Putting Brains on the Couch by Susan Begley

For doctors who treat illnesses that strike from the neck down, a patient's symptoms are only the first step toward a diagnosis. No sooner do they hear 'it hurts when I climb stairs' than they order blood work, x-rays or other tests. In psychiatry, though, the laundry list of symptoms is it, the only basis for diagnosis. Maybe that helps explain why 70% of patients with bipolar disorder are misdiagnosed, as are up to half of women with depression. They take drug after drug, taking each dose of each medication for four to six weeks until one works or they give up, wasting money and time while their suffering continues. It's hard to avoid the sense that psychiatry could stand to be dragged into... well, let's start with the 20th century.

The American Psychiatric Association is updating its immense diagnostic manual, which offers 20 forms of bipolar disorder alone. "But it's still just a checklist of symptoms, which different physicians can interpret differently," says psychiatrist James Greenblatt, who directs the eating-disorders unit at Waltham Hospital in Massachusetts. For him and a growing number of psychiatrists, the search for a modern, objective diagnostic tool has led to the past: the electroencephalogram, first used in 1929 to record the brains electrical activity.

For an EEG, which typically costs about $150 and takes 45 minutes, a patient has about 20 electrodes pasted to his scalp, where they measure the electrical activity of neurons - brain waves - directly beneath. In the 1980's, researchers tried to base diagnoses on EEGs, but it didn't work. The same squiggles could mean different illnesses, and one illness could be marked by different EEG's. The new use of EEG's skips the diagnosis and goes straight to a recommended treatment. An EEG is compared to a database that includes 13,000 pairings of EEGs with which drugs helped in each case. A California company called CNS Response, which runs the database, finds a match and sends the physician an analysis indicating which drugs patients with that EEG are sensitive or resistant to.

That would be humdrum if, say, the analysis said 'Prozac' for a patient with depression. But according to the studies of hundreds of patients "in some three quarters of patients the EEG database leads the physician to something he wouldn't have thought of," says CNS President Len Brandt. The EEG matches aren't perfect. For about one quarter of patients, the $500 analysis suggests treatments that work no better than what they'd already tried. It has proved most beneficial in stubborn cases and in those with no obvious first line drug, such as eating disorders and addiction.

One reason for the sometimes odd pairings of illnesses and drugs is that many different brain states can produce the same mental symptoms, and many different symptoms can arise from the same brain state. The mind has not yielded all its mysteries quite yet.

(Edited for space. Thanks to Al & Judy Peraino for this!)

Who's your anchor? (I know who mine is....)

When Medicine Got it Wrong

NAMI will kick off its 30th anniversary on July 5th at the national convention in San Francisco with a special screening of the PBS documentary When Medicine Got it Wrong. The film, produced by Katie Cadigan, is about NAMI's dramatic grassroots origins and founding as a national organization.

When Medicine Got it Wrong focuses on the years when most doctors blamed parents for schizophrenia or other disorders in their children and the loving parents who rebelled against the conventional wisdom and rejected those theories. Their activism helped revolutionize treatment and spur investment in scientific research, recognizing mental illness as a physical illness involving the brain. The documentary will premiere nationally on PBS in the fall of 2009.

Cadigan hopes the film will inspire people "to evaluate our collective responsibility to treat and care for those among us with severe mental illness... The film will be a success if it sparks dialogue about the current state of our mental health care system." Cadigan's brother, John, lives with schizophrenia and in 2004 she won a NAMI award for producing People Say I'm Crazy, directed by her brother -- the first major film directed by a person living with schizophrenia.

To Dad, with love

This morning I got a text from my dear daughter-in-law that read,"Happy 'Father's day' to a lovely lady who did both parenting roles for two kids. You are loved by all your youngins.!" Tickled me pink to get that as I clearly remember the challenge of trying to fill those shoes... buying my son a jock strap for Little League, explaining the birds and the bees and later having the "protection" talk over a box of condoms- not much fun for either of us. I often fretted about the lack of a healthy male role model, for both of my kids, as a little girl also learns how a woman should relate to a man from her father. But for my son (with the challenge of a mental illness,) this lack of a role model and of the acceptance and approval of a man- it always seemed so hurtful to him. His biological father just wasn't up to the challenge of accepting his boy as perfectly imperfect.

