Archive for June, 2009
Pres. Obama Should Push Back On Questions About His Smoking
I’ve noted before that the DC media has had much fun poking at President Barack Obama about how much he still smokes and how I think the media ought to stay out of the President’s private life (or do they plan on asking what he eats each day, if he drinks soda pop and whether he and the First Lady have sex?) and stick to far more important questions.
But, no. During yesterday’s press conference a reporter who identified herself as a former smoker went after President Obama about smoking. If I’ve watched one trend over my 15 years as a reporter, it’s that once a media person stops drinking or smoking (or whatever), they become most virulent in attacking that which they once did. For instance, I know of recovering alcoholics in the press corps who will go hammer-and-tong on homeless housing programs where chronic inebriates are allowed to drink, even though there’s good evidence that such programs are helpful, simply because the method of stopping drinking that worked for them must work for one and all (no, I won’t get into any names here). You’d think their editors would be smart enough and attentive enough to questions of unfair bias to assign such stories to clearer minds, but when it comes to that perceived to be a vice all those old standards fall apart.
Here’s yesterday’s exchange (deep down in this transcript) between McClatchy’s Margaret Talev and President Obama:
“Q: How many cigarettes a day do you now smoke? Do you smoke alone or in the presence of other people? And do you believe the new law would help you to quit? If so, why?”
“THE PRESIDENT: Well, first of all, the new law that was put in place is not about me, it’s about the next generation of kids coming up. So I think it’s fair, Margaret, to just say that you just think it’s neat to ask me about my smoking, as opposed to it being relevant to my new law. (Laughter.) But that’s fine, I understand. It’s an interesting human — it’s an interesting human interest story.
“But I’ve said before that, as a former smoker, I constantly struggle with it. Have I fallen off the wagon sometimes? Yes. Am I a daily smoker, a constant smoker? No. I don’t do it in front of my kids, I don’t do it in front of my family, and I would say that I am 95 percent cured, but there are times where — (laughter) — there are times where I mess up. And, I mean, I’ve said this before. I get this question about once every month or so, and I don’t know what to tell you, other than the fact that, like folks who go to AA, once you’ve gone down this path, then it’s something you continually struggle with, which is precisely why the legislation we signed was so important, because what we don’t want is kids going down that path in the first place. Okay?”
If the President was once a pack-a-day smoker, then 95 percent cured would translate into something on the order of seven cigarettes a week as his current consumption (rumor has it he smokes Parliament Lights, or P-Funks as they are known), plus all that nicotine gum he reportedly chews–and the media is chipping him up about it? And asking if he smokes in front of others? Does Talev ask stupid, biased questions in front of the world? Please. I’m glad the President called Talev, clearly religious on the matter (hopefully, her bureau chief chewed her ass out afterwards), out for messing with him on what is fundamentally a trivial matter and a personal choice.
That said, I’m a bit tired of watching the President handle the smoking question with such selfishness (I don’t know another term to use here, but I can assure you that his smoking is not all about him). The reason the media keeps pressing him on smoking has very little to do with him per se and everything to do with a culture war over smoking and other Nanny State concerns (food, soda pop, weight, exercise, guns, etc.). Between 40 million and 50 million American adults smoke cigarettes regularly and there are millions more closet smokers out there as well. The sheer persistence of this bloc of smokers drives the anti-smoking advocacy groups (funded with billions of dollars from pharma companies, pharma-connected foundations and a huge slush fund from the Master Tobacco settlement of the 1990s) and Nanny State health departments absolutely batty. They’ve been rolling out their smoking education programs since the early-1990s (often making spurious claims about smoking), running smoking ban initiatives throughout the country (often making unscientific claims about secondhand smoke), driving up the price of cigarettes and other tobacco through their tax-loving minions in various state legislatures and the Congress and, finally, getting regulation of tobacco into the hands of the FDA. And yet 40 million to 50 million adult Americans make the choice each day to light up. (For the record, I am one of them.)
What the anti-smoking advocates want is a big symbolic victory, their grand teaching moment and they want it in the form of President Obama.
