Society for Humanistic Psychology

Allen Frances: Don't Confuse Grief with Depression

2012-01-27T11:34:00.000-08:00

Allen Frances at Psychology Today reports:

A front page story by Ben Carey in January 24th's New York Times carries the poetic title: 'When does a broken heart become a diagnosis?' It describes a puzzling proposal by D.S.M. 5 to transform what is now considered normal grief into Major Depressive Disorder.

D.S.M. IV already recognizes that some people respond to loss with severe problems that warrant immediate attention. It therefore encourages the diagnosis of major depression whenever bereavement is persistent or is associated with severe, impairing, delusional, or suicidal symptoms. D.S.M. IV thus makes a crucial distinction between the transient pain of expectable grief and the severe and/or persistent symptoms of major depression. D.S.M. 5 proposes to eliminate this distinction. It would allow the diagnosis of major depressive disorder after only two weeks of fairly mild symptoms.

The point of departure of the Times article is a landmark review co-authored by Jerome Wakefield and just published in World Psychiatry, the official journal of the World Psychiatric Association. An accompanying editorial written by Professor Mario Maj (president of the Association) also strongly opposes the D.S.M. 5 proposal.

I asked Dr. Wakefield to summarize the findings of his review. His reply:

1)There is no scientific evidence to support diagnosing as major depression two weeks of grief-related depressive feelings of the kind currently excluded from diagnosis. The D.S.M. 5 literature reviews cite dozens of studies, but NOT ONE has samples of people who would get the diagnosis under the new D.S.M. 5 rules.

2) The two most rigorous studies both show that people experiencing short periods of mild grief (of the kind excluded by D.S.M. IV from the diagnosis of major depression) are no more likely to go on to further diagnosable depression than are people in the general population -- whereas real depression has a high rate of recurrence. This directly contradicts the D.S.M.-5 assertion that there is 'no difference... between grief-related depression and any other depression.'

3)There is no evidence that normal grief-related depressive feelings (of the kind now excluded from diagnosis) are associated with a greater risk for suicide.

4) Contrary to D.S.M.-5 claims that potential treatment benefits justify its proposed change, there are no controlled studies demonstrating any drug benefit for expectable grief symptoms of the kind now excluded. The D.S.M. 5 proposal could result in the over-medication of millions of the bereaved -- even though antidepressants are already under challenge as no more effective than placebo for milder depressions.

Dr. Wakefield goes on to point out that:

An estimated 8 to 10 million people lose a loved one every year, and something like a third to a half of them suffer depressive symptoms for up to month afterward. The proposed change would pathologize them for behavior previously thought to be normal. Until now, bereavement is one area that has been immune to the excessive encroachment of psychiatric diagnosis. This is because studies show that many depressive symptoms are common during normal grief, and it is obvious from common experience that grief after loss of a loved one can be very intense and involve depressive symptoms even when it is entirely normal.

I also asked Russell Friedman, Executive Director of the Grief Recovery Institute, to put a human face on the issue: "Imagine that your spouse of 52 years has just died. In the weeks that follow, you experience some or all of the typical reactions to this overwhelming loss. You are sad and lose interest in things. You find it hard to focus or concentrate. Your sleeping patterns are off. Your eating habits are out of whack. If you do manage to sleep, you wake up exhausted, not rested at all, and lacking energy. Your well-meaning daughter brings you to the doctor. You tell him what's going on and he quickly slaps on a diagnoses of Major Depression and prescribes pills. Drug companies will have a feeding frenzy exploiting this huge new market. They will spend hundreds of millions of dollars 'educating' doctors and the public on the D.S.M. 5 revelation that grief is a psychiatric illness. This is madness."

This is a classic case of 'if it aint broke, don't fix it' -- especially if the fix will cause many new problems. D.S.M. IV usefully distinguishes the mild, transient, and self-correcting symptoms of normal grief in contrast to the severe and persistent symptoms of clinical depression. Grief is the normal and absolutely unavoidable price we must pay for having the capacity to love -- it is most certainly not a disease. There is no reason and much risk in turning expectable grief into diagnosable mental disorder. D.S.M. 5 would cheapen the dignity of grief; substitute an impersonal medical procedure for traditional, deeply embedded cultural rituals; and result in much careless and unnecessary use of medication.

The D.S.M. 5 proposal to medicalize grief has always seemed strangely incongruous just on the face of it. Most people not hermetically sealed within the D.S.M. 5 inner sanctum immediately recognize how ridiculous it is to apply the label 'major depression' to someone after just two weeks of perfectly normal symptoms of bereavement. Hopefully, Dr. Wakefield's careful review bringing data and common sense to the issue will penetrate the D.S.M. 5 denial of the obvious. We must preserve the dignity of bereavement and protect it from the inappropriate encroachment of D.S.M. 5 diagnostic ambitions.

ARTICLE HERE.

Allen Frances: Defenses From DSM 5 Get 'Curioser and Curioser'

2012-01-24T18:46:00.000-08:00

Allen Frances at Psychology Today reports:

Elizabeth Lopatto has written an excellent piece in today's Bloomberg News summarizing concerns that DSM 5 will expand the boundaries of psychiatry, increase the already existing diagnostic inflation, and promote the excessive use of medications to treat life problems that don't really require them.

The Vice Chair of the DSM 5 Task Force tries to defend DSM 5 but with statements that have a strange Alice-in-Wonderland out-of-touch-with-reality quality.

Quote 1: "The idea of medicalising normality comes from a perspective
that there are no psychiatric disorders, and you need to avoid
stigmatizing people by giving them one."

Response 1: Wow. This argument implies that all of the criticism that has been specifically directed at DSM 5 must be really be based on a more general bias against psychiatry and against diagnosis. Where does this straw man come from and how can it possibly apply to me- a very concerned critic of DSM 5, but a determined defender of psychiatry when it is done well and with respect for the appropriate uses of psychiatric diagnosis and treatment. The DSM 5 proposals are criticized (by me and many others) because they are poorly conceived, poorly written, unsupported by convincing evidence, and likely to have dangerous unintended consequences. The point is that DSM 5 would expand psychiatry beyond its competence (treating clearcut, more severe psychiatric disorders) by focusing attention instead on milder conditions for which diagnosis and treatment will often do more harm than good- and waste much needed mental health resources.

Quote 2: “Our intent is not to increase or decrease prevalence, but to make
something that is more accurate and scientifically based.”

Response 2: This is a strange claim. The petition to reform DSM 5 (endorsed by 45 mental health organizations) was made necessary precisely because the science supporting the DSM 5 proposals is so very weak and incomplete. The future users of DSM 5 have made the completely reasonable request that there now be a more rigorous scientific review of its proposals, done independently from APA, and using the widely accepted methods of evidence based medicine. Moreover, it was a serious error of the DSM 5 field trials not even to attempt to measure the impact of its proposals on prevalence rates, when this will have such a dramatic effect on individual and public health (see my immediately preceding blogs).

Quote 3: "The revision should be 'a living document'... That’s so we can convene expert panels more frequently in the future.”

Response 3: A previous quote along the same lines was even more alarming- that DSM 5 is a admittedly a set of insufficiently tested hypothesis, but can always be teshttp://www.blogger.com/img/blank.gifted later after DSM 5 is published. No. No. No. DSM 5 is an official nomenclature that will affect people's lives now- not a document to set an agenda for future research. DSM 5 should be a public trust, not a public health experiment. Everything in it must be safe and scientifically sound. And given this experience, having APa convene expert panels doesn't seem like such a great idea.

Bottom line- DSM 5 needs to drop its controversial proposals or have them subjected to a thorough and independent review; it needs to be much more carefully written; and it must be field tested again to determine if it can achieve adequate reliability and what will be its impact on prevalence.
Anything less will lead to a careless and potentially quite harmful DSM 5.

FULL ARTICLE HERE.

DSM5 and Diagnostic Inflation: Reply to Misleading Comments from the Task Force

2012-01-23T20:22:00.000-08:00

Allen Frances at Psychology Today reports:

My biggest concern regarding DSM 5 is that it will dramatically increase the rates of mental disorder and cheapen the currency of psychiatric diagnosis. The DSM 5 proposals do this two ways: 1) by reducing thresholds for existing disorders; and, 2) by introducing new high prevalence disorders at the boundary with normality. Unless corrected, DSM 5 may create millions of newly mislabeled 'patients,' with resulting unnecessary and potentially harmful treatment, stigma, and wasteful misallocation of scarce resources.

In a recent commentary in the American Journal of Psychiatry, the DSM 5 leadership defend their opposite position. They admit that they are indifferent to the manual's impact on rates and justify this on the grounds that no one knows for sure what the true or optimal rates should be. In an earlier blog, I chided the Task Force fohttp://www.blogger.com/img/blank.gifr ignoring the real world harmful unintended consequences that will follow the dramatic increase in prevalence rates caused by their untested and risky proposals.

The Task Force has come back with the following Q and A which popped up at the APA website, apparently in response to my warnings about diagnostic inflation. You can find it at:
http://www.dsm5.org/Documents/QA_Reliability_and_Prevalence_in_DS...

"Q: Was prevalence estimated in the DSM-5 Field Trials?
A: The prevalence of every target diagnosis evaluated in the field trial was estimated.
Q: Will the prevalence of DSM-5 disorders be very much higher than the
prevalence of DSM-IV disorders?
A: In general, the prevalence rates of the diagnoses evaluated in the Field
Trials are slightly lower than DSM-IV prevalence rates."

The wording is remarkably misleading. Note that the DSM IV rates in the field trial were "estimated" by chart review, but that the DSM 5 rates were ""evaluated" by systematic interview. This results in a totally meaningless comparison of apples and oranges. The DSM IV and DSM 5 rates should have been systematically compared (as is customary) using common data gathered in the field trial diagnostic interviews. This is absolutely standard research operating procedure- always compare apples to apples, don't switch assessment methods. It is beyond understanding why this simple step was omitted in the DSM 5 field trials and why chart diagnosis is offered now as a lame substitute.

The Q/A prediction that DSM 5 prevalence rates will be lower than DSM IV is wrong, impossible, even laughable. It is obvious that most changes suggested for DSM 5 will increase prevalence rates above those in DSM IV, often quite dramatically. And most clearly, this is the case for the new diagnoses whose high rates could not possibly be estimated given the limitations of the field trials. The DSM 5 team should most certainly know better than to claim that DSM 5 won't raise prevalences. I am not sure which of the two possible interpretations is worse- that they are being deliberately misleading or that they are terminally self deluded. Either way, the failure to measure prevalences in the field trial is an unaccountable error and the failure to reckon the risky consequences of DSM 5 proposals is just plain reckless.

As I first pointed out before the DSM 5 field trials began, the proper design should have included:
1) For existing disorders- Ratings of DSM IV, ICD 10, and DSM 5 criteria items to allow comparison of rates across the three systems.
2) For new disorders- sampling their likely rates in general psychiatric settings, in primary care, and (by telephone) in the general population.
The academic centers that were selected for DSM 5 field testing are ivory towers that don't generalize well to the real world. Indeed, most psychiatric diagnosihttp://www.blogger.com/img/blank.gifs and medication treatment is now done by primary care doctors and the impact of DSM 5 must be tested where it will most be used.

The whole purpose of field testing is to identify and correct problems in preliminary DSM suggestions before they are set in stone as official guides to diagnostic practice. The design of DSM 5 field trial unaccountably left out the most important question (its impact in rates) and the most important settings (routine clinical practice). The DSM 5 leadership now provides a fudged, incorrect, and belated reply to the risks of diagnostic inflation- don't worry, trust us, it won't happen. This is nonsense- diagnostic inflation will most certainly happen unless DSM 5 is corrected before publication. Such willful blindness is a sure prescription for bad surprises and serious unintended consequences.

ARTICLE HERE.

Dr. Gabor Maté ~ Who We Are When We Are Not Addicted: The Possible Human

2012-01-21T21:09:00.000-08:00

Dr. Gabor Maté gives us clues as to who we are when we are not addicted. Filmed January 9th, 2012 in Vancouver, B.C. as part of a launch for Beyond Addiction: The Yogic Path to Recovery. This four weekend program with Dr. Gabor Maté and Sat Dharam Kaur N.D. begins January 20th, 2012 in Vancouver. For more information see kundaliniyogatraining.com - Kundalini Training Programs - Beyond Addiction, Vancouver.

Idea to Take the 'D' Out of PTSD Studied

2012-01-18T22:21:00.001-08:00

Lindsay Wise at Houston Chronicle reports:

The president of the American Psychiatric Association says he is "very open" to a request from the Army to come up with an alternative name for post-traumatic stress disorder so that troops returning from combat will feel less stigmatized and more encouraged to seek treatment.

Dr. John Oldham, who serves as senior vice president and chief of staff at the Houston-based Menninger Clinic, said he is looking into the possibility of updating the association's diagnostic manual with a new subcategory for PTSD. The subcategory could be "combat post-traumatic stress injury," or a similar term, he said.

"It would link it clearly to the impact and the injury of the combat situation and the deployment experience, rather than what people somewhat inaccurately but often assume, which is that you got it because you weren't strong enough," Oldham said.

The potential change was prompted by a request from Gen. Peter Chiarelli, the Army's vice chief of staff, who wrote to Oldham last year, suggesting APA drop the world "disorder" from PTSD.

"Calling it a disorder contributes to the stigma and makes it so some folks -- not all, but some folks -- don't get the help they need," Chiarelli said.

The general doesn't like to use the word disorder. "It's not a dirty word, but I think it's misused here," he said. "I don't think that the post-traumatic stress that soldiers experience is a disorder. It's not something that happens just to weak people or people that are somehow inclined to be affected by horrible things that they see or are required to do. I think it causes an actual injury to the brain and how the brain works."

Early discussions

After receiving Chiarelli's letter, Oldham wrote back to say he appreciated his concern, but dropping the word disorder might not be the best way to go. He said he was eager to work with Chiarelli to see what APA could do.

The general invited Oldham to the Pentagon to discuss the situation. They met for about an hour and a half on Dec. 9. Oldham agreed to bring the general's suggestion to the APA work group tasked with reviewing PTSD for the next version of the association's Diagnostic and Statistical Manual of Mental Disorders, the classification book used by psychiatrists in America. APA is finalizing the fifth edition of the manual, due in May 2013.

Oldham cautioned the discussion is very preliminary but speculated that a new subcategory like "combat post-traumatic stress injury" might work.

Although Chiarelli still would prefer to lose "disorder" entirely, he said a new subcategory would be a start. "I'm frustrated with how long this is taking to be honest," he said.

The general pointed out that PTSD has had many names over the years, from shell shock to battle fatigue. "It's been called all kinds of different things and somehow we decided to go with PTSD and I think that's just wrong," he said.

Chiarelli's campaign to change the name of PTSD is part of the Army's effort to reduce alarming suicide rates among soldiers. Statistics released last month identified 260 potential suicides in 2011. Of that total, 154 were active-duty soldiers, 73 were National Guard troops and 33 were reservists.

Silence over stigma

Stigma is a major problem. A study published in the Archives of General Psychiatry in October found that soldiers were two to four times more willing to report PTSD, depression, and suicidal thoughts if they were allowed to answer a survey anonymously, rather than put their names on a routine post-deployment screening form.

Of the soldiers who screened positive for PTSD or depression, 20 percent said they weren't comfortable answering honestly on the routine form. The study concluded that the Army's screening process misses most soldiers with significant mental health problems.

Dr. Harry Croft, a psychiatrist in San Antonio, said the findings jibe with what he hears from veterans he treats for PTSD.

"Even though the rules, as I understand them, say you don't get kicked out if you get diagnosed with PTSD, depression or any other issues, a lot of veterans say, 'I knew damn well if I answered the questions right my chance to get promoted was gone,' " Croft said.

Croft has mixed feelings about changing the name of PTSD. He understands the concern about stigmatizing troops but thinks whether the condition is called PTSD or something else will have little effect on the suicide rate.
http://www.blogger.com/img/blank.gif
"Rather than concentrate on what we call it, we need to concentrate more on how to help warriors coming back from the combat zone, because I don't think the name we give it will have much of an impact on the 18 suicides a day and all the other problems that we see," Croft said. "That's putting a Band-Aid on a much bigger wound."

Chiarelli says his main concern is getting soldiers into treatment, so if calling post-traumatic stress a disorder keeps them from seeking help, then the wording needs to change, the sooner the better.

"You can have the very, very best treatments in the world, but if you can't get people take advantage of them, they don't do any good," he said.

ARTICLE HERE.

Richard Bentall: Diagnoses are Psychiatry's Star Signs -- Let's Listen More and Drug People Less

2012-01-18T16:11:00.001-08:00

Richard Bentall in The Guardian reports:

The biological approach to treating mental illness has been a lamentable failure. We must focus on a patient as a person

Surveying the history of psychiatry, the medical historian Edward Shorter remarked: "If there is one central intellectual reality at the end of the 20th century, it is that the biological approach to psychiatry – treating mental illness as a genetically influenced disorder of the brain chemistry – has been a smashing success."

Far from being a success, there is compelling evidence that the biological approach has been a lamentable failure. Whereas last century saw dramatic improvements in the survival rates of patients suffering from heart diseases and cancer, so far as we can tell, outcomes for patients suffering from the severest forms of psychiatric disorder – the psychoses (disorders in which the patient experiences hallucinations or delusions, usually resulting in a diagnosis of schizophrenia or bipolar disorder) – have hardly changed since the Victorian period. Poor countries without well-resourced psychiatric services seem to do at least as well as the developed world. Therefore, although the perception is often different, there is little evidence that modern psychiatric services have had a global, positive impact on mental health.

At the beginning of the 21st century a new picture of severe mental illness is emerging, which shows that the genetically determined brain disease paradigm is not only ineffective but scientifically flawed. First, it seems that diagnoses such as schizophrenia and bipolar disorder do not identify discrete conditions analogous to, say, appendicitis or tuberculosis. Patients with a mixture of bipolar and schizophrenia symptoms are at least as common as patients who fit one or other diagnosis. The concept of schizophrenia is so broad that two patients can share the diagnosis while having no symptoms in common.

In the case of both types of symptoms, there appear to be many people whose experiences place them on the borderline between health and illness, so that we can think of a spectrum running from ordinariness, through eccentricity and creative thinking, to full-blown psychiatric disorder. Research has also shown that psychiatric diagnoses are poor predictors of response to treatment, giving little indication of which patients will respond to which drugs. They are therefore hardly more meaningful than star signs – another diagnostic system that is supposed to tell us something about ourselves and what will happen in the future, and which is widely embraced despite no evidence of its usefulness.

When new methods of molecular genetics have been used to study psychiatric patients, no genes of major effect have been found. The latest evidence suggests that many genes – possibly thousands – each make a tiny contribution to vulnerability to psychiatric disorder, and that these effects are highly non-specific (the same genes are implicated in patients with different diagnoses).

Some findings that were announced with enormous fanfare have not been replicated in subsequent studies. Much, for instance, has been made of the discovery of a variant of the 5-HTTLPR gene, which appears to make people liable to depression if they are exposed to unpleasant life events. A recently published analysis of the data available on this gene found no evidence that it directly causes depression, or that it makes people vulnerable to depression. However, it was found that negative life events had a direct impact on mood: as our mothers could have told us, bad things tend to make us miserable.

This last observation is consistent with other evidence that life experiences shape even the most severe forms of mental illness. Migrants have at least a four times greater risk of psychosis than other groups, and this effect is most pronounced if they live in areas in which they are in a minority. Early separation from parents has also been shown to increase the risk of psychosis, as have growing up in an urban environment and chronic bullying.

Many studies have also reported an association between trauma in early life and psychosis. These effects are large: one recent study estimated that individuals who had been sexually abused in childhood were 12 times more likely than others to suffer from serious mental illness, and another calculated that the population-attributable risk of a diagnosis of schizophrenia associated with an inner-city childhood was 15% (that is, there would be 15% fewer cases if we all grew up in the countryside). The risk associated with having a parent with the diagnosis is 7% (ie, there would be 7% fewer cases if patients stopped having children).

These effects are understandable in the light of psychological research. For example, early trauma seems to disrupt the process by which we distinguish between our own thoughts and our perceptions, leading to a specific risk of hallucinations. Disruption of early relationships with caregivers, coupled with victimisation, create a tendency to mistrust others and to anticipate threats, leading to paranoid delusions.

The cruel and ineffective treatments that characterised psychiatry in the mid-20th century – for instance, prefrontal leucotomy and insulin coma therapy – would not have been accepted had psychiatrists not been in thrall to the idea that mental illnesses are genetically determined brain diseases. Today, although mental health professionals are usually much more compassionate than in those dark times, psychiatric services continue to see their primary objective as ensuring that patients take their medication.

Legislation has been introduced allowing doctors to coerce patients to take their drugs with threats of a return to hospital if they do not comply. Patients often find that their own understandings of their troubles are ignored. A study of psychiatrists in London found that, when patients asked questions about the meaning of their experiences, the doctors typically changed the subject.

Meanwhile, research on the biology of severe mental illness continues to be prioritised over social and psychological research. Biological investigations into psychosis currently outnumber those on environmental factors by at least five to one, and are much more generously funded by the UK's Medical Research Council. To date, about 30 trials of cognitive therapy for psychosis have been completed; by comparison, in the period 2001-3, nearly 400 drug trials were published in the five leading American psychiatric journals. There is therefore an urgent need to develop a less drug-based, more person-centred approach to understanding and treating mental illness, which builds on the recent scientific findings and which takes the experiences of patients seriously.

Massachusettes Judge Orders Mentally Ill Woman to Have an Abortion and Be Sterilized

2012-01-18T15:42:00.000-08:00

Andrea Johnson in Minot Daily News reports:

Forced sterilization is a practice I thought went out with the dark ages, but apparently not.

A judge in Massachusetts ordered that a pregnant woman with bipolar disorder and schizophrenia have an abortion against her will and be sterilized at the same time.

According to the Associated Press story, Family and Probate Court Judge Christina Harms "found the woman would choose to end her pregnancy if she were competent and agreed to appoint her parents as guardians "for the purpose of consenting to the extraordinary procedures of abortion and sterilization. '"

The 32-year-old woman's identity was not given, but Harms apparently ordered the abortion so she can be given medication for her mental illness that she can't take if she's pregnant. She ordered the sterilization "to avoid this painful situation from recurring in the future." The woman, who is about five months pregnant, describes herself as "very Catholic" and has made it very clear that she doesn't want an abortion.

Fortunately, the Massachusetts Appeals Court just reversed the decision, but it is frightening that Harms even thought this was acceptable.

I can guess what was running through Harms' mind. There isn't much doubt that this child will start life with a number of disadvantages. A woman with uncontrolled bipolar disorder and schizophrenia probably is not going to be able to raise a baby, at least not without some help. No mention was made of the man who fathered this child, but if he's unknown or incompetent in some way himself, the child may well end up the responsibility of this woman's aging parents or of the foster care system.

People are usually eager to adopt babies, but some adoptive parents might be reluctant to adopt a child who could eventually develop bipolar disorder and schizophrenia, both of which can be hereditary conditions.

Most people would say it would better if this woman does not have more children, at least until her condition is stabilized. But that isn't a decision that anyone except that woman has a right to make. The minute we take the decision out of her hands we start the trip down the slippery slope that leads to eugenics and the Nazis.

The "right to choose" is most definitely also the right to choose life, even when others disagree.

ARTICLE HERE.

Dr. King on the Nonviolence Movement

2012-01-16T17:09:00.001-08:00

Pharmageddon: Profits peak from Prozac nation's pills passion

2012-01-15T18:40:00.001-08:00

British Psychological Society Issues Statement to DSM-5

2011-12-17T11:08:00.000-08:00

From the British Psychological Society website:

The Society has today (13 December 2011) released a statement expressing concerns regarding the proposed revisions of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, which is one the main internationally-used classification systems for diagnosis of people with mental health problems in clinical settings and for research trials.

The Society for Humanistic Psychology (Division 32) of the American Psychological Association (APA)has recently published an open letter to the DSM-5 taskforce raising a number of concerns about the draft revisions proposed for DSM-5 and citing a number of issues raised previously by the BPS.

In its statement today, the Society shares the concerns expressed in the open letter from the Society of Humanistic Psychology (Division 32) of the APA and encourages members of the Society to read the letter themselves and consider signing the petition.

David Murphy, Chair of the Society’s Professional Practice Board said:

“The Society recognises that a range of views exist amongst psychologists, and other mental health professionals, regarding the validity and usefulness of diagnostic frameworks in general and the Diagnostic and Statistical Manual of the American Psychiatric Association, in particular.

“However, there is a widespread consensus amongst our members that some of the changes proposed for the new framework could lead to potentially stigmatizing medical labels being inappropriately applied to normal experiences and also to the unnecessary use of potentially harmful interventions.

“We therefore urge the DSM 5 taskforce to consider seriously all the issues that have been raised and we would echo the American Psychological Association’s call for the taskforce to adhere to an open transparent process based on the best available science and in the best interest of the public”.

You can read the Society statement in full online.

Thich Nhat Hanh on True Love

2011-12-17T11:05:00.001-08:00

Thich Nhat Hanh speaks on true love

Alan Watts: A Conversation with Myself

2011-12-10T16:58:00.000-08:00

A 1971 television recording with Alan Watts walking in the mountains and talking about the limitations of technology and the problem of trying to keep track of an infinite universe with a single tracked mind. Video courtesy of alanwatts.com home of the Alan Watts archives.

Allen Frances: APA Attempts to Defend Itself

2011-12-05T22:16:00.000-08:00

By Allen Frances, MD | December 5, 2011

This blog is a follow-up to an earlier post. The great news is that there is an active public debate on DSM-5. The leadership of the American Counseling Association (ACA) recently sent a thoughtful letter to the leadership of the American Psychiatric Association(APA) that summarizes the most serious flaws in the DSM 5 and recommends the steps necessary to regain its lost credibility and earn the support of potential users. The letter has tremendous force because the ACA represents fully 20% of all the mental health professionals who will eventually have to decide whether to use DSM-5 (it is available at: http://www.counseling.org/Resources/pdfs/ACA_DSM-5_letter_11-11.pdf).

The APA's response to ACA is long-winded, something of a classic (available at: http://www.dsm5.org/Documents/DOC001.pdf). The cloudy confusion in the APA response deserves more detailed deconstruction in later blogs—but for now, let's maintain a tight focus on what is missing—5 straight answers to these 5 simple questions:

1) Why is APA not willing to have an independent external scientific review of questionable DSM-5 proposals- especially since its own internal, super-secret review process has been so badly discredited? APA response: There have already been multiple layers of review from its DSM-5 workgroups, task force, advisors, and scientific review group. The claim is that this constitutes an "independent" review, simply because few of the people involved are paid APA employees. This doesn't pass the most forgiving smell test.

2) Since the DSM-5 suggestions will all broaden the definition of mental disorder, why should we not worry about diagnostic inflation and the massive mislabeling of normal people as mentally ill?

3) Won't this diagnostic inflation exacerbate the already rampant over-prescription of psychotropic medications (especially by primary care doctors, especially antipsychotics, especially to kids)?

4) Why should we not worry about the unintended forensic complications of a sloppily written DSM-5 containing suggestions that are obvious targets for forensic misuse?

5) Won't the many small, needless, and arbitrary changes in DSM-5 complicate future research efforts and make impossible the interpretation of data collected before versus after DSM-5?

APA's response dodges all 5 questions. Perhaps this is because DSM-5 is so fundamentally flawed that it is defensible only by smoke screen. And experience has proven that DSM-5 cannot self correct—its current version is virtually equivalent to the frightening first draft posted in February 2010. The calls for public comment have turned out to be no be more than sham, public relations window dressing with no substantive impact on product. It is by now crystal clear that APA will produce a safe and scientifically sound DSM-5—only if its users rise up and force it to. Concerned? You can help by signing the petition to reform DSM-5 at http://www.ipetitions.com/petition/dsm5/.

Antipsychotic Drugs Tied to Diabetes Risk in Kids

2011-11-22T21:31:00.000-08:00

Amy Norton at Reuters reports:

The antipsychotic drugs that are increasingly being used to treat bipolar disorder, autism and other mental disorders in children may come with an increased risk of diabetes, a new study suggests.

