A Trauma-Informed Perspective on Oscar Pistorius

By epower

PistoriusHow is it that Oscar Pistorius’ case of “shoot your girlfriend and get away with it” isn’t evoking universal outrage?  There is no doubt that bullets from the gun he fired killed his girlfriend.  There is no doubt that her parents and many others are enraged with grief and want someone to pay.  That’s the normal, predictable reaction.

Even the legal beagles of South Africa are adopting enraged positions. In a Tweet, James Grant, Wits University criminal law professor said, “Masipa doesn’t accept that accused intended to kill anyone. Huh? His defence was he didn’t intend to UNLAWFULLY kill.”  He Tweeted again, “How can you voluntarily fire four shots into a toilet cubicle & not foresee the possibility of killing whoever was in there.”

But this outrage hasn’t leaked into the public consciousness – family and law professors can and are shouting to the high heavens, but the public seems uncharacteristically accepting. Why?

Continue reading… »



Before You Medicate, Read This

By epower
Image: Flickr/NeilsHeidenrich cc license

Image: Flickr/NeilsHeidenrich cc license

Yesterday I wrote about the pros and cons of psychotropic medicines; basically, I’m all for drugs that make people feel better quickly. But the physical, mental, emotional and financial costs of these drugs as currently prescribed so often outweigh their benefit. Yesterday after I clicked “publish”, I started thinking about a couple things I wanted to say – you know, like coming up with the perfect comeback in the shower, six hours after you could’ve used it. Most of these short points center around the idea that learning to “feel better” without medicines is a difficult and lengthy process for people diagnosed with mental illness. And so for many of us the question become whether we try to feel better quickly with drugs in a process that may or may not have worthwhile results, or whether we do the painstaking work of learning to feel and act closer to the ways in which people without a diagnosed mental illness would feel and act, without drugs. Again, what is right for you or the person you love may vary. But here are a couple things I’ve been thinking about on my own long and winding road toward majority culture cognitive and emotional processes:

1. If feeling is something you are unaccustomed to, how can you learn to feel?

Feelings can be pretty scary things.  Trust me: after disconnecting from my emotions for a very long time, learning to live with (and love them along with the information they bring) was a terrifying journey.  It took lots of time, and lots of work, and I am pretty sure that as far as I have come, I have that far to go again.  But for me, the payoff is worth the price: the world of emotions is a rich, juicy, complex one worthy of a life of difficult learning.  No matter how many emotions we learn about—their names, where others feel them in their bodies, under what circumstance, and how those others manage these emotions, there are still more emotions – more names, more situations, more difficult and sometimes confusing management. If you wanted a quick “how-to” for learning to experience and manage emotions, I’m sorry to disappoint; but through hard work I’ve come a long ways and I know that I’m not that unique – sorry for the glib bow tied on this package, but if I can do it, you can too!

2. If exercise is the best intervention for depression, what keeps us from exercising more?

Think about this as a bigger question: if some sort of hard work is the best medicine for a diagnosed mental illness, why don’t we do it? Well, it terms of exercise and depression, sometimes it’s not having any company while doing so.  Sometimes exercise is inconvenient.  Sometimes it’s frightening to be outside, or inside, or anywhere.  Sometimes it goes back to #1: moving means feeling and feeling is terrifying. But eventually, every person I know wants to feel—it’s just that some want to feel differently. As terrified as we are to feel, depression is a feeling too and we’re stuck in it. The question is whether we’re more terrified (and immobilized or comfortable) in the mental health diagnosis or more terrified of the state of feeling that hard work could bring for us. The people I know who take big psychotropics don’t want to be “crazy,” and they don’t want to be shut down by their medications, either. In some cases, “hard work” interventions – like exercise for depression – might work. But darn does it take courage to find out the alternative…

3. If medication works for you, why not use it as a tool?

It’s a great premise: we know medication changes brain pathways so why not use it to grow the brain pathways that would make us feel better?  One of the most gifted clinicians I ever worked with asked a group I was in of childhood trauma survivors to go on very low-dose antidepressants for a year, while we also did work to learn how to feel happy (which many of us never had).  In that year, not only did we do expressive work, we also did somatic work, and cognitive restructuring.  Other than the fact that I was only able to tolerate the medication for six months, it was great.  I learned a lot.  I practiced hard.  I achieved an optimal level of happiness that served as a great baseline for the rest of my life – though I couldn’t always fly at that altitude, I always had something to shoot for and I knew it was there.  If you can use meds as tool while you learn, great.  If it becomes a long-term support, okay.  But when meds stand in the way of real development, and potentially a means of social control in which clinicians or others medicate away different, valid ways of being in favor of the great ugly blanket of “normalcy”, I get nervous.