I think that the President should use the opportunity to shift the conversation from one of when is he going to quit 100 percent (from the looks of things, I’d say never) to pointing out to his occasional interrogators on the subject that the tens of millions of Americans who do smoke also have rights and that those rights are being trampled on a regular basis. I don’t even think I need to get into the housing discrimination that smokers now face across the country and that a lot of that discrimination disproportionately targets lower-income Americans and, in some cases, Americans with mental illnesses such as schizophrenia (some of the most disadvantaged Americans of all). The President ought to use questions about his smoking to point out how nutso this kind of discrimination has gotten (real world example: a friend of mine in Seattle was recently denied a new apartment due to the fact that he told the landlord he wouldn’t smoke on the property and the landlord told him that he wouldn’t rent to a smoker under any circumstances regardless of where they smoked), particularly in regards to a product that is legal (or are we going to start denying rental housing to someone who drinks a six-pack a week?). It would be really nice to hear the President go all-contrarian and community organizer on the ex-smokers who toy with him.
I think President Obama should use future questions about his smoking to make the point that, like it or not, nicotine is a stimulant, well-known as such for hundreds of years and that it does have beneficial effects (as does caffeine, as do other stimulants). The President could even use these supposed teaching moments for a teaching moment of his own and ask why if so many millions are into nicotine while the most common delivery method of said nicotine is allegedly so bad, then why hasn’t some smarty pants come up with a better, safer nicotine delivery method. I can assure you that nicotine gum is not a replacement and neither are the Swedish snus and the e-cigarettes. There is something deeply magical about a cigarette and perhaps it’s time for a federal stimulus program to find a way to replicate that magic in a more socially-acceptable form.
In other words, it’s time for President Obama to stop acting so conflicted about his own smoking and embrace it a bit more, at least psychologically, and also realize that the game is far bigger than his own smoking and that it speaks to the concerns, in all directions, of many millions of Americans who smoke and are feeling quite put upon these days.
It sure would be a hell of a lot simpler than figuring out what tone to strike on Iran, dealing with the economy or engineering a victory on health care reform.
Posted in Sen. Grassley Goes After Medical Schools To Reveal Pharma Ties Policies
Sen. Charles Grassley (R-Iowa) has struck again, today sending a letter to 23 medical schools and asking them to reveal policies on conflicts of interest and requirements for disclosure of financial relationships between faculty and Big Pharma. The 23 schools had previously not responded to a similar request from the American Medical Student Association.
“‘There’s a lot of skepticism about financial relationships between doctors and drug companies,’ Grassley said in a statement. ‘Disclosure of those ties would help to build confidence that there’s nothing to hide.’”
Schools on the list include Tulane University School of Medicine, Dartmouth Medical School, Howard University College of Medicine, Louisiana State University School of Medicine – New Orleans, New York College of Osteopathic Medicine of the New York Institute of Technology, University at Buffalo School of Medicine and the University of South Carolina School of Medicine.
It ought to be fun to see what kinds of responses the Senator gets.
Not-so-lucky 13
One of the things psychiatrists try to assess during the mental exam is judgment. Mostly we guess, be we’re not bad guessers, and we usually can tell how someone’s judgment is by listening to the stories they tell about their lives.
What makes for bad judgment? Children often don’t have the best judgment, an issue of maturity and experience to help form it. Teenagers, particularly boys, aren’t noted for their great judgment, either. Substance abuse lead to bad decision in realms beyond those that can simply be attributed to the pursuit of a substance. Mental illnesses, particularly mania, are marked by poor judgment, and certainly brain tumors, delirium, intoxication…..
Okay, so I’m pasting an article from the Associated Press about a mom who was denied custody of her children when she came to court after 13 beers. If she was hoping to get the children back, I think it’s safe to say she might have impaired judgment (”might”….oy I’ve never seen her, who knows if AP is reporting this accurately, and so I’m hedging…)…found it in my local paper under “Weird news”…
3:22 PM EDT, June 24, 2009
FORT SMITH, Ark. (AP) — A mother who drank 13 beers before a psychological evaluation failed to recover custody of her three young children despite claiming she wasn’t drunk because she “can drink like a fish.” The woman wanted to get the children back from her husband’s stepmother. The Arkansas Court of Appeals rejected her Wednesday, citing addictions, frequent absences and criminal activity to support her habits. It said the woman made no meaningful efforts to restructure her life. The children are ages 6, 4 and 4. The state took custody in 2007 when the woman’s mother said she could no longer care for the children. Human Services workers later won an order declaring the children’s mother unfit and want to see the children adopted.
