American Mental Health Foundation

Imperfect Democracy and Mental Health

elomke@americanmentalhealthfoundation.org (Evander Lomke) — Mon, 05 Jan 2009 15:00:07 EST

The January 5, 2009, New York Times reports in its Memo from Pravda that "In Eastern Europe, Lives Languish in Mental Facilities." http://www.nytimes.com/2009/01/05/world/europe/05bulgaria.html

"A study of guardianship in eight former Communist countries completed last year by the Mental Disability Advocacy Center in Budapest found jaillike regimens for patients with a wide range of mental disabilities, with one million adults in the region subject to 'significant, arbitrary and automatic' violations of their human rights."

This disturbing article goes on to report: "In the two decades since free markets and imperfect democracy took hold in Eastern Europe, the laws governing guardianship have largely remained intact, stripping hundreds of thousands of people of the authority to make the most basic decisions about their lives, even when they may be capable of looking after themselves, advocates say."

The article by Matthew Brunwasser goes on to say:

(1) The laws of Bulgaria and across the region fail to ensure oversight of guardians. This is called "civil death," certainly an oxymoron.

(2) Legislation makes it too easy to petition courts and for courts to grant guardianship to those who hardly qualify; those who would take advantage of their authority.

(3) Legal appeals to remove guardianship and restore legal capacity lead to Kafkaesque situations. Some countries, like Hungary, show progress in changing this deplorable "system" of dumping and forgetting those with mental illness.

It is difficult to believe these are 21st-century conditions. The American Mental Health Foundation urges all readers of this blog to contact the Mental Disability Advocacy Center and other human-rights groups to protest these horrors and to foster humane treatment for those who most need our protection. Does anyone remember the Gospel? (quoted here perhaps imperfectly): "Whatever you do to the least of mine, you also do to me."

Psychoanalytic Humor For The New Year

elomke@americanmentalhealthfoundation.org (Evander Lomke) — Mon, 05 Jan 2009 14:37:25 EST

Happy New Year to all our readers! If it seems I am preoccupied with cartoons, especially of The New Yorker variety . . . I am!

Page 54 of the January 5, 2009, issue has a wonderful cartoon by Harry Bliss. It is a group session of an unusual variety. A couple (presumably) are in a love-seat. They are flanked by two analysts with spiral-bound books. The psychiatrist on the right is taking notes with his left hand. He very much has the Freudian look: thick glasses (no eyeballs), mustache, bow tie and vest. The other analyst to the left and in the foreground is almost bald. He also has thick glasses as we can discern one side from his profile. In the center love-seat, each spouse speaks to one of the psychiatrists. The man mostly has his back to us, but we can see he has a serious expression bordering on anger. His head is slightly raised as he makes his point to the dutifully writing Freudian. Whether the woman's psychiatrist is meant to be of the Jungian School is difficult to tell. She is casually dressed with one hand supporting the side of her head. The woman is far less animated than the man.

This is a group-analytic session of an unusual kind. When there is more than one person, by definition there is a group. But two therapists? The humor, of course, is in the love-seat. Do these people love one another? Probably. Otherwise, why would they be in a session together, even if they are talking at cross-purposes?

Do couples need His and Her analysts? Probably. There is no caption to this cartoon; it speaks for itself.

Why is there so much humor to be found in psychoanalysis? Is this some sort of social defense mechanism? The same issue of The New Yorker has an AT&T ad "Introducing the Samsung Epix." The poor device is so confused it sits in actual-size form, and therefore out of normal proportion, on a couch while a Sopranos-like female analyst looks, listens, and takes notes. The Epix on the couch asks, "Am I a touchscreen phone with Qwerty? Or a Qwerty phone with a touchscreen?" Again, the seriousness of an identity crisis is japed. Perhaps, again, the ad registers the defense mechanism of humor.

Watch out for Dual Roles

(bvo53) — Mon, 01 Dec 2008 15:31:06 EST

Lately in the media there has been great attention toward physicians who do research and also have a financial interest in a drug company or receive benefits from a drug company.

At least one profession cautions against such "dual roles." The primary and over-riding loyalty of mental health clinicians is to their clients. although there are becoming more and more exceptions to this.

