Showing posts with label mental illness. Show all posts
Showing posts with label mental illness. Show all posts

7/03/2012

Just Like Someone Without Mental Illness Only More So: A Memoir Review

Just Like Someone Without Mental Illness Only More So: A Memoir
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Mark Vonnegut, son of Kurt Vonnegut, Jr., first wrote about his struggle with mental illness in The Eden Express. His newest book has an updated focus, written from a seasoned perspective, with doses of humor which make the book very engaging. To get a fuller perspective about how the newer volume fits into Mark's life, I'd strongly suggest reading The Eden Express first. No, it isn't necessary, but does add perspective and a historical comparison between views about mental health in the 70s and now. It also makes it easier to grasp Vonnegut's changed views of mental health diagnosis and treatment.
By Mark Vonnegut's own admission, "craziness" ran in his family and manic depression affected at least four generations of the Vonneguts - and maybe even more. Alcoholism also seemed to be a common theme, with his great-grandfather drinking when he needed to escape from the voices he heard in his head. His maternal grandmother went through periods of psychiatric hospitalization.
When he wrote The Eden Express, Mark believed he had schizophrenia and was even formally diagnosed as schizophrenic. But he later decided that he actually had a form of bipolar illness, characterized by periods of mania as well as depression. Perhaps that is the prime reason his new book has more of an emphasis on bipolar illness. Vonnegut now questions the vitamin therapy which he credited in The Eden Express for much of his recovery. He has revisited that treatment option, noting it didn't work for many others.
Having read The Eden Express, I was eager to find out what had happened to Mark Vonnegut in the years since its publication. As it turns out, he'd not only gone to Harvard Medical School but became a practicing physician, all described in detail in his latest work. He also had to deal with the loss of his famous father and other blows. He eventually had a relapse (his fourth), complete with hallucinations, hearing voices and delusions that led to potentially lethal acts.
For those who are familiar with some of the biographical information about the Vonnegut family, it is relevant to keep in mind how the family history of depression may have made Mark particularly vulnerable. Mark's father (Kurt Vonnegut,Jr) had spells of depression so severe that he couldn't write for long periods of time. Mark's grandmother (Kurt's mother) committed suicide. So there is a case to be made that a tendency towards depression, bipolar illness, and alcoholism was inherited and may have played no small part in Mark Vonnegut's psychotic breaks.
Adding to the complexities, Vonnegut came of age in the 70s, a time when there was some support for the belief that there was no such thing as "mental illness" and that it was society which was "crazy" or out of whack. This was the time period and social construct when The Eden Express was written - but not the same time frame for his newest book. Finally, like so many in the late 60s and early to mid 70s, Mark took drugs and this complicated things even further. He joined a commune and was seen as a mystical figure, helping to obscure his increasingly disjointed thinking and delusions.
When Just Like Someone Without Mental Illness..etc...was written, drugs were still a factor but consisted primarily of Xanax and alcohol (never a good combination, potentially fatal). After Mark recovered from his first breakdown, the one chronicled in The Eden Express, and became a physician he also became a fairly heavy drinker, although he was careful not to drink at work. He'd sometimes add a bit of Xanax to the mix. Then he stopped drinking, quit the Xanax and everything went haywire again. He started to hear voices, something which hadn't happened to him in 14 years. Then he spiraled downward, began listening to the voices and ended up leaping through a glass window as an act of faith. In short order, he was back in a mental hospital and put on a daily dose of Xanax which seemed to be the bright spot in his day. At one point, he was also put on Haldol. All of this is chronicled very well by Vonnegut.
Maybe all this seems too grim for the average reader. But this isn't just a memoir about very bad periods in Vonnegut's life but also serves as an inspiring and truthful look at getting on with life, in spite of the possibility of regression. It took some bumpy years for Vonnegut to find some sort of equilibrium. After taking a close look at his past, Vonnegut began going to AA meetings and worked hard on his marriage. Although he was out of the psychiatric unit of a hospital, he still had to face a wealth of continuing problems - that turbulent marriage, a dying mother, uncertain funds, and more. And yet he persevered and became a practicing physician again. His success came in bits and pieces and this book chronicles his journey, from the lowest moments to the decisions he made to find some normalcy again.
Whether potential readers of Vonnegut's book have experienced mental illness or known someone who has, this memoir is worth reading. I hope it dispels some of the stigma about bipolar illness and other forms of mental illness. It is a courageous and open account. Vonnegut's memoir also lends credence to the fact that mental illness is a condition which can affect anyone, including those who are highly creative and famous as well as the poor and homeless. Vonnegut is proof that even a respected physician, someone named a leading physician by Boston Magazine, could be seriously impacted by bipolar illness. Vonnegut also doesn't take the stance that there is such a thing as complete mental wellness.
But he does find a way to schedule his life in hopes of staying well enough to be happy, function in the world and (hopefully) avoid any recurrence of severe episodes. He attends AA meetings and adds creative activities, including remodeling homes, to his life. All of this seems to help. I found the tone of the book to be best described as one of cautious optimism, of learning to be "comfortable with being uncomfortable" (as Vonnegut puts it). In his own way, he seems to have come to terms with his family's history of psychiatric problems and found his unique methods for maintaining some balance.
Perhaps Vonnegut expresses it best when he writes: "None of us are entirely well, and none of us are irrevocably sick. At my best I have islands of being sick entirely. At my worst I had islands of being well. Except for a reluctance to give up on myself there isn't anything I can claim credit for that helped me recover from my breaks. Even that doesn't count. You either have or don't have a reluctance to give up on yourself. It helps a lot if others don't give up on you."

