Eve Ensler on what made her sick

Eve Ensler is the brilliant author, playwright, feminist (the list goes on) who is best known for The Vagina Monologues, which she wrote and performed along with countless other well-known women. She is currently on a book tour to promote her memoir, In the Body of the World.  Eve is an incest survivor whose writing focuses on the female body, violence and sex, so it is ironic that much of her recent history is taken up with her struggle with uterine cancer.

from The Globe and Mail
“She has a theory about what may have made her sick: The sexual abuse she suffered as a child, as well as the countless stories of horror she has heard over the years, may have contributed. So she has made a decision: She’ll still listen to those stories as she signs books or meets people at fundraisers, but she is not seeking those stories out any more.

“I just can’t. I have to protect myself,” she says. “I feel like I spent 15 years absorbing the stories. And I’m committed. I signed up. I don’t need to be convinced any more.”

Wise woman. She listened to the messages her body was signalling. To survive, she stopped dwelling on things that make her sick. There’s a message here for anyone. Eve Ensler also contributed a terrific chapter to Goddess Shift: Women Leading for a Change. (See the book elsewhere on this page.)

From Wiki
“This is a ravishing book of revelation and healing, lashing truths and deep emotion, courage and perseverance, compassion and generosity. Warm, funny, furious, and astute, as well as poetic, passionate, and heroic, Ensler harnesses all that she lost and learned to articulate a galvanizing vision of the essence of life: “The only salvation is kindness.””
 

CAMH psychiatrist reviews Silver Linings Playbook (unmoved by its lighter side)

A word of explanation. The Centre for Addiction and Mental Health (CAMH) is the facility in Toronto where Chris began his ordeal as a psychiatric patient in 2003. The place where we began to lose all hope.

Here’s why. TVO’s Inside Agenda blog recently rounded up CAMH psychiatrist Dr. Stephen Sokolov to review the film Silver Linings Playbook. Sokolov is predictably a voice of doom and gloom when it comes to “mental illness.” Abandon all hope, ye who enter CAMH! Family members, included.

Although Dr. Sokolov wasn’t one of the psychiatrists who saw Chris, his attitude is typical of the ones who did. Doctors who, no doubt meant well, but who kept the discussion clinical, which is alienating for patients and families. Imagine dealing with Sokolov when your “loved one” has been admitted to CAMH for the first time. He’ll dash any faint hopes you might be harboring. If you are lucky, perhaps you will find the reserves within you to reject the psychiatrist’s self-serving view of mental illness as a “treatable” disease, but it’ll probably take years to undo the damage.

From Sokolov’s review:

“The next day, we see Solitano taking his medications. The markings on the pills are clearly visible on screen as lithium 150 mg and Seroquel™ 100 mg — both, I must say, at subtherapeutic dose.”

and

“This isn’t the first time we’ve seen light treatment in film of a tragic subject (the obnoxious “Life is Beautiful” comes to mind).”

and

“In my opinion, the result is a trivialization of these serious conditions and the damage they inflict on people’s families, careers and, for too many, their lives, especially for the not unsubstantial number who commit suicide. The implicit theme in “Silver Linings Playbook,” true to the romantic comedy format, is: “Take your medicine, and you’ll get the girl.” I can’t help feel in part that this disingenuous and simplistic message dishonours many of those people who I’ve seen struggle with this terrible but treatable disease.

Last day to register for interactive family recovery course

I have registered for this course even though I feel that in many ways, our family is on top of our situation with our son, Chris. (I hope Chris feels the same way, too.) But, I can’t presume that I know everything there is to know about recovery from major psychiatric conditions and that there is nothing left to learn. I had to cobble together my wisdom over many years without access to resources that offer a positive perspective of recovery.

If you or someone you know might be interested in learning about the family recovery perspective through a weekly online course, please encourage them to consider enrolling.

Recovering our Families
8 Weeks of Hope and Healing

Our fully facilitated, interactive online course supports individuals, families, and friends who are recovering from or working with mental health challenges, trauma or psychiatric diagnoses such as schizophrenia, major depression, bipolar, anxiety and other disorders.

