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Living Foods for Living People 09/25/2012

Posted by ALT in Alternative Lifestyles, Treatments.
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2 comments

It amazes me how many different and conflicting belief systems there are about diet – what we should eat, what we shouldn’t, what’s good for your brain, your teeth, your toes. I use the phrase “belief systems” deliberately because most camps can produce dozens of academic publications, statistics, etc. justifying their dietary assertions (or at least showing there’s no “conclusive evidence” that they’re wrong).

A good friend of mine is the offspring of some hardcore Vegans; I myself come from a family firmly entrenched in the Weston Price camp (animal fats being considered essential for good health).  Both of our parents have a tendency towards nutritional proselytization. “My parents would think yours suffer lack of energy and low brain function because they’re starved of animal fats,” I said.  “Mine think your parents’ arteries are clogged with the disgusting detritus of a heavy meat diet, and that they’ll die early, cholesterol-induced deaths,” he cheerfully replied.  We both laughed.

My thought is this: dietary needs differ between people.  Even in one person, they can cycle.  A lot of times I find this corresponds naturally to the change in season.  But it can also be affected by life events, other ongoing healing processes, changes in environment or routine, etc.

Given those variables, however, there are a few nutritional truths that apply to everyone:

  1. processed foods (that means, anything that has an “ingredients list” on the back!) are not nourishing
  2. locally produced, small-scale plant or animal foods are far more nourishing than mass-produced plant or animal foods monocultured under industrialized conditions
  3. live foods are far more nourishing than dead ones

The first two are basically common knowledge at this point.  But the last one?  Here in America there seems to be a cultural aversion to live foods, which are commonly perceived as dangerous, potentially culprits in food poisoning debacles.  This is unfortunate, because without live foods, your gut health suffers, and the link between gut health and mental health (not to mention overall health!) is pretty firmly established at this point.

Live Foods

A live food is any food that has not been irradiated, pasteurized, sterilized, or otherwise treated for the removal of bacteria and enzymes — that includes cooking at very high temps. By this definition, truly fresh foods are all live.  An apple from the tree, lettuce from the garden, raw milk from a cow.

But an apple from the grocery store?  Not likely.  Most produce at the grocery store is irradiated or otherwise sterilized, ostensibly to kill E.coli and salmonella and other such plagues of modern, industrialized food production. But the sterilization of food has another consequence – it decreases our immune system’s ability to function by depriving us of all the enzymes and helpful bacteria contained in live foods, thereby making us more susceptible to not just E. coli and salmonella, but many other bacterial infections as well.  Catch-22.

REALLY Live Foods

Beyond live foods are fermented foods, where good bacteria — called probiotics, meaning “for life” — are deliberately cultured and multiplied.  These include things like homemade sauerkraut, pickled eggs, yogurt, kefir, kvass, kombucha, relishes, miso,  and  of course beer and wine (store-bought versions of these items are likely not live, though that varies… check the label.  In any case it’s always best to make your own).  Probiotics help us digest food better, which means we are better nourished.  They are connected to higher immune system functioning, better mental and physical health, better mood, [see here] and they have been part of nearly every long-lived, sustainable culinary tradition studied

The removal of live and especially fermented foods from our food supply has led to severe, culture-wide dietary problems that manifest themselves in so many different ways.  More fundamentally, the conversion of food into mere commodity, instead of nourishing, life-giving BLESSING to be shared by humankind has had a huge impact on the way we relate each other, the earth, and the divine:

The difference between food produced by someone you know and shared through means that respects both producer and consumer, and food grown, processed, and sold by strangers working for faceless corporations, is a difference you can taste. The body responds differently. Food given in fair and respectful exchange by someone you know and trust is more nourishing…

Food should not be primarily a commodity. Food is a gift of God’s Good Earth, for which all religious traditions teach gratitude. To subject it to the economic regime of the lowest bidder is to desecrate the gift and insult the Giver. For most of human history, the sharing of food was a significant social act, cementing ties between friends and kin, showing welcome to strangers. Today it has become an anonymous act of commerce.Other people in other times would no doubt have thought it exceedingly strange, if not downright obscene, for total strangers to grow, process, and even cook nearly all one’s food…

- from Charles Eisenstein’s essay, “Economics of Fermentation

What you put into your body has a profound effect on what comes out of it – that’s an essential tenet of nearly every religious discipline. 

If we’re putting almost exclusively dead things in our bodies, why are we surprised at the outpourings of a deadened mind and spirit that result?

   

Ferments and Foments

This is why I consider the production and consumption of truly live and fermented foods to be a revolutionary act.  I revolt against society’s demand for sterilization and monoculture in the realm of ideas, the realm of the spirit, and in the realm of food! I do not worship death, I worship life.  Life is what I put into this earthly vessel, and an enlivened spirit is what comes out!

Long-acting injections of antipsychotics: pharma can’t shake the stigma, or the data! 05/17/2012

Posted by ALT in Pharmaceuticals, Treatments, Uncategorized.
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In honor of Robert Whitaker’s recent kick-ass article beautifully re-affirming the central premise of Anatomy of an Epidemic (namely that anti-psychotic medications worsen long-term outcomes for patients, making schizophrenia into a chronic, lifelong disease when in its natural state it is episodic; and therefore that patients who refuse treatment with antipsychotics are scientifically justified in doing so), I thought we might launch our own little expedition into the stormy seas of antipsychotic/neuroleptic discourse.

