Am I Recovered Yet?

Today on our local public radio station I heard an interview with Tonier Cain, a team leader for the National Center for Trauma Informed Care. Ms. Cain is a renown speaker who has appeared at multiple national venues to talk about her horrific childhood history of sexual and physical abuse, multiple adult arrests, history of prostitution and drug abuse, and incarceration in our own Maryland prison system. Her story is remarkable for her 180 degree transformation to become an accomplished organizer and advocate. She has repeated her narrative many times online, on the radio, and even in local theater. She frequently speaks to women prisoners to talk about the importance of trauma recovery therapy.

I was familiar with her story because the state of Maryland passed a law last year which mandated that anyone working in a state facility must be given training in trauma-informed care. I went through this training myself where I saw a shortened version of the documentary "Healing Neen," about Ms. Cain. Following the presentation the instructor asked what we thought about the film. Everyone in the room thought that it was wonderful, that Ms. Cain's story was amazing, that the trauma recovery treatment she had had was miraculous.

"Isn't it amazing how she has overcome her trauma?" the instructor asked.

I should have kept my mouth shut. I really should have.

But I couldn't help myself.

"But she hasn't recovered!" I blurted out. "She just reshaped it. She has recreated her personal and professional identity around her trauma narrative." And that's true---she is now a professional trauma victim/survivor. How is this overcoming her past? How is this recovery?

The room fell silent. People looked at me, a bit aghast and shocked. Some people tried to explain: "Well, you don't ever really COMPLETELY overcome the past, you just learn to live with it."

Well OK, that sounded reasonable. But wasn't the point of the trauma recovery movement that you actually are supposed to recover? That at some point, you stop being a patient? I mean, when I treat someone my goal is complete recovery----zero symptoms----that's what I call recovery. My goal is to free someone from being my patient, as much as possible.  Isn't that the goal of the trauma-recovery movement?

Maybe I just was uninformed. Maybe I needed to read more about it.

I did a PubMed search using the terms "outcome" and "trauma-informed care." This search produced all of four articles. One focussed solely on trauma-informed interventions to reduce seclusion and restraints in the hospital. Another paper discussed the dirth of outcome-based evidence for trauma informed care for people with schizophrenia. There were no controlled trials, nothing in the way of any standard study of anything related to trauma informed care.

Yet education about this recovery movement and treatment approach is being mandated by our state government. There's something seriously wrong here. An intervention with no evidence base is being required and weighed on the same level as a requirement for CPR certification.

The trauma recovery and prevention movement also has moved into the domain of disaster psychiatry. This is the idea that prompt mental health intervention can prevent longterm psychiatric complications for people who experience traumatic events. I've written about this before on the blog in my posts "I Don't Need to Talk" and "I Still Don't Need to Talk", including a review of studies to suggest that for some people these interventions may actually be harmful. In his Mental Illness Policy blog, DJ Jaffe expressed similar concerns in his post "NYS Office of Mental Health: Wrong Response to Hurricane Sandy," where he discussed the diversion of mental health workers to crisis counseling and away from services for the seriously mentally ill.

Government money for mental health services is limited, and should be directed toward people with serious mental illnesses and evidence based practices.

One Dad's Perspective

Okay, while our presidential candidates are debating, I thought I would link to an article by a former state legislator.  In "How I Helped Create a Flawed Mental Health System That Failed Millions -- and My Son," Paul Gianfriddo talks about his decades-long attempts to help his ill son, a young man who sounds to have mental health and educational needs that couldn't be met by a system with limitations.

Gianfriddo writes:

The 1980s was the decade when many of the state’s large psychiatric hospitals were emptied. We had the right idea. After years of neglect, the hospitals’ programs and buildings were in decay. But we didn’t always understand what we were doing. In my new legislative role, I jumped at the opportunity to move people out of “those places.” Through my subcommittee, I initiated funding for community mental health and substance abuse treatment programs for adults, returned young people from institution-based “special school districts” to schools in their hometowns, and provided for care coordinators to help manage the transition of people back into the community. 

