I think everyone deserves a cramp-inducing-cuteness fix at least once a week, if not more.

Posted by liz at 06:59 PM | Permalink | Comments (0)

I don't want to get all into politics because it's not properly my beat. I'm here to amuse and educate, not to make people mad at me. And yet, I find that I must share my feelings with you: George W. Bush is a putz. This is a man who's pledged support on mental health issues, and yet wants to cut funding for a suicide hotline. I mean, come on. It's a hotline. It's less than $300,000. Bush probably wipes his tushie with more money than that.

It's more complex than just writing a check, of course. The government wants to continue its plunder of civil liberties by tracking the calls that come into a new suicide hotline—one that's not the vaunted 1.800.SUICIDE, which has helped millions of people. Along with PostSecret, the most awesomest blog and art project ever, I want to officially send a call out: Write those letters and make your voice heard.

Read more here.

Posted by liz at 04:29 PM | Permalink | Comments (0)

I'm not sure what's going on here at TTWS, but things are certainly amiss. All the text seems to be smooshing to the right, and we can't have the smooshing, no? I'm kind of investigating, in my hapless way, and I decided to switch the photo of me under "About Me." Because let's face the facts, shall we? I don't look the same way I did four years ago, so why use that outdated photo? I took the new photo myself! And I'm afraid it looks like I did.

UPDATE: Thanks so much to PW websmistress (and rollergirl extraordinaire) for fixing the site and giving it a whole new look. Don't we feel better now? We do.

Posted by liz at 01:28 PM | Permalink | Comments (0)

A headline today from the wire service All Headline News reads: "One In 5 Violent Crimes Committed By People With Mental Illness." At first glance, this is a damning statistic, and if someone were to just read the headline, they'd come away with their stereotypes enforced: The mentally ill are violent.

But the headline doesn't match up with all the conflicting interpretations of the study results. In fact, a spokesman for the Sainsbury Centre for Mental Health told BBC news, "This study shows clearly that people with severe mental health conditions commit a very small proportion of violent crimes and that the widely held prejudices about schizophrenia are inaccurate and unfair." (Emphasis mine.)

A few days ago the American Journal of Psychiatry released a study about the mentally ill and violence that's incredibly long, complex and jargon-filled. I tried reading the entire thing, but my eyes started to cross and smoke blew out of my ears with a choo-choo sound effect. It was too much for me. Nonetheless, it's an important study, and so as a public service, I present it here in its entirety. (Hey, I paid $15 for it; I might as well use it.) It's after the jump, and is not for the faint of heart. Oh, and every time you see a reference to a Table, simply accept its absence and move forward. I'll try to post those later.

[Image by Jessica Griffin]

Introduction
Increasing recognition is being given to the public health burden of violence (1). Every year, over half a million people die from interpersonal violence, nearly double that from armed conflict (2). It is the sixth leading cause of death among people ages 15–44 (3). In addition, many more people survive acts of violence than die from them and suffer physical injury and psychological consequences. Consequently, violence is estimated to be among the 20 leading causes of disability-adjusted life years worldwide (4), and its contribution to worldwide disability is projected to increase in the next two decades (5). Evidence suggests that among the potentially modifiable risk factors for violent crime is severe mental illness. Studies of birth cohorts in Scandinavia (6–8) and New Zealand (9), psychiatric case registers in Australia (10–12) and the United Kingdom (13), and discharged psychiatric patients in the United States (14) have indicated that psychoses are modest risk factors for violent offending. This research has estimated that the risk of an individual with psychosis committing a violent offense compared with a general population group of a similar age is between two and six times for men and two and eight times for women.

However, previous research has estimated the probability that an individual with a severe mental illness receives any violent conviction, not accounting for an individual repeat offender or the number of different crimes that make up a single conviction. In addition, and more important from a public health perspective, focusing solely on relative risk does not account for the absolute base rate of these crimes and gives an incomplete picture of the dangerousness of those with severe mental illness. Risk estimates underestimate the population impact of these patients to violent crime if individuals with severe mental illness offend more frequently than the general population. In support, recent evidence from Australia (11) suggests that offenders with schizophrenia have two times more convictions over their lifetime than offenders without schizophrenia when matched for age and neighborhood. If, on the other hand, they offend less frequently, the relative risk will exaggerate the population impact. To clarify this issue, calculating the population-attributable risk of severe mental illness to violent crime—the proportion of violent crimes that can be attributed to individuals with severe mental illness—is necessary (15). By analogy, it is known that the relative risk of developing lung and pancreatic cancers is significantly higher in smokers, but the population-attributable risk of smoking differs substantially between them. It is estimated at 90% for lung cancer, but for pancreatic cancer, it is 33% because of the contribution of other risk factors, such as alcohol use (16).

In order to empirically investigate the population impact of severe mental illness on violent crime, we examined data from high-quality national hospital and crime registers in Sweden covering the period 1988–2000. We calculated the population-attributable risk: the number of violent crimes committed per 1,000 persons in the whole population that would not have occurred if the risk factor—severe mental illness—had been absent, and the population-attributable risk fraction, which is the proportion of violent crimes in the whole population that may be attributed to individuals with severe mental illness. Because the population impact was the focus of the study, we included all categories of violent crime—not just homicide—which is a relatively rare event compared to other types of violent crime. We discuss these findings in light of the assumption of these methods that there is a causal relationship between risk factor and outcome.

METHODS
Study Setting
In Sweden, all residents, including immigrants on arrival to the country, are given a unique 12-digit identification number that is used in national registers for health care and crime. With a population of nearly 9 million, Sweden has the largest inpatient hospital register in the world. This register includes individuals who are admitted to any general or psychiatric hospital for assessment and/or treatment, including secure hospitals, and the few private providers of health care. All patients are given a clinical diagnosis at discharge, according to ICD-9 (before 1996) and ICD-10 (from 1997 on) registered by their unique identification number. Hospital discharge diagnoses are thought to be comprehensive in terms of national coverage from 1988. The register is high quality—of the 1,421,795 patients discharged with psychiatric diagnoses from 1988 to 2000, no personal identification number was available for 13,669 discharge episodes (1.0%), and these were excluded from subsequent analyses.
Patients
We extracted information on all individuals discharged from hospitals from Jan. 1, 1988, to Dec. 31, 2000, with any principal diagnosis of a severe mental illness who were ages 15 and older (the age of legal responsibility in Sweden). We included two groups of patients: those with schizophrenia (diagnostic codes 295.0–6, 295.8–9, and F20–21) and those with other psychoses (schizoaffective disorder [295.7, F25], affective psychoses [296], paranoid states [297], other nonorganic psychoses [298, F28, F29], persistent and induced delusional disorders [F22, F24], acute and transient psychotic disorders [F23], manic episode [F30], bipolar affective disorder with psychotic symptoms [F31.2, F31.5], and depressive disorders with psychotic symptoms [F32.3, F33.3]). Both groups included patients with comorbid diagnoses, such as substance abuse. We chose these diagnostic categories in part because research has found that this register is valid and reliable for diagnoses of severe mental illness; 86% of those diagnosed with schizophrenia corresponded with a file-based review by psychiatrists (17). Consequently, the register has been used in recent epidemiological investigations (18, 19). Sweden experienced de-institutionalization in the 1970s, in line with other Western countries.
Outcome Measures
We obtained unique identification numbers for all individuals ages 15 (the age of criminal responsibility) and older who committed a violent crime from 1988 to 2000 from the national crime register. Of the 205,846 violent convictions, only 105 (0.001%) were without a personal identification number and were excluded from subsequent analyses. For the purposes of this study, a violent crime was defined as homicide and attempted homicide, aggravated assault (an assault that is life-threatening in nature or causes severe bodily harm), common assault, robbery, threatening behavior, harassment, arson, and any sexual crime. We used conviction data because, in Sweden, in common with only a few countries in the world, individuals with mental disorders who are charged by the courts are convicted as if they did not have mental disorders (i.e., regardless of their mental state at the time of the offense), although sentencing does take mental health issues into account. Therefore, conviction data included those for which a court ordered detention in a psychiatric hospital or a noncustodial sentence and determined legal insanity (in someone who suffered from "psychosis regardless of aetiology" at the time of the offense established by a court-ordered forensic psychiatric evaluation). It also included cases in which the prosecutor issued a warning of caution or a fine (e.g., in less serious violent crimes or some juvenile cases). In addition, because plea bargaining is not permitted in the Swedish legal system at the conviction stage, the crime register more accurately reflects the burden of officially resolved criminality in the population than in most other countries. Sweden does not substantially differ from other members of the European Union in the rates of violent crime and their resolution (20).

