Tag Archives: Mental disorder

Hope and Recovery

Pat Deegan reflects on her own experience an shares about the need for hope in recovery:

He said, I should retire from life and avoid stress. I have come to call my psychiatrist’s pronouncement a “prognosis of doom”. He was condemning me to a life of handicaptivity wherein I was expected to take high dose neuroleptics, avoid stress, retire from life and I was not even 18 years old! My psychiatrist did not understand that boredom is stressful! A life devoid of meaning and purpose is stressful! A vegetative life is stressful. A life in handicaptivity, lived out within the confines of the human services landscape, where the only people who spend time with you, are people who are paid to be with you – that is stressful! Living on disability checks from the government is stressful.

When I was diagnosed I needed hopeful messages and role models. I needed to hear that there were pathways into a better future for me. I needed to connect with others who had been diagnosed with schizophrenia and who had recovered lives of meaning and purpose. I needed to find others who had completed college and who had jobs and who got married and had families, and had an apartment and a car.

Why is hope important to recovery? Because hope is the root of life’s energy. In order to recover, I had to turn away from the wish that psychiatrists could fix me. I had to turn away from the myth that psychiatric treatments could cure me. Instead, I had to mobilize all of the energy I had. I had to become an active partner in my recovery. I had to learn to work collaboratively with my treatment team and to draw strength from the wisdom of my peers. I had to begin striving for my goals, not when I was “all better”, but from day one. I had to believe that there was a life for me beyond the confines of the mental health system. That is hope. Hope is the tenacious pursuit of pathways to a better life, despite the odds. Without hope, there is no recovery.

Amen. Please go and read the whole post at her blog and spend some time poking around her posts.

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Sentences to ponder

by karola riegler photography

by karola riegler photography

Nearly one-third of U.S. veterans who are given psychiatric medications by their doctors do not have a diagnosed mental health problem

Many vets given psychiatric drugs without diagnosis | Reuters

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by | November 11, 2013 · 5:55 am

Recover from ==> Recovery to

wellness_wheelCommenter Web Servant responded to the a recent “Sentence to Ponder” from Bill White about the need to expand the scope of treatment and recovery services that create pathways to natural community supports and adopt a wellness model. His comments seem worthy of a post of their own.

The place of treatment in recovery is to help people stop using (ie “recovery from”), the place of mental health and primary care in recovery is to address other issues which may undermine recovery and the place of community in recovery is to help people stay stopped and help sustain and maintain the full change in lifestyle and thinking that is needed “recovery too” – and can only only take place within the community.

I responded:

I like this. And, I’m thinking that this is probably true for any chronic illness where the most effective treatments are behavioral. The chronic disease burden threatens to crush the American health care system. Maybe the biggest factor is not better pills, procedures and systems, but it’s the absence of communities of recovery to support those behavioral changes.

Web Servant responds back:

Your right, nothing about this approach is specific to addiction – it applies equally to mental health, diabetes, obesity, disability maybe even ageing. So many of the struggles we have with these health conditions in the West risen from the professionalization of health care. While professional health care is essential and has had led to great achievements, it has stepped way outside of its rightful place. Especially the notion that professionals have a monopoly on human healing – a notion that has radically undermined and dis-empowered individuals and their communities from what they used to do for themselves.

This phenomenon is beautifully documented in the book The Careless Society: Community and Its Counterfeits by John McKnight where describes how the best efforts of experts to rebuild and revitalize communities can in fact destroying them through the four “counterfeiting” aspects of society: professionalism, medicine, human service systems, and the criminal justice system.

“These systems do too much, intervene where they are ineffective, and try to substitute service for irreplaceable care. Instead of more or better services, the book demonstrates that the community capacity of the local citizens is the basis for resolving many of America’s social problems.”

Bill White has talked about the need to differentiate treatment and recovery. If we fail to make this distinction, we’re more likely to drift into treatment-oriented treatment rather than recovery-oriented treatment. After watching the video below, I’ve often wondered what American health would look like if the health care system invested a little less heavily in stents and more heavily in supporting creating community/social pathways for patients to integrate more physical activity into their lives.

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Filed under Mental Health, Mutual Aid, Policy, Research, Treatment

Care that never quits


I spent a little more time with Jim Contopulos’ video memorial for his son and an interview he did will Bill White. There’s a lot to all of this, but a couple of things stuck with me.

In the interview, he discussed being a scared parent and seeking to buy recovery:

Yes. At the age of 15 we placed Nick in his first of many, long term residential treatment centers. This was the beginning of many years of cycling ˜in and out’ of residential treatment centers throughout the country. In the beginning, we felt, perhaps, that we could “buy” recovery. We were desperate to save his life and have our son return to us. Like many desperate and well meaning’ loved ones, we fell prey to what I call the 30/60/90 day false promises.

It took us and Nick, many years and many efforts to realize that recovery can not be purchased. Many times, we witnessed Nick’s hard work of recovery and recovery’s reward of self respect, only to experience the devastation of this relentless, chronic, terminal disease. Once we realized that “recovery could not be purchased” we continued to support Nick in his own efforts to find recovery at the many free recovery locations such as Salvation Army.

