Archive for October, 2009
Sneezing at health care reform
I ride a public bus to and from work, and today some of my fellow commuters were sneezing. My guess is that people sneeze on the bus ride every day, but I am especially mindful of any contagion at the moment. And well I should be. We’ve got the regular seasonal bug out there, plus the ominous swine flu on the horizon. And the airwaves and newspapers are filled with warnings about this year’s heightened risk for a flu pandemic. More than 30,000 have already been struck by swine flu, with more than 100 deaths.
A stranger’s sneeze can be a good thing in a way. Think of it as a public service announcement, a very-simple-to-understand message about health risk. A sneeze can remind us to wash our hands and schedule our inoculations—probably more effectively than a lecture. But what if, in our hyper-vigilance, we overreact to everyday sneezes and coughs and sniffles? Can such signals change healthy prudence into an unreasonable fearfulness about germs and more?
A team of University of Michigan researchers thought that might be the case, and ran a couple field studies to test the idea. Psychologist Norbert Schwarz and grad student Spike Lee suspected that a heightened perception of risk for a flu pandemic might unconsciously trigger fears of other, totally unrelated hazards. So last May, when the first wave of swine flu was just beginning to claim lives, the researchers stationed a sneezing actor in a busy campus building. As large numbers of students passed on their way to and from class, the actor would occasionally sneeze loudly. The psychologists then cornered and interviewed the students—and compared those who has witnessed the sneeze and those who had not.
They asked both groups to assess the risk of an “average American” getting a serious disease. They didn’t mention the flu, although it is a serious disease and could well have been on some of the students’ minds. Perhaps not surprisingly, those who had just witnessed someone sneezing perceived a greater chance of falling ill. But here’s the interesting part: Those with sneezing on their mind also perceived an increased risk of dying of a heart attack before age 50, dying in an accident, or dying as result of a crime. That is, the public sneeze triggered a broad fear of all health threats, even ones that couldn’t possibly be linked to germs—and sparked thoughts of mortality.
What’s going on here? Well, it gets better—or worse. The researchers asked the same people their views on the country’s existing health care system: Is it a wreck, or working pretty much okay? Those within hearing distance of the sneezing actor had far more negative views of health care in America. Think about that: The country’s health care system encompasses everything from obstetrics to diabetes prevention to insect-borne illnesses, yet a single sneeze in the corridor colored people’s views of the entire system.
This last finding was so striking that the psychologists ran another version of the sneezing scenario at a local mall, just to double-check the perplexing results. This time the interviewer himself sneezed and coughed (or did not) while conducting the interview, and in this version the interviewer didn’t even bother to ask about the personal risk of illness—at least not directly. Instead, the interviewer was ostensibly doing a public opinion survey on federal budget priorities. He asked, for example: Given limited tax dollars, should the government spend the money on vaccine production or on green jobs?
Clearly this issue is only tangentially connected to the flu or personal health, but it does play into people’s fears and doubts about health and disease: Is the government watching out for Americans’ welfare, broadly construed? And the results (to be published in a forthcoming issue of the journal Psychological Science) were unambiguous. Those who had just witnessed someone sneezing were much more likely to favor a public investment in vaccine production rather than green jobs. In other words, the sneeze sparked concerns not about personal health, but more broadly about public health.
This is quite remarkable when you tie it all together: Completely outside of awareness, a simple sneeze triggered fear of the flu, which in turn sparked fears of mortality, which even shaped people’s views on a somewhat abstract public policy question. So achoo! Let’s write our Congressmen about health care reform.
For more insights into the quirks of human nature, visit the “Full Frontal Psychology” blog at True/Slant. Selections from “We’re Only Human” also appear regularly at Newsweek.com and in the magazine Scientific American Mind.
Posted in Let Me Tell You About My Days
By last night, I felt like I was supposed to blog about this. Several people mentioned a book to me that was written by a Bellevue psychiatrist– Julie Holland– and an NPR Interview they’d heard. One pretty much convinced me I might want to actually read the book (reading about psychiatry isn’t quite my idea of a leisure activity). So I get home and check my email: there’s a link to the NPR page and interview about this book. There’s an e-mail from Clink about how this is stuff kind of looks like the stuff from the book we’re in the process of writing. I read a little of the Fresh Air piece and think, wow, this does sound kind of like our stuff. Sort of.