Previous research has linked the so-called second-generation antipsychotics to an increased risk of diabetes in adults. And there's been some evidence that the drugs can cause weight gain in children.

The new findings, published in the journal Pediatrics, add to concerns that the medications may ultimately lead to diabetes in some kids.

Using records from three U.S. health plans, researchers found that children and teens who started on an antipsychotic had four times the risk of being diagnosed with diabetes, versus kids not using any psychiatric medication.

They developed diabetes at a rate of just over three cases per 1,000 children per year. That compared with just under 0.8 cases per 1,000 among medication-free kids.

Second-generation antipsychotics include drugs such as Risperdal, known generically as risperidone, Zyprexa (olanzapine), Seroquel (quetiapine) and Abilify (aripiprazole).

The drugs are used to treat conditions like bipolar disorder, schizophrenia and irritability and aggression in children with autism. They are also sometimes given to children with attention-deficit hyperactivity disorder (ADHD), even though there's no research evidence to support that.

And it's the growing use of the drugs in kids -- particularly for conditions in which the benefit is unclear -- that makes the potential diabetes risk concerning, according to Dr. Jonathan Mink, chief of child neurology at the University of Rochester Medical Center in New York.

CONTINUE TO FULL ARTICLE HERE.

The DSM-5 and the Danger of Pharmaceutical Companies: Jacqueline Simon Gunn and Kyle Arnold on "Sex and Politics" Radio

2011-11-20T17:49:00.000-08:00

Join "Sex and Politics" host Philip Rosenberg as he interviews Jacqueline Simon Gunn and Kyle Arnold in an attempt to figure out the why's and wherefores of the DSM-5's upcoming edits.

LISTEN TO THE SHOW HERE.

Roy Eidelson: Letter to APA Division Presidents on the PENS Report

2011-11-18T09:07:00.001-08:00

Dear APA Division Presidents,

The Coalition for an Ethical Psychology appreciates your engagement -- and the engagement of your division memberships -- regarding the issue of annulling the APA’s 2005 PENS Report. As reflected in our petition initiative (www.ethicalpsychology.org/pens), we and many other individuals and organizations strongly believe that annulment is a necessary and urgent step.

For those of you who are still undecided, we encourage you to consider a brief “What Would You Have Done?” thought experiment. Imagine that you personally had been in charge of creating the PENS Task Force in mid-2005, amid reports from the International Committee of the Red Cross, the New York Times, and other media outlets that psychologists were involved in abusive and torturous interrogations of national security detainees at Guantanamo Bay and elsewhere. Imagine that it was your responsibility to bring together a small group to examine the key question of whether the APA Ethics Code adequately addressed the ethical dimensions of psychologists’ involvement in such interrogations and other national security-related activities.

Placing yourself in that decisive leadership role, how would you have answered these seven questions?:

In creating a task force of nine voting members, would you have selected six individuals who were on the payroll of the military/intelligence establishment, including several who worked in the chains of command when and where instances of abuse and torture had reportedly occurred?

Would you have given leadership responsibility to a senior APA staff member whose spouse had been a Behavioral Science Consultation Team (BSCT) psychologist at Guantanamo, and was therefore a member of the cohort of psychologists for whom the Task Force was to provide guidance?

Regarding issues of torture and cruel, inhuman, and degrading treatment, would you have agreed that U.S. law, as reinterpreted by the Bush Administration, should supersede longstanding international human rights standards in the PENS Report?

Given that the task force’s mandate included examining the role of psychologists in investigations related to national security, would you have permitted a Board Liaison to prevent task force discussion of reported instances of psychologists' involvement in abusive interrogations of national security detainees?

As the task force leader, would you have considered it appropriate to incorporate key language into the APA report drawn directly from military BSCT documents –namely, that psychologists serve to keep interrogations "safe, legal, ethical, and effective”?

Given that psychologists faced strong situational pressures (without access to independent outside consultants) and were subject to a military code that prioritized military orders over psychological ethics, would you have concluded that “a central role for psychologists working in the area of national security-related investigations is to assist in assuring that processes are safe, legal and ethical for all participants”?

Would you have supported the Board’s decision to approve the report through “emergency” procedures, bypassing the standard governance process of review and acceptance by the full Council of Representatives, which was set to meet within six weeks?

At the time, the APA Task Force leadership opted for “Yes” in response to all seven of these questions, and they have defended those answers ever since. As a result, the PENS Report continues to be an authoritative and influential document in military/intelligence and psychological settings. The report is used by the Department of Defense as guidance for BSCT psychologists; by military psychologists seeking to advance “operational psychology” as an area of specialization including aggressive counterintelligence and counterterrorism operations; and by the APA Ethics Committee as a guide to ethical behavior in national security settings.

If, like many other concerned psychologists and human rights advocates, you would have answered "No” to some of these questions, please review the petition materials at www.ethicalpsychology.org/pens and consider joining the 1,000 individuals and 22 organizations that have already signed on. Your personal support for annulment of the PENS Report can make a difference. We would certainly welcome your sharing this email and thought experiment with the general membership of your divisions as well. Thank you.

Sincerely,

Roy Eidelson, on behalf of the Coalition for an Ethical Psychology

P.S. Our great thanks to those of you who have already signed the petition.

Note: Society for Humanistic Psychology (Division 32 of APA), based on a vote of the Executive Committee, is proud to have signed the petition to annul the PENS Report, initiated by Coalition for an Ethical Psychology, and we are grateful for the Coalition for an Ethical Psychology for their continued vigilance with regard to issues of human rights that bear upon the field of psychology.

Ignacio Martin-Baro: Psychology of Liberation, or in the Service of the Status Quo?

2011-11-18T08:51:00.000-08:00

"Among the criticisms most often made of psychologists...is that the majority devote most, if not all, of their attention to the well-to-do sectors, and as such, their work tends to center on the personal roots of problems--a focus that causes them to ignore social factors. The social context is thus converted into a kind of natural phenomenon, an unquestioned assumption, before whose 'objective' demands the individual must seek, individually and even 'subjectively,' the solutions to his or her problems. With this focus and with this clientele, it is not a surprise that psychology is serving the interests of the established social order, as a useful instrument for reproducing the system."

-- Ignacio Martin-Baro, "Writings for a Liberation Psychology (pp. 37-38)

Psychiatric Drug Use Spreads: Pharmacy Data Show a Big Rise in Antipsychotic and Adult ADHD Treatments

2011-11-18T07:17:00.000-08:00

Shirley S. Wang at Wall Street Journal reports:

The medicating of Americans for mental illnesses continued to grow over the past decade, with one in five adults now taking at least one psychiatric drug such as antidepressants, antipsychotics and anti-anxiety medications, according to an analysis of pharmacy-claims data.

WSJ's Shirley Wang reports the use of psychiatric medications among adults and children in the U.S. has risen substantially since 2000. Photo by Abid Katib/Getty Images

Among the most striking findings was a big increase in the use of powerful antipsychotic drugs across all ages, as well as growth in adult use of drugs for attention-deficit hyperactivity disorder—a condition typically diagnosed in childhood. Use of ADHD drugs such as Concerta and Vyvanse tripled among those aged 20 to 44 between 2001 and 2010, and it doubled over that time among women in the 45-to-65 group, according to the report.

Overall use of psychiatric medications among adults grew 22% from 2001 to 2010. The new figures, released Wednesday, are based on prescription-drug pharmacy claims of two million U.S. insured adults and children reported by Medco Health Solutions Inc., a pharmacy-benefit manager.

"People from all walks of life are taking medications for mental-health conditions," said David Muzina, a psychiatrist and head of Medco's Neuroscience Therapeutic Resource Center, whose team compiled the report.

While the use of most psychiatric drugs grew strongly, there were declines in antidepressant use in children and anti-anxiety drug use in the elderly, likely in part because of concern over potential side effects.

The patterns are consistent with, but more pronounced than, published findings from national government data, which tend to have a lag time. A recent Archives of General Psychiatry paper looking at data before 2005 found that about 10% of the population took an antidepressant. Wednesday's data found that about 10% of adult men used antidepressants in 2010, but 21% in adult women did.

Psychiatric medications are among the most widely prescribed and biggest-selling class of drugs in the U.S. In 2010, Americans spent $16.1 billion on antipsychotics to treat depression, bipolar disorder and schizophrenia, $11.6 billion on antidepressants and $7.2 billion on treatment for ADHD, according to IMS Health, which tracks prescription-drug sales.

Whether psychiatric drugs are used appropriately or not has been a longstanding concern among medical professionals and policy makers in the U.S. Evidence continues to grow about possible serious side effects, particularly among children and the elderly. For instance, in 2004 the Food and Drug Administration required a "black box" warning—its most serious—about the possible increase in suicidal thoughts in children and teens taking antidepressants, and in 2005 it warned about the increased risk of death with certain antipsychotics in elderly patients with dementia.

Wednesday's report offered some evidence that such warnings have impact: Antidepressant use in children peaked in 2004 and dropped last year to 2001 levels, around 2.5% for girls and just over 2% for boys.

Still, there was a pronounced increase in medications to treat ADHD among young and middle-aged adults, particularly in women. Use in the over-65 population also increased about 30% for men and women between 2001 and 2010. An earlier study published in the New England Journal of Medicine found a similar trend in examining data between 2002 and 2005, and these latest figures suggest that the uptick isn't slowing. Reasons for the rise could include people who were diagnosed and treated as children who continue to suffer from symptoms, adults who were never treated previously but suspect they have symptoms, and increased awareness from marketing pushes by companies approved to market these drugs to adults, Medco's Dr. Muzina said.

Shire PLC, maker of Vyvanse and Adderall, pointed to an increased recognition of ADHD as a lifelong disorder as a main factor for growth in treatment in adults, as well as marketing and awareness campaigns have led to the awareness that this is a real entity, said Jeff Jonas, head of Shire research and development. Johnson & Johnson, maker of ADHD drug Concerta, declined to comment.

David Sallen was diagnosed in his mid-30s with attention deficit disorder, a variant of ADHD, after an extensive testing session at Massachusetts General Hospital in Boston. Though he had felt as a child that something was wrong with him, he never considered that he had ADD until one day in the late 1990s when he lost his train of thought when talking with a friend and jokingly said he thought he had ADD. The friend agreed, prompting Mr. Sallen to get tested. Mr. Sallen, of North Attleborough, Mass., started medication, eventually settling on the drug Adderall. On the medicine, he says he was able to fully shift his attention from one situation to the next rather than perseverate on a previous conversation, and could plan what he was going to do next rather than get distracted by a phone call and forget what he was doing. Mr. Sallen, who had been a college dropout, says he returned to get his degree and went to graduate school. "It was day and night," he said of his life before and after treatment.

WSJ's Louise Radnofsky has details of a Health and Human Service study that indicates government-funded prescription drug plans are lacking data as to whether drugs in the plans are approved by Medicare. AP Photo.

Use of antipsychotics such as J&J's Risperdal and Bristol-Myers Squibb Co.'s Abilify grew substantially in the past decade in both kids and adults. The rise, despite increased awareness about potential side effects like weight gain, high cholesterol and diabetes, is worrisome, according to Mark Olfson, a professor of clinical psychiatry at Columbia University who studies psychiatric drug utilization patterns but wasn't involved in the current report.

Separate Medco data not included in the report find that only a minority of patients on these medicines is getting their blood sugar checked annually, according to Dr. Muzina. "When we see this trend of increasing use, it makes me wonder: Are patients appropriately followed with safety monitoring?" he says.

A pair of legal developments could let drug makers pitch products to treat ailments not listed on the medicine bottle, a practice long outlawed by federal regulators. Thomas Burton has details on Lunch Break.

In the elderly, the use of anti-anxiety drugs, particularly ones that stay in the body for a longer period of time like Valium, is a major worry, but there has been relatively little in the way of research on their use in this population, according to Dr. Olfson. These new data about the 44% decrease in use of these drugs in the elderly represent a major shift in usage patterns in the last decade and are an "encouraging development," he says.

The trend is likely in part related to the fact that these drugs aren't covered by Medicare part D, which offers the drug coverage for seniors and came into effect in 2006, according to Dr. Muzina.

CONTINUE TO FULL ARTICLE HERE.

Counselors Turn Against DSM-5: Can APA Ignore 120,000 Users?

2011-11-18T05:29:00.000-08:00

Allen Frances at Psychiatric Times reports:

The users’ revolt against DSM-5 marches on and just became a much, much bigger parade. There are 120,000 counselors in the US—more than 20% of all mental health professionals—and DSM-5 is integral to their daily work. The American Counseling Association DSM-5 Task Force, skillfully led by Dr Dayle Jones, has made a meticulous study of DSM-5 and is alarmed by many of its suggestions.

The following open letter from the ACA president to the president of the American Psychiatric Association, quoted in full, was just posted. It nicely summarizes what is wrong with DSM-5 and recommends essential corrective actions. How long can DSM-5 afford to battle with its users.

***

Dear Dr. Oldham:

I am sending this letter on behalf of the American Counseling Association (ACA), the world’s largest association for professional counselors. There are 120,000 licensed professional counselors in the United States; as such, we represent the second largest group that routinely uses the DSM.

ACA appreciates the efforts of the American Psychiatric Association (APA) and the Task Force to update the manual according to new scientific evidence. However, professional counselors have voiced several concerns about the DSM-5 development process and they have reservations about many of the proposed revisions. We believe resolving these issues are critical to counselors’ continued confidence in the DSM as a tool for competent and ethical diagnosis of psychopathology. Our concerns focus on empirical evidence, dimensional and cross-cutting assessments, field trials, the definition of mental disorder, and transparency.

Empirical Evidence. While we appreciate APA’s commitment to quality research, counselors are concerned that a number of the DSM-5 proposals have little basis in empirical studies. A systematic and independent review of the research base is critical when revising diagnostic criteria. Unfortunately, guidelines for conducting evidence-based reviews (eg, Kendler et al., 2009) were not provided to work groups until approximately 18 months after revisions had begun. The rationales posted on the DSM-5 website provide either incomplete or insufficient empirical evidence to support many of the proposed revisions. Reportedly in response to this, the DSM-5 Task Force appointed a Scientific Review Committee (SRC) charged with reviewing the empirical evidence supporting the proposed revisions. While we strongly applaud this decision, we would like more information as to how the SRC will conduct their review so that those outside the process can be assured of the solidity of the empirical evidence behind the proposals.

Dimensional and Cross-Cutting Assessments. ACA members were initially supportive of the idea of using dimensional and cross-cutting assessments, but our review of the proposed assessments on the DSM-5 website causes us considerable worry. Little information regarding scale development has been provided and, according to the field trial protocols, there is no evaluation using external validators. Furthermore, more than half the disorders—including important disorders such as attention-deficit/hyperactivity disorder and conduct disorder—have no assessments posted on the website, so we cannot effectively evaluate all of the measures being proposed.

Field Trials. Evaluating diagnostic validity using “a variety of external criteria” is essential in developing or revising diagnostic criteria (Kraemer, 2007, p. S9). Yet, the DSM-5 field trial protocols focus exclusively on reliability, feasibility, and user acceptability. There is an absence of external validators (i.e., evaluation of validity using external criterion measures); thus, there is no way of determining whether any of the proposed changes improve the validity of the DSM. Furthermore, since the DSM-IV and DSM-5 criteria are not being simultaneously applied to the same clients, there is no way to assess the impact of changes on prevalence rates of the various mental disorders.

Definition of Mental Disorder. The DSM-5 Task Force has proposed a new definition of mental disorder which includes, “A behavioral or psychological syndrome or pattern that occurs in an individual that reflects an underlying psychobiological dysfunction” (APA, 2011). Using the term psychobiological implies that all mental disorders have an underlying biological component. Although advances in neuroscience have greatly enhanced our understanding of psychopathology, the current science does not fully support a biological connection for all mental disorders. We therefore request that the definition of mental disorder be amended to indicate that mental disorders may not have a biological component.

Transparency. Although the DSM-5 Task Force has described its development process as “open, transparent and free of bias” (Kupfer and Regier, 2009, p. 40), all work group members were required to sign confidentiality agreements that prohibit them from divulging information about the DSM-5 process, even after it is published. Most problematic, the reports of the DSM-5 SRC are not available for public inspection, which is a violation of one of the most basic and vital tenets of science—open access to data and/or processes for independent evaluation and critique. Without full transparency and openness, counselors may have difficulty having confidence in and trusting the DSM-5.

In conclusion, based on these issues, professional counselors have expressed uncertainty about the quality and credibility of the DSM-5. Therefore, to ensure continued trust and confidence in the

DSM-5, we ask that the APA carry out the following recommendations:

1. Make public all empirical evidence submitted to the DSM-5 Scientific Review Work Group, as well as the group’s evaluations and recommendations.

2. Submit all evidence and data (from work groups and field trials) for review by an external, independent group of experts in evidenced-based decision-making and make the results of this review public.

3. Remove any DSM-5 proposed revisions deemed to lack strong empirical evidence by external, independent review, or add them to the Appendix for Criteria Sets Provided for Further Study.

4. Eliminate any dimensional or cross-cutting assessments that lack supportive reliability and validity evidence, limited feasibility and poor clinical utility.

We appreciate and value the work APA has done in developing a diagnostic classification system that is used by over half a million non-psychiatric mental health professionals in the United States. However, to produce a credible diagnostic manual, it is essential that the DSM-5 be based on research that involves rigorous, systematic, and objective procedures; an open process; and independent, objective scientific review.

Sincerely,
Don W. Locke, PhD
ACA President

References [as they appear in Dr Locke's open letter, located at http://www.counseling.org/Resources/pdfs/ACA_DSM-5_letter_11-11.pdf.]

American Psychiatric Association (APA). (2011). Definition of mental disorder [sic]. Retrieved from http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=465.

Kendler K, Kupfer D, Narrow W, Phillips K, Fawcet J. (2009). Guidelines for making changes to DSM-V. Retrieved from http://www.dsm5.org/ProgressReports/Documents/Guidelines-for-Making-Changes-to-DSM_1.pdf.

Kraemer HC. (2007) DSM categories and dimensions in clinical and research contexts. International Journal of Methods in Psychiatric Research, 16(S1), S8-S15.

Kupfer DJ, Regier DA. (2009). Counterpoint: Toward credible conflict of interest policies in clinical psychiatry. Psychiatric Times, 26(1), 40-41.

American Counseling Association (ACA) Expresses DSM-5 Concerns to the American Psychiatric Association

2011-11-17T17:41:00.000-08:00

ACA President Don W. Locke has sent a letter to the American Psychiatric Association on behalf of professional counselors expressing current concerns about the DSM-5 revision process. The letter focuses on the need for better empirical evidence, the lack of information about proposed dimensional and cross cutting assessments, problems with the ongoing field trials, concerns about the biological emphasis of the revised definition of mental disorders, and the need for greater transparency.

To view the ACA letter sent to American Psychiatric Association President John Oldham, click here.

If you support ACA's criticism of the DSM-5, please considering signing the Open Letter to the DSM-5 petition HERE.

Viktor Frankl: A Purely Technological Approach to Psychotherapy Misses the Point

2011-11-13T10:32:00.000-08:00

"A purely technological approach to psychotherapy may block its therapeutic effect...As soon, and as long as we actually interpret our assignment merely in terms of techniques and dynamics we have missed the point--and we have missed the hearts of those to whim we wish to offer mental first aid in their predicament. Approaching human beings merely in terms of techniques necessarily implies manipulating them. Approaching them merely in terms of dynamics implies reifying them, making human beings into mere things. And these human beings immediately feel and notice the manipulative quality of our approach and our tendency to reify them." -- Viktor Frankl

Frank, V.E. (1967). Logotherapy and existentialism. Psychotherapy: Theory, research and practice, 4(3), 128-143.

DSM-5: "Living Document" or "Dead on Arrival"

2011-11-11T15:01:00.001-08:00

Untested "Scientific Hypotheses" Must Be Dropped

Allen Frances at Psychology Today:

News flash From Medscape Medical News - 'APA Answers DSM-5 Critics,' a defense of DSM 5 offered by Darrel A. Regier, MD, vice-chair of the DSM-5 Task Force. Wonderful news that APA is attempting to address the fact that DSM 5 alarms many of its potential users- it is long past time for an open dialog. Unfortunately, however, Dr Regier dodges the concerns that must be addressed if DSM 5 is to become a safe and credible document. Five simple questions were previously posed to APA with a request for five straight answers:

1) Why is APA not willing to have an independent scientific review of questionable DSM 5 proposals- especially since its own internal and confidential review process has been so badly discredited?

2) Since the DSM 5 suggestions will all broaden the definition of mental disorder, why should we not worry about diagnostic inflation and the massive mislabeling of normal people as mentally ill?

3) Won't this diagnostic inflation exacerbate the already rampant over prescription of psychotropic medications (especially by primary care doctors, especially antipsychotics, especially to kids)?

4) Why should we not worry about the unintended forensic complications of a sloppily written DSM 5 containing suggestions that are obvious targets for forensic misuse?

5) Won't the many small, needless, and arbitrary changes in DSM 5 complicate future research efforts and make impossible the interpretation of data collected before vs after DSM 5?

None of the five questions gets anything approaching a real answer. Instead Dr Regier tells us that:

1) "We hear your concerns and are aware of those from others in the mental health field, and take them under serious consideration in our deliberations".

But if APA really heard our concerns, there would be an immediate independent scientific review to allay them. What possible excuse is there for not taking the one obvious step that will make DSM 5 credible?

2) Dr Regier assures us not to worry about the radical DSM 5 suggestions, promising "a rigorous test-retest design to assess the reliability and clinical utility of proposed criteria ... in 11 academic field trial centers." "The full range of disorders will be assessed in this field trial and the findings will contribute to the final decisions about the diagnoses."

But, simply stated, the field trials are completely useless for DSM 5 decision making. They failed to ask and therefore cannot begin to answer the only really important question- what will be the effect of DSM 5 on the rates of mental disorder? Will DSM 5 mislabel as mentally ill millions of people who have problems that are just part of the human condition. And experience teaches us that results generated in academic centers often have nothing at all to do with how DSM is actually used (and often misused) in the real world.

3) Dr. Regier goes on to admit the obvious- that the new DSM 5 proposals are not based on anything resembling adequate research: "However, a lot of this has not been tested as well as we would like." "Some of these fixes are not as well studied as others and we recognize that. But we can't move forward without some of these put into practice. So we think this is a much more testable set of scientific hypotheses." "And that's what the DSM is - a set of scientific hypotheses that are intended to be tested and disproved if the evidence isn't found to support them."

There could not possibly be any more eloquent testimony to exactly where DSM 5 has gone badly and dangerously off the tracks. DSM 5 most definitely should not harbor the ambition of providing a set of 'scientific hypotheses' created by and for researchers to encourage further testing of their pet ideas. DSM 5 is not at all meant to be a program setting forth 'scientific hypotheses' to guide future research. Instead, DSM 5 is a guide to current clinical practice that will have a crucial impact on the lives of the people misdiagnosed- they will often be hurt, sometimes badly hurt, by receiving unnecessary medicine and unnecessary stigma. Recent experience proves that children will be particularly vulnerable to the mislabeling that will follow this exercise in DSM 5 'hypotheses testing.' To say nothing of the misallocation of resources away from the truly ill (who desperately need them) and toward the worried well (who often will be more harmed than helped). There is no conceivable excuse for conducting what amounts to an uncontrolled public health experiment just so the DSM 5 researchers can further the testing of their pet ideas.

4) Dr Regier is fond of calling DSM 5 a "living document that can be revised regularly." "We're thinking of having a DSM-5.1, DSM-5.2, etc". The implication of this 'living document' concept is chillingly out of touch with the perils of clinical reality. Although he doesn't come right out and say it, Dr Regier seems to be reassuring us with something like- Don't you worry if our untested hypotheses get it wrong now, we can always fix it up later. This blithely ignores the needless and sometimes dangerous medication side effects and stigma to be endured by those who are mislabeled by the premature and untested DSM 5 'scientific hypotheses'. The makers of DSM 5 have forgotten the most important injunction in medicine - the Hippocratic First Do No Harm.

What needs to be done? In the short term, APA has only two choices- submit DSM 5 to external review or drop the most dangerous suggestions. Otherwise DSM 5 risks not being trusted and not being used by mental health clinicians.

For the future, the lesson couldn't be clearer- never again allow researchers the freedom to turn DSM into a plaything for their pet 'scientific hypotheses'. The DSM's are not meant to be a casually undertaken experiment. They have become far too important an influence on clinical practice and public health policy. DSM 5's radical ambitions have failed- it attempted to fly too high and now must come back to earth.

If you agree we me that the APA defense of DSM 5 is much more troubling than reassuring, consider signing the petition requesting reform at:
http://www.ipetitions.com/petition/dsm5/

Number of Children on Antipsychotic Drugs Doubles

2011-11-10T18:32:00.000-08:00

Victor MacDonald at Channel 4 News reports:

The number of children - some as young as five - being prescribed powerful antipsychotic drugs has doubled in the past 10 years, according to an investigation by Channel 4 News.

As many as 15,000 children and young people under the age of 18 were prescribed this medication last year. But these figures are only from GP surgeries and primary care trusts and do not include hospital prescribing, which suggests the true number could be far higher.

Astonishingly, no official data is kept on the number of youngsters being given anti-psychotics. This has only now been revealed after Channel 4 News commissioned a drug database company to collate them.

The investigation comes as the government announced that GPs could face jail if they are found to be "chemically coshing" elderly patients with dementia. But no mention was made of children and young people in the announcements.

Anti-psychotics are meant for patients with serious mental conditions such as schizophrenia, bipolar disorder and psychosis. But mental health experts now say that they would also appear, in some instances, to be being used to control children's behaviour.

The investigation also found children are being left on the drugs for years at a time and are not being properly monitored, which is against best practice guidelines.

Professor Tim Kendall, who has been asked to write the first ever guidance on prescribing anti-psychotics to young people with serious mental illness, said that these findings are extremely concerning.

"As far as I am aware there is no evidence that there has been a doubling in the rate of psychosis. So if there is a doubling in the rate of children being given anti-psychotics, that is a worry," Prof Kendall said.

"My worry is that these drugs are being used for other purposes."

Family stories

And that would be appear to be what is happening. We have spoken to families whose children have been given the drug for attention deficit hyperactivity disorder (ADHD) and for autism.

The family of one young boy first prescribed an anti-psychotic when he was five for so-called "challenging behaviour" has subsequently been told that he was in fact in pain. The boy, now aged eight, is autistic and regularly banged his head against hard surfaces and lay on the floor kicking and screaming. But his parents said the anti-psychotics he had been on for three years had had no benefit at all.

Eventually he was seen by Professor Chris Oliver, of Birmingham University, who has been researching behavioural problems in children with autism. His conclusion was that the young boy was most probably in pain - suffering from gastro-oesophageal reflux, more commonly known as heartburn. But because of his autism he was not able to articulate that he was physically suffering.

Anti-psychotics were developed in the 1950s and have been widely prescribed to adults since the 1970s. But they can cause, among other things, dramatic weight gain, diabetes and heart disorders. They can also leave patients with a Parkinson's disease-like tremor which does not stop even if they are taken off the medication.

What nobody knows with any certainty, though, are the long-term effects on children. And all approaches made to authorities here to find out if there is any data on trials involving children have been blocked by the pharmaceutical companies.

Prof Kendall was even hampered by America's Food and Drug Administration, which does hold data on any trials conducted on anti-psychotics. When he requested access to the information he was told to put in a freedom of information request.

"If there are trials that are unpublished, what that means is there will either be trials which show the drugs work as well as we think or in fact they might be even more harmful than we think," he said.

"I am appalled, absolutely appalled. This data should be available for people such as us who are working on behalf of the NHS, patients and parents."

In a statement the Association of the British Pharmaceutical Industry told Channel 4 News: "The industry is committed to being as open and transparent as possible in its disclosure of information."

It added that any prescription of anti-psychotic drugs to children "will only occur after careful consideration and risk-benefit assessment by the health care professional on a case by case basis."

