Bipolar 2 From Inside and Out

Posts tagged ‘media and mental illness’

The Experiment That Changed Psychiatry

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The experiment was famous in the annals of psychiatric history. As I put it in a post in 2016:

A professor at Stanford University devised a simple experiment. He sent eight volunteers, including both women and men, to psychiatric hospitals. Each person complained of hearing a voice saying three words – and no other symptoms.

All – all – were admitted and diagnosed, most of them as schizophrenic. Afterward, the “pseudopatients”  reported to their doctors and nurses that they no longer heard the voices and were sane. They remained in the psychiatric wards for an average of 19 days. They were required to take antipsychotic drugs as a condition of their release.

Rosenhan’s report, “On being sane in insane places,” created quite a stir. Indignant hospital administrators claimed that their staff were actually quite adept at identifying fakes and challenged Rosenhan to repeat the experiment.

This time hospital personnel were on their guard. They identified over 40 people as being “pseudopatients” who were faking mental illness. Rosenhan, however, had sent no volunteer pseudopatients this time. It was a dismal showing for the psychiatric community.

Except now the wind seems to be shifting. Many psychological experiments from those long-gone days have been called into serious question, some because of reports from participants and others because of unreproducibility. The Rosenhan study, which is widely featured in psychology textbooks, is no exception.

I picked up Susannah Cahalan’s book The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness, expecting to find more details of the experiment – maybe the reports written by the test subjects. Instead, I found a piece of journalistic research that attempted to track down the pseudopatients, and used Rosenhan’s notes for his unpublished, half-finished book extensively.

The author’s conclusion? That the experiment, though published in the prestigious journal Science, was at best dubious and at worse fraudulent. Rosenhan, the author says did not get volunteers from among his grad students, teach them to “cheek” pills so they wouldn’t actually be taking psychotropic meds, and turn them loose on several unsuspecting mental institutions.

Instead, the author says, Rosenhan himself was one of the pseudopatients and so were two friends of his. A sample size of eight or nine is small, but one of three is anecdotal in the extreme. Rosenhan’s write-up of the experiment used an even smaller sample – two, himself and one other. The third was relegated to a footnote as an outlier, one who found his assigned mental hospital to be a kind, helpful, and nurturing place. The sample of two related that the biggest problem on the wards was boredom, barely relieved by the occasional group session, and brief, infrequent drop-ins by a psychiatrist. Nurses remained in “cages” where they could view the floor of the dayroom and hand out meds at the assigned time.

There is doubt, too about how the three pseudopatients got out of their situations. They were all voluntarily committed, so could walk out any time they wanted, but Rosenhan’s notes say that the were released AMA (against medical advice), but with a diagnosis of “schizophrenia, in remission.” (Only one of the alleged pseudopatients had a different diagnosis of bipolar disorder.) Apparently, Rosenhan claimed to have had a lawyer draw up writs of habeus corpus, should the pseudopatients need to be “sprung,” but according to the lawyer involved, this did not happen, but was only briefly discussed.

So, after all this time, what difference does it make whether there were nine pseudopatients or only two or three; whether Science was hoodwinked into publishing a paper the author knew to be deeply flawed (to put it kindly)? We all know that such a situation could not happen today. It takes much more than a self-report of brief auditory hallucinations to get into a psych ward these days. There are extensive interviews, the MMPI test, various screeners to go through. Many of these procedures may have been put in place because of the influence of Rosenhan’s experiment.

But Calahan says that the most far-reaching effect of the experiment was that, not only did it put the entire field of psychiatry in doubt, it was cited again and again in other papers. Those papers – and thus the experiment – were influential in the massive closing of psychiatric hospitals, leading to the current situation of actual people with serious mental illness (SMI) with no place to go, a lack of psychiatric beds in hospitals, sufferers forced to live with untrained relatives, no supervision of medication, and various other breakdowns in the system.

It would be unfair to say that Rosenhan caused all that, but according to Cahalan’s reporting, his paper contributed significantly to exacerbating the problem.

 

Systemic Breakdown and Involuntary Commitment

I don’t often review books in this blog, but Lynn Nanos has written one that has caused me to think long and deeply about an important topic, so I felt compelled to share my take on it.

The book, Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry, deals with the involuntary commitment of people who experience schizophrenia, psychosis, some mood disorders, and anosognosia (lack of understanding or awareness of one’s own mental condition). Nanos lays out her thesis logically yet compassionately, with lots of references to back up her opinions.

