Thursday, March 29, 2012

Another SSRI story?

Here are some highlights from the latest New York Times article on the ruckus on the Jet Blue aircraft.

Two years ago, the F.A.A. relaxed its longstanding ban on psychiatric medications for pilots, saying that new drugs for depression had fewer side effects than older drugs. The agency now grants waivers allowing pilots to fly while taking Prozac, Zoloft, Celexa or Lexapro, and their generic equivalents.

The F.A.A.’s administrator at the time, J. Randolph Babbitt, said the agency was relaxing its ban because it was concerned that some pilots with depression were not being treated, or were being secretive about it. “We need to change the culture and remove the stigma associate with depression,” Mr. Babbitt said then.

But the F.A.A. said in an e-mail on Wednesday that since April 2010, less than one-half of 1 percent (0.016 percent or 20 out of 120,000 pilots who have a first-class medical certificate) have taken advantage of the F.A.A.’s policy. Pilots on commercial airliners are required to have a first-class certificate.

A 2006 study by the F.A.A. of post-mortem toxicological evaluations of 4,143 pilots killed in accidents from 1993 to 2003 found that 223 were using mood-altering drugs like antidepressants, according to The Associated Press. Only 14 of the pilots who tested positive for the drugs reported a psychological condition on their medical forms, and only one reported using a mood-altering drug. None of the pilots determined to have used neurological medications had reported that on their medical forms, the AP reported.

Tuesday, March 27, 2012

Beware a public backlash against psychotherapists and a return to medications

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

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

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

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

Check out NAMI Westside LA upcoming conference

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

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

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

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

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

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

Monday, March 26, 2012

Schizophrenia research study hogwash

I dunno about you, but I have trouble figuring out what most psychiatric research studies are actually saying. The language is clinical gibberish. Here's a typical example that I found at the Mad in America blog. My own take on this, not what the study actually says, is that depression accompanying  high levels of insight correlate with people correctly interpreting the hopelessness conveyed by their diagnosis. (Note the study's definition of recovery. This is not recovery in my books. What it is is managing your illness.)

The conclusions drawn from this study are some of the reasons I don't believe in mental illness. I do believe that there are people who believe in mental illness, and they will do their best to convince you that you are hopeless. As long as someone else believes you are mentally ill, and you are in close proximity to that person, chances are you will remain mentally ill.

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

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


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


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


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


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

Wednesday, March 21, 2012

Clozapine's new ambassador - Claire Danes

I actually wanted to have a nastier title, (two P words came to mind before I came up with "ambassador") but I thought better of it. I wish Claire Danes had at least thought about the implications of what she is doing - but of course, money talks. May the Karma truck eventually drive up to her door and dump a load of excess calories her way.

Here's a look behind the scenes at clozapine, courtesy of David Healy's Mad in America post.

In the latest hit series Homeland Claire Danes plays Carrie Mathison a CIA agent with bipolar disorder taking Clozapine. She takes the drug to prevent herself tipping over into frank paranoia in a world where being paranoid is necessary for survival.

Anyone who knows anything about Clozapine knows Claire Danes is definitely not on it – she would not be as slim and svelte as she is if she were taking it. Weight gain is something Evident about clozapine that stands in contrast to the Evidence showing no weight gain that companies have gone out of their way to produce for Clozapine and related drugs like Zyprexa and Seroquel (see False Friends).

The question is what does Claire Danes know about Clozapine and should she get paranoid rather than just play the paranoid? As an actress is she killing people playing the part she plays? Is there anything else Evident about Clozapine being hidden by the Evidence?

Clozapine began life in 1958. It was given to the world’s leading psychopharmacologist Pierre Deniker to assess. At the time the neuroleptic/antipsychotic group of drugs was regarded as very safe. Several of Deniker’s patients died on Clozapine and startled by the number and range of deaths he said it was Evident that it should not be developed.

The company who made Clozapine (Wander) paid no heed to him; business and clinical evidence are two different things. Clozapine’s development continued even after Wander was taken over by Sandoz. Then in 1975 a series of deaths on Clozapine following drops in white blood cell counts happened in Finland. Clozapine was removed from markets in Europe and never made it to the US – Homeland Security (aka the FDA) intervened.

But it re-emerged in 1988 in the United States, in part because of efforts within Homeland Security. The history of clozapine’s return has been spun and respun – see The Creation of Psychopharmacology – in the course of which a myth has been created that clozapine is more effective than other antipsychotics (very important for someone on whose wits the fate of America depends) even though head to head trials in first episode psychoses show clozapine to be no better than older drugs like chlorpromazine.

