Thanks to Beyond Meds for bringing to our attention Doris Lessing's thoughts on schizophrenia. "So, craziness is not as far away as we'd like to think," and she goes on further in the article to give her thoughts about loneliness bringing on craziness and how what we call Alzheimers and dementia might be linked to the loneliness of old age.
My mother started to develop signs of dementia about the same time that Chris began developing signs of dementia praecox (schizophrenia). I don't know what really caused this, we tend to think of it as something that just happens in old age, but I do know that it began to develop around the time that my parents decided it was time to move back to Canada from Florida to be closer to my sister. The timing of this has convinced me to avoid making any life-changing decisions involving moving great distances when I am that old. My mother was a very intelligent woman and she was panicked by dementia. But, it was noticeable that she would "rise to the occasion" as my father would say, when they had company. She otherwise would spend many lonely hours in a house and a town she didn't know or care for, humming to herself. For a while, she could still win at bridge.
My sisters and I wanted my father to get a break from being a twenty-four hour caregiver, so we tried to persuade my mother to check out an activities program at the local hospital. She sensed something was wrong as we drove into the parking lot. She started to curse under her breath that there was no way in hell she was going to go to a "program." Miraculously, she pulled herself together on the tour on the five pin bowling room and the art therapy class. You would never know she had problems by the way she asked appropriate questions and professed great admiration for the set-up. She thanked the staff very nicely and then went home and refused to go back.
We once left Chris by himself for a week when my husband and I were both on business travel. This was at a time when he seemed to be well enough for us to chance it. When I got home, he was acting really strange He had drawn all the blinds and was talking gibberish and acting "spooked." This took a few weeks to work its way through. It was enough to convince me that being alone, being abandoned, is the almost worst thing that can happen to someone.
Thursday, April 29, 2010
After Her Brain Broke
After Her Brain Broke: Helping My Daughter Recover Her Sanity, by Susan Inman (introduction by Michael Kirby, Chair, National Mental Health Commission of Canada; with endorsements by E. Fuller Torrey, MD, Daniel Kalla, MD, Stephanie Engel, MD and others)
I ordered this book, not because I thought I would agree with it, but because there is actually another mother out there who has written about the mental health diagnosis of her child, which in this case is kickstarted by Paxil for some kind of depression/difficulties, thus raising bipolar, which then becomes schizoaffective, schizophrenia and OCD. With that many diagnoses, I would have lost my faith in psychiatry much earlier than I actually did. Susan Inman has not lost faith in psychiatry, only with the kind of psychiatry that doesn't come with a prescription. If you are a person, like I am, who believes that schizophrenia is not a brain disease and that medications are ruinous in the long run, then this book is not for you. I am dismayed about how heavily the author relies on E. Fuller Torrey. Many people feel that the references cited in this book, including E. Fuller Torrey, Dr. Nancy Andreasen, and the National Alliance on Mental Illness (NAMI) have contributed to the rise in the overuse of antipsychotic medications today.
Mothers come in all shapes and sizes and political leanings. If there is one thing that the author and I might be able to agree on is the dismal state of psychiatry and how badly it has served both patients and families alike. Where we differ is in the details. It would come as no surprise to anyone since E. Fuller Torrey endorses this book, that Susan Inman fully subscribes to the broken brain theory of mental illness. The title strikes me as an homage to psychiatrist Dr. Nancy Andreasen's book, The Broken Brain. Now even Dr. Andreasen has started to warn about the dangers of long term use of antipsychotic medication, something she helped promulgate. That's no help to the people who have suffered under this regime, but hey, again, that's how badly served people are by psychiatry. Susan Inman, despite the ten different medications her daughter has been on in about as many years, still clings to the idea that a better drug will be invented.
I can excuse that belief to some extent because the broken brain biochemistry model is what people have been told for decades by doctors they are supposed to trust, and families are desperate. However, my son and my family and others are the products of the NAMI/Torrey/Andreasen cabal that insists that medications are the only way to deal with schizophrenia. We suffer at the hands of doctors who refuse to consider that medications aren't helping and are actually hurting people's chances of real recovery. The doctors weren't honest with us. They never clued us in that there are competing theories of mental illness, and that medication is not always the way to go. This is called "full disclosure" in other areas of endeavor. Neuroleptic medications are a bitch to withdraw from. Telling the doctors that weight gain, increased risk of diabetes, tardive dyskinesia and early death is unacceptable when there are other avenues out there falls on deaf ears.
I have a hard time with Susan Inman's other main point (and Dr. Torrey's): That the family background has nothing to do with a mental illness. She seems unwilling to even remotely entertain the idea that maybe there is something in the family environment beyond just a medical diagnosis of bipolar and epilepsy in distant relatives, that might have something to do with the rage and suspicion that her daughter spat back at her. She is upset with anybody who seems to even hint at this. Like it or not, most people labeled mentally ill, I have found, do believe it is their family that contributed to their breakdown. (People don't listen to mental patients' actual complaints.) No, the problem is with her daughter's biochemistry, she asserts. The family is not dysfunctional, her daughter is mentally ill. She bristles at the suggestion of Expressed Emotion, as one of the doctors in a family education class spoke about. She reasons that she and her husband have been very careful not to criticize their daughter. The problem with Expressed Emotion, in my opinion, is that it is a concept that nobody has bothered to properly explain and therefore nobody really knows what it is about. It is a concept that I believe is valid, and is much larger than the family criticizing (or not) their relative. It is also the emotion around being told that you are mentally ill and that you must accept your sickness. Organizations like NAMI do this very well. What it tells the suffering individual is that there is something wrong with them. How can someone get well if they are constantly told they are sick and that they must accept that they are sick or they won't get well? That is like a school teacher telling a child that they are stupid, but if they want to do well, they must first admit their stupidity. This approach is discouraged in every other area except mental health, apparently. Pity is also Expressed Emotion. So are medications (feeling singled out trauma associated with being fat, drooling, unable to drink alcohol when everybody else can, etc.). Expressed Emotion can be delivered by doctors and society. (Schizophrenia is the Diagnosis of Doom.) I had to find out about Expressed Emotion for myself. It is not mentioned much these days for exactly for the reason that Susan Inman found objectionable. She writes: "Fuller Torrey sees a lot of this work as just one of many efforts to find new ways to blame families." Really? If anything, I think that family background has been unexamined for decades for fear of offending people.
I'm a mother, too, and I may not be wild about people hinting that maybe I should take a look at myself, but what I cannot understand is someone who isn't intellectually curious and fearless enough to be willing to investigate the possibility if it could result in breakthroughs for her daughter. Yes, there are good therapies that address this (even for schizophrenia!), but that would mean, of course, that they might tread into family background. Susan Inman refuses to go down that path. She paints an idyllic but sketchy portrait of family life. How many of us are that fine and noble as parents? I am ashamed of things I have said and done in moments of anger when my children were small. My son's childhood was normal enough, but mental illness is a lot more nuanced that what is on the surface. People on the outside looking in might think that ours was a normal family, and it was, but it isn't really. No family is normal. None. What is so hard about that?
Susan Inman has such fears about anything less than a perfect family for her children that I fear she has not stretched herself enough to be honest with her daughter or herself. A holistic person would feel that the person with the label is on to something, even if not understanding the root of it. Psychiatry has been too busy with the prescription pad in the second half of the last century to build on the base established by Freud, Jung and others in the first half. Freud appears to be utter rubbish to her. She has bought the medical model. She routinely dismisses the idea that there is another side to this. When a member of the Vancouver Playwrights' Theatre Centre writes a letter objecting to the terms of the guidelines of the conference the author is sponsoring, saying that there is no evidence that schizophrenia is a neurobiological disorder, she portrays the basis for his opinion as mental illness being invented by psychiatry and pharmaceutical companies to make money. Full stop. No acknowledging that this is a widely held opinion by many thoughtful people. Most people have no opinion about schizophrenia unless they have an intimate involvement with it, as I would assume the letter writer has. She sees his complaint as romanticizing mental illness. This is what she calls an anti-science approach, which makes me sad because science hasn't been especially good to her daughter or my son. When her daughter manages to enroll in a sociology class, she discovers to her horror that the teacher tells the class that pharmaceutical companies in cahoots with psychiatrists have made up a bunch of mental disorders for which there is no evidence. Well, isn't a first year college course (especially sociology) exactly the kind of place that should challenge your closely held assumptions? Not when it comes to mental illness, I guess.
To Susan Inman's credit, she is tenacious, but in a completely opposite way than I would go. She's got involved with NAMI to fight the stigma. I said NAMI perpetuates stigma. Stigma will remain as long as people are not getting better. "Science" has enabled people to remain mentally ill and now it wants mental illness to be accepted by removing the goal posts. NAMI is an organization that encourages relatives to continue to medicate their relatives, thus putting real recovery even further out of reach. U.S. Congressional investigators have determined that, in recent years, the majority of NAMI's donations have come from drug makers. The disclosure came about after longstanding criticism of NAMI for coordinating its lobbying efforts with drug makers and pushing legislation that also benefits the pharmaceutical industry.
To illustrate what a colossal train wreck the biochemical model of mental illness is, it is interesting to see how dosage is viewed in different countries. Of course, recommended doses are changing yet again, so what Susan Inman and I were told a few years ago is not what we would be told today, but here is her experience. She goes to the Menninger Clinic in the United States and is told that the level of meds her daughter was on in Canada was not high enough. Doctors in the United States administer much higher doses of antipsychotics early in the treatment because they have found it more effective in stamping out psychosis. This causes her to worry, naturally, that it is too late for her daughter. In Europe where we live, the doctors told me that in North America the doses are too high and that in Europe they have found that minimal doses work best. I am not thrilled with the European logic, either, because what is actually considered a low dose? If someone passed me an antipsychotic and urged me to try one, even at a low dose, I would decline. I don't think I would function very well.
Kudos to Susan Inman for being a mother willing to write about a difficult subject. I have wrestled with the rating I want to give this book. It's a gripping read. My hesitation is that when someone first is given The Diagnosis of Doom the doctor may suggest that you read E. Fuller Torrey, and now maybe they will include Susan Inman's book. If you want to actually get over your diagnosis, you will have to look elsewhere. The web is full of self-help advice from people who've been there and emerged transformed. No praise to this book for perpetuating the NAMI biochemical "just take your meds and don't even bring up the family environment" version of mental illness. Schizophrenia is not like any other illness. It has to be tackled with more imagination and respect than just administering drugs and telling your relative that it's brain damage. Refusing to recognize the importance of the family background will guarantee the persistence of the purely pharmaceutical model and extended mental illness.
I ordered this book, not because I thought I would agree with it, but because there is actually another mother out there who has written about the mental health diagnosis of her child, which in this case is kickstarted by Paxil for some kind of depression/difficulties, thus raising bipolar, which then becomes schizoaffective, schizophrenia and OCD. With that many diagnoses, I would have lost my faith in psychiatry much earlier than I actually did. Susan Inman has not lost faith in psychiatry, only with the kind of psychiatry that doesn't come with a prescription. If you are a person, like I am, who believes that schizophrenia is not a brain disease and that medications are ruinous in the long run, then this book is not for you. I am dismayed about how heavily the author relies on E. Fuller Torrey. Many people feel that the references cited in this book, including E. Fuller Torrey, Dr. Nancy Andreasen, and the National Alliance on Mental Illness (NAMI) have contributed to the rise in the overuse of antipsychotic medications today.
Mothers come in all shapes and sizes and political leanings. If there is one thing that the author and I might be able to agree on is the dismal state of psychiatry and how badly it has served both patients and families alike. Where we differ is in the details. It would come as no surprise to anyone since E. Fuller Torrey endorses this book, that Susan Inman fully subscribes to the broken brain theory of mental illness. The title strikes me as an homage to psychiatrist Dr. Nancy Andreasen's book, The Broken Brain. Now even Dr. Andreasen has started to warn about the dangers of long term use of antipsychotic medication, something she helped promulgate. That's no help to the people who have suffered under this regime, but hey, again, that's how badly served people are by psychiatry. Susan Inman, despite the ten different medications her daughter has been on in about as many years, still clings to the idea that a better drug will be invented.
I can excuse that belief to some extent because the broken brain biochemistry model is what people have been told for decades by doctors they are supposed to trust, and families are desperate. However, my son and my family and others are the products of the NAMI/Torrey/Andreasen cabal that insists that medications are the only way to deal with schizophrenia. We suffer at the hands of doctors who refuse to consider that medications aren't helping and are actually hurting people's chances of real recovery. The doctors weren't honest with us. They never clued us in that there are competing theories of mental illness, and that medication is not always the way to go. This is called "full disclosure" in other areas of endeavor. Neuroleptic medications are a bitch to withdraw from. Telling the doctors that weight gain, increased risk of diabetes, tardive dyskinesia and early death is unacceptable when there are other avenues out there falls on deaf ears.
