Over three years, those never treated with antipsychotics had much better outcomes – 8 per cent relapse versus 62 per cent for the drug-treated. I could cite other, more recent studies with similar findings. This is why we may be holding the tail of a tiger. We may be unwittingly turning an acute and generally time-limited condition into a chronic disability.
"My vantage is unusual: As a consulting doctor, I think I have seen more cases of possession than any other physician in the world."
What should we do about paedophiles? by Sophie Elmhirst [The Guardian] They have committed unspeakable crimes that demand harsh punishment. But most will eventually be set free. Are we prepared to support efforts to rehabilitate them? [more inside]
One “advantage” of working in psychiatry is getting a window into an otherwise invisible world of really miserable people. Scott Alexander writes about mental health and well being in America.
"I work in a wealthy, mostly-white college town consistently ranked one of the best places to live in the country. If there’s anywhere that you might dare hope wasn’t filled to the brim with people living hopeless lives, it would be here. But that hope is not realized. Every day I get to listen to people describe problems that would seem overwrought if they were in a novel, and made-up if they were in a thinkpiece on The Fragmentation Of American Society."
Scott Alexander writes a lot. He's a psychiatrist, but talks about all kinds of stuff (in his about page, he calls out cognitive science, psychology, history, politics, medicine, religion, statistics, transhumanism, corny puns, and applied eschatology). Every time I read something of his, I'm struck by how reasonable he is. Evidently, I'm not alone: his posts each attract hundreds of comments. And he gets linked here a good bit. So a long-time reader of his combed through all his writings of the past decade-or-so and assembled this best-hits list. It's going to take me several happy months to get through it.
And now, weak, short of breath, my once-firm muscles melted away by cancer, I find my thoughts, increasingly, not on the supernatural or spiritual, but on what is meant by living a good and worthwhile life — achieving a sense of peace within oneself. I find my thoughts drifting to the Sabbath, the day of rest, the seventh day of the week, and perhaps the seventh day of one’s life as well, when one can feel that one’s work is done, and one may, in good conscience, rest.Sabbath, an essay by Oliver Sacks (NYT) [more inside]
From Frontiers in Psychology, a list of inaccurate, misleading, misused, ambiguous, and logically confused words and phrases. "The goal of this article is to promote clear thinking and clear writing among students and teachers of psychological science by curbing terminological misinformation and confusion. To this end, we present a provisional list of 50 commonly used terms in psychology, psychiatry, and allied fields that should be avoided, or at most used sparingly and with explicit caveats."
"Humans as Superorganisms: How Microbes, Viruses, Imprinted Genes and Other Selfish Entities Shape Our Behavior" by Peter Kramer and Paola Bressan discusses the idea that an individual homo sapiens is only one component of the human superorganism we call a person, focusing on the psychological and psychiatric ramifications thereof. (Paola Bressan previously.)
"What you want to avoid is panic. What you want to teach yourself is that you deserve better than lying alone in a dark room, imagining yourself buried." || Diana Spechler for NYT's Opinionator: 10 Things I'd Tell My Former (Medicated) Self, the final installment in Going Off, a series of essays recounting the challenges Spechler has faced in gradually discontinuing her regimen of psychiatric medications.
Euthanasia for psychiatric patients was rare in the early years of the law, but patients complained that they were being unfairly stigmatized: psychic suffering, they argued, was just as unbearable as physical pain. Like cancer patients, they were subjected to futile treatments that diminished their quality of life. Dirk De Wachter, a professor of psychiatry at the University of Leuven and the president of the ethics commission for the university's psychiatric center, said that he reconsidered his opposition to euthanasia after a patient whose request he had rejected committed suicide. In 2004, she set up a camera in front of a newspaper office in Antwerp and set herself on fire.Rachel Aviv traveled to Belgium, where euthanasia has been legal since 2002, to report on the complications and consequences that surround the practice of assisted suicide and euthanasia for psychiatric patients: The Death Treatment.
Hallucination, or Divine Revelation? Emma Green of The Atlantic speaks to Andrew Scull, author of the recently-published Madness in Civilization. Scull on "Madness and Meaning" in the Paris Review. [more inside]
The first thing you need to know about secure psychiatric facilities is that their bathrooms smell strongly of pee. What does it feel like to suffer from a mental illness? How can you explain that unique pain? I don't know how to explain it but this post hits a few points in a profound way.