Read the rest here.

Monday, March 19, 2012

Søren Kierkegaard on anxiety

From Opinionator
March 17, 2012, 2:30 pm

The Danish Doctor of Dread


The way we negotiate anxiety plays no small part in shaping our lives and character. And yet, historically speaking, the lovers of wisdom, the philosophers, have all but repressed thinking about that amorphous feeling that haunts many of us hour by hour, and day by day. The 19th-century philosopher-theologian Soren Kierkegaard stands as a striking exception to this rule. It was because of this virtuoso of the inner life that other members of the Socrates guild, such as Heidegger and Sartre, could begin to philosophize about angst.

It is in our anxiety that we come to understand feelingly that we are free, that the possibilities are endless.

Though he was a genius of the intellectual high wire, Kierkegaard was a philosopher who wrote from experience. And that experience included considerable acquaintance with the chronic, disquieting feeling that something not so good was about to happen. In one journal entry, he wrote, “All existence makes me anxious, from the smallest fly to the mysteries of the Incarnation; the whole thing is inexplicable, I most of all; to me all existence is infected, I most of all. My distress is enormous, boundless; no one knows it except God in heaven, and he will not console me….”

Is there any doubt that were he alive today he would be supplied with a refillable prescription for Xanax?

Read the rest here.

Sunday, March 18, 2012

Same wood work, different meaning this time

This post is really not such much about changing my mind on how I felt about something at the time, but seeing the wisdom of doing something meaningful at the right time.

Chris recently started volunteering any spare time he has on the week-ends to help the amateur operatic group he sings with construct sets and props. The idea to volunteer for behind the scenes work was suggested by his occupational therapist. Under guidance from two older men in the group, Chris is swinging a hammer and sawing wood and doing whatever one must do to set the stage for April. He's enjoying himself and he gets to hear all kinds of interesting stories from the men with whom he works.

The kind of work he is doing now is the kind of work that failed miserably —oh so many years ago after he had finished his two year day program. The day program hadn't "fixed" him, and, as kind of a last resort, the psychiatrist at the program arranged for Chris to "apprentice" with a cabinet maker. The apprenticeship or sheltered workshop or whatever it was considered, was covered through our health insurance policy. Chris didn't succeed as an apprentice cabinet maker or sheltered workshop worker, because, well, frankly, he didn't do any work. He didn't do any work not because he wasn't encouraged to, but because he couldn't. According to Chris, he just drank cups of coffee, spoke very little, and watched the cabinet maker hard at work sanding and buffing. Ian and I had to drive Chris to the door of the shop, otherwise he wouldn't go in.

I believe that institutionalizing mental illness through day programs and sheltered workshops hinders recovery because it makes the person feel and act like a patient. The word "disabled" comes to mind.

Perhaps what the doctors in the program should have thought about, but probably didn't, was that parents are still dealing with grief mixed with expectations about their relative. I felt the doctors were trying to turn my academically promising son into a disabled worker. They were lowering his expectations (and mine!) by having him sand wood in a gloomy workshop. Only two years earlier he was at university. Chris's psychiatrist told me point blank that Chris would never again be the promising student that he once was. So, I feel I correctly interpreted what the wood studio meant for Chris's future. Chances are Chris came to the same conclusions as I did.

Today, I can't say I'm thrilled that Chris sees an occupational therapist, because I don't see him as "handicapped" (and this, to me, is what having an occupational therapist implies) but at some point, I just stopped trying to run interference with his recovery and leave it to the wisdom of others. I never thought I had all the answers, but I also don't believe they have all the answers either. I'm very pleased that Chris is happy hacking and sawing away to his heart's content in a woodworking shop. The difference is that this time his being there is a natural outgrowth of his love of the musical theater work that he is doing.

Here's an interesting perspective from Raymond's Room on what's happening vis a vis sheltered workshops in Oregon State.

Friday, March 16, 2012

David Healy in Toronto on promotional tour for new website

Thanks to Chris for spotting this article.

From The Globe and Mail
Drug-risk website aimed at consumers

anne mcilroy Published Wednesday, Mar. 14, 2012 4:05PM EDT

Julie and Peter Wood say they wish they had known more about the stimulant a doctor prescribed for their son to help him concentrate.

John David Wood, a student at the University of Toronto, became addicted to the medication and developed serious mental health problems after he abruptly went off it. He committed suicide in 2008, at the age of 26.

