Prepared by:
National Stigma Clearinghouse
Website: http://www.stigmanet.org

NEWS ARCHIVE 2007

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December 30, 2007 - News of the Week



TAC'S "TOP 10 STORIES OF 2007" CONTINUE A PATTERN OF FEARMONGERING

Last week, the Treatment Advocacy Center, the nation's leading proponent of compulsory neuroleptic medication, issued a list of ten "under-reported stories of 2007." Eight of the ten stories involve crime or dangerousness. Clearly, http://www.psychlaws.org intends to continue its pattern of fanning fear to win public support for its controversial agenda.

Also troubling are errors of fact. For example, by lifting a phrase out of a research study published by Jeffrey Swanson et.al. (Archives of General Psychiatry, May 2006), TAC created an astounding rate of violence for patients with schizophrenia, 10 times greater than the general public, (or 19.1% vs 2%).

Acts considered violent by TAC range from a brief threatening gesture to a physical assault causing injury. TAC fails to mention that the Swanson team found two levels of violence: only 3.6% of research participants were involved in serious violence. This rate is similar to the general population rate of 2% (ECA data circa 1980).

For the public, violence means danger. But Swanson's research team uses the word to mean involvment in a fight whether or not the respondent was the aggressor or defending himself. The researchers called such fights assaults by the respondents. The fights involving 15.5% were called "minor violence" (no injury and no use of threat or knife). The remaining 3.6% were called "serious violence" (a weapon was used or there was some injury, at least a bruise.) Quoting from Heathcote W. Wales, Georgetown U., letter to the Washington Post, "Hype Won't Help The Mentally Ill," 6/4/06.

The Treatment Advocacy Center also ignored the Swanson team's finding that the odds of violent behavior varied with factors other than psychotic symptoms.

Further, the data used for the Swanson study was designed for a different project, the Catie study on medications. This raises questions about the data's findings.

MORE INFORMATION


For an interesting an interesting commentary by John Grohol, psychologist and publisher of of PsychCentral.com ,about pitfalls and variations that plague research on violence. Go to
http://psychcentral.com/blog/archives/2007/05/04/crime-consequences-and-mental-illness/


December 14, 2007 - News of the Week

ADVOCATES DENOUNCE STIGMATIZING AD CAMPAIGN

Mental health advocates are struggling to escape pain and damage from a harsh new campaign meant to publicize children's mental health issues.

With ransom notes as a hook, the ads portray children as hostages to conditions such as autism. The ads are being tested in New York City using billboards, kiosks and magazines. Plans call for massive expansion nationwide on behalf of the New York University Child Study Center led by Dr. Harold S. Koplewicz.

Purporting to raise public awareness, the ads predict agonizing outcomes for six childhood conditions. Each ad ends with a grim ransom note to parents such as, "Do nothing and see what happens," and "Ignore this and your kid will pay." (See ads below)

It is difficult to imagine parents will be helped by such callous non-advice. It is also difficult to imagine that public empathy will increase by framing children's disabilities in a gangster context. Particularly agonizing for families is the implication that they are complacent when finding and paying for help is a superhuman challenge.

The tone of the campaign has been captured best by the New York Daily News.

ARTICLE: source, New York Daily News, Saturday, December 15, 2007

Psych groups' fury over 'ransom' ads

BY CHRISTINA BOYLE
DAILY NEWS STAFF WRITER


The words are scrawled in thick black ink and spell out a parent's worst nightmare: "WE HAVE YOUR SON."

Others are typed or cut from the pages of a magazine but all contain the same harrowing message: "This is only the beginning . . . Ignore this and your kid will pay."

These "ransom notes" are being plastered all over town as part of a new ad campaign about the dangers of psychiatric disorders like autism, attention-deficit/hyperactivity disorder and Asperger's syndrome. They are causing outrage among many of the groups they are designed to represent - prompting parents and disability advocates to demand they be taken down.

"I was offended. It's not a helpful way to think about a disorder," said Kristina Chew, who has a 10-year-old son with autism. "It makes you feel like there's some sort of criminal element to the disorder."

"The child has not been 'taken,' they just need a little extra help," said Melissa Ramirez, 26, who has a cousin with autism. "It's basically showing [parents] they have no control over their child. It's inappropriate."

The ad campaign is being rolled out over the next four months by the NYU Child Study Center, which says the posters are designed to highlight the plight of children who suffer from undiagnosed or untreated psychiatric problems.

"I understand some people's feelings are hurt. For that, I apologize. It was never our intention to offend or insult anyone," said Dr.Harold Koplewicz, founder and director of the Child Study Center, who says he has also received e-mails praising the campaign.

"It's harsh and edgy and shocking but I don't think it's nearly as shocking as the diseases themselves, and the lack of treatment," he said. "It's time for psychotic disorders to be equal to physical disorders."

More than 200 ads will appear on construction sites and kiosks across the city. Eleven billboards will display the shocking messages and a handful of newspapers, magazines and Web sites will print the ads, designed for free by the BBDO agency.

Disability advocates including Not Dead Yet and the Autism Acceptance Project have united in protest.

"There needs to be recognition that not all attention is good attention," said Ari Ne'eman, president of the Autistic Self Advocacy Network who suffers from Asperger's syndrome.

"The message that this campaign is sending, specifically that children with disabilities are shells, that somehow we have had our true selves stolen away or kidnapped ... is one that has a lot of terrible consequences."

cboyle@nydailynews.com

End of NY Daily News Article
Reprinted using Fair Use Standard
____________________________


Click this link for a New York Times article (registration required, free and quick), "Campaign on Childhood Mental Illness Succeeds at Being Provocative," by Joanne Kaufman ( http://www.nytimes.com/2007/12/14/business/media/14adco.html?_r=1&oref=slogin )

___________________________

Two press releases give additional information.

AGAINST THE ADS
A coalition of advocates led by Ari Ne'eman of ASAN, The Autistic Self Advocacy Network website: www.autisticadvocacy.org has protested the campaign in letters to Harold S. Koplewicz, founder and director of the NYU Child Study Center and John Osborn, President and CEO of BBDO New York.

For ASAN's press release, click http://www.autisticadvocacy.org/modules/smartsection/item.php?itemid=21
Information about how to support the coalition's effort is posted here.
 

POSITION OF CAMPAIGN SPONSORS:
New York University Child Study Center, 12/1/07
For press release, click http://www.aboutourkids.org/files/news/press_room/assets/ransom_notes_release.pdf



TEXT OF RANSOM NOTES


Each note carries the tag line, "Don't let a psychiatric disorder take your child."


We have your son. We will make sure he will no longer be able to care for himself or interact socially as long as he lives. This is only the beginning…Autism.
 

We are in possession of your son. We are making him squirm and fidget until he is a detriment to himself and those around him. Ignore this and your kid will pay…ADHD
 

We have your son. We are destroying his ability for social interaction and driving him into a life of complete isolation. It's up to you now…Asperger's Syndrome
 

We have your daughter. We are forcing her to throw up after every meal she eats. It's only going to get worse…Bulimia
 

We have taken your son. We have imprisoned him in a maze of darkness with no hope of ever getting out. Do nothing and see what happens…Depression
 

We have your daughter. We are making her wash her hands until they are raw, everyday. This is only the beginning…OCD

November 26, 2007 - News of the Week


WELSH HEALTH MINISTER CALLS FOR LAW TO GUARANTEE PATIENTS' RIGHT TO TREATMENT

See More Information
No one has counted how many individuals with serious psychiatric conditions are turned away by over-burdened treatment centers. Advocates in Wales estimate that half of the people who end up in coercive treatment have previously asked for help, but were denied it.

To remedy this, Jonathan Morgan, Wales's Shadow Health Minister, is currently sponsoring a law to provide a right to assessment and treatment in a therapeutic setting before compulsion becomes the only option. Click here.

In the U.S., finding help requires superhuman persistence. Jail or prison is the fate for many who are rejected or prematurely discharged from treatment facilities. A typical failure to find crisis help was reported this week in San Jose CA with the headline, "Suspect in killing of father sought treatment." Click here.

When help is denied, the details most commonly surface months after a tragedy occurs. The best-known example is Andrew Goldstein, who pushed Kendra Webdale into the path of an oncoming Manhattan subway train on January 3, 1999. Five months later, an investigative report by the New York Times (later confirmed by an official state investigation) revealed that Goldstein had been repeatedly denied the treatment he knew he needed.

But by the time the trail of gross system failure was made public, Goldstein had been indelibly mis-labeled by proponents of compulsory treatment as a "treatment refuser." State officials, under pressure from coercion advocates and the media, quickly passed a forced treatment law (Kendra's Law). Andrew Goldstein was sentenced to prison.

Medication compliance is the primary aim of all compulsory treatment programs in the U.S. But because medications affect each individual differently, they are the most problem-prone aspect of treating serious mental illnesses. Prescribing psychotropic meds requires doctor/patient cooperation and a trial-and-error approach. If trust between a doctor and patient is missing (a risk in coerced treatment) problems arising from metabolic or behavioral changes will be missed.

Model programs show that treatment success depends on high quality community support services and social networks. Basic necessities include safe housing, opportunities to work and pursue one's interests, and programs designed specifically to help those who have substance abuse problems in addition to a mental illness. The full range of options is rarely available -- not to patients who are coerced into treatment, and not to those who seek help voluntarily.


MORE INFORMATION


LINK: "A New Vision of Public Mental Health," an Act providing right to mental health services and supports. Source:
Bazelon Center for Mental Health Law, 2002.



ARTICLE: "A Stable Doctor for a Scattered Life", by Elissa Ely, New York Times November 27, 2007. Article highlights need for trust and continuity.

A Stable Doctor for a Scattered Life
By ELISSA ELY, M.D.


It was clear when we met that the patient's intelligence was severely limited. He could hardly find his own thoughts. Rocking in a chair not built for rocking, he gave a scattered history of head trauma and explosiveness. He was fresh from prison (another sentence for assault), living in the shelter and tired of himself. He hated hurting people, he said. He wanted a medication to cure this once and for all.

We reviewed his psychiatric hospitalizations. There had been many. He would be started on some new medication, then be discharged to the streets with two weeks of pills and a diagnosis to add to his definition of self. "I'm bipolar schizophrenic with attention deficit and P.T.S.D.," he said, using the initials for post-traumatic stress disorder. Polysyllabic diagnoses always tell more about a hospital than a patient.

Freed, he would suddenly decide that he had always wanted to see downtown Baltimore, or that he needed to catch up with an old friend who might still be in Seattle. When the two-week prescription ran out, there was no refilling doctor. It wouldn't take long before some slight motion of a stranger would enrage him; another assault, another admission, another medication.

He took them in a cloud, dozens of them, and could not remember their names — except for one. It had worked perfectly for him. He even knew the dosage: it was Haldol, 15 milligrams. "At hour of sleep," he said, reciting from the hospital chart.

No one gives Haldol to patients with brain damage anymore, especially at such a high dose. It is an old-school antipsychotic that causes restlessness, Parkinsonian stiffness, the involuntary movements called tardive dyskinesia, and — rarely but unforgettably — a dystonic reaction, in which muscles go into spasm and the patient is left outwardly paralyzed but inwardly in agony.

"Haldol has terrible side effects for some people," I said.

"Oh, yeah," he replied, as I recall. "I had a friend who took it once. His eyes rolled back, his head snapped, he couldn't swallow, he was crying and screaming in pain, man, it was terrible. But 15 milligrams at hour of sleep is what I need."

The specificity of this limited man was impressive. He knew the name of the drug he wanted — a drug no one takes voluntarily — and its dosage. Would he take another medication with it to prevent side effects? He was firm. It was Haldol at a high dose, and nothing else. Against educated instinct, I wrote a prescription: Haldol 15 milligrams at hour of sleep. His experience trumped mine.

The homeless shelter called the next morning. After one dose, he had gone into a catastrophic dystonic reaction. It was just as he had described; his eyes rolled, the neck snapped back. He was sent by ambulance to an emergency room, shot full of Benadryl, and returned, shaking, to the shelter.

The friend he had been talking about was himself. In his simple-minded way, he had given warning. But I had not heard correctly. I had been listening literally, instead of with a third ear. A day later, he disappeared with no forwarding address or phone number. I assumed I had driven him away. I certainly would have driven me away.

That was the end of the story. Then, eight months later, there was a call from an E.R. nurse somewhere in Florida. "I'm sitting here with Mr. X," she said. "He gave us your name and said that you're his psychiatrist. He speaks very highly of you, and he'd like to make a follow-up appointment." She made it sound as if the office door had just shut behind him.

"He's in Florida," I said, confused.

"Yes. But he's thinking of taking a bus back to Boston, and wants to know how your schedule looks for next week."

One humbly learns. The harm I had caused in a single meeting was nowhere near as important as the idea that he had a doctor of his own, someone he could call from an emergency room in Florida for a follow-up appointment after eight months, someone — at last — who would see him again.

That mattered. The rest, it turned out, was easily forgiven.

Elissa Ely is a psychiatrist in Boston.

Copyright 2007 The New York Times Company

Reprinted using Fair Use Standard


October 21, 2007 - News of the Week

OBJECTIONS TO PSYCHIATRIC DIAGNOSIS CLASSIFICATIONS MOUNT

Will the next diagnostic manual respond to critics?
There is rising concern throughout the field of psychiatry about problems with psychiatric diagnoses. Critics of the current diagnostic method comprise a cross section of the mental health community. Neuroscientist Nancy C. Andreasen, psychiatrist Sally Satel, and MindFreedom CEO David Oaks all favor changes (see footnote). While the search continues for indisputable scientific markers and causes for serious psychiatric conditions, the field looks for optimal ways to use present knowledge.

The present diagnostic method was adopted in the U.S. in 1980 with publication of the DSM III diagnostic manual. Since then, psychiatrists worldwide have based their diagnoses on explict rule-based classifications. Work is now beginning on the next revision of the manual, the DSM V, planned for publication in 2011.

The article below focuses on problems with the category "schizophrenia" and offers several viewpoints on the issue.

ARTICLE:
"Muddy Thinking"
BY KATE HILPERN


The term schizophrenia was coined more than 100 years ago as a provisional category covering a wide range of psychiatric disorders. Isn't it time we retired this vague and stigmatised label, asks Kate Hilpern

Tuesday October 09 2007
The Guardian

Pete Bullimore will never forget the day he opened his front door to a French spy. The spy, he recalls, was disguised as a social worker. "My wife and I had applied to become foster carers, but when the social worker turned up, I was warned that she was actually a spy. It was the first of many destructive, frightening and uncontrollable voices from within that began to bombard my life," he recalls. "It was like someone had switched a radio on in my head."

Needless to say, Bullimore and his wife did not become foster carers. He was diagnosed with chronic schizophrenia, a verdict that eventually led to him losing his family and his business. "I was given enough drugs to knock out a cow. It was a case of drug 'em up and shut 'em up. I spent long periods in a secure unit and for weeks on end, I had a towel under my mouth to soak up my dripping saliva." Life wasn't much better in the outside world. "I've been spat at, verbally abused and was even slashed with a knife. The police were less than sympathetic towards my case when they discovered I was a 'known schizophrenic'."

Eventually, against his doctor's wishes, Bullimore reduced his cocktail of medication and tried a self-help model of recovery. It worked. He is now in a successful job using his experiences to help others with mental health issues, his children are proud of him, and he is happy.

More and more people like Bullimore are turning their backs on the label of schizophrenia and its conventional treatments in an attempt to reclaim their lives. In fact, many have joined a growing group of renowned psychologists and psychiatrists to form the Campaign for Abolition of the Schizophrenia Label (CASL). "The idea that schizophrenia can be viewed as a specific, genetically determined, biologically driven brain disease has been based on bad science and social control since its inception," says Paul Hammersley, who teaches cognitive behaviour therapies for psychosis at the University of Manchester, and who is leading the campaign.

Schizophrenia, a name with Greek origins that roughly translates as "shattered mind", simply does not exist, insists Hammersley. "What's more, it is extremely damaging to those to whom it is applied." There is, he says, no consistency in how people are diagnosed. "It has been shown that it is possible for 15 individuals with nothing in common to be gathered together in one room and all to be diagnosed with schizophrenia. It has also been shown that when people are tested for a second time for schizophrenia, as few as 37% of people are found to have it. Scientists can't even agree with themselves."

The significance of genetic inheritance in schizophrenia is uncertain, he adds. "There is a widespread assertion that schizophrenia has a prevalence rate of 1% in all societies. But in fact there is wide disparity between rural and urban environments and between different countries. The lowest rates have been found in the Amish population, one of the most peaceful populations, where prevalence drops below 1%, whereas in Somalia, rates of schizophrenia go through the roof. If it really is a genetic brain disease, how can such disparity be explained?"