So there you go. Those are the little addendums I wanted to add to yesterday’s post. The thing is, there are thousands more points to be made about this delicate balance of medicines versus difficult work in this crazy thing society calls mental health (pun intended). I would love to hear about your experiences. What are the factors you take into account when choosing for yourself, your loved ones, and the people in society with a diagnosed mental illness? With meds, there’s all there’s nothing and then there’s careful nuance. What’s your opinion of the best use of these medications?

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The Pros and Cons of Psychotropic Medications

By epower
Image: Flickr/Sam_Catch cc license

Image: Flickr/Sam_Catch cc license

Many people think I am anti-medication.  In some ways, I am—and in many others, absolutely not. It’s a tricky balance – one that takes into account wanting to feel better quickly, but one that also takes into account the risk and cost of medications and even the risk that comes with feeling too good, too fast. Here’s how I see it:

Here’s where I am “against medication”:

A lot of us are unwilling to “do the work” that is required to not need medication: we won’t lose weight to manage diabetes, arthritis, or heart disease because it’s easier to take a pill.  Even though the medications for each of these seemingly benign conditions carry effects no one wants, and some can have fatal consequences, it’s easier to take medications than, say, get up off the couch and walk.  Stop eating processed foods.  Start drinking more water and going to bed earlier.  We’re, ahem, lazy. Yes, that bothers me. And similar is true of medications prescribed to treat people diagnosed with mental illness. It may be much easier to believe the promise of a pill than it is to do the hard work that would allow you (and me…) to act like other people act without medication.

Some of us have such idiosyncratic reactions to medications that our options are much more limited.  We are required, by our hypersensitivities, to do things differently rather than medicating away our troubles.  Our bodies cannot tolerate many medications.  The effects are much worse than the benefits.  For us, many medications—for many things—don’t seem to be an option.  We are required by our bodies to work: to exercise, change foods, walk more.  This bothers me, too, even though being forced into hard work by the inability to take medication is probably healthier in the long run.

Here’s where I am “for” medication:

Am I against feeling better quickly?  Are you kidding me?  Seriously?  The answer is a flat NO.  I am all for feeling better—and quickly—because I know that when I feel better, I act better.  So does everyone else.  I don’t think anyone—anyone—wakes up thinking, “Wow!  I’d really like to try Zyprexa, or Seroquel, or lithium—yeah—and stay on it for twenty or forty years or maybe the rest of my life.”

“Feeling better” and “quickly” are the key phrases.

I believe in neuroplasticity (the brain’s ability to rewire itself to adapt to its surroundings), and I believe in similar behavioral plasticity due to epigenetic changes to DNA and RNA that occur as a result of historic trauma and other environmental influences, something about which we are just now learning.  For example, the Episcopal Church’s 1928 Book of Common Prayer writes about “the sins of the father visited upon the children” and epigenetics may be a mechanism to make it happen – how you were parented, what you experienced, how you took care of or neglected your body, and even how your parents cared for their bodies and brains before you were born all make epigenetic changes to the very makeup of how your DNA is expressed.  (For another example, do your own research and check out the recent discoveries about the impact of trauma showing up in the short tail of the RNA of a man’s sperm.)

However, these epigenetic changes don’t have to be expressed – your experience needn’t define your RNA, which needn’t define who you are.  Just as RNA was changed in our example by a father’s experience, it can be changed by a child’s experience.  The two million connections a child’s brain makes every single day in the first five years of life organize themselves according to the child’s experiences.  Those patterns are flexible—more so in childhood, still at least a bit so ‘till death.  “Feeling better” is a combination of neurochemicals, structural changes in the brain and change in behavior…which, of course, are then turned around and written into the brain.

