Friday, April 27, 2007

Commitment Phobia

E. Fuller Torrey has a great article in the Wall Street Journal today.
The question inevitably follows the carnage at Virginia Tech: Are individuals with severe mental illnesses more dangerous than the general population? Since the 1960s, when the emptying of public mental hospitals went on fast forward, this question has recurred with each publicized psychiatric tragedy. And each time, mental health organizations have replied with an identical mantra: Psychiatric patients are not more dangerous than the general population.

This answer may be politically correct, but it is factually incorrect. To be precise, mentally ill individuals who are taking medication to control the symptoms of their illness are not more dangerous. But on any given day, approximately half of severely mentally ill individuals are not taking medication. The evidence is clear that a portion of these individuals are significantly more dangerous....

All of this is known but assiduously ignored by most mental health organizations. The reason usually given is that to talk publicly about violence increases stigma against all individuals with mental illness. The problem with such reasoning is that the violent episodes themselves are the main source of stigma -- until the issue of violence is addressed the stigma will remain. This was illustrated by a 1996 survey that found that 31% of Americans associated mental illness with violence, an unexpected increase from a similar survey in 1950 that had reported that only 13% did. The general public apparently bases its opinion on actual events, not on mythology fashioned by mental health organizations.

The most remarkable aspect of psychiatrically related tragedies is that most of them can be avoided. Studies suggest that problems of violence are associated with a small percentage -- approximately 10% -- of all individuals with serious mental illnesses. These are often the same individuals who are intermittently homeless, incarcerated and rehospitalized. Because of their brain disease, these individuals have little or no awareness of their illness and will not voluntarily take medication, because they believe there is nothing wrong with them.

Dr. Torrey is the President of the Treatment Advocacy Center. Visit their site here.

Thursday, April 26, 2007

Autism, Schizophrenia and advanced paternal age

A reader sent me these links on these subjects. I pass them along to my readers. Make of them what you will. I find this fascinating, and plan to keep my ear to the ground on this topic.
Dr J

Many of these blogs are citing the same studies, but there are some differences in perspective among them. I report them for what they may be worth to my readers.

more from the families...

Thank you for writing the article that imagines what it would be like to be the parent of a seriously mentally ill child. The letter written by Seung Cho's sister was (I thought) a heartfelt response to an unspeakable tragedy. I don't know what the family was like except for an article I saw on the internet with an interview with a relative from South Korea. People will be interested (to some extent) in information about Cho's family, hopefully as a response to try and discover what may have helped to avert this tragedy. I am sure some articles will blame the parents and law enforcement, and then legislature for not having the right laws in place. Perhaps former psychologists or psychiatrists will be blamed as well. The website for NAMI, National Alliance for the Mentally Ill doesn't even want to count Cho as mentally ill, a fact that greatly lessens my opinion of NAMI. I am sad for all the families. And I know that as a parent of a seriously mentally ill child, it is a misery, so far, unmatched in my life.

Still more from the families...

Thank you for your discussion of these issues. I have a 21 year old son,currently diagnosed as major psychotic depression possibly schizophrenic, who has had three short term stays in two local psychiatric hospitals. He is now inside,but we don’t know how long they will treat him. It could be as little as four days,up to ninty days depending on a variety of variables. We know from experience that when he’s released in our care(Mom & Dad), the clock is ticking. The best he’s done so far is two weeks,the worst is two days. Whilehe’s out,many are at risk,including us. Again, I thank you for bringing up the unpleasant reality of our mental health programme.

My award for the greatest disservice to our mentally ill goes to Thomas Szasz whose influential book,The Myth of Mental Illness,helped us get to where we are today.

More readiing on Mental Illness

Here is a book suggested by a reader. I haven't read it myself, so I can't vouch for it.
I recently read a book that has some excellent insights for parents" Raising Depression-Free Children by Kathleen Hockey. It's a great read and covers understanding, prevention, and hope. Moreover, it addresses whole families in a commonsense way and teaches skills and healthy practices for the mind, body, and soul.

readers, feel free to post your suggested readings in the comments to this or any other relevant post.
Dr J

More on Mental Illness and the Virginia Tech Massacre

Here is a note from a long-time reader of mine, with his perspective on the problem of the mentally ill in a free society.
Some in your blog might ask: "Why?" the situation regarding support for the mentally ill is so desperate in a country as blessed as America? Linked below is the history of how we got to where we are. It's not a pretty picture. Really, a comedy [that's not at all funny] of unintended consequences and legislative mis-steps that has left the innocent and the afflicted condemned to relive the bitter harvest of well intentioned, but serious mistakes and...

