Elise Stobbe – Brain Blogger http://brainblogger.com Health and Science Blog Covering Brain Topics Wed, 30 May 2018 15:00:03 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.6 Integrative Psychiatry: Mental Symptoms and Nutrients http://brainblogger.com/2006/07/14/integrative-psychiatry-mental-symptoms-and-nutrients/ http://brainblogger.com/2006/07/14/integrative-psychiatry-mental-symptoms-and-nutrients/#comments Fri, 14 Jul 2006 09:00:18 +0000 http://brainblogger.com/2006/07/14/integrative-psychiatry-mental-symptoms-and-nutrients/ Psychiatry_Psychology2.jpgOne of the benefits of visiting a psychiatrist who also specializes in holistic, complementary or alternative medicine is that he or she can determine whether or not a nutritional deficiency is the cause of some mental symptoms. Nutrients play a critical role in mental health. They are the building blocks of the nervous system. In fact, the brain has first call on the available supply of nutrients. Therefore, the first effects of nutritional deficiencies are often mental symptoms. Deficiencies in almost any of the vitamins and minerals can show up first as emotional or mental symptoms, such as depression, anxiety, or impaired memory and concentration. For example, folate deficiency is a common occurrence in psychiatric disorders, whether organic or functional, particularly in depressive illness.

There are specific nutrients which cause mental symptoms when that nutrient is lacking:

Calcium: Depression, delusions and irritability.

Chromium: Anxiety.

Copper: Depression.

Folic Acid: Apathy, depression, insomnia, paranoia.

Iron: Depression.

Magnesium: Anxiety, confusion, hyperactivity, nervousness, restlessness.

Niacin (B3): Confusion, depression, emotional instability, irritability, memory impairment.

Pantothenic acid (B5): Depression, irritability.

Potassium: Depression, insomnia, mental impairment, nervousness.

Pyridoxine (B6): Depression, irritability.

Riboflavin: Depression, nervousness.

Thiamin: Confusion, irritability, memory loss, nervousness. Individuals with a thiamin deficiency can develop Wernicke-Korsakoff syndrome, which is characterized by confusion, mental changes, abnormal eye movements, and unsteadiness that can progress to severe memory loss.

Vitamin B-12: Depression, irritability, dementia, mental disturbances, moodiness.

Vitamin C: Depression, irritability.

Zinc: Depression, irritability, lethargy, memory impairment, paranoia.

Omega-3 Fatty Acids: Depression.

Low Cholesterol: Depression.

There are three amino acids that are most directly related to mood and depression: phenylalanine, tyro-sine, and tryptophan. Phenylalanine and tyrosine produce the neurotransmitter norepinephrine, and tryptophan is eventually converted to serotonin.

Research has proven the effectiveness of amino acid therapy in fighting depression. Both phenylalanine and tyrosine-which is created in the body from phenylalanine-have been found to be as effective as the antidepressant drug imipramine. Phenylalanine has also been shown to reduce pain by preserving brain levels of endorphins, the body’s natural painkiller. Tyrosine is helpful in the treatment of PMS and chronic fatigue syndrome. Tryptophan, which the body converts into the precursor 5-hydroxytryptophan (5-HT), has also been found to be as effective as the synthetic antidepressants. (Cass)

Correct testing and understanding of deficiencies or overloads can pinpoint the causes of many mental symptoms, thus opening the door to hope and recovery. Positively demonstrating that nutrient supplementation improves mental disorders and proving that mental disorders are in fact due to nutritional deficiencies is difficult, however. Much research needs to be done to further explore this area.

Sources

Goldberg, Ivan, M.D. A Medline Search. “Folate, Vitamin B-12 and Depression“.

Wipond, Rob. “Healthy Brain, Happy Mind”.

Kapllan, Bonnie. “The Relationship Between Nutrition and Mental Disorders“.

Cass, Hyla M.D. “Nutritional Approaches to Mental Health“.

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The Future of Psychiatry with Alternative Treatments http://brainblogger.com/2006/07/04/integrative-psychiatry-the-future-of-psychiatry-with-alternative-treatments/ http://brainblogger.com/2006/07/04/integrative-psychiatry-the-future-of-psychiatry-with-alternative-treatments/#comments Tue, 04 Jul 2006 16:09:41 +0000 http://brainblogger.com/2006/07/04/integrative-psychiatry-the-future-of-psychiatry-with-alternative-treatments/ Alternative_Medicine2.jpgMainstream psychiatry is becoming more biology-based in practice and today uses medication as a major form of treatment. The problem with this, say some, is that psychiatric medication is dangerous or over-prescribed. Alternative medicine offers other therapeutic choices for people who are against biological psychiatry. What is alternative medicine, when applied to mental illness? This is indeed a perplexing question. The alternative methods of treatment for various types of mental illness include as many as 300 different therapies in this growing and diverse field, such as:

Accupunture, nutrition, spiritual activities, massage, yoga, chiropractic, reiki, counseling, ayurvedic and mind-body medicine (an ancient medical system from India), homeopathic medicine, reflexology, oxygen therapy, chelation, metal toxicity, biofeedback, imagery, self-hypnosis, meditation, therapeutic touch, correction of metabolic or hormone deficiencies; macrobiotics or a more natural organic chemical free diet; Eye Movement Desensitization and Reprocessing, and so on.

How is the average person able to navigate the maze of alternative treatments and claims? Fortunately, psychiatry and alternative therapies don’t have to be either-or choices. The term “integrative psychiatry” describes a combined medical-alternative approach to psychiatry. “It is healing-oriented psychiatry that takes account of the whole person (body, mind, and spirit). It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.” (1) Most integrative psychiatrists use alternative medicine as an adjunct to psychiatric medications. In other words, they are meant to help reduce the dosage, not replace the medicine all together. But if a person is opposed to psychiatric medication, these specialists are available for guidance in which alternative treatments might best fit the individual need. Osteopathic Psychiatrists also offer alternative therapies, along the lines of mind-body healing. (Osteopathic Psychiatrists use structural diagnosis and manipulative therapy in addition to all other traditional forms of diagnosis and treatment.)