So go for it: Dr. Julie Holland writes about her work as an ER psychiatrist.
Okay, I only read a few paragraphs, and there was more of an edge to it than I want for our book.
For nine years, psychiatrist Julie Holland ran the psychiatric emergency room at Bellevue Hospital in New York City on Saturday and Sunday nights. Along with treating patients, she served as liaison to the medical ER and the toxicology department.
Holland says one of the hardest parts of her job was figuring out which patients were manic or schizophrenic and which were high on cocaine or methamphetamines. An expert on street drugs, Holland spent her college years researching and writing Ecstasy: The Complete Guide. Her new memoir is called Weekends at Bellevue: Nine Years on the Night Shift at the psych ER.
See what you think.
JAMA Study Finds Explosive Weight Gain In Kids On Antipsychotics
A study to be published in JAMA tomorrow finds staggering weight gain in kids given antipsychotics. According to the AP:
“Children on widely used psychiatric drugs can quickly gain an alarming amount of weight; many pack on nearly 20 pounds and become obese within just 11 weeks, a study found.
“‘Sometimes this stuff just happens like an explosion. You can actually see them grow between appointments,’ said Dr. Christopher Varley, a psychiatrist with Seattle Children’s Hospital who called the study ‘sobering.’
“Weight gain is a known possible side effect of the anti-psychotic drugs which are prescribed for bipolar disorder and schizophrenia, but also increasingly for autism, attention deficit disorders and other behavior problems. The new study in mostly older children and teens suggests they may be more vulnerable to weight gain than adults.”
That is very rapid and very significant weight gain. The drugs involved were Risperdal, Seroquel, Zyprexa and Abilify. Since I’ve not seen the study, which involved 205 New York-area kids aged 4 to 17, I don’t know what range of diagnoses kids were getting these drugs for, but it’ll likely be the usual muddle of schizophrenia, pediatric bipolar disorder, autism, ADHD and so on.
If this study does not give pause to those who wish to medicate kids, then nothing will.
HUD’s Definition of Homelessness
HUD’s definition of what constitutes a “homeless” person is disturbing.
The United States Code contains the official definition of homelessness as defined by the United States governmnet. In Title 42, Chapter 119, Subchapter I, homeless is defined as:
§11302. General definition of homeless individual
(a) In general
For purposes of this chapter, the term “homeless” or “homeless individual or homeless person” includes—
- an individual who lacks a fixed, regular, and adequate nighttime residence; and
- an individual who has a primary nighttime residence that is —
- a supervised publicly or privately operated shelter designed to provide temporary living accommodations (including welfare hotels, congregate shelters, and transitional housing for the mentally ill);
- an institution that provides a temporary residence for individuals intended to be institutionalized; or
- a public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings.
Notice the word “individual”. This description excludes families or couples who are homeless. It also excludes people who are “couch surfing” or moving from house to house of family members and/or friends. But the definition which disturbs me the most is how the federal government defines “chronic” homelessness. In my opinion this is the most important segment of homelessness we need to address because people who repeatedly return to shelters and live the homeless lifestyle constitute the majority of the homeless population and utilize the majority of the services with very little reduction in their homeless status. Yet the federal government does not even recognize a large percentage of this population.
HUD’s definition of a “chronically homeless person”:
“In general, a chronically homeless person is an unaccompanied disabled individual who has been continuously homeless for over one year.”
This means that the families (and their children) passing through our dorms are not “chronically homeless” according to the federal government because; 1) they are not “unaccompanied”, the parents are with children and the children are with parents, 2) they are not disabled and 3) they do not usually stay in the dorms for over one year (it’s more like 3-6 months). Yet these same families are repeatedly coming back to the shelter, staying in other shelters or “couch surfing” with friends or family. I have a mother with 3 children in the shelter now who has been moving from shelter to shelter and through various housing programs since 1999! Is that not “chronically homeless”?