Now, at VT, [AGAIN] the completely innocent suffer this harvest of ultimate bitterness. I do pray for them and for future innocents, but I harbor little hope of real repair for it seems to me, we only poorly understand the real cause of our communal trauma. How does it feel [Dr. J] to be a "voice crying out in the desert?"

The catastrophic dismantling of the "delivery system" was aggravated, strangely enough, by the absolutely incredible effectiveness of "new" medications. See John Kennedy quoted in the attached link. If [and it's a big if] the right meds "cocktail" can be found and the patient can accept lifelong treatment, some hope remains. But, the appearance and "feel" of normalcy during periods of effective med management will beguile all but the most discerning of the afflicted. Few will stay on their meds as others in the blog confirm. In fact, many will conclude they were mis-diagnosed to begin with by overanxious parents and doctors.

The real problem IMO, as you correctly point out in both your books, is the abandonment [by choice] of a shared value system that correctly balances the needs of the weakest among us [children and the mentally ill] and our "rights" as individuals. New discussion, same about that?

[The Story of Deinstitutionalization - Pat M. Stubbs - updated 9/1/98]
"The homeless mentally ill problem has given rise to issues ranging from legal to ethical - the answer may lay in a simple, straightforward large-scale values clarification by asking ourselves the question, Can we as an advanced, wealthy nation afford to allow the problem to continue?"

More Editorial Comments on Mental Illness and the Virginia Tech Massacre

Suzanne Fields starts strong and trails off. Parents are not necessarily "reluctant to commit" their children. In some cases, parents have few opportunities to get meaningful treatment for their children. Contrary to some of the comments over at Town Hall, there are people who really are dangerous to themselves and others. About a third of the "homeless" population have serious mental illnesses. We are doing no one any favor by pretending they are just a little different, or just transgressive non-conformists. Of course, there is the danger of over-treating people, or of commiting people who shouldn't be committed. But at this time in our history, the pendulum has swung so far in the direction of protecting the civil liberties of the insane, rather than protecting the sanity of the mentally ill (which can sometimes be improved with medications) and the safety of the public.
Daniel Henninger, at the Wall Street Journal, refers to the Safe Schools report and its perhaps surprising conclusion that although most of th school shooters gave indications that should have been recognized, not all of the school shooters were certifiablly insane.
One of the Safe School report's most relevant findings, for the purposes of stopping another Virginia Tech, is that the 37 school attacks weren't typically carried out by severely ill, unhinged psychotics like Cho Seung-Hui. This is not to say they were happy campers (the study interviewed 10 perpetrators in depth). Though few of them would get off by reason of insanity, they were all mentally very unhappy campers; and what is more, other people knew that. And in nearly every case, someone knew they were planning the attack: "In nearly two thirds of the incidents, more than one person had information about the attack before it occurred."

Henniger's bottom line is that people need to DO something when they notice strange behavior. Running to get medication or commitment papers is not the "something" that needs to be done in all cases. But we need to stop being so passive:
Among the reasons widely adduced for not doing something about Cho's violent proclivities are HIPAA and FERPA, the confidentiality laws for health records and college students' records. Well, there's no FERPA for high schools. There is merely the weird cultural refusal to turn in bad actors to adult authority. In one school attack, so many students knew it was coming that 24 were waiting on a mezzanine to watch, one with a camera. The enemy is us....

If there is a sliver of silver lining in the Virginia Tech aftermath, it is that there seems to be a willingness to look hard at the status quo -- no matter what assumptions pre-existed about rights, privacy, stigma, coercion, security or whether we can blame it on Karl Rove. On Tuesday, for example, the Chronicle of Higher Education published a piece by a professor titled, "Why It's OK to Rat On Other Students." Here, as with the message screaming off the pages of the Safe School report, the exhortation is to do something, no matter what the intimidations of the law or received wisdom.

What this means is that some college presidents, and their lawyers, rather than rolling over before those confidentiality laws, should tell some aggrieved student who is refusing to take the medication prescribed for his psychosis: So sue! Let a judge decide whether 32 deaths warrant a reconsideration of these restrictions.

Wednesday, April 25, 2007

When is a Woman Not a Woman?

The medical profession has come up with a solution to the ultimate "women's problem." something that will literally, make us just like one of the guys. A pill that eliminates our periods. This pill, which is expecting FDA approval soon, is a form of contraception.
What is "feminist" about something that removes everything distinctive about being a woman?