Take me away: Gov. Sanford
So I feel pretty silly, not knowing or even suggesting to anyone that Governor Sanford was having an affair, wasn’t hiking in the Appalachians as he led us to believe.
The transcript of his confession indicates that he’s getting some religious coaching, attends a bible study, and is trying to work this through whatever this is. No matter, he says, his heart is in the right place. We’re not judging.
Five months later, still attending to his studies, still consulting with his spiritual advisers, still no change. Just blather about a walk in the woods, more lies, and another disappearing act or three. More misbehavin’.
Are we out of line to suggest the obvious? Like, Get therapy, Governor Sanford.
Thanks Mary Ann Chastain at The Fix-Chris Cillizza’s politics blog at the Washington Post for that photograph that what will be, one day, famous, maybe already is.
Man cries. Feels the angst.
During the day the news just got juicier– while my sympathetic post from this morning, alas, all about getting away, finding a happy medium between tuning out and neglecting one’s relationships, did not.
That said, here you go. At least you find out what I did yesterday, knocking off work. And you’ll see, apparently, I wasn’t the only one duped.
There are ways of getting away, you know, and there are ways of getting away.
You can do what Governor Sanford did, hop into your SUV with your hiking boots to commune with nature; or you can say to your best friend, your main squeeze, that significant other, not just anyone,
Take me away.
Which is what we did, me and FD, took off a weekday to celebrate our 34th anniversary, 35th year of our relationship.
We pretended we were going on our first date and bopped around downtown. The idea was to enjoy the day together, see the people, feel the pulse, but focus on each other. If only for a day. Our phones would still ring and we would take calls, as always. But we could do it, get away, the easy way.
Before getting out of the house, however, FD handed me the Wall Street Journal and said, “Can you kindly make sense of this story for me? As a mental health professional, can you please tell me:
What is going on with this guy!!??”
In case you’re unfamiliar with the story, South Carolina Gov. Mark Sanford took off last Thursday night in a sports utility vehicle, unattended by his bodyguard, for five days. Alex Roth and Valerie Bauerlein at WSJ tell us,
Mr. Sanford has regularly ditched his bodyguards when taking a run or dashing out to Taco Bell or other favorite spots in the past.
He didn’t tell anyone where he was going, apparently felt like hiking the Appalachian Trail. The word is that the Governor does this now and again, turns off his phone and doesn’t tell anyone where he is going, usually after a legislative session. He needs to unwind.
He has a lot on his mind, and one way to clear it is to take off.
Except that he’s the Governor. That’s Governor with a capital g, a man many hope to be a US Presidential contender in 2012.**
That’s basically the whole story. Man gets tired of it all. Man goes off into the woods, does whatever it is guys do when they need to get away.
Everyone copes differently. And it’s likely that the good people of South Carolina could care less. They elected him, and they know the score. The state is a mess and Sanford doesn’t want to accept the Federal stimulus package, the President’s bail out, doesn’t believe in it.
This might be a difficult thing for an elected official to pull off, turning down $700 million dollars.
That’s a lot of stress.
First Lady Jenny Sanford of Winnetka, Illinois, by the way, a long way from home, told the Associated Press on Monday that she hadn’t heard from him, but that he
“was writing something and wanted some space to get away from the kids.”
And FD wants to know what I think.
I’d say, quick and dirty, that the Sanford marriage is a good example of how far a guy can stretch that rubber band and still not break it. We’re not hearing Mrs. Sanford complaining to reporters. In fact, she’s avoiding them. A little space can be good for a relationship.
We also hit a wedding last night and balancing hors d’euvres and drinks with two other women, both of them started to tell me this story at the exact same moment. It was hysterical because neither stopped, so it was hard to hear what either of them said, but one surely thought it outrageous that Governor Sanford does this, goes unaccountable for four days running, and the other thought it phenomenal.
