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Obama’s Mental Health Policy Recommendations: Expect a little Good and lots of Bad and Ugly 01/22/2013

Posted by ALT in Children's Mental Health, Mental Health Policy and Inititatives, Patient Rights and Advocacy.
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12 comments

A life lesson: Whenever someone says they’re “doing it for the kids,” you can expect very little Good and LOTS of Bad and Ugly.

Doing it for the kids

A week ago Wednesday, surrounded by adoring children, President Obama presented his plan to protect our children and communities by reducing gun violence.

Part 4 of that four-part plan was entitled “Increasing Access to Mental Health Services,” which says:

If even one child’s life can be saved, then we need to act. Now is the time to do the right thing for our children, our communities, and the country we love.

That’s right, folks: this time we’re doing it for the kids.

do it for the kids

Spare no expense when you’re doing it for the kids!

Obama’s proposals come with a big price tag: $55 million!

And they seem geared towards one basic thing: get more children into professional  mental health treatment (he even sets a specific goal of 750,000 children — pretty nice for Johnson&Johnson, Eli Lilly, et al to have advance notice of the number of new potential lifelong customers, eh? ).

What’s wrong with encouraging young people to seek treatment?

My parents did what millions of American parents have been taught to do: they saw how much emotional pain I was in, and they sought “help” for me in the “mental health” system. They had no idea that my entrance into a psychiatrist’s office as a young teenager would end up stripping me of my health, my hope, and my sense of Self. Today, we are able to come together as a family with forgiveness, acceptance, love, and gratitude, to talk about how counterintuitive my journey into a system of proclaimed “healing” ended up being; indeed, as the result of being “shielded from harm” by the “mental health” system, I experienced more harm than I could have ever imagined for myself.

—Laura Delano, in her essay “Free from Harm? Reflecting on the Dangers of the White House’s Proposed ‘Now is the Time’ Gun Control Plan” (you should read it… it’s good)

In other words, Obama’s placing the spirit of America’s youth on the altar.

Do it for the kids.

Mental Health First Aid: The Good?

So what exactly is the government buying with $55 million of my —and my fellow Americans’— hard-earned cash?

One of the proposed interventions, “Mental Health First Aid,” is a 12-year-old evidence-based practice (that’s on the verge of a lucrative adolescence, it seems). Developed and initially implemented in Australia, it’s a 12-hour course for the layperson that teaches people to:

  • know the signs of mental health problems
  • provide first aid for mental health crises (like suicidal behaviors, panic attacks, etc.)
  • promote and enhance recovery.

These don’t sound like bad goals at all. And, really, much of the documentation on Mental Health First Aid is helpful, non-stigmatizing, very human (as opposed to institutional) stuff. For example, the Mental Health First Aid sheet on “psychosis” says:

How can I be supportive?

Treat the person with respect. You should try to empathize with how the person feels about their beliefs and experiences, without stating any judgments about the content of those beliefs and experiences…

Should I encourage the person to seek professional help?

You should ask the person if they have felt this way before and if so, what they have done in the past that has been helpful. Try to find out what type of assistance they believe will help them. Also, try to determine whether the person has a supportive social network and if they do, encourage them to utilize these supports.

Mental Health First Aid sheet on “psychosis”

Respect, dignity, being non-judgmental, activating a social support network of peers, friends, family, and asking the individual what sort of assistance he or she would prefer — quite frankly, that sounds fantastic!

That sounds like self-advocacy! That sounds empowering!

Actually, it sounds a lot like the principles of WRAP [Wellness Recovery Action Plan] – a wellness tool developed in part by Mary Ellen Copeland that has helped so many individuals reclaim their right to define wellness, and to find the resources they need for achieving it inside themselves…

Unfortunately, the emphasis on self-advocacy/determination and peer support is spotty at best when you examine the entire body of Mental Health First Aid literature. The truth is these folks are just as intent as Obama on directing people towards the “necessary professional help,” with self-care and self-help an optional second.

The Bad and the Ugly

Things go from bad to worse when you take a look at the Manual for Mental Health First Aid. In here, we learn that:

The symptoms of depression are thought to be due to changes in natural brain chemicals called neurotransmitters. These chemicals send messages from one nerve cell to another in the brain. When a person becomes depressed, the brain can have less of certain of these chemical messengers. One of these is serotonin, a mood-regulating brain chemical.

- Manual for Mental Health First Aid, 2009

Eeek! That’s just one more branch on the eugenics tree…

And a few pages further in the manual, we find these ugly sentiments:

A team of Australian mental health researchers has reviewed the scientific evidence for the effectiveness of a wide range of treatments for depression. The following rating system was developed to show the treatments whose effectiveness was best supported by the evidence:

☺☺☺ These treatments are very useful. They are strongly supported as effective by scientific evidence.

☺☺ These treatments are useful and are supported by scientific evidence as effective, but the evidence is not as strong.

☺These treatments may be useful and have some evidence to support them. More evidence is needed that they work.

smiley rating system

Since when is a therapy that’s been shown to be no more effective than placebo [antidepressants] rightfully classified as ”very useful,” and “strongly supported…by scientific evidence”?

And they’re giving three smiley faces for electroconvulsive therapy, too?!

Electroshock devices still have not been thoroughly reviewed for safety by the FDA (if they were, they’d have to nail down that nasty little statistic of how many deaths by ECT per 100,000?), and many studies counter the “three smiley faces” rating, including this large literature review, whose authors state:

The cost-benefit analysis for ECT is so poor that its use cannot be scientifically justified.

—John Read and Richard Bentall in “The effectiveness of electroconvulsive therapy: A literature review

Moreover, firsthand accounts of electroshock are often anything but “smiley.” In the words of Ernest Hemingway, a shock survivor:

Well, what is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business? It was a brilliant cure but we lost the patient….

Electroshock? Don't worry about it! ☺☺☺  Instead, look at this cute koala bear (official Mental Health First Aid mascot)!!

Electroshock? Don’t worry about it! ☺☺☺ Instead, look at this cute koala bear (official Mental Health First Aid mascot)!!

[More electroshock survivor voices here; also check out this article about a forced electroshock experience from writer Chris Dubey]

Imagine an alternative

Imagine an alternative. Imagine that the President recommended a course of action that emphasized self-reliance, empowerment, and advocacy, an “evidence based practice” that was steeped in the philosophy of respect and dignity for all (rather than just a semblance of it). One that emphasized treatments that were cost-effective or even free (rather than relying on very expensive, “appropriate professional help”), and one that pointed people towards achieving their visions for their lives, their wellness.

In other words, what if the president had set aside $55 million for the teaching of WRAP [Wellness Recovery Action Plans], or something like it, to anyone who so desired?

Those might be the last few dollars ever spent on so-called “mental health care”— with a population empowered to embrace its own humanity and resilience, there’d be no more need for it.

DEADLY police force often directed towards individuals with mental health issues 12/12/2012

Posted by ALT in Mental Health News, Mental Health Policy and Inititatives.
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6 comments

The Portland Press Herald [Maine] has exhibited exemplary journalistic skill and integrity (rare, these days) by publishing an extensive report on police shootings of individuals with mental health issues. The focus is, of course, on Maine:

In Maine, 42% of people shot by police since 2000 – and 58% of those who died from their injuries – had mental health problems. The Maine Attorney General’s Office, which investigates all police shootings, has never found one to be unjustified. The office doesn’t ask whether violence could have been avoided.

But the national statistic they published shocked me, too:

About half of the estimated 375-500 people shot and killed by police each year have mental health issues. In many cases, the officers knew from the start that the subjects were unstable.