We linked patients with severe mental illness to the crime register using their unique identification numbers. Thus, any patient with severe mental illness during the period from 1988 to 2000 who was convicted of a violent offense during the same time period, regardless of the timing of the hospital discharge and the violent conviction, was included. We calculated all individual counts of violent crimes from each conviction, regardless of psychiatric status, so that all violent offenses were included. For example, if someone convicted of attempted murder also committed other violent offenses at the same time, all of these different offenses would have been included in the analyses. The next step was to include all crimes over time in the same individual so that the nature and extent of re-offending were accounted for. We then calculated the population-attributable risk (the absolute difference in the rate of violent crimes in the whole population and the rate in individuals who had not been patients with severe mental illness) and the population-attributable risk fraction (the proportion of violent crimes in the whole population that could be attributed to patients with severe mental illness), according to standard methods (21). Our choice of using individual counts of crime was to capture, as much as possible from official statistics, the public health burden of violent crime. However, we redid the analysis by studying the proportion of violent convictions that could be attributed to patients with severe mental illness and also the proportion of violent criminals who were patients.

Statistical Analyses

The base rate r was defined as the number of separate violent crimes committed per 1,000 in the general population over the 13-year period based on Sweden’s average population during the period 1988–2000, which was 7,176,361 for those ages 15 and over (22). r0 was defined as the number of violent crimes per 1,000 individuals who had not been patients with severe mental illness (unexposed), and r1 was the number of violent crimes per 1,000 patients with severe mental illness (exposed). We then calculated the population-attributable risk as the difference in r–r0 and the population-attributable risk fraction as population-attributable risk/r. These were estimated by major diagnostic group (schizophrenia and other psychoses), gender, and age band. Three age bands (15–24 years inclusive, 25–39, and 40 years and over)—referring to the age at first violent conviction—were chosen on theoretical grounds, reflecting a peak in criminal behavior in the general population in 15–24-year-olds (23) and a significant decline in offending in those over 40 (24). We calculated the cross-product odds ratio with Cornfield 95% confidence intervals (CIs) with EpiInfo software, version 3.01 (Centers for Disease Control, Atlanta, 2003). The individual population-attributable risk fractions and odds ratios for schizophrenia and for other psychoses were estimated assuming a diagnostic hierarchy that placed schizophrenia above other psychoses. We received research ethics approval from Huddinge University Hospital, Stockholm (number 194/02).

Results
During the period 1988–2000, 98,082 patients with severe mental illness, or 1.4% of the general population, were discharged from the hospital (55.8% women) (Table 1). These individuals were admitted to the hospital 504,337 times, with 5.1 admissions on average (SD=7.5, median=3, mode=1, range=1–184). The number of individuals with severe mental illness who committed at least one violent crime over the time period was 6,510. Therefore, of all patients with severe mental illness, 6.6% had a violence conviction. This compared with 130,421 individuals, or 1.8% of the general population, who had a violence conviction (Table 2).

Those with severe mental illness committed 21,119 individual counts of violent crime (3.2 violent crimes per convicted individual with a severe mental illness) compared with 303,264 counts of violent crime in the general population (2.3 violent crimes per convicted individual in the general population). Among patients and others who offended, the pattern of repeat offending was similar: 19.4% of patients (N=1,266) were convicted on two or more occasions, compared with 15.6% (N=21,356) of the general population; 0.3% of all patients (N=21) were convicted at least 10 times compared with 0.1% (N=118) of the general population.

Odds Ratios

The overall crude odds ratio for patients with severe mental illness for violent convictions during the period 1988–2000 was 3.8 (95% CI=3.7–3.9). The odds ratio was higher in women than in men and higher in those 25 years and older than in those 15–24 years old

Population-Attributable Risk

Forty-five violent crimes per 1,000 inhabitants were committed during 1988–2000. In comparison, 215 violent crimes were committed per 1,000 patients with severe mental illness. For those who had never been hospitalized with a diagnosis of severe mental illness, 43 violent crimes were recorded per 1,000 individuals. The population-attributable risk for patients with severe mental illness was 2.4, and the population-attributable risk fraction was 5.2%. In other words, patients with severe mental illness, as identified by hospital admissions, committed about 5% of all violent crimes.

Population-attributable risk fractions were calculated by age band and gender (Table 3). The population-attributable risk fraction for both genders was lower in the 15–24 age band than in the older age bands. Six violent crimes were committed per 1,000 women in the general population, of which 0.6 could be attributed to patients with severe mental illness. Women with severe mental illness committed about one-ninth of the violent offenses than the men with severe mental illness (47 violent crimes per 1,000 female patients versus 427 violent crimes per 1,000 male patients). Women had higher population-attributable risk fractions compared with men, particularly for those ages 25–39 years and those 40 and over. The population-attributable risk fraction for women ages 40 and over was 19%.
We also calculated the population-attributable risk fraction by looking at the proportion of violent convictions (rather than individual counts of violent crime) that could be attributed to patients with severe mental illness (Table 3). The population-attributable risk fraction was 4.3%. We also calculated the population-attributable risk fraction by looking at the proportion of violent criminals who were patients with severe mental illness. The population-attributable risk fraction was 4.8%. Because these two alternate methods of calculating the population-attributable risk fraction were not materially different from using individual counts of violent crime, subsequent analyses focused on individual counts of violent crime.
Schizophrenia and Other Psychoses
For schizophrenia, the crude odds ratio was 6.3 (95% CI=6.1–6.6), and for other psychoses, it was 3.2 (95% CI=3.1–3.3). We calculated the population-attributable risk and the population-attributable risk fraction for these patients. A total of 26,663 individuals were discharged from the hospital with schizophrenia, and 71,419 individuals were discharged with other psychoses. The number of violent crimes committed was 328 per 1,000 patients with schizophrenia and 173 per 1,000 patients with other psychoses. The population-attributable risk for patients with schizophrenia to violent crimes was 1.0 (out of 45) per 1,000 inhabitants in the population, and for other psychoses, it was 1.4. This corresponded to a population-attributable risk fraction of 2.3% for patients with schizophrenia and 2.9% for patients with other psychoses.

Thus, these population-attributable risk fractions and odds ratios point in different directions. Although the odds ratio was higher for those with schizophrenia than for those with other psychoses, the attributable risk fraction was higher for those with other psychoses.