Of concern to a growing number of experts is the effect they have on developing brains. They said proper monitoring was essential. But Channel 4 News has obtained a confidential report into the way mental health trusts look after children and young people on anti-psychotic drugs. It found there was "no evidence" whatsoever that some young people are being properly monitored.

'No monitoring at all'

A young girl (her family did not want her identified) we met was put on the medication at the age of nine after she developed psychosis. It is agreed that she needed help, but her father said that he had been unprepared for the effect the anti-psychotic would have on his daughter.

"I was not told how dangerous this drug was," he said. "There was no monitoring at all."

The father said that his daughter lost her memory, could not dress herself, even needed help brushing her teeth.

I was not told how dangerous this drug was. Father of girl prescribed antipsychotics

"You have to get a hold of their hand and walk them everywhere, their thinking is so muddled and the increase in appetite is incredible," he said.

"She would eat raw sugar out of the packet. She would go through a whole bottle of ketchup."

After intervention she has now had her dosage and medication changed and is also receiving intensive therapy. Her behaviour is beginning to improve.

Professor Peter Tyrer, who is an expert in the use of anti-psychotics, said that the unmonitored use of this medication is a "slow fuse to disaster". Prof Tyrer, from Imperial College in London, said that drugs affect almost every part of the body.

"This is particularly alarming because of course children have got their whole lives ahead of them."

Chemical cosh?

What is also alarming experts is that these drugs are being used for the wrong reasons. While nobody disputed that they are sometimes needed and can, indeed, save lives, there is the fear that too often they are being used as a chemical coshttp://www.blogger.com/img/blank.gifh.

A Department of Health spokesperson told Channel 4 News: "NICE guidance states that children and adolescents should only be given antipsychotics following specialist assessment and they should be under specialist supervision.

"For children suffering from severe psychotic illnesses, appropriate drugs can help both the child and his or her parents live a more normal life, and in some cases this can mean the difference between a child going in to care or living at home.

"The government is committed to improving children's mental health and has recently announced £32million to provide access to effective psychological therapies specifically designed for children and young people."

FULL ARTICLE HERE.

Psychologists Challenge Proposed New Diagnoses in DSM-5

2011-11-09T19:35:00.000-08:00

Rita Rubin at USA Today reports:

The next edition of the American Psychiatric Association's diagnostic bible will lead to millions of healthy people being labeled with a mental disorder and treated with potentially dangerous drugs, some psychologists say.

They've drawn up an online petition urging the group to reconsider adding a number of diagnoses to the fifth edition of the Diagnostic and Statistical Manual (DSM-5), to be published in 2013.

Among the disorders the petition calls "unsubstantiated and questionable" are "apathy syndrome," "Internet addiction disorder" and "parental alienation syndrome."

The petition, posted Oct. 22, now has more than 5,000 signatures, says David Elkins, president of the Society for Humanistic Psychology and professor emeritus at Pepperdine University.

Most additions aren't supported by published scientific research, he says.

Children and the elderly are particularly vulnerable to being mislabeled with a mental illness, he says. For example, the DSM-5 proposes adding the diagnosis "mild neurocognitive disorder," which could lead doctors to prescribe medication to older patients experiencing the normal age-related decline in mental ability.

One of the most outspoken critics of the proposed changes is psychiatrist Allen Frances, who chaired the task force behind the last update, in 1994.

Psychiatric medications "are very useful when used appropriately," says Frances, professor emeritus of psychiatry at Duke University.

But, he says, the DSM-5 proposes about a dozen "really bad" changes that could lead to over-prescribing.

"They are all tremendously well-meaning," Frances says of the DSM-5 task force members, both psychiatrists and psychologists. "They are not doing it because they are in bed with drug companies. What they are totally naïve about is how the things in the book are transformed in actual practice."

Frances and Elkins are calling for an independent scientific review of the proposed changes in DSM-5.

It is the first to be developed in the Internet age, so the public has been able to read drafts and post comments online, at www.DSM5.org.

On Friday, the task force posted a response to the petition. Some newer diagnoses, it says, are still being tested in "field trials" at academic centers and in "routine clinical practice settings" by psychologists, social workers, counselors and psychiatrists.

The task force will open the website for public comment one final time next year, according to the posting.

FULL ARTICLE HERE.

SIGN THE PETITION HERE!!!

Response to Letter from DSM-5 Task Force and the American Psychiatric Association

2011-11-07T20:21:00.000-08:00

ATTENTION:
David J. Kupfer, M.D., Chair of DSM-5 Task Force
Darrel A. Ragier, M.D., M.P.H., Vice Chair of DSM-5 Task Force
John M. Oldham, M.D., President of the American Psychiatric Association
Dilip V. Jeste, M.D., President-Elect of the American Psychiatric Association
Roger Peele, M.D., Secretary of the American Psychiatric Association

To the DSM-5 Task Force and the American Psychiatric Association:

Thank you for your response to the Open Letter that was composed by the Society for Humanistic Psychology (Division 32 of the American Psychological Association) and endorsed by over 4,600 individuals and 17 organizations, including nine other divisions of the American Psychological Association. In this context, it should be noted that the American Psychological Association itself has not taken a position on this matter other than to encourage its members to participate in the DSM-5 development process. It is our understanding that President Melba Vasquez will be responding to your letter separately on behalf of the American Psychological Association. We are writing on behalf of the Society for Humanistic Psychology Open Letter Committee to express our gratitude that the Task Force has opened a public dialogue about these issues and to let you know that we are happy to share your letter with our membership. We are pleased that the Task Force will consider the issues we described in our Open Letter as well as those raised by others in the mental health field.

However, we remain deeply concerned about the issues we raised and find that your response did not adequately address them. Our main concerns include:

(1) The lowering of diagnostic thresholds, which may artificially inflate the prevalence of numerous disorders. By increasing the number of people who qualify for a diagnosis, DSM-5 may lead to the excessive medicalization and stigmatization of normative or transient distress.

(2) The potential consequences of lowered thresholds and new disorder categories on vulnerable populations such as children and the elderly. These populations are already at risk for excessive and inappropriate treatment with medications that have dangerous side effects. We are particularly concerned about the overuse of medications for “Attenuated Psychosis Syndrome,” “Disruptive Mood Dysregulation Disorder,” “Mild Neurocognitive Disorder,” Attention Deficit/Hyperactivity Disorder, and Generalized Anxiety Disorder.

(3) The lack of scientific evidence substantiating many of these new proposals.

Our rationale for these concerns can be found in our open letter, which is available at http://www.ipetitions.com/petition/dsm5/ for all interested mental health professionals to sign.

Although we appreciate your explanations of the Task Force’s activities, we did not find them sufficient to address our concerns for the following reasons:

• A single set of field trials, no matter how large and diverse the sample size, is not an adequate replacement for a body of scientific literature that is built over time through the contributions of multiple and independent researchers. Many of the newly proposed disorder categories lack this important and critically necessary body of scientific support.

• Though reliability and utility are important, we are also concerned about validity and potential social consequences. As you know, increasing the number of people who qualify for a psychiatric diagnosis may lead to epidemiological inflation and, as a consequence, the inappropriate medication and stigmatization of individuals with normative conditions. It also leads to ethical and moral concerns about our professions.

• Though we are pleased to learn you are not considering the inclusion of several conditions proposed by outside sources (such as Parental Alienation Disorder), it would help to avoid confusion if you removed these conditions from the list of DSM-5 considerations at your website (where they still appear as of 11/7/11): http://www.dsm5.org/proposedrevision/Pages/Conditions-Proposed-by-Outside-Sources.aspx

• We do not assume that the Task Force is intentionally deemphasizing social and psychological explanations. However, the proposed language deemphasizes social and psychological explanations and may lead to the pathologization of sociopolitical deviance. We emphasize again that the Stein et al. definition of mental disorder would result in the scientifically unsubstantiated reduction of all DSM-defined disorders to biological bases.

• We are aware that the DSM-5 Task Force and Work Groups include not only psychiatrists but also some psychologists and other mental health professionals. However, these teams represent a highly selective and circumscribed group of academic mental health professionals whose experiences differ from those of mental health professionals working in the field on an everyday basis. The purpose of the open letter is to represent the wide spectrum of voices in our community.

We believe it is important that the Task Force give serious consideration to the public feedback by thousands of mental health professionals and others who have signed the open letter to date. The open letter’s list of individual and organizational signatories continues to grow. As of today, we have over 4,600 individual signatures as well as endorsements from the following organizations: Behavioral Neuroscience and Comparative Psychology (Division 6 of the American Psychological Association), the Division of Developmental Psychology (Division 7 of the American Psychological Association), the Society for Community Research and Action: Division of Community Psychology (Division 27 of the American Psychological Association), Psychotherapy (Division 29 of the American Psychological Association), the Society for the Psychology of Women (Division 35 of the American Psychological Association), the Division of Psychoanalysis (Division 39 of the American Psychological Association), Psychologists in Independent Practice (Division 42 of the American Psychological Association), the Society for Group Psychology and Psychotherapy (Division 49 of the American Psychological Association), the Society for the Psychological Study of Men & Masculinity (Division 51 of the American Psychological Association), the Association for Women in Psychology, the Society for Personality Assessment, the Society for Descriptive Psychology, the UK Council for Psychotherapy (UKCP), the Constructivist Psychology Network (CPN), the Taos Institute, Psychoanalysis for Social Responsibility (Section IX of Division 39 of the American Psychological Association), and the Association for Counselor Education and Supervision (Division of the American Counseling Association). In addition, some are now considering a consumer petition that could tap into the concerns of hundreds of thousands of consumers. We believe you are also aware that the British Psychological Society (nearly 50, 000 members), the American Counseling Association (45,000 members), and two previous chairs of DSM Task Forces have also raised concerns about the current proposals for DSM-5.

Again, we appreciate the Task Force’s assurance that the concerns expressed in our open letter will be taken into consideration. However, we believe these concerns to be of sufficient gravity to warrant more than confidential deliberations among those who invented and supported the problematic proposals. Further, the scientific review of DSM-5 conducted by the American Psychiatric Association was internal, and both the methods and findings of that review remain completely undisclosed to the public.

In view of the above concerns, as well as the unprecedented level of criticism of DSM-5 as currently proposed, we respectfully request an external review of the DSM-5 proposals by scientists and scholars who are not appointed by or affiliated with the American Psychiatric Association. We believe that only such an external review (alongside the implementation of any revisions recommended by the reviewers) will assure the mental health professions that DSM-5 is credible and safe to use.

For the future welfare of our clients/patients, as well as for the credibility of our professions, we hope you will submit the DSM-5 to independent, comprehensive, and scientific review.

Yours sincerely,

David N. Elkins, Ph.D.
President, Society for Humanistic Psychology, Division 32 of the American Psychological Association

Brent Dean Robbins, Ph.D.
Secretary, Division 32, Society for Humanistic Psychology, American Psychological Association

Sarah R. Kamens, M.A.
Doctoral Candidate in Clinical Psychology, Fordham University, Student Representative, Division 32

Note: User comments are disabled for this blog entry. Questions and concerns can be directed to Brent Dean Robbins, Ph.D., brobbins@pointpark.edu -- BDR

Petition Calls for Critical Changes to Upcoming DSM-5

2011-11-05T09:04:00.000-07:00

Group Says It Has 'Serious Reservations' About Lowering Diagnostic Thresholds

Deborah Brauser at Medscape Today reports:

Divisions of the American Psychological Association have created an online petition addressing "serious reservations" about the upcoming Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Launched October 22, the petition has already garnered more than 3000 signatures from mental health professionals, students, and organizations.

Formatted as an "Open Letter" to the DSM-5 task force of the American Psychiatric Association, the document questions the new manual's "lowering of diagnostic thresholds for multiple disorder categories, about the introduction of disorders that may lead to inappropriate medical treatment of vulnerable populations, and about specific proposals that appear to lack empirical grounding."

The American Psychological Association's Division 32 (the Society for Humanistic Psychology) sponsored the petition in alliance with divisions 27 and 49 (the Society for Community Research and Action: Division of Community Psychology and the Society for Group Psychology and Psychotherapy, respectively).

According to David N. Elkins, PhD, president of the Society for Humanistic Psychology, the petition was created to get attention from a task force that has "become very insular" and has not addressed many of the concerns raised by several organizations, including the British Psychological Society and the American Counseling Association.

"We basically put this together to urge the DSM-5 committee to reconsider some of the diagnostic categories they are proposing," Dr. Elkins, who is also a professor of psychology at Pepperdine University in Los Angeles, California, told Medscape Medical News.

Medscape Medical News approached the American Psychiatric Association, which sponsors the DSM-5, for comment, but the association declined. "The APA is not offering comment on the petition," said the association's media spokesperson, Erin Connors.

Unresponsive to Public Feedback

Increasing the number of people who qualify for a diagnosis may lead to excessive medicalization and stigmatization of transitive, even normative distress.

When asked why the petition has been released at this late stage in the manual's revision process, Dr. Elkins said that although the task force has invited public feedback on its Web site, it has not been very responsive to the concerns received.

"With the manual scheduled to come out in 2013, it's getting to the point that if something isn't done, and done rather quickly, we're going to have a DSM-5 that has some things that we believe are dangerous to certain populations and could contribute significantly to the problems of diagnosing normal people, and kids, and the elderly with a mental disorder," he said.

"That said, we support the DSM-5 and remain hopeful that it will be modified where it needs to be."

Dr. Elkins said that when the petition was first created, the hope was it would persuade the DSM-5 task force to listen to feedback from clinicians who will be using the manual.

"We hope that they will address and make changes to really just a few areas, but very, very important areas."

Calling the DSM-5's proposal to lower diagnostic thresholds "scientifically premature," the petition states: "Increasing the number of people who qualify for a diagnosis may lead to excessive medicalization and stigmatization of transitive, even normative distress." Areas of particular concern include:

--questions about attenuated psychosis syndrome,
--the proposed removal of the bereavement exclusion from major depressive disorder,
--the reduction in criteria needed to diagnose attention deficit disorder, and
--the reduction in necessary diagnostic criteria and symptom duration for generalized anxiety disorder.

Unintended Consequences

Sarah R. Kamens, a doctoral candidate in clinical psychology at Fordham University in New York City, and student representative to the American Psychological Association's Division 32, said that some of the responses from the DSM-5 task force have not adequately dealt with issues brought up during the public feedback sessions.

For example, she said that attenuated psychosis syndrome started out as psychosis risk syndrome.

"There's this idea that if you identify people early, somehow you'll be able to prevent a full-blown psychosis or full-blown schizophrenia. But research has shown that only up to 20% to 30% of identified people actually went on to develop psychosis, meaning up to 70% or 80% of these people received treatment for a disorder they never ended up developing," said Ms. Kamens.

"But in response to those concerns, the DSM-5 group just changed the name, which wasn't really the point. Overall, we're looking at a risk–benefit analysis with primary prevention vs medicating people who are really closer to that threshold of normality."

Dr. Elkins said that overmedication of vulnerable populations remains one of their biggest concerns with the upcoming manual.

"We don't believe the DSM-5 committee intentionally wants to hurt children or the elderly. In fact, I think their rationale and their efforts are coming from very good intentions. But we just disagree with them in terms of what the unintended consequences will be."

Lack of Evidence?

In addition, the petition cites "lack of empirical grounding" for its concerns with the proposed reorganization of the personality disorders section of the manual. "It appears to be a complex and idiosyncratic combined categorical-dimensional system that is only based on extant scientific research."

This is an issue that is especially critical to Brent Dean Robbins, PhD, director of the psychology program at Point Park University in Pittsburgh, Pennsylvania, and secretary of Division 32.

"Personally, I would like to see an emphasis on changes that are backed up by substantial empirical evidence, not just one single research group or one single university," said Dr. Robbins.

"I'd also like to see it leaning in the direction of caution, towards not pathologizing 'normal' kids, but more clearly delineating between those who really need help from medication or from therapy and those who do not."

CONTINUE TO FULL ARTICLE HERE.

Allen Frances: Why Psychiatrists Should Sign the Petition to Reform DSM 5: The Fight for the Future of Psychiatry

2011-11-05T08:56:00.001-07:00

Allen Frances at Psychology Today reports:

Psychiatrists may be more reluctant than are other mental health clinicians to sign a petition questioning the safety and value of DSM 5. After all, it is the American Psychiatric Association that is sponsoring DSM 5 and there is a natural tendency to want to trust the wisdom of one's own Association. We also tend to feel the greatest loyalty to our profession when it seems to be under sharp attack from without.

All this is completely understandable to me. I have not felt the least bit comfortable assuming the role fate assigned me as critic of DSM 5 and of the APA. It was a case of responsibility calling and my feeling compelled to answer. If DSM 5 were not proposing some really dangerous changes, I would have stayed comfortably on the sidelines. But I think DSM 5 is too risky to ignore and that all psychiatrists should feel the same call that I did to restrain it before it is too late.

What needs to be done to get a safe and credible DSM 5? Clearly, an independent review is needed to evaluate about a dozen of the most radical DSM 5 proposals- the ones that are bad for patients and bad for the credibility of APA and psychiatry. The petition urges that APA to take the necessary step of reevaluating the most questionable proposals before they are set in stone. The APA's own internal review process has failed to be rigorous or independent enough to convince anyone outside of the small (and out of touch) circle of the DSM 5 and APA leadership.

Here are some of the issues that scare me about DSM 5 and I think should also scare you:

1) DSM 5 is suggesting many new and untested diagnoses and also markedly reduced thresholds for old ones. This will result in inaccurate diagnosis, massive diagnostic inflation, unnecessary stigma, harmful misuse of medications, and misallocation of resources.

2) Overprescription of psychotropic medications (particularly by primary care physicians) is already out of control. Remarkably, antipsychotics have become the number one revenue producer of all classes of drugs. Antidepressants are fourth and antianxiety meds are eighth. 11% of the population are on antidepressants; 4% of kids are on stimulants. There are now more ER visits for overdoses with prescription meds than with street drugs. Most of the prescribing is done by primary care docs who have little training, no time, and are susceptible to drug company 'education' and patient pressure. Psychiatrists must take the lead in advocating for more careful diagnosis and responsible prescribing habits. The DSM 5 suggestions all go in just the wrong direction of promoting loose diagnosis and loose prescribing.

3) DSM 5 has been sloppily organized and wastefully done. Every single deadline has been badly missed- leading to a mad rush at the end. The field trials will cost APA several million wasted dollars and will yield no useful information. The scientific review has been cursory and has no credibility. The extended persistence of really foolish suggestions is a great embarrassment to DSM 5 and to APA.

4) The APA leadership has been passive and unresponsive to warnings that DSM 5 has been running off the rails. They will awake from their leaden stupor and take responsible fiduciary action only under pressure from the membership.

You may be asking yourself - how could Frances possibly be right and all those DSM 5 experts be so wrong? The answer is simple. The people preparing DSM 5 are well meaning, smart, and expert in their highly specialized fields- but they are mostly ivory tower research types who have not had much real world clinical experience and don't understand what will be the unintended consequences of their DSM 5 suggestions. Bob Spitzer and I have been through the mill with DSM III, DSM IIIR, and DSM IV and know what are the pitfalls and dangers- because we have lived through them. DSM 5 has been running blindly into a whole series of unnecessary minefields and is paying a heavy price for its inability to chart a safe course.

Here is the worst example among many bad DSM 5 suggestions for new diagnoses (indeed,this is the one that got me alarmed enough to speak up 2 years ago). 'Attenuated psychosis syndrome' will have a ridiculously high false positive rate ( 80-90%), no effective treatment, would promote unnecessary exposure to harmful antipsychotics, and would cause needless worry and stigma. Since studies prove conclusively that the symptoms are so very rarely predictive of psychosis, why in the world would DSM 5 give someone the stigmatizing and absurdly misleading label 'attenuated psychosis syndrome' and open the door to inappropriate antipsychotic use. Recognizing all these risks, a large portion of schizophrenia and prodromal researchers are sensibly opposed to the inclusion of 'attenuated psychosis syndrome' in DSM 5. But unaccountably, the work group stubbornly clings to its proposal and, without the petition, there is a good chance it may sneak into DSM 5.

This one really dreadful proposal should be enough to motivate your signing the petition, but there are a dozen more that are almost as frightening. And the other DSM 5 workgroups have been equally intransigent in defending proposals that are almost equally indefensible.

I am just one among many, many psychiatrists who fear the negative impact of a misguided DSM 5 on our patients and profession. The Society Of Biological Psychiatry published an editorial suggesting DSM 5 be scrapped. All psychiatrists who care about personality disorders are appalled by the DSM 5 personality disorders section. And here is a telling statement made by James Dillon, MD as he was signing the DSM 5 petition:

"I am the chief psychiatrist in the Department of Community Health for Michigan... I will be discussing with my colleagues the merit of abandoning the DSM altogether in favor of the ICD system if DSM 5, as currently proposed (It is November 2011), is formally adopted."

The APA leadership must hear from the members it is supposed to represent just how alarmed they are by the reckless DSM 5 proposals and the embarrassment they are causing our field.

What are the risks to DSM 5 and to APA if DSM 5 is not reformed? Unless corrected, DSM 5 will be bad for patent care, may cost APA stewardship of future DSM revisions, and will do grave harm to the credibility of APA and psychiatry. The APA leadership has been asleep at the wheel and should never have allowed DSM 5 to become such a public embarrassment.

But what is the most compelling reason for signing the petition to reform DSM 5? This is easy. Our first responsibility as physicians is to DO NO HARM!!! DSM 5 will do grave harm to the people who are misdiagnosed and then often receive unnehttp://www.blogger.com/img/blank.gifcessary medication (especially the widely overprecribed antipsychotics that can cause such dangerous weight gains).

On a personal note, I was enjoying a peaceful and happy beach retirement and had several times resisted Bob Spitzer's early entreaties to join him in pointing out that DSM 5 was headed for serious trouble. I saw it as Bob's fight, not mine. Only years later was I forced to speak when it became clear that the harm caused by DSM 5 was too egregious to ignore. I have complete empathy for anyone who prefers the sidelines- I'd like to be there myself. But this one is not a close call and it is important that we all do the right thing for our patients and for psychiatry.

The petition can be accessed at:
http://www.ipetitions.com/petition/dsm5/

Elements of the Proposed DSM 5: From Travesty to Potential Tragedy

2011-11-05T08:06:00.000-07:00

Speaking out on behalf of millions of unsuspecting grievers

Russell Friedman at Psychology Today reports:

The intent of this blog post is to encourage you to read and sign a petition titled, Open Letter to the DSM-5. We are particularly focused on the proposed change in the bereavement exclusion which is one of the major protests in the petition. You can skip the blog and go directly to the petition: http://www.ipetitions.com/petition/dsm5/

From Travesty to Potential Tragedy

The Dangerous DSM-5 Bereavement Exclusion Train Must Be Derailed BEFORE It Causes Permanent Harm To Unsuspecting Grievers

We are: John W. James and Russell Friedman, co-founders of The Grief Recovery Institute Educational Foundation, and co-creators of The Grief Recovery Method®. We are also co-authors of The Grief Recovery Handbook and When Children Grieve [both published by HarperCollins] and Moving On [M. Evans].

Our experience: Over the past 30 years we've had direct contact with more than 100,000 grieving people, the vast majority of whom contacted us because of the impact of the death of someone important in their lives. Through our books—which are translated into 15 languages, and our media and public appearances, millions more have seen and heard us talk about the fact that grief is the normal and natural reaction to loss, and that recovery from significant emotional loss is actually possible. Additionally, through our network of more than 5000 Certified Grief Recovery Specialists®, our Method has helped more than 500,000 grieving people.

Frankly, we don't know of any other individuals or organizations that have the practical experience in listening to and helping grieving people. Therefore, in the matter of the proposed changes to the bereavement exclusion to be included in the DSM 5, we believe that our voices should be heard.

The topic at hand relates to one of the proposed changes from the current DSM IV to the next version, DSM5 scheduled for publication in May of 2013. In particular, we are gravely concerned about the proposal that would endorse and condone diagnosing a newly bereaved person—within the first two weeks, post loss—as having a Major Depressive Episode [MDE] when they are exhibiting normal bereavement reactions.

For those of you who are not familiar with the topic, we are talking about the proposed changes to the Diagnostic and Statistical Manual of Mental Disorders-and therein lies the problem.

"Grief is the normal and natural reaction to loss. Of itself it is neither a pathological condition nor a personality [or mental] disorder." [From page 47 of The Grief Recovery Handbook.]

An Explanation By A Former DSM Contributor

Here's a simple explanation about the DSM 5 bereavment exclusion debacle according to Dr. Allen Frances:
http://www.blogger.com/img/blank.gif
"So the test case is someone who has lost a spouse or child and has just two weeks of sadness and loss of interest, appetite, sleep, and energy. Such a person would have to be diagnosed with MDE if we were to follow the DSM 5 suggestion to simply remove the Bereavement exclusion."

[Allen Frances, M.D., was chair of the DSM-IV Task Force and is currently professor emeritus at Duke. He has many other bones to pick with the DSM-5. Read more about them on his Psychology Today blog - http://www.psychologytoday.com/blog/dsm5-in-distress/201110/psychologists-start-petition-against-dsm-5 ]

The Grief Recovery Institute's Reaction

For us, when a book devoted to Mental Disorders refers to the normal and natural reaction to grief-producing events as pathological, we are up in arms. Granted we have disagreements with our friends and colleagues about if and when grief ever becomes pathological, and what to call it, but we are in total union with them in opposing the proposed change in the bereavement exclusion.

We speak out here, not for ourselves, but on behalf of millions of unsuspecting grievers who will be diagnosed as having had a MDE and placed on an array of psychotropic drugs within two weeks of the death of someone who had meaning in their life. This will happen solely because they may have mentioned that they had any of the normal and natural reactions to that death, and not because they have exhibited or been tested for any signs of clinical depression.

This is insanity—and worse. Keep in mind that we're talking about a trusting citizen who goes to a doctor or mental health professional, tells the truth about how he or she feels, and then has that trust betrayed by being falsely diagnosed as depressed and then placed on meds. Those meds will essentially cover up the normal and natural feelings that might be helpful in effectively communicating about the natural emotions triggered by the loss.

Real Life Example

Imagine a brand new widow or widower whose spouse of 50 years has just died. Think about what it might feel like after 18,250 consecutive days of living with, eating with, sleeping with that person, and he or she is no longer there.

Does it make sense that that person would have some emotional and physical reactions to that incredible change in their personal universe? Think about it from an even more logical perspective. Does it make any sense at all that that person would NOT have a reaction to the death? After all, their universe is upside down, so it only makes sense that they might be sad, confused, have a hard time concentrating, struggle with eating or sleeping patterns, and be on an emotional roller coaster.

What the hyper-pathologically focused folks at the DSM 5 don't get is that the symptoms of normal and natural grief tend to be parallel to the symptoms of MDE. They are: sadness, confusion, lack of concentration, eating and sleeping issues, and wide ranging emotions.

The tragedy is that we have to remind the DSM people of that basic truth, and tell them not to confuse the two and diagnose normal bereavement responses as clinical depression.

Studies Say Guidelines Encompass Many Who Are Just Sad

A study of 8800 clients established that a large percentage of the grieving people diagnosed as depressed and placed on antidepressant drugs are NOT clinically depressed. The study suggests that those people would benefit far more from actions [like those of Grief Recovery-our comment] which can keep many of them from http://www.blogger.com/img/blank.gifdeveloping full blown depression. [National Comorbidity Study, Archives of General Psychiatry, volume 64, April, 2007, Wakefield, Schmitz, First, Horwitz, et. al.]

A more recent study concluded: Bereavement-related, single, brief depressive episodes have distinct demographic and symptom profiles compared with other types of depressive episodes and are not associated with increased risk of future depression. The findings support preserving the DSM-IV bereavement exclusion criterion for major depressive episodes in the DSM-5. [Bereavement-Related Depressive Episodes - Characteristics, 3-Year Course, and Implications for the DSM-5 , Ramin Mojtabai, MD, PhD, MPH, Archives of General Psychiatry, Vol. 68 No, 9 September 2011.]