SLNYT - Suicdal treatment-resistant depression vs. DBT One man's experience with dialectical behavior therapy, or DBT. Previously, and again. [more inside]
Could depression be an infectious disease? Might hallucinogenic mushrooms be an effective treatment for depression (New York Times link)? Do antipsychotic drugs hinder long-term recovery from episodes of schizophrenia?
2014 marks the 100th anniversary of the outbreak of World War 1: a pivotal time for Europe and a key transition point for medical science. The Lancet marks this centenary with a three part series ‘Legacy of the war 1914-1918’. The three papers examine the impact of World War 1 on infectious disease, military psychiatry, and amputation related pain.
According to the American Society of Addiction Medicine, addiction is “a primary, chronic disease of brain reward, motivation, memory and related circuitry.” However, that’s not what the epidemiology of the disorder suggests. By age 35, half of all people who qualified for active alcoholism or addiction diagnoses during their teens and 20s no longer do, according to a study of over 42,000 Americans in a sample designed to represent the adult population.
Only a quarter of people who recover have ever sought assistance in doing so (including via 12-step programs). This actually makes addictions the psychiatric disorder with the highest odds of recovery.Metafilter's own maias on myths surrounding the disease(?) of substance addiction, and their impact on medicine and policy.
They say that one night of ayahuasca is like ten years seeing a psychiatrist.
"Let’s note that I write this while experiencing psychosis, and that much of this has been written during a strain of psychosis known as Cotard’s delusion, in which the patient believes that she is dead. What the writer’s confused state means to either of us is not beside the point, because it is the point. The point is that I am in here, somewhere: cogito ergo sum." (via)
Over the past 20 years, medical researchers have found new ways to quantify the effects of the relentless violence on America’s inner cities, [and are] only now beginning to trace the effects of untreated PTSD on neighborhoods that are already struggling with unemployment, poverty and the devastating impact of the war on drugs. [...] Despite the growing evidence of PTSD in civilians, little is being done to address the problem. Hospital trauma centers often provide adequate care for physical wounds, but do almost nothing to help patients cope with the mental and emotional aftermath of trauma.
Your body is home to about 100 trillion bacteria and other microbes, collectively known as your microbiome. Naturalists first became aware of our invisible lodgers in the 1600s, but it wasn’t until the past few years that we’ve become really familiar with them. This recent research has given the microbiome a cuddly kind of fame. We’ve come to appreciate how beneficial our microbes are — breaking down our food, fighting off infections and nurturing our immune system. It’s a lovely, invisible garden we should be tending for our own well-being. But in the journal Bioessays, a team of scientists has raised a creepier possibility. Perhaps our menagerie of germs is also influencing our behavior in order to advance its own evolutionary success — giving us cravings for certain foods, for example.[more inside]
Twilight in the Box. "The suicide statistics, the squalor and the recidivism haven’t ended solitary confinement. Maybe the brain studies will." [Via]
Here are some links to online galleries that combine science, medicine, and art in some way. (previously: psychiatry and art)
The Freudian notion that “dreams are the royal road to the unconscious” is clinically useful, after all. Thanks adamvasco!
Would you take a mentally-ill stranger into your home to live with you like family, possibly for the rest of his life? What if your town had been doing it successfully for 700 years? Welcome to Geel, Belgium. [more inside]
Insomnia causes depression as much as depression causes insomnia: Three surprising points from a fascinating episode of KQED Forum [audio, no transcript] with guest Dr. Michelle Primeau of the Stanford School of Medicine.
First story: Treating Insomnia to Heal Depression,
Follow up a couple of days later: Double Effectiveness of Depression Treatment by Treating Insomnia,
Two readers (both psychiatrists) respond, and
A NYT editorial. [more inside]
- Insomnia has long been taught to be a symptom of depression, but in many cases is a cause of depression.
- CBT (Cognitive Behavioral Therapy) is an effective treatment for both insomnia and depression.
