Beware a public backlash against psychotherapists and a return to medications

I wrote a comment about the perils of blame on the Op-Ed page at the Mad in America blog. I’m wondering if either I have got it all wrong by seeing blame in the piece where no blame was intended, or else I’ve rightly sensed that psychologists are publicly back to blaming family for a relative’s mental illness because they are sensing a growing strength in numbers. At least one other blogger at the Mad in America site got jumped on recently for family bashing. He denied it of course, but like the Op-Ed author, he sprinkled his post with anecdotes about nasty family members of his patients. I call this kind third party relaying of a message “hear say.” Perhaps it’s hypocritical of me, but in my opinion, it’s okay for a patient to blame a family member for his suffering (as he’s 100% entitled to interpret the cause of his suffering the way he does because he knows his experience) but it’s different thing for a psychotherapist to turn around and publicly make negative attributions on individuals he’s probably never met outside of the therapy room. What purpose does this serve? There are ways of getting a healing message across that will not lead to charges of family bashing.

I think it’s appropriate for parents and relatives to examine their role in a family member’s mental illness (parents, especially), and I know how difficult it has been to get this message across in the era of no-blame antipsychotics, when parents would prefer to blame faulty biochemistry rather than venture out into more helpful ways of looking at mental illness. I do believe in personally looking in the mirror and then doing whatever it takes to changing aspects of the relationship that may have caused trauma for your relative. I do believe this and I encourage others to do the same thing because one really can help someone recover this way.

Selling the “look yourself in the mirror” message is a particular hard sell to parents because all parents feel guilty at some level about the way they have raised their children, whether there is a diagnosis of mental illness or not. Nobody likes criticism. Most people don’t react well to it, unless it’s done constructively. When psychiatrists or psychologists write or speak in a public forum, I believe they have a special duty to be non-inflammatory, and non-judgmental. This doesn’t mean that, if they believe the family environment is an important factor in the development of mental illness, they shouldn’t say so, but they should be super vigilant about how their words will be construed.

I’d like to know what you think about Albert Silver’s Op-Ed piece. Is he really family bashing or have I got it wrong? I’d like to hear what you think because I believe this topic is going to become increasingly debated as psychotherapy gains ground at the expense of medications. I contributed a lengthy comment at the end of his Op-Ed in which I pointed out that there may very well be a backlash if the role of family in mental illness isn’t handled constructively.

Check out NAMI Westside LA upcoming conference

They say change always starts in California (the birthplace of NAMI). The NAMI Westside LA agenda for its annual conference (April 22, 2012) includes Robert Whitaker (author, Anatomy of an Epidemic), Dr. Daniel Dorman (author, Dante’s Cure), Catherine Penny and Dr. Michael Livittan.

SESSION 1
Workshop 1 – Robert Whitaker
Evidence-Based Solutions that Promote Robust Recovery: Open Dialogue Therapy in Finland, Exercise for Depression, and Other Promising Therapies
In western Lapland in Finland, only a small percentage of first-episode psychiatric patients are treated with antipsychotics, with the focus instead on psychosocial care. The long-term outcomes for these patients are now the best in the Western World. Why does this approach work so well, and could it be adopted here? Meanwhile, in Britain, depressed patients can obtain a prescription for exercise, which has been shown to produce a much better long-term stay-well rate than antidepressants.

Here in the United States, there is a non-profit group that has formed, called the Foundation for Excellence in Mental Health Care, that is seeking to promote such evidence-based therapies that best promote robust recovery.Worshop 4 – Daniel Dorman, Catherine Penny

This workshop will explore therapeutic approaches that have proven to produce good long-term outcomes, and detail the efforts of the Foundation for Excellence in Mental Health Care to promote such evidence-based therapies here.