This is a message every responsible treatment program needs to hear. Families are desperate to save their loved one and they are looking to purchase something we can’t promise. It drives home the importance of providing good care and communicating the limitations of treatment. I’ve been using an obesity analogy more and more. That going to residential treatment is a lot like going to a residential weight loss program. The patient is going to get lots of structure, support, information and skills that will help them lose weight. If everything goes well, they’ll come out looking great, feeling strong, proud and motivated. BUT, we all know that what happens in the weeks and months after the program is going to be critical.

This is why it’s important for us to use approaches that:

  • help patients construct personal narratives and identities around recovery rather than pathology;
  • emphasize long term monitoring, support and early re-intervention;
  • build social support for long-term change (social anchors too!);
  • address structural/environmental factors like exposure to temptation and access to good food and exercise equipment; and
  • help the patient examine the roles of other lifestyle factors, like employment.

The other thing that leapt out at me was this passage from the video:

Slowly Nick, very slowly we came to understand that there is no formula for recovery. Looking back now we recognize the common ingredients of communities that affect a true change, for not only sobriety but long-term recovery. We need more. Communities and see the addict and the mentally ill the patients not problems; facilities that are able to treat these diseases concurrently; communities that are built upon humanity not humiliation; that encourage mutual respect, meaningful work and purpose; communities that afford the individual with the necessary time in order to restructure long-held habits; communities that encourage honesty and openness; communities to see beyond addictive actions labeled as bad and envision the value of the individual–the value in his recovery. We need to grow communities to become a culture of inclusiveness and helping. Nick as you know community such as these are extremely rare, but i hope for a better day. A day seeded by the pain and loss of losing such beautiful boys as yourself a day when the words of a cancer treatment facilities–care that never quits–becomes the words of those who care for the addicted and the mentally ill.

What a beautiful and thoughtful description of the role of community and vision of support for long-term recovery from a chronic illness.

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3 fold preference for talk-therapy

i_love_evidence_based_medicine_key_chains-r33ff90ead6aa425ea368e31ca9ee70e5_x7j3z_8byvr_512I swear I don’t go looking for this stuff.

This post from the British Psychological Society just popped up in my feed reader:

A line was crossed in 2005 as anti-depressant medication became the most widely prescribed class of drug in the USA. …

“It is unclear why the shift toward pharmacologic and away from psychological treatment is occurring,” the researchers said, “although limited access to evidence-based psychological treatments certainly plays some role.”

Kathryn McHugh and her colleagues identified 34 relevant peer-reviewed studies up to August 2011 involving 90,483 people, in which the participants were asked to indicate a straight preference between psychotherapy or drugs. Half the studies involved patients awaiting treatment, the others involved participants who were asked to indicate their preference if they were diagnosed with a psychiatric disorder. The researchers had hoped to study preferences among patients with a diverse range of diagnoses but they were restricted by the available literature – 65 per cent studies pertained to depression with the remainder mostly involving anxiety disorders.

Overall, 75 per cent of participants stated a preference for psychotherapy over drugs. Stated differently, participants were three times as likely to state that they preferred psychological treatment rather than medication. The preference for therapy remained but was slightly lower (69 per cent) when focusing just on treatment-seeking patients, and when focusing only on studies that looked at depression (70 per cent). Desire for psychotherapy was stronger in studies that involved more women or younger participants.

The author’s noted that, given the evidence showing comparable efficacy for psychotherapy and medication in treating most forms of anxiety and depression, there is strong empirical support for greater use of talk-therapy.

UPDATE: Ross shared this APA post on the cost-effectiveness of talk-therapy:

A quick fix?

The behavioral health management companies that now dominate the field have a good reason to prefer medication to psychotherapy: They don’t have to pay for patients’ pills.

Managed-care companies typically “carve out” the mental health portion of patients’ medical care, assigning that responsibility to specialized behavioral health companies. These companies, however, cover only the cost of providing patients with access to mental health providers and facilities. Responsibility for paying prescription drug costs lies with the original managed-care companies. Since behavioral health companies must squeeze psychotherapy costs out of tight budgets, says Pomerantz, it’s not surprising that they favor general practitioners over psychotherapists and psychopharmacological solutions over psychotherapeutic ones. By doing so, he explains, they shift costs back to the managed-care companies themselves.

Even more importantly, says Pomerantz, behavioral health carve-outs typically have a short-term perspective when they consider their bottom lines. While medication gets doled out over long stretches of time, psychotherapy is typically provided in short but intensive periods. Because health plans’ budgets focus on expenses in a given year, medication has an obvious short-term advantage no matter what the eventual long-term cost.

Although conditions such as schizophrenia and manic depression clearly warrant medication, he adds, behavioral health companies are pushing patients toward medication even when psychotherapy or a combination of psychotherapy and medication would be best for them.

“In a recent survey, almost 90 percent of patients who visit psychiatrists are taking psychotropic medications,” says C. Henry Engleka, assistant executive director for marketing in APA’s Practice Directorate. “Instead of medication being used as an adjunct to psychotherapy, the opposite is generally true in most managed-care practices now.”

