(10-08-18) I recently interviewed Baltimore psychiatrist Dinah Miller about mental health care today from her professional and personal vantage point. Dr. Miller is a  practicing psychiatrist, instructor in psychiatry at Johns Hopkins School of Medicine,  a prolific blogger and nonfiction and fiction author. Her new book, co-authored with Dr. Annette Hanson, is Committed: The Battle over Involuntary Psychiatric Care.

Question:   Much talk lately has been about focusing on “serious mental illnesses” as opposed to the broader range of all mental illnesses. Do you accept this delineation and, if not, why?

Dr. Miller:  Pete, this is a great question, and it’s more of a political question.  Obviously, some people experience psychiatric disorders in more chronic and/or disabling ways, and some people need more than others.  There are two things I don’t like about the designation of “serious mental illness.”  For one, it sets up a bit of an “us” versus “them” dynamic and seems to imply that there are people who are different from the rest of the population, and that this small set of of very ill people somehow stand out in a way that obviously identifies them.  People can be very sick at one point in time and very healthy at another point in time.

That division is based on the presence of specific psychiatric diagnoses: schizophrenia, bipolar disorder, or severe depression.  Our diagnoses are decided by committees, and what we designate as a disorder changes over time, and the same person may be given different diagnoses at different times; this isn’t a precise thing.

The problem is that based on this idea of ‘severe mental illness’ is the political idea that the mental health pot of dollars should be divided so that these individuals get more, at the expense of services to those who don’t have serious mental illness.  And then we get to terms like “worried well,” which serves to demean the suffering of people who do not have debilitating conditions.

But what is serious?

Click to continue…

 

(10-5-18) When it comes to mental illnesses, we still continue to think of the brain as being separate from the rest of the body. As this New York Times story by science writer Moises Velasquez-Manoff, documents this is foolish thinking. 

He Got Schizophrenia. He Got Cancer. And Then He Got Cured.

Published in The New York Times. Written by Moises Velasquez-Manoff, science writer.

The man was 23 when the delusions came on. He became convinced that his thoughts were leaking out of his head and that other people could hear them. When he watched television, he thought the actors were signaling him, trying to communicate. He became irritable and anxious and couldn’t sleep.

Dr. Tsuyoshi Miyaoka, a psychiatrist treating him at the Shimane University School of Medicine in Japan, eventually diagnosed paranoid schizophrenia. He then prescribed a series of antipsychotic drugs. None helped. The man’s symptoms were, in medical parlance, “treatment resistant.”

A year later, the man’s condition worsened. He developed fatigue, fever and shortness of breath, and it turned out he had a cancer of the blood called acute myeloid leukemia. He’d need a bone-marrow transplant to survive. After the procedure came the miracle. The man’s delusions and paranoia almost completely disappeared. His schizophrenia seemingly vanished.

Years later, “he is completely off all medication and shows no psychiatric symptoms,” Dr. Miyaoka told me in an email. Somehow the transplant cured the man’s schizophrenia.

Click to continue…

((10-1-18) Washington Post Reporter Justin Jouvenal has revealed that Fairfax County has paid $750,000 in a court-sealed wrongful death settlement to the family of Natasha McKenna.

In February 2015, my wife, Patti, read a tiny item in the Post that noted a woman had died while in custody.

“Do you think she had a mental illness?” she asked me.

Several phone calls later, I’d learned that Natasha McKenna, 37, who reportedly had schizophrenia, had suffered a heart attack after being repeatedly stunned with a taser by deputies while being moved from her cell.

I posted a blog about what I had learned and alerted the Post and other local media.

Her death sparked justifiable community outrage.

Click to continue…

(9-28-18) This week, the Treatment Advocacy Center released a study of commitment laws by state, assigning each a letter grade. I will provide highlights of that report in a bit but first a personal story.

I rushed my adult son to a local emergency room when he was having a psychotic break but was told to leave after four hours because the doctor said my son didn’t pose an “imminent danger” to himself or others.