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6/27/2012

The Changing Face of Health Care Social Work: Professional Practice in Managed Behavioral Health Care, Second Edition (Springer Series on Social Work) Review

The Changing Face of Health Care Social Work: Professional Practice in Managed Behavioral Health Care, Second Edition (Springer Series on Social Work)
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I received this book and it was in excellent condition. There was a short period of time between ordering and receiving.

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Updated and revised, this text advocates a proactive stance for health care social workers, as a practical guide that addresses the principles of practice in our current health care environment.

With the advent of numerous health care changes, such as managed health care with its focus on behaviorally-based outcomes and objectives, this volume illustrates the "new" face of health care social work. This comprehensive text is full of practice-oriented tips, professional "profiles" in diverse arenas (emergency room, home care, case management, and hospice), questions for further study, and Website resources in each chapter. It will help prepare social workers for the practice change needed in order to become viable clinical practitioners.


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6/08/2012

Asylum: Inside the Closed World of State Mental Hospitals Review

Asylum: Inside the Closed World of State Mental Hospitals
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I'd been looking forward to Christopher Payne's new book, as I've long had a copy of his book on the forgotten subway power substations.
His new book "Asylum" is even richer than the previous book, as it captures the mood of many of these abandoned mental hospitals. I especially like the interior shots of hallways, treatment areas and especially the behind the scenes shots of boiler rooms,work shops and storage areas.
The exterior shots of many of the hospitals built before 1900 give a glimpse of a whole other approach to the treatment of people in trouble. Many of the buildings look more like resorts and reflect a model of the hospital as a positive place to get away from the pressures of life.
Payne was blessed with access to many of these unused buildings and is further blessed with an eye that sees much and captures it on photos.

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Powerful photographs of the grand exteriors and crumbling interiors ofAmerica's abandoned state mental hospitals.