I’m steering us straight towards the tempest, towards the ever-blurrier line between “compliance,” “adherence,” and outright “forced treatment,” towards a history of Orwellian language shift that simply can’t seem to shake the truth.

Long-acting injections of antipsychotic medication

Long-acting injections are monthly, time-released, intramuscular injections of antipsychotic medications.  They figure prominently in current “assisted outpatient” therapeutic practice (ie, forced drugging outside the walls of the psychiatric institutions), and are being heavily promoted by drug companies who see expiration dates on patents for oral antipsychotic medications looming in the near future or already arrived.  Can the pharma marketing machine succeed in making LAIs the next wave of antipsychotic blockbuster drugs?

It’s going to take a serious makeover.  You see, long-acting injections have got something of a “bad image” in the press, and in the hearts and minds of the people.  Perceived as brain-altering drugs violently administered to unwilling subjects, clinicans’ last resort to enforce adherence to an un-agreed-upon reality [treatment plan], a hideously efficient way for pharma to make a buck or two [hundred].

But is this really a case of “bad image”, of misperception… or is it an accurate appraisal of long-acting injections’ intended and fully acknowledged clinical applications?

As clinicians we struggle on a daily basis with patients who do not want treatment because they do not perceive that medication helps or because they do not conceptualise their experiences within a medical illness framework.  Long-acting injections have often been used to enforce adherence in patients who do not or will not take medication; they can be a mechanism allowing clinicians to take control.

-Richard Gray, RN, PhD*in “Antipsychotic long-acting injections in clinical practice: medication management and patient choice” [emphasis added]

And furthermore…

According to systematic reviews approximately 40–60% of patients with schizophrenia are known to be partially or totally non-adherent to oral antipsychotic medication. Long-acting injections are indicated where medication adherence is a cause for concern. Thus it is argued by some that it might seem reasonable to consider such injections for approximately half of patients with schizophrenia.

- authors Maxine Patel, Mark Taylor and Anthony S. David** in “Antipsychotic Long-Acting Injections: Mind the Gap” [emphasis added]

Yep.  We had you guys all wrong.  This isn’t about forcing patient adherence to clinicians’ treatment plans, and it certainly isn’t about expanding the market for LAIs.

Funny thing.  “Long-acting injections,” when first introduced in the 1960s, were referred to as “depot injections” … but the name acquired a strong stigma and had to be changed:

Many proponents of LAIs [long-acting injections] have attempted to dodge this [image problem] by rejecting the term ‘depot,’ which was perceived to be stigmatizing, in favour of ‘long-acting injection’ … this was partly an attempt to move away from stigmatizing stereotypes, and also to promote therapeutic optimism for a population for whom hope can be all too scarce.

- Patel et al in “Antipsychotic Long-Acting Injections: Mind the Gap

As late as 2008, long-acting injections of Risperidone were still being called “depot” injections, but by 2009 articles like the one cited above made clear that this terminology had been abandoned.

But they couldn’t shake the stigma

Not only that, but serious, data-based challenges to the forced administration of long-acting injections –- and, more fundamentally, the existence of any clinical value for antipsychotics whatsoever —  are rapidly multiplying.  As one example:

We are embracing the increased use of outpatient commitment laws that force people to take antipsychotic medications, and we do so under the belief that these drugs are a necessary good for those people. This is an extraordinary thing for a society to do, to force people to take medications that alter their minds and experience of the world.

Yet, here is the story told in Anatomy of an Epidemic: If we look closely at Harrow’s study [citation here] and a long list of other research, there is good reason to believe that these medications increase psychotic symptoms over the long-term, increase feelings of anxiety, impair cognitive function, cause tardive dyskinesia with some frequency, and dramatically reduce the likelihood that people will fully recover and be able to work. If this is so, how can we, as a society, defend our increasing embrace of forced treatment laws?

-Robert Whitaker, author of Anatomy of an Epidemic, in the aforementioned kick-ass essay

From pharma’s perspective, another Orwellian language shift is needed.  Time to reset the dial of public opinion on long-acting injections… and so I give you the newest name for an old terror:

Intramuscular Medication

That does sound better!  It doesn’t make me think of needles.  Doesn’t even sound like an injection… sounds more like a “muscle relaxer,” only more intra.

I first saw the term a few weeks ago in Dr. H. Steven Moffic’s delightful little Psychiatric Times blog entitled “Is it time for Re-institutionalization?

Recently, I was asked to write a request to possibly extend the outpatient commitment of a patient of mine. What for, I said to myself? This would be a waste of time because he had not exhibited any more dangerous behavior, was taking care of himself, and was compliant with his intramuscular medication. However, when as part of the ongoing monitoring of my patient’s improvement, I asked him to rate on a 0-10 (best) scale how well the medication was working, he said “0”. When I asked why, he said it was because he didn’t need the medication. Uh, oh, I thought. Could this be Anosognosia?…

There’s no way he’ll be committed longer, but will he stay on the medication voluntarily? Without it he’d surely relapse into psychosis and possible dangerousness. If he then went inpatient again, would he only stay a few days, not enough to address his ideas about the medication? It didn’t help enough the first time around.