Forty-eight hours later, my son broke into a stranger’s unoccupied house to take a bubble bath and was arrested. He was charged with two felonies – breaking and entering and destruction of property.

Ever since my son’s arrest, I have spoken out against the “imminent danger” criteria. I consider it a fools’ standard. No one can accurately predict dangerousness.

This doesn’t mean that I am against safeguards.

I simply believe waiting until someone becomes dangerous is a recipe for disaster. Our misguided “dangerous” standard contributes to psychotic individuals remaining homeless on our streets, being arrested, and being incarcerated. In certain instances, it has played a key role in mass murders, including the shootings at Virginia Tech and in Tucson.

Click to continue…

(9-24-18) I recently found myself sitting next to Kay Warren, the co-founder of the Saddleback Church in California, at a meeting of religious leaders and mental health professionals.

This first of its kind event was organized by Shannon Royce, Director of the Center for Faith and Opportunity Initiatives at the U.S. Department of Health and Human Services (HHS Center) and SAMHSA to discuss ways to better educate pastors about mental illnesses and mental health professionals about how spirituality can assist an individual’s recovery.

Pastors often are the first called by religious families and many are ill prepared.

I was deeply moved when Ms. Warren spoke lovingly about her son, Matthew, who ended his life at age 27 in April 2013, after a long battle with mental illness. She and her husband, Rick Warren, have used their pulpits to bring mental illnesses out of the evangelical closet.

“A sad reality that I’ve experienced,” Ms. Warren was quoted saying in a Christian Today interview, “is when Christians look at another Christian and say you can’t possibly be experiencing depression or anxiety or if you are you’ve failed, or you don’t love Jesus enough or aren’t praying enough. That just stabs me in the heart..”

After the conference, I began reading her blog. My father was a minister and I spent much of my life involved in different churches, although lately I’ve been slack about attending and generally don’t talk about my personal religious (or political) beliefs in this blog.

Ms. Warren generously offered to allow me to reprint one of her writings. It was difficult to choose  because so much of what she has written is timely and powerful.  (See Sitting On The Edge Of Hell, a recent post about mental illness.)

I have chosen a Facebook post that she authored shortly after her son’s  death – perhaps because my wife, Patti, and I both have had to deal with unexpected deaths. Patti’s first husband and two younger sisters died from cancer. I lost my 16 year-old sister, Alice, when I was a teen. Grief is difficult for everyone, especially those who have lost a loved one to suicide.

I am not alone in admiring her 800-word Facebook missive. It went viral with 3.75 million readers and 10,000 comments.

Used by permission. Copyrighted by Kay Warren on Facebook:

As the one-year anniversary of Matthew’s death approaches, I have been shocked by some subtle and not-so-subtle comments indicating that perhaps I should be ready to “move on.” The soft, compassionate cocoon that has enveloped us for the last 11 1/2 months had lulled me into believing others would be patient with us on our grief journey, and while I’m sure many will read this and quickly say “Take all the time you need,” I’m increasingly aware that the cocoon may be in the process of collapsing. It’s understandable when you take a step back. I mean, life goes on. The thousands who supported us in the aftermath of Matthew’s suicide wept and mourned with us, prayed passionately for us, and sent an unbelievable volume of cards, letters, emails, texts, phone calls, and gifts. The support was utterly amazing.

Click to continue…

FROM MY FILES FRIDAY:  Mental illnesses can strike multiple family members as this email sent to me some six years ago shows.

Hi Pete Earley,

…I came across your book while looking for a source of comfort during my own family’s time of need. Two months ago, my dad was finally forced into treatment for his undiagnosed severe bipolar disorder and coexisting extreme alcoholism. My mother and I (I am an only child) have been trying unsuccessfully for years to get him help.

In order for him to finally be involuntary subjected to treatment, he had to have a major traumatic psychotic episode. He had a previous psychotic episode earlier this year that landed him in a mental health facility for one week. But the latest one proved even more traumatic to all of us.

Click to continue…