Father's Day means more to me today than it ever has. My life has been graced by a wonderful, caring man who has embraced the role of 'Dad' like he was born to it. His affection and acceptance of my children is unprecedented as he never had any of his own. But it goes beyond that. My husband and I had only been married for 4 months when my son attempted suicide. While my son slept on my couch, not showering, moving only to eat and then to engage only with a computer for months, my new husband rose to the challenge. He attended the 12 week Family to Family course with me and learned about mental illness. He talked to my boy, and really listened, he gave him space, he gave him time. Their relationship has only grown sweeter to me through the last four years. I realized I didn't have to be 'dad' anymore.

I missed out on a father. I'm so glad my kids finally have a Dad. Happy Father's Day.

Bullied to Death

Addressing harassment and suicide prevention in schools
By Charles Robbins, Executive Director & CEO, The Trevor Project and Eliza Byard, PhD, Executive Director, the Gay, Lesbian and Straight Education Network (GLSEN)

The impacts of language and behavior can be deadly, especially in a school environment where young people are already highly impressionable and vulnerable. Unfortunately, this difficult lesson has been conveyed many times when young people resort to drastic and permanent measures to escape the despair of enduring constant bullying and harassment at school.

It is deeply disturbing that on April 6, Carl Joseph Walker-Hoover, an 11-year-old sixth-grader from Springfield, Mass., hanged himself with an extension cord in his family’s home after being subjected to continuous anti-gay bullying and harassment at his middle school. It is equally as disheartening that on April 16, less than two weeks later, Jaheem Herrera, an 11-year-old fifth-grader from DeKalb County, Ga., also hanged himself at home after being the subject of anti-gay taunts from his classmates. These were two completely separate and isolated instances, but the tragic and preventable nature of each unfortunate loss of life remains the same.

Neither Carl nor Jaheem identified as gay, yet their peers’ defamatory language and hurtful behaviors broke the barriers of sexual orientation and gender identity. Being taunted as “faggot,” “queer” or “homo” by classmates is offensive and demeaning to any student – straight, gay, lesbian, bisexual, transgender and questioning alike.

Carl is the fourth middle school student this year to complete suicide due to bullying, and Jaheem was still in elementary school. Older students are also at a high risk, as suicide is one of the top three causes of death among 15 to 24-year-olds and the second leading cause of death on college campuses. Lesbian, gay, bisexual, transgender and questioning youth are up to four times more likely to attempt suicide than their heterosexual peers, and those who come from a rejecting family are up to nine times more likely to do so.

Enough is enough. It is time for school administrators, educators, parents, students and the government to work together to stop bullying and harassment in schools. Furthermore, we must teach young people to understand the profound impact of words and actions, and to recognize depression and suicidal ideations amongst their peers. By helping young people take responsibility for their actions and respect their peers, and simultaneously empowering them with the knowledge and skills they need to understand when their classmates are in crisis, we can work toward ending the dual epidemics of school bullying and youth suicide once and for all.

It is our hope that in memory of Carl and Jaheem, and in honor of all young people who have completed suicide after enduring constant torment at school, we will be able to work together to promote school environments that celebrate diversity and encourage acceptance of all people. Only then will we be confident that our children are receiving the respect and education they deserve today in order to become the successful and equality-minded leaders of tomorrow.

The Trevor Project is the non-profit organization that operates the only nationwide, around-the-clock crisis and suicide prevention helpline for lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth. The Trevor Project was established in 1998 to promote acceptance of LGBTQ youth, and to aid in crisis and suicide prevention among that group.

GLSEN, the Gay, Lesbian and Straight Education Network, is the leading national education organization focused on ensuring safe schools for all students. Established nationally in 1995, GLSEN envisions a world in which every child learns to respect and accept all people, regardless of sexual orientation or gender identity/expression

Musing on suicide as we say goodbye to David

On June 4th, we lost one of my favorite actors, David Carradine. I loved the old Kung Fu series and watched it in syndication for years... I still use the moniker "grasshopper" when explaining just about anything to anybody; it will probably always make me smile. I had a huge pre-adolescent crush on Caine, who was so unshakable and such a badass. I was delighted to see Carradine in the Tarantino Kill Bill flicks, back to work in something worthy of him and looking fabulous for his age. I was horrified to hear the news of his death, an apparent suicide.