PSYCHOTHERAPY OF SCHIZOPHRENIA RESULTING IN FULL RECOVERY. Dr. Dorman and his former patient, Catherine Penney, will discuss “What worked.”
Catherine Penny, age nineteen was admitted to UCLA Hospital suffering from catatonic schizophrenia. Daniel Dorman, M.D., then a resident-in-training, was interested in treating those suffering from schizophrenia psychotherapeutically, without medication, hoping that a human connection oriented towards understanding his patients’ struggles might be curative. Ms. Penney and Dr. Dorman will discuss how their relationship served to help Ms. Penney establish a sense of self, thus relieving her of her terrors and poor self-esteem which allowed her to resume her life, free of the hallucinations and mental shut-down that characterized her years of suffering from schizophrenia. Dr. Dorman and Ms. Penney will also discuss how the current medical model of mental illness needs to be expanded to include a person’s meanings and efforts toward individuation and self-sufficiency.
 
SESSION 2
Workshop 10- Dr. Michael Livittan
HEALING TRAUMA: THE MIND, THE BRAIN, AND THE FAMILY
This seminar provides an understanding of trauma and its effects on the individual mind, brain, and the family as a whole. The definition, impact, symptoms, and dynamics of trauma are explored in simple yet in-depth terms. Mental and emotional processes, as well as new research on the brain, are explained to highlight the consequences of trauma. In addition, the impact on the family is examined in order to better understand post-traumatic behaviors. Methods and practical tools are provided to facilitate coping, healing, and moving forward with compassion, vitality, and wisdom.

complete list of Robert Whitaker’s upcoming speaking engagements is found on the Mad in America site.

Schizophrenia research study hogwash

I dunno about you, but I have trouble figuring out what most psychiatric research studies are actually saying. The language is clinical gibberish. Here’s a typical example that I found at the Mad in America blog. My own take on this, not what the study actually says, is that depression accompanying  high levels of insight correlate with people correctly interpreting the hopelessness conveyed by their diagnosis. (Note the study’s definition of recovery. This is not recovery in my books. What it is is managing your illness.)
The conclusions drawn from this study are some of the reasons I don’t believe in mental illness. I do believe that there are people who believe in mental illness, and they will do their best to convince you that you are hopeless. As long as someone else believes you are mentally ill, and you are in close proximity to that person, chances are you will remain mentally ill.
http://onlinelibrary.wiley.com/doi/10.1002/jclp.20872/abstract

The Role of Subjective Illness Beliefs and Attitude Toward Recovery Within the Relationship of Insight and Depressive Symptoms Among People With Schizophrenia Spectrum Disorders

Keywords:

  • psychosis;
  • awareness;
  • demoralization;
  • illness perception;
  • recovery;
  • hope

Objective

Low levels of insight are a risk factor for treatment nonadherence in schizophrenia, which can contribute to poor clinical outcome. On the other hand, high levels of insight have been associated with negative outcome, such as depression, hopelessness, and lowered quality of life. The present study investigates mechanisms underlying the association of insight and depressive symptoms and protective factors as potential therapeutic targets.

Methods

One hundred and forty-two outpatients with schizophrenia or schizoaffective disorder (35.2% women, mean age of 44.83 years) were studied using questionnaires and interviews to assess insight, depressive symptoms, recovery attitude, and illness appraisals with regard to course, functional impairments, and controllability. Psychotic and negative symptoms were assessed as control variables. The cross-sectional data were analyzed using structural equation models and multiple linear regression analyses with latent variables.

Results

Higher levels of insight and psychotic symptoms were associated with more depressive symptoms. The association of negative symptoms with depressive symptoms was not significant. The relationship between insight and depressive symptoms was mediated by the participants’ perception of their illness as being chronic and disabling, as well as suppressed by their expectation of symptom control due to treatment. Finally, the association of insight and depressive symptoms was less pronounced in the patients with a positive recovery attitude than in those without this protective factor.

Conclusions

To achieve recovery, which includes symptom reduction, functional improvement, and subjective well-being, it is necessary to prevent depressive symptoms as indicators of a demoralization process, which may arise as a consequence of growing insight. Possible treatment strategies focusing on changes of dysfunctional beliefs about the illness and the self and inducing a positive recovery attitude are discussed.

