Coursera’s free online university course on social context of mental health

Feel free to check out the massive online courses (MOOC) offered by Coursera. The Social Context of Mental Health and Illness starts June 24th, taught by University of Toronto Faculty of Social Work associate professor Charmaine Williams.

Course description:
This course is an opportunity to explore how social practices and ideas contribute to the ways in which society, families and individuals are affected by mental health and mental illness. We will look at issues like why some people think mental illness is a myth, how people think about mental health and illness in different cultures, who gets mentally ill and why, how families are affected by mental illness and what interventions are available to treat mental illness and promote mental health.”

Course Syllabus

Week One: A brief history of madness 
Week Two: What is mental health and what causes mental illness?
Week Three: The social context of diagnosis and treatment of mental illnesses
Week Four: Culture, mental health and mental illness
Week Five: Families, caregiving and mental illness
Week Six: Society, communities and mental health

They’re writing self-help books, but not for me

(Apologies to George Gershwin.  (….They’re writing songs of love, but not for me)

I caught the tail end of a BBC radio interview last night. British libraries have begun stocking 30 evidence based self help books for mild to moderate mental conditions. Two thirds of people suffering from anxiety and depression in the UK apparently are not getting help.

After much discussion of the growing evidence base that self help books can help people feel better, the interviewer eventually piped up, “So, I guess this is not for people with major problems, say, bipolar.”

Well, it’s not. Apparently, people with “major mental illnesses” are beyond self help. Best to leave their supposedly intractable problems with the professionals, as we read in a different interview with clinical psychologist Neil Frude:

“The use of good self-help books is endorsed by the National Institute for Health and Clinical Excellence, although Frude said Nice does not say which books should be used, whereas it would with particular drugs.

“They are not for everybody,” Frude said. “And of course we are not talking about people with serious illnesses, but one in six of us will have a diagnosable mental illness in our lifetime.”

I can think of many self-help books for schizophrenia and bipolar. Let’s start with The Bible. Then, there’s The Divided Self (R.D. Laing), Selfhood (Dr. Terry Lynch), just about anything by Joseph Campbell, books on Eastern mysticism, poetry books, philosophical treatises on man’s relationship to God and nature. Agnes’s Jacket. No doctor’s prescription or NICE endorsement needed.

Making madness fun

Humanity has advanced, when it has advanced, not because it has been sober, responsible, and cautious, but because it has been playful, rebellious, and immature. ― Tom Robbins

Ron Unger writes about madness and play over at the Mad in America webzine. Don’t miss this one!  Madness these days is viewed in the same way as the Ladies Temperance Society viewed alcoholic beverages. We are “awfulizing it.” Let’s get others to lighten up and recognize that a little humor goes a long way. Laughter is often the best medicine and as for play:

Ron writes:

“Curiously, those convinced that the best way to reduce “stigma” is to portray madness as an “illness like any other” see it as part of their job to suppress any notion that there can be something fun about madness. For example, a NAMI page on stigma reduction contains the following paragraph:

Another triumph came in the field of advertising. Nestle’s line of Tasty, Tangy Taffy Bars featured wrappers bearing distorted cartoon faces of characters with names like “Psycho Sam,””Loony Jerry” and “Weird Wally.” Two alerts and even a letter from former First Lady Rosalynn Carter convinced Nestle to repackage the candies, minus the stigmatizing names and cartoons.

Of course, if madness is not an “illness like any other,” if it is more of a human thing, very multifaceted and containing potential for growth and change as well as hazards, then it might be a good thing to notice the fun side of madness; to notice not just the dangers, but also how it might be sometimes be liberating or even just amusing.”

The value of networking

The job possibilities are endless with my LinkedIn account profile as “Rossa Forbes.”

Novartis posted a job you might be interested in:
Director, Payment Policy, Public Affairs

Job Purpose: Develop, align and represent the Novartis position on Healthcare policy with particular focus on payment policies for medicines/devices such as Health Technology Assessment, Referene Pricing, Value of Medicines and various cost…

Kelly Scientific Resources posted a job you might be interested in:

Head Medical Affairs

AbbVie is a global biopharmaceutical R&D company focused in developing leading-edge therapies and innovations. Their expertise in research and development of pharmaceutical products goes back to a 125-year legacy. They are the owner of a solid…

Not so Far From the Tree, but relatives greatly in need of help

Please note that Far From the Tree was published in 2012, so the interviews below are relatively recent. The level of ignorance is astonishing. Harvard psychiatrists tapering their patients by 30% every week, people not being aware that clozapine requires liver testing, many families not knowing that if you treat someone with respect and empathy and encourage daily contact, they will blossom.

MacLean pychiatrist: “Then we come up with a plan to taper their medication by about thirty percent every week.”