- CBT can be more effective and longer lasting than sleeping pills
A new dystopian novel in the classic mode takes the form of a dictionary of madness. Sam Kriss reviews a recent book. [more inside]
PTSD and Gene Kelly's lost wartime star turn: For the last six decades or so, a copy [of "Combat Fatigue Irritability"] has been filed away, along with thousands of other films, at the National Library of Medicine. The only people it has been lost to are the public and Gene Kelly’s devoted and still numerous fans. But now the National Library of Medicine is featuring Combat Fatigue Irritability in Medical Movies on the Web, and the film will be given a well-deserved, though very belated, New York premiere, on October 5, 2013, at the New York Academy of Medicine. [more inside]
Songs from the Black Chair, published by Bellevue Literary Review in 2004, from a 2005 memoir by the same name, by Charles Barber
"Founded in 1912 as a farm colony of Brooklyn State Hospital, the Creedmoor Psychiatric Center in Queens [New York] became, by mid-century, a world unto itself. At its peak, it housed some 7,000 patients. They tended gardens and raised livestock on the hospital’s grounds. The hospital contained gymnasiums, a swimming pool, a theater, a television studio, and giant kitchens and laundries where patients were put to work. Today, Creedmoor, still run by the New York State Office of Mental Health, has only a few hundred patients" and houses The Living Museum, an 'art asylum within an asylum' where patients can create and exhibit their art. But what is life like inside the institution itself? In 2010, Katherine B. Olsen spent weeks interviewing staff and patients. Her essay, published this week, 'Something More Wrong' takes us inside Creedmoor's women's ward. [more inside]
National Institute of Mental Health director Thomas Insell reports that NIMH will phase out its reliance on the Diagnostic and Statistical Manual of Mental Disorders (DSM), in favor of a revamped psychiatric diagnostic system based on "genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system." [more inside]
Schizophrenic. Killer. My Cousin. "It's insanity to kill your father with a kitchen knife. It's also insanity to close hospitals, fire therapists, and leave families to face mental illness on their own." [Via]
On December 2, the American Psychiatric Association's board of trustees voted on the latest revisions to the Diagnostic and Statistical Manual of Mental Disorders, to be published as the fifth edition (DSM-5) in May 2013. The results of the vote have not been released publicly, and some have questioned the limited press coverage of decisions that will affect people worldwide who receive psychiatric diagnoses. Dr. Allen Francis, chair of the DSM-IV revision committee, says that the board "has given its final approval to a deeply flawed DSM 5". (The title of this post is also drawn from this link.) [more inside]
Is Everyone on the Spectrum? "In the nineties, clinicians began reconceptualizing autism from a singular disorder to a cluster of related conditions on a spectrum of severity; as the criteria broadened to encompass less acutely impaired people—such as the more verbal group diagnosed with Asperger’s—prevalence rose dramatically. Before 1980, one in 2,000 children was thought to be autistic. By 2007, the Centers for Disease Control were reporting that one in 152 American children had an autism-spectrum disorder. Two years later, the CDC updated the ratio to one in 110. This past March, the CDC revised the number upward again, to one in 88 (one in 54, if you just count boys, who are five times as likely to have one as girls). A South Korean study from last year put the number even higher, at one in 38. And in New Jersey, according to the latest numbers, an improbable one in 29 boys is on the spectrum."
"Every year thousands of westerners flock to India to meditate, practice yoga, and seek spiritual transcendence. Some find what they're looking for. Others give up and go home. A few become so consumed by their quest for godliness that it kills them."
In Treatment was an HBO series that ran three seasons from 2008 through 2010. Adapated - often word-for-word - from the Israeli drama BeTipul, it depicted the weekly sessions of a psychologist (Emmy-nominated Gabriel Byrne) with his patients (including Debra Winger, Emmy-nominated Hope Davis, and, in her first American role, Mia Wasikowska) and with his own therapist (Emmy-winning Dianne Wiest). The filming of the series placed extraordinary demands on Byrne - which are well described in this interview with showrunner Warren Leight. (h/t: MCMikeNamara) You can watch its entire first episode here. (possible spoilers throughout)
Growing up on the grounds of a notorious high security psychiatric hospital.
"Beyond the Brain" In the 1990s, scientists declared that schizophrenia and other psychiatric illnesses were pure brain disorders that would eventually yield to drugs. Now they are recognizing that social factors are among the causes, and must be part of the cure.