But we legislators in Connecticut and many other states made a series of critical misjudgments that have haunted us all ever since. 

First, we didn’t understand how poorly prepared the public school systems were to educate children with serious mental illnesses in regular schools and classrooms. Second, we didn’t adequately fund community agencies to meet the new demand for community mental health services—ultimately forcing our county jails to fill the void. And third, we didn’t realize how important it would be to create collaborations among educators, primary care clinicians, mental health professionals, social services providers, and even members of the criminal justice system, if people with serious mental illnesses were to have a reasonable chance of living successfully in the community. 

During the twenty-five years since, I’ve experienced firsthand the devastating consequences of these mistakes.

The story about his son is heart-breaking and there is no happy ending.  I'll leave you to read the whole article and see what you think.  And if you'd like to check it out, Mr. Gianfriddo blogs, often about mental health issues, at Our Health Policy Matters.

Why Psychiatric Patients Die Younger

If you're reading this for the answer, you can stop now.  I don't know why psychiatric patients die younger than people who do not have psychiatric disorders.  I think that fact only applies to those with chronic psychiatric illnesses, not to someone who has had a single episode of depression or anxiety.  What qualifies as a chronic mental illness?  I'm not sure -- but certainly if you get on-going disability (SSDI) benefits because of your psychiatric disorder, or if you live with a careprovider and attend a long-term psychosocial rehabilitation program for years, or have resided in a state hospital for years.  

How much less time do psychiatric patients live?  The numbers vary from 8 years to 25 years, though I have hard time believing that the average lifespan of a psychiatric patient is only a little over 50.  I have had a few psychiatric patients who have died young, but none under age 50.

So, if we start from the premise that psychiatric patients die younger than people without chronic and persistent mental illnesses, then why?  I'll throw out some ideas.  None of them are the right answer because there is no right answer, just my thoughts on some possible contributing factors.

• Poor coordination of care: psychiatric patients may be less likely to make appointments, coordinate their care, and may receive medical treatment of their conditions at a substandard rate. (Roy likes this one, I bet)
• Psychiatric patients smoke cigarettes at rates that are higher than the general public.   
• Psychiatric medications predispose people to weight gain and metabolic syndromes that may precipitate diabetes and heart disease.
• Psychiatric patients have high co-morbidity with substance abuse disorders and substance abusers die young for many reasons.
• Psychiatric patients have higher rates of suicide and suicide is common cause of death among young people.
• People with psychiatric disorders may not be evaluated as carefully as people without such disorders when they present to a medical professional with problems.  The medical professionals may be too quick to attribute problems to anxiety or depression or psychiatric concerns.
• Certain psychiatric conditions may predispose people to  behaviors that are not good for them.
• Certain psychiatric conditions may predispose people to have less interest in investing energy in the caring for themselves or making lifestyle decisions that favor good health.
• Chronic mental illness is associated with poverty and this is associated with obesity, and as well as a lower likelihood of investing in more expensive and healthier food choices, gym memberships, and a full range of medical care.
• Patients with psychiatric disorders may have fewer close relationships and family members often cajole their relatives to take care of themselves, pursue medical care, and provide a reason to live.

Just my thoughts.  Tell me what I missed.

Diane Rehm Show: Mental Health Under the Affordable Care Act

I was a guest on today's Diane Rehm Show on National Public Radio, along with Rachel Garfield from the Kaiser Family Foundation, Pamela Hyde from SAMHSA, and Richard Frank, the Harvard health economist.

The topic was about the Accountable Care Act (ACA) and its potential impact on mental health and addiction services.

They already have the recording up, as well as a transcript.

Things I'm Thinking About This Holiday Weekend

Happy Presidents' Day.  I probably have 50 blog posts floating around in my head, but I thought I'd share with you some of the stuff I've been reading on line lately.  