I have a hard time with Susan Inman's other main point (and Dr. Torrey's): That the family background has nothing to do with a mental illness. She seems unwilling to even remotely entertain the idea that maybe there is something in the family environment beyond just a medical diagnosis of bipolar and epilepsy in distant relatives, that might have something to do with the rage and suspicion that her daughter spat back at her. She is upset with anybody who seems to even hint at this. Like it or not, most people labeled mentally ill, I have found, do believe it is their family that contributed to their breakdown. (People don't listen to mental patients' actual complaints.) No, the problem is with her daughter's biochemistry, she asserts. The family is not dysfunctional, her daughter is mentally ill. She bristles at the suggestion of Expressed Emotion, as one of the doctors in a family education class spoke about. She reasons that she and her husband have been very careful not to criticize their daughter. The problem with Expressed Emotion, in my opinion, is that it is a concept that nobody has bothered to properly explain and therefore nobody really knows what it is about. It is a concept that I believe is valid, and is much larger than the family criticizing (or not) their relative. It is also the emotion around being told that you are mentally ill and that you must accept your sickness. Organizations like NAMI do this very well. What it tells the suffering individual is that there is something wrong with them. How can someone get well if they are constantly told they are sick and that they must accept that they are sick or they won't get well? That is like a school teacher telling a child that they are stupid, but if they want to do well, they must first admit their stupidity. This approach is discouraged in every other area except mental health, apparently. Pity is also Expressed Emotion. So are medications (feeling singled out trauma associated with being fat, drooling, unable to drink alcohol when everybody else can, etc.). Expressed Emotion can be delivered by doctors and society. (Schizophrenia is the Diagnosis of Doom.) I had to find out about Expressed Emotion for myself. It is not mentioned much these days for exactly for the reason that Susan Inman found objectionable. She writes: "Fuller Torrey sees a lot of this work as just one of many efforts to find new ways to blame families." Really? If anything, I think that family background has been unexamined for decades for fear of offending people.
I'm a mother, too, and I may not be wild about people hinting that maybe I should take a look at myself, but what I cannot understand is someone who isn't intellectually curious and fearless enough to be willing to investigate the possibility if it could result in breakthroughs for her daughter. Yes, there are good therapies that address this (even for schizophrenia!), but that would mean, of course, that they might tread into family background. Susan Inman refuses to go down that path. She paints an idyllic but sketchy portrait of family life. How many of us are that fine and noble as parents? I am ashamed of things I have said and done in moments of anger when my children were small. My son's childhood was normal enough, but mental illness is a lot more nuanced that what is on the surface. People on the outside looking in might think that ours was a normal family, and it was, but it isn't really. No family is normal. None. What is so hard about that?
Susan Inman has such fears about anything less than a perfect family for her children that I fear she has not stretched herself enough to be honest with her daughter or herself. A holistic person would feel that the person with the label is on to something, even if not understanding the root of it. Psychiatry has been too busy with the prescription pad in the second half of the last century to build on the base established by Freud, Jung and others in the first half. Freud appears to be utter rubbish to her. She has bought the medical model. She routinely dismisses the idea that there is another side to this. When a member of the Vancouver Playwrights' Theatre Centre writes a letter objecting to the terms of the guidelines of the conference the author is sponsoring, saying that there is no evidence that schizophrenia is a neurobiological disorder, she portrays the basis for his opinion as mental illness being invented by psychiatry and pharmaceutical companies to make money. Full stop. No acknowledging that this is a widely held opinion by many thoughtful people. Most people have no opinion about schizophrenia unless they have an intimate involvement with it, as I would assume the letter writer has. She sees his complaint as romanticizing mental illness. This is what she calls an anti-science approach, which makes me sad because science hasn't been especially good to her daughter or my son. When her daughter manages to enroll in a sociology class, she discovers to her horror that the teacher tells the class that pharmaceutical companies in cahoots with psychiatrists have made up a bunch of mental disorders for which there is no evidence. Well, isn't a first year college course (especially sociology) exactly the kind of place that should challenge your closely held assumptions? Not when it comes to mental illness, I guess.
To Susan Inman's credit, she is tenacious, but in a completely opposite way than I would go. She's got involved with NAMI to fight the stigma. I said NAMI perpetuates stigma. Stigma will remain as long as people are not getting better. "Science" has enabled people to remain mentally ill and now it wants mental illness to be accepted by removing the goal posts. NAMI is an organization that encourages relatives to continue to medicate their relatives, thus putting real recovery even further out of reach. U.S. Congressional investigators have determined that, in recent years, the majority of NAMI's donations have come from drug makers. The disclosure came about after longstanding criticism of NAMI for coordinating its lobbying efforts with drug makers and pushing legislation that also benefits the pharmaceutical industry.
To illustrate what a colossal train wreck the biochemical model of mental illness is, it is interesting to see how dosage is viewed in different countries. Of course, recommended doses are changing yet again, so what Susan Inman and I were told a few years ago is not what we would be told today, but here is her experience. She goes to the Menninger Clinic in the United States and is told that the level of meds her daughter was on in Canada was not high enough. Doctors in the United States administer much higher doses of antipsychotics early in the treatment because they have found it more effective in stamping out psychosis. This causes her to worry, naturally, that it is too late for her daughter. In Europe where we live, the doctors told me that in North America the doses are too high and that in Europe they have found that minimal doses work best. I am not thrilled with the European logic, either, because what is actually considered a low dose? If someone passed me an antipsychotic and urged me to try one, even at a low dose, I would decline. I don't think I would function very well.
Kudos to Susan Inman for being a mother willing to write about a difficult subject. I have wrestled with the rating I want to give this book. It's a gripping read. My hesitation is that when someone first is given The Diagnosis of Doom the doctor may suggest that you read E. Fuller Torrey, and now maybe they will include Susan Inman's book. If you want to actually get over your diagnosis, you will have to look elsewhere. The web is full of self-help advice from people who've been there and emerged transformed. No praise to this book for perpetuating the NAMI biochemical "just take your meds and don't even bring up the family environment" version of mental illness. Schizophrenia is not like any other illness. It has to be tackled with more imagination and respect than just administering drugs and telling your relative that it's brain damage. Refusing to recognize the importance of the family background will guarantee the persistence of the purely pharmaceutical model and extended mental illness.
Tuesday, April 27, 2010
Thoughts in passing
I wonder about the U.S. Military. How is it that being under psychiatric treatment means you get to STAY in the military and still perform your functions? Flat feet used to render you unfit to serve in World War II, although Donald Duck did serve in the army (KP duty I've heard.)
I wonder how come we are doing the legwork on Chris's meds reduction rather than allowing the psychiatrists to manage the process?
I wonder why Daniel Carlat thinks he's been too focused on hunting for textbook symptoms of mental disorder in his patients and then he turns around and diagnoses a patient with ADD and gives her Ritalin like he has learned nothing at all?
I wonder how Phillip Dawdy and Mike and Sam are these days.
I wonder how come we are doing the legwork on Chris's meds reduction rather than allowing the psychiatrists to manage the process?
I wonder why Daniel Carlat thinks he's been too focused on hunting for textbook symptoms of mental disorder in his patients and then he turns around and diagnoses a patient with ADD and gives her Ritalin like he has learned nothing at all?
I wonder how Phillip Dawdy and Mike and Sam are these days.
Another run at med reduction
Chris has the go-ahead by his psychiatrists to start lowering the Serdolect. (He is on 8 mg Serdolect and he remains on 10 mg Abilify for the foreseeable future.) I am not necessarily optimistic that this will be the beginning of the end of the medications, but I'm willing to entertain the thought. The problem the last time, despite the fact that the psychiatrist recommended a program of supplements and slow, methodical lowering over a one year period, was that Chris relapsed anyway eight months after finishing the reduction program. So, I tend to take it all with a grain of salt.
This time I consulted a website that instructs Chris to pre-taper for a week before the taper by adding certain supplements such as Omega 3 and Body Calm. Then he begins an exponential process of lowering his meds by 5% every fourteen days for a total of six weeks, waiting two weeks, then reducing every two weeks by 10% until the end. The number of vitamins he needs is minimal to the thirty-five supplements he was on the last time.
I hesitate to leave the process entirely to Dr. Stern, mainly because doctors have a reputation of lowering the medication too fast. Whether or not anything we are doing will define the outcome remains to be seen. Chris is also thinking about starting yoga classes, which in addition to his chakra spinning sound therapy and the books he reads hopefully will give him the resilience he needs to successfully pull this off.
Chris has been on medications for six years, and only off them for a brief period of about a year. I must confess to feeling a bit jaded about the outcomes. We can do everything right and he could still relapse. There is more to relapse than blaming it all on the meds. So, we will try to maintain a calm, non-judgemental environment. We will not put pressure on him do start any new directions.
This time I consulted a website that instructs Chris to pre-taper for a week before the taper by adding certain supplements such as Omega 3 and Body Calm. Then he begins an exponential process of lowering his meds by 5% every fourteen days for a total of six weeks, waiting two weeks, then reducing every two weeks by 10% until the end. The number of vitamins he needs is minimal to the thirty-five supplements he was on the last time.
I hesitate to leave the process entirely to Dr. Stern, mainly because doctors have a reputation of lowering the medication too fast. Whether or not anything we are doing will define the outcome remains to be seen. Chris is also thinking about starting yoga classes, which in addition to his chakra spinning sound therapy and the books he reads hopefully will give him the resilience he needs to successfully pull this off.
Chris has been on medications for six years, and only off them for a brief period of about a year. I must confess to feeling a bit jaded about the outcomes. We can do everything right and he could still relapse. There is more to relapse than blaming it all on the meds. So, we will try to maintain a calm, non-judgemental environment. We will not put pressure on him do start any new directions.
This week's obituaries
Alice Miller, a psychoanalyst who repositioned the family as a locus of dysfunction with her theory that parental power and punishment lay at the root of nearly all human problems, died at her home in Provence on April 14. She was 87.
Dr. Mortimer Sackler. . . became a prominent psychiatrist, specializing in schizophrenia and depression, before becoming a pharmaceutical entrepreneur along with his brothers Arthur and Raymond. The brothers were convinced that pharmaceutical solutions and what they called psychobiology could replace common treatments such as electric shock or lobotomy. But it was only when Mortimer was nearly 80, 14 years ago, that the painkiller OxyContin, produced by his company Purdue Pharma, brought him a serious fortune. That drug alone brought in $2.5bn last year. He and his family were estimated a few years ago as worth £300m but he gave much, if not most, of his wealth to education, science, medicine and culture.
Dr. Mortimer Sackler. . . became a prominent psychiatrist, specializing in schizophrenia and depression, before becoming a pharmaceutical entrepreneur along with his brothers Arthur and Raymond. The brothers were convinced that pharmaceutical solutions and what they called psychobiology could replace common treatments such as electric shock or lobotomy. But it was only when Mortimer was nearly 80, 14 years ago, that the painkiller OxyContin, produced by his company Purdue Pharma, brought him a serious fortune. That drug alone brought in $2.5bn last year. He and his family were estimated a few years ago as worth £300m but he gave much, if not most, of his wealth to education, science, medicine and culture.
Monday, April 26, 2010
The readers' revenge
A sample of readers' comments to the Carlat article in today's New York Times:
"I'm glad that at least one psychiatrist has noticed that most psychiatrists could be replaced very effectively by an online multiple-choice questionnaire and a vending machine."
"Your profession is not listening to your patients. Of course talk therapy should not be suspended. That seems obvious. Why is it not to you and your profession? And why has your profession accepted the "20 minutes" deemed by the insurance companies as adequate and the standard of care?"
"A psychiatrist is advocating for the importance of understanding the person for whom he/she is prescribing medication. That would be refreshing news, were it not so dismaying that we have a system of treatment where such an obvious and fundamental principle is in need of such advocacy. Part of the problem with psychiatric care is the fact that you perceive other mental health professionals as "lower in the mental-health hierarchy," rather than as colleagues."
"I'm glad you've written a book, Dr. Carlat. I could write a book--actually I have--wrote it at UCSF, too. I've had over 20 years of various forms of pscyotherapy,counselling, my own personal psychopharmacologist, and the one thing none of these many professionals has ever "gotten" is that I'm a human being. I keep wondering how that can be. On the other hand, back when I was married to a philosophy professor (when he was teaching at a v. small college), I met his new colleague across the hall, the psychology prof. Turned out he'd never read Freud, or so he claimed. I'm no particular fan of Freud overall, but it does seem to me that someone who has taken the trouble to earn a PhD in psychology might at least have the curiosity to find out what the man had to say. And that in an anecdotal nutshell is what is wrong with psychiatry today--most professions today--lack of curiosity about what's outside the walls of the profession."
"Clearly, mental illness is a brain disease.." I'm sorry, but that is not clear at all. The mind and the brain are not the same thing; they may overlap in a functional sense, but the physical organ of the brain is neither the seat of consciousness nor the locus of the sense of self. It is sad that psychology, the only discipline of modern medicine that took the mind seriously, has devolved into the simplistic materialism of its peers."
"Am I the only reader who found it discouraging that Doctor Carlat spent a just a little more time with a patient and then congratulated himself on finding yet another drug to prescribe? He does not seem to have abandoned his deeply ingrained practice of symptom hunting at all."
"I undoubtably have an unbalance or two but those years in therapy taught me the SKILLS I needed to face any problems I come across head on, and deal with the resulting feelings. My mother, on the otherhand, accepted the "medicate" method of treatment over the years, and continues to have years that are like train wrecks."
"One psychiatrist attending one of my sons as an in patient even exhorted me several times in a single visit to get on anti-depressants myself, “Mr., I see it in your eyes!” My response was, "Yes, I'm depressed over my son's situation, but no thank you, I'm going to a lap pool instead!"
See also, Brainless and Mindless my post from today.
"I'm glad that at least one psychiatrist has noticed that most psychiatrists could be replaced very effectively by an online multiple-choice questionnaire and a vending machine."
"Your profession is not listening to your patients. Of course talk therapy should not be suspended. That seems obvious. Why is it not to you and your profession? And why has your profession accepted the "20 minutes" deemed by the insurance companies as adequate and the standard of care?"
"A psychiatrist is advocating for the importance of understanding the person for whom he/she is prescribing medication. That would be refreshing news, were it not so dismaying that we have a system of treatment where such an obvious and fundamental principle is in need of such advocacy. Part of the problem with psychiatric care is the fact that you perceive other mental health professionals as "lower in the mental-health hierarchy," rather than as colleagues."