Thinking back over the past few years, I can remember a few specific incidents nationally where police murdered – there’s really no other word for it – an individual who could NOT reasonably be believed to possess even the means (let alone the intention) to use deadly force against the officers in question.

Kelly Thomas.

Brian Claunch.

The Press Herald report documents an astonishing number of stories from Maine as well (click here to peruse the database of incidents and Attorney General’s reports compiled by the reporters). Many of these stories are complicated; there’s a lot of pain and desolation here. A fair amount of misunderstanding, fear, and police aggression as well.

One of the main points of the series is that reform is needed…

Specifically:

1. a more rigorous system for official review of the use of deadly force (that actually includes consideration of administrative/disciplinary action and asks the question: “could the use of deadly force been avoided?”)

2. better training for officers in dealing with crisis situations, so that the use of deadly force can be avoided.

I find myself thinking of Michael Cornwall’s recommendations for using a heart-centered approach to individuals in extreme emotional distress.

Michael not only has his own personal experience of distress to draw on, but also years of working with individuals in these states (several of those years taking place in the medication and diagnosis-free sanctuary for the treatment of first-break psychosis, I-Ward) to inform this wise approach:

Responding to Madness with Loving Receptivity: A Practical Guide

Aggression, rage, and other extreme out-pourings of energy — sometimes taking the form of physical force — were not uncommon on I-Ward, according to Michael. But the staff was dedicated to a.) using a heart-centered approach to address these challenges and b.) not involving the police. What happened most frequently was that the emotions were discharged (often, the staff would use what Michael calls a “loving embrace” to hold the person in the throes of such emotion) and then staff took the opportunity to process what happened with the individuals involved.

We used no restraints [on I-Ward] and every time after long periods of wild raging people would wind down and end up cuddling into the sometimes 2 or 3 staff needed to hold them. They would then softly start to cry and sometimes sob in a deep regrression of safely being held by strong and loving parental figures.

-Michael Cornwall, in a description of I-Ward 

The contrast between the heart-centered approach and the gun-centered approach is clear. Can we, as a people, a community, a society, choose the path that leads towards a life preserved, healing begun?

I hope we can.

DSM-5 conflicts of interest hit mainstream media; protestors rally, but is it for the right reasons? 03/14/2012

Posted by ALT in DSM-5, Mental Health Policy and Inititatives, Patient Rights and Advocacy.
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7 comments

I’m no journalist.

I did write for my high school newspaper (I can recall a particularly riveting article about different styles of shoes!), but these days I’m strictly a blogger, cavalierly inserting humor, my own biased opinion, and all manner of distractions and sidetracks into my “articles.” 

Nevertheless, this ABC news article from yesterday (“DSM-5 Under Fire for Financial Conflicts of Interest”) follows the exact argument I put forward in my little piece entitled “For the DSM-5 Task Force, Being Greasy Never Been So Easy!”  Whoa, did I inadvertently produce some journalism here?

I have to admit, I liked my title better.

Ok, ALT; stop patting yourself on the back!

Done.  Now let’s dig in.

The ABC story was fueled by the publication of an academic analysis of the conflicts of interest of the various DSM-5 committees, conducted by the same researcher (Lisa Cosgrove) who published a similar analysis in the days of DSM-IV development. 

As I wrote awhile ago, it’s practically a conflict-of-interest OLYMPICS!  Cosgrove found that about ¾ of the work groups have a majority of members with major ties to the pharmaceutical industry.  Some standout groups include:

- Mood Disorders Group: 67% of members report ties to industry

- Psychotic Disorders: 83%

- Sleep/Wake Disorders: 100%

Moreover, when comparing the figures from the DSM-5 to her previous analysis of the DSM-IV workgroups, Cosgrove has found that in about half the work groups, conflicts of interests have only gotten worse.  

Check it:

[click to enlarge]

It appears that the APA thought transparency alone would be a solution to their metastisizing “conflict of interest” problem. 

Well, they’re wrong.  We can clearly see the giant, throbbing tumor now, but the fact is it’s still there.

The whole point of disclosing conflicts of interest is determining whether someone is unencumbered enough to participate in a decision-making/fact-finding process.  For this to be in any way legitimate, there must be some threshold where the person’s conflicts of interest are too great, where they are removed from the process. But the APA apparently has no limit. 

Oh, sure, they say something about “no more than $10,000/year directly from the pharmaceutical industry and no more than $50,000 in pharma stock options” … but with major gaps in their disclosure policy and no dollar amounts made public, how can we be sure this is any less of an empty gesture than the rest of their carefully choreographed “transparency” dance?

DSM detractors say the darndest things…

A wave of protest against the DSM has been building over the past few months, but I’m not sure that I’ll be able to unite with the mainstream (or “middle way”) DSM protesters.  Here’s why:

Middle way protestors are against the DSM-5 in particular, criticizing the development process, the addition of so-called “unscientific diagnoses,” financial conflicts of interest of the developers, etc. 

The idea being that we simply need a better process for creating this thing.  And that the botched development of the DSM-5, which will result in flaws that could’ve been avoided with more rigorous procedures, is a risky business because it might turn the tide of public opinion against the very institution of the DSM; which would be terrible because we need some kind of DSM in order to treat mental illness at all.  The DSM detractors quoted in this article all seem to fall into that camp; Allen Frances, David Elkins, and Cosgrove herself. 

But there’s another camp, which I and many others belong to.  Instead of being against the DSM-5 in particular, we’re against the institution of the DSM, period. Instead of arguing that the DSM-5 is marginalizing, stigmatizing, unscientific, we argue that the practice of diagnosing people itself is all of these things and worst of all… dehumanizing! 

In ABC’s coverage, only the “middle way” DSM detractors are represented.  And I find myself feeling a little piqued by what they have to say.  For example:

Dr. Allen Frances, who chaired the revisions committee for DSM-4, said the new additions would “radically and recklessly” expand the boundaries of psychiatry.

“They’re at the boundary of normality,” said Frances, who is professor emeritus of psychiatry at Duke University. “And these days, most diagnostic decisions are not made by psychiatrists trained to distinguish between the two [normality and mental illness, presumably]…”

- From ABC News article “DSM-5 Under Fire for Financial Conflicts of Interest

The boundary of normality?  He speaks as if he knows exactly where that is!  And that the DSM-IV catalogs “diseases” that fall well beyond it.

I beg to differ.

Take so-called “schizophrenia,” or psychosis, for example.  As John Perry so nicely puts it:

In my opinion, the real pathology in psychosis does not reside in the “mental content,” the images and the symbolic sequences.  All of that appears to be a natural psychic process, present and working in all of us.  This is normal madness, so to speak.  The schizophrenic “disorder” lies rather in the ego, which suffers from a constricted consciousness… The problem of the prepsychotic state is how to discover the impassioned life, and nature has its own answer in the form of a turbulent ordeal, a trial by immersion in the source of the passions – that is, a psychosis.

- John Perry, in The Far Side of Madness

[If you liked that quote and have some time on your hands, read this!]

From Perry’s point of view, psychosis is often a naturally transformative and healing process, somewhat like childbirth.  If there is such a thing as a “boundary of normality” (which I doubt), it falls well within it.  Psychosis is the “normal” response of a psyche needing to heal.

Here’s another rather disturbing quote from the middle camp:

“My best hope would be for the APA to respond in a substantive way to the concerns we’ve raised.  They have an opportunity here to make a correction that would give the appearance, if not the reality of developing a diagnostic instrument that’s objective and has integrity.”