Integrative psychiatry is a holistic approach that uses both conventional and alternative therapies in the treatment of psychiatric disorders. Personalized treatments are typically developed by practitioners to suit each person’s lifestyle and needs. But most integrative psychiatry practitioners agree in a contraindication for individuals with active suicidal thoughts or psychosis, who require a more intensive level of psychiatric care. (2)

“An Integrative Psychiatrist is attuned to the many dimensions that affect emotional distress and wellness. These dimensions include physical, emotional, interpersonal, behavioral, nutritional, environmental and spiritual elements.” (3)

Finding integrative psychiatry practitioners and alternative medicine providers is as easy as using the phone book or internet search engine. But the alternative treatments offered at each practice may differ widely. Some may use psychiatric medications and psychotherapy treatment in combination with a selection of alternative medicines, and others may not use psychiatric medications but will use other alternative methods. There are more choices are available than the average person seeking mental health treatment might believe.

References

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Psychiatry Discriminates Against People with Borderline Personality Disorder http://brainblogger.com/2006/06/20/anti-stigmatization-psychiatry-discriminates-against-people-with-borderline-personality-disorder/ http://brainblogger.com/2006/06/20/anti-stigmatization-psychiatry-discriminates-against-people-with-borderline-personality-disorder/#comments Tue, 20 Jun 2006 12:00:26 +0000 http://brainblogger.com/2006/06/20/anti-stigmatization-psychiatry-discriminates-against-people-with-borderline-personality-disorder/ Anti_Stigmatization.jpgBorderline Personality Disorder (BPD) is characterized by a pattern of unstable relationships, a self-image that is always changing, and poor impulse control. The person suffering from BPD fears abandonment and will go to any lengths to prevent this, including threats of suicide. Self-harm is a characteristic.

There may be no other psychiatric diagnosis more laden with stereotypes and stigma than Borderline Personality Disorder. People who live with this label — the majority being female — often have problems accessing good mental health services. (1) Unlike the stigmatization that society puts on mental illness, the stigma associated with BPD often comes from mental health professionals and their patronizing attitudes.

Many psychiatrists will not treat BPD patients, or they may limit the number of BPD patients in their practice or drop them as ”treatment resistant.” Often attempts to treat borderlines fail, and some professionals blame the patient for not responding to treatment. (2) It is often undiagnosed, misdiagnosed, or treated inappropriately. According to Dr. Joel Dvoskin, former Commissioner of the New York State Office Of Mental Health,

“Why would psychiatry and psychology turn so viciously against people they call mentally disordered? Apparently the greatest sin a client can commit is poor response to treatment. What is apparently so wrong about these unfortunate souls is that they have yet to demonstrate the ability to get better in response to our treatment. Thus, they don’t make us feel very good. With a few notable exceptions, we have simply given up on helping people who desperately need us to do a better job of helping them.” (3)

Many mental health professionals discriminate against BPD patients because of what their co-workers have said about them. They watch other professional people “rolling their eyes” when someone mentions BPD. This is just evidence showing others that “everyone knows that people with BPD are horrible people and hard to manage”. (4)

Clients who come to services with a diagnosis of BPD “may already be disliked before they have even been seen. Clients in treatment are often embroiled in clinician attitudes which are derogatory or denying the legitimacy of their right to access resources. Studies have demonstrated clinicians having less empathy for people meeting diagnostic criteria for borderline personality disorder than other diagnostic groups and making more belittling comments.” (5)

Support services for consumers and families are woefully inadequate. The public is generally unaware of the disorder due to the lack of educational materials available from various mental health organizations. No celebrity has yet come forward to put a face on BPD, probably because BPD is the most stigmatized of all mental illnesses today. (6)

Recent research studies have demonstrated the effectiveness of individual cognitive behavioral therapy along with group psychoeducation and skills training that teach emotional regulation skills, distress tolerance, improved interpersonal relationship behaviors and awareness (mindfulness). This, combined with careful medication management, may allow the patient to achieve significant progress. (7)

Effective treatment can reduce symptoms and improve quality of life. There is also considerable short-term fluctuation in symptoms and distress, and the long-term outcome for many patients is often better than originally thought, even without treatment. (8) A fairly new psychosocial treatment termed dialectical behavior therapy (DBT) which was developed specifically to treat BPD is available. But without willing professionals, people with BPD are denied the help they need.

References

(1) Nehls, N. Issues Mental Health Nursing. “Border Personality Disorder: Gender Types, Stigma and Limited System of Care“. Abstract. Entrez PubMed.

(2) Bogod, Elizabeth. Mental Health Matters. “Borderline Personality Disorder Label Creates Stigma“.

(3) CAMI Journal on BPD, Vol 8 cited by TARA Association, “Understanding Borderline Personality Disorder“.

(4) Fleener, Patty, M.S.W. BPD Today. “Stigma and Borderline Personality Disorder“. (2002).

(5) Krawitz, Roy and Watson, Christine. Mental Health Commission Occasional Publications: No. 2. “Borderline Personality Disorder: Pathways to Effective Service Delivery and Clinical Treatment Options.” (October, 1999).

(6) Porr, Valerie. TARA Association. How Advocacy is Bringing Borderline Personality Disorder Into the Light“. (Nov. 2001).

(7) TARA Association, “Understanding Borderline Personality Disorder“.

(8) Livesley, W. John, M.D. The Canadian Journal of Psychiatry. Editorial: “Progress in the Treatment of Borderline Personality Disorder”. (July 2005).

