A few days ago, Dr. Stern, Chris’s psychiatrist recommended that he go back on Abilify. I was dumbfounded! My observations were that Chris had been doing particularly well in the past weeks. He keeps up with his musical theater work, he was a project leader on a volunteer day, and he recently invited a woman friend over for dinner. A potential love interest is always promising news, IMHO.

So I e-mailed Dr. Stern asking her what she saw that I didn’t. And in return I got a list of behaviors that Chris was showing that were causing Dr. Stern to think he should be back on a low dose of Abilify for the time being. He was continuously late for his appointments, he kept forgetting to buy an appointment book (despite her many reminders)  he was talking very negatively about himself and his body movements were becoming less coordinated. According to Dr. Stern, he is showing prodromal symptoms. For several months, Dr. Stern has been taking a wait and see attitude with regard to possibly reinstating Chris’s med.

Before telling Ian (my husband) about this latest development, I asked him how he thought Chris was doing. “Getting worse” wasn’t his answer. He thought for a while, probably wondering what answer I was hoping he would say, and then said something to the effect that he’s doing okay, there’s always room for improvement, etc.  

Once I divulged to Ian what Dr. Stern had to say, then he said he could see what she was talking about. He was all for getting Chris back on a medication.

I know what Dr. Stern is talking about. I noticed that Chris seemed more anxious for a while, and then the anxiety subsided.  He has been dragging himself to his weekly appointments with Dr. Stern for ever, it seems, and he’s often late.  I wonder if Chris is more anxious in the presence of Dr. Stern. I also wonder if Chris is sick and tired of seeing her twice a week, while he continues to have nothing to fill his days with. I’d be depressed, too. Is his showing up late for his appointments a passive reminder that he doesn’t want to be there, anymore? He seems to have no trouble arriving for his rehearsals on time.  For now, anyway.

The cyclical nature of the past eight years has taught me that things may seem good for a really long time, there is always the danger of a backslide.

I can bitch about the fact that Dr. Stern’s twice a week psychotherapy hasn’t fixed Chris, and his occupational therapist hasn’t managed to get Chris occupied with work, but neither can I ignore their observations.

The last time Chris relapsed was when his youngest brother went away to college, the same period when Chris was finally off all his medications. Is this coincidence or not? I honestly don’t know. When I asked Chris at the time, why he relapsed, his answer was that he missed having Taylor around. With his little brother gone, he got more and more weepy, and he took on all of the prodromal symptoms of what is called “psychosis,” which eventually put him back in the hospital and back on medication. This time around, our middle son, Alex, has moved out. Sept. 15th to be precise. Chris is already expressing his sadness at not having Alex around, even if he only saw Alex for a minute in the morning or a little bit a night.

Dr. Stern acted fast to hopefully turn off the early signs  of future relapse. I say, hopefully, because I just don’t know what helps prevent relapse and what doesn’t. I’ve feel I’ve looked at the question from all angles and still come up short. What I do think I know is that, at this stage of Chris’s evolution, having regular work and, better yet, paid work during the day, and cultivating friendships in the workplace might go a long way to help his depression. I say “might” because I really don’t know what recovery is all about. Everybody has a theory. I can’t make recovery happen for Chris. I can guide, I can step back, I can supply him with information, but at some point I give up.

The first step is to break Chris’s unhappiness before it gets out of control, and if this has to be a chemical cosh, it will just have to be. I’ve tried all kinds of non-drug alternatives that have increased his resilience. He’s just not 100% resilient, yet.  I will ignore all the doom and gloom information about antipsychotic drugs and their side effects, because it’s in my best interests now to stay calm. Antipsychotics have their place, and they may be the only tool at one’s disposal during a crisis that can stabilize the situation quickly.

In the meantime, here’s what I’m doing to handle this crisis, in no particular order.