Why is this important? I don’t know how other shelters do things but I know the one I work at produces a lot of documentation and data for various grants and programs for the homeless. One of the questions we are often asked is if the client is “chronically homeless” according to the HUD definition. You can immediately see the problem. The majority of our clients are chronically homeless as the mother and children mentioned above. Yet, according to the federal government they are not counted as chronically homeless. If the United States government is basing programs for the chronically homeless on the definition above it is no wonder we are woefully underfunded.
Study, BBC Claim Anti-Depressants Work Instantly, 6 Reasons To Be Skeptical
That’s right: A study in this month’s American Journal of Psychiatry was written up by the BBC yesterday–not sure if there was a report on the radio or TV–and framed as establishing that anti-depressants work “instantly” to quote the BBC’s headline. That would run counter to what most researchers and patients believe to be true (and plenty of studies have shown to be true) that anti-depressants take as long as several weeks to deliver a measurable effect. What Oxford researchers found was that depressed patients had a quick response to an anti-depressant called Reboxetine. They established this by measuring how patients’ negative thoughts improved (using emotional recall kinds of tests) and found that negative thoughts improved within a few hours and even did so in healthy, non-depressed volunteers taking the drug.
“Dr Harmer said: ‘We found the antidepressants target the negative thoughts before the patient is aware of any change in feeling subjectively.’
“‘Over time, this will affect our mood and how we feel because we are receiving more positive information.’”
Michael Thase, a psychiatry professor at the University of Pennsylvania, called the finding possibly “paradigm changing.”
We live in interesting times when researchers can claim an anti-depressant is “working” when a patient has no sign of depression symptom improvement. As usual, several skeptical thoughts come to mind.
1. You don’t know you are feeling better but you are is one of the study’s main conclusions. That strikes me as a dubious claim, especially absent any knowledge of how the patients and healthy volunteers fared over time. I mean, isn’t the point of treating depression to treat depression and not get all wound up about emotional recall tests? To the degree that it might predict later response to depression treatment, the response might be interesting.
2. The choice of Reboxetine (brand name Vestra) is an odd one. A recent study found it the least effective of all the modern anti-depressants and the FDA has not approved it for use in the US (which tells you something) and it’s not widely-used in Europe. Why the researchers didn’t choose a more commonly used medication is beyond me. It really doesn’t tell doctors and patients much in a clinically useful way.
3. The study is of a small enough sample size–31 depressed patients, 30 healthy volunteers; half of each group on active medication–to make its findings little more than suggestive and not the paradigm changer Thase claims. It’s research that needs to be replicated several times.
4. I’m not buying that someone on Reboxetine identifying more faces (two more on average) on a facial recognition test than someone not on Reboxetine means that much in a real world way. Maybe I’m being too skeptical here, but it doesn’t quite add up.
5. The study’s two primary authors (Guy Goodwin and Catherine Harmer–interesting name for a doc) have oddles of pharma funding in their past from the likes of AstraZeneca, BMS, Lilly and so on.
6. For the BBC to generalize from results of a Reboxetine study that its findings apply to all anti-depressants is complete bunk and lazy reporting and editing. And that’s pretty much what the article and its headline claim.
AP Reports Health Insurance Company Profits Not Very High
I’m sure most of you are aware that health insurance companies have been just about every Democrats favorite whipping boy in the ongoing health care reform debate. Their profits are obscene and so on goes the rhetorical line out there and the companies are allegedly the cause of the explosion in health care costs in America. Well, a reporter at the AP went and did some checking and it turns out, according to the AP that across the health insurance industry profit margins are nowhere near the 25 percent some people claim.
“Health insurance profit margins typically run about 6 percent, give or take a point or two. That’s anemic compared with other forms of insurance and a broad array of industries, even some beleaguered ones.
“Profits barely exceeded 2 percent of revenues in the latest annual measure. This partly explains why the credit ratings of some of the largest insurers were downgraded to negative from stable heading into this year, as investors were warned of a stagnant if not shrinking market for private plans….”
“Health insurers posted a 2.2 percent profit margin last year, placing them 35th on the Fortune 500 list of top industries. As is typical, other health sectors did much better – drugs and medical products and services were both in the top 10.
“The railroads brought in a 12.6 percent profit margin. Leading the list: network and other communications equipment, at 20.4 percent.”