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Family Doctor or Psychiatrist? http://brainblogger.com/2006/06/15/anti-stigmatization-family-doctor-or-psychiatrist/ http://brainblogger.com/2006/06/15/anti-stigmatization-family-doctor-or-psychiatrist/#comments Fri, 16 Jun 2006 01:40:52 +0000 http://brainblogger.com/2006/06/15/anti-stigmatization-family-doctor-or-psychiatrist/ Anti_Stigmatization2.jpgWho wants to admit that they need to see a psychiatrist? There is often an inner sense of shame and disgrace when people seek psychiatric consultation, yet the pain of mental illness compels many people to seek help from family doctors or psychiatrists.

Most people who suspect mental illness initially go to their family doctors. However, it is valuable if the ill person knows the pro’s and con’s of consulting their family doctor about their mental symptoms as opposed to a psychiatrist or who specializes in diagnosing and treating mental illness.

Studies show that 74% of people seeking help for depression, for example, will first go to the family doctor. Of these cases, as many as 50% are misdiagnosed.(1) These general practitioners or internal medicine specialists are trained to recognize mental illness, but do not have the updated specialized education and expertise as do psychiatrists, to most correctly diagnose and treat mental illnesses.

There is a lot of depression diagnosed by family doctors, especially since depression has become more advertised on television and less stigmatized. If the family doctor chooses not to make a referral to a psychiatrist or psychologist, he or she will probably will treat it with an SSRI like Prozac. But the true diagnosis may turn out to be something different than depression. Not recognizing mania combined with depression, for example, is a risk because this is how many bipolar disorders are missed. Even of the depression cases that are correctly diagnosed by the family doctor, 80% are given too little medication for too short a time.(2) Starting with the family doctor might still be a good idea for anyone suspecting mental illness, however, because the doctor can rule out possible physical causes for mental symptoms. Some tests that are commonly done are EEG, MRI, or PET scans to rule out seizure disorders, and some lab tests to determine pituitary and thyroid function.

In mainstream mental health, medication is an important ingredient in treatment of mental illness. Although the family doctor can prescribe medications, a psychiatrist is more familiar with the wide range of psychiatric medications, how to use them in combination, and how to manage their side effects.(3)

A majority of people diagnosed with a mental illness by their family doctor are not referred to psychiatrists. The doctor probably chats with them for a few minutes, writes a prescription, and sends the individual home. If the individual is concerned that additional professional investigation is needed, they should insist on being referred to a psychiatrist. On the other hand, if the family doctor does suggest that an individual see a psychiatrist many people do not go at all and refuse additional treatment, because for the rest of their lives, when asked “have you ever been to a mental health professional”, they will have to say “yes”, risking jobs, relationships, insurance coverage, admission to schools, etc. due to stigmatization. They are afraid that a visit to a psychiatrist will label them as “nuts”. They may not have faith in the mental health system at all, or may not have confidence in psychiatric drugs. And, it might just seem easier to keep their illness secret if they consult with only their family doctor.

It is society’s discrimination against the mentally ill which puts a person seeking treatment in the predicament of risking the results of stigma just by trying to find the best treatment for an illness that deserves no more discrimination than any physical illness.

References

(1) “Understanding Depression Treatment“. WebMD Medical Reference. (2005).

(2) Ibid.

(3) “Choosing a Mental Health Provider: How to Find One Who Suits Your Needs”. Mayo Clinic Staff. (2005).

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Stigmatization: Myths and Minds http://brainblogger.com/2006/06/06/anti-stigmatization-myths-and-minds/ http://brainblogger.com/2006/06/06/anti-stigmatization-myths-and-minds/#respond Tue, 06 Jun 2006 13:46:00 +0000 http://blog.gnif.org/?p=523 Anti_Stigmatization.jpgIt has only been within the past decade or two that we have begun to better understand the biochemical causes of mental illness. Although there is still much to be discovered, it is now known that mental illnesses are similar to physical illnesses, since they often have biochemical causes and medical treatments.Most cultures view or have viewed severely mentally ill persons as crazy, lacking will-power, possessed, frightening or violent. One universal element of this stigmatization and discrimination against the mentally ill is the traditional belief that severe mental illness is caused by something supernatural or paranormal, such as possession by spirits, curses or sorcery attacks, influence by the moon (“lunacy”), divine punishment, karma, or is the result of a moral transgression. This myth about the cause of mental illness keeps the stigmatization of the mentally ill strong around the world. (There are exceptions, such as Native Americans, who historically have shown tolerance, compassion and respect for mentally ill people).

In the past, these supernatural explanations were widely accepted. In less advanced societies today, many of these myths still exist. “Treatment” can sometimes take the form of exorcism, torture or bartering with evil spirits. This is not to say that some traditional supernatural treatments were/are of no value, however. Again using the example of Native Americans, Native American shamans summoned supernatural powers to treat the mentally ill, incorporating rituals of atonement and purification. (1) A case could be made that this treatment can be compared to modern psychotherapy as far as outcome.

Today, even in the most advanced societies around the world, there is a certain supernatural-based prejudice against severely mentally ill people stemming from dogma about literal possession by evil spirits in the form of demonic manifestations, combined with the belief that sometimes the behaviors of a severely mentally ill person demonstrate spirit possession and do not stem from a biochemical cause. This is not to debate whether or not spirit possession or other supernatural explanations exist, but rather to demonstrate that severe mental illness is a separate entity from the supernatural and can be explained through science. Still, science doesn’t claim to have all the answers and things we call supernatural today might be explained by science tomorrow. The point is, labeling a mentally ill person as possessed by evil spirits and abandoning them to only religious solutions denies them a chance for symptom relief through psychiatric care or alternative medicine.

