The Chicago News Cooperative takes up the problem of Mayor Rahm Emanuel’s decision to cut six of Chicago’s 12 mental health centers. In Philly, that would be devastating, so I can’t imagine it’s any different there. Of course the government is saying that people will be taken care of somehow, but that’s the kind of thing they always say, right? They say they patients from the other centers can just go to the ones that will stay open. But, um, that would mean a 71 percent increase in patients for the remaining clinics and a 0 percent increase in resources. Sounds like a plan.
Go here to read the stories of the people whose lives will be impacted by the cuts. Interestingly, though you’d imagine they’re depressing, they’re actually stories of hope. People with these illnesses are so strong, they are such survivors. They’re remarkable, and they deserve better.
EnVivo Pharmaceuticals is touting positive results of research into a drug they’re developing for schizophrenia. The drug right now is called EVP-6124, but will eventually be called Relaxafin or something equally ridiculous. The Phase 2b study of the drug was tested on 319 “chronic schizophrenia patients” in the U.S., Russia, Ukraine and Serbia, a practice that continues to interest me. I wonder, for example, if diagnostic criteria differ in those countries and how cultural differences shape the notion of who is called a chronic case. Phase 3 will focus on the drug’s efficacy in treating cognitive symptoms of schizophrenia. For the full press release, go here.
In other news, Targacept is about to go into Phase 2 trials of TC-5619, which the makers are hoping will treat both schizophrenia and ADHD. For the schizophrenia trial, this study will be conducted in the U.S. (25 percent) and Eastern Europe (75 percent) and will enroll 450 participants. For the ADHD trial, the 85 enrollees will be primarily in the U.S.
What’s especially interesting to me about this latter study is the focus on symptoms of inattention in ADHD, which, according to Targacept, are not currently being addressed pharmacologically. What concerns me greatly, however, is that this means we’ll have another drug on the market that is basically intended to treat children. Some children may benefit. But others may be medicated to their detriment and unnecessarily.
Speaking of which:
An incredibly eloquent submission by Joe Gutstein.
Let’s imagine for a moment that you are long into the public mental health system. You have been in the hospital multiple times, in a couple of partial hospitalization programs, and have spent years in sheltered workshops and day programs. You’ve received the Prophecy of Doom, “Too sick for too long to get any better.” You’ve heard plenty of statements beginning with “You can’t, You won’t, and You will never.” You’ve been told endlessly that something is intrinsically (genetically) wrong with you and the only thing that will truly save you is a medication yet to be discovered. You’ve also been told that the most important thing you can do is get on SSI or SSDI in light of the prolonged and persistent nature of your illness. You’ve been told to engage in meaningful activities generally limited to walking, listening to music, and reading. You’ve been told countless times to avoid any stressors which might be associated with more rewarding activities and these stressors will doubtless lead to yet another hospitalization. You’ve been told so many things.
You’ve lived through several successive Eras: Psychosocial Rehabilitation, Evidence Based Practices, Transformation, Recovery and now Recovery and Wellness but the only thing that actually changed was your medication. You’ve been referred to as a patient, a recipient, a client, a consumer, a prosumer, a self advocate and now a “person with ….” but everything is the same at the hospitals, the sheltered workshops, the partial hospitalization programs and the very day program you now attend. You are now told pursuant to the Recovery model that you are suddenly empowered but what evidences your empowerment? What is it in your life that is now different? When did you last hold a meaningful job, live in decent housing, go on a date, attend to a party which wasn’t held at 3 pm or have friends over to your place? Has your health improved? Has your circle of friends and acquaintances changed? Has your income increased to provide for more options? What activities do you now engage in which you wouldn’t have before you were empowered?
Are you empowered? Not really, nothing has changed in your existence. What you do have is a familiar long standing delusion in which you are empowered. You imagine, it is part of your symptomatology, that you can provide anyone anything and everything with a CGI script. This is an empowering belief within your disempowering reality and among all the other folks at the day program it gives you a unique identity, a unique story where being unique in other areas might not be highly regarded. Fortunately, there is no impact on your role as a person in the day program unless you chatter away about it. (No more so than your peer who believes he is being watched by friends on another planet. After all, he is no longer alone all the time. Someone is watching over him where no one else might otherwise care about him.)