ARTICLE HERE.

Nature News: Mental-Health Guide Accused of Overreach

2011-11-04T22:12:00.000-07:00

Heidi Ledford at Nature News reports on the Division 32 led petition, "Open Letter to the DSM-5":

Psychologist David Elkins had modest ambitions for his petition. He and his colleagues were worried that proposed changes to an influential handbook of mental disorders could classify normal behaviours as psychological conditions, potentially leading to inappropriate treatments. So they laid out their concerns in an open letter, co-sponsored by five divisions of the American Psychological Association in Washington DC. “I thought, 'Well, maybe we'll get a couple or maybe 30 signatures',” says Elkins, an emeritus professor at Pepperdine University in Malibu, California.

But the letter, posted online on 22 October (http://go.nature.com/uhmvqq), touched a nerve. Within 10 days more than 2,800 people had signed it, many identifying themselves as mental-health professionals.

The petition targets proposed revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a tome used by psychiatrists, psychologists, counsellors and others worldwide to diagnose mental maladies and set research agendas. The American Psychiatric Association, based in Arlington, Virginia, plans to publish a new edition of the manual, DSM-5, in 2013. The association has declined to comment on Elkins's petition.

Psychiatrist Allen Frances, who was the chief architect of DSM-IV and is an outspoken critic of its successor, has dubbed the open letter a “buyer's revolt”. “I think the petition is the last best hope to influence the DSM-5 from the outside,” says Frances, an emeritus professor at Duke University School of Medicine in Durham, North Carolina.

CONTINUE TO FULL ARTICLE HERE.

Allen Frances: DSM-5 Needs an Independent Scientific Review

2011-11-04T21:14:00.001-07:00

Allen Frances, MD, at Psychology Today reports:

After all this controversy and opposition, there is one thing (and one thing only) that will save the credibility of DSM 5 and guarantee its safety--a credible process of external scientific review. APA is conducting its own internal scientific review, but it strikes out badly on all four requirements that must be met before a review deserves to be taken seriously as a trustworthy stamp of approval.

The scientific review must be:

1) Open: But DSM 5 is engaged in the curious process of a confidential, secret scientific review. Real science and real scientific review are completely incompatible with secrecy.

2) Independent: But most of the people reviewing the much reviled DSM 5 suggestions have been closely involved in the development of DSM 5 and would have to recuse themselves if this were anything like an independent review.

3) Systematic: But the DSM 5 reviews show no method or thoroughness or consistency. Often most of papers cited were done by those making the proposals.

4) Rigorous: But the DSM 5 review process was discredited from its moment of birth. Its very first decision was to accept the scientific credentials of a new diagnosis invented six years ago and studied by just one group. This travesty could never have occurred were such an inadequate proposal exposed to external review.

The American Psychiatric Association has failed to explain why anyone should accept as credible an internal scientific review process that is so closed, homegrown, cursory, and forgiving. APA also offers no explanation why external review doesn't make complete sense. There is every reason for everyone to be extremely skeptical and to demand a real scientific review.

None of the radical and highly controversial DSM 5 suggestions should be accepted unless and until first subjected to a completely independent review of scientifific merit and a risk/benefit analysis of its likely impact on actual clinical practice. The most important outcome of the DSM 5 petition could be to smoke APA out on this issue and pressure it to invite outside review.

The DSM 5 petition is now about 11 days old and has been signed by almost 3500 people. In the first week the rate was about 250 people a day. In the last few days, the rate has grown to almost 500 per day. The petition is clearly gaining momentum. It can be accessed at ipetitions.com

FULL ARTICLE HERE.

Antipsychotic Drugs Increase Mortality

2011-11-04T21:06:00.000-07:00

Healthcare News reports:

Antipsychotic drugs are over prescribed to people with dementia, according to care services minister Paul Burstow.

Speaking at the National Dementia Congress yesterday, Mr Burstow claimed that the drugs are killing people by increasing the risk of strokes and other life threatening conditions.

The department claims 1,800 people die prematurely every year as a result of antipsychotic drugs.

Commenting on Mr Burstow's claims, the Alzheimer's Society stated: "This abuse must end. The government has had two years to find a way to significantly reduce these prescription levels.

"We need to see a mandatory review of antipsychotic prescriptions after 12 weeks put in place."

Scientific research has also confirmed that antipsychotic drugs increase the risk of death in people with dementia.http://www.blogger.com/img/blank.gif

Antipsychotic drugs are used to treat psychotic conditions, such as schizophrenia, but they are also used to control manic behaviour in dementia patients.

A Philadelphia study claims that both newer atypical antipsychotics and older conventional antipsychotics are associated with increased mortality. However, the highest risk is posed by older conventional drugs.

FULL ARTICLE HERE.

Antidepressant Use Up 400% in U.S.

2011-11-04T20:36:00.000-07:00

Janice Wood at PsychCentral reports:

The rate of antidepressant use in the United States increased nearly 400 percent over the last two decades, according to a report released Oct. 19.

The report from the Centers for Disease Control and Prevention’s National Center for Health Statistics found that 11 percent of Americans over the age of 12 takes an antidepressant, with about 14 percent taking the medication for more than 10 years.

The National Health and Nutrition Examination Survey found that antidepressants were the third most common prescription drug taken by Americans of all ages from 2005 to 2008 and the most frequently used medication by people between the ages of 18 and 44.

The study also found that women are two and a half times more likely to take antidepressant medication as males, while 23 percent of women ages 40 to 59 take antidepressants, more than in any other age or sex group.

Among both males and females, the study found that people aged 40 and older are more likely to take antidepressants than younger people.

The study also found that among those taking antidepressants, approximately 14 percent take more than one. While less than one-half of those patients had seen a mental health professional in the past year, the researchers did find that the likelihood of having seen a mental health professional increased as the number of antidepressants taken increased.

Other findings show that about 14 percent of non-Hispanic white persons take antidepressant medications, compared with 4 percent of non-Hispanic black and 3 percent of Mexican-American persons.

Researchers concluded that there is no difference by income in the prevalence of antidepressant use.

CONTINUE TO FULL ARTICLE HERE.

Searching for Meaning

2011-11-01T21:33:00.001-07:00

Existential-humanistic psychologists hope to promote the idea that therapy can change not only minds but lives.

Michael Price at the APA Monitor reports:

Many areas of psychology are great at answering such questions as how stress influences mood or why depression can lead to substance abuse. But what if you want answers broader than a diagnosis or a neurochemical explanation for why your brain does what it does? What if you want to know how to lead a fuller, richer life, not just change a problematic behavior?

You might consider existential-humanistic psychology, which seeks to give clients a greater awareness of how their constellation of pleasures, worries, thrills and anxieties all come together to form their experience of living.

What can existential-humanistic psychology offer?

"It asks about the meaning of life," says Louise Sundararajan, PhD, president of Div. 32 (Humanistic). "That term sounds kind of trite, but it's not."

Existential-humanistic psychology doesn't promise the answer to that question, she says, but it can help clients and other psychologists frame their questions about the larger issues at work behind depression, anxiety and other causes of mental angst and dissatisfaction with life. Many people want a more holistic experience that does more than address their symptoms, she says. They want a therapy that helps them know more about their lives and feelings.

To that end, humanistic psychologies draw from a range of philosophical approaches such as existentialism, feminism, postmodernism and constructivism, all designed to orient the study of the mind and behavior toward understanding what it means to a be a human being. Existential-humanistic psychology emphasizes the importance of human choices and decisions and feelings of awe toward life.

Put in a therapeutic context, existential-humanistic approaches to therapy emphasize the same factors that research suggests make any therapy successful, such as therapeutic alliance, empathy, the provision of meaning, the provision of hope and affective attunement, says Kirk Schneider, PhD, a psychologist and faculty member at Saybrook University and the Existential-Humanistic Institute in San Francisco, who advocates for the field. Schneider and his colleague Orah Krug, PhD, also at Saybrook, last year co-edited APA's first book about the field, "Existential-Humanistic Therapy." This fall, Schneider says, a partnership between Saybrook and EHI will launch the first nationally recognized certificate program in existential-humanistic practice.

What sets apart existential-humanistic psychology, Schneider says, is that all aspects of therapy are seen through the lens of a concept called presence. He describes presence as entering into a heightened awareness of yourself, opening yourself up to learning what truly matters to you and experiencing in the here-and-now the barriers to and opportunities for change that therapy offers.

"We try to work with everyone in as present a manner as possible — presence is essential to an existential approach," he says, for both clients and their therapists. "Presence helps us to understand and attune to the fuller ranges of a person's experience. … You learn to co-exist with your anxieties."
Meeting needs

Existential-humanistic psychology's roots go back several decades, to Rollo May, PhD, who helped found Saybrook University in San Francisco in 1971, and to the work of Abraham Maslow, PhD, who developed a hierarchy of human needs. Maslow, May and like-minded colleagues emphasized understanding the existential causes of mental distress rather than just focusing on symptoms.

Other modes of psychology aren't always as equipped to deal with such heady issues, believes Steven Hayes, PhD, a clinical psychologist at the University of Nevada, Reno, who focuses on mindfulness. Hayes hasn't traditionally been linked to existential-humanistic psychology — in fact, he's more often been identified as having behaviorist leanings. But in 2008, he contributed a chapter to a book edited by Schneider, "Existential-Integrative Psychotherapy," encouraging researchers and practitioners to home in on the more existential, client-focused elements of therapy, such as presence and therapeutic alliance. Many fields of psychology, he says, have specialized so much that while they're great at helping clients work through specific issues, an existential framework might work better to help clients see the big picture in their lives, if that's what they're looking for.

The fact that cognitive-behavioral treatments are beginning to incorporate aspects of meditation and mindfulness hints that psychology as a field is starting to buy into the existential-humanistic framework, says Bruce Wampold, PhD, a counseling psychologist at the University of Wisconsin–Madison and an expert on various modes of psychotherapy.

"It could be," he elaborates in a 2008 PsycCritiques article, "that an understanding of the principles of existential therapy is needed by all therapists, as it adds a perspective that might ... form the basis for all effective treatments." In fact, many of existential-humanistic psychology's insights might already be at work among mental health workers, according to a paper published in January in the Journal of Humanistic Psychology (Vol. 51, No. 1). In it, Elliot Benjamin, PhD, a mathematician and doctoral student studying humanistic psychology at Saybrook University, notes that the core ingredients of a humanistic approach — empathy, authenticity and dedication to creating a bond with a client — are frequently practiced by mental health professionals, whether they identify those as existential-humanistic practices or not.

The strength of a specifically existential approach, says Hayes, is that therapists can go beyond helping clients address their stated concerns and get at the roots of a client's cognitive distress. "It's one thing to label something as existential angst and it's another to know how to identify it in someone's life and … to understand where they came from in the first place, to learn why the modern world would give rise to anxiety," he says.

Barry Wolfe, PhD, a clinical psychologist in Rockville, Md., integrates existential and humanistic practices with other forms of therapy such as cognitive-behavioral therapy and psychodynamic therapy. In a typical session, he says, he'll first work to build a therapeutic alliance with his client, because that's the foundational step for any effective therapy. Next, he'll use cognitive-behavioral therapy to give people the tools to get past their fears and anxieties. But then he gives his clients a choice: whether to delve deeper into their anxieties and figure out what's ultimately behind them, or to stop there and leave them with their cognitive-behavioral tools.

Many people are just fine stopping at that point, he says. The existential-humanistic framework isn't universally applicable. Action-oriented people who want to know what to do to get over their insecurities and then move on with their lives don't care much about the root causes of those insecurities.

"But some people, not many but some, really do live inside their feelings," he says. "If they want to explore the roots of their anxieties, I'll shift focus. You have to work with the framework that the client brings."

Wolfe gives an example of a young, recently married woman who came to him seeking help for her driving phobia. As therapy progressed, he says, they discovered what was behind that phobia.

It turned out that her marriage was built on convenience and she regretted the fact that she'd never evolved into an independent person before she settled down.

"Her fear was that if she drove too far, she'd never come back home, she'd never come back to her marriage," Wolfe says.

So she felt trapped between her desire for independence and the time and energy she'd invested in her relationship. In other words, an existential crisis. They could have stopped therapy after providing her with the tools to get past her phobia, but she ultimately learned much more about herself, her emotions and needs by going deeper, he says.
Criticism and proof

Existential-humanistic psychologists consider their looseness and openness a strength, but their approach has also isolated the field somewhat from other forms of psychology that rely more on empirical evidence and quantifiable results.

Schneider says that, in the case of existential-humanistic psychology, a qualitative approach instead is often the most useful. "Existential psychology teases out deep, subjective shifts," he says, which are difficult to capture using quantitative methods.

But that doesn't mean that these issues can't be investigated and discussed from a more empirical point of view, Sundararajan says. Because it hasn't yet been done doesn't mean that it shouldn't be. "It's entirely possible to do both quantitative and qualitative [research]," she says. "And I think that you should do both."

Some researchers are, in fact, trying to quantify whether existential-humanistic approaches to therapy work, Hayes says. For example, an article published in December in Archives of General Psychiatry (Vol. 67, No. 12) found that mindfulness-based cognitive-behavioral therapy was as successful as antidepressants in preventing relapse in symptoms of major depressive disorder. But large-scale empirical testing of existential methods and the existential framework remains to be done.

That shouldn't stop clients and other psychologists from turning to the existential-humanistic framework to expand the range of their therapies and emphasize the importance of the big picture, though, Schneider says. That's a worthwhile and doable goal for anyone looking for more meaning in his or her life.

"If it's ignored, the whole question of what is meaningful in a person's life — and not just what is meaningful from an intellectual standpoint or from a culturally conditioned standpoint, but from that person's deep subjective point of view — could be overlooked," he says.

CONTINUE TO FULL ARTICLE HERE.

Eric Maisel, PhD: The DSM-5 Controversy

2011-10-28T19:22:00.000-07:00

Eric Maisel at Psychology Today reports:

Whole divisions of the American Psychological Association are up in arms about proposed changes that will appear in the new DSM-V that comes out in 2013.

Bereavement, which has always been excluded from the mood disorders, will become a mental disorder. Mild forgetfulness will become a mental disorder ("mild neurocognitive disorder"). Your child's temper tantrums will become a mental disorder ("disruptive mood dysregulation disorder"). Even preferring one of your parents to the other will become a mental disorder! (Yes, really: "parental alienation disorder").

You will need to display fewer and fewer symptoms to get labeled with certain disorders, for example Attention Deficit Disorder and Generalized Anxiety Disorder. Children will have more and more mental disorder labels available to pin on them. These are clearly boons to the mental health industry but are they legitimate additions to the manual that mental health professionals use to diagnose their clients?

Here are a few excerpts from the petition that is circulating among mental health practitioners. Regarding changes in the diagnosing of personality disorders:

It is particularly concerning that a member of the Personality Disorders Workgroup has publicly described the proposals as "a disappointing and confusing mixture of innovation and preservation of the status quo that is inconsistent, lacks coherence, is impractical, and, in places, is incompatible with empirical facts" (Livesley, 2010), and that, similarly, Chair of DSM-III Task Force Robert Spitzer has stated that, of all of the problematic proposals, "Probably the most problematic is the revision of personality disorders, where they've made major changes; and the changes are not all supported by any empirical basis."

Regarding the creation of new disorders:

The Conditions Proposed by Outside Sources that are under consideration for DSM-5 contain several unsubstantiated and questionable disorder categories. For example, "Apathy Syndrome," "Internet Addiction Disorder," and "Parental Alienation Syndrome" have virtually no basis in the empirical literature.

If you are a mental health professional and interested in signing the petition being circulated by three divisions of the American Psychological Association demanding that the DSM-V task force back off its efforts at creating millions of new mental patients, here is the place to go:

http://www.ipetitions.com/petition/dsm5/

If you are not a mental health professional but are concerned about these matters, please stay tuned. In this blog I'll be focusing on three things: how we currently conceptualize and "treat" mental disorders, why we should completely revamp and revision our views about "mental health," and how we can genuinely help people become happier and healthier. Let's be vigilant!

FULL ARTICLE HERE.

Remembering James Hillman (1926-2011)

2011-10-27T19:33:00.000-07:00

Psychology Today: Psychologists' DSM5 Petition Catching Like Wildfire

2011-10-27T12:20:00.000-07:00

Karen Franklin, Ph.D., at Psychology Today reports:

An online petition by psychologists concerned about the lack of science underlying proposed changes in the American Psychiatric Association's Diagnostic and Statistical Manual (DSM) is taking off like wildfire, with more than 1,100 signatures as of this morning.

The blaze of interest is especially remarkable because the petition was launched without any publicity at all, and has gained traction solely through word of mouth.

The coalition of psychologists is publicly urging the American Psychiatric Association to reconsider the mental illness expansions and biomedical emphasis proposed for the fifth edition of the DSM, due out in 2013. The DSM-5 will reify disorders with little empirical support, lower the threshold for mental disorder, and foreground a purely biological approach to mental illness.

coalition's online petitition comes on the heels of a similar public statement by the British Psychological Society, which I blogged about back in June.

The petition coalition expresses grave concern about the overemphasis on biomedical explanations for mental health problems, and the resulting overprescribing of dangerous psychiatric drugs...

Allen Frances, who chaired the task force of the previous DSM, the DSM-IV, and has been openly critical of the current process, said in an article in yesterday's Psychiatric Times that the APA plans no official response:

They hope to ride out the storm of opposition mounting on all sides and dismiss it as the work of professional rivals or antipsychiatry malcontents. Characteristically, DSM-5 offers no rebuttal based on evidence. Instead, it stubbornly soldiers on in its promotion of radical diagnostic changes that are risky, untested, unsupported by a strong science base, and vigorously opposed by the field.

Frances has another good commentary on the petition and its ramifications at his Psychology Today blog, DSM5 in Distress:

DSM 5 has lived in a world that seems to be hermetically sealed. Despite the obvious impossibility of many of its proposals, it shows no ability to self correct or learn from outside advice. The current drafts have changed almost not at all from their deeply flawed originals. The DSM 5 field trials ask the wrong questions and will make no contribution to the endgame.

But the DSM 5 deafness may finally be cured by a users' revolt. The APA budget depends heavily on the huge publishing profits that accrue from its DSM sales. APA has ignored the scientific, clinical, and public health reasons it should omit the most dangerous suggestions- but I suspect APA will be more sensitive to the looming risk of a boycott by users.

I encourage readers to view and sign this important petition, by clicking on the link below. You can also email the petition to others. So, spread the word.

CLICK HERE TO VISIT THE PETITION SITE.

READ FULL ARTICLE HERE.

Allen Frances, MD, Chair of DSM-IV, supports the Division 32 sponsored Open Letter to DSM-5

2011-10-25T22:05:00.000-07:00

Allen Frances, MD, writes at his Psychology Today blog:

Several divisions of the American Psychological Association have just written an open letter highly critical of DSM 5. They are inviting mental health professionals and mental health organizations to sign a petition addressed to the DSM5 Task Force of the American Psychiatric Association. You can read the letter and sign up at http://www.ipetitions.com/petition/dsm5/ It is an extremely detailed, thoughtful and well written statement that deserves your attention and support.

The letter summarizes the grave dangers of DSM 5 that for some time have seemed patently apparent to everyone except those who are actually working on it. The short list of the most compelling problems includes: reckless expansion of the diagnostic system (through the inclusion of untested new diagnoses and reduced thresholds for old ones); the lack of scientific rigor and independent review; and dimensional proposals that are too impossibly complex ever to be used by clinicians.

The American Psychiatric Association has no special mandate or ownership rights giving it any sovereignty over psychiatric diagnosis. APA took on the task of preparing DSM's sixty years ago because it then seemed so thankless that no other group was prepared or willing to do it. The DSM franchise has stayed with APA only because its products were credible enough to gain widespread acceptance. People used the manual only because it was useful.

DSM 5 has strained that credibility to the breaking point and (unless radically changed) will be much more harmful than useful. We have reached a turning point that will soon become a point of no return. A near final version of DSM 5 must be ready by next spring and all final wording will be set in stone within a year. Time is running out if DSM 5 is to be saved from itself.

CONTINUE TO FULL ARTICLE HERE.

Open Letter to the DSM-5 Task Force and the American Psychiatric Association

2011-10-22T14:39:00.000-07:00

The following open letter to the DSM-5 Task Force is sponsored by the Society for Humanistic Psychology, Division 32 of the American Psychological Association, in alliance with Society for Community Research and Action: Division of Community Psychology (Division 27 of APA) and Society for Group Psychology and Psychotherapy (Division 49 of APA). We invite institutions and mental health professionals to sign on in support of this petition to the DSM5 Task Force of the American Psychiatric Association.

To the DSM-5 Task Force and the American Psychiatric Association:

As you are aware, the DSM is a central component of the research, education, and practice of most licensed psychologists in the United States. Psychologists are not only consumers and utilizers of the manual, but we are also producers of seminal research on DSM-defined disorder categories and their empirical correlates. Practicing psychologists in both private and public service utilize the DSM to conceptualize, communicate, and support their clinical work.

For these reasons, we believe that the development and revision of DSM diagnoses should include the contribution of psychologists, not only as select individuals on a committee, but as a professional community. We have therefore decided to offer the below response to DSM-5 development. This document was composed in recognition of, and with sensitivity to, the longstanding and congenial relationship between American psychologists and our psychiatrist colleagues.

Overview

Though we admire various efforts of the DSM-5 Task Force, especially efforts to update the manual according to new empirical research, we have substantial reservations about a number of the proposed changes that are presented on www.dsm5.org. As we will detail below, we are concerned about the lowering of diagnostic thresholds for multiple disorder categories, about the introduction of disorders that may lead to inappropriate medical treatment of vulnerable populations, and about specific proposals that appear to lack empirical grounding. In addition, we question proposed changes to the definition(s) of mental disorder that deemphasize sociocultural variation while placing more emphasis on biological theory. In light of the growing empirical evidence that neurobiology does not fully account for the emergence of mental distress, as well as new longitudinal studies revealing long-term hazards of standard neurobiological (psychotropic) treatment, we believe that these changes pose substantial risks to patients/clients, practitioners, and the mental health professions in general.

Given the changes currently taking place in the profession and science of psychiatry, as well as the developing empirical landscape from which psychiatric knowledge is drawn, we believe that it is important to make our opinions known at this particular historical moment. As stated at the conclusion of this letter, we believe that it is time for psychiatry and psychology collaboratively to explore the possibility of developing an alternative approach to the conceptualization of emotional distress. We believe that the risks posed by DSM-5, as outlined below, only highlight the need for a descriptive and empirical approach that is unencumbered by previous deductive and theoretical models.

In more detail, our response to DSM-5 is as follows:

Advances Made by the DSM-5 Task Force

We applaud certain efforts of the DSM-5 Task Force, most notably efforts to resolve the widening gap between the current manual and the growing body of scientific knowledge on psychological distress. In particular, we appreciate the efforts of the Task Force to address limitations to the validity of the current categorical system, including the high rates of comorbidity and Not Otherwise Specified (NOS) diagnoses, as well as the taxonomic failure to establish ‘zones of rarity’ between purported disorder entities (Kendell & Jablensky, 2003). We agree with the APA/DSM-5 Task Force statement that, from a systemic perspective,

The DSM-III categorical diagnoses with operational criteria were a major advance for our field, but they are now holding us back because the system has not kept up with current thinking. Clinicians complain that the current DSM-IV system poorly reflects the clinical realities of their patients. Researchers are skeptical that the existing DSM categories represent a valid basis for scientific investigations, and accumulating evidence supports this skepticism. (Schatzberg, Scully, Kupfer, & Regier, 2009)

As researchers and clinicians, we appreciate the attempt to address these problems. However, we have serious reservations about the proposed means for doing so. Again, we are concerned about the potential consequences of the new manual for patients and consumers; for psychiatrists, psychologists, and other practitioners; and for forensics, health insurance practice, and public policy. Our specific reservations are as follows:

Lowering of Diagnostic Thresholds

The proposal to lower diagnostic thresholds is scientifically premature and holds numerous risks. Diagnostic sensitivity is particularly important given the established limitations and side-effects of popular antipsychotic medications. Increasing the number of people who qualify for a diagnosis may lead to excessive medicalization and stigmatization of transitive, even normative distress. As suggested by the Chair of DSM-IV Task Force Allen Frances (2010), among others, the lowering of diagnostic thresholds poses the epidemiological risk of triggering false-positive epidemics.

We are particularly concerned about:

• “Attenuated Psychosis Syndrome,” which describes experiences common in the general population, and which was developed from a “risk” concept with strikingly low predictive validity for conversion to full psychosis.

• The proposed removal of Major Depressive Disorder’s bereavement exclusion, which currently prevents the pathologization of grief, a normal life process.

• The reduction in the number of criteria necessary for the diagnosis of Attention Deficit Disorder, a diagnosis that is already subject to epidemiological inflation.

• The reduction in symptomatic duration and the number of necessary criteria for the diagnosis of Generalized Anxiety Disorder.

Though we also have faith in the perspicacity of clinicians, we believe that expertise in clinical decision-making is not ubiquitous amongst practitioners and, more importantly, cannot prevent epidemiological trends that arise from societal and institutional processes. We believe that the protection of society, including the prevention of false epidemics, should be prioritized above nomenclatural exploration.

Vulnerable Populations

We are also gravely concerned about the introduction of disorder categories that risk misuse in particularly vulnerable populations. For example, Mild Neurocognitive Disorder might be diagnosed in elderly with expected cognitive decline, especially in memory functions. Additionally, children and adolescents will be particularly susceptible to receiving a diagnosis of Disruptive Mood Dysregulation Disorder or Attenuated Psychosis Syndrome. Neither of these newly proposed disorders have a solid basis in the clinical research literature, and both may result in treatment with neuroleptics, which, as growing evidence suggests, have particularly dangerous side-effects (see below)—as well as a history of inappropriate prescriptions to vulnerable populations, such as children and the elderly

Sociocultural Variation

The DSM-5 has proposed to change the Definition of a Mental Disorder such that DSM-IV’s Feature E: “Neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual,” will instead read “[A mental disorder is a behavioral or psychological syndrome or pattern] [t]hat is not primarily a result of social deviance or conflicts with society.” The latter version fails to explicitly state that deviant behavior and primary conflicts between the individual and society are not mental disorders. Instead, the new proposal focuses on whether mental disorder is a “result” of deviance/social conflicts. Taken literally, DSM-5’s version suggests that mental disorder may be the result of these factors so long as they are not “primarily” the cause. In other words, this change will require the clinician to draw on subjective etiological theory to make a judgment about the cause of presenting problems. It will further require the clinician to make a hierarchical decision about the primacy of these causal factors, which will then (partially) determine whether mental disorder is said to be present. Given lack of consensus as to the “primary” causes of mental distress, this proposed change may result in the labeling of sociopolitical deviance as mental disorder.

Revisions to Existing Disorder Groupings

Several new proposals with little empirical basis also warrant hesitation:

• As mentioned above, Attenuated Psychosis Syndrome and Disruptive Mood Dysregulation Disorder (DMDD) have questionable diagnostic validity, and the research on these purported disorders is relatively recent and sparse.

• The proposed overhaul of the Personality Disorders is perplexing. It appears to be a complex and idiosyncratic combined categorical-dimensional system that is only loosely based on extant scientific research. It is particularly concerning that a member of the Personality Disorders Workgroup has publicly described the proposals as “a disappointing and confusing mixture of innovation and preservation of the status quo that is inconsistent, lacks coherence, is impractical, and, in places, is incompatible with empirical facts” (Livesley, 2010), and that, similarly, Chair of DSM-III Task Force Robert Spitzer has stated that, of all of the problematic proposals, “Probably the most problematic is the revision of personality disorders, where they’ve made major changes; and the changes are not all supported by any empirical basis.”

• The Conditions Proposed by Outside Sources that are under consideration for DSM-5 contain several unsubstantiated and questionable disorder categories. For example, “Apathy Syndrome,” “Internet Addiction Disorder,” and “Parental Alienation Syndrome” have virtually no basis in the empirical literature.