In many situations "wearing different hats" can be very positive--one who does so gets things done.

But college teachers should not sell life insurance to students in their class. Therapists should not see family members--loyalty to family trumps therapeutic role. Owners of newspapers should not refuse to print facts contrary to their own political views. The list goes on and on.

When a researcher takes money from a certain drug company, this may compromise objectivity.
Or if a drug is prescribed for someone solely or partly because of a physician's economic interest in the drug, there is more than the patient which is being considered. Hopefully situations would not occur that contradict the Hippocratic Oath, "First, do no harm", but this is not a guarantee.

Be careful.

PSYCHOLOGY OF GRATITUDE

(bvo53) — Fri, 28 Nov 2008 12:56:40 EST

On this Thanksgiving Holiday it's great to know that mental health professionals are more and more emphasizing GRATITUDE in their therapies and publications. Just one example is Martin Seligman's book on POSITIVE PSYCHOLOGY. While insight about the past can be helpful for some, an attitude of appreciation for life in the here-and-now is a good one, and will prevent such things as "blaming of parents" which might have occurred in the past.

Happy Thanksgiving to all, and may we follow Oprah's practice of finding five things to be grateful for each day!

The Psychopath, Modern Science, and the Therapist

elomke@americanmentalhealthfoundation.org (Evander Lomke) — Mon, 17 Nov 2008 09:32:54 EST

John Seabrook, author of the book Flash of Genius and Other True Stories of Invention writes on the subject of Suffering Souls in the November 10, 2008, issue of The New Yorker.

Can new and improved MRI techniques identify and help analysts deal with psychopaths? The psychopath, think characters in a Thomas Harris novel, also falling under the label "antisocial personality disordered," are considered untreatable. Faced with the psychopath's penetrating, mesmerizing stare, the therapist is often reduced to a quivering mass. Or the therapist becomes an enabler of the manipulative psychopath, somewhat in the tradition of the so-called Stockholm syndrome.

Psychopathology is undoubtedly a form of mental illness; but it is distinct, and is not universally recognized as such. Cognitive neuroscience has seen the development of fMRI studies. To date, fMRI studies only reinforce different models of psychopathology. But there are high hopes for the portable scanner developed by Dr. Kent Kiehl. Kiehl is described by Seabrook as a techie whose early training in psychopathology coincided with the emergence of computerized neuro-imaging devices.

Whether Dr. Kiehl succeeds in guaranteeing that psychopathy be accepted as a mental disorder among the cold, calculating, and often urbane people who display it, and whether psychopathology will in time become a "treatable condition," the database Kiehl is amassing, among a population heretofore amorphously identified, will undoubtedly benefit society.

The American Mental Health Foundation applauds this and all research into the unknown abnormalities of the human psyche: which we generally know is, appropriately, the ancient Greek word for the Soul.

Lantern Books Publishes for Stressed Parents

elomke@americanmentalhealthfoundation.org (Evander Lomke) — Fri, 07 Nov 2008 17:55:21 EST

Permit me to say this about Lantern Books's exceptional new title An Unchanged Mind: The Problem of Immaturity in Adolescence by Harvard psychiatrist John A. McKinnon, MD: I wish I were issuing this book myself. The reason being, I am the publisher of American Mental Health Foundation Books.

Adolescent behavior in its extreme forms is always in the news. The New York Times magazine, just two months ago (September 14, 2008), ran a long story on bipolar disorder in children. Except for the long-term problems associated with aging and senility, adolescence is the most stressful prolonged period of human development. It is complicated and pressure-packed under any circumstances—especially so when caregiving adults are faced with issues of arrested development and disrupted maturation.

Dr. McKinnon is not your conventional therapist. Unhappy with today's jungle of impersonal institutions and MBA-dominated health-insurance companies, he wanted to do something original and dynamic; and so co-founded, with his wife, Montana Academy. This is a therapeutic school for troubled teens.

Written in an accessible style, McKinnon's book is not simply the story of his innovative Academy. With many real-case examples (the identities are disguised), An Unchanged Mind will be of immense value to all parents of teens in crisis. McKinnon's inspiring message is that no behavioral problem along these lines is hopeless. He shows how he has done it.

