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Peer Support Helps People With Dual Diagnosis

Dec 26 2011 | Comments 11


I’m always proud to tell people I’m a Certified Peer Specialist (CPS), but it isn’t something that’s well understood by people outside of the mental health community (and even by some inside). Explaining it is a little awkward: Phrases like “lived experience” aren’t familiar to most laypeople, so you actually do have to say, “I have been trained to help people who, like I do, have behavioral health challenges.” Then you get into the problem of the language: Is it appropriate to say challenges? It’s more politically correct to say “people who have been diagnosed with…” but many disavow those diagnoses and feel they’re inaccurate. Additionally, the phrase “behavioral health” doesn’t mean much to laypeople either. I either end up doing a weird self-deprecating thing (which jibes with my overall shtick) about being “crazy” or getting far too detailed about the history and successes of peer support in the United States, which frankly bores the crap out of people.

This is why it’s good that the media continues to cover peer support—so that it becomes more widely understood and accepted. The New York Times‘ Benedict Carey, who’s the best journalist covering the mental health beat, bar none, wrote about peer support in the last installment of his series “Lives Restored,” about people with severe mental illnesses living full lives in the open. In this final episode, Carey profiles Antonio Lambert, who deals with the challenge of dual diagnosis, which, as Carey points out, is a bitch (well, he puts it differently, but you know).

About peer support, Carey is a bit abbreviated:

The mental health care system has long made use of former patients as counselors and the practice has been controversial, in part because doctors and caseworkers have questioned their effectiveness. But recent research suggests that peer support can reduce costs, and in 2007, federal health officials ruled that states could bill for the services under Medicaid — if the state had a system in place to train and certify peer providers.

In the years since, “peer support has just exploded; I have been in this field for 25 years, and I have never seen anything happen so quickly,” said Larry Davidson, a mental health researcher at Yale. “Peers are living, breathing proof that recovery is possible, that it is real.”

One thing that struck me about the article is something I don’t hear people say enough: that peer specialists are willing to do things other traditional helpers are not. Lambert, now a successful recovery motivational speaker and counselor, started small but had a tremendous impact on the first place he worked as a peer specialist.

“He had the worst cases; he had to go into these high gang areas, places no one else would go,” said Sue Bethune, his boss at the time, who is now a mental health consultant in Greensboro. “He really opened the door for the program to be able to send people in there.”

When I managed peer specialists with dual diagnosis, in particular, that was something I saw again and again: fearlessness. There is nothing they haven’t been through and nothing they won’t do now to help someone else. That’s why it’s risky work for them, and why some, even Lambert, do relapse. But their ability to show up in dark places tells the person they’re working with: you’re important and I’m here and I’ll be here no matter where you go.

Lambert still struggles to believe he’s gotten to where he is. I’ve heard that a lot too. People who say, “I used to live on that grate and I’d score crack around that corner, and now I’m walking by in a suit and tie on my way to a meeting with city officials to talk about how to deal with people living on grates and scoring crack.” That disjunction can be a little overwhelming, and it’s a lot of pressure to be seen as a model for a community. What if you don’t measure up?

Read the rest of Lambert’s story and see a video of him here to see how he handles it all.

liz | 2:13 PM | dual diagnosis, peer support, antonio lambert, benedict carey, certified peer specialist, media coverage peer support, peer support programs

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

Cute Fix: Puppy Christmas

Dec 22 2011 | Comments 2

Hey, everyone. So I’m out on vacation today and tomorrow, celebrating the holidays in Los Angeles, of all places. I wish I could be here with you, but I’m giving you the next best thing—or maybe something much better: puppies. I know this is Christmas, and some of you may not be Christian (as I’m not). But I think we can all agree that puppies are religion-neutral, unless it’s the religion of CUTE.

liz | 10:27 AM | cute fix, puppy christmas

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

Facebook Suicide Note: RIP Gabby Josephs

Dec 21 2011 | Comments 2


If you recall, we recently posted about Facebook’s new effort to combat suicide in conjunction with Lifeline. Today comes news of a beautiful, reportedly bubbly young woman (pictured) who posted to her account shortly before throwing herself under a train. From The Independent:

Gabrielle Joseph, 16, posted a message to friends on the social networking site hours before taking her own life. The teenager, from Briton Ferry in South Wales, went on to post a message to a friend saying: “I am going to kill myself tonight.”

The words were written after a boy she had planned to go with to the cinema called off their date.

The news of her Facebook message came out at an inquest about her death, which occurred in April.

I’m not sure if things have changed or if my perspective on them has changed, but it seems as though the world is a more dangerous place if teenage suicides are triggered by a canceled date. Even when we felt “suicidal” about a boy’s rejection when I was in high school, there was always enough perspective to understand that it wasn’t the end of the world. I was lucky to have a parent there for me, reminding me that things would be different. Perhaps Josephs didn’t.