- Lisa Cosgrove, in the ABC News article DSM-5 Under Fire for Financial Conflicts of Interest; emphasis added

A semblance of objectivity and integrity – not necessarily the real thing – is her best hope for the DSM committee??

And our best hope for dessert is a big slice of "pretend pie"!

Way to aim high!

A question

Should all the DSM-V detractors put aside their differences and join together to protest the DSM-V, or are the two camps far enough apart that their protests really can’t align?

As you ponder, consider this: a large DSM-5 protest (Occupy the APA) is planned for May 5th in Philadelphia at the site of the APA convention.  The middle way camp will necessarily be inside the convention (most of them belong to the APA, after all), while the rest of us will be standing outside, barred from entry.

It appears that more than mere distance separates our two camps.

SAMHSA calls for a vote on “noteworthy accomplishments” in behavioral health — let’s raise our voices! 02/29/2012

Posted by ALT in Mental Health Policy and Inititatives, Treatments.
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3 comments

As they occasionally do, SAMHSA [Substance Abuse and Mental Health Services Administration] is holding one of their “periodic stakeholder engagement” demonstrations (in the form of an online vote).  They want to hear what we have to say! 

Maybe.

By staring very intently at your face, it appears that I am listening to you. Is it working? Goooooood.

Not sure what really comes from these voting sessions, exactly, as I’ve never followed one from beginning to end.  I do know that most people who receive a formal invitation from SAMHSA to vote have jobs funded by SAMHSA and are obviously putting their mouths where the money is (like so; and like so). 

Nevertheless, every taxpayer is a “stakeholder,” and therefore allowed to vote.  So consider yourselves officially invited to answer (or vote for other people’s answers to) SAMHSA’s question:

What do you think are some of the most noteworthy accomplishments and changes in the behavioral health field over the past several years?

I was pleased to see that, so far, the winner by far of the voting is this entry from a Mad In America blogger about 10 peer support alternatives to traditional psychiatry that lead to healing and wellness.  Including the harm reduction approach to decreasing medication!  Love it.

Also mentioned was the Open Dialogue approach (more on that here; there’s also a lovely documentary about it).  And the idea of viewing mental illness as distress rather than disease – meaning of course that distress passes, is a situational part of life, while disease is chronic and biological. 

Needless to say, I voted for all of the above.  I encourage you to go vote for your favorites, whatever they may be!

NOT my favorite

I was distressed, appalled, shocked to see that one of the other frontrunners was “Court-ordered Outpatient Therapy.”  As a noteworthy accomplishment in the field of behavioral health.

WHAT? 

This, of course, includes court-ordered, non-consensual electroshock therapy (like that of Elizabeth Ellis) and anti-psychotic injections (like that of Christina Walko).  It constitutes a major violation of some of the most basic human rights we know. 

This is an advancement?

In the description, we are informed that

Court ordered Outpatient treatment is the other option to keep people safe by giving probate judges the authority to order treatment. Any person or family member can petition the court via a downloadable affidavit as to the condition of a loved one to effect this treatment by whatever measure necessary.

- Ingrid Silvian, who contributed the “Court-ordered outpatient Therapy” item to SAMHSA’s vote

Lovely.  A family member who cares can join the psychiatrists who care in making sure a loved one gets plenty of Janssen injections of long-acting antipsychotics (or whatever brand the doctor/courts order, I suppose).

I was incredibly moved by the comments of a woman named Cathy Levin in response to this.  First, she shares her personal story:

I once had a court order to take medication, but I was able to leave the town and move to a big city because no one prevented me. In the big city, there was public transportation and I went back to school to study basic English writing under a scholarship from a mental health program. I worked for 12 years. Recently applied for a scholarship to study art at a prestigious art school. Had my state had IO, I would have been forced to stay in the town where the state hospital was, where I gotten court ordered medications, I would spent 9-2pm M-F at day treatment, gotten injections of meds bi-weekly at the CMHC, and slept the rest of my life away.

-Cathy Levin, in response to “Court-ordered Outpatient Therapy” in the SAMHSA stakeholder engagement vote

And next, she says something very profound (and Foucauldian!) about the treatment of the mentally ill in society:

It’s like medicating the canaries in the coal mine. When poor people keep going crazy in the streets it is a sign that something is wrong with society. These are the canaries in the coal mines who indicate life as we live it today is toxic.

-Cathy Levin

Hurrah for the canaries in the coal mine!  May their processes be the catalyst for a community-wide transformation, a vision of a healthier, more balanced way of being!

The APA is going to “Occupy Medicine?” Let’s show them a REAL occupation! 01/24/2012

Posted by ALT in Mental Health Policy and Inititatives, Patient Rights and Advocacy.
Tags: , , , , , , , ,
6 comments

The APA must have an almost supernaturally subtle sense of humor and irony – the finest and most unflinching I have ever encountered.

Or else they are so steeped in hypocrisy that even the most blatant contradictions, the most horrendous lies (cross-referenced, of course), are fervently preached as gospel truth.  A pack of true believers, indeed.

There’s a spirit of unrest sweeping this country – the recent and successful PIPA/SOPA internet blackout protest, the various “Occupy” movements, the multiple student protests on college and occasionally high school campuses being a few examples.  People are getting stirred up. 

Well, the APA doesn’t want to be left out.  Let it be known that they, too, can occupy something!

“Occupy Medicine: Reclaiming our lost leadership”

A call to arms was issued in the January edition of the APA’s journal, the Psychiatric Times.  It’s hard to know whether to laugh or cry bloody tears of frustration.  Let’s try to laugh, shall we?

It begins like this:

Maybe the “Occupy Wall Street” movement suggests a different kind of protest …What about “Occupy Medicine” for us psychiatrists? This may sound somewhat ridiculous, given that psychiatrists still make a good living, but we are surely in the 99% of medicine. In fact, we may be in the lower 1% for reimbursement… I’m often struck that plumbers make more per hour.

- H. Steven Moffic in “Occupy Medicine” Psychiatric Times article

Now this article is posted right next to the “Psychiatry Compensation Survey 2011,” an annual survey regarding income and income satisfaction of APA members, on the Psychiatric Times website. The average income of these 99%-ers was neatly displayed in colorful pie graphs just inches away from Moffic’s petulant cries for protest.

[click to enlarge

The majority of psychiatrists make over $175,000/yr, yet Moffic proudly proclaims them an oppressed part of the “99%”!  Is this that subtle sense of irony again?

Oh, and plumbers do NOT make more money.

As near as I can tell (and they didn’t include much information about their survey methods, so it’s hard to say for sure) – but it appears that this survey only counts money directly obtained through practicing psychiatry.  So it does NOT include any “extra” income, like money from pharmaceutical companiesYou know, honoraria, “lectures,” “consulting,” “research,” etc.  Considering that 1 in 4 doctors offer these kinds of “services” to pharma, adding that income would further enhance their salaries.

Nevertheless, over 40% of the psychiatrists surveyed were “disappointed” with their level of income. 

Yes, psychiatrists are a downtrodden lot.  Much has been taken from them.  For example:

Other medical and mental health professionals have taken over our business to a great extent.  Take primary care physicians, who now prescribe well over half of psychiatric medication prescriptions, despite evidence of limited expertise and success.

-Dr. Moffic

“Limited expertise and success,” eh?  One could surely say the same about psychiatrists!   But I digress…

Where psychiatrists are really bleeding money is in the land of diagnosis, which should, according to Moffic, be their own exclusive province. 