What Nanos says is that involuntary commitment should be more widely available and easier to accomplish. Her experience as a clinician in Massachusetts involved many instances when she was involved with administering “Section 12” orders for involuntary commitment.

I’ll confess my bias up front. I’ve always been leery of involuntary commitment. As a person with bipolar disorder which was long untreated and un- or misdiagnosed, I have suffered with the fear that I might be committed at some point in my life. I’m a great believer in civil rights and believe that patients should have the right to refuse treatment.

Nanos is changing my mind, at least in the case of psychiatric disorders which prevent victims from knowing their own needs and taking care of themselves. She makes an excellent case that schizophrenic and psychotic patients, especially those with anosognosia, are the most likely of all psychiatric patients to commit violence and be victims of violence. This she refers to as “dying with their rights on,” a powerful phrase.

As it currently works – or doesn’t – forced commitment often leads to a revolving door of hospital emergency department stays, early release from psychiatric units, and the patients who most need help being discriminated against by psych units that turn them away because of their potential for violence and the difficulty in treating them. This results in homelessness, overuse of emergency services, release to relatives ill-equipped to handle a schizophrenic or psychotic person, and other potential dangers.

Nanos thoroughly discusses Assisted Outpatient Treatment (AOT) and other versions of court-ordered therapy and medication. Though these strategies are not without their flaws, Nanos indicates that her experience with them is that they are substantially beneficial and reduce violent behavior significantly.

Breakdown does not imply that there are simple or one-size-fits-all solutions to the serious problems with emergency psychiatry. The part insurance companies and hospitals play in not supplying adequate treatment is not ignored.

Lest one think that this is a dry, academic tome, though, Nanos fills the book with empathetic and sometimes searing stories of people that the system has failed – both patients themselves and the victims of their sometimes violent behavior.

How has Nanos’s book affected my opinions on involuntary commitment and related areas? The criteria she recommends for the procedure are far from superficial: She posits that involuntary commitment should be used only for those who are actively schizophrenic or psychotic and are unable to recognize the nature of their disorder and are unable to care for themselves – especially if they have shown signs of violent behavior or serious threats. (“Unable to care for self” takes the place of the older “danger to self” and includes conditions like homelessness, malnutrition, etc., not just being suicidal.)

Do I now think that involuntary commitment and/or AOT should be easier to accomplish? Yes, with the understanding that easier does not mean easy. We’re still talking about people’s civil rights, and those should not be broached with serious thought and safeguards in place. But my own fears of being involuntarily committed are revealed to have been irrational, a product of my bipolar disorder.

Has the psychiatric “system” broken down to the point where involuntary commitment is a necessary and even a beneficial thing? The answer, sadly, is yes. Lynn Nanos’s Breakdown has convinced me of that.

 

Does Immorality Cause Mental Illness?

Aaand…we have a new contender for what causes mental illness.  According to U.S. Attorney General William Barr, it’s a breakdown in Judeo-Christian morality. In fact, he blames a lot of woes on what he calls “secularism”:

Along with the wreckage of the family, we are seeing record levels of depression and mental illness, dispirited young people, soaring suicide rates, increasing numbers of angry and alienated young males, an increase in senseless violence and a deadly drug epidemic.”

Let’s look at that for a minute. Immorality causes wrecked families, depression and mental illness, suicide, violence, and drug epidemics. Lack of religion – or at least the proper Judeo-Christian one – brings on everything but the zombie apocalypse.

Steve Benen, writing for MSNBC, points out the flaws:

For one thing, it’s factually wrong. There are complex factors that contribute to problems such as drug abuse, gun violence, mental illness, and suicide, but to assume these issues would disappear in a more religious society is absurd. There are plenty of Western societies, for example, that are far more secular than the United States, and many of them are in better positions on these same social ills.

http://www.msnbc.com/rachel-maddow-show/ag-barr-blames-moral-upheaval-conspiring-us-secularists

Plus, Barr’s theory would have you believe that in the most religious places in the United States, such ills should not occur. Sadly, we have learned that no community is exempt from these tragedies. And it completely ignores the fact that many mass shooters and bombers cite the Bible as justification for their horrendous crimes.

Ah, but you say, those crimes are attributable to mental illness, which, as Barr tells us, is a product of the breakdown of moral values. It’s a simple equation to him: Immorality leads to mental illness leads to an increase in senseless violence. (As opposed to sensible violence, I suppose.)