• I’m trying to be positive and upbeat.
• I’m using mindfulness techniques and visualizations.
• I’m giving Chris practical advice (and, yes a few ultimatums) for organizing himself. One is get a mobile phone by Friday and load all of his contact numbers into it. Two is to get a bus pass. No more excuses of being late to appointments because he doesn’t have change for the bus.
• I’m trying to put this latest piece of news in perspective. Chris has generally been doing well, so this is just a bump on the road to eventual full recovery.
• I’m taking a renewed interest in helping him find his way.

Get Behind Open Dialogue Movement for Mental Health

Target: US Department of Health and Human Services  
Sponsored by: Susan V  

Dr. Peter Lynch has released a new video in his series exposing misinformation that has dominated the mental healthcare industry far too long.

He, among others, says it’s not true that chemical imbalances in the brain cause mental illness, that psychiatry is solidly grounded in science or that its drugs correct any so-called imbalances. Also false, says Lynch, is that psychiatry and drugs are the best we have to deal with mental illness – that no other treatment options exist.

The real problem, he says, is not brain pathology. “It is emotional distress.”

And Dr. Jaakko Seikkula would agree. In the 1980s Seikkula and a team in Tornio, Finland developed an innovative treatment program that focuses on alleviating the emotional trauma of those in distress. This “Open Dialogue” has consistently reduced the need for hospitalization and medication and also reduced relapse “when compared with treatment as usual.”

With PTSD on the rise, exacerbated by two wars and added economic stress, it is destructive for the US DHHS to continue supporting the old myths about mental illness, while ignoring this new and effective treatment that the Institute for Dialogic Practice is teaching within the US.

Tell the Dept of Health to put full steam behind the Open Dialogue movement.

sign here

One of my favorite blogs is Refusing Psychiatry (Without Pissing Off the Neighbors). The author’s bio says “I became an attorney late in life primarily to advocate for the universal human right to refuse psychiatry.” I believe that the author is now retired but volunteers his legal services in his state’s penal institutions. You can follow him on Twitter: @mentalhealthlaw 

In his most recent post, he examines the case of Rep. Jesse Jackson Jr.. Rep. Jackson recently was released from the Mayo Clinic after being treated for bipolar II disorder.

MONDAY, AUGUST 27, 2012

The August 26 edition of the Southtown Star, a neighborhood newspaper in Chicago, includes a letter from one Cornell Hudson of Steger.

Mr. Hudson complains that U.S. Rep. Jesse Jackson Jr. (D-2nd) is receiving the best medical care in the world from the Mayo Clinic, which most of his constituents could never afford.  He continues, “Because of a recent lack of funding, his constituents can no longer visit the recently closed community mental health center that has served the South Side for 37 years. Had Jackson sought care from this center, it might still be open.”

But community mental health centers, and state institutions like Tinley Park Mental Health Center, are being closed because the people of Illinois simply do not want to pay for this garbage any more. Psychiatry has clearly failed to reduce mental illness by operating under a medical model, given the opportunity of almost unlimited funding for at least two generations. Arguably, the total efforts of the mental health orthodoxy have dramatically increased the incidence of mental illness and disability!

Read the rest here

Monica Cassani at Beyond Meds has alerted me to an excellent article at the Wilson Quarterly.

Concerning the content of the Wilson piece, she writes:

Yes, slowly but surely there begins a recognition that what gets called mental illness cannot be explained with the bio-medical model.

From The Wilson Quarterly an article well worth reading with the recent history of how that which is called mental illness is considered in society and how that is changing since the psychopharmacological era has clearly failed:

Please check out Monica’s page for a list of high quality recovery resources that she recommends. She also has a bookstore on her site where you can order much of the material.

