Friday, June 26, 2009

Insomnia: Meds Vs Therapy: Therapy wins. Again. Tell your Physician. JAMA May 20 2009.

Charles M. Morin; Annie Vallières; Bernard Guay; Hans Ivers; Josée Savard; Chantal Mérette; Célyne Bastien; Lucie Baillargeon.Cognitive Behavioral Therapy, Singly and Combined With Medication, for Persistent InsomniaA Randomized Controlled Trial.JAMA. 2009;301:2005-2015. May 20, 2009.

This study has great news. If you can call the repetition of a well-recognized result "news." We have known for decandes that cognitive-behavioral therapy works for sleep. The new part is knocking down yet another late-comer (carrying along its side-effect baggage with it): Ambien.

If you have insomnia problems, and you go in to see your physician - prinary care, gynecologist, whomever - they are generally more likely to prescribe a med versus informing you that you ought to seek a therapist who is trained in helping people address sleep problems, and do some psychotherapy for your sleep problems.

However, that is the wrong answer.

Why?

As this recent study shows, talk therapy has equivalent results to sleep meds in the short term;plus when the short-term treatment is done, you are left with skills and strategies you can use anytime, anywhere, whether your meds run out or not;You are not limited to the warning to only use the intervention for two weeks or less;you avoid the side effects of sleep medications - in this article, Ambien is tested - sleep meds including Ambien lead to sleep-walking behaviors in some - sleep-eating, sleep-driving, sleep-s ex which can be both good and bad in your relationship, but not for you because you don't remember; etc.;Nearly all of the sleep medications have risk of dependence if used for longer than the approved short terms;For some, the psychotherapeutic intervention for sleep can be done by self-help, or with "bibliotherapy" - just get a therapist to guide you through the book, versus providing the entire treatment - this can greatly reduce counselign sessions, lowering time and cost;etc.

Why does the doc not guide you to the treamtent that has equivalent results but a greatly reduced side effect issue?

Several reasons.
Problems come from the physician side, but also the psychotherapist side.
Physicians generally do not hold sufficent respect for psychotherapy, and so do not maintain decent relationships with local psychotherapists. Psychotherapists do not systematically reach out to their local medical community and build relationships to overcome these barriers. And psychotherapists tend to fail to provide feedback to the physician, so the physician gets no info on whether you, or other patients, benefited or not - so the physician ends up losing the opportunity to discover a valuable resource, and gets a negative view of psychotherapists as isolative and non-communicative.

Physicians have all the means they need to address these problems when they occur - physicians can ask you, the patient with sleep problems, about your sleep treatment, and can ask you to sign a piece of paper giving the physician and psychotherapist permission to share your private information, and encourage you to encourage your psychotherapist to provide updates. Including in this, you can ask your psychotherapist to discuss some things and not discuss others. So, if you have disucssed private information with your psychotherapist, in the course of the treatment for sleep, just tell the talk therapist to not mention that, but just to discuss sleep.

In fact, you can write this on the piece of paper giving permission for these two to communicate - there will be a blank where you enter what info and a blank for what purposes - for info just put "info specific to psychological treamtent for sleep," and for purposes, put "coordination of clinical care, and update clinical providers on clinical progress."

Like this, the talk therapist and physician are free to discuss the sleep treatment. The physician needs to keep up to date in order to consider whether some medical problem -such as chronic pain as part of some medical comdition, some hormonal problem, sleep apnea, etc., is accounting for poor sleep. Plus, the physician needs to know if the psychotherapist is a good provider, or if they are merely sitting there in the chair, collecting $100/hour, and repeatedly asking "how does that make you feel" -- That is not cognitive-behavioral therapy for sleep - that is someone who is not properly delivering empirically recognized psychotherapy for sleep problems but is just acting like it. Your physician needs to know who the good talk therapists are in your geographic area.

Along with all of this, your physican is regularly visited by a salesperson whose job is to plant an easy decision in the mind of your physician for various problems - as here, the salesperson informs your physician that when someone mentions sleep problems, the physician should automatically think "Ambien."

