There’s actually some good news here.
At Afghan shrine, ancient treatment for mental illness
By Kevin Sieff, Wednesday, October 24, 3:00 AMThe Washington Post JALALABAD, Afghanistan
— No one here knows the man whose left leg is shackled to the wall of cell No. 5. Last week, he finished tearing his mattress to shreds and then moved onto his clothes, ripping his shirt and pants off before falling asleep naked.
“He’s insane,” say the villagers who have come to gawk at him. “He doesn’t know whether he’s in this world or another.”
“He’s getting better!” said Mia Shafiq, the man responsible for his recovery and the one who shackled him to the wall of a shrine in this eastern Afghan city.
The man’s brothers drove him here from southern Kandahar province two weeks ago, drawn by the same belief that has attracted families from across Afghanistan for more than two centuries. Legend has it that those with mental disorders will be healed after spending 40 days in one of the shrine’s 16 tiny concrete cells. They live on a subsistence diet of bread, water and black pepper near the grave of a famous pir, or spiritual leader, named Mia Ali Sahib.
Every year, hundreds of Afghans bring mentally ill relatives here rather than to hospitals, rejecting a clinical approach to what many here see as a spiritual deficiency. The treatment meted out at the shrine and a handful of others like it nationwide might be archaic, but the symptoms are often a response to 21st-century warfare: 11 years of nighttime raids, assassinations and suicide bombings.
For over a decade, Western donors have helped train Afghan psychiatrists, who diagnose many of their patients as having an ailment with a distinctly modern acronym: PTSD, or post-traumatic stress disorder. Mental health departments in Afghanistan are plastered with posters detailing the disorder’s symptoms. Pharmacies are stocked with antipsychotic drugs.
But many of those suffering from the disorder never see doctors or pharmacists. Instead, they are taken on the long, unmarked dirt road, through a village of mud huts, that leads to an L-shaped agglomeration of cells.
Read the rest here
Bob Chiarelli is an Ottawa and provincial politician who is contemplating a bid for the Ontario Liberal leadership. This story appeared today in the Ottawa Citizen.
It’s frustrating for me that no comments on this article are allowed, and I assume it is a way of protecting the man and the position from some of the more outrageous things that the public likes to say in comment boxes. If comments were allowed, I would respectfully take issue with the dismal depiction of schizophrenia as a life long brain disorder and chemical imbalance, and with the notion expressed in the article that “medications are so much better” these days – an opinion that is compromised by the mounting evidence about the ineffectiveness of the drugs and the side effects. I was astonished to read that Chiarelli’s son Christopher was on 100 pills a day when he was first hospitalized. 100 pills a day? Did I read that right?
My sympathy is very much with Mr. Chiarelli and his family in their bereavement. My issue is with the continued spreading of pessismism, by the media and through the media, about “schizophrenia.” How can one recover or help others to recover when the condition is draped in black cloth? So called “mental” illness is considered after all, mental, and therefore IS particularly amenable to a positive thinking approach.
Casual readers of the Citizen story will come away with the same dismal view of schizophrenia that has the effect of preventing the public at large from learning that, properly understood and handled, “schizophrenia” is not a life-time sentence. (Talk about stigma!) When I read articles like this, I ask myself, what if members of my extended family read this? Would they assume my son will eventually work full time, get married and lead an otherwise productive life, OR, would they, like the general public absorb the pessimistic message? My guess is the latter. Unlike me, my family hasn’t needed to be up to speed on the latest research and controversies about the label, so they may rely on articles like these to tell them what’s what.
I hope that Mr. Chiarelli will continue to work for mental health organizations, and will keep an open mind about the good news coming out of today’s recovery movement.
Dr. Steve Balt, psychiatrist and editor-in-chief, The Carlat Psychiatry Report, and Dr. Richard Friedman, director, Psychopharmacology Clinic, Weill Cornell Medical College
NEAL CONAN, HOST:
This is TALK OF THE NATION. I’m Neal Conan in Washington. Just about everyone’s image of a psychiatrist’s office includes a long couch, dim lights and a doctor with a notepad asking: And how did that make you feel? A stereotype, of course, and way out of date at that. Over the past 20 years, few professions have seen more change than psychiatry.
