story)

Oh, ok.  That Seroquel.

That Seroquel that’s getting really bad press as an antipsychotic; that’s the one they’re starting to call an “antidepressant” or an “antidepressant augmentor.”  Actually, they’re doing the same thing with Abilfy (another atypical antipsychotic), as demonstrated in this recent commercial.  Notice that they don’t use the word “antipsychotic” anywhere; the emphasis is on antidepressants:

It’s an antipsychotic wide trend.  They’re not really antipsychotics anymore (since they’re increasingly getting such a bad rap); they’re antidepressant augmentors, or maybe just plain ol’ antidepressants.  Or at least they will be, as soon as pharma can get the FDA fully on board. 

Keep watching these Orwellian language changes.  It’s doubleplusgood fun, don’t you agree?

Youth living in nursing homes 02/20/2011

Posted by ALT in Children's Mental Health, Mental Health News.
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Modern society runs at a pretty fast pace – for the elderly, who like to take things a little slower, it can be jarring, I’m sure.

She seems to be keeping up all right...

A nursing home is probably one of the few places where the schedule is tailored specifically to the preferences of the elderly (IE, 4:30pm is the “evening,” and 4:30am is a perfectly reasonably time to get up in the morning).

Which is why this comes as such a shock: adults ages 31-64 make up the fastest growing nursing home population (about 14% total, up from around 10% in 2000 – this doesn’t include the more than 6,000 young people under 21 living nursing homes).  And due to recent adjustments to Medicaid reimbursement laws [citation forthcoming!], it doesn’t look like that’s going to change anytime soon.

   

Home-based care vs. nursing home care

There may be a few in this age group whose true preference is to live in a nursing home for the elderly; but this recent NPR piece makes it quite clear that for most, it’s not a choice at all.

I was the youngest person in the nursing home. Most of the others were very old. I had only a few friends that would come and see me. I missed everyone very much.  And I wanted to leave. I wanted to live with my family so that I would not miss them so much.

(Matthew Harp, 22 years old)

Listen to audio here.

In most cases, the cost of providing care at home is only a third of the cost of providing care in a nursing home or institution (according to this study, which breaks it down by geographic region).  But there are some upfront costs to states to make home-based care work, and more and more these programs are being cut from state budgets.

The quality of care provided in a nursing home (especially to young folks) can be distressingly low.  A commenter shared this information: her son, Tim Stoklosa began living in a nursing home in his 20s because a lack of other “independent” options.  He tells a little bit of his story in this short film:

After living at the nursing home for a year and a half he lost thirty pounds and became gravely ill. He was admitted to the intensive care unit of the local hospital and almost died. He became ventilator dependent.

Just from watching the film, you can see how incongruous it is; this young man, with a very active mind, in the day room with elderly patients, some of whom are clearly in the “fog of psychotropic drugs.”  Who will he interact with?  Certainly there is much to be learned from talking to elders, but a young person craves the society of people his own age, too.

So what gives?  Why are children and young adults being sent to nursing homes for care when a. it’s not their preference b. it’s not cheaper c. it’s just not appropriate?

  

Post Script

A good story sparks discussion from many sides of an issue.  Here is a comment from the story that I found especially noteworthy:

One big source of kids in nursing homes are parents who go ahead with births of kids that they are warned are certain to have severe health problems, instead of terminating the pregnancies. Then when the kids are born and end up in the NICU [Neonatal Intensive Care Unit] the parents see how much care the kids will require, then they turn them over to the state. Sometimes the parents could make the decision to do the right thing and remove the kid from life support, but instead they turn it over to the state. And the state by law must give all possible care, no matter how expensive the treatments or how miserable a life the kid will have.

Often it’s a drug using mother, or an illegal immigrant with no prenatal care that end up birthing these basket cases. Destined to be bedridden for decades because mom couldn’t put down the crack pipe or show up for free hypertension care. Sometimes the parents are religious freaks to whom “all life is precious” and don’t have the guts to make the difficult but correct moral choice. Nature does not intend all pregnancies to be successful, but advancing medical technology (with even faster advancing costs) is making the Frankenstein baby a reality.

Take a stroll through a big city NICU and see for yourself.

(comment from “Youth In Nursing Homes Seek Alternative Care” NPR story)

What a total and complete lack of respect for parents and caregivers of disabled people.  Basket casesFrankenstein baby? Please tell me I’m not alone in being shocked and saddened by this point of view (I guess that makes me one of those “religious freaks” who thinks that all life is precious… yes, proudly!).