That salesperson will NOT be carrying copies of the decades of studies showing that talk therapy works for sleep problems. The salesperson WILL have a handout summarizing, with simple pictures, the result of some biased study that was designed to give the med the edge over a placebo, or some watered-down psychotherapy. And the salesperson will act like this new info, due to its newness, puts the old info out of the picture - as if it updates it, like Windows Vista updates Windows XP, making it irrelevant. This is how Microsoft works, but clinical care is just not like this. If talk therapy worked in the 1970s, and the 1980s, and the 1990s, and in the 2000s, there is no med study that will make those results irrelevant. Old = trusted, proven, and dependable, not retired and obsolete.

Sad to say, but this is what you are up against if you start at your physican when starting your journey in seeking sleep help. However, You, or your family member, have every right to insist that the process go in the correct direction: 1. that your physician help you locate a decent psychotherapist, and 2. at the same time help rule out any likely medical reasons for poor sleep, such as pain, or sleep apnea and 3. your physician stay up-to-date with your psychotherapist.

As I have said, psychotherapists somehow need to develop the networks with physicans to improve communication.

Patients have a role, too.

In the field of psychotherapy, some therapists believe that patients who get a good benefit have an obligation to share the news when they can - since therapists are ethically prevented from shouting the most recent success fro mthe rooftops, it is up to the patients. This would include sharing this news with your physician. Along with the salesperson, patients with psychotherapy success stories could give the info that physicians do not quite get from research studies such as this JAMA study.

Thursday, June 25, 2009

Lesson of Michael Jackson: Child Exploitation Bad for your Mental Health

OK, I will be the first blogger to note the moral story in the Michael Jackson Tragedy. Or, maybe amongst the first 1,000.

Michael Jackson was a victim of child abuse and child exploitation. Many people were aware of the conditions under which he was growing up, but it occurred to no one that the conditions were leading to eventual problems in adulthood.

Ideally, in a proper, fostering childhood, children have the support, guidance and protection as they encounter lessons concerning how to cope and manage the challenges of life. A certain level of work, and discipline, is proper and necessary across the developmental span.

But no child should have the burden of work, with adult-level expectations of productivity and performance, that was expected of the Jackson Five, including Michael, the emerging character of this ensemble.

Research: we know these lessons of nurturance. We need to know more fully so that we can manage things such as child stardom, or how to maximally raise gifted children who might be able to intellectually handle college while socially and chronologically in middle school.
We need to be able to clearly say what level of work, expectation, pressure, travel, et cetera, is too much.

And when that level is exceeded, we need to know how to detect this, and how to help.
Except for Liz Taylor and Uri Geller, we don't know Michael's story. But for those of us who remember all the way from the child star days up to the current day of untimely death, it is not too difficult to believe that the array of odd behaviors and phases were some atempt to address and resolve the traumatic experiences of this unusual, exploitative childhood. I daresay his efforts would not align with the treatment plans of therapists experienced in helping adults address past childhood exploitation and abuse.

I guess that these unusual life experiences somehow led to whatever behaviors might have proximally contributed to this heart failure. At this point, the autopsy is yet to be performed. Dehydration, exhaustion, substance abuse, anorexia, and other conditions can lead to heart failure. It is very plausible that the childhood abuse and exploitation led to these curcumstances, and without proper psychological resolution and treatment, Michael Jackson was on track for a tragedy.

So, from my armchair, I believe that many people failed Michael Jackson. Many people saw him being exploited, pressured, etc., as a child. Many people saw his troubled side and troubled behaviors in his adulthood. It is likely that a troubling history of pain medication dependence may emerge. People knew about this, just as they knew for Anna Nicole Smith.

The point is that we need to increasingly appreciate the impact of these adult-level opportunities and roles on children, and address them when we can. During childhood, or if necessary retrospectively address them when the person figures these things out in adulthood, under the guidance of a decent therapist.

A problem like this does not fit in the DSM very well, and pills do not cure it. These problems are psychological problems, and require psychological assessment and treatment.

Tuesday, June 23, 2009

"Suicidal food addict drops 400 lbs." --with meds or therapy?

Today Show's Joy Fit Club: From suicidal to happy with counseling and exercise: Where is the genetically-based serotonin disorder?

http://www.msnbc.msn.com/id/25708021/ns/today_health-diet_and_nutrition?pg=2#tdy_Joy_FitClub_SS

This link will probably not work after a while. Hopefully this great story can be tracked down by noting the woman's name, Tammey.