For parents torn between competing and confusing treatment methods, inappropriate pharmacological approaches, and the stresses and sufferings of daily life with a teen "who refuses to grow up," this book will be invaluable.

PRESCHOOL INTERVENTION

(bvo53) — Wed, 05 Nov 2008 20:42:44 EST

Now that preschool classes are under full swing, there may be some parents who wonder if their own child is keeping up with milestones.

A common reaction of all us may be to try to look at the bright side and call this a "stage" or something "that will be grown out of."

Yes, it can be detrimental to label a young child as having a problem.

But yes, it can be even more detrimental to ignore a problem and lose out on helpful educational or therapeutic intervention.

If you have any concerns about your child, ask your preschool director, pediatrician, or school district where screenings are being held to assess any problems that can be addressed.

As a clinical psychologist, I have seen many children helped by these programs.

Our New Video

elomke@americanmentalhealthfoundation.org (Evander Lomke) — Fri, 17 Oct 2008 15:59:47 EST

Under the auspices of LanternMedia, the American Mental Health Foundation has produced a short video about its history and program. You may watch it below:

Learn about Down Syndrome

(bvo53) — Fri, 17 Oct 2008 11:05:02 EST

Here is the link for the American Down Syndrome Association:

National Association of Down Syndrome

Reaching an Autistic Teenager

(bvo53) — Fri, 17 Oct 2008 10:37:21 EST

An excellent feature story about a young man with autism is in the Sunday New York Times for Sunday, October 19, 2008:

Reaching an Autistic Teenager

Now, Voyager, and psychoanalysis

elomke@americanmentalhealthfoundation.org (Evander Lomke) — Thu, 16 Oct 2008 12:14:02 EST

A wonderful movie was made in 1942. The critics at the time considered it a standard "weepie." Yet, the film Now, Voyager, has stood the test of time. Why?

The title is taken from a short and obscure lyric by Walt Whitman, a two-liner almost of a type out of the still-to-be-developed Imagist School, on the unfulfilled want. Desire. Desire is certainly one of the great motivating emotions of the human world.

But this film is much more. Like The Snakepit, which was made several years later in the same decade, Now, Voyager, centers on a theme of psychoanalysis. Specifically, this movie--starring Bette Davis (Charlotte Vale), Claude Rains (analyst Dr. Jasquith), and Paul Henreid (Jerry Durrance)--is The Ugly Duckling story with a modern analytic twist.

Charlotte is a homely, painfully shy, even antisocial, upper-crust New Englander who lives under the roof and thumb of her sadistic mother. Enter Dr. Jasquith. Through intensive analysis, Charlotte is transformed into a beauty with stunning grace and poise. Liberated, she falls in love with Jerry Durrance, who is married and has a daughter with issues similar to Charlotte's. Everything works out, to some degree, by the conclusion of the film. (Undoubtedly, the Hays Office diluted the central relationships; the story is taken from a novel. But the contours of the story are clear.)

The movie touches on a number of relevant themes. One of the most important: Could psychoanalysis have such a transformative power? Dr. Jasquith is no Victor Frankenstein. Dr. Jasquith cannot create a new person virtually ex nihilo. Truth is, the real Charlotte was always inside her. It takes a talented psychiatrist to reveal the reality within, the core-human within--desire and spirit are unfettered. In her case, Charlotte was suppressed by a jealous, manipulative parent until Dr. Jasquith came along. Charlotte is helped to such a degree that not only could she act decisively and form a meaningful relationship, she could also help a young woman overcome many of the same emotional problems. As the movie begins, the idea that Charlotte would be in a position to help anyone would be laughable.

As played by Claude Rains, Dr. Jasquith is the ultimate film psychiatrist. Unrealistic? To a degree. The process of analysis can be terribly painful. It does not always work, as it does for Charlotte; certainly, not within the confines of a two-hour Hollywood movie. Most analysts could never be the perfect father or mother figure, the God-like figure we secretly crave. But Dr. Jasquith has an uncanny eye and an intelligence that transcends his immediate circumstances.