-Dr. Steven Moffic

But it’s cropping up elsewhere, too – in the academic literature, and in drug company advertising materials, of course.  You can even see the shift in brand names as new antipsychotic injections are approved over time; the earliest approved LAI, Janssen’s Risperdal, is frequently referred to as LARI [Long-acting Risperidone Injection], while the more recently approved Zyprexa injection’s official brand name is “Zyprexa Intramuscular.”

I forecast the increasing encroachment of the term “intramuscular medication” into the official, APA/pharma-approved, “therapeutic” language, until our fears of “long-acting injections” are a half-forgotten nightmare that no longer sees the light of day.

OR

Or we could insist on calling a spade a spade.

So-called “antipsychotics” are nothing of the kind (they’ve actually been shown to cause psychosis), and are much more appropriately referred to by their first given name, neuroleptic, which literally means “brain damage inducing.”  Why?  Because that is what the research proves, over and over again, they do.

From now on let’s choose names that accurately describe the items to which they’re attached.  For example, “rose” = a pretty flower that smells good.  A few other examples:

Intramuscular Medication = Neuroleptic (brain damage inducing) Injection

Non-compliant Patient = Conscientious Objector to the Chemical Takeover of His Mind

That sums it up pretty clearly, doesn’t it?


* (Oh, and by the way, Richard Gray has received funding and/or fees from AstraZeneca Pharmaceuticals, Bristol-Myers Squibb, Janssen Pharmaceuticals, Eli Lilly, Otsuka Pharmaceuticals and Pfizer.)

** (And it should come as no surprise that the authors have been reimbursed for attendance at scientific conferences and have received consultation fees from Janssen-Cilag and Eli Lilly, received investigator-initiated grants from Janssen-Cilag and Eli Lilly, have worked on two clinical drug trials for Janssen-Cilag, and have received hospitality and advisory or speaker fees from AstraZeneca, Bristol-Myers Squibb, Eli Lilly and Janssen-Cilag within the past 5 years.)

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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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!

Thoughts from John Perry on psychosis as vision, schizophrenia as process, and healing as the natural result 01/30/2012

Posted by ALT in Philosophy/Spirituality, Treatments.
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I’m sure most of you are already familiar with the work of Dr. Loren Mosher at Soteria House (if not, this is my favorite article about it). 

His is the most famous of these un-medicated, peer support-based treatment approaches for first break (or not) schizophrenia. It also happens to be the best documented, scientifically; and what excellent documentation it is!  85-90% of “acute sufferers” were able to return to the community and did not suffer relapse. 

John Weir Perry

But, as I have been delighted to learn recently, his is by no means the only iteration of this treatment model.  Another pioneer in this field – a friend and contemporary of Mosher’s, in fact – was the Jungian John Weir Perry.  His treatment center, called Diabasis, operated in San Francisco in the 70s.  Heavily influenced by Jungian approaches to psychosis (Perry did study with him in Switzerland) and Chinese philosophy, Diabasis was a place for schizophrenics to process their internal Apocalypse with the loving support of the laypeople staffed by the project.  Medication was, for the most part, avoided, as were restraints and coercion of any kind.

Today I stumbled upon an extensive and fascinating interview with John Weir Perry about the nature of psychosis and “schizophrenia” and the approach of Diabasis to these phenomena.  I’ve pasted a few of my favorite excerpts below, but you can also download the entire thing here.

On Diabasis and the healing nature of a supportive, home-like environment:

One has to let the visionary process unfold itself spontaneously.

Under these conditions, to our surprise, we found that our clients got into a clear space very quickly! We had started out with the notion that we would surely be in for a lot of bedlam with all this “madness” going on, but actually the opposite was true! People would come in just a crazy as could be on the first day or two, but they’d settle down very soon into a state of coherency and clarity… The calming effect of a supportive environment is truly amazing!

Now throughout all this there was nothing scheduled, nothing mandatory.  It was all informal… You see, we wanted them to be in this house of their own free will.  They had to realise their own desire to belong in the house, and they did.

So this whole approach is essentially one of releasing, rather than suppression.  We allowed everything and encouraged its expression — not towards chaos, but toward communication!  Communication tends to order.

[emphasis added]

Schizophrenia as a self-healing process:

“Schizophrenia” is a self-healing process – one in which, specifically, the pathological complexes dissolve themselves. The whole schizophrenic turmoil is really a self-organising, healing experience. It’s like a molten state. Everything seems to be made of free energy, an inner free play of imagery through which the alienated psyche spontaneously re-organises itself – in such a way that the conscious ego is brought back into communication with the unconscious again…

It [psychosis] is like the mythological image in a perfect stained-glass window being smashed, and all the bits and pieces being scattered. The effect is very colourful, but it’s very hard to discern how the pieces belong to each other. Any attempt to make sense of it is an exercise in abstraction from the actual experience. The important thing is to find the process running through it all.

[emphasis added]

“Chronic schizophrenia” – a cultural construct:

[Interviewer:] So are you saying that the reason we have so-called “chronic schizophrenia” in our society, – where a person is medicated, distressed or hospitalized for decades – is really cultural? A society which refuses to understand the healing nature of the phenomenon?