And that’s where this slippery slope gets dangerous for those of us who have mental illnesses. Not only are we stigmatized by being blamed for mass violence, we are stigmatized by “ignoring” the cure for our disorders – adherence to the right religious values. (I think it’s fair to assume that Buddhist, Islamic, Baha’i, or Shinto religious values don’t count. In fact, to some religious people, such beliefs are tantamount to mental illness themselves.)

If mental illnesses can be cured by inculcating appropriate religious values, why are we spending so much money on psychologists and psychiatrists, medications, and hospital beds? According to Barr’s theory, that money would be better spent on religious indoctrination, especially for young people. There are many, especially in the halls of power, who agree with him.

You’d think that with the crumbling of the “pray away the gay” philosophy, these people would be hesitant to attempt changing someone’s internal constitution and thought processes simply through the exercise of religion.

Make no mistake, it’s an exercise that is doomed to failure. God does not miraculously grant the right balance of neurotransmitters to the faithful. He does not prevent or cure schizophrenia in those who pray to Him. He does not see to it that tendencies to mental disorders are not handed down through the generations in godly families. Mental illness can strike anyone and does afflict one in four people at some time in their lives. Surely that 25% of people are not all secularists. Just because people with mental disorders are sometimes shunned by faith communities (and that does happen) doesn’t mean that they aren’t religious enough.

Morality is not just for the mentally healthy and mental illness is not just for the immoral. If we let this absurd statement go unchallenged, we are setting ourselves up for more stigma, less funding, less freedom, less choice, and less dignity. If we make sure to oppose this dangerous notion whenever we encounter it, we are doing ourselves, our families and friends, and our nation a service. Educating people about mental illness may begin at home, but it needs to spread to society at large or we will be bombarded by more of these ridiculous, dangerous theories.

Should You Lie About Your Disorder?

We all know that when writing a resume, you should write either “good” or “excellent” when you refer to your health. Any other response will make it certain that your resume will be headed straight for the circular file.
But what about your mental health? Most resumes and most job applications don’t include a space for that, but what if they did? What would you answer? What should you answer? And should you tell the truth if you do answer?
 
In one corner of England, job seekers were encouraged to hedge their bets or to flat-out lie. The British newspaper The Guardian reported that welfare personnel “have urged jobseekers who have depression to hide their diagnosis and only admit on work applications that they are experiencing ‘low mood.'” 
 
Fortunately, there has been a backlash from mental health organizations, who describe the advice as an “outrage” likely to increase stigma. They point out that “the law provided protection to disabled people, including those with mental health problems, if their disability has a substantial, adverse, and long-term effect on normal daily activities.”
 
The welfare department in question brushed off the controversy by saying the suggestion was only “well-intentioned local advice” and encouraging people seeking jobs to “speak freely about a health condition or disability.” But that’s not a choice that everyone is willing to make.
 
Whether or not to disclose one’s mental health condition when applying for a job is not an easy decision. American law (at the moment) protects employees and potential employees under the Americans with Disabilities Act (ADA). But many people are rightly suspicious that disclosing a mental illness at the application is a one-way ticket to unemployment. Even when applications invite you to disclose and pointedly proclaim that they abide by EEOC regulations, many people choose not to disclose.
 
Disclosing after you’ve been hired or have been working at a place for a while is another matter. Many people (including me) have lost jobs because their bosses and coworkers don’t understand mental illness. There is plenty of motivation never to mention it.
 
That may not always be possible, however. Sometimes, the symptoms of bipolar disorder or another serious mental illness are obvious and negatively affect work. (I’m included here, too.) If a person isn’t able to do the work – for whatever reason – it’s understandable that they will be let go.
 
That brings us to the subject of accommodations that permit a person to do the work. Under ADA law, persons with disabilities, including mental disorders, are to be given “reasonable accommodations” to help them perform their job duties. For blind, deaf, or mobility-impaired workers, these accommodations are obviously necessary and most employers can and will provide them. (There is also no question as to whether to disclose these disabilities or not. Visible disabilities are more widely understood than invisible ones.)
 
Accommodations for mental disorders need not be difficult, either. Solutions such as flextime, work-at-home situations, or time off for appointments are more and more being offered to all employees, regardless of ability level, and these can certainly help people with mental illness, too. Other reasonable accommodations might include flexible break times, an office with a door or full-spectrum lighting, or the understanding that phone calls and emails need not be returned instantly. Of course, to receive these accommodations, one must disclose the disorder and negotiate the possible solutions, which can certainly be daunting, if not impossible, for those with anxiety disorders, for example.
 