How do we change these experiences that then become our brain’s new normal, which then in turn influences our future experiences? Well, medication can—and for many—does help, especially when it’s a medication that works without being dulling or causing more toxic side effects.  Creating this careful ecosystem of medication takes wise, careful, judicious work—often not the specialty of crowded, underfunded, overworked prescribers who would like to do more, be better, offer more effective help.

The word “Quickly”, the other key phrase, is just as critical as “feeling better”.  For people who are depressed in a big way, sometimes the trajectory of “feeling better” isn’t fast enough and trapped in this limbo of slow change, they feel well enough only to do what their depression has been begging them to do—namely, commit suicide. On the other hand, if you feel too better too quickly, the “mania” as it’s called can be dangerous.  Medication can help people “feel better” “quickly” and if they can tolerate feeling better, that’s a good thing. But this immediate sea change in function can be hard to handle – even change for the better if it’s too extreme too quickly can be a dangerous magic.

So am I “against medication” or am I “for” medication?  I am for conscious and careful medication that helps more of the people about whom I care live better lives, longer, with fewer effects that cause catastrophic health and life consequences.  I am also for increasing functioning, a combination of learning and if needed a little chemical help. I am against overmedications of chemical soups that people on limited incomes can’t afford to take or not to take – soups that can have unintended and heartbreaking effects if not carefully managed.

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Robin Williams and The Thing That Lurks For Us

By epower

Robin.Williams.picHow can I not jump on the wagon and talk about suicide?  Robin Williams’ death is a shocking loss to all of us, made even more poignant for me because a number of my colleagues met him, knew him, and admired him.  I did too.  I often pointed to him as an example, if such a thing could be named, of “functional multiplicity” especially when I saw him as the Genie in Aladdin.  He could shift among persona faster than anyone I knew and with more pizzazz to boot.

In my travels this week, I saw someone wearing a T-shirt that had “10 Reasons I am an Episcopalian” on the back—attributed to Robin Williams.  Only a few days later, I read of his death by suicide at 63—only two years older than I, and the same age as my sister.  I remember the people whose lives have been too unbearable for them to continue who were my cousins.  I remember my friends who could find no open door, many exceptionally creative, all tormented, all lost.

I remember the times I have considered suicide in my earlier years, and I rankle—no, rage—at Fox News’ reaction all but calling anyone who considers (let alone those who succeed) suicide “cowards.”  If they only knew the heroic efforts it takes for a severely depressed person to continue.  If they only knew.  Just like every comic who overcompensates to try and force love and humor into his or her own life when there is instead an empty cavern, these Fox News anchors seem to rely on their assumed positions for emotional safety.  The message is, “If only you were so fortunate to be like us: conservative, well-grounded in our beliefs and certain of our rightness, you wouldn’t crave the weakness of suicide.”

It is, sadly, a shell of a different color that can easily hide—for a time—the deep cavernous darkness of never feeling the satisfaction of applause for a job done well; the terrifying knowledge of self as unlovable; the internalized belief of being fundamentally flawed and defective; feeling like a thing made only for others’ use.  We are, those of us who know, as busy as three cats: one looking, one digging, and one covering up as we scratch desperately to make meaning in lives that underneath it all feel as if they have no meaning except to feed The Thing That Lurks For Us: emptiness, internal annihilation, self-oppression, depression, alienation from love we can feel unless… unless, perhaps we are dissociated, high, drunk, in the limelight, medicated.  We work incredibly hard, we face unhearable and unbearable stories, we wrestle with every fiber to quell The Thing That Lurks For Us.

Our brains are not on fire—though they may fire frequently, often, and with great light in our professions—they feel like little tiny peas that can’t even rattle because they mean so little.  And so we are angry, or sad, or withdrawn, or covering like those three cats, trying to pass.  It shows in our eyes, though, a deep sadness, a distance that Ajax used to call the “ten thousand mile stare” that afflicts those whose lives have overwhelmed them in some way.  Robin Williams was a great light, a good man, and a beloved fellow Episcopalian.  I beseech All That Is for his peace and ease, and for peace and comfort for his family.  He was, despite the flawed logic of a self-absorbed news channel, a generous, giving, and gracious hero.

Who among us is invulnerable to the despair of years of effort and unrelenting work to overcome our darkness?