Yes, it seems so. Of course, there are some unusual cases where the individual simply can’t handle the impact of all this unconscious content, or doesn’t know what to do with it, and freaks out. But from my experience at Diabasis, I’ve seen so many people go the other way that I really do feel “chronic schizophrenia” is created by society’s negative response to what is actually a perfectly natural and healthy process.

Goal of Perry’s treatment approach:

The tendency [amongst first break schizophrenics]… is to concretise all the symbolic stuff and believe there are enemies out there, and that the walls are wired, that there are people with guns at the  window, and subversive political parties trying to do things, or that one is being watched because one is the head of some organisation and everybody knows it. All of that is a mistaken, “concretistic” tendency to take too literally things whose correct meaning is actually symbolic.

So yes, the therapeutic goal is to achieve that attitude which perceives the symbolic nature of the ideation which belongs to the inner reality. Now, the inner reality is real! It’s very important to grant it that reality, but not to get the two realities mixed up. That’s the trick! Actually, for most people it’s surprisingly easy…

The average person tends to go along with the inner journey and to realise – well, they do need to be reminded – but once they’re reminded, they tend to quickly perceive that it is a spiritual test, or a symbolic test, and not the actual end of the actual world.

[emphasis added]

Again, the full interview with Perry is available here

If you’re intrigued by Diabasis and would like to know more, Perry wrote a book called The Far Side of Madness about the program.  Additionally, Michael Cornwall over at Mad In America is blogging about his experience with the program.  I suggest you check out what he has to say about it as well!

“Cancer is Serious Business” – watch this film! 01/26/2012

Posted by ALT in Pharmaceuticals, Treatments.
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Psychotropic drugs are the top sellers for pharma.  But cancer drugs – specifically those involved in chemotherapy – are big money makers, too.  Very serious business.

You know the business model  – pharma comes up with a drug to “treat” a specific condition that just happens to cause that condition.  Anti-depressants cause suicidal ideation, anti-psychotics cause psychosis, mood stabilizers cause mania, anti-convulsants cause seizures.

It’s no different outside the world of mental health, folks.  Cancer drugs (chemotherapy) are radioactive, carcinogenic.  By their very nature, they increase the likelihood of cancerous growth.  Nevertheless, (literally) poisonous and deadly cancer drugs from the 70s and 80s continue to sell like hotcakes to desperate families who are told there’s no other option, never mind the cure is in most cases far worse than the cancer itself!

A highly unethical, but nevertheless enriching business model for pharma and friends.

But what happens when an independent inventor – unassociated with any pharmaceutical company — discovers a cheaper therapy with significantly higher efficacy and virtually no side effects?

This simply cannot be allowed.

They [pharma, FDA, National Cancer Institute, etc.] do everything in their power to crush that man out of existence.  And if that doesn’t work [it didn’t], then they try to steal his invention!  And if that doesn’t work, well they do it all over again until sheer exhaustion sets in.

I’m talking about Dr. Stanislav Burzynski, the inventor and sole patent-holder on a set of chemicals which he calls “anti-neoplastons.”  Derived from healthy human urine, the anti-neoplastons are made up of peptides and amino acids lacking in cancer patients.  Astonishingly, anti-neoplaston therapy has significantly better results than chemotherapy.  How much better?

Take cancer of the brainstem glioma, most commonly found in children, with a near 100% death rate.  Chemotherapy has been shown to cure [cure being defined as living 5 years after diagnosis] .9% of patients.  Anti-neoplastons?

Almost 25%.

 Whoa.

There’s a lot more to tell, but I don’t want to spoil the film for you.

I hope you enjoy this as much as I did!

PS – for interested parties there are shorter excerpts from the film, as well as full access to all source documents available on Burzynski’s website.

Empowerment in the context of trauma 03/31/2011

Posted by ALT in Philosophy/Spirituality, Treatments.
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Empowerment: the new favorite buzzword of mental health policymakers.  I’ve already mused a little bit about what that word might mean – both to them [certainly not having much to do with agency or self-actualization] and those of us interested in practicing true psychiatry (literally, soul healing).

A few more thoughts about empowerment in the specific context of trauma and trauma resolution, drawn mostly from famed trauma specialist and mind-body healer Dr. Peter Levine’s book Waking the Tiger.

According to Levine, trauma response is a necessary survival skill common to all members of the animal kingdom, and there are three basic, built-in strategies: fight, flight, or freeze.  After the previous two efforts (fight or flight) have failed, action is suspended and the intense survival energy is literally frozen in the motionless body of the prey.  This “freeze” response  is helpful for a couple reasons: 1. playing dead may lure the predator into a false sense of security, allowing for future escape 2. if escape is not possible, it is the body’s natural anesthesia for the coming pain of death.  Interestingly, for the prey who escape the event is not over until the discharge of the frozen energy – via convulsions or shaking — occurs.  It is an essential and instinctive conclusion to the traumatic episode.  It is how they move on with their lives sans emotional baggage/trauma.

Again, this is a response seen in all members of the animal kingdom; the gazelle trapped in the jaws of a tiger, the mouse being batted around by your adorable tabby cat.  The frozen, seemingly lifeless body.  The surge of energy and quick escape at the opportune moment.  And then the shaking or convulsions afterwards — a release of the stored energy.