Geriatric care from loved ones will clear the “fog of psychotropic drugs” 02/19/2011

Posted by ALT in Alternative Lifestyles, Mental Health of the Elderly.
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This recent piece from the NY Times shed a few rays of light on the issue of psychotropic drugging  in nursing homes (they call it the “fog of psychotropic drugs”). It’s a subject not often talked about—but the elderly make up a very significant (and growing) chunk of the market for psychotropics. In 2004 a national survey found that 25% of nursing home residents were taking psychotropic drugs, many of them on potent cocktails of 2-4.

A nursing home which made an attempt to step down the medication of its patients (and with excellent results) was the feature in the Times. This is encouraging, especially in light of some disturbing statistics about the harm over-medicating the elderly can cause:

  • 10-20% of adults over the age of 65 who go to the hospital do so because of prescription medicines that have been taken improperly.
  • 1 in 3 elderly hospital patients becomes sicker during hospitalization because of prescription drugs.
  • Up to 140,000 seniors die each year because of problems with medications—three times as many people as die from breast or prostate cancer, which are both considered public-health emergencies.
    (from the research of Dr. Andrew Duxbury)

Now, geriatric professionals claim that psychotropic medications are necessary because: 1. the all-too-common condition of clinical depression in the elderly is best addressed with SSRIs 2. the early stages of so-called “dementia” involve a lot of disruptive behavior that is not conducive to institutionalized “order” nursing home staff generally require.

In short, psychotropic medications are a way to suppress the feelings (quite legitimate, in my mind) of some “residents” that they don’t want to be there, they don’t like the way they’re being treated, and that something is very wrong with a world where the elders are left to finish out their days in an institution, cut off from the rest of society that is so desperately in need of their wisdom.

When there aren’t nursing homes

Not every country is quite as “advanced” as the United States when it comes to geriatric care; in a lot of places the elderly are cared for by their children (not professionals, and with no official “certification”), at home.

I had the privilege to witness this personally. In the summer of 2008 I spent about two months in Oaxaca, Mexico — one of the poorest states in the country; it also had the second highest indigenous population. Much of that time was spent in a small village, called “Totontepec,” high up in the mountains. The folks there were from an indigenous group called the “Mixe” (pronounced MEE-hay), and nearly everyone was bilingual, speaking both Mixe and Spanish.

Totontepec

The Gomez family – Vidal and Eusabian (husband and wife), Eusabian’s sister Maura, and their mother (we just called her “Mama”) – welcomed me with open arms. They showed me their life together, subsisting mostly off the food they grew in their milpa, working and laughing together most of the day. I will never forget their kindness…

Maura (left) and Eusabian (right)... sisters

Mama, happy at home.

Mama had Alzheimer’s, and it had progressed to the point where she didn’t always recognize everyone, had trouble bathing herself, was sometimes incontinent, and was telling the same jokes every 5 minutes or so (I gather she was quite the humorist in her younger years!). But she was cared for in house, not as a favor or duty, but as a matter of course.

At that point in my development, I didn’t question the necessity for nursing homes. Elderly people need to have somewhere to go, right? And their children are likely too busy with their careers to take care of them. So it makes sense that they should go to nursing homes!

But in Totontepec, the number one priority is taking care of family. That is your career. You walk the mountain road to the milpa in the morning for the family. You grind the corn into masa and cook tortillas on the metate for the family.

And you have a grand time doing it, laughing the day away with smiles and love and compassion, with the ones you love!

Through halting dialogue (my Spanish at the time was atrocious), I tried to express my admiration for them, for the care they gave their mother. They really couldn’t understand it, because they couldn’t conceive of another way. So I tried to explain about nursing homes. I’m not sure how much I conveyed, but I read expressions of dismay and perhaps horror on their faces. What a place! God, save us.

From my Oaxaca journal:

July 1, 2008
But the thing is, these people are letting their mother, who has Alzheimer’s, can’t remember a blessed thing, and hockers incessantly, live with them; they’re taking care of her, and not grudgingly, either. They love her, and she knows she’s loved. She can’t be left alone, so someone is always home to take care of her. She sleeps in Maura’s bed – sometimes (3 or 4 times since I’ve been here, I think) she wets the bed. They just laugh it off!

As it is with the young, so it is with the old – the best caregiver will always be the one who feels an unconditional love for you, the one who shares that bond. Love of this kind makes the caregiver infinitely sensitive, considerate, and compassionate. What Mama needed in order to be comfortable and cared for was, above all, unfettered/uninstitutionalized human contact, the hand of her daughter on her shoulder telling her that she’s loved.

What I learned that July: I will be that daughter someday. Happily, and with all my heart.