Weekly, 45-minute appointments are largely a thing of the past. Many psychiatrists see patients for 15 minutes, one after another. Instead of listening, they ask a series of questions, write out prescriptions, and refer their patients to a psychologist or to a social worker for therapy.
While some in mental health circles feel these changes are necessary, others worry they hurt both patients and doctors. We want to hear from psychiatrists in our audience today. How has your practice changed? Give us a call, 800-989-8255. Email us, firstname.lastname@example.org. You can also join the conversation by going on our website. That’s at npr.org. Click on TALK OF THE NATION.
Read the rest of the transcript and listen to the audio link.
Yesterday, I sat down with my son to discuss his recent difficulties that resulted in his going back on medication, the warning signs – will he be able to recognize them in future? – and observations about what we can do in the meantime to avert future episodes.
I’ll get to the title of this post after I meander through the events of this past summer and how they are informing some current thoughts about Chris’s troubles of the past ten years.
The latest mini-crisis may have started in June with Chris complaining about not sleeping well. He had finally come off the Abilify in April or May, having tapered over the course of one year from 5 mg down to nothing. His lack of sleep could have been related to going off the drug, and/or, lack of sleep could be something that he always needs to guard against. (Even as a toddler, he put himself to bed, early, which was kind of unusual, I would say.)
To be honest I didn’t give the latest professed lack of sleep too much thought, for several reasons. One is that Chris didn’t look or act like someone who wasn’t sleeping well. He got up early every day like clockwork, he went to bed at a reasonable hour each night, he didn’t have bags under his eyes. In September, when he again complained about not sleeping well (there were periods in between when he said he was getting a good night’s sleep), I suggested that he ask Dr. Stern for a sleeping pill. The rest is history. Dr. Stern put him back on an antipsychotic within two weeks of his asking for help sleeping.
If lack of sleep is the cause of this latest drama, then Chris’s growing lack of self-confidence that I DID observe in September, is a possible by-product. He was becoming downright weepy and talked of himself in very self-deprecating terms. Lack of sleep will do that for some people. For other people, lack of sleep will make them hostile, aggressive, or paranoid. Prolonged lack of sleep can eventually lead to hallucinations.
If you haven’t listened to Will Hall’s presentation in front of the American Psychiatric Association, please do. Will knows the territory of psychosis very well. In his speech he makes reference to lack of sleep as an under-recognized/under-treated factor in psychosis. Many people claim that they became psychotic following a period of intense sleeplessness. That fact I know well, but then it gets complicated. As Chris pointed out, the psychiatrists when he was first hospitalized talked about the importance of sleep in the recovery process, but they didn’t relate it to a possible reason for his becoming psychotic in the first place.
Chris started to go psychotic during his last year of high school, a time of intense academic pressure. He tells me that he drank coffee to keep himself awake into the early hours of the morning. For many people staying up late wouldn’t be a problem, but perhaps for Chris, who put himself to bed voluntarily as a toddler, lack of sleep for him means more than just being tired the next day.
My latest effort to help improve Chris’s resilience (help him get better sleep to avoid psychosis) was to move him into a bedroom that is much darker and quieter at night, and to keep him supplied with Dr. Hoffer’s niacin combination, which also aids sleep.
Perhaps if his psychiatrists at the hospital had focused on lack of sleep as a possible primary cause of his psychosis, rather than merely one of many symptoms of psychosis, his recovery to date would have been more straightforward. Why couldn’t he have been treated with a sedative at night, like Joanne Greenberg (author of I Never Promised You a Rose Garden) was given when she was a patient at Chestnut Lodge in the late 1950s? I suspect the answer may be that today’s patients are given antipsychotics during the day (which have a sedating effect), and sent home quickly in order to avoid costly hospital stays. Hospitals are not prepared to be Soterias. Joanne Greenberg spent three years at Chestnut Lodge, where she wandered the hospital during the day conversing with other patients, and saw her psychiatrist once a week. She was unmedicated and quite psychotic, but presumably got a good night’s sleep. After three years, she was released from hospital.