You may not be familiar with this Today Show feature: the Joy fit Club.
They profile people who were greatly overweight, then changed their life habits and lost a great deal of weight. Tammey's story includes the fact that she felt so hopeless that she tried to kill herself...

""After trying but failing to diet for decades, Tammey “gave up all hope.” Frustrated and isolated by her weight, she couldn’t see her situation improving. And so, in 2002, she attempted suicide.
“I was unable to see the light at the end of the tunnel,” she explained. “I did not want to be a burden to anyone.”
After her suicide attempt failed, it was clear to Tammey that that she needed professional help to overcome her weaknesses. Determined to heal “from the inside out,” she turned to a psychologist to begin healing the emotional wounds that often led her to binge-eating.""


Psychologist for counseling, plus a lot of behavior change regarding diet and exercise. Result? No longer suicidal.

How can this be?

If Tammey has a genetic "brain disorder," how can talking change her genetic disorder? Did her DNA change in response to the counseling? Did her brain physiology change in response to the diet? the exercise?

When you trust the thought leaders in psychiatry, and when you trust Big Pharma, they don't discuss this type of treatment and result. Your problem is a brain disorder, and the cure is medication. And when the medication does not work - wait don't tell me - yes, you need to take TWO medications.

Never mind that person behind the curtain!! That person who changed her behavior, did some talk therapy, and now is no longer suicidal!! Never mind the warning label for the medication that says that suicide is a side effect!!

In fact, Pharma will try to tell you that she should have been taking PILLS for her suicidality, and pills for her WEIGHT - oh, wait - Meridia, the weight-loss pill, has suicidality along with cardiovascular problems as one of many side effects, and yet another weight loss pill phen-fen had to be pulled off the market for cardiovascular problems.

Successful Depression Treatment as a Side Effect. Ornish’s Heart Health Intervention. AJPH July '09

Successful Depression Treatment as a Side Effect. Ornish’s Heart Health Intervention.

Meds vs. therapy. Therapy wins this one.

American Journal of Public Health is publishing a big, well-conducted study of health behavior interventions for heart disease risk. Not pills to treat the risk of heart disease, but coached, taught behaviors.

“Socioeconomic status and improvements in lifestyle, coronary risk factors, and quality of life: the Multisite Cardiac Lifestyle Intervention Program.” American Journal of Public Health, July 2009.

This comes to us from aptly named heart health physician Dean Ornish, now firmly established as the dean of heart health.

The heart of the matter is that a LIFESTYLE program leads to clinically worthwhile improvement in heart health for people with heart disease.

The lifestyle program, in brief, includes twice-a-week meetings for three months, where staff guide the participants through diet change, beneficial exercise, stress management, and group support focused on these lifestyle changes.

I will skip the heart health outcomes - they will probably be covered in the media pretty well.

Here is the profound outcome that is sure to upset the Pharma-sponsored psychiatrists, and everyone else who believes the serotonin-hypothesis, genetic-hypothesis, “brain disorder,” pills-are-needed-to-cure-it version of depression:

This healthy lifestyle program reduced depression scores. Effect size point five. Impressive!

In other words, without a pill in sight, depression scores got lower as a SIDE EFFECT of a heart health program. A SIDE EFFECT.

Profoundly? Not quite profoundly, but impressively.

Depression can be effectively treated with an intervention developed for lowering cholesterol and lowering blood pressure.

Does this fit the serotonin-hypothesis, genetic-hypothesis, “brain disorder,” pills-are-needed-to-cure-it version of depression?

No.

Possibly, it might, on the extremely small possibility that the promoted 3 grams per day omega-3 fatty acid supplement pill brought about this cure. Unlikely. That is the only pill in sight. Fish oil.

No Prozac, no Zoloft, no citalopram, no escitalopram. And no antipsychotics for depression, God-forbid. No zyprexa, no clozaril, no risperdal.

Take a gander at those pill-based treatments for depression, and figure out their side effects. Do they cause heart health? No. Does the behavioral heart health program have depression reduction as a side effect? Yes.

Pick your poison.