Where we’ve really given up our product is in diagnosis. Though the APA has put out the official diagnostic manuals in the United States for decades, it opened up its use to any clinician who claimed enough expertise and knowledge. The APA makes a lot of money selling these manuals to other clinicians, who far outnumber psychiatrists, but what does this do to our role and status? …

Psychiatry is a strange kind of business. We’ve given out our products for free, then watched as other businesses—whether they be other types of clinicians or insurance companies—take over what we do… as important as what the diagnostic criteria should be, so is who is qualified to use them.

- Dr. Moffic [emphasis added]

Their “products?”  But I thought the DSM was an objective, scientifically-derived set of criteria defining real, biologically-based diseases?  And psychiatry a scientific discipline, not a business?

Clearly, an occupation is needed, so that psychiatrists can reclaim the [additional] wealth that is rightfully theirs.  There are some barriers, however.  You see, according to Moffic “psychiatrists tend to caring and compassion,” and so they have passively allowed the oppression thus far.  But Moffic remains hopeful:

Thankfully, the anti-psychiatry movement has died down. In an unexpected way, there’s more of a pro-psychiatry movement becoming embedded in our systems. These are our patient consumers and peer specialists. Could they be recruited as our advance force for Occupy Medicine? Who knows better?  Most naturally our patients and their families know what the illnesses have caused them to lose and what they need to recover.

-Dr. Moffic

Oh, that’s rich.

What say ye, psychiatric survivors?  Would you like to join forces with the APA in demanding that psychiatrists make more money?  Let’s catapult them into the top 1%, where they belong! 

Anybody? No?

Let me present an alternative

One that may be more to your liking.

In the run-up to the release of the DSM-V on May 5th, Mind Freedom International [MFI] is urging its members to “Occupy Normal.”  It is a “fight to stop corporate and government sponsored brain damage, trauma and an epidemic of human suffering” by “occupying the mental health system.” 

They have a number of ways you can participate listed on their website.  Additionally, a large protest is planned for that fateful day – May 5th – in Philadelphia, the site of the APA conference where the DSM-V will officially be released.  Lots of influential folks in the anti-psychiatry movement (which is alive and well, thank you very much Dr. Moffic!) will be there, including Robert Whitaker, author of Mad in America and Anatomy of an Epidemic.

Now what say ye, psychiatric survivors, peer supporters, and people who think critically about mental health in our society?  Is this an occupation more to your liking?

Oh, yeah.

Flowers in the Bloodstream: one man’s quest to make the prescribing of long-acting antipsychotic injections an ethical obligation 01/19/2012

Posted by ALT in Mental Health News, Mental Health Policy and Inititatives, Pharmaceuticals.
Tags: , , , , , , , , ,
7 comments

This is an ad I saw in my sidebar the other day.  Look at what they did.  It’s so devilishly clever, isn’t it?

(click image to enlarge)

If you’re a real “psychiatrist who cares,” you’ll talk to your patients about [or, rather, talk them into] a long-lasting injection of anti-psychotic medication – essentially, Risperdal — directly into their bloodstream.

Now some patients are not going to be compliant when it comes to having these akathisia-, diabetes-, tardive dyskinesia-causing, brain-shrinking drugs with [at best] dubious efficacy forcibly slow-released in their bodies for a month.  So Janssen has kindly provided several little educational videos (accessible by clicking on the ad, or here) to help doctors figure out how to do that.

They’re set up to look like academic lectures, and they have nice-sounding titles like “Positive Engagement: Therapeutic Alliance & Long-acting Therapy Given by Injection in the Treatment of Schizophrenia.”  I felt really good after I read words like “positive,” “engagement,” and “therapeutic.”

But then I watched one of them.

It features a man by the name of Xavier Amador, Ph.D. giving a powerpoint lecture designed by Janssen.

Xavier Amador, for Janssen Pharmaceuticals

In it, he explains what is really meant by those lovely words I mentioned above.

Most fascinating is the manner in which he approaches “therapeutic.”  According to Xavier, part of the problem with schizophrenics is that they don’t always agree that they’re suffering from a lifelong illness, that recovery is impossible, and that they need drugs for the rest of their lives.*  They don’t know they’re sick!

There’s a special name for this in psycho-babble – it’s called anosognosia.

Here’s the key: folks who do know they’re sick (again, by the above definition), are the ones most likely to take their medications.  To be compliant.  And so the real role of the “psychiatrist who cares” is to therapeutically convince the patient that he is indeed sick in this manner, and that he should take his meds, preferably via injection.

Dr. Xavier Amador, funded by Janssen, has spent a good deal of his professional career hawking an evidence-based practice (he calls it “LEAP”) guaranteed to do just that.

He goes into greater detail in another presentation, also funded by Janssen, which he gave at a government-sponsored conference in New Jersey last year.

Entitled, “I am not sick, I don’t need help,” the presentation is all about anosognosia, how it “impairs common sense judgment about the need for treatment,” and how overcoming it is “one of the top predictors of long-term medication adherence.” [which he appears to equate with recovery]

What causes anosognosia?  Our beloved Amador posits that it may be

Psychological defense? “Culture” and/or Education?  Or Neuropsychological Defects??

- Xavier Amador, in his presentation “I am not sick, I don’t need help” [emphasis added]

Yes, it is somewhat funny that a self-proclaimed “academic” would stand – in all seriousness – in front of a slide bearing that message.

But as it turns out Amador has been standing in front of silly slides and saying equally ridiculous things for years.

Amador and anosognosia go way back

All the way back to 1997, in fact, when Amador was involved in the trial of Ted Kaczynski, also known as the “Unabomber.”  Kaczynski did not want to mount a defense based on a plea of mental illness or insanity and actually went to great lengths to block his attorneys from doing so.  He maintained that his actions were deliberate, a logical result of his personal philosophy as outlined in his Manifesto and extensive journals (which he stated he kept, in part, to prove that he was not “mentally ill”).  Kaczynski wanted people to understand the motivations for his actions and not have them be discredited as the “ravings” of a schizophrenic – and he was willing to risk the death penalty in order to so.

Nevertheless, a court-ordered psychiatric evaluation conducted found him to be schizophrenic (full text available here – also by court order, so that the public might gain a “better understanding of the Unabomber’s [schizophrenic] motivations”).

That he was found to be schizophrenic really comes as no surprise.  As one of my favorite studies shows, even people displaying no psychiatric symptoms whatsoever have little trouble obtaining that label.

And what were Kaczynski’s symptoms? His “lack of personal relationships,” his “delusional thinking involving being controlled by modern technology,” and (drumroll, please) anosognosia.

Amador, who served as an independent expert for the court, reviewed Kaczyinski’s extensive psychiatric records, neuropsychological test results, and the infamous unabomber diaries. Amador then supplied the court with mounting evidence that Kaczynski’s refusal to be evaluated related to anosognosia, a manifestation of Kaczynski’s schizophrenia.

- from this article on Amador’s anosognosia activism

That one of Kaczynski’s three main symptoms of schizophrenia was his detailed and carefully documented denial of having it and resistance to being labelled doesn’t appear to strike Amador as funny.  I might add that Kaczynski’s other main symptom — “delusional” worries about the all-important role technology seems to play in our society and the isolating effects that understandably follow — has troubled me, and hundreds of thousands of others, from time to time.  Does that make us all sick?

I guess it does if they say it does!