Offense Type

Population-attributable risk fractions were broken down by category of offense. Higher population-attributable risk fractions were found for homicide and attempted homicide (18.2%) and arson (15.7%). Population-attributable risk fractions for threats and harassment was 7.5%; for assaulting an officer, 6.8%, for aggravated assault, 6.3%; sexual offenses, 4.9%; robbery, 3.6%, and common assault, 3.1%.

This study calculated the population-attributable risk and attributable risk fraction of patients with severe mental illness in relation to violent crime. It did so by linking high-quality national databases for hospital discharges and violent convictions in Sweden, involving 98,082 patients who committed 21,119 crimes. Over a 13-year period, 45 violent crimes were committed per 1,000 inhabitants, of which 2.4 were attributable to patients with severe mental illness. This corresponded to a rate of approximately one violent crime per 1,000 inhabitants every 5 years that could be attributed to patients with severe mental illness. The attributable risk fraction of these patients to violent crime was 5.2%. Assuming that there is a causal relationship between severe mental illness and violent crime, one way of interpreting this attributable risk fraction is that violent crime would have been reduced by 5.2%, if, hypothetically, all those with severe mental illness had been institutionalized indefinitely.

This study has a number of limitations. First, we defined patients with severe mental illness by their status as inpatients. There were individuals with such illnesses who were not admitted to the hospital, although in Sweden, this is unlikely to exceed 10% of such patients (25, 26). Studying inpatients only, however, has the advantage of specificity and allows for estimation of the potential impact of any interventions. Second, this investigation has defined violent crime by officially recorded conviction data. Although this avoids the reporting biases associated with self-report and informant questionnaires for violence, it is an underestimate of the extent of violent behavior in society (14). However, the Dunedin Study (9) found that this underestimate did not alter the odds ratios for violent behaviors in those with psychiatric disorders because the amount of violence underestimated was similar among those with psychiatric disorders and those without such disorders. A particular advantage of using Swedish conviction data is that it includes individuals who are sentenced by the court to psychiatric hospitals and who are cautioned or fined. In addition, Swedish data are not affected by plea bargaining, which can alter the final recorded conviction in some legal systems. Third, the method of population-attributable risk assumes causality. However, the relationship between severe mental illness and crime is more complex than simple causality, and nonmodifiable risk factors, such as age, gender, socioeconomic status, and previous criminality are important, as are other potentially treatable factors such as substance abuse, personality disorder (27, 28), and medication compliance (29). Comorbid substance abuse, in particular, increases the risk of violent crime in those with severe mental illness (8, 11, 14). However, because substance abuse and severe mental illness are not independent of each other, we did not calculate the attributable risk separately for those with and without comorbidity because the focus of this study was the attributable risk of patients with severe mental illness, not of the psychosis itself.

This approach makes no assumptions about the timing of the offense. This means that individuals who were hospitalized after the offense occurred are included in population-attributable risk estimates. Although it is reasonable to assume that the severe mental illnesses that were included in this study are mostly lifelong, this might overestimate the contribution of severe mental illness to violent crime. But it may also underestimate the contribution because it assumes that all those with severe mental illness have been admitted to the hospital over a 13-year period. The chronicity of these conditions argues for the approach of population-attributable risk because including only the patients whose diagnoses preceded the offense misses significant numbers of individuals who were first diagnosed after assessment by forensic psychiatric services. This study did not estimate the unique contribution of psychotic symptoms to violent crime or examine the possible mechanisms of offending, but rather, it addressed from a public health perspective the potentially more relevant issue of the attributable risk of patients with severe mental illness. Calculation of the attributable risk for psychotic symptoms would require further adjustment by potential confounders, which would further reduce the risk of violence uniquely attributable to severe mental illness. A final possible limitation is the generalizability of this data to other countries. Although Sweden is average for Western Europe in terms of the rate of violent crime per head of population, it has lower rates of homicides (around 100 homicides per year in a population of 9 million) than countries with more liberal gun ownership laws, such as the United States. This will alter the attributable risk for homicide, which is likely to be lower in countries such as the United States, but it is unlikely to substantially modify the overall attributable risk for violent crime, which is mostly accounted for by much more common crimes, such as assault.

Population-attributable risk is not directly relevant to estimating the dangerousness of individuals with severe mental illness relative to others. Rather, relative risks do that, and we have reported odds ratios that are significantly higher in patients with severe mental illness compared with the general population. Because this study is based on 6,510 violent criminals with severe mental illness, it was larger than previously published work. For schizophrenia, the odds ratio was estimated to be 6.3 and similar to findings in other investigations of Australian (10), Danish (8), and Finnish (7) patients. The odds ratios reported in this study, however, might be underestimates because there were individuals with severe mental illness who were not admitted to the hospital over the 13-year period but who nevertheless committed violent crimes.

The definition of violent crime used in this investigation was intentionally broad enough to include offenses that potentially cause significant physical disease and psychological distress. In addition, overall attributable risk fractions were calculated by type of offense. A relatively larger contribution of severe mental illness was observed for homicide and attempted homicide (18%) and arson (16%). Because these are higher-profile crimes, this would partly explain the impression given by the media of the high rates of violence in psychiatric patients (30). However, focusing solely on such crimes would not give a complete picture of the public health burden of violence because the base rates are so low, accountable for only 0.6% of the violent crimes in Sweden in the case of homicide and attempted homicide. There was no straightforward relationship between crime severity and attributable risk. For example, the attributable risk for threats and harassment (7.5%) was higher than that for aggravated assault (6.3%).
The contribution of female patients with severe mental illness to violent crime in Sweden was very small. The population-attributable risk of female patients with severe mental illness was 0.6 violent crimes per 1,000 women inhabitants over the period 1988–2000. In other words, less than one violent crime was committed per 1,000 women that was attributable to patients with severe mental illness over a 13-year period in Sweden. Although previous research has shown that female patients with severe mental illness have a higher relative risk of violent offending than male patients (8), which was also found in the present study, this does not represent a significant public health burden. Nevertheless, violent offending in women was more attributable to severe mental illness than in men. This was especially the case for older women who committed violent crimes, and our investigation would imply that the courts could consider routinely screening such women for psychiatric illness.

This study found that the population-attributable risk fraction was lowest for the youngest age band of 15–24 years, at 2.3% for men and 2.9% for women. This is consistent with research that has reliably established that the two most important risk factors for violence are being male and being young (23, 24). When a subpopulation is concomitantly exposed to several risk factors for a certain outcome or disease, the attributable risk of each risk factor will be less significant. Therefore, in younger persons, violent crime was less attributable to the one risk factor, i.e., severe mental illness, as identified by hospitalization, which was examined in this study.

In conclusion, even if one assumes that the association between severe mental illness and recorded violent crime is entirely causal, this population study has demonstrated that the overall contribution of patients with severe mental illness to such crime was about 5% in Sweden between 1988 and 2000. Although this contribution varied by gender, age, and type of violent crime, this finding should generate a more informed debate on the contribution of persons with severe mental illness to societal violence.

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Posted by liz at 12:01 PM | Permalink | Comments (3)

In the years since Andrea Yates drowned her five children in a bathtub as a result of postpartum depression and mental illness, I've had many people ask me about the difference between postpartum psychosis and lower-level sadness that can sometimes take over after pregnancy. Brooke Shields, believe it or not, did an exemplary job of articulating the difference in her memoir, but I know most people aren't reading that. So kudos to the Houston Chronicle for taking the question on in a Q&A with a psychiatrist. It helps clarify the issue for the layperson, especially those of us terrified of having children.

