About a year ago, I posted some material on the new field of "bibliotherapy," the employment of literature "as a therapeutic tool." At the time, I disliked the idea -- or, at least, its execution; according to the BBC, the titles most likely to be "prescribed" were those "that act as an inspiration to help the reader forget their troubles, or those that will cheer them up by making them laugh." But, in my opinion and experience, misery loves company, and that love can be the start of mental health. When depressed, I want identification, not distraction.
Less objectionable is a new scheme in the UK to prescribe self-help books to patients who might otherwise recieve little to no treatment. "By the summer," the Guardian reports, "there will be 80 self-help clinics in Devon, all using books based on cognitive behavioural therapy." While the books won't solve the problems of the UK's mental health system, quotes like these (excepting the last sentence, and its attitude towards therapy) prove encouraging:
'The best thing about these books are they are full of case studies that make you realise you are not alone,' [one woman] said. 'Depression means you feel extremely isolated. [The books] also remove the stigma as you can do it in the privacy of your home. For me, the antidepressants stopped working but the book did not and it meant I was making myself better instead of relying on someone else.'
If you didn't catch it, I sincerely recommend Alix Spiegel's profile of Robert Spitzer in last week's New Yorker.
Although the DSM was first published in 1952 and a second edition (DSM-II) came out in 1968, early versions of the document were largely ignored. Spitzer began work on the third version (DSM-III) in 1974, when the manual was a spiral-bound paperback of a hundred and fifty pages. It provided cursory descriptions of about a hundred mental disorders, and was sold primarily to large state mental institutions, for three dollars and fifty cents. Under Spitzer’s direction—which lasted through the DSM-III, published in 1980, and the DSM-IIIR (“R” for “revision”), published in 1987—both the girth of the DSM and its stature substantially increased. It is now nine hundred pages, defines close to three hundred mental illnesses, and sells hundreds of thousands of copies, at eighty-three dollars each. But a mere description of the physical evolution of the DSM doesn’t fully capture what Spitzer was able to accomplish. In the course of defining more than a hundred mental diseases, he not only revolutionized the practice of psychiatry but also gave people all over the United States a new language with which to interpret their daily experiences and tame the anarchy of their emotional lives.It's an article Foucault would have clipped and, no doubt, written about. Spitzer, the article implies, almost singelhandedly created the DSM we now treat so deferentially, and research has never verified the DSM's assertions.
“The DSM revolution in reliability is a revolution in rhetoric, not in reality,” Kutchins and Kirk write. Kirk told me, “No one really scrutinized the science very carefully.” This was owing, in part, to the manual’s imposing physical appearance. “One of the objections was that it appeared to be more authoritative than it was. The way it was laid out made it seem like a textbook, as if it was a depository of all known facts,” David Shaffer says. “The average reader would feel that it carried great authority and weight, which was not necessarily merited.”
"was good for the world at large. Good for psychiatry, good for patients. Good for everyone at that point in time to have someone whose view may have been more simpleminded than the world really is. A more complex view of life at that point would have resulted in a ho-hum ‘We have this book and maybe it will be useful in our field.’ The revolution came not just from the material itself, from the substance of it, but from the passion with which it was introduced."
Two middle-aged ladies wandered in to a branch of a well-known booksellers. Helmet-coiffed and enthusiastically made up, they marched straight up to the counter."We're looking for Caring for the Suicidal."
I looked down at the grubby keyboard. My fingers tapped and there it was: Caring for the Suicidal. It was in print, but we would have to order it.
"How long?" the second lady asked.
"Two weeks."
They looked at each other and then at me. "Too late," they chimed and walked out.
The idea of a VR-approximation of schizophrenia has been in the works for some time now, but this article, unlike others, describes the 'approximation''s content:
While only someone afflicted with the mental illness can know what it's like to be at the mercy of delusions, an interactive computer technology called Virtual Hallucinations is allowing others to experience a snapshot approximation.Wearing earphones and viewing goggles, a person can step into the schizophrenic's shoes and see the world through his eyes and ears as he makes his way through a supermarket to the in-store pharmacy counter.
"I lost my medication a couple of weeks ago and I need to get my refill," the pseudo-schizophrenic is told to say.
Behind the counter, the pharmacist seems to warp-speed from one spot to another as she checks on the customer's insurance coverage, then says she must call his doctor. She laughs with a co-worker, but it turns to a cackling whisper: "Why did they let him out of the hospital?"