But what we’re talking about here is not whether to disclose a disability on an application or to an employer. What we are talking about is misrepresenting a potentially disabling condition – or to use the less polite term, lying about it. I don’t have “occasional mood swings,” I have bipolar disorder. My depression is not simply a “low mood,” it can be debilitating. And I suspect that even admitting to a “low mood” might be greeted with something less than understanding by a potential or actual employer.
 
Ayaz Manji, a senior policy officer at a mental health charity in England, said of the semi-disclosure policy, “Anyone who discloses a mental health problem at work deserves to be treated with respect, and jobcentres should not be reinforcing stigma by advising people not to disclose.”
 
He’s right, of course. Disclosing or not disclosing is a hard enough choice for the mentally ill. Lying about one’s condition should not even be a consideration. And isn’t lying on resumes and applications an automatic cause for dismissal? 
 
For more information:

Mental Illness: Fact and Fiction

I’ve had a bit of experience with mental health and nonfiction, though none so far with bipolar fiction. But lately, I’ve been thinking about it.

Bipolar nonfiction is (comparatively) easy to write. There are numerous memoirs, essays, and blogs – including my own. Bipolar disorder has not appeared much in fiction, however. There are reasons for this.

First, let’s tackle the idea of mental illness in “genre fiction” (fantasy, science fiction, mystery, horror, and the like – not mainstream fiction, anyway). A friend of mine recently attended the World Science Fiction Convention in Dublin, Ireland, where they had a panel discussion on just that topic.

My friend reports that the panel “had a mental health nurse, a psychologist and some writers talking about portrayals of mental illness that got it right or wrong.”

He went on to add, “Consensus seemed to be that the Punisher completely nailed PTSD, that Drax in the first GotG movie nailed Aspie but that they rewrote him into a cute Manic Pixie Dream Creature for the second one; and the depiction of Sheldon from Big Bang is an abomination against God and Man.” (To unpack that just a bit, the Punisher is a character from Marvel, GotG means the “Guardians of the Galaxy” movies, and “Manic Pixie Dream Creature” is a riff on “Manic Pixie Dream Girl,” a trope in which one woman (the MPDG) opens the hero’s eyes to life lived fully so that he can then go off and win his One True Love, who is not the MPDG.)

I myself have no experience with the Punisher and saw only one of the GotG movies. Sheldon from The Big Bang Theory is a character I know a little more about. As I understand it, Sheldon Cooper is not intended to represent a person with any particular sort of mental illness (as he always points out, “My mother had me tested”). Still, the character exhibits behaviors that are often associated with Asperger’s, OCD, and perhaps some other mental illnesses or conditions.

I have read that Jim Parsons, the actor who portrays Sheldon, did no research on any of those conditions or illnesses because he didn’t want Sheldon to represent a person with any particular disorder. This allows the viewer to read into the character whatever he or she believes Sheldon’s “problem” is (if any).

But an important point was brought up in the book Philosophy and The Big Bang Theory. One of its essays questioned whether the audience should feel comfortable laughing at Sheldon. If one believes that he has a mental illness or Asperger’s, the answer is, of course, “no.” Yet most of the audience does – apart from those who see the portrayal as an “abomination.”

It’s so hard to get a portrayal of mental illness right, on TV or particularly in genre fiction. Take bipolar disorder, for example. Abigail Padgett’s Bo Bradley series of mysteries features a protagonist who has bipolar disorder. But most of the depiction depends on whether or not the character is having a manic episode at any given time. While the depiction is laudable – and I like the series immensely – it is telling that bipolar depression is seldom a plot element.

Perhaps this is because depression is too, well, depressing to write or read about. A character who is unable to leave her bed or who questions her very existence is hardly likely to move the plot forward. Searing depictions of depression, both bipolar and unipolar, have been written about, but almost exclusively in nonfiction. Even those can be hard to read for someone who experiences clinical depression.

Depression, however, did become a metaphor in the writing of J.K. Rowling. She has said that in her portrayal of “Dementors” in her Harry Potter fantasy epic, she was specifically thinking of depression and its soul-sucking effects on those who suffer from it. That’s genre fiction and that’s doing mental illness right.

In talking about mental illness and genre fiction, I’m deliberately ignoring the many portrayals of sociopaths in shows such as Dexter. Those are stereotypes too, but I’m wondering about less “drama-friendly” mental illnesses. Dissociative identity disorder seems to be one of the few other mental illnesses that feature prominently in popular forms of fiction, usually in the psyche of a villain. You could also count the many detective characters suffering from PTSD, a commonly used trope that is seldom examined closely but rather serves as a personality trait associated with violence.

