Newly minted pastor Ed Stetzer, writing in CNN.beliefnet, writes of his dealings with a man in his congregation. This person would often disappear for days at a time, and later Stetzer would hear that the fellow had spent hours praying the psalms. Later the man killed himself, leading Stetzer to reflect of aproaches churches could use to better engage parishioners with mental illness.

This led Spetzer to reflect on the kinds of practices that would lead to better acceptance of persons with mental illness. One of these is to view the church community as a refuge, as a place of welcome or safety. It is intriguing that the meaning of the word "asylum"—which not has such a negative connotation—means safe place or sanctuary.

As Edward R. Murrow said, there are two sides to every story. Our previous probing into an increase and acceleration in funding for research into the brain waxed positively. A different viewpoint—now taken by major pharmaceutical industries—suggests that their interest in brain research is waning. Reuters reports the following:

"Many pharmaceutical companies harbor deep doubts about whether neuroscience is worth their investment dollars as a boom period for once-highly profitable psychiatric medicines comes to an end and new drugs prove hard to find."

President Barack Obama made headlines with his proposal to encourage American scientists to work toward understanding the great mysteries of the brain. Done as a massive project, this could rival past collective enterprises such as Getting a Man to the Moon; when President Kennedy suggested this, it took everyone's breath away. It looked unattainable in the early 1960s. But the country did it.

The new project has garnered unusual bipartisan support.

Since the Greek philosophers there has always been great interest in the brain. St. Thomas Aquinas believed it was necessary but not sufficient for human consciousness. Descartes believed there was an interaction between the brain and the soul: melding somewhere in the pineal gland.

Many other philosophers have speculated that consciousness is a byproduct of the brain itself and concluded that we are the products of the natural forces we are comprised of. As such, our lives our determined by the forces of chemistry, biology, genetics, and past experience.

Consumers of mental-health services may not realize the extensive system of codes that go into insurance billing and medical records, both for mental-health services and other medical services. For mental health, every person who receives insurance reimbursement receives a diagnostic code from the most current Diagnostic and Statistical Manual of the American Psychiatric Association, as well as a code describing the service. The codes are called CPTs (Current Procedural Terminologies).

There are nearly 300 diagnostic codes in the DSM IV TR. These range from well-known and common conditions such as major depression, bipolar disorder, obsessive compulsive disorder, and panic disorder. Lesser known diagnoses such as Munchausen's syndrome are also included. The clinician is also able to note a secondary code if a learning disorder, developmental disorder, or personality disorder is diagnosed.

After physicists split the atom, unanticipated positive effects emerged—such as medical isotopes—and many negative ones as well. Where do we store the waste? How do we understand fallout and its deadly effect? What happens when there are nuclear plant accidents?

Biologists work in a similar environment as they work to split the genome. Once again, there may be negative effects unrealized. One is the temptation to use genetic manipulation to "improve" humanity. A look at what happened a century ago gives pause. Then, and now, genetics may be viewed as a way to enhance human thinking and mental health.

It seems we are reminded every day about posttraumatic stress disorder (PTSD). It reveals itself in soldier suicides, which are occurring in a way that is more than we can bear. Shootings continue. In one city (Chicago), one mother has been so badly traumatized: She has lost four children over the years to street violence.

With all of this going on, it is good to review some of the things we know about PTSD. No doubt there would be a Nobel Prize for someone who found a fully effective treatment for everyone. This may never happen, but there are some things we know that help us to make a realistic assessment about what we know and what we don't know.

A new documentary film presents the emotional health history of a famous American family of artists—the Hemingways—according to CNN, whose sources we quote. This film, Running from Crazy, premiered last week at the Sundance Film Festival. Oprah Winfrey is executive producer.

"'Suicide has no rhyme or reason,' [Mariel] Hemingway said. 'Some people, it's 20 dark minutes of their life that they decide to take their life that come out of the blue. It's very random, it's very frightening.'

Although the therapeutic dimension of sports on the highest level, which is usually the professional, is well accepted, players are often assessed—or worse, judged—by club executives and fans alike based on issues or "characteristics" of mental health. This can be unfortunate.

As the Major League Baseball Cy Young (for pitchers) and Most Valuable Player Awards have been announced for 2012, it is interesting to consider, as this fascinating article does—which was brought to my attention by National Review Online "Right Field"—two recent award-winners and their mental-health travails. The players are pitcher Zack Greinke and outfielder Josh Hamilton. Greinke is diagnosed with SAD, or social anxiety disorder; Hamilton has had issues with substance abuse.