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1/15/2012

Madness in America: Cultural and Medical Perceptions of Mental Illness Before 1914 (Cornell Studies in the History of Psychiatry) Review

Madness in America: Cultural and Medical Perceptions of Mental Illness Before 1914 (Cornell Studies in the History of Psychiatry)
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MADNESS IN AMERICA: Cultural and Medical Perceptions of Mental Illness before 1914 is a delectably readable, in depth investigation of mental illness during a time when few kind words for the clinically insane were in vogue. Psychiatry hadn't really evolved into a respectable zone of medicine until Freud and people with now well-defined disorders of the mind were grouped into madhouses and insane asylums populated by tertiary syphilitics, victims of brain tumors, and mentally retarded unfortunates. This 'untouchable' status left the population free to derive all manner of perverse etiologies from demonolgy to withcraft to religious punishment and that opened the door for not only charlatans but also for artists of every field to interpret whatever they wished. As the keenly gifted authors Lynn Gamwell and Nancy Tomes have researched and described in this lavishly illustrated tome, madness was a much maligned yet rich source of inspiration for scientists and artists alike. Extensive illustrations of the ghastly tools of the asylum doctors' trade are interwoven with beautiful and accurate renderings of the human nervous syatem and etchings, drawings and paintings by well known artists whose works were never thought to reflect madness until this volume. This book could (and most assuredly does) easily stand on its own; the fact that it accompanied an exhibition showing the drawings, instruments, and art inspired by madness during a learned physical documentary in 1995 only adds to the richness of this venture. Kudos to the authors, the publisher, and the curators for a true gift to the realm of scientifically artistic investigation.

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11/16/2011

Psychiatry for Medical Students, Third Edition Review

Psychiatry for Medical Students, Third Edition
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This is a great review book for the most commonly found conditions in psychiatry as well as covering geriatric AND pediatric issues. It has the DSM-IV criteria for these conditions, a great section on differentials (which comes in SUPER handy at test time).
Took off 1 star as a few items (mainly treatment related) are outdated or not present as it is from 1997.

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For medical students taking their first course in psychiatry or entering their first clinical clerkship, their early encounters with psychiatric patients and their need to master vast amounts of new information on complicated illnesses can be a bewildering, grueling, and intimidating experience. Fortunately, these newcomers have a reliable and trusted source that makes psychiatry more accessible to them. Widely used in medical schools and allied mental health curricula, the third edition of Psychiatry for Medical Students is the standard against which all psychiatric texts for beginning medical students are measured. This popular book gives medical students, primary care physicians, nurses, social workers, and psychologists a jargon-free introduction to the basics, including topics such as schizophrenia, electroconvulsive therapy, transference, and tranquilizers.The text also helps the reader develop the basic skills needed to carry out a diagnostic evaluation and provides systematic coverage of common psychiatric disorders, groups of patients, specialized psychiatric fields, special problems encountered among patients with a broad range of psychiatric conditions, and psychotherapies and somatic therapies. This updated edition incorporates the changes in DSM-IV and contains discussions of recent developments throughout the field. Filled with new references and the latest research, this book can be used as a quick reference during clinical work and a starting point for further reading.