The “release of energy” part  is where human beings can get into trouble.  A lot of times our natural traumatic response does not reach its instinctive conclusion, and instead the energy is trapped in an ever-deepening cycle inside the body, undischarged and untamed.

So a complete trauma response looks like this:

And an incomplete response looks like this:

Levine’s premise (based on over 20 years of clinical work with the traumatized) is that the trauma response can be completed at any time – even many years later.  What is essential to completing the response [ie, healing] is not necessarily a cerebral re-living or re-telling of the memory (though this could help), but allowing the body to experience the completed, successful response, and to achieve the empowering reality of a challenge (trauma) successfully met. 

So in the context of traumatic response, empowerment is an instinctive self-actualization.  The means to achieving a complete trauma response are built in, biologically, to the mammalian brain

Which means: self-actualization doesn’t have to be an entirely esoteric, philosophical pursuit!  

And you don't have to read all/any of these.

  

Great news, because overly cerebral processes often end up feeling artificial and insincere.  A healthy dose of instinct can clear that right up.

Guidelines for Empathic Therapy 03/18/2011

Posted by ALT in Treatments.
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The Center for the Study of Empathic Therapy, Education and Living is a project spearheaded by Dr. Peter Breggin (psychiatrist, medical expert, psychiatry’s main “anti-psychiatry” activist… and author of numerous books including Medication Madness).  But it is by no means a dictatorship; a brief look at the Advisory Council list shows that constituents from across the board are involved – from psychiatry to counseling, obstetrics, law, and of course advocates and psychiatric survivors (notably Mary Maddock, a very eloquent critic of ECT [electro-convulsive therapy] and co-founder of MindFreedom Ireland). 

So whatever you may think of Dr. Peter Breggin personally, have a look at the recently released “Guidelines for Empathic Therapy,” conceived of and developed by Breggin in partnership with the entire Advisory Council.  Though not flawless, I find them to be truly inspiring and hope that more and more therapeutic relationships will come to resemble the vision they lay out here:   

 

Guidelines for Empathic Therapy

As empathic therapists:

(1) We treasure those who seek our help and we view therapy as a sacred and inviolable trust. With humility and gratitude, we honor the privilege of being therapists.

(2) We rely upon relationships built on trust, honesty, caring, genuine engagement and mutual respect.

(3) We bring out the best in ourselves in order to bring out the best in others.

(4) We create a safe space for self-exploration and honest communication by holding ourselves to the highest ethical standards, including honesty, informed consent, confidentiality, professional boundaries and respect for personal freedom, autonomy and individuality.

(5) We encourage overcoming psychological helplessness and taking responsibility for emotions, thoughts and actions — and ultimately, for living a self-determined life.

(6) We offer empathic understanding and, when useful, we build on that understanding to offer new perspectives and guidance for the further fulfillment of personal goals and freely chosen values.

(7) When useful, we help to identify self-defeating patterns learned in childhood and adulthood in order to promote the development of more effective choice-making and conduct.

(8) We do not treat people against their will or in any way use coercion, threats, manipulation or authoritarianism.

(9) We do not reduce others to diagnostic categories or labels — a process that diminishes personal identity, over-simplifies life, instills dependency on authority and impedes post-traumatic growth. Instead, we encourage people to understand and to embrace the depth, richness and complexity of their unique emotional and intellectual lives.

(10) We do not falsely attribute emotional suffering and personal difficulties to biochemistry and genetics. Instead, we focus on each person’s capacity to take responsibility and to determine the course of his or her own life.

(11) We recognize that a drug-free mind is best suited to personal growth and to facing critical life issues. Psychiatric drugs cloud the mind, impair judgment and insight, suppress emotions and spirituality, inhibit relationships and love and reduce willpower and autonomy. They are anti-therapeutic.

(12) We apply the guidelines for empathic therapy to all therapeutic relationships, including persons who suffer from brain injuries or from the most profound emotional disturbances. Individuals who are mentally, emotionally and physically fragile are especially vulnerable to injury from psychiatric drugs and authoritarian therapies, and are in need of the best we have to offer as empathic therapists.

(13) Because children are among our most vulnerable and treasured citizens, we especially need to protect them from psychiatric diagnoses and drugs. We need to offer them the family life, education and moral and spiritual guidance that will help them to fulfill their potential as children and adults.

(14) Because personal failure and suffering cannot be separated from the ethics and values that guide our conduct, we promote basic human values including personal responsibility, freedom, gratitude, love and the courage to honestly self-evaluate and to grow.

(15) Because human beings thrive when living by their highest ideals, individuals may wish to explore their most important personal values, including spiritual beliefs or religious faith, and to integrate them into their therapy and their personal growth.

“The seriously mentally ill die, on average, 25 years earlier than the general population…” 03/15/2011

Posted by ALT in Mental Health Research, Treatments.
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(exploring the source of a statistic)

Are you familiar with this oft-quoted statistic: “people with serious mental illness served by the public mental health system die, on average, 25 years earlier than the general population”?  You see it everywhere – for example in TIME magazine, USA Today, and throughout the mental health blogosphere.