The New York Times Op Ed editor doesn't seem to like stimulants these days.   A few weeks back there was an article talking about a study showing that long-term stimulants aren't helpful, and today there is a piece by a writer who finds distraction helpful...told with some contempt towards his friend's son whom he calls Ritalin Boy.  Steve over on Thought Broadcast has his own take on ADD meds.   
 What do you think: are stimulants helpful or not?  I'll stand aside for this one. 


Then there was the article about the business/computer whiz who put hundreds of thousands of dollars of his own money (and all his time) into a kidney transplant matchmaking service.  If you need an uplifting story, this is an interesting one. 


Over on KevinMD,  Dr. George Lundberg is a bit skeptical of SAMHSA's new defining features for the Recovery Movement.  I more or less agree, it feels like it's more about semantics (what does it mean to say recovery is "person-driven"? as opposed to?) than substance, and a lot of it seems to boil down to the idea that patients should be treated with respect and people with mental illnesses should work towards achieving their full potential.  Those things I agree with, for everyone. 


And finally, for the writers among us, Pete Earley has a Before You Quit Your Day Job post up on his blog.  I'm still pondering the $80,000 advance.  The Shrink Rappers need an agent, oh, but we do love our friends over at Johns Hopkins University Press.  


And finally, for my friend ClinkShrink the Introvert,  who wrote a review of a Quiet: The Power of Introverts in a World that Can't stop Talking (---huh, stop looking at me), here is an article called The Brainstorming Myth by Jonah Lehrer in The New Yorker. 


Okay, lots of links.  This is what I've been thinking about.  Aside from that, I made a quick trip to NYC and had my photo taken with Cookie Monster in Times Square, and I loved Jersey Boys.

NYT: Story about Antonio Lambert and Peer Counseling

This is a great story about turning around ones life with addiction and mental illness, giving back by training others to do peer counseling, which is such a proven strategy that Medicaid will pay for it.
[posted via email]
From The New York Times:
LIVES RESTORED : After Drugs and Dark Times, Helping Others to Stand Back Up
The mental health care system has long made use of former patients as counselors, like Antonio Lambert, an ex-convict turned mental health educator in Delaware.
http://nyti.ms/uxDM2Y

Guest Post from Eric Stevenson: Caring for a chronic illness patient: A difficulty on its own

This Guest Post is from Eric Stevenson, a health and safety advocate who resides in the South Eastern US.

Having a chronic illness can be extremely tough, not only for the patient themselves but also for those who care for them. The process of loving and supporting someone with a chronic illness can be very difficult and challenging. Many times caregivers don’t want to speak up about their own stress because they may feel guilty or that it doesn’t matter as much than the patient’s problems. Luckily, there are a few ways to be prepared and help in the difficult situation of caring for a person with a chronic illness. 

There’s a great amount of social factors and possible coping strategies involved with care giving, as some things can influence stress levels in a positive or negative direction. Financial instability can cause major stress and mental issues for caregivers. In many times a chronic illness can lead to major financial problems as hospital bills continue to stack up. Financial factors can influence the mental state of caregivers in either direction. With more financial support, caregivers are often able to delegate some of their responsibilities, thus lowering stress and improving mental health. 

Social support also plays a huge role in the process of caring for a chronic illness patient. The help of family, friends, or even neighbors can play both a positive and negative part in the mental state. Not allowing for any support for the patient can often cause problems, but so can minimal support for yourself or a care giver. The stress and difficulty of taking care of someone with a chronic illness can be a major burden. Not having anyone to talk to or vent is often a major cursor to stress. 

Many people deal with side effects of coping strategies. Some may take to avoidance, but in many cases that will lead to further health problems. Avoidance as a coping strategy has been known to bring on many cases of depression. Many caregivers with low self esteem will use emotionally charged coping strategies, while those with high self esteem may turn to task centered coping methods. In the end, research has shown a large connection in self esteem and depression within caregivers. 

Factors such as the type of illness and location will also play a large part in the process. Some diseases like mesothelioma (a cancer forming from asbestos exposure) will have a severely low life expectancy. When compared to a patient that may be expected to live many years longer, the care giving situation will be extremely different. 