New Emphasis on Medico-Physiological Theory

Advances in neuroscience, genetics, and psychophysiology have greatly enhanced our understanding of psychological distress. The neurobiological revolution has been incredibly useful in conceptualizing the conditions with which we work. Yet, even after “the decade of the brain,” not one biological marker (“biomarker”) can reliably substantiate a DSM diagnostic category. In addition, empirical studies of etiology are often inconclusive, at best pointing to a diathesis-stress model with multiple (and multifactorial) determinants and correlates. Despite this fact, proposed changes to certain DSM-5 disorder categories and to the general definition of mental disorder subtly accentuate biological theory. In the absence of compelling evidence, we are concerned that these reconceptualizations of mental disorder as primarily medical phenomena may have scientific, socioeconomic, and forensic consequences. New emphasis on biological theory can be found in the following DSM-5 proposals:

• The first of DSM-5’s proposed revisions to the Definition of a Mental Disorder transforms DSM-IV’s versatile Criterion D: “A manifestation of a behavioral, psychological, or biological dysfunction in the individual” into a newly collapsed Criterion B: [A behavioral or psychological syndrome] “That reflects an underlying psychobiological dysfunction.” The new definition states that all mental disorders represent underlying biological dysfunction. We believe that there is insufficient empirical evidence for this claim.

• The change in Criterion H under “Other Considerations” for the Definition of a Mental Disorder adds a comparison between medical disorders and mental disorders with no discussion of the differences between the two. Specifically, the qualifying phrase “No definition adequately specifies precise boundaries for the concept of ‘mental disorder’” was changed to “No definition perfectly specifies precise boundaries for the concept of either ’medical disorder’ or ‘mental/psychiatric disorder’.” This effectively transforms a statement meant to clarify the conceptual limitations of mental disorder into a statement equating medical and mental phenomena.

• We are puzzled by the proposals to “De-emphasize medically unexplained symptoms” in Somatic Symptom Disorders (SSDs) and to reclassify Factitious Disorder as an SSD. The SSD Workgroup explains: “…because of the implicit mind-body dualism and the unreliability of assessments of ‘medically unexplained symptoms,’ these symptoms are no longer emphasized as core features of many of these disorders.” We do not agree that hypothesizing a medical explanation for these symptoms will resolve the philosophical problem of Cartesian dualism inherent in the concept of “mental illness.” Further, merging the medico-physical with the psychological eradicates the conceptual and historical basis for somatoform phenomena, which are by definition somatic symptoms that are not traceable to known medical conditions. Though such a redefinition may appear to lend these symptoms a solid medico-physiological foundation, we believe that the lack of empirical evidence for this foundation may lead to practitioner confusion, as might the stated comparison between these disorders and research on cancer, cardiovascular, and respiratory diseases.

• The proposed reclassification of Attention Deficit/Hyperactivity Disorder (ADHD) from Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence to the new grouping “Neurodevelopmental Disorders” seems to suggests that that ADHD has a definitive neurological basis. This change, in combination with the proposal to lower the diagnostic threshold for this category as described above, poses high risk of exacerbating the extant over-medicalization and over-diagnosis of this disorder category.

• A recent publication by the Task Force, The Conceptual Evolution of DSM-5 (Regier, Narrow, Kuhl, & Kupfer, 2011), states that the primary goal of DSM-5 is “to produce diagnostic criteria and disorder categories that keep pace with advances in neuroscience.” We believe that the primary goal of DSM-5 should be to keep pace with advances in all types of empirical knowledge (e.g., psychological, social, cultural, etc.).

Taken together, these proposed changes seem to depart from DSM’s 30-year “atheoretical” stance in favor of a pathophysiological model. This move appears to overlook growing disenchantment with strict neurobiological theories of mental disorder (e.g., “chemical imbalance” theories such as the dopamine theory of schizophrenia and the serotonin theory of depression), as well as the general failure of the neo-Kraepelinian model for validating psychiatric illness. Or in the words of the Task Force:

“…epidemiological, neurobiological, cross-cultural, and basic behavioral research conducted since DSM-IV has suggested that demonstrating construct validity for many of these strict diagnostic categories (as envisioned most notably by Robins and Guze) will remain an elusive goal” (Kendler, Kupfer, Narrow, Phillips, & Fawcett, 2009, p. 1).

We thus believe that a move towards biological theory directly contradicts evidence that psychopathology, unlike medical pathology, cannot be reduced to pathognomonic physiological signs or even multiple biomarkers. Further, growing evidence suggests that though psychotropic medications do not necessarily correct putative chemical imbalances, they do pose substantial iatrogenic hazards. For example, the increasingly popular neuroleptic (antipsychotic) medications, though helpful for many people in the short term, pose the long-term risks of obesity, diabetes, movement disorders, cognitive decline, worsening of psychotic symptoms, reduction in brain volume, and shortened lifespan (Ho, Andreasen, Ziebell, Pierson, & Magnotta, 2011; Whitaker, 2002, 2010). Indeed, though neurobiology may not fully explain the etiology of DSM-defined disorders, mounting longitudinal evidence suggests that the brain is dramatically altered over the course of psychiatric treatment.

Conclusions

In sum, we have serious reservations about the proposed content of the future DSM-5, as we believe that the new proposals pose the risk of exacerbating longstanding problems with the current system. Many of our reservations, including some of the problems described above, have already been articulated in the formal response to DSM-5 issued by the British Psychological Society (BPS, 2011) and in the email communication of the American Counseling Association (ACA) to Allen Frances (Frances, 2011b).

In light of the above-listed reservations concerning DSM-5’s proposed changes, we hereby voice agreement with BPS that:

• “…clients and the general public are negatively affected by the continued and continuous medicalization of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation.”

• “The putative diagnoses presented in DSM-V are clearly based largely on social norms, with 'symptoms' that all rely on subjective judgments, with little confirmatory physical 'signs' or evidence of biological causation. The criteria are not value-free, but rather reflect current normative social expectations.”

• “… [taxonomic] systems such as this are based on identifying problems as located within individuals. This misses the relational context of problems and the undeniable social causation of many such problems.”

• There is a need for “a revision of the way mental distress is thought about, starting with recognition of the overwhelming evidence that it is on a spectrum with 'normal' experience” and the fact that strongly evidenced causal factors include “psychosocial factors such as poverty, unemployment and trauma.”

• An ideal empirical system for classification would not be based on past theory but rather would “ begin from the bottom up – starting with specific experiences, problems or ‘symptoms’ or ‘complaints’.”

The present DSM-5 development period may provide a unique opportunity to address these dilemmas, especially given the Task Force’s willingness to reconceptualize the general architecture of psychiatric taxonomy. However, we believe that the proposals presented on www.dsm5.org are more likely to exacerbate rather than mitigate these longstanding problems. We share BPS’s hopes for a more inductive, descriptive approach in the future, and we join BPS in offering participation and guidance in the revision process.

Online Petition by iPetitions.com

References

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British Psychological Society. (2011) Response to the American Psychiatric Association: DSM-5
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Compton, M. T. (2008). Advances in the early detection and prevention of schizophrenia.
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Frances, A. (2011a). DSM-5 approves new fad diagnosis for child psychiatry: Antipsychotic use
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Frances, A. (2011b). Who needs DSM-5? A strong warning comes from professional counselors
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Livesley, W. J. (2010). Confusion and incoherence in the classification of Personality Disorder:
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DSM-5. Arlington, VA: American Psychiatric Publishing.

Schatzberg, A. F., Scully, J. H., Kupfer, D. J., & Regier, D. A. (2009). Setting the record
straight: A response to Frances commentary on DSM-V. Psychiatric Times, 26. Retrieved from http://www.psychiatrictimes.com/dsm/content/article/10168/1425806

Whitaker, R. (2002). Mad in America. Cambridge, MA: Basic Books. Also see http://www.
madinamerica.com/madinamerica.com/Schizophrenia.html

Whitaker, R. (2010). Anatomy of an epidemic. New York, NY: Random House.

The Interrupters

2011-10-21T17:54:00.000-07:00

The Interrupters tells the moving and surprising stories of three Violence Interrupters who try to protect their Chicago communities from the violence they once employed. From acclaimed director Steve James and bestselling author Alex Kotlowitz, this film is an unusually intimate journey into the stubborn, persistence of violence in our cities. Shot over the course of a year out of Kartemquin Films, The Interrupters captures a period in Chicago when it became a national symbol for the violence in our cities. During that period, the city was besieged by high-profile incidents, most notably the brutal beating of Derrion Albert, a Chicago High School student, whose death was caught on videotape. The film's main subjects work for an innovative organization, CeaseFire, which believes that the spread of violence mimics the spread of infectious diseases, and so the treatment should be similar: go after the most infected...

The Horse Boy

2011-10-19T07:38:00.000-07:00

Now on DVD from Zeitgeist Video. How far would you travel to heal someone you love? An intensely personal yet epic spiritual journey, The Horse Boy follows one Texas couple and their autistic son as they trek on horseback through Outer Mongolia in a desperate attempt to treat his condition with shamanic healing. When two-year-old Rowan was diagnosed with autism, Rupert Isaacson, a writer and former horse trainer, and his wife Kristin Neff, a psychology professor, sought the best possible medical care for their son—but traditional therapies had little effect. Then they discovered that Rowan has a profound affinity for animals—particularly horses—and the family set off on a quest for a possible cure.

The Horse Boy is part travel adventure, part insight into shamanic tradition and part intimate look at the autistic mind. In telling one familys extraordinary story, the film gives voice to the thousands who display amazing courage and creativity everyday in the battle against this mysterious and heartbreaking epidemic. The filmic companion to Isaacsons best-selling book of the same name and a festival favorite, this ravishing documentary odyssey gives insight into how, in lifes darkest moments, one can find the gateway to joy and wonder.

More Info: http://www.zeitgeistfilms.com/horseboy

William J. Richardson on Heidegger's Being and Time

2011-10-17T19:37:00.000-07:00

Bill Richardson on Heidegger's Being and Time with reflections on Errancy and Truth. In reply to Babette Babich.

Can't Buy Love: Materialism Kills Marriages

2011-10-14T10:19:00.000-07:00

Courtney Hutchison at ABC News reports (excerpt):

Focusing too heavily on the "for richer" part of the nuptial vows could spell disaster for a marriage, according to research published today by Brigham Young University.

In a survey of 1,700 married couples, researchers found that couples in which one or both partners placed a high priority on getting or spending money were much less likely to have satisfying and stable marriages.

"Our study found that materialism was associated with spouses having lower levels of responsiveness and less emotional maturity. Materialism was also linked to less effective communication, higher levels of negative conflict, lower relationship satisfaction, and less marriage stability," said Jason Carroll, a BYU professor of family life in Provo, Utah, and lead author of the study.

Researchers gauged materialism using self-report surveys that asked questions such as to what extent do you agree with these statements? "I like to own things to impress people" or "money can buy happiness." Spouses were then surveyed on aspects of their marriage.

For one out of every five couples in the study, both partners admitted a strong love of money. These couples were worse off in terms of marriage stability, marriage satisfaction, communications skills and other metrics of healthy matrimony that researchers studied.

The one out of seven couples that reported low-levels of materialism in both partners scored 10 to 15 percent higher in all metrics of marital quality and satisfaction. Interestingly, the correlation between materialism and marital difficulties remained stable regardless of the actual wealth of the couple.

CONTINUE TO FULL ARTICLE HERE.

Neuromania? The Possibilities and Pitfalls of Our Fascination with Brains

2011-10-07T21:19:00.000-07:00

Philosopher and author Professor Raymond Tallis and RSA chief executive Matthew Taylor debate the competing claims made for the ability of neuroscience to explain human behaviour, culture and society.

Talk Therapy Lifts Severe Schizophrenics

2011-10-06T21:35:00.000-07:00

Benedict Carey in the New York Times reports:

People with severe schizophrenia who have been isolated, withdrawn and considered beyond help can learn to become more active, social and employable by engaging in a type of talk therapy that was invented to treat depression, scientists reported on Monday.

These new findings suggest that such patients have far more capability to improve their lives than was previously assumed and, if replicated, could change the way that doctors treat the one million patients for whom the disorder is profoundly limiting.

The therapy — a variant of cognitive behavior therapy, which focuses on defusing self-defeating assumptions — increased motivation and reduced symptoms. In previous studies, researchers have used cognitive techniques to help people with schizophrenia manage their hallucinations and sharpen their attention and memory. The new study is the first to rigorously test using the therapy to combat so-called negative symptoms — the listlessness, exhaustion and emotional flatness that trap many people in solitary lives, playing out their days smoking in front of the TV or holed up in their homes.

Dr. Bob Buchanan, a psychiatrist at the University of Maryland School of Medicine who was not involved in the study, said the results looked impressive. “This is a group of patients who have tried just about everything — drug treatments as well as psychosocial ones — and many clinicians and systems of care have essentially given up on them. If there’s an intervention out there that can make a difference, I think that’s an incredibly important development.”

In the study, appearing in the current issue of The Archives of General Psychiatry, researchers at the University of Pennsylvania enrolled 31 people from community health clinics in Philadelphia in a therapy program that included weekly sessions, each about an hour in length, in addition to their normal medication regimen. Each person set a goal, whether to find a job, start a relationship or go back to school. Aided by the therapist, the person then took incremental steps toward that goal, going out for coffee, visiting a local bookshop or volunteering at a community center.

“It took a long time to get patients engaged,” said Dr. Aaron T. Beck, a psychiatrist and one of the authors. “We used video games a lot at the beginning, just to give them a sense of some mastery.” Dr. Beck invented cognitive therapy decades ago, about the same time another therapist, Albert Ellis, was developing similar techniques.

The therapists in the study, all either psychiatrists or Ph.D.’s, all working frhttp://www.blogger.com/img/blank.gifom manuals guiding the technique, helped their patients correct self-defeating beliefs, like “taking even a small risk is foolish because the loss is likely to be a disaster,” and “making new friends isn’t worth the energy it takes.” After about six months, the patients began to show measurable improvement. After 18 months the benefit was clear, on the Global Assessment Scale, a standard scale tracking overall functioning.

“They made a jump of about 10 points on that scale, on average, which we consider to be moving a whole level up in terms of functioning,” said Paul M. Grant, the study’s lead author. A comparison group of 29 patients who received standard treatment — medication, and case management services as needed — showed no such improvement.

CONTINUE TO FULL ARTICLE HERE.

The African American Personalist Perspective on Person as Embodied in the Life and Thought of Martin Luther King Jr.

2011-10-05T16:53:00.001-07:00

by Lawrence Edward Carter, Sr., Morehouse College

Excerpt:

In studying the Gandhian nonviolent method of nonviolent resistance, King discovered in his philosophically based activism a consistency between the principles of personalism and the inherent respect for the person in the method of nonviolence as a strategy and a way of life. Thus, King thought nonviolent direct action was reasonable, practical, and moral in its regards for persons. Nonviolent personalism operated on the following fourteen assumptions, which bring into view King's conception of the person:

1. Nonviolent personalism stressed the sacred dignity of persons.

2. Nonviolent personalism focused especially on the centrality of the oppressed and poor persons, using their conditions as an index of the health and justice of their society.

3. Nonviolent personalism was suspicious of systems, the market economy, and the government, because they were not ultimately focused on the inviolable dignity of persons.

4. Nonviolent personalists believed in the inner revolution and the personal reformation that comes from the personal reflection and practice of ethical principles or the science of ideals.

5. Nonviolent personalists believed that awakening the power of the person's individual potential through conscious evolution and changes in conscience-ness could realize the power of our social potential.

6. Nonviolent personalists did not stop with the conversion of the individual: they understood the importance of negotiating through institutions; hence, they acted politically for social and structural change.

7. Nonviolent personalists believed that people in community could govern themselves and their needs to reduce the conflicts caused by competitive individualism, laissez-faire capitalism, and corporate liberalism.

8. Nonviolent personalists assumed the essential harmony of personal and political life, that virtues like compassion and cooperation could and should be applied to politics as long as they are grounded in ethical principles.

9. Nonviolent personalists believed in the harmony of rhetoric and reality. They believed that language was communal and that the purpose of words was to tell the truth.

10. Nonviolent personalists also believed in the harmony of means and ends (Farrell 1997, 6–8).

11. Nonviolent personalists fostered the view of a personal God who is the liberator of the oppressed. A coherent critique of the nature of Ultimate Reality and of one's connection to it frees one to save him or herself.

12. Nonviolent personalism stressed the relational, the connectedness, and the co-original interdependence or social nature of reality and life.

13. Nonviolent personalism called attention to four dimensions of personality: I–It relations to the environment investigated by psychology and the physical sciences; I–We relations of group life, the concern of interpersonal psychology and the social sciences; I–Me relation of mind and body examined by psychoanalysis and the biological sciences; and I–Thou relation of God, the ultimate creative Being, considered by personalistic psychology, and the ideal sciences or philosophy, ethics and theology (Schilling 1973, 43–66).

14. Nonviolent personalism had as its goal the beloved community because "person" is always person-in-community and community is locked-stitched into the institutional structures and procedures of society, says Walter George Muelder (quoted in Deats 1972, 296).

Reference

Carter, L.E., Sr. (2006). The African American personalist perspective on person as embodied in the life and thought of Martin Luther King Jr. The Journal of Speculative Philosophy, 20(3), 2109-223.

Social and Electronic Immortality

2011-09-30T00:58:00.000-07:00

by Rolf von Eckartsberg and Elsa von Eckartsberg

From the new issue of Janus Head: Journal of Interdisciplinary Studies:

How can we overcome the death barrier? Existentialism claims that we cannot. Our life is characterized by finitude which has death as its limit condition. But the sting of death--mortality--and our acknowledgment of this reality makes us wake up to life and be resolute for our projects of self-realization. Yet we die alone! But what if this existential conviction is based on shaky ground?

Are we not born into family-community and do we not die within a community of extended family and friends within the social body of our “existential ensemble” (von Eckartsberg, 1979) which we have co-created by our living? This cast of characters of our existence survives our death.

The survival community is launched at the funeral of the deceased. While the dead person is lowered into the ground, the person’s spirit is raised in speech and imagination of the survivors. A spiritual rebirth occurs. To the deceased person a new state of being, a new life: social immortality is bestowed in and through our collective commemoration. It exists as a circulation in image-consciousness and speech. This is the point of view of co-existentialism. Personal immortality for oneself may well be impossible, but social immortality, continued life in the consciousness and speaking of others is not.

Existentialism focused on subjectivity, the actor’s point of view, and the life-span of the individual. The individual experiences the world and him- or herself in consciousness which produces the meanings which guide our decisions and actions. In this article we will revision this ego- and conscio-centric attitude of existentialism with regards to the issues of immortality.

Consciousness is not the autonomous creation of the person alone. It is grounded in and permeated by human language which co-articulates our experience. The life of the community, of others, life in interpersonal relationships, life between us, precedes, envelops, and succeeds the life of the individual. CONTINUE...

CONTINUE TO FULL ARTICLE HERE.

U.S. Advisors Urge FDA to Address Antipsychotics in Kids

2011-09-25T22:26:00.000-07:00

Alina Selyukh at Reuters reports:

U.S. pediatric health advisers on Thursday urged drug regulators to continue studying weight gain and other side-effects of antipsychotic drugs as they are increasingly taken by children.

Significant numbers of U.S. children are receiving drugs to tame aggression, attention deficit disorder and other mental problems, even though there is little conclusive data to show exactly how the medications work or whether they damage kids' health.

The pediatric advisory panel on Thursday listened to preliminary results of a study sponsored in part by the FDA that, inconclusively still, compared whether some antipsychotic drugs put children at a higher risk of developing diabetes than others.

Similar to the recommendations the panel has made in previous years, it voted 16-1 to support the U.S. Food and Drug Administration's routine safety monitoring of the new generation of antipsychotics.

But the panel did so with a caveat that the agency specifically look at how to clarify the drugs' labels to highlight concerns about their impact on children, namely the risks of weight gain and diabetes.

"There is serious concern that children may be at a higher risk for serious adverse effects and we just don't have sufficient data to answer that question," said Dr. Jonathan Mink, a child neurology expert from the University of Rochester Medical Center.

Dr. Jeffrey Wagener, a pediatric pulmonologist from the University of Colorado Medical School, was the one adviser to vote "no" out of concern that wouldn't get regulators closer to dealing with the risks of using antipsychotics in children.

"I don't see how the FDA is responding to the December 8, 2009 request by this committee in a thorough fashion," he said. "It's taken them two years to not respond to that that we need to be more than in the observational role."

The FDA in the next month to six weeks will release a revised label for Abilify, a drug sold by Bristol-Myers Squibb Co and Otsuka Pharmaceutical and approved to treat schizophrenia in adolescents, bipolar disorder in children 10 to 17 years old and irritability associated with autism in those as young as six.

"We ask that with this upcoming revision that you carefully consider the language around pediatric use and adverse events," said Dr. Geoffrey Rosenthal, the committee's chair and director of Pediatric and Congenital Heart Center at the University of Maryland Medical Center.

Abilify's new label will detail the drug's latest clinical trials, warn of metabolic concerns and remind doctors to monitor weight and symptoms of diabetes in all patients, said Dr. Thomas Laughren, FDA's psychiatry products chief. The pediatric section of the label would contain a reference to those warnings, he said..

Such revisions, which are already incorporated into Johnson & Johnson's antipsychotic medication Invega Sustenna, are being considered for other similar drugs on a case by case basis, Laughren said.

The new generation of antipsychotic medications has raised a wave of concerns as they are increasingly being prescribed for a host of uses and for younger and younger patients, with little conclusive research addressing their impact on children and sometimes with little evidence they work.

Newer antipsychotics include J&J's Risperdal, known generically as risperidone; Eli Lilly & Co's Zyprexa or olanzapine; AstraZeneca's Seroquel or quetiapine; and Abilify, known generically as aripiprazole.

U.S. researchers have found that the drugs' use in children increased by 65 percent from 2002 to 2009, primarily through prescriptions for teenagers.

From fall 2009 to spring of this year, 1.9 million prescriptions of Abilify alone were dispensed to patients under 18, including even 875 prescriptions for toddlers younger than 2, according to FDA research.

Most commonly, the prescriptions were for bipolar disorder in teenagers and preschoolers, and for affective psychoses in children between the ages of seven and 12.

Advisers also voted unanimously to require the FDA to show them label revisions and report back in the next year or 18 months on progress in designing more studies of the drugs in children.

FULL ARTICLE HERE.

Embodiment and Psychopathology: Thomas Fuchs

2011-09-24T20:31:00.001-07:00

Jim Fadiman Interview: The Psychedelic Explorer's Guide

2011-09-24T20:21:00.000-07:00

Interview with ITP professor Dr. Jim Fadiman about his new book, The Psychedelic Explorer's Guide: Safe, Therapeutic, and Sacred Journeys.

Antipsychotics Linked to Metabolic Syndrome Spike in Children

2011-09-20T18:54:00.001-07:00

Heidi Splete at Clinical Psychiatry News reports:

The percentage of children and adolescents who developed metabolic syndrome while taking antipsychotics more than doubled from 3% after 3 months of use to 7% after 12 months, according to data from a longitudinal study of 235 children and adolescents, Jessica Merchán-Naranjo reported at the Annual Congress of the European College of Neuropsychopharmacology.

Data from previous studies have shown the development of metabolic adverse effects as a result of antipsychotics, but the nature of the impact on children has not been well studied, said Ms. Merchán-Naranjo of the Hospital General Universitario Gregorio Marañón in Madrid.

At baseline, 116 children had no prior antipsychotic treatment and 119 had fewer than 30 days of exposure to antipsychotics. The patients were assessed at baseline and again after 3, 6, and 12 months of antipsychotic use. The mean age of the children was 14 years, 141 were male, and 89% were white.

The diagnoses were divided into three groups: schizophrenia or other disorders with psychotic symptoms (93 patients), bipolar disorder (38 patients), and other disorders (104 patients). The majority of the children were treated with risperidone (146 patients). The most common additional medications were olanzapine (39 patients), and quetiapine (38 patients). The remaining patients were treated with clozapine, haloperidol, pimozide, or aripiprazole.

The percentage of children who met criteria for metabolic syndrome at 3, 6, and 12 months was 3%, 6%, and 7%, respectively. Metabolic syndrome was defined as at least three of the following conditions: body mass index in the 95th percentile or highttp://www.blogger.com/img/blank.gifher, triglycerides greater than 110 mg/dL, HDL cholesterol less than 40 mg/dL, and glucose of 110 mg/dL or higher.

The percentage of children who were considered at risk for metabolic syndrome at 3, 6, and 12 months was 22%, 24%, and 33%, respectively. The researchers defined "at risk" as either a body mass index in the 95th percentile or higher, or a BMI in the 85th percentile or higher plus the presence of hypertension, dyslipidemia, or hyperglycemia.

The results confirm that adverse events should be monitored in children and adolescents taking antipsychotics throughout the entire treatment period, she added.

FULL ARTICLE HERE.

New Study Finds Link Between ADHD-like Behavior and Sleep Habits

2011-09-20T18:23:00.000-07:00

http://www.blogger.com/img/blank.gif
Gabby Gonzalez at WNDU reports:

A new study finds that children's bedtime habits can lead to a misdiagnosis of ADHD, according to the New England Center for Pediatric Psychology...

“ADHD is a difficult diagnosis because its based on symptoms,” Dr. Mary Graber said. “We require that kids have symptoms in more than one situation.”

Diagnosing the disorder seems to be tricky due to other factors that can contribute to a child’s behavior. The study by the New England Center for Pediatric Psychology found that children who do not have a regular bedtime had ADHD-like behaviors eight times more frequently than children who did have a regular bedtime...

“We know that kids that don’t get enough sleep have more trouble with focus, more trouble with impulsivity, more trouble with mood,” Graber said.

Dr. Graber said that the changes in our day-to-day environment could be to blame for the increased prevalence of ADHD.

“We know that the more TV children watch before the age of five, the more likely they are to have ADHD,” she said. “Twenty-five percent of two-year-olds have a TV http://www.blogger.com/img/blank.gifin their rooms. That was not happening before.”

Graber suggests that elementary-age children need about 10 to 12 hours of sleep per night. This can help kids be more focused during the school day.

READ FULL STORY HERE.

The Marketing of Madness

2011-09-18T18:07:00.000-07:00

The Marketing of Madness is the definitive documentary on the psychiatric drugging industry. Here is the real story of the high income partnership between psychiatry and drug companies that has created an $80 billion psychotropic drug profit center.

But appearances are deceiving. How valid are psychiatrists' diagnoses-and how safe are their drugs? Digging deep beneath the corporate veneer, this documentary exposes the truth behind the slick marketing schemes and scientific deceit that conceal dangerous and often deadly sales campaigns.

In this film you'll discover that... Many of the drugs side effects may actually make your 'mental illness' worse. Psychiatric drugs can induce aggression or depression. Some psychotropic drugs prescribed to children are more addictive than cocaine. Psychiatric diagnoses appears to be based on dubious science. Of the 297 mental disorders contained with the Diagnostic and Statistical Manual of Mental Disorders, none can be objectively measured by pathological tests.

Mental illness symptoms within this manual are arbitrarily assigned by a subjective voting system in a psychiatric panel. It is estimated that 100 million people globally use psychotropic drugs.

The Marketing of Madness exposes the real insanity in our psychiatric 'health care' system: profit-driven drug marketing at the expense of human rights.

This film plunges into an industry corrupted by corporate greed and delivers a shocking warning from courageous experts who value public health over dollar.

APA Response to Time Magazine On-Line Q&A with Alan Kazdin: Melba J. T. Vasquez, PhD, President, American Psychological Association

2011-09-17T09:47:00.000-07:00

Dear Editor:

Psychotherapy is a highly effective treatment for many disorders, including anxiety and depression. That’s an important and data-based message for health care consumers, which unfortunately was ignored by Maia Szalavitz in her interview with Dr. Alan Kazdin; Q&A: Yale Psychologist Calls for the End of Individual Psychotherapy, (September 13).