All that being said, surely this wasn’t the only thing that was troubling the young model. While the headlines are focusing on the fact of the date being the precipitating factor, there’s something missing, right? Even her father said she seemed “groggy and pale” the day of the event, which was out of character for her. I wonder if we’ll find out there were drugs involved—and when I say drugs, I actually mean either illicit drugs or newly prescribed antidepressants.

liz | 1:50 PM | suicide, facebook suicide note, gabby josephs, gabrielle josephs

Countdown to Recovery: Ten Days Left to Get Your Shit Together

Dec 21 2011 | Comments 4


So it’s December 21st, which means it’s only 10 days away from the due date, as it were, for NAMI’s Countdown to Recovery. It’s a fundraising concept meant to highlight NAMI’s work, and given that they do, in fact, play a very important role in the lives of people with whatever-you-call-it (mental illnesses, Freudian slippages, brain disorders, yadda blah blah), I’d encourage you do donate if you can.

I have heard plenty of people complain about NAMI—about its being compromised by Big Pharma involvement or about its teaming up with TAC in some instances. But I’ll tell you, in my experience working in the mental health field, I have been blown away by how incredibly helpful and supportive NAMI groups are for people whose loved ones have been diagnosed with mental illness. I’ve been at these groups and watched parents cry and share and be there for each other in a way no one else in their life can. I’ve seen NAMI sponsor educational events that cleared the way for people to get better. And I’ve seen NAMI stand at the forefront of peer support advocacy and every other struggle people with mental illnesses fight for. No organization is perfect. I can’t speak for every single state and city affiliated group. But overall, the balance of the work that NAMI does is frankly indispensable.

Perhaps the PR gambit is an unfortunate choice of word, though, when we know that 10 days from now everything in the system will be exactly the same. As one reader wrote of the Countdown, “Of course, my peers and I will find the same system we’ve always had come January 1, 2012.” No question, wise reader.

liz | 10:10 AM | Uncategorized, countdown to recovery, family support, nami

Happy Birthday Linda Andre!

Dec 20 2011 | Comments 18


It’s almost the end of the day, but not too late to wish mental health advocate, activist and author Linda Andre a very happy birthday. Andre is the author of Doctors of Deception: What They Don’t Want You to Know About Shock Treatment. Andre has probably done more than any other mental health advocate to draw attention to the problematic history of ECT and the corruption within the industry—and she did it all without help and with the force of the industry against her. For so many years she was a voice crying in the wilderness, but she never stopped. She is truly one of my heroes and an inspiration to me to keep going in the service of something you believe in.

liz | 5:19 PM | electroshock (ECT)

What Personality Disorder Afflicted Kim Jong-il?

Dec 20 2011 | Comments 0

Kim Jong Il

So the dear leader—frequently called Kim Jong Mentally-Ill—is dead. This hasn’t exactly occasioned an outpouring of grief, but it is an appropriate time to consider Kim Jong-il’s psychology, which, according to the limited reports received over the years by Western media, seems very distorted. Is this type of distortion—a personality disorder, perhaps—true of all dictators? There’s certainly a level of grandiosity that far exceeds that of the normal person.

Scientific American published an article yesterday: “The Psychology of Dictatorship: Kim Jong-Il” by Jason G. Goldman. Goldman starts where we all might—with Hitler, citing a 2007 study in which five experts were asked to analyze Hitler according to DSM diagnosis. The group did the same with Saddam Hussein, and in 2009, with Kim Jong-il. All three studies revealed six personality disorders that may affect dictators: sadistic, antisocial, paranoid, narcissistic, schizoid, and schizotypal.

Goldman does an admirable job of putting this information into perspective—pointing out, for instance, that most people who have such personality disorders do not, in fact, become dictators.

Also on Scientific American’s website, there’s a blog entry by Gary Stix, who writes: “What was up with a world leader who thought he could control the weather while engaging in his passion for Elizabeth Taylor movies?” He cites the same studies that Goldman does, but quotes the researchers on the political implications of dealing with such a leader:

“Kim Jong-il’s antisocial features, such as his fearlessness in the face of sanctions and punishment, serve to make negotiations extraordinarily difficult. Even ‘submitting to negotiations’ makes many antisocial individuals unwilling and hostile. Kim Jong-il appears to pride himself on North Korea’s independence, despite the extreme hardships it appears to place on the North Korean people. This behavior appears to emanate, in large part, from his antisocial personality pattern.”

liz | 10:36 AM | personality disorders, politics, kim jong il mentally ill, kim jong il personality disorder, psychology of dictators, psychology of kim jong il

A Case for “Forced Treatment”?