Ballplayers in American society are placed on a pedestal. However, once stigmatized by diagnoses the public, and even their peers and immediate superiors, are fed by print and electronic media, such players have even more to prove.

It is unfortunate players need "to prove" anything but their abilities.

Maybe it is all this simple: Society needs to lighten up and to cast a more compassionate eye on the frailties of its heroes.

A few months ago I wrote about Marsha Linehan and Dialectical Behavior Therapy here on this blog. It is a creative and empirically-supported treatment that combines cognitive and behavior therapy as well as wisdom from philosophical and religious traditions. Last week, at the 120th Annual Meeting of the American Psychological Association in Orlando, Florida, Linehan was awarded the Gold Medal for Life Achievement in the Application of Psychology. I have quoted the actual citation as well as some further background information here.

Edward Hallowell and John Ratey have published a follow-up to their successful book Driven to Distraction. On a hopeful note, it is titled Delivered from Distraction. The first book was written in the 1990s. It contains much good advice on ADHD: diagnosis, medications, telling it apart from other conditions as well as finding it in combination with others, and—exceptionally helpful—it offers structured ideas for parents, teachers, and those who have ADHD themselves. This more-recent book gives a superb update on medications and includes detailed case history. These are two exceptional volumes.

On May 2, 2012, it will be sixty-five years since release of Miracle on 34th Street. But the film is hardly ready for retirement. It is one of twenty-one movies identified by AMHF for discussion relevant to the Foundation mission statement.

Released one year before Dr. Stefan de Schill assumed directorship of research at AMHF, Miracle on 34th Street is about delusion and the nature of goodness and sanity. Who is delusional? The seemingly "rational mother," Doris Walker (Maureen O'Hara), and her "illusion-free" daughter (Natalie Wood)? Or the gentleman who, in all candor, says that he is Santa Claus? In this sense, Miracle shares some thematic elements with the previously discussed satire, Don Juan DeMarco.

The American Psychological Association has announced, in the January 2012 issue of American Psychologist, "Guidelines for Assessment of and Intervention With Persons of Disabilities." This document lists twenty-two practice-guidelines for psychologists who work with persons displaying disabilities of various kinds. The task force for this report was chaired by Kurt F. Geisinger of the University of Nebraska, Lincoln.

The first five guidelines cover the following areas: Psychologists strive to learn about disability paradigms, examine their beliefs and reactions toward those with disabilities (and how this may affect their own work), increase their knowledge about working with persons with disabilities, learn about federal law that support and protect people with disabilities, and provide barrier-free barriers for services.

In the recent yearly "Reports of the Association" issue of the American Psychologist (December 2011), the American Psychological Association announced "Practice Guidelines Regarding Psychologists' Involvement in Pharmacological Issues." This report notes several factors that will make psychologists more involved in medication-management issues. One survey noted that the number of Americans using antidepressants increased from 6.7 percent in 1990 to 15.1 percent in 1998. Another study indicates that psychologists reported that 43 percent of their patients were using psychotropic medications. In two states, Louisiana and New Mexico, as well as the US Military, psychologists who have been "appropriately trained" are able to prescribe medications.

The task force that came up with this report noted that there is a continuum among psychologists concerning how involved each is with regard to psychopharmacological issues. This article notes three particular points on the continuum for psychologist involvement in psychopharmacology. First, the group of psychologists with actual prescriptive authority (a small, but growing group). Second, psychologists who actively participate in medication decision-making, such as by offering a consultative recommendation about a class of medicines or even a particular medicine to someone (physician, nurse practitioner), retain the legal responsibility for prescribing. Third, psychologists who provide information that may be relevant to pharmacotherapy decision makers, such as referring someone for a medication evaluation or discussing with patients how to address medication concerns with their prescriber. Following are some of the ideas the Task Force came up with.

Alcohol, cocaine, hallucinogens, marijuana, and opiates have had a varied and ambiguous legal and political history prior to the 21st century, and these substances will continue to need study, examination, policy, and law-making into the 21st century and beyond. Dwight Vick and Elizabeth Rhoades have written Drugs and Alcohol in the 21st Century: Theory, Behavior, and Policy (ebook) Rochelle Cade offers a review of the book in Counseling Today.