One thing that struck me about the Wilson Quarterly article was the recognition that diagnosing someone with a mental illness almost always guarantees that recovery will be harder to achieve. For quite some time researchers have puzzled over why schizophrenia outcomes are invariably better in countries with less reliance on Western medical practices. The article sheds some light on this:

Indian families also don’t treat people with schizophrenia as if they have a soul-destroying illness. As an anthropology graduate student, Amy Sousa spent more than a year in northern India, sitting with doctors as they treated patients who came with their families into a dingy hospital where overworked psychiatrists can routinely have 10 appointments an hour. Many of the doctors didn’t mention a diagnosis. Many of the families didn’t ask. There was a good deal of deception—wives grinding medication into the flour for the daily chapattis they made for their husbands, doctors explaining to patients that they were completely well but should take strengthening pills to protect themselves from the ravages of their youth. As a result, none of the patients thought of themselves as having a career-ending illness, and every one of them expected to get better. And at least compared to patients in the West, they generally did.

It’s heartening to see that the the Indian deception (the biochemical model of the illness calls this “denial”), is finding its way into the American health care system. Under the old United States’ regime, as the article explains, people had to state their diagnosis in order to get housing.

The new kind of intervention simply gives people housing without asking them to admit to a diagnosis. Programs like the one that helped Susan are supported by federal funding set aside for people with serious mental illness, but the benefit is not described that way to clients. Though Susan knows that she has subsidized housing, she thinks she got it because she entered a program at a shelter to help her get off crack. Those who created programs like the one Susan is in believe that the social setting in which a patient lives and imagines herself have as much to do with her treatment as any medication. In general, the data prove that they are right. People are more likely to accept housing when offered it in these programs than in care-as-usual settings, and after they are housed their symptoms lessen—whether or not they are taking medications.  

School teachers don’t encourage their students to become better students by labelling them stupid. Empowering students by bolstering their self-esteem was a revolution of its own kind – remember the dunce cap?

The recovery movement in mental health is more and more vocal about rejecting the diagnosis because it has long recognized how self-limiting for people the diagnosis can be. In my son’s case, my husband and I reversed our thinking about the diagnosis and the best treatment, but it has taken us years to get the message across to my son that we were wrong to uphold it for as long as we did. I’m still not sure that our message of empowerment has trumped in his mind the original, discouraging diagnosis.

Read the rest of the Wilson Quarterly article here

September is here and my “children” are no longer even attending university, so I don’t get the same frisson of back to school excitement that I used to get around this time. Alex, our 26 year old, has just this week moved out to a place of his own. Taylor, the 22 year old, has started his first job a few time zones away.

That leaves Chris (28) at home. I’ve already broached the subject with him of his starting university afresh, if not this year, then the following year, but he should at least begin planning towards this goal. Chris is well enough now that he can take steps to become more independent and work toward some career goals. It’s a scary prospect, of course. Four years ago when I encouraged him to go back to university, he promptly suffered a relapse. He’s much more resilient now,

There are so many factors he needs to consider:

• Is he ready?
• What would he study?
• Is he willing and able to tackle the application process? 
• What size of institution will make him feel more comfortable? Big or small?
• How will he handle the fact that he will be a mature student in a sea of 18 to 22 year olds? A smaller college might be more to his liking, but there will be fewer people his own age. How can he overcome loneliness?

This plan may not happen this year, because there is still the possibility that Chris may not be ready, and I’ll just have to accept that.

Eventually, something’s gotta give.

Dr. Thomas Szasz, Psychiatrist Who Led Movement Against His Field, Dies at 92

By BENEDICT CAREY

Published: September 11, 2012

Thomas Szasz, a psychiatrist whose 1961 book “The Myth of Mental Illness” questioned the legitimacy of his field and provided the intellectual grounding for generations of critics, patient advocates and antipsychiatry activists, making enemies of many fellow doctors, died Saturday at his home in Manlius, N.Y. He was 92.

He died after a fall, his daughter Dr. Margot Szasz Peters said.

Dr. Szasz (pronounced sahz) published his critique at a particularly vulnerable moment for psychiatry. With Freudian theorizing just beginning to fall out of favor, the field was trying to become more medically oriented and empirically based. Fresh from Freudian training himself, Dr. Szasz saw psychiatry’s medical foundation as shaky at best, and his book hammered away, placing the discipline “in the company of alchemy and astrology.”