A more likely explanation, he believes, is that the psychotic episodes that lead to a diagnosis of schizophrenia are brought on by trauma. In fact, tests have shown that a high proportion of people who have psychotic episodes have experienced trauma.

Advocates of schizophrenia as a diagnosis say it is a chronic deteriorating condition in all cases. But, says Hammersley, many people recover and, like Bullimore, some do so outside psychiatry, using techniques ranging from cognitive behavioural therapy to family intervention and self-help methods of controlling their inner voices.

Probably the most invidious feature of schizophrenia is its stigma. Statistics show that many people try to commit suicide after being diagnosed, not least because the label implies that they are dangerous and unpredictable, chronically ill, unable to work or indeed function at any level, and in need of medication that may be ineffective and will usually cause unpleasant side effects.

"When people find out about my illness, it is 50/50 whether they close me down or accept me," says Richard Shrubb, 32, from Bristol. "I hate the fact that I have the same label as that guy who's been in the news for murdering someone as a result of his schizophrenia."

"As a single word, schizophrenia can ruin a life as surely as any bullet," says Hammersley. "I know of one woman whose psychiatrist told her it would have been better for her to have cancer. Our desire to dump schizophrenia in the diagnostic dustbin is therefore not just about the poor science that surrounds it, but the immense damage that this label brings about. Lives are being ruined on the basis of a highly suspect diagnostic system."

Schizophrenia was first posited in 1896 by a scientist called Emil Kraepelin. "By 1920, Kraepelin was still saying it should be a provisional category. I think the only reason it has stayed with us is that we have not come up with anything better," says Robin Murray, professor of psychiatry at the Institute of Psychiatry.

Like many psychiatrists, he would like to see schizophrenia replaced by the term "dopamine disregulation disorder". "We know that disregulation of [brain chemical] dopamine is the final common pathway to developing psychotic symptoms," he says.

In Japan, schizophrenia has already been replaced with "integration disorder". The Japanese Society of Psychiatry felt the old term had purely negative connotations, was ambiguous and was partly to blame for the inhumane treatment of those who carried the diagnosis. But does a new name provide a solution? Even Murray has doubts. "Japanese psychiatrists have told me that the stigma has become reattached to the new label, and I can see how that could happen with dopamine disregulation disorder too."

Mary Boyle, recently retired professor of psychology at the University of East London, adds that dopamine disregulation disorder focuses on what is supposedly going on in people's brains rather than in their lives and, as such, implies that drugs are still the preferred intervention. "What we need instead is not simply a different label but entirely different ways of thinking about those psychological experiences and behaviours that have been mislabelled and misunderstood as symptoms of schizophrenia," she says.

To this end, there is support for a model that
breaks down some of the symptoms of so-called schizophrenia into four categories, which include such phenomena as hallucinations, withdrawal, scrambled speech and depression. The idea is that the four dimensions of functioning could be analysed independently from each other (since not all people diagnosed with schizophrenia have all of them) and placed on a continuum, which would bring the illness into line with others such as autism spectrum disorder.

But Richard Bentall, professor of clinical psychology at the University of Wales, Bangor, isn't convinced it will take off. "Psychiatrists like to put people into categories because it's easier and quicker. The government does too because they want a simple rule about who gets treatment," he says.

At the other end of the spectrum, Jeffrey Lieberman, director of the department of psychiatry at Columbia University, insists schizophrenia's "reliability and usefulness are indisputable". Lieberman says, "People with schizophrenia have abnormalities in brain structure and function seen on neuroimaging and electrophysiological tests. In addition, the evidence that vulnerability to schizophrenia is at least partly genetic is indisputable. Unfortunately, changing the name of the condition or even abolishing the concept will not affect the root cause of the stigma - the public's ignorance and fear of people with mental illness."

Majorie Wallace, chief executive of Sane, is also in favour of keeping the term. "The difficulty with changing the name schizo-phrenia is how you would raise awareness and fund research into the causes of an illness that doesn't exist or which has become too bland a word," she points out.

Ultimately, the decision will be made by the people who compile the diagnostic manuals used by the international medical professions. A working party has already been created to explore the schizophrenia issue: their conclusions will be drawn published in 2011, when the next manuals are due to be published.

Copyright Guardian News and Media Limited

Reprinted using Fair Use Standard
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FOOTNOTE: MORE INFORMATION
  • ARTICLE: DSM and the Death of Phenomenology in America: An Example of Unintended Consequences, by Nancy C. Andreasen, Schizophrenia Bulletin,vol.33, no.l Jan 2007.
    Excerpt: "...there has been a steady decline in the teaching of careful clinical evaluation that is targeted to the individual's personal problems and social context and that is enriched by a good general knowledge of psychopathlogy."

    Read Abstract: http://schizophreniabulletin.oxfordjournals.org/cgi/content/abstract/33/1/108.

    For full text of article, call 319-350-1553, or e-mail: luann-godlove@uiowa.edu


  • OP-ED: Mind Over Manual, by Sally Satel, New York Times, Oct. 9, 2006.
    http://query.nytimes.com/gst/fullpage.html?res=9C02E0DA123FF930A2575AC0A9619C8B63
    Excerpt: "One manifestation of our limited knowledge is that many patients meet several diagnostic definitions at once. Roughly half of adults with clinical depression, for example, also have symptoms that fit the definition of an anxiety disorder. Do these patients actually suffer from more than one illness or do they just appear to?"

    3 Letters to the editor: http://query.nytimes.com/gst/fullpage.html?res=9D03E3D71338F933A1575AC0A9619C8B63

    ***(NY Times Registration is free and fast!)


  • 3 ARTICLES: Schizophrenia Misused as Label for Harm-causing conditions, National Stigma Clearinghouse, October 9, 2006. http://community-2.webtv.net/stigmanet/newsarchive2006jan/index.html#09oct06.


  • July 29, 2007 - NEWS of the WEEK


    POWERFUL VIDEO EXPOSES MEDIA BIAS

    Painful to Watch; Too Real to Ignore


    Activist David Gonzalez of Recovery x-Change has posted a shocking antistigma video on YouTube (http://www.youtube.com/watch?v=zthzeEX2lco).

    The 8-minute video shows how film, television, and print media have for decades entertained audiences with stigmatizing images of "mental illnesses."

    The video is an appeal to the media for balance and accuracy. Caution: members of the mental health community may find the material disturbing.

    Contact: david@mentalhealthstigma.com


    David Gonzalez is the founder and creator of www.mentalhealthstigma.com. Currently active in mental health advocacy in New York, he was a hunger striker in the Fast for Freedom in Mental Health in 2003.

    David is also involved in the recovery movement and is constructing a recovery website at www.recoveryxchange.org/about.html

    ____________________

    July 22, 2007 - News of the Week

    MENTAL HEALTH CONSUMERS/SURVIVORS DE-MYSTIFY "MENTAL ILLNESSES" ON THE INTERNET

    A website not to be missed is "Strategies for Change: Rethinking Stigma, Ending Discrimination," a self-help project of the California Network of Mental Health Clients (CNMHC)

    Against all odds, mental health consumers/ex-patients/survivors have become a sizable constituency bursting with talent, intelligence, and energy. The Internet is a good place to witness this expansion.

    Below is a shortlist of interesting websites that contain a wealth of LINKS !

    1) http://www.patdeegan.com: Patricia Deegan is an activist and clinical psychologist who was diagnosed with schizophrenia in adolescence. Deegan's powerful early articles pioneered understanding of schizophrenia from a patient perspective, explained the process of recovery, and exposed the inhumanity within the mental health system. Her present research on medication use is providing clinicians, policy makers, and laypeople with uniquely valuable insights.

    2) http://www.hymes.wordpress.com: Alison Hymes is a mental health survivor, one of 2 who serve on the Virginia Chief Justice's Commission on Mental Health Law Reform. Hymes posts comments mostly concerning mental health issues almost daily. Her interactive site lists LINKS to a range of categories not found elsewhere. Hymes also writes satire and parody stories for TheSpoof.com.

    3) http://www.furiousseasons.com/about.html: Philip Dawdy is the moving force behind Furious Seasons, home for a trove of commentary and a goldmine of LINKS that include patient blogs, doctor blogs, activist news, and science/big pharma ethics. Dawdy's background is reporting.

    4) http://trouble.philadelphiaweekly.com: Liz Spikol's column, "The Trouble With Spikol," has won awards for its eye-opening commentary about mental health. Her blog began with mental illness and now touches upon policy, news, personal journeys, and more. Spikol is the managing editor of Philadelphia Weekly.

    5) http://www.copelandcenter.com/: The Copeland Center for Wellness and Recovery, founded by Mary Ellen Copeland, is a leading source for education materials, training, and research about recovery from serious mental illnesses. Her self-help materials are especially useful in an environment where secure housing and support services are in place.

    July 15 2007 - NEWS of the WEEK

    AN OUTRAGED ADVOCATE ASKS, WHERE ARE OUR LEADERS?

    Every maligned minority devotes substantial energy and resources to educating the media. The mental health community, for reasons unexplained, is less visible in this respect.

    David Gonzalez is an eloquent New Yorker who is concerned that biased reporting threatens all the goals of mental health advocates. Below is his wake-up call.


    WHERE ARE OUR LEADERS?
    by David Gonzalez, Sunday, July 15, 2007
    E-mail address: david@recoveryxchange.org


    Since the VT massacre, I have stood by and watched in dread as the media has, day-in and day-out, equated "the mentally-ill" with everyone from cannibals, to mass murderers, to serial killers. And the silence of our nationally recognized leaders has left me stunned. The silence is deafening!
     
    How dare CNN blatantly, and with no compunction whatsoever, compare me and my peers to Jeffery Dahmer. And then go on to assert on prime time TV that my peers and colleagues don't know the difference between right and wrong.
     
    In their latest so-called report called Criminal Insanity, CNN boldly asserts that criminal insanity and "mental illness" are one and the same thing. They even implied in this report that "disability advocates" were responsible for the murder of a mother by her son.
     
    Would this be acceptable if CNN had equated criminal insanity with the Latino or African-American community? Would this be acceptable if they had equated criminal insanity with the LGBT community? Would this be acceptable if they had equated criminal insanity with the Islamic community?
     
    Why is it acceptable for them to equate criminal insanity with the mental health community???
     
    Where are our leaders?
     
    Let me remind you that the Jewish community was criminalized by the mainstream media in Nazi Germany - thereby inciting fear and hatred of the Jewish people as a whole. And NO ONE SAID ANYTHING.
     
    How many of you know that shortly after WWII, in 1956, a bill was put forth by special interest groups in the U.S. for the government to purchase one million acres of Alaskan wilderness to build a huge psychiatric facility to house "the mentally-ill." This was to be followed up by changing the commitment laws to make it easier to force "the mentally-ill" into treatment.
     
    This bill, referred to as "Siberia USA," soared through the House of Representatives – but when the public caught wind of what was really going on they were outraged and the bill was defeated. The reason why this bill was defeated was because we were too close to the horrors of the Holocaust and the obvious bio-philosophical similarities were plainly apparent. Is history repeating itself?
     
    I contend that we are so far removed from the Holocaust today - that as a result of these CNN reports if a similar proposal were reintroduced in 2007 it would pass in a heartbeat. Keep in mind that eugenics did not start in Nazi Germany. It started right here in our free democratic United States of America.
     
    When will these non-stop micro-aggressions be seen for what they are - hate crimes. 
     
    Has the time finally come for our leaders to take a unified stand on this type of assault on our community? Can we bring a class action suit against these types of hate crimes? Or must I continue to pay for the crimes of the criminally insane?
     
    "Psychopathology is not the same as psychopathy." (Wikipedia)
     
    David Gonzalez – Hunger Striker, Fast for Freedom in Mental Health
    E-mail: david@recoveryxchange.org


    For a transcript of CNN's feature, "Criminally Insane" click
    http://transcripts.cnn.com/TRANSCRIPTS/0707/14/siu.02.html

    CLICK TO SEND COMMENTS TO CNN

    _____________________________


    July 15 2007 - NEWS of the WEEK
    AN OUTRAGED ADVOCATE ASKS, WHERE ARE OUR LEADERS?

    Every maligned minority devotes substantial energy and resources to educating the media. The mental health community, for reasons unexplained, is less visible in this respect.

    David Gonzalez is an eloquent New Yorker who is concerned that biased reporting threatens all the goals of mental health advocates. Below is his wake-up call.


    WHERE ARE OUR LEADERS?
    by David Gonzalez, Sunday, July 15, 2007
    E-mail address: david@recoveryxchange.org


    Since the VT massacre, I have stood by and watched in dread as the media has, day-in and day-out, equated "the mentally-ill" with everyone from cannibals, to mass murderers, to serial killers. And the silence of our nationally recognized leaders has left me stunned. The silence is deafening!
     
    How dare CNN blatantly, and with no compunction whatsoever, compare me and my peers to Jeffery Dahmer. And then go on to assert on prime time TV that my peers and colleagues don't know the difference between right and wrong.
     
    In their latest so-called report called Criminal Insanity, CNN boldly asserts that criminal insanity and "mental illness" are one and the same thing. They even implied in this report that "disability advocates" were responsible for the murder of a mother by her son.
     
    Would this be acceptable if CNN had equated criminal insanity with the Latino or African-American community? Would this be acceptable if they had equated criminal insanity with the LGBT community? Would this be acceptable if they had equated criminal insanity with the Islamic community?
     
    Why is it acceptable for them to equate criminal insanity with the mental health community???
     
    Where are our leaders?
     
    Let me remind you that the Jewish community was criminalized by the mainstream media in Nazi Germany - thereby inciting fear and hatred of the Jewish people as a whole. And NO ONE SAID ANYTHING.
     
    How many of you know that shortly after WWII, in 1956, a bill was put forth by special interest groups in the U.S. for the government to purchase one million acres of Alaskan wilderness to build a huge psychiatric facility to house "the mentally-ill." This was to be followed up by changing the commitment laws to make it easier to force "the mentally-ill" into treatment.
     
    This bill, referred to as "Siberia USA," soared through the House of Representatives – but when the public caught wind of what was really going on they were outraged and the bill was defeated. The reason why this bill was defeated was because we were too close to the horrors of the Holocaust and the obvious bio-philosophical similarities were plainly apparent. Is history repeating itself?
     
    I contend that we are so far removed from the Holocaust today - that as a result of these CNN reports if a similar proposal were reintroduced in 2007 it would pass in a heartbeat. Keep in mind that eugenics did not start in Nazi Germany. It started right here in our free democratic United States of America.
     
    When will these non-stop micro-aggressions be seen for what they are - hate crimes. 
     
    Has the time finally come for our leaders to take a unified stand on this type of assault on our community? Can we bring a class action suit against these types of hate crimes? Or must I continue to pay for the crimes of the criminally insane?
     
    "Psychopathology is not the same as psychopathy." (Wikipedia)
     
    David Gonzalez – Hunger Striker, Fast for Freedom in Mental Health
    E-mail: david@recoveryxchange.org


    For a transcript of CNN's feature, "Criminally Insane" click
    http://transcripts.cnn.com/TRANSCRIPTS/0707/14/siu.02.html

    CLICK TO SEND COMMENTS TO CNN

    _____________________________


    July 12, 2007 - News of the Week

    A JOURNALISM STANDARDS-SETTER GIVES CAUSE FOR CONCERN

    The Poynter Institute is a school for journalists, future journalists, and teachers of journalism. It was therefore discouraging for a Poynter columnist to miss important points concerning the current push to put names of involuntary psychiatric patients on an FBI criminal database.

    Below is a National Stigma Clearinghouse response to the Poynter Online column by Al Tompkins, Tuesday, July 10, 2007. (http://www.poynter.org/column.asp?id=2&aid=12693). Scroll to July 10 column.

    July 11, 2007
    From: Jean Arnold, National Stigma Clearinghouse 
    To: Poynter Online
    Re: Tuesday Edition: Only 22 States Share Records With FBI Gun Database
     
    Al Tompkins asks what is wrong with putting the names of people with mental illnesses on a federal database of prohibited gun purchasers.  It is a good question, and it was answered in 1994 by two top experts on mental health law.  John Monahan, Ph.D. and Paul Appelbaum, M.D., both members of the MacArthur Foundation's Research Center on Mental Health and the Law, identified the hazards of putting the names of law abiding mental health patients on a national database alongside convicted criminals and other lawbreakers. Below are excerpts from an op-ed article written soon after passage of the Brady Act.
    "A centralized database that allows the police -- and their friends -- to find out who has been committed for treatment for depression, post-traumatic stress disorder and other psychiatric conditions is a privacy nightmare."
     
    "It is not difficult to imagine patients and families turning away from psychiatric care for fear that if committed, their names will be inscribed indelibly in a huge, interlocking database."
     