"I'm glad you've written a book, Dr. Carlat. I could write a book--actually I have--wrote it at UCSF, too. I've had over 20 years of various forms of pscyotherapy,counselling, my own personal psychopharmacologist, and the one thing none of these many professionals has ever "gotten" is that I'm a human being. I keep wondering how that can be. On the other hand, back when I was married to a philosophy professor (when he was teaching at a v. small college), I met his new colleague across the hall, the psychology prof. Turned out he'd never read Freud, or so he claimed. I'm no particular fan of Freud overall, but it does seem to me that someone who has taken the trouble to earn a PhD in psychology might at least have the curiosity to find out what the man had to say. And that in an anecdotal nutshell is what is wrong with psychiatry today--most professions today--lack of curiosity about what's outside the walls of the profession."
"Clearly, mental illness is a brain disease.." I'm sorry, but that is not clear at all. The mind and the brain are not the same thing; they may overlap in a functional sense, but the physical organ of the brain is neither the seat of consciousness nor the locus of the sense of self. It is sad that psychology, the only discipline of modern medicine that took the mind seriously, has devolved into the simplistic materialism of its peers."
"Am I the only reader who found it discouraging that Doctor Carlat spent a just a little more time with a patient and then congratulated himself on finding yet another drug to prescribe? He does not seem to have abandoned his deeply ingrained practice of symptom hunting at all."
"I undoubtably have an unbalance or two but those years in therapy taught me the SKILLS I needed to face any problems I come across head on, and deal with the resulting feelings. My mother, on the otherhand, accepted the "medicate" method of treatment over the years, and continues to have years that are like train wrecks."
"One psychiatrist attending one of my sons as an in patient even exhorted me several times in a single visit to get on anti-depressants myself, “Mr., I see it in your eyes!” My response was, "Yes, I'm depressed over my son's situation, but no thank you, I'm going to a lap pool instead!"
See also, Brainless and Mindless my post from today.
Laws with people's first names on them
There has been a growing tendency in the United States to push for laws in remembrance of the victim. So, we have "Kendra's" law, New York State legislation that forces the mentally ill into treatment programs if they meet the following criteria:
•is 18 years of age or older; and
•is suffering from a mental illness; and
•is unlikely to survive safely in the community without supervision, based on a clinical determination; and
•has a history of lack of compliance with treatment for mental illness which has led to either:
◦2 hospitalizations for mental illness in the preceding 36 months, or
◦1 or more acts of serious violent behavior toward self or others or threats of, or attempts at, serious physical harm to self or others within the last 48 months; and
•is unlikely to voluntarily participate in outpatient treatment that would enable him or her to live safely in the community; and
•is in need of AOT in order to avoid a relapse or deterioration which would be likely to result in serious harm to self or others; and
•is likely to benefit from AOT.
Kendra's law has a sunset provision for June 2010. According to a petition that is circulating: The proposed new law includes provisions such as increasing the original court order from 6 months to one year; not requiring doctor testimony, requiring fiscal management, allowing an expired order to be renewed 60 days after it expires without needing a new hearing, and viewing "non-compliance" with drugs, urine or blood tests, or drugs and alcohol use as grounds for "dangerousness".
I can understand society's frustration with mentally ill people who are violent and roaming the streets, but statistics show that most violent crime is committed by the "non-mentally" ill. That is no comfort to the victim or the victim's family, so we end up with laws like Kendra's, aimed at justice for the individual while claiming justice for society. My concern with Kendra's law. "Assisted Outpatient Treatment" smells like meds to me. Are meds all they're going to get? Is that it? Any real therapy going on here? It smells to me like people will be stuffed full of meds until they are so zoned out they are no longer violent, but also not employable. Kendra's law has a whiff of buck passing. Nobody wants to be responsible here, so again, make it look responsible by passing a law, get drugs into them and you've done your duty. If they fail to adhere, then there is always America's already over-crowded prison system.
One glaring absence in the reporting about Andrew Goldstein, who pushed Kendra Webdale into the path of an on-coming subway train, was Andrew's family. Where were they? It appears he was abandoned to a group home after lurching around New York City for a number of lonely years. Not one mention of his family other than the fact that his mother refused to see him. That doesn't cut it with me. How about an "Andrew's law" that would force families into therapy along with their relative and would force the family to take their relative off the streets. If you don't like Andrew's law, there's always "Kendra's law".
My "Andrew's law" social engineering proposal at least has some merits that I think are missing in Kendra's law. One is the acknowledgement that a supportive family is key and that families should be expected to be fully involved from the outset. Another is to give the individual and the family factual information about what is out there in terms of help that doesn't involve medications. A third is to let the individual/the family decide what therapy is best for them and support this choice. If they want to bring in an African shaman or a Celtic priest or decide that orthomolecular therapy is also what they want, then assume that they know best. A fourth option is a personal favorite, which is "emulation." Let people find out from other real people in real life situations what worked for them. A fifth option is to give the family some relief through short term accommodations where drugs will not be automatically administered. (The fifth option is not available in most jurisictions and is why we tried to keep Chris out of the hospital when he was relapsing.)
The "system" such as it is, discourages the family in favor of the professional and the use of medications from the start. The family is told that alternative treatments are unproven. All of this instills fear into the family, who quickly come to regard their relative as strange and hopeless.
What Andrew's family did was to warehouse him in a group home. That is harsh judgement for me to make, not knowing much more than what I read. But it's got to be said. Their son was their responsibility in the end, despite the problems with the way medical help was offered. The tragedy may have been prevented had the parents been given more hope from the onset and encouraged to be an integral part of their son's recovery process. They probably weren't told that their son could recover from schizophrenia without drugs if other interventions were in place. They were probably told instead that he had a damaged brain and that schizophrenia could only be treated using medications. If they had done more, despite the lack of help from institutions, and been encouraged with better disclosure of treatment options, perhaps there wouldn't be a Kendra's law. If real help was available for them perhaps this tragedy would not have happened.
The New York Times deals with the issue of the warehousing in the army's trauma care units. It reminded me very much of the day program Chris was enrolled in for two years. Chris never wanted to go to the day program, where he felt demeaned, despite the "best of intentions." He felt like a freak there, so he acted like one. All in all, I figured two years of "recovery" were wasted by good intentions that didn't support the family working it out for themselves in their own way. Once you enter a program, you abide by its definition of recovery and how to go about it.
The article interviewed the mother of one young man about his experiences in the transition unit.
But things are looking up, his mother believes: he will be able to stay with her in Michigan while awaiting his discharge. His mother, Sally Darrow, has already seen one son commit suicide. She believes that Michael would become the second if he had to return to Fort Carson and the transition unit. “At home, with family and schoolmates, he’s dealing with things better,” Ms. Darrow said. “He’s not safe there.”
•is 18 years of age or older; and
•is suffering from a mental illness; and
•is unlikely to survive safely in the community without supervision, based on a clinical determination; and
•has a history of lack of compliance with treatment for mental illness which has led to either:
◦2 hospitalizations for mental illness in the preceding 36 months, or
◦1 or more acts of serious violent behavior toward self or others or threats of, or attempts at, serious physical harm to self or others within the last 48 months; and
•is unlikely to voluntarily participate in outpatient treatment that would enable him or her to live safely in the community; and
•is in need of AOT in order to avoid a relapse or deterioration which would be likely to result in serious harm to self or others; and
•is likely to benefit from AOT.
Kendra's law has a sunset provision for June 2010. According to a petition that is circulating: The proposed new law includes provisions such as increasing the original court order from 6 months to one year; not requiring doctor testimony, requiring fiscal management, allowing an expired order to be renewed 60 days after it expires without needing a new hearing, and viewing "non-compliance" with drugs, urine or blood tests, or drugs and alcohol use as grounds for "dangerousness".
I can understand society's frustration with mentally ill people who are violent and roaming the streets, but statistics show that most violent crime is committed by the "non-mentally" ill. That is no comfort to the victim or the victim's family, so we end up with laws like Kendra's, aimed at justice for the individual while claiming justice for society. My concern with Kendra's law. "Assisted Outpatient Treatment" smells like meds to me. Are meds all they're going to get? Is that it? Any real therapy going on here? It smells to me like people will be stuffed full of meds until they are so zoned out they are no longer violent, but also not employable. Kendra's law has a whiff of buck passing. Nobody wants to be responsible here, so again, make it look responsible by passing a law, get drugs into them and you've done your duty. If they fail to adhere, then there is always America's already over-crowded prison system.
One glaring absence in the reporting about Andrew Goldstein, who pushed Kendra Webdale into the path of an on-coming subway train, was Andrew's family. Where were they? It appears he was abandoned to a group home after lurching around New York City for a number of lonely years. Not one mention of his family other than the fact that his mother refused to see him. That doesn't cut it with me. How about an "Andrew's law" that would force families into therapy along with their relative and would force the family to take their relative off the streets. If you don't like Andrew's law, there's always "Kendra's law".
My "Andrew's law" social engineering proposal at least has some merits that I think are missing in Kendra's law. One is the acknowledgement that a supportive family is key and that families should be expected to be fully involved from the outset. Another is to give the individual and the family factual information about what is out there in terms of help that doesn't involve medications. A third is to let the individual/the family decide what therapy is best for them and support this choice. If they want to bring in an African shaman or a Celtic priest or decide that orthomolecular therapy is also what they want, then assume that they know best. A fourth option is a personal favorite, which is "emulation." Let people find out from other real people in real life situations what worked for them. A fifth option is to give the family some relief through short term accommodations where drugs will not be automatically administered. (The fifth option is not available in most jurisictions and is why we tried to keep Chris out of the hospital when he was relapsing.)
The "system" such as it is, discourages the family in favor of the professional and the use of medications from the start. The family is told that alternative treatments are unproven. All of this instills fear into the family, who quickly come to regard their relative as strange and hopeless.
What Andrew's family did was to warehouse him in a group home. That is harsh judgement for me to make, not knowing much more than what I read. But it's got to be said. Their son was their responsibility in the end, despite the problems with the way medical help was offered. The tragedy may have been prevented had the parents been given more hope from the onset and encouraged to be an integral part of their son's recovery process. They probably weren't told that their son could recover from schizophrenia without drugs if other interventions were in place. They were probably told instead that he had a damaged brain and that schizophrenia could only be treated using medications. If they had done more, despite the lack of help from institutions, and been encouraged with better disclosure of treatment options, perhaps there wouldn't be a Kendra's law. If real help was available for them perhaps this tragedy would not have happened.
The New York Times deals with the issue of the warehousing in the army's trauma care units. It reminded me very much of the day program Chris was enrolled in for two years. Chris never wanted to go to the day program, where he felt demeaned, despite the "best of intentions." He felt like a freak there, so he acted like one. All in all, I figured two years of "recovery" were wasted by good intentions that didn't support the family working it out for themselves in their own way. Once you enter a program, you abide by its definition of recovery and how to go about it.
The article interviewed the mother of one young man about his experiences in the transition unit.
But things are looking up, his mother believes: he will be able to stay with her in Michigan while awaiting his discharge. His mother, Sally Darrow, has already seen one son commit suicide. She believes that Michael would become the second if he had to return to Fort Carson and the transition unit. “At home, with family and schoolmates, he’s dealing with things better,” Ms. Darrow said. “He’s not safe there.”
Brainless and mindless
The day program that Chris was involved with for two years made me a critic of the mental health industry. Chris was clearly not recovering, was horribly overweight, and yet the doctors refused to consider that maybe medications weren't helpful in his case. (By the way, no matter what your diagnosis was in that program, you all got the same drugs. This reasoning strikes me as not very scientific.)
Ron Unger points out this hypocrisy in his latest blog post. It's well worth a read.
Here's psychiatrist Daniel Carlat's take in today's New York Times on why this is so. About the only thing I can say to this shabby admission, is well, at least he's honest with his readers if he hasn't up until now been honest with his patients. The lack of intellectual curiosity about what makes the individual tick is appalling in most doctors. There are enough Daniel Carlats beginning to rethink the psychopharmacology model that there is hope. However, to these doctors, schizophrenia is always a special case, so I don't hold out much optimism that much will change unless change is forced on them by "schizo positive" activists.
After J.J. left my office, I realized, uncomfortably, that somehow, over the course of the decade following my residency, my way of thinking about patients had veered away from psychological curiosity. Instead, I had come to focus on symptoms, as if they were objective medical findings, much the way internists view blood-pressure readings or potassium levels. Psychiatry, for me and many of my colleagues, had become a process of corralling patients’ symptoms into labels and finding a drug to match
Ron Unger points out this hypocrisy in his latest blog post. It's well worth a read.
Here's psychiatrist Daniel Carlat's take in today's New York Times on why this is so. About the only thing I can say to this shabby admission, is well, at least he's honest with his readers if he hasn't up until now been honest with his patients. The lack of intellectual curiosity about what makes the individual tick is appalling in most doctors. There are enough Daniel Carlats beginning to rethink the psychopharmacology model that there is hope. However, to these doctors, schizophrenia is always a special case, so I don't hold out much optimism that much will change unless change is forced on them by "schizo positive" activists.
After J.J. left my office, I realized, uncomfortably, that somehow, over the course of the decade following my residency, my way of thinking about patients had veered away from psychological curiosity. Instead, I had come to focus on symptoms, as if they were objective medical findings, much the way internists view blood-pressure readings or potassium levels. Psychiatry, for me and many of my colleagues, had become a process of corralling patients’ symptoms into labels and finding a drug to match
Saturday, April 24, 2010
Belief systems are not science but they can produce outcomes
We who do not believe in mental illness as pathological disease continue to have our work cut out for us. In a blog with the tantalizing title Family Dysfunction and Mental Illness, psychiatrist Dr. David Allen believes that there is something called "true bipolar" which does not arise from childhood trauma because it is "genetic." Dr. Allen also asserts that "psychosis is never a normal variant of anything."