Tuesday, April 24, 2007

More Parents write in on Mental Illness and the Virginia Tech Massacre

As the parent of a child with mental illness (now an adult), who almost isolated himself like the young man at Virigina Tech, and for whom I had to constantly fight for services (often unsuccessfully even in the school system), I am in complete agreement with your column. My heart grieves for the parents of the children who were brutally murdered. Yet, I so sympathize with the family who feels hopeless, lost, and obviously shamed by this. I know how the system works--or does not. If you haven't read Crazy by Pete Earley. He also has a website. Many of the sentiments posted in his "Guestbook" echo your thoughts.

More on Mental Illness and the Virginia Tech Massacre

A reader writes in:

The time we as a people spend talking about this and critiquing the young man and his parents is directly proportional to the degree that we ignore (cover-up) the real problems. Or you could say, pointing the finger at the 'other guy'. There has not been, to my knowledge, little, if any, discussion on the amount of time young men...and now unfortunately young girls, spend playing violent videos games - 'shooter games'! The nation's attitude to the incident at VT is typical of the "we - them" mentality. Until we provide a more intellectually challenging life for young boys conbined with verbal approval and appreciation of their masculine genius we, as a people, will be destined to extinction.

It is odd, isn't it, that the mass murderers and school shooters are male, during this era in which we can't seem to face the genuine differences between boys and girls and men and women.

Friday, April 20, 2007

More on Sociopaths

A reader sent me this link to an article about psychopathology. Very interesting. I suggest reading it. However, I hasten to add that this particular diagnosis is different in kind from what many of my other readers are dealing with, such as schizophrenia and bipolar disorder.

Thinking about psychopathy leads us very quickly to a single fundamental question: Why are some people like this?

Unfortunately, the forces that produce a psychopath are still obscure, an admission those looking for clear answers will find unsatisfying. Nevertheless, there are several rudimentary theories about the cause of psychopathy worth considering. At one end of the spectrum are theories that view psychopathy as largely the product of genetic or biological factors (nature), whereas theories at the other end posit that psychopathy results entirely from a faulty early social environment (nurture).

The position that I favor is that psychopathy emerges from a complex—and poorly understood—interplay between biological factors and social forces. It is based on evidence that genetic factors contribute to the biological bases of brain function and to basic personality structure, which in turn influence the way an individual responds to, and interacts with, life experiences and the social environment. In effect, the core elements needed for the development of psychopathy—including a profound inability to experience empathy and the complete range of emotions, including fear—are in part provided by nature and possibly by some unknown biological influences on the developing fetus and neonate. As a result, the capacity for developing internal controls and conscience and for making emotional "connections" with others is greatly reduced.

(This article from Psychology Today was published in 1994 and is an excerpt from a book, by Robert Hare, called Without Conscience:The Disturbing World of the Psychopaths Among Us )
The one disorder I know best is called reactive attachment disorder, which I wrote about in Love and Economics:why the Laissez-Faire Family Doesn't Work. That disorder is almost certainly environmentally driven, as it is found among children who have spent substantial time in orphanages or in foster care, or with a profoundly negligent adult, such as a drug addict. I have come to believe that this environmentally triggered condition, does have a physiological component. The development of the limbic brain in infants is stimulated by being in relationship with a loving care-giver, usually, but not necessarily, the mother. When a baby is born, he has to develop a sense of self and of the difference between himself and other people. To do this, the baby needs to look for another person, and have that person look back. This activity actually stimulates the development of the part of the brain that governs the ability to be social and have empathy for other people. Hence, if the baby has no one to look at, as is often the situation of orphanage children, their brains do not develop properly. They may have been born with every capacity for normal social development, but had it stunted by their environment. I learned this stuff from a great book called, A General Theory of Love. After I learned this, I included it in my second book, Smart Sex: Finding Life-long Love in a Hook-up World.

Having said this, I hasten to add: just because some sociopaths are made, does not preclude the possibility that some sociopaths are born. I think born are quite possible. We need an explanatory strategy that can account for both possiblities.
I also hasten to add: the experience that many of my readers are reporting is not really about sociopathology, but about other mental illnesses that have different origins, symptoms and treatments. That is why I caution against painting with too broad a brush.

Thanks from a Virginia Tech Prof

This came in early yesterday:

I would like to complement you on your article on NRO today. One of too few careful and thoughtful pieces on the situation. It is clear that our handling of Cho was inadequate. The results speak for themselves. But I've gotten pretty tired of reading that we "did nothing." This is just a vile insult to the teachers, police, councilors, and mental health professional who tried (and, yes,
failed) to deal with this man's mental illness. We can face (and in fact probably welcome) serious criticism. I'm just getting sick of the stupid potshot. Thanks for writing with a clear head.

Your welcome.

What to do with a sociopath?