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10/19/2011

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America Review

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America
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Robert Whitaker's Anatomy of an Epidemic reveals the damage that can and very often does result from long-term use of psychotropic drugs, and, along with it, the alarming rise in chronic mental illness in this country since such drugs as Thorazine were introduced in the 1950s. Because this drug could cause tardive dyskinesia and other permanent nervous system damage, the pharmaceutical industry got to work on new generations of drugs that are being used now.
The rise in drug use corresponds with psychiatry staking a renewed claim to therapeutic expertise and market share, which had begun to erode due to competition from counselors, social workers and others (see the Selling of DSM by Kirk and Kutchins -- [...]-- and Making Us Crazy by the same authors). The prescription pad, and the power of academic psychiatry in collaboration with Big Pharma, allowed psychiatry to open up a very large market, one that today seems to encompass the entire population.
Whitaker documents the alarming rise of disability and increasing number of people on SSI and SSDI due to mental illness over the last 50 years, including the increase since the 1980s, when serotonin reuptake inhibitors such as Prozac were introduced, and again, with the introduction of what are called atypical antipsychotics (e.g., Risperdal, Zyprexa), and reliance on drugs in the benzodiazepine family (Valium). But perhaps the most tragic of all cases with drugs used to treat what were once considered within the range of "normal" behavior (e.g., shyness) is the prescribing of amphetamine-like agents such as Ritalin or Adderall for so-called attention deficit disorder (ADHD) in children, and, even worse, powerful psychotropic drug cocktails to treat a newly introduced category of illness, childhood-onset bipolar disorder. In all of these cases, Whitaker documents how long-term use of such drugs can lead to severe debilitating effects and what may be irreversible brain damage. He also reveals that there is no scientific evidence, none whatsoever, for the psychiatric storyline that psychotropic drugs compensate for chemical imbalances in the brain.
Impeccably researched and documented, Whitaker's book is based on long-term outcome studies that have received almost no publicity from psychiatry and other guardians of the psychiatric establishment, including, of course, the pharmaceutical companies that keep churning out new generations of magic bullets. It's a multibillion dollar industry with a lot to lose were the full truth about the drug risks disclosed and understood.
While far from an anti-psychiatry or anti-drug polemic, Whitaker's interviews with patients who are on psychiatric medications are nonetheless heartrending. Also revealing is his disclosure of the brutal treatment meted out to maverick doctors like Peter Breggin, David Healy and Loren Mosher, who all questioned the efficacy of pharmaceutical treatment of mental disorders, from schizophrenia to bipolar disorder and other maladies. Harvard Medical School-trained Breggin was in effect blacklisted. Mosher lost his position with the NIMH over his successful drug-free treatment of patients through the Soteria project he founded. And Healy promptly lost a job offer after publicizing his criticism of SSRIs and their possible relation to suicide.
In a TLS April 2009 review of Healy's book Mania, the reviewer says Healy "goes on to describe how Big Pharma has captured almost total control over the research process, to say nothing of buying up academic experts and turning them into marketing shills." Whitaker essentially reports the same thing; especially telling is the chapter titled Tallying Up the Profits, including a subsection titled the Money Tree.
On top of this, there is the DSM, or Diagnostic and Statistical Manual (the fifth edition soon to be released; see Ofer Zur's critique at the Zur Institute site), with its ever-expanding list of disorders. No longer are only those thought to be suffering from schizophrenia or bipolar disorder entreated to take their medication, without which, they are told, they would be like a "diabetic without insulin." Now everyone suffering from problems such as grief or the blues or any number of things -- in the case of children, ADHD, "oppositional defiant disorder" or childhood-onset bipolar disorder -- are also told they should take drugs, as if they needed the psychological equivalent of insulin. The tragedy in the case of children is that often, after taking stimulant drugs, they begin to experience psychotic symptoms. Then, more drugs are used to treat the additional symptoms, a fact that accounts for more and more young people ending up on disability rolls.
I hope everyone who sees a primary care doctor or counselor or any kind of therapist will read this book and think twice or a dozen times before attempting to solve any type of emotional problem or bedeviling symptoms with Big Pharma remedies. While Whitaker does explain how such medicines can be useful in taking down severe symptoms on a short-term basis, this book sounds the alarm to proceed with caution. Once "treatment" is begun, brain chemistry is altered, and an insidious dependence on the drugs can develop. Withdrawal from the drugs also sounds as if it might be more challenging than withdrawal from heroin or cocaine.
On a positive note, Whitaker has started a blog that accompanies description of this book at his Mad in America book site. Here, he not only lists results of the long-term studies he documents, but also lists promising alternative treatments, including exercise, that are helping people. I admire Whitaker's courage in writing this book, which can give hope to all the people psychiatry may have condemned to chronic illness. Disclosure: After meeting Robert Whitaker for the first time and hearing him speak about his book last week, we are now friends on Facebook.


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