     "The Brady Bill could have been a historic first step in contolling the handgun violence that plagues America. In focusing on people with mental illness, though, it threatens to make that first step a false one.  For the rare people with serious mental illness who may commit violent acts with handguns, putting meaningful mental health benefits in health care reform is a much more promising prophylactic measure.
     
    Excerpts are from "Brady Bill's False Step," by Paul Appelbaum, M.D. and John Monahan, Ph.D.,The Boston Globe, July 29, 1994
     
    Since the early 1990's, gun control advocates have used rare acts of highly-publicized violence by mentally ill assailants to win support. The mental health community has long protested this exploitation of mentally ill assailants, who in fact commit a small fraction of the nation's violent crimes.  Yet the "blame the mentally ill" technique helped to pass the Brady Act in 1993 and to create the National Instant Background Check System (NICS) in 1998.  In 2002, an attempt to plug huge holes in the NICS data system was tied to a double murder by a mentally ill man in Long Island, New York.  Currently, the Virginia Tech tragedy has launched yet another attempt to round up the NICS' missing records.
     
    The repeated linking of the NICS list and mental illness has skewed the public's view of gun violence.  For example, who would guess that the NICS list reports 38 million missing criminal records, 14 million missing drug abuse records, and 2 million missing restraining order records?  Considering these huge gaps, it seems absurd to focus on the 2.7 million  missing  records of law-abiding people who were involuntarily hospitalized at some time in their lives. Very few of these individuals are potentially dangerous. 
     
    Interestingly, two of the nation's best-known assailants, John Hinckley and Colin Ferguson, would not have appeared on the NICS list. Neither had records of psychiatric hospitalization, mental incompetence, or criminal acts.
     
    The Poynter column lumps people with mental illnesses together with "potentially dangerous" lawbreakers in describing the NICS list as a "database that lets gun dealers across the country identify potentially dangerous buyers before selling them weapons."  This assumption of dangerousness is the most damaging stereotype faced by the mental health community. More than half of all Americans believe that people who have a mental illness are likely to be violent, an assumption that blocks all kinds of social interactions and reduces spending on treatment programs.
     
    It is now widely accepted that the rate of violent acts committed by people diagnosed with mental illnesses mirrors that of their communities (however, the risk rises with alcohol and substance use).  It should also be noted that mentally ill people are victimized by others at far higher rates than the general population. 
     
    If violent crime reduction is truly the nation's goal, the crime fighters' first concern should be people with histories of criminal violence.  It makes little sense to focus on people who are predominantly law abiding.
     
    For more information, please visit the link below.
     
    Articles from 2002-2004 concerning
    The National Instant Criminal Background Check System (NICS)
    http://community-2.webtv.net/stigmanet/BackgroundOLOPA/index.html
     
    Sincerely,
     
    Jean Arnold, Co-founder and Chair
    National Stigma Clearinghouse
    245 Eighth Avenue, #213
    New York, NY 10011
    Tel: 212-255-4411
    Email: stigmanet@webtv.net

    June 16, 2007 - NEWS of the Week

    LANGUAGE MATTERS: THE MAKING OF A PREJUDICIAL STEREOTYPE
    "I'm sure you have noticed that in many of the issues that divide our society, the first battle is control of the vocabulary." Morris Boyd, City Church NYC, 1995

    For years, the Treatment Advocacy Center (psychlaws.org) in Arlington Virginia has worked to frame mental illnesses as a public safety issue. The small but effective team at Psychlaws keeps violence at the forefront of every public discussion about people with psychiatric vulnerabilities. Endless repetition has turned phrases like "1,000 homicides" into pseudo-scientific factoids. Euphemisms like "treatment advocacy" and "assisted outpatient treatment" mask Psychlaws' law enforcement approach to medication.

    Mental health advocates are seeing stepped-up attempts to popularize "anosognosia," a term for poor insight formerly applied to cases of brain injury. Psychiatry's use of the term appeared in the DSM in 2000.

    Most distressing, however, is the violence spin Psychlaws is giving to the term anosognosia. Its new briefing paper states, "anosognosia is a major contributor to aggressive and violent behavior among individuals with severe psychiatric disorders."  

    It is alarming that an obscure term with violent overtones is primed to enter the mainstream vocabulary to replace the straightforward "lack of insight."  

    Last week, the Psychlaws team announced in a blog that researchers had found a link between lack of insight, violence, and criminal behavior. The blog begins, "An upcoming study of factors contributing to violence and criminality of patients with schizophrenia illustrates the importance of addressing lack of insight and treatment nonadherence."

    A word of caution: Psychlaws.org has a history of mining the research of others and presenting their findings in inaccurate ways. For example, a suggested briefing paper lists 8 studies to support the claim that "anosognosia is a major contributor to aggressive and violent behavior among individuals with severe psychiatric disorders." But at least one and perhaps many of the cited studies was misrepresented. A study by the respected research team of Swartz, Swanson, and Hiday, et.al, found that poor insight was not significantly related to serious violence. Further, none of the studies as described in the briefing paper use the term, "anosognosia."

    Is it surprising that public support for mental health services is weak and services are shrinking? The public's notion that mentally ill people are violent causes irreparable harm. A study by Corrigan et.al (Psychiatric Services, May 2004) stated that 75 percent of the public views people with mental illnesses as dangerous. The study further concluded that an over-emphasis on violence makes the public less willing to provide resources and more willing to endorse coerced psychiatric treatment, avoidance, and segregation.

    Will the mental health community cede control of the vocabulary to a group with a highly controversial agenda? To do so fuels prejudicial stereotypes and blocks informed discussion of mental health issues.
     

    Footnote:

    The passage below refers to a Wisconsin court decision in September, 2002.

    EXCERPT:

    In an amicus curiae brief, the Treatment Advocacy Center argued that patients' lack of insight necessitated the Fifth Standard, which broadens the courts' power to overrule patients' objections to medication. To give scientific weight to their argument, the TAC cited the work of Dr. Xavier Amador, among others. Dr. Amador is a foremost researcher on the subject of "lack of insight" in people diagnosed with mental illnesses. His work is frequently cited by forced medication advocates to justify harsher involuntary commitment laws.

    So often is Dr. Amador's work cited by coercion advocates, we assumed that he too supports coercion. Not true. In fact, Amador views coercion as counter-productive. His approach to treatment, described in his book, I Am Not Sick; I Don't Need Help!, tells families and caregivers how to avoid the power struggles that so often poison relationships and derail efforts to help. It is therefore incongruous that Dr. Amador's name is closely associated with the Treatment Advocacy Center and its state-by-state efforts to broaden court-ordered medication laws.

    The Court did not hear that Amador sees coercion as counter-productive or at best a temporary fix for a person's unawareness. It did not hear Amador's view, developed over years of experience with patients and his own brother, that a partnership approach to treatment is far more effective and achieves more lasting results. It did not hear about his meticulously detailed and compassionate guide for helping patients and caregivers to work together in a non-coercive way.

    To suggest that Dr. Amador is a mainstay supporter of involuntary treatment, one must ignore all that he espouses.

    The above is an excerpt from
    Antistigma Home Page
    National Stigma Clearinghouse
    Archive 9/28/2002


    June 4, 2007 - News of the Week

    HOW TO END BIAS AND DISCRIMINATION
    Article source: newarkadvocate.com, Newark Ohio, June 1, 2007
    "Each day that another person decides not to perpetuate mental illness stereotypes and takes the time to understand the issue, we as a community take one step closer to becoming a healthier community. It is that simple."

    Don't treat those with mental illness with bias or discrimination
    By Wendy Williams


    Do you understand mental illness?

    For many, when the issue of mental illness arises it conjures up preconceived notions and stereotypes that have affected the way mental illness is discussed, depicted, understood and even funded. These preconceptions and stigma have been passed on from one generation to the next.

    While progress has been made, even today individuals who suffer from mental illness face bias, distrust, avoidance and discrimination.

    So what does that mean for you?

    Mental illness affects people in many ways. Mental disorders need to be understood and treated on an individual basis. About one in five people has or will have a mental illness at some point in their lives. This includes anxiety, depression, eating disorders, substance abuse problems, bipolar disorder, schizophrenia -- any of which can affect people throughout their lives.

    The fact is mental illness does not discriminate. It is a real issue for real people we know.

    The fact is mental and physical health go hand-in-hand and are both essential to overall well being. I applaud the work of our statewide and local Community Mental Health and Recovery Board-supported organizations and what they do each day to assist individuals in their recovery process. These professionals and advocates who work hard to provide education, advocacy and treatment for mental health issues are to be celebrated.

    Recent legislative changes can also have an impact. The Mental Health Parity Act, which requires health insurers in the state to offer the same coverage for mental illnesses as they do for physical illnesses, is a significant step in the right direction.

    Each day that another person decides not to perpetuate mental illness stereotypes and takes the time to understand the issue, we as a community take one step closer to becoming a healthier community. It is that simple.

    For additional information about mental illness stigma, the following Web sites can serve as resources: www.nami.org; www.nimh.nih.gov; and www.mh.state.oh.us. For more information about CMHRB and providers of care go to www.communitymhrb.org or call (740) 522-1234 or (866) 559-6650.

    End of article

    _______________________________

    May 2, 2007 - News of the Week


    VIRGINIA TECH TRAGEDY REFUELS GUN LAW CONTROVERSY

    The Virginia Tech tragedy has re-activated the efforts of Sen. Charles E. Schumer and Rep. Carolyn McCarthy, who say that adding more psychiatric records to the National Instant Criminal Background Check System (NICS) will reduce gun deaths. But is this true?

    Two of the nation's best-known assassins, John Hinckley and Colin Ferguson, met the nation's strictest qualifications for gun ownership. Hinckley, who attempted to assassinate President Reagan, would easily have passed a background check. Ferguson, who killed Rep. McCarthy's husband and wounded her son in 1993, bought his gun legitimately, meeting every requirement in California's strict gun law, including a 15-day waiting period.

    It is ironic that the calls to expand the criminal database focus on people with mental illnesses, giving the impression that mental illness is a crime. As in their campaign of 2003, Schumer and McCarthy concentrate on the mentally ill while ignoring huge gaps in the NICS database of criminal records.

    The latest estimate (2003) reports 38 million missing criminal records, 14 million missing drug abuse records, and 2 million missing restraining order records. When 54 million names of potentially dangerous individuals are missing from the NICS data, it is absurd to target 2.7 million law-abiding people simply because they have been involuntarily hospitalized at some time in their lives.

    In turn, the media treat mentally ill people as the nation's most dangerous citizens. On Sunday April 24, "60 Minutes" aired a second update of a 5-year-old feature, "Armed and Dangerous." The segment is full of errors and bias against people who have had involuntary psychiatric treatment. Despite advocates' objections to the segment's previous broadcasts, host Steve Croft and his guests proceeded, for the third time, to inflict harm.

    FOR MORE INFORMATION


    Article: "Congress Revisits Backup Checks for Gun Buyers: supporters of reform legislation hope it has a better likelihood of passing this year, with the change in congressional leadership and the tragedy at Virginia Tech," by Alexandra Marks, The Christian Science Monitor, April 23, 2007.

    Web page: "Background: The National Instant Criminal Background Check System (NICS) controversy." Articles concerning the expansion of the NICS database, posted by the National Stigma Clearinghouse from 2002-2004.

    April 29, 2007 -News of the Week

    IS PSYCHLAWS.ORG CO-OPTING THE VIRGINIA TECH TRAGEDY?
    Thankfully, much of the early media coverage of the tragic shootings at Virginia Tech avoided snap judgments and sensationalism. Reporting focused on the lives of the 32 students and faculty members who died, the shocked reactions on campus, and non-sensational speculation about the shooter's motives, the role of gun access, and mental health services on university campuses. Experts pointed out that rampage murders are so rare that they are of little help in designing preventive measures.

    While it seems clear that Seung-Hui Cho was deeply troubled, his history and diagnosis are unknown. But guesswork thrives when facts are missing. And those with axes to grind fill in the blanks with self-serving assumptions.

    With Virginia in the midst of examining its mental health laws for possible change, the Virginia Tech case supplies an ideal public platform to proselytize a point of view. The unending stream of media coverage now airs the controversial views of the Treatment Adocacy Center, the creator of an aggressive crusade to expand compulsory antipsychotic medication laws. The Virginia-based center (psychlaws.org) and its supporters contend that Cho's diagnosis was classic paranoid schizophrenia, that he lacked insight into his illness, and that he refused to accept treatment.
     
    These unsubstantiated opinions, stated as fact by psychlaws.org, polarize public opinion. Consider the labeling of Andrew Goldstein as a "treatment refuser" in 1999. This false label lives on, having fueled the passage of Kendra's law while ignoring Goldstein's futile search for supervised treatment.

    The articles and website links below are intended to give informed opinion about a range of topics related to the Virginia Tech shootings.
     
    FOR MORE INFORMATION

    Articles:
    "Experts Shy From Instant Diagnoses..."
    "Student Mental Health Issues"
    "Talk To the Chos"
    "From Brothers' Death, A Crusade" 

    Click here for Websites



    ARTICLE: New York Times, April 20, 2007

    Experts Shy From Instant Diagnoses of Gunman's Mental Illness, but Hints Abound

    By JOHN SCHWARTZ and BENEDICT CAREY


    The video testament that Cho Seung-Hui mailed to NBC during the intermission in his killing spree offers a compelling peek into the troubles that shaped a gunman, experts in forensic psychology say.

    The clips suggest a person with holes in his soul, who lacked features like the emotional control and empathy for others that keep a lid on the violent impulses anyone might have.

    But can grainy, YouTube-ish video snippets offer real insight into the nature of Mr. Cho's mental illness?

    A solid diagnosis requires time and access to the patient, whose history can be as important as his actions; and most people with mental illness are far more likely to harm themselves than others. There is a universe of possible labels, and the exercise can be an empty one, said Robert Hare, an expert in violent behavior who has been a consultant to the F.B.I.

    "Diagnoses are ill advised if they are made too quickly," said Dr. Hare, who created one of the most authoritative models for detecting psychopathy. "After-the-fact explanations of this sort can go in about a thousand different directions."

    Experts who have watched the videos say that while the picture may yet change, they did see sentiments and thought that hint at Mr. Cho's mental landscape. Their opinions coalesce around a handful of conditions with names like "psychotic depression" and "avoidant personality disorder" and "schizophrenia-paranoid type."

    Dr. Michael Stone, an expert on personality disorders and killers, said in an interview that he saw in the videos "a paranoid person with sadistic traits, possibly psychotic." These are people, he said, who might see conspiracies all around, and who have so little empathy that they "can do the most heinous things almost as if they were whittling wood."

    Dr. Stone, who is a professor of clinical psychiatry at Columbia University, said this lack of empathy did not define any single mental illness. Mr. Cho appears to be a near opposite of psychopaths, who often have superficial charm to go along with an indifference to the effect of their actions on others.

    In the video manifesto, Dr. Stone said he saw a man characterized fundamentally by a feeling of powerlessness. "For 23 years he was a powerless, impotent cipher," the professor said, and so, "for two hours of his life, he was a powerful man."

    Mr. Cho's taped rants, and his peers' descriptions of him as a classmate, suggest a blend of severe and specific personality problems, said Dr. Theodore Millon, dean and scientific director of the Institute for Advanced Studies in Personology and Psychopathology in Coral Gables, Fla., who has designed testing questionnaires used in many colleges.

    People with so-called avoidant personality disorder shun social situations because of a paralyzing dread of disapproval or criticism. Those with paranoid personality disorder nourish a deep distrust of others and see insults and malicious meanings in almost every interaction. Both are stubborn patterns of behavior that can begin in adolescence or earlier, and in his influential book,

    "Disorders of Personality" (Wiley, 1996), Dr. Millon identifies a blend of the two as "insular paranoid" disorder.

    "Such people feel persecuted, deeply isolated, that the world rejects them, and they will often replace the real world with an inner one in which they act out their fantasies," Dr. Millon said, adding that this inner world can be elaborate, a "pseudo-community" modeled after the real one in which they live.

    "The acting out usually stops there," Dr. Millon said. "Only in rare circumstances do they confuse reality with this inner world."
    Severe psychiatric disorders like bipolar disorder and schizophrenia often first emerge during late adolescence or in the early 20s. People diagnosed with schizophrenia, a disorder characterized by delusions and imaginary voices, most often have their first psychotic "break" as young adults. Some of Mr. Cho's actions are suggestive of that kind of a break with reality, some experts said.

    "If you think of the problem of psychosis as blowing a fuse in the brain that allows us to distinguish clearly between what is really happening and what is not — between real things and ideas, fantasy — you see some evidence of that here," said Dr. Frank Ochberg of the Dart Center for Journalism and Trauma and an expert on violence and psychiatry who worked with officials at Columbine High School after the deadly shootings there in 1999.

    Dr. Ochberg said that a first psychosis was often a terrifying experience, and that eventually people with schizophrenia developed "ways of coping by projecting, denying and at times indulging in this grandiose fantasy about their own purpose and lives."