Tragedies like Virginia Tech invariably bring out ideas for what to do differently. Here is one I got from a reader, with my comments interspersed.

1% of all humans born – no matter where, no matter what race, gender, group, etc. are psychopaths (meaning, at heart, they have no conscience). No technique, not psychotherapy, not medicine, not anything except two things work on them. The two things are: 1) scaring them and 2) avoiding them.

Where do you get the 1% figure? That means in my neighborhood of 40 houses, there are 2 or 3 born psychopaths. I'm not convinced. Also, I'm not convinced that all psychopaths, or sociopaths, which is the more accurate term, are born. I can believe that some are born, but it is possible to turn perfectly normal infants into sociopaths, if you neglect them profoundly enough. I have written about this in my books, especially Love and Economics
Also, there is an important distinction between the child without a conscience, who is the real sociopath, and the kind of delusional mentally ill person we saw at Virginia Tech. You are painting with too broad a brush here.
I see this problem at the root of wars, Virginia tech massacres, Enron, you name it. I advocate we monitor these people from children, and to be honest limit their constitutional rights, for our safety. That is preferable to numerous laws that limit behaviors for everyone (like Sarbanes Oxley for example).

There is something to this. A free society needs to be populated by people who can use their freedom without bothering other people too much. Again, that was the whole point of Love and Economics, whose subtitle is "Why the Laissez-Faire Family Doesn't Work." My libertarian friends never forgave me for that subtitle, I guess.
My solution has problems – such as false diagnosis of psychopaths, misdiagnosis (these people can fool others easily), since psychopaths break laws we have now, they will break these as well. Also, amending the constitution is not something you do in a four paragraph email, and we will have to have a different constitution for psychos, what a discussion that will bring. But we ought to think about some way to monitor them, limit the harm they can do, and protect others from them. We do a lot already – it could be worse, but acknowledging this problem might help us improve.

No kidding, your solution has problems. But, in effect, that is what we are now trying to do with sex offenders: monitor them for life, since we are so pessimistic about ever really changing them. And you are absolutely right that we have to acknowledge that we have a problem. That is where we are falling down on the job with the mentally ill. We keep trying to redefine them as a special case of something else, which they are not. We are treating them as if their civil liberties were more important to them and to us, than their sanity. See Carol Hawkins post below about how her mother, now in her right mind, sincerely wishes someone had honored her sanity more than her "freedom."
The only other advice is to follow the example of Jesus – do not be afraid of the devil (psychopaths)! Know what to look for, Face them, pushback from their nonsense when you see them in real life, and yes we all do see them.

Once again, you are painting with too broad a brush. We are dealing with multiple problems here. We can "push back" as you say, in the case of the person without a conscience, because they are extremely manipulative and go in for the juggular at the first display of weakness. But the families who are writing to me are dealing with something quite different.
There is one teaching of Jesus that we really have to be careful about applying correctly: turn the other cheek. We have no right to turn someone else's cheek: if we have any responsibility for protecting the public, we have no right to ask that someone else turn their cheek. And, in many cases, we aren't doing the person any favor by overlooking their behavior. For the truly mentally ill person, we need to confront their illness on its terms and deal with it. For the person without a conscience, we need to confront their behavior, set extremetly tight limits on it, with no excuses.
And you are right about this: we need to not be afraid.

Memories of the change in mental health

Does anyone else have memories similar to this reader's?

I remember when the mental hospitals were shut down allegedly on the basis of civil liberties violations. When the media began attacks on mental institutions I was in college, in Virginia no less, and had the opportunity to tour one of Virigia's largest in Staunton (some 5000 patients). I was impressed with how clean the place was and how well cared for the patients appeared. Not the description you got in the media.

A Long Post from Another Family Member

Here is an article I received from a reader, who has graciously allowed me to post it, with her name. She is very interested in working with anyone who wants to change some of the laws dealing with the mentally ill.