In an effort to help other families learn more about the potential downside of prescription drugs, his parents are working with David Healy, a high-profile critic of the pharmaceutical industry, on a new website –

They hope the website will make it easy for people to research any drug that is approved for use in Canada or the United States, both brand names and generics. But they also want to build a grassroots database on side effects of these medications. For now, patients can search the new website, at no cost, for information about the adverse impact of drugs collected by the Food and Drug Administration in the U.S. But if all goes according to plan, in a few weeks the new website will ask patients to report side effects and allow them to see whether other people have experienced the same symptoms.

Read the rest here

Thursday, March 15, 2012

International society removes 'schizophrenia' from its title


International society removes 'schizophrenia' from its title

A statement from the ISPS today reveals that the society has voted to remove the word 'schizophrenia' from its title due to the term being deemed 'unscientific andstigmatizing':  
"Members of the International Society for the Psychological Treatments of the Schizophrenias and Other Psychoses ( have just voted, by an overwhelming majority, to change the society’s name to the International Society for Psychological and Social Approaches to Psychosis. The new logo and letterhead are to be adopted by the end of March.  
The change comes at a time when the scientific validity of the term schizophrenia is being hotly debated in the lead up to the publication of the latest edition of the Diagnostic and Statistical Manual (see  

Read more

Wednesday, March 14, 2012

Dr. Drew said it

With a straight face, I may add. He said that before a psychiatric diagnosis is rendered, the doctor will systematically rule out potential biological causes.


Like rule them out as in schizophrenia?

He's got to be joking. Let's see, no doctor ever suggested running some tests on Chris, "just to see if he had any underlying biological problems." The only time Chris ever got blood tests on the doctor's orders was when he was on antipsychotic medication.

The person who suggested that we "run some tests" on Chris was me. He got a brain scan only after I suggested he have one. The doctors didn't just stop at not recommending biological testing. They also balked at sending him for complementary and alternative treatment. 

Running tests to rule out underlying biological problems for cases of mental illness is a myth that goes down well with the public, especially on prime time television. It's like believing that a judge is a neutral party who impartially weighs all the evidence and then delivers a verdict. Hah!

Monday, March 12, 2012

Taken as prescribed, medications kill 100,000 people per year

What use do you make of your physician?” said the king to Molière one day. “We chat together, sire; he gives me his prescriptions; I never follow them, and so I get well.”

The 100,000 per year body count  is for the United States only. Medications, properly prescribed and properly taken, kill twice the number of people per day than car accidents do. The unsettling death statistics from prescribed meds is not something we hear much about. Yet many, if not most of us, simply take the medications we are given and probably take more than we need. It's one thing if a person has a life threatening illness or condition and needs the medication in order to survive. But many people are taking prescription medications that they could shed if they changed their habits and did a bit of research into alternatives.

I got to thinking about this today when I visited a friend of mine in the hospital. She'll be 90 years of age this month. She loves to tell me what her mother told her -- to always buy the best food, because otherwise, instead of paying the grocer, you'll be paying the doctor. She eats butter, not margarine. Up until a few weeks ago, my friend was on no prescription meds. None. She has a heart condition that gave her occasional problems in the past, but she always refused meds for the problem.  Today, the doctor informed her in my presence that she will need to take the meds he had prescribed her the rest of her life. After he left, she complained bitterly to me that she hated being on "these things." I congratulated her for managing to dodge these bullets up until now, that she probably was healthier for having done so, and suggested that taking the meds now for the rest of her life was a small price to pay for avoiding landing back in the hospital. By all indications, she should be able to resume her normal activities within a month. But, she will be hounding her doctor to keep the medications to a minimum, I can guarantee it.

My favorite doctor, the one I prefer to go to avoid health problems in the first place, is Andrew Saul, Ph.D. When people protest that vitamins, not just meds, kill people, thereby implying that vitamins are inherently dangerous, Saul always asks the question, "where are the bodies?" He has done extensive data gathered from 61 U.S. poison control centers, which reported a mere 10 deaths linked to vitamins over the past 25 years.

Saul also recounts that “More than 1.5 million Americans are injured every year by drug errors in hospitals, nursing homes and doctor's offices, a count that doesn't even estimate patients' own medication mix-ups. . . (O)n average, a hospitalized patient is subject to at least one medication error per day.” 

Just as I was about to push the publish button for this post, I was delighted to see that there is a new website about prescription medication side effects that contains a database for logging adverse effects.  The medical and research team behind this venture includes Dr. David Healy and author Robert Whitaker, and many other prominent names in pharmacology and other disciplines.