Psychosis? Baby Blues? What's the difference?

[Image by soupboy]

Posted by liz at 11:14 AM | Permalink | Comments (0)

Sometimes when I skim the New York Times website and see headlines from the paper some 40 years ago, I think they're breaking news, like today's "Russian becomes first woman to walk in space." My first reaction was, "Hey! Good for her!" But it happened in 1963.

Posted by liz at 10:55 AM | Permalink | Comments (0)

The writer of the craigslist post just sent this note in:

A sincere soul emailed this link to me and for the first time in..in..I think the first time ever, I cried tears of joy. Posting that ad on CL was just a reach into the darkness. I didn't think I would get any responses, and the ones I thought I would get would be from rude, inconsiderate people, but I was sadly mistaken. Every response was extremely heartfelt and sincere. When I get low, I will never forget that there are people like liz out there. And I will keep the song of the day in heavy rotation:)

Words can't express how thankful I am. My tears pretty much summed up my appreciation for the responses.

We're here for you. Hang in there.

Posted by liz at 05:56 PM | Permalink | Comments (1)

Drug Makers Pay for Lunch as They Pitch

Another in the NYT series examining how money from drug and medical device companies can influence the ways doctors conduct business and practice medicine.

Posted by liz at 04:41 PM | Permalink | Comments (1)

Uncle tells us not to be mad at Auntie about this. He says we move around too much and that's why Auntie can't take our pictures. But then he told us secretly that if Auntie knew how to use the camera, she wouldn't say the bad words, and we would all look very pretty in the photos. But he told us not to say anything to Auntie about not understanding her new machinery, so maybe I shouldn't have said that.

It has been so long since I wrote, that the babies are quite big. Auntie has dumb names for them: Rosemary and Shackleton. I prefer to call them Baby 1 and Baby 2. Baby 1 is the girl, and she's shy and pretty. I have to take care of her all the time because she sniffles and cries if you leave her alone. Baby 2 is the boy and he is very adventurous. I guess he got that from me. Mama still nurses them a little, but they have also started eating the paste Auntie gives us. Sometimes they try to hold mealworms, but they don't really know how to use their hands, so it's a mess. I try to be patient with them, but they are not easy.

I hear Auntie and Uncle talk about taking them away. Auntie wants to keep them and buy a bigger cage. Uncle tells her she must move to another apartment far away from Uncle if she does that. Auntie gets sad but always says, "Yes, I know. We have to get rid of them." Mama and Papa have not heard these conversations because they don't understand the humanspeak very well. That's good. I don't dare tell them that the babies are going away. Papa, especially, would be very sad to see them go. He stays with them all day and night. What will he do when they are gone? Play tug of war with the humans? Doesn't seem as much fun as it used to.

Well, that is all for now. As long as Baby 1 and 2 keep nursing, they will stay with us. So I have been whispering to them and telling them not to eat the paste. I don't know if they understand what I mean. Oh well. They're babies.

[This is a photo of me showing Auntie my bald spot. She said, "Tuck your head, you sweet lovey pie!" So I did.]

Posted by liz at 02:08 PM | Permalink | Comments (1)

Someone just sent me this post from craigslist:

I'll keep this short

-Diagnosed with bipolar disorder in 2001 but suffering since adolescence
-Kept the diagnosis hidden; those that know me think I am just a free-spirit spontaneous adventurous gal
-Experiencing rapid cycling, visual and auditory hallucinations, mixed moods, lack of concentration, short-term memory loss, unwarranted irritability,indecisiveness, extreme anxiety, clouded judgment, unrealistice expectations, lack of motivation, feelings of hopelessness,extreme hostility, reckless and excessive behaviour (once bought a brand new car with only $300 to my name because I convinced myself that I needed it even though I knew I couldn't afford it), thoughts of death and suicide

If anyone can relate, please respond. I have no one to turn to, and thanks to the wonderful healthcare system, i can't get proffessional help for another 6 wks. Please let me know that I am not alone.

Because of the stigma associated with behavioral helth, all info and correspondence will be confidential. No details about personal life outside of the disorder will be discussed (place of work, family and friends names, location of residence, etc.) and fake names will be used.

Let's send this person good wishes and encouragement so she can have some support till her healthcare kicks in. Go here to respond to her.

[The image is of Bill Withers, of "Lean on Me" fame. Let's make that TTWS Song of the Day for our friend on craigslist.]

Posted by liz at 12:24 PM | Permalink | Comments (0)

Last night I dreamt I was looking at the possibility of making a career change. So I applied for a job as publicist for the up-and-coming rock band called Chevron, which was based in Portland, Ore. My friends in Philly doubted the wisdom of the move, but I argued, "Portland has the highest number of Ph.Ds in the country." I'm not sure why I thought this was a persuasive argument.

Chevron, like any good indie band, responded to my resume with a funky homemade postcard. "We got your resume!!! We're interested!!! Please send a writing sample. If you can't, that's okay because we can read the stuff on your blog."

And I thought: "Chevron knows about my blog? Cool."

Today I learned there is actually a band called Chevron—well, there's a guy named Jonathan Valentine who records techno under that name. This is a photo of him from his website. Maybe he'll read this and send me a postcard.

Posted by liz at 11:29 AM | Permalink | Comments (0)

State Throws Millions at Mental Health Problems

I haven't even read the article and I already love it. The headline sounds great! Now if they'd only throw millions at this state's mental health blogger...

Posted by liz at 11:16 AM | Permalink | Comments (0)

This is groundbreaking news, and groundbreaking thinking. Here's the full press release from the Mental Health Association of Southeastern PA:

PHILADELPHIA (7/27/06) – People in recovery from psychiatric disabilities, researchers and others from around the country gathered on July 16-17, 2006, at the Renaissance Philadelphia Airport Hotel to create a new national trade association – the National Alliance of Peer Specialists – that will promote the emerging profession of certified peer specialist.

The participants – representing a “who’s who” of national and regional mental health advocacy, service and research organizations – met to establish the organization in response to the growing influence of the new profession of peer specialist – that is, people in recovery from psychiatric disabilities who are employed to help their peers work toward their own recovery, often in places where credentialing requirements have traditionally excluded consumers from staff positions.

“Peer specialists offer hope because they are walking, talking examples of recovery,” said Joseph A. Rogers, president and CEO of the Mental Health Association of Southeastern Pennsylvania (MHASP), which organized the meeting and which is fostering the peer specialist initiative throughout Pennsylvania. MHASP’s Institute for Recovery and Community Integration teaches aspiring peer specialists the skills for providing peer support – such as how to help others with problem solving and goal setting – as well as serving as a model for recovery.

Georgia was the first state to make peer specialist services Medicaid-reimbursable. Larry Fricks, who helped make this happen when he headed the Georgia Division of Mental Health Office of Consumer Relations, noted that the federal Substance Abuse and Mental Health Services Administration is due to release a resource kit called “Building a Foundation for Recovery – How States Can Establish Medicaid-Funded Peer Support Services and a Trained Workforce of Peers.” “Hopefully, a federally funded kit is another indicator that this peer specialist workforce is essential to system transformation and that peer specialists are ready for a recognized association with nationwide membership,” said Fricks, who participated in the July 16-17 meeting and who now heads the Appalachian Consulting Group.
Other states with Medicaid-reimbursable peer specialist services include Arizona, Iowa, Michigan and Washington, as well as the District of Columbia. Pennsylvania expects its peer specialist services to be Medicaid-reimbursable beginning in October 2006.