His fan, the one who thought it phenomenal, screamed, “Poor guy decides to turn off his phone for a couple of days and everyone acts as if he’s committed a federal offense.”
Well, leaving the state unattended may not be a federal offense, but it’s not exactly model citizenship.
The women are talking at me, and the crowd starts to fill in, everyone’s all dressed in their best, one guest more beautiful than the next, and all of a sudden I’ve got that song in my head, the Natasha Bedingfield song*, the one that goes,
I got a pocket, got a pocketful of sunshine.
I got a love, and I know that it’s all mine.
Oh.Do what you want, but you’re never gonna break me.
Sticks and stones are never gonna shake me.
No.Take me away: A secret place.
A sweet escape: Take me away.Take me away to better days.
Take me away: A higher place.I got a pocket, got a pocketful of sunshine.
I got a love, and I know that it’s all mine.
Oh.Wish that you could, but you ain’t gonna own me.
Do anything you can to control me.
Oh, no.Take me away: A secret place.
A sweet escape: Take me away.There’s a place that I go,
But nobody knows.
Where the rivers flow,
And I call it home.And there’s no more lies.
In the darkness, there’s light.
And nobody cries.
There’s only butterflies.Take me away: A secret place.
A sweet escape: Take me away.Take me away to better days.
Take me away: A higher place.The sun is on my side.
Take me for a ride.
I smile up to the sky.
I know I’ll be all right.The sun is on my side.
Take me for a ride.
I smile up to the sky.
I know I’ll be all right.
It’s not all that hard to do this, you know, get away. It’s a psychological thing, or it can be. Sometimes being with a lot of people, being anonymous (or not) in a huge crowd, in the big city, is as good as it gets.
We really did pretend it was our first date, a blind date. I’m by myself at the fountain (in reality he’s dropped me off to park the car).
I get a call.
It’s him.
“I’m nearing the park,” he says. “How will I recognize you?”
“I’m in a black dress, standing by the red sculpture, overlooking the fountain, talking on the phone.”
“Okay. I’m wearing a dark straw hat.”
“A straw hat?”
“Uh, huh.”
I see him approaching and I walk towards him. “Excuse me, are you looking for me?”
“Are you ____?”
“Yes. Did you bring food?”
That’s kind of how our dates go.
Anyway, it was fun, people-watching and reminding ourselves what it was like to be young, or merely to be on vacation. For who has time, anyway, even if you’re not a governor, in the middle of the day, in the middle of the week, to go downtown and look at the skyline?
We were too late to get into the Art Institute, but the gardens were open and some high school aged kids were romping around, taking each others’ pictures.
And we made it to the that wedding, too, which was wonderful.
So no, we didn’t turn off our phones, and miraculously, neither of us had many calls. It was like they knew, not that we told anyone. And he looked great, and he said I did, too. It’s nice to dress up and just go.
Millenium Park teemed with people, for it always does, and everyone it seemed was in a good mood.
It’s been a long winter and summer’s finally here.
Here are a couple of pictures, in case you’ve never been to Chicago’s downtown playground. The monolith with the reddish portrait is a moving picture, the camera is on her, I think, and she’s in the park somewhere, for all we know. It’s really quite remarkable. You can’t tell, maybe, but the monolith is a fountain.
And these kids are just goofing around by the Chinese sculpture exhibit. They’re not the art students mentioned above, but they’re quite adorable.
So I’m thinking, Governor Sanford, maybe you could do this, too. Grab the missus and take her with you, wherever it is you go, or perhaps compromise, go someplace she wants to go that works for you, too. Get a sitter if you have to, tell someone how to reach you, and go. Start working on a smaller rubber band.
For the sake of the nation, the Republicans would say.
And maybe take in a wedding, while you’re at it.
Although something tells me you won’t see weddings like this one in South Carolina. But I could be wrong. They’re feel-good events, in any case. Most of the time.
therapydoc
*If you’re religious and blush easily and don’t like seeing alluring women singing in YouTube videos, don’t watch this one with Natasha Bedingfield singing Pocket Full of Sunshine.