Dismissing the value of individual psychotherapy is not supported by the research data and does not help address the access and barriers-to-care issues that many mental health consumers currently experience. Dr. Kazdin’s message that the field needs to continue to evolve additional interventions to help expand empirically supported treatment options and improve patient access to such care is critical. Dr. Kazdin himself has developed two such proven-effective treatments for aggressive and anti-social behavior in children. Additionally, we need to study, and where appropriate embrace, new and innovative ways of ensuring access to evidence-based care for patients who don’t currently have that access.

We agree with Drs. Kazdin and Stacy Blase, who in their 2011 article, "Rebooting Psychotherapy Research and Practice to Reduce the Burden of Mental Illness" (Perspectives on Psychological Science), state that while psychological interventions have “advanced remarkably” over the last few decades the mental health professions need to do more to put these empirically proven treatments to work in order to reduce the burden of mental illness.

Importantly, for some disorders, psychotherapy treatment can be more effective, safer, and less expensive in the long-term than drug treatment. Unfortunately, your article may discourage people who could be helped by psychotherapy from seeking such treatment.

Melba J. T. Vasquez, PhD
President
American Psychological Association

Call for Proposals: 5th Annual Conference of the Society for Humanistic Psychology (Division 32 of APA)

2011-09-12T18:51:00.001-07:00

Annual Conference of the Society for Humanistic Psychology

Announcing the Fifth Annual Conference of the Society for Humanistic Psychology, Division 32 of the American Psychological Association

Person, Consciousness and Community

Hosted by Point Park University and the Society for Humanistic Psychology

March 29 - April 1, 2012

Point Park University rightly prides itself on its academic, artistic and professional interrelationship with its diverse urban community. Our community sustains us, as we in turn nurture our community.

Although person, consciousness and community can be considered discrete entities, our conference theme indicates a confluence and co-creating emergence of this tripartite. We do need each other and we are, to some extent, of each other; and yet, each of us are unique, our agency and individuality honored. Our attempt then is to carefully walk Martin Buber’s narrow bridge which is an intermediate journey (avoiding extremism and polarization) toward recognition, appreciation and empowerment of others, all others, as well as the community we build together. And so, we hope that many of the presentations will foster interdisciplinary bridges that allow us all to be deeply moved by the alterity, creativity, values and ideas of others. The aforesaid is a utopian vision of invitation and possibility and not of certainty and completeness.

A utopia for the community is a hermeneutics of love and a transformation of consciousness, and as such, love comes forward as the structure by which we evaluate our theories about, and interventions with others.

As Bernard Lonergan wrote, "...transforming love has its occasions, its conditions, its cases. But once it comes and as long as it lasts, it takes over...There has been opened up a new world in which the old adage, 'Nothing is loved unless it is first known,' yields to the new truth, 'Nothing is truly known unless it is first loved.'"

Chairpersons

Brent Dean Robbins, Ph.D., associate professor of psychology, Point Park University, brobbins@pointpark.edu

Robert G. McInerney, Ph.D. assistant professor of psychology, Point Park University, rmcinerney@pointpark.edu

Keynote Speakers

Isaac Prilleltensky, Ph.D.

Isaac Prilleltensky, Ph.D., is dean of the School of Education and professor of educational and psychological studies at the University of Miami. Throughout his prolific career as a psychologist, educator, and scholar, he has broken new ground in developing community-based approaches to psychological and social health. He is a renowned authority on the prevention of child abuse and has written several seminal texts that strengthen the important link between psychology and social justice. A fellow of the American Psychological Association, the American Educational Research Association, and the Society for Community Research and Action, Prilleltensky has published seven books and more than 100 articles and book chapters. He has received 25 external grants in Canada, Australia, and the United States, and has presented keynote addresses at international conferences in 16 countries. His recent book, Promoting Well-Being: Linking Personal, Organizational, and Community Change, co-authored with his wife Ora Prilleltensky, a School of Education clinical assistant professor, sets the foundation for a new research and training project designed to optimize the interaction between psychological wellness and organizational and community health.

Constance Fischer, Ph.D.

Constance T. Fischer, Ph.D., ABPP, is a professor of psychology at Duquesne University. She is best known for pioneering an individualized/collaborative/therapeutic approach to psychological assessment. She has received the Society for Personality Assessment's Mayman and Klopfer Awards for her outstanding contributions to the assessment literature and for impact on the field of personality assessment. She has also been active in promoting qualitative research, especially empirical phenomenological research. Fischer has published e-p studies of being criminally victimized (with F. Wertz), and on rapport, intimacy, privacy, living back pain (with M.A. Murphy), and becoming angry. She published (2006) Qualitative Research Methods for Psychologists: Introduction through Empirical Studies, San Diego: Academic Press. For her work in individualized assessment and qualitative research, she has received the Carl Rogers Award from the APA division of Humanistic Psychology and Duquesne University's Presidential Award for Scholarship. Fischer has participated in psychology associations both nationally and locally, and has served as president of the state psychological association, APA's divisions of theoretical and philosophical psychology, and of humanistic psychology, and she has been on the local association's ethics committee for more than 20 years. At Duquesne, she was the N.J. Dick Endowed Chair of Community Outreach (2005-10).

Robert Stolorow, Ph.D.

Robert Stolorow, Ph.D., is a founding faculty member and training and supervising analyst at the Institute of Contemporary Psychoanalysis, Los Angeles; a founding faculty member at the Institute for the Psychoanalytic Study of Subjectivity, New York City; and a clinical professor of psychiatry at the UCLA School of Medicine.
He is the author of World, Affectivity, Trauma: Heidegger and Post-Cartesian Psychoanalysis (2011) and Trauma and Human Existence: Autobiographical, Psychoanalytic, and Philosophical Reflections (2007), and co-author of Worlds of Experience: Interweaving Philosophical and Clinical Dimensions in Psychoanalysis (2002), Working Intersubjectively: Contextualism in Psychoanalytic Practice (1997), Contexts of Being: The Intersubjective Foundations of Psychological Life (1992), Psychoanalytic Treatment: An Intersubjective Approach (1987), Structures of Subjectivity: Explorations in Psychoanalytic Phenomenology (1984), Psychoanalysis of Developmental Arrests: Theory and Treatment (1980), and Faces in a Cloud: Intersubjectivity in Personality Theory (1993 [1979], 2nd. ed.). He is also co-editor of The Intersubjective Perspective (1994) and has authored or co-authored more than 200 articles. He received his Ph.D. in clinical psychology from Harvard University in 1970 and a certificate in psychoanalysis and psychotherapy from the Psychoanalytic Institute of the Postgraduate Center for Mental Health, New York City, in 1974. He also received a Ph.D. in philosophy from the University of California at Riverside in 2007. He holds diplomas both in clinical psychology and in psychoanalysis from the American Board of Professional Psychology and he is a fellow in the Division of Psychoanalysis of the American Psychological Association. He received the Distinguished Scientific Award from the Division of Psychoanalysis in 1995 and the Haskell Norman Prize for Excellence in Psychoanalysis from the San Francisco Center for Psychoanalysis in 2011. Stolorow will receive the Hans W. Loewald Memorial Award from the International Forum for Psychoanalytic Education in 2012.

Special Events

SYMPOSIUM: Martin Luther King's Vision of the Beloved Community and Humanistic Psychology: Common Ground

Featuring invited speakers:

Jerome Taylor, Ph.D., is chair of the Department of Africana Studies and associate professor of psychology at the University of Pittsburgh, and founder of the Center for Family Excellence in Pittsburgh, Pa. His applied research in community psychology is informed by Martin Luther King, Jr's vision of the beloved community.

Jennifer Selig, Ph.D., is a core faculty member and chair of the Jungian and Archetypal Studies specialization at Pacifica Graduate Institute. She wrote her dissertation on Martin Luther King, Jr. exploring his ideas from a jungian, archetypal perspective, and continues to publish pioneering work on this topic.

Royal Alsup, Ph.D., is an adjunct faculty member at Saybrook Graduate School and co-founder of the Humanistic and Transpersonal Psychotherapy Center in Arcata, Ca. In a series of publications in the Journal of Humanistic Psychology, Alsup has articulated a vision of a liberation psychology that integrates Martin Luther King Jr.'s personalism and vision of the beloved community with the humanistic psychological tradition.http://www.blogger.com/img/blank.gif

SYMPOSIUM: Celebrating the Women of Humanistic Psychology

Constance T. Fischer, Ph.D., and other women who helped to shape the humanistic tradition of psychology will be honored during a special symposium. Chair: Richard Bargdill, Ph.D., University of Virginia Commonwealth. Please stay tuned for more details on this important event.

And more to be announced soon...

To submit a proposal, visit the conference website here:
http://www.pointpark.edu/Academics/Schools/SchoolofArtsandSciences/Departments/HumanitiesandHumanSciences/Psychology/PersonCommunityandConsciousness

Alva Noe: Addiction is Not a Disease of the Brain

2011-09-11T18:59:00.000-07:00

Addiction has been moralized, medicalized, politicized, and criminalized. And, of course, many of us are addicts, have been addicts or have been close to addicts. Addiction runs very hot as a theme.

Part of what makes addiction so compelling is that it forms a kind of conceptual/political crossroads for thinking about human nature. After all, to make sense of addiction we need to make sense of what it is to be an agent who acts, with values, in the face of consequences, under pressure, with compulsion, out of need and desire. One needs a whole philosophy to understand addiction.

Today I want to respond to readers who were outraged by my willingness even to question whether addiction is a disease of the brain.

Let us first ask: what makes something — a substance or an activity — addictive? Is there a property shared by all the things to which we can get addicted?

Unlikely. Addictive substances such as alcohol, heroin and nicotine are chemically distinct. Moreover, activities such as gambling, eating, sex — activities that are widely believed to be addictive — have no ingredients.

And yet it is remarkable — as Gene Heyman notes in his excellent book on addiction — that there are only 20 or so distinct activities and substances that produce addiction. There must be something in virtue of which these things, and these things alone, give rise to the distinctive pattern of use and abuse in the face of the medical, personal and legal perils that we know can stem from addiction.

What do gambling, sex, heroin and cocaine — and the other things that can addict us — have in common?

One strategy is to look not to the substances and activities themselves, but to the effects that they produce in addicts. And here neuroscience has delivered important insights.

If you feed an electrical wire through a rat's skull and onto to a short dopamine release circuit that connects the VTA (ventral tegmental area) and the nucleus accumbens, and if you attach that wire to a lever-press, the rat will self-stimulate — press the lever to produce the increase in dopamine — and it will do so basically foreover, forgoing food, sex, water and exercise. Addiction, it would seem, is produced by direct action on the brain!

(See here for a useful Wikipedia review of this literature.)

And indeed, there is now a substantial body of evidence supporting the claim that all drugs or activities of abuse (as we can call them), have precisely this kind of effect on this dopamine neurochemical circuit.

When the American Society of Addiction Medicine recently declared addiction to be a brain disease their conclusion was based on findings like this. Addiction is an effect brought about in a neurochemical circuit in the brain. If true, this is important, for it means that if you want to treat addiction, you need to find ways to act on this neural substrate.

All the rest — the actual gambling or drug taking, the highs and lows, the stealing, lying and covering up, the indifference to work and incompetence in the workplace, the self-loathing and anxiety about getting high, or getting discovered, or about trying to stop, and the loss of friends and family, the life stories and personal and social pressures — all these are merely symptoms of the underlying neurological disease.

But not so fast. Consider:

All addictive drugs and activities elevate the dopamine release system. Such activation, we may say, is a necessary condition of addiction. But it is very doubtful that it is sufficient. Neuroscientists refer to the system in question as the "reward-reinforcement pathway" precisely because all rewarding activities, including nonaddictive ones like reading the comics on sunday morning or fixing the leaky pipe in the basement, modulate its activity. Elevated activity in the reward-reinforcement pathway is a normal concomitant of healthy, nonaddictive, engaged life.

Neuroscientists like to say that addictive drugs and activities, but not the nonaddictive ones, "highjack" the reward-reinforcement pathway, they don't merely activate it. This is the real upshot of the rat example. The rat preferred lever-pressing to everything; it dis-valued everything in comparison with lever-pressing. And not because of the intrinsic value of lever-pressing, but because of the link artificially established between the lever-pressing and the dopamine release.

If this is right, then we haven't discovered, in the reward reinforcement system, a neurochemical signature of addiction. We haven't discovered the place where addiction happens in the brain. After all, the so-called highjacking of the reward system is not itself a neurochemical process; it is a process whereby neurochemical events get entrained within in a larger pattern of action and decision making.

Is addiction a disease of the brain? That's a bit like saying that eating is a phenomenon of the stomach. The stomach is an important part of the story. But don't forget the mouth, the intestines, the blood, and don't forget the hunger, and also the whole socially-sustained practice of producing, shopping for and cooking food.

And so with addiction. The neural events in VTA clearly belong to the underlying mechanisms of addiction. They are necessary, but not sufficient; they are only part of the story.

CONTINUE TO FULL STORY HERE.

Remembering the Victims of 9/11/01: Poetry by Thomas Greening and David Elkins

2011-09-10T21:13:00.001-07:00

Jumping

Seth came from a family of jumpers,
but never thought he'd follow their tradition
in quite this way.
In 1942 his father jumped off a train in Poland
on its way to Auschwitz
and kept scrambling until he landed in the Bronx.
His uncle Harold jumped into Normandy in 1944
and got a medal.
Today Seth was not going to tumble down a grassy embankment
or parachute with comrades into a soggy field.
This was a beautiful September morning in New York
but neither freedom nor victory were options.

The heat and smoke were getting bad
and the way to the stairwell was blocked.
He said goodbye to his wife
just as the phone went dead.
He took a last look at the carefully posed photograph
of her and their son by the Statue of Liberty
and at the stack of unread reports
from which he was now liberated,
then stood on his desk
and smashed open the window with a chair.
He could see Newark, where he grew up poor,
and wryly congratulated himself
for not blowing his bonus
on a new BMW.
His mind leapt to a quote
from one of the Flying Wallendas:
"Life is on the wire. Everything else is preparation."
"Well, no one prepares for this," he thought,
"but I can do it."
Christine clambered up on the desk
and he took her hand.
"Are you scared?" she asked.
"Not really," he replied, "just kind of awed,
and amazed that we're standing here like this."

The heat and smoke got worse,
and it became hard to breathe.
Without speaking, they knew
when it was time to go,
and they flew off together,
his $300 yellow and blue tie flapping over his shoulder
and her auburn hair streaming behind her,
bequeathing themselves to history
and to the humbled witnesses
who must go on living in the world
they sanctified.

Tom Greening

Reassurance

I wasn't there on 9/11
and didn't see the people jumping,
but I am reassured to hear
from Denise, age 5,
who was at school across the street,
that the jumpers floated down slowly, gently,
suspended from brightly colored parachutes.

Thus the world is not as horrible as I feared,
and soon the towers will be rebuilt
strong enough to last forever
so that when Denise grows up
planes will just bounce off them,
and the bad people will know we are all good
and will try to be just like us.

Tom Greening

Note: More poems on the theme of 9/11 are available from Dr. Greening.

September 11
by
Dave Elkins

Those planes, those buildings, those fireballs,
Those people jumping, that thick dust rolling,
Those crashing towers, those people inside,
Those firefighters, those families watching in terror
At home, knowing their husband, wife, father, mother,
Or friend was inside those buildings, on those planes.
The Pentagon, the black scar where the plane hit,
The ones inside who never had a chance.
That Pennsylvania farm. “Let’s roll,” he said,
And they did – right into our hearts and into eternity.

Images -- forever cut into the soul and history of America.

And then came the politics.
Americans – and allies around the world – divided, polarized.
French Fries or Freedom Fries, take your pick and show your
Patriotism – or maybe just your ideology.
Shock and Awe – and we watch it on TV. Popcorn, anyone?
Blood on the popcorn? Don’t worry. We’ve hired a PR firm to wipe
It all away.
What? No weapons of mass destruction. But I thought…
Flawed intelligence or cynical politics – our nation
divided. Still torn in two, even to this day – about that day.

Sandy was 18 and Jim was 20 – and in the National Guard
The wedding was already planned but Jim said, “Wait until I’m home
for good. I don’t want to be separated after we’re married.”
He made it thru 3 tours of duty but in his 4th the wedding plans,
Along with Jim’s Hummer, exploded
and Sandy and Jim’s dreams broke into pieces and
flew 3000 feet into the Iraqi sky.
Two weeks later, Sandy bought a one-way
Ticket – some called it an overdose – to go see Jim.

But maybe today, Maybe today, 10 years later,
Maybe today we can remember:
How we came together. How we spoke to neighbors. How we filed onto
Sidewalks, into city streets and parks – How we shook hands,
or gave strangers – who somehow were not strangers -- a hug.
How our souls became one giant Soul , how we were one people. How
E Pluribus Unum jumped off coins and into our hearts.
Black and White, Latino and Asian, Christian and Jew, Hindu and Muslim ,
Straight and Gay, Republican and Democrat –

A melting pot -- a true melting pot. And we had only one name: Americans
Or better yet: human beings

And remember how friends around the world -- people in other countries
-- sent faxes and e-mails by the millions saying, “We
are so sorry. So sorry -- and we are thinking of you, praying for you,
Americans.” No longer were we “ugly Americans”. The truth came out:
they were our friends – there for us when the chips were down.

But perhaps the thing that tore our hearts out were those
Lost people, wandering aimlessly in the aftermath, at the edge of the ruins,
Looking for any sign of their loved one. And those notes on the fences,
fluttering in the New York breeze, and saying things
Like: Bill Johnson, if you read this, please call your family. Maria
Gomez. If you know where she is, call me at 776-8843 – I’m her mother.
And “Here’s a picture of Daddy and me
last Xmas. If you see him somewhere, maybe in the hospital, tell him
Tammy loves him and really really needs to see him.”

And then those readings of the names. Hours just reading names.
Names of husbands, wives, children, brothers, sisters, uncles, aunts, cousins, grandmothers, grandfathers, friends, frefighters, policemen, flight attendants, pilots, passengers. Would they ever stop reading those names? Would the list ever end? Would the pain spreading out like ripples on a lake to immediate families, extended families, close friends, other friends, business friends, church friends, temple friends, mosque friends … would the pain and the ripples and the names ever stop. Would the ponds and lakes, the seas and oceans, ever be calm again. Those names, Those beautiful names, Those beautiful haunting names.

So here we are a decade later. Remembering. Trying to say
Something, anything, that might pay tribute, honor, to those who just
Wanted to drink their morning coffee, just wanted to check their overnight e-mails
Just wanted to call home to remind their husband to go to the cleaners, just wanted to
Say hi to their kids because they had left for work that morning while they were still in bed.

Yes, here we are. September 11, 2011 – with no words that even come close.

When Aldous Huxley came to the end of his life, the great philosopher said that
It was a bit embarrassing that he had spent his entire life working on the human problem
And had nothing of substance to offer but this: “Try to be a little kinder.”

Perhaps Aldous had it right.
We did it 10 years ago. Perhaps we can do it again.
And maybe that would be the best memorial of all:
"Try to be a little kinder. Just ---“Try to be a little kinder.”
-- Dave Elkins

The Experience of Joy: Interview with Brent Robbins

2011-09-10T08:42:00.000-07:00

The following is an interview in the magazine, The Point:

Visit your favorite bookstore, in person or online, and search for titles about depression; more than 21,000 are on Amazon.com. Now look for titles about feeling joy; 158 are on Amazon. What makes you joyful? Is it similar for everyone? How do you attain joy? Questions like these, and the lack of research, led Brent Robbins, Ph.D., director of Point Park’s psychology program, to begin to study “joy” in 1998. He completed his dissertation on it, has been exploring the subject ever since, and is writing a book to (ultimately) help people find it. The Point talked with Dr. Robbins about his research.

What prompted you to study joy?

BR: In my first-year doctoral program, this 21-year-old woman comes in. When it’s the first day, you ask what the presenting problem is: ‘What brings you here?’ First thing out of her mouth was ‘I don’t have any joy in my life.’ That was how she presented her problem. My first thought was, I never heard that before. My second thought was, I don’t know what you are supposed to do in therapy to help people find joy. The Diagnostic and Statistical Manual of Mental Disorders doesn’t say anything about joy deficit disorder. There’s depression, there’s anxiety disorders, there’s schizophrenia and other psychotic disorders, but nothing about joy. There’s nothing about how to have a better life, how to build your strengths. It’s all about how to get rid of symptoms.

Given that your research was just beginning, how did you ultimately help your patient?

BR: I went back to this person and asked her, ‘What do you imagine joy would be and what do you think you need to do in order to find it?’ We started to explore that. In that case, it was a two-year process where her symptoms in the beginning of her therapy ultimately led her to the realization that she wanted to have a child. She wanted to be a mother, but she didn’t feel like she was worthy of being a mother. That was all unconscious. In the beginning she wasn’t explicitly aware of that, but we worked through all that; she decided that’s what she wanted to do. Her desire to have joy in her life was to have a little one. That’s what it was for her; maybe it would be different for somebody else.

What have you learned in your research to define joy?

BR: Joy seems to include both elation on one hand and relaxed serenity on the other. When you ask people to describe times when they felt joy, you get something along that continuum. Some people talk about hanging out with friends by the campfire, feeling at home, relaxed and at peace. Others talk about the buildup in tension: the winning touchdown in the Super Bowl or they’re walking with their boyfriend and he turns around and proposes suddenly. There’s this tension, then ‘boom,’ the surprise, and then there’s elation. They are not thinking about what’s coming next, they’re not thinking about what’s happened. They’re completely in that present moment.

You described one aspect of the feeling of joy as fecundity. Explain that.

BR: It has this sense of plentifulness. There is so much to see, so much to feel in this moment. It will never end. It will always be enough, and I never need anything more than what I’m having right now. That’s fecundity, and that’s a core thematic element of joy. It’s all throughout the experiences of joy.

You believe there is a connection between meditation and joy?

BR: Depression and anxiety is almost the antithesis of joy. It’s when people get caught up in their thoughts. When people describe doing meditation, and having those moments of feeling fully present in the moment, it’s almost indistinguishable from what people describe when they talk about joy, especially the serene version of joy. Really what people are looking for, when they’re looking to be healed of their suffering, is not so much getting rid of their symptoms but to cultivate a life of joy.

You stated, “If joy becomes a goal in and of itself, it becomes strangely elusive.” Why?

BR: It goes back to the time consciousness of joy, the temporality of joy. It’s about being present in the moment. A goal is something that’s happening in the future. So if you say, ‘I’m going to work on having joy in the future,’ you’re already out of the present moment.

Can someone be joyful alone?

BR: Yes, very much so. We were just doing joy experiences in my Methods class, and one of the students was talking about dancing in the rain by herself, a wonderful image. When people have a state of joy, they feel emotionally connected to people in their lives, even when they’re not physically present. That’s an important distinction. You can experience joy when you’re physically alone, but I think it’s really hard to feel it when you’re lonely. And you can be lonely in a room full of people.

You also noted, for adults, joy is rare. Why?

BR: I think what happens is when you’re an adult, you have a lot of responsibilities; you have children, you have jobs. At any particular moment in time, it’s very difficult to be fully present in the moment because there’s always something else that needs to be done.

Tell me about the book you are working on.

BR: It’s tentatively titled The Joyful Life - An Existential, Humanistic Approach to Positive Psychology. The goal of that is really to provide guidelines for people on what kinds of lives people live who really experience a lot of joy in their life. What does it look like, so you can know if you already have it; then you can just appreciate that you have it. If you don’t, you have some idea about what you’re shooting for. There will be information about how to get that; how to get from where you are to a more joyful life.

What gives you joy?

BR: My sons, my wife. Having kids can be the most stressful moments of our lives, but it’s also the moments of the greatest joy. Also, I’m a spiritual person, and I have a relationship with God. It’s in my deepening relationship with God that I think I have some of my greatest joys. It’s not politically correct sometimes to talk about your relationship with God, but it’s important for me.

Bloodletting and Psychotherapy

2011-09-08T23:20:00.001-07:00

The following letter, composed by Division 32 members, appeared this month in the APA Monitor:

Nancy Moore, PhD, APA's executive director of governance affairs, addressed the possible impact of neurobiological advances for the practice of psychology and was quoted in the May Monitor article "It's Time to Shake Up Psychology," as follows: "Within 10 years, what we understand about the brain is going to make our current understanding look like we didn't know anything â€¦. I could see that if we are not careful, talk therapy could look like bloodletting in terms of effective intervention."

We appreciate the exciting advances in the neurosciences, but the thousands of scientific studies showing psychotherapy to be robustly effective are also impressive. The superstitious practice of bloodletting fails as an appropriate comparison to scientifically supported psychotherapy. In contrast, much of the data supporting the effectiveness of psychiatric drugs has come under scrutiny in recent years. We know that psychiatric drug studies can be and have been biased at times by self-interested pharmaceutical companies and the researchers they hire. We know that overprescribing of psychiatric drugs, including powerful antipsychotics, for children and the elderly has become a national problem. We know that psychiatric drugs can have serious side effects including death. When compared to psychiatric drugs, psychotherapy begins to look quite attractive. Psychotherapy is often as effective as psychiatric drugs for an array of emotional problems—without the deleterious side effects of drugs. Therefore, we see no reason, scientific or otherwise, to anticipate that in 10 years psychotherapy will be replaced by neuroscience and designer drugs. Instead, we may look back and be shocked at the rampant abuse and overuse of psychiatric drugs in our day. Perhaps what needs to be shaken up is not the future prospects for psychotherapy, but our current overreliance on biological interventions for emotional problems that are amenable to psychological solutions.

David N. Elkins, PhD
Jennifer C. Franklin, PhD
Harris L. Friedman, PhD
Thomas Greening, PhD
Steven J. Hendlin, PhD
Brent D. Robbins, PhD

Barbara Ehnrenreich: Smile or Die

2011-08-28T21:43:00.000-07:00

Acclaimed journalist, author and political activist Barbara Ehrenreich explores the darker side of positive thinking.

War on Children: A Review of Joel Bakan's "Children Under Siege"

2011-08-27T08:04:00.000-07:00

Elisabeth Young Bruehl of the Globe and Mail has written a review of Joel Bakan's new book, Children Under Siege. Here is an excerpt:

If a group of legislators or policy-makers concerned to protect children and childhood from being targeted by corporations were looking for a briefing book, a catalogue of abuses, Joel Bakan’s Childhood Under Siege would certainly be the right choice. It would inform them about the key American fronts of an undeclared corporate anti-child war. But it would not help them analyze the war’s cause, track its history or strategize their fight.

Devoting a chapter to each, Joel Bakan takes up eight areas where corporations and their advertising departments are pushing developmentally inappropriate and unhealthy goods on kids and lobbying for anti-child policies.

He explores, first, the world of video games and online “entertainments,” offering appalling examples of calculated manipulations of children’s love of excitement and their needs for company.

Then on to corporations of various sorts purveying a “curriculum” to children. Precociously, they learn about sex from explicit sexual scenes and pornography that are available without check. Sexy clothes and gadgets can be bought by anyone; sexy chat and sexting are free. Violence and mayhem are ubiquitous. “Ninety per cent of [U.S.] children between the ages of four and six are on-screen for at least two hours a day. …Tweens and teens spend, on average, eight hours a day … consuming media.”

Big Pharma has found in children the new frontier for selling psychotropics. Doctors and psychiatrists are manipulated into prescribing to children, whose brains are still developing, all kinds of meds, including anti-psychotics. Big Pharma’s marketing techniques are similar to those of food-producing corporations that market junk food, addicting children to regimes of sugar and caffeine, contributing to zooming rates of childhood obesity and diabetes and neurological disorders.

These corporations are just as oblivious to the harm they are doing to children’s health as the environmental polluters responsible for making asthma the leading cause of child hospital admissions and school absences, as one in 10 U.S. children suffer from it. Childhood cancers are on the rise, and the main culprits are environmental toxins. Corporations make sure that toxicity standards are made from adult data, while children are vulnerable to toxins at much lower levels.

Child labour is slowly being reinstated, particularly in agriculture. Corporations are taking over the field of public education, which was supposed to have become universal with the institution of anti-child-labour laws in the early 20th century. Charter schools are subsidized with taxpayers’ money for their profit-making enterprises.