“New York State was the first state to develop and hire peer specialists,” said Peter Ashenden, executive director of the Mental Health Empowerment Project and another meeting participant. “We are proud of this fact but heartily support the work that has been developed in other states to much further expand upon this important initiative.”

Among other participants in the meeting was a representative of the Centers for Medicare & Medicaid Services. Additional representatives were from the National Mental Health Association and the NAMI STAR Center as well as several organizations run by people in recovery from psychiatric disabilities. Besides the Appalachian Consulting Group and the Mental Health Empowerment Project, the latter group included three federally funded consumer-run national technical assistance centers – CONTAC, the National Empowerment Center and the National Mental Health Consumers’ Self-Help Clearinghouse (an MHASP program) – as well as the Depression and Bipolar Support Alliance, the Copeland Center for Wellness and Recovery and Project Return of Los Angeles. Also attending were researchers from the University of Pennsylvania, the University of Massachusetts Medical School, and the Missouri Institute of Mental Health, as well as representatives of META Services in Phoenix, and the Mental Health Association in New Jersey, which started a statewide organization dedicated to the profession of peer specialist in 1999.

Plans are under way to incorporate the Alliance, whose board would comprise at least 75 percent peer specialists.

“Trained peers are powerful change agents and good fiscal investments for transformation to a strength-based recovery system,” Fricks said. For example, research shows that people who receive peer support services have fewer and shorter hospitalizations – which cuts costs – and an improved quality of life.

Montgomery County, Pa., is the first county in Pennsylvania to employ peer specialists. Nancy Wieman, the county’s deputy administrator for mental health services, is a cheerleader for the program. “It’s helped the entire system,” she says. “These peer specialists give everybody – consumers and staff and providers – a personal vision of hope. When this is funded through Medicaid, we’ll be able to have more consumers involved as part of the everyday work of an agency, and the culture of the agency will start to change. It will become a partnership where everyone will learn from one another, all the time. And that will enable us to grow and grow.”

Posted by liz at 04:15 PM | Permalink | Comments (5)

I can't imagine what Mark Bibbee and his ex-wife have gone through in the past few years. First their son David, who was bipolar, committed suicide by shooting himself. Then, about a year later, their son Brian, who'd been diagnosed with ADHD, also committed suicide—this time by hanging. They were both in their early 20s.

What must that loss be like? How do you go on from there?

Mark and his ex-wife are now suing Forest Laboratories Inc. of New York, which manufactured the Lexapro that both boys were taking at the time of their deaths. Both had received the drug in sample packets, which don't have a suicide warning. That warning was required by law as of 2004 (though not required on sample packets), but the Bibbees assert the warning should have been placed earlier, since the drug company knew the risk was there well before the FDA forced them to feature it on the packaging.

It'll be interesting to see how this one plays out. It's unlikely they'll win, but maybe this is something they need to do to put their lives back together, or to have such a tragedy make some kind of sense.

Anti-depressant drug maker sued for sons' suicides

Posted by liz at 01:35 PM | Permalink | Comments (0)

Finally, some bad news about mental healthcare that's not in the U.S.

'Psychotic' killer let down by mental health care services

Posted by liz at 12:38 PM | Permalink | Comments (1)

"Did anyone really think Philadelphia would get the fucking Olympics? I mean, I love Philly, but come on."

Posted by liz at 12:11 PM | Permalink | Comments (1)

The situation in the Middle East is so upsetting, it's invading my every subconscious moment. The other day I thought I saw the headline "Jewsmakers" in Newsweek when it was actually "Newsmakers." But then I thought it would be really funny to have a spoof publication called Jewsweek, and I got so into the idea, I really let it spin out in my head for about an hour. (There is actually a website that's called Jewsweek, so it's not an original idea, apparently.)

A couple nights ago I had a dream about a Jewish newspaper in Philadelphia. The paper was unnamed in the dream, and it must be said, bore no resemblance to the actual Jewish newspaper here. (I don't want to get into any trouble. They hate me already.) For now, let's call the paper Jewsweek, just for fun.

The dream began with a call from a Jewsweek reporter. She wanted to set up a secret meeting to talk about the Jewsweek's "covert racism." We sat in PW's editor's office and listened to her tale: As they were putting the paper together for that week, an obituary came in over the transom, as they say. It was for an African-American man, and the staffers at Jewsweek decided not to publish the obit because they didn't want a black guy next to the Jewish people.

The young reporter was horrified. Now she wanted to write a story for us about working there, sort of like an undercover report by a slaughterhouse employee.

The idea seemed great. If this was true about Jewsweek, it would run counter to the radical community spirit that blacks and Jews shared during the civil rights movement and beyond. It would be a shocking turn for a newspaper that claimed to represent the voice of Jews, an ethnic and religious group traditionally known for being progressive, if not communists. Comedians and activists: two proud Jewish legacies.

The reporter returned to her gig, and we awaited her story. Then we heard through the grapevine that she was not, in fact, Jewish, as she'd implied. This changed things significantly. It's one thing to air the community's dirty laundry, which is already taboo. It's another thing to have a shikse do it.

In the end, we decided not to run the story. I was relieved because there were people in the Philadelphia Jewish community who'd heard about it and were pissed off, even before it ran. One of those people was an elderly woman holding a squeaky faux-leather handbag like my grandmother Yetta used to favor. She hit me over the head with it and called me a self-hater. I woke up bathed in sweat and guilt.

"Am I an anti-Semite?", I wondered glumly while I brushed my teeth. "I can't be. I love being Jewish." Oy vey.

Posted by liz at 12:01 PM | Permalink | Comments (0)

I sent an email to the Daily Show's Ed Helms, asking him to look at my YouTube videos. The reason I picked him? We both went to Oberlin.

Hours later, I realized I hadn't given him the link to the page, so I wrote back with the URL.

Sometimes I'm just embarrassed to be me.

Posted by liz at 10:51 PM | Permalink | Comments (2)

Yates Found Innocent by Reason of Insanity

National Mental Health Association Policy Positions: In Support of the Insanity Defense

Posted by liz at 05:13 PM | Permalink | Comments (0)

I don't define my health status by whether or not I'm seeing someone about it (although I am, and in context in the hospital I have no problem saying patient). But context is the whole thing. In identifying myself to someone new I say I have bipolar disorder. Specific and only stigmatizing as far as the word bipolar has been misunderstood. Admittedly a lot.

Saying I have any diagnosis is controversial to a few extremists who deny mental illness, and although I'm not supportive of that idea I do have to talk to them, and write about shared ground with diplomatic language.

A new word? The best neutral word I use in professional talk also works socially - stakeholder. Like it?

Posted by liz at 04:52 PM | Permalink | Comments (0)

Posted by liz at 02:22 PM | Permalink | Comments (2)

When I started the Song of the Day feature here, I felt slightly guilty: After all, it didn't have anything to do with mental health, but as I used to edit the music section at PW, and as I have kick-ass eclective taste (she says humbly), I figured I could make a case for it.

Now I find such a precedent, um, precedes me. PW music editor Brian McManus just hipped me to a band called BiPolar Bears out of Australia; he suggested they become the official TTWS house band. But there's actually an organization called the Mental Health Music Network, that is committed to providing a creative outlet for people with mental illnesses, and there are several bands and individuals making crazy music. Granted, most of this action to be taking place in Melbourne, but I feel certain it's an idea that could catch on here. I can't see it now: Spikol and the Trouble plays CBGBs.