ALGERNON MONCRIEFF: The doctors found out that Bunbury could not Bunbury died.

LADY BRACKNELL: He seems to have great confidence in the opinion of his physicians. I am glad, however, that he made up his mind at the last to some definite course of action, and acted under proper medical advice. (From Act III of The Importance of Being Earnest by Oscar Wilde)

The humorous quotes on this page were directly cribbed from Andrew Saul's website:

Sunday, March 11, 2012

There is hope for even chronic cases of "schizophrenia"

Ron Unger is the best blogger I know who can decode schizophrenia to the outside observer and offer  healing words of wisdom. His most recent post is a must read. It's a lengthy look at what Carl Jung believed about schizophrenia. For people who want to know if there is hope for people with " schizophrenia," here's what Jung wrote:

In regard to the latter (i.e., severe cases), Jung stated: “It would be a mistake to suppose that more or less suitable methods of treatment exist. Theoretical assumptions in this respect count for next to nothing. Also, one would do well not to speak of ‘methods’ at all. The thing that really matters is the personal commitment, the serious purpose, the devotion, indeed the self-sacrifice, of those who give the treatment. I have seen results that were truly miraculous, as when sympathetic nurses and laymen were able, by their courage and steady devotion, to re-establish psychic rapport with their patients and so achieve quite astounding cures” (p.265).

Jung then addresses certain countertransference issues:

“But even so one can bring about noticeable improvements in severe schizophrenics, and even cure them, by psychological treatment, provided that one’s own constitution holds out [in my own experience, I have had situations where I continued the long-term psychotherapy of several patients in inpatient state hospital settings, later transferred into my practice, in which I was physically attacked, reported to have sexually molested the patient , etc, to very positive outcomes, e.g., to the point where family thought their family member was originally misdiagnosed as schizophrenic, never having to return to the state hospital after many years of residing there, etc]. This question is very much to the point, because the treatment not only demands uncommon efforts but may also induce psychic infections in a therapist who himself has a rather unstable disposition. I have seen no less than three cases of induced psychoses in treatments of this kind” (pp. 265-266).

Thursday, March 8, 2012

Schizophrenia, conversion disorder, stress and immigration

Year ago, when Taylor, my youngest son, was in third grade, he had a friend "Jeremy" (not his real name). Like us, Jeremy and his family had relocated from North America to Europe that year, where the father was employed in high tech. Jeremy was an only child. His mother told me that when they were in the final stages of moving, Jeremy woke up one day and said he had lost all sight in both his eyes. He was blind for about a week or two. You can imagine how terrifying that was for all concerned.

That's what stress can do to the human mind, or, to turn it around, that's what the powerful mind can do to the human body. When researchers note that there is a higher proportion of "schizophrenics" seen in the Jamaican immigrant population in England, this doesn't surprise me. There are enough Jamaican immigrants to form a ready research pool. Moving continents and cultures is a shock. Schizophrenia is a stress reaction but no stranger than going blind is. You have to see it to believe it.

I came across a similar story to Jeremy's when I was searching for the latest article on the teenage girls in Le Roy, New York who developed bodily tics and twitches. Jeremy had what by all accounts would be  "conversion disorder." It used to be called hysteria.

What did happen to the girls in Le Roy? There is a fascinating article in the New York Times Magazine  by Susan Dominus. Dominus writes that when the environmental explanation for the phenomenon did not hold up, and the diagnosis was the stress-related conversion disorder, here's what happened.

To many parents, the diagnosis was woefully inadequate, even insulting.“It’s a very hard pill for me to swallow — what are we, living in the 1600s?” the guardian of one of the girls said. Besides, kids are always stressed, and some of these kids may have been less stressed than most. On CNN, James DuPont, the father of an afflicted girl, said, “A lot of these kids were just, you know, having a happy, normal life.” Miller told me she did not buy the diagnosis, not one bit. “My daughter hasn’t had any trauma,” she said. “She was just happy, going along. She was as happy as can be.”

Like with schizophrenia, it is hard for many people to equate the really strange behavior with the stressors that many of us take for granted in our own lives.

According to Dominus:

A common thread emerged among the five girls I interviewed extensively: none had stable relationships with their biological fathers. And the father of a sixth girl had seen little of his high-school daughter until his concern about the tics galvanized their relationship. Another student was a foster child who switched foster homes shortly before his tics came on; yet another is in the custody of an older sibling. Another two have spotty contact with their fathers. One young woman I interviewed was close to homeless after she and her mother left her father’s trailer. They’re staying with a friend of a friend while her mother, who was laid off two times in the last year, tries to scrape together first and last month’s rent so they can get a place of their own.