In the end, there are certainly a few factors that will play a large part in the role of a caregiver for those with chronic illnesses. The value of a support system and being educated on the disease will remain important. Caring can end up being extremely difficult and stressful, thus caregivers should also be looked out for in the future.

You Need Help!

Sometimes in my real life it becomes obvious that a friend or acquaintance is having a problem. Either they are wearing obvious signs of mental illness or they just show signs of being 'stuck' in life or, worse, of moving backwards. Often they don't see it. I suppose there is the outsider's vantage point of making a judgment that may reflect my own value system and not their reality: to me, I may see someone who has family and job and connections who sees leaving those things as a healthy escape and their withdrawal as a good kind of comfort with keeping their own company. Usually these aren't my close friends, but what do you do when you notice that someone in your life is changing and might possibly benefit from help?

In general, I've found that "You need help" is not helpful. People hear this as an insult, not as a kind suggestion from a concerned friend. And from a psychiatrist friend it may be worse and easier to blow off---shrinks think everyone's crazy, they push drugs, they think everyone needs therapy, they see the world in a skewed way (at least this is how the commercial runs).

So I wondered: how do people let their friends know they need help in a way that inspires them to get it in the absence of a crisis? If you're in treatment because someone else suggested it, what enabled you to hear the suggestion without being wounded or insulted?

Repealed: Kansas voters repeal law that could block people with mental illness from right to vote

Back in the 1970s, Kansas passed a law that could prevent people with mental illness from voting. The law was never used, but advocates were successful in getting an amendment passed that revoked that law.

This law was passed at a time when stigma against mental illness was much higher than now. I'm guessing it was presumed that folks with a mental illness could not reason enough to exercise an informed vote, which is not true, of course. If 1outta5 have a psychiatric illness, including anxiety, depression, and substance abuse, then there could have been a huge swath of disenfranchised voters.

And there already exists, to a degree, a basic cognitive test for voting -- navigating the whole ballot process.  In Maryland, ours was electronic and no harder to use than an iPad, but I could still imaging some with severe dementia unable to navigate the system.  But there should never be a cognitive bar one must pass to vote; the challenge would be where you draw the line.

What Makes Mental Illness Bad?

So why is it that some people have a psychiatric disorder and they bounce back and it's not a big deal, while others struggle terribly? For the unlucky ones, mental illness defines them.

Here are some factors that affect how much impact psychiatric illness has in a person's life:
(Note to Roy: did I get the effect/affect thing right here?)

1) The severity of the symptoms.
Any way you dice it, mild-to-moderate anxiety can often be hidden and isn't as disruptive as an episode of psychosis with hallucinations and paranoid delusions.
Just to give an example.

2) The duration of the episodes.
So a chronic depression or severe obsessive compulsive disorder may be more disabling than a brief episode of psychosis.

3) The form of the symptoms.
Some symptoms are intrinsically more public than others, or more difficult to bounce back from. In terms of "Can I be a doctor if I have bipolar disorder?," one episode of walking around the hospital naked may be all it takes to get sent home.

Form and severity of symptoms, and the duration of the episodes, are likely to be intrinsic to the disease and not something the individual controls.

4) How responsive the illness is to treatments.
Some people have very severe symptoms that are very responsive to treatment.

5) External support systems: access to good care, chicken soup, and TLC. Job flexibility may enable some people to quietly take time off when the going gets rough. Understanding friends & family-- these are all good things.

6) Individual personality features that support good coping. This is vague and I just made it up, but it's the best I can do--- maybe 'resilience' is another term for it.

7) Individual special features which help a person compensate. So being extremely intelligent, or extremely efficient and diligent, or very charming and charismatic, may make everything else a bit easier.

8) Stress load. This is hard to say for all people--- many people really struggle when things go wrong, and not all people with psychiatric illnesses relapse under severe stress, but all things being equal, it's probably better to not have a lot of loss and stress in life if one is trying to cope well with mental illness.

9) Co-morbid substance abuse. People with psychiatric disorders and drug or alcohol addictions just don't do as well. Often, it's a toxic combination.

