The latest threshold that psychiatry has crossed

Mommy, am I really bipolar? is the title of a Newsweek piece by Stuart L. Kaplan, M.D. Dr. Kaplan argues that there is no scientific evidence that bipolar disorder surfaces in childhood. Dr. Kaplan goes through the recent history of this diagnosis which began in the 1990s with the book The Bipolar Child, and he discusses how quickly psychiatry and the public rallied around this label. Judging from the force of the comments to this article, mainly all negative in regard to Dr. Kaplan’s opinion, there should be a huge blow coming to psychiatry’s credibility as it tries to backpedal on this diagnosis in children. Why should these parents believe psychiatry now?

As much as I agree with much of what Dr. Kaplan writes, there is a huge credibility problem that has been simmering along for the profession and could boil over. Since psychiatry has put all its efforts into magic bullets it has neglected to figure out how to relieve human suffering. In fact, it has gone out of its way to tell parents that it was dangerously old-fashioned to believe that maybe the family environment has a good deal to do with why the child is behaving in a certain way and that chemicals are the main solution. I would be all in favor of what Dr. Kaplan is saying, except that he undermining this position by further arguing that bipolar in children is most often ADHD, and psychiatry has chemicals to treat that. He also refers to ADHD as less trendy than bipolar. Maybe so now, but not so when my kids were in elementary school. ADD and ADHD was THE buzz with the mothers in the schoolyard. So, all Dr. Kaplan is doing is trading one diagnosis for another diagnosis that has the FDA ‘s blessing for the drugs that are used in children.

Many young parents don’t know what they believe themselves, so they believe their doctor. They believed their doctor, perhaps after initially putting up resistance (or perhaps not), when the doctor told them their child was bipolar. Now, all of a sudden, the same doctor is telling them that the child is not bipolar? How is the doctor going to explain away the drugs and the fact that their kid is still messed up? Why should the parent believe this latest fad un-diagnosis? You would think that a parent would be delighted to hear that their child is inattentive and hyperactive, rather than the more ominous bipolar, but that doesn’t seem to be what is happening with the parents who commented on this article. They are lining up behind the belief that their child is horribly, mentally ill and they don’t want the label dropped. By giving parents this option, psychiatry has created a much bigger problem that has invaded every nook and cranny of family life and parents want to hold psychiatry to it. They won’t be able, to, unfortunately.

Psychiatry should be in big trouble from these parents now that it is backpedalling on the bipolar diagnosis. Memories are short, however. The parents of under 18s now will not be the same group of parents of under 18s ten years from now. The bipolar label is going to be folded into a new label. I’ll let Dr. Kaplan explain the new think:

The tide may be turning. The American Psychiatric Association is deliberating intensely on new criteria that would dramatically restrict this fad diagnosis. One step the association is recommending is a new diagnosis called temper dysregulation disorder, a more accurate way of describing extreme irritability in children. If mental-health professionals can be persuaded to consider these alternative diagnoses, many thousands of children could be spared an unwarranted, stigmatizing label that sticks with them the rest of their lives.

The controversy over bipolar will fade, since there is a good chance the current drugs won’t get approved for use in children, anyway, and the next generation of parents will be snowed once again by the profession using new labels and different drugs.

For those who want off the merry-go-round, this latest controversy is all the more reason to rely on one’s own intuition, to expand one’s belief system, and look to emulate people who have cured themselves.

I’m tempted to report this guy as “inappropriate”

There has been a tremendous outpouring of positive response from New York Times readers to the self-outing of Dr. Marsha Linehan. Dr. Linehan is the creator of DBT therapy, whose story of recovery from a diagnosis of schizophrenia appeared in yesterday’s paper.

Perhaps you can spot the problem in Mark’s take on mental illness. (Well, there are two actually.)

mark
Providence, RIJune 24th, 20119:41 am

Dr. Linehan has done a great service to all people who suffer from emotional and mental problems, and she deserves tremendous praise for having the courage to reveal her personal story. Her story gives hope to those who read it, but the story is more complicated than the Times reports.

Having practiced psychiatry, child psychiatry and primary care medicine for 20 years, I have been impressed that mental illness is a concept that is not as simple as it is often portrayed, and that by oversimplifying it, in tends to stigmatize many people. To begin with Borderline Personality is not a unitary concept, but an aggregate of behaviors and mental and emotional experiences that varies in its intensity and characteristics from one person to the next. There may be 20 or more variants of borderline personality. Many patients who do not meet the DSM criteria are diagnosed with “borderline traits”. Many diagnoses in the DSM are probably best not viewed as mental “illnesses” but rather problems that have complex social, cultural and economic contexts. Among these should probably be adjustment disorders, learning disabilities and substance abuse disorders. While I would agree that Schizophrenia and Bipolar Disorder are true mental illnesses, we must recognize that sometimes these terms have been used to describe borderline patients and other patients out of countertransference more than because the patient truly met the criteria, out of an expression of anger and frustration at the process of treating people with provocative behavior.
Personality disorders have a strange place in the pantheon of mental disorders (By the way, what is a disorder? Is it equivalent to an illness or something different). As Dr. John Oldham has written in his books on Personality Disorders, these conditions reflect a spectrum of personality traits that range from the normal to the pathological. The pathological is largely defined by the extent of the traits.