Emerging research

That’s too bad, says Pomerantz, because over the long run psychotherapy is often more effective, and thus cheaper, for many conditions. Although psychotherapy requires more of an upfront investment, he explains, it pays off by getting the job done and preventing relapses. By contrast, patients on medication often relapse once their medication stops and may require a lifetime of expensive pills. In a column in Drug Benefit Trends, Pomerantz cites several studies from the ever-increasing literature on this topic to prove his point:

  • In a randomized, controlled trial, researchers assigned 75 outpatients with recurrent major depression to three groups: acute and maintenance treatment with antidepressants, acute and maintenance cognitive therapy and acute antidepressants followed by maintenance cognitive therapy. Cognitive therapy proved as effective as medication in both the acute and maintenance phases, with a trend favoring cognitive therapy’s long-term efficacy (British Journal of Psychiatry, 1997, Vol. 171, p. 328-334).
  • In another study, researchers randomly assigned 40 patients who had been successfully treated with medication for recurrent major depression to two groups: clinical management or cognitive-behavioral therapy. Over 20 weeks, antidepressants were tapered off and then discontinued in both groups. Two years later, only 25 percent of the patients who received cognitive-behavioral therapy had relapsed compared with 80 percent of the other group [Archives of General Psychiatry, 1998, Vol. 55(9), p. 816-820].
  • In a meta-analysis of studies published between 1974 and 1994, researchers compared controlled trials of cognitive-behavioral therapy and pharmacological treatment for patients with panic disorder. While both treatments worked in the short run, the results were more positive and longer lasting for cognitive-behavioral therapy (Clinical Psychology Review,1995, Vol. 15, p. 819-844).

There are plenty of other studies with similar results, says psychologist Steven D. Hollon, PhD, of Vanderbilt University, citing the work of psychologists like David H. Barlow, PhD, on panic disorders and G. Terence Wilson, PhD, on bulimia. Hollon’s own research on depression has also found that people who receive focused psychotherapy stay better longer than people who just receive medication.

If the insurance industry would only listen to this research, says Hollon, the implications could be far-reaching.

“Just do the math,” he says, noting that pharmacotherapists may keep depressed patients on expensive antidepressants for the rest of their lives. “If you can get with four months of psychotherapy the same benefits you get from a year and a half to two years of continuous medication, you begin to break even after about a year’s time even though it’s more expensive upfront to provide psychotherapy. If the benefits extend over a half decade or decade, your savings really start piling up. But managed-care folks don’t think that way.”

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Filed under Controversies, Treatment

How’s this for a teaser?

who am i?

who am i? (Photo credit: paurian)

 

I’ve always been very invested in the idea that I was severely and clinically mentally ill.

 

It grabbed my attention.

 

Read the rest of the post at After Party Chat.

 

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Filed under Mental Health, Mutual Aid, Treatment

“manifestly unsuitable for (psychiatric) treatment”

Will Self reviews a recently published book on psychiatry and has some interesting observations on the relationships between addicts, mutual aid groups and psychiatry:

healinghands

Interestingly there is one large sector of the “mentally ill” that Burns believes are manifestly unsuitable for treatment – drug addicts and alcoholics. He points to the ineffectiveness of almost all treatment regimens, possibly because the cosmic solecism of treating those addicted to psychoactive drugs with more psychoactive drugs hits home despite his well-padded professional armour. Elsewhere in Our Necessary Shadow he seems to embrace the idea that self-help groups of one kind or another could help to alleviate a great deal of mental illness, and it struck me as strange that he couldn’t join the dots: after all, the one treatment that does have long-term efficacy for addictive illness is precisely this one.

Psychiatrists are notoriously unwilling to endorse the 12-step programmes, and argue that statistically the results are not convincing. There may be some truth in this – but there’s also the inconvenient fact that there’s no place for psychiatrists, or indeed any of the psy professionals, in autonomously organised self-help groups. Burns agrees with Davies that our reliance on psychiatry, and by extension, psycho-pharmacology, may well be related to our increasingly alienated state of mind in mass societies with weakened family ties, and often non-existent community ones. Surely self-help groups can play a large role in facilitating the rebirth of these nurturing and supportive networks? But Burns seems to feel that just as we will always need a professional to come and mend the septic tank, so we will always need a pro to sweep out the Augean psychic stables. I’m not so sure; psychiatry has been bedevilled over the last two centuries by “treatments” and “cures” that have subsequently been revealed to be significantly harmful. From mesmerism, to lobotomy, to electroconvulsive therapy, to Valium and other benzodiazepines – the list of these nostrums is long and ignoble, and I’ve no doubt that the SSRIs will soon be added to their number.

Sooner or later we will all have to wake up, smell the snake oil, and realise that while medical science may bring incalculable benefit to us, medical pseudo-science remains just as capable of advance. After all, one of the drugs that Irving Kirsch’s meta‑analysis of antidepressant trials revealed as being just as efficacious as the SSRIs was … heroin.

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