The article goes on to share some of Amador’s initial inspiration to coin and then promote the term “anosognosia:”

It was his experience as a clinician and as a brother of someone with schizophrenia, Amador said, that led him to do research on anosognosia, “which is not to be confused with denial,” he emphasized, although in the beginning, he did not make that distinction. “That’s what I called it when my brother refused to take his medications, and that is what I called it when after his third hospitalization, I found his Haldol in the trashcan,” said Amador.

I suppose there’s no other possible explanation for a thinking, feeling, decision-making, adult human being throwing his Haldol in the trash can.

From a made-up word to the DSM-V: Amador takes anosognosia to the next level

About a year ago, when the DSM-V Task Force was really going at it hot and heavy, Xavier Amador issued this appeal on the Internet:

Dear Friends,

 …Right now, there is no proposal to measure insight in persons with schizophrenia or bipolar disorder much less require that clinicians diagnose a subtype (with or without insight or with or without anosognosia). Such a requirement will drastically change treatment plans and hospital discharge plans. If a doctor has to diagnosis a lack of awareness of illness, then s/he is ethically obligated to address this problem, this symptom, and the non-adherence to treatment it causes. Rather than simply send the person on their way with a prescription they will never fill. I hope you will comment on the website Dr. Torrey recommends below.

We don’t have much time as the deadline for public comments is less that one month away…

Best wishes,

Xavier Amador

[emphasis added]

Doctors will be obligated to ensure adherence to treatment plan…  “psychiatrists who care” must make sure their patients take their meds (perhaps in the form of injection)…

Isn’t that the exact sales pitch Janssen is using for their long-acting injection of Risperdal?

If anosognosia is officially added as a “symptom” of schizophrenia in the DSM-V, it essentially would make prescribing long-acting anti-psychotic injections to folks who “don’t know they’re sick” an ethical obligation!

Sounds like Janssen, and any other pharmaceutical company that manufactures a “flowers-in-the-bloodstream” shot, is going to score.  Big time.

Thanks in part to the presumably very well paid** Amador.

And that’s just one more reason why we need to protest the DSM-V.

Join me in Philadelphia — or do it from anywhere else in the world! — on May 5thin saying “enough is enough.”


*This definition of schizophrenia, though it is endorsed by the APA [American Psychiatric Association] and NIMH [National Institute of Mental Health], is of course completely false.  See Robert Whitaker’s research, and also the work of Loren Mosher, as proof. Also, a few recovery stories as living proof.

**Just how well paid?  We’ll know his exact price in just a couple of months, but for this kind of a score, I’m expecting to see a lot of zeros.

For the DSM-V Task Force, being greasy never been so easy! 01/16/2012

Posted by ALT in Mental Health Policy and Inititatives, Pharmaceuticals.
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It’s not easy to balance a private medical practice, pharmaceutical company-sponsored lecture tours or research projects, and the invention of new psychiatric diagnoses… but at least 68% of the DSM-V Task Force is doing it!  Yup; 68% of them openly report financial ties to the pharmaceutical industry (that’s up from the last time around, when 56% of the DSM-IV Task Force reported financial ties to pharma).*

That's pretty greasy...

It’s the Conflict of Interest Championships!

The DSM-V task force is divided into 13 work groups: ADHD, Anxiety, Child-Adolescence, Eating, Mood, Neurocognitive, Neurodevelopmental, Personality, Psychosis, Sexual-GID, Sleep-Wake, Somatic Distress, and Substance-Related. [They're wild about hyphens over at the APA...]  Each task force has 8-12 members, and each one of those members is required to disclose all ties to industry, professional organizations, and any other conflicts of interest [COI].

So here’s a fun game: go to the APA’s “Meet the Work Groups” web page, pick your favorite task force, and do a little investigating.  How many members have financial ties to the pharmaceutical industry?  And what kind of ties… is their research funded by pharma?  Are they being paid for the use of their “expert opinion” in drug advertisements?  Or is it an out-and-out bribe?

I’ve been playing the game all morning.  Here’s the score:

Psychotic Disorders Work Group

80% (8 of 10 reporting members) have direct financial ties to the pharmaceutical industry.

4 of those 8 receive it in the form of what I like to call “free money” – they simply stand in front of a pharmaceutical company-designed powerpoint or give their name to a ghostwritten scholarly article, lending it an air of credibility, and win a cash prize!  It’s called “honoraria,” “consultation,” or sometimes just “other” in the COI disclosures published on the APA’s website.

All Star Member: Wolfgang Gaebel, Professor Dr. med., M.D.

9 reported ties to pharmaceutical companies, including: Astra-Zeneca, Bristol-Myers Squibb, Lilly, Janssen-Cilag, Novartis, and Wyeth.

Coincidentally [or not], the makers of the 5 most commonly prescribed atypical antipsychotic medications** — in order… Astra-Zeneca (Seroquel), Janssen-Cilag (Risperdal),Bristol-Myers Squibb (Abilify), Lilly (Zyprexa), Pfizer (Geodon) — have ALL sponsored one or more members of the Psychotic Disorders Work Group.

ADHD Work Group

57% (4 of 7 reporting members) have direct financial ties to the pharmaceutical industry.

All 4 are receiving “free money.”

All Star Member: Rosemary Tannock, Ph.D.

8 reported ties to pharmaceutical companies, including: Pfizer, Lilly, and McNeil.  She also helped make an “informational” video about ADHD for teachers.  Great.

Mood Disorders Work Group

56% (5 of 9 reporting members) have direct financial ties to the pharmaceutical industry.

All 5 receiving “free money.”

All Star Member: Trisha Suppes, M.D.

46 reported ties to pharmaceutical companies including: Abbot Laboratories, Astra-Zeneca, GlaxoSmithKline, JDS Pharmaceuticals, Janssen, Lilly, Novartis, Pfizer, and Wyeth.  And she’s a professor at Stanford to boot!  She might just be our league MVP.

Again, this strange coincidence: The makers of the 5 most commonly prescribed antidepressants – in order… Zoloft (Pfizer), Prozac (Lilly), Cymbalta (Lilly), Effexor (Pfizer), and Wellbutrin (GlaxoSmithKline) – are all contributing to the various bank accounts of our Mood Disorders Work Group workers.

The makers of 3 common “mood stabilizer” medications — Abbot Laboratories (Depakote), GlaxoSmithKline (Lamictal), Pfizer (Gabapentin) — are doing the same.

And our All Star, Trisha Suppes, represents the makers of ALL of these drugs, by herself!

Looks like greasy goes down real easy with her.

Anxiety Disorders Work Group

56% (5 of 9 reporting members) have direct financial ties to the pharmaceutical industry.

All 5 receiving “free money.”

All Star Member: Murray B. Stein, M.D., M.P.H., FRCPCC [they should have him guest star on Sesame Street!]

 

12 reported ties to pharmaceutical companies including:Forest, GSK, Astra-Zeneca, Lilly, Bristol-Myers Squibb, Johnson & Johnson, and Avera.  Plenty of free money to be had from these folks!

Now you know what I’m going to say; the makers of drugs commonly prescribed to patients labeled in this category are well represented in those COI statements released by the Anxiety Disorders Work Group.

“But we thought the more hyphens and COI disclosures, the better!”

Sorry, APA.  I don’t think you guys get it.

Let me make it real simple:

Hyphens for the sake of hyphens don’t make you look smart, and COI disclosures made with no fear of penalty or reprimand don’t make you look ethical.

The whole point of disclosing conflicts of interest is determining whether someone is unencumbered enough to participate in a decision-making/fact-finding process.   So when Trisha Suppes says, “I have 46 financial ties to pharmaceutical companies, many of whom are trying to sell drugs to the people I’m trying to label,” … that should raise some red flags.   She should not be included in the Mood Disorders Work Group, because she is clearly NOT capable of making unbiased contributions.