In most cases psychiatric drugs are not valuable commodities on the street: antipsychotics and antidepressants with names such as Thorazine, Haldol, Resperidal, Tofranil, SSRIs, Wellbutrin, Abilify, Lithium, and others generally must build up a therapeutic dosage in the bloodstream to become effective. There is no immediate "rush" or feeling of euphoria. In acute-psychiatric illness, a person may be admitted to the hospital where higher initial dosages can be given under supervision. Huge amounts of these substances crisscross the country each day in the U.S. Mail, with 90-day supplies being sent from big box pharmacies to patients.

There are exceptions. In the 1960s and 1970s, the anti-anxiety drugs Valium and Librium were too frequently prescribed or not watched closely enough. They have "a street value" because of the euphoria or sense of calmness rapidly induced. They are seriously addictive. Ritalin and its derivative amphetamine substances, prescribed for Attention Deficit Hyperactivity Disorder, also maintains solid street-value, frequently sought after by college students studying for finals or high-stakes exams like the LSAT, GRE, or MCAT.

From the 14th edition of Abnormal Psychology by James N. Butcher, Susan Mineka, and Jill M. Hooley (Boston: Allyn and Bacon):

"The concept of mental disorder, as we have seen, suffers from the lack of a truly objective means of what is disordered and what is not. It is also in the financial interests of mental health professionals to be more and more inclusive of the kinds of problems that might be regarded as 'mentally disordered.' Not surprisingly, there is often more pressure to include in the DSM more and more kinds of socially undesirable behavior. One proposal was the inclusion in DSM IV of road rage (anger at other drivers) as a newly discovered mental disorder. However, anger directed at other drivers is so common that almost all of us would be at risk of being diagnosed with this new disorder if it had been added to the DSM.

AMHF attended the 51st Annual Meeting of the New England Psychological Association (NEPA), held October 28-29 at Fairfield University in Fairfield, Connecticut. After a wonderful dinner, hosted by Drs. Robin Crabtree and Susan Franzosa, deans at Fairfield, participants heard child-development expert Dr. James Garbarino speak of "Children and the Dark Side of Human Experience: Confronting Global Realities and Rethinking Child Development."

On Friday, October 28, 2011, AMHF attended the 17th Annual Meeting of the Northeast Conference for Teachers of Psychology. This is a group of psychologists, who teach in colleges and universities, dedicated to improving their teaching of undergraduates and graduates. Participants of the group come from a wide range of specialties and interests including developmental, clinical, counseling, organizational, experimental, and many other fields.

I found the Afternoon Keynote Address, by Dr. Wade Pickren, to be especially interesting in view of our recent discussions on the AMHF blog on the upcoming Diagnostic and Statistical Manual of Psychiatric Disorders (DSM V).

PREVENTING YOUTH VIOLENCE
PART 2: INDIVIDUAL AND GROUP APPROACHES

Raymond B. Flannery Jr., Ph.D., FAPM,
Harvard Medical School,
The University of Massachusetts Medical School

Part 1 of these two essays/blogs on youth violence examined the basic cultural, biological, sociological, and psychological theories of youth violence and the continuum of early (disrupted mastery, attachment, meaning), serious (depression, substance abuse, untreated psychological trauma), and urgent (conduct disorder, moral depravity) warning signs of individual at-risk youth. Part 1 also noted that there are usually multiple warning signs in any given troubled child/adolescent and that the warning signs are related to the potential sources of violence in the various theories.

PREVENTING YOUTH VIOLENCE
PART 1: ITS GENERAL NATURE AND WARNING SIGNS

Raymond B. Flannery Jr., Ph.D., FAPM,
Harvard Medical School,
The University of Massachusetts Medical School

Recent months have seen outbreaks of mindless violence by youth in Canada, Europe, and the United States. These acts have included homicide rape, robbery, assault, arson, and rioting among other crimes. Thoughtful adults respond in disbelief, anger, and bewilderment. How has it come to this? Why are children today so angry, when they are growing up in a period that has seen the most money, education, material goods, and other resources in human history? Were there no warning signs? Can anything be done to correct this?

This two-part series begins to respond to these concerns. Part 1 examines the various theories of youth violence and the warning signs of troubled youth, signs that have been surprisingly consistent for the past one-hundred years. Part 2 examines both individual and group interventions to address troubled youth before violence erupts. Society is not helpless in the face of youth violence. There are things that can be done. (1, 2)

Theories of Youth Violence

To understand the precipitants to youth violence, it is helpful to be first aware of the three domains of good physical and mental health: reasonable mastery, caring attachments to others, and a meaningful purpose in life.