Treatment by Other Means
By Carol Hawkins
I sympathize with all police officers and their families when a death results from a police action. No officer desires this kind of outcome when responding to a call. In fact, such a tragic result causes the officers who were involved incredible stress and sorrow, although you’d never know that from the press coverage, the complaints that are filed with the independent review board, or
the particularly vituperative screeds of self-appointed police watch groups.
I have watched police officers subdue various individuals over the years. The intensity of the interaction can be shocking. However, I have never been in a street fight and don’t have firsthand experience. I know, from my participation in the Portland Police Bureau’s Citizens’ Academy,
that officers are not trained to fight using the Marquis of Queensberry rules. Such interactions are not meant to be an equal contest between the officer and the person s/he is confronting.
Officers are trained to subdue the person with whom they are fighting as soon as possible and by using just “that level of force necessary” to succeed. We need to keep this in mind when we see police officers handling someone who is violently resisting arrest.
I do know firsthand what it is like to deal with mentally ill individuals, specifically schizophrenics who refuse treatment for their illness – and the legal issues involved in dealing with the mentally ill. Consider the following case.
A very bright and talented (albeit difficult) woman has become increasingly delusional. Her family members try to convince her to seek help, which she refuses. She comes to believe she is secretly married to NBC News Anchor Tom Brokaw. She decides that her loving and tolerant (real) husband has conspired against her, leaves him, and moves to an apartment. Here, she intentionally leaves the doors and windows propped open – not just unlocked – because “the archangel Michael” told her to do so. She winds up with bruises and other mysterious injuries which she claims are due to an assault. She spends her meager retirement income on expensive jewelry and clothes and refuses to pay rent, since “Tom” is paying her rent. When she is
inevitably evicted, she moves in with a daughter, who tries to talk her into getting help. She refuses. Her delusional beliefs cause great distress in her daughter’s family. Grandma eventually decides that her daughter and son-in-law are poisoning her and holding her captive. She threatens a handyman with a loaded gun. She decides her 12-year-old granddaughter is spying on her and treats that child abominably. When her daughter remonstrates with her, she steals her son-inlaw’s pickup truck and disappears.
When she is discovered living in a motel 10 days later, the woman’s five children decide to try to have her mental condition evaluated against her will. The daughter takes reams of her mother’s written materials, detailing her delusional beliefs, to the local authorities to have her mother involuntarily committed, diagnosed and, hopefully, treated. It’s the hardest thing this loving daughter has ever had to do. The county assigns her mother a lawyer, who argues that it is the
mother’s “right” to hold bizarre beliefs, such as that she is the rightful heir to the throne of England. The psychiatrist who evaluates the woman diagnoses her as having a paranoid illness, probably schizophrenia, with delusions of grandeur. The judge, however, rules that although he believes this diagnosis is accurate, the woman is NOT a danger to herself or others, nd that although she is, indeed, “gravely disabled” as any reasonable person would understand that term,
she is not “gravely disabled” as the law defines it.
The mother is released, and subsequently disappears - for more than four years. Her children have no idea whether she is dead or alive. When, in an incredible coincidence, the same daughter who took her in finds her again, it turns out that the mother she tried so hard to help had become homeless, had lost her car and all her other possessions, and had spent every penny of her retirement income. She had been found in a park by a kindly deputy sheriff, who noted that she was not your “usual” street person. He had helped to settle her in a motel for transients, where she shared one bathroom and one kitchen with 17 other people.
This is a true story. I am one of this woman’s five children, and it was my sister who courageously took her through the court system to try to get her help - a court system which failed to help her, and instead, by upholding her “right” to her paranoid beliefs and subsequent actions, assured that she would become destitute.
Is this justice?
Consider another real-life example from downtown Portland. One day, when leaving Meier & Frank, I came up behind a man pushing an overflowing grocery
cart into the crosswalk on 5th Avenue. The cart was so full of trash bags that he couldn’t see over the top of it, and he plowed it directly into someone crossing from the other side. That man spoke sharply to him, saying “Watch where you’re going!” and then turned left to cross Morrison Street. The first man pulled a long piece of conduit from the cart and, muttering angrily, started after the man who had crossed Morrison Street – clearly intending to hit him from behind.
Before I could stop myself, I yelled “Hey!” He turned, glared at me and muttered, and shuffled off across 5th Avenue with the cart. This man was obviously angry and dangerous, and this incident is only one of many such interactions I have witnessed in downtown Portland.
I absolutely agree with Chief Sizer and Mayor Potter that mental illness treatment options are totally inadequate here. Mentally ill people are wandering around untreated in this city every day and the City Council hasn’t considered this problem a priority. Now, the mayor is saying that it is the County and State government’s responsibility to provide adequate funding for treatment. I do agree that funding is necessary, but that is not the only issue that must be addressed. I believe the most important issue to be corrected is the legal definition of when one becomes a “danger” to one’s self or others or is considered “gravely disabled.”
The bottom line for me is this: If we can’t compel the mentally ill to accept treatment, why is funding necessary? Schizophrenics are notorious for refusing treatment. They apparently feel hyperaware and superior when they are not on medication. And, once they have been on medication for a time, they may decide they don’t need to take it any more – and they have the legal right make that decision.
The present legal standard which allows the mentally ill to refuse treatment focuses on an individual’s right to believe whatever he or she chooses. This had been an inviolate right in our country (contrarily, this same country in which politically correct restraints are now being placed on free thought and speech). As we have seen in recent months, the delusional person is finally deemed to be a danger only after s/he has injured or killed another person. By then, it’s too late - for the mentally ill person - for the victim - and for the police officers who are required to
I do understand the need to protect an individual’s right to believe what he or she chooses. However, if someone is clearly delusional, why is it impossible to overrule these beliefs long enough to get the individual treated, and to allow a family the right to monitor ongoing treatment? If my mother had been in her right mind, she would not have wanted a narrow legal focus on her “right” to believe things that weren’t true to cause her to lose everything she treasured. Now that she is medicated, she can’t believe that she did lose it all, and she intensely
mourns that loss.
Something needs to change – now. As a culture, we should be ashamed of having allowed these tortured people to end up on the streets, victims of our complacency, our lack of compassion, and our own tolerance of their “right” to wind up homeless.
Mom, I am so sorry that you lost everything. Your children tried – but we were not allowed to protect you. At least today we know where you are and that you are safe.