Now, to be fair to those who believe in the “medical model,” disease-model, serotonin-hypothesis, genetic-hypothesis, “brain disorder,” pills-are-needed-to-cure-it, we-need-more-genetics-studies version of depression, the depression levels noted in this study are “subclinical” level. Depression scale scores (on the CES-D, where higher scores indicate greater levels of depression symptoms) above the norm of 8, but mostly below the recognized level of 16, indicating the likelihood that a person scoring at that level would get a diagnosis of depression if given a formal, complete psychological assessment.

But this is worth noting: “subclinical” levels of depression scores, while not as severe as “clinical” depression, IS associated with similar impact on “misery” (by quality-of-life scores) felt from depression, and is associated with similar levels of other bad outcomes such as increased sick-days at work, increased medical care use, increased risk of poor management of diabetes and other health care conditions, increased risk for heart disease, etc.

Also worth noting: one challenge for depression research is achieving “full symptom remission.” Why? For Big Pharma, they want you to ADD another pill. Take TWO pills for depression, not one. So they can SELL twice as many pills. Or so TWO Pharma companies can BOTH make money off of your misery. Medication-based studies of depression treatment lately have been focusing on getting scores reduced from this moderate range down to normal, “I am no longer depressed” range.

If you think about it, it would seem more difficult to drop depression level A LOT for people with moderate, not high, levels of depression. But this study does.

Results are given by education level. Depression scores dropped 20% of a standard deviation (this is a common way - portion of change in terms of the range of “average” scores -- to report change in some outcome that allows you to compare across studies despite varying questionnaires used to measure symptom level) for high-school-or-lower education levels.

For the study participants above the high school education level, scores dropped 50% of a standard deviation.

In plain English, these are very strong results.

These results fly in the face of the serotonin-hypothesis, genetic-hypothesis, “brain disorder,” pills-are-needed-to-cure-it version of depression.

These results strongly support the vast amount of already established literature that psychosocial interventions are a leading treatment for depression.

All of this fits with the psychosocial explanation of depression, and fits with the psychosocial treatments. Various pieces of this heart health treatment are recognized as being depression treatments: in other guises, lots of this stuff is called “exercise intervention,” “behavioral activation,” “interpersonal therapy” AKA “IPT,” stress management, “supportive therapy,” etc.

And depression was just a side-effect of this heart disease intervention.

Other side effects included:
reduced hostility scores.
Reduced stress scores.
Improved “quality of life,” both physical health (broadly) and mental health (broadly).

Now, pay attention to the warning label on the box, and the list of side effects quickly noted in the TV commercials for the pill-based depression treatments. Suicide. Wait: did they just say suicide is a side effect of medication-based depression treatment? I thought suicide was a symptom, not part of the cure. Hey, if you missed the TV commercial, just read the warning label on the package. Or read the package insert. Or check Rxlist.com for “known” side effects of antidepressants. Or check www.ssri-stories.com for a multitude of case reports. Or ask your friends and family who have taken these pills.

Pick your poison.

Friday, June 12, 2009

A great intervention to prevent problems in kids. No meds necessary. The Rx? a decent family.

Institutional Rearing and Psychiatric Disorders in Romanian Preschool Children.Charles H. Zeanah, M.D., Helen L. Egger, M.D., Anna T. Smyke, Ph.D., Charles A. Nelson, Ph.D., Nathan A. Fox, Ph.D., Peter J. Marshall, Ph.D., and Donald Guthrie, Ph.D. American Journal of Psychiatry - Early Online.

We have all hear the terrible stories of the inappropriate care for foster care / orphan infants and children in diverse locales, including Romania. Heart-wrenching stories of neglect.

We know those children are likely to have great emotional need, and problems in the future. You can't just set a kid in a crib, and feed the kid, and expect it to grow up well.

We human beings require a certain set of conditions in our infancy and childhood in order for us to grow up properly - emotionally, cognitively, socially, etc.

The International classification of Diseases (ICD) actually has a label, with corresponding diagnostic code for children who do not grow up with the suffiicent human warmth and care required to avoid health problems, emotional problems, developmental problems, socializing problems, etc. The label is "undersocialized."

Am J Psychiatry has just published an impressive, optimistic study: for a group of Romanian foster children, randomly assigned to either institutional, group foster care as usual, or placed in single-family homes, the children placed in the single family homes fared much better than the institutionalized children.