Indigestion…

With this level of greasiness going down, you guys are in for some serious indigestion.  But, hey, don’t worry — there’s a pill for that!


*The figures for the DSM-V Task Force come from this article; for the DSM-IV, they come from here.

**As of 2009, according to this ranking.  It appears to be the most recent ranking available.  I’ve used it for all subsequent classes of drugs, as well.

THE GREAT PUSH FOR MENTAL HEALTH? 06/16/2011

Posted by ALT in Mental Health Policy and Inititatives, Patient Rights and Advocacy.
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The World Federation for Mental Health has just announced its 2011 World Mental Health Day Campaign: THE GREAT PUSH FOR MENTAL HEALTH.  The campaign has four stated ideological themes – unity, visibility, rights, and recovery – but what exactly is meant by this language?  What will this organization be “pushing” for on October 10, 2011?   

The World Federation for Mental Health [WFMH] is one of many “world” organizations to spring up in the immediate aftermath of WWII.

And like most global organizations from that period, the execuitve council is made up entirely of Europeans and Americans... oh, and this Argentinian Einstein lookalike.

It was intended by its founders to form a non-governmental link between the World Health Organization [WHO], United Nations agencies, and grassroots mental health organizations the world over.  More practically, the organization is responsible for mobilizing, generating, or (when all else fails) creating the appearance of grassroots support for global mental health policy initiatives adopted or soon-to-be-adopted by the UN, WHO, and other world governmental bodies. 

In the case of the Great Push, the WFMH is quite forthcoming about this desire to create grassroots support.  They state, “We shall succeed through People Power… We need to show our UNITY! By creating a global network of people in support of these changes we will show our unity, our power, our commitment to change.” 

[There is, of course, a key difference between lending institutional support to an existing movement and creating a “movement” to legitimate an institution’s pre-existing goals or initiatives.]

According to the WFMH Great Push campaign literature, “Perceptions of disunity in the mental health world… need to be dispelled.  The first round of the WMFH Great Global Consensus has demonstrated substantial agreement on fundamental issues with over 530 replies from organizations and individuals demonstrating over 95% agreement on the 10 principles of the World Federation.”  It therefore seems clear that for the WFMH the theme of “unity” translates to “universal agreement with WFMH principles.” 

They aim for a hegemonic control of mental health rights activism, and are creating a “grassroots” campaign to achieve it.

The WFMH principles (full list available here) span a broad ideological territory.  However, a common thread through them all is the emphasis on a universal, objective definition of what “mental health” and “mental illness” are.  This knowledge is apparently not self-evident; some possess it and some do not.  And according to WFMH principle #8: “There will be an efficient means of communicating and disseminating policy, educational, technological, and scientific information on mental health from those who have it to those who do not.” 

The “educational, technological, and scientific information” referred to by the WFMH almost certainly includes such mainstays of Western psychiatric practice as the Diagnostic and Statistic Manual [DSM], “evidence-based practices”/standardized therapies like Cognitive-Behavioral Therapy [CBT], and psychotropic medication.*

This brings us to the true ideological heart of this campaign: what the WFMH is calling for is the universal, global right of all people to be psychiatrized, in a Westernized fashion.  The right to be labeled according to the DSM, and to be treated according to Western “professional standards” – with or without consent.  It’s stated explicitly in the 1989 WFMH Declaration of Human Rights and Mental Health:

The fundamental rights of persons who are labeled, or diagnosed, treated or defined as mentally or emotionally ill or distressed… include the right to coercion-free,** dignified, human, and qualified treatment with access to medically psychologically and socially indicated technology.

(from the 1989 WFMH Declaration of Human Rights and Mental Health)

As this quote makes clear, a “mentally ill” person is labeled, diagnosed or defined – by someone else.  The person has no say in the matter, no right to determine for him or herself whether that label seems to adequately reflect the challenges he/she currently faces. 

The mentally ill person must be treated by someone “qualified,” a professional trained in Western psychiatric “technology.”  This is also echoed in Great Push campaign literature, where the WFMH states:

Thousands, perhaps millions receive no mental health care because of the absence of professionals to assess and diagnose their illnesses… We now have methods using computer technology able to empower nurses and health assistants, aimed at improving the detection, diagnosis and treatment of mental illness. We recognize that these are only the first steps to true recovery; nevertheless they are an essential starting point.

(from the WFMH Great Push Campaign literature)

According to the WFMH “true recovery” can only be achieved via Western technology. 

But the experiences of numerous psychiatric survivors, therapists, and caregivers from many cultures (including the “Western” cultures these technologies are supposedly best suited to treat) belie this assumption. 

Scientific evidence, too, seems to point a different direction: that traditional healing practices carried about by laypeople in the lower income countries the WFMH is so concerned about are actually more effective at treating mental illness than Western psychiatric technology.

In 1969, the WHO launched a study looking at outcomes for people diagnosed with schizophrenia in multiple countries.  What WHO found was that patients in poorer countries (India, Nigeria, and Columbia), were doing much better than their Western counterparts at both 2 and 5 year follow-ups.  They were more likely to be “fully recovered and faring well in society;” at 5 years 64% of these patients had no symptoms and were functioning well.  Only about 24% were “doing poorly.”  Compare this to Western schizophrenics: at 5 years, only 18% had no symptoms and were doing well, while 65% had poor outcomes (were suffering chronically).  One of the biggest differences in treatment was the use of psychotropic medications in the richer, Western countries, but not in the poorer countries.  (Another big difference was the existence of more informal/community supports in the poorer countries). 

This study was replicated, with some stricter criteria to facilitate better comparison, in 1992 (studying only 2 year outcomes this time, however) – with almost the same results.  In poorer countries where lay counselors, societal supports, and low usage of antipsychotics are the norm, outcomes are better and schizophrenia isn’t chronic (ie recurrent and lasting over time) for over 2/3 of those who have an initial episode.***

The WFMH asks all mental health advocates to “UNITE!” in support of a hegemonic, global psychiatrization of the peoples of the world according to Western standards of psychiatric care as a basic human right, when that model’s effectiveness (let alone superiority!) has yet to be proven in any culture or sub-population.  They wish to create a semblance of grassroots support for this agenda in order to “push” it into the United Nations’ Millennium Development Goals, and other major policy initiatives of the global governmental bodies.

For those who embrace an alternative vision of mental health rights, one which includes free and voluntary choice of treatment, it may indeed be time to “PUSH BACK,” as David Oaks (founder and executive director of MindFreedom International) recommends.  It may be time to proclaim loudly, and proudly, a different “Declaration of Human Rights and Mental Health:”

That all human beings are created different.

That every human being has the right to be mentally free and independent.

That every human being has the right to feel, see, hear, sense, imagine, believe, or experience anything at all, in any way, at any time.

That every human being has the right to behave in any way that does not harm others or break fair and just laws.

That no human being shall be subjected without consent to incarceration, restraint, punishment, or psychological or medical intervention in an attempt to control, repress, or alter the individual’s thoughts, feelings, or experiences.