When it took a village to raise a child, we didn’t need institutions 02/18/2011

Posted by ALT in Alternative Lifestyles, Children's Mental Health, Historical Context.
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“It takes a village to raise a child” seems to be the official slogan of social workers and children’s mental health professionals everywhere.  They chant it from the podium at their national conferences and write it in bold, ALL CAPS on the tops of position papers and task force reports.

It’s an old African proverb, though it seems to apply to traditional cultures worldwide.  The idea was – and in a few places, still is – that the village is a combination playground/one-room schoolhouse, and each villager a potential mentor, teacher, or caregiver.  Everybody has a stake in providing support, love, and kindness to children, because, as the old cliché goes, the children are our future. 

[I always say that a cliché is someone else’s epiphany that you just haven’t had yet…]

But, again, we see that the language has been changed to suit the purposes of an industrialized society.  What the proverb seems to mean today is that it takes a cadre of certified professionals and a good amount of restrictive, institutionalized settings to get the job of raising children up to be “productive members of society” done.

A great way to insure job security – but is it a great way to raise a child?  I’ve seen the children with said “village” watching their every move… they don’t seem too happy about it. 

There was a time in this country when it did take a village to raise a child, in the traditional sense.  Back then, they didn’t have compulsory schooling, Child Protective Services, hospitalized birthing, child psychiatrists.  Below is a slideshow of some images from those days.  For me, these photographs evoke a wistfulness, a curious longing…

They make me wonder:  What have we done?

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Addendum to “In favor of a more honest discussion of ADHD stigma” 02/18/2011

Posted by ALT in Mental Health News.
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We’ve already taken a nice long look at Dr. Barkley’s expert opinions from the “front lines of medicine.” But I just learned a little piece of information that goes a long way towards explaining some of his “eccentricities” (consistently advocating for the use of medications in folks ages 0-100, insisting that ADHD is a real disease, and, more generally, using incredibly misleading subtitles to reframe important discussions into APA press release-appropriate topics).

Dr. Barkley regularly consults for pharmaceutical companies.  More specifically, he works hand-in-hand with Lilly, the makers of Strattera.

From Dr. Barkley’s website:

Full Disclosure

Below is an actual listing of the proportion of income he has recently received (tax year 2008):

Presentations/workshops (35%)

- Various professional associations, hospitals, universities
- Federal, state, & local agencies

Books, newsletter, and other product royalties (36%)

- Guilford Publications, Compact Clinicals, J&K Seminars
- New England Educational Institute, ContinuingEducation.com,

Retirement pension (5%)

- Univ. of Mass. Med. School

Speaker/Consultant for pharmaceutical companies (24%)

- Eli Lilly Co., Shire, Novartis

(from Dr. Barkley’s website; emphasis added…)

Now, if a pension from U Mass Med School is only 5% of his income, how much money would that make the 24% he’s receiving from pharmaceutical companies? (Hint: it would be about 5 times as much as his pension…).  That makes for a whopping conflict of interest from our courageous, front lines reporter.

As a commentor at the NY Times put it, ever-so-nicely:

“C’mon, NYT, why don’t you interview a liquor store owner on the benefits of booze?”

Beware the Vampyre! For he is an archetypal representation of abuse 02/17/2011

Posted by ALT in Children's Mental Health, Historical Context.
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4 comments

Vampires are so in right now.

If you spend much time around pre-teen/tween/teen/young adult women, you’re likely aware of the Twilight phenomenon: quite possibly the most poorly constructed, badly written novels ever, the author’s disturbing pulp vampire fantasies barely hidden behind one dimensional, mostly Mary Sue characters (Stephanie Meyer should’ve just gone ahead and named the main character “Stephanie;” it would’ve saved us all a lot of trouble).

The cover should've looked more like this.

For today’s teenagers, this is basically the love story of their generation—or so it’s been marketed.  T-shirts, full-size posters, figurines, teen pop magazine pictures you can kiss before you go to bed at night proclaim the supreme love of Bella (human) and Edward (vampire).  [For some of the weirder Twi-fan stuff out there, check this out.  Also, this.]

Also, it's apparently not just for teenagers...

Young people want to learn about love, and these days they’re learning it from the media, as the topic has successfully become taboo in many families and certainly in school.  I can just imagine a young person, not really knowing too much about romance, reading the book (or seeing the movie) and thinking “That’s it… that’s love.”

Folks—that’s an entire generation being taught that abuse is the ultimate in romance, that love is dark, desperate, controlling, that the man of your dreams ought to be a threat to your soul.

