Thursday, April 19, 2012

I'm really tired of Yale University

Editor's note: Yale University is a wonderful place to peddle the status quo while making money helping commercial interests fatten their bottom lines. We are all supposed to genuflect when we hear that someone teaches at or graduated from Yale! Yale and academia in general sold out long ago to the imperatives of business.

About the only thing I can agree with in the following interview with Mary D. Moller is her statement "We need to give people time to heal. We’re pushing people too fast. We have not done a good job of helping people cope with the psychological and emotional consequences of psychoses. Recovery is so much more than symptom management and obtaining meaningful work."

Oherwise, I find the interview very disturbing. Prof. Moller has built her professional life around the biochemical model of the illness. Now, she is ensconced at Yale University, awash in research grants that promote recovery as a state of perpetual patienthood. Being a patient is stigmatizing, demoralizing, and unhealthy. But Ms Moller is a nurse first and foremost. She can't be a nurse unless she has medicated patients.There is no incentive for her to connect the dots, and so she doesn't.  She does not believe in full recovery. She believes in exacerbations and remissions, and of course, meds.

Though no disclosure was provided for this interview, MEDSCAP discloses that Mary D. Moller has received grants for clinical research, served as an advisor or consultant to, and received honorarium for promotional talks, from AstraZeneca Pharmaceuticals.


NAMI Talks to Mary Moller about Post-Psychotic Adjustment

By Sarah Christen, NAMI Convention Manager

Mary D. Moller D.N.P., M.S.N., A.R.N.P., is an advanced registered nurse practitioner dually certified as a clinical specialist in adult psychiatric mental health nursing and a psychiatric rehabilitation practitioner.

We are looking forward to Mary’s presentation, "From the Couch, to the Mall, to Work! Understanding the Relationship of Post-psychotic Adjustment to Recovery,” at the NAMI National Convention on Wednesday afternoon, June 27.

NAMI recently talked to Mary Moller to get some insight into her life’s work and what she will be highlighting at the convention.

Can you tell us about your history?

I have been working in psychiatry since 1978. Prior to that, I worked in neurology for seven years. I had no experience in psychiatry when I started—I just noticed a complete parallel in behaviors and symptoms in psychosis that I saw on the acute neurology unit. I started providing the same kind of nursing care for psychiatric patients I did in neuro-rehab.

In 1992 I moved to Washington state because the nurse practice act allowed for autonomous prescriptive authority and independent practice. I started the first independent nurse-managed and owned outpatient psychiatric clinic to provide wellness-focused, one-on-one services and group psychoeducation for people living with serious mental illness and their family members.

When [the medication] aripiprazole came out in 2002, I noticed several individuals living with schizophrenia had a new level of awakening that hadn’t occurred with their previous medications. I started holding focus groups to develop a new rating scale I was calling “The Impact of Psychosis Questionnaire.” I was curious as to why some people seemed stuck in their ability to move forward with their lives. I wasn’t prepared for the often long-enduring anguish over the traumatic impact of psychosis that I was reading in the narrative section of the questionnaire as well as in the focus group discussions.

I realized that the consequences of psychosis was reflecting difficulty in adjusting to life with all the changes caused by a mental illness. I called the phenomenon “post-psychotic adjustment process."

What is the Milestones of Adjustment Post-psychosis (MAPP) Recovery Model?

In 2003, there was nothing published on this phenomenon. My career has been spent attempting to understand the lived experience of psychosis from the person and the family experience. This was a new level to learn. I went back to school and studied this phenomenon for my doctoral thesis. The result is the MAPP Recovery model—Milestones of Adjustment Post-psychosis.

My research identified a four-phase process with 50 measurable cognitive, emotional, interpersonal and physical milestones that occur over at least a two-year period. Understanding this process assists both family members and the person living with mental illness to develop skills that will assist in meeting their desired recovery goals and aspirations.

We need to give people time to heal. We’re pushing people too fast. We have not done a good job of helping people cope with the psychological and emotional consequences of psychoses. Recovery is so much more than symptom management and obtaining meaningful work. I look at where an individual is along the trajectory and, with the help of the person, create an individualized set of goals and interventions to reach a desired target. The key to success in navigating the MAPP is the need for family support and medications that assist in managing symptoms.

How has mental health care changed in the last 30 years?

Science has shown us that psychiatric illnesses are very serious neurobiological disorders. We need to approach these illnesses as we do all other chronic health problems recognizing that there are exacerbations and remissions. They are very serious medical illnesses of the brain. Left untreated, they can cause very serious and lifelong consequences.

Stigma is still our major battle. The stigma runs so deep that it affects policy development and implementation. Politicians want to speak nicely, but dollars for community-based mental health care are still sadly lacking. We still have far too many people who are homeless or now being treated in jails. Housing and long-term services for individuals with psychiatric illnesses is still sadly lacking. Many excellent programs have been developed but had to close because of loss of funding.

Mary Moller is currently an associate professor of nursing at the Yale University School of Nursing, where she is director of the psychiatric nursing master's program. She received the Case Western Dean’s Legacy Award for her research, "The Lived Experience of the Patient with Schizophrenia in the Post-psychotic Adjustment Phase of Recovery from Psychosis."

3 comments:

  1. oh wow! truly sad... Like learning that Pete Earley's book is required reading at WSU's nursing program--to give the students a real world family perspective?! I spoke to the Dean of Nursing about my thoughts on THAT. I wonder if this woman even considered “post-psychotic adjustment process" is so difficult because of the traumatic impact of being robbed of any real autonomy, e.g. "you now officially have NO insight into your own life. You no longer have any right to say no, unless your 'treatment team' allows it. You cannot live where you wish unless your 'treatment team' ALLOWS it. In a million ways large and small, your treatment team will remind you so that you don't you ever forget: we can make you comply with treatment; after all, you now have a 'Psychiatric Diagnosis' and there is no cure only 'treatment.' BTW, YOUR consent or approval is not needed. Your consent is not as important as you knowing that: YOU DO have to take the drugs we tell you to. Compliance is how mental health 'professionals'of the bio-maniacal persuasion quantify 'successful treatment. Remember it's only done out of altruistic advocacy 'for your own good!'

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  2. After reading Ms Moller's resumé I thought about changing the title of this post to "Academic over-achiever hasn't got a clue about underachievement in the patient population" Too long?

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  3. tracy.rose@healthline.comNovember 13, 2012 at 7:31 PM

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I am no longer approving comments. All I ask is that you be respectful of others and refrain from using profanity.