Interesting stuff, but it doesn’t make me sympathize with health insurance companies because they are a gigantic pain to deal with.
NPR Does It Again
NPR’s “Morning Edition” today had yet another installment on what it’s essentially declaring a mental health crisis on college campuses. Based on what I know not. Today’s show again focuses on Stanford University. I really cannot force myself to summarize the piece’s contents. Listen to it or read it here and let me know what you think in comments.
Ending Homelessness 2
I originally posted an article, The Secret to Ending Homeless in America on October 14th in response to an article by Michael at SLO Homeless, “Absurdity of the Bureaucratic Mindset“. Dave, at his blog, Dare to Dream has posted some interesting counterpoints to my arguments in his article, Barriers, Behaviors, Sub-cultures and the Homeless Population. His arguments are intelligent and articulate and I will take the opportunity to respond to them here.
Dave’s comments are in italics throughout this piece.
“Our world has always had an underclass, a group of individuals who have been largely invisible in the US except during the Depression. These people largely function outside the visible society and economy.”
“They are chronically under or unemployment and are not collecting Social Security, either because they don’t qualify, try though they may to apply, or they haven’t the where-with-all to get themselves qualified. This chronic underclass is best described as a sub-culture. They are structurally built into the economy. “Full employment” doesn’t include them. Because they have given up on finding work, they no longer register with unemployment offices and so are not counted among the unemployed. Those who are chronically homeless are a sub-group of this sub-culture, and probably represents some of its most dysfunctional members.”
I am hoping that Dave is not equating the unemployed of the Depression era with the current population of chronically homeless people. I do want to make it clear that the population of which I am writing is not the working class family which has suddenly lost both of their jobs and for the first time found themselves staying at a homeless shelter. I am talking about the group of people who are repeatedly homeless and have repeatedly utilized shelters. This is the population which uses most of the services and monies – and which benefits the least from them. No matter how much case management and financial assistance we pour into them, they return to the shelters. I have a woman with 3 children staying at the shelter right now who has been cycling around and around in the shelters and social services system since 1999. She has been in every program and received every resource. She has been case managed and helped by numerous social workers. She has received financial assistance from every resource multipel times.
I do not equate this population with the mass of people who found themselves without employment during the Depression for one main reason: the people who were out of work during the Depression were horrified at the aspect of having to be on “welfare” or to accept any kind of charity. They desperately wanted jobs, not assistance. This is why programs like the CCS and the WPA were created for them. In my humble opinion, I would not consider the chronically homeless of our current era to be “unemployed” or “underemployed”. They simply do not work. They hows and whys of this are a mystery to me. I think one problem is that many of the programs they use to sustain themselves are prematurely cutoff if they obtain full-time employment, i.e. daycare or food stamps. The social services system actually punishes them for obtaining and maintaining full-time employment.
However, there is another factor which I simply cannot explain. I have seen too many people in this population obtain a full-time job and simply walk off it or not show up for it. And they do so for reasons which I cannot explain or understand.
A 52 year old grandmother was staying in the homeless shelter. Her son, daughter-in-law and their three children were residing in the family dorm. They had ended up in the shelter because her son and her daughter-in-law had walked off their full-time jobs with in one week of each other, then Mom moved in and the financial burden became untenable. Mom, the grandmother obtained a full-time job within one month of moving into the shelter. She walked off it after only one week because it was, in her words, “too boring”. The family has been set up in affordable housing as of this writing. Mom has continued to refuse to look for work and has now moved in with the family. She is not on the lease or part of the housing agreement. If her presence is discovered there, the family will be evicted for breaking the lease contract and they will all return to the homeless shelter. Repeated attempts by caseworkers to get the family to realize this has failed to have an impact.
I have had numerous clients who were offered jobs but refused them citing reasons I cannot understand. “I don’t like to get up that early.” “They want me to work at nights.” “I don’t want to do that kind of work.” Most of our clients have very, very poor work histories with long histories of impulsively walking off jobs or failing to report to work for various reasons. Their thought processes seem to be very impulsive with no thought for the future or the consequences of their decisions. This is the emotional immaturity and arrested development to which I refer in the original article.