William’s sister: My father found a small house for him in the woods, away from the summer community, so no one would see him. In fact, my father saw him only three times in thirty years.” Sister finally intervenes when her brother is aged 52. “That kind of denial, the way my father was–ate him alive, and now he’s just a hollow wreck. A whole life slipped away, that didn’t have to”

Malcolm’s brother: Just after Malcolm died: “No one expected Malcolm to die when he did. Peter said, “of course the illness reduces your life expectancy, and the medication, even though it’s helping you, reduces your life expectancy, too. But, at least he got himself to the best place he could. We’ll take this death because of the quality of life he had.”
After the coroner’s report on Malcolm: The coroner’s office took blood samples, just to rule out the possibility of wrong doing. A few months later, the family learned that clozapine ended the same life it had redeemed. “We didn’t realize death by clozapine was even possible, but are gradually learning more about it,” Peter wrote to me. “It seems like the toxic levels of clozapine built up over time because his liver was not processing it. Some have suggested to us that liver function should be tested regularly to make sure there is not a buildup in toxicity, and that this is a matter of standard medical practice…..Now we are left with the final tragedy–the medications we forced him to take, which he railed against and fought with all his spirit for most of his life, killed him.”

Paul and Freda, who now have two sons, live in terror of seeing them develop schizophrenia. they considered using a sperm donor, but couldn’t bring themselves to do so. …In 2008, Paul and Freda agreed to participate in a survey on schizophrenia genetics. “We sit by the phone, Freda said, “waiting to find out what the gene is, so we can test the kids.”

Harry’s mother: (Why didn’t the author let Harry speak for himself?  Harry’s mother’s testimony is hearsay)
“He presents as much better than he is, so even since his diagnosis, his therapists have picked up much less than they should have. He still thinks that if he acts like he’s normal he’ll be treated more normally by the world. All it means is that he doesn’t get as much help as he needs.”

Not so Far From the Tree

I’ve just started reading Far From the Tree, by Andrew Solomon. My friend, Lisa, who will be a first time grandmother in the next few weeks, handed it over to me because it wasn’t the kind of bedtime story a soon-to-be grandmother should be reading. Solomon’s book is about parents coming to grips with their child’s deafness, dwarfism, gayness, schizophrenia, etc.  Lisa said every chapter seemed to have an interview with a mother who said, “all seemed fine . . . until the baby was born.”

Does the apple fall far from the tree?  I don’t believe it does. Perhaps it’s my experience in Family Constellation Therapy that tells me that family inheritance is social and subtle, not all genetic. Andrew Solomon is gay, and in the forward to the book, he says something that is quite astonishing to me. He writes that most parents of gays are straight, and sexual identity gets picked up in the exterior environment with which the child comes into contact. Wait, wait! Sexuality, like other character traits, is on a spectrum. Not all men and women are robust representatives of their sexual assignment. Many people who have what we might think of as latent homosexual tendencies, get married and have children.  Sex may not be a big part of the relationship, other than feeling a societal duty to procreate. The child, will, however, observe, and draw a sexual identity

So, it’s telling that the author would portray schizophrenia as a brain disease,and pooh pooh the environmental influence almost altogether. He has been indoctrinated in the E. Fuller Torrey approach that is so discredited by activists in the psychiatric rights community.  Who did he interview for the schizophrenia chapter? The misery crowd. Mainly elderly parents of middle aged children who appear not to have made any attempt to understand their children in the context of a greater truths. The book description poses the question: “All parenting turns on a crucial question: to what extent parents should accept their children for who they are, and to what extent they should help them become their best selves.” By and large, the parents and families is the schizophrenia chapter appear to have neither accepted nor encouraged.

Had these parents shown more empathy and understanding, perhaps these stories would be different. Many tossed out their children to the streets, or group homes. Some chose not to speak to their child for years. (This sounds like how homosexuals were treated in years past, and in many cultures today.) They term their own progeny “crazy” and describe all the awful things their child has done to them. Today, would a parent be so derogatory towards a gay son or daughter? No, in western cultures, at least, there has been a revolution in thought, understanding and acceptance of a deviation from the norm.

Shouldn’t Andrew Solomon, given his identification with being a gay person, have realized the irony of the schizophrenia chapter? His portrayal of schizophrenia as dismal and chronic, just reinforces how strongly lobby groups like the Treatment Advocacy Center and NAMI have influenced the public understanding of mental illness. The misery crowd has blocked the public’s ability to see the common ground between gay rights activists and mental health activists. People with mental health issues, marginalized as crazy by TAC like groups, will not be effective advocates for themselves.

I’m looking forward to rereading the schizophrenia chapter and doing further posts on this subject. The author has some interesting observations that I would like to tease out.

How to help someone recover

The best advice I’ve come across about how to help someone recover from a mental illness is from Pat Deegan, Director of Training and Education at The National Empowerment Center. The entire article is available for a nominal fee from the National Empowerment Center. If you know someone who is experiencing a mental health crisis, you can become their powerful ally by absorbing the message in Recovery as a Journey of the Heart. Her article explains how people like herself who have been labelled mentally ill defend themselves againt profound disappointment and hurt.