Recommend Recommended by 0 Readers Report as Inappropriate.

How we arrived at the mess we are in

I say “we” because even though the references here are mainly U.S.-centric, psychiatry in developed countries has been heavily influenced by the pharmaceutical industry. Here is an excerpt from the second installment of Marcia Angell’s three part review of The Emperor’s New Drugs; Anatomy of an Epidemic; and Unhinged. Dr. Angell is the first woman to have served as editor-in-chief of The New England Journal of Medicine.

One of the leaders of modern psychiatry, Leon Eisenberg, a professor at Johns Hopkins and then Harvard Medical School, who was among the first to study the effects of stimulants on attention deficit disorder in children, wrote that American psychiatry in the late twentieth century moved from a state of “brainlessness” to one of “mindlessness.”2 By that he meant that before psychoactive drugs (drugs that affect the mental state) were introduced, the profession had little interest in neurotransmitters or any other aspect of the physical brain. Instead, it subscribed to the Freudian view that mental illness had its roots in unconscious conflicts, usually originating in childhood, that affected the mind as though it were separate from the brain.

But with the introduction of psychoactive drugs in the 1950s, and sharply accelerating in the 1980s, the focus shifted to the brain. Psychiatrists began to refer to themselves as psychopharmacologists, and they had less and less interest in exploring the life stories of their patients. Their main concern was to eliminate or reduce symptoms by treating sufferers with drugs that would alter brain function. An early advocate of this biological model of mental illness, Eisenberg in his later years became an outspoken critic of what he saw as the indiscriminate use of psychoactive drugs, driven largely by the machinations of the pharmaceutical industry.
………

In addition to the money spent on the psychiatric profession directly, drug companies heavily support many related patient advocacy groups and educational organizations. Whitaker writes that in the first quarter of 2009 alone,

Eli Lilly gave $551,000 to NAMI [National Alliance on Mental Illness] and its local chapters, $465,000 to the National Mental Health Association, $130,000 to CHADD (an ADHD [attention deficit/hyperactivity disorder] patient-advocacy group), and $69,250 to the American Foundation for Suicide Prevention.
 And that’s just one company in three months; one can imagine what the yearly total would be from all companies that make psychoactive drugs. These groups ostensibly exist to raise public awareness of psychiatric disorders, but they also have the effect of promoting the use of psychoactive drugs and influencing insurers to cover them. Whitaker summarizes the growth of industry influence after the publication of the DSM-III as follows:

In short, a powerful quartet of voices came together during the 1980’s eager to inform the public that mental disorders were brain diseases. Pharmaceutical companies provided the financial muscle. The APA and psychiatrists at top medical schools conferred intellectual legitimacy upon the enterprise. The NIMH [National Institute of Mental Health] put the government’s stamp of approval on the story. NAMI provided a moral authority.

……………
Growing numbers of for-profit firms specialize in helping poor families apply for SSI benefits. But to qualify nearly always requires that applicants, including children, be taking psychoactive drugs. According to a New York Times story, a Rutgers University study found that children from low-income families are four times as likely as privately insured children to receive antipsychotic medicines.

Read the NYR article here.

The definition of short

So, if we still don’t know what is meant by “short term” use of antipsychotics, is there a doctor in the house or out in cyberspace who can shed some light on this? If I don’t get an answer, shall I assume that nobody is looking seriously at this issue?

The question is quite deliberate on my part. Since most of us don’t get a dress rehearsal for a schizophrenia diagnosis (60% of new “cases” apparently do not have family history), we will find ourselves on medications because we haven’t got a clue that there are other ways of dealing with trauma.

I have heard that the most recent research says (patients have been saying this for years) that medications, if used at all, should be short term. If this is so, then people ought to know what short term is so they, and their doctors, can agree on an end date while bolstering their recovery with alternative therapies. Many doctors will claim that the patient has to be “stable” in order to go off them, while many patients claim that they shouldn’t be on meds in the first place and don’t function well on them. Doctors (pharma) have been getting a free pass up until now because the specifics, if there are any, are cloaked in mystery. I am not referring to how to go about withdrawal (there’s lots of information here), I mean how short is short?