Duh. No-brainer.

Additionally, these kids were compared to a set of children simply growing up in their bio families, with no notable neglect, and just recruited as a "normal" comparison group, out of pediatric practices.

Both groups of foster kids were worse compared to the kids growing up in normal families/homes.

So, it is not so good to be abandoned, and be in foster care, but if you are, it is better to be raised in a single-family setting than in an institution.
Intuitive.

Here is the problem for everyone pushing psych drugs, ESPECIALLY FOR PRESCHOOL-AGE KIDS: that game is largely built on the claim that these are genetic, biologically-based "brain disorders" that REQUIRE a corresponding biological treatment: psychoactive medications.

People. let's wake up: that is disproven by this emerging Romanian evidence:
INFANTS AND CHILDREN NEED TO BE RAISED IN A CERTAIN TYPE OF ENVIRONMENT, or you will see resulting problems for which Dr. Biederman would quickly label "brain disorder" and prescribe corresponding "brain disorder" meds.

How can it be genetics? How can it be a "brain disorder"? The foster kids were RANDOMLY assigned to institution, or family home. The presence of a disorder depended upon this assignment, NOT genetics.

Even if the kids CAME FROM parents with mental illness genes, a reasonable thought since the mental illness genes may have contributed to the poor ability to parent / reason for fostering the child.

Even for this genetically-at-risk-for-mental-illness group of parents whose children have gone into foster care, the parenting dimension is critical.

What does this mean for us?

A lot.

For us, it means that proper psychiatric assessment SHOULD include a thorough evaluation of the social and family circumstances. In all of the psych-drug-focused child studies I read, sponsored by Big Pharma, there is very little to NO info on how the role of insufficient social support was ruled out! What instrument was used to ensure that these factors were systematically assessed? These exist. The pharma-sponsored psychiatric researchers often willfully neglect this.

Furthermore: we know that there are psychotherapeutic interventions to address these behavioral problems. I have done it myself. For me, starting with kids at the age of five. Others have treated families with kids having behavioral or emotional problems younger than five. We have seen before-and-after success. That, plus the tons of empirical studies, is enough info for me, no matter how many drugs get approved to treat preschool kids with "brain disorders."

This emerging Romanian evidence tells us that we need to assess psychosocial setting, and address that, before Rxing the dangerous psych drugs.

In the two recent high-profile, horrifying deaths in preschoolers due to psych meds, we have EASILY DETECTABLE evidence of insufficient social support and parenting.

Destiny Hager: a 3-year-old, with two neglectful, drug-addicted parents, prescribed not one but TWO antipsychotic meds, and Rx AT LEAST ONE at FULL adult dose. She died from a med side effect - the meds caused her to have slowed bowel function, and sepsis (internal infection) resulted.
http://www.cjonline.com/news/state/2009-06-06/child%E2%80%99s_death_a_tragic_destiny

Rebecca Riley: a four-year-old, under "psych" treatment since the age of TWO and a HALF (?!?!?!) for "ADHD" and "CHILDHOOD BIPOLAR" died from POLYpharmacy to control "psych" problems that were bothering and disturbing the peaceful "retirement" of her unemployed, lazy, neglectful, drug-abusing, freeloader parents, including suspected-sex-abuser father:
http://en.wikipedia.org/wiki/Rebecca_Riley

How, in the social setting of either one of these preschool-age children, could anyone POSSIBLY begin psychopharmaceutical drug treatment, knowing that the social environment, as clearly noted in this Romanian study, is necessary for children, lest they end up with these behavior patterns?

We ALL saw the classic "Harlow's monkeys" pictures, and maybe videos, in college:
http://darkwing.uoregon.edu/~adoption/studies/HarlowMLE.htm

Even a monkey knows it needs a warm momma to cuddle up with.

I just don't know what to say. We have ALL the info we need right in front of our eyes to drive the clear family / social assessment needs for these preschool kids with emotional or behavior problems: get the family straightened out. Then see what, if any, problems remain.
This Romanian foster care study helps make it all the more clear.

Tuesday, June 9, 2009

In the news: "Too little sleep may raise blood pressure"

Too little sleep may raise blood pressure:
Missing an hour a night over five years boosts risk 37 percent, study finds.
http://www.msnbc.msn.com/id/31186808/

Quick note: Too little sleep may raise blood pressure.