What is going to replace this powerful delusion and that which accrues to you by virtue of it? Let’s consider your options and the system of supports and services which will assist you in replacing it. Knowing that it is best not to ask for anything specific which might fall beyond the groups found at the day program, You say, “I want to be empowered.” The reply is “Of course, we can help you with this. Did you know that the day program has an Empowerment Group?” (You knew there was an Empowerment Group.) Consequently, you are signed up for the day program’s Empowerment Group. It meets in the same room as the Socialization Group which was going to help you get a date on Saturday night and the Pre-Vocational Group which was going to help you get a meaningful job. But you know the folks in the Empowerment Group. Not a one has become empowered. (The group meets weekly and all the chairs are in a therapeutic arrangement. There are handouts and members of the group so inclined read aloud from the handouts.)
So in the final analysis, you have the delusion and the Empowerment Group. The delusion is empowering but the Empowerment Group isn’t. Sadly, no one asked you the right question in the Era of Wellness & Recovery. Now – for the first time – the very question he or she would want to be asked in the same circumstances is being asked, “What do you need to thrive?” What is it that would lead you to hope for a life where the delusion has no value and might be patently detrimental. And for once you truly know that your answer shouldn’t be limited to something that happens in another group but involves real skills, fostered and facilitated in the real world with services and supports which promote a life. And just maybe you’ll now believe in the possibility of that date on Saturday night and a meaningful job for this new reality is more satisfying and empowering then any long held delusion.
In the recovery movement, which is the zeitgeist in the delivery of mental health services at this time, we are supposed to look past someone’s diagnosis. I am not “a bipolar” or “depressive” or “schizophrenic.” I have been diagnosed with such, but the relevance of that diagnosis is highly suspect. Because aren’t I just Liz? Liz who is addicted to Dunkin Donuts hazelnut coffee, Liz who likes chihuahuas in sweaters, Liz who tries to do gluteal exercises to increase her butt’s circumference — without success. So many things make up my Liz-ness, right? So who cares what some doctor said?
Generally speaking, I agree with this approach. For many years we have been labelling people in an attempt to treat them, and the results aren’t exactly stellar. So why not change protocols, DSM by damned?
Yet as a person who works on the frontlines of mental health care, I sometimes do find myself stymied by a person’s behavior, and a diagnosis can (infrequently) help. Because there certainly are definable characteristics of certain illnesses that can help me understand where a person is coming from. It also helps in distinguishing substance abuse from simple illness.
Here’s what I mean. Say I meet a guy who talks to me about his power over floating CGI-enhanced rabbit-shaped angels — who says he can get me anything I want by talking to them and persuading them. This is not true. By any measure we use to determine reality, the CGI-enhanced rabbit-shaped angel is clearly a fiction. But what if he slurs while he tells me this? What if he leaves that day and I have to understand what’s going on so I can advocate for him? Wouldn’t many people think, “That guy is on some serious crack.”
Now, we’d like to think a mental health professional would be more sophisticated than that, but then, you’d be assuming a level of knowledge that some MHPs simply don’t have (I say that with love). So if you look at this guy’s medical records and it says he has been diagnosed 10 times by 10 different doctors in the last 10 years as a person with schizophrenia, that might be good knowledge to have. Additionally, if his records state that he has never used drugs or alcohol, that’s also good to know.
I’m not saying that guy is only his diagnosis. I’m saying that hearing what psychiatrists have labeled him with for a decade might be useful information for me to have if I’m going to help him.
