Saturday, September 11, 2010

Top 10 Controversial Psychiatric Disorders -Part 2

8. Narcissistic Personality Disorder - Someone with an inflated ego, need for constant praise and lack of empathy for others might sound like a shoe-in for psychotherapy. But the introduction of narcissistic personality disorder into the DSM in 1980 was not without controversy. The biggest problem was that no one could agree on who had the disorder. Up to half of people diagnosed with a narcissistic personality also met the criteria for other personality disorders, like histrionic personality disorder or borderline personality disorder, according to a 2001 review in the Journal of Mental Health Counseling. Which diagnosis they got seemed almost arbitrary. To solve the problem, the American Psychiatric Association has proposed big changes to the personality disorder section of the DSM-5 in 2010. The new edition would move away from specific personality disorders to a system of dysfunctional types and traits. The idea, according to the APA, is to cut out the overlap and create categories that would be useful for patients who have personality problems, not just full-blown disorders.

7. Dissociative Identity Disorder -
Once known as multiple personality disorder, dissociative identity disorder was made famous by the book "Sybil" (Independent Pub Group, 1973), which was made into a movie of the same name in 1976. The film and book told the story of Shirley Mason, pseudonym Sybil, who was diagnosed as having 16 separate personalities as a result of physical and sexual abuse by her mother. The book and the movie were hits, but the diagnosis soon came under fire. In 1995, psychiatrist Herbert Spiegel, who consulted on Mason's case, told the "New York Review of Books" that he believed Mason's "personalities" were created by her therapist, who -- perhaps unwittingly -- suggested that Mason's different emotional states were distinct personalities with names. Likewise, critics of the dissociative identity diagnosis argue that the disorder is artificial, perpetuated by well-meaning therapists who convince troubled and suggestible patients that their problems are due to multiple personalities. Nonetheless, dissociative identity disorder has weathered this criticism and won't undergo any major changes in the DSM-5. (ed. note - Having met someone who underwent extensive therapy and reached recovery with this diagnosis, I'm having trouble believing it doesn't exist... it may be rare, but I think it's real.)

From an article by Stephanie Pappas. First installment here.

Top 10 Controversial Psychiatric Disorders -Part 1

The proposed revisions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) have spurred debate over what illnesses to include in the essential psychiatric handbook. Everything from gender identity disorder to childhood mood swings has come under fire, and it's not the first time. The history of psychiatry is littered with impassioned fights over controversial diagnoses.

10. Hysteria -In the Victorian era, hysteria was a catch-all diagnosis for women in distress. The symptoms were vague (discontentment, weakness, outbursts of emotion, nerves) and the history sexist (Plato blamed the wanderings of an "unfruitful" uterus). The treatment for hysteria? "Hysterical paroxysm," also known as orgasm. Physicians would massage their patients' genitals either manually or with a vibrator, a task they found tedious but surprisingly uncontroversial. More contentious was the practice of putting "hysterical" women on bed rest or demanding that they not work or socialize, a treatment that often worsened anxiety or depression.According to a 2002 editorial in the journal Spinal Cord, the diagnosis of hysteria gradually petered out throughout the 20th century. By 1980, hysteria disappeared from the DSM in favor of newer diagnoses like conversion and dissociative disorders.

9. Penis Envy -
Sigmund Freud revolutionized psychiatry in the late 1800s and early 1900s with his theories on the unconscious state, talk therapy and psychosexual development. Nowadays, many of these theories -- like his conclusion that young girls' sexual development is driven by jealousy over lack of a penis and sexual desire for their father -- seem outdated. But not everyone has consigned Freud to the dust heap. Organizations like the American Psychoanalytic Association still practice and promote Freudian-style psychoanalysis, and groups like the International Neuropsychoanalysis Society try to combine cutting-edge neuroscience research with Freud's century-old theories. How successful they'll be is unknown: A 2008 study in the Journal of the American Psychoanalytic Association found that today's psychology departments rarely teach psychoanalysis.