Dave refers to this group as an “underclass sub-culture” and I thank him for this idea. I hadn’t thought of it previously but I think he is definitely onto something here for this group truly has a culture of their own, individual from the predominant culture. Because so much of what they do seems to be in opposition to the dominant culture I wonder if they would not constitute a ”counterculture”. I have listened to homeless males talking on the bus and I think there is a definite group of the homeless who are proud of refusing to comply with societal norms and behavioral demands. But I’m not sure this is the same group I see cycling through the shelters. I suspect that this group openly shuns charity and social services, preferring to make it on their own. But at the same time I see that “on their own” usually involves panhandling or asking for “charity” which doesn’t require participating in a lengthy procedural proceess (keeping appointments, completing paperwork, complying with program requirements). I work primarily with homeless families and single women, so the culture of homeless men may be vastly different.
“It’s important to discourage a prejudice developing against a whole group of people who are already stigmatized along with the “welfare mother” of the AFDC era. But we are not going to get to a more complete solution without understanding the problem. I suspect that why there is little commentary on this topic.”
I couldn’t agree more. The sad thing is that the “welfare mother” to whom he refers is functioning better than the homeless mothers with whom I work. She keeps her affordable housing, she keeps her food stamps, she keeps her benefits in place. Most of the mothers I’m working with have had all the welfare benefits the “welfare queen” has, but have failed to maintain them. As Dave points out, it is important not to stigmatize these mothers. I do not think this is a personal failing or a lack of character. The mothers I see want to succeed, they want to be good parents, they want to have a piece of the American dream, but they do not seem to possess even the most basic skills for going about it. What is the problem? I’m not sure. That is what I hope to provoke a dialogue about. As Dave astutely points out, “we are not going to get to a more complete solution without understanding the problem”. Lack of affordable housing is not the problem. The lack of functioning of this population is the problem. I think that makes funders and administrators uncomfortable. They seem to prefer problems they can fix by throwing money at them or building more houses. But that isn’t working here. It is only exacerbating the problem. We have to actually sit down with these people and address their humanity.
“Persons who are members of the underclass see dysfunction as normal. They’ve never known any different. Many think this is how everyone lives. While they may dream of a good job, they appear to not have the self-discipline to keep a good job. Many of this group might be diagnosed with an anti-social personality DO. Personally, I think this diagnosis is misleading at best. A person earns this diagnosis if their history includes sufficient “anti-social” behavior. This doesn’t account for family cultures that teach a confusing mix of conventional and anti-social values.”
This is so, so true from what I’m seeing. And I think this further makes the case for Dave’s description of this group as a “culture”. Most of my clients were raised in homes which were chronically homeless and very nomadic. And as he says, they’ve never known anything else. They have social norms and values which seem consistent within the group, for they seem to understand each other completely. But these norms are in conflict with the norms of society in general. And this often manifests not only in the way they function in social programs, but in employment. They not only dream of good jobs, they are intelligent and personable enough to land them. But they do not keep them. The reasons for this need to be investigated fully – and addressed.
Dave is absolutely correct that a disproportionate number of this population is diagnosed with Antisocial Personality Disorder. His attribution to this behavior as a result of living on the streets and having to survive by street rules combined with the effects of PTSD from the traumas they have survived is right on. I would add one more factor: the influence of social service programs. I think we teach clients to lie to us without realizing it, then diagnose them as being “manipulative” and “evasive” when they do.
If a client comes to shelter staff after missing curfew one night and tells them the true reason they missed, because they relapsed on crack, they will be punished by being banned from the shelter. So they lie to save their bed and avoid being thrown back out on the streets and into a world filled with the drugs they are desperately trying to abstain from.
The same thing applies to employment. They’ve lost, walked off or been fired from every job they’ve ever had. They don’t really know why they can’t keep a job, but getting one will only lead to losing it and is a sure way to experience another failure. They also realize that the safest place they’ve ever been is the shelter. When placed in affordable or transitional housing in the community, they eventually get evicted and return to the shelter. Humiliated once again. And they do not have any insight about why they failed because there are no programs to help them identify and change these patterns. So they sit in the caseworker’s office – and lie. “I want to get a job and get an apartment so I can get back out of the shelter.” This is what the caseworker wants to hear in order to keep them in a bed. If they truly opened up to the caseworker and said what they really wanted, to stay in the shelter where it is safe for as long as possible and to avoid getting another job only to lose it, they would be tossed out into the streets. So they lie. What else can they do? What would any of us do in their shoes?