In a corporation, which is a “person” in U.S. legal terms, the bottom line rules absolutely. Making the maximum for shareholders is a corporation’s legal raison d’etre, explains Bakan, a professor of law in Vancouver. So by its very nature, a corporation will not serve the people or “the commons” that belongs to everyone. This was the theme of Bakan’s 2004 bestselling book The Corporation and of a very fine documentary that was made from it. Children Under Siege is an offshoot of a long section in that book on “the nag factor” – that is, on how corporations set children at odds with their parents, who become powerless as their children are turned into consumers.

CONTINUE TO FULL ARTICLE HERE.

The Truth About Psychiatric Drugs: 3 New Studies

2011-08-13T18:03:00.000-07:00

The Alliance for Human Research Protection reports:

Three new published studies--one, a pharmaco-genetic study, is groundbreaking--confirm that widely prescribed psychotropic drugs that pose serious risks of harm, offer no therapeutic benefit.

For two decades, medical professionals, the public, and public health policy officials who determine the allocation of public funds for healthcare, have been misled about the safety and benefits of psychiatric drugs--in particular, the newer, expensive drugs, the so-called SSRI antidepressants, and the new neuroleptics, marketed as 'atypical antipsychotics'.

Pharmaceutical industry marketing hype, deceptively packaged as "scientific study findings," gained the appearance of legitimacy when they were accepted by the FDA for licensure, and accepted for publication in medical journals. Those reported "findings" were fraudulent, concocted and aggressively disseminated by manufacturers of these drugs. The deception has seriously undermined the integrity of the scientific literature, and misled physicians who unwittingly prescribe hazardous drugs causing patients irreparable harm. Thanks to years of litigation during which company documents have been uncovered, the truth has been revealed.

We now know that SSRI antidepressants and the 'atypical' antipsychotics have failed decisively to demonstrate therapeutic benefits in clinical trials and in clinical practice. Instead, these drugs have triggered debilitating, chronic illness and even life-threatening risks: antidepressants increase the suicide risk and trigger serotonin syndrome, which is potentially fatal. Antipsychotics undermine normal metabolic, cardiovascular, hormonal function, resulting in cardiac arrest, obesity, metabolic syndrome and diabetes.

A groundbreaking pharmaco-genetic study by Australian psychopharmacology experts--Dr. Yolande Lucire, a forensic psychiatrist, and Christopher Crotty, a pharmacogeneticist--report in the peer reviewed journal, Pharmacogenomics and Personalized Medicine, (abstract below) an alarming finding. They report a significant association among genetic variants, metabolism of psychiatric drugs, and severe, homicidal akathisia.

SEE HERE:
http://www.dovepress.com/antidepressant-induced-akathisia-related-homicides-associated-with-dim-a7993

The authors examined the relationship between genetic variants in the CYP450 family, the interaction of antidepressant-induced akathisia, and violence, including homicide in 129 forensic patients who had referred to Dr. Lucire by lawyers. Of 138 persons tested for CYP450 genes, 129 had experienced adverse events, "mainly akathisia, due to psychiatric drugs, and nine were first degree relatives of those treated who also had a history of adversity on other drugs."

Of the 129 persons who experienced drug-induced adverse effects, 8 had committed homicide, 3 had committed suicide, and one had sleepwalked to her death. The authors report that: " In all of the cases presented here, the subjects were prescribed antidepressants that failed to mitigate distress emerging from their predicaments, which encompassed psychosocial stressors such as bereavement, marital and relationship difficulties, and work-related stress. Every subject’s emotional reaction worsened while their prescribing physicians continued the “trial and error” approach, increasing from standard to higher dose and/or switching to other antidepressants, with disastrous consequences. In some cases the violence ensued from changes occasioned by withdrawal and polypharmacy. In all of these cases, the subjects were put into a state of drug induced toxicity manifesting as akathisia, which resolved only upon discontinuation of the antidepressant drugs."

"This paper has detailed and substantiated in specific terms how the metabolism of each of the antidepressant drugs used by the subjects would have been seriously impaired both before and at the time they committed or attempted homicide. They were experiencing severe reported side effects, adverse drug reactions due to impaired metabolism complicated by drug–drug interactions against a background of variant CYP450 alleles."

The authors state: "The results presented here concerning a sample of persons given antidepressants for psychosocial distress demonstrate the extent to which the psychopharmacology industry has expanded its influence beyond its ability to cure. The roles of both regulatory agencies and drug safety “pharmacovigilantes” in ensuring quality and transparency of industry information is highlighted."

Two other recently published studies, one in the British Medical Journal (BMJ), the other in the Journal of the American Medical Association, also debunk the validity of psychiatry's prescribing practices whose rationale is mostly commercially propagated.

The authors of the BMJ report, "Antidepressant Use and Risk of Adverse Outcomes in Older People: Population Based Cohort Study," analyzed data for 60,746 persons in the UK who were over 65 and diagnosed with depression between 1996 and 2007. The authors followed the subjects until December, 2008. They found that those prescribed SSRI antidepressants are at increased risk of death and heart attack, stroke, falls and seizures than those who were prescribed the older, cheaper, tricyclic antidepressants.

SEE HERE:
http://www.bmj.com/content/343/bmj.d4551.full

During those 10 years, patients not taking any antidepressants had a 7% risk of dying from any cause. But the risk rose to 8.1% for those taking the older antidepressants and increased to 10.6% for patients prescribed SSRIs.

"All classes of antidepressant drug were associated with significantly increased risks of all cause mortality, attempted suicide/self harm, falls, fractures, and upper gastrointestinal bleeding compared with when these drugs were not being used. Selective serotonin reuptake inhibitors and the group of other antidepressant drugs were associated with increased risks of stroke/transient ischaemic attack and epilepsy/seizures; selective serotonin reuptake inhibitors were also associated with increased risks of myocardial infarction and hyponatraemia."

According to government data, 10% to 20% of soldiers who see heavy combat develop lasting symptoms of Post Traumatic Stress Disorder (PTSD), and about a fifth of those who are treated are prescribed an antipsychotic drug. The JAMA report, by prominent psychiatrists on the faculty of Yale University, examines the treatment outcome for veterans suffering from PTSD, whose treatment with SSRI antidepressants failed, who were then prescribed antipsychotics.

See, "Adjunctive Risperidone Treatment for Antidepressant-Resistant Symptoms of Chronic Military Service–Related PTSD A Randomized Trial":
http://jama.ama-assn.org/content/306/5/493

The finding: after six months of treatment, the veterans who were prescribed Risperdal were doing no better than a similar group of 124 veterans, who were given a placebo. About 5% in both groups recovered, and 10% to 20% reported at least some improvement, based on standardized measures.

“We didn’t find any suggestion that the drug treatment was having an overall benefit on their lives,” said Dr. John H. Krystal, the director of the clinical neurosciences division of the Department of Veterans Affairs’ National Center for PTSD and the lead author of the study.

The New York Times reports: "The surprising finding, from the largest study of its kind in veterans, challenges current treatment standards so directly that it could alter practice soon, some experts said."

In an accompanying editorial, Dr. Charles Hoge, a senior scientist at the Walter Reed Army Institute of Research, who was not involved in the study, stated: “I think it’s a very important study given how frequently the drugs have been prescribed. It definitely calls into question the use of antipsychotics in general for PTSD.”

Although the study focused on one antipsychotic, Johnson & Johnson's Risperdal, experts agree that the results most likely extend to the entire class, including the drugs, Seroquel, Geodon and Abilify. These three reports are the latest in a string of scientific reports, untainted by industry influence, that examined the evidence and found that current psychiatric drug prescribing practices are of little, if any, therapeutic value. But since the drugs pose serious risks of harm by triggering drug-induced (iatrogenic) illness--which significantly increases healthcare costs--why does the U.S. government waste billions of taxpayer dollars to subsidize their cost?

Read more....
http://www.ahrp.org/cms/content/view/831/9/

Contact: Vera Hassner Sharav veracare@ahrp.org 212-595-8974

Johnson & Johnson Settles Charge in Risperidone Marketing

2011-08-13T16:24:00.000-07:00

Nancy A. Melville at Medscape Today reports:

Johnson & Johnson (J&J) says it has reached an agreement with the US Department of Justice on a misdemeanor charge related to the marketing of the company's antipsychotic drug risperidone (Risperdal), which went generic about 3 years ago after the company lost the patent.

In a regulatory filing with the Securities and Exchange Commission this week, the company said it has allocated an undisclosed amount for a proposed settlement of the charge.

"Discussions have been ongoing in an effort to resolve criminal penalties under the Food Drug and Cosmetic Act related to the promotion of [risperidone]," the company stated in the filing.

"An agreement in principal on key issues relevant to a disposition of criminal charges pursuant to a single misdemeanor violation of the Food Drug and Cosmetic Act has been reached, but certain issues remain open before a settlement can be finalized. The company has adjusted the accrued amount in the second quarter of 2011 to cover the financial component of the proposed criminal settlement."

Multiple Lawsuits

J&J said that the Department of Justice notified the company of its plans to intervene or join in multiple lawsuits that have been filed against the company and its Janssen Pharmaceuticals division.

The various lawsuits, which date back to 2004, allege that the company promoted risperidone and a related antipsychotic drug, paliperidone (Invega), for unapproved uses, including dementia and mood and anxiety disorders, and downplayed potential risks, according to Bloomberg News. The drugs are both indicated for schizophrenia.

The involvement of federal prosecutors in such cases typically indicates that the government is confident that millions of dollars paid for Medicare and Medicaid patients' prescriptions can be recovered, according to an Associated Press report.

Eleven states are seeking reimbursement for the Medicaid or other public funds used to pay for risperidone prescriptions. A jury in Louisiana ordered J&J to pay nearly $258 million to the state in 2010 in relation to charges of making misleading claims about risperidone's safety.

CONTINUE TO FULL ARTICLE HERE.

Judge Won't Order Inquiry Over Psychologist's Role in Guantanamo

2011-08-12T17:37:00.000-07:00

John Eligon in the New York Times reports:

New York State cannot be forced to investigate a psychologist accused by a human rights organization of overseeing coercive interrogation tactics at Guantánamo Bay, Cuba, a judge in Manhattan ruled on Thursday.

The rights group, the Center for Justice and Accountability, had brought a suit claiming that the psychologist, John Francis Leso, helped develop a plan of coercive techniques, including sleep deprivation and isolation, to use on detainees at Guantánamo. The suit was brought on behalf of Steven Reisner, a psychologist and an assistant professor of clinical psychiatry at the New York University School of Medicine. It sought an investigation of Dr. Leso by a professional disciplinary office in the state’s Education Department that regulates psychologists’ licenses.

But in a 12-page ruling filed in State Supreme Court, Justice Saliann Scarpulla wrote that Dr. Reisner had no standing to force an investigation. Nothing in state education law, Justice Scarpulla wrote, guarantees that the office “formally investigate every single complaint of professional misconduct, no matter the contents of applicability of the complaint.”

The judge also ruled that Dr. Reisner did not suffer an injury as a result of the state’s decision not to investigate.

CONTINUE TO FULL ARTICLE HERE.

Miles Groth: "The Boy Is Father To The Man"

2011-07-30T18:09:00.000-07:00

Professor Miles Groth presenting his talk "The Boy Is Father To The Man" at the 2011 AIMHS Symposium.

For more information, visit: http://aimhs.com.au

Professor Miles Groth is full professor in the Department of Psychology at Wagner College, Staten Island, New York. He trained as a psychoanalyst in New York, where he has lectured residents in psychiatry on integrating existential analysis with traditional inpatient treatment. He has been in private practice since 1977.

American Psychologist Works to Include Spirituality in Psychotherapeutic Practice

2011-07-29T21:53:00.000-07:00

The San Francisco Chronicle reports on Dr. David Lukoff, Member-at-Large of the Society for Humanistic Psychology:

American psychologist and mental health pioneer, Dr. David Lukoff, attended the Austrian Transpersonal Association Conference held at Schloss Puchberg, a 400-year-old palace that was renovated into a conference center by the Catholic Church. The theme of the conference was "Transpersonal Psychotherapy: Our Responsibility in the World".

Dr. David Lukoff is known for his groundbreaking work in the emerging field of Spiritual Psychology. His work has been instrumental in developing a specific category in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders. The DSM is used in the United States of America and in varying degrees around the world, by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies, and policy makers.

Dr. Lukoff is a Professor in the Spiritually-oriented Clinical Psy.D. Program at the Institute of Transpersonal Psychology, and he is a licensed psychologist in California, with expertise in the treatment of schizophrenia, transpersonal psychotherapy, spiritual issues in clinical practice, and case study methodology. He incorporates many transpersonal approaches in his clinical work including meditation, compassion training, and guided imagery as well as leading groups on spirituality. He is author of 80 articles and chapters on spiritual issues and mental health; co-author of the DSM-IV category "Religious or Spiritual Problem"; founding board member of the Institute for Spirituality and Psychology and of the Association for Transpersonal Psychology; and maintains the Spiritual Competency Resource Center.

In addition to Dr. Lukoff's work around the world to incorporate Spirituality into the study of Psychology, he maintains an active role educating the next generation of clinicians at the Institute of Transpersonal Psychology.

CONTINUE TO FULL ARTICLE HERE.

Cocaine: The Evolution of the Once 'Wonder' Drug

2011-07-28T06:12:00.000-07:00

CNN reports:

Long before drug cartels, crack wars and TV shows about addiction, cocaine was promoted as a wonder drug, sold as a cure-all and praised by some of the greatest minds in medical history, including Sigmund Freud and the pioneering surgeon William Halsted.

According to historian Dr. Howard Markel, it was even promoted by the likes of Thomas Edison, Queen Victoria and Pope Leo XIII.

It was an explosive debut that would be echoed a century later, when cocaine re-emerged as a different kind of miracle drug, the kind that could let you party all night long with no ill effects and no risk of addiction. Each time, the enthusiasm was misplaced and the explosion left a wreckage of human lives behind.

In 1884, Sigmund Freud was a young physician in Vienna, struggling to make a living even as he dreamed of being a world-famous medical pioneer. He just needed a discovery -- and he thought he had it.

"If all goes well," he wrote his future wife, Martha, "I will write an essay on it and I expect it will win its place in therapeutics by the side of morphine and superior to it. ... I take very small doses of it regularly against depression and against indigestion and with the most brilliant of success."

Dr. Howard Markel: Freud's cocaine problem

Freud wasn't the first to write about cocaine. The drug is derived from the coca plant, where natives in South America had been chewing the leaves for centuries.

By 1880, a number of companies had succeeded in creating a concentrated version: cocaine hydrochloride -- that would set the world reeling.

"It was tens to hundreds of times more powerful than chewing on a coca leaf," Markel says. "It was extremely pure and extremely powerful."

In the 1880s, medical literature consisted of case reports: doctors writing about their trial and error with individual patients. By the early 1880s, there were case reports on cocaine, many published in the widely read Therapeutic Gazette, which was published by Parke-Davis, cocaine's largest manufacturer.

According to Markel, Freud devoured these reports and set himself to writing the definitive tome. The result, in 1884, was "Uber Coca," 70 pages of tribute to the white powder that Freud thought could prove a cure for morphine addiction. ... Somehow in his rapture, he mentioned only in passing that the drug could also serve as a potent topical painkiller -- for which it is still sometimes used.

Halsted, then 32, was already a well-known surgeon in New York when he read Freud's paper and was immediately drawn to explore its uses as a painkiller. Aside from high rates of infection, surgery in the 1880s was a brutal business.

Ether and chloroform were used as anesthetics, but according to Markel, doctors and nurses would have to literally wrestle the patient to keep them down as they administered the choking gas.

Seeking a better method, Halsted began injecting cocaine into his own limbs, as well as those of friends, students and colleagues. While he discovered a valuable means of deadening nerve endings, the findings came at a high price. By the time a patient came in to his operating room a few months later, with a compound leg fracture, the surgeon was a physical and mental wreck.

Says Markel, "(Halsted) was so high on cocaine that he knew he couldn't operate. So he just left the scene, took a cab and went home, and stayed at his townhouse for the next seven months, high on cocaine."

No doubt there were many addicts like Halsted, but in large part their problems were hidden by a wave of positive publicity.

"There were all sorts of health claims being made," says Markel. "If you had a stomach ache, if you were nervous, if you were lethargic, if you needed energy, if you had tuberculosis, if you had asthma, all sorts of things. It was going to cure what you had. And this was how it was advertised, too. Not only by marketers who made these drinks, but by major pharmaceutical houses."

CONTINUE TO FULL ARTICLE AND VIDEO HERE.

DSM-5 Drafters Should Be Diagnosed with Commonsense Deficit Disorder

2011-07-27T19:23:00.000-07:00

The Australian reports:

PROPOSED new criteria for diagnosing Attention Deficit Hyperactivity Disorder, which include impatience and "acting without thinking", turn normal life into a medical condition and could see more children using Ritalin, critics say.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), the bible for psychiatrists, is being revised and there are proposals to include four new ways of determining whether a patient has ADHD.

The proposed new criteria is, firstly, "acting without thinking, such as starting tasks without adequate preparation or avoid-ing reading or listening to instructions".

Patients may also be "often impatient, as shown by feeling restless when waiting for others and wanting to move faster than others, wanting people to get to the point, speeding while driving, and cutting into traffic faster than others".

ADHD sufferers may also be "uncomfortable doing things slowly and systematically and often rush through activities and tasks".

Finally, they may find it "difficult to resist temptations or opportunities, even if it means taking risks.

"A child may grab toys off a store shelf or play with dangerous objects; adults may commit to a relationship after only a brief acquaintance."

Anti-ADHD drug campaigner and West Australian Labor MP Martin Whitely says the new guidelines show the American Psychiatric Association, which is considering them for inclusion in the diagnostic manual, has forfeited the right to be taken seriously.

"All of the new DSM5 criteria are normal human behaviours," she said.

"The people who wrote the proposed DSM5 ADHD diagnostic criteria obviously suffer from commonsense deficit disorder."

Newcastle University academic and author Ray Moynihan says the new criteria are a "threat to human health" because over-treatment and over-diagnosis is increasingly being recognised by the medical profession as a problem.

"The way in which psychologists are turning normal life into a medical condition is extremely dangerous and wasteful," he said.

A consultant psychiatrist at the Royal Brisbane Women's and Children's Hospital, James Scott, said it was very easy to take some parts of the DSM out of context and say it was nothing special. "One of the risks is people will pick out symptoms in isolation and say every child grabs a toy," he said.

The DSM required those criteria to cause a social or educational impairment in the patient, he said. While existing diagnostic criteria were far from perfect, "if people started making up their own criteria, we'd be in real trouble".

Prescriptions for the ADHD drug Ritalin soared 300 per cent between 2002 and 2009 and it is estimated that 1 per cent of boys and 0.5 per cent of girls have been prescribed the medication.

Australia's ADHD guidelines are being redeveloped after a US psychiatrist, Joseph Biederman, whose work is heavily cited in existing draft guidelines, was sanctioned by Harvard University for violating conflict-of-interest rules.

FULL ARTICLE HERE.

Time on the Couch

2011-07-26T20:43:00.000-07:00

Readingeagle.com reports:

The length of time people stay in therapy varies widely depending on personal needs - some work through their problems in just a few sessions, while others take many years - so there is no prescription for how long therapy should take.

• 8 - average number of visits among U.S. patients receiving psychotherapy in 2007, according to a study published last year in the American Journal of Psychiatry.

• 41 - percent of patients in the U.S. who quit psychotherapy prematurely, according to a 2010 study in the journal Psychotherapy Theory, Research, Practice, Training.

• 13-18 - number of sessions required to see improvement in about 50 percent of patients with depressive or anxiety disorders, according to a study published in 2003 in the journal Mental Health Services Research.

More Generalized Anxiety Disorder Patients Switch from Branded Antidepressants to Atypical Antipsychotics than Between Antidepressant Brands

2011-07-25T19:09:00.000-07:00

According to Pharmiweb, the new trend in pharmaceuticals is a change in the treatment of Generalized Anxiety Disorder (GAD) from its standard treatments, including psychotherapy and antidepressants (SSRI's) to atypical antipsychotics. Why might this switch be occurring? SSRI drugs are going off-patent, so they are no longer being marketed to physicians. Instead, the more recently patented atypical antipsychotics are being marketed. As a result, the more carefully studied antidepressants, which have lower side effects, seem to be giving over to treatments with the atypical antipsychotics for purely economically-driven reasons.

Excerpt:

Decision Resources, one of the world’s leading research and advisory firms focusing on pharmaceutical and healthcare issues, finds that among recently treated generalized anxiety disorder (GAD) patients, a higher percentage of switching occurred from branded antidepressants to atypical antipsychotics than between branded antidepressants. The findings, from the analysis of patient-level claims data from the fourth quarter of 2010, suggest that failure of a branded selective serotonin reuptake inhibitor (SSRI) or serotonin/norepinephrine reuptake inhibitor (SNRI) will result in a switch to an atypical antipsychotic rather than a switch within or between antidepressant drug classes.

The analysis is from Treatment Algorithms in Generalized Anxiety Disorder, which also finds that only 7.7 percent of recently treated GAD patients received atypical antipsychotics in the fourth quarter of 2010.

“Although the number of patients progressing to atypical antipsychotics is small, these agents captured a large percentage of new business during the last quarter of 2010 when compared with other drug classes, primarily from patients adding or switching to these agents when progressing to later lines of therapy,” said Decision Resources Analyst Jonathon Loring. “Treatment-resistant GAD patients present an opportunity for branded atypical antipsychotic agents such as AstraZeneca’s Seroquel and Bristol-Myers Squibb/Otsuka Pharmaceuticals’ Abilify as atypical antipsychotics have proven efficacious in treatment-resistant GAD patients, and these agents have a better side effect profile than other drugs in this class.”

CONTINUE TO FULL ARTICLE HERE.

Erich Fromm: Vintage TV Interview by Mike Wallace

2011-07-25T15:00:00.000-07:00

Erich Fromm, psychoanalyst and social critic, talks to Mike Wallace about society, materialism, relationships, government, religion, and happiness in this vintage television interview.

The Autism Generation

2011-07-24T09:04:00.000-07:00

Allen Frances, MD, in the Korea Joongang Daily reports (excerpt):

Not long ago, autism was among the rarest of disorders, afflicting only one child in every 2,000 to 5,000. This changed dramatically with the publication in 1994 of DSM IV (the manual of psychiatric diagnosis widely used around the world). Soon, rates exploded to about 1 per 100. And a large study in Korea recently reported a further jump to 1 in 38 - an astounding 3 percent of the general population was labeled autistic. What is causing this epidemic and where are we headed?...

...Before DSM IV, autism was among the most narrowly and clearly defined of disorders. Symptoms had to begin before age three and comprised a striking and unmistakable combination of severe language deficits, inability to form social relationships and a preoccupation with a very narrow set of stereotyped behaviors. In preparing DSM IV, we decided to add a new category describing a milder (and therefore much more difficult to define and distinguish) form of autism, called Asperger’s Disorder. This seemed necessary because some (still quite rare) children presented with more or less normal language development, but with grave social and behavioral difficulties. We knew that Asperger’s would likely triple the rate of autistic disorders to about 1 per 500 to 1,000, but this doesn’t explain the new rate of 1 per 38...

...The most likely cause of the autism epidemic is that autism has become fashionable - a popular fad diagnosis. Once rare and unmistakable, the term is now used loosely to describe people who do not really satisfy the narrow criteria intended for it by DSM IV. Autism now casts a wide net, catching much milder problems that previously went undiagnosed altogether or were given other labels. Autism is no longer seen as an extremely disabling condition, and many creative and normally eccentric people have discovered their inner autistic self.

This dramatic swing from under- to overdiagnosis has been fueled by widespread publicity, Internet support and advocacy groups, and the fact that expensive school services are provided only for those who have received the diagnosis...

..The autism “epidemic” is set to spread further starting in May 2013, when the next revision of the diagnostic manual (DSM 5) will be published. The DSM 5 definition of an “autistic spectrum” will cast an even wider net, capturing many people now considered to be normal or to have another disorder. Their symptoms will not have changed - just the label.

CONTINUE TO FULL ARTICLE HERE.

DSM-5 Approves New Fad Diagnosis for Child Psychiatry: Antipsychotic Use Likely to Rise

2011-07-22T20:01:00.001-07:00

Allen Frances, MD, at Psychiatric Times, reports on a new development in the DSM-5. Here is an excerpt:

The DSM-5 Scientific Review Group was the last hope for an eleventh hour DSM-5 save. This hope recently died. Its first decision makes clear that the group will be no more than an easy rubber stamp willing to approve even the worst ideas dreamed up by the DSM-5 work groups. Its quick acceptance of Disruptive Mood Dysregulation Disorder (DMDD, also known as Temper Dysregulation) shows that just about anything can make it through this sham review process. Watch out for yet another fad sparked by child psychiatry....

The scientific review group's first action was to issue a blank check that will allow child psychiatry to start another diagnostic fad. Child psychiatry has been on a reckless binge of overdiagnosis with no fewer than three false 'epidemics' to its credit—childhood bipolar, attention deficit, and autism. Unchastened, the field now offers up DMDD as a new and completely untested diagnosis—and amazingly enough, the scientific review group has swallowed it whole.

There is virtually no research on DMDD—it has been studied by only one group and for only six years. We don't know how high will be its rate in the bustle of primary care, its proportion of misdiagnosed false positives, its natural course and response to treatment, even its optimal definition. We can make only one safe prediction—DMDD will almost surely increase the already outrageous overdiagnosis of mental disorder in kids and the consequent overprescription of dangerous antipsychotic drugs.

Everyone (even the scientific work group and the child work group) must have known that DMDD is a made up and unstudied diagnosis with no real scientific support. The review group probably bought the child group's argument that DMDD is a lesser evil replacement for childhood bipolar disorder—less stigmatizing and less likely to result in reflex long term antipsychotic use. But their proposed fix is a disaster in the making that will most likely make an already bad situation much worse....

Too often prescribing a pill follows all too quickly and mindlessly after the (mis)labeling of the ill. And too often the pill is an antipsychotic with all its risks of huge weight gain and dire complications. Amazingly, the newer antipsychotics have already stretched their off label usage to become the number one revenue producing class of drugs in the United States—raking in $15 billion per year. The inclusion of DMDD in DSM-5 will most likely add further to the overuse of antipsychotics in kids, not solve it....

CONTINUE TO FULL ARTICLE HERE.

For an in-depth review of the problems with the new DMDD diagnostic label, see:

"Conflicts of interest in research on antipsychotic treatment of pediatric bipolar disorder, temper dysregulation disorder, and attenuated psychotic symptoms syndrome: Exploring the unholy alliance between big pharma and psychiatry" by Brent Robbins, Meghan Higgins, Maureen Fisher, and Katie over. CLICK HERE.

Investors Are Preparing for a Backlash Against Psychotropic Drugs, According to Forbes Magazine

2011-07-22T06:44:00.000-07:00

Christopher Faille at Forbes Magazine reports that investors are beginning to pull their money from investment into the psychopharmacology market and into other pharma markets. Excerpt:

Among the public, scholars and within the medical profession, a backlash has developed against the widespread use of psychoactive drugs. This backlash will help define the biotech and pharmaceutical industries in the coming years, because it means over time a shift in opportunities and capital away from a search for the next psychiatric blockbuster toward solutions to more tractable human troubles that arise outside of the central nervous system.

Eli Lilly’s (NYSE: LLY) Prozac is perhaps still the most cited instance of a real or alleged psychopharmacological breakthrough. It is an anti-depressant, the result of laboratory research conducted in the 1970s, approved for sale in the U.S. by the FDA in 1986. By 1990, it was not only the most widely prescribed anti-depressant in the U.S., it merited a Newsweek cover story.

The corporate history of another much touted drug, Adderall, is more complicated. Adderall, a stimulant used to treat both ADHD and narcolepsy, and for various off-label purposes, was once exclusively associated with Shire Pharmaceutical (NASDAQ: SHPGY). Shire no longer produces the instant release (IR) form of the drug. It sold those rights years ago to Dura Pharmaceuticals, which was in turn acquired by Teva Pharmaceuticals Industries Ltd. (NASDAQ: TEVA).