Therapy wins this one. The "cogntive behavioral," sleep-hygiene type interventions for sleep are clearly superior to sleep medications. And, without the nasty side effects.

This headline refers to a new observational study. A good discovery.

Of course, there are some big question marks. For example: it is possible that people in less stable economic circumstances, and/or people in less stable social circumstances, have poorer sleep.
There is no pill to improve your economic status. But you can get financial counseling, etc.
There is no pill to improve your social circumstances (well, unless giving them away makes you the life of the party). But a major use of talk therapy - difficult to detect because there is no "DSM diagnosis" -- is to address and improve social relationships.
Also, many people have noted that when they are exercising regularly, they have better sleep.
So, a very promising area for health improvement, hinted by this headline, is psychotherapeutic interventions for sleep, or related problems to protect blood pressure.

Genetically differing suicidality responses to SSRIs?

An emerging issue is the problem of antidepressant medications possibly causing suicidality.

[to get up to speed, google "ssri" and "suicide," or look at www.ssri-stories.com.]

This is a challenge to comprehend: how can a drug that is supposed to HELP depression lead to the increase of one of its symptoms? The most concering symptom?

One recently emerging idea is that there may be a subset of people, based on genetic variance, who will get suicidality as a side effect of the serotonin-affecting antidepressants.

A recently published genetic analysis opens up some data on this topic to get us thinking. The study was NOT trying to understand SSRIs and suicide - I added that idea onto the study. But the study exploratively, tentatively, develops associations between types of suicidality and genetic variations.

In plain English: suicide behavior seems to differ by genetics.

It is possible that the suicidality seen with SSRI antidepressants is seen in one or more of these subgroups. Definitely worth exploring.

It would have been worth EXPLORING versus HIDING, back in the 1980s as prozac was developed.

Here is the recent study, and abstract. food for thought. Let's hope this line of thinkign can make things better for people in the future.

http://www.nature.com/mp/journal/vaop/ncurrent/abs/mp200919a.html

Molecular Psychiatry advance online publication 21 April 2009; doi: 10.1038/mp.2009.19
Differences and similarities in the serotonergic diathesis for suicide attempts and mood disorders: a 22-year longitudinal gene–environment studyJ Brezo1, A Bureau2,3, C Mérette2,4, V Jomphe2, E D Barker5,6,7, F Vitaro5, M Hébert8, R Carbonneau5, R E Tremblay5,9,10 and G Turecki1,10
Top of pageAbstractTo investigate similarities and differences in the serotonergic diathesis for mood disorders and suicide attempts, we conducted a study in a cohort followed longitudinally for 22 years. A total of 1255 members of this cohort, which is representative of the French-speaking population of Quebec, were investigated. Main outcome measures included (1) mood disorders (bipolar disorder and major depression) and suicide attempts by early adulthood; (2) odds ratios and probabilities associated with 143 single nucleotide polymorphisms in 11 serotonergic genes, acting directly or as moderators in gene–environment interactions with childhood sexual or childhood physical abuse (CPA), and in gene–gene interactions; (3) regression coefficients for putative endophenotypes for mood disorders (childhood anxiousness) and suicide attempts (childhood disruptiveness). Five genes showed significant adjusted effects (HTR2A, TPH1, HTR5A, SLC6A4 and HTR1A). Of these, HTR2A variation influenced both suicide attempts and mood disorders, although through different mechanisms. In suicide attempts, HTR2A variants (rs6561333, rs7997012 and rs1885884) were involved through interactions with histories of sexual and physical abuse whereas in mood disorders through one main effect (rs9316235). In terms of phenotype-specific contributions, TPH1 variation (rs10488683) was relevant only in the diathesis for suicide attempts. Three genes contributed exclusively to mood disorders, one through a main effect (HTR5A (rs1657268)) and two through gene–environment interactions with CPA (HTR1A (rs878567) and SLC6A4 (rs3794808)). Childhood anxiousness did not mediate the effects of HTR2A and HTR5A on mood disorders, nor did childhood disruptiveness mediate the effects of TPH1 on suicide attempts. Of the serotonergic genes implicated in mood disorders and suicidal behaviors, four exhibited phenotype-specific effects, suggesting that despite their high concordance and common genetic determinants, suicide attempts and mood disorders may also have partially independent etiological pathways. To identify where these pathways diverge, we need to understand the differential, phenotype-specific gene–environment interactions such as the ones observed in the present study, using suitably powered samples.