Voices, male and female, barrage the mind. "Don't take that, they're trying to poison you."
ANN ARBOR, Mich., Oct. 14 (AScribe Newswire) -- The brains of people with severe depression have lower levels of several related molecules that are key to the development, organization, growth and repair of the brain than the brains of people without the disease, or those with the bipolar form of depression, a new study finds.The discovery, which surprised researchers in the multi-university consortium that made it, suggests a whole new direction for understanding depression and developing new depression treatments. It may even help scientists understand how some antidepressant medications work in the brain to ease symptoms, and why there is wide variation in how depressed people respond to different antidepressants.
... In the current paper, the researchers report what they found when they zeroed in on a group of six kinds of related mRNA that had the most coordinated differences between the samples from depressed brains, the non-depressed brains and the bipolar brains.
These turned out to be mRNAs for four different FGF molecules and two receptors that bind to FGF and are key to their function. Levels of all of the mRNAs encoding these proteins were lower in the brains of people with major depression. Lower mRNA levels mean the brain may not produce enough protein to carry out normal function.
... Akil notes that the brains of bipolar people in the study did not show the decreased FGF gene activity. "This was all the more remarkable since both groups of individuals were severely depressed at the time of death," she says. "This is yet another indication that bipolar illness, though classified with depression as a mood disorder, is biologically a very different disease.
The NY Times examines the posthumous success of playwright Sarah Kane:
Moreover, Ms. Kane's tendency toward poetic imagery and form seems to translate well. As an example, she writes in "Psychosis": "They love me for that which destroys me, the sword in my dreams, the dust of my thoughts, the sickness that breeds in the folds of my mind." And that, too, has come to seem prophetic.Ms. Kenyon said that those words were flowing out of a sudden bout of depression that Ms. Kane had neither expected nor prepared for. "She had no control over it," Ms. Kenyon said. "She said: 'You don't know what its like. It just comes back.' "
The circumstances of her death, of course, inevitably leave a sad question hanging over Ms. Kane's work: Is she produced now because she was good and bold and ahead of her time? Or is it her biography - and especially the circumstances of "4.48 Psychosis" - that has added to her allure and that of her play?
"She has become more popular over the last five years, but I wouldn't be comfortable with saying it's because she killed herself," Mr. Kane said, before adding: "I'd like to think it wasn't. She's a great writer. It would be doing her a disservice to say she's popular just because she committed suicide."
Ms. Kenyon added: "I think people have become more aware of her work, unfortunately, and I think she has been more produced since she died."
From the article, "FDA Panel Backs Implant To Counter Depression":
The device has been used in the United States since 1997 to control epileptic seizures. The manufacturer, Cyberonics Inc. of Houston, hopes to expand its market: Fifteen to 25 percent of the 19 million Americans with depression may not respond to available treatments, Rush said.The implant involves connecting a wire to the left vagus nerve in the side of the neck; a battery is implanted high in the left chest or under the armpit, and the amount of current can be regulated externally. Typically, the implant sends a 30-second pulse of current followed by a five-minute pause, 24 hours a day.
Karmen McGuffee of Garland, Tex., told the panel she had tried virtually every antidepressant drug on the market before getting the device. Improvement came within weeks, she said.
"My mother said she wasn't looking into the eyes of a dead person anymore," she said. When people asked why she was willing to get an implant, she replied, "I had nothing to lose" …
… The panelists mostly agreed that the data presented by Cyberonics had problems but were swayed by the lack of alternative treatments and the evidence that the device is generally safe, based on its widespread use to reduce epileptic seizures.
Cyberonics' central study was a randomized trial involving 221 patients. All received implants, but the power was turned on for only half the group.
Of 111 patients getting stimulation, 17 showed an improvement of at least 50 percent on a psychiatric scale of depression after 12 weeks. Of 110 patients getting "sham" treatment, only 10 showed similar improvement. The difference between the groups was not statistically significant, however.