10) Co-morbid medical disorders.

11) A willingness to devote time, energy, money and resources to a healthy lifestyle.
(It can't hurt)

What'd I miss?

Why Can't We Be Sad?

Today's New York Times Magazine has a really interesting article by Jonah Lehrer called "Depression's Upside." Mr. Lehrer talks about a possible evolutionary purpose for Major Depression.

Mr. Lehrer writes:

The persistence of this affliction — and the fact that it seemed to be heritable — posed a serious challenge to Darwin’s new evolutionary theory. If depression was a disorder, then evolution had made a tragic mistake, allowing an illness that impedes reproduction — it leads people to stop having sex and consider suicide — to spread throughout the population. For some unknown reason, the modern human mind is tilted toward sadness and, as we’ve now come to think, needs drugs to rescue itself.

The alternative, of course, is that depression has a secret purpose and our medical interventions are making a bad situation even worse. Like a fever that helps the immune system fight off infection — increased body temperature sends white blood cells into overdrive — depression might be an unpleasant yet adaptive response to affliction. Maybe Darwin was right. We suffer — we suffer terribly — but we don’t suffer in vain.

So I didn't like the article at the beginning; it relied on anecdotes--the woman who felt so much better with antidepressants that she'd grown complacent in a bad marriage, for example. It doesn't capture all the patients I see, and any way you dice it, if you end up dead from suicide, your productivity comes to a halt. It seems to me that there are some people who suffer in ways that these anecdotes don't explain. I suppose, however, even if we assume that depression is an unproductive, tormenting state, when it ends, is there something to be gained from having gone through it. Lehrer tells us, "Wisdom isn't cheap, and we pay for it with pain." I, personally, think there remains a differentiation between pain and major depression, and that perhaps one can grow through all sorts of suffering, and I'm all in favor of finding my own personal path to wisdom in ways that might not entail so much suffering. Just a thought.

But I ultimately, I liked the article because Lehrer, while clearly a proponent of the "don't mess with evolution, less drugs, please," school of thought, presents a balanced view. He gives Peter Kramer (Listening to Prozac) a voice, and talks about the objections to the viewpoint he puts forth. He describes a theory that depression is evolutionarily helpful because of the ruminative nature of the illness. He also cues us in that this is just one explanatory theory which remains unproven, and there are others. Lehrer continues:

Other scientists, including Randolph Nesse at the University of Michigan, say that complex psychiatric disorders like depression rarely have simple evolutionary explanations. In fact, the analytic-rumination hypothesis is merely the latest attempt to explain the prevalence of depression. There is, for example, the “plea for help” theory, which suggests that depression is a way of eliciting assistance from loved ones. There’s also the “signal of defeat” hypothesis, which argues that feelings of despair after a loss in social status help prevent unnecessary attacks; we’re too busy sulking to fight back. And then there’s “depressive realism”: several studies have found that people with depression have a more accurate view of reality and are better at predicting future outcomes. While each of these speculations has scientific support, none are sufficient to explain an illness that afflicts so many people. The moral, Nesse says, is that sadness, like happiness, has many functions.

The article finishes off with the idea that people in depressive states are better thinkers, they notice more, they work better. He talks about a study that shows that on gloomy days with dismal music playing, shoppers notice more trinkets by the cash register. Gloomy weather and oppressive music might set a low mood tone, but this seems a far cry from an episode of major depression, and not something that is generalizable to anything more than clouds and music and trinkets. There's a second study mentioned of undergrads doing an abstract reasoning test that shows people with a "negative mood" perform or focus better; again, it falls short of being a comparison for major depression. The shrinks among us find it hard to imagine that 'negative moods' and Major Depression are all that linked. Everyone has negative moods. Not everyone has major depression.

What about the studies that link mood disorders and creative tendencies? This does seem likely, and we're left to wonder (my own thoughts, not the article) if the intense experience of an episode of mood disturbance either fuels creativity by feeding it material or requiring a release, or if the genetics are wired such that mood disorders and artistic talents might be coded near one another.