May 8, 2013 – July 3, 2013
Register Now, Space is Limited

During our 8-week course, individuals, families and supporters will explore key recovery concepts including:

1. Sharing our experiences

2. Exploring recovery fundamentals

3. Understanding mental health

4. Harnessing the power of hope

5. Using a strengths-based approach

6. Building relationships amidst psychosis

7. Creating healthy boundaries

8. Celebrating recovery stories

Our classes are open to anyone working with emotional distress – individuals, families, friends and mental health care providers. Group discussions, exercises and reflections will be guided by our family recovery coach in a password protected, media-rich closed group website to encourage safe sharing and healing in a supportive community.

About Us
Families Healing Together provides interactive, online family mental health education designed to help families and individuals transform the experience of emotional distress, psychosis and other challenges that may have psychiatric diagnoses. Our strengths-based recovery approach helps families move from distress, fear and confusion to greater sense of well-being, wholeness and connection. Families Healing Together is a collaboration between Family Outreach and Response, PracticeRecovery.com and Mother Bear CAN, three organizations dedicated to helping families recover from mental health challenges through healing power of community.

Course Title: Recovering Our Families

Next Session: May 8th – July 3rd 2013

Duration: 8 weeks

Facilitator: Krista MacKinnon

Time commitment: As little or as much as you can invest. To receive benefits from the course, a minimum of one hour per week is be required.

Cost: $150 USD

Register Here: Paypal Registration

New paradigm novels

My  guest today is author Jilaine Tarisa, who kindly gave me her permission to reprint her reflections on what is meant by a new paradigm novel. Her new paradigm novel, A Moment of Time, is available as an e-book. I got to know Jilaine because we were both writing about revolutionary ideas and ways of understanding old themes; she approaching it in the form of a novel and I in the form of memoir.

What Is a New Paradigm Novel? (Part Two)

Part Two: What Is a Paradigm?

Many people would consider his opinions extreme, Kimo knew, so he mostly kept them to himself. He could afford to view unsustainable lifestyles and practices with disdain, for he had never benefited from the prevailing model; he had no vested interest.
(from Chapter 24, A Moment of Time)

In Part One, I noted some of the characteristics of the conceptual box that has become known as the novel. In Part Two, I describe some of the features of paradigms.

In 1962, historian of science Thomas S. Kuhn published The Structure of Scientific Revolutions (hereafter “SSR”), a controversial work that challenged cherished notions about the nature of scientific development. Kuhn proposed that science does not progress in a linear fashion, as many had supposed, but encounters revolutionary periods during which the paradigm that has governed scientific inquiry and methodology is replaced with a new and incommensurate paradigm. In other words, the new view is incompatible with the old view and cannot simply be incorporated into the existing model. The new paradigm may be superior to the old one because its theories provide better explanations for questions the old paradigm could not answer; using the new paradigm’s methodologies, scientists may be able to solve problems that adherents of the old paradigm were unable or unwilling to address. New discoveries or inventions can precipitate a paradigm shift, allowing approaches to emerge that previously were not possible or feasible. (Study of the behavior of minute particles awaited the availability of instruments that made observation possible, for example.)

Kuhn’s early training was in physics and his primary interest was in articulating his views about the beliefs and practices unique to the natural sciences. (Science is a self-governing community; scientists themselves decide upon the rules and review each other’s work. Though researchers must adhere to ethical standards imposed by the larger community in which they exist (and practitioners of professions like medicine must comply with licensing requirements), no external authority defines the scope of scientific activity or determines whether a theory is plausible.) Nonetheless, in developing his theses Kuhn turned to the social sciences as well as philosophy. (He reviewed studies about the nature of human perception, for example, and refers in his work to Gestalt and Wittgenstein.) As a result, many of Kuhn’s observations apply to human endeavors outside of the scientific tradition. Since the 1960s, use of the term paradigm has spread to psychology, theology, and economics and is popular beyond the world of academia.

In SSR, Kuhn used the term “paradigm” in two ways. The first use refers to “the entire constellation of beliefs, values, techniques, and so on shared by the members of a given community.” (1969 Postscript to the third edition) (The second use, paradigms as exemplary past achievements, is less relevant to the discussion that follows.)

Despite individual differences, members of a community accept the particular views that the model they follow prescribes. Beliefs and assumptions can be explicit or unexpressed, but the adherence to the model is what defines the community. Different schools of thought within a discipline or profession may use similar terminology, share basic assumptions, and even study the same kinds of phenomena, but they will interpret the data according to the model, or paradigm, that guides their inquiry and determines the value of the results obtained. Ideas that run contrary to expectations predicted by the model are dismissed—the continued existence of the paradigm requires the elimination of extraneous matters so that the matters that are explained by the paradigm can be articulated in depth and detail. Problems that the paradigm cannot resolve are rejected as “metaphysical” or the concern of another discipline. (E.g., science cannot prove or disprove the continuation of consciousness after death; it remains, therefore, a matter of “faith.”)

