Lisa Loren: Catalysis

Shoma Morita founded Morita therapy in 1919 to treat shinkeishitsu, a Japanese culture-specific anxiety disorder characterized by hypochondria and social phobia. Since then, its use has expanded to anxiety, depression, bereavement, shyness, and some inconclusive trials for schizophrenia. In addition to cognitive-behavioral therapy, it is one of the primary therapies used in China.

Morita therapy encourages its patients to accept their feelings as natural, without trying to change them. According to the Morita framework, feelings cannot be controlled. Patients learn to focus their attention away from their emotions and simply act without trying to change how they feel. The focus is on a “reality-oriented attitude”, which is less self-centered and more in touch with the external world. According to the ToDo Institute:

Cure is not defined by the alleviation of discomfort or the attainment of some ideal feeling state (which is impossible) but by taking constructive action in one’s life which helps one to live a full and meaningful existence and not be ruled by one’s emotional state.

Morita is called a “psychology of action”, because it trusts that the actions people take will improve their moods and feelings, while introspection will not.  It greatly resembles modern-day behavioral therapy in this regard - startling for a therapy pioneered when B.F. Skinner was barely fifteen.

Do you know that old question about what might have happened to Van Gogh if he’d had antidepressants available? It’s a stupid question, in a lot of ways. He killed himself, probably as a result of the same mental illness that shows up in his work. If he’d had Prozac, he might he might have lived to see his own work become famous.

And yet, people ask. Didn’t he gain something? Didn’t we?

There’s no glory to a life lost to mental illness, whether through time wasted away in sickness or through suicide. There’s nothing romantic about depression. (I write this a few days after hearing about Heath Ledger’s possible suicide.) We, as humans, have lost too many people to mental illness, to early death, to unbearable pain. We have lost brilliant people to psychotic worlds of their own creation. No amount of creativity will ever justify the raw cost of mental illness. No benefit can justify this degree of human suffering. So, maybe Van Gogh never would have painted The Starry Night, and the world would go on without him. Maybe he would have become a better painter, tempered by age and experience. Maybe he would have prevented World War I. We will never know.

I’m going somewhere with this, actually. There’s an article up on The Guardians’ Joe Public blog asking, Would you vote for an MP with mental health issues? The attached poll, at this moment, is resoundly in favor of doing so, but I’m inclined to wonder if Americans would so easily say the same thing. Americans seem to like strong leaders, and I can imagine the fear that someone with a history of depression might break under stress. But I think of Winston Churchill (depression), and Abraham Lincoln (also depression), and I know that these people made spectacular leaders.

Here’s where Van Gogh comes in. People with mental illnesses are, above all, people; some are full of wisdom and some seem stuck in their own minds. However, I think that people with mental illness must derive some advantage from it. I don’t honestly believe that depression has an evolutionary advantage, but as we see in Van Gogh, it does have some connection to creativity. Various studies have found that people with depression tend to gravitate towards creative professions.

I think, also, that depression makes people more aware of the pain of others. Suffering builds compassion, and the pointless suffering of depression helps us to feel for people who have gone through things without actually enduring them.  On a fundamental level, this means that people who have gone through depression and overcome it are more equipped to help those in trouble, tend to those in pain, and console those living with grief.  Where depressive episodes make people less sociable, depression in life can make people better social animals.

I would never wish Van Gogh’s life on anyone. Whatever benefits depression may offer, they aren’t worth hurting innocent people for. I believe, however, that the people out there with mental illnesses can find some benefit in what they’re experiencing, instead of letting themselves suffer for no reason. What differentiates Van Gogh from so many others is that he used his illness to give something to the world.

Paragraphein has a beautiful post about the new PBS documentary, The Lobotomist:

The common practices, the reactions to anyone “deviant…”, they’ve all evolved over the years. All products of their times.

What tends not to change, though, is the voices of the people who’ve lived through the basic, core experience: losing a child to adoption; suffering from a mental illness.

You’d think, this being the case, that whenever the “experts” have the next great idea, whenever they want to implement a new practice, they might thus stop to consult us–you know, the people who live it, and the people who–across the ages–tend to use the same metaphors for our experiences.

But too often, the “experts” don’t listen. Too often, they don’t even ask. And too often, it doesn’t even occur to them to ask.

I wrote this academic essay of King’s “Letter to Birmingham Jail” this summer. I’m a great admirer of King, and although I don’t have time to write a post on his thoughts today, I don’t want to let today’s celebration of his life pass unmarked. May your message live on, Dr. King.