Similarly, the search for diagnosis can be a good road to travel. In today’s Washington Post, a mother asks Marguerite Kelly what her depressed daughter should do — meds or exercise? Kelly gives an answer that anyone should get in the absence of clinical assessment:
It’s time for your daughter to find an experienced board-certified internist who listens well and is curious enough to test her for viruses, low thyroid, high cortisol, candida and many other conditions that can cause depression. If she’s healthy, she then should be evaluated by a psychologist or a psychiatrist, who will ask her about any trauma or loss that she’s had, any history of depression in the family, any bad PMS occurrences or any sadness in the winter, all of which can trigger depression.
This is a good protocol in search of a diagnosis. That being said, my psychiatrist reminds me again and again he doesn’t care what my label is; he just wants to help me feel better. And it’s true that it doesn’t matter if you call it OCD or bipolar of DID or PPP (for Poo Poo Poo), if you’re counting every crack in the sidewalk, it’s probably time for some help.
These are my thoughts for today, messy though they are. I’d love to hear your thoughts.
Not because she’s a phenomenal actor, which she is, but because she’s just initiated a new project to banish stigma. The project is highly personal, as she explains on Huffington Post:
As I’ve written and spoken about before, my sister suffers from a bipolar disorder and my nephew from schizoaffective disorder. There has, in fact, been a lot of depression and alcoholism in my family and, traditionally, no one ever spoke about it. It just wasn’t done. The stigma is toxic. And, like millions of others who live with mental illness in their families, I’ve seen what they endure: the struggle of just getting through the day, and the hurt caused every time someone casually describes someone as “crazy,” “nuts,” or “psycho”.
What’s remarkable is not her frankness about this personal history, but her motivation to act, which seems almost like a wholesale rethinking of her career and what it’s meant in popular culture. In Fatal Attraction, for example, she played a woman obsessed with Michael Douglas (those were the days, right Michael?). She loses control of the obsession and becomes terrifying. As Close writes, the movie was a great success, and audiences loved to hate her character.
Alex Forrest is considered by most people to be evil incarnate. People still come up to me saying how much she terrified them. Yet in my research into her behavior, I only ended up empathizing with her. She was a human being in great psychological pain who definitely needed meds. I consulted with several psychiatrists to better understand the “whys” of what she did and learned that she was far more dangerous to herself than to others.
The original ending of Fatal Attraction actually had Alex commit suicide. But that didn’t “test” well. Alex had terrified the audiences and they wanted her punished for it. A tortured and self-destructive Alex was too upsetting. She had to be blown away.
So, we went back and shot the now famous bathroom scene. A knife was put into Alex’s hand, making her a dangerous psychopath. When the wife shot her in self-defense, the audience was given catharsis through bloodshed — Alex’s blood. And everyone felt safe again.
The ending worked. It was thrilling and the movie was a big hit. But it sent a misleading message about the reality of mental illness.
This is a bold admission from a woman who derived so much success from this role, but there’s no escaping what she says. It has long bothered me — and, I suspect, other advocates — that the message there is one of terror and fear.
Not only does Close take on her role in that film, she assesses the entertainment industry as a whole:
Whether it is Norman Bates in Psycho, Jack Torrance in The Shining, or Kathy Bates’ portrayal of Annie Wilkes in Misery, scriptwriters invariably tell us that the mentally ill are dangerous threats who must be contained, if not destroyed. It makes for thrilling entertainment.
There are some notable exceptions, of course — Dustin Hoffman in Rainman, or Russell Crowe’s portrayal of John Nash in A Beautiful Mind. But more often than not, the movie or TV version of someone suffering from a mental disorder is a sociopath who must be stopped.
I like to think that her speaking out will change this. As she so eloquently says, silence is the problem. Read more of her elegant prose here. It is well worth it. There you’ll find links to the initiative she’s promoting.
Thank you, Glenn, for speaking out against silence. You rock.
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
Invega has now come out with a different formulation: the sustained release. Apparently, this is the first atypical to be approved for the once-monthly injection formulation, though there are other neuroleptics used in this fashion. Personally, I’d love a once-monthly instead of the everyday pill. Bring it, yo evildoers at AstraZeneca! I’m ready for my Seroquel shot!