**This is NOT a political blog, not an endorsement of Gov Sanford for president in 2012. It’s just a story and he happens to add the brushstrokes. Thanks, Gov, and I hope someone checked you out for lime disease.
Slow, Slow News Week
It happens each year and usually in June, and so far this week I’ve seen very little news on interest or import on the mental health front. I doubt that the trend lasts, so I expect to be back to a vaguely regular pace soon, perhaps later today.
How to Overcome Challenges
Life is full of challenges and learning how to meet them, and overcome them, is one of Life’s lessons. Here are a few things I have learned about dealing with Life’s little curve balls.
1. Emote
Feel your feelings and let them out in whatever way you feel comfortable. If your challenge scares you, hurts you, angers you or grieves you, express it. Whether you cry on a friend’s shoulder, use your anger to remodel the spare bedroom, use your pain to start a support group for others facing the same challenge or quake with fear – get it out. Tell it to others, sing it, journal about it, paint it, whatever method serves you best.
2. Connect
The support of helpful friends and family is important when you are faced with difficult challenges. I emphasize helpful here. Having a friend around who always has a bigger problem than you, or a sibling who drags a mountain of negativity into the room with her, or a mother who is a professional critic is not helplful when you are trying to deal with your own challenge. You may want to take this opportunity to notice who shows up and is there for you. When you have recouped, you may want to invest more in these relationships.
3. Sleep
Be sure to get plenty of sleep. If you are feeling stressed and losing sleep because of it, you may want to consider doing something calming before bedtime, using a natural sleep aid like melatonin, or developing a nighttime ritual to help calm yourself and promote good sleep. Deep sleep is when your body repairs itself and heals the ravages of the day. If you are stressed, your body is experiencing additional wear and tear so sleep becomes even more important. Sleep also mends your mind and allows you to concentrate better and think more clearly the next day.
4. Exercise
If your challenge is not one which affects your health, be sure to maintain your daily exercise routine (or perhaps invest in a new one). I found that an hour of intense weight lifting a few hours before bedtime wore me out and made me sleep like a rock. Swimming has the same effect for me. Yoga, Tai Chi and Qi Gong have all been shown to help with anxiety and stress. They emphasize the importance of deep, rhythmic breathing which we often forget to do, especially when stressed. Strenuous exercise can also help burn off stress hormones released into the body. It may help you run off anxiety, but it may also increase it. Test it and see whether strenuous exercise or something more calming like yoga is more helpful to you. But get up and move in some way.
5. Drink
Water! A body that is hydrated has more energy and flushes away toxins more readily. Water aids digestion, cushions vital organs, and helps the body regulate its temperature. Not drinking enough water can increase fatigue and make your thinking fuzzy. When your body is already stressed, be sure to keep it hydrated.
6. Monitor Your Thoughts
Examine your thought patterns for any messages which might be exacerbating a situation that is already stressful.
“I can’t take this.”
“I’m going to go crazy.”
“I’ll never get over this.”
Thoughts like this don’t help and are usually (hopefully) false. Do a reality check. Are you really unable to take this, or do you just not want to? Are you really about to go crazy or are you just feeling scared or emotional? Will you really never get over this or is it just going to take awhile and be unpleasant while it lasts? Thoughts like this are referred to as “catastrophizing”. Catastrophizing makes things seem worse than they really are. Life is full of enough challenges without creating additional ones. Focus on what is really happening and think about it realistically without exaggeration.
7. Learn
From every adversity I have faced I have tried to learn something. What strength did I find that I did not know I had? What friends did I find that I had previously not appreciated enough? What coping skills did I develop from overcoming this difficulty? What part did I play in creating the problem and how can I avoid repeating it in the future? If you learn something from your struggles all is not lost.
8. Breathe
A lot of times when under stress we forget to stop and breathe. Under stress or panic our breathing becomes shallow and rapid, our heart rate increases and our blood pressure rises. Controlling the speed of your heart rate or your blood pressure is difficult, but it is very easy to control the speed and depth of your lungs inhaling and exhaling. Breathe long and deep, hold it, release, repeat. Your heart rate and blood pressure will follow. As I mentioned above, Yoga, Tai Chi and Qi Gong all focus on regulated breathing while performing their movements. Investing in one of these for an hour a day when in stressful times can greatly help reduce anxiety.