* These tools’ effectiveness in promoting wellness and recovery, in any culture, is a matter of serious debate.  But there is no question that they were designed by Westerners for a uniquely Western definition of “health,” and their applications to other cultural groups, which have fundamentally different ways of looking at health and wellness, are dubious at best.  To cite just one example, as Eduardo Duran, Native American mental health activist and therapist writes in Healing the Soul Wound, “Traditional Healing in most Aboriginal cultures is based on the belief that illness itself has a consciousness that relates to the psyche and the body of the individual.  Belief that illness is conscious leads to the idea that all illness has a distinct purpose that eventually will teach and bring wholeness to the individual… The mind-set and psychology that the Traditional Healer utilizes as part of the naming of the illness in order to extract or balance the energy creating the problem for the patient is very different from the Western medical model approach.”]

**  One might assume that the phrase “coercion-free” indicates the WFMH’s opposition to involuntary treatment.  Not so.  The Declaration later goes on to define some of the rights of involuntarily committed patients, which include the right to “impartial representation, review, and appeal,” but certainly not the right to refuse treatment in the first place.

*** J. Leff, “The International Pilot Study of Schizophrenia; Five-Year Follow-Up Findings,” Psychological Medicine 22(1992): 131-145.  For information on the treatment of schizophrenia with societal supports provided by lay people (and without medication) in a Western context, see the work of Dr. Loren Mosher.

May is Mental Health Awareness Month? All right; let’s do this FOR REAL! 05/04/2011

Posted by ALT in Mental Health Policy and Inititatives, Patient Rights and Advocacy, Philosophy/Spirituality.
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So, it’s “Mental Health Awareness Month.”

But that’s not all!

Sheesh! It's going to be a busy month.

Better get to work on “neurofibromatosis” right way… and I must admit I’m very much looking forward to celebrating “Better Sleep Month” in style (once I’ve become sufficiently aware of everything else, of course).

 

Ever wonder where all these medical awareness months come from?

News is something somebody doesn’t want printed; all else is advertising.

(William Randolph Hearst)

It should come as no surprise that they are often just one component of a complete public relations package pharmaceutical and medical device companies purchase from firms like DWJ Television, Schwartz PR, and others specializing in health industry promotions.  The awareness month’s main function is not really to promote awareness of a condition or issue – but to promote certain (expensive and patented) treatments for that condition.

They are also used to propel what are called “Video News Reports [VNR]” into the forefront of the media.  A VNR is essentially the multimedia evolution of a press release – a ready-made story that broadcasters can air as their own “reporting” with only minimal doctoring.

Here’s an example of one from the dental industry:

As you can see, a VNR looks exactly like a news short, and may even come with a script that the station’s reporter can read over the pre-manufactured footage [that's the voiceover you heard in the above video; it's a separate audio track that can be removed and replaced with the station's customized one].  Stations have something to fill dead airtime that costs them almost nothing to produce, and PR firms get to hawk their wares in a subtle and really quite insidious way; most viewers have no idea that they’re essentially watching a commercial – they think it’s objective, fact-based reporting (news).

The pharmaceutical industry was one of the first to use VNRs to promote drugs.  And as early as 1990, critics were calling attention to the practice, decrying the “covert” nature of VNRs and their ability to “reach the unguarded mind.”

Now, in order for the VNR to air, it has to be newsworthy, connected in some way to current events.  But what if there is no related current event?  Why, then you must invent one, of course!

Production companies often build VNRs around events that are manufactured or exaggerated for dramatic purposes… But sometimes, a production company has to get creative.  “If there is no hard news, we will generally do it in terms of a disease, and get a real person suffering from the condition who has had it improved by taking this medication,” Friedman [PR executive at the aforementioned firm DWJ Television] says.  “So we may see him or her with a physician; we may see him or her doing things in everyday life; and we’ll also interview on-screen, and interview the physician on-screen.”  Many production companies build VNRs around disease-awareness events.  The national Sleep Foundation, an organization funded by manufacturers of sleep drugs and other sleep aids, often uses National Sleep Awareness Week as a hook, usually coupled with a survey about how much trouble Americans have sleeping.  “To me, that’s the last possibility,” says Friedman.  “There’s always a day, there’s always a week, there’s always a month.”

(from Carl Elliott’s White Coat, Black Hat: Adventures on the dark side of medicine; emphasis added)

Why do I bring this up?  Believe it or not, it’s not so that we can all joyously engage in another round of pharma-bashing [I’ve had enough of that].

It was fun while it lasted... cathartic, even. But it's time to move on.

I believe that there is a desperate need for a Mental Health Awareness Month.  Speaking as someone who – just 2 short years ago – knew NOTHING about the mental health world except the so-called “common knowledge” the general population shares, I am well aware how much was missing.  But, given the origins of these “awareness months,” is this May going to fill the gap?

No.

The Mental Health Awareness Month we’re likely going to have is one envisioned, carefully outlined, and “generously” funded by pharmaceutical companies and their friends, one that efficiently conveys only the dominant, pharmaceutical companies’ profit-enhancing message.

In this pharmaceutical-funded framework, there’ll be no room for alternatives.

No unauthorized survivor voices.   No stories of [un-medicated] recovery, resilience, survivance.  Of alternative healing, balance, and perhaps even acceptance of some of these pathologized “extreme states of consciousness.”

Unless… we step outside the framework.

UNLESS WE SUPPLY THE MISSING PERSPECTIVES! 

We humans, we who aspire to join the ranks of soul healers, we who have either experienced “extreme states of consciousness” or support those who do – we have to claim Mental Health Awareness Month as our own!  As our rightful platform to speak, in the first person voice, about what these experiences might mean, to individuals, and to society!

If we raise our voices, we could be the start of a true awakening, a renaissance, a new and much truer awareness of so-called “mental health,” and the integral role that it plays in individual and collective health (wellness/balance).

That being said, here are a few things about the mental health world I wish I’d known, I wish everyone knew as part of that cultural package of “common knowledge” every member of the general population has.

If it were up to me to envision the central message of a “Mental Health Awareness” Campaign, it would include these key points:

Those mental health labels that people have attached to them – labels like “schizophrenic” or “bipolar” – somebody, somewhere, at some time, subjectively made that shit up.

Despite the mantra (“Mental illness is just like diabetes; mental illness is just like diabetes…”), mental illness is fundamentally NOT like diabetes.  Diabetes is a physical illness, a grouping of bodily pathologies (the body fails to produce sufficient insulin) that produce certain recognizable symptoms (low blood sugar, susceptibility to infections, constant urination).  There is a physical test for diabetes (blood test), known treatments that are proven to directly address the underlying disease mechanism/pathology.

These “mental illnesses” are something else entirely.  Take schizophrenia, for example.  The inventor of the term, an Austrian doctor by the name of Emil Kraeplin, was trying to describe a common set of symptoms he saw in many asylum patients.  But it later turned out that these patients were suffering from a [rare, now, but somewhat common, at the time] disease called encephalitis lethargica, which produced Parkinsonian-type problems in its victims (shuffling gait, drooling, vacant expression, uncontrollable, jerky motions, psychosis).  When psychiatrists subtracted all the patients who had the physical, virus-caused encephalitis lethargica from the schizophrenia roll call, there were almost no patients remaining!  So the term “schizophrenia” began a long process of evolution and shape-shifting, its parameters changing with every new edition of the DSM [Diagnostic and Statistical Manual] to match the cultural prejudices of the time.  The term was so amorphous for so long, in fact, that the writers of the 2nd edition of the DSM-II freely admitted:

Even if it had tried, the [APA] Committee could not establish agreement about what this disorder is; it could only agree on what to call it.

(from the 2nd edition of the DSM)

They [the committee of psychiatric experts, literally “sworn to secrecy,” that develops the diagnostic criteria] are at it again, set to release a new edition of the DSM in 2013.  You can rest assured that it will contain quite a few more “diseases” with neat little acronyms and pre-approved drug therapies included.