I wasn’t at the convention and didn’t hear the panel (though I would have loved to), but it raised interesting questions. What would a protagonist (or other character) with bipolar disorder be like or do in what is too often a formulaic plot? Can a mentally ill character be portrayed accurately within the confines of genre fiction? Can mental illness be anything but a metaphor – or be experienced by a character other than one played for laughs? Is there any such book that I should be reading?

I don’t have the answers. But we need facts in fiction. We need understanding. We need representation. I haven’t tried to write fiction featuring a bipolar character, much less a main character who is bipolar. 

Maybe I should.

Children’s Bodies, Children’s Minds

I read recently that the Duchess of Cambridge was visiting a series of schools to mark Children’s Mental Health Week. The duchess is the royal patron of Place2Be, a children’s mental health charity. The article said that this year’s theme for Mental Health Week would be “Healthy: Inside and Out, focusing on the connection between physical and mental health.”

The article explained, “The charity works with more than 280 primary and secondary schools across England, Scotland and Wales, providing support and expert training to improve the emotional wellbeing of pupils, families, teachers and school staff.” 

The duchess, it says, would be meeting with members of the school community to discuss students’ school readiness, teacher welfare, the wellbeing of the school community, and the importance of being active; and also talk with parents about good routines and habits around sleep, screen time, healthy eating, and exercise.

All of which sounds fine and worthy. But does anyone else see something missing from this public relations tour? Maybe it’s just me, but there doesn’t seem to be much actual emphasis on children’s mental health.

Yes, we know that the body and the mind are intimately connected. Yes, we know that children need a sense of wellbeing. Yes, we know that being active and eating healthy are important for kids. And we know that parents, teachers, and school communities have important roles to play in students’ healthy development. We also know that sleep, healthy eating, and exercise are good for people with mental illnesses. Hell, they’re good for everyone.

But there’s a lot more to mental health than physical fitness and a sense of wellbeing. If that was all it took, we could just eat kale and kiwis, meditate, and send the therapists home.

Of course, the article was short and seemed to focus on the duchess’s meetings with the youngest kids, who after all the most photogenic. Maybe the charity and the duchess also educate about the thornier aspects of mental health. Maybe they promote dialogue about self-harm, suicide prevention, childhood depression, and other conditions. I would like to think that they do.

But the article and many others like it focus on the physical and feel-good aspects of mental health and not the mental and emotional. Bubble baths for self-care! Pets as the best therapists! Super foods for regulating moods!

Memes are not the answer. And the physical aspects of mental health are certainly important. But we’re talking about mental illness and mood disorders here. Can’t we at least spend time talking about the mind and the emotions?  Maybe even have a dialogue about what happens when something goes wrong with them? Stress the importance of seeking help when one is confused, overwhelmed, and despairing?

I think society at large is still uncomfortable talking about mental illness and twice as uncomfortable talking about mental illness in children. Many of us are still laboring under the illusion that childhood is a uniformly happy time. In fact, many kids suffer from serious mental illnesses. If the statistics give any indication, 20% to 25% of them will experience a mental health problem at some time in their lives.

We should talk about this and ultimately do something about it. Something more than emphasizing good physical health and getting celebrities to do 30-second spots about how they too experience depression, though these are indeed good things.

I’ve written before about what I think a mental health curriculum in schools should look like (https://wp.me/p4e9Hv-Jw, https://wp.me/p4e9Hv-Hl). I suppose that first we need to be aware that children can and do have mental health problems – that it may not be “just a phase they’re going through” or something they’ll “just get over.” It’s a serious problem and requires serious attention, not to mention serious actions.

Whatever else we do, let’s put the mental back into mental health.

 

 

What Schools Are – and Aren’t – Doing About Mental Health

I believe that mental health education belongs in schools. I’ve written about that (https://wp.me/p4e9Hv-Jw). There’s good news about the subject and there’s less-good news. I’ll let you sort out which is which.

First, two U.S. states are now required by law to include mental health in their curriculum – New York and Virginia.

New York’s law mandates teaching the subject as part of the K-12 health curriculum, which has only two other specifically required topics: alcohol, drug and tobacco abuse and the prevention and detection of certain cancers. According to the law, the new education requirements seek to “open up dialogue about mental health and combat the stigma around the topic.” Free resources for New York schools, such as teacher training, are available online. These include lesson plans, though schools and teachers are free to design their own curricula.