Are you in?

Bipolar Bears PR Page

Posted by liz at 12:55 PM | Permalink | Comments (1)

My column this week, posted here for your amusement—you know, a kind of mental-health pick-me-up:

>>THE TROUBLE WITH SPIKOL

Heeling Hearts and Minds
Lindsay Lohan talks to PW about depression.

by Liz Spikol

“Lindsay Lohan says sexy stilettos stop her from feeling depressed. The Just My Luck actress has suffered constant criticism from the media over her slim figure and her wild partying—but she reveals high heels help her keep upbeat. She said: ‘If I'm having a bad day, I put on a pair of stilettos, some red lipstick and a great dress and I go shopping!'”
— THEBOSH.COM

Last year, in the wake of Tom Cruise's saucy remarks about Brooke Shields and postpartum depression, PW lured the tiny actor to our offices for an exclusive interview about his disregard for psychiatric medications.

Now Lindsay Lohan has been brave enough to speak out on the subject of depression—without the intervention of a cult that rules her brain—and I want to thank everyone who made this interview happen: Lindsay's publicist, her publicist's pilates instructor, her stylist's husband's baby mama, her umbrella holder's Chihuahua (hola, Pedro!) and everyone else PW leaned on to convince La Lohan, as she's known, to sit down with us—exclusively!—to talk about her newest area of expertise.

Lindsay, thank you so much for coming.
“No problem, Lynnette.”

It's Liz, actually.
“Whatev.”

First I want to ask how you came up with that amazing strategy for beating the blues.
“[Cell phone rings.] Shit. Hold on. Hello? Yeah, this is Lindsay. What? [She hangs up.] You know what [looking at publicist], Jackleen? This is bullshit! These crank calls have to stop now.”

Oh my God. [Thinking “scoopity scoop scoop.”] Was that Paris Hilton?
“Wha?”

I heard you and Paris are having kind of a fight about your BlackBerry or something.
“[Sigh. Flip of hair. Frantic application of Stila lipgloss. Picking at nails—artfully, so they'll look kind of 20th-century Gwen Stefani. Adjusting of pink bra strap. Recrossing of legs sheathed in Imitation of Christ jeans. Pseudo-awkward twist of ankle, revealing Christian Louboutin open-toed platform heels and coral-dusted toenails.] It wasn't Paris. But … ”

Yes? [Unsightly journalist drool.]
“Let's just say it maybe was a person who she might, like, know.”

Ohhh. Speaking of mental health, Paris called you “delusional” for saying you dated her ex-boyfriend Stavros.
“Ugh. She's such a slit. I don't want to get into the whole Stavros thing right now. Let's just say, it isn't Greek to me. [Eyebrow lift.]”

I don't know what that means.
“[Grinding cuticle bite.] Hmm. Me neither.”

But … you do have a unique strategy for combatting depression. Do you suffer from the illness often?
“Well, if I'm at home, like, I might feel bad. Like, my dad's in jail, Paris has a greased string up her twat—boo hoo and all that, you know? Sometimes Jackleen's all like, ‘Lin, you so totally have to go to this club. It's crazy Us Weekly in there. Everyone's going.' And then I get there, and it's just Leo, as always, and maybe some weird British person with a funky locket with some blow in it. And I'm like waiting all night for something to happen, and then P. Duddy or some hip-hop impesairio or whatever takes my seat.”

And then you have to tell him to move, and he tells the tabloids …
“Exac. Or say I get invited to like the Grammys, or like God forbid the Tonys, and I have to go. And then I like get the gift bag, and it has some lame little gold Bonne Bell Lipsmacker keychain that's all ‘retro' and stuff? But, um, hello? I was born in 1986!”

So that's when you might get depressed.
“Totally! I get home and I'm just like, WTF? What's the point? Like my hair is totally fried from the dye, so I can't change it yet, and it's like, okay, maybe the heels will do it.”

Okay, for our readers: high heels like the ones you're wearing now?
“Yes! [Giggling.] Oh my God, Linda! You so totally get me!”

Actually, it's …
“And I'll tell you a secret … [Cell phone beeps.] Hold on. Someone texted me. [Looks down.] I can't believe this shit! That is so fucked up.”

Oh, we can't say “fuck” in the paper.
“No, I didn't say ‘fucked.' I said ‘fexed.' Like when someone texts you, but they're being assholes.”

Oh, like fexted up, I guess?
“I guess. Anyway, so the secret is that if you put on the heels and the lipstick and the dress and you still feel like shit, you just [pushes chest forward] … you know?”

You give them a little flash?
“Yes! I mean, fuck them—oh, sorry—screw the paparazzi with their magnaphoto lenses or whatever. Like they're all in my face and trying to see if I've had a boob job and like … Are you okay, Lisa?”

[Unsightly journalist panting.] Yes, it's …
“And I'm like, ‘You know what, Jackleen? I'm just going to give it to them! You know?' And she's all, ‘No! Lin! Don't do it! It'll be like Paris and the video.' And I'm like, ‘Right on, girlfriend.' And she's like, ‘OMG. I can't believe you!' And I'm like, ‘I know! It's crazy!'”

And that's when you did it: You nippled them.

“[Laughing] Yes! Totally! Well, it was actually a half-nipple, so it wasn't some dumb Justin/Janet type shit. But yeah!”

I saw the picture. It was … illuminating.
“I know. I totally used bronzer there, just in case I ran into someone.”

Someone named Mykonos, maybe?
“Girl, you're hilarious!”

Right. Well, this has been great. I really appreciate your talking to all our readers who struggle with these issues.
“It's absolutely no problem, Lynn. It's really important to me to make a difference.”

Ed. note: For those of you without health insurance, both Aldo and the new Steve Madden store have the same shoes for, like, 10 times less than the Louboutins.

[Illustration by Alex Fine]

Posted by liz at 11:39 AM | Permalink | Comments (0)

South Africa's Society of Psychiatrists released a statement today that says, in part:

"Both the public and people treating HIV infection should be aware of the mental manifestations of HIV infection. These range from minor intellectual difficulties (forgetfulness, poor concentration) to serious memory problems and sudden onset of psychiatric symptoms such as psychosis and mania."

In addition, 89 percent of home-based care workers were said to be suffering from depression, which elucidates something I try to mention here from time to time: Caretakers are especially vulnerable to mental health issues and should be vigilant in caring for themselves.

AIDS patients need more than drugs

Posted by liz at 03:15 PM | Permalink | Comments (0)

...is available for seven people who are certifiably loony. Doilies on antique dressers; shared bathrooms with lace toilet-seat covers; canopy beds; guest books with fountain pens; old photographs of non-family members ... everything you find in a B&B, but for the insane!

Jolly good—except the poll question at the end of the article.

Rasen B&B turned into mental health unit

Posted by liz at 02:49 PM | Permalink | Comments (0)

The EADT, Suffolk and Essex's daily newspaper online, featured an article a couple days ago about a woman, Dorothy Schwarz, who recently published a book about her daughter's struggle with bipolar disorder. The article is followed up by another article about why Dorothy felt she should make their family's tragedy—Zoë killed herself at 27—public.

Both articles are extremely powerful, mostly because the family was well-heeled, had plenty of resources and was yet still mired in the kind of ignorance that allowed Zoë's behavior to seem more annoying than pathological. It seems clear she could have been helped if her symptoms were identified sooner.