Let me explain…

Vampire as the archetypal abuser/abused

As most literary figures and themes, vampires are a symbol; I’d go so far as to say that they are an archetype (IE, an ancient and nearly universal symbol recognized by many human cultures across time).  The vampire represents the victim of abuse who, having lost his soul, is transformed into an “undead” creature victimizing and therefore condemning other humans to the same fate.

Here are some common characteristics of the vampire archetype:

  • A reanimated corpse, “undead”
  • Vampires only travel at night (in darkness)
  • Maintains its immortality by drinking the blood of humans
  • The vampire’s need for blood destroys the victim
  • The victim of a vampire will become a vampire

It’s easy to see how these traits align very well with those of a victim of abuse/abuser…

[But first, a quick aside: my use of the "victim of abuse/abuser" construct may be a bit confusing—is the abuser the vampire? Or is the victim?  But as we shall see the symbolic relationship between the two is complex… it is commonly understood that the victim often identifies with, or retains a piece of, the abuser as part of the traumatic experience.  They bleed together… and so the symbolic representation of their relationship (the vampire) is a single entity from this perspective.]

Reanimated Corpse, undead

This represents the disassociation or severe depersonalization that a trauma victim experiences; many have described it as feeling “like a zombie.”  Victims say they have “lost a part of themselves,” and repressed traumatic material in the unconscious can contribute to this feeling.

Immortality by drinking the blood of others

Many (though not all) abusers are victims of abuse themselves.  It’s called “intergenerational trauma,” and it’s a phenomenon that’s quite well-known; childhood abuse inhibits the development of coping skills in a young person.  When that person becomes a parent, he does not have a positive example of parenting and has few skills to find one for himself.  She may also have developed a dependence on a chemical substance as a false coping skill, making it extremely difficult to care for children (addiction gets in the way).  Thus the cycle of abuse is perpetuated.

Additionally:

Drinking the blood of the victim can be equated with the act of abuse itself.  Like the vampire drinking the blood of its victim for food, the abuser seeks a kind of perverted nourishment from the abusive situation.  Some therapists maintain that the abuser is recapitulating an earlier trauma in order to master it… Tragically, the desired fulfillment, if achieved at all, is temporary and the abuser, like the vampire, is once again tormented.  For both vampire and abuser, there is no lasting security or resolution from the act.  Abusers often report that they experience the abuse as a regrettable and empty situation, and that they act on impulse, as the vampire acts on instinct.
(Micahel Butz, “The Vampire as a Metaphor for Working with Childhood Abuse” — read the entire article here.)

From here it is easy to carry on the metaphor… the vampire destroys the victim’s humanity be drinking his blood.  Likewise, a survivor of a traumatic experience may feel that his humanity was destroyed or severely injured.  If the trauma is not properly dealt with, this victim may find inappropriate ways of releasing the negative energy that was passed on to him by the abuser; in short he may become an abuser himself.

It doesn't get much more obvious than this: the apple, his hand on her neck, her posture, the exposed skin and "sacrificial victim" look of the dress, the bracelets - or are they handcuffs? ... (actual press photo for Twilight film)

The vampire in literature

This interpretation of the vampire archetype (as abuser) is one that is quite evident in the first modern literary appearance of the vampire: Bram Stoker’s Dracula. The classic reading of the novel is that the Count Dracula, in his interactions with both Lucy and Mina, represents Victorian ideas about rape, feminine victimry, and abuse.

Not so today.  In Twilight (and I think we can safely assume all of the knockoff literature that has followed), vampire love is something to be embraced.  A love of this kind is as inevitable as the that of Romeo and Juliet, and in some way more alluring, seductive and desirable.

The symbology of abuse is barely hidden beneath the veneer of “true love,” as several bloggers have already pointed out.

The language of symbols is a mostly sub/unconscious one… readers of the novels are learning to valorize abusive love, whether they know it or not. What are the connotations for the millions of teenage readers who embrace this “love story” as the pattern upon which a relationship should be based?



In favor of a more honest discussion of ADHD stigma 02/16/2011

Posted by ALT in Children's Mental Health, Mental Health News.
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Another NY Times missive from the “Front Lines of Medicine.” 

I got my hopes up when I saw this subtitle: THE STIGMA OF ADHD.  Good, a discussion of stigma. 

Perhaps we could touch on mental health patients’ status as second class citizens, routine violations of their basic rights to informed consent and “do no harm” care, the continuous silencing of their voices and descriptions of their experiences of reality… Or maybe ADHD’s very specific role as an entryway for kids in to the mental health system, the growing recognition that Strattera, Adderall, Concerta, and especially Ritalin can lead to psychotic episodes and therefore subsequent diagnosis of schizophrenia, bipolar disorder, and years of routine medication, all before this human being’s brain is fully developed or he’s achieved the legal right to decide for himself how he’d like to experience reality…

Nope.