    To Dr. Hare, the nagging question is recognizing the traits that will lead to violence. Most warning signs often stand out only in retrospect, he said, and many of Mr. Cho's traits were "not all that uncommon."
    The population of killers is very small, and no one knows how prevalent their common traits are in the population at large.

    "We have to try to understand," Dr. Hare said. "The basic research can be done."

    Copyright 2007 The New York Times Company


    ______________________________

    STATEMENT on "Student Mental Health Issues" by Robert Bernstein. The Bazelon Center highlights a paradox in attitudes toward mental health problems at colleges and universities.

    "Washington DC, April 24, 2007 - The Bazelon Center wishes to express its deepest sympathies to the families, friends, and peers of the Virginia Tech shooting victims. In the wake of this tragedy, many students may suffer emotional distress. It is critically important that counseling and other mental health services be available to them and that they feel safe asking for help. Seeking help is often difficult.

    The goal of campus policies should be to maximize the likelihood that students who require mental health treatment receive it and to ensure that their problems not reach crisis proportions before services become available. To that end, schools should take actions to de-stigmatize mental illness, encourage students to seek help early, remove barriers to seeking treatment, and ensure that students will not be penalized when they ask for help. Unfortunately, some schools have created a paradox for students in need: while encouraging students who struggle with mental health problems to seek assistance, the school administration then applies disciplinary measures when students take this difficult step, in an effort to remove mental health problems from the campus. Last year, the Bazelon Center represented a George Washington University student who voluntarily sought hospital treatment for depression and then faced disciplinary action by the university administration and was suspended from school. In another suit, we represented a Hunter College student who voluntarily admitted herself to the hospital for treatment of depression and as a consequence was locked out of her dorm by the college administration.

    By responding in such a way, schools create an appalling dilemma for students in crisis; they either jeopardize their education by asking for help or forego needed mental health treatment. Such approaches may actually increase the risk of harm by discouraging students from getting help for themselves or their friends. The Bazelon Center's successful representation of students who have been punished for getting mental health care is aimed at breaking down this shameful obstacle. In the wake of the Virginia Tech tragedy, the Bazelon Center urges that educational institutions do all they can to identify and remove barriers to youths' getting help. We feel strongly that meaningful remedies rest not in abruptly diluting legal protections for people with mental health needs, but in addressing the enormous gaps in service availability.

    All students should know whom to call when they or their fellow students are in trouble and should have ready access to counseling and other support. Moreover, mental health programs need to work in partnership with schools to make mental health service readily available, including getting out of their clinics and reaching out to students who are at obvious risk

    One can only hope that this tragedy will focus constructive attention on how difficult it is for youth to connect with the help they need."


    End of statement by Robert Bernstein, Bazelon Center for Mental Health Law
    _______________________________


    OP-ED ARTICLE: "Talk to the Chos" by Dave Cullen, New York Times, 4/27/07. Addresses the information gap following the tragedies at Virginia Tech and Columbine, and the complexity of releasing vital facts about mass killings.

    "A judge ruled this month that depositions by the parents of the gunmen in the 1999 Colmbine school shootings would remain sealed until 2027. It would be tragic to also have to wait 28 years to hear from the family of Seung-Hui Cho, the killer at Virginia Tech. But the tense legal standoff that led to the Columbine ruling is likely to repeat itself in Virginia if we don't quickly devise an alternative.

    In the Columbine case, as in Virginia Tech, the killers' families went into seclusion and released statements of regret and bewilderment. Parents of mass murderers have their own grieving to do. When the Chos resurface, a ravenous press corps will stalk them, and the public will be hungry for answers. The questions will grow increasingly belligerent and accusatory.

    Eventually the parents of the Columbine killers, Eric Harris and Dylan Klebold, appeared willing to speak, but the threat of lawsuits drove them to silence. The families reached an impasse: the killers' parents would talk only if the victims disavowed legal action, but the victims would waive lawsuits only if the parents spoke.

    The Cho family's troubles may intensify again when Virginia's statute of limitations for civil suits expires. At the moment Littleton braced for the first Columbine anniversary, more than a dozen families filed suits. The victims weren't after the money; they wanted answers -- for themselves, for the public, and most of all, for any psychiatric expert who could help pevent the next catastrophe. And the Harrises and Klebolds were looking for a measure of security. Everyone lost.

    Like Eric Harris and Dylan Klebold, Seung-Hui Cho left voluminous writings and videos to explain himself. But those rants have to be measured against an objecive reality. Was Mr. Cho bullied or sneered at by the rich brats he railed against? Or was he responding to voices in his head? When did he first experience difficulty socializing? Did those troubles lead to withdrawal, or was he already a loner? How did his parents respond? Was anything successful?

    We know Mr. Co demonstrated symptoms consistent with autism and Asperger's syndrome, but these can also be signs of schizophrenia. Experts are eager to interview the Cho family to tease out the differences. If Mr. Cho experienced outright psychotic episodes, how often and with what intensity? How was he treated, and with what results? A deeper understanding of Mr. Cho's pathway to murder can help us predict dangerous behavior and respond better to warning signs.

    The Harrises and Klobolds settled their last lawsuits in 2003. Their homeowners' insurance had already agreed to pay $1.6 million, but five holdout families demanded information. The killers' parents were deposed in a closed federal courtroom, to which the plaintiffs gained access by agreeing to a gag order. Fourteen days before Mr. Cho opened fire at Virginia Tech, a district court judge ruled that the transcripts of these meetings could remain sealed for 20 more years.

    It was an ugly compromise. The victims got answers, at the price of hiding them from experts and the public. The Harrises and Klebolds endured eight years of vilification and legal action.

    If Columbine has taught us anything, it is that we should avoid a similar stalemate in the Virginia Tech massacre. The Chos' lawyers should broker a deal with psychiatric experts before trust is eroded. The psychiatrists can offer medical privilege and the hope of authentic scientific advancement in exchange for openness from the family. They should promise to divulge their conclusions to the public, but to work with the Cho lawyers to withhold any details likely to land the family in court.

    There are risks in this for the Cho family, but inaction presents the greater risk -- of lawsuits and of never finding answers. The questions that plague the victims' families weigh just as heavily on those who loved the perpetators."

    Dave Cullen is writing a book about the Columbine killers.

    Reprinted using Fair Use standard


    End of Op-Ed article by Dave Cullen
    _______________________________


    PROFILE: "From Brother's Death, a Crusade" by Tamar Lewin, New York Times. 4/26/07. A profile of a young woman's dedicated mission to promote mental illness awareness on university campuses.

    "There's so much talk about sexual identity and racial relations on college campuses. It was ridiculous in my mind that mental health wasn't right up there with them." Alison Malmon, Founder of Active Minds, Inc.

    WASHINGTON, April 23 — One Friday afternoon in March 2000, Alison Malmon, a freshman at the University of Pennsylvania, got word that her brother, Brian, a 22-year-old on leave from Columbia, had committed suicide.

    Brian had been a kind of star on campus, with a 3.7 grade-point average, and a lively wit that shone through his roles as sports editor of the newspaper, president of an a cappella group and actor in the annual student-written musical.

    The death of her only brother, and the discovery that he had hidden his struggles with mental illness from his friends and family for years after he began hearing voices, rocked Ms. Malmon's world, and by her junior year led her to start the student group that evolved into Active Minds Inc., a nonprofit organization with student-run chapters on 65 campuses, devoted to increasing awareness of mental illness.

    She started small. Very small. Only three people showed up for the first meeting at Penn of what she initially called Open Minds.

    "I asked them to help me figure out what we should do, " said Ms. Malmon, now 25. "There's so much talk about sexual identity and racial relations on college campuses. It was ridiculous in my mind that mental health wasn't right up there with them, since it's an issue that touches so many people."

    The prevalence of mental illness on campus is stunning, she found when she began researching the topic: Suicide is the second leading cause among death for college students. Almost one in 10 college students has made a suicide plan. Nearly half of all students report having felt so depressed that they could not function in the previous year. Most people with schizophrenia develop the disease before they are 25.

    And yet, Ms. Malmon said, mental illness like her brother's is so stigmatized that it is often kept secret.

    "Mental illness is such an isolating thing," she said. "It's not something that's easy to tell your family and friends about. That is the impetus for this. I firmly believe that Brian took his life because he didn't know how to live with mental illness. It's terrifying, because there aren't positive role models, there's just the people you see on the streets."

    Now, with the Virginia Tech shootings, Ms. Malmon is concerned about a resurgence of the stigma against mental illness. "I worry that as a society we're going to look toward everybody with mental illness as being violent, and that stigma will build right back up," she said. "We want to emphasize the need for students to talk about what they're going through, and share their experiences."

    Active Minds is one place where students can do that. While each chapter is different, the membership blurs the lines between students with mental illness; students with friends or family members living with mental illness; and a smattering of psychology students, social workers and nurses.

    "When we have panel discussions, some are about what you can do to help a friend you're concerned about, that you should go and say, 'I'm worried about you, is everything O.K.?' and walk them over to the counseling center," Ms. Malmon said. "Others are about how to live with mental illness, where people discuss their own experiences with anxiety disorder or depression. It may sound a little mushy, but all these things help get the word out," whether it is showing "A Beautiful Mind," sponsoring a Stamp Out Stigma run or having a speaker.

    When a college student develops a mental illness, she said, friends are often the only ones who notice. Active Minds seeks to ensure that everyone on campus knows what mental health services are available and when to use them. On each campus, Active Minds has tables offering materials on mental health — often the same materials available at the counseling center, Ms. Malmon said, but more visible. In some cases, a chapter has worked even more closely with the counseling center, providing student interviewers to sit in when candidates are interviewed for counseling jobs.

    Ms. Malmon, a sunny and impressively composed young woman who was a gymnast as a child and a varsity cheerleader at Penn, grew up in Potomac, Md., with her mother, Joanne, a social worker, and her father, Stuart, a lawyer. They separated when she was 8 and divorced when she was 12. "That's really when Brian and I bonded, traveling back and forth from one to the other," she said. "It was very important having a brother with me."

    Ms. Malmon was always interested in psychology. As a freshman, she studied historical perspectives on mental illness, and abnormal psychology. Brian's death focused her interests further. Her senior thesis was "Attitudes Toward Mental Illness Among Ivy League Undergraduates."

    In 2003, Ms. Malmon graduated Phi Beta Kappa from Penn, incorporated Active Minds, and became the youngest recipient of the Tipper Gore Remember the Children Award from the National Mental Health Association.

    Now, financed by a combination of individual donations and foundation grants, Active Minds is her full-time job. She shares the headquarters, a crammed one-room office in Washington, with two other women who coordinate the campus chapters. And soon, she expects, they will need more space. Every week brings inquiries about starting chapters, most recently from students or staff members at Arizona State University, Luzerne County Community College in Pennsylvania, the University of Central Florida and Humboldt State University in California.

    "We just got a $100,000 three-year grant to do outreach," Ms. Malmon said. "The goal is a chapter on every campus, but more realistic is that we'll have about 300 chapters in the next three years. Mental illness is such an important issue. I expect to grow, not stay a little nothing nonprofit."

    End of article by Tamar Lewin
    ______________________________
    Copyright 2007 The New York Times Company

    Reprinted using Fair Use standard
     

    WEBSITES


    Mental Illness Watch
    http://www.miwatch.org/VTU.htm

    MindFreedom International
    http://www.mindfreedom.org/kb/youth-mental-health/virginia-tech/seung-hui-cho

    National Mental Health Consumers' Self-Help Clearinghouse
    http:www.mhselfhelp.org/blog/

    SAMHSA (Substance Abuse/Mental Health Services Administration)
    http://www.samhsa.gov/MentalHealth/understanding_Mentalllness.aspx
     
     

    April 1, 2007 - News of the Week


    ARTICLE DESCRIBES COPING WITH AUDITORY HALLUCINATIONS

    (Click for resource information)

    Article Source: New York Times Magazine, Sunday, March 25, 2007
    Reprinted Using Fair Use Standard

    CAN YOU LIVE WITH THE VOICES IN YOUR HEAD?

    By DANIEL B. SMITH
    Auditory hallucinations have always been understood as a sign of severe mental illness. For some, that's part of the problem.

    Angelo, a London-born scientist in his early 30s with sandy brown hair, round wire-frame glasses and a slight, unobtrusive stammer, vividly recalls the day he began to hear voices. It was Jan. 7, 2001, and he had recently passed his Ph.D. oral exams in chemistry at an American university, where, for the previous four and a half years, he conducted research into infrared electromagnetism. Angelo was walking home from the laboratory when, all of a sudden, he heard two voices in his head. "It was like hearing thoughts in my mind that were not mine," he explained recently. "They identified themselves as Andrew and Oliver, two angels. In my mind's eye, I could see an image of a bald, middle-aged man dressed in white against a white background. This, I was told, was Oliver." What the angels said, to Angelo's horror, was that in the coming days, he would die of a brain hemorrhage. Terrified, Angelo hurried home and locked himself into his apartment. For three long days he waited out his fate, at which time his supervisor drove him to a local hospital, where Angelo was admitted to the psychiatric ward. It was his first time under psychiatric care. He had never heard voices before. His diagnosis was schizophrenia with depressive overtones.

    Angelo remembers his time at the hospital as the deepening of a nightmare. On top of his natural confusion and fear over the shattering of his psychological stability, Angelo did not react well to the antipsychotic he'd been prescribed, risperidone, which is meant to alleviate the symptoms of schizophrenia by reducing the level of dopamine in the brain. In Angelo's case, the pills had a predominantly negative effect. His voices remained strong and disturbing — an unshakable presence, quiet only in sleep — while he grew sluggish and enervated. "If you think of the mind as a flowing river of thoughts," he told me in an e-mail message, "the drug made my mind feel like a slow-moving river of treacle." Several days into his stay, Angelo's parents flew to the United States from London and took him back home.

    More than six years later, Angelo still lives at his parents' house. He currently takes a cocktail of antidepressants and antipsychotics, with tolerable side effects, and sees a psychologist every two months to monitor his medication. The pills help Angelo to manage his voices, but they have not been able to eradicate them. Shortly after his return to London, he made an attempt to resume his career, accepting a research position at the university where he had received his undergraduate degree. He lasted eight months (his neighbors heard him screaming at his voices and called the police), checked himself into the hospital for six weeks and returned home. Despite these setbacks, Angelo has maintained his optimism. He is eager to discover new ways to combat his voices. Not long ago, he found one. In November, his psychologist informed him of a local support group for people who hear voices, from which he thought Angelo might benefit. Angelo began to attend the group late last year.

    I first met Angelo at a meeting of the group in mid-January. (I was given permission to sit in on the condition that I not divulge the participants' last names.) The meeting took place in the bright, cheerfully decorated back room of a community mental-health center in North Finchley, an affluent, grassy suburb in the northern reaches of London. The gathering was small but eclectic. In addition to the group's facilitators — Jo Kutchinsky, an occupational therapist, and Liana Kaiser, a social-work student — five men and women assembled in a circle of bulky wool-knit chairs around a worn coffee table. Besides Angelo, there was Stewart, a young, working-class Londoner with a shaved head and a hoop earring; Jenny, an affable woman in her 50s who spoke of her fondness for arts and crafts; Michelle, a heavyset woman who dominated the session with her forceful opinions; and David, a 60-something man with a thick gray beard and a pageboy haircut who slumped in his seat and dozed throughout much of the meeting.

    Angelo was the newest member of this group — it was his third visit — and he did not seem inclined to participate fully. When Kutchinsky opened the meeting by asking each member to discuss the previous week's experience hearing voices, he softly mentioned that his voices made it difficult to read, then quickly ceded the floor. What followed was sometimes painful. Stewart in particular was visibly agitated. His hallucinatory life, as he described it, was chaotic and irrepressible. He heard voices pleading to him for help; he heard the voices of strangers; he heard the voice of his father. Sometimes he heard the voices of military commandos, who offered to defend him against this confusion. "I haven't been well for a long time," he said glumly. Yet most of the members spoke of their voices in the way that comedians speak of mothers-in-law: burdensome and irritating, but an inescapable part of life that you might as well learn to deal with. When David's name was called, he lifted his head and discussed his struggle to accept his voices as part of his consciousness. "I've learned over time that my voices can't be rejected," he said. "No matter what I do, they won't go away. I have to find a way to live with them." Jenny discussed how keeping busy quieted her voices; she seemed to have taken a remarkable number of adult-education courses. Michelle expressed her belief that her voices were nothing more exotic than powerfully negative thoughts. "Negative thoughts are universal," she said. "Everyone has them. Everyone. What matters is how you cope with them: that's what counts."