People with mental illness sometimes castigate themselves. “Individuals suffering from depression and feelings of hopelessness and helplessness because of their illness, may focus on religious themes of judgment. Some people believe that God must be punishing them or why would God have them in this situation. There is a strong feeling that the person is the guilty one, who has failed others and him/herself. The person believes that punishment from God is deserved.” (2) Again, this is not to debate God issues, but to point out that now it is widely accepted and understood that mental illness is a malfunction of the neurotransmitters of the brain. It is a biochemical imbalance, not moral weakness, divine judgment or other supernatural cause. So the same logic used by an individual to castigate him for a mental illness must be applied to any physical illness.

Ignorance continues to fuel prejudice and reinforces stigma. We need to accept that a mental illness is an illness. We have become aware that an imbalance in our bodies can increase the likelihood that we will have a disease like diabetes. It is time that we understand the same is true for mental illnesses. (3)

Society needs to view mental illness in a less judgmental, more scientific way. In the best of cases, we hope that individuals with mental illness are treated with respect and compassion. Mental illness should be treated with research, medicine and legislation rather than moralizing. (4)

References

(1) Mental Wellness.com. “History of Mental Illness”.

(2) Pathways to Promise. “Working with People with Mental Illness – Themes“.

(3) Stephens, The Reverend Charles J. “Attacking the Stigma of Mental Illness”. (2002).

(4) Palmer, Ann. “20th Century History of the Treatment of Mental Illness: A Review“.

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Mental Health Spending – A Low Priority for Government http://brainblogger.com/2006/05/31/anti-stigmatization-mental-health-spending-a-low-priority-for-government/ http://brainblogger.com/2006/05/31/anti-stigmatization-mental-health-spending-a-low-priority-for-government/#comments Thu, 01 Jun 2006 02:58:00 +0000 http://blog.gnif.org/?p=520 Law_Politics2.jpgThe power of stigmatization of the mentally ill is so strong that it keeps mental health low on the list of public priorities for spending. One of the barriers to treatment for the mentally ill is the inability to pay for it, and another is how to access it. Policy-making and funding decisions for mental health by federal, state and local legislators result in inadequate government-funded mental health care facilities, insurance reimbursement, community programs and treatment specialists available.

Mental health does not usually have parity with physical health benefits in private insurance policies, making it expensive for anyone, even if fortunate enough to be insured. Even those on Medicare have limitations on benefits and reimbursements not at parity with physical conditions. Many others have insurance, but mental health treatment is not covered.

Perhaps the individual has no insurance and does not qualify for government programs like Medicaid. There is treatment available based on income level. Government community-based facilities usually have sliding-scale payment arrangements, but have long waiting lists and limitations on what they can offer. Again, this is the result of inadequate funding for mental health care indicating that our legislators and policy makers stigmatize and discriminate against the mentally ill.

As in most politics, power (and funding) generally flow towards the already powerful. The marginalized and stigmatized population of moderately to severely mentally ill and substance abusing folks out there, though large in numbers, are not generally well enough organized or well funded to make much of an impact on those in power. Despite the few groups lobbying for compassionate care for mental illness, there are many other powerful groups chasing down other (sometimes worthy, sometimes not) funding agendas. It is all too easy for well-healed politicians to ignore the mentally ill. (1)

Policy makers are “people too”, with their own biases. Their attitudes about the mentally ill reflect those of the general population. Some are enlightened and educated about mental illness, but many are not. The result has been under-funded community systems and symptomatic people on the streets and in jail. Policy makers need to realize that the public ultimately pays more for untreated mentally ill people because of the high costs of housing them in mental hospitals or jails. With more funding for mental health, the collateral benefits and return of investment can be very high, as many negative external impacts of mental illness can be avoided, such as allowing treated mentally ill individuals to maintain or regain employment which contributes to society.

Given the tremendous costs in human and economic terms, given that these diseases touch a fifth of all Americans, you would think we would be mobilizing resources to address the mental health needs of this country. Instead we seem to have a system that blames mental illness on the mentally ill and ignores the impact on society. (2)

What Can Be Done

Destigmatizing mental illness can help remove financial barriers to treatment. Public attitudes need to be transformed, so that mental illness is viewed as a real disease, equal to physical illness.

Write to your government representatives and express your opinions. Mental health advocacy information can be found at both the National Mental Health Association (NMHA), and National Alliance for the Mentally Ill (NAMI) websites.

References

(1) Dombeck, Mark Ph.d. Health Policy and Advocacy. “Counting the Mentally Ill: The Needs Haven’t Changed, Only Their Definitions“. (March 1, 2002).

(2) Texas Medical Association. Mental Health Policy in the 21st Century. “Remarks of Congressman Patrick J. Kennedy“. University of Texas Southwestern, Department of Psychiatry. (Jan. 28, 2002)

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Resistance to Seeking Treatment for Mental Illness – How Others Can Help http://brainblogger.com/2006/05/27/anti-stigmatization-resistance-to-seeking-treatment-for-mental-illness-how-others-can-help/ http://brainblogger.com/2006/05/27/anti-stigmatization-resistance-to-seeking-treatment-for-mental-illness-how-others-can-help/#comments Sat, 27 May 2006 12:40:00 +0000 http://blog.gnif.org/?p=517 Anti_Stigmatization2.jpgThere is a time when a mentally ill person may realize that they need help. Symptoms worry them or others enough that they consider getting treatment. But the White House Conference on Mental Health identified stigma as the most important barrier to treatment for the mentally ill. (1) More than any other reason, stigma, or fear of the consequences of being labeled “mentally ill”, prevents a person–who realizes he or she may need help–from reaching out for that help. Powerful and pervasive, the stigma of mental illness makes it hard enough for a person to personally admit that he or she has a mental illness, much less talk about it to others. (2)

Half of the severely mentally ill do not deny the reality of their illness, but because of the stigma and discrimination involved will not seek treatment for some of these stigma-related reasons:

  • Fearing loss of self-esteem;
  • Not wanting anyone to find out they are on psychiatric medication;
  • Thinking they will spontaneously get better if they just hide the illness from others;
  • Believing that doctors might look down on them;
  • Fearing rejections and exclusions in the community;
  • Fearing losing the love or respect of their family or other loved ones;
  • If employed, being afraid of their employer finding out;
  • Fear that they might be declared incompetent;
  • Fearing losing custody of their children; or
  • Fearing that someone they know could see them at the psychiatrist’s office.