Now, Voyager, does not delve into the nitty-gritty of analysis--issues involving transference and countertransference for example. What it does beautifully is show, almost as a parable would, how analysis at its best and most effective could change the world for one individual. As the individual's world is changed, so is the world in which she lives.

Thank you for reading this blog, and all our AMHF blogs.

American Psychological Association

(bvo53) — Wed, 17 Sep 2008 11:21:02 EST

The American Psychological Association, a group of over 100,000 psychologists in the U.S.A., offers helpful information for professionals as well as the public on its website:

click here for APA link

The Bipolar Child

(bvo53) — Mon, 15 Sep 2008 14:29:55 EST

An outstanding article appeared in The New York Times Magazine on September 14, 2008:

click here for bipolar children article

Reading this will provide anyone with a greater understanding of bipolar children and the problems that they and their families face.

There is hope for the future, as advances in psychopharmacology, genetic tests for liver enzymes that metabolize medicines, behavior therapy, special school programs, individual therapies, and parent counseling are developed.

A graduate student's thoughts on depression

(bvo53) — Mon, 15 Sep 2008 14:17:16 EST

We are very lucky that so many talented young people are choosing to devote their careers to helping other people in the mental health field. Here are some ideas on "depression" from a young woman who is studying to be a New York State Certified School Psychologist:

Depression is a disorder that affects all types of people regardless of their
background, culture, socioeconomic status, gender, or age. I think of all the
disorders or problems we will run into as psychologists, this will be most
prevalent (next to anxiety). People often misconstrue depression to be nothing
more than a passing mood that will go away on its own with time. What they fail
to realize is that although this may be the case for some, depression can also
be a clinical medical condition that significantly changes the way one thinks,
acts, feels, or even responds to their environment.

Research shows that depression is commonly mistaken for other disorders such as
such as Bipolar or ADHD. Studies done on gender and depression illustrate that
women are twice as likely then men to suffer from depression. In adolescence,
girls are also more likely to suffer from depression than boys are due to
developmental issues. It is important for those working in the helping field to
be prepared and have the proper knowledge necessary to handle depression.

Depression can have some serious consequences if overlooked. Suicide is one
consequence that is strongly linked to depression. Suicide is a scary topic to
deal with and the worst case scenario for all parties involved. By
understanding and better detecting the different components of depression, we
can work towards early treatment of this disorder and help prevent further
suffering.

Anna Freud, WAR AND CHILDREN, 9-11

(bvo53) — Thu, 11 Sep 2008 11:30:01 EST

On this day of sadness and mourning I'm thinking about a book that Anna Freud wrote during World War Two.

CHILDREN AND WAR was written for the women of London who were holding down the country during the deadly German bombings. These heroic women did just about everything to keep London alive in front-line conditions.

Anna Freud addressed concerns about "how do we deal with the children when we are under continual attack" with special concern for the bombing raids.

One major theme of the book is to always make the children feel safe, keep routines going, even on the worst days where there is bombing, keep the schools going, even if underground, and find courage to find steadfastness within oneself so that fear and anxiety are not transmitted to the children.

One memorable thought will always remain with me: keep the birthday parties scheduled! Even on the worst days, there will be things to look forward to--affirming life and celebrating its presence, even when living in the subways or bomb shelters.

Anna Freud's past treasure of understanding people and events provides at least a modicum of shared experience and ways to cope when things appear to be the darkest. Keeping our children mentally healthy even during the worst of times may be a task we need to be prepared for.

Our thoughts and prayers are with everyone on 9-11-08, especially for those who have suffered directly or lost someone they love.

The New Yorker doesn't quite get it after all

elomke@americanmentalhealthfoundation.org (Evander Lomke) — Thu, 04 Sep 2008 16:37:01 EST

The contest-winning caption on the Wizard of Oz group-therapy session drawing is in.

The judges went for the cheap laugh.

"And my hourly fee is six hundred dollars. You're not in Kansas anymore." The winning entry is by Bill Craig of Ridgewood, New Jersey.

Mr. Craig has written an amusing caption to be sure. His victory ought to be untainted. It is funny. I am not knocking him. For all I know, he may be a professional in the field.

Unfortunately, the caption does make light, unfairly, of a serious situation.