    I had trouble gauging Angelo's reaction throughout these testimonies, so afterward I pulled him aside and asked him what he thought. "It's interesting to hear people's stories," he said. "Before I started coming, I hadn't realized just how long some people have suffered. I've heard voices for six years. Some people have heard them for 15 or 20. It's amazing." I asked him if this knowledge reassured or frightened him. "It's a bit scary, in a way. I think, I could be this way for a long time." Still, he appeared to appreciate the camaraderie. For years, he had been socially isolated. He spends most of his time with his parents and a sympathetic older sister. His neighbors know only that he is "off work." It was comforting, he said, to speak at last with people who understood.

    The meeting that I attended in London is one of dozens like it affiliated with a small but influential grass-roots organization known as Hearing Voices Network. Based in Manchester, Hearing Voices Network (H.V.N.) has since its inception, in 1991, developed a range of services related to the phenomenon known as auditory hallucination: a hot line for people who suffer from the experience, a series of educational workshops for mental-health professionals and 170 support groups across Britain, with more in development. H.V.N., which openly challenges the standard psychiatric relationship of expert physician and psychotic patient, might be said to take the consumer movement in mental health care to its logical endpoint. Although H.V.N. groups meet in a variety of settings — from psychiatric wards to churches to the organization's headquarters — all must be run by, or there must be active plans for them to be run by, voice-hearers themselves. What's more, H.V.N. groups must accept all interpretations of auditory hallucinations as equally valid. If an individual comes to a group claiming that he is hearing the voice of the queen of England, and he finds this belief useful, no attempt is made to divest him of it, but rather to figure out what it means to him.

    H.V.N.'s ecumenical approach makes it a difficult organization to pin down. I have met members who believed that their voices were a result of a biochemical glitch, requiring all the tools modern pharmacology has to offer; I have met those who believed their voices were signs from the spirit realm — a cherished gift. Yet the organization's clearest rhetorical note is oppositional and antipsychiatric.

    For more than a half-century, auditory hallucinations have primarily been studied and discussed in terms of severe mental illness, most notably schizophrenia, and linked to bizarre delusions, disordered thought and emotional dissociation. Approximately 75 percent of patients diagnosed with schizophrenia hear voices, and for the majority the experience is overwhelmingly negative. Those voices may issue commands, comment sarcastically on everyday actions or berate, curse and insult the hearer. As many as one-third of people with schizophrenia attempt suicide; as many as one-fifth hear voices that command them to do so. H.V.N. does not dispute that auditory hallucinations are frequently painful: many of the organization's leading members have endured harrowing voices themselves and, at one time or another, sought psychiatric help.

    What H.V.N. does dispute is that the psychological anguish caused by hearing voices is indicative of an overarching mental illness. This argument, disseminated through a quarterly newsletter, numerous pamphlets and speeches and alternative mental-health journals, are as voluminous and diverse as its membership. But H.V.N.'s brief against psychiatry can be boiled down to two core positions. The first is that many more people hear voices, and hear many more kinds of voices, than is usually assumed. The second is that auditory hallucination — or "voice-hearing," H.V.N.'s more neutral preference — should be thought of not as a pathological phenomenon in need of eradication but as a meaningful, interpretable experience, intimately linked to a hearer's life story and, more commonly than not, to unresolved personal traumas. In 2005, Louise Pembroke, a prominent member of H.V.N., proposed a World Hearing Voices Day (held the next year) that would "challenge negative attitudes toward people who hear voices on the incorrect assumption that this is in itself a sign of illness, an assumption made about them that is not based on their own experiences, is stigmatizing, isolating and makes people ill."

    H.V.N.'s insistence that it is not just the psychotic who hear voices does not, in fact, contradict psychiatric orthodoxy. According to the Diagnostic and Statistical Manual of Mental Disorders, the so-called bible of psychiatry, auditory hallucinations are only a potential symptom of mental illness — they must appear with other symptoms, persist for a specified length of time and impede day-to-day functioning in order to become part of a diagnosable syndrome. In a 2001 debate on whether voices are by definition pathological, Tony David, a neuropsychiatrist at the Institute of Psychiatry in London, noted that a "voice-hearer who is not in any distress, who lives a fruitful and productive life according to commonsense criteria, would never enter the arena in which the possibility of mental illness was up for discussion." Nor does psychiatry insist that the syndrome in question when a voice-hearer is in distress is invariably schizophrenia. Approximately 20 percent of patients suffering from mania and 10 percent of patients suffering from depression hear voices. Auditory hallucinations can also be caused by "organic" conditions, like Parkinson's, Alzheimer's, temporal-lobe epilepsy, hyperthyroidism and migraine headaches, and have long been known to occur in the twilight consciousness between wakefulness and sleep.

    That said, H.V.N.'s insistence that voice-hearers should attend carefully to what their hallucinations say is far from traditional. Prolonged exposure to untreated psychosis is held by many experts to be damaging to an individual's ability to hold down a job or to maintain a meaningful relationship and by others to be damaging to brain function — what clinicians refer to as "psychosocial toxicity" and "neurotoxicity," respectively. And though psychiatrists acknowledge that almost anyone is capable of hallucinating a voice under certain circumstances, they maintain that the hallucinations that occur with psychoses are qualitatively different. "One shouldn't place too much emphasis on the content of hallucinations," says Jeffrey Lieberman, chairman of the psychiatry department at Columbia University. "When establishing a correct diagnosis, it's important to focus on the signs or symptoms" of a particular disorder. That is, it's crucial to determine how the voices manifest themselves. Voices that speak in the third person, echo a patient's thoughts or provide a running commentary on his actions are considered classically indicative of schizophrenia.

    Interpreting voices in relation to a patient's past has a checkered history in the treatment of psychosis. Though Freud discouraged the application of psychoanalysis to psychotic patients, it nonetheless became, for 25 years after World War II, a widespread treatment for schizophrenia in the English-speaking world. This episode in psychiatry is now widely acknowledged to have been a medical and moral disaster; crippling psychoses were routinely blamed on insufficiently nurturing and "schizophrenogenic" mothers. "The psychoanalytic approach to psychosis was toxic," says Peter Weiden, a professor of psychiatry at SUNY Downstate Medical Center in Brooklyn. "Clinicians of that time were often highly antagonistic toward family members. They blamed the parents, left them out of the treatment process and isolated the patient from his family." Over the past 30 years, the biomedical model displaced the psychoanalytic one, bolstered by advances in pharmacology, modern genetic and neurological research and the completion of large-scale empirical studies that concluded that psychoanalysis was useless at best and actively destructive at worst. Today, medication is typically prescribed to extinguish, or at least mitigate, voices (about 80 percent of patients experience a reduction in voices, Weiden says, from medication alone, though this does not always translate into an equal improvement in day-to-day functioning); psychotherapy is usually admitted as an adjunct, to deal with issues of social functioning and stigma.

    There are signs, however, that psychotherapy is again encroaching on the biomedical paradigm in the treatment of psychoses. Since the 1990s, a growing number of researchers and clinicians, predominantly based in England, have been comparing voice-hearing in psychotic patients with voice-hearing in nonpatients, measuring the incidence of hallucinations in the general population, and using cognitive behavioral therapy (C.B.T.), a popular, short-term treatment for depression and anxiety, to help them manage their responses to the voices they continue to hear. C.B.T. typically asks patients to scrutinize how they interpret their symptoms rather than focusing on an illness as an underlying cause. "The matter of whether it's effective, and to what extent," Lieberman says, is still being investigated. So far, the use of C.B.T. in the treatment of psychoses is much more prevalent in the U.K. than in the U.S. In large part, Lieberman says, this is because "the motivation to research the treatment has mostly come from investigators in England." But, he added, "you could also read into the situation the influence of a strong antipsychiatry or antimedication movement in England — there's more of an interest in getting nonmedication treatments into clinical use."

    In England, this new cognitive approach to psychosis and the efforts of Hearing Voices Network are independent of each other, and are sometimes at odds. H.V.N.'s leading members, for instance, frequently criticize even sympathetic academic researchers for being insufficiently political. Yet both approaches share a similar purpose in seeking to place voice-hearing within the continuum of normal human experience — one, in order to better treat patients, the other, out of a firm conviction that hearing voices need not interfere with leading an otherwise "normal" life. Over the years, they have forged something of an alliance; psychologists, though they may not embrace H.V.N.'s more polemical views, frequently refer their patients to H.V.N. groups, while H.V.N. frequently cites the research of psychologists. And both H.V.N. and the cognitive approach to psychosis can be traced, to varying degrees, to the same radical figure.

    When H.V.N. is accused of being hostile to psychiatry, its members sometimes point out that the organization was, in effect, founded by a psychiatrist — albeit a singularly unorthodox one. In 1986, Marius Romme, a professor of psychiatry at Maastricht University in the Netherlands, was referred a patient, Patsy Hage, who suffered from chronic auditory hallucinations and fell into a deep, suicidal depression. Hage took comfort only from reading "The Origin of Consciousness in the Breakdown of the Bicameral Mind," an eccentric book, published in 1976, by Julian Jaynes, a Princeton psychologist, in which he argues that before around 2,000 B.C., all humans were guided by hallucinated verbal commands caused by a physical split between the right and left hemispheres of the brain.

    Romme wondered whether Hage might benefit from communicating this theory with other voice-hearers and arranged to appear with his patient on a popular Dutch television program. They invited people who heard voices to contact them: 450 people called in, one-third of whom claimed they were able to live alongside their voices without much difficulty. It struck Romme that this smaller group, the existence of which surprised him, might serve as a therapeutic resource. He asked 20 men and women who had learned to manage their voices to serve as speakers at a conference for voice-hearers. The governing principle of the meeting was that all interpretations of voice-hearing, no matter how unusual, would be accepted.

    Today, H.V.N.'s members speak of that first conference as the birthplace of their organization — and, indeed, of a worldwide Hearing Voices movement. There are currently self-help organizations for people who hear voices in more than 15 countries, including Germany, Japan and Australia. (The group has only recently begun to make inroads in the U.S.) Meanwhile, Romme has emerged as a spirited leader-activist, increasingly speaking of psychiatry in terms of cultural and personal oppression. People who hear voices, he has declared, "are like homosexuals in the 1950s — in need of liberation, not cure." H.V.N. often echoes this protesting stance. Its annual conferences, held in Manchester, project an antiestablishment tenor. Ron Coleman, a prominent member, sports a tattoo that reads "Psychotic and Proud" and looks forward to a day when he can "walk the streets talking to his voices and not be denied his freedom."

    In its publicly disseminated material, however, H.V.N. tends to focus less on Romme's rhetoric than on his research. In an article published with a group of colleagues in The Journal of Nervous and Mental Disease in 1998, Romme reported on the hallucinations of three groups: patients with schizophrenia, patients with dissociative disorder and nonpatients. All three groups heard a mixture of positive and negative voices (though the patients heard more negative voices than nonpatients), reported traumatic experiences in their past and heard both external and internal voices. What for Romme distinguished the voices of the patients most from those of the nonpatients was that the latter felt that they had control over their voices; they rarely sought to eradicate or ignore them and devised ways of coping with and understanding them. "Helping the patient to accept the voices and actively developing effective coping strategies with the patient," Romme had noted earlier, "may well prove an effective adjunct to psychiatric rehabilitation."

    The concept of "coping" is central to H.V.N., based on its belief that people feel better not when their voices are extinguished but when the person hearing voices learns to listen to his hallucinations without anguish. Jacqui Dillon, the national chairwoman of H.V.N., embraces this credo based on personal experience. Dillon, a mother of two, has heard voices for more than 30 years and has never taken medication for them. Mostly, she says, her voices are supportive and even witty, though occasionally they are cruel — they swear and tell her to harm herself. But she no longer heeds their commands or allows them to bother her. Instead, she takes them as symbols of her unconscious thoughts. "Sometimes voices carry messages that you don't want to hear," she told me. "Nevertheless, you don't shoot the messenger. You listen to him."

    When Romme's gospel of hallucinatory "acceptance" emerged in the early 1990s, it sparked a notably sharp rebuke in the mainstream British Medical Journal. Reviewing "Accepting Voices" (1993) — a hodgepodge of research findings, coping strategies and firsthand testimonies edited by Romme and his wife and colleague, Sandra Escher — Raymond Cochrane, a professor of psychology at the University of Birmingham, wrote, "Anything that may encourage people to accept the reality of delusional beliefs, and even attribute to these beliefs some mystical supernatural power, can only prolong the existence of these beliefs and make recovery from schizophrenia more protracted and more uncertain."

    But Romme's work influenced a number of researchers and clinicians, even those not inclined to agitate for the liberation of voice-hearers. "By the late 1980s, hearing voices had become such a stigmatized experience, people had forgotten that it is not just the insane who hear voices," says Douglas Turkington, a psychiatrist at the Royal Victoria Infirmary, in Newcastle. "The standard line was: 'Don't talk to patients about the experience. It'll only make it worse.' " Romme's report that there existed numerous people living in the community who heard voices and were not distressed, Turkington says, provided ballast for a psychotherapeutic approach to schizophrenia that he and a colleague, David Kingdon, a professor of psychiatry at the University of Southampton, had already embarked on. Adapting the techniques of cognitive behavior therapy, they started in the late 1980s to lead patients, through Socratic-style questioning, toward an understanding of their hallucinations as coming from their own minds. The therapy included mitigating patients' fears of madness by pointing out that even "normal" people can hear voices. Turkington and Kingdon's efforts are now widely credited with helping to reopen the door to psychotherapeutic approaches to psychotic symptoms.

    Richard Bentall, a professor of psychology at the University of Manchester, embraced not only the clinical implications of Romme's research but also some of his political activism. Over the past 15 years, Bentall has garnered a reputation as an opponent of traditional psychiatric diagnostics and as an enthusiastic supporter of consumer-based therapies. In the early 1990s, as a professor at the University of Liverpool, Bentall supported the first H.V.N. group in that city, and last August he joined Romme and H.V.N. at a news conference held to announce the Campaign for the Abolition of the Schizophrenia Label, which they billed as "the last great civil rights movement."

    For Bentall, schizophrenia is the diagnostic equivalent of a circus tent, sheltering a heterogeneous crowd of experiences and serving to stigmatize patients. Clinicians, he maintains, should be treating individual symptoms, not syndromes. He is not merely indulging in the kind of rhetoric favored by the antipsychiatrists of the 1960s and 1970s, with whom he is sometimes compared. Questioning the validity of schizophrenia as a label is not new — even the architects of the DSM acknowledge that it is useful only insofar as it guides research and treatment. And while Bentall's argument that specific psychotic symptoms should be studied in relation to the psychological mechanisms that give rise to them places him outside the mainstream, he publishes frequently in leading peer-reviewed journals and is often cited by psychologists (who are more inclined than their psychiatric counterparts to place auditory hallucinations on a continuum of everyday experience). He has also received support from the British government for his clinical work, most recently a $2.9 million grant from the U.K. Medical Research Council to investigate whether C.B.T. can prevent people who exhibit early signs of psychosis from developing a full-blown disorder.

    In his 2003 book, "Madness Explained," Bentall draws on the theory that auditory hallucinations may have their roots in what psychologists call "inner speech." All of us, every day, produce a steady stream of silent, inward-directed speech: plans, thoughts, quotations, memories. People hear voices, Bentall argues, when they make faulty judgments about whether this inner speech is the product of their own consciousness or of something alien to their consciousness. Lapses in what researchers call "source monitoring" may occur for a number of reasons — because an individual is primed to expect a perception to occur, because the level of background noise makes it difficult to separate what is internal from what is external, because he or she is in a state of emotional arousal. But whatever the cause, Bentall writes, there is evidence to suggest that hallucinating "can be explained in terms of the same kinds of mental processes that affect normal perceptual judgments."

    This theory raises the critical question of why making source-monitoring errors results in psychosis: why, when people mistake their private speech for someone else's, does it cause them to grow so distressed that they seek professional help? The answer Bentall gives echoes Romme's observation that a fundamental difference between voice-hearers in the community and voice-hearers under psychiatric care is that the latter think negatively about their experience. According to Bentall, how patients perceive auditory hallucinations can have a significant impact on how those hallucinations are experienced. Bentall cites a landmark 1994 study by Max Birchwood, at the University of Birmingham, and Paul Chadwick, of the Royal South Hants Hospital in Southampton, to support this view. Published in The British Journal of Psychiatry, it proposes that the anguish experienced by patients who hear voices is directly related to their beliefs in the malevolence and power of the voices. A more recent study, published in 2004 and led by Anthony Morrison, a colleague of Bentall's at the University of Manchester, also found that negative beliefs about voices are associated with an increase in the distress of the experience, and often these negative beliefs are reinforced by both mental-health services and the media.