International society removes ‘schizophrenia’ from its title

TUESDAY, 13 MARCH 2012

International society removes ‘schizophrenia’ from its title

A statement from the ISPS today reveals that the society has voted to remove the word ‘schizophrenia’ from its title due to the term being deemed ‘unscientific andstigmatizing’:  

“Members of the International Society for the Psychological Treatments of the Schizophrenias and Other Psychoses (www.isps.org) have just voted, by an overwhelming majority, to change the society’s name to the International Society for Psychological and Social Approaches to Psychosis. The new logo and letterhead are to be adopted by the end of March.  

The change comes at a time when the scientific validity of the term schizophrenia is being hotly debated in the lead up to the publication of the latest edition of the Diagnostic and Statistical Manual (see http://dxrevisionwatch.wordpress.com).  

Read more  http://blog.humangivens.com/2012/03/international-society-removes.html

TV Ontario’s new series on mental health

Toronto blog correspondent “Liz” has tipped me off to a new TV Ontario series on mental health. The series kicks off with a psychiatrist Iain McGilchrist (author of The Master and his Emissary: The Divided Brain and the Making of the Western World) joining a debate with psychiatrist Norman Doidge (author of The Brain That Changes Itself) and Roger McIntyre, Professor of Psychiatry and Pharmacology, University of Toronto), discussing whether we are any closer to understanding the source of mental illness.

Here’s the link to the debate. It’s actually quite an interesting discussion, especially McGilchrist’s contribution. Read the promotion for the series (below). I think TVO should be looking for its better understanding of mental illness outside of the mental institution (CAMH) with which it is partnering. CAMH is notorious for retracting its job offer to David Healy in 2000 when Eli Lilly objected to his comments that Prozac and SSRIs can lead to  suicide. (see footnote* about the Healy affair at the bottom of this page)

Institution are there to preserve the status quo, no more so than when they are psychiatric institutions. You may recall that Chris spent time in CAMH’s Early Psychosis Unit. I question whether anybody at CAMH now has a better understanding of mental health than when Chris was there in 2003. Nobody at CAMH talked to us about brain plasticity. In fact, they told us that if Chris didn’t take the drugs his brain would atrophy. (This was their way of panicking us to buy into the drugs.) The doctor labelled him “schizophrenic” after speaking with him for an hour – tops. We were told that he would probably need the medications for life.

No sirree, if I were TV Ontario and looking for ways to understand the source of “mental illness,” I wouldn’t go to institutions that, for self-serving reasons, fail to understand mental illness. I were TV Ontario, I’d be looking to writers, poets, ex-patients to explain.

Mental Health Matters
..by Sandra Gionas Tuesday March 6, 2012

When our Agenda on the Road series was winding down, and we began to rethink how we would engage our audience across the province, we envisioned leaving the studio, not spurred by geography, but rather by a cause or idea that resonates in people’s lives.

And there are few topics which affect as many people as mental health issues. Whether or not you are the one in five Canadians who will have a mental illness during your lifetime, you will certainly have a child, parent, sibling, relative, friend, colleague, or neighbour who will. While we’ve come a long way in understanding more about mental illness and the stigma that surrounds it, we still have far to go.

What we here at The Agenda, indeed TVO, hope to accomplish in the months ahead, is to engage our viewers and bring about a better understanding of mental health. To help us to that end, we have partnered with the Centre for Addiction and Mental Health (CAMH). What this partnership will bring to our Agenda audience is access to the knowledge capital at CAMH, as well as engaging live chats, Q&As, and blog posts from the medical front line; from the community leaders at the world-renowned facility.

We even took our partnership to new heights in January, in a basketball challenge with CAMH clients at their Queen Street site.

The Agenda team after a spirited afternoon of basketball.

Aside from basketball, we’ve been engaging with CAMH professionals and clients since the beginning of this season, in order to enrich our own understanding of the issues, and the mental health community around CAMH.
To that effect, from today forward, we will be airing a mental health-themed discussion on The Agenda every other Tuesday. We will be launching our permanent Mental Health Matters microsite in mid-April, with a plethora of mental health stories, using the depth and richness of TVO’s archived content, along with additional resources. All this will culminate in Mental Health Matters week at TVO, which will coincide with Canadian Mental Health Week, May 7-13, 2012. Look for five nights of original programming, both in studio and with studio audiences (more information on how you can join us will come in the weeks ahead).