On April 12, 1963, with Martin Luther King in Birmingham jail and tension mounting in the city, eight white Alabama clergymen issued a statement condemning the “extreme measures” of the Birmingham demonstrations as “unwise and untimely.” Although King responded directly to this statement with his famous “Letter from Birmingham Jail,” the clergy’s statement didn’t actually address him at all. Aside from a brief disparaging remark about protests “directed and led in part by outsiders”, in fact, it never mentioned the leaders of the civil rights movement at all. (Carpenter et all) Instead, they addressed the statement towards “our Negro citizens.” King’s choice, then, to address his open letter to them directly, rather than to the black citizenry he depends on, strikes an odd chord at first. Wouldn’t his response be better directed to the same people the Alabama clergymen target? Why does he bother with those white preachers at all?

Continue reading ‘King and Clergy in Birmingham’

Imagine a world where psychiatric medication works 100% of the time, relieves 100% of symptoms, and causes no side effects. In this world, we all agree on the precise differences between mental illness and personality. It’s easy to tell the difference between someone who tires easily and someone who has the flu, right? Why should mental illness be any different? Imagine that drugs work perfectly, and they don’t alter who the “real” person is. In the world I’m describing, there are no rational reasons to refuse treatment - unlike in this one. Do people with mental illnesses still have a right to refuse pills, or inpatient commitment, or whatever we find works well?

In the real world, this world that we live in, there are no absolute cures for mental illness. Up until pretty recently, scientists considered brutal procedures like the lobotomy acceptable treatments for mental illness. Today the lobotomy has been replaced by drugs that can cause permanent facial ticks and neurological symptoms, drugs that cause massive weight gain, diabetes, and heart disease. Electroconvulsive therapy, which can cause permanent memory loss, is coming back into fashion. In addition to whatever personal objections they might muster to treatment, often patients only have the option of treatments that stand to cause them significant, lasting harm.

This confuses the issue of the right to refuse treatment. It makes perfect sense to refuse a treatment that could destroy your memory, right? It seems reasonable that people might rather hallucinate than have a heart attack. Unfortunately, this leads us to focus on medication only as a heath decision, weighting the health benefits versus the health costs. Given that side effects generally don’t show up in the medical community’s consciousness, this leads doctors to feel safe in trying to force newer medications on their patient. But, more than that, it ignores the fact that these kind of decisions ought not to be based on a simple balancing of the possible heath benefits and risks. The right to refuse treatment is a human right, the right to sovereignty over one’s own mind. We cannot deny people their rights simply because we think we know what would benefit them.

It doesn’t matter, then, how close to the ideal our world may be. We don’t abstain from medicating people against their wills because we think that they understand the risks and benefits better than their doctors. While occasionally, as compassionate human beings, it may be necessary to stop the sickest among us from destroying themselves, for the most part we cannot ethically interfere with the way people chose to live their lives and deal with their illnesses. The law allows people to make their own choices about what they do to their bodies and minds because we respect their autonomy as human beings.

Thinking of suicide?

Wait. Just for a minute. Take a deep breath. Make yourself a cup of tea, if you like.

Read this first.

I do not want to talk you out of your bad feelings. I am not a therapist or other mental health professional - only someone who knows what it is like to be in pain.

Try this. Or this. Or this. Maybe this.

I believe that people don’t attempt suicide until they’ve run out of other options. I’m putting this page together because I want to offer people way to stay alive for a little while longer. The desire to die does fade, in time, but death lasts forever. This is a list of ways to cope with thoughts of suicide.

Talk to Someone

A hundred years ago, Sigmund Freud discovered something that people have known since we learned to walk upright and draw pictures: talk helps people heal. Talking to another person can ease despair, reduce suffering, and help you cope with pain. Thousands of people out there want to help you so much that they man the phones at crisis centers and suicide hotlines for the chance to help people hurting just like you. These aren’t professionals, and they aren’t getting paid. The only reason they show up is to help people.

• 1-800-273-TALK (8255)
• 1-800-1-800-SUICIDE
• Find a helpline at http://www.befrienders.org/ (US and international)
• Email the Samaritans

Ask for Help

If you have friends of family that you trust to help you out, try talking to them. (Needless to say, if you think someone will be overemotional or angry, he or she is probably not a good candidate for this.) Most untrained people won’t know what to say when dealing with a suicidal friend, so you may have to be clear on what you need. Consider printing out one of these sheets from metanoia.org, this one from the American Association of Suicidology, or anything else that you find helpful. Ask someone to sit with you for a little while, or listen to you. You don’t even need to say that you’re suicidal, although if you’re seriously considering harming yourself, it might be best to let someone else know. Don’t be afraid of waking someone up or interrupting them. Suicidal people often feel guilty, or as if they’re not worthwhile, but you’re important to the people around you. Your friends would much rather lose a night’s sleep than lose a friend.

Learn Coping Techniques

Try Distress Tolerance. Originally developed to handle the suicidality and self-harming behaviors in Borderline Personality Disorder, these techniques can work well for anyone in crisis. Some of it might seem a little corny or oversimplified, but it’s kept people in a lot of pain alive and out of hospitals.