You thoughts?

Danny Weinberger: Mental Health in 2020

-from Nature

Mental health

Daniel R. Weinberger

Senior investigator, US National Institute of Mental Health

The search over the past decade for genes behind mental illness has led to the realization that mental disorders are not discrete conditions with specific causes. Rather, they are the result of interactions between risk factors that affect development; psychiatric symptoms can arise from many causes and are more interrelated than current disease models allow. By 2020, this insight, which has been slow to take hold, will have transformed how doctors understand and treat psychiatric conditions.

Finding specific genes for mental illness now seems a pipe dream. A more realistic endeavour for the next ten years is to look for genes that code for basic cellular and brain functions that modulate our responses to the environment and that come together in particular ways in individuals at increased risk. Many hundreds of genes may contribute to raised vulnerability, and such defects may affect brain development and function independently of any specific psychiatric diagnosis. There is no straight road to psychiatric illness, but a highly diverse network of developmental pathways.

This approach will lead to diagnosis and treatment based on a proper grasp of the underlying biology, rather than on an interpretation of symptoms. Psychiatric research is poised to realize Sigmund Freud's dream of a biological psychology, but it will require new applications of old thinking (see also page 9).

Mental Health and MLB

Roy asked me to post about this article, by Shirley Wang,
from the Wall Street Journal:
Professional Baseball Faces Loaded Problem: Mental Health

The article starts by talking about the fact that there are three Major League Baseball players on the Disabled List (the D-L) for anxiety. It goes on to talk about 'butterflies' and golfers' 'yips.' It names some professional athletes who've suffered from other mental health issues, and there is talk of pitchers who suddenly couldn't throw. The players, apparently, have access to a counselor.

What don't I like about the article? Somehow, I read it and had the flavor that these players are disabled by anxiety from the stress of their profession and the performance demands...the article ends with a psychologist being quoted as saying that anxiety is normal.

My best guess...and I don't know these players and have never examined them....is that there is more to it than stage fright, or the pressure of the biz. When you're getting paid what these guys get, I don't think they let you bow out and go on the D-L because you're job's too much and you get butterflies in front of the crowd. By the time you're on the D-L, the mental health issue is probably quite disabling, and not the normal or expectable anxiety that goes along with jitters and yips. And I can't imagine that professional sportsmen are any less vulnerable than the rest of the population to mental health issues.

Psychiatry on Broadway

The world is so weird. This morning, I looked out my back window and wondered if the neighbor behind me was pregnant. You can't really ask someone this-- it could just be 15 unwanted pounds, kind of concentrated in one place. I went to her Facebook page, and there was a comment on her wall, "Congratulations on the Pregnancy!" Okay, so it's official.

So today's New York Times mental health Shrink-Rappable article comes from the Arts & Leisure section. Patricia Cohen writes in "Mental Health, the Musical, Aims for Truth" about Broadway plays where mental illness is the focus of attention. She talks about a new Broadway play, Next to Normal, as well as about Proof and Equus. Cohen writes:

Mental illness on the stage and screen is often portrayed in extreme ways, and not just for dramatic effect. In Western culture psychic pain has tended to be seen as the territory of the artist, visionary, rebel and genius, from Emily Dickinson to Sylvia Plath and Friedrich Nietzsche to John Forbes Nash Jr. So it should be no surprise that madness is often used to signify creativity, sensitivity or spiritual and intellectual depth.

She goes on to write:

The musical now presents a much more subtle and complex view of psychotherapy. In “My Psychopharmacologist and I,” Diana catalogs the side effects of her drugs — nausea, drowsiness, sexual dysfunction, headaches, seizures — until she finally says, “I don’t feel anything.”

The doctor pronounces, “Patient stable.”

Will I see it? No...sounds too much like going to the office.

"Dumping Grounds"

The Chicago Sun-Times has an article today by Carla K. Johnson about a tragedy occurring in a nursing home where an older man is beaten by a younger resident who has a mental illness.  She refers to how "nursing homes across the nation have become dumping grounds for young and middle-age people with mental illness."