Note: Since no gene has been discovered for schizophrenia or bipolar we can take any "proof" of a genetic link as hearsay. Epigenetics, on the other hand, is the study of inherited changes in gene appearance that do not change the underlying DNA sequence. These changes can come from the environment, can last for the life of the cell and express themselves over generations. So, if one of your grandparents went on wild spending sprees, had multiple sexual partners and/or was down in the dumps a lot, there is a chance that this behavior is established currency in the generations that followed whether you like it or not. Your genetic coding looks like the culprit, but so far it it not.
Dr. Allen writes: We know that true bipolar disorder is a real brain disease that has a significant genetic component. Earlier studies indicated that if you have a bipolar parent, your odds of developing the disorder are 5 to 10 times higher than the general population. Since the prevalence in the general population is about 1 percent, that means you have a five to ten percent chance of developing the disorder yourself. True bipolar disorder usually manifests itself in the late teens or early 20’s, most frequently with a depressive rather than a manic episode.
Further on in the same blog he writes: "Some 12 year olds actually do have mania and are psychotic, but they are extremely rare" and in the comments to one of his earlier posts, "With schizophrenia, however, I do not think that the evidence that the condition is due to to trauma or abuse is particularly strong. There is a lot of evidence now being developed that there are marked changes in the neural networks of the frontal lobes in schizophenia that are well outside the bounds of normal neural plasticity.
Admittedly, we still have not pinpointed the exact nature of the brain pathology in schizophrenia, nor have we found out what causes it. In the past, patients with true bipolar were often misdiagnosed as schizophrenic, so some of the people who "got better" may have been misdiagnosed in the first place.
Dr. Allen believes that family trauma does not contribute to schizophrenia or true bipolar. These are always "special cases." Dr. Allen is expressing opinion, not hard science, because science isn't there yet. Patients operating under a doctor's belief system are probably under the impression that his advice is science. They are doomed from a treatment point of view because their doctor believes that they are intrinsically a separate species. The rest of you might be helped, but, despite the fact that the blog links family problems to mental illness, "schizophrenia and true bipolar" mysteriously are not the results of your birth environment. Psychiatrists who believe that schizophrenia and bipolar are true brain diseases will not give their clients the kind of help they deserve. I'll let Dr. Allen have the final word here.
After dealing for over 30 years with what I consider to be the extreme case of normal reactions to abnormal situations - borderline personality disorder - and with schizophrenia, I remain convinced that schizophrenia is a true brain disease.. . . Just for other readers, claims of 75-85% recovery rates for schizophrenia from non-traditional medicine are pure snake oil. I hate to see people given false help through outrageous claims. True psychosis is never a normal variant of anything. And I never tell people that they have a chemical imbalance, because that is truly a meaningless phrase.
Note: Since no gene has been discovered for schizophrenia or bipolar we can take any "proof" of a genetic link as hearsay. Epigenetics, on the other hand, is the study of inherited changes in gene appearance that do not change the underlying DNA sequence. These changes can come from the environment, can last for the life of the cell and express themselves over generations. So, if one of your grandparents went on wild spending sprees, had multiple sexual partners and/or was down in the dumps a lot, there is a chance that this behavior is established currency in the generations that followed whether you like it or not. Your genetic coding looks like the culprit, but so far it it not.
Dr. Allen writes: We know that true bipolar disorder is a real brain disease that has a significant genetic component. Earlier studies indicated that if you have a bipolar parent, your odds of developing the disorder are 5 to 10 times higher than the general population. Since the prevalence in the general population is about 1 percent, that means you have a five to ten percent chance of developing the disorder yourself. True bipolar disorder usually manifests itself in the late teens or early 20’s, most frequently with a depressive rather than a manic episode.
Further on in the same blog he writes: "Some 12 year olds actually do have mania and are psychotic, but they are extremely rare" and in the comments to one of his earlier posts, "With schizophrenia, however, I do not think that the evidence that the condition is due to to trauma or abuse is particularly strong. There is a lot of evidence now being developed that there are marked changes in the neural networks of the frontal lobes in schizophenia that are well outside the bounds of normal neural plasticity.
Admittedly, we still have not pinpointed the exact nature of the brain pathology in schizophrenia, nor have we found out what causes it. In the past, patients with true bipolar were often misdiagnosed as schizophrenic, so some of the people who "got better" may have been misdiagnosed in the first place.
Dr. Allen believes that family trauma does not contribute to schizophrenia or true bipolar. These are always "special cases." Dr. Allen is expressing opinion, not hard science, because science isn't there yet. Patients operating under a doctor's belief system are probably under the impression that his advice is science. They are doomed from a treatment point of view because their doctor believes that they are intrinsically a separate species. The rest of you might be helped, but, despite the fact that the blog links family problems to mental illness, "schizophrenia and true bipolar" mysteriously are not the results of your birth environment. Psychiatrists who believe that schizophrenia and bipolar are true brain diseases will not give their clients the kind of help they deserve. I'll let Dr. Allen have the final word here.
After dealing for over 30 years with what I consider to be the extreme case of normal reactions to abnormal situations - borderline personality disorder - and with schizophrenia, I remain convinced that schizophrenia is a true brain disease.. . . Just for other readers, claims of 75-85% recovery rates for schizophrenia from non-traditional medicine are pure snake oil. I hate to see people given false help through outrageous claims. True psychosis is never a normal variant of anything. And I never tell people that they have a chemical imbalance, because that is truly a meaningless phrase.
Friday, April 23, 2010
Paranoid or "on to something?"
My husband, Ian, fondly recalls his high school teacher telling him back in the 1970s that in the future, we would all be faced with the "problem" of what to do with our leisure time, due to advances in labor saving devices. We all know how that worked out. If we do have leisure time, it might be because we are unemployed. There is now an imbalance of work in many industrialized societies.
You know the standard line "as a journalist, I don't believe in conspiracy theories?" This line is supposed to make people like me who do, go underground in fear of being labelled small-minded, low I.Q. or a paranoid right winger.
So, here's one conspiracy I've been mulling over lately. The set-up: People are supposedly living longer, well into their nineties. There are more and more old people blowing out their 100th birthday candles. We have been told that advances in medicine will make people live longer healthier lives. At the same time, old, sick people are a burden on society. The national coffers will not be able to keep up with the health care need. So, how is this going to play out?
The solution? Convince people that they will benefit from taking advantage of the latest labor saving medical advances, such as, but not limited to, antipsychotic medication. Studies show that long term use of antipychotics shortens an average lifespan by twenty-five years. Extrapolate that to medications for other conditions, and who knows how far the predicted lifespans can be brought into line with national budgets?
You know the standard line "as a journalist, I don't believe in conspiracy theories?" This line is supposed to make people like me who do, go underground in fear of being labelled small-minded, low I.Q. or a paranoid right winger.
So, here's one conspiracy I've been mulling over lately. The set-up: People are supposedly living longer, well into their nineties. There are more and more old people blowing out their 100th birthday candles. We have been told that advances in medicine will make people live longer healthier lives. At the same time, old, sick people are a burden on society. The national coffers will not be able to keep up with the health care need. So, how is this going to play out?
The solution? Convince people that they will benefit from taking advantage of the latest labor saving medical advances, such as, but not limited to, antipsychotic medication. Studies show that long term use of antipychotics shortens an average lifespan by twenty-five years. Extrapolate that to medications for other conditions, and who knows how far the predicted lifespans can be brought into line with national budgets?
Thursday, April 22, 2010
Al Siebert's double binds
Al Siebert, who passed away last year, has a website called "Successful Schizophrenia." Here is an excerpt from Psychiatry's Lack of Insight: Four Double-Binds That Place Patients in a Living Nightmare. The third double-bind below demonstrates the reason I have always had trouble with Dr. E. Fuller Torrey. I don't think he sees people with a diagnosis of schizophrenia as fully human. He's not alone, however. Family members often demonstrate the same lack of insight.
The third double-bind is to perceive someone as being "a schizophrenic" and then express humanitarian love and compassion for them.
The activity of allowing one's mind to engage in "negative nouning" is similar to swearing. Perceiving someone as mentally ill is a stress reaction in the mind of the beholder. It constricts and reduces the person into something not fully human. When the viewer sees a person as a defective or sick it prevents the viewer from experiencing the diagnosed person as unique in a special way (the basis for love.)
The authors of DSM-III recognized diagnostic labeling as a problem and took the following position: "A common misconception is that the classification of mental disorders classifies individuals, when actually what are being classified are disorders that individuals have. For this reason, the text of DSM-III avoids the use of such phrases as "a schizophrenic" or "an alcoholic," and instead uses the more accurate, but admittedly more wordy "an individual with Schizophrenia" or "an individual with Alcohol Dependence."
Yet, even with the adoption of this position by the American Psychiatric Association in 1980, statements about "schizophrenics" abound in modern psychiatry. Psychiatrist E. Fuller Torrey, for example, tours the country telling audiences "there are over 100,000 active schizophrenics roaming the streets of our cities."
An example of the "Love for Schizophrenics" double-bind can be found in Torrey's recommendations on "How to Behave Toward a Schizophrenic." He states, "In general, the people who get along best with schizophrenics are those who treat them most naturally as people."
Silvano Arieti is a leading authority on schizophrenia. In concluding his award winning book Understanding and Helping the Schizophrenic: A Guidebook for Family and Friends, he states: "...where modern psychiatric science and our hearts meet, is the place in which help for the schizophrenic is to be found..."
The experience of people viewed as schizophrenic is something like being told by a smiling, powerful authority "I have only love and compassion for rotten assholes like you."
The third double-bind is to perceive someone as being "a schizophrenic" and then express humanitarian love and compassion for them.
The activity of allowing one's mind to engage in "negative nouning" is similar to swearing. Perceiving someone as mentally ill is a stress reaction in the mind of the beholder. It constricts and reduces the person into something not fully human. When the viewer sees a person as a defective or sick it prevents the viewer from experiencing the diagnosed person as unique in a special way (the basis for love.)
The authors of DSM-III recognized diagnostic labeling as a problem and took the following position: "A common misconception is that the classification of mental disorders classifies individuals, when actually what are being classified are disorders that individuals have. For this reason, the text of DSM-III avoids the use of such phrases as "a schizophrenic" or "an alcoholic," and instead uses the more accurate, but admittedly more wordy "an individual with Schizophrenia" or "an individual with Alcohol Dependence."
Yet, even with the adoption of this position by the American Psychiatric Association in 1980, statements about "schizophrenics" abound in modern psychiatry. Psychiatrist E. Fuller Torrey, for example, tours the country telling audiences "there are over 100,000 active schizophrenics roaming the streets of our cities."
An example of the "Love for Schizophrenics" double-bind can be found in Torrey's recommendations on "How to Behave Toward a Schizophrenic." He states, "In general, the people who get along best with schizophrenics are those who treat them most naturally as people."
Silvano Arieti is a leading authority on schizophrenia. In concluding his award winning book Understanding and Helping the Schizophrenic: A Guidebook for Family and Friends, he states: "...where modern psychiatric science and our hearts meet, is the place in which help for the schizophrenic is to be found..."
The experience of people viewed as schizophrenic is something like being told by a smiling, powerful authority "I have only love and compassion for rotten assholes like you."
Wednesday, April 21, 2010
Yoga and med
When "the crisis" unfolded several years ago, I went to my family doctor and asked him to give me something to help me get through this. I got Paxil. At first I was grateful for it making my mind less like a stuck record, endlessly obsessing about how awful life must be for Chris. I gained a lot of weight, but I also gained a certain distance from my own thoughts. I could maintain a stoicism that I didn't feel I otherwise posessed. In the interim, I needed this crutch.
When I then tried to get off the Paxil, the haunting fears came rushing back. I thought I was going to be a "lifer" on an antidepressant because I obviously couldn't handle life as it was. To make a long story short, I found a homeopath, took some natural products and weaned myself off the Paxil very slowly. (The weight loss was more stubborn.) I also took up yoga and meditation. That was three years ago. Yoga is the first "hobby" that Ian and I have done together in our close to thirty years of marriage. Ian and I are no spring chickens, we were both overweight and I couldn't move one arm above my head for some mysterious reason.
The yoga was both wonderful and difficult. We knew it was the answer to our stress, so we perservered. Doing yoga is like letting the air out of our psychic balloon. Sometimes tears would roll down my face, not from the exercise, but from the spiritual release. The music in combination with the poses got to me in ways that organized religion up to that point had not been able to, regular church goer that I am. Ian and I also dabbled a bit in meditation, althogh not as consistently as the yoga. Today, I feel I can handle whatever it was that I couldn't manage before. I understand spirituality better because I feel I have lived it. I am at peace.
When I then tried to get off the Paxil, the haunting fears came rushing back. I thought I was going to be a "lifer" on an antidepressant because I obviously couldn't handle life as it was. To make a long story short, I found a homeopath, took some natural products and weaned myself off the Paxil very slowly. (The weight loss was more stubborn.) I also took up yoga and meditation. That was three years ago. Yoga is the first "hobby" that Ian and I have done together in our close to thirty years of marriage. Ian and I are no spring chickens, we were both overweight and I couldn't move one arm above my head for some mysterious reason.
The yoga was both wonderful and difficult. We knew it was the answer to our stress, so we perservered. Doing yoga is like letting the air out of our psychic balloon. Sometimes tears would roll down my face, not from the exercise, but from the spiritual release. The music in combination with the poses got to me in ways that organized religion up to that point had not been able to, regular church goer that I am. Ian and I also dabbled a bit in meditation, althogh not as consistently as the yoga. Today, I feel I can handle whatever it was that I couldn't manage before. I understand spirituality better because I feel I have lived it. I am at peace.