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Whether Biology or Trauma, Mental Illness Requires Care not Cure

By epower
Image: Flickr/MariaMorri cc license

Image: Flickr/MariaMorri cc license

In a beautiful article for Nature, David Adams recently wrote, “Psychiatric research has yet to provide a single reliable biomarker to aid diagnosis and treatment. Self-reported symptoms and their subjective interpretations remain the basis for clinical diagnosis. Drug companies have walked away.”

For years I have taught and will continue to teach that the symptoms don’t care about the diagnosis. And working from the other side, people have wrestled with what diagnosis creates what symptoms. It’s a paradox that we are still working to unravel – does the “nature” of biomarkers we haven’t found yet create mental illness, or do experiences create symptoms that in turn lead to a diagnosis? Nature or nurture?

For example, biochemical markers exist for syphilitic lesions (a neurological problem whose symptoms are relegated to “mental illness”), and also for inflammation of the basal ganglia (another neurological problem whose symptoms are relegated to “mental illness”), and for the newly emergent science of the biome (the “second brain” as it is called, that wonderful universe of gut bacteria that can create symptoms related to, you guessed it, “mental illness”).  Oh, and we now know that there is a connection between some parasites and suicidality but, again, guess what–that gets relegated to mental illness as well, not parasitology.

So what the heck is mental illness anyway? Maybe some mishmash of these conditions that affect the brain with experiences that we carry with us and likewise adjust our thoughts and emotions?

More people get treated (often poorly) for “mental illness” than are assessed for these bug-based causes of brain challenges. In part, that’s because the germ-based theories underlying the medical model of mental illness don’t hold up, which is part of what has led to the abandonment by drug-makers.

There’s a challenge here: we want relief, the sooner the better, and the challenge is that if at least part of what we call mental illness is due to some form of overwhelming experience and not to a bad bug, the secret to relief isn’t in a pill but in managing emotions, creating and fostering connections, and feeling worthy of life.

And there’s another challenge in this dichotomy between what happens to us and what’s wrong with us – the symptoms and the diagnosis: the cause of mental illness influences the degree to which society “blames” those with a diagnosis. The parent of a mentally ill child leans hard on the biological explanation that gets him/her off the hook for parenting that could cause symptoms of mental illness, whereas the person with the diagnosis who fears being victimized because of their behaviors/symptoms leans on the diagnosis to engender understanding and compassion.

Cure is unlikely – it takes an act of sorcery to utterly rewire the brain to a totally neurotypical pattern. And frankly, we probably don’t want it.  We don’t want to eradicate the Albert Einsteins, Temple Grandins. John Nashes, Mary Lincolns, Ellyn Saks and many others of us who are bright (if not brilliant) and different to the point of diagnosis.

Care is a better term than cure. It means feeling as well as we can by the best means possible. It means committing to health as much as we commit to treating illness. It means we need to offer one another kind support.

To me, the process of being diagnosed and figuring out how to live well in spite of symptoms that were maddening to others has been such an education.  I came to the realization that – no matter nature or nurture, parasites or experiences – the most important task in front of me was to disregard diagnosis and figure out how to act more like the people whom I thought were “mentally healthy.” It required a lot of learning. And believe you me, I’m still learning every day.

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Who’s Afraid of the Mentally Ill? Better to Fear the “Frustrated Entitled”

By epower
Image: Flickr/JohnMcStravick

Image: Flickr/JohnMcStravick

Headline reads, “Attorney: Mental Health Could Factor in Dog Killings.”  The story is out of Reno, Nevada.  The man dismembered six—count them—six dogs.  “Mental Illness Cases Swamp Criminal Justice System,” the USA Today headline reads, describing a 2006 Justice Department study.  When a person diagnosed with mental illness commits a crime, it’s news. But when thousands of non-diagnosed people commit crimes, it’s not.

I get it: a diagnosis lets everyone without a diagnosis “explain” violent crimes – lets them blame these actions on people who are unlike themselves, dangerous “mentally ill” people who should be incarcerated. And of course instead of care (not cure, care) it’s easier to incarcerate folks (which usually makes them more, not less, mentally ill).