Janet, of Humanophone, just reminded me to link to this piece from the NY Times Magazine on the relationship between happiness and prejudice. If you haven't already read it, here's a quick excerpt:
Researchers found that angry people are more likely to make negative evaluations when judging members of other social groups. That, perhaps, will not come as a great surprise. But the same seems to be true of happy people, the researchers noted. The happier your mood, the more liable you are to make bigoted judgments -- like deciding that someone is guilty of a crime simply because he's a member of a minority group. Why? Nobody's sure. One interesting hypothesis, though, is that happy people have an ''everything is fine'' attitude that reduces the motivation for analytical thought. So they fall back on stereotypes -- including malicious ones.I'm interested in hearing readers' reactions.
meds
-Serzone to be pulled off the U.S. market
-Reboxetine is a selective noradrenaline reuptake inhibitor (NaRI), the first drug in a new class of antidepressants
-Neurontin was marketed illegally for bipolar disorder
more/other
-the basics of dialectical behavioral therapy
-discovering your stress type
-the L.A. Times interviews lobotomy victims (reg. required, but you can always bypass the process with www.bugmenot.com)
headlines that state the obvious
-Television Advertisements For Foods Promote Eating In Children
-Study: N.J. Suicides Outnumber Homicides
Articles
-The Disability Movement Turns to Brains
-Different Approaches to Healing the Sick: Reversing the downward spiral of mental illness
-Wave of Mental Problems Follows GIs Home
Studies
-Thyroid function in clinical subtypes of major depression: an exploratory study
-Severe Depression Responds To Low-Frequency Stimulation
-Family Factors Less Crucial In Episodic Depression
Book Reviews
-Acquainted With the Night: A Parent's Quest to Understand Depression and Bipolar Disorder in His Children.
-Rethinking ADD
-A Social History of Psychology
Recently, the NY Times reviewed Steven Johnson's Mind Wide Open, which sounds like it has the potential to be a fascinating book.
Until recently, introspective people could lie on a couch and free-associate, or sit at a desk and write ''The Metamorphosis.'' People couldn't look into themselves directly to explore what Gerard Manley Hopkins called, wistfully, our ''inscapes.'' But now we can. With M.R.I.'s, PET scans and many other high-tech mirrors that neuroscientists are holding up in front of us, we can see right through our own foreheads and begin to watch our mental apparatus in action.RelatedIn ''Mind Wide Open,'' Johnson makes himself his own test subject to see what the neuroscientists can show us about our attention spans, talents, moods, thoughts and drives -- our selves. He got the idea for this voyage of self-discovery a few years ago while he was hooked up to a biofeedback machine. Lying on a couch with sensors attached to his palms, fingertips and forehead made him feel nervous, and he started cracking jokes with the biofeedback guy. The machine was designed to monitor adrenaline levels, like a lie detector. With each joke he made, the monitor displayed a huge spike of adrenaline: ''I found myself wondering how many of these little chemical subroutines are running in my brain on any given day? At any given moment? And what would it tell me about myself if I could see them, the way I could see those adrenaline spikes on the printout?'
Toward the end of her 1981 book Psychoanalysis: The Impossible Profession, Janet Malcolm reports on the last of her many intimate conversations with "Aaron Green," a disguised New York psychoanalyst. He had compared analysis several times to surgery, and Malcolm asks him why he is so attached to that analogy. "Because it's so radical," he says. "Because it indicates how impersonal and intimate analysis is. Because it tells you that it is not a casual procedure, that it is serious and dangerous, that it is dire." I know there's a difference between five-times-a-week classical psychoanalysis and the mere three-times-a-week psychotherapy that I'm putting myself through, but his radical analogy, and his use of that awful word "dire," have me, for now, in their grip. One of my many strange fantasies while in therapy has been to be hospitalized for an extended period. For what? I'm a healthy, reasonably socialized, reasonably happy person—or at least I was before I went into psychotherapy.The above comes from Rick Whitaker's short personal essay in the current issue of the Village Voice. The premise -- the unexpected perils of psychotherapy -- has potential, but Whitaker, either because of the essay's length or some reluctance to diverge from straight autobiography, lays out the premise with little development or nuancing. Can therapy, like a botched surgery, cause more harm than good? Or is the pain of repressed emotions, freshly accessed, the cost of improvement? Does therapy fetishize childhood trauma, and, most comfortable dealing with self-pity and feelings of betrayal, require or elicit those feelings from its clients? Or is therapy more self-critical and self-aware than we give it credit for?
More books should have websites like the one for Mad in America, Robert Whitaker's critique of the American mental health system. The site not only links to new research relevant to the book's premise, but also includes summaries for each of the book's chapters.