Thanks to Robert Whitaker’s book, Anatomy of an Epidemic, we now know that the “medication is to schizophrenia just like insulin is to diabetes” argument was an falsehood (or misconception, depending on how you look at it) that was not clarified by the pharmaceutical companies until the author put the question directly to a pharmaceutical company executive.

If we are starting to hear that drugs, if used at all, should be short term, what is meant by short term?

Best practice for short term use of neuroleptic medication

Here’s a question that’s been puzzling me. There is a growing consensus that says that neuroleptic medication, if administered at all, should be of short duration and used only when and if necessary during periods of acute psychosis.

My question is, where is the best practice that defines “short term?” Are we talking one month, three months, one year maximum? What is meant by “short term?”

Does anyone out there have some information on this topic?

Horses and humans

It never ceases to amaze me that we still fail to recognize and treat trauma in the “mentally ill” human.

“Buck“

The story of Buck Brannaman and, by extension, the documentary is on the surface that of a man who turned hurt into grace operating from a reservoir of patience and profound love of horses. It’s also, as his quiet stories and those of friends who also pay witness to his cruel history make vividly, at times mistily clear, a look at the lines connecting parent to child, man to beast. Mr. Brannaman’s childhood was a horror, and while the movie includes chilling reminiscences, the most revealing moment comes in an old film clip that Ms. Meehl smartly tucks in and that shows the older Mr. Brannaman leading his small, blindfolded boys toward the front of a stage, his grip digging so hard into Buck’s shoulder that you may wince.

Schizoaffective disorder: More junk science

Here’s a telling quote (and audience reaction) from the APA 2009 convention.

William T. Carpenter, Jr., MD, from the University of Maryland in Baltimore and head of the psychotic-disorders work group, which includes schizophrenia, outlined several main changes being considered in this area that might be controversial.

One of these questions is whether to retain schizoaffective disorder as a diagnostic entity. “We had hoped to get rid of schizoaffective as a diagnostic category because we don’t think it’s valid and we don’t think it’s reliable,” he said. “On the other hand, we think it’s absolutely indispensable to clinical practice,” he added wryly, drawing a laugh from the audience.

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REPORTED IN MEDSCAPE.COM

A righteous dude

“The lack of insight in modern psychiatry is more extreme than the lack of insight in patients.”

Lawrence Albert “Al” Siebert, (January 21, 1934 – June 25, 2009)

What I like about Al Siebert is that he is on “your side.” He will agree that you’re all right, which, to my way of thinking encourages patients to “become all right.” I don’t get the same feeling from most psychiatrists.

NIMH table spreads cheer at NAMI convention

Or, this is what your government wants you to believe about mental illness. It’s strictly brain-based.

The NIMH (National Institute of Mental Health) invites you to visit our table at the NAMI 2011 Annual Convention

Chicago, IL July 6-9, 2011
Exhibit Booth 106 – Southeast Exhibit Hall
Location: Chicago Hilton
720 S. Michigan Avenue, Chicago, IL60605Now available to view on the NIMH website:

Brain Basics

A self-guided education module that uses images and animation to show how the brain works, how mental illnesses are disorders of the brain, and ongoing research that helps us better understand and treat disorders.

Mental Health Statistics

A resource that represents an extensive collection of our best statistics on the prevalence, treatment, and costs of mental disorders. Equally important are sections that have been included on mental health-related disability and on suicide.

Featured below are several publications that may be of interest. All NIMH publications are available at no cost.

Suicide in America: Frequently Asked Questions

A brief overview of the statistics on depression and suicide with information on depression treatments and suicide prevention.

Learn more about this publication.

Brain Development During Childhood and Adolescence (Fact Sheet)

A fact sheet that describes the past, present and future of research on brain development.

Learn more about this publication.

About Us

The mission of NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure.

Our Location

6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda, MD20892-9663
Phone: 301-443-4513
Toll-free: 1-866-615-6464
TTY: 301-443-8431
TTY Toll-free: 1-866-415-8051
Fax: 301-443-4279
E-mail: nimhinfo@nih.gov
Website: http://www.nimh.nih.gov

We also invite you to view NIMH Science News about mental health.
For the latest NIMH research news and funding opportunities, subscribe to a NIMH e-mail newsletter or RSS feed.

Haven’t registered yet for the NAMI Convention?

NO PROBLEM — YOU CAN REGISTER ON-SITE AT THE CONVENTION:

Just come to the on-site registration desk located on the lower level of the Chicago Hilton.You can register for the full convention or just for one day. On-site registration will be open Wednesday – Saturday.
Visit www.nami.org/convention for details on registration fees. You can also download a complete program schedule to help you plan your time at the convention.