“The fact that I was unmotivated was seen as a problem by the people who worked with me. But for me, giving up was not a problem, it was a solution. It was a solution because it protected me from wanting anything. If I didn’t want anything, then it couldn’t be taken away. If I didn’t try, then I wouldn’t have to undergo another failure. If I didn’t care, then nothing could hurt me again.”

Think about how Pat Deegan’s observations might apply to your own relative.

Lindsay Lohan, detox, and Adderall

Stories like the one below suggest to the public that (a) getting off prescription drugs doesn’t take long and (b) Adderall is a weight loss drug.

Editor’s note: Perhaps drug companies have a devious sense of humor. The word “addle,” which is embedded in Adderall, means “to make someone feel confused and unable to think clearly.”
(Cambridge Dictionary Online)

From The Daily Mail

And Lindsay Lohan is to be allowed to continue to take the prescription drug during her spell in rehab – at least for now.

On her entry to the Betty Ford Clinic in Indio, California, Lohan was required to undergo a 48-hour drug detox, which she has just successfully completed.

A source told website TMZ: ‘Doctors are currently evaluating Lindsay’s diagnosis and the efficacy of the drug. If doctors disbelieve her diagnosis or the usefulness of Adderall, they will cut her off.’

Lohan has taken the drug for years and believes she cannot function without it.

Her choice of rehab for her 90-day court-ordered stay was said to depend on finding one that would allow her both to continue taking the drug, and to smoke.

In an interview with the Daily Mail just last week she explained: ‘I have severe ADD. I can’t stand still.

‘So I take Adderall for that, it calms me.’

Lohan admitted that she knew the drug could be abused by those keen to experience its side effects.

Read more: http://www.dailymail.co.uk/tvshowbiz/article-2320905/Lindsay-Lohan-completes-48-hour-drug-detox-settles-rehab–shes-allowed-Adderall.html#ixzz2SsQa2ysB

 

The final few frontiers

Chris has come a long, long way, in many areas of growth, except for one very fundamental one. His sense of self is lagging. Always has. As a baby, toddler, and adolescent, he would be what he thought anyone wanted him to be. He expressed no preferences of his own, just took the preferences of others. I sensed his not wanting to confront or struggle while he was in the womb. (A possible clue: He was born twenty seven days overdue!) In high school, it kind of went undercover. He had friends, activities, school work to focus on. Then, boom, going away to university caused his non-existent sense of self to come tumbling down. My regret is that I should have recognized this a problem that he wouldn’t grow out of without some help, rather than thinking that he would eventually find himself. It’s a huge challenge for him now.

Today is Ascension Day, a holiday in many European countries. Chris knocked on our bedroom door around 9 a.m. to announce that he was going to his piano lesson. “On a holiday?” I asked. Apparently.  Less than an hour later I heard the key in the front door and Chris was back. Why was I not surprised? “The trains are only running on the hour, instead of every half hour, ” said Chris. “So, why didn’t you call me and I would have come and picked you up and driven you there?” said I, knowing full well that Chris never asks for anything that he thinks might cause others even slight inconvenience, which is why he never asks. He used to be endlessly apologetic; if you stepped on his toes, he’d figure it was his fault, but thankfully, less so these days. On the one hand, this particular character trait often reveals a kind heart and generous spirit. The dark side of this trait is not setting your own boundaries.

I got exasperated. “Chris, why do you deliberately sabotage these things? You must have known that the holiday train and bus schedule is always slower, and yet you went through the motions of going to your piano lesson, something you profess to enjoy, seemingly ignoring the fact that you need to plan ahead for the changed schedule. Why are you doing this to yourself?”

Tangled in with all of this is Chris’s huge fear of failure and a perverse perfectionism, so an unwillingness to try too hard.

Chris and I sat down and we went over the pattern of behavior. Chris feels bad, knows it’s a problem, but can’t for the life of him figure out what to do about it. (Eight years of psychiatry and we’re only beginning to crack this one.) “Do you read self-help books?” I asked. “Yes,” he answered.

“Chris, you can begin by small things. (I’ve been giving him this advice for years now, but it hasn’t sunk in.) Start asking people for help. Reach out. You’ll get mainly yes’s, but you’ll also get no’s, so deal with it. And, when your father sees you and asks you how your piano lesson went, what are you going to say?”

“Great?” ventured Chris.

 “You’re learning, Chris.”

Chris has a pathological inability to lie. Telling the truth is admirable and the best policy in most situations, but white lies can be useful protective devices from going into conversations you don’t want to have.

Half an hour later Chris asked me if I would drive him later today to a rendez-vous outside of town.

“With pleasure.”

“Oh, I should have said please,” said Chris.

“Why don’t you temporarily abandon ‘please’ while you build up a better sense of self? I said.”Look at your brother.” I pointed to Alex, who had just groggily emerged from his room.”Huge sense of self, doesn’t do anything that doesn’t suit him. He can be a pain in the ass, but he at least he gets what he wants.”

We both laughed.