The Importance of The Box

Kuhn says that “normal science” (i.e., “the activity in which most scientists inevitably spend almost all their time”) is an attempt to force nature “into the conceptual boxes supplied by professional education.” In other words, our training—in science or in other areas—tells us which items in the world of stimuli, experience, data, and sensation we should notice and pay attention to and which pieces are irrelevant or unimportant and can be ignored. Normal science strives “to bring theory and fact into closer agreement.” The paradigm’s raison d’être is to provide a framework for research that applies theory; the paradigm dictates what will be studied and how it will be studied. It also determines which results are valued and which are considered worthless (e.g., “mere” facts that do not advance understanding of the matters being studied). The placebo effect may merit investigation by some other discipline, but bears no relation to the question of a drug’s effectiveness in treating a particular disorder.

Commitment to a paradigm is essential; we must believe in what we are doing, or how could we invest the time, energy, and resources necessary to succeed in our endeavors? The firefighter must believe he (or she) has the necessary training and ability to rescue trapped inhabitants of a burning building before entering; the cult followers must believe they are on their way to a better life when they follow their leader’s instructions to drink cyanide-laced punch. Many of our choices in life are influenced by our beliefs and assumptions—and the stakes can be high.

If you are an astronomer and you believe that all the planets in our solar system have been discovered, you will initially attempt to identify an unknown celestial body as a comet or a star—which is exactly what happened for a century, until Sir William Herschel identified the planet Uranus after studying its orbit. (Of course, the community of astronomers decides what qualifies as a “planet”–a term that had no official definition until 2006, when the International
 read the rest here

Lowest effective dose is often much lower than the minimum dose

Common sense seems to be returning now that pharma is coming more and more under scrutiny. Keep in mind that lowest effective dose applies to psych drugs, too, and it may be more than half the minimum dose.

Here is an excerpt from The Globe and Mail.
Canadians overmedicated because MDs unaware of drug risks, experts say

ADRIANA BARTON The Globe and Mail
Published Thursday, Apr. 25 2013, 6:03 PM EDT
Last updated Thursday, Apr. 25 2013, 6:23 PM EDT

But more often than not, McCormack said, the dosage is too high. A phenomenon he calls the “unintentional medication overdosing” of Canadians is due to a systemic flaw in the drug regulatory process, he said. To prove that a medication works in clinical trials, drug companies select a dose high enough to generate a response in the majority of patients. The studied dose becomes the marketed dose – and the dose that most health professionals choose, he explained.

Studies to determine the lowest effective dose are rarely conducted. Nevertheless, many drugs work in much smaller doses, with fewer side effects, he said. For example, when the antidepressant Sinequan was introduced as a sleeping aid, the studied dose was 25 to 50 milligrams. Years later, however, a follow-up study found that 1 milligram of Sinequan “was effective for sleep,” McCormack said.

Unless a condition is severe or life-threatening, he said, patients should ask their doctor about starting with one-quarter to one-half of the marketed dose, and then increasing the dose as needed.

Memories

Driving to a doctor’s appointment today, I rounded a corner and thought I saw one of the mothers from Chris’s old recovery program about to cross the street. It’s been eight years since Chris and her son were in the program, and I wondered how she and he were doing. Did she manage to overcome the sadness that every parent in the program seemed to share about the hopes of their child’s recovery? Does she no longer believe in the medical model of psychosis that the program reinforced? I wonder.

Community Treatment Orders – superficially appealing

It’s really quite amazing that the British psychiatrist who was a champion of Community Treatment Orders, tested his own theory (published in The Lancet) and acknowledges that he was wrong. The evidence suggests CTOs don’t work. The re-hospitalization percentage was the same for both groups (those force treated for a short time) and those on CTOs. In my opinion, the damage inflicted on the CTO patient in the form of stigma and loss of civil liberties is a big contributor to worse mental health outcomes over time.

From The Independent

In the study, researchers compared two separate groups of mentally ill patients to test if they experienced fewer hospital admissions. The first set of 166 patients were under CTOs, which can initially last for up to six months and can be renewed at the end of this period. Meanwhile, the other 167 participants tested had been placed on Section 17 leave, which is intended to be only a very short-term solution and can last a matter of days.