In Virginia, mental health education is required only in grades 9-10. Huffington Post reports that the legislation came about “after state Sen. R. Creigh Deeds (D-Charlottesville) saw that three high school students had researched, developed and presented the proposed legislation, which struck close to home for the legislator, who had lost his son to suicide in 2013.”

Indeed, those laws are good things, though one could wish that the other 48 states would take note and do likewise. They are, of course, not forbidden to teach mental health education, and many do, especially around the topics of drug and alcohol prevention and suicide prevention. Some of them even require education on those two topics, along with bullying. Many of these efforts are sincere, significant, and even life-saving, but it is worth noting that bullying and student suicide are events for which schools are at risk of legal liability. One might wonder whether that has influenced the laws, rather than supporting more comprehensive mental health education.

Contrast the U.S. experience with England, where all secondary school teachers and other school staff are being given training that will help them identify mental health issues in children, including depression and anxiety, self-harm, and eating disorders. This is thanks in part to Prince Harry’s openness about needing counseling to help him deal with the death of his mother, Princess Diana, which happened when he was 12. The Prime Minister has said that the prince’s disclosures will help “smash the stigma” regarding mental illness and the need for getting help.

“The programme is delivered by social enterprise Mental Health First Aid (MHFA) England, backed by £200,000 in Government funding,” notes the Telegraph, “and will be extended to primary schools by 2022.”

The campaigns around the mental health mandate, especially those featuring Princes William and Harry, have focused on the need for Britons to abandon their “stiff upper lip” image and to accept that men can and do need to seek help for mental difficulties. While that is indeed a vital message, one hopes that girls and women do not get left behind in the efforts.

What about U.S. states where mental health education is not a fact of life?

For schools in the U.S. that have not mandated mental health education, the National Alliance for Mental Illness (NAMI) has developed resources that can help districts, schools, teachers, and families address the problem through the NAMI Parents & Teachers as Allies program of training.

They have also developed a presentation for students called NAMI Ending the Silence, “designed for middle and high school students that includes warning signs, facts and statistics and how to get help for themselves or a friend.” These programs are offered free to schools and communities. For more information, go to https://www.nami.org/Learn-More/Public-Policy/Mental-Health-in-Schools.

For a more DIY approach, youth.gov (https://youth.gov/youth-topics/youth-mental-health/school-based) recommends that schools “partner with community mental health organizations and agencies to develop an integrated, comprehensive program of support and services.” Among the actions they recommend are for schools and partnerships to:

  • develop evidence-based programs to provide positive school climate and promote student skills in dealing with bullying and conflicts, solving problems, developing healthy peer relationships, engaging in activities to prevent suicide and substance use, and so on.
  • develop early intervention services for students in need of additional supports such as skill groups to deal with grief, anger, anxiety, sadness, and so on.

In other words, for schools to spend the time and energy to do for themselves what the state and national governments are unwilling or unlikely to do.

To me, this is one of those times when a national curriculum makes sense, or at the very least a mandate in every state. Mental health education should be comprehensive, freely available, easy to access, and scientifically accurate for all schools and schoolchildren. The education this would provide and the statement it would make would be invaluable. Drug and alcohol, bullying, and suicide prevention are just a start, but a start that many states have not made.

 

 

Inspiration and Mental Illness

high angle view of pencils on table

Photo by Pixabay on Pexels.com

I was manicky this week and it affected my blog writing. I had a post all ready to go this morning, but last night I thought about it and realized it was crap. It meandered, without focus. The ideas were confused. It sucked. So I got up this morning to write something different instead.

Many of you may recognize this aspect of mania or hypomania. You do something that you think is fantastic  while in the grip of mania and when you come down, you can’t see what you ever saw in it. Or you begin an ambitious project that you work on and work on but never can complete.

I was toying with the idea of “inspiration porn” – the sort of post or story or TV show that holds someone up as an ideal, usually because they’ve lost a bunch of weight and gotten themselves into shape, or have an illness or disability and managed to do – whatever – again. Think “The Biggest Loser.” Or amputees who’ve learned to eat with their feet. It’s put out there for entertainment and to make everyone feel good that whoever it is conquered whatever it was. It takes a regular person out of the context of their lives and reduces them to their condition. And the subtext is that if this brave person can become able to do or be whatever again, so can everyone else with the same problem.

It happened to a friend of mine who was at a gym on a treadmill. A woman came up to her and said how inspiring it was to see her working so hard to lose all that weight. “Excuse me?” was my friend’s reaction. She was doing it for herself, not for anyone else, and especially not to inspire some random stranger.