It comes from this 2006 report on mortality and morbidity in the seriously mentally ill population published by the National Association of State Mental Health Program Directors [NASMHPD].  The report also contains several other [less frequently quoted but no less powerful] statistics.  Consider:

  • suicide accounts for 30% of excess mortality [in the population suffering from “serious mental illness”], but 60% of premature deaths are due to other causes such as cardiovascular and pulmonary disease, obesity, and smoking – causes which are in some ways preventable.
  • people diagnosed with schizophrenia are 2.7X more likely to die of diabetes than the general population; 2.3X more likely to die of cardiovascular disease, 3.2X more likely to die of respiratory disease, and 3.4X more likely to die of infectious disease.  All of these causes of death are exacerbated by the following risk factors – obesity, smoking, diabetes, hypertension, and dyslipidemia [high blood cholesterol] – which are, again, significantly more prevalent amongst this population.

These are shocking things for science to say, surely a kind of gauntlet thrown at the feet of this population and those who serve/support/love them.

Methinks a champion is required; and this guy is probably NOT it.

What causes this shocking mortality/morbidity problem, and what can be done?

    

Are you thinking what I’m thinking?

In light of all that we’ve recently learned about psychotropic medications, antipsychotics in particular (causing brain shrinkage, diabetes, obesity, heart disease, et al): does the NASMHPD report have the guts to honestly own up to the fact that most of the abovementioned risk factors can often be traced back directly to the psychotropic medications so glibly prescribed to this population?  Actually, they do a pretty good job, acknowledging all of the following:

Residence in group care facilities and homeless shelters (exposure to TB [tuberculosis] and other infectious diseases as well as less opportunity to modify individual nutritional practices)… symptoms associated with serious mental illness [such as] feelings of hopelessness and powerlessness, learned helplessness…

Psychotropic medications may mask symptoms of medical illness and contribute to symptoms of medical illness and cause metabolic syndrome… [and] polypharmacy [is] identified as a risk factor for sudden death.

(from the 2006 NASMPHD report on mortality in the mental health population)

 

Seeing such promising signs – a willingness to acknowledge these usually unspoken-of risk/causative factors – I eagerly turned to the “Policy Recommendations” section…

Only to be severely disappointed.  Nothing addresses the risk factors listed above.  NOTHING.

[alright – they did briefly mention a tool used in New York State hospitals to insure folks weren’t prescribed 3 or more antipsychotic medications at the same time but that was just a subordinate clause in a very long sentence buried near the bottom of page 47… and I feel that’s just a tad inadequate, don’t you?]

Here’s what they do instead:

 

Policy Recommendations?  Change the language, of course…

The “Policy Recommendations for Providers and Clinicians” section starts out with some powerful and exciting language: mentally ill people must be assisted in finding “hope for tomorrow” and to “understand the hopeful message of recovery.”  They must be “enabled to engage as equal partners in care and treatment” and “empowered.”

But what is really meant is that the language must be changed so that these things are implied, while treatment remains largely the same.  Here is how NASMHPD recommends achieving a “partnership with the people we serve:”

Agree on a Treatment Plan

“Adherence” is the goal because it implies sticking to a collaboratively developed plan, as opposed to the more directive term “compliance.”  Six specific actions can increase the likelihood of adherence: keep the regimen simple, write out treatment details, give specifics about the expected benefits of treatment and the timetable, prepare the patient for side effects and optional courses of action, discuss obstacles to moving forward with the regimen, and get patient feedback.

(from the 2006 NASMHPD report)

So partnership” between providers and “consumers” is to be achieved by a mere change of language (from “compliance” to “adherence”), which no longer implies the directive (ie use of force), power flowing from provider to patient.  Never mind that involuntary commitment and treatment of the mentally ill is as frequent a practice as ever, and that a patient’s supposed mental competence/ability to provide informed consent is often judged solely on the basis of the patient’s willingness to “adhere” to whatever lucrative treatment the doctor prescribes (take for example the strange case of Paul Henri Thomas, who was competent as long as he said “yes” to expensive ECT treatments, but was immediately “incompetent” upon refusing treatment).

What’s more, from the NASMHPD’s above use of the terms “regimen” and “side effects,” it’s clear they’re mainly talking about treatment centered on medication.

So in an almost incomprehensibly illogical turn of events, the NASMHPD first acknowledges that psychotropics and polypharmacy are causative factors for the increased mortality rate of the seriously mentally ill population, and then strongly emphasizes in the policy recommendations section the importance of compliance with/adherence to medication regimens!

   

What’s the big deal?

Ok. So the NASMHPD put out a lousy report in 2006 that, while acknowledging the mortality rate for the mentally ill population, failed to make good policy recommendations addressing its own listed causative/risk factors… so what?

What it boils down to is there’s a reason this statistic is quoted so often (a reason apart from its shocking nature).  The NASMHPD report forms the very foundation of some of the most important nationwide “official” mental health initiatives — and what I mean by that are SAMHSA [Substance Abuse and Mental Health Services Administration] and DHHS-funded [Department of Health and Human Services] initiatives.  These initiatives are meant to address the issue of mortality of the seriously mentally ill population; but they’re also taking their cues from the fatally flawed “Policy Recommendations” section… and that’s not a good thing.  In fact, it’s the most self-defeating setup imaginable.

There’s a lot more to say about this, so meet me here tomorrow — same time, same place — and we’ll talk.