    According to Louise Johns, a psychologist at the Institute of Psychiatry in London, cognitive models of psychosis have had a significant impact on mental-health practice in Britain. Few psychologists trumpet C.B.T. as a panacea; it is considered an adjunct to, not a replacement for, standard medical intervention, most frequently in cases where patients do not respond well to medication or are chronically ill. Since the early 1990s, more than 20 randomized clinical trials have been conducted with C.B.T. for psychosis, showing that C.B.T. can be useful in helping patients cope with psychotic symptoms, increasing insight into psychosis and promoting compliance with medication. Based on the findings of these studies, the National Institute for Health and Clinical Excellence — the advisory body of the British National Health Service — in 2002 announced that all "individuals with schizophrenia who are experiencing persistent psychotic symptoms should be offered C.B.T."

    Members of H.V.N. express a wary appreciation of these developments. Many are glad that the mental-health professions are taking a psychological approach to psychosis seriously (their literature even notes the increasing availability of cognitive behavioral therapy), but they worry that the organization's more radical, populist message is being obscured. As always, said Jacqui Dillon, the chairwoman of Hearing Voices Network, the mainstream is attending to what scientists have to say about how to treat voice-hearing rather than what nonscientists like her have to say about how to accept the phenomenon.
    It was just before noon on a mild Friday in January when the North Finchley hearing-voices group reconvened after a 15-minute coffee break. A sixth participant had joined the group: Chris, light-haired, overweight and audibly short of breath, who has been a member for four years. He seemed completely at ease.

    Earlier in the day, Kutchinsky and Kaiser printed out a list of coping strategies that another group's members had found useful, cutting each description into thin rectangles, which they now spread across the table, facedown. The participants were asked to choose one and discuss. Angelo picked first: "Hobbies." He cleared his throat, and in a gentle, measured voice, began: "Collecting, day or evening classes, visiting a library, computer skills, reading and sport. All these activities are not only fun and relaxing; they can fill voids in our lives and help to occupy us during the day or evening. They can improve concentration and reduce isolation. They can also boost our morale and confidence and give us a feel-good factor." Finished, Angelo lifted his head from the paper and looked around.

    "Well, do you have any hobbies, Angelo?" Kutchinsky asked.

    "I like to play chess," he said. "And, as I've said, I like to read. But it's difficult. I can really only handle something light or humorous. Like Dave Barry."

    "I see. Does reading help to block the voices at all?"

    Angelo's eyes seemed to darken. "No. I'm afraid nothing at all blocks the voices. Even if I play music really loud, it doesn't help at all."

    The coping strategies that followed were within the same vein as the first — commonsensical lifestyle suggestions geared toward improving one's frame of mind, or sanding down the edges of the experience's effects. Liana chose "Exercise"; Jenny chose "Religious Activities"; David chose "Pamper Yourself" ("Put nice music on in the next room, put some scented candles around the room. You could even have a bath with your partner!"). The most novel strategy, and the only one that seemed to cause the group's members to perk up, came under the heading of "Mobile Phones." If you have the temptation to yell at your voices in public, one suggestion went, you should do so with a phone to your ear. That way you can feel free to let loose, and no one who sees you will think you're crazy. Chris in particular seemed to cozy to the suggestion. "I sometimes talk to my voices in public," he said matter-of-factly. "It's very upsetting. I have to bite my knuckles to suppress the urge."

    Participants in H.V.N.'s self-help groups take comfort from strategies like these not least because they approach voices as you would approach any other painful but normal experience, like anxiety or stress. Many of the members of the North Finchley group, however, pursue pharmaceutical treatment in addition to coping strategies: they talk at the same time that they are on pills. Indeed, as Kutchinsky told me, they sometimes talk about their pills. They talk about the best dosage and about how to deal with the anxiety and sluggishness and impotence that pills sometimes cause. There is, of course, nothing wrong with this combination. It might even be ideal: who better to talk to about medication than people who are actually on it? And if you were struggling from an experience as complicated as hearing voices, why wouldn't you use every means at your disposal to deal with it?

    As for Angelo, his concern is not to choose one option over another — but only to recover. "I have found the group interesting," Angelo wrote via e-mail three weeks after we met. "It has made me realize that many voice-hearers have had the problem for many years, and that many never stop hearing the voices, though some are successful in that regard. One lady has recently quit the group as she no longer hears voices. I also see that some hearers are quite high-functioning and are able to hold down a job despite the voices. I hope to do this myself. Perhaps the right combination of drugs will make this possible."

    _______________________________________
    Daniel B. Smith is the author of "Muses, Madmen and Prophets: Rethinking the History, Science and Meaning of Auditory Hallucination," just published by the Penguin Press and from which this article is in part adapted.

    Copyright 2007 The New York Times Company

    _____________________________________________

    RESOURCES: In 1995, advocate Patricia Deegan described the Hearing Voices Network in an article, "Hearing voices that are distressing: Self-help resources and strategies." We asked Pat about current resources in the U.S. Three excellent links are listed below. Jean Arnold

  • http://www.intervoiceonline.org

  • http://www.hvn-usa.org

  • http://www.patdeegan.com.


  • March 13, 2007 - News of the Week

    NEW YORK WILL CONFINE VIOLENT SEX OFFENDERS IN MENTAL HEALTH FACILITIES AT HUGE EXPENSE

    Who Will Pay?


    New York's mental health community was hoping for positive change in 2007. Michael Hogan, the state's newly-appointed Commissioner of the Office of Mental Health, is among the most knowledgeable mental health administrators in the country. Governor Eliot Spitzer's appointment of Hogan seemed to signal his intention to build an exemplary mental health system.

    But last week the governor focused his attention on another population: imprisoned sex offenders. By the week's end, the governor and legislature had passed the "Sex Offender Management and Treatment Act" allowing New York's most dangerous sex offenders to be confined indefinitely in psychiatric centers after their prison terms expire.

    Judging from experiences in 19 other states, New York will spend about $225,000 annually per sex offender to deter further crimes, compared to $32,000 for a year in prison. The annual cost will reach $188 million by 2010.

    Mental health advocates are concerned that new tasks assigned to the Office of Mental Health -- requiring considerable planning, staffing, training, and money -- will squeeze people with psychiatric disabilies off the radar screen. After decades of broken promises, community housing and support programs must not once again be shortchanged to fund a hot-button project.

    RELATED READING


    Wrong Turn on Sex Offenders, New York Times Editorial, March 13, 2007

    Ten Things You Should Know About Sex Offenders and Treatment, by the Association for the Treatment of Sexual Abusers (2005)

    Facts About Adult Sex Offenders, by the Association for the Treatment of Sexual Abusers



    WRONG TURN ON SEX OFFENDERS
    Editorial, The New York Times
    Published: March 13, 2007

    Reprinted using Fair Use Standard

    With little public discussion and no opposition to speak of, Gov. Eliot Spitzer has made New York the latest state to travel down a murky legal road, to a place where laws are made not in response to facts, but to wishfulness and fear. It is a place where prisoners who finish their sentences remain locked up for crimes they might commit, submitting to psychological treatment that nearly always fails and whose only sure outcome is the open-ended spending of tens of millions of dollars a year.

    This is the result of the Legislature's passing a bill last week calling for the civil commitment of sex offenders. Nineteen other states have such laws, which are motivated by the public's intense revulsion at sexual crimes and fear of predatory offenders. Gov. George Pataki pushed for one for years, but never was able to get a bill past the Assembly. Then Mr. Spitzer tried and quickly got a different result, using the method he supposedly went to Albany to abolish: hashing legislation out behind closed doors and presenting it to the public as a done deal.

    Mr. Spitzer says New York's system will be a model for the country. It had better be, given that other states' experiences are so troubling. These were laid out in a recent three-part series in The Times, which found that civil commitment laws have led to post-prison warehouses, where offenders check in, but don't check out.

    About 2,700 men are being held involuntarily in civil commitment programs around the country. The legal basis for their confinement, affirmed by the Supreme Court in 1997, is treatment for a mental abnormality. But no one knows for sure if therapy works, and there are no studies of civil commitment's effectiveness in preventing new crimes because so few offenders have been released from it.

    There is, however, evidence that civil commitment can become a judicial fraud, with men being sent away on the psychological testimony of uncertified nonexperts into programs compromised by their conflicting mandates of offering therapy and being lockups. They cost, on average, four times more per inmate than prison, but almost never make an offender fit to rejoin society.

    Sometimes the results are disastrous, like the Florida program, where offenders got drunk and reportedly had sex with staff members and one another. Offenders often shirk treatment; most never complete it. A few do, then get out to rape and murder again. Others are warehoused long past the time anyone would consider them a reasonable threat. Leroy Hendricks, the offender who challenged his confinement in the Supreme Court and lost, is now a 72-year-old stroke survivor who uses a wheelchair and costs Kansas taxpayers $185,000 a year.

    There are other ways to handle the agonizingly difficult problem of sexually violent predators, and the bill, to its credit, contains several. It creates an elaborate regime of quasi-judicial proceedings, panels of experts and juries and judges that should satisfy many due-process concerns, though at a far higher cost than prison — hundreds of thousands of dollars per patient per year. It sharply increases criminal penalties for sex crimes, eliminates parole for sex-related felonies and provides long-term supervision for offenders who go free. It mandates treatment in prison.

    It is clear that Mr. Spitzer and many lawmakers — though not the braying Republicans who sought a pandering lock-'em-all-up measure — have grappled seriously with the issue and fashioned a bill that is more decent that it could have been. But it is easy to doubt that the layer of protections they have created will work in the real, messy world.

    And when you consider the recent explosion of local laws designed to keep sex offenders at bay — restricting where they can live and work, forcing them to the literal fringes of society, like some human form of toxic waste — what you see is not a rational system for managing risks and rehabilitating people, but a system for managing public fear. The state must be sure to monitor civil commitment to measure its effectiveness and be prepared to quickly revamp the program as flaws become apparent.

    If the goal is to prevent as many sex crimes as possible with the resources at hand, then the state should be prepared to conclude that it might be smarter to spread its effort around. This might mean treating and supervising the large cohort of criminals who would never qualify for civil commitment, rather than lavishing resources on the impossible task of identifying one tiny subset, the worst of the worst, locking them indefinitely in dubious therapy as a much larger universe of offenders continues to abuse at will.

    End of New York Times Editorial
    Wrong Turn on Sex Offenders
    __________________________________________


    TEN THINGS YOU SHOULD KNOW
    ABOUT SEX OFFENDERS AND TREATMENT

    by the Association for Treatment of Sexual Offenders

    1. Over 95% of convicted sex offenders eventually return to the community. Treatment improves the chance for successful reintegration.
     
    2. Most sexual offenders assault victims whom they know. Children are most likely to be assaulted by members of their family followed by acquaintances (e.g., neighbors, family friends); adults are most likely to be assaulted by a current or former husband, a cohabitating partner or a date.
     
    3. Sexual perpetrators represent an extremely diverse group of offenders in educational, income, and racial background, as well as personality and coping skills. Assessment results often uncover unique patterns of deficits and strengths. Treatment and supervision must be tailored to the unique characteristics and needs of the offender.
     
    4. Treatment has a substantially better chance of working if the offender takes responsibility for his past and future actions.
     
    5. Fewer than 5 percent of sex offenders suffer from a psychotic mental illness. Current sexual offender treatment uses cognitive-behavioral techniques to teach the offender to control his thoughts and behaviors to prevent future offending.
     
    6. Many treatment providers use a relapse prevention approach that assumes the escalation prior to the offense is relatively unique to, and consistent for, each offender. This pattern of escalation (often called a crime cycle) can be used to monitor the offender's level of risk at any point in time. This allows the offender and sometimes those treating and monitoring him to take action, when necessary, to prevent new offenses when re-offense risk is high.
     
    7. Sex offenders vary widely in their risk to re-offend. Estimates suggest that 40%-45% of untreated sexual offenders will sexually re-offend in their lifetime. These rates are considerably lower than rates of re-offense for other types of violent offenders.
     
    8. Research has shown that well-designed sex offender treatment can reduce the recidivism of sexual offenders.
     
    9. Lifestyle circumstances can affect the chances of new offenses. Stable housing and employment, healthy social and leisure activities, a vigilant and pro-social support system, and ongoing treatment are all important to ensure success.
     
    10. Despite its effectiveness, treatment is only one component of an effective strategy to protect the community from sex offenders. Monitoring and support by community corrections agents, other professionals, the offender's social support system, and the entire community play a crucial role.

    End of Ten Things You Should Know...

    __________________________________________



    Policy Should Be Driven by Facts, Not Fear

    FACTS ABOUT ADULT SEX OFFENDERS

    by the Association for the Treatment of Sexual Abusers

    Can sex offenders be cured?
    Sexual offending, like many mental and medical conditions, can not be cured. Contemporary cognitive behavioral treatment, however, helps offenders learn to control their behavior. By recognizing and changing the thoughts that rationalize and justify sexually abusive behavior, sex offenders can become more aware of the harm caused to victims and view their own behavior differently. As well, sex offenders learn to identify their patterns of behavior, including the people, places, and things that put them at risk for offending. Through avoidance of certain situations, acquiring new coping skills, and learning to meet their emotional and sexual needs in healthy ways, motivated sex offenders can prevent future offending. Although some sex offenders may continue to be attracted to children, they can learn to avoid acting on their impulses. Consider this analogy: When adults get married, they do not stop being attracted to other people. They do stop acting on that attraction, because the way they think about the commitment of marriage helps them to control their behavior. Likewise, many chemically addicted persons continue to struggle with urges to use drugs or alcohol. Through treatment and recovery, however, they choose to change their behavior because they are committed to a new, healthy and productive lifestyle.

    Does sex offender treatment really work?
    Early studies, conducted in the 70's and 80's, were unable to detect differences in recidivism rates between sex offenders who had undergone treatment and those who had not (Furby, Weinrott, & Blackshaw, 1989). This finding was widely publicized, leading to skepticism about the benefits of treatment, and opening the door to punitive public policies. Actually, although the research is not unequivocal, treatment has been found to decrease sex offense recidivism. Recent, statistically sophisticated studies with extremely large combined samples have found that contemporary cognitive-behavioral treatment does help to reduce rates of sexual reoffending by as much as 40% (Hanson, Gordon, Harris, Marques, Murphy, Quinsey, & Seto, 2002). However, treatment does not work equally well for all offenders (like any psychological or mental health treatment -- or medical interventions, for that matter). Some research indicates that comprehensive programs and length of time in treatment are also important factors in the effectiveness of treatment (Hall, 1995; Lowden, Hetz, Harrison, Patrick, English, & Pasini-Hill, 2003). Treatment failure is associated with higher recidivism rates, and some research indicates that sex offenders who successfully complete a treatment program reoffend less often than those who do not demonstrate that they "got it" (Marques, Miederanders, Day, Nelson, & van Ommeren, 2005).

    Don't most sex offenders reoffend?
    There is a perception that the vast majority of sex offenders will repeat their crimes. Research studies by the US Dept. of Justice and the Canadian Government have found, however, that sexual offense recidivism rates are much lower than commonly believed, averaging between 14 and 20% over 5-year follow-up periods. Studies that have tracked sex offenders over longer follow-up periods have found that pedophiles who molest boys, and rapists of adult women, were the types of offenders most likely to recidivate at rates of 52% and 39% respectively. Repeat offenders are more likely to reoffend than first-time offenders. Those who comply with probation and treatment have lower reoffense rates that those who violate the conditions of their release. Sex offenders who target strangers are more dangerous than those with victims inside their own family

    It is also important to recognize that official recidivism statistics are always lower than actual reoffense rates, because some sex offenders commit many sex crimes that go unreported and undetected. It is estimated that less than 10% of all sex crimes result in a criminal conviction. This means that there are many sex offenders in our communities who have not yet been identified.

    Although extensive media attention is paid to child abductions, such cases occur relatively rarely, and less than 1% of sex crimes involve murder. Despite myths of stranger danger, the vast majority of sexually abused children (80-90%) are molested by family members and close friends or acquaintances.

    How do we know who will reoffend?
    Progress has been made in the science of risk assessment, which allows us to determine the likelihood that a sex offender will commit a new sex crime in the future. Although we cannot predict with certainty that any particular offender will act in a specific way, we can estimate, with moderate accuracy, whether or not an offender belongs to a high- or low-risk group. Using risk factors that have been correlated with recidivism, qualified practitioners can use scientific risk assessment tools to screen offenders into risk categories. These procedures are similar to the ways in which insurance companies assess risk and assign premiums, and how doctors evaluate a patient's risk for developing a medical illness. Risk assessment allows us to identify the most dangerous sex offenders, and apply the most intensive interventions to those who need the greatest level of supervision, treatment, and restriction.

    What percentage of convicted sex offenders undergo treatment?
    Most states require convicted sex offenders to participate in treatment while in prison or on probation. According to the Safer Society Survey (McGrath, Cumming, & Burchard, 2003) there are 1,549 sex offender treatment programs in the U.S. Most of them are community-based (80%) with about 40% of them treating adults, and the rest targeting adolescents and children with sexual behavior problems. Although numbers vary widely, on average, about 70 adult sex offenders are treated each year in each outpatient program.