Medical studies have found that early intervention and quality treatment reduces the costs and improves the likelihood of recovery from mental illness. “Delaying treatment results in permanent harm, including increased treatment resistance, worsening severity of symptoms, increased hospitalizations and delayed remission of symptoms.” (3) So it is important that the mentally ill person who resists treatment be educated on the value of treatment despite stigma. Others can help do this. It is invaluable if the ill person can get the support and involvement of a friend or family member who knows of the individual’s mental symptoms, and is aware of their reluctance to seek treatment.

The ill person needs assurance that the first step just needs to be taken, which is to get a correct diagnosis from a psychiatrist. (A referral might be needed from the family physician). The friend or family member can offer to go with them to their appointment. The friend or family member can suggest that together they can write down questions for the doctor in advance, so they go prepared.

The ill person can be counseled that it would be a bad choice to miss a treatable cause of the mental illness or medication that would alleviate symptoms. They should reassure the ill person that there are ways to deal with what others might think or say. The friend or family member can further advise that if found to have a mental illness, the mentally ill person can take suggested treatment stage-by-stage. After a diagnosis is made, he or she will decide what comes next, and so on.

With support of others, the ill person is more likely to seek treatment. Psychologist Xavier Amador counsels friends and family to “externalize the illness by Listening, Emphasizing, Agreeing and finding Partnership (the LEAP approach). LEAP is a way of connecting and getting out of the battle… to find a common ground to allow an ill person to find his own reasons for being compliant.” (4) Further information on this can be found in the book “I am Not Sick, I Don’t Need Help” (Vida Press).

If the person is not willing to listen, then a non-confrontational, non-judgmental intervention is suggested, with emphasis on the fact that friends and family inform the individual that he or she is still loved and respected despite a mental illness.

Whatever the reason the mentally ill person does finally seek treatment, he or she should be congratulated for heroism in seeking it. The ill person can be shown that improvement benefits not only themselves, but their loved ones. Once the mentally ill person has found effective treatment, it is a matter of dealing with the stigma issues one at a time, and supportive family, friends, clergy and mental health professionals can assist. “Appropriate medication and family and caregiver involvement coupled with assertive treatment targeted on patient rehabilitation are essential to effective treatment”. (5)

References

(1) Torrey, E. Fuller, M.D. and Zdandowicz, Mary T., J.D., Deinstitutionalization hasn’t worked. The Washington Post (July 1999)

(2) Mental Health: A Report of the Surgeon General (1999) Chapt. 8

(3) See Torrey.

(4) Navigating the Mental Health Maze NAMI-NYC Metro.

(5) Institute of Governmental Studies. Public Affairs Report. Mental Health Care Quality Is in the Eye of the Beholder. University of Berkeley. (Vol 43 No. 1 Spring, 2002)

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Impaired Awareness of Mental Illness http://brainblogger.com/2006/05/22/anti-stigmatization-impaired-awareness-of-mental-illness/ http://brainblogger.com/2006/05/22/anti-stigmatization-impaired-awareness-of-mental-illness/#comments Mon, 22 May 2006 19:17:00 +0000 http://blog.gnif.org/?p=514 Psychiatry_Psychology.jpgThere are about six million severely mentally ill people in the United States. About half of these severely mentally ill do not know they are ill. (1) (Severe mental illness includes schizophrenia, bipolar disorder and a few other diagnoses). There is a medical term for this condition: anosognosia, an impaired awareness of one’s own disturbed mental condition, despite evidence to the contrary. An ill person may claim that everything is fine, when it is not. This impaired awareness of mental illness is caused by damage to specific parts of the brain. Neurocognitive deficits, or symptoms of a brain dysfunction, are part of the mental illness. People with anosognosia do not recognize that hallucinations, mania, delusions, paranoia or other symptoms of mental illness are, in fact, mental illness. For this reason, many refuse medication if it is prescribed. Others may take medication for awhile, but then throw it away. Remaining unmedicated has many dangers, such as the illness might get worse, they may need hospitalization, they may unable to hold a job or their safety may be at risk.

Individuals with impaired awareness will not voluntarily utilize psychiatric services, no matter how attractive those services are, because they do not believe that they have an illness. (2) Without treatment, many of them end up homeless or in jail. This is a large root cause of the stigma against the mentally ill. The image of the crazy homeless person is a stereotype which produces stigmatization against all mentally ill, homeless or not. Or perhaps in small cases the untreated mentally ill individual creates the sort of violence that makes headlines. That too fuels stigmatization against the mentally ill. The public often believes that since the troubled person refused to seek treatment, they “deserve what they got”, another evidence of stigmatization.

Sometimes the individual with anosognosia is aware of their illness, and sometimes not aware. This is because the illness might fluctuate in severity. The individual might be more aware when in remission, but loses the awareness when relapse occurs.

The symptoms of someone in psychosis may be observed by others, but if the person has anosognosia, their feelings and beliefs are so real for them that when others try to persuade them that their feelings and beliefs are not real, they think that others are just insulting them. This may put a wedge between the person’s doctor, friends, family and them because the person may feel victimized, and often becomes even less cooperative. It is difficult to convince them to seek help.