Why is it, I wonder, that only the people who commit mass murder  (more than 4 people in one rampage) in the U.S. are lumped in with “the mentally ill”?  Where are the domestic violence perpetrators? Or the common everyday maniacs who shoot down commercial airliners, blast each other to smithereens, lie in wait with pounds of plastic explosives strapped to their bodies? Who is served by withholding diagnostic labels from people—men (and women)—who beat or murder the people they say they love?  Or by leaving out those whose life work it is to exterminate a people, a race, a country?  Who does it help to distort the figures?

Not people who actually have a diagnosis ranging from everyday depression to the psychosis of grief or schizophrenia, I’ll tell you that. These people are lumped in with the violent mentally ill, layering stigma on top of what may already be challenge. The stigma of “the other” – of being included in a category that only includes the most perverse perpetrators – drives people in need of connection underground, isolating them even further.

In fact, the people I know with a mental health diagnosis are more likely to be victim than perpetrator. For example, the people I work with who provide services to people who escape intimate partner violence know their clients are called “victims” and “survivors” and the people they run from are called “perpetrators”—and the clients are often the ones who get a diagnosis.

Not the perpetrators, who are spoken of with contempt, scorn and fury but without diagnoses, labels that stigmatize and separate.  The perpetrator may go to work the next day as if nothing at all had happened, without a diagnosis, without the stigma, as if they had not just broken a child’s arm as he shielded his mother; as if they had not snapped a kitten’s neck in front of a little girl to show her what would happen if she talked to anyone about seeing her mom get beaten.

The terrible truth is that it is more common for people diagnosed with major mental illnesses to be vulnerable to assault and abuse than it is for these individuals to be prone to violence.  Sadly, we spend a lot of time taking in what the media tell us about mental illness instead of looking at the research.

For example, and I’ll say it again:  the research—solid research—indicates that at most 17 percent of violent crimes are committed by people diagnosed with mental illness.  That word “diagnosed” makes it easy to leave out the everyday maniac who belittles, berates, and beats his wife.  The parent who slams their child against the wall, and many others. And, again, researchers Charlotte and Harriet Childress, showed that 98 percent of the mass murderers were men between the ages of 23 and 40 who, contrary to the stereotype of being “mentally ill”, simply felt entitled to something they weren’t getting like women or attention.

Maybe violence isn’t the fault of the “the mentally ill.”  Maybe it’s the “frustrated entitled” who think they aren’t getting what they believe they deserve?  This could certainly include people with diagnoses, and it would umbrella the disgruntled religious, the bullied, the people wrestling with loss of privilege, those oppressed who snap—a much larger umbrella than the inaccurate “mentally ill.”

Unfortunately, if you say something loud enough and often enough, people start to believe without looking at the data.  We have been told that the “mentally ill” are responsible for the worst violent crimes so often and so loudly that we have come to believe it.

Due to this belief, a diagnosis of mental illness essentially means—for many—invisibility when it comes to opinion, believability, and place.  In fact, those diagnosed with mental illness are disallowed “normal” feelings of anger and rage – in a situation that evokes anger in “normal” people, the “mentally ill” are not allowed to feel this natural anger because something might happen.

Protesting doesn’t do much good either, because the well-meaning and frightened caretakers decide that a mentally ill person’s protests are a byproduct of the disease.  And getting upset must be an indication of being off one’s medication. Where is the right of a person diagnosed with mental illness to express natural, healthy anger? Where is their right to have this important emotion taken seriously? Is it any wonder the mentally ill snap a second time, sometimes more profoundly than the first?  The box in which they are kept is so very small…



5 Ways People Diagnosed With Mental Illness Can Become “Athletes of the Mind”

By epower

Mentally.IllI once spoke at Pike’s Peak Mental Health Center at the invitation of Dr. Honeybee Crandall, MD, to the staff working with people with severe and persistent mental illness. I asked how the patients behaved, how they functioned.  Not well, I was told, because they had mental illnesses. We assume people diagnosed with mental illness can’t do well, and we are perilously unwilling to let them—and the Finnish studies on Open Dialogue are good reminders of how we can do something different.  Looking at the mental health systems and practices other countries employ is helpful.  We get what we expect from people.  People with mental illness are expected to conform to others’ expectations and when they do, we say they’re “not doing well”. But what is doing well? Is it being “normal” (a setting on a dryer, as some say)? Instead, I know people with severe and persistent mental illness who defy the expectations and “do well” on their own terms: they hold jobs, they have friends, their lives are rich and full. I call these people athletes of the mind. Here are five keys to helping people diagnosed with mental illness find their own, unique paths to “doing well” in life:

1. Forget Insight

The old “anosgosnia” argument says we can’t get better because we don’t believe we are ill – without insight into the fact of our mental illness, we can’t change this mental illness. I’m not the only one saying it:  Insight doesn’t equal change; different behavior—even without insight—produces change.  Insight is the booby prize, and sometimes it can even lead to feelings much worse than the ones that preceded it.

2. Find the Courage to Look Past “Evidence-Based”

It takes a very long time for a practice or process to clear double-blind studies to earn the gold standard label of “evidence-based”.  Then, the number of people who become trained to deliver evidence-based practices grows at a desperately slow rate. This system of research and testing is poorly constructed to allow new ideas. Don’t get me wrong: evidence based practices are great for the populations on whom they are tested when there are people who are trained to use them properly. But keep in mind that most “evidence-based” practices are tested on small subpopulations of one culture—and the evidence is not there for many groups. They don’t work so well with indigenous populations because they are universally Western in thinking—which means a population in desperate need is left out. They haven’t been tested to determine the impact of gender differences. Give me a treatment that I will work for me, one that helps me learn to function the way people who do well function—and let’s define “do well” first.

3. Promote Relationships

Relationships—and their power—are hard to study with quantitative techniques.  Qualitative analysis is dismissed with the wave of a hand in the face of the scientific method, as if it can have no validity. And yet relationships are often the key ingredient in recovery and healing from mild to severe mental illness.  Risking Connection, Sidran Institute’s flagship model for healing after trauma, gave me words for this.  People who feel they are worthy of life, who have skills for managing and modulating feelings, and who have strong positive connections with others (people, animals, God, etc.) have far fewer crises.   And, of course, when sturdy relationships are never developed, missing, or ruptured, or when the situation exceeds the individual’s self-capacities, problematic behavior erupts. By focusing on helping parents have more fun with their children in meaningful ways, or providing what Bruce Perry calls “kind support” we can help people reduce mental illnesses and create relationships that give rise to better functioning. By the way, have you checked out the Goldfish Fun Zone from Pepperidge Farm? It’s a great free resource for family fun.

4. Embrace Differences

We assume that differences in how people process life mentally and emotionally are bad. Yet, we value people like Einstein, Schweitzer, Hawking—we value Joan Borysenko, Marsha Linehan, and Elyn Saks. John Nash won a Nobel Prize in economics. Each of these have very different mental processing styles. Here’s an example: take hearing voices – the dominant approach is to make the voices shut up, rather than wondering what the voices have to say, trying to befriend them. We do the same with visual and sensate experiences. Only a couple of organizations like Hearing Voices and the Open Dialogue Project consider people with unique mental abilities on equal footing with those who have majority mental experiences. Other cultures do, such as the spiritual traditions of the Dagora in Africa and some indigenous communities in the United States.

5. Practice New Thoughts, Feelings

Of the many people I know who have diagnoses of some sort, almost everyone wants to believe they can be happier, healthier, and more functional. They want to be “athletes of the mind.”  You don’t get there simply through awareness, or by trying to squish unique mental experiences into the small box of “normal”, or by using medications to change one’s brain chemistry without learning new behaviors to accompany it. The people who have a diagnosis and live well with it? Who function with aplomb? They get there by adopting different thoughts and feelings and practicing new ways of being. They are the athletes of the mind.

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“Assisted Outpatient Treatment” and Psychiatric Hospitalization is Costly, Ineffective and Dangerous

By epower

Mental.HealthLaws mandating court-ordered involuntary outpatient treatment and forced medication have been on the books for 20 years in some states. States soften the language, calling it Assisted Outpatient Treatment (AOT), intending the treatment for those diagnosed with sever bipolar disorder or schizophrenia. I can see how appropriate use could save money and lives. But the extension of coercive mental health care proposed by Rep. Tim Murphy (R., Pa.) goes too far – there is great danger in forced medication and psychiatric hospitalization. Murphy’s reactionary bill has the potential to trap the bodies and blunt the brains of hundreds of thousands of patients fairly or unfairly diagnosed with mental illness.