• Distract yourself (the link has examples of ways to do this)
• Invoke your senses (this grounds you and helps you take control of your emotions)
• List the pros and cons of hurting yourself

DBSA has these suggestions:

• Keep a journal to write down your thoughts. Each day, write about your hopes for the future and the people you value in your life. Read what you’ve written when you need to remind yourself why your own life is important.
• Go out with friends and family. When we are well, we enjoy spending time with friends and family. When we’re depressed, it becomes more difficult, but it is still very important. It may help you feel better to visit, or allow visits from, family and friends who are caring and can understand.
• Avoid drugs and alcohol. Most deaths by suicide result from sudden, uncontrolled impulses. Since drugs and alcohol contribute to such impulses, it’s essential to avoid them. Drugs and alcohol also interfere with the effectiveness of medications prescribed for depression.
• Learn to recognize your earliest warning signs of a suicidal episode. There are often subtle warning signs your body will give you when an episode is developing. As you learn to manage your illness, you’ll learn how to be sensitive to them. They are signals to treat yourself with the utmost care, instead of becoming ashamed or angry with yourself.

Educate yourself about suicide. Try Psych Central’s FAQ, the AAS fact sheets, or the chapter on suicide in Andrew Solomon’s Atlas of Depression.

Seek Professional Help

If your feeling about suicide last, or if they’re too strong for you to cope with, you should consider looking for professional help. If you have health insurance, most insurance companies will give you a list of professionals they’ve approved in your area. (They say they’ll only give you a few sessions, but usually will pay for more if it means keeping you out of the hospital. It’s worth a try, at least.) Your local crisis center will also probably be able to refer you to someone. Therapy can get expensive, but some therapists work on a sliding scale. Still, going to therapy is an investment of time and resources.

Call 911

Hospitals see people in crisis all the time. Police deal with people in crisis all the time. It’s extremely difficult to kill yourself in a hospital, so if you’re worried that you might do something impulsive, going to your local emergency room can give you a chance to get a grip on your emotions. I don’t honestly believe that checking yourself into a hospital helps most people get better, but it can buy you time. Furthermore, most hospitals will set you up with outpatient treatment when you leave. When you’re not feeling well, going through your insurance company’s big list of therapists can be exhausting. The people at your local hospital can help you with that.

Don’t try to do it alone.

Most people can’t do everything by themselves, no matter how much they want to. Maybe you’re an exception to the rule, and maybe you don’t need anyone else, but do you really need to take that chance? You’re important. Make yourself a priority. Get help.

From, Science Daily, an interesting little piece about the results of new fMRI studies done on borderline patients: Brain Abnormalities Underlying Key Element Of Borderline Personality Disorder Identified.

The research may help explain how specific biological or psychological therapies could ease symptoms of borderline personality disorder for some patients, by addressing the underlying biology of impulsivity in the context of overwhelming negative emotion. The more scientists understand the neurological aberrations that give rise to the disorder, the greater the hope for new, highly targeted drugs or other therapeutic interventions.

In the afterword to her book, The Center Cannot Hold, Elyn Saks mentions that a psychiatrist friend cautioned her to use a pen name, lest she be known publicly as “the schizophrenic with a job.” Her descriptions of psychosis are so lucid that it’s easy to see why friends would want her to hide it. Saks has been crazy in the worst sense possible, paranoid and raving and threatening violence. In this memoir, I feel like I’ve been given a window into what schizophrenia looks like from the outside and feels like from within. If this written had been written by someone who didn’t suffer from schizophrenia, I would call it “compassionate”, but the word doesn’t quite seem to fit in this case. Saks wastes no time in self-pity. This is a brave book, at the heart of it, filled with the hope that one day we all can get the help we need to live.

I admit, I came to the book already in awe of Ms. Saks. Only one out of ten schizophrenics manages to hold a job, let alone win awards or publish books. Forty years ago, Saks would have been confined to an institution for life, without the hope of treatment. Her CV is inspiring. This book is less a motivational speech than a window into another world, where beings from the sky control people’s thoughts and someone can die ten times a day and still be around to worry about it happening again. That she built herself a sane life, however fragile, is a testament to her doctors, her friends, and her own iron will.

Highly recommended.

The issue of individual civil rights for the seriously mentally ill is a major controversy today. Do you feel that schizophrenic patients should ever be institutionalized against their will? If you answer yes, under what conditions should the decision be made and who should have the authority to make this decision?