I am deliberately hedging my bets here about putting too much emphasis on sleep deprivation as a cause of Chris’s psychosis, but I do think it is an area that psychiatry has put too little emphasis on as a possible causative factor for some individuals. Sleeplessness in most people leads to anxiety, lack of self-esteem, aggression, and, in a certain segment of people, to hallucinations, all of which are considered symptoms of psychosis. Why not begin with aggressively treating sleeplessness through the more conventional means of sedatives at night and preparing the proper sleep environment?
There is an interesting article on giftedness published in 1999 by the Davidson Institute for Talent Development, The impact of giftedness on psychological well-being. This is quite a good article, that makes me look at a possible cause/mislabelling of schizophrenia in a way I had not fully considered before. What got me thinking was a conversation I had this morning with a colleague about his sixteen year old son. I came away from our discussion wondering if schizophrenia and other mental health problems often crop up in adolescence as adjustment and maturity difficulties, as this article hypothesizes. I have thought the same thing, but not directly in relation to the double-edged sword of having a high I.Q. Certainly, in Chris’s case, as a child, he easily grasped academic material without putting any of his personality into the process. Perhaps my mistake was thinking that he would start to work, as lots of teenage boys do, when push comes to shove, sometime in the high school years. I should have picked up on the signal that Chris hadn’t learned to challenge himself and put himself in win/lose situations at an early age. He missed out on a necessary developmental stage.
I don’t want to make this look that any reasonably bright person who has had an easy time of it for a while academically, can fall into the horror of psychosis, but perhaps a key ingredient here is not just being bright, but being acutely sensitive. According to my colleague, his son has been hospitalized a couple of times due to severe anxiety, has run away from hopitals and home on several occasions, and has had huge difficulties with school attendance. It was only this past year that a teacher suggested that his unwillingness to learn might be related to double-edged gift of a high I.Q. High I.Q. children often don’t develop good study habits or a need to perserve, because their intelligence has provided a short term fix when they are young. Anxiety kicks in more and more as the child moves into the teen-age years and must learn better coping skills. At this point, they panic. In some or many cases, the teenager will be given a mental health label, and treated by the mental health system in terms of depression, bipolar, schizophrenia, etc. My friend said that his son was relieved to have his problems cast in a different framework – rather than “crazy” it is his intellect that has been his enemy. It remains to be seen, his father told me, how his son will adapt to a new school with a different pedagogical approach than what he was used to, but so far, he is eager to go to school each morning.
There is a long history of interest in how giftedness affects psychological well-being (Berndt, Kaiser, & Van Aalst, 1982; Eysenck, 1995; Freeman, 1983; Hollingworth, 1942; Parker & Mills, 1996; Ramaseshan, 1957; Reynolds & Bradley, 1983; Richards, 1989; Strang, 1950; Watson, 1965). During the last 50 years, two conflicting views prevailed. The first is that gifted children are generally better adjusted than their nongifted peers; that giftedness protects children from maladjustment. This view hypothesized that the gifted are capable of greater understanding of self and others due to their cognitive capacities and therefore cope better with stress, conflicts and developmental dyssynchrony than their peers. Studies supporting this view report that gifted children demonstrate better adjustment than their average peers when measured on a variety of factors (Baker, 1995; Jacobs, 1971; Kaiser, Berndt, & Stanley, 1987; Neihart, 1991; Ramasheshan, 1957; Scholwinski & Reynols, 1985).
The second view is that gifted children are more at-risk for adjustment problems than their nongifted peers, that giftedness increases a child’s vulnerability to adjustment difficulties. Supporters of this view believe that gifted children are at greater risk for emotional and social problems, particularly during adolescence and adulthood. Their hypothesis is that the gifted are more sensitive to interpersonal conflicts and experience greater degrees of alienation and stress than do their peers as a result of their cognitive capacities.
Read the rest here
Thanks to everyone who sent me encouraging words and helpful comments. I changed the original title of this post from “crisis averted” to “crisis postponed” because the crisis did, in fact, happen, and there is always the possibility of a new crisis somewhere in the future. Such is life. Due to the events of the last few days, I’m trying to be more philosophical about the need for Chris to be back on a medication. We had to grab an additional weapon that might stand a chance of stopping his growing anxiety, emotionalism and negative self-image. I’ve seen in the past where this can lead, and it was the hospital.