Dec 19 2011 | Comments 6

Bipolar Burble blogger Natasha Tracy has a post up today about Laura’s Law (California), which mandates mental health treatment for people who are considered both severely ill and dangerously violent as a court-ordered condition of their living in the community. Unlike forced electroshock, mandated Assisted Outpatient Treatment (AOT) (which doesn’t include forced medication) is showing positive results. Tracy cites results from other states, which show that AOT “helps the seriously mentally ill by reducing homelessness (74%), suicide attempts (55%) and substance abuse (48%).” She also cites gains of the implementation of Laura’s Law, including reduced hospitalization and reduced incarceration.

If you have objections to AOT, check out Tracy’s post. You may find she engages your arguments—and dismantles them.

liz | 2:18 PM | bipolar disorder, criminal justice system, electroshock (ECT), assisted outpatient treatment, bipolar burble, forced electroshock, forced treatment, laura's law, natasha tracy

A Bad Time of Year for Compulsive Shoppers

Dec 19 2011 | Comments 4

Photo from Design Boom

Photo from Design Boom

A lot of people seem to think compulsive shopping is a joke. I can hear a beer-bellied former frat boy saying to his buddies, “Don’t all women have that disease?” Hardy har. The reality is that as with any compulsion, the compulsion to spend can be just as destructive as the compulsion to drink or gamble or shoot up.

I have a family history of compulsive spending, and without getting into personal details (a first, I know, but I’m protecting someone), it still affects the way I deal with (or don’t deal with) money and possessions. Material objects for those who come from compulsive environments become associated with dishonesty, shame and frenetic need. They’re not a source of joy. And yet, I myself have struggled to keep my finances in order—not because I spend too much, but because I can’t bear to touch anything having to do with money, and that includes bills. In a sense, money doesn’t exist to me, which makes it difficult when it comes time to file your taxes. In my younger days, I defaulted on student loans, allowed my credit rating to sink, let credit card interest accrue. It wasn’t all connected to my family history, but some of it certainly was. Being complicit in someone else’s compulsive behavior, as I was as a child, makes for an adulthood spend under the covers, metaphorically, when it comes to that substance. Like the child of an alcoholic, you want to stay safe—and if that means never touching a drink (or money), so be it.

For people who celebrate Christmas, this is a tough time of year for many reasons: family dynamics, stressful travel, and in this terrible economy, facing the reality of not having enough money to buy gifts. For compulsive shoppers, however, it’s particularly hard. CNN has a story about it today:

For compulsive shoppers, buying something creates a feeling related to the euphoria that alcohol induces, said Bonny Forrest, a psychologist in San Diego. As with alcoholics, it’s hard to keep away from that rush of pleasure.

About 6% of women and 5.5% of men are compulsive buyers, according to a 2006 study from Stanford University in the American Journal of Psychiatry. The mental disorder has not been studied extensively, but it is thought to be an impulse control disorder.

… Compulsive shopping sometimes goes hand in hand with alcoholism and eating disorders, Forrest said. It’s not currently a separate diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, the “Bible” by which mental health professionals identify conditions. Psychologists usually view it as an issue of impulse control rather than a sign of obsessive-compulsive disorder; OCD medications do not tend to work for shopping problems, Forrest said.

There’s no hard line between treating yourself to a pair of shoes on a bad day and being a compulsive shopper — it is a spectrum. When shopping causes distress in your relationship or if shopping is the only way you can deal with negative feelings, it can be a real problem, Forrest says.

Here are some tips to control the problem:

-Pay for purchases by cash, check, debit card.
-Make a shopping list and only buy what is on the list.
-Destroy all credit cards except one to be used for emergency only.
-Avoid discount warehouses. Allocate only a certain amount of cash to be spent if you do visit one.
-”Window shop” only after stores have closed. If you do “look” during the day, leave your wallet at home.
-Avoid phoning in catalog orders and don’t watch TV shopping channels.
-If you’re traveling to visit friends or relatives, have your gifts wrapped and call the project finished; people tend to make more extraneous purchases when they shop outside their own communities.
-Take a walk or exercise when the urge to shop comes on.
-If you feel out of control, you probably are. Seek counseling or a support group such as Debtors Anonymous.
-Avoid people or places which tempt you to shop/spend
-Cut up plastic; close charge accounts; rip up credit card offers and home equity applications
-Make lists before going to the store; buy what you need only – call support people, take a trusted friend
-Wait a good period of time before you make an impulsive purchase
-Ask yourself: Do I need this or do I just want it?
-Seek out specialized counseling, medication, support groups, read books about compulsive shopping/spending

For more see Shopaholics Anonymous and Debtors Anonymous.

liz | 12:37 PM | anxiety, compulsive shopping, compulsive spending, holiday shopping problems, impulse control disorders

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