And the programming and web content won’t begin and end there, with us. Big Ideas, TVOKids, TVOParents, Allan Gregg in Conversation, Saturday Night at the Movies, and TVO Doc Studio will also focus on Mental Health Matters, both online — beginning in April — and on air during Mental Health Week.

Which brings us to tonight’s kick-off broadcast. Noted British psychiatrist Iain McGilchrist is the author of The Master and His Emissary: The Divided Brain and the Making of the Western World, a book examining the relationship between the brain’s two hemispheres. He’ll sit down for an interview with Steve Paikin.

McGilchrist’s appearance on Monday night at the Gardiner Museum — which will air on Big Ideas during Mental Health Week — was standing room only.

After his feature interview with Steve, Dr. McGilchrist will join our roundtable for a discussion on where mental illness resides: Is it in our biology? Or does it occur because of social pressures? In other words, we’re starting small, with a simple debate on Nature versus Nurture!

We hope you join us in the weeks ahead, and of course tonight – by watching the program at either 8:00 p.m. or 11:00 p.m., or by watching our live stream at 8:00 p.m., and joining our live chat, hosted by myself and producer Daniel Kitts. And please don’t forget to come back here to let us know what you thought of our programming, to share your own stories, and to join us on this very important journey.

Follow me on Twitter @sandragionas

________________________
*On December 7, 2000, shortly after Healy’s talk he received an email from Dr. Goldbloom, who was retracting his previously offered position at CAMH. The reason Goldbloom indicated was as follows: “Essentially, we believe that it is not a good fit between you and the role as leader of an academic program in mood and anxiety disorders at the Centre and in relation to the University. This view was solidified by your recent appearance at the Centre in the context of an academic lecture. While you are held in high regard as a scholar of the history of modern psychiatry, we do not feel your approach is compatible with the goals for development of the academic and clinical resource that we have.”[18] However, Healy believes that his job offer was retracted because his critical views of the pharmaceutical industry and especially Eli Lilly. This has been denied by the then-President of the University of Toronto, Prof. Robert Birgeneau who stated in a letter to the Canadian Association of University Teachers (CAUT) that Healy’s contract was “not influenced in any way by Eli Lilly or by any other pharmaceutical company.”[19]

Eli Lilly was a significant contributor to the University of Toronto. It supported 52 percent of the budget for the Mood and Anxiety Disorder Clinic that Healy would have headed up. In addition it gave a 1.5 million dollar gift to CAMH to help its fundraising campaign. Furthermore, there was precedent for Eli Lilly removing its financial support in response to anti-Prozac comments or publications. In March 2000, the Hasting Center published an article by Healy which indicated that Prozac induced suicide. Eli Lilly pulled their support of $25,000 per annum. The Hasting Center re-reviewed the article but stood behind its decision.

Psychiatrists: Put away the prescription pads and bring out the controllers

A new industry has been born — the vast brain training industry, which is only going to increase in market share.

Being a natural skeptic, I am somewhat dubious about the claims that brain training will alleviate the symptoms of schizophrenia, but I applaud any efforts to help people get back onto their feet that don’t involve drugs. In my experience, almost any therapy that Chris undertook that didn’t involve drugs helped him improve without debilitating side-effects. The brain is not the mind, however, and it’s this distinction that may be lost when it comes to helping people overcome schizophrenia through the use of video games. Brain training implies that the person has brain and cognitive deficits, that as far as I know, have not been scîentifically proven when it comes to schizophrenia. Much of schizophrenia has to do with the “soft science” of treating emotional issues.
 
Treating schizophrenia: Game on

Michael Merzenich has a plan for how to convince sceptics of the worth of his brain-training video games: prove that the software can help people with schizophrenia.