Tuesday, April 20, 2010
Whatever it takes
Speak of the devil. The New York Times ran an article on Bill W. and the spiritual and chemical influences on the creation of Alcoholics Anonymous.
Were Bill Wilson’s spiritual awakening and influential sobriety the products of a belladonna hallucination shortly after his discussions with his friend Ebby Thacher? Could they have been incited by his alcohol withdrawal symptoms? Or did something else happen to him that science cannot explain? In the end, millions of people who have benefited from Alcoholics Anonymous and similar 12-step programs around the world would say that such pharmacological, physical or spiritual parsing hardly matters.
Were Bill Wilson’s spiritual awakening and influential sobriety the products of a belladonna hallucination shortly after his discussions with his friend Ebby Thacher? Could they have been incited by his alcohol withdrawal symptoms? Or did something else happen to him that science cannot explain? In the end, millions of people who have benefited from Alcoholics Anonymous and similar 12-step programs around the world would say that such pharmacological, physical or spiritual parsing hardly matters.
America's medicated adults
I am a cynic when it comes to children's charities. I have stopped even thinking of donating to a charity that uses children to pull at the purse strings of the donor. Just the other day at a famous coffee shop, right by the cash, was a box that said something to the effect, "children - donate". Sure, there was some worthy cause connected to it, but not a lot of information about what you were donating to and why. It was felt that simply putting "child" on the label was enough to part you from your spare change.
So, when it comes to the overmedication of the children, permit me to be just a tiny bit cynical. Not for the reasons you are thinking. It is horribly wrong to stuff children full of unproven psychiatric drugs for dubious diagnoses. But, are we overlooking that is is just as wrong to stuff adults full of these same unproven drugs for dubious diagnoses? Why is a 17 year old a child and an 18 year old an adult when it comes to bad medication and lack of access to more effective non-drug interventions? Let's not let the wholesale assault on adults go unlamented. If it's wrong for children, it's wrong for adults.
I will continue to ignore charities "for the kids", because I know that child poverty is adult poverty - just a fancy way of diverting your attention from the totality of the problem.
So, when it comes to the overmedication of the children, permit me to be just a tiny bit cynical. Not for the reasons you are thinking. It is horribly wrong to stuff children full of unproven psychiatric drugs for dubious diagnoses. But, are we overlooking that is is just as wrong to stuff adults full of these same unproven drugs for dubious diagnoses? Why is a 17 year old a child and an 18 year old an adult when it comes to bad medication and lack of access to more effective non-drug interventions? Let's not let the wholesale assault on adults go unlamented. If it's wrong for children, it's wrong for adults.
I will continue to ignore charities "for the kids", because I know that child poverty is adult poverty - just a fancy way of diverting your attention from the totality of the problem.
Monday, April 19, 2010
Alcoholism and niacin
The relationship of Bill W., one of the founders of Alcoholics Anonymous, with niacin therapy is controversial. I first became aware of Bill W. and A.A. in Dr. Abram Hoffer's book How to Live with Schizophrenia. 'PASS IT ON' the biography of Bill Wilson also discusses this chapter in A.A.'s development.
Dr. Abram Hoffer used megadoses of niacin to treat his schizophrenic and alcoholic patients because his research indicated that they were suffering from a vitamin B3 deficiency, similar to what is seen with pellagra. Pellagra is cured by introducing B3 into the diet just like scurvy is cured by ingesting vitamin C. One indication of a possible vitamin B3 deficiency is nicotine or alcohol addiction, another is severe acne.
I wish I had known about vitamin B3 when Chris developed severe acne as a teenager. Instead, I put him on medication. There may be no causal connection whatsoever, but within a few months of going off the medication, Chris was starting to develop psychosis. He may have already been developing early signs of psychosis due to the acne.
Vitamin B3 also lowers blood cholesterol. I can personally attest to this. I take 3 grams of niacinimide every day and six grams of vitamin C, along with a B complex vitamin. Every two years I see the company medical service for a check-up. The doctor remarks that while my good cholesterol is somewhat elevated, my "bad" cholesterol readings are the lowest she has ever seen.
I am a big fan on megavitamin therapy because I have personally experienced the results. So it is a bit troubling to read that Bill W., who also found niacin therapy very helpful in treating his addictions, parted ways with A.A. over niacin.
'PASS IT ON' describes the rift that developed over Bill W. endorsing a product or ethos that was outside of A.A.'s considered mandate. Now, apart from the fact that Bill W. may have been overzealous in trying to convert others in the organization to the benefits of niacin, I question why an organization dedicated to helping people with alcohol problems wouldn't be more open-minded on the subject of vitamin therapy. Vitamins are not patented. You can buy whatever brand of niacin and vitamin C you choose, and they will all be more or less the same. Bill W. didn't appear to be saying that A.A. should be aligning itself with a certain vitamin producing company or brand of vitamins. He was saying that A. A. could be aligning itself with the belief that alcoholics could also improve their health with niacin.
Having read both Dr. Hoffer's and A.A.'s book, I now understand how the alcoholism came to be viewed as a disease. Prior to the vitamin research done in the 1940s, alcoholism was viewed as a moral weaknesses. The beginnings of A.A. grew out of the Oxford Group, which took a more Christian attitude to the problems of alcoholism. Indeed, it was Carl Jung who advised Roland H. to find a religious experience if he was ever going to beat this. Bill W. got quite far in his recovery from alcoholism by subscribing to the A.A. 12 steps, but he also became interested in the biochemical model of alcoholism when he met Doctors Hoffer and Osmond, who had initially introduced him to LSD. He felt that the LSD experience was beneficial, and he further benefited from the niacin work done by the same doctors.
To me, Bill W. was doing what responsible people should when it comes to their own health, which is to be open-minded to more than one intervention. A.A. embraced the alcoholism as disease concept, but fell short of presenting further information to its members about vitamins that they could choose to follow or not. There is a lesson here about organizations and your freedom to choose. Take the best of what they can offer, but keep in mind that your allegiance is to your own health. There will often be a conflict.
Dr. Abram Hoffer used megadoses of niacin to treat his schizophrenic and alcoholic patients because his research indicated that they were suffering from a vitamin B3 deficiency, similar to what is seen with pellagra. Pellagra is cured by introducing B3 into the diet just like scurvy is cured by ingesting vitamin C. One indication of a possible vitamin B3 deficiency is nicotine or alcohol addiction, another is severe acne.
I wish I had known about vitamin B3 when Chris developed severe acne as a teenager. Instead, I put him on medication. There may be no causal connection whatsoever, but within a few months of going off the medication, Chris was starting to develop psychosis. He may have already been developing early signs of psychosis due to the acne.
Vitamin B3 also lowers blood cholesterol. I can personally attest to this. I take 3 grams of niacinimide every day and six grams of vitamin C, along with a B complex vitamin. Every two years I see the company medical service for a check-up. The doctor remarks that while my good cholesterol is somewhat elevated, my "bad" cholesterol readings are the lowest she has ever seen.
I am a big fan on megavitamin therapy because I have personally experienced the results. So it is a bit troubling to read that Bill W., who also found niacin therapy very helpful in treating his addictions, parted ways with A.A. over niacin.
'PASS IT ON' describes the rift that developed over Bill W. endorsing a product or ethos that was outside of A.A.'s considered mandate. Now, apart from the fact that Bill W. may have been overzealous in trying to convert others in the organization to the benefits of niacin, I question why an organization dedicated to helping people with alcohol problems wouldn't be more open-minded on the subject of vitamin therapy. Vitamins are not patented. You can buy whatever brand of niacin and vitamin C you choose, and they will all be more or less the same. Bill W. didn't appear to be saying that A.A. should be aligning itself with a certain vitamin producing company or brand of vitamins. He was saying that A. A. could be aligning itself with the belief that alcoholics could also improve their health with niacin.
Having read both Dr. Hoffer's and A.A.'s book, I now understand how the alcoholism came to be viewed as a disease. Prior to the vitamin research done in the 1940s, alcoholism was viewed as a moral weaknesses. The beginnings of A.A. grew out of the Oxford Group, which took a more Christian attitude to the problems of alcoholism. Indeed, it was Carl Jung who advised Roland H. to find a religious experience if he was ever going to beat this. Bill W. got quite far in his recovery from alcoholism by subscribing to the A.A. 12 steps, but he also became interested in the biochemical model of alcoholism when he met Doctors Hoffer and Osmond, who had initially introduced him to LSD. He felt that the LSD experience was beneficial, and he further benefited from the niacin work done by the same doctors.
To me, Bill W. was doing what responsible people should when it comes to their own health, which is to be open-minded to more than one intervention. A.A. embraced the alcoholism as disease concept, but fell short of presenting further information to its members about vitamins that they could choose to follow or not. There is a lesson here about organizations and your freedom to choose. Take the best of what they can offer, but keep in mind that your allegiance is to your own health. There will often be a conflict.
Friday, April 16, 2010
Cold turkey
Just back from a meeting with three psychiatrists. In the room were me, Chris, Ian, Chris's psychotherapist, Chris's medication doctor and her boss. I was looking forward to the meeting as a chance to move forward, to congratulate ourselves somewhat on things to date, until Chris let it out this morning before I left for work that he actually had stopped taking his medication a few days ago. A few days ago? How many days ago? This he wouldn't say. Just dropped them cold turkey.
I saw this meeting going down the tube fast. "Chris," I snarled, "get down to the pharmacy when it opens eight minutes from now and get that prescription filled." Of course, he didn't know where the prescription was, but luckily the pharmacist is okay with filling it first and bringing the prescription later.
What was Chris thinking? He is so close to shedding at least one of the drugs and possibly one psychiatrist if the meeting went well, why would he risk it all by showing up with a chance of looking and acting peculiar? As it turned out, Chris and Dr. Stern were there when I arrived at the clinic. I don't know if she suspected anything. Chris looked kind of red around the gills but that was all.
The meeting was fine. At some point Chris offered up that he had not taken his medication, he claimed it was only for four days, but I have my doubts as I seem to be spending more time recently having these quiet "talks" with him. I got to say my piece about the meds. I decided in advance that I wasn't going to debate the merits of Serdolect versus any other drug, I was simply going to "appeal" to their more noble selves by saying that Chris was spending too much time being a patient, and therefore not moving forward as much as he could and should. Having to schedule an ECG because of the Serdolect keeps him a patient, but so does seeing so many psychiatrists, no offense, of course! I told them that I personally don't believe that two drugs are better than one, and that the reason Chris is on two is simply because the institution believes in two.
The chief psychiatrist picked up on Chris's "forgetting" his meds and asked him if this was his way of saying he wanted off them. We chased that around a bit, and the upshot is that the chief said that cutting it down to one drug is in the realm of possibility. Dr. Stern had rather cleverly introduced the idea that Chris, in addition to gaining weight, was often tired. That may seal the fate of the Serdolect.
There is one thing that the chief psychiatrist said that rankled. He referred to Chris's "disease". However, here's the good part. He said that Chris "had" a disease, using the past tense. This was sounding more like disease as metaphor to me. Ian picked up on this and his parting words to the psychiatrist was that he was glad to see that he used the past tense, because at least as far as Ian was concerned, Chris's real problems were in the past.
I saw this meeting going down the tube fast. "Chris," I snarled, "get down to the pharmacy when it opens eight minutes from now and get that prescription filled." Of course, he didn't know where the prescription was, but luckily the pharmacist is okay with filling it first and bringing the prescription later.
What was Chris thinking? He is so close to shedding at least one of the drugs and possibly one psychiatrist if the meeting went well, why would he risk it all by showing up with a chance of looking and acting peculiar? As it turned out, Chris and Dr. Stern were there when I arrived at the clinic. I don't know if she suspected anything. Chris looked kind of red around the gills but that was all.
The meeting was fine. At some point Chris offered up that he had not taken his medication, he claimed it was only for four days, but I have my doubts as I seem to be spending more time recently having these quiet "talks" with him. I got to say my piece about the meds. I decided in advance that I wasn't going to debate the merits of Serdolect versus any other drug, I was simply going to "appeal" to their more noble selves by saying that Chris was spending too much time being a patient, and therefore not moving forward as much as he could and should. Having to schedule an ECG because of the Serdolect keeps him a patient, but so does seeing so many psychiatrists, no offense, of course! I told them that I personally don't believe that two drugs are better than one, and that the reason Chris is on two is simply because the institution believes in two.
The chief psychiatrist picked up on Chris's "forgetting" his meds and asked him if this was his way of saying he wanted off them. We chased that around a bit, and the upshot is that the chief said that cutting it down to one drug is in the realm of possibility. Dr. Stern had rather cleverly introduced the idea that Chris, in addition to gaining weight, was often tired. That may seal the fate of the Serdolect.
There is one thing that the chief psychiatrist said that rankled. He referred to Chris's "disease". However, here's the good part. He said that Chris "had" a disease, using the past tense. This was sounding more like disease as metaphor to me. Ian picked up on this and his parting words to the psychiatrist was that he was glad to see that he used the past tense, because at least as far as Ian was concerned, Chris's real problems were in the past.
Thursday, April 15, 2010
Biology of relief
Here is how I read a book of non-fiction these days. I begin with the index and look for "schizophrenia" then flip back to the relevant pages. (I often feel I have read the book just by becoming intimately acquainted with what's in the index.) My "schizo positive" meter is constantly scanning for the author's "take" on this condition. Is the author "schizo positive" or "schizo negative?" So, it was a bit surprising to pick up The Biology of Belief, a book about how thoughts are much more controlling of health outcomes than one would imagine, and discover how the author classifies schizophrenia. Bruce Lipton refers to schizophrenia as a disease.