 

A story about trusting yourself and the healing path 03/08/2011

Posted by ALT in Philosophy/Spirituality, Treatments.
Tags: , , , ,
1 comment so far

[This story comes from Thierry Janssen's book, The Solution lies Within: Towards a New Medicine of Body and Mind]

***

At the time I met John, he was 50 years old.  Eight years earlier, a blood test had shown the unthinkable: he was HIV-positive.  When he was told this, he plunged into a profound depression.  Then, little by little he had recovered his taste for living – just up to the date when his best friend was killed in a road accident… Over the following month, John lost four kilos.  He looked grey and his eyes were sad.  I became worried.  ‘Everything is alright, I just want to die,’ he replied in an ironical tone.  The following day, dark blotches appeared on his legs.  The dermatologist at the hospital confirmed my fears, it was a Kaopsi’s sarcoma, a cutaneous cancer which supervenes in patients whose immunity is weakened.  In just a few days, John went from the sero-positive state to the full state of AIDS.  Immediate medical treatment was needed.

Two weeks later, John telephoned me.  His condition had deteriorated; he could not tolerate the medication prescribed and he did not want to continue with the treatment.  ‘What do you think, Doctor?’ he asked me, his voice full of anxiety.  I replied that I did not know.  The medicines certainly had some value, but I could not imagine what would make him take them.  It was not I who was the patient.  It was he who had to feel and decide what would be right for him.  Irritated, he said that he wanted advice.  I repeated that I was sorry, but I could not advise him.  My reply angered him.

And that was what I wanted.  In my experience of therapy, I had learned that anger is a very powerful force, the same as the elan vital, our ‘rage to survive’.  Surprised by the power of the anger that shook him, John decided to use that energy to get moving he took up sport, consulted an acupuncturist and took a massage every two days…

When he was seen at the hospital, his doctor was impressed by the improvement in his general condition.  John explained his recipe: no more medicines, just exercise, acupuncture and massage.  The physician raised his eyes to heaven and replied that this course could produce a transitory improvement but in no case a cure.  If John did not start again to take his medicines, his chances of survival were very slender, his remaining time being counted in days or at most in months.

As soon as the consultation was over, John telephoned me.  He was distraught: on the one hand, he felt better, almost as well as before he fell ill, but on the other hand, his doctor had told him he would die.  I reassured him by saying one should believe what one sees – and for now, we had to admit that his regime worked better than the medicaments prescribed by his doctor.  All the same, John was in doubt.  What if the specialist in infectious diseases knew better than he himself what would be good for him?  What if his apparent improvement was only an illusion?  Frustrated, John decided to take his medicines again.  His appetite declined, his strength left him, he stopped his sport and he could not find the energy to go to see his acupuncturist.

Ten days later I found him in a deep depression.  Again he asked me what I thought, and again I said that I could not put myself in his place.  I told him that I thought his doctor was afraid of giving him false hope, and that he had to mistrust those who cast spells.  I told him a number of stories of voodoo witch-doctors.

John reacted instantly.  ‘That’s right,’ he said.  ‘I am the only one who can know.  I have no wish to be condemned to death by this doctor.  He should bring proof for what he says.  After all, it’s my life.  I shall decide.’  Once again, this experience confirmed me in my belief that an essential element in healing is the anger of the patient.  Not the destructive anger which takes on the whole world, nor the suppressed revolt which ends by exhausting him who cannot express it openly, but the strength to assert what one wants and to accomplish it.  I therefore found John’s attitude very reassuring.  Because how can one imagine that  a patient could mobilize all his strength to fight against an outside enemy called ‘AIDS’, if he allows himself to be put down by the catastrophic prophecies of a High Priest of modern medicine?  How can one survive without hope?

John decided a second time to abandon the medicines and he took up a sport, acupuncture, and massage again.  ‘I enjoy this,’ he said jubilantly.  Today, three years later, John is still alive.

I always hesitate to tell the story of John because it would be dangerous to draw hasty conclusions.  In fact, every case is unique.  I would never allow myself to advise a patient to stop taking medicines; that would be dangerous.  On the other hand, I always try hard to hear what he is trying to tell me: that which he does not dare admit to himself—because to me it is essential to help the other ot reach autonomy.  To do so demands that I inform, discuss, but never impose.  Who has the right to impose?  What certainty do we really have?  How much do we know about the pitfalls in our beliefs, be they scientific, philosophic or religious?

John clearly wanted to resume control of his life, and his illness was an opportunity for doing so. 

***

 

Nonsense and the human experience 03/02/2011

Posted by ALT in Philosophy/Spirituality, Treatments.
Tags: , , , ,
1 comment so far

    

Much Madness is Divinest Sense

by Emily Dickinson

   

Much Madness is divinest Sense —

To a discerning Eye —

Much Sense — the starkest Madness —

’Tis the Majority

In this, as All, prevail —

Assent — and you are sane —

Demur — you’re straightway dangerous —

And handled with a Chain —

***

To be in the world is to be constantly and mercilessly bombarded with INFORMATION.

Much of it is consumerist in nature, meaning that it is specifically designed to reach us at sub- and semi-conscious levels, to inspire uncontrollable urges to buy or in some other way partake.  The visual stimuli pasted on billboards, springing up as deformed and manipulative forests on the outskirts of every major American city; on buses, slantingly reflected in the windows of the buildings they pass; wrapped around the food we eat, woven into the fabric of our post-industrial lives – it’s not an easy wilderness to negotiate.

