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Clarification on Assisted Outpatient Treatment (AOT)

Dec 26 2011 | Comments 9

I cited Natasha Tracy’s post on AOT a few days ago, and got some intense feedback. I’d like to clarify my position. I fully understand people’s mistrust of system interventions and compelled treatments and the proverbial slippery slope they believe such treatments represent. But after working on the front lines of direct services to people with chronic mental illness, I believe you might feel differently—at least in some cases.

No one is advocating AOT for every person who has been diagnosed with a mental illness. That’s not how things work. People who are monitored under AOT have met certain criteria, like committing a criminal act. It is unfortunate that people’s illnesses do infrequently cause them to commit illegal acts, but when they do, they must—like every other person in our society—be held to account for those actions. Because we don’t want them to just be thrown in jail without considering their health problems, we find alternative ways to address issues of safety and accountability.

AOT for someone who has committed a crime is not, in my opinion, a slippery slope to someone like me—diagnosed with bipolar disorder—being forced to submit to similar conditions in my everyday life. I think the invocation of the slippery slope is a lazy rhetorical device employed by people who are afraid and angry, sometimes justifiably so. But is it borne out by facts? I don’t believe so.

A couple years ago I was the manager of a peer support program for a mental health organization. The goal of the peer support program was to reduce repeat hospital visits for “frequent flyers,” as the hospitals so sweetly called them. This reduction in hospital visits had an obvious benefit for the people we worked with. And I don’t think anyone objecting to AOT, which has the same goal in many cases, would object to peer support. There are many different tools we use to make lives better for people who have been diagnosed. Those who live in extremis due to their illness—those who are homeless, or who spend every weekend in the ER—need bold intervention.

I have a friend who runs an Assertive Community Treatment (ACT) program. Some people object to ACT for the same reasons they object to AOT. But my friend has seen people’s lives change radically—especially people living in poverty who were unable to manage their own resources. Sometimes in our zeal to protect rights in general, across the board, we forget about the individuals who are suffering on a daily basis. Should someone who lives in poverty and can’t get food because of his delusions prevent him from processing the complexity of government paperwork for food stamps be denied help so the rest of us can preserve our rights—which we only theorize are being threatened?

I am no fan of E. Fuller Torrey or TAC. I think he’s terribly destructive. He does not allow for subtlety. He has a twisted agenda. He’s a dangerous guy. I am not endorsing his positions, and I didn’t mention him—though someone affiliated my remarks with him. I do endorse careful, responsible consideration of practices that may help individuals in a system that continues to underserve them.

liz | 10:16 AM | alternative treatments, hospitals / hospitalization, ACT, AOT, forced treatment, laura's law

Maybe We Should Cry for Her After All

Dec 21 2011 | Comments 2


Eva Perón may have had a lobotomy. It’s a shocking revelation because we think of Evita as strong, competent, lucid and driven. How could this have happened to her? The answer is that Perón had cervical cancer, and was lobotomized to ameliorate her pain—one of the reasons were performed in 1952. From the New York Times:

Dr. [Daniel E.] Nijensohn’s research, to be published soon in the journal World Neurosurgery and recently posted online, turned up several pieces of suggestive evidence. He confirmed details of Dr. Udvarhelyi’s story and found other contemporaries of Perón who had said she had had surgery for her pain.

Dr. Nijensohn also unearthed information indicating that Dr. James L. Poppen, a neurosurgeon at the Lahey Clinic in Boston and an international expert on the use of lobotomy for intractable pain, had been summoned to operate on Perón in the summer of 1952. X-rays of Perón’s skull, Dr. Nijensohn found, showed indentations in the areas where lobotomies were usually performed.

Dr. Nijensohn believes that a lobotomy was performed in May or June of 1952, meaning that Perón may have already had the procedure at the time of her last public appearance, riding in a limousine at her husband’s second inaugural.

The idea of utilizing lobotomy to treat pain is interesting to me. I can almost go for it. What would I prefer: excrutiating chronic pain or being a bit of an idiot? The latter sounds a lot more appealing. But as author Barron H. Lerner points out, there was already pain treatment available: opiates. And those make you idiotic too, so it’s like two for the price of one but without any surgery.