This may simply be an oversight on his part, because the book is not at all about schizophrenia, though it could be, given all its emphasis on quantum physics and energy psychology. These topics are schizophrenia's home turf.
The book is about epigenetics, the study of inherited changes in gene appearance that do not change the underlying DNA sequence. These changes can come from the environment, can last for the life of the cell and express themselves over generations.
This book makes a good case that the environment before conception is vitally important to the general well-being of the unborn child. Epigenetics explains why genetically related siblings in the same family are born into a unique environment. We don't treat all our children alike because the parents circumstances change before, during and after conception. Maybe we had financial worries, didn't plan to become pregnant, or argued constantly in the process of marital adjustment. The list of hazards can be endless. All of this sounds kind of hopeless and Darwinian, were it not for the fact that people can change their cellular biology by changing their thought patterns, which can also come about by a change of environment. Moreover, cells replace themselves completely every seven to ten years, so you are not the person you thought you were. You can renew yourself.
Epigenetics shows that there can be a positive outcome to the negative diagnosis that mainstream medicine hands you, no matter whether it is a mental health diagnosis or something else. It also dovetails very nicely with the Family Constellation Therapy that our family undertook. Family Constellation Therapy acknowledges that people with schizophrenia are particularly prone to "atonement" of a generation's past wrongs. Through identifying the family drama, "acting" it out, and through the act of forgiveness, healing is effected at the deepest levels.
This may simply be an oversight on his part, because the book is not at all about schizophrenia, though it could be, given all its emphasis on quantum physics and energy psychology. These topics are schizophrenia's home turf.
The book is about epigenetics, the study of inherited changes in gene appearance that do not change the underlying DNA sequence. These changes can come from the environment, can last for the life of the cell and express themselves over generations.
This book makes a good case that the environment before conception is vitally important to the general well-being of the unborn child. Epigenetics explains why genetically related siblings in the same family are born into a unique environment. We don't treat all our children alike because the parents circumstances change before, during and after conception. Maybe we had financial worries, didn't plan to become pregnant, or argued constantly in the process of marital adjustment. The list of hazards can be endless. All of this sounds kind of hopeless and Darwinian, were it not for the fact that people can change their cellular biology by changing their thought patterns, which can also come about by a change of environment. Moreover, cells replace themselves completely every seven to ten years, so you are not the person you thought you were. You can renew yourself.
Epigenetics shows that there can be a positive outcome to the negative diagnosis that mainstream medicine hands you, no matter whether it is a mental health diagnosis or something else. It also dovetails very nicely with the Family Constellation Therapy that our family undertook. Family Constellation Therapy acknowledges that people with schizophrenia are particularly prone to "atonement" of a generation's past wrongs. Through identifying the family drama, "acting" it out, and through the act of forgiveness, healing is effected at the deepest levels.
Wednesday, April 14, 2010
Schizophrenia, too, as metaphor
We used to see drunks, now we see drinking problems. Are we ready for another new view? What would happen in homes, jails and hospitals if we started treating drug and alcohol abusers as highly evolved spiritual creatures. Like the disguised Princess in the story the Princess and Pea, perhaps these people are the sensitive ones whose "dis-ease" mirrors for all of us the pain we feel when we are emotionally separated from each other and spiritually separated from our Creator.
...We know that if we do battle against drugs and alcohol we are simply attacking the messenger without attending to the message it carries.
What is the message in the metaphor? The message is that alcoholism is a gift . . . to individuals, to society and to the planet. It is a way to get spiritual. The world is becoming aware that political and economic policies have not given us solutions to the ills of the world. The healing must take place in attitude. We must change our minds if we are to change the world. The next evolutionary leap is towards higher consciousness. If we are to survive as a species, we must begin to see our oneness.
The foregoing was written by Jaqueline Castine in 1989. Recovery from Rescuing is dedicated to her children, in one of the most unusual dedications on record:
"At great personal cost and inconvenience to themselves they lovingly, purposefully and persistently dedicated themselves to their roles of chemical dependency and irresponsbility until I learned the lessons they came into my life to teach me. . ."
The Inspiration came from her own mother: "I gave the best 20 years of my life to my family, and it has taken them 20 years to recover from it."
...We know that if we do battle against drugs and alcohol we are simply attacking the messenger without attending to the message it carries.
What is the message in the metaphor? The message is that alcoholism is a gift . . . to individuals, to society and to the planet. It is a way to get spiritual. The world is becoming aware that political and economic policies have not given us solutions to the ills of the world. The healing must take place in attitude. We must change our minds if we are to change the world. The next evolutionary leap is towards higher consciousness. If we are to survive as a species, we must begin to see our oneness.
The foregoing was written by Jaqueline Castine in 1989. Recovery from Rescuing is dedicated to her children, in one of the most unusual dedications on record:
"At great personal cost and inconvenience to themselves they lovingly, purposefully and persistently dedicated themselves to their roles of chemical dependency and irresponsbility until I learned the lessons they came into my life to teach me. . ."
The Inspiration came from her own mother: "I gave the best 20 years of my life to my family, and it has taken them 20 years to recover from it."
Tuesday, April 13, 2010
Pharmacology and consciousness
Abstracts from the 9th Annual International Bioethics Forum that will take place April 22-23 2010 in Madison, Wisconsin.
Neurochemistry and Receptors as Mediators of Consciousness
David Nichols, Ph.D.
In the science of pharmacology, if one wishes to understand some physiological process, one can administer a substance that perturbs the process in some way, and then observe some effect that hopefully leads to understanding of the normal unperturbed process. Likewise, if one wishes to understand consciousness, the same principle should apply, and one could employ a substance that perturbs consciousness. As we know, psychedelics produce dramatic alterations in consciousness and would therefore seem to be perfect tools to help understand consciousness. Thus, this presentation will focus on some of the molecular aspects of psychedelics, including their brain targets, how they interact with those targets, the kinds of signals they generate, and some of the brain areas where these effects occur. There is now a general consensus that psychedelics activate the 5-HT2A type of serotonin receptor. These receptors are quite ancient, probably differentiating from the larger serotonin receptor family about 600-700 million years ago. Thus, these receptors have been around since the evolution of nervous systems began and, one might argue, have therefore been integrated into brain function at a very fundamental level. Reductionist neuroscience approaches to the study of this receptor in the brain will no doubt ultimately elucidate many of the components and processes involved in consciousness; the so-called “easy problems” of consciousness. It seems unlikely, however, that this knowledge will lead in any direct way to understanding consciousness. The explanatory gap between physical processes and consciousness is not one that will be easily bridged, but understanding how some of the component processes are affected by psychedelics may at least give some appreciation for the difficulty of the problem.
Psychological dimensions, neural networks and neurotransmitter dynamics associated with psychedelic-induced altered states of consciousness in humans
Franz X. Vollenweider, M.D. will first present new data on the phenomenology and structure of psychedelic-induced altered states of consciousness (ASC) based on a meta-analysis of a series of controlled studies conducted in healthy human subjects (n= 534) using state-of-the art psychometric and neuropsychological measures. Second, he will demonstrate that specific etiology-independent key dimensions of ASC, such as the experience of unity, ecstatic or anxious loss of ego-boundaries, religious exaltation or visionary states, are associated with circumscribed changes in brain activity in various extended neural networks. Third, he will also present novel data indicating that the serotonin 5-HT2A receptor together with the glutamate system plays a key role in the mechanism of action of classic hallucinogens such as psilocybin, and will discuss the implication of this recent finding for the understanding and putative treatment of some psychiatric disorders.
Geyer M. A. and Vollenweider F. X. (2008) Serotonin research: contributions to understanding psychoses. Trends Pharmacol. Sci. 29, 445-453.
Neurochemistry and Receptors as Mediators of Consciousness
David Nichols, Ph.D.
In the science of pharmacology, if one wishes to understand some physiological process, one can administer a substance that perturbs the process in some way, and then observe some effect that hopefully leads to understanding of the normal unperturbed process. Likewise, if one wishes to understand consciousness, the same principle should apply, and one could employ a substance that perturbs consciousness. As we know, psychedelics produce dramatic alterations in consciousness and would therefore seem to be perfect tools to help understand consciousness. Thus, this presentation will focus on some of the molecular aspects of psychedelics, including their brain targets, how they interact with those targets, the kinds of signals they generate, and some of the brain areas where these effects occur. There is now a general consensus that psychedelics activate the 5-HT2A type of serotonin receptor. These receptors are quite ancient, probably differentiating from the larger serotonin receptor family about 600-700 million years ago. Thus, these receptors have been around since the evolution of nervous systems began and, one might argue, have therefore been integrated into brain function at a very fundamental level. Reductionist neuroscience approaches to the study of this receptor in the brain will no doubt ultimately elucidate many of the components and processes involved in consciousness; the so-called “easy problems” of consciousness. It seems unlikely, however, that this knowledge will lead in any direct way to understanding consciousness. The explanatory gap between physical processes and consciousness is not one that will be easily bridged, but understanding how some of the component processes are affected by psychedelics may at least give some appreciation for the difficulty of the problem.
Psychological dimensions, neural networks and neurotransmitter dynamics associated with psychedelic-induced altered states of consciousness in humans
Franz X. Vollenweider, M.D. will first present new data on the phenomenology and structure of psychedelic-induced altered states of consciousness (ASC) based on a meta-analysis of a series of controlled studies conducted in healthy human subjects (n= 534) using state-of-the art psychometric and neuropsychological measures. Second, he will demonstrate that specific etiology-independent key dimensions of ASC, such as the experience of unity, ecstatic or anxious loss of ego-boundaries, religious exaltation or visionary states, are associated with circumscribed changes in brain activity in various extended neural networks. Third, he will also present novel data indicating that the serotonin 5-HT2A receptor together with the glutamate system plays a key role in the mechanism of action of classic hallucinogens such as psilocybin, and will discuss the implication of this recent finding for the understanding and putative treatment of some psychiatric disorders.
Geyer M. A. and Vollenweider F. X. (2008) Serotonin research: contributions to understanding psychoses. Trends Pharmacol. Sci. 29, 445-453.
The picket line
Schizophrenia should take a leaf from the Gay Pride movement. I have written several posts on the double standard that psychiatry exercises when it comes to a schizophrenia diagnosis. Scratch beneath the surface of most psychiatrists and you find the medical school training hardwired into their DNA. Medical school tells them that schizophrenia is a brain disorder, that it is most likely genetic, and that the "disease" is chronic. In other words, there is something really wrong with you by nature.
If you want help in overcoming a diagnosis of schizophrenia, it would be useful to interview your psychiatrist to ferret out the true feelings about your "illness" before you invest a lot of time and money thinking that this person is going to help you. Of course, in the end, nobody can help you but you, but some people can "encourage you" to be you, damn what others may say.
Psychiatry also believed that homosexuality was a mental illness, just like schizophrenia, just like depression, just like all the other labels that exist today that are still on the books in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Maybe homosexuality is a mental illness, just like schizophrenia, but who cares as long people who have "it" are otherwise happy and fulfilled?
The Gay Pride movement serves as a useful roadmap for what could happen to schizophrenia. In 1973 homosexuality was dropped from the DSM simply because homosexuals didn't consider themselves mentally ill and objected to the stigma, and they began "outing" the psychiatric profession on their entrenched attitudes. To most psychiatrists, if someone with a diagnosis of schizophrenia actually "recovers", then it is obvious to these thinkers that the diagnosis was wrong. Other mental disorders don't suffer the same stigma, hence the double standard.
My suggestion is when psychiatrist shopping, to ask your shrink point blank where he or she stands on schizophrenia. Is he or she "schizo" positive? Chances are you will hear all the right words at first, enough to make you invest a bit of time and energy. Soon enough it should become apparent where the doctor's convictions really lie.
Take a leaf from Gay Pride. Are you really "mentally ill" just because the DSM says so? Suffering the stigma of the medical profession and society in general does nothing to further you as a human being. Start picketing doctors who are not SZ positive. Man the barricades. You can change much about the way you are treated simply by being dropped from the DSM.
If you want help in overcoming a diagnosis of schizophrenia, it would be useful to interview your psychiatrist to ferret out the true feelings about your "illness" before you invest a lot of time and money thinking that this person is going to help you. Of course, in the end, nobody can help you but you, but some people can "encourage you" to be you, damn what others may say.
Psychiatry also believed that homosexuality was a mental illness, just like schizophrenia, just like depression, just like all the other labels that exist today that are still on the books in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Maybe homosexuality is a mental illness, just like schizophrenia, but who cares as long people who have "it" are otherwise happy and fulfilled?
The Gay Pride movement serves as a useful roadmap for what could happen to schizophrenia. In 1973 homosexuality was dropped from the DSM simply because homosexuals didn't consider themselves mentally ill and objected to the stigma, and they began "outing" the psychiatric profession on their entrenched attitudes. To most psychiatrists, if someone with a diagnosis of schizophrenia actually "recovers", then it is obvious to these thinkers that the diagnosis was wrong. Other mental disorders don't suffer the same stigma, hence the double standard.
My suggestion is when psychiatrist shopping, to ask your shrink point blank where he or she stands on schizophrenia. Is he or she "schizo" positive? Chances are you will hear all the right words at first, enough to make you invest a bit of time and energy. Soon enough it should become apparent where the doctor's convictions really lie.
Take a leaf from Gay Pride. Are you really "mentally ill" just because the DSM says so? Suffering the stigma of the medical profession and society in general does nothing to further you as a human being. Start picketing doctors who are not SZ positive. Man the barricades. You can change much about the way you are treated simply by being dropped from the DSM.