Can the severely mentally ill be treated against their will in the United States? Many state laws require an individual to be an imminent danger to self or others before he or she can involuntarily be committed, but there are other jurisdictions with a broader definition. The process of involuntary commitment involves a judge or presiding panel, who go by their best judgment based on the evidence.

There are various types of involuntary treatment, including both inpatient and outpatient, and laws vary from state to state. Yet it takes a lot to get the homeless mentally ill person who has impaired awareness of illness from the streets into a psychiatric hospital. The complex problem of how to treat the mentally ill with anosognosia involves moral and ethical issues, legal issues, civil rights issues and funding issues. Some argue that “the only answer is to treat them involuntarily”, and say that “there is a budding trend toward this solution in state laws.” (3) But because of past deinstitutionalization of the mentally ill, most of the psychiatric hospital beds have been lost, and funding for outpatient treatment facilities is inadequate. It will take many factions working together to facilitate humane and effective involuntary treatment programs while, hopefully, maintaining civil rights.

Most severely mentally ill who were medicated involuntarily agreed, in retrospect, that the medication was in their best interest. Forced medication often results in a more rapid return of freedom to be discharged from involuntary hospitalization. (4) But involuntary commitment is not the only answer. “Some mentally ill persons are able to overcome the feeling of ‘I Am Not Sick’. The odds favor those whose family and care takers understand the complexities of these no fault mental illnesses. The successes are sometimes fragile and are most common when families and professionals are able to offer, with patience and persistence, opportunities for medical care, psychological counseling and supervision.” (5)

References

(1) Treatment Advocacy Center. Briefing Paper. “What Percentage of Individuals with Severe Mental Illness are Untreated and Why”.

(2) Ibid.

(3) Lowry, Rich. (July 31, 2003). Townhall.com. “Mistreating the Mentally Ill“.

(4) Treatment Advocacy Center. Briefing Paper. “The Effects of Involuntary Medication on Individuals with Schizophrenia and Manic-Depressive Illiness”.

(5) Families of People with Untreated Mental Illness. (September 23, 2005). Lack of Insight Mental Illness. “We are Their Only Voice”.

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Social Isolation and Mental Illness http://brainblogger.com/2006/05/15/anti-stigmatization-social-isolation-and-mental-illness/ http://brainblogger.com/2006/05/15/anti-stigmatization-social-isolation-and-mental-illness/#comments Mon, 15 May 2006 13:34:00 +0000 http://blog.gnif.org/?p=510 Think about what it would be like to spend most of your time alone because being around other people is just too difficult. You feel that others are judging you for your mental illness, and so you are scared to face the world. You withdraw to avoid this stigmatization. This social withdrawal is emotionally very costly. But this is a two-way street — the mentally ill withdraw from society–society withdraws from them.

An Australian survey reported that two-thirds of people affected by a mental illness feel lonely “often” or “all of the time”. The research says in contrast, just 10 per cent of the general population reported feelings of loneliness. (1)

Social relationships are important for anyone in maintaining health, but for the mentally ill it is especially important. People with mental illness value contact with family. But families may be unwilling to interact with their mentally ill family member. Social isolation is also sometimes due to the unwillingness of others to befriend the mentally ill. The public may avoid them altogether. The stigma associated with mental illness creates huge barriers to socialization.

People with severe mental illness are probably the most isolated social group of all. They are judged, disrespected and made into pariahs. They fear rejection from others, who may be afraid of the mentally ill, so the mentally ill person may feel overwhelmed by the thought of attempting to form new friendships. Just avoiding any contact is often the choice. Or, they may make a great effort to conceal their condition from others, which results in additional stress from worrying about their true condition being discovered.

It is sometimes the case that the severely mentally ill person becomes homeless. This in itself is isolating, and they then must suffer the double stigmatization of being homeless as well as mentally ill.

Another reason the person with mental illness may experience social isolation is the nature of their mental illness. Social phobias like agoraphobia, or severe anxiety or depression often cause the suffering person to be afraid to venture out into society.

When anyone, mentally ill or not, does not have enough social contact, it affects them mentally and even physically. Loneliness creates stress, taking a toll on health. Other things affected can be the ability to learn and memory function. High blood pressure is also seen. It can be the trigger of depression and alcoholism. (2) Imagine the consequences, then, if you are already depressed or have other mental illnesses? Loneliness can make you worse. Loneliness and loss of self-worth lead many mentally ill to believe that they are useless, and so they live with a sense of hopelessness and low self-esteem.

Social isolation is both a cause and an effect of mental distress. When the person isolates more, they face more mental distress. With more mental distress, they want to isolate. This vicious cycle relegates many people with severe mental illness to a life of social segregation and isolation.

Many people with severe psychiatric disabilities say that the stigma associated with their illness is as distressing as the symptoms themselves. This stigmatization not only prevents them from interacting with others, but may prevent them from seeking treatment, which in turn exposes them to a greater risk of suicide.

Too often the public does not understand the challenges of the mentally ill and doesn’t want to try. It is therefore necessary to confront biased social attitudes in order to reduce the discrimination and stigma of people who are living with mental illness.

References

1. Mentally Ill ‘neglected by communities’. (05/08/2002). Yahoo. AU.

Image via KYTan / Shutterstock.