Ed. note: From an article by Stephanie Pappas on LiveScience.

Saturday, September 4, 2010

10 Ways to Reduce Anxiety... Part 4

8. Breathe it out. You may notice that when your body is tense you hold your breath. Focusing on breathing is a common but effective technique for calming the nerves. Where is your breath now, and where is your mind? Bring them together. Listen to the movement of your breath. Does your mind wander somewhere else? Call it back. Concentrate only on breathing in and out, beginning and ending, breath to breath, moment to moment.

9. Make peace with time. When you're a worrier, everything can feel like an emergency. But notice this about all your anxious arousal: It's temporary. Every feeling of panic comes to an end, every concern eventually wears itself out, every so-called emergency seems to evaporate. Ask yourself, "How will I feel about this in a week or in a month?" This one, too, really will pass.

10. Don't let your worries stop you from living your life. Many of them will turn out to be false, and the consequences of your anxiety -- less sleep, a rapid pulse, a little embarrassment-- are just inconveniences when it comes down to it. What can you still do even if you feel anxious? Almost anything.

Ed. note: Part of an excellent series by Robert L. Leahy, PhD and director of the American Institute for Cognitive Therapy in NY, NY. See the first three installments here, here, and here.

Thursday, August 19, 2010

‘Magic’ anti-depressant?

Ketamine, a general anesthetic usually administered to children and pets but perhaps best known as a horse tranquilizer, is also highly effective in low doses as an anti-depressant, according a study published Thursday.

Researchers at Yale University wrote in the August 20 issue of the journal Science that unlike most anti-depressants on the market which can take weeks to take full effect ketamine can begin to counter depression in hours.

"It's like a magic drug -- one dose can work rapidly and last for seven to 10 days," said Ronald Duman, professor of psychiatry and pharmacology at Yale and senior author of the study.

The researchers noted that ketamine was tested as a rapid treatment for people with suicidal thoughts. Traditional anti-depressants can take several weeks to take effect, they noted.

About 40 percent of people suffering from depression do not respond to medication, and many others only respond after many months or years of trying different treatments.

Read the rest of the story here....

Wednesday, August 18, 2010

I Walk Alone

I walk a lonely road

The only one that I have ever known

Don't know where it goes

But it's home to me and I walk alone



I walk this empty street

On the Boulevard of Broken Dreams

Where the city sleeps

and I'm the only one and I walk alone



My shadow's the only one that walks beside me

My shallow heart's the only thing that's beating

Sometimes I wish someone out there will find me

'Til then I walk alone



I'm walking down the line

That divides me somewhere in my mind

On the border line

Of the edge and where I walk alone



Read between the lines

What's fucked up and everything's alright

Check my vital signs

To know I'm still alive and I walk alone



My shadow's the only one that walks beside me

My shallow heart's the only thing that's beating

Sometimes I wish someone out there will find me

'Til then I walk alone



I walk this empty street

On the Boulevard of Broken Dreams

Where the city sleeps

And I'm the only one and I walk alone



My shadow's the only one that walks beside me

My shallow heart's the only thing that's beating

Sometimes I wish someone out there will find me

'Til then I walk alone...



So Green Day hits the nail on the head with this song, no? Sometimes checking my vital signs doesn't convince me.... and the truth of the matter is that no one "out there" will find me, or give me any answers. Not today anyway.

Wednesday, July 21, 2010

Was Bullying Really Behind Phoebe Prince's Suicide?

Coverage of Phoebe Prince's bullying (ours included) has told the story of a clique of evil kids systematically tormenting an outcast. But now one reporter says this isn't accurate — and the bullies are victims too.