A new way to deal with disturbing voices offers hope for those with other forms of psychosis.
Hans used to be overwhelmed by the voices. He heard them for hours, yelling at him, cursing him, telling him he should be dragged off into the forest and tortured and left to die. The most difficult things to grasp about the voices people with psychotic illness hear are how loud and insistent they are, and how hard it is to function in a world where no one else can hear them. It’s not like wearing an iPod. It’s like being surrounded by a gang of bullies. You feel horrible, crazy, because the voices are real to no one else, yet also strangely special, and they wrap you like a cocoon. Hans found it impossible to concentrate on everyday things. He sat in his room and hid. But then the voices went away for good.
Daniel Amen and the use of SPECT imaging in clinical psychiatry. Daniel Amen's clinics grossed $20 million last year, using SPECT imaging to tailor psychiatric treatments to individuals. The psychiatric establishment is skeptical: "'In my opinion, what he's doing is the modern equivalent of phrenology,' says Jeffrey Lieberman, APA president-elect, author of the textbook “Psychiatry” and chairman of Psychiatry at Columbia University College of Physicians and Surgeons."
Culture, delusions, and the early treatment of schizophrenia.
Greg Downey: Living in the prodrome, part 1, part 2. [more inside]
Greg Downey: Living in the prodrome, part 1, part 2. [more inside]
Body Integrity Identity Disorder is when a subject feels that he or she would be happier living as an amputee. This raises several questions: should amputation be offered as a treatment to people suffering from Body Integrity Identity Disorder? Or, should the alien limb be integrated into the body image? To what extent is the disorder psychological or neurological? Regardless, further research is needed. That said, in talking about newly categorized disorders such as BIID, do we spread "semantic contagion"? [previously]
There is a critical shortage of acute mental health services throughout the nation that is making it increasingly difficult for people who don't meet standards for "imminent danger" to receive adequate care. Barring a dramatic change in the systems that provide care, what alternatives are there for seriously mentally ill people? Incarceration has often become a form of care provision, but behavioral courts are an emerging alternative. (Previously.) [more inside]
A pilot study testing for statistically significant blood biomarkers found in early-onset MDD: "Discovery of blood transcriptomic markers for depression in animal models and pilot validation in subjects with early-onset major depression" [PDF], published by the online, open source journal Translational Psychiatry**, April 2012, Volume 2. [more inside]
Falling STAR*D?: It is common practice for psychiatrists to switch depressive patients between different antidepressants if their current drug does not evince a symptomatic response. Despite clinical wisdom supporting this, little empirical, controlled evidence exists to direct “switching” protocols (e.g. if a patient with Z characteristics is on drug X, is it usually better to switch to drug A, B, or C? Will switching help at all?) in the psychopharmacological treatment of depression. The NIMH-funded STAR*D (Sequenced Alternatives to Relieve Depression) study aimed to address these questions of treatment direction in a very large (n>4000), “real-world” sample using a multi-phase treatment plan with different drugs (and cognitive therapy) at every step to maximize chances of eventual remission. Overall, the NIMH reported that about 67% of patients eventually achieved remission, with few differences in effectiveness between different types of treatment at each step. However, researchers and commentators have raised concerns regarding inconsistent reporting of outcomes, after-the-fact changes in study design and analysis, and other issues that may have inflated, partially invalidated, or misrepresented widely reported treatment outcomes. These inequities may also have implications for the secondary moderator analyses (i.e. does trait A predict switching to X or Y is better?) that were a major reason for the study. [more inside]
Being gay was considered a mental disorder by psychiatry - until 1973 - when the battle lines were drawn. Reporter Alix Spiegel continues the gripping story that spurred a radical rethink. It's the story of a closeted cartel of powerful, gay psychiatrists; of confrontations with angry activists; a shrink dressed in a Nixon mask, and a pivotal encounter in a Hawaiian bar. [more inside]
In DSM 5- 'Living Document' or 'Dead on Arrival', Allen Frances, chair of the DSM-IV development committee details some of the problems with the DSM-5 development process and alludes to some of the current controversies. The post is part of his ongoing series DSM-5 In Distress. [more inside]