Am I being hypersensitive and humorless? Perhaps. But the caption plays on the idea that the therapist is in it only for the money.

Would someone "pay any price" to feel better? To feel happy? Do therapists, especially group therapists, exploit the misfortunes of those who seek help?

Just the opposite.

One of the hallmarks of Dr. Stefan de Schill's group work under the umbrella of AMHF was the economic advantage this work offered each patient.

There are six members of the cartoon group. Let's imagine they meet twice a week. That is fifty dollars per patient. Not bad.

When group work is well led, by a professional with the gift for this work that is also well-trained, the special dynamic that emerges over a period of time can have enormous beneficial consequences.

We may laugh at the contrast of big-city Oz with Kansas, as conveyed to the frowning book characters--six-hundred bucks for an hour of listening!--but let's remember this is serious work.

Money is an important aspect to be sure. Dr. de Schill believed that to charge nothing would function as insufficient motivation for almost any patient. It is human nature to work harder when the stakes are higher; when there is an actual investment; when one pays. But those in group sessions benefit not only from the other group members themselves, that special dynamic of self-discovery--and more to the point of The New Yorker drawing--from the reduced fees each member pays.

DRIVEN TO DISTRACTION

(bvo53) — Thu, 04 Sep 2008 10:46:29 EST

I have been reading a wonderful book, DRIVEN TO DISTRACTION: Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood by Edward M. Hallowell, M.D., and John Ratey. M.D.

This book brings to a general trade audience wisdom gained from peer-reviewed studies and research. Unlike some books on this topic, there is no ax to grind or ideology to defend. The authors have expertise in both the medical, cognitive, and behavioral treatment of this problem. Much of the attention has looked at boys with ADD; their antics can test the patience of teacher, parent, or saint. Many think boys are overdiagnosed with this disorder. However, girls and adults may be underdiagnosed. The authors offer screening tests and DSM IV criteria for ADD. These can be used as a first step and are obviously not valid for diagnosis.

There are helpful chapters on how ADD enters a family or a marriage and whose presence reverberates around all relationships. This knowledge forms a basis for connecting the person with ADD back into meaningful relationships with those who can offer great support--if the problem is acknowledged, diagnosed, and talked about.

I discovered great wisdom in the chapter that teaches us how to discern the presence of ADD with anxiety, depression, substance abuse, borderline states, and family problems. Are these different manifestations of ADD + another condition or are there many different and unique disorders? Perhaps brain imaging studies and further research and understanding will lead to new categorizations in DSM V and VI.

There are 50 tips on how to manage ADD--each helpful and practical. I especially like this one: "Recharge your batteries. Related to number 30, most adults with ADD need, on a daily basis some time to waste without feeling guilty about it. One guilt-free way to conceptualize it is to call it time to recharge your batteries. Take a nap, watch TV, meditate. Something calm, restful, at ease." (p. 250). Those without ADD may find many of the approaches helpful!

For parents and teachers, there is a section on 50 classroom management tips. This chapter would be especially helpful to therapists who consult in schools.

Is there a genetic link to ADD? Is it present at birth? Is is strictly a neurological disease? How do small environments or even the environment of our culture itself potentiate or even cause the problem?
Many theorists and researchers grapple with this as I write.

Freud started his career as a neurologist and believed that psychiatric conditions over time would be reformulated into neurological ones as our understanding of the brain increased. This poses an interesting challenge to psychodynamic therapists: how do you talk about the presence of this gorilla in the living room, present and powerful in the developmental years of early childhood, cunning and able to disrupt even the best of families, and complicated enough to challenge even the most competent diagnostician? I believe this challenge will be met, and to the benefit of very many people.

PSYCHODYNAMIC DIAGNOSTIC MANUAL: Helpful companion the DSM IV

(bvo53) — Wed, 03 Sep 2008 10:32:54 EST

In the latter part of the 20th century a dramatic shift occurred regarding the manner in which psychiatrists and other mental health professionals described and diagnosed psychological problems.