The book became a sensation in mental health circles, as well as a bible for those who felt misused by the mental health system.

Dr. Szasz argued against coercive treatments, like involuntary confinement, and the use of psychiatric diagnoses in the courts, calling both practices unscientific and unethical. He was soon placed in the company of other prominent critics of psychiatry, including the Canadian sociologist Erving Goffman and the French philosopher Michel Foucault.

Edward Shorter, the author of “A History of Psychiatry: From the Era of the Asylum to the Age of Prozac” (1997), called Dr. Szasz “the biggest of the antipsychiatry intellectuals.”

“Together,” he added, “they tried their hardest to keep people away from psychiatric treatment on the grounds that if patients did not have actual brain disease, their only real difficulties were ‘problems in living.’ ”

This attack had some merit in the 1950s, Dr. Shorter said, but not later on, when the field began developing more scientific approaches.

To those skeptical of modern psychiatry, however, Dr. Szasz was a foundational figure.

“We did not agree on everything, like his view that there is no such thing as mental illness,” said Vera Hassner Sharav, president and founder of the Alliance for Human Research Protection, a patient advocacy group, and a longtime critic of the field. “But his message that people get designated as ill, labeled and then shafted out of society and preyed on by an industry dominated by drugs — that’s where he was very valuable.”

After making his name, Dr. Szasz only turned up the heat. From his base in the psychiatry department of SUNY Upstate Medical University in Syracuse, he wrote hundreds of articles and more than 30 books, including “Ideology and Insanity: Essays on the Psychiatric Dehumanization of Man” (1970) and “Psychiatric Slavery: When Confinement and Coercion Masquerade as Cure” (1977).

In 1969, in a move that damaged his credibility even among allies, he joined with the Church of Scientology to found the Citizens Commission on Human Rights, which portrays the field as abusive and regularly pickets psychiatric meetings.

Dr. Szasz was not a Scientologist himself, and he later distanced himself from the church, but he shared the religion’s critical view of psychiatry. His provocations were not without cost. In the 1960s, New York mental health officials, outraged at his attacks on the state system, blocked Dr. Szasz from teaching at a state hospital where residents trained, according to two former colleagues. Dr. Szasz bristled but had little recourse, and his teaching was curtailed.

Dr. Szasz opposed the American Psychiatric Association’s broadening of its diagnoses in its new manual.

“For the record, I will say that I admired him, even though I think he was dead wrong about the nature of schizophrenia,” said Dr. E. Fuller Torrey, founder of the Treatment Advocacy Center in Arlington, Va., which supports stronger laws to ensure treatment of people with severe mental disorders. “But he made a major contribution to the issue of the misuse of psychiatry. His message is important today.”

Thomas Stephen Szasz was born in Budapest on April 15, 1920, the second child of Julius Szasz, a lawyer, and the former Lily Wellisch. The family moved to Cincinnati in 1938, where the boy became a star student. He earned a degree in physics from the University of Cincinnati and graduated from the university’s medical school in 1944.

After an internship and residency, he enrolled at the Chicago Institute for Psychoanalysis, earning his diploma in 1950. He worked at the Chicago institute and served in the United States Naval Reserve before joining the faculty of SUNY Upstate.

He wife, Rosine, died in 1971. Beside his daughter Dr. Peters, he is survived by another daughter, Suzy Szasz Palmer; a brother, George; and a grandson.

Dr. Szasz was widely sought after as a speaker and presented with dozens of national and international awards. Until the end of his life he continued to discuss psychotherapy, the practice he was trained to perform and of which he became so skeptical.

“The goal is to assume more responsibility and therefore gain more liberty and more control over one’s own life,” he said of talk therapy in an interview in 2000 with the Web site Psychotherapy.net. “The issues or questions for the patient become to what extent is he willing to recognize his evasions of responsibility, often expressed as ‘symptoms.’ ”

A version of this article appeared in print on September 12, 2012, on page A29 of the New York edition with the headline: Dr. Thomas Szasz, Psychiatrist Who Led Movement Against His Field, Dies at 92.