Back to diabetes: there’s a huge difference between Doctor A who tells his patient “You have diabetes,” and Doctor B who tells his patient “You’re schizophrenic.”  Doctor A knows his patient has diabetes – he did a blood test.  Meanwhile, Doctor B only thinks he knows his patient is schizophrenic, and that is based mainly on the patient’s willingness to self-report symptoms and the doctor’s interpretation of those symptoms.  Keep in mind that Doctor B might have made this decision in 15 minutes or less, and that his subjective decision is likely going to stick with the patient for life (regardless of the patient’s later “return to sanity” it’s “once diagnosed, never undiagnosed”).

You’re getting the picture: these labels don’t [objectively] mean much.

The so-called “mentally ill” person’s experiences and interpretations of those experiences are where true meaning lies – but it is up to that person (with the help of his supporters) to assign meaning to the experiences, in his own way, his own time.

I like to refer to this person as “our hero” — because that’s really who he/she is.  Here’s a quote from one such hero:

Just as there are many forms of “cancer” so too there are many forms of “psychotic experience.” Just as with any other illness, we don’t get to choose what kind we get. It is however, up to us to determine how we are going to interpret our experience and find purpose and meaning in it. I would not have made it through that experience of mine were it not for a few critical factors[:]… my ability to accept that my experience was uniquely individual and mine alone… my willingness to accept whatever came up and deal with it, not necessarily in graceful fashion… [and] the very vital support of people who cared about me: my husband, some exceptionally good friends, and some very kind strangers. Love alone was my saving grace.

(from an inspirational psychiatric survival story which you can read in full here)

I also talked a little more about the right to experience reality for oneself once here.

So-called “mental illness” does not have to be a chronic, lifelong experience.

Objective, scientific data describing the psychotic experiences of people in underdeveloped countries (where mental illness is treated, not with drugs, but with increased social support and engagement in community) show that for many, a psychotic episode is a once-in-a-lifetime experience.  Outcomes there are much better than in the US, where it can indeed turn into a chronic problem – because of the “treatment” applied to it.  Please see this entry for more info.  And, if you like, read the study (a controversial duplication of a previous study; both produced the same results: outcomes for “schizophrenics” in countries where drug therapy is uncommon are consistently better than in so-called developed countries where drug therapy is the first line treatment).

The very best medicine or “treatment” for a psychotic episode/spiritual crisis/extreme state of consciousness (or whatever you want to call it!) is LOVE.

Love, compassion, empathy, support.  The willingness to listen calmly, to avoid at all costs doing anything which might threaten, dehumanize, or traumatize an individual that is already going through so much.  These are all things which you definitely don’t have to be a professional to provide (or, rather – give).   In fact, it’s been shown that it usually works better if you’re not (in America, once, here; and in the present day, here!).

JUST IMAGINE: what if, this month, May of 2011, the general public learned these four basic ideas, became aware and self-aware on a societal level, of them.  What would the future hold?

Would we see changes in the way the so-called mentally ill (the outliers, the exceptions) are treated?  Would life in this modern, corporate, industrialized society be a little bit less traumatic for both those who experiences things differently, and those who have learned to empathize with them?  Would there be more love, more compassion, more sense (as opposed to senseless waste and hurt)?

YES.

We gather together… to eat this pot roast! 05/03/2011

Posted by ALT in Children's Mental Health, Mental Health Policy and Inititatives.
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(and to prevent childhood obesity)   

What am I talking about?  Something positive in the anti-childhood obesity world, for once! 

No, not THISNote to childhood obesity activists: kids don’t like being locked in school buildings, with no windows and very little self-determination; they want out!  So if you associate exercising with being inside the school—well, that’s just self-defeating.

Even a scantily-clad, flouncy Beyonce isn't enough to make a school cafeteria a fun place to work out.

I’m talking about the most recent edition of the journal PEDIATRICS, which includes a pretty impressive study (or meta-analysis of previously conducted studies, to be more exact) that points to an intuitive (but very encouraging!) conclusion: the more meals a family shares together, the less likely the kids are to have issues with obesity or “disordered eating.”

Disordered Eating, or if you want to get all DSM-IV with it, “Eating Disorder NOS (Not Otherwise Specified),” includes things like: bingeing/purging, deliberate vomiting, excessive fasting, missing meals, taking diet pills, smoking as a weight loss strategy, using diuretics or laxatives… essentially, any excessive misuse of food to resolve emotional problems.

  

Statistics and Such

The study authors compared the effects of sharing 3 or more meals per week versus 1 or none, using a total sample size of 182,836 children and adolescents (ages 2.8-17.3 years).  When it comes to statistical analysis, that’s HUGE!  For those of you who like to throw numbers and percentages around, here’s a bit of ammunition:

(As compared to families that shared less than 3 meals per week, children in families that shared 3 or more meals per week were…)

  • 12% less likely to be overweight
  • Had a  20% reduction in the odds of eating unhealthy foods
  • Had a 24% increase in the odds of eating healthy foods and maintaining healthy dietary habits (like eating breakfast, eating fruits and vegetables, and taking a multivitamin).

Additionally, children and adolescents in families that shared 5 or more meals together per week were 35% less likely to engage in disordered eating than those who did not.

The study looked at different ages, races, and socioeconomic statuses and found that, for the most part, there wasn’t a significant difference between these categories. 

A family meal is much more likely to be a home-cooked meal (as opposed to pre-packaged) – so nutritionally it’s a lot better.  What’s more, the dinner table is a place to air concerns about the day, share funny tidbits, to joke around and just have some quality time together.  It’s a place to address some of the emotional problems that might lead to “disordered eating” in the first place.  I think we can all agree that getting love from your family is much more satisfying than getting it from a piece of cake.

... sure you do.

  

Families have the power!

The best part about this study is it puts the power to achieve balance/wellness where it belongs: with families and the love they hold for one another.  Institutions have nothing to do with this!  They can’t touch it! 

I’d bet good money that if they did a similar study of kids who shared at least 3 meals with their friendly area social worker, or perhaps their principal, or psychiatrist, or probation officer, the results would be different.  Having a meal with an authority figure that makes you feel uncomfortable and restricted (and is billing you for their time) would probably give you indigestion!   

So this study’s policy recommendations – quite simply, that families eat meals together (I’d also add: and schools get the HELL out of the way!) is exactly the direction I’d like to see the so-called “campaign against childhood obesity” go.  Let’s keep moving towards intuitive (some might even say obvious), family-focused actions that are not blame-based. 

For example, instead of schools recruiting parents to guard the entrances of corner stores to stop kids from buying junk food (literally calling them “foot soldiers in a battle over children’s diets”) — what if kids were given a little more time in the morning to eat breakfast with their parents and had enough time to go home and eat lunch, too?   Instead of school officials blaming parents for their lack of nutritional knowledge, why can’t we recognize that a meal eaten together, as a family, has a certain amount of [mental and emotional] nutritional value independent of the kind of food served (which will nevertheless almost certainly be more wholesome than what they’re serving up in school lunches)?

Ah, the simple things in life!  Love, family, togetherness.  Away-from-institution-ness

I think achieving wellness, as individuals, communities, and as a society, is something we can do without Michelle Obama and her cadre of “experts” convening conferences here, there, and everywhere; without intereference from schools or any of the other “helping professions” so bent on justifying their supposed “expertise” and keeping their jobs.

I think we can do it, quite successfully, just by using a little common sense and by reclaiming some of those aforementioned simple things in life.

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