Here, the book's Preface, summarized:
The World Health Organization has repeatedly found that people diagnosed with schizophrenia in the U.S. and other developed countries fare much worse than schizophrenia patients in poor countries. In the poor countries, a high percentage of patients recover and lead active social lives. In the U.S. and other developed countries, most patients so diagnosed become chronically ill. An understanding of this failure of modern medicine can be found by tracing the history of medical treatments for madness to the present day.And a summary of the fourth chapter:
After the fall of moral treatment in the late 1800s, American psychiatry once again devoted itself to finding physical remedies for psychotic disorders. Therapies of every kind were tried. These ranged from water therapies like the continuous bath, in which patients were kept in bathtubs for days on end, to gastrointestinal surgery. Doctors also tried fever, sleep and referigeration therapies (this last one involving cooling patients to the point they lost consciousness.) Finally, in the 1930s, there arose a trio of therapies--insulin coma therapy, metrazole convulsive therapy, and electroshock--that all worked, as was freely acknowledged at the time, by damaging the brain.The summaries of later chapters are also worth a read; on the subject of "atypical" drugs, they offer a different perspective from the one offered in the excerpt, below.
From the article, "Biggest challenge of mental illness is the stigmatization," first linked to by nutz'so:
We joke about our own behavior sometimes. But there is really nothing funny at all about the experience of serious mental illness. Coping with it requires an outstanding level of strength, willingness, motivation and commitment. Most people could not survive it; in fact, many of us don’t. I, personally, thank God every day for the new generation of "atypical" psychotropic drugs; they have freed me from the nightmare of cognitive confusion, misperception and emotional deadness that I lived with for almost half a century, whether acutely or in relative remission. But I have paid a price for the use of the drug that changed everything for me: my body thermostat has been ruined and I suffer regularly from overheating and feverish states. This long-range effect was not known when I started on it. This is a typical example of the kind of trade-offs we are required to make in exchange for the blessing of being functional and feeling well.
can be found here. Some of the more relevant posts:
"I rarely get lonely, and so call myself an introvert. But I think loneliness is the healthy impulse to spend time with people."
"The seasonal pattern for suicide is highly significant with the rate of suicides being above average all spring and below average all winter. In the United States, April is usually the peak month and December is usually the trough. Suicide rates for persons aged 35 and older may peak again in the fall."
link via A Writing Teacher's Blog
Related:
-The Suicidology Web
-Understanding Thoughts of Suicide
While a profile of a politician would never mention his or her past trips to the psych ward, profiles of poets treat mental hospitals like PhD programs: an indication of intellectual and artistic authenticity.
A Writer Carries on His Father's Legacy of Poetry and PainJames Wright, who died in 1980, won the Pulitzer for poetry in 1972; the two Wrights are believed to be the first father and son ever to win the award. "I wish my father could be around," Mr. Wright said simply. Yes, it's a bond, even in death.
The younger Mr. Wright is tall and stooped, with a deep voice, which has little tonal variation. His face is largely expressionless. He is teaching for a semester here at the University of Arkansas.
"He was a very fragile, scared person," Mr. Wright said of his father. "I'm just like him. If not worse." Mr. Wright smiles, looks sidelong and becomes a handsome man. "There are people who recall my father as a saint and a monster," he added. "I'm quite sure I will share the same fate."
As much as any contemporary poet's work, Mr. Wright's is haunted by a father, who abandoned him and whom he longs for even at 51, battered as he is by manic-depression, alcoholism and drug addiction. Like father, like son: the older Wright was also an alcoholic and institutionalized.
From a study on cognitive functions in depressive disorders, carried out at Stockholm University:
The total group of depressed individuals showed impairments in tasks tapping episodic memory and mental flexibility. Of more interest, however, was the observation that the pattern of impairments varied as a function of depression subgroup: the major depression and mixed anxiety-depressive disorder groups exhibited significant memory dysfunction, whereas individuals with dysthymia showed pronounced difficulties in mental flexibility. Minor depression did not affect cognitive performance. Verbal fluency and perceptual-motor speed were not affected by depression.
-Does the moon affect moods?
-Subjective Time Estimates Differ Between Depressed, Manic, and Normal Individuals
-Cognitive Benefits Differ Among Newer Antipsychotics
-Psychosis Has Minimal Impact on Neurocognition
- Optic Nerve Disease May Cause Sleep Disorders