9. Relax
Take time out of stress-filled days to have some down time. Meditate, visit with family or friends who are comforting and supportive, listen to music, read a good book.
10. Laugh
I like to keep on hand some movies which I think are very funny. They are also safe since I have seen them before. I know no one runs over a dog, or gets shot in the face or dies in the end. And since I know the lines by heart if I space out for 15 minutes I can jump back in and not have missed anything. I use this “brain candy” for days or times when my mind has been stressed enough and needs security and humor. I also call one of my sisters who can always make me laugh and are masters at finding humor in the darkest situations. Laughter is the best medicine whether it comes in the form of a movie, a television show, a good book, a comedy show or a friend who makes you laugh.
11. Keep Walking
Most times, getting through a difficult period is a matter of taking one step at a time, one day at a time. You just have to keep walking until you walk through it. Trying to take on the entire problem at one time may be too overwhelming. Try to remember to just get through this step or this day and keep moving until you come out on the other side.
12. Monitor Your Mental Intake
Computer programmers have a saying, “GIGO”, Garbage In Garbage Out. The same is true for human minds. I try to monitor what I am putting in my head, whether it is refusing to watch people eat roaches on television, avoiding slasher flicks or bypassing conversations with negative people. When stressed this is even more important. I will never forget a client who came to me complaining of nightmares during a very stressful time. When she stopped watching horror films every night before going to bed her nightmares greatly decreased. GIGO.
I hope that any challenge you are facing is a temporary one and that peace soon returns to your life. In the meantime, I hope some of these suggestions may help someone during a difficult time.
Peace.
38 Cents per Cancer Stick
When I was growing up, cigarettes were something people bought from vending machines. I’ve never been a smoker, but I want to say they cost about a dollar? I’m not so sure, and it’s not something I pay much attention to. Today, I learned that a carton of cigarettes cost $75! $7.50 a pack, or 38 cents a cigarette. So someone who smokes 2 packs/day, pays about $450 a month.
The funny thing is, I didn’t know this because people never complain to me about the cost of cigarettes. They complain about the cost of medicines (this sometimes includes patients with medicaid who have a $1 co-pay for their meds), the cost of health insurance, and the cost of medical treatment. At times, I’ve suggested that patients with heavy habits cut down by one pack a month (so less than a cigarette a day) to be able to afford their medicines and I’ve been met with groans.
Do I think cigarettes should cost this much? Yes. The health problems they cause and the cost they inflict on society is so huge, that I believe they should be heavily taxed– and the monies should go to medical expenses incurred by smokers and research on how to better prevent addictions (my personal rant, added at no additional cost). But I think it speaks to power of their addiction that people are willing to put out this huge sum of money on cigarettes– people who don’t have it, people who really can’t afford it, people who would go without necessary medical insurance or medical care, meals at nice restaurants, vacations, and many other things that $5,000 a year would buy.
So why is this a Shrink Rap post? Patients with severe and persistent mental illnesses have higher rates of smoking than the population as a whole, and they also die a lot younger, often from cardiovascular disease. Check out this post on Psych Central.
Where Do Psychiatrists Turn With Their Problems? Other Psychiatrists
Elissa Ely, a Massachusetts psychiatrist, has an interesting essay in the New York Times:
“Psychiatry is a relatively safe profession, but it has a hazard that is not apparent at first glance: if you are in it long enough, there may be no one to talk to about your own problems.”
As Ely writes there are some psychiatrists who have been psychotic and were able to return to practice–although shouldn’t a patient get a full disclosure on that kind of thing?–and it made me wonder what percentage of psych docs have ever been on psych meds. I have no idea.
Anyway, as it turns out, psychiatrists turn to other psychiatrists for help with their own problems. No surprise there. I wish I knew how they felt about the experience.
Bipolar Disorder and Trauma
I’m reading articles on the major mental illnesses and how they may be the result of trauma rather than a biological disorder. The article regards and article by Dr. Benjamin Levy, “The Broad Relationship Between Bipolar Disorder and Disorders of Psychological Trauma – Time-Limited to Life-Long Need for Mood Stabilizers”. In short, why treating the trauma resolves the patient’s need for medication for the rest of their life.