Monday, April 12, 2010
Hallucinogens Have Doctors Tuning In Again
Hot off the press from the New York Times. Talk of coincidences!
Scientists are taking a new look at hallucinogens, which became taboo among regulators after enthusiasts like Timothy Leary promoted them in the 1960s with the slogan “Turn on, tune in, drop out.” Now, using rigorous protocols and safeguards, scientists have won permission to study once again the drugs’ potential for treating mental problems and illuminating the nature of consciousness.
Scientists are taking a new look at hallucinogens, which became taboo among regulators after enthusiasts like Timothy Leary promoted them in the 1960s with the slogan “Turn on, tune in, drop out.” Now, using rigorous protocols and safeguards, scientists have won permission to study once again the drugs’ potential for treating mental problems and illuminating the nature of consciousness.
Sunday, April 11, 2010
A. A., LSD, and SZ
Doctors Abram Hoffer and Humphrey Osmond had a pronounced biochemical approach to alcoholism and schizophrenia. Their research showed niacin (vitamin B3) was an effective treatment in combination with vitamin C and other B-vitamins. Bill W. and A.A. had taken a more spiritual approach to the understanding of alcoholism, which had been derived from the teachings of the Oxford Group (later renamed Moral Rearmament).
Bill W. was introduced to these doctors in the 1950s, initially because of their work using LSD and mescaline on their schizophrenic and alcoholic patients in Saskatchewan. In the case of alcoholics they noticed that many who had once experienced an attack of delirium tremens swore off alcohol for good. Hoffer and Osmond thought that if they introduced LSD under controlled settings to alcoholics, it would give them a taste of what was in store for them if they continued to drink.
Bill W. at first resisted the idea of giving alcoholics more drugs, but later changed his mind. His thinking was not what Hoffer and Osmond were thinking, though. "It was not the material itself that actually produces these experiences. It seems to have the result of sharply reducing the forces of the ego -- temporarily, of course. It is a generally acknowledge fact in spiritual development that ego reduction makes the influx of God's grace
possible."
Many psychiatrists at this time also acknowledged that a high percentage of alcoholics were also schizophrenics and reasoned that LSD was one way of shortening the long process of psychotherapy. I couldn't agree more. Should we have to wait for a random chance encounter with God's grace if there is some way we can experience it sooner?
The non-chemical experience that Chris has been undertaking recently with the sound shaman seems as close to LSD as you can get and still be legal. Chris tells me he feels happy, but he knows he doesn't look especially happy and he is very unsure of what he wants. Chris these days reminds me of Aldous Huxley's quote. "The man who comes back through the Door in the Wall will never be quite the same as the man who went out. He will be wiser but less cocksure, happier but less self-satisfied, humbler in acknowledging his ignorance but better equipped to understand the relationship of words to things, of systematic reasoning to the unfathomable Mystery which it tries forever, vainly, to comprehend."
A.A. outside of Bill W. wasn't keen to align itself with LSD. It was nonetheless a controversial drug and only became more so once it found its way into street use in the 1960s.
___________
From 'PASS IT ON' The story of Bill Wilson and how the A.A. message reached the world, Alcoholics Anonymous World Service, Inc. 1984, pg. 383-385.
Bill W. was introduced to these doctors in the 1950s, initially because of their work using LSD and mescaline on their schizophrenic and alcoholic patients in Saskatchewan. In the case of alcoholics they noticed that many who had once experienced an attack of delirium tremens swore off alcohol for good. Hoffer and Osmond thought that if they introduced LSD under controlled settings to alcoholics, it would give them a taste of what was in store for them if they continued to drink.
Bill W. at first resisted the idea of giving alcoholics more drugs, but later changed his mind. His thinking was not what Hoffer and Osmond were thinking, though. "It was not the material itself that actually produces these experiences. It seems to have the result of sharply reducing the forces of the ego -- temporarily, of course. It is a generally acknowledge fact in spiritual development that ego reduction makes the influx of God's grace
possible."
Many psychiatrists at this time also acknowledged that a high percentage of alcoholics were also schizophrenics and reasoned that LSD was one way of shortening the long process of psychotherapy. I couldn't agree more. Should we have to wait for a random chance encounter with God's grace if there is some way we can experience it sooner?
The non-chemical experience that Chris has been undertaking recently with the sound shaman seems as close to LSD as you can get and still be legal. Chris tells me he feels happy, but he knows he doesn't look especially happy and he is very unsure of what he wants. Chris these days reminds me of Aldous Huxley's quote. "The man who comes back through the Door in the Wall will never be quite the same as the man who went out. He will be wiser but less cocksure, happier but less self-satisfied, humbler in acknowledging his ignorance but better equipped to understand the relationship of words to things, of systematic reasoning to the unfathomable Mystery which it tries forever, vainly, to comprehend."
A.A. outside of Bill W. wasn't keen to align itself with LSD. It was nonetheless a controversial drug and only became more so once it found its way into street use in the 1960s.
___________
From 'PASS IT ON' The story of Bill Wilson and how the A.A. message reached the world, Alcoholics Anonymous World Service, Inc. 1984, pg. 383-385.
The Holy Spirit
Letter from Carl Jung in reply to Bill Wilson, founder of Alcoholics Anonymous, dated 30 January 1961, Kusnacht, Switzerland. Bill Wilson wrote a letter of appreciation to Carl Jung. "Very many thoughtful A.A.'s are students of your writings. Because of your conviction that man is something more than intellect, emotion, and two dollars's worth of chemicals, you have especially endeared yourself to us . . . "
Dear Mr. Wilson,
Your letter has been very welcome indeed.
I had no news from Rowland H. anymore and often wondered what had been his fate. Our conversation which he has adequately reported to you had an aspect of which he did not know. The reason I could not tell him everything was that those days I had to be exceedingly careful of what I said. I found out that I was misunderstood in every possible way. Thus I was very careful when I talked to Rowland H. But what I really thought about was the result of many experiences with men of his kind.
His craving for alcohol was the equivalent on a low level of the spiritual thirst of our being for wholeness, expressed in medieval language: the union with God.*
How could one formulate such an insight in a language that is not misunderstood in our days?
The only right and legitimate way to such an experience is that it happens to you in reality, and it can only happen to you when you walk on a path which leads you to higher understanding. You might be led to that goal by an act of grace or through a personal and honest contact with friends, or through a higher education of the mind beyond the confines of mere rationalism. I see from your letter that Rowland H. has chosen the second way, which was, under the circumstances, obviously the best one.
I am strongly convinced that the evil principle prevailing in this world leads the unrecognized spiritual need into perdition, if it is not counteracted either by a real religious insight or by the protective wall of human community. An ordinary man, not protected by an action from above and isolated in society, cannot resist the power of evil, which is called very aptly the Devil. But the use of such words arouse(s) so many mistakes that one can only keep aloof from them as much as possible.
These are the reasons why I could not give a full and sufficient explanation to Rowland H., but (I) am risking it with you because I conclude from your very decent and honest letter that you have acquired a point of view about the misleading platitudes one usually hears about alcoholism.
Alcohol in Latin in spiritus, and you use the same word for the highest religious experience as well as for the most depraving poison. The helpful formula therefore is: spiritus contra spiritum.
Thanking you again for your kind letter, I remain yours sincerely, C.G. Jung.
_________________
"* 'As the hart panteth after the water brooks, so panteth my soul after thee, O God.' Psalm 42,1"
Letter reprinted in 'PASS IT ON' The story of Bill Wilson and how the A.A. message reached the world, Alcoholics Anonymous World Service, Inc. 1984, pg. 383-385.
Dear Mr. Wilson,
Your letter has been very welcome indeed.
I had no news from Rowland H. anymore and often wondered what had been his fate. Our conversation which he has adequately reported to you had an aspect of which he did not know. The reason I could not tell him everything was that those days I had to be exceedingly careful of what I said. I found out that I was misunderstood in every possible way. Thus I was very careful when I talked to Rowland H. But what I really thought about was the result of many experiences with men of his kind.
His craving for alcohol was the equivalent on a low level of the spiritual thirst of our being for wholeness, expressed in medieval language: the union with God.*
How could one formulate such an insight in a language that is not misunderstood in our days?
The only right and legitimate way to such an experience is that it happens to you in reality, and it can only happen to you when you walk on a path which leads you to higher understanding. You might be led to that goal by an act of grace or through a personal and honest contact with friends, or through a higher education of the mind beyond the confines of mere rationalism. I see from your letter that Rowland H. has chosen the second way, which was, under the circumstances, obviously the best one.
I am strongly convinced that the evil principle prevailing in this world leads the unrecognized spiritual need into perdition, if it is not counteracted either by a real religious insight or by the protective wall of human community. An ordinary man, not protected by an action from above and isolated in society, cannot resist the power of evil, which is called very aptly the Devil. But the use of such words arouse(s) so many mistakes that one can only keep aloof from them as much as possible.
These are the reasons why I could not give a full and sufficient explanation to Rowland H., but (I) am risking it with you because I conclude from your very decent and honest letter that you have acquired a point of view about the misleading platitudes one usually hears about alcoholism.
Alcohol in Latin in spiritus, and you use the same word for the highest religious experience as well as for the most depraving poison. The helpful formula therefore is: spiritus contra spiritum.
Thanking you again for your kind letter, I remain yours sincerely, C.G. Jung.
_________________
"* 'As the hart panteth after the water brooks, so panteth my soul after thee, O God.' Psalm 42,1"
Letter reprinted in 'PASS IT ON' The story of Bill Wilson and how the A.A. message reached the world, Alcoholics Anonymous World Service, Inc. 1984, pg. 383-385.
Friday, April 9, 2010
Goddess Shift
Goddess Shift: Women Leading for a Change was published in February. People ask me how I managed to snag a chapter in a book in which mainly famous women are featured, women who have made reputations for themselves in fields as diverse as theatre, medicine, politics and writing. To answer that, I have to back up a few years, to when it began to dawn on me that what Chris and I were going through was something extraordinary. I was beginning to emerge from the crippling fear that had engulfed me, which coincided with my seeing that there was light at the end of the tunnel. This was not a sudden conversion experience, by the way. It was simply a recognition that there was some extraordinary help out there for schizophrenia that more people should be tapping into.
The question was, what could I do about this. I could light candles in a church or contribute money to a charity in appreciation, but I felt a bigger gesture was needed. Someone in an on-line group suggested that the best way to get the message out was through a book. That was a great idea, except that my writing skills were pretty rusty. However, I knew the story was compelling, so I started writing it all down. I fell into the new writer's habit of relying on quotations from other people to begin every chapter, because I didn't have confidence in my own voice.
One lunch hour while swimming laps, I got the bright idea to send my unwieldy unfinished manuscript to well-known holistic author and editor Stephanie Marohn. It was her book, The Natural Medicine Guide to Schizophrenia, that kick-started my awareness that there is a better way of looking at schizophrenia. She jettisoned all the quotes from other people (I favored rock lyrics)and tamed the document into something more manageable. I wrote some more, then sent it again to her for further editing. The book is almost finished once again, but the journey continues. Had I stopped it where I originally planned, there would be no recognition that relapse may sometimes be a necessary step and of the energetic healing power of music and vibration.
Stephanie Marohn is the editor of Goddess Shift. She has assembled an interesting group of woman contributors. Jean Shinoda Bolen, for example, is a psychiatrist and Jungian analyst who writes about feminine archetypes and the search for meaning. She is joined by Madonna, who explains what originally attracted her to study the Kabbalah. There is an interesting chapter by Frances Green, a New York lawyer who was once a nun. J.K. Rowling's personal story may be too well known, but she contributes a moving insight into the value of failure. A lot of these women are controversial and many of us are prepared not to like them because we think we know them. When we write honestly about ourselves, as this book encourages us to do, we bridge our differences.
All royalties from Goddess Shift go to the following nonprofit organizations dedicated to improving the lives of girls and young women around the world:
The Global Fund for Women
Promotes women’s economic security, health, education, and leadership
Capacitar (Spanish for "To Empower")
Teaching simple wellness practices in communities affected by violence, poverty and trauma
Tostan
Community-led development
The question was, what could I do about this. I could light candles in a church or contribute money to a charity in appreciation, but I felt a bigger gesture was needed. Someone in an on-line group suggested that the best way to get the message out was through a book. That was a great idea, except that my writing skills were pretty rusty. However, I knew the story was compelling, so I started writing it all down. I fell into the new writer's habit of relying on quotations from other people to begin every chapter, because I didn't have confidence in my own voice.
One lunch hour while swimming laps, I got the bright idea to send my unwieldy unfinished manuscript to well-known holistic author and editor Stephanie Marohn. It was her book, The Natural Medicine Guide to Schizophrenia, that kick-started my awareness that there is a better way of looking at schizophrenia. She jettisoned all the quotes from other people (I favored rock lyrics)and tamed the document into something more manageable. I wrote some more, then sent it again to her for further editing. The book is almost finished once again, but the journey continues. Had I stopped it where I originally planned, there would be no recognition that relapse may sometimes be a necessary step and of the energetic healing power of music and vibration.
Stephanie Marohn is the editor of Goddess Shift. She has assembled an interesting group of woman contributors. Jean Shinoda Bolen, for example, is a psychiatrist and Jungian analyst who writes about feminine archetypes and the search for meaning. She is joined by Madonna, who explains what originally attracted her to study the Kabbalah. There is an interesting chapter by Frances Green, a New York lawyer who was once a nun. J.K. Rowling's personal story may be too well known, but she contributes a moving insight into the value of failure. A lot of these women are controversial and many of us are prepared not to like them because we think we know them. When we write honestly about ourselves, as this book encourages us to do, we bridge our differences.
