Cell 2 Soul: The Humane Health Care Blog

Healing: Our Path from Mental Illness to Mental Health

Thomas Insel, M.D. was, at one time, the chief of the National Institute for Mental Health (NIMH). He was in charge of a $20 billion budget and after 10 years
as chief there he realized that the NIMH had not accomplished anything as far as outcomes. He learned that the medical approach to mental illness introduces too many restrictions and restraints to deal effectively with patients.

His recent book, Healing: Our Path from Mental Illness to Mental Health (2022) is lucid and important.

If interested, you can see my notes at Healing, by Thomas Insel.  If you can't open the link, please write to me and I'll send an invitation to read them.

 

DJ Elpern

Bitter Pill

a chronicle of psychiatric harm

Bitter Pill by Rachel Aviv
The New Yorker, April 8, 2019

Link to Full Article.

This significant article chronicles the life of a young woman who was given multiple psychiatric diagnoses by some of the "best" psychiatrists in the country. She was placed on almost every imaginable psychiatric medicine that appear to have done her great harm. It's a cautionary tale that is well worth a close reading. The article is quite long and rambles a bit but much in it of teaching value. Charles Medawar covered a lot of this in his book, name, around 20 years ago!^1,2 But who paid attention?

The protagonist of “Bitter Pill” is Laura Delano, who was diagnosed with bipolar disorder shortly before she entered Harvard as a freshman in 2001. She saw psychiatrists at McLean Hospital in Belmont Massachusetts. There she was initially placed on Prozac, Provigil and Ambien.

Link to DJE's notes.

Here is a moving lecture by Laura Delano.

Luh Ketut Suryani and Nova Riyanti Yusuf: Fighting for Indonesia's Mentally Ill

Around 25 years ago, I met the Balinese anthropologist and psychiatrist, Dr. Luh Ketut Suryani. She went on to establish the Suryani Institute for Mental Health in 2005, because, she said, “A large number of mentally ill people in Bali are essentially abandoned, permanently kept under restrains, chained or in makeshift cages by their families, or community (pasung).”

The NY Times “Saturday Profile for October 21, 2016” is devoted to Nova Riyanti Yusuf’s life and work. Dr. Nova’s passions and experiences run parallel to Suryani’s.

Indonesia spends less than 1 percent of its total health budget to mental health, uncommonly low even compared with other lower middle-income countries. It has only about 700 trained psychiatrists, roughly one for every 350,000 citizens.

Drs. Nova and Suryani have devoted their lives to improving the care and living conditions for Indonesia’s mentally ill. Pause for a moment to honor these two visionary women.

Dr. Luh Ketut Suryani

 

Dr. Nova Riyanti Yusuf

 Here is a German language You Tube on "Bali's Dark Side."  (Unfortunately, I can't find a copy with English subtitles, but the film can be viewed and appreciated even with the German narration.)

Runs in the Family

New findings about schizophrenia rekindle old questions about genes and identity.
Annals of Science
The New Yorker March 28, 2016
By Siddhartha Mukherjee

Mukherjee, the author of "The Emperor of All Maladies, has a personal interest in schizophrenia, hence the title: "Runs in the Family."  This lucid New Yorker essay takes us from a "lunatic home" in Calcutta where his cousin resides to that sterile labs of prestigious research institutes whose scientists are teasing out the fascinating and complex genetics of mental illness. 

While this is a long article, it is worth the effort and is available free full text.

(Also see: The Gene: An Intimate History by Siddhartha Mukherjee. To be published May 17, 2016)

Where Homeless Meets Crazy

"In every corner of the world, there are people who are flagrantly ill, people who mutter to invisible others and box at the air. But because the cultural texture is different in different settings, the experience of madness can be quite different, too. That is true even of such a blunt assault on human feeling as homelessness."

This is a profound Op-Ed peice by the anthropologist T.M. Luhrmann.  If you are interested in mental health, homelessness and cultural differences in care you will find much in Luhrmann's "Where Homeless Meets Crazy." Among other things, Luhrmann compares the approach to the homeless in Chennai, India and Chicago.

This is a photo of Banyan, an Indian NGO, that, since 1993, has been an integral part of the chain of care for people with mental illness in Chennai. Their projects have changed the lives of over 5,000 people by providing services to support them in reaching their definition of recovery. They have taken over 1500 homeless women off the streets and started the rehabilitation process.

 

Little Green Pill

by Madelyn D. Kamen

Print version is better formatted: Download Little Green Pill

He was there every day,
Looking at her from the other side of the window,
Smiling at her as she handed over his little green pill.
He wasn’t that old and she wasn’t that young;
Neither had ever married.
She was a psychiatric nurse’s aide who understood the inmates
Because she had been abused as a child, pulling into herself
To avoid punishment.
He was there because he had been bullied as a little boy,
Making it a habit of staying away from the big guys who could
Beat him up.
Now, they were adults, albeit imperfect ones, who
Occasionally would sit together on her coffee breaks
And tell light-hearted jokes.  And forget their pain for a while.
Their shrink had suggested they might have a lot in common.
And truth be told, it had occurred to both of them.