Dominus also reveals that Dr. Rosario Trifiletti, who has diagnosed a mysterious and ill-defined "PANDAS-like illness" was unaware of the trauma in his patient's lives:

When I spoke to him in late February, Trifiletti told me that the girls he was treating were showing dramatic signs of improvement. Katie’s parents said they believed that she was responding well to the antibiotics; Chelsey’s family reported that the drugs are helping her as well. But another patient of Trifiletti’s said she was still fainting.

When the subject of the girls’ personal backgrounds came up — the biopsychosocial factors that might be affecting their health — Trifiletti said he had not had the time to ask them about those kinds of things. The abuse, the troubling family circumstances — much of it came as news to him. “Jeez, I didn’t realize the extent,” Trifiletti said. “These aren’t things people want to talk about. I don’t know, maybe I’m wrong. It’s hard to distinguish between the drug and the placebo effect.”

Schizophrenia is much more common than conversion disorder. Yet, medicine stubbornly resists linking schizophrenia to trauma or stress factors. Medical science favors the biochemical imbalance theory of schizophrenia, almost exclusively. It's quite insulting, really, to those of us who are wanting answers for schizophrenia, and more importantly, more meaningful help, that conversion disorder is taken more seriously than schizophrenia from the psycho/social point of view.

The psychological explanation, of course, hasn't stopped some of the Le Roy parents from putting their teenage girls on drugs. The Dominus article reports that at least one girl is on eleven different medications! One can only presume it is because the parents don't believe that stress alone can produce something so strange.

Well, stress can, and does.

Below are some readers' comments to the Dominus article.

..Shame on you New York Times for writing such an offensive article. We are not in the dark ages. And to go so far as to blame these girls "instability" on living with single moms is disgusting. These girls don't have conversion disorder. This is just a made up diagnosis for doctors that have egos so big they can't say the words "I don't Know".

And, the following quote from simon Wessely is offensive to every person who has an illness that is not yet understood by science.

"Wessely, the epidemiologist, cited a medical-journal paper whose title had long resonated with him: “If You Have to Prove You Are Ill, You Can’t Get Better.”

Here is another quote from a recent Washington post article on chronic lyme that I think is more fitting for what is going on in Le Roy.

"Just because scientists don’t understand the cause of a disease doesn’t mean that it doesn’t exist."

AS Minnesota
..All of the comments here that suggest that somehow their doctors were being "mean," or were incompetent, or just not empathic enough because they conferred a psychological etiology just seems to further prove the point that for many folks, it IS in their head! Someone who honestly assumes that their doctor is mean for suggesting a psychological contribution has obvious psychological issues. Do you honestly think your doctor is intentionally trying to be mean to you? Why so defensive?? What is so threatening about a psychological diagnosis?? We experience physical symptoms as a result of psychological stress all the time. Nervous about an upcoming performance or a big date (i.e., psychological cause), and so you get an upset stomach (i.e., physical symptom)? Financial stress or work stress (i.e., psychological cause) giving you a splitting headache (i.e., physical symptom)? Honestly, people. Given the complexity of the human brain, it is utterly preposterous that all ailments are due to a physiological cause. Anyone who doctor shops enough will find someone who will eventually render a medical diagnosis (no matter how random or "rare") that suits their PSYCHOLOGICAL need to have a medical explanation rather than a psychological one. Whenever I hear people maligning the "it's all in your head" comment, I think to myself, "where else would it be?? OF COURSE it's all in your head. that's where the most complex organ in your body sits."

Matt Evans New Jersey
..There is a fifth dimension, beyond that which is known to man. It is a dimension as vast as space and as timeless as infinity. It is the middle ground between light and shadow, between science and superstition. - Rod Serling

Wednesday, March 7, 2012

TV Ontario's new series on mental health

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

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

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

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

Mental Health Matters Sandra Gionas Tuesday March 6, 2012

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

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

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

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

The Agenda team after a spirited afternoon of basketball.

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

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

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

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

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

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

Follow me on Twitter @sandragionas

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

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

Tuesday, March 6, 2012

Why I don't invest my faith in the latest scientific findings

I am reprinting an interesting comment to Dr. Sandra Steingard's Mad in America blog post entitled Why I Prescribe. The writer of the comment demontrates how fickle scientific "truth" can be. The option she refers to in her opening paragraph is the option to accept or decline meds.