All royalties from Goddess Shift go to the following nonprofit organizations dedicated to improving the lives of girls and young women around the world:
The Global Fund for Women
Promotes women’s economic security, health, education, and leadership
Capacitar (Spanish for "To Empower")
Teaching simple wellness practices in communities affected by violence, poverty and trauma
Tostan
Community-led development
Thursday, April 8, 2010
The fall-out from Dr. Nancy C. Andreasen's bombshell
From an interview with well-known neuroscientist and psychiatrist Dr. Nancy Andreasen which appeared in Sept. 2009 in the New York Times:
Q. AND WHAT HAVE YOU FOUND?
A. I haven’t published this yet. But I have spoken about it in public lectures. The big finding is that people with schizophrenia are losing brain tissue at a more rapid rate than healthy people of comparable age. Some are losing as much as 1 percent per year. That’s an awful lot over an 18-year period. And then we’re trying to figure out why. Another thing we’ve discovered is that the more drugs you’ve been given, the more brain tissue you lose.
Q. WHAT EACTLY DO THESE DRUGS DO?
A. They block basal ganglia activity. The prefrontal cortex doesn't get the input it needs and is being shut down by drugs. That reduces the psychotic symptoms. It also causes the prefrontal cortex to slowly atrophy.
Q. WHAT ARE THE POLICY IMPLICATIONS OF THIS FINDING?
A. Implication 1: that these drugs have to be used at the lowest possible dose, which often doesn’t happen now. There’s huge economic pressure to medicate patients very rapidly and to get them out of the hospital right away. Implication 2: we need to find other drugs that work on other systems and parts of the brain. Implication 3: whatever medications we use need to be combined with more nonmedication-oriented treatments, like cognitive or social therapies.
Where do we go from here? Dr. Andreasen, by her own admission, sat on her findings for two years. Findings, might I add, the substance of which consumers have been complaining about for years. Our opinion, of course, is considered "anecdote" by people smarter than we are, such as Dr. Andreasen. I can quibble about her findings, because there is also something called the "plastic brain" which is a concept that wasn't in much vogue a decade ago. The plastic brain, unlike the brain set in concrete, is adaptive and will find solutions and neuronal pathways around problems.
If Dr. Andreasen's research will stick for the next decade or so until it is overthrown by yet another biochemical explanation for mental illness, then the service she has provided is that she has armed you with "scientific information" from a well-know U.S. researcher that you can take to your doctor and demand either no drugs and better alternative treatments to help you through this, or else medications only for the period of crisis and in low doses.
The Bonkers Institute for Nearly Genuine Resarch provides a look at the drug-addled schizophrenic brain. Before you feel like ending it all when you see this image, keep in mind that the brain is plastic and that science is unreliable.
Q. AND WHAT HAVE YOU FOUND?
A. I haven’t published this yet. But I have spoken about it in public lectures. The big finding is that people with schizophrenia are losing brain tissue at a more rapid rate than healthy people of comparable age. Some are losing as much as 1 percent per year. That’s an awful lot over an 18-year period. And then we’re trying to figure out why. Another thing we’ve discovered is that the more drugs you’ve been given, the more brain tissue you lose.
Q. WHAT EACTLY DO THESE DRUGS DO?
A. They block basal ganglia activity. The prefrontal cortex doesn't get the input it needs and is being shut down by drugs. That reduces the psychotic symptoms. It also causes the prefrontal cortex to slowly atrophy.
Q. WHAT ARE THE POLICY IMPLICATIONS OF THIS FINDING?
A. Implication 1: that these drugs have to be used at the lowest possible dose, which often doesn’t happen now. There’s huge economic pressure to medicate patients very rapidly and to get them out of the hospital right away. Implication 2: we need to find other drugs that work on other systems and parts of the brain. Implication 3: whatever medications we use need to be combined with more nonmedication-oriented treatments, like cognitive or social therapies.
Where do we go from here? Dr. Andreasen, by her own admission, sat on her findings for two years. Findings, might I add, the substance of which consumers have been complaining about for years. Our opinion, of course, is considered "anecdote" by people smarter than we are, such as Dr. Andreasen. I can quibble about her findings, because there is also something called the "plastic brain" which is a concept that wasn't in much vogue a decade ago. The plastic brain, unlike the brain set in concrete, is adaptive and will find solutions and neuronal pathways around problems.
If Dr. Andreasen's research will stick for the next decade or so until it is overthrown by yet another biochemical explanation for mental illness, then the service she has provided is that she has armed you with "scientific information" from a well-know U.S. researcher that you can take to your doctor and demand either no drugs and better alternative treatments to help you through this, or else medications only for the period of crisis and in low doses.
The Bonkers Institute for Nearly Genuine Resarch provides a look at the drug-addled schizophrenic brain. Before you feel like ending it all when you see this image, keep in mind that the brain is plastic and that science is unreliable.
Wednesday, April 7, 2010
The new medicine is not lesser medicine
Give consumers the power of choice and we will generally opt for fewer and less costly medical interventions that have unproven efficacy yet known side effects.
From today's New York Times: In Medicine, the Power of No logically should extend to mental health care.
The better bet for the new reformers — starting with Donald Berwick, the physician who will run Medicare — is to channel American culture, not fight it. We want the best possible care, no matter what. Yet we often do not get it because the current system tends to deliver more care even when it means worse care.
It’s not just CT scans. Caesarean births have become more common, with little benefit to babies and significant burden to mothers. Men who would never have died from prostate cancer have been treated for it and left incontinent or impotent. Cardiac stenting and bypasses, with all their side effects, have become popular partly because people believe they reduce heart attacks. For many patients, the evidence suggests, that’s not true.
Advocates for less intensive medicine have been too timid about all this. They often come across as bean counters, while the try-anything crowd occupies the moral high ground. The reality, though, is that unnecessary care causes a lot of pain and even death.
From today's New York Times: In Medicine, the Power of No logically should extend to mental health care.
The better bet for the new reformers — starting with Donald Berwick, the physician who will run Medicare — is to channel American culture, not fight it. We want the best possible care, no matter what. Yet we often do not get it because the current system tends to deliver more care even when it means worse care.
It’s not just CT scans. Caesarean births have become more common, with little benefit to babies and significant burden to mothers. Men who would never have died from prostate cancer have been treated for it and left incontinent or impotent. Cardiac stenting and bypasses, with all their side effects, have become popular partly because people believe they reduce heart attacks. For many patients, the evidence suggests, that’s not true.
Advocates for less intensive medicine have been too timid about all this. They often come across as bean counters, while the try-anything crowd occupies the moral high ground. The reality, though, is that unnecessary care causes a lot of pain and even death.
A.A. and SZ
Dr. Abram Hoffer, the originator of niacin treatment for schizophrenia, believed that alcoholism was often a coping mechanism for latent schizophrenia. These two conditions, while on the outside may not have much in common, respond well to megadoses of niacin in combination with other vitamins. There is also a psycho/spiritual dimension that cannot be ignored in both. It is interesting, given that these two conditions have much in common, that programs like Alcoholics Anonymous have seen many success stories, while the same cannot be said for schizophrenia treatment programs.
A.A.'s growth and track record is due to some principles that were understood from the beginning. The founders recognized that in order to succeed in their work, A.A. had to be a volunteer organization, where alcoholics were there to counsel others as peers. They managed to secure some initial funding from J.D. Rockefeller, but Rockefeller and his associates were reluctant to fund them further, warning them to steer clear of the trap of "professionalism". Money, it was felt, would spoil a good thing. Paid volunteers, according to A.A.'s members, would destroy trust.
The spiritual/religious dimension is a very strong part of A.A. Contrast this with schizophrenia, where religiosity is considered a symptom of psychosis to be chemically eliminated.
The treatment approach that came closest to A.A. for schizophrenia was Soteria, which relied on non-medical people to work closely with the patients. In fact, many people who have recovered from schizophrenia credit their recovery to someone who cared, who was able to empathize with them, perhaps someone who had been there himself. A.A. incidentally, deliberately preferred to staff the organization with recovered alcoholics, including medical doctors.
Today's schizophrenia programs, by and large, are not success stories. They rely on paid medical staff (who, presumably, are not former schizophrenics), not counseling by peers. The doctor knows best, the patients' personal life stories are considered irrelevant in the face of the "proven efficacy" of the biochemical model.
A.A.'s growth and track record is due to some principles that were understood from the beginning. The founders recognized that in order to succeed in their work, A.A. had to be a volunteer organization, where alcoholics were there to counsel others as peers. They managed to secure some initial funding from J.D. Rockefeller, but Rockefeller and his associates were reluctant to fund them further, warning them to steer clear of the trap of "professionalism". Money, it was felt, would spoil a good thing. Paid volunteers, according to A.A.'s members, would destroy trust.
The spiritual/religious dimension is a very strong part of A.A. Contrast this with schizophrenia, where religiosity is considered a symptom of psychosis to be chemically eliminated.
The treatment approach that came closest to A.A. for schizophrenia was Soteria, which relied on non-medical people to work closely with the patients. In fact, many people who have recovered from schizophrenia credit their recovery to someone who cared, who was able to empathize with them, perhaps someone who had been there himself. A.A. incidentally, deliberately preferred to staff the organization with recovered alcoholics, including medical doctors.
Today's schizophrenia programs, by and large, are not success stories. They rely on paid medical staff (who, presumably, are not former schizophrenics), not counseling by peers. The doctor knows best, the patients' personal life stories are considered irrelevant in the face of the "proven efficacy" of the biochemical model.
Monday, April 5, 2010
A rags to riches story
While making my way out the back door of the church on Easter Sunday, I picked up a discarded copy of PASS IT ON, the biography of Bill W., founder of Alcoholics Anonymous. A.A. holds regular meetings in the basement of my church.
There is so much in this book. Bill W. was a failure at high school, at university, at business, but he was possessed of such a keen mind that he became successful on Wall Street in the 1920s as one of the first stock pickers, a niche job that was almost unheard of until he came along. Of course, he lost all of that many times over through a craving for alcohol. Rock bottom for him was tested on many occasions. His doctor said he would either die or be confined to a mental institution for the rest of his life. But still, he kept drinking.
An acquaintance of his had gone to Switzerland to seek help from Carl Jung. After a year of therapy and a subsequent relapse, he went back to see Jung who told him he would never beat this until he had a "spiritual awakening." Belief in God was not enough. He advised him to align himself with a religious movement.
Bill W. was not very religious, but he sensed that spirituality was a missing element in his life. It was some time after this that he had what is called a conversion experience. He cried out during a particularly dark moment "If there be a God, let Him show Himself!" The room suddenly set ablaze with a white light and Bill W. experienced the same kind of ecstasy that was known to Teresa of Avila, Saul on the road to Damascus and others. He was 39 years old.
There is so much in this book. Bill W. was a failure at high school, at university, at business, but he was possessed of such a keen mind that he became successful on Wall Street in the 1920s as one of the first stock pickers, a niche job that was almost unheard of until he came along. Of course, he lost all of that many times over through a craving for alcohol. Rock bottom for him was tested on many occasions. His doctor said he would either die or be confined to a mental institution for the rest of his life. But still, he kept drinking.
An acquaintance of his had gone to Switzerland to seek help from Carl Jung. After a year of therapy and a subsequent relapse, he went back to see Jung who told him he would never beat this until he had a "spiritual awakening." Belief in God was not enough. He advised him to align himself with a religious movement.
Bill W. was not very religious, but he sensed that spirituality was a missing element in his life. It was some time after this that he had what is called a conversion experience. He cried out during a particularly dark moment "If there be a God, let Him show Himself!" The room suddenly set ablaze with a white light and Bill W. experienced the same kind of ecstasy that was known to Teresa of Avila, Saul on the road to Damascus and others. He was 39 years old.
Sunday, April 4, 2010
The delusion and the Empowerment Group
I "borrowed" this "incredibly eloquent submission by Joe Gutstein," from The Trouble with Spikol. The full submission can be at found Liz Spikol's blog. If you do nothing else today, she advises, read this. It underscores a favorite gripe of mine, that support groups and day programs undermine empowerment.
"Let’s imagine for a moment that you are long into the public mental health system. You have been in the hospital multiple times, in a couple of partial hospitalization programs, and have spent years in sheltered workshops and day programs. You’ve received the Prophecy of Doom, “Too sick for too long to get any better.” You’ve heard plenty of statements beginning with “You can’t, You won’t, and You will never.” You’ve been told endlessly that something is intrinsically (genetically) wrong with you and the only thing that will truly save you is a medication yet to be discovered. You’ve also been told that the most important thing you can do is get on SSI or SSDI in light of the prolonged and persistent nature of your illness. You’ve been told to engage in meaningful activities generally limited to walking, listening to music, and reading. You’ve been told countless times to avoid any stressors which might be associated with more rewarding activities and these stressors will doubtless lead to yet another hospitalization. You’ve been told so many things."
. . .
"Let’s imagine for a moment that you are long into the public mental health system. You have been in the hospital multiple times, in a couple of partial hospitalization programs, and have spent years in sheltered workshops and day programs. You’ve received the Prophecy of Doom, “Too sick for too long to get any better.” You’ve heard plenty of statements beginning with “You can’t, You won’t, and You will never.” You’ve been told endlessly that something is intrinsically (genetically) wrong with you and the only thing that will truly save you is a medication yet to be discovered. You’ve also been told that the most important thing you can do is get on SSI or SSDI in light of the prolonged and persistent nature of your illness. You’ve been told to engage in meaningful activities generally limited to walking, listening to music, and reading. You’ve been told countless times to avoid any stressors which might be associated with more rewarding activities and these stressors will doubtless lead to yet another hospitalization. You’ve been told so many things."
. . .
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