    Is sex offender treatment cost-effective?
    It is estimated that whereas treatment of sex offenders costs about $5,000 per year, incarceration costs more than $20,000 per year per offender (http://www.csom.org/). A study of the costs and benefits of treatment have found that treatment saves more money than it costs: about $4 is saved for every dollar spent on treatment services (McGrath et al., 2003). The Preliminary Results from the Washington State Institute for Public Policy's Economic Analysis of Sex Offender Programs estimated that each taxpayer dollar spent on a cognitive-behavioral program for adult offenders returns between $1.19 and $5.27 in victim and taxpayers benefits. Because treated offenders reoffend at lower rates than untreated offenders, providing therapeutic intervention saves money on investigation, prosecution, incarceration, and victim services.

    All sex offenders are not the same.
    Although virtually all pedophiles are child molesters, not all child molesters are pedophiles. Pedophiles are men with a clear sexual preference for children rather than adults. Child molesters are described as individuals who have committed a sexual offense against a child victim. There are, however, no "pure" types, and offenders are best conceptualized as closer to one end of the continuum or the other.

    Pedophiles
    True pedophiles are motivated by their sexual attraction to children and are their offenses are directed toward vulnerable children whom they court or groom for the purpose of victimization.

    Offenders who seek out children to victimize by placing themselves in positions of trust, authority, and easy access to youngsters can have hundreds of victims over the course of their lifetimes. One study found that the average number of victims for non-incestuous pedophiles who molest girls is 20; for pedophiles who prefer boys, over 100.

    Predatory pedophiles, especially those who molest boys, are the sex offenders who have the highest recidivism rates. Over long follow-up periods, more than half of convicted pedophiles are rearrested for a new offense.

    Pedophiles frequently are uncomfortable with adult intimacy and may spend their lives maneuvering to be near children. They may be extremely charming and skilled at manipulating adults, and they will use adult relationships to gain access to children.

    The pedophile may spend years working his way up to a position of authority and trust within a church, school, or youth organization in order to have access to children.

    Their offenses are usually predatory, directed towards children whom they engage in relationships for the purpose of victimization. However, pedophiles may also sexually abuse children in their own families.

    Pedophiles are sometime referred to as "fixated," "preferential," " predatory," "extrafamilial," or "nonfamilial."

    Non-pedophilic Child Molesters
    The non-predatory molester tends to be a man whose primary sexual attraction is toward adults, but who may molest children in a maladaptive attempt to meet emotional needs.

    Incest offenders are more likely to be non-pedophilic molesters

    Research has found that many heterosexual incest offenders have sexual interests that are indistinguishable from those of normal males.

    However, there are many research studies that indicate, under conditions of anonymous survey, guaranteed confidentiality, or polygraph, that approximately 60% of incest offenders also molest non-relative children.

    Data suggest that incestuous offenders, regardless of the gender of the victim, have lower numbers of victims and are less likely to be rearrested for new sex crimes after they've been convicted.

    Non-pedophilic molesters may turn to a child for sex out of a perceived inability to be close with an adult partner, out of poor self-esteem, or to escape feelings of powerlessness and loneliness.

    This type of offender often has appropriate (but dysfunctional) relationships with peers and may be married.

    These child molesters are sometimes called "regressed," "situational," or "opportunistic," and often are apprehended in incestuous situations.

    Outcome studies have demonstrated consistently low rates of recidivism for incestuous offenders. However, it is important to note that incest victims are among the least likely to report sexual crimes, and incest is one of the most damaging types of sexual abuse to victims.

    Intrafamilial offenders may be among those most likely to benefit from therapeutic
    intervention.

    What is a sexual predator?
    The definition of "predator" differs from state to state, but is generally reserved for the most dangerous sex offenders. Many states use nearly identical words to describe this type of sex offender and the offenses he perpetrates. In the words of the Kansas Sexually Violent Predator Act, "predatory acts" are those "acts directed towards strangers or individuals with whom relationships have been established or promoted for the primary purpose of victimization." The state of California states: "'Predatory' means an act is directed toward a stranger, a person of casual acquaintance with whom no substantial relationship exists, or an individual with whom a relationship has been established or promoted for the primary purpose of victimization." In some states, the definition includes criteria involving the use of violence, weapons, or causing injury during the commission of a sex crime, or those offenders who have had multiple victims. Repeat offenders, and those who have committed abduction of children or adults for sexual purposes may also be considered predators.

    It is important to remember that although recent media attention has been focused on child abduction and molestation, rapists of adult women can also be highly dangerous sexual predators. They often have many victims, and are more likely than child molesters to use violence or weapons to gain compliance from victims. The majority of victims of sexually motivated murders are adult women.

    Will stricter laws and national registries make us safer?

    COMMUNITY NOTIFICATION
    In 1994, following the 1989 abduction of an 11 year old boy in Minnesota, a federal law was passed mandating sex offenders to register with local law enforcement agencies so that their current whereabouts are known ("Jacob Wetterling Crimes Against Children and Sexually Violent Offender Registration Act," 1994). In 1996, President Clinton signed "Megan's Law," which requires states to disseminate information to the public about sex offenders who live in close proximity.

    About half of the states in the U.S. assign offenders to one of three risk levels and notify the public differentially according to the offenders risk. Other states employ broad community notification, publicizing the location of all sex offenders without regard for risk assessment (Matson & Lieb, 1996).

    There is no evidence that community notification reduces sex offense recidivism or increases community safety. The only study to date found no statistically significant difference in recidivism rates between offenders who were subjected to notification in Washington (19% recidivism) and those who were not (22% recidivism). Sex offenders who were subjected to community notification were, however, arrested more quickly for new sex crimes than those not publicly identified. It was found that 63% of the new sex offenses occurred in the jurisdiction where notification took place, suggesting that notification did not deter offenders or motivate them to venture outside their jurisdictions (where they would be less likely identified) to commit crimes. Based on these findings, the authors concluded that community notification appeared to have little effect on sex offense recidivism (Schram & Milloy, 1995).

    Interestingly, most results have indicated that citizens report increased anxiety due to notification because of the lack of strategies offered for protecting themselves from sex offenders (Caputo, 2001; Zevitz, Crim, & Farkas, 2000).

    Research suggests that about one-third to one-half of sex offenders subjected to community notification experience dire events such as the loss of a job or home, threats or harassment, or property damage (Levenson & Cotter, 2005b; Tewksbury, 2005). Physical assault seems to occur in 5-16% of cases. About 19% of sex offenders report that these negative consequences have affected other members their households.

    It has been suggested that notification may, ironically, interfere with its stated goal of enhancing public safety by exacerbating the stressors (e.g., isolation, disempowerment, shame, depression, anxiety, lack of social supports) that may trigger some sex offenders to relapse. Such dynamic factors have been associated with increased recidivism (Hanson & Harris, 1998; Hanson & Morton-Bourgon, 2004), and although sex offenders inspire little sympathy from the public, ostracizing them may inadvertently increase their risk.

    RESIDENCE RESTRICTIONS

    Fourteen states (Alabama, Arkansas, California, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Ohio, Oklahoma, Oregon, and Tennessee) have enacted buffer zones which prohibit sex offenders from residing within close proximity to a school, park, day care center, or school bus stop. The least restrictive distance requirement is in Illinois (500 feet), but most common are 1,000 to 2,000 foot boundaries.

    There is no research to support the idea that residence restrictions prevent repeat sex crimes.

    In Colorado it was found that molesters who reoffended while on probation were randomly scattered throughout the geographical area, and did not seem to live closer than non-recidivists to schools or child care centers (Colorado Department of Public Safety, 2004).

    In Minnesota, sex offenders' proximity to schools or parks was not a factor in recidivism, nor did it impact community safety (Minnesota Department of Corrections, 2003). In fact, the opposite was found to be true -- a sex offender was more likely to travel to another neighborhood in which he could seek victims without being recognized.

    Public safety and child protection are understandably the primary considerations when sex offender restrictions are imposed. Advocates of residence restrictions believe that such laws will diminish the likelihood that sex offenders will come in contact with children whom they might potentially victimize. However, concerns have been raised that such mandates might exacerbate the shortage of housing options for sex offenders and force them to move to rural areas where they would be increasingly isolated with few employment and treatment options (Minnesota Department of Corrections, 2003). The dispersal of parks and schools may lead to overlapping restriction zones, making it essentially impossible for sex offenders in some cities to find suitable housing. In some urban areas, offenders might be forced to cluster in high-crime neighborhoods. Such restrictions can lead to homelessness and transience, which interfere with effective tracking, monitoring, and close probationary supervision.

    A survey of 135 sex offenders in Florida revealed that housing restrictions increased isolation, created financial and emotional stress, and led to decreased stability for sex offenders. Respondents also indicated that they did not perceive residence restrictions as helpful in risk management, and in fact, reported that such restrictions may inadvertently increase triggers for reoffense
    (Levenson & Cotter, 2005a).

    Summary & Recommendations

    Public Policy should be used to strengthen, not replace, other efforts designed to prevent sexual abuse. Sex offenders should be held responsible for their actions while receiving treatment to help them change their behavior.

    According to the Center for Sex Offender Management (operated under a grant from the U.S. Department of Justice), prevention of sexual violence requires a well-planned, comprehensive, inter-disciplinary response that begins with developing clear goals and objectives, implementing strategies based on empirical research, and collecting and analyzing data on an ongoing basis.

    Emotionally charged reactions to sex crimes often lead to legislation that is not driven by data or science but rather by outrage and fear. Lawmakers and citizens should advocate for research-based social policies that protect women and children as well as rehabilitate perpetrators. Policymakers should advocate for the most efficient and cost-effective implementation of laws based on the limited empirical research that exists.
    Some sex offenders are highly dangerous and require more intensive interventions. Community notification and residence restrictions should employ evidence based risk assessment procedures and differential strategies concordant with the level of threat that an offender poses to a community.

    Collaborative efforts should exist between citizens, law enforcement, offenders, and treatment providers to render management, probationary supervision, and rehabilitation services that promote community safety.
    Educational efforts should be directed at the prevention of sexual abuse. Communities are entitled to factual and research-based information and education about sexual violence and sexual perpetrators.

    Empirical inquiry is needed into the impact and effectiveness of public policies designed to prevent sexual violence. Funding for research investigating the impact and effectiveness of sexual violence policies should be a priority.

    References:
    Caputo, A. A. (2001). Community notification laws for sex offenders: Possible mediators and moderators of citizen coping.Dissertation Abstracts International, 61(9-B).
    Colorado Department of Public Safety. (2004).Report on safety issues raised by living arrangements for and location of sex offenders in the community. Denver, CO: Sex Offender Management Board.
    Furby, L., Weinrott, M., & Blackshaw, L. (1989). Sex offender recidivism: A review. Psychological Bulletin, 105(1), 3-30.
    Hanson, R. K., Gordon, A., Harris, A. J. R., Marques, J. K., Murphy, W., Quinsey, V. L., & Seto, M. C. (2002). First report of the collaborative outcome data project on the effectiveness of treatment for sex offenders. Sexual Abuse: A Journal of Research and Treatment, 14(2), 169-194.
    Hanson, R. K., & Harris, A. J. R. (1998). Dynamic predictors of sexual recidivism. Ottawa, Canada: Department of the Solicitor General of Canada.
    Hanson, R. K., & Morton-Bourgon, K. (2004). Predictors of sexual recidivism: An updated meta-analysis. Ottawa, CA: Public Works and Government Services.
    Jacob Wetterling Crimes Against Children and Sexually Violent Offender Registration Act, Public Law 103-322 (1994).
    Levenson, J., & Cotter, L. (2005a). The impact of sex offender residence restrictions: 1,000 feet from danger or one step from absurd? International Journal of Offender Therapy and Comparative Criminology, 49(2), 168-178.
    Levenson, J. S., & Cotter, L. (2005b). The impact of Megan's Law on sex offender reintegration. Journal of Contemporary Criminal Justice, 21(1), 49-66.
    Marques, J. K., Miederanders, M., Day, D. M., Nelson, C., & van Ommeren, A. (2005). Effects of a relapse prevention program on sexual recidivism: Final results from California's Sex Offender Treatment and Evaluation Project (SOTEP). Sexual Abuse: A Journal of Research & Treatment, 17(1), 79-107.
    Matson, S., & Lieb, R. (1996). Community notification in Washington State: A 1996 survey of law enforcement. Olympia, WA: Wasington State Institute for Public Policy.
    McGrath, R. J., Cumming, G. F., & Burchard, B. L. (2003). Current practices and trends in sexual abuser management: The Safer Society 2002 Nationwide Survey. Brandon, VT: Safer Society Foundation, Inc.
    Minnesota Department of Corrections. (2003). Level three sex offenders residential placement issues. St. Paul: author.
    Schram, D., & Milloy, C. D. (1995). Community notification: A study of offender characteristics and recidivism. Olympia, WA: Washington Institute for Public Policy.
    Tewksbury, R. (2005). Collateral consequences of sex offender registration. Journal of Contemporary Criminal Justice, 21(1), 67-82.
    Zevitz, R. G., Crim, D., & Farkas, M. A. (2000). Sex offender community notification: Examining the importance of neighborhood meetings. Behavioral Sciences and the Law, 18, 393-408

    End of "FACTS ABOUT ADULT SEX OFFENDERS," by the Association for the Treatment of Sexual Abusers (2005)
    __________________________________________



    March 25, 2007 - News of the Week



    PREJUDICE HIDES IN PLAIN SIGHT

    ARTICLE
    Stigmas of mental illness remain
    Tuesday, February 27, 2007

    By TOM DAVIS
    RECORD COLUMNIST

    http://www.northjersey.com

    Five times he called her a "loon" or "lunatic." Each time, the peace activist reacted to Bill O'Reilly's name-calling with a shrug or smirk. But this encounter on "The O'Reilly Factor" raised the question: Who was more outrageous?

    Was it O'Reilly for using words that some might interpret as slurs? Or was it the activist for not taking him to task?

    For a long time, words and images that define mental illness have been used to describe a person who holds a differing opinion as out of line or evil.

    Mental health professionals recoil when they hear such talk or see such pictures. Now they're speaking out to stop the use of words and images that stigmatize people who suffer from schizophrenia, bipolar disorder, obsessive- compulsive disorder and depression.

    Stereotypes sell

    Otto Wahl, a psychology professor at the University of Hartford, says that despite years of advances in mental health awareness, the media still rely on stereotypes to sell books, magazines, news-papers, movies and TV shows.

    In his book, "Media Madness," Wahl displays movie posters that make light of mental illness.

    One for "Crazy People," for instance, shows a cracked egg that appears to be sticking its tongue at people.

    "The stereotypes of people with mental illnesses have just these qualities -- they are extremely dangerous, outstandingly different, and/or excessively ridiculous," Wahl writes in his book. "They are, in other words, entertaining and profitable."

    The media have even created myths, Wahl and others say. The so-called "psycho killer," for example, has become a mystery-novel slasher-movie trademark. It even is the title of a hit song by the Talking Heads.

    Not only does the term stigmatize people with mental illness, mental health professionals say the labeling is incorrect. They point to studies that show only 4 percent of people who commit murder are mentally ill.

    But the media are making some progress, mental health professionals say.

    Star power helps

    Hollywood has achieved some measure of critical and commercial success by using likable or sympathetic characters to portray mental illness.

    Gary Morris, a lecturer at the University of Leeds in the United Kingdom and author of the textbook "Mental Health Issues and the Media," cited Russell Crowe in "A Beautiful Mind" as an example of a box-office star taking on a sensitive role of a mentally ill professor.

    Even Jack Nicholson's cranky Melvin Udall in "As Good as It Gets," Morris says, could be considered a favorable portrayal.

    "It is helped to some degree because we, as an audience, largely admire the actor Jack Nicholson, and his character's warm side begins to emerge, enabling a more positive attraction to be formed," Morris writes.

    The Coping column appears every other Tuesday. To suggest topics, write to Tom Davis, The Record, 150 River St., Hackensack, NJ 07601 or e-mail davist@northjersey.com. Please include your phone number with all correspondence.

    Copyright © 2007 North Jersey Media Group Inc.

    Reprinted using Fair Use Standard


    February 25, 2007 - News of the Week

    ANNOUNCING A NEW MENTAL ILLNESS WEB SITE -- (http://www.miwatch.org)

    ITS AIM: TO PROVIDE A MEETING GROUND ON ISSUES


    In 1982, advocate Phyllis Vine focused attention on a developing disaster: society's abandonment of people diagnosed with serious mental illnesses. Her prescient book, "Families in Pain," was the first to expose the devastating consequences of emptying psychiatric institutions without a plan for the future.