Marianne on March 5, 2012 at 6:24 pm said:

I wish I had been given an option when I was 18 and heard voices. I am 62 now, and still hear them from time to time, but I have figured out what they are. I took “anti-psychotics” for years. They made me eat more and didn’t change the voices.

I had to go along with the doctors to get out of hospital, that is lie to them.

For several years, their theory was that schizophrenics had “too much dopamine”. In 1968, when I was started on phenothiazines, there was something called the Thorazine Shuffle, or “pseudo-Parkinsonism”.

One never hears that term now, even though the side effects still include Parkinson-like rigidity. I also found out that phenothiazines are actually pesticides and Parkinson’s didn’t exist before pesticides were used for killing pests. (Insecticides, herbicides, rodenticides).

Now there are so-called professionals telling people that Dopamine is the “feel good” chemical in the brain! I still have journal articles from the 1960′s and 1970′s with the theory that was the opposite, and also about when L-dopa was being used for Parkinson’s patients, with short-term effects.

Can you explain how dopamine went from causing schizophrenia to being the “feel good chemical” without some major tampering by scientists?

I also cannot find a doctor who will work with me to get off of drugs. A long history of a label has caused me extreme misery over the years.

If only someone had told me those voices were from inside of me, instead of ECT and meds, and counseled me that things would be ok…I was only 18. If only there had been some compassion.

Reply ↓

Sandy Steingard

on March 5, 2012 at 7:48 pm said:


Thanks for your comments. Dopamine is the neurotransmitter in the so-called pleasure and reward center of the brain. As Whitaker and others point out, there is no evidence that there is an abnormality of dopamine in the brains of people who hear voices or experience other psychotic symptoms. The dopamine hypothesis of schizophrenia – that there is too much dopamine in the brains of people who experienced psychosis -was proposed because the neuroleptic drugs are known to block dopamine. Over many years, scientists never found any evidence to support the dopamine hypothesis of schizophrenia.
Perhaps you could copy some of the articles from this website so you could discuss it with your doctor. Philip Thomas, MD posted an excellent blog on this topic today.


How can parents help kids who don’t want help?

Please read this very pertinent post by Corinna West at the Mad in America blog.

Monday, March 5, 2012

Working the system

I just left a comment over at Michael Cornwall's Mad in America blog post. In my comment I linked to an excellent article in the Los Angeles Times about the reasons behind the vast surge in the autism diagnosis.

The LA Times article provides plausible reasons for the jump in autism rates that are not what meets the eye. According to the author of the article, autism has boomed in large part because parents want access to state funded services, and they talk amongst themselves about how to work the system to their advantage.

Three-year-old Benjamin was nothing like the severely impaired children Bailey had seen in clinic waiting rooms. But he didn't speak much, was mesmerized by ceiling fans and liked to be left alone.

On the day of his evaluation by specialists from the L.A. Unified School District, Bailey purposely didn't feed him breakfast. “I wanted him to look as bad as possible,” she recalled. “It's not like he didn't deserve services. I just wanted to stack the odds in our favor.”

It worked. Benjamin threw a tantrum. Over the next three years, the district paid for speech therapy, motor skills training and the attention of a one-on-one aide throughout the school day.

..... Peter Bearman, a sociologist at Columbia University, has demonstrated how such social forces are driving autism rates.

Analyzing state data, he identified a 386-square-mile area centered in West Hollywood that consistently produced three times as many autism cases as would be expected from birth rates.

Affluence helped set the area apart. But delving deeper, Bearman detected a more surprising pattern that existed across the state: Rich or poor, children living near somebody with autism were more likely to have the diagnosis themselves.

Living within 250 meters boosted the chances by 42%, compared to living between 500 and 1,000 meters away.

The reason, his analysis suggested, was simple: People talk.

They talk about how to recognize autism, which doctors to see, how to navigate the bureaucracies to secure services. They talk more if they live next door or visit the same parks, or if their children go to the same preschool.

The influence of neighbors alone accounts for 16% of the growth of autism cases in the state developmental system between 2000 and 2005, Bearman estimated.

In other words, autism is not contagious, but the diagnosis is.

I thought about posting the L.A. Times article when it appeared in December 2011, but decided not to at the time. I try to stick to the knitting on my blog, meaning I stick to schizophrenia as much as possible, and weigh the pros and cons of posting information about other diagnoses, even though, there is much in common between many mental health diagnoses. I decided to post the link today because both the Cornwall article and the L.A. Times article are excellent contributions to our growing understanding of how social factors shape trends in mental health diagnoses diagnoses.