Dr. Levy writes, “While bipolar disorder is generally thought of as a life-long illness, naturalistic studies report that some patients have a self-limtited course.” He adds that “in some of these patients, the bipolar disorder has a course that mirrors the recovery from the disorder of psychological trauma. This notion that Bipolar Disorder may have a self-limiting course is not usually presented to patients. They are typically told they have a “biological” disorder which will require life-long medication maintenance and that has a poor prognosis.
Mood Swings vs. Mood Episodes
Dr. Levy does a wonderful service to the psychological community of distinguishing between “mood swings” and “mood episodes” and posits that this distinction “has everything to do with recommending the right treatment”. He states, “the ‘mood swings’ of trauma disorders are treated primarily with psychotherapy, with psychopharmacology added for symptom relief. The ‘mood episodes’ of bipolar disorder are treated primarily with psychopharmacology, with psychotherapy added to help the person adopt to and manage a chronic mental illness.” Dr. Levy then presents three case studies of patients who were originally diagnosed with Bipolar Disorder who were able to discontinue their mood stabilizers after addressing the original trauma.
I have seen this repeatedly. Clients who are very emotionally reactive when triggered by events in their present to remember trauma from their past are labeled as having “mood swings” and put on a mood stabilizer. But their “mood swings” are immediate, intense and transitory, usually not lasting more than a few minutes to a few hours. They also typically induce great anxiety and sometimes pure terror, not the euphoria for which mania is known. This is a different pattern from the gradual descent into depression or ascent into mania which lasts for weeks or months at a time and which Dr. Levy describes more accurately as “mood episodes”.
I believe we are going to see greater awareness of the effects of trauma and less emphasis on the “biological” emphasis when treating mental illness in the near future. If you would like to see what mania looks like I recommend the film, “Mr. Jones” with Richard Gere. Though not an impeccable portrayal of mania, Gere does a fairly accurate job of capturing mania with grandiosity and thought disorder.
You may also want to read, “Mood Swings are Normal” and “Bipolar vs. Borderline vs. Histrionic vs. PTSD” on this blog .
Reference
Levy, B. F. (2007). The broad relationship between bipolar disorder and disorders of psychological trauma-time-limited to life-long need for mood stabilizers. Journal of Psychological Trauma, 6(2/3), 99-125.
Trauma and Schizophrenia
I read an interesting article by the same name, “Trauma and Schizophrenia” (Karon 2007). In it Karon states,
“Schizophrenia is a chronic terror syndrome. In World War II there were battlefield traums that always produced classic schizophrenic symptoms. However, if the patients were healthy before the trauma, they spontaneously recovered. The myth of the incurability of schizophrenia led to the belief that these individuals could not be schizophrenic if they recovered. But all schizophrenics are the victims of lives filled with trauma, sometimes subtle but usually obvious. Professionals have tried not to listen. But if one investigates, most of the bad things patients talk about or symbolize in their symtpoms are not delusional, but real traumas. It helps to face the truth.”
Karon goes to state, ”every soldier who underwent a particular battefield experience developed schizophrenic symptoms.”
The soldier was under fire. He was in danger of being killed. He dug a foxhole under fire as quickly as he could, one just barely big enough to get into. He crawled into it and stayed there. He did not eat or drink. He urinated and defecated on himself because there was no other place to urinate or defecate without being killed. If the situation lasted for several days, every single soldier appeared classically schizophrenic when the shooting stopped, and his buddies came up to him.
These soldiers exhibited typical symptoms of schizophrenia including; thought disorder (inability to think logically and clearly), autism (inability to relate to people), inappropriate or no affect (the experience of feelings or emotions, moods), hallucinations (experiencing things which are not actually there), delusions (believing things which are not true) and catatonic symptoms (extreme loss of motor skills).