more from the families...

How refreshing it was to read your column today! I have been unable to listen to much of the coverage of the VT massacre as I have both a sister and brother who both have schizophrenia.
My sister has been ill for over 40 years and my brother for about 25 years.
Listening to these pundits try to dissect the ramblings of an obviously paranoid schizophrenic man is making me crazy. ( I spent tweny years trying to convince my mother that you cannot reason with a schizophrenic.) You are exactly right when describing the parents. My parents had eleven children , yet they bent over backwards trying to get help for my sister's severe mental illness years ago. In those days , when there were state hospitals ,it was still extremely hard to get help, and today it is even worse.
Yes, there are more helpful drugs available, but as you said , convincing a crazy person to take them is no easy task. And the ACLU makes sure they retain the right to be insane.

Thursday, April 19, 2007

The Problems of Medication

Along with the general problem of treatment, there is the particular issue of the proper use of medication. This reader brings up an excellent point.
I believe a new and more urgent topic needs to be discussed as openly as possible about the over-prescribing and dispensing of psychotropic drugs, particularly to adolescents and young adults. From personal experience I believe that too little is known about the long term effects these drugs have and particularly the effects from discontinuation of these drugs. My son, aged 18 at the time, had been prescribed Zoloft for approximately 3 years for mild depression by his pediatrician. He discontinued taking this medication, and although he did it slowly he experienced a suicidal/homicidal ideation episode that required us to hospitalize him. He was placed on another psychotropic medication and is currently under the care of a psychiatrist, but it has taken months for him to achieve a semblance of his former equanimity. Because of the initial episode, we--his father and I--, will never be able to completely breathe a sigh of relief because, as I have experienced, mental illness is never predictable nor cured.

While I have not been able to find any literature on whether discontinuing a psychotropic medication actually enhances the likelihood of psychotic episode (especially in younger people--Consider the two youths of Columbine) I truly believe that this needs to be examined. Openly. Prior to my son's discontinuing the Zoloft he had never displayed any psychotic behaviors or tendencies, and when I broached the matter with the psychiatrist, she would not entertain this idea. How many others will experience the same effects. And, is it better to not prescribe the drug if there is no support mechanism for the person during and after prescription?

If I have rambled, I apologize. Thank you for the avenue to vent my concerns. I just wish there was a better way to get a public forum going on this issue.

I am not well informed about this particular problem. I do know from experience, however, that giving someone the wrong medication can seriously mess them up. These are powerful medications. Accurate diagnosis is crucial.
One book I found helpful years ago was this one: The Bipolar Child by Demitri and Janice Papolos. This book taught me that bipolar disorder is sometimes misdiagnosed as something else. If the child is treated for ADHD, for instance, when he is really bipolar, the wrong medication can induce dreadful symptoms.

From the families of the mentally ill

OK, you should see my In-Box. I am getting letters from the families of mentally ill people, describing their frustration and heartache at not being able to get meaningful treatment for their loved ones. I am posting some of these. Please, please, if you know anyone in this situation, send them to this blog. Use this as an opportunity to get the word out that the laws and policies need to change, for the good of the mentally ill themselves, their families, and the safety of society as a whole.
Here is a sampling of my mail:

Thank you so much. I am one of those parents from the other side with a brilliant but mentally ill daughter and we are struggling with sending her to college at all. I hear everyone talk about stricter measures to keep everyone safe from the crazy people. And I agree with them. But it is also my baby they are talking about. It is enough to seriously break you apart. My home is a 24 hour mental institution. It is difficult every day. Thank you for saying out loud what no one wants to think about at all, and wish would just go away. Its not going away.