Of course, now the word "apparent" is taking the forefront; Carradine was working on a film and in good spirits and it seems far more likely that his death was accidental. This brought me back to a recent conversation in our mental health support group - we often talk about suicidal feelings as many of us experience them and support group is for... support. Talking about difficult feelings in a safe place often diffuses them somewhat and it never hurts to know that you are hardly the only one who feels that ending the pain might just be a workable solution.

So anyway, part of this conversation revolved around how many suicides are indeed accidental... the result of simply not being too on top of just how many xanax you've actually taken and rinsing them down with wine instead of water. Let's face it, if you're in the pit of depression or, even worse, flying high on the wave of mania, you are not exactly thinking clearly. You are NOT rational, you are NOT in control, and you are probably NOT the person who should be dispensing your medication, or driving your car, or trying some new risky adventure. But you're probably still going to do those sorts of things and you might end up dead. Even if that really wasn't your intention.

This brings us to the question of having a safety plan. I nag about this constantly. You need to create a plan when you're good, when you're rational, and you need to know it by heart so that when you're not good and not rational, you will turn to it by rote, out of habit. That plan needs to include someone you trust that can look after you a bit, check up on you, say NO to you. That plan needs to include a place of safety and a thing that will take you from zero to survival. The thing can be a walk, a long bath, going to a movie, getting out with people - only you know what will turn you momentarily away from the abyss. Let me emphasize that this thing only has to take you from zero to survival - not to feeling well, or even feeling better. If you're still willing to breathe another breath, that's the ticket.

Maybe David didn't have a safety plan. And maybe it was all just a horrible accident. Either way he will be missed.

And so would you.

Mental Health and the Fairer Sex

A new report released today on gender-based differences in mental health shows women are nearly twice as likely as men to suffer from major depression. The report addresses many other mental health issues facing women, including the effect trauma and violence can have on long term mental health, and outlines action steps for policy makers, health care professionals and researchers.

Action Steps for Improving Women's Mental Health, released by the U.S. Department of Health and Human Services' Office on Women's Health (OWH), brings together the most recent research on mental health issues in women and explores the role gender plays in diagnosing, treating and coping with mental illness. It also points to resiliency and social support systems as key factors in overcoming mental illness. Other highlights include:

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Rates of anxiety disorders are two to three times higher in women than men.
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Having a history of violence, trauma or abuse is associated with increased risk of depression, post traumatic stress disorder (PTSD), panic disorder and a tendency to engage in risky behaviors.
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Female veterans may face a higher risk of PTSD than their male counterparts.
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Family and other interpersonal connections in a woman's life may play an important role in building resiliency and offering protection from mental illness.

Acting Surgeon General Steven Galson, M.D., M.P.H., emphasizes, "Mental illness is often incorrectly perceived as a weakness, which prevents women from recognizing the signs and symptoms and seeking treatment. In order to reduce stigma, we need to encourage open, honest conversations."

The report also outlines specific action steps for policy makers, health care providers, and researchers to take in an effort to address the burden of mental illness on women's lives and increase their capacity for recovery. "We have an unprecedented opportunity to improve the mental health of women," says Dr. Wanda Jones, Director of the Office on Women's Health and Deputy Assistant Secretary of Health in the U.S. Department of Health and Human Services. "Our hope in releasing this report is that these groups will come together and turn these recommendations into action so that we better the health of our nation."

The Office on Women's Health also produced a booklet for women that addresses the stigma associated with mental health. Women's Mental Health: What It Means To You includes information on the signs and symptoms of mental illness, suggestions about where to turn for support and solutions for preventing and coping with mental illness.

Action Steps for Improving Women's Mental Health and Women's Mental Health: What It Means To You are available for free by visiting www.womenshealth.gov or by calling 1-877-SAMHSA-7 (1-877-726-4727).