Because the soldiers recovered they were said that have Schizophreniform Psychosis instead of Schizophrenia because it was believed that Schizophrenia was incurable. However, Karon maintains that these soldiers are just one example of patients who experience extreme traumas and develop schizophrenic symptoms as a result. He defines Schizophrenia as a “chronic terror syndrome” and explains:
“Human beings are intended to be terrified for minutes, possibly for hours, so that emergencies can be dealt with. We are not intended to be terrified for days, weeks, or months. The only physiological findings with respect to persons with schizophrenia that can be replicated are those which are components of terror in non-schizophrenic individuals, or which are side effects of medications. The medications, which are helpful in the short run, are all medications which dampen down affect, including terror.”
Karon posits that all symptoms of schizophrenia are “manifestations of terror (e.g. not being able to think clearly, not being comfortable with people), defenses against terror (e.g. avoiding people, obsessive symptoms), or symbolic acts.” He adds that the catatonic stupor seen in schizophrenic patients mimics the strategy of playing dead that animals employ when attacked by a predator. This is beautifully described in Peter Levine’s book, Waking the Tiger. When an impala being chased by a tiger can no longer run for its life, it will throw itself on the ground and play dead. A predator will not eat meat it has not killed because it might be dead for disease. In this death-like state, the impala is cognitively aware of what is happening, but the body is paralyzed. It does not respond to biting or clawing by the tiger.
Karon cites research by Ciompi in Swirzerland which found that “the ‘disease’ of schizophrenia does not seem to follow the course of a physiological disease, but rather the order of the social crises in a human being’s life experiences.” Karon reports that when long-term studies are done, “no improvement has been shown in long-term outcome, with the introduction of modern medication”. He cites Harding’s study which found that
“50% of schizophrenic patients stop taking their medication against medical advice, and the 30% who fully recovered in the long run were from that ‘non-compliant’* 50%. No patient who continued to take their medication indefinitely as required by their psychiatrists had a fully recovery, suggesting either that the healthier patient felt freer to stop against medical advice or that the medications, helpful in the short run, interfere with full recovery.”
This is indicative of a human suffering from grief or trauma, not a biological problem. A biological problem should respond to a biological intervention (medication). The medications used to treat Schizophrenia have serious side effects, most of which are very uncomfortable. They are heavy duty tranquilizers which usually damp down all emotions (even happiness) and often leave the patient in an emotional and cognitive straight jacket. This is why many patients choose to discontinue them. The side effects are unpleasant, unless you are so traumatized you temporarily need to be tranquilized in order to collect yourself.
In working with patients with schizophrenia over the past 15 years I too have heard the trauma stories Karon describes and his description of how the medical community deals with those told traumas is entirely accurate.
“These straumas have often been explained away either as delusional (i.e., as if the trauma never occurred), or as being the result of the illness (i.e., as if the patient arranges to be traumatized). Early in my career, when schizophrenic patients described traumatic events, particularly child abuse, I tended to consider them delusional until the evidence forced me to teh conclusion that almost always the traumatic events had really occurred. In those few instances where the traumatic events are not real, they always represenst a real problem that is distorted either in its recall or its description.”
The medical community in general seems to be guilty of making Freud’s mistake. Freud discovered that the “hysteria” from which many of his female patients suffered was induced by molestation and incest during childhood. However, he began seeing so much of it he could not believe it. He also felt the wrath of accused fathers. As a result, Freud eventually recanted his belief that hysteria was a reaction to sexual abuse and stated he believed it to be a “fantasy” that the father would seduce the daughter rather than an actualilty. This position remained until the rise of the feminist movement in the 1970’s and the reawakening in awareness of childhood sexual abuse.
Karon then provides several examples of cases in which psychosis was decreased or eliminated by addressing the trauma(s) and the emotions behind them. An interesting article indeed which provides another explanation for Schizophrenia which bears consideration.
Footnote
*I’ve always hated the word “non-compliant” when used for patients who discontinue their medications. Patients are expected to blindly heed the doctor’s “orders” while not being allowed any input. If the treatment fails, it is blamed on the patient’s refusal to comply, rather than the doctor’s misdiagnosis or inappropriate treatment.
Reference
Karon, B. P. (2007). Trauma and schizophrenia. Journal of Psychological Trauma, 6(2/3), 127-144.