Dear Ms. Morse,
I appreciated your article because while the talking heads can call this event evil it won't address the real issue of mental illness which is the evil that needs to be confronted.

My mother is schizophrenic, and at the age of 83 she has experienced numerous episodes in which she has been committed to a mental hospital until she was deemed fit to return to society. We were fortunate that her illness is a nonviolent form. Over the years the medicines available to treat all forms of psychological problems have improved in quality and quantity. While this is a blessing, society at large can not grasp the ongoing nature (and shame) of this illness, just as you noted in your article. No amount of medication ever "heals" the illness. Constant supervision is a family's only ally, and even then keeping a person suffering from psychosis on their medication is often a matter of sleight of hand, or trickery, at least from my and my family's experience. Simply put, when the person has "recovered" they believe they no longer need the medication and often refuse to take it.

Dear Ms Morse:
I could almost cry after reading your cogent and moving description today , of what the family members of the mentally ill face year after year, somehow always living in the fear that the proverbial other shoe will drop as it has so many times in years past.

My only sibling is mentally ill having been diagnosed around 17 with paranoid schizophrenia … there is a lucid or almost other worldly aspect to the mentally ill at times with their observations and ability to push buttons in those closest to them. I certainly feel exhausted of late after another rough period with my sister and several brief hospitalizations. And it does not get easier with our parents now in early 80’s. I have advocated, attended sessions with family and sister, kept track of meds, suggested structure via a weekly therapist out of my pocket. All to seemingly no avail…the calm periods seem to be shorter and shorter.

What I do know after decades of heart ache, anger and frustration is that there does not seem to be any easy or ready answer to such tragic lives or worse the outcome such as in Virginia. Certainly though better rehab treatments and day programs can be developed? Sigh… I just don’t know really what to say, except how profoundly sad I feel for the deaths of innocent people, the family of the insane young man and perhaps most of all the tears that come when I think of my sister as a small “healthy” vibrant girl (was it ever so? or is this my memory comforting me?) ;and the same calm demeanor of the shooter at Virginia tech before extreme isolation, depression and self loathing claimed his heart and mind in later years. In the case of the Virginia tragedy it does appear that people reached out in the class room and in 2005 for an evaluation, clearly long term hospitalization may be the only answer for some patients.

People have reached out to my sister as well, she always pushes them away… The only tools that I have seen as helping the mentally ill are: staying on proper meds, talk therapy and structure day to day of some kind. The act of coming out of isolation is crucial to those that suffer with the disease and those that care for the mentally ill especially family members. Without such tool all else is darkness and tragedy

This is a teachable moment. We need to get on the radio talk shows and discuss this. Your stories need to be told. If you know anyone else in this situation who can testisfy about life with the mentally ill, please send them to this site. Let's see if we can't use this teachable moment.

Mental Illness and the Virginia Tech Massacre

My commentary called, "Waiting until it is too late," is up on National Review. Here is the bottom line:
What would be constructive is an honest discussion about how a free society should face the reality of mental illness. It is not a protection of civil liberties to redefine the mentally ill as if they were rational and able to make informed decisions about their care and treatment, even when they are obviously not. As we can see from the Virginia Tech massacre, it is not consistent with public safety to wait until a mentally ill person has committed a crime. It is not “personal responsibility” to expect the families of mentally ill people to take care of them themselves. This means turning their homes into a 24-hours-a-day mental institution, staffed by relatives who never get training, help, or a day off.

Some smart radio talk-show host could do a real public service by inviting the relatives of mentally ill people to call in and describe the challenges they have faced in getting meaningful help. They will give you an earful. They will tell you about the legal institutions that protect the civil liberties of the ill, without providing protection for the well. They will tell you about being sent home from the hospital with medications they can’t make their relative take. They will tell you about the revolving door between the street, the hospital and the jail.

Let these relatives of the seriously mentally ill tell their stories. I promise you a much more interesting hour of talk radio than yet another hour of yammering about gun control.

Facing the reality of mental illness just might prevent another round of school-shooting victims.

I'm getting many reactions to this article, which I will post later today.