2. Psychology Today. The Dangers of Loneliness. Morano, Hara Estroff. (Aug. 21, 2033).

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Severe Psychiatric Disabilities and Employment http://brainblogger.com/2006/05/13/anti-stigmatization-severe-psychiatric-disabilities-and-employment/ http://brainblogger.com/2006/05/13/anti-stigmatization-severe-psychiatric-disabilities-and-employment/#comments Sat, 13 May 2006 04:23:00 +0000 http://blog.gnif.org/?p=508 Anti_Stigmatization2.jpgThere are many people with common neurotic anxiety disorders who continue to work despite their condition, depending on severity. However, people with more serious psychiatric disabilities such as schizophrenia or bipolar I disorder, often drop out of the workplace when their mental condition reaches a critical level. Those with such severe psychiatric disabilities usually have difficulty just trying to get through the day! Without being able to work, they often deplete their assets and must either rely on government programs for assistance, if they can qualify, or may have nowhere to live unless family or friends will take them in.

It is at this point that the seriously mentally ill person needs others the most. Family members often have to help their relative with everyday activities, transportation, housing or financial assistance. Yet the stigma of being seriously mentally ill can prevent others from wanting to help. The perception is that this person brought on these troubles herself; she may be a “bottomless pit” of need; she is dangerous to live with; and she is better off left to government assistance programs.

National Alliance for the Mentally Ill found that 85% of people with serious mental illness are unemployed. (1) Only 30-40% of people with serious mental health problems are capable of holding down a job, so this means that the majority are not capable of working. (2) Still, if the person needs employment and wants to try to work, the prejudices and stigmatization from employers makes this task difficult. Many employers have concerns over job performance and attendance, and don’t wish to increase their health insurance costs by hiring people with psychiatric disabilities. The high unemployment rate among the mentally ill is due partly to this stigmatization at the workplace.

Sometimes the seriously mentally ill person is not the best judge of whether or not she can work because she is not aware of her own behaviors. Others may have to point out that some of the things she says or does will not fit into the workplace. (3) This may leave her in a desperate situation because although she may not be able to work, she may have no choice but to try anyway.

So what we see is that the seriously mentally ill person might have difficulty just getting through the day with her mental suffering, may have little or no money, and if she tries to make the effort of looking for work, she will risk further rejection which adds to mental suffering.

But how hard is it to get a job? Many individuals do not even disclose a mental illness for fear of discrimination. “One-third of people with mental health problems report having been dismissed or forced to resign from their job because of their previous psychiatric history and more than two-thirds had put off applying for jobs for fear of unfair treatment.” (4) But if the seriously mentally ill person is honest with the prospective employer about her illness, the Americans with Disability Act demands that she is not discriminated against and reasonable accommodations must be made. But in real life, if the employer doesn’t want to hire that person, there are plenty of excuses to not hire her. The benefit of disclosing the illness during the interview process, however, is that the law does stand behind the mentally disabled person and if she needs special accommodations or time off from work if hired, then she will more likely receive what she needs. Yet many employers cannot offer the degree of flexibility needed by the mentally ill employee, just by the nature of the job.

Fewer than four in ten employers say they would hire someone who is mentally ill. (5) Reasons given for excluding people with mental illnesses from steady work range from concern over job performance and attendance, to fears about rising healthcare and insurance costs. “Many employers and employees have unwarranted fears and see persons with psychiatric disabilities as unskilled, unproductive, unreliable, violent or unable to handle workplace pressures.” (6)

Even if they are hired, and manage to perform their job tasks adequately, they face additional barriers such as co-workers being disturbed about working alongside someone who has a psychiatric disability. A person with bipolar disorder, for example, may enter a manic phase and behave erratically, which confirms the co-worker’s fears.

The seriously mentally ill person also faces the stress of doing the job itself. “Unlike people with a physical health problem who tend to take time off, those with mental health problems go to work but require greater effort to function.” (7) There is additional stress if she hid her illness and its symptoms. This stress is related to lying to the employer and fears of being found out. Yet there are still benefits to working, even if it is difficult. One benefit of working is that the mentally ill “report that they are use hospital and crisis services less when they are working than they did when they were not working.” (8) Other benefits include gaining a sense of stability, there is social interaction available and the boost to self-esteem they need helps improve their mental state.

So is it worth it?

  • Work for people with serious mental illness tends to be sporadic, poorly paid and lacking employee benefits.” (9)
  • Few jobs available to people with mental illnesses have mental health care coverage, so those individuals receiving government assistance may be forced to choose between employment and access to mental health care.
  • A US report found that 43 % of federal employers and 22 % of private employers cited negative attitudes of supervisors and coworkers toward people with disabilities as a barrier to continued employment and advancement. (10)
  • Although there are benefits to working, the work itself may also cause the illness to grow worse because of stress.

With these barriers to employment, it is understandable why so many of those with severe psychiatric disabilities remain unemployed, caught in a desperate cycle of poverty and social isolation which neither their families nor the business world can depended upon to alleviate.

Source

Canadian Mental Health Association, Thunder Bay Branch, Facts About Work and Mental Illness (2001).

References

(1) Nobel, Jr., John H. et al.(09/14/00) NAMI. A Legacy of Failure: the Inability of the Federal-State Vocational Rehabilitation System to Serve People with Serious Mental Illness.

(2) Boardman, Jed. (2003) British Journal of Psychiatry. Advances in Psychiatric Treatment. Work, Employment and Psychiatric Disability. 9: 327-334

(3) Long, Phillip W., M.D. Mental Illness and Work. Canadian Psychiatric Association. Copyright 1995-2005

(4) Office of the Deputy Prime Minister, Social Exclusion Unit. Employment and Mental Health. Copyright 2004.

(5) Office of the Deputy Prime Minister. Mental Health and Social Exclusion. June 2004.

(6) Long, Phillip W., M.D. Mental Illness and Work. Canadian Psychiatric Association. Copyright 1995-2005

(7) Dewa, C.S. and E Lin (July 2000) Chronic Physical Illness, Mental Disorder and Disability in the Workplace. Social Science and Medicine 51(2000) 41-50

(8) Trainor, John et al. (Sept. 1996) Consumer/Survivor Development Initiative Evaluation Report, Ontario.