What we get under such a promising subtitle is an expert redirection – instead of discussing any of the above, Dr. Meh [his real name] leads our favorite “expert” Dr. Barkley very nicely to a discussion of the stigma that ADHD itself has to put up with; ie, all those pesky critics out there who doubt its status as a “real” disease and suspect the APA/pharmaceutical company conglomerate of making it up!

The Stigma of A.D.H.D.

Q.

Is there any way to combat the pervasive view of A.D.H.D. as a made-up disorder that benefits not the child, but the pharmaceutical companies and doctors?
Dr. Meh, Boston

A.

Dr. Barkley responds:

The pervasive view that A.D.H.D. is a fiction invented by drug companies has never had any basis in fact. The diagnosis of the disorder predates the widespread clinical use of medications to treat it and thousands of studies on the disorder have been done with no involvement of the drug industry. Those studies show that the disorder is legitimate, valid and widely impairing of an individual’s ability to effectively participate in major life activities like school, work, family, social relations, driving, money management and child-rearing.

Critics of A.D.H.D., including fringe religious groups, are part of the source for such propaganda against the disorder. Their claims have sometimes been uncritically perpetrated by journalists who fail to check out the source of the claim or the group asserting it. Getting accurate information into the media is one of the best ways to counteract this false assertion.

(read the entire post here…)

“Critics of ADHD, including fringe religious groups…”  That’s pretty rich. 

I think what Dr. Barkley is trying to say is that if you don't believe in ADHD, the islamo-fascist-muslim-freedom-hating-terrorists win!

 

Left to my own devices, I was able to find some significantly more credible voices of dissent.  There is, of course,  a body of research linking ADHD “symptoms” to unnatural and oppressive learning conditions in compulsory/industrialized schooling; preservatives, artificial chemicals, and excessive amounts of sugar in children’s food; and the onslaught of electronic media that today’s children must learn to navigate (many of it saturated with advertisements specifically designed to hit them at a subconscious level)…

But I thought, in the spirit of a real discussion on stigma, we might turn instead to some survivor voices of children diagnosed with ADHD:

  

On ADHD and school…

I was in trouble in school a lot before I took my medicine.  After I took my medicine, I wasn’t in trouble anymore…If someone told me I could stop taking my medicine, I would still keep taking it because when I take it I can study for my spelling tests on Fridays.

–Miles, age 7

 

I first was told about ADHD in the 5th grade I think.  My Uncle Dan (who is a child psychiatrist) told me about it and I said that I didn’t have it.  I tried to fight it all the way to 7th grade, I think, and then I gave in and finally started taking Concerta.  And with the medicine, my grades actually boosted from C’s and low B’s to A’s and B’s because I was doing my homework and concentrating more.

 –James, age 18

 

On the effects of ADHD medication…

Well, the advice that I give is don’t try too hard to be creative while you’re on medicine, because then you won’t be as creative as you would be off medicine.  Like, I like it when I’m doing schoolwork, but when I’m in my arts classes I don’t like it really because it’s- kind of shuts down my creative mind.  It’s easier to be focused, but it seems like my creative mind is off.

–Kendrick Royal, age 12 (New Orleans)

 

Before I took Ritalin, I used to be nervous and afraid all the time. That was natural me. Shy, depressed, nervous and anxious. Obviously I couldn’t concentrate in school, or do my homework. So then I tried Ritalin. The first time I tried Ritalin was when I was 15 years old. I thought it was great. It made me super-confident and took away all inhibitions. The comedowns from Ritalin were terrible, I had pretty bad downfalls. So i stopped taking Ritalin. Anyway, after a while I realized something different about myself.

 Even though in the long-run i felt confident and happy, I noticed that i had been stripped of all other emotions and feelings. I never got nervous, never got scared, never cried. That’s good, Right?

But there was something else. I had NO libido. NOTHING. It’s been two years now, and my libido hasn’t come back. Im not interested in anything at all. I used to be an artist and I can’t draw anymore. I used to be talented in music and I don’t play anymore. I have nothing left. I am like a robot. I don’t have any FEELINGS at all.

 And nobody can help me.

 Because the doctors tell me it’s all psychological.

 They tell me that it is not a true side effect of Ritalin.

 But what would they know ?

–Amy (Perth, Australia)

 I regret that I wasn’t able to find more directly related quotes from youngsters dealing with an ADHD diagnosis (or an attempt at labeling them so)… It seems this is a voice that is not often heard.  If anyone has something to share about this, it would be more than welcome…

If Calvin were diagnosed with ADHD...

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