Or maybe not. A new Lancet study says older antipsychotics, like clozapine, are safer over the long term than Seroquel, Zyprexa and Risperdal. From the L.A. Times health blog:
Researchers in Finland, where clozapine is still widely prescribed for schizophrenia patients, found that users of the drug were less likely to die than those who took any one of three other second-generation (also called “atypical”) antipsychotics — Seroquel, Risperdal and Zyprexa — or those who took the first generation schizophrenia medication pherphenazine (once marketed as Trilafon).
Sufferers of schizophrenia have long been known to die earlier than the general population, markedly more often by suicide and by complications of diabetes. They are far more likely to engage in behaviors that lead to earlier death as well, including tobacco use, substance abuse and sedentary lifestyles. The Lancet article found that a schizophrenia patient who took any of the studied medications for seven to 11 years was less likely to die prematurely. And the longer she took it, the less likely she was to die an early death.
American physicians have largely abandoned Clozaril, which has been on the U.S. market since 1989, in favor of Zyprexa, Seroquel, Risperdal and Abilify — all newer drugs that have been aggressively marketed to doctors and patients as safer and more effective than the first-generation of antipsychotic drugs, including pherphenazine and haliperidol (better known by its commercial name, Haldol).
Meanwhile, the numbers of people being prescribed these powerful psychiatric drugs have skyrocketed. In 2008, 50 million prescriptions for antipsychotic drugs — overwhelmingly the newer ones — were filled.
Thanks to Tony W. for sending a link to a NY Daily News article about Scott McCann, who placed a fake bomb at LaGuardia. He’s now at Bellevue for observation, and his mother is upset, to say the least:
The distraught mother of would-be LaGuardia bomber Scott McGann defended her mentally ill son Sunday night.
“He’s not a kook,” Margie Jones told the Daily News, barely able to speak through her tears.
She said her 32-year-old son suffers from catatonic schizophrenia – a form of the disease that leaves victims in a psychotic state where they’re unable to speak, respond or even move.
“I love my son,” said Jones, a school psychologist who lives three hours north of San Francisco in Willits, a town of 5,000.
The heartsick mother had planned to see McGann this past weekend after buying him a ticket to fly to California some time before Saturday’s airport scare.
The question of his mental illness and diagnosis is likely to be pursued intently if there’s a criminal trial, and catatonic schizophrenia seems, on the surface, an odd explanation for this particular event. More about McGann from the article:
A computer programmer and artist, McGann was described by friends as a kind and pensive person who peddled his handmade goods in Union Square.
“He was a friendly guy who worked a lot with skateboarders,” said William Saar, 50, who sells used books in Union Square.
“He didn’t seem like the type of guy to do something like this,” Saar said.
Christopher Gause, 20, another artist who sells in Union Square, said McGann made sculptures out of scrap metal.
“There was some spirituality he found in his art,” Gause said. “He was very calm, very friendly, and smiled.”
Sounds like such a nice guy. I wish the diagnosis hadn’t been disclosed so early on — or maybe I just wish it weren’t true. While to “normal” citizens, the diagnosis seemingly explains bizarre behavior, to those who deal with mental health issues — especially those with schizophrenia — it merely exacerbates the perception that we’re all dangerous and could “snap” at any moment.
For a more humorous look at the situation, you must check out New York Magazine’s take on how Scott McGann could be your boyfriend.
[Photo copyright NY Daily News]
From the Charlotte-Observer, about Demeatrius Montgomery, who killed two police officers two years ago. (Hmm. Those wheels of justice sure do turn … slowly.)
A relative recounted for a courtroom Monday how Demeatrius Antonio Montgomery looked out the window of her home and said “they’re after me.”
At other times, Gwendolyn Hinton said her nephew would talk to himself, burst into laughter during serious conversations and behaved almost childlike.
The picture of a disturbed and occasionally violent Montgomery emerged during a hearing to determine whether he is mentally competent to stand trial in the 2007 shooting deaths of Charlotte-Mecklenburg police officers Sean Clark and Jeff Shelton.