To do so successfully requires an ability to interpret, to make sense of things.  Given an incomplete dataset, can you infer the rest, and come to a conclusion?

You know what these say, right?

These “making sense of nonsense” skills, most likely developed during our eat-or-be-eaten days, are essential to survival – then and now.  Then: a faint scent of predator on the breeze, a rustling sound from an apparently empty field – put the pieces together and save your own life.

Now: living often as though “under siege” in our mad society – the strange and sometimes terrible machinations of this industrial machine need to make sense to us! 

Thankfully, they most often do; as Emily Dickinson so nicely put it, much madness is sense to a discerning eye.  In other words, it all depends on how you look at it, what context you can see, what history you can trace.  Even the most illogical occurrences (like Astra-Zenca, post-$250 billion-off-label-marketing lawsuit, still referring to Seroquel as an “antidepressant”) can become understandable given that all-important information.

  

A philosophical question  

IS there truly such a thing as naturally-occurring nonsense?  [Nonsense being defined as “a communication in what appears to be a human language or other symbolic system that does not in fact carry any identifiable meaning.”]  Sure, human code jammers during WWII would produce nonsense “white noise” in hopes that the enemy would get stuck trying to decode that, but is nature capable of such deception? 

And if it were, what would happen when a human being – bent on putting incomplete pictures together into sensical wholes – comes across one of these naturally-occurring  pieces of nonsense? 

Well, it would be very problematic.  Even if you rationally recognize it as nonsense, that doesn’t stop the instinctual part of you from struggling unceasingly to make sense of the thing.  In the 1950s, BF Skinner [please, don’t interpret this as an endorsement!] did an interesting experiment.  He made a recording of randomly selected phonemes (sound bytes used in the production of language).  It was played to participants sitting behind a rather thick partition, so that they would not hear it 100% clearly.  What he found was that most participants reported hearing their native language, and some could even repeat specific sentences they heard.  [Compare this to the innumerable theories about the messages you will “hear” when you play certain records backwards.  Very similar, I think.]

The mind will attempt make sense of nonsense.  It’s what we do.  And if it can’t achieve sense or meaning of some kind, we will cycle, again and again…

RD Laing argued rather convincingly that this (he calls it the “double bind”) can be a trigger for so-called “schizophrenic episodes.”  This is especially so with children.  [A fascinating explanation of the double bind theory expounded on by a Laingian can be found here.]

  

Too much sense

On the other end of the spectrum is the very real (and terrifying!) problem of things making too much sense.  In other words, finding confirmation in public and other seemingly impossible places for ideas that originate in your head:

At some point I started to think the radio was talking to me, and I started reading all these really deep meanings in the billboards downtown and on the highways that no one else was seeing.  I was convinced there were subliminal messages everywhere trying to tell a small amount of people that the world was about to go through drastic changes and we needed to be ready for it.  People would talk to me and I was obsessed with the idea that there was this whole other language underneath what we thought we were saying that everyone was using without even realizing it.

(Sascha Altman DuBrul, from the Icarus Project’s Navigating the Space Between Brilliance and Madness)

One could look at this “manic” behavior as confirmation bias gone awry (or even just “going, going, going…”) 

confirmation bias: the human tendency to collect information that confirms our opinions, theories, or partial reconstructions of incomplete pictures in our world, and to throw out evidence that doesn’t support them. 

As human beings, we are all subject to it, and to a certain extent, it is incredibly helpful.  After all, it takes conviction to make sense of this world and its dangers.  If you spend too much time questioning whether or not you really do smell predator, you’re basically dead meat.

"I don't CARE if you thought it smelled like flowers, Phil; just GO!"

So if your point of departure was a theory that “the opposite sex just doesn’t find me attractive,” and you were constantly on the lookout for corroborating evidence – odds are pretty good that you would find it, all around you.  Doesn’t matter that this is highly unlikely – there’s someone out there for everyone – you may come to believe it fervently, self-destructively.  You may come to cling to that belief for all sorts of reasons.

The same goes for someone whose starting point is “the world will end soon and I am one of the few who knows about it.” 

  

Embrace the “mad;” they are part of the continuum of human experience

Stigma and discrimination against the mentally ill are founded on the idea that the “mentally ill” are somehow OTHER, that they are cut off from the rest of humanity by their experiences which are fundamentally not human.    

It just isn’t so.  The experiences of the “mentally ill” may be extreme, but they are connected directly to experiences that all humans share.  Making sense of nonsense and confirmation bias are just two examples.    

Folks, this is REALLY GOOD NEWS! 

Why?  Because even if you’ve never had a psychotic episode, a manic phase, even if you’ve never experienced hallucinations or mind-numbing depression – you can relate!  You don’t need to react in fear, because this is not entirely the unknown. 

Instead, you can utilize your compassion and ability to empathize.  You can respond in the way that you would like to be responded to if the roles were reversed.  And, by giving your support, person-to-person, to a friend in need you can help just as much (if not more) than a certified “professional.” *

We humans were made to achieve homeostasis/balance/wellness, not as individuals, but together, across the entire continuum of human experience.  Everyone should be included in the loving embrace of this life-affirming process.

   

     

     

*If you don’t believe me, read a little bit about the work of Dr. Loren Mosher and Soteria House.

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