Wednesday, June 3, 2009

Tiller/Roeder: Mental Health Care Systems Fail, Anti-Murder Advocates Are Blamed. Does this add up?

It is very upsetting to discover, yet again, that we do and do not have the ability to treat mental illness.
We do, in terms of diagnosis and treatment.
We don't, in terms of being able to get people in need into treatment to the point of benefit.
The first aspect, the "do," has to do with where we spend the lion's share of our time and effort: diagnosis and treatment.
The second, the "don't," is where we should be focusing, but are not: organization and delivery of health care. Including care for mental illness.
Late-term abortion provider Dr. Tiller was recently shot and killed by Scott Roeder. This killing seems motivated by Roeder's political views regarding legal abortion, including late-term abortion.
The views are not unusual. Most in the U.S. do not favor legal late-term abortion. Roughly half favor very restricted legal abortion, or no abortion at all. This is all a matter of established fact. Roeder's view, that there should be no abortion, is not at all unusual. Roeder's view ,that abortion should not be legal, is fairly normal. We can't pin an abnormal act on this normal view, although many are trying.
It is now emerging that Roeder has a history of mental illness, possibly a psychotic disorder. At least a history of involvement in mental health treatment. It is clear that he was not being consistently, optimally treated.
Roeder is an example of the failure of the mental health care system.
Falling through the cracks, and insufficient care, is not at all unusual in the world of mental health treatment. This is actually par-for-the-course. Public and private sources of mental health care are, across the nation, woefully inadequate.
We have not yet figured out how to organize mental health care to adequately treat recognized problems.
We do know how to treat, when the patient is right in front of us. But we don't: we don't know how to keep people in treamtent, or how to provide what they need to achieve decent outcomes.
For progress, we have to focus on the "we don't."
we have to accept that our problem is NOT that we need yet another me-too drug : another SSRI, another SNRI, another "atypical antipsychotic." Sure, new drugs with efficacy plus ever-decreasing side effect profiles are great.
But how much benefit do we get from each new drug? Each new drug is yet another treatment that will fail to reach those in need.
Because the "we don't" issue - we don't know how to treat mental health problems - is more pressing.
Scott Roeder had been in the mental health treatment system. But somehow it failed. And, as can occasionally happen to some with a mental illness, his off-track thoughts lead to terrible behaviors. This is not the norm: a recent study has yet again reinforced the reality that people with schizophrenia are not more dangerous than the average person without schizophrenia. But in rare cases, poorly managed mental illness, including from psychoticism as well as other mental illness symptomatology, can result in tragedy.
Just like Andrea Yates. The problem was not a belief in the devil, but poorly managed mental illness. She had extensive interaction across years with mental health care, but it was inadequate. The failure was ours - our mental health care system. Just like Seung-Hui Choi and the Virginia Tech Massacre - he had extensive mental health care involvement. The failure was ours - the failure to have any sort of coordinated system by which a person would not fall through the cracks, where overworked staff do not have the means to keep things going in the right direction.
With the Virginia Tech Massacre, the true issue was discovered. Lots of response has occurred in that geographic area, amongst the various mental health care systems. Why? The signal-to-noise ratio was strong enough. The extensive mental health care involvement, plus its fragmented nature, was revealed in the course of the story, even as others tried to define the story as a matter of [fill in the blank: gun control, bullying, racism, video games, etc].
As this Tiller/Roeder case evolves, it appears that the signal is not strong enough to rise above the noise.
Pro-choice advocates are attempting to define this mental health care system failure as a different issue: that beneath the civility, and Constitutionally favored, all-American, red-white-and-blue patriotic behavior, of all right-to-life activists is the supposedly true nature: a supposed desire to willfully kill in the style of a person with years of mental illness who was known to the mental health system but inadequately treated.
This off-track behavior is egregious: while history and official statements clearly demonstrate the scorn that the leading organized right-to-life community has for this murder, the leading pro-choice groups have nearly in totality come out declaring that this incident reveals the supposed true heart of all pro-lifers: a group ready to murder the abortion-providing physicians supposedly if only they could get a supposed clear shot and not face earlthy consequences.