Cornwall writes:
When I-Ward closed I was transferred to an adult clinic as a therapist for about 3 years until the bio-psychiatry, big pharma agenda made possible by NAMI testimony got the statewide Bronzon legislation passed. That law said that so-called severely and persistently mentally ill adults should be given priority for the allocation of adult services that are funded by the state and federal government.

It was supported by bio-psychiatry claims based on their incurable brain disease model that asserted that consumers were best served to be maintained by medication and case management. The law didn’t say therapy had to be eliminated, but the statewide cowardly mental health director’s association saw the handwriting on the wall and decided to announce the wisdom of eliminating therapy ASAP to placate NAMI, and the growing power of Psychiatry in every county system.

Friday, March 2, 2012

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

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

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

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

Erika Check Hayden
29 February 2012

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

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

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

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

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

Thursday, March 1, 2012

Another study shows biological view of mental illness increases stigma

from Acta Psychiatrica Scandinavica
Article first published online: 13 JAN 2012

Schomerus G, Schwahn C, Holzinger A, Corrigan PW, Grabe HJ, Carta MG, Angermeyer MC. Evolution of public attitudes about mental illness: a systematic review and meta-analysis.

Objective:  To explore whether the increase in knowledge about the biological correlates of mental disorders over the last decades has translated into improved public understanding of mental illness, increased readiness to seek mental health care and more tolerant attitudes towards mentally ill persons.

Method:  A systematic review of all studies on mental illness-related beliefs and attitudes in the general population published before 31 March 2011, examining the time trends of attitudes with a follow-up interval of at least 2 years and using national representative population samples. A subsample of methodologically homogeneous studies was further included in a meta-regression analysis of time trends.

Results:  Thirty-three reports on 16 studies on national time trends met our inclusion criteria, six of which were eligible for a meta-regression analysis. Two major trends emerged: there was a coherent trend to greater mental health literacy, in particular towards a biological model of mental illness, and greater acceptance of professional help for mental health problems. In contrast, however, no changes or even changes to the worse were observed regarding the attitudes towards people with mental illness.

Conclusion:  Increasing public understanding of the biological correlates of mental illness seems not to result in better social acceptance of persons with mental illness.

No surprise here. Despite increased pushing by pharma, academia and physicians of the biological model of "mental illness," "no changes or even changes to the worse were observed regarding the attitudes towards people with mental illness. The results of this study correlate with the Auburn University study, which concluded:

In general, the disease view did not improve attitudes, except in terms of blame. It did, however, tend to provoke harsher behavior. In contrast, the psychosocial view induced treatment no different from that toward normal others. The results provide little support for the claim that regarding the mentally disordered as sick or diseased will promote greater acceptance and more favorable treatment.

Now, I ask myself, why would anybody think that labeling someone as sick and diseased (a stigmatizing label to begin with) would improve other people's tolerance of the mentally ill? It would improve drug sales, though. (Just a thought.) What would improve people's tolerance of the mentally ill are effective non-drug therapies that allow individuals to thrive and take their rightful place in society - the quicker the better. This amazingly simple idea seems to have eluded many people who claim they are helping the mentally ill. Many jobs depend on having a steady, long term supply of mentally ill clients. Lack of effective therapies and over-reliance of drug therapies will ensure that a large population of the mentally ill will continue be be stigmatized.

New schizophrenia memoir chapter

I've decided to post random chapters from my book into this blog. I've noticed that seeing the chapter "live"  sharpens my eye to make further editorial changes. So, what I will do is introduce some of the chapters that have already undergone extensive editorial work with a brief word of explanation. In this chapter, Chris has been admitted to hospital for the first time (during the first semester of his second year at university). He is living far away from home.

Further editorial suggestions are always appreciated.

Chapter 5 My Name is Legion On Sunday evening, the dean sent me an e-mail. He had received an encouraging verbal report on Chris from Jessica, the residence assistant at Chris’s dorm. She had visited with Chris for close to twenty minutes earlier that day and had delivered his guitar to him, which he was delighted to receive. She reported that he was about to be moved to the Early Psychosis unit of the hospital and that he already seemed to be much more aware of his surroundings than she had observed during the fall term -- he was now making eye contact and his speech was clearer. They joked about hospital food compared to Trinity food. Chris told Jennifer that he wanted his family to know he was eating okay, doing fine, feeling healthy, and, as the doctors thought he might be released as an outpatient the next week, so he did not want his plane ticket cancelled.