Their findings, published in The Lancet this month, revealed that 36 per cent of patients in both groups were readmitted to hospital within one year. There were no significant differences between the two groups in terms of the frequency and duration of admissions, the study found.

Both sets of patients were also remarkably similar in their social and medical outcomes.

Professor Burns added: “We were all a bit stunned by the result, but it was very clear data and we got a crystal clear result. So I’ve had to change my mind. I think sadly – because I’ve supported them for 20-odd years – the evidence is staring us in the face that CTOs don’t work.”

The Lancet study

The Lancet, Early Online Publication, 26 March 2013
doi:10.1016/S0140-6736(13)60107-5
This article can be found in the following collections: Psychiatry (Schizophrenia)

Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial

Prof Tom Burns DSc, Jorun Rugås, PhD, Andrew Molodynski MBChB , John Dawson LLD, Ksenija Yeeles BSc , Maria Vazquez-Montes PhD, Merryn Voysey MBiostat, Julia Sinclair DPhil, Prof Stefan Priebe FRCPsych 

Interpretation

In well coordinated mental health services the imposition of compulsory supervision does not reduce the rate of readmission of psychotic patients. We found no support in terms of any reduction in overall hospital admission to justify the significant curtailment of patients’ personal liberty.

Take us both off the “mommy track” – please

I haven’t been posting much in the past few months, because, well, I feel increasingly awkward writing about my 29 year old son like he’s in kindergarten. “Chris’s first day at school, Chris tied his shoelaces today, etc. ” For crying out loud, he’s 29 and “mommy” should take a back seat, even if Chris isn’t the driver of the car. It just isn’t seemly on my part, at my age, to be so involved in being a mother to someone Chris’s age. Chris still doesn’t drive a car, BTW, as his problems came on just as he was taking young driver lessons. Hopefully, he will eventually decide to learn to drive and I can actually climb into that backseat.

However, I’m determined to show to parents and interested parties what the journey has been like, from the mother’s point of view, and the journey continues, as it does for all of us.  We still need to be find support for our situation when most of us aren’t in close physical contact with relatives of those with lived experience. So, here goes.

The goods news is that Chris had been meditating for over a year, is involved in his amateur theatre work, continues to take voice lessons, and has a girlfriend.  That takes a lot of the heat off me. My job has been to increasingly encourage Chris to take the lead in his own health and to speak up for himself. Maybe I’m way off base here, but I wonder how many 29 year old males are really motivated to get curious about their own health and research what to do about it? “I’m tired of doing all the legwork, Chris,” I whined last night (for the umpteenth time). There are self-help groups all over the net and YOU should be involved in them. I shouldn’t always have to draw them to your attention.” This last statement was uttered because Chris still occasionally struggles with hallucinations when he is alone during the day. And, being alone during the day with most of your activities skewed to nights and week-ends is a breeding ground for paranoia.

Another interesting development is that Chris and Dr. Stern are working on switching his medication to one (Risperdal) that affects fewer neurotransmitters than his current medication, Abilify. Abilify affects seven neurotransmitters, while Risperdal affects “only” four. Perhaps one reason Chris was recently not successful getting off the Abilify than he might have otherwise been if he were on a different medication, was that more neurotransmitters were implicated in the withdrawal. But, handling the meds are between Chris and Dr. Stern, and the switch is something they have apparently been discussing for a while. He’s been on Risperdal before. It was the medication that he was given when he was hospitalized for the first time. Chris said, and I agreed, that not one of the drugs he has used was particularly effective, but there you are.

Ian and I are still waiting for the day when Chris will work towards getting a university degree or announce he’s taking some course of action/training that will lead to employment. He tells me he is quite afraid of sitting in a classroom, which is odd, since he seems to have no trouble being on stage or singing solos in church. This is the big frustation point for us as his parents. We, of course, want him to move on to independence and self-sufficiency.

“Schizophrenic” teens and transgendered teens: Some observations

About a Boy, by Margaret Talbot, features in the March 15 edition of the New Yorker Magazine. The author writes about the growing numbers of teenagers–increasingly female ones– who are being surgically transgendered. The New Yorker only posts a small part of the article on the link I’ve provided. Do your own sleuthing to obtain this article, or, better yet, buy it in the name of sociological research. If you don’t already know anyone through your network of friends and relatives who has opted to become transgendered, trust me, you will. It is likely that a friend’s daughter is about to become your friend’s son. Through my own network of friends and relatives, I have personally met four cases, all of them female, who have started or have completed, the transition to male.