The thing is, there really isn’t any mental health inspiration porn. For one thing, it would make lousy TV. Oh, they’d get advertisers – all those purveyors of psychotropics that clog the airwaves. But who would watch a depressed person finally getting out of bed and taking a shower, unless she had a coach yelling at her?

Inspiration for those of us with mental health problems takes other forms. Celebrities who speak about their struggles with mental illness are one. They are inspiring because they break the taboo about talking about mental illness in public and because they have done so to help other people.

Then there are the superstars of mental health inspiration. Carrie Fisher, Glenn Close, and Jenny Lawson, to name a few. These are people who focus light on the difficulties and struggles of mental illness. Their communications don’t stop with the announcement that they have a condition and encouraging people to get treatment, though those are also good things. But the real inspirations are those who open their lives, take others with them through the journey of symptoms, treatments, relapses, small triumphs, and bigger successes. They speak and keep speaking and keep speaking their message. They don’t make the process sound easy, because it isn’t. And they speak with authenticity and authority because we know they’ve been there.

They do inspire us because they are honest and open, and they clearly care about helping others in the same proverbial boat.

We lost a true inspiration when we lost Mama Carrie. No one will ever really take her place. But you can tell that she was an inspiration by the many people whose life she touched and how they remember her. If someday they make a movie of her life, I hope it features not only her personal struggles, but all that she did for others. Her speaking and continuing to speak despite – or because – of her ongoing struggles.

We can carry on her work by doing the same, by shedding the stigma, by talking to others, even family and friends. Recently a friend “came out” to me that she takes an antidepressant and an anti-anxiety med (the same ones I take). I was proud of her, but I didn’t make a big deal of it. But I was impressed and pleased that she was able and willing to share even that much. She was saying that she was part of our tribe.

As Jenny Lawson reminds us, in this we are alone together. And that’s inspiring. 

Low-Jacked Pills and High-Tech Mental Health

I’m a known geek and ordinarily a fan of technology – though not technology for its own sake. It has to do something useful and needed.

Imagine my surprise to learn that tech companies are now doing what so many of our public institutions aren’t, and devising possible solutions to assorted mental health problems. Stat reported (in their Business section) that now:

with an influx of funding, companies are revamping pills with digital sensors, designing virtual reality worlds to treat addiction and other conditions, and building chatbots for interactive therapy.

But are these techno-wonders likely to be any help? Let’s take the innovations in reverse order, shall we?

Chatbots. We already have remote counselors, which may be a godsend for people with no access to mental health clinics (although they charge a fee, which may be prohibitive for some). I’ve never investigated this service, so maybe some of you who have can tell me how they work and how well.

Remote counselors rely on already existing technology, however, and are therefore not of interest to tech innovators (or potential funders). Chatbots are something else. They are, essentially, computers that respond to human input with output that is supposed to simulate human responses.

To my knowledge, no computer has ever passed the “Turing Test,” which means that a person has no idea whether they’re chatting with a real person or a computer. A psych computer is likely to respond with generic responses such as, “Why do you feel angry with your sister?” “What do you mean when you say anxiety?” “Explain how depression affects you,” and “Tell me more about your mother.” The supposed AI is in no way trained in psychology or any therapeutic techniques.

One company that received funding for “telepsychiatry” (called Regroup Therapy and Woebot Labs) brands their idea as “Your charming robot friend who is ready to listen, 24/7.” Admittedly, many persons with mental health issues need someone who’ll listen, but that’s far from all they need.

Virtual reality for addiction (and other conditions). Startup Limbix wants to sell its programs to therapists and clinics. According to Stat,

Among the company’s VR programs is an exposure therapy for patients with phobias or trauma associated with driving. While patients strap on the headset, clinicians can work with them to introduce different conditions (a clear or rainy day) or different road situations (a bridge or a tunnel or blind left turns).

This sounds promising, though the cost of VR headsets and the programming for various conditions again might be prohibitive for your average community or campus or rural mental health clinic. I’m not clear on how it would work for addiction, unless combined with aversion therapy, which is generally brutal.

Pills with digital sensors. Aren’t psychotropic medications already too expensive, especially for people who have no insurance? Now we need technological pills that must make a profit for both drug and tech companies?

And what a pill they’re talking about. Basically, it’s a pill that rats you out if you don’t take it, or rather alerts your doctor when you do take it. Presumably, your doctor has enough staff to monitor whether clients take the pills and record it if they don’t. Then what? A robocall telling you to take your meds? A visit from a social worker?