First let’s look at a quick cost-benefit. Larry Drain of Hopeworks Community has done the research. He says, in contrast to psychiatric hospitalization, that, “Peer support centers in Tennessee serve 3500 people a day for $4.5 million dollars and reduce hospitalization for 90% of the people who attend. A hospital bed costs $335K a year and doesn’t even reduce psychiatric hospitalization.” Do the math: hospitalizing people for psychiatric concerns is costly and one hospitalization does nothing to lower the risk of future hospitalizations (as opposed to peer support models that do reduce future hospitalizations).

The broader definition of effectiveness is another issue. Why do lawmakers assume that psychiatric hospitalization is helpful?  Anecdotally, I know very few people in the health care industry who think inpatient care is particularly effective.  And, any time the UNHRC issues bulletins in which mental health care is compared to torture, and class action suits about terrifying care in hospitals are brought and won, it seems as if legislators would get the point: restrictive care is expensive and doesn’t work!

From the patient perspective, almost no one wants hospitalization. It’s terrifying and often as injurious as it is helpful. It used to be a familiar threat for us kids when we misbehaved: “We’ll send you to Broughton!” From the patient perspective, “effective” means you get better.  And “better” means you can function outside of the hospital. Psychiatric hospitalization doesn’t make patients better.

The problem is assumptions and expectations. We are whipped in a frenzy to correlate mental illness with horrific violent behavior. For some, this unfair assumption justifies drugging people diagnosed with mental illness into stupor (or perhaps unintended violence as side effects of medication!). The expectation is that “those people” are violent, and that “those people” who are medicated are unable to function. Physical incarceration or mental incapacitation is preferable to the violence we expect. Who cares about human rights?

Representative Murphy probably can’t conceive of the value of healthy, strong, sustaining relationships that are honest and effective as healing in situations of mental illness.  If he could, he might see, as I do, that reducing the crises in mental health care is dependent on helping people increase their self-capacities (not making them dependent on medications or psychiatric incarceration).  Only by working with instead of against people diagnosed with mental illness to boost skills and coping mechanisms can we contain health care costs and create true effectiveness. By collaborating with instead of incarcerating this population of vibrant, worthwhile, challenged individuals we can see real change.

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PTSD Goes Beyond the Moment of Your Terror

By epower

LonelinessJune is PTSD awareness month. Whether the diagnosis is from medical events, natural disaster, accident, abuse, neglect, combat or exposure to trauma in other ways, PTSD is life changing.

I was diagnosed with PTSD in the very early 80s — not from combat — and the very real challenge was, then, to illuminate the discrimination against non-combat PTSD and in particular women with the disorder. At the time, PTSD was gaining acceptance as a legitimate diagnosis for combat veterans of Vietnam and Korea – no longer were they considered “shell shocked” but were starting to be seen as patients with a condition as real as cancer or Alzheimer’s.

Not so for people whose PTSD was generated by other sources, especially for women. Though our trauma was no less real (believe me), our diagnosis and especially the acceptance of this diagnosis as a “real” disease lagged far behind. For women in the 80s, PTSD was “all in our mind”. A veteran with PTSD engendered compassion; a woman with PTSD created doubt about our experience or even contempt for daring to put our trauma on par with that of those who served in the military.

While I have in many ways recovered—not without a few side trips along the way—the costs have been enormous. Work? I kept it together well enough to work and even complete graduate school, even during the most challenging years in the 90s. While I have the skills to deal with retirement, I certainly don’t have the necessary savings. Therapy for PTSD and associated concerns consumed over a quarter of a million out of pocket. Yes, out of pocket—not one penny through insurance. Physical health? Pretty good, but the changes we now know are correlated with chronic overwhelming events beginning in early childhood are starting to show.

And so in addition to the acute experience of PTSD there are the very real, poorly understood long-term consequences of PTSD that are just starting to rise from the water like Godzilla hitting the Tokyo shore. The first generation of diagnosed PTSD is aging – me and women like me along with the combat vets. Many of us have done hard work to put our lives back together in some fashion. While we are far more than we would have been without the trauma that caused the PTSD—post-traumatic growth is good—the ravages of trauma exact a price.