DSM I, the first version of the Diagnostic and Statistical Manual, was a modest size paperback handbook providing broad categories of mental health problems. It was the job of the therapist to extensively interview the client and to discover the unique strengths and weaknesses of this person, a full background history, and to work to discover how treatment could help give the person greater psychological freedom. This assessment was something that couldn't be done in an hour. If one were to read different assessments by a master therapist, one would be truly amazed how each was different and captured in writing a unique human being who was striving for psychological health. DSM II continued in this manner.

By the 1980s, insurance began to require more specific diagnoses in order to provide reimbursement. DSM III--a much larger book than either of its predecessors--offered more categories for "illnesses" and very specific criteria for identifying these. "Symptoms" might be very behavioral, such as "obsessions and compulsions for more than one hour per day" or "a chronic disturbance in which 15 or more of the following were present."

It was the intention of the Task Force creating this manual that the diagnoses continue to be a first step and that highly detailed individual descriptions of each disorder would follow.

Unfortunately, the pragmatics of how this manual was used led to shorthand definitions--often with the clinician going no further than the symptoms in the book. Sadly, sometimes the numerical code became the most important part of the assessment.

Under this system, 500,000 people could receive a diagnosis of Major Depression, and a detailed historical and contemporary exposition of the experience (phenomenology) was lost.

The PSYCHODYNAMIC DIAGNOSTIC MANUAL, created by a task force of the American Psychoanalytic Association, offers clinicians with ways to shift away from the specifically behavioral symptoms and to produce a full phenomenology. The book is readily understandable and free from jargon and offers clinicians a companion resource to use when working with the DSM IV TR.

One hope for a future edition of this work is to offer discussion and treatment approaches for older clients and the complex mental health problems they and their families grapple with.

The citation for the book is: Psychodynamic Task Force. Psychodynamic Diagnostic Manual. Silver Spring, MD: Alliance of Psychoanalytic Organizations, 2006.

Leave it to The New Yorker

elomke@americanmentalhealthfoundation.org (Evander Lomke) — Fri, 29 Aug 2008 11:39:53 EST

Not that I am such a rabid reader of The New Yorker magazine, but in the past several weeks their cartoonists have outdone themselves in relevance to AMHF.

At this writing, the "Wizard of Oz" group-session caption has not been selected. It ought to be final by Labor Day. But the August 25 and September 1 issues again play--literally--on the theme of analysis.

One drawing, by Charles Barsotti (Aug. 25, p. 78), depicts a Freud-like analyst on the right, taking notes with his left hand, while a righthanded baseball player, in full uniform, including glove, is on the couch. "My life is a powerful blast to center field easily snagged on the warning track."

The September 1 cartoon is on page 126, and is by Robert Mankoff. In a shuttered room (which might have been Dr. de Schill's home office), the analyst sits cross-legged on a large easy chair. Like his Freudian confrere of the previous cartoon, the psychiatrist wears thick glasses, which likewise hide the details of his eyes, He sits beneath a framed diploma, with a large lamp, so that he is flanked by the patient on the couch, and the leamp and end table. "But if you cure my hypochondria I won't have hobbies."

Games. Play. And psychoanalysis. What is their relation? The priest-poet Gerard Manley Hopkins describes the mind as a great cliff. Sheer. A place from which the sane could fall at any moment. But there is that playful side, too. These cartoons, as well as TV shows such as "The Sopranos" and "Psych," indicate our self-fascination. They illustrate how quickly and totally emotions can shift, without warning. How there is the comical side to the severe Hopkins poetic world.

The New Yorker magazine gets it Part 2

elomke@americanmentalhealthfoundation.org (Evander Lomke) — Tue, 19 Aug 2008 12:16:50 EST

This week, we have the three finalists among caption-writers in The New Yorker Cartoon Capton Contest. "And my hourly fee is six hundred dollars. You're not in Kansas anymore." "If you adopt her, please understand that she comes with a lot of baggage." "Home--is there really no place like it? Who'd like to start?"

All come from the group-leading therapist. To remind readers, he is flanked by The Cowardly Lion and Dorothy. The Scarecrow and The Tin Man are next in the circle. Seated in the forefront, opposite the therapist, are a man and woman outside the L. Frank Baum story but nonetheless part of the group. Everyone wears a sad expression.

Which would you pick?

Which do you think readers would choose?