Erika Check Hayden
29 February 2012

The brain-training industry — which was projected to grow from US$265 million in 2008 to between $1 billion and $5 billion by 2015 — markets games that claim to boost skills such as memory or focus in healthy adults. But for those likely to need it most, such as elderly people, there has been no convincing evidence that the games work any better than the mostly free activities that physicians routinely recommend, such as physical exercise, socializing with friends, taking up a new hobby or playing a musical instrument. “Really well-designed clinical trials to test the efficacy of these devices are few and far between. It’s sort of like the Wild West,” says Peter Snyder, a neurologist at Brown University’s Alpert Medical School in Providence, Rhode Island.

Merzenich, however, feels that he has fought long enough to prove the validity of brain training. Now, he says, it is time for regulators to weigh in. Treating schizophrenia with software would mark a change for psychiatry, which tends to focus on dispensing drugs in the first instance. Vinogradov says that the growing realization of drugs’ shortcomings and a shift away from the idea that brain deficits are immutable are sparking desire for alternative options.


“The dominant force in psychiatry has been the focus on treating symptoms, not the underlying dysfunction. The patient is this passive object to whom you give pills, as opposed to actively helping to stimulate constructive interaction with his or her environment,” Vinogradov says.


And Merzenich doesn’t plan to stop with schizophrenia. The Brain Plasticity Institute in San Francisco, another Merzenich-founded company, is studying brain-training software for conditions ranging from Alzheimer’s disease to traumatic brain injury. “If we do this in a disciplined way, with scientific confirmation that is beyond question,” Merzenich says, “we’ll very rapidly evolve into a very important aspect of psychiatric medicine.”

This could be your new relationship with your psychiatrist.
scene from The 40 Year Old Virgin

Wellness Wordworks peer support intervention

Wellness Wordworks

Instant Mental Health Peer Support Showing emotional distress as temporary and transformative

“Peer Support is THE most effective mental health intervention”



– National Association of State Mental Health Program Directors, “What Helps, What Hinders,” a report on how effective Peer Support is for Mental Health Recovery

Wellness Wordworks was founded in 2008 by Corinna West. We are building an innovative mental health care model called Instant Peer Support. We are using Google Gigabit technology to provide a 24 hour video call in support line for people to find resources for handling emotional distress. All of our staff will be people who are themselves in recovery for mental health diagnoses. Our video line will be linked with crisis care opportunities and community mentors to bring people into social activities.

This will relieve much of the burden on our over-stressed local mental health centers. We plan for recovery outcomes that are much higher than current mental health delivery models.

Consider joining this great initiative

We have a duty to protect our children

Becky Murphy is the force behind Involuntary Transformation.

Op-Ed

A MadMother: We Have a Duty To Protect Children

Becky Murphy
February 15, 2012

The recent reports by ABC News and the Senate Hearing on December 1, 2011, which was presided over by Senator Tom Carper, are the latest of many investigations and hearings into psychiatric drugs being used on foster children. But the fact is that the indiscriminate use of psychotropic drugs prescribed off-label is widespread, and not limited to children in foster care. Children who live with their parents often have the same safety and protection issues as children in foster care and experience equally harmful effects from the drugs.

When children are harmed instead of helped with psychiatric drugs it is always tragic. When the child lives with his or her parents, the parents can’t understand why the help—the medication—is not helping, but hurting.

My son was diagnosed with temporal lobe epilepsy the month he turned seven years old. It is a neurological condition known to be caused by a brain injury, and can cause the same symptoms as schizophrenia. When he was diagnosed with temporal lobe epilepsy, he also had been getting mental health treatment services for over three years and had a diagnosis of PTSD. He had this diagnosis because he had been the victim of violent assault when he was three years old and in foster care.

My children were in foster care due to my own failure to deal with the effects of my own traumatic childhood. I placed my sons in foster care, when I became unable to care for them. My youngest son was placed in a home that had twelve reports filed with Child Protective Services. After he was victimized, I believe that the State of Washington attempted to cover it up, with little regard for how this would cause my son further harm. I was not informed of the trauma my son had experienced.

Read the rest of this moving testimonial here.