Why am I talking about transgender themes on my schizophrenia* blog? Because, as  someone who believes in the value of psychotherapy, who is skeptical of brain and body transforming medications and surgical interventions (electroshock), there is something very alarming indeed about the acceptance by the very young (and perhaps more reluctantly by their parents), of costly and dangerous cosmetic surgical interventions that have lifelong implications. A lifetime of drugs, a body that in other contexts is considered mutilated (think of the outcry surrounding female genital circumcision) and no going back. Homosexuality doesn’t call for medications or surgery, but transgender interventions do.  It is ironic that on the one hand, mental health activists are condemning the widespread medicating and over medicating of children and adults, electroshock for depression, and the dearth of access to psychotherapy, and on the other hand, under eighteens and young adults are clamoring for surgery, medications, and declaring that childhood trauma is not the issue here. I’ll bet that a sound argument can be made that these teens and young adults have trauma issues and that these issues should be explored in great depth before rushing into no going back decisions. But, that argument isn’t being raised.

I recently met with a MTFT transgendered person, who got her surgery done in Thailand by a Thai doctor who has done hundreds of these operations in his lengthy career. Because of this person’s age (60) and the fact that she had many years to consider her choice, the surgeon waived the ten year time frame that the decision process is supposed to take.

Medical misgivings aside, it is interesting that all the parents of the teens in the article are divorced, and the small sample of people I know who have transgendered, have parents who are divorced or never married. Coincidental or not coincidental? Transgendering is like saying I am now almost physically equal to a male or female and I will become more like the absent parent.

Years ago, when the baby boomer generation started getting divorced in droves, we were fed then latest societal myth about the effect of divorce on the child. Children are enormously resilient, we were told.  And it was in our interests to believe that myth. It was, after all, tailored to us and our needs, and the last thing anyone wants to feel about divorcing when children are involved, is guilty. The resiliency myth soothed our guilt. Well, now we are beginning to see one change that can happen in this day and age when children grow up with a remote male or female presence, secure in the knowledge that genders are equal, nourished by an increasingly daring Internet pop culture, and a slavish rejection by key opinion leaders of agreed cultural norms that that were built up over centuries norms.

Back to The New Yorker article: “But Danielle, a lawyer who had studied literary theory in graduate school, told me that she found herself puzzling over Aidan’s desire to transition. ‘I feel like of lot of these kids, including my daughter, might be going through identity struggles, a lot of them are trying on roles.’ We were having coffee at a pie shop in the Mission, at a long communal table. (At one point, the college student who’d been studying across from us politely interrupted to say that she, too, was about to transition to male.) Talking about Aidan, Danielle slipped back and forth between ‘she’ and ‘he,’ saying, ‘I’m still not convinced that it’s a good idea to give hormones and assume that, in most cases, it will solve all their problems. I know the clinics giving them out think they’re doing something wonderful and saving lives. But a lot of these kids are sad for a variety of reasons. Maybe the gender feelings are the underlying causes, maybe not……………….Danielle said that she had met many teenagers who seemed to regard their bodies as endlessly modifiable, through piercings, or tattoos, or even workout regimens. She wondered if sexual orientation was beginning to seem boring as a form of identity; gay people were getting married and perhaps seemed too settled……….’The kids who are edgy and funky and drawn to artsy things—these are conversations that are taking place in dorm rooms,’ Danielle said. ‘There are tides of history that wash in, and when they wash out they leave some people stranded. The drug culture of the sixties was like that and the sexual culture of the eighties, with AIDS. I think this could be the next wave like that, and I don’t want my daughter to become a casualty.’

Danielle thinks that “Aidan” is going through an identity struggle. Just as many people believe that a young person presenting as “schizophrenic” is also going through an identity struggle. The acquiescence to patients groups for the two conditions by psychiatry is telling. The DSM-5 continues to cling to the stigmatizing schizophrenia diagnosis, despite the opposition of those so labelled, but it has done away with the Gender Identity Disorder diagnosis, and replaced it with the more obfuscating term “Gender Dysphoria.” One group is listened to by psychiatry, the other is not.