I love you but I can't live like this
Why I had to write daughter's sad story
Behind a Glass Wall

Posted by liz at 01:00 PM | Permalink | Comments (1)

A new study about schizophrenics in Ireland yields some less-than-encouraging results:

-53% were given no choice in relation to medication.

-52% were given no choice in their mental health treatment generally.

-44% had tried to stop or reduce their medication at some point in their treatment, however just 18% were offered help in doing so.

-48% said alternative treatments were never discussed with them.

-28% found that side-effects had a high impact on their day-to-day life.

There's more here.

Posted by liz at 12:05 PM | Permalink | Comments (1)

One of TTWS' readers, "Passionate," sent me two articles last week from the Hindustan Times. One is about the military's desire to essentially limit female involvement, a very sexist and regressive attitude. The other was the article below, which shows a serious lack of mental-health savvy on the part of military commanders.

Indian Armywoman lieutenant commits suicide
A woman lieutenant of the Indian Army, commissioned just 10 months ago, committed suicide by shooting herself in Udhampur, headquarters of the army's Northern Command in Jammu and Kashmir, apparently because she was "dissatisfied and unhappy with her job."

Lt Susmita Chakraborthy of the 5071 Army Service Corps (ASC) Battalion did not leave any suicide note. She had undergone four psychiatric counselling sessions in March, army authorities in New Delhi said.
Army and police officials in Udhampur, 65 km north of Jammu, said the 25-year-old officer went to the officer's mess near her official quarters on Thursday evening and asked the sentry for his rifle "as she wanted to get photographed with it."

The unsuspecting sentry handed his weapon and, within moments, Chakraborthy shot herself with it. She was taken to the Command Hospital in Udhampur where she was declared brought dead.

This is the first incident of its kind in Jammu and Kashmir of a woman army officer committing suicide. A male captain, Sumit Kohli, had allegedly committed suicide in the state in late May and the government says it has asked the army to probe the incident. An enquiry has also been ordered into Chakraborthy's death.

The officer's mother, Sadhana Chakraborthy, told reporters in Udhampur her daughter had "unwillingly joined the army about 10 months ago." The family hailed from Bhopal in Madhya Pradesh and she was a first grade masters in chemistry. Her father PB Chakraborthy works with the state-owned Bharat Heavy Electricals Limited (BHEL).

An army spokesman in New Delhi rubbished this, saying Chakraborthy had passed a stringent entrance test to be admitted to the Officers Training School (OTS) in Chennai where she had undergone nine months rigorous training before being commissioned as a short service commission officer September 17, 2005.

The spokesman admitted that given her high qualifications, Chakraborthy's "aspirations might not have been met", adding, "But then, it must be remembered that she joined the army of her own volition."

Chakraborthy had been posted as a platoon commander with the 5071 ASC Battalion. She had completed pre-course training June 2-15 for undergoing a Young Officer's Course at the ASC Centre, Bangalore.
In December, she had taken 15 days leave to go home to Bhopal, the spokesman said.

"In mid-March, her Commanding Officer noticed a change in her behavioural pattern. She seemed depressed. She was referred to a psychiatrist and underwent four counselling sessions March 15-31. Thereafter, she said she had adjusted to the environment," the spokesman added.

"Chakraborthy took 30 days leave from May 1 and extended this by another 30 days. She rejoined on June 1," the spokesman said.

"I came with her as she was feeling very low," her mother said in Udhampur. The elder Chakraborthy said her daughter was very short tempered and had become more so as she was "disillusioned with her present job." She wanted to quit the army but could not do so as "she had to pay the bond money to the army."

"We had told her that the money could be arranged by selling off the house in Bhopal," Sadhana Chakraborthy said, adding her daughter did not agree to this "because she was concerned about her younger brother too who had just passed Class 12."

The army spokesman brushed this aside, saying there was "no question" of the officer having been asked to repay the money spent on her training.

"The first we heard of Chakraborthy wanting to leave was from her mother," the spokesman added.
The only time payment is demanded is when a cadet wants to quit midway through training at the National Defence Academy (NDA), the Indian Military Academy (IMA), or the Officer Training School (OTS).
"We have calculated the cost of training at Rs 7,500 a month. If a cadet quits midstream, he or she has to pay for the number of weeks spent in training," the spokesman explained.

The Indian Army has 918 women serving as Short Service Commission officers in various branches -- excluding the Army Medical Corps and the Army Dental Corps. They initially serve for five years, which can be extended by five years and finally by another four years for a total of 14 years.

"If they want to quit during the first five years, they have to resign and this has to be accepted by the Defence Ministry. If they want to quit in the next five years, they are released after approval from army headquarters," the spokesman stated.

During 2005, four women officers had resigned and 16 had been released. One-woman officer had sent her resignation while nine had been released in the current year.

Posted by liz at 11:23 AM | Permalink | Comments (0)

Yes, that's right—it's Tuesday's International, the day when the rest of the world exists. To start things off on the right note, I present a speech I gave many years ago in Malta, of all places, where I spent three days at an AstraZeneca conference meant to promote the approved use of Seroquel for bipolar disorder. What a strange and beautiful country. Divorce and abortion are illegal there; it's probably the most Catholic spot on the globe. Sometimes I look around a place and wonder if I'm the only Jew there. In Malta, I didn't even have to think about it.

I gave a few speeches for AZ because I believed I was on a mission to spread the gospel of psychopharmacology—the gospel of Seroquel, in particular. It really did save my life, so I figured why not give back a little. In Malta.

I spent one morning trekking around a fishing village with a guy who did global marketing for AZ. He was a nice guy, despite his job. We got some really fresh fish for lunch, and he snapped a photo of me standing in front of colorful boats. I look like I've just nibbled something sour. Maybe big pharma spores were polluting the air.

Anyway, the speech is after the jump. Because the audience was coming from all over Europe, I tried to use terms everyone would understand. Hence I sound like I'm speaking English as a second language.

Incidentally, Malta was the last time I collaborated on anything with AZ. I learned some things about their marketing that made me uncomfortable, and I decided to sever my ties. It's better now. I have to shower less, for one thing.

Inspirational Speech No. 543:

I've never been to Malta before. I've traveled widely in Europe and Central America, but this is my first time on this beautiful island. When I was leaving my father said, "Well, it was good enough for Churchill and Stalin and Roosevelt, so it's got to be a great place for a conference." I said, "Dad, that was Yalta." The reason I'm in Malta now is, of course, because Astra Zeneca invited me to speak. But the reason I was able to say yes to that invitation is because of Seroquel.

I'm not vain enough to believe you haven't heard patient testimonials before. And perhaps what's important about my story is that it's not unique--that what happened to me can and does happen to other people all the time.

I had a happy childhood. My parents loved me and doted on me. I lived in an exciting city in a tight-knit community with friends on every corner. We lived near a large city park with a fountain that children and dogs played in in the summer, and that iced over into a cool, beautiful blue in the winter. I enjoyed my schoolwork and as I got older I began to sing in the choir and act in school plays. I applied to university and was accepted to my first choice. It was an unremarkable life, but lovely in its way.

Then, when I was 18, I was raped. The circumstances are unimportant, but what I've been told by doctors is that the trauma of being raped triggered an illness that lay dormant in my genetic code. My mother had bipolar disorder--also called manic depression in English--but I had not inherited it. Or so we thought. But it was simply hiding, and after the rape, it surged into being. Though I struggled through college--grappling with hallucinations and depression--by the time I was 22 I was no longer able to live normally and I had to be admitted to a psychiatric hospital. The next few years were horrible: an endless, nightmarish litany of new drugs, new side effects, new hospitals, new doctors. I tried to kill myself many times and, worst of all, by the time I was 24 the psychosis had gotten out of control.