(9) Can Health Services Research Influence Public Policy and Private Actions? Mental Illness and the Workplace. Conference sponsored by the Association of Health Services Research and NAMI. Dec. 8-9, 1999

(10) Livingston, Sandra. (July 23, 2000) The Plain Dealer, Cleveland Ohio.

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Movies Stigmatize Mentally Ill as Violent and Dangerous http://brainblogger.com/2006/04/28/anti-stigmatization-movies-stigmatize-mentally-ill-as-violent-and-dangerous/ http://brainblogger.com/2006/04/28/anti-stigmatization-movies-stigmatize-mentally-ill-as-violent-and-dangerous/#comments Fri, 28 Apr 2006 12:00:00 +0000 http://blog.gnif.org/?p=502 Anti_Stigmatization.jpgThink of popular movies you have seen which portray someone who is mentally ill. Often the fictional character is violent, dangerous and scary. You may not have thought of that portrayal as stigmatizing to the mentally ill, but after viewing a movie with a homicidal maniac or other violent psychotic involved, consider the effect on the stereotypical beliefs about the mentally ill on families of the mentally ill, legislators, or the patient themselves?

Here are some notable examples of movies sensationalizing homicidal maniacs:

As far back as 1909, D. W. Griffith gave the American public The Maniac Cook. “In this film, Griffith introduced the stereotype of the deranged mental patient who is dangerously violent and requires incarceration lest he or she wreak havoc upon society.” (1) In this film, a “cook becmes distressed and starts attacking her employers and is led away by the police. She escapes and first plans to kill her employers in their bed with a kitchen knife, but instead kidnaps the baby and puts it in the oven to roast.” (2)

The sociopath killer entered Academy Award consciousness in 1937 when Robert Montgomery was nominated for Best Actor for his performance in Night Must Fall.

Psycho (1960). A homicidal maniac portrayed by Anthony Perkins kills a woman in the famous bloody shower scene. He is later discovered to be wearing his mother’s clothing and believes he is his dead mother.

Halloween series (1978 and later). A psychotic murderer institutionalized since childhood escapes on a mindless rampage while his doctor chases him through the streets.

Friday the 13th series (1980 and later). Many years after two summer camp counselors are killed at Camp Crystal Lake, the owner decides to reopen, which sparks a series of grisly murders by homicidal maniac “Jason”.

In 1990, Kathy Bates in Misery brought attention to the female homicidal maniac.

Silence of the Lambs (1991) and later the movie Hannibal brought to the screen the character of Hannibal Lecter, the homicidal psychiatrist who killed his victims and, in one case, ate his liver “with some fava beans and a nice Chianti.”

Summer of Sam (1999), directed by Spike Lee, tells the story of the summer of 1977, “when all of New York City was paralyzed with fear by the Son of Sam, David Berkowitz. The murders are depicted in chilling detail, and there are vivid demonstrations of the protagonist in the throes of his psychosis, howling at the moon and wrecking his room.” (3) There were many other films of this genre, including The Bone Collector (1999) and Primal Fear (1996).

American Psycho (2000). “Christian Bale plays Patrick Bateman, the ultimate yuppie homicidal maniac. The film never resolves whether the character is actually committing the gruesome murders or whether they exist solely in his imagination. In any event, the title and the message are that psychosis is equivalent to homicidal mania.” (4)

Other films portraying dangerous and violent mentally ill are The Boston Strangler (1968); Confessions of a Serial Killer (1987); Copycat (1995); Henry: Portrait of a Serial Killer (1990) and Henry, Part 2 (1996); Kalifornia (1993); Kiss the Girls (1997); Natural Born Killers (1994); Texas Chain Saw Massacre (1974); Basket Case (1982); Disturbed (1990); The Howling (1981); Maniac Cops (1988); Clean, Shaven (1993); and Butterfly Kiss (1994).

Movies portraying fearsome and violent mentally ill characters obviously influence peoples’ perceptions of the mentally ill. But are these movies portraying reality? Are the mentally ill really dangerous and violent? Sometimes the answer is “yes”, but this is true only in a small number of cases.

“In actuality (with certain exceptions, e.g., substance-induced psychoses), individuals with mental disorders are not more likely to commit violent crimes than is the general population.” (5) The fact is, according to the National Alliance for the Mentally Ill, statistically, people with mental illness are more often the victims of crime than its perpetrators and are no more violent than people who do not have mental illness. People “diagnosed with mental illnesses are, by far, not the most violent group in American society, and, in fact, according to the FBI Law Enforcement Bulletin, are responsible for no more than 3% of the violence in the United States.” (6)

It is true that a mentally ill patient will act out in terrifying ways in certain situations. Examples of this are Jeffrey Dahmer, Dennis Nilson and other serial killers. It is the unusual cases like these which receive the most publicity. This sensationalism, combined with other factors such as the stigmatization of the mentally ill resulting from portrayals of dangerous and violent mentally ill people in films, results in injustice and prejudice to the great majority of the non-violent mentally ill.

Stigmatization of people with mental disorders has persisted throughout history, but the continuing portrayal of the violent mentally ill in movies is a huge contributor to stigmatization today. Such distorted and formalistic images of the “homicidal maniac” impoverish the lives of people diagnosed with mental illness, who are overwhelmingly non-violent. The effect of such stereotypes is to create a pariah status of the mentally ill in a world made increasingly hostile to them.

Sources

(1)(3)(4)(5)
Stigma Continues in Hollywood
By Steven H. Hyler, M.D.
Psychiatric Times June 2003 Vol. XX Issue 6

(2)
Mental Health: A Report of the Surgeon General
1999
Office of the Surgeon General, Health and Human Services

(6)
Stereotyping Mental Illness
by Ron Schraiber, M.A.

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