    Twenty-five years later, the mental health community is a vibrant constituency. Despite this, problems may be outpacing progress. For example, it is beyond belief that more than half the nation's incarcerated prisoners are people with psychiatric disabilities. Many were arrested for minor offenses traceable to illness and abandonment.

    Has the widely-diverse mental health community had too little opportunity for constructive dialog? Are the views of policy makers and researchers isolated in subscription-only journals?

    "Mental Illness Watch" (http://www.miwatch.org) has embarked on an attempt to provide a "meeting place" for the mental illness constituency. The ultimate aim is to strengthen the movement's ability to influence public opinion.

    This fledgling site features news items, a terrific resource library, links to related organizations, articles by noteworthy contributors, book reviews, and much more. A bulletin board is under construction.

    THIS IS A WEB SITE TO BROWSE AND TO PARTICIPATE IN!

    For More Information:


  • For more about Phyllis Vine, click here.

  • For reports by the U.S. Justice Department (Dec. 2006) and Human Rights Watch (2003) concerning mental health problems in jails and prisons, go to the MIWatch.org Resource Library and scroll to topic.


  • February 11, 2007 - News of the Week

    ABRAHAM LINCOLN'S STRUGGLE WITH SEVERE DEPRESSION IS REVEALED IN PAPERBACK BY JOSHUA WOLF SHENK

    Lincoln's Melancholy
    by Joshua Wolf Shenk

    ARTICLE #1:
    A Review by Phyllis Vine
    Reprinted with permission from
    http://www.miwatch.org

    Abraham Lincoln "forged meaning from his affliction so that it becomes not merely an obstacle to overcome, but a factor in his good life," writes Joshua Shenk in a 2006 paperback release of Lincoln's Melancholy (Marine Books). Although books about Abraham Lincoln fill our library shelves, few biographers have credited the impact of his life-long depression with more than a passing reference and then usually just to mention a single moment in the 1830s.

    Shenk buries doubts, if any lingered, about the severity of  depression spanning most of Lincoln's adult life. His discussion of depression before it was marked by a powerful stigma conveys how Lincoln's friends responded to his so-called "blue days" by standing suicide watch over the lanky, small-town lawyer living without the comforts of family in New Salem, Illinois.
     
    Shenk steeps this powerful biography in a culture where the social recognition of melancholy -- the 19th century equivalent of chronic depression -- was deeply embedded. Herman Melville gave it texture in the opening lines of Moby Dick as a "damp, drizzly November in my soul." Poe, Byron and Emerson wrote of a "fitful storm," "a fearful gift" and "the pale cast of thought." The successful transit to adulthood presumed a man would conquer melancholy, at which point it became a sign of nobility, an element of manliness.

    With rich detail, Shenk creates an indelible image of the moods Lincoln's friends observed. Much of the detail resides in oral histories collected by his law partner, William Herndon, after the assassination, when contemporaries described their memories of the slain president. They form a picture of someone who was withdrawn, lonely, somewhat emaciated, and almost obsessively preoccupied with reading law as a young men.  Friends feared "he would craze himself -- make himself derange."  His talk turned to suicide, and his circle remained watchful. In New Salem, Illinois, "These men did not consider Lincoln's melancholy a mere liability, nor did they distance themselves from Lincoln because of it," Shenk writes. "Indeed, when Lincoln was in distress, he could count on receiving aid." Fearing the worst, friends also removed razors from his room.

    Feelings of misery, social isolation, and morbid preoccupations were companion to the 16th President.  He approached his marriage to Mary Todd with dread, and expressed little joy in his election to Congress for the single term he served in the House of Representatives.  And it wasn't just his own assessment of his mood, his affect was  conspicuous, even to strangers. A reporter sent by the Chicago Tribune in 1854 to cover Senator Stephen Douglas's debating tour over the Kansas-Nebraska Act compared Lincoln's sadness to a Shakespearean figure.  The day following his nomination as presidential candidate for the new Republican Party he was gloomy and sullen.

    Lincoln was fortunate that his mood disorder, severe as it was, never led  onlookers to presume he had crossed the threshold into lunacy or imbecility. His efforts to find help may have led to debilitating medical treatments with purgatives, leaches, or blood letting that were, as the cliché goes, worse than the illness, but his reputation and his community provided a modicum of shelter.  Little by little, struggle by struggle, with an instinct to see the world darkly, he was able to focus his energies undaunted even if ungratified. His mood, Shenk argues, led to a "temperamental inclination to see and prepare for the worst," an advantage that humbled this war-time president, and also predisposed him to see the nation's crisis as one requiring the reconciliation of clashing interests, a test of fiery and incompatible goals, capable of redemption from the deepest suffering. "With malice toward none; with charity for all" -- the spirit of the Gettysburgh Address -- was rooted in the internal struggle that comprised his very being.  According to Shenk, "These words were a peroration, not just to the speech but to Lincoln's whole career," which, as he promises on the field of Gettysburgh, "to bind up the nation's wounds; to care for him who shall have borne the battle, and for his widow and his orphan -- to do all which may achieve and cherish a just and lasting peace among ourselves, and with all nations."

    Today we are not surprised to learn that talking about his sadness, characterizing his loneliness and despair, actually helped Lincoln survive. But however much his symptoms fit a recognized category for chronic depression, he was more than a bundle of items to check off on a list, more than the diagnosis that would most likely deliver a label along with the consternation of employers, landlords, even of  family. Shenk is mindful of this modern phenomenon, noting how treatment for depression demolished prospects for Tom Eagleton, George McGovern's running mate who dropped off the ticket after it was disclosed he suffered from depression and had been treated with electric shock therapies.  In 1972, at the beginning of the revolving door to community-based mental health treatments, the nation was not helped to understand the prevalence of depression, or its treatments.  Unlike the embrace of Lincoln, Eagleton was scorned, his reputation suspect, his political future shredded.

    Shenk is no stranger to depression.  And he well knew how Lincoln used his suffering as an insight to greater wisdom, not purposefully, not willfully, but consequential to his inner turmoil. The power of this story, however, is not only as the back-story to Lincoln and elements of his leadership style.  Rather it points to major differences in how the medicalization of depression, actually of all the mental illnesses, has inadvertently drawn a line between the healthy and the troubled, and placed the person who suffers on the "other" side of an artificial boundary of worth. By watching how Lincoln's loyal and dedicated friends held him dear within their circle, we can begin to see how elements of community promote healing and how insights from that process can change the world as we, or as Lincoln, knew it.

    End of review by Phyllis Vine


    Phyllis Vine is the creator and editor of a new web site,"Mental Illness Watch" (http://www.miwatch.org). E-mail comments to: editor@miwatch.org.
    ____________________________



    ARTICLE #2:
    Source: http://www.mercatornet.com

    ABE LINCOLN'S SURPRISING STRENGTH

    By Theron Bowers   
    Sunday, 11 February 2007


    On the Great Emancipator's birthday the question of his depression deserves more than a 30-second, feel-good pitch from CBS Cares.
      
    What did Beethoven, Lincoln and Hemingway have in common? According to CBS television star, Mandy Patinkin, all three had depression.
     
    During the month when Lincoln's birthday (February 12) is honoured, CBS Cares will run a destigmatisation campaign about mental illness using Honest Abe, now Sad Abe. Despite Presidents' Day being celebrated this month, Lincoln's name may become more associated with depression than Emancipation.

    Destigmatisation is a neologism used in therapeutic circles. Current dogma assumes that depression is under-treated because people are too embarrassed to ask for help. Therefore, pinning mental illness on the coattails of giants should remove the shame attached to a condition and draw sufferers into treatment.
     
    Strangely, I've never had anyone drop into my office announcing their decision to seek treatment because of Lincoln, Hemingway, Mike Wallace or any other popular figure. However, in our daytime public confessionals -- Oprah, Tyra, Jerry, and others we know on a first name basis -- this kind of celebrity identification seems to be routine. Despite the gooey sentimentality of the Celebrity Misfit Hour, the viewers may actually get some useful information.
     
    No helpful information is contained in the CBS commercials. Tagging room-temperature heroic figures with various human ailments yields zero insight into that person or the "illness". Would Prozac have made Poe less creepy? Would a happier Sherman have not burned down Atlanta? You won't find the answer at CBS Cares. Our passion for diagnosing the dead is another skin-deep facet of the diversity movement.
     
    Yet, wouldn't someone suffering from depression want to know more about how Beethoven, Hemingway and Lincoln lived with and dealt with depression in their lives? Not much is really known about Beethoven and depression. Hemingway was a horrible alcoholic who splattered his brains with a shotgun. He blamed electroconvulsive therapy for destroying his memory and ending his career. If alive today, he might have joined Tom Cruise in hyperkinetic eruptions against psychiatric treatment.
     
    Lincoln's struggles are the most astonishing. On the Great Emancipator's birthday, the question of Lincoln's depression deserves more than a 30-second, feel-good pitch. How did this untreated backwoodsman suffering from chronic mental illness become President? Did the depression impair or aid his decision making? Did his depression make him a better leader? It's bad enough that Lincoln's birthday, now only celebrated in a few states, has been replaced by Presidents' Day. Who really wants to celebrate Harding and Polk, much less Nixon or Carter?
     
    Fortunately, we can have a deeper understanding of this brilliant man and his "illness". In 2005 Joshua Wolf Shenk provided an analysis of Lincoln and depression in his book, Lincoln's Melancholy. Shenk goes beyond the usual agenda of the troubled genius exposé. The book doesn't settle for simply emboldening sufferers. Shenk moves the questions about Lincoln's mood disorder from the realm of pop history and posters for Mental Health Awareness Month to the level of serious scholarship. He proclaims his ambitious goal in the subtitle of the book: How Depression Challenged a President and Fueled his Greatness.
     
    Shenk gathers convincing evidence supporting the diagnosis of major depression (a severe, mood disorder) and dysthymia (chronic, milder depression) for Lincoln. The author uses original, first-person accounts and Lincoln's own writings to demonstrate episodes of depression involving long periods of withdrawal, misery, hopelessness and even suicidal thinking. According to Shenk, during an episode in his twenties Lincoln's friends placed him on "suicide watch". Shenk also notes that Lincoln "didn't carry a knife in his pocket for fear of what he might do with it.' While a state legislator in 1841 Lincoln became confined to his home and was described as "sick in body & mind." Even when Lincoln was not severely depressed, he lived with a smoldering, chronic melancholia. Shenk quotes a journalist who concluded that Lincoln had "a marked predisposition to melancholy."
     
    Lincoln's moodiness wasn't a secret but was witnessed and reported by many of his acquaintances. The irony of the CBS Cares campaign to destigmatize depression by highlighting Lincoln is that a candidate with a similar history today would be hounded out of the running by his opponents and press, including the caring folks at CBS. The 1972 Democratic vice-presidential nominee, Senator Thomas Eagleton, didn'tt last three weeks after the revelation of his hospitalisation for depression and electroconvulsive therapy.
     
    Not only did Lincoln overcome crippling and life threatening symptoms; Shenk paradoxically argues that Lincoln's depression strengthened him and prepared him for the greatest challenge of any American president. He concludes: "Lincoln didn't do great work because he solved the problem of his melancholy. The problem of his melancholy was all the more fuel for the fire of his great work."
     
    Shenk suggests that the low expectations characteristic of melancholia, balanced with Lincoln's desire to improve his country, produced a philosophy of "depressive realism". Lincoln found his purpose in the conflict over slavery. He applied the lessons of his own suffering to the challenge of resolving slavery. He knew that evil at times must be tolerated but always denounced. Never a utopian, Lincoln had hoped to limit slavery and then see the institution whither away. Compared to the optimistic, self-assured General McClellan, who crumbled in the face of defeat, Lincoln was an impenetrable fortress against the expansion of slavery.
     
    Compare Lincoln, the doleful commander-in-chief who persevered despite four years of mostly defeats and unprecedented losses, with our modern, compulsively buoyant politicians. The president with the biggest grin ever by man or horse, the willfully naïve Jimmy Carter, started his crusade for human rights by abandoning the Shah of Iran, only to encounter a far worse regime which paralyzed his administration. Even the contagiously sunny but more realistic Reagan quickly left Lebanon after the slaughter of 200 marines.
     
    Shenk elevates Lincoln from modern poster child for mental health to iconoclast against the modern biological conception of depression. Psychiatry built the medical tower of mental disorders by equating emotional suffering with disease. The American Psychiatric Association's Diagnostic and Statistical Manual (DSM) identifies distress as a hallmark of mental disorder. The focus on distress is so entrenched that many perversions such as bestiality, sado-masochism and transvestitism are no longer classified as mental disorders unless the practitioner is distressed over the behavior.
     
    Emotional suffering is only evidence of a mental disorder in the way that physical pain is evidence of disease. All aspects of depression -- brief versus chronic, mild versus severe -- have labels attached in the DSM. Sadness has no more meaning than a rash. Certain cognitive habits associated with depression are also deemed unhealthy. Hopelessness and low self esteem have acquired mythological powers for explaining our social problems.
     
    Shenk's Lincoln restores sanity and hope to our present notions about depression. The story of Lincoln and his troubled mind doesn't follow any script, treatment algorithm or predictable outcomes. Lincoln's Melancholy provides both surprising answers and true inspiration.

    End of review by Theron Bowers
    _____________________________________

     
    Theron Bowers MD is a psychiatrist Deep in the Heart of Texas and may be contacted at tcbowers@sbcglobal.net
     

    January 14, 2007 - News of the Week

    SAMHSA ISSUES OUTSTANDING GUIDE TO STIGMA REDUCTION

    Here is the guide antistigma advocates have been wishing for! This encyclopedic "how-to" manual provides 97 pages of expert advice, dozens of sample materials, recent examples of real-world antistigma work, and much, much more. True to its stated aim, this kit provides you with nearly everything you need to mount a local, regional, or statewide stigma and discrimination reduction initiative.

    "Developing a Stigma Reduction Initiative" is the most comprehensive antistigma resource we've seen that is designed for mental health advocates. It was produced by the Center for Mental Health Services (CMHS) working with Vanguard Communicatons and the Gallup Organization, and was published by the federal Substance Abuse and Mental Health Service Administration (SAMHSA Publication No. SMA06-4176).

    After a brief introduction, this hefty volume is divided into four sections: Mounting a Stigma Reduction Initiative; Outreach Materials; Best Practices-Lessons Learned and Tips; and Resources. Thanks to explicit topic titles within each section, advocates can find solutions to their indvidual needs. For others, just browsing the impressive table of contents is a broadening experience bound to inspire action.

    The guide's groundwork was laid by the "Eliminate the Barriers Initiative" (EBI), a federal pilot project launched by SAMHSA in January 2003 to build awareness and counter discrimination and stigma. The project's eight participating states generated a variety of experiences sharing a common thread, an energized burst of antistigma activity.

    This guide is a gem of information whether one needs a sample letter for pitching a media story or guidance in designing a major antistigma campaign.

    Below is a passage from Section IV: Lessons Learned and Tips

    Using Person-to-Person Contact Effectively To Address Stigma and Discrimination

    Like most prejudices and stereotypes, the stigma attached to mental illness is most often a result of misunderstanding or ignorance. So it may seem that countering stigma and discrimination against people with mental illnesses is simply a matter of presenting facts that clear up the misunderstandings.

    Unfortunately, it is not that easy. Presenting data and statistics that counteract false beliefs about people with mental illnesses is a good first step, but ultimately it is not enough to effect sustainable change in attitudes, beliefs, and behaviors.

    These negative stereotypes and beliefs persist despite evidence to the contrary because they have been reinforced time and again by media, by language, and at various levels of consciousness. It would be impossible to present people with facts about people with mental illnesses every time they read that someone was "a schizophrenic" or heard another person being called "crazy."

    Fortunately, a more realistic tool exists for dislodging stereotypes and prejudices: people with mental illnesses themselves. Studies repeatedly show that contact with people who have mental illnesses is the most effective method of changing attitudes(3). Research also provides some guidance for people with mental illnesses interested in telling their stories publicly in an effort to reduce stigma and discrimination.


    (3) Corrigan, Patrick and Lundin, Robert, Don't Call Me Nuts!: Coping With the Stigma of Mental Illness, 2001, Recovery Press, Chicago, IL., p. 303





    FOR A FREE COPY:


    DOWNLOAD: "Developing a Stigma Reduction Initiative" can be downloaded from the Internet (PDF version, about 100 pages print). Go to http://mentalhealth.samhsa.gov/publications/allpubs/sma06-4176/

    ORDER BY PHONE: Order book w/CD (free). Call 1-800-789-2647 and place your order for publication #SMA06-4176 with the National Mental Health Information Center.

    ORDER ONLINE: Order book w/CD (free): Click http://nmhicstore.samhsa.gov/stigma/pubs.aspx . Scroll to #SMA06-4176. Click "add to cart"

    (Sorry, international orders cannot be taken at this time)


     

     

     

     

     

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