Based on Jessica's report, and comparing his own observations of Chris during the fall semester, the dean wrote that the news sounded encouraging. He added that during the fall, he had noticed that Chris was tired, spending long periods in the dorm hallways at night, simply staring, or sitting in the computer room for lengthy periods with no lights on. Whenever the dean spoke with him, Chris seemed surprised but answered briefly. At times, the dean continued, Chris would sit by himself in the dining hall, seemingly content to be alone; other times he’d seek out company but tended to watch from the periphery. Chris's friends told the Dean that Chris often followed them to a pub but declined to go inside.

I heard later from the chaplain that Chris sometimes stood for long periods in the college courtyard, like a statue. Once he stood in the rain for hours, the rain thoroughly soaking his new tweed jacket. These revelations were painful, but perhaps none as painful as learning much later from Jane that when she and Jessica went to clean out Chris’s room, it was littered with plastic bags of excrement and bottles of urine. The turd in the planter had indeed been a harbinger of things to come. My sister noticed that Chris also kept a copy on his bookshelf of Karl Menninger’s classic, Whatever Became of Sin? When I probed Chris months later about his lack of eye contact, he said he couldn’t make eye contact with people because he felt his eyes would do them harm, but also that their eyes would do him harm.  He was becoming acutely aware of good and evil. This explained in part his reading preferences and why he spent every day that term on his knees praying.

For a few confusing days following Chris's admission to CAMH, I didn't have the contact details of the treatment team and I relied on reports from the dean, the chaplain and my sister. Three days after Chris was admitted, I got a name and a phone number from the chaplain of one of the doctors familiar with Chris’s condition. When I got through to her, I soon realized that Jessica's optimistic assessment of the speed of Chris's turn-around was bit premature. Chris’s belief that he was going to be allowed to come home turned out to be wishful thinking on his part.

“Well, he’s not one of our sickest patients,” the doctor said, but apparently neither was he one of their better patients. Her tone implied sick, very sick. “Our team here doesn't think it's a good idea for Chris to leave the hospital. He's a voluntary patient, but if he pushes to leave the hospital to get on a plane,” the doctor warned, “we'll change his status to certifiable.” 

“This is not our preferred option, ” she continued. “We'd prefer to keep the goodwill and trust. As a voluntary patient Chris will be given a day pass and allowed out today to go back to his dorm room and gather a few things.”

Before we finished our conversation, I had promised the doctor that our family would visit Chris as soon as we could arrange the plane tickets.  This year we would move Christmas to Toronto.

Peter Strand offered us the use of his house over Christmas while he and his family were visiting relatives in the United States. We were overwhelmed by his generosity.

The plane reservations took about a week to arrange. During this period, I began looking at everyday things differently. Faces on crowded sidewalks that I had given no thought to before, suddenly became wolf-like with golden eyes that were staring directly at me. Images began to ooze off advertising billboards like a Salvador Dali painting and the bright colors bled into each other. I felt I was losing my mind. My adrenaline was surging; my heart was continuously pounding. I was experiencing a primal understanding of the prolonged effect of anxiety on the nervous system.

Just before leaving for Toronto I made an appointment with the medical service at work and obtained a supply of Xanax to keep me on an even keel. I had never taken an anxiety blocker before, but I felt I needed one now because life was beginning to take on a grotesque quality.

This was, by far, the biggest crisis that Ian and I had encountered in our twenty years of marriage. It was the biggest crisis I had encountered in any aspect of my life. Thankfully, Ian and I had always relied on our church, both in Ottawa and Geneva. We needed it now more than ever. The problem was, I didn’t know how to pray. The idea of becoming emotionally invested in prayer was still a foreign concept to me; I just didn’t get it. Father Nicholas was accustomed to this kind of Christian and more than willing to share his expertise with me. Through a series of conversations and e-mails, he gave me a beginner’s introduction to prayer, which I found comforting.

I dug out my Good News Bible for the first time in years. I randomly opened the book and my finger fell on the verses where Jesus cures the man possessed by demons. What a coincidence. I was struck by the realization that mental illness has been for around a long time. Jesus asks the man’s name and he answers, “My name is Legion, for there are many of me.” What stirred my interest was that Jesus cured the man. This really was good news! I was elated until another thought dampened my fledgling hope: Since Jesus cured the demon possessed, why today are there so many men and women live on the edge of society, in our streets and homeless shelters? Why do we in the church speak of so often of faith, but are reluctant to believe in miracles?