Not that I have changed my mind and think that the drugs are safe or particularly effective, but, they can work in a pinch, and often they do work to shut down the symptoms I described above. (I’ll not go into the side effects in this post. We all know them, and the first visible one, even at a low dose, is usually weight gain.) Vigilance is needed on everyone’s part (especially Dr. Stern’s) to maintain the drug at the lowest dose for the shortest period while continuing to find other ways of making Chris even more resilient the next time a crisis looms.
I think it’s important to point out that a supportive family and intensive psychotherapy didn’t stop the crisis from happening, and based on my past experience, won’t necessarily prevent it from getting worse. But, with all the holistic interventions Chris has undergone in the past eight years, he’s in a much better position to not prolong this latest crisis. Ian and I acted quite business as usual with Chris and did not aggravate the situation by over-reacting.
Chris agreed to the resumption of Abilify, and seemed back to whatever his normal is the following day. He’s keeping up with his musical theater practices and finally bought himself a cell phone so he could keep better track of his appointments and his growing group of friends. Ian and I picked up where we left off with him, and are no longer walking around in a state of fear.
Some people may think about the medication, well, what’s the big deal? Everybody knows that low dose is best. Well, that’s not exactly the way the doctors presented this to me eight years ago. Eight years ago nobody I spoke with mentioned low dose or a single medication only. I had to do my own homework, and was treated like an idiot who didn’t understand the problem. Now, lowest possible dose and fewest drugs are on everybody’s lips. To get Chris to a low dose of one drug only, took a lot of arguing and willingness to change doctors on my part. Leonard Cohen’s crack of light getting in, at least where psychiatry is concerned, is largely thanks to the growing stridency of the psychiatric survivor movement.
Two articles caught my attention over the week-end, both having to do with coercive psychiatry. The first is a book review of who got sent to asylums in Victorian England, and the second is an in-depth look by social worker Jack Carney at New York State’s Kendra’s Law, Dr. E. Fuller Torrey and DJ Jaffe.
Inconvenient People: Lunacy, Liberty and the Mad Doctors in Victorian England, by Sarah Wise, Bodley Head RRP£20, 496 pages
The most potent image of Victorian insanity in popular culture is that of the “clothed hyena” Bertha, the mad wife in Charlotte Brontë’s Jane Eyre. It is, writes Sarah Wise in Inconvenient People, “perhaps the most vicious depiction of an insane person to have been committed to paper”.
Yet in 1847, when the novel was published, Mr Rochester’s decision not to place Bertha in an institution was intended to be read as “a mark of his nobility, not perversity, or brutality”. Through vivid case histories, Wise’s fascinating book traces almost a century of legislation dealing with the insane.
Bertha’s plight gave rise to a celebrated work of feminist literary scholarship, Sandra Gilbert and Susan Gubar’s The Madwoman in the Attic (1979). But Wise seeks to refute the notion that the 19th-century lunacy laws were yet another manifestation of male dominance and female victimisation. Her research indicates that men were just as likely to be “victims of malicious asylum incarceration”; perhaps more so, given that these cases often revolved around money.
There are some villainous mothers here, seeking to regain control of a son’s inheritance, or prevent an unsuitable match. In 1829, Edward Davies, a wealthy young tea-broker of endearingly eccentric habits, was dragged from a London coffee house by two burly men who tried to bundle him into a cab. Such force angered the public and a mob formed to prevent the abduction. Wise shows how the robust notion of English liberty trumping all other considerations declined as the century progressed, allowing state intervention in previously sacrosanct areas: within families or even marriage. (Emphasis my own)
Read the rest of this fascinating book review here
Fast forward from Victorian England to New York State today.
More on New York’s Kendra’s Law: Opponents Lining Up for Decisive Battle in 2015
By Jack Carney, DSW
“I sit on a man’s back, choking him and making him carry me, and yet assure myself and others that I am sorry for him and wish to ease his lot by all possible means — except by getting off his back.” Leo Tolstoy, Writings on Civil Disobedience and Nonviolence (1886)
This article is about coercion in its various forms – that which is direct, unequivocal, almost thuggish, and that which is more subtle, usually masked as well-meaning, referred to by David Oaks as “velvet gloved.”…..