Hat tip to Susan and Holly for this article.

When Lobotomy Was Advanced [NYT]

liz | 3:04 PM | alternative treatments, barron lerner, cervical cancer treatment, chronic pain, eva peron lobotomy, evita lobotomy

Don’t Betray the Moment

Dec 9 2011 | Comments 5


There are things — books, movies, Journey songs — that help put things into context for me when I feel down. It’s usually about resetting time; I get very caught up in mulling over things that have happened in the past that have compromised the present. Or I’m thinking about the future in a way that makes me feel confounded and hopeless.

But recently I saw a documentary about a man, Joe Hutto, who raised 16 wild turkeys, and I was simply blown away by it. It was the most moving thing I’ve seen in many years, and it has absolutely become key to my understanding of staying in the present. In the film, Hutto says,

So many of us live either in the past or the future and betray the moment. And in some sense we forget to live our lives. … And wild turkeys don’t do that. They are convinced that everything they need, that all their needs will be met only in the present moment and in this space and the world is not better a half mile through the woods, it’s not better an hour from now, and its not better tomorrow. That this is as good as it gets. So they constantly reminded me to do better and to not live in this abstraction of the future which by definition will never exist. And so we sort of betray our lives in the moment so the wild turkeys reminded me to be present, to be here.”

Every time I find myself feeling frustrated or bored now, I think, “Don’t betray the moment,” and I look around to see what’s beautiful or special about the world around me. Right now, it’s how my dog has arranged the blankets with exceeding care so she could curl up in a circle and go to sleep. I can hear her little puffs of breath, and when she sleeps she smells like corn. I know that’s odd, but that’s the moment, and I have to appreciate it because, sadly, dogs don’t live forever. If I betray this moment by thinking about how bored I am or depressed or bloated (PMS?), I’ve missed seeing the world. And people don’t live forever either. It’s a gift to listen to and watch a little dog sleep.

liz | 3:53 PM | alternative treatments, depression, joe hutto, my life as a turkey, pbs nature

Deep Brain Stimulation Research Makes Headlines, But Proceed With Caution

Dec 9 2011 | Comments 2


This week has been kind to Deep Brain Stimulation (DBS) after the results of a study were published in the Journal of Neurosurgery. Headlines like “More Evidence DBS Effective for Severe Depression,” “Depression Symptoms Eased With Deep Brain Stimulation,” “Deep Brain Stimulation therapy helps fight depression,” etc. will give people with treatment-resistant depression new hope. But as with all study results, it’s best to be cautious about these.

The study included 21 patients who’d tried at least 16 medications without good results, had depression for 20 years and were unable to work due to the condition. The DBS device was implanted to target the subcallosal cingulate gyrus (natch), which had shown good responses to DBS at a single center before but researchers wanted to see if results could be replicated across multiple centers.

It seems that the issue with DBS at the moment is sustaining the improvement. From the study abstract:

Patients treated with SCG DBS had an RESP50 of 57% at 1 month, 48% at 6 months, and 29% at 12 months. The response rate after 12 months of DBS, however, increased to 62% when defined as a reduction in the baseline HRSD-17 of 40% or more. Reductions in depressive symptomatology were associated with amelioration in disease severity in patients who responded to surgery.

In a Medscape translation by Deborah Brauser, that means the study actually had mixed results.

Results showed that although 57% of the participants had a 50% reduction in HRSD-17 symptom scores at the 1-month follow-up, only 48% showed the reduction at the 6-month mark and only 29% showed it at the 1-year mark.

“The apparent drop in efficacy…is potentially worrisome but may be somewhat of an artifact of the data analysis,” write the investigators.

Brauser also points to an editorial in the journal that makes the headlines this research is getting even more misleading:

“[Principal investigator Andres M. Lozano] and his clinical collaborators have given us an interesting and important study,” writes Kim J. Burchiel, MD, from the Department of Neurological Surgery at Oregon Health and Science University in Portland, in an accompanying editorial.

However, Dr. Burchiel notes that because of its open-label design, the study “cannot be regarded as evidence of efficacy; only safety can be assessed to some degree.”