Am I the only one bothered by the use of the term dumping grounds?  Like people with mental illness are trash, or are unworthy.  Yes, this was a tragic situation, but demonizing all people with mental illness as dangerous, violent ticking time bombs is yellow journalism at its worst.  I understand the point, that younger people with no where else to go are being sent to nursing homes, but must we resort to this poor use of terms?

Take a look at the headline currently being run: "Deadly mix: mentally ill in nursing homes".  If you have an opinion on this, please let the Sun-Times know.

The NAMI Mental Health Report Card: Grading the States 2009

The National Alliance on Mentally Ill Mental Illness came out with their report card on how each state is taking care of mental health issues. The national average is a big, fat D. As the kids would say, "epic FAIL!".

Only 6 states scored a B (sorry, no A's): Connecticut, Maine, Maryland, Massachusetts, New York, and Oklahoma. Nice to see in Maryland we moved from a C in 2006 to a B.

What prevents us (all states) from doing better?

Shrink Rap: Grand Rounds is up at Doc Gurley

Doc Gurley did something pretty cool for this week's Grand Rounds -- a LIVE edition.  Click on the image to go to her post and listen to GR... or you can read it there, as well.

Interesting or shrinky topics: dating site for folks with mental illness; how to tweet your next conference; "what if real life were like health care?" (this one by Doc Rob is pure brilliance); long-term outcomes of deep brain stimulation (Dr Shock); what's the ICD9 code for saving the whales? (Cockroach Catcher); and the ICD-10 code for Insect bite of anus, Initial encounter (S30.867A).

Checking Out the Other Shrink Blogs

When we started blogging, we looked for the blogs of other psychiatrists, and even other non-shrink docs, and linked to them. It's been a while (oh, nearly 3 years) and mental health blogs have come and gone. I thought I'd survey the scene again. So just a list:
Dr. X's Free Associations : psychology with a conservative (?) bent.
May Shrink or Fade: a young(?) inpatient psychiatrist in New England ponders the world.
Turn Your Head and Scoff: by our correctional friend in San Diego, FooFoo5
The Last Psychiatrist: Assorted psychiatric and other rantings
Garth Kroeker is a blogging psychiatrist
The Psychiatrist Blog is written by Dr. Michelle Tempest.
Mind Hacks: Neuroscience and Psychology
Psyched Out: Musings of a psychiatric social worker
In Practice: Peter Kramer's psychiatry blog in Psychology Today.
Oh, Psychology Today actually has a whole list of mental health blogs: try here.
PsychCentral is ...oh, psych central.
Carlat's Psychiatry Blog: focuses on medications and medical research
Clinical Psychology and Psychiatry: A Closer Look
CorePsychBlog: psychiatry with a radio show.
Psychiatric Drug Facts with Dr. Peter Breggin features a psychiatrist who doesn't like meds
The Treatment Advocacy Center -- kind of describes itself.
Mental Nurse: a multi-author mental health blog in the UK
Intueri: to contemplate -- by a psychiatrist.
Ars Psychiatrica: by another psychiatrist! mixes with art and literature Couch Trip: by a psychologist (or soon-to-be?)
Everyone Needs Therapy by a PhD in social work (--Really?)
Jung at Heart by a Jungian psychotherapist
Somatosphere: a multi-author, multi-specialty blog, includes psychiatry
And from Irving, Texas: A psychiatrist who learned from veterans.
I've somehow lost Shiny Happy Person and her Trick Cycling for beginners blog.
The Snarky Gerbil is a psychotherapist-in-training.
Our blog friend psychiatrist TigerMom writes with two other docs on Two Women Blogging (these people can't count).
Juliaink is a psychiatrist who posts on Mothers In Medicine.
Modern Psychoanalysis is a blog by Jim about....psychoanalysis.
Shrinkwrapped (!!!) is a psychiatrist/psychoanalyst in New Jersey. Ah, he needs a better blog name. Might I suggest....
Dr. Deb talks about her work as a psychologist.
Katie Malinski is a social worker who is a parenting coach.
CoffeeYogurt is a blog by a psychologist who visits us.
Dr. Doug Bremmer writes: Before You Take That Pill.
Dr. Shock, M.D., PhD, has a 'neurostimulating blog' with a chocolate post!