In our country, schizophrenics tend to be disruptive, scary. In a place where we can, for the most part, cordon ourselves off from the unpleasant realities of human poverty and sickness, schizophrenics stick out as reminders of the frailty and eventual decline of the human psyche. They make us uncomfortable; they make us afraid in a way that bears no relation to to harm they may bear us. I cannot talk about institutionalization, about the involuntary confinement of these people, without acknowledging the degree that it makes us more comfortable to have them locked up and put away where we do not need to see them. These people may benefit hugely from treatment, but any “treatment” that makes them docile and calm and non-disruptive also benefits us. When we consider involuntary confinement, it is important to make sure that we are helping the people in question, not merely removing our own discomfort and guilt.

This is what I believe about involuntary hospitalization: it’s wrong. Two hundred years ago lunatics were rounded up in asylum and showed off to crowds, the freaks, animals in cages. To imprison some against their will is to deprive them of their humanity, to reduce them to the status of pets and children. Imprisoning the innocent against theirs wills is barbaric.
This I also believe: when you have to tools to help a person, it is wrong to allow them to suffer and die. Schizophrenia undoubtedly causes anguish, and 15% of sufferers kill themselves. This is an illness that strips people of their reason and drives them to suicide. If they are incapable of comprehending, by reason of illness, that treatment may help them, don’t we have an obligation to force them into reason long enough for them to make their own choices?

Two wrongs, they say, don’t make a right. It is no less evil to imprison someone when they are incapable of comprehending what they’re doing, and it is no less moral to turn your back on someone because they can’t understand that you can help them. Treating schizophrenia, then, becomes a question of picking the lesser of two evils. I believe that it should always e a hard choice to make, to commit someone, and that anyone who doesn’t feel anguish at depriving another human being of their rights shouldn’t be in the position to make that judgment.

Anguish, however, can’t easily be proven in a court of law. The decision to imprison or free a person, them, needs to be made someone who at least has nothing to gain from hiding the patient away. I suggest a judge. Family members may care deeply about the person in question, but they often become the primary caretakers, and therefore have a vested interest in letting someone else take care of their schizophrenic relative. I sympathize with them, hugely, but decisions involving involuntary commitment need to be made purely based on the needs of the sick person, and family members simply aren’t capable of that. I believe psychiatrists ought to be involved in the process, but I believe that they shouldn’t have the final call. In clinical practice and in diagnosis, I think, it becomes too easy to address the symptoms rather than the person. Schizophrenia may be better treated in a confined and easily monitored setting, but Joe, the person, might do better with outpatient treatment. In addition, the psychiatrist who commits a patient often end up caring for him, and so it would be a poor business move to turn patients away.

Given that commitment is a form of imprisonment, it makes sense that only a judge ought to be able to do it, and the need to follow pretty stringent guidelines. First, someone must establish that the person is incapable of making rational decisions. That, I suppose, is where the psychiatrist comes in, as we can only rely on his judgment. Beyond that, I propose that one of two conditions must be met. First, if a person can be proved to be a danger to himself or people around him, he can be confined, and likely medicated in an attempt to restore reason. Seeing as schizophrenics are not actually much more violent than the rest of the population, I’d propose that people be considered nonviolent by default unless proven otherwise. If no one could provide evidence (including statements, therapy transcripts, et cetera) a person could only be involuntarily committed if they had, clearly, under no duress, and in writing, provided directions that they wished to be hospitalized during a schizophrenic episode or psychotic break. That way, those who need and might want help can get it, while those who want nothing to do with psychiatry aren’t forced into hospitals purely by virtue of their illness.

by Pete Earley

In reading about mental illness and treatment, you come across crazy people who think that all psychiatric drugs are poison, and crazy people who thing that all mentally ill people should be forcibly medicated. Pete Earley isn’t a another distinct type of personality; one of those family members who believes that everything would be okay, if only they had the power to hospitalize and drug their family members without their consent. It’s kind of touching and a little sad. If only hospitals were that much better than the prison wards, and everyone could get enough time in them. If only we could cure mental illnesses instead of trying to manage them, and picking up the pieces when out loved ones inevitably fall down.

I’ll be honest: this book scares me. Pete Earley takes the sickest of the sick, the most violent and disjointed of the mentally ill, and generalizes out from them. He doesn’t come out and say it, I don’t think, but it’s pretty clear that he thinks all mentally ill people should be forcibly medicated, and possibly hospitalized long-term. Thanks, Pete, but I’ve read about the days when family members could lock people away on word-of-craziness alone. Back when women who didn’t want husbands were considered insane and institutionalized? I don’t deny the existence of mental illness, oh no, but I’ve read my history, and I know that it’s subjective. There are no tests for schizophrenia or bipolar disorder, no way to tell for sure if someone ought to be given medication. Our mental health system is pretty horrific for criminals, but Pete Earley doesn’t have any good solutions for fixing it.

I know this man comes from a fundamentally compassionate place, but I feel like I need to read an anti-Prozac diatribe just to get the feel of it out of my head.