One day, he was not at the window.
On her break she sought him out.
In his room, the bed was stripped.
His toiletries and clothes were gone.
Where was he, she wondered?
She asked the nurses.
They answered in soft voices with hooded eyes.
They said they didn’t know.
The next day in the obituary column she found his name. She went to the funeral with the little
cup and a pillbox in her purse.  After service was over, she pulled out the familiar little green pill, the one she had given him every day, and dropped it in the coffin.

Author Bio:  Madelyn D. Kamen, D.P.H. is a free-lance writer and the founder of a document development and management-consulting firm.  Prior to establishing this company, she was an associate dean and professor at the University of Texas Health Science Center at Houston. Kamen holds masters and doctorate degrees in public health. She has served on numerous boards in the community, particularly in the areas of women and children’s health and welfare.

 

T.M. Luhrmann on Mental Illness

T.M. Lurhmann is an anthrolologist, psychological anthropologist and essayist.  Much of what she writes is prescient.  Her recent piece, Redefining Mental Illness, in the Sunday, January 18, 2015 NY Times gives one much to contemplate.  Here are some extracts, reordered for clarity.

"Mental and behavioral problems are the biggest single cause of disability on the planet. In low- and middle-income countries, about four of five of those disabled by these illnesses do not receive treatment for them. The World Health Organization estimates that one in four people will have an episode of mental illness in their lifetime."

"Diagnoses were neither particularly useful nor accurate for understanding the brain, and should no longer be used to guide research."

"The implications are that social experience plays a significant role in who becomes mentally ill, when they fall ill and how their illness unfolds. We should view illness as caused not only by brain deficits but also by abuse, deprivation and inequality, which alter the way brains behave. Illness thus requires social interventions, not just pharmacological ones."

"One outcome of this rethinking of mental illness could be that talk therapy will regain some of the importance it lost when the new diagnostic system was young. And we know how to do talk therapy. That doesn’t rule out medication: while there may be problems with the long-term use of antipsychotics, many people find them useful when their symptoms are severe."

 

Depressed but Not Ashamed

by Madeline Halpert and Eva Rosenfeld,
NY Times, May 21, 2014
The authors of this NY Times Opinion piece are managing editors at their high school newspaper in Michigan.

"Most of our closest friends didn’t know that we struggled with depression. It just wasn’t something we discussed with our high school classmates. We found that we both had taken Prozac only when one of us caught a glimpse of a prescription bottle in a suitcase during a journalism conference last November. For the first time, we openly discussed our feelings and our use of antidepressants with someone who could relate. We took a risk sharing our experiences with depression, but in our honesty, we found a support system. We knew we had to take the idea further."

Full Opinion Piece in the Times

Here’s an article with background information on “Depressed but Not Ashamed.

Caring Not Curing

To Cure Sometimes, To Relieve Often,
To Comfort Always

 

Photo taken from "The Raw Story."

 Shaving William is something like performing surgery, and when the weather permits, our back porch becomes our operating room.

 So begins "Caring for William," a recent New England Journal of Medicine essay by Robert Jones.  It will resonate with many of you for some time to come.

Robert Jones is an unusual medical student.  He has chosen to divide his life between two very different worlds: a hospital, where I'm a medical student, and a homeless shelter, where I live and work... the boundaries often blur...

The New England Journal of Medicine's articles are often stodgy, pedantic and dense.  Occasionally, a piece blazes with poignant insights.  Caring for William is one of these.  Because this link may not work for you since most NEJM articles are not free open-access,  I have provided access to the essay here: Download Caring for William  (but I will remove it in three days, so as not to incur the wrath of NEJM). If you want to read it later, contact me and I'll send you a pdf (it's the equivalent of a photocopy and should be okay with the publisher).

Regarding the Open Access question see Digital Activist's Suicide Sheds Light on Open Access Movement.

Jonah Zuflacht, a first year medical student at Columbia P&S has this comment: "Robert Jones' essay artfully portrays his relationship with a schizophrenic, homeless man. It serves as both a window into the absurd nature of the system in which he (and other soon-to-be physicians) will practice and a reminder of what drew many of us into medicine to begin with."

 

Minds on the Edge: Facing Mental Illness

Minds on the Edge: Facing Mental Illness is a multi-platform media project that explores severe mental illness in America. The centerpiece of the project is a television program that premiered on PBS stations in October 2009. This video component is part of a national initiative that includes an extensive web site and an ambitious strategy to engage citizens, professionals in many fields, and policy makers at all levels of government. The goal is to advance consensus about how to improve the kinds of support and treatment available for people with mental illness.

Susan Rose, from North Adams, Massachusetts, alerted us to this excellent PBS forum.  She writes: "As a person who has struggled with a mental illness for decades, I found this 2009 video compelling. The Supreme Court justice Stephen Breyer and Nobel Prize winning neuroscientist Eric R Kandel were just two of the speakers.  I wish I could share this with the people closing Greylock Pavilion, our inpatient mental health unit  in North Adams, Massachusetts. Everyone needs to listen to the discussion on this video. The situation is worsening because nationally many psychiatric units are closing their doors for financial reasons. The consequences of these closings will be devastating to mental health patients, their families, and the communities they served.  The pain of mental illness affects everyone. The cost saved by shutting down mental health units will be offset by an increased rate of incarceration, as patients are forced into jails because there is no other place for them to go."

About Minds on the Edge program.