Admittedly, such low-jacked pills might have a place in situations where schizophrenics are court-ordered to take their medication, but again there is the problem of what to do about non-compliance.

Another company plans to sell “a cardiac drug meant to be popped like a mint to people anxious about public speaking and first dates.” Would people need prescriptions for those, or will they be dispensed like Tic-Tacs? Even anti-anxiety drugs aren’t meant to be “popped like a mint.” And a cardiac drug? I can’t see any possible downside there.

If only the ingenuity and investment that goes into these products were instead available to fund and repair the shaky mental health system instead. What we need are more psychiatrists and therapists, more hospital beds for psych patients, less expensive drugs, better insurance, more education for the public about mental illness, and an end to stigma.

But those would require systemic reform and political backing, not just some new-fangled gadget. And good luck getting investors for those.

Reference

https://www.statnews.com/2018/07/20/tech-developers-tackle-mental-health/

Would You Try Electroshock?

Photo by Mike T

In the course of dealing with my bipolar disorder, I had a near brush with electroshock. I managed to avoid it, but I did give it serious thought.

Now 60 Minutes has come out with a piece called “Is Shock Therapy Making a Comeback?” You can see the segment here: 60 Minutes.

ECT(electroconvulsive therapy, the modern name for the procedure), which is often done on an outpatient basis, works by inducing a brief seizure in a patient. The seizure, which lasts about a minute, releases multiple neurotransmitters in the brain, all at once. The patient is required to have someone to transport them to and from the appointment. Treatments are typically applied one or two times per week for 6-8 weeks.

In a brief article excerpted from the news show segment, Dr. Charlie Welch, of McLean Psychiatric Hospital, explains how ECT differs from how it was performed in the past: “What’s different first of all is that it’s done under general anesthesia with a muscle relaxant. So when the treatment is done, the patient is sound asleep and completely relaxed.” Call it a kinder, gentler shock treatment.

That was the procedure that my psychiatrist offered me after he had spent a number of years trying me on various medications that either didn’t work, or helped only partially.

My immediate reaction was negative. I recall thinking, “Fuck, NO! Keep away from my brain, you Nazi sadist!” After I calmed down a bit, I did some research.

ECT, my sources said, was a long way from the cruel, stigmatizing procedure portrayed in One Flew Over the Cuckoo’s Nest. The Internet was little help, though. The opinions and experiences of people who had undergone electroshock ranged from “It was hideous” to “It was a miracle.”

Truthfully, I was appalled by the notion of electrical jolts surging through my brain. My precious brain, which had both sustained me and betrayed me throughout my life.

Then I thought some more. So ECT sometimes causes memory loss. I already had that, thanks to some of my meds. I would be altering my brain with electricity. But hadn’t I been altering it for years with chemicals – medications that no one seemed to know how they worked?

So I went back to my doctor and said I would at least talk to the doctor who would perform the procedure. And I lined up a journalist friend to write about my experiences if her editor approved. (Note: In the 60 Minutes piece, former Massachusetts First Lady Kitty Dukakis gave permission to have her treatment filmed and broadcast.)

My psychiatrist, however, had one more medication that he wanted me to try before we took that next step. And it worked. So much for electroshock.

Now as to that side effect of memory loss – Dr. Sarah Lisanby of the National Institute of Mental Health in Maryland has developed a new treatment that seems to avoid that particular consequence.

The procedure is called Magnetic Seizure Therapy (MST) and it uses magnets (duh!) to stimulate more precisely focused seizures than ECT does. These focused seizures seem to avoid the parts of the brain associated with memories. As Dr. Lisanby told the 60 Minutes reporters, “For some people, ECT may still be needed. But if Magnetic Seizure Therapy could be effective without the memory loss who wouldn’t want to try that first?”

Would I try MST if I relapsed into treatment-resistant depression? I would certainly consider it, if it were out of the testing stage by then. And I’d do that before I signed up for ECT. While I have memories I’d prefer to forget, with my luck, those would be the ones left unaffected.

The cynical side of me says that these seizure-causing therapies are becoming more popular because insurance companies like the notion of a short course of 6-8 weeks of treatment instead of years of talk-and-medication. (Although Kitty Dukakis said that she has done ECT for years now and expects to continue into the foreseeable future.)

But I could be wrong. It is possible that some kind of treatment could be short in length but longer-lasting in effectiveness. I’m not ruling it out. At this point I’m not ruling out anything that could aid in my progress and my healing.

 

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