The roots of PTSD are in being chronically overwhelmed —and the earlier trauma began, without the ability to be soothed and re-regulated, without what can be called “kind support”, the greater the long term challenges. No matter the source, overwhelming events with which we cannot cope and from which there is no reprieve can create PTSD. And no matter the source, the acute experience of PTSD is only one side of the coin.

This June during PTSD Awareness Month, please join me in extending compassion and kind support to all those who diagnosed with PTSD. Whether they flutter like moths too close to the flame or they are experiencing the long-term effects of changed life possibilities and second-order health consequences, extend them your care.

Please join me on Facebook to discuss personal and organizational trauma, healing, ethics, and innovation.

Image: SYED ALI WASIF via Compfight



DARPA Brain Implant Project: Mind Control Redux?

By epower

preparing (cc)A new $71 million program at the Defense Advanced Research Project Agency, or DARPA, working with Massachusetts General Hospital and UCSF, focuses on developing implants to place in the brain for the purpose of “treating depression, anxiety and symptoms of PTSD.”  If this doesn’t make the hair on the back of your neck stand up, it should. 

Or should it?  What do you think about brain implants?  Do you fear they will be forced on people, required of soldiers?  And if they work, does it matter?  When the symptoms of anxiety, depression or PTSD run your life, it seems like the obvious answer is no – the benefits may outweigh the risks.  I think even in light of potential cases of dramatic symptom reduction, the morality, development, rigor and ethics of brain implants deserve a closer look. I resonate with the comments of Carl Erik Fisher in the January/February 2014 Scientific American Mind in the article “Psychiatry’s New Surgeons.”

While brain implants in the non-defense sector show promise in treating such disorders as Parkinson’s, specializing them for the purpose of treating those conditions we call mental illness becomes a much riskier issue.  For example, when there’s problematic behavior—e.g. psychiatric symptoms—involved, who is the person bothered?  How does the problematic behavior help the person who’s expressing the behavior?  How do we avoid the risk of creating a mind-control nightmare the likes of which hasn’t been seen since the work of Dr. Ewen Cameron, recorded by Harvey Weinstein in “Psychiatry and the CIA”? (Not to seem doomsday or anything.)

To reduce the role of a behavior’s meaning is to challenge our notions of what it means to be fully human.  The risk of allowing others to control one’s behavior by manipulating devices implanted in the brain is even more challenging—and by no means do I wish to demean the positive impact of DBS, or Deep Brain Stimulation, or the other techniques involving brain implants that benefit people with medical problems

Our government has long history of asserting that its intention is one thing while covertly doing another.  Such secrecy is the nature of all hierarchies seeking to preserve themselves.  Even without a healthy dose of conspiracy theory added in, experiments with mind-altering drugs, giving people syphilis, and countless other instances of government misbehavior should raise the alarm on the well-meaning sound of fine-tuning a person’s brain to treat anxiety, depression and PTSD.

Specifically, evaluate the plusses and minuses of brain implants in light of the following:

 

1.       The overwhelming events, many beginning in early childhood, that are foundational in the development of anxiety and PTSD—and perhaps depression—are often accompanied by behavior that is both adaptive and problematic, and has meaning that needs to be found or made.  Simply extinguishing this behavior by changing the circuitry may eliminate the opportunity of appropriate meaning making.

2.       The risk of external control is possible, until and unless the device is a purely closed loop device that once set, has zero risk of malfunction or being adjusted by anyone—the user for a greater sense of wellbeing, the implanter for the purpose of control.

3.       The potential of capitalizing on emergent understandings of neuroplasticity is phenomenal.  We know the brain is adaptive, and it may be that anxiety, depression, and PTSD are adaptations that can be quickly and easily changed again with implanted devices.  This would reduce the time, trauma, and cost of healing.

4.       While it may reduce or eliminate symptoms, improve the wiring, no device can teach the user how to function as a person without anxiety, depression or PTSD—which is where health develops.

 

Promise and challenge: DARPA’s brain implant program offers both. I desperately hope that in this case, ethics keep pace with science.

– Please join me on Facebook to discuss personal and organizational trauma, healing, ethics, and innovation.

Image: Martin Fisch via Compfight



 
 

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