It is crystal clear that this is not the case. Even bordering-on-the-edge radical Terry Randall has not come out in favor of this, or any other, ends-justifies-the-means murder of an abortion performer.
As long as the dialogue fosuses on whether the half of Americans, the half who are opposed to abortion, are actually killers waiting and wishing for an opportunity, we will miss the true problem: a fragmented, insufficient, underfunded, disrespected mental health care sytem that contributes to individual tragedy daily, and occasionally results in a national, headline-stealing tragedy.
Folks, let's admit it: We do not know how to treat mental illness. We do not know how to fund and organize care for the burden of need that is out there. We do not know how to develop care systems that are attractive and valued enough to keep the mental health consumers in active care. We do not know how to actually have a client get involved in the recommended service whenever we make our weak "referrals." We fail at this handoff more often than we succeed. We have failed to recognize the burning desire for the warranted assistance of case management, and we have failed to respond to the burning desire for empirically proven psychotherapeutic interventions, while we continue to push the unpleasant, and often marginally effective, medication-based "treatments," which are incrasingly being recognized as not only marginally effective, but also damaging, with increased risk of a range of bad outcomes in the short-term and long-term - which we are largely clueless about because we have no will to monitor and honestly acknowledge long-term bad side effects.
When we fail, most of those in need suffer, and their families suffer. As we know, at rare times, people with mental illnesses, including because of the interference of psychotic thought processes, can perform regretable actions: being led by psychoticism to murder their parents, to kill innocent bystanders, etc. It is rare, but it happens. Sometimes, when thinking is off-track, people with disturbed thought processes, or disturbed reality testing, or whatever we are going to call it, the person will get caught up in some big issue, with some fertile, active, energetic group. Sometimes it is a religious theme (Andrea Yates wary of the devil), and sometimes it is political theme (Charles Manson pro-counter-culture and wary of a racist government, etc.). This time, it was political: separatists who threw pro-life issues in with the rest of their anti-government views. Roeder's ex-wife has revealed that Roeder himself was not initially interested in the pro-life aspect, but the soveriegnty/no-tax anti-government dimension.
It just does not fit - at all- anywhere in this whole story - that Roeder is anywhere close to the pro-life. activists.
At this point, I am not going to quote and link to the range of the recognized, leading pro-choice organizations to prove that they are dishonestly painting this issue in the wrong colors. Ask yourself who these groups are, then Google their name, plus "Tiller" or "Roeder." YOU go find their official positions and statements for yourself.
And then you go ask yourself, honestly, when no one else is around to ensure your political correctness or to ensure that you are following the marching orders from the self-proclaimed virtue police, ask yourself: does their official definition of this tragedy match reality?
Doe their spin fit - at all - anything close to reality?
Half of the United States adults (what, maybe 100 million people?) disapprove of abortion, and there are literally thousands of people active in the pro-life efforts, yet the supposed views of these pro-choice groups has translated into only eight murders in the Roe era?
And each and every leading pro-life group has quickly come out with a statement, thoroughly consistent with well-stated organizational principles, of thorough denouncement of any supposed-justification of any murder of any abortion provider.
Who is adding noise, causing us to miss the signal: an inadequate mental health care system?
Either the pro-life advocates are, collectively, a terrible shot, or they simply are not bent on killing people. You decide.
Here is another way to judge who might be trustworthy and honest, and who might be seeking to make political gain: follow the money.
Folks, I hate to break the news to ya, but there is not much money or financially fruitful political career, to be made in pro-life activism. There is much money and financially fruitful political power in the pro-choice realm.
Hopefully, with decent reporting, my blog comment here, and other discussion, we can increasingly come to recognize that we are failing to recognize one problem, and we are looking in the wrong direction.
It would not be so bad to be failing to treat mental health problems, if we were at least looking at the problem in the right way. but if we keep failing to recognize the problem, and keep blaming the wrong problem, we are really delaying and detouring ourselves from getting on-track.
Our narrow view of the world, our rose-colored glasses, prevent us from seeing what is the true tragedy, and we go after an entirely wrong culprit.