In addition, he calls the 29% 1-year improvement rate “modest,” adding that it may be consistent with a placebo response.[Emphases mine}

It also distresses me to learn that one of the study participants committed suicide, though I realize those things happen in such research trials. Was the suicide due to the implantation? An attempted suicide, Brauser writes, took place “between weeks 4 and 5, but this was thought to be due to a family matter.”

The reality is that even for those people who had a short-term benefit, they may have felt it was worth it after so many years of suffering.

liz | 1:58 PM | alternative treatments, depression, DBS, deborah brauser, deep brain stimulation, kim burchiel, st jude hospital, treatment-resistant depression

Omega-3 Is Not the Bullet

Oct 27 2009 | Comments 23

A new study of heart patients suffering from depression is in itself depressing — at least if you were excited about the potential of omega-3 fatty acids to life your spirits. From the New York Times:

The patients were randomly assigned to a combination of sertraline, an anti-depressant, and either omega-3s or a corn oil placebo. After 10 weeks, there was “absolutely no difference” in depression remission rates between the 59 patients taking omega-3s and the 56 patients taking the placebo, said Robert M. Carney, lead author of the study, which appeared in the Oct. 21 issue of the Journal of the American Medical Association.

“It was very disappointing,” he said.

The trial was launched because patients with heart disease are at greater risk of dying if they are depressed, Dr. Carney said. Depressed patients are known to have low levels of omega-3s, which are a risk factor for heart disease, as well.

Now, with any study, there are multitudinous caveats. It’s a small sample. They had lower levels of omega-3s to begin with. Perhaps there were other factors (i.e., physical illness) that superseded the treatment of depression, yadda yadda.

And there has been other research to suggest omega-3s are useful for depression. USA Today broke down a different study in 2007:

The omega-3 fatty acid in some fish may be a “brain food” that helps ward off depression because it increases gray matter in three areas that tend to be smaller in people who have serious depression, a study suggests today.
The increase could help explain why past studies have found that the omega-3 acid DHA reduces symptoms of depression. The richest sources of DHA are fatty fish and fish-oil capsules.

Researchers gave magnetic resonance imaging tests to 55 adults. Participants also reported everything they ate for 24 hours on two randomly selected days, says study leader Sarah Conklin, a neuroscientist at University of Pittsburgh Medical School. She’ll report her findings at the American Psychosomatic Society meeting in Budapest.

The more DHA a person consumed, the more gray matter there was in three areas of the brain linked to mood: the amygdala, the hippocampus and the cingulate, Conklin says. Seriously depressed people tend to have less gray matter in these areas, she says.

For every yes in research, there’s a no. It’s really frustrating for people looking for answers. That’s why it’s best to just go with your gut: Try what feels right and if it works for you, great. If it doesn’t work for you, move on to something else. But remember: There is no magic bullet — oily or otherwise.

liz | 2:52 PM | alternative treatments, depression

Liveblogging Primetime Outsiders

Aug 25 2009 | Comments 18

All the below is about this show.

Madigan: They didn’t flatter you with that lighting.

David Oaks: You’re looking so handsome! I had no idea. Your eyebrows are very sexy. (I’m completely sincere.)

“But critics worry …” That’s journalism-speak for “We don’t have any specific sources who say this, but we’ll generalize it so we have reason to focus on …”

… violence. That’s what they’re focusing on. Why am I not surprised?

So of all the things they could talk about related to Mad Pride — and related to mental health — this is what they’ve come up with: criminals and violent crime. Ugh. TV is so predictable and depressing.

Okay, so now we’re telling the story of a kid with hallucinations and delusions (the CIA, yadda yadda) who KILLS HIS MOTHER? Does the average American viewer understand how fucking rare this kind of thing is? That it’s not the necessary result of deciding not to take meds?

On to the withdrawal story: Clearly, the program wasn’t looking for a success story. This poor woman who decided to do the show so they could feed off her misery — I knew that’s what they wanted. Is she doing the withdrawal in conjunction with a doctor? Who the hell knows? The show doesn’t tell you. It hardly tells you her name. And …

Oh! There it is again: “Critics worry … ” (that she’s going to be “a time bomb” without her meds). Who are these critics worrying about this girl? Frank Rich? David Denby? I’d love to know.

“Violence is unpredictable with or without drugs.” Brilliant script.