In an exhaustively researched and frankly pretty disturbing series of articles for Slate, Emily Bazelon questions the dominant narrative (again, promulgated in this space as elsewhere) of South Hadley High School mean girls and their erstwhile boyfriends hounding Phoebe Prince to death. Her basic points:

— Prince was depressed and troubled before the bullying started. She missed her absent father, engaged in self-mutilation, and had tried to commit suicide once before, in response to the breakup of a relationship (with senior Sean Mulveyhill, now charged with a civil rights violation and statutory rape in connection with Prince's death).
— Though it led to tragedy, the bullying Prince suffered was neither systematic nor organized (one teen actually stopped when school officials told her to, yet still faces criminal prosecution), and was not extraordinary for teens — several students called it "normal girl drama."
— The six students charged in Prince's death face prosecution not because their actions were so heinous, but because South Hadley has an overzealous district attorney with a history of seeking excessive punishment.

Of these, the last is the most upsetting. In 2007, South Hadley DA Elizabeth Scheibel slapped a 17-year-old kid who had Asperger's with charges carrying a maximum 60-year sentence, all for making YouTube videos of himself lighting explosives in a field (he was acquitted). And there's evidence, according to Bazelon, that Scheibel was punishing the bullying teens for their school's negligence. Bazelon writes, "Scheibel and her staff stepped in because they thought South Hadley High mishandled the lead-up to and the aftermath of Phoebe's death. Does that amount to penalizing teenagers because the adults failed to do so?" Maybe — especially if it's true that, as Bazelon says, their bullying was far less organized and far shorter in duration than Scheibel claims. And certainly the teens, who could face up to 10 years in prison, are being much more harshly punished now than they ever could have been by their school.

This new take on the Prince case exposes two serious and related problems. One is how catastrophically bad schools are at identifying and helping at-risk kids. Bazelon writes that Phoebe's mom told the school that Phoebe had suffered bullying in her native Ireland and was on antidepressants, but the school didn't mount any sort of concerted effort to help her, or notify administrators of her troubles — even after her first suicide attempt. The principal even said "she seemed to be doing pretty well when she came back" from that attempt, and didn't seem in need of further monitoring. But all the while, Prince was, according to Bazelon, "asking for help from older boys who seemed ill-equipped to provide it." In a heart-wrenching statement, one such boy told police,

She lifted up her hoodie and showed cuts on her chest above her bra and all the way down to her hips. I really didn't look too long. I found it to be very painful. This was someone I cared about and she was harming herself. Phoebe asked for help healing them. I told her to use Neosporin but I wasn't too sure.

And these boys lead into the second problem that contributed to Prince's death: slut-shaming. Phoebe's bullying back in Ireland also had to do with her seeing older boys, and an anonymous adult says of her troubles at South Hadley, "In the end you can call it bullying. But to the other kids, Phoebe was the one with the power. She was attracting guys away from relationships." Not all the boys Prince has been linked to were actually in relationships at the time she was seeing them, but regardless, the claim that she "attracted them away" is a bit slut-shaming in itself. A fellow student seems to understand the situation better: "Each person had his own conflict with Phoebe-that's what no one outside our school seems to understand. The girls found out she'd been with the boys, and true to high-school girls, they got mad at the girl instead of the boyfriend."

That's how society seems to work too, not just high-school girls, and it appears Prince got caught in a vicious cycle. No adults stepped in to help her, so she turned to older guys, which only made other girls madder. There's no excuse for the way some of these girls — and allegedly Sean Mulveyhill as well — treated Prince. Bazelon doesn't dispute that the teens called Prince a "whore" and a "cunt" and harassed her in school on at least two occasions. But it's not clear that this behavior deserves a ten-year prison sentence, especially since throwing the book at the teens may obscure the systemic problems that led to Prince's death in the first place. Nothing Bazelon has uncovered excuses bullying — but it does expose how deeply incompetent schools are at protecting troubled kids and preventing slut-shaming, and how endemic such shaming is both here and, apparently, in Ireland. To pretend that Prince's death was solely caused by a few kids who were simply evil is to ignore these very serious problems — and potentially to keep other kids like Prince from getting the help they need.

Thanks to Jezebel for this story.