Last year, Basic Books published The Emperor’s New Drugs, by Irving Kirsch. Kirsch is himself no outsider to the world he is critiquing here. He has spent decades in the discipline of psychology since receiving a Ph.D. therein, in 1973, and has been at work on the subject of this book since 1998, when he and Guy Sapirstein co-wrote a meta-analysis of the effects of antidepressant medicines that they rather jauntily called “Listening to Prozac but Hearing Placebo.”

In The Emperor’s New Drugs, Kirsch says that he and Sapirstein were “cautious in our interpretation of the data” back in 1998. They were, despite that title, too kind to the hypothesis that the drugs under examination actually did have therapeutic value that a placebo could not duplicate. Since then, though, “the process of addressing the objections of my critics has steadily driven me to a set of much more far-reaching conclusions.”

“In the long run,” he now believes, “psychotherapy is both cheaper and more effective” than chemical therapies, “even for very serious levels of depression.”

Also last year, Crown Publishing came out with a book on much the same subject by journalist Robert Whitaker. Whitaker’s tone in Anatomy of an Epidemic (2010) is angrier than Kirsch’s. While Kirsch focuses on the good that psychoactive drugs seem to do, and finds that only the patient’s confidence in the healing power of the pills actually does that good, Whitaker focuses on the harm that he contends such pills do.

He believes that the rush to prescribe pills is behind the fact that the “number of disabled mentally ill has risen dramatically since 1955, and during the last two decades, a period when the prescribing of psychiatric medicines has exploded, the number of adults and children disabled by mental illness has risen at a mind-boggling rate.”

In June, Marcia Angel reviewed both Kirsch and Whitaker in The New York Review of Books – so sympathetically that she must be considered a member of the same choir – and she is no stranger or philistine, but the former editor in chief of the New England Journal of Medicine.

Meanwhile, the drug companies themselves have been dropping or reducing research into fields that once looked promising. Daniel Cressy, writing about this in Nature last month, was mournful in tone: “Many people affected by mental illness are facing a bleak future as drug companies abandon research into the area and other providers fail to take up the slack,” he says.

My own suspicion is that his tone is misdirected. For those for whom the future is bleak, it is bleak because the critics are right, and the drugs really don’t do anything valuable, which is to say the bleakness arises because the research program has continued in a misguided direction for far too long.

CONTINUE TO FULL ARTICLE HERE.

Yoga for Schizophrenia

2011-07-21T21:09:00.000-07:00

Natural Standard reports:

In a new study, researchers randomly assigned 18 stable schizophrenic patients to either a treatment group or a wait-list control group. In the treatment group, patients participated in various yoga exercises such as postures, breathing exercises and relaxation. Schizophrenia symptoms and quality of life were measured using the Positive and Negative Syndrome Scale and the World Health Organization Quality of Life questionnaire before treatment and again after eight weeks.

The patients who participated in yoga therapy presented significant improvements in schizophrenia symptoms, such as paranoia, depression and general psychopathology, when compared to the control group. Additionally, yoga therapy patients showed significant improvements in quality of life.

CONTINUE TO FULL ARTICLE HERE.

Couch Wars: Does One Form of Psychotherapy Work Better Than Another?

2011-07-21T18:19:00.001-07:00

Alastair GeePosted at Slate reports:

The Dodo.Is there a "dodo-bird verdict" effect in psychotherapy?

Soon after Alice descends into Wonderland in Lewis Carroll's novel, she and the Mouse, the Duck, the Eaglet, and the Lory find themselves competing in a race with no clear beginning or end. A half-hour later they ask the organizer of the event, the Dodo, to name a victor. The bird mulls it over and then proclaims, "Everybody has won, and all must have prizes."

For 75 years, the same dictum has been applied to the study of psychotherapy: Alice and the animals are like patients who each choose their own form of treatment and find their own path to happiness. It doesn't matter which style of therapy they get, Freudian or cognitive-behavioral or interpersonal, because in the end, everybody feels better.

We know that therapy works—studies find it's about as useful as antidepressants for treating moderate to severe depression—but curiously, these benefits seem to be realized irrespective of the therapists' theoretical beliefs. This effect—or rather, this appraisal of the field of psychotherapy—is called the dodo-bird verdict. All patients get a prize.

Nonetheless, some researchers argue that the dodo-bird verdict is far from settled. They concede that no established form of treatment has an advantage when it comes to mildly depressed adults, and they agree that in such cases any intervention at all seems to work better than no intervention. But that doesn't mean that all treatments are the same in every case. Cognitive-behavioral therapy, for example, may be particularly well-suited to patients suffering from panic disorder. Exposure-based therapies seem to work best for post-traumatic stress disorder.

The debate has played out in duelling studies over the past 35 years. But the question of whether the dodo really has wings will soon be even more important for Americans. As part of the health care reform act passed last year, psychological treatment will be more accessible to more people, and patients and insurers will demand to know how best to spend their money and time. Should the dodo verdict be overturned?

The notion that no therapy is better than any other originated in the 1930s with psychologist Saul Rosenzweig, then a research associate at the Harvard Psychological Clinic. His ideas on the matter were shaped by an interest in the history of curative techniques, from the kings who applied the healing "royal touch" to the therapeutic spinning chair proposed by Erasmus Darwin and the theories of Sigmund Freud. Rosenzweig thought that all these healers and treatments (which he had memorialized in a peculiar wall-hanging displayed in his office) had a similar way of working on the minds of patients—they used drama and ritual to effectuate a cure. If that approach worked for hundreds or thousands of years of human history, he reasoned, why should contemporary mind-based therapies be any different?

In 1936, Rosenzweig proposed a catchall recipe for treatment—any treatment at all—in a famous paper titled "Some Implicit Common Factors in Diverse Methods of Psychotherapy." The ingredients most frequently cited today include the collaborative bond between the patient and therapist, known as the "therapeutic alliance"; the provision of a believable framework that normalizes the patient's distress; and the buoying hope the patient feels once he has embarked on therapy.

Over the years, Rosenzweig's argument has been bolstered by the research literature. An important paper from 2002 gathered together 17 prior studies of the relative merits of various psychotherapies, mostly for depression. The authors found that the treatments—which included cognitive-behavioral, psychodynamic, and systematic desensitization therapy—showed few differences in terms of outcome, and concluded that the dodo-bird verdict is "alive and well—mostly." The caveat refers to a few data points suggesting that short-term psychodynamic treatment—which focuses on how past experiences affect your present-day life—doesn't work as well as cognitive-behavioral therapy. Similar surveys (here, here, and here) have supported the dodo-bird verdict with fewer qualifications.

CONTINUE TO FULL ARTICLE HERE.

The End of Evolutionary Psychology

2011-07-21T05:02:00.000-07:00

Razib Khan, at the Gene Expression blog, has pronounced the death of evolutionary psychology. He states:

A new paper in PLoS Biology is rather like the last person to leave turning the light off. Evolutionary psychology as we understood it in the 1980s and 1990s is over. Darwin in Mind: New Opportunities for Evolutionary Psychology:

None of the aforementioned scientific developments render evolutionary psychology unfeasible; they merely require that EP should change its daily practice. The key concepts of EP have led to a series of widely held assumptions (e.g., that human behaviour is unlikely to be adaptive in modern environments, that cognition is domain-specific, that there is a universal human nature), which with the benefit of hindsight we now know to be questionable. A modern EP would embrace a broader, more open, and multi-disciplinary theoretical framework, drawing on, rather than being isolated from, the full repertoire of knowledge and tools available in adjacent disciplines. Such a field would embrace the challenge of exploring empirically, for instance, to what extent human cognition is domain-general or domain specific, under what circumstances human behaviour is adaptive, how best to explain variation in human behaviour and cognition. The evidence from adjacent disciplines suggests that, if EP can reconsider its basic tenets, it will flourish as a scientific discipline.

Khan continues:

By “evolutionary psychology” the authors are not addressing a field just at the intersection of evolutionary biology and psychology. Rather, they’re speaking to the group of scholars who came to the fore in the 1990s under the leadership of Leda Cosmides and John Toobey as UCSB. These thinkers adhered to a specific set of parameters outlined above in regards to the basic theoretical framework of evolution and cognition through which their empirical research was framed. I can not speak to the cognitive psychology, the presumed massive modularity for example, but it does seem that their assumptions about human evolutionary history are a touch antiquated. Sometimes I wonder if this might be a feature and not a bug. I’ve been told personally by two people who knew the goings on at the UT Austin evolutionary psychology program that there wasn’t much emphasis on keeping up to date on the most recent work in evolutionary or genetic science (or at least there wasn’t in the mid-2000s, which is when my sources were familiar with the state of the research being done). The impression I received is that that would just muddy the waters and weaken the theoretical basis of the research program.

CONTINUE TO THE FULL BLOG ENTRY HERE.

Study: Patients Who Use Anti-Depressants are More Likely to Relapse

2011-07-20T09:05:00.000-07:00

PharmaPro reports:

A paper published in the journal Frontiers of Psychology suggests that patients who use anti-depressants are nearly twice as likely to suffer relapses of major depression than those who use no medication at all, Science Daily reported Tuesday.

For the study, psychologist Paul Andrews and colleagues performed a meta-analysis of dozens of published studies to compare outcomes for patients who used anti-depressants compared to those who used placebos and found that people who have not been taking any medication are at a 25 percent risk of relapse, compared to 42 percent or higher for those who have taken and gone off an anti-depressant.

Andrews claims anti-depressants interfere with the brain's natural self-regulation of serotonin and other neurotransmitters, and that the brain can overcorrect once the drug is suspended, triggering new depression.

"We found that the more these drugs affect serotonin and other neurotransmitters in your brain -- and that's what they're supposed to do -- the greater your risk of relapse once you stop taking them," Andrews says.

All these drugs do reduce symptoms, probably to some degree, in the short-term. The trick is what happens in the long term. Our results suggest that when you try to go off the drugs, depression will bounce back. This can leave people stuck in a cycle where they need to keep taking anti-depressants to prevent a return of symptoms," he added.

ARTICLE HERE.

The Postconventional Personality: Assessing, Researching, and Theorizing Higher Development

2011-07-20T07:31:00.000-07:00

Cutting-edge volume devoted to optimal adult development.

Postconventional stages of personality development involve growth well beyond the average, and have become a rapidly growing subject of research not only in developmental psychology circles but also in areas such as executive leadership development. This book is the first to bring together many of the major researchers in the field, showcasing diverse perspectives ranging from the spiritual to the corporate. The contributors present research on essential questions about the existence and prevalence of high levels of personal growth, whether such achievement is correlated with other types of psychological growth, whether high levels of growth actually indicate happiness, what kinds of people exhibit these higher levels of development, how they may have developed this expanded perspective, and the characteristics of their viewpoints, abilities, and preoccupations. For anyone interested in Ken Wilber’s integral psychology, as well as those in executive coaching, this volume is an invaluable resource and will be a standard reference for years to come.

"This is a convention-breaking book that makes a much-needed contribution to the field. Its varied scholarly chapters explore the far reaches of human growth and potential—including the oft-neglected dimension of personality development. Chapters are written by veteran researchers and exemplars in adult development studies. Included are wonderfully creative theoretical explorations on personality development as well as original contributions that push the envelope of spiritual and religious development to unprecedented lengths." — Melvin E. Miller, coeditor of Self and No-Self: Continuing the Dialogue between Buddhism and Psychotherapy

“This book is the best place to go for current views on late-stage ego-development theory, practice, and measurement. It clarifies the promise and importance of these methods and models that stem from Loevinger (and H. S. Sullivan), casting an eye over a fascinating array of topics. But the book also explores the limitations and blind spots inherent in these methods. This is an excellent contribution to scholarly literature about the further reaches of human potential.” — Zachary Stein, Harvard University

Angela H. Pfaffenberger has a PhD in psychology and is an independent researcher in personality theory. She maintains a private practice as a psychotherapist and acupuncturist in Salem, Oregon.

Paul W. Marko has a PhD in psychology from Saybrook Graduate School and Research Center. He is a developmental psychologist who works with both organizations and individuals.

Allan Combs is Professor of Transformative Studies at the California Institute of Integral Studies and Professor Emeritus of Psychology at the University of North Carolina at Asheville. His many books include Consciousness Explained Better: Towards an Integral Understanding of the Multifaceted Nature of Consciousness.

Is Harry Potter a Christ Figure?

2011-07-20T07:19:00.000-07:00

Why do some Christian groups admire C.S. Lewis and reject J.K. Rowling? Both authors utilize heavy biblical themes in their semi-allegorical fiction works. Watch as Emory University professor Adriane Ivey explores religion and morality in the context of "Harry Potter" and Harry's role as a Christ figure.

Project Nim

2011-07-19T22:50:00.000-07:00

Trailer for the documentary, Project Nim, directed by James Marsh (Man on a Wire). From the team behind Man on Wire comes the story of Nim, the chimpanzee who in the 1970s became the focus of a landmark experiment which aimed to show that an ape could learn to communicate with language if raised and nurtured like a human child. Following Nim's extraordinary journey through human society, and the enduring impact he makes on the people he meets along the way, the film is an unflinching and unsentimental biography of an animal we tried to make human. What we learn about his true nature - and indeed our own - is comic, revealing and profoundly unsettling.

READ REVIEWS OF THE FILM HERE.

Julia Kristeva: Feminism under pressure in China

2011-07-18T09:17:00.000-07:00

Repression greets those brave women who are fighting against scandal and abuse

Julia Kristeva at The Guardian reports:

Whatever its detractors may say, feminism is very much alive. Helped by globalisation, it is still contributing to greater freedom for humanity as a whole. Recent events are testimony to the start of a new phase in female emancipation, with women taking an active part in the "jasmine revolution", a growing awareness in French public opinion of gender-related violence, and support for the desire to have children and its ethical implications.

Ancient and recent history seem to have prepared the combative vitality of the "other half of the sky" represented by China's second sex. We should remember that in the land of yin and yang, Tao Buddhism and Confucius, the bourgeois revolution was nationalist, socialist and feminist. In 1912 Chinese suffragettes invaded parliament. The women's rights movement inspired the May Fourth Movement in 1919, which called for equal rights for men and women, an end to polygamy and arranged marriages, and access to higher education for women. The law on marriage introduced by the People's Republic in 1950 abolished the "head of the family" and allowed mothers to keep their maiden name and bequeath property to their children. Meanwhile, housework entitled them to property rights.

Increasing numbers of contemporary Chinese women are doing more than simply contribute to the growth of an emerging economic giant, or just protesting about all those left by the wayside. Neither the consenting victims of the religious fundamentalism that prevails under other regimes, nor yet the docile agents of marketing for the hyper-connected, they refuse to be intimidated by human rights violations. More and more women are defending and promoting the rights of their sisters. They realise that by demanding that state authorities implement the international agreements China has signed – as well as the articles (33 to 37) of the 4 December 1982 constitution on individual freedoms – they are contributing to social reform and progress towards constitutional democracy. At the same time they are vigorously condemning scandals, abuses and corruption.

But these women are also subject to pressure, harassment and intimidation. Growing repression comes on top of stricter surveillance of the internet and tighter control by censors, fed by the fear that the rebellious spirit of the Middle East and Mediterranean countries may spread to China.

In January 2010 the jury of the Simone de Beauvoir prize for women's liberty chose to honour two Chinese women for upholding women's rights: the lawyer Guo Jianmei and the professor of comparative literature and film-maker Ai Xiaoming. Only the former was able to attend the award ceremony in Paris in 2011, her fellow prize-winner not having been allowed to leave China.

CONTINUE TO FULL ARTICLE HERE.

The Ecology of the Child: Children's Mental Health

2011-07-18T06:59:00.000-07:00

Children today face increasing challenges that can act as triggers for rising psychiatric symptoms. These range from reduced sleep, pressured school, disconnected family life, escalating obesity, depressed mothers, intrusive media and poor nutrition. In addition, there is a rapidly escalating use of psychiatric medication. Dr. Scott Shannon examines many of the assumptions built into our current system of pediatric and adolescent mental health, and offers a new vision for the future.

Mass Psychosis in the U.S.: How Big Pharma Got Americans Hooked on Anti-Psychotic Drugs

2011-07-16T11:03:00.000-07:00

James Ridgeway at Al Jazeera reports:

Has America become a nation of psychotics? You would certainly think so, based on the explosion in the use of antipsychotic medications. In 2008, with over $14 billion in sales, antipsychotics became the single top-selling therapeutic class of prescription drugs in the United States, surpassing drugs used to treat high cholesterol and acid reflux.

Once upon a time, antipsychotics were reserved for a relatively small number of patients with hard-core psychiatric diagnoses - primarily schizophrenia and bipolar disorder - to treat such symptoms as delusions, hallucinations, or formal thought disorder. Today, it seems, everyone is taking antipsychotics. Parents are told that their unruly kids are in fact bipolar, and in need of anti-psychotics, while old people with dementia are dosed, in large numbers, with drugs once reserved largely for schizophrenics. Americans with symptoms ranging from chronic depression to anxiety to insomnia are now being prescribed anti-psychotics at rates that seem to indicate a national mass psychosis.

It is anything but a coincidence that the explosion in antipsychotic use coincides with the pharmaceutical industry's development of a new class of medications known as "atypical antipsychotics." Beginning with Zyprexa, Risperdal, and Seroquel in the 1990s, followed by Abilify in the early 2000s, these drugs were touted as being more effective than older antipsychotics like Haldol and Thorazine. More importantly, they lacked the most noxious side effects of the older drugs - in particular, the tremors and other motor control problems.

The atypical anti-psychotics were the bright new stars in the pharmaceutical industry's roster of psychotropic drugs - costly, patented medications that made people feel and behave better without any shaking or drooling. Sales grew steadily, until by 2009 Seroquel and Abilify numbered fifth and sixth in annual drug sales, and prescriptions written for the top three atypical antipsychotics totaled more than 20 million. Suddenly, antipsychotics weren't just for psychotics any more.

Not just for psychotics anymore

By now, just about everyone knows how the drug industry works to influence the minds of American doctors, plying them with gifts, junkets, ego-tripping awards, and research funding in exchange for endorsing or prescribing the latest and most lucrative drugs. "Psychiatrists are particularly targeted by Big Pharma because psychiatric diagnoses are very subjective," says Dr. Adriane Fugh-Berman, whose PharmedOut project tracks the industry's influence on American medicine, and who last month hosted a conference on the subject at Georgetown. A shrink can't give you a blood test or an MRI to figure out precisely what's wrong with you. So it's often a case of diagnosis by prescription. (If you feel better after you take an anti-depressant, it's assumed that you were depressed.) As the researchers in one study of the drug industry's influence put it, "the lack of biological tests for mental disorders renders psychiatry especially vulnerable to industry influence." For this reason, they argue, it's particularly important that the guidelines for diagnosing and treating mental illness be compiled "on the basis of an objective review of the scientific evidence" - and not on whether the doctors writing them got a big grant from Merck or own stock in AstraZeneca.

Marcia Angell, former editor of the New England Journal of Medicine and a leading critic of the Big Pharma, puts it more bluntly: "Psychiatrists are in the pocket of industry." Angell has pointed out that most of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the bible of mental health clinicians, have ties to the drug industry. Likewise, a 2009 study showed that 18 out of 20 of the shrinks who wrote the American Psychiatric Association's most recent clinical guidelines for treating depression, bipolar disorders, and schizophrenia had financial ties to drug companies.

In a recent article in The New York Review of Books, Angell deconstructs what she calls an apparent "raging epidemic of mental illness" among Americans. The use of psychoactive drugs—including both antidepressants and antipsychotics—has exploded, and if the new drugs are so effective, Angell points out, we should "expect the prevalence of mental illness to be declining, not rising." Instead, "the tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007 - from one in 184 Americans to one in seventy-six. For children, the rise is even more startling - a thirty-five-fold increase in the same two decades. Mental illness is now the leading cause of disability in children." Under the tutelage of Big Pharma, we are "simply expanding the criteria for mental illness so that nearly everyone has one." Fugh-Berman agrees: In the age of aggressive drug marketing, she says, "Psychiatric diagnoses have expanded to include many perfectly normal people."

Cost benefit analysis

What's especially troubling about the over-prescription of the new antipsychotics is its prevalence among the very young and the very old - vulnerable groups who often do not make their own choices when it comes to what medications they take. Investigations into antipsychotic use suggests that their purpose, in these cases, may be to subdue and tranquilize rather than to treat any genuine psychosis.

Carl Elliott reports in Mother Jones magazine: "Once bipolar disorder could be treated with atypicals, rates of diagnoses rose dramatically, especially in children. According to a recent Columbia University study, the number of children and adolescents treated for bipolar disorder rose 40-fold between 1994 and 2003." And according to another study, "one in five children who visited a psychiatrist came away with a prescription for an antipsychotic drug."

A remarkable series published in the Palm Beach Post in May true revealed that the state of Florida's juvenile justice department has literally been pouring these drugs into juvenile facilities, "routinely" doling them out "for reasons that never were approved by federal regulators." The numbers are staggering: "In 2007, for example, the Department of Juvenile Justice bought more than twice as much Seroquel as ibuprofen. Overall, in 24 months, the department bought 326,081 tablets of Seroquel, Abilify, Risperdal and other antipsychotic drugs for use in state-operated jails and homes for children…That's enough to hand out 446 pills a day, seven days a week, for two years in a row, to kids in jails and programs that can hold no more than 2,300 boys and girls on a given day." Further, the paper discovered that "One in three of the psychiatrists who have contracted with the state Department of Juvenile Justice in the past five years has taken speaker fees or gifts from companies that make antipsychotic medications."

In addition to expanding the diagnoses of serious mental illness, drug companies have encouraged doctors to prescribe atypical anti-psychotics for a host of off-label uses. In one particularly notorious episode, the drugmaker Eli Lilly pushed Zyprexa on the caregivers of old people with Alzheimer's and other forms of dementia, as well as agitation, anxiety, and insomnia. In selling to nursing home doctors, sales reps reportedly used the slogan "five at five"—meaning that five milligrams of Zyprexa at 5 pm would sedate their more difficult charges. The practice persisted even after FDA had warned Lilly that the drug was not approved for such uses, and that it could lead to obesity and even diabetes in elderly patients.

CONTINUE TO FULL ARTICLE HERE.

Review of "Love & Arms: Violence and Justification after Levinas" by Helen Douglas

2011-07-16T09:44:00.001-07:00

In Mail & Guardian, Kai Horsthemke reviews the new book by philosopher Helen Douglas:

How should we respond to violence and injustice?

A famous anti-war slogan of the late 1960s stated that "fighting for peace is like fucking for chastity".

Yet, according to an aphorism attributed in some form or other to Edmund Burke: "All it takes for evil to triumph is for decent people to do nothing."

If these two assertions are at all plausible, then we face the choice between incoherence or inconsistency on the one hand and inefficiency on the other. Neither is attractive for those who are committed to resistance but who are unsure about the direction their commitment should take.

This characterises the paradox of just violence, which is at the heart of Helen Douglas's book.

How does one resist aggression without becoming a functional cog in the perpetual cycle of violence, aggression and injustice, a vicious circle that involves not only negation of the aggressor's humanity ("he's not human"; "he's a monster"), but also, importantly, the diminution of the activist's human dignity?

Making ethical sense of things

Douglas, a Canadian with a personal history of involvement in the South African anti-apartheid struggle, draws chiefly on the thoughts and writings of the Lithuania-born French-Jewish philosopher Emmanuel Levinas in her attempt to make ethical sense of the dilemma. The problem is that any justification of a violent act tends to lose sight of what makes violence and injustice, especially violent injustice, ethically wrong in the first place. Or does it?

The ethical problem of violence turns on the issue of justification. When, if ever, is violence justified? If it is, then what form should violence take? Is only retributive violence justified? Or is preventive violence permissible, too? Not according to the argument advanced in the first chapter, where the paradox of just violence receives an initial exploration: "In violently resisting unjust violence, one finds oneself ethically obligated to do the wrong thing."

Douglas examines justification of such resistance to aggression in terms of fairness and proportional retaliation (which explains why preventive violence cannot be condoned), social approval and conventional endorsement, and immediate retribution, as in self-defence.

Levinas occupies pride of place in chapter two, which is, in some sense, the most difficult chapter to wade through in this book. When Douglas expresses an awareness of "Levinas's excesses", she is not referring to the philosopher's verbal intemperance, it would appear. The writer herself is prone to indulging in a fair amount of fancy etymological footwork and portentous capitalising of key nouns. Chronicling the phenomenality of contact, the chapter provides careful analysis of "proximity", "Self" and "Other" and paves the way towards what turns out to be an important distinction: between having a face and being faceless.

The development of the notion of "having a face", in the sense of "showing" a face, is significant in terms of being able to make sense of proximity, of ethical obligation and responsibility, and especially of justice.

Different kinds of violence

With the desired groundwork done in chapter two, Douglas finds herself in a position to respond to the "question of how the struggle against violence -- which is not necessarily a refusal of violence -- could avoid instituting further violence".

Levinas's challenge implies that there must be a way to distinguish between different kinds of violence, namely "between the 'bad violence' of aggression and the 'just violence' of resistance to aggression". Both Douglas and Levinas appear to find the Burkean dictum compelling. As Douglas puts it, "Bad guys fight to win", and a commitment to non-violence easily translates into mere non-resistance, which involves a failure to honour one's obligations to those at the receiving end of "bad violence" or aggression and, which, indeed, makes them conspire in the injustice done to those "in proximity".

What is a human rights activist permitted to do in terms of resisting -- for example -- patriarchal laws and customs involving violence such as clitoridectomy, virginity testing, honour killings and the like? What is an appropriate response to an organisation or institution perpetrating economic injustice against its employees? If I act or resist on behalf of someone else, am I not encroaching on a person's agency, diminishing that person even further? What is the status of the violence committed by someone who performs a requested abortion following rape? What about the violent actions of animal liberationists?

The answers to these questions are contained in this book, but they are not given explicitly....

Those who seek an entry point to the work of Levinas will be richly rewarded. (The book's appendix contains an excerpt from Levinas's Otherwise than Being.) Those who seek quick and clear answers to certain questions about matters of life and death will have to invest a considerable amount of patient detective work.

Nonetheless, Love & Arms exhibits a combination of analytical rigour, compassion and frequently poetic commitment -- a rare achievement.

READ FULL REVIEW HERE.

Ritalin and Prozac -- A Troubling Combo for Children?

2011-07-15T19:38:00.000-07:00

Melissa Healy at the Los Angeles Times reports:

Four in 10 kids who get a diagnosis of either depression or attention-deficit hyperactivity disorder (ADHD) end up getting both diagnoses sometime in their young lives. That means a lot will spend some part of their adolescence taking two psychiatric medications: methylphenidate (better known by its commercial name, Ritalin) and fluoxetine (better known as Prozac, the only of the new-generation antidepressants approved for kids as young as 8 years old). A new study conducted on rats suggests that taking that combination of drugs may change the adults they will become in ways that are distinctly troubling.

Taking Ritalin and Prozac together during adolescence appears to set in motion subtle changes in brain function that, in adulthood, makes an individual more sensitive to reward as well as to stress, and more likely to exhibit the pessimism and hopelessness seen in depression, concluded the study, published this week in the Journal of Neuroscience.

The study's findings suggest "that combining methyphenidate and fluoxetine early in life may lead to lifelong behavioral and chemical abnormalities," wrote the authors, from Florida State University and Cal State San Bernardino. Specifically, the combination of the stimulant drug methyphenidate and the serotonin-boosting antidepressant fluoxetine appears to act on the brain in much the same way as does cocaine.

In children's developing brains, the researchers demonstrated that that combination turns on and off production of certain proteins in the ventral tegmental area, a key node in the brain's reward circuitry. If those production processes get knocked out of whack during adolescence, the result can be subtle changes in an adult's ability to regulate mood and to moderate reward-seeking behavior such as eating, drug-taking or sexual activity.

CONTINUE TO FULL ARTICLE HERE.