Clark, 34, and Shelton, 35, were killed at the Timber Ridge apartment complex in east Charlotte. Their deaths prompted a citywide outpouring of grief as thousands attended their funerals.
Authorities arrested and charged Montgomery, 27, with two counts of first-degree murder. Since then, state mental health workers and his lawyers have tried to assess his mental stability.
But for the most part, Montgomery has refused to speak to them, witnesses testified Monday.
Psychiatrist George Corvin said he has tried to examine Montgomery seven times, but most of the time “he is completely mute.”
Montgomery also has refused to speak with his attorneys, Corvin said.
Corvin, testifying as an expert witness for the defense, said he believes Montgomery has paranoid schizophrenia and is not competent to stand trial. But a state psychiatrist who examined Montgomery disagrees..
In fact, prosecutors think they’re being played.
They noted he has never sought mental health treatment and that his father said his behavior is likely linked to drug use.
Prosecutors said he has functioned well enough while incarcerated to ask relatives to send him books on civil rights leaders and religious material, such as the Quran.
Either way, this case has tragedy written all over it, even above the murders of the officers. First of all, Montgomery has two children, so that’s no good. And his life sounds troubled.
At Monday’s hearing, Hinton, his aunt, spoke of a troubled man who has remained mentally unstable since his teen years.
Montgomery lived with his grandmother as a child because his mother drank heavily, Hinton said. His mother died in a 2003 fire.
Montgomery had little contact with his father, she said.
He attended South Mecklenburg High School, but dropped out in 11th grade. At the time of the police shooting, he was one credit shy of earning his GED certificate.
Hinton said Montgomery’s behavior became erratic after an altercation with police in 1999. Montgomery suffered an injury to his head.
Records show Montgomery was arrested in 1998, charged with larceny and resisting a public officer. He was 16. Montgomery has been found guilty of assaulting a government official or resisting a public officer at least four times, N.C. court records show
In 2004, Montgomery was arrested for hitting the mother of his two children. The police report said he punched the woman on the side of the face several times at their northeast Charlotte apartment, leaving red marks and a bloodshot eye. He was sentenced to 18 months of probation, which records show he violated in 2005.
Hinton said relatives encouraged Montgomery to seek mental health treatment, but never forced him. She said she was worried about his behavior because even as a grown-up he played with children’s toys and watched cartoons.
Montgomery’s competency hearing resumes today.
liz | 1:59 PM | SCHIZOPHRENIA
The son of former Chicago newsman Bill Kurtis (pictured) was found dead early Monday, July 20, on the Kansas cattle ranch owned by his father, family members said.
Scott Kurtis, 38, suffered from paranoid schizophrenia since his mid-teens, said his stepmother, Donna LaPietra.
Mr. Kurtis was last seen during the day Sunday and may have died late Sunday or early Monday. At the time of his death, Mr. Kurtis was alone in his home on the ranch, LaPietra said.
He was found by his sister, Mary Kristin Kurtis, who lives near the ranch.
Mr. Kurtis’ family is expected to get the results of an autopsy by Thursday, LaPietra said. Mr. Kurtis also suffered heart and thyroid ailments as a result of the schizophrenia, she said.
“It’s a lonely life — it’s a very sad illness,” LaPietra said.
“Quite frankly, there’s not very much anyone can do, so he struggled with that illness and various complications that arise from it,” LaPietra said. “Tragically, Bill and I have known for a while that often … schizophrenics do not live past the age of 40. It was something we always had in the back of our minds, and Scott really struggled.”
For the last 10 years, Scott Kurtis had worked at the ranch in Sedan, LaPietra said.
Her stepson often said his dream was to be a truck driver so he could travel and see the country, LaPietra said.
“He loved the road. It was always a battle for us to persuade him that it was better to be on the land than on the road,” LaPietra said. “It was his obsession.”
Full story here.
liz | 9:48 AM | SCHIZOPHRENIA