Wednesday, April 18, 2007

Amy Richards reacts to the debate

This post inadvertantly (I'm sure)confirms my point that Women's Studies (WS) programs are not serving any purpose on campus. She claims that WS serve as part of a liberal education by forcing students to confront views they disagree with. However, my argument was that the major premises of feminism are false. By Amy Richards' argument, students could broaden their horizons by taking chemistry classes in alchemy, physics classes in the flat earth theory and astronomy classes in astrology. She doesn't even attempt to refute my argument that men and women are different in significant ways.
Her attempts to defuse my reasons for proposing Mens' Studies as a counterpoint to Women's Studies are each seriously flawed. If any reader cares to go to the text of my speech, you will find footnotes for every significant factual claim. Amy Richards' responses have no research or substance to them. Some are just plain laughable. Here she is:
I stayed on topic because I thought it pointless to try to fight "her facts" with "my facts." And I knew most of her facts to be bogus. True, men might be more likely to commit suicide but it's disproportionately gay men and therefore, most likely because they didn't fit into society's (aka Morse's) definition of men. It's not that men suffer more depression, but they are less likely to seek help thus having the depression manifest more negatively than in women (again, the reason men often repress their depression is because this illness might disqualify them from the strong, protector, de-facto role they otherwise inhabit). Women might be more likely to "file" for divorce—but most have been pushed to that place either because they have been emotionally abandoned in their marriages or because they realize life will be easier without being saddled with someone else.

She has no evidence to back up her claim that the disproportion in mens suicide rate is driven entirely by gay men. The claim is preposterous, considering that 1. gay men are about 1% of the population and 2. divorced men have three times the suicide rate as married men. Does she seriously expect us to believe that all the divorced men committing suicide were closeted gay men?
Her speculations on depression are just that: speculations. I didn't even bring up depression in my talk. Depression and suicide are two different things. As it happens, women are more likely to experience depression, and more likely to attempt suicide. Men are more likely to succee in committing suicide. As it happens, this is the behavior most studied among gays and lesbians as well. They are more likely to attempt suicide, more likely to report having thought about suicide, but it is difficult to prove that they are more likely to actually "succeed" in their suicide attempts. Bringing up gay men is simply changing the subject.
Likewise, her claim to know why women initiate most divorces is speculation on her part. She shows no sign of knowing that this subject has been studied.
If this is the best Women's Studies can do to defend themselves, they are in big trouble.
By the way, just to set the record straight here: I answered a question from the audience about "having it all." A female student asked me what women should do who wanted to have careers and children. My response was careful in this way: I prefaced it by saying, "If having children is an important life goal for you, then..." To hear Amy Richards recount the debate, I am insisting that everyone do everything my way. Not true. I simply say, if having children is an importnat life goal, I think you should be married first, for their sakes. And I think you should take the goal of marriage and motherhood as seriously as you take your educational and career goals, and PLAN for them.
If I'm not mistaken, Rebecca Walker, Alice Walker's daughter, who considers herself a feminist, is saying pretty much this very thing to women. So, I'm not sure what the disagreement is on this point.

Tuesday, April 03, 2007

Is Feminism Finished? Re-Axs

More reactions:

Superb piece. We men are awfully wimpy when it comes to standing up for ourselves and especially when it comes to taking on radical feminists as it generally isn't considered manly to compete with or verbally "attack" a woman. We need to be more assertive and will need women as yourself, Christina Hoff-Sommers, Camille Paglia, and others to assist as no man relishes being called a "patriarchal sexist misogynist" looking to keep women "barefoot and pregnant." makes us into that 'strong silent' type that creates the vacuum fomenting the, IMO, anti male climate destructive to both women looking for quality men and men trying to be quality.

Me: this is particularly interesting b/c of something my friend Warren Farrell points out: men have a tendency to want to protect women, not fight with them. Personally, I think this is in-born. But the fact is that men are very reluctant to fight with women, and in fact are very vulnerable to crying women. Case in point: Larry Summers. In his time as Number 1 and Number 2 man at the Dept of Treasury, he didn't blink in the face of a possible meltdown of the world currency system. But as President of Harvard, one hysterical woman faked a fainting spell, and he collapsed.

Men are capable of heroic loyalty in the defense of those weaker than themselves. IMO, the tragedy is that no one asks this of men any more. We have labelled them as selfish beasts, sexual predators and bumbling louts. Neither men nor women really appreciate men's distinctive virtues any longer.

Is Feminism Finished? Re-Axs

Reader re-axs to my Town Hall column:
I always find it amazing that whenever anyone talks about making college more affordable its always in terms of providing more money for student financial aid. No one ever seems to talk about controlling the cost of the university. Eliminating the whole scheme of grievance studies and getting back to basic education would be a good start.

Me: Hard to argue with that. In the debate, I made this point: why should the taxpayers of Virginia pay for an ideological department whose purpose is to make students feel good about themselves?

Is Feminism Finished?

Is the name of my Town Hall article, re-capping of my recent debate at the University of Virginia. You can read my entire speech here.