For the past twenty-five years and more, E. Fuller Torrey has pushed the notion that persons diagnosed with serious mental illnesses, particularly schizophrenia, are so dangerous and potentially violent that they must be treated, i.e., medicated, with or without their consent. His basic strategy has been to pursue, state by state, the passage of outpatient treatment commitment legislation, which effort has been facilitated by his long collaboration with NAMI and by his Treatment Advocacy Center, founded by him in 1998. He has been quite successful in this endeavor – to date, 42 states have passed involuntary outpatient commitment laws – and he appears to have set his sights on Kendra’s Law and changing its status from temporary to permanent. A preview of his pursuit of that objective was on display this past summer, when two police officers were stabbed by persons presumed to be mentally ill and a great clamor was raised in much of the media to expand Kendra’s Law. Civil rights and peer/survivor advocates rallied and beat back the effort, convincing State legislators that the expansion of treatment services was the more effective remedy not the addition of coercive amendments to the existing Law. Perhaps not the ideal response for those of us who’d prefer to see the mental health system shrink, but an indication of the continuing influence of civil libertarian arguments in liberal New York.
Read more here
It’s very exciting to see a growing number of documentary films on mental health recovery, focusing on the current problems of the mental health care system, and the alternatives to the status quo. The latest such film is HEALING VOICES. But, making the film a reality takes money. Most of us are hard pressed these days to donate, but we can do so for as little as $1.00. Dollars add up.
HEALING VOICES is a feature-length documentary film examining mainstream mental healthcare and psychiatry in the United States.
See the trailer on the Kickstarter site and consider a donation to the cause.
Launched: Sep 6, 2012
WHAT IS THIS FILM ABOUT ?
Through the lens of individuals at various stages of their mental health story, HEALING VOICES will investigate topics including the stigma of psychiatric diagnoses, the role of trauma, pharmacology, alternatives to the Western one-size-fits-all medical model, and the power of storytelling in recovery.
WHO IS STEERING THE SHIP ?
The film is directed by PJ Moynihan of Digital Eyes Film, a US-based independent production company whose work in the field of mental health and recovery alternatives represents the growing body of evidence around progressive ways we as a society can support people experiencing mental health issues.
WHAT WAS THE GENESIS OF THIS PROJECT ?
Moynihan partnered with co-Producer and psychiatric survivor Oryx Cohen to create a short film for a mental health advocacy group that Cohen helped found, to be featured on Forbes.com. Accompanied by a written pitch featuring the personal account of Cohen’s friend and fellow activist Will Hall, it became one of the most highly viewed stories on the entire Forbes site for several days running. This impassioned response suggested a critical need to raise the level of dialogue around mental health issues, and gave rise to the concept for a feature-length documentary.
A journalist since 1968, Ken Braiterman has been advocating for recovery- and trauma-informed services since 1977, full-time since 1997. He is board chair of Wellness Wordworks, a certified advanced WRAP trainer, former chair of the NH Mental Health Consumer Advocacy Council, and a lecturer at the NH Police Academy and NH Hospital. A prolific writer and compelling speaker, he can be reached at email@example.com.
Why Mainstream Media Ignore Our Movement or Get It Wrong
by Ken Braitherman
Having been a news reporter for a small-city daily for many years, I know some reasons why mainstream media ignore our movement, or get it wrong. that have nothing to do with hostility or being bought by Big Pharma. Advocates can do something about it with their local media, but it’s an uphill struggle that requires some awareness of the problems they face every day.
The built-in limitations of daily journalism have gotten much worse since I left the business. Mostly a lack of space and staff time. Space for news shrinks in proportion to the shrinking advertising.
Staffs keep shrinking, but the number of important subjects does not, Newspapers are fighting a losing battle to maintain quality and journalistic standards as fewer people struggle to do the same amount of work.
And there are so many stories a local paper is required to cover, like the school board, cops, local elections, and city council. Mental health stories are required only when someone goes on a shooting spree.
Read Ken’s advice about the steps you can take to approach your local newspaper.