Oh, there are more. I tried to confine it to blogs by mental health professionals...but there are so many great medical blogs, and blogs by patients, and many of our readers have neat things going on. More another day. If I missed a psychiatry blog, then by all means....

The Robin Hood Foundation and Dwayne Mayes Tells his Story

Samantha from the Robin Hood Foundation in New York City writes:

"Dwayne Mayes was honored Tuesday at the Robin Hood Foundation’s annual Heroes breakfast.

To give you a little background, this Tuesday the Robin Hood Foundation held their annual Heroes breakfast. Each year, Robin Hood honors outstanding New Yorkers for their efforts to improve the community and transform the lives of the city’s underprivileged residents. The four organizations represented by the recipients of the Heroes Awards – Uncommon Schools, Year Up, Community Access and Food Bank for New York City will each receive a grant of $50,000 from Robin Hood. "

Mr. Mayes tells his own story about a tortured past, mental illness, addiction, and rising from it all, in a story full of hope and resilience---

Parity as Bogus Bail-out Bonus?

[credit: flickr user The_Leader]

Nice to see Clink sharing her AAPL learnings with us, as the forensic experts try to understand the behavior of forensic bogeymen (or the gender-neutral bogeypeople) like Freddie and Jason.   Just in time for Halloween. 

I was struck by the total lack of understanding by two nay-sayers in yesterday's Opinion column in the Baltimore Sun.  Richard Vatz and Jeffrey Schaler often write about the so-called "myth of mental illness", taking a page from the 1960 Szasz book of the same name.

In the newspaper article, they lambast our legislators for using "political legerdemain" to sneak the long-negotiated Mental Health Parity Bill into the $700B bank bail-out bill.  Their opinion is that the category of "mental illness" is too broad and too costly, and provides an impression that most people with a label of mental illness are actually just whiny babies who can't accept the responsibility of dealing with "problems in living", like death, rape, or loss of job/house/401k/spouse.  They write:

"• Supporters of parity celebrate the new law as signaling the end of "stigma," but they fail to consider that stigmatization is a marvelous negative reinforcer for undesired behavior, some of which is called "mental illness." 



• Substance disorders are arguably a function of behavioral choices and in no way constitute diseases to which insurance should apply. Such self-destructive behavior is best explained by mindset, personal values and how a person copes with his or her environment. Incidence varies by cultural context, and people can clearly stop or control their addictions through an exercise of free will. Not so when it comes to bodily illness; one can no more will away cancer, heart disease or diabetes than he or she can will their onset."

Lack of understanding.

They appear to also have a lack of understanding about how our health care system works for other (non-mental) illnesses.  One of the reasons they are against parity is that "there is no way to accurately confirm or disconfirm 'mental illness' ."  The same could be said for many somatic problems, such as headaches, back pain, nausea, and fatigue.  However, our health care system will pay for treatment of all these conditions, no matter how minor or subjective.  There is not a severity-based system where only physical conditions deemed worthy or severe enough get covered.  If you go to the doctor for a stubbed toe, the insurance company will pay for the visit and the Xray.  So, unless they advocate just as strongly for similar changes to the rest of health care, this argument does not hold water. 

By the way, I also did not like the fact that the Parity bill was tacked on to the Bail-out bill, but only because I think such a bill should pass on its own merits.  

And with Halloween right around the corner, what is truly frightening about their article is that one of the authors is an associate editor for the Psychology section of USA Today magazine, and is thus in an influential position to control what the nation's population of hotel customers and other readers get to read about these topics.  [Correction: I think this is USA Today Magazine, which appears to be a very different animal than the newspaper that gets placed in front of every hotel room door every morning... still...]

Boo!