Like Dave, I do not believe there are any more antisocials in the homeless population than there are in the general population. This seems to be a misapplication of the norms of the predominant culture to the norms of a counterculture.
“Having grown up in a chaotic home and living a chaotic lifestyle, repeated trauma has numbed their emotions to the point that they are unable to make proper judgments about who is worthy of trust. The predator-prey dyad began in their family of origin where parents exploited the children when they were young, and when the children grow up, they exploit their vulnerable elderly parents.”
Beautifully stated. This is absolutely right. I’m absolutely horrified at how most of my clients were treated as children. Abandoned to the point they had no food or decent clothing, not sent to school but allowed to run the streets and prostituted in exchange for their parent’s drugs are only a few examples. The creation process for the predator-prey dyad is obvious when they tell you their histories. As is the reason for some type of self-medication for the symptoms of trauma.
“Chaotic events in close proximity in time give the victim the impression they have no control of their fate and so they scramble for every edge in the moment, and anxiously await for the next disaster to strike.”
I have to agree with Dave on this as well, only he stated it much better than I did. In addition to an impaired judgment process I see that many people in this population act they way they do as a result of a trauma response. Something ordinary triggers them and they respond with a fight, flight or freeze behavior. If they respond by fighting they end up with assault charges. I think the majority respond with flight responses which contribute to their unstable, unreliable, “irresponsible” behaviors, such as walking away from jobs or suddenly moving to another geographical area leaving a wasteland of broken leases, unpaid utilities and bad credit histories. They appear to constantly teeter on the edge, failing to plan further ahead than the next day or even the next hour and I believe Dave is right that they live this way because they know of no other. They often displaly a kind of fatalism that prevents them from taking proactive measures or investing in the future.
Dave cites Bipolar Disorder as being largely prevalent in this population and a factor in their dysfunction by I strongly disagree. I believe that most people today are diagnosed with Bipolar Disorder as a result of having “mood swings”. Bipolar Disorder is much more serious than mere mood swings and emotional lability is one of the symptoms of PTSD. I think this is just another way that PTSD is minimized by the psychiatric community and medicated instead of treated properly with counseling – which takes time and effort. Recent research is showing that Schizophrenia, Schizotypal Personality Disorder and Bipolar Disorder may not be actual “biochemical imbalances” but responses to trauma which, if treated with psychtherapy, can be resolved and medication at least sharply decreased if not eliminated completely. I wish we could stop labeling and diagnosing people with “disorders” and simply work with their history and their humanity. I do agree that a very large number of this population use various substances to try to self-medicate their symptoms of trauma. But we need to work to eradicate the symptoms not just medicate people with psychotropics or stick them in a substance abuse program.
“So what solutions are there for healing the cultural divide? The problem is mostly economic. The underclass lacks a realistic chance for escaping their plight. Oh, sure a few make it, usually through advanced education. But many will hit a ceiling in achievement when they rely too heavily on “temporary feel good” behavior that provides relief from stress, but self-destructively complicates their lives and increases the chances they will fall out of their newly found middle-class status.
The middle-class in is shrinking, many of the hard working blue collar workers are falling into the underclass from where with a floundering economy, escape will be difficult. Jobs programs, affordable housing, and counseling are sorely needed but remains largely unfunded. What infrastructure is present is actually shrinking with government tax dollars.”
Well, I have to strongly disagree with Dave here. I whole heartedly agree that the middle class is shrinking and that the working class is floundering horribly. (For a more enlightened view on the economics of this, see the video by Richard Wolff, economics professor at the University of Massachusetts at Amherst, “Capitalism Hits the Fan: A Marxian View“.) I would be the first to advocate for more services and assistance for the working class who is laboring so hard to just to stay afloat, but I do not think that the overburdened middle class are the people in the homeless shelters. A few working class people are admitted to the shelters during the year, but they are very few and they stick out like a sore thumb. Their behavior is markedly different from that of the chronically homeless. And I see many more who never enter the shelters because they have the support of friends and family who take them in. I believe they have this support because they have not burnt these bridges nor have they spent a lifetime needed to be supported. This is an isolated incident in their case and family and friends are happy to help them get out of it. And get out of it they do. And they move on with their lives.