Blurry homeless images. Madigan cello-ing. … This show is so bad, it’s like a joke. I guess it all goes back to what producer Ia Robinson told me, when we discussed my being on the show: She doesn’t have any friends or family who have mental problems, so the whole topic was like “walking on the moon.” Yes, that’s the phrase she used. The show should’ve been blasted out to Mars.

Except Joey P. He’s delightful and a voice of reason.

liz | 9:34 PM | SCHIZOPHRENIA, alternative treatments, bipolar disorder, celebrities, criminal justice system, depression, hospitals / hospitalization, meds, philadelphia, side effects, stigma, suicide, violence

Vacation Days

Jul 25 2009 | Comments 4

This blog will be on vacation from Monday, July 27, through Wednesday, July 29. Please come back and see us on Thursday, when our well-restedness will no doubt yield great insight on the subject of mental health.



liz | 8:38 AM | alternative treatments

Ricky Williams’ Journey

Jul 23 2009 | Comments 7

The New York Times ran an article about Ricky Williams that I think was really well-done. It talks about his struggle with marijuana addiction, which compromised his career in the NFL, but more than that, it portrays his psychic battles and explores the way his mind works. It’s a much more nuanced piece than the type we normally see about sports stars; but equally important, it examines the life of the mind in a way that doesn’t pathologize. Ricky Williams is just Ricky Williams, an interesting, layered human being. I wish people were more often written about this way, especially people with “troubles.”

Ricky Williams Is Hoping to Heal Others, and His Image

liz | 8:44 AM | alternative treatments, celebrities

Goodbye, Anti-Sacred and Profane Writing Machine

Jun 25 2009 | Comments 2

After a long battle with cancer, PW staff writer, Guardian columnist, punk-rock novelist, NME gadfly, gender-twisting rebel comedian and poet Steven Wells has gone on to other things. Well, not really. According to Steven, there’s no such thing as the afterlife, and if there is, I guarantee he’s really, really pissed off right now. I can just picture him at St. Peter’s Gates, saying, “Fuck me! This shit actually exists?”

We’ll all miss Steven so much, and I’ll say more about that later. For now, I’m wishing the best to all family and friends who are hurting. That’s what Steven really cared about in the end, though he was very passionately annoyed by knitting, as well.

Steven was often told he was anti-American. I loved his passion, and he cracked us the fuck up every day. This video was part of a series he did for PW called Steven Wells’ America, in which he took sacred cows and basically grilled them for dinner. Below, he reflects on the religiosity of an America that voted for Bush a second time (Steven was a staunch atheist). Toward the end he smiles a bit, so you know that he knows he’s being ridiculous. And that’s part of what was so cute about Steven — he’d rant, but then laugh at himself.

liz | 10:41 AM | BIG PHARMA, Funny or Offensive?, GLBT, Song of the Day, alternative treatments, anxiety, celebrities, children, cute fix, depression, hospitals / hospitalization, media, meds, military, philadelphia, phobias, politics, random, religion, suicide, violence

Men, Christians, Lend Me Your Ear

Jun 9 2009 | Comments 3

There’s a new Christian therapy group for men facilitated by John G. Taylor (pictured) forming that I read about on Craigslist. I have no idea if it’s good or silly or what, but I like the idea of alternative coping strategies, and I like some of the topics the group will address:

Wk 3: What is Domestic Violence?

Week 4: How to have a conversation with your mate?

Week 5 & 6: The Bible and your anger

Week 8: How build trust in relationships

Week 9: Techniques to control your anger

Week 15: When does an affair begin?

Week 16: How do we deal with our partners being more accomplished?

Week 18: How to deal with being sexually abused or being a perpetrator

Week 19: What is takes to be a responsible father

Week 20: How do you treat females are you abusive?

You should know there’s a $15 “investment” per group meeting. Also, at the end of the list of topics, the notice says: “God needs for his Sons to be prepared for warfare!” Which is odd, right? Still, here’s the info:

Meeting every 2nd & 4th Thursday)
6 -7:30pm
Christian Talk Therapy
2449 Golf Rd, Ste. 3, Philadelphia, PA
rsvp to 215-931-3070 or

liz | 12:21 PM | alternative treatments, religion

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