I heard via the grapevine that Thomas Szasz died today, but have seen nothing in today’s newspapers about this event. Whatever the outcome, Thomas Szasz will be alive and kicking up controversy for years to come.

Here’s a recent letter to the editor of Cato Unbound condemning the Cato Institute for continuing to uphold Szasz’s libertarian ideas about the power of the state. The author takes issue with Szasz’s central belief that there is no such thing as mental illness and she asserts that government policy was deeply endebted to Szasz’s thinking by closing state hospitals. The editorial writer is experiencing a distressed state of her own, as it was largely the advent of the first generation anti-psychotics, not public policy embracing hippiedom, that emptied  state mental hospitals. It wasn’t just tthe new drugs, of course. The state has long believed in exactly in something called mental illness and has always acted on that belief, never very efficiently or elegantly. To think that Thomas Szasz influenced public policy back then is absurd. Hollywood, perhaps. One Flew Over the Cuckoo’s Nest, definitely.

excerpt: The upshot was that a literally mad idea—the bizarre conceit that the ancient, ongoing and universal scourge of mental illness did not in fact exist—became the foundation of public policy. Legislators and lawyers emptied state mental hospitals. As readers of Amanda Pustilnik’s contribution already know, their role has been taken over by jails and prisons. Involuntary commitment became contingent on imminent dangerousness and even then treatment was uncertain because the law instituted a right to refuse treatment, which could be exercised even after commitment.

I blog about my own particular experience with Chris’s diagnosis of schizophrenia. One thing that I have not had to grapple with is recreational drug use. This makes my experience dissimilar to that of some of other parents that I have been in contact with over the years.  I don’t know the territory. Neither Chris, nor his two brothers, to the best of my knowledge, have ever taken street drugs, like marijuana, like LSD, etc. Or, if they has experimented with these drugs (I’m not totally naive), their behavior never brought it to my attention. I guess I am lucky that the only drugs Chris has been subjected to were the “legal” ones prescribed by his psychiatrists.  This makes our journey less complicated in some ways, as a war is not being conducted on two fronts.

But how does one handle a son or daughter who refuses to believe you when you say to them that their love of the weed is not helping their psychosis? What do you do or say if they insist otherwise? There is a part of me that believes their version of what is good for them, or needed at the time, should be respected. But, it is hard to sit by and watch someone deteriorate into paranoia, panick, and anxiety when the drug wears off following an initial happy, pleasant, and lucid experience. Habitual recreational drug use often chooses your friends for you, and may expose you to dangerous situations. Like prescribed medication, it becomes hard to sort out the effects of the drugs from the effects of the causative trauma.

There are special addiction programs, for individuals and for relatives. The trouble with these, as I see it, is that they treat the symptoms, not the person. The person, in their eyes, is considered an addict, a dual-diagnosed, and a problem in need of fixing. The goal is to get them clean. These programs may divert attention away from getting better help.

Where is good advice available on how to discuss your concerns about recreational drug use with your relative that is respectful of their own views on this matter? Is there a particular book that you recommend? A documented approach? Is there a more creative approach that a family member can use that will help a person resolve underlying emotional issues that doesn’t allow recreational drug use to become a stumbling block in the conversation?

From the Well Column of the New York Times: Overtreatment Is Taking a Harmful Toll

After several years of physical suffering and near financial ruin from the medical costs, the couple began questioning the treatment after consulting with other patients in online support groups. Mr. Power spoke with his own primary care doctor, who advised him to find a new specialist to oversee Ms. Power’s care. “It’s a really hard thing to determine when they’ve crossed the line,” Mr. Power said. “You think she’s getting the best care in the world, but after a while you start to wonder, what is the objective? He seemed caring, but he didn’t really consider my wife’s time and the suffering she was going through having all these tests done.”

Under the new doctor’s care, the regular testing stopped and Ms. Power was finally able to achieve remission. Now she sees the doctor only four or five times a year.

Read the rest here.