The clients I’m talking about only appear to break out of the homeless pattern and only then with the help of a lot of social services and financial assistance. Even with these supports they quickly flounder and sink back into homelessness and return to the shelter. All too often I see that the working class “makes too much money” to qualify for services rendered to the chronically homeless. Yet another “barrier” erected by the social services system which punishes people for working.
I also disagree that more affordable housing will solve the problem. Most of my clients have had affordable housing and lost it. They are either banned from applying for it again or have to wait a year to reapply. Their reasons for losing it are various, yet typical; not paying rent, not maintaining utilities, drug activity, domestic violence, damage to the property. This is the primary reason that I believe it is not an economic situation. As pointed out earlier in this article, the alleged “welfare queen” is also economically struggling. Yet she maintains her housing, often for decades. I think we need to stop calling it an economic situation and look at individuals factors which differentiate between housed and unhoused families in the poverty sector. Research has been done and there are some marked differences in their functioning.
“Too often the only role models for success are the gang members, drug dealers or pimps who drive fancy cars and flash wads of money.”
Since I’m working mostly with single women and families the role models are not so much gang members and drug dealers, but the idea here is absolutely right. Research has shown that children raised in homeless families grow up to raise homeless families themselves. This is where the pattern begins and it is passed from generation to generation just as surely as DNA. This is an issue which any successful intervention must address – the family patterns. Dave describes a successful “mental health boot camp” in which he is working. I would like to see something like this for families, where housing is provided for the entire family, but the adults must work for the government entity providing it full-time. Children will be enrolled in daycare or school and counseling will be provided for the entire family. This comprehensive intervention would work to “reparent” the parents and provide the children and their parents with healthy role models to emulate. Psychologists know that humans are very social creatures and modeling behavior is a very powerful tool. As Dave astutely pointed out above, the chronically homeless reside in a culture of their own. And the role models provided for them in that culture are one of the major sources of their dysfunction. I believe that any intervention that will be successful must address these factors.
Dave? Counterpoints? Anyone else?
I’m Listening
This post is for any of our blog readers who have ever been involuntarily admitted to a hospital or treated with medication against their will. I’m trying to put together some ideas for things my patients can do to help live with their symptoms (and help them avoid imposing their symptoms on others) without the use of medication.
So my questions are:
1. Which symptoms bothered you the most and what did you do to deal with them?
2. How could you tell when your symptoms were causing problems with others?
3. If someone told you that you were doing something unusual or bothersome, would you have listened when you were sick?
4. What was the most helpful thing someone said or did to help you get by when you were ill?
5. When you were on the inpatient unit, did you notice other people’s symptoms? How did you deal with them?
The things you tell me may help my patients, so please speak up.
Animal Study Finds Psych Meds Given To Young Create Psychiatric Disorders In Later Life
That is the conclusion of a study by a neuroscience graduate student at Georgetown University, but let me add some caveats: the applicability of animal studies to humans isn’t 100 percent and this study has not been published yet. It’s scheduled to be presented this week at a neuroscience meeting. Nonetheless, its conclusion is bound to be controversial.
“Using behavioral tests to detect characteristics of autism and schizophrenia, the researchers found that when given to infant rats, the drugs caused behavioral abnormalities later in life. What’s more, the abnormalities were not limited to the drugs known to cause neuronal cell death.
“‘That is of particular concern because some of the drugs may predispose to psychiatric disorders later in life,’ says lead author Patrick Forcelli, a graduate student in the Interdisciplinary Program in Neuroscience at GUMC. ‘At the same time, our studies identify specific drugs that cause little or no long-term behavioral impairment.’”
The drugs given the rats were described as ones for epilepsy, mood disorders and pain (meaning mostly likely they used anti-convulsants, anti-depressants and hydrocodone or similar drugs). I don’t have any specificity beyond that, so I sure look forward to this study’s presentation.