Most people haven't experienced psychosis, so I'd like to describe it briefly. Psychosis is very noisy. Like when you vacuum the floor or wash the dishes--it's that kind of surging noise that won't go away. You hear people speaking to you, but they're all talking at different speeds, and you know, even through all this, that they're not really there. Your senses are heightened. So something you'd normally hear as background noise--maybe someone sweeping the street outside your window--becomes painfully loud. Your thoughts won't stop jumping. They feel like they ricochet off the inside of your skull. After a while it becomes so tormenting, you detach from reality.

During my fight against psychosis, I was given shock treatments or electroconvulsive treatments. I lost a good deal of memory because of those treatments and have cognitive problems I still struggle with today. But that's how desperate I was. And they didn't work.

Because my diagnosis is bipolar disorder, I was given Lithium, then Depakote, then Prozac, then Zoloft--the list is longer than you can imagine. Finally, in a hospital, a doctor finally gave me an antipsychotic for the first time. It was Thorazine and, for the first time in many years, things were quiet. I didn't know what they gave me, but I knew I wanted more.

Of course, these days, you can't stay on Thorazine or you're liable to end up with tardive dyskenisia, and no one wants that. So I tried Zyprexa. And it worked, which convinced the doctors and I that antipsychotics would be the answer for me. But I gained 30 pounds and was so depressed, I refused to go with my mother to buy a wedding dress. She picked one out without me, and I felt ugly and ashamed. Next I tried Risperdal, which also controlled my symptoms. But this time I got pregnant. My breasts hurt, my body felt heavy--all the signs were there. My psychiatrist told me to consider an abortion because I wasn't able to have a child given my illness. When I went to my gynecologist to discuss it, she told me I wasn't pregnant after all. The Risperdal had simply raised my prolactin levels so high, it gave me a false pregnancy.

Because all the antipsychotics had failed in one way or another, I was back in the hospital in 1997 because I'd tried to kill myself again. Now I had to take money from the government because I could no longer work. I had become a burden to society. Then, in 1998, my doctor told me about a new drug he thought was worth a shot. I was skeptical--wouldn't it just be the same old problems? But I decided to try it anyway because even when you have no reason to hope any more, you can't help it--you hope.

The day I tried Seroquel was the day my life changed forever. All those voices were quiet, the noises, the chaos, was hushed. I felt peaceful, and was able to think clearly. Though I worried for weeks about weight gain, I never gained a pound. In fact, I lost weight because I was off all the other drugs that had caused the gain. I didn't have any bloating or dry mouth. I simply had, well, peace. It was finally, after all these years, a drug I could not only live with but thrive on.

Gradually, my life began to improve. I took a part-time job that turned into a full-time job. I became self-sufficient. I moved into an apartment of my own and stopped relying on my parents to care for me. In short, I began to live the life I deserved and fought for.

I know I've taken far longer than I was supposed to, but I think it's important for you to know how important what you're doing really is. This drug saved my life in every way possible, which is why I started by saying it's what enabled me to be here with you today. I'm very grateful to you all for your committment to helping people live full lives, especially those of us with bipolar disorder. Thank you.

Posted by liz at 10:29 AM | Permalink | Comments (1)

A group of mental patients (how's that for an un-P.C. term?) in Hungary are riding a rollercoaster (pictured) for 10 days straight to attract attention to the issue of bipolar disorder. I wish I could get off of work and join them—I love rollercoasters, especially when they're not in my brain.

The amusing piece linked below is the first entry in Tuesday's International, a new feature here. Each Tuesday we're going to focus our efforts on global mental health stories, and possibly feature some embarrassing photos from the author's well-traveled past.

Granted, today isn't Tuesday. But I'm just getting you ready for the warm, splashy feelings of interconnectedness you're going to have tomorrow.

American's Rollercoaster Ride Inspires World Record Attempt

Posted by liz at 04:59 PM | Permalink | Comments (1)

Lots of good writing is coming in on the subject of the word "consumer." From Sarah:

I only recently heard the term consumer in reference to psychiatric patients and was rather shocked at it -- only because I am personally so anti-consumerist. Seriously, don't laugh. I hate shopping, I hate buying things that I don't need and I don't like being told to buy stuff because it's trendy.

The same thing goes for medications. I really resent the drug company advertising, simply because it turns hardcore medications into the next gotta-have item. I can't tell you how many stories I've heard from doctors about patients who come in and request a medication they don't need -- simply because they were brainwashed by the incessant advertising on TV. Yes, I'm quite aware that I should be thanking advertisers for giving me a paycheck, but that doesn't mean I have to agree with them.

Believe it or not, I've never been offended by the term patient. I have an illness, I'm managing it, but I'm still under doctor's care regarding the illness. Do we refer to those dealing with Crohn's disease as consumers? How 'bout erectile dysfunction?

While the term patient can seem like a dirty label, it's still the truth. But while I don't really mind being referred to as a patient, I would prefer you just call me Sarah. Cut the label crap out altogether.

Posted by liz at 03:53 PM | Permalink | Comments (2)

John McManamy, oddly enough, is also wondering about the word "consumer," and he'll be talking about the issue soon on his blog. John and I are very in sync, apparently. I told him if I were still plagued by magical thinking (damn psychosis!) I'd believe our timing was a sign of something—though I'm not sure what.

Anyway, you have to read McManamy's entire post, because it's really good, but here are a few tidbits until the full post is up:

I have a chronic and debilitating medical illness that affects the largest and most metabolically active organ in the body. Left untreated, I have a one in five chance of my life coming to a precipitous end. The lifetime costs of my illness may be as high as $600,000, which includes lost employment. The medical complications of my illness affect every organ system in the body and will result in my dying seven years earlier than someone without my illness.

Don’t call me a consumer. That is a gross insult. I am a patient. The person who treats me has an MD. I will be taking medications the rest of my life.

Why are names so important? People who think mental illness is not real and who oppose all forms of psychiatry love the term consumer. ... The euphemism, consumer, after all strongly suggests that we are not real patients with a real medical illness. ... But only true medical “illnesses” draw top research dollars. According to a 2003 report by the Treatment Advocacy Center and Public Citizen, the NIH in 1999 spent $2,240.88 per AIDS/HIV patient in researching AIDS/HIV and $476.26 per lung cancer patient in researching lung cancer. For schizophrenia, the per patient figure was $74.95, bipolar disorder $25.95, and depression $18.60.

To add insult to injury, the DSM-IV classifies all serious mental illnesses as “disorders,” as if to suggest we have no more than some kind of head cold. No wonder your health plan and our public health system (such as it is) treats a disease of the heart with far more respect than a disease of the brain.

[Photo of McManamy by Leigha Cohen]

Posted by liz at 01:54 PM | Permalink | Comments (0)

New name for this blog: The Trouble With Spikole.

Posted by liz at 01:14 PM | Permalink | Comments (3)

In May the Hartford Courant—a good paper, but no New York Times in terms of public perception—ran a series about the military's inadequate handling of soldiers with mental health issues. The initial info had been gleaned by United Press International, but the Courant's excellent reporting made it a national issue.

Today an article from Psychiatric Times picks up the thread (as many other news outlets have done) and gets comment from the higher ups, namely Col. Robert Ireland, the program director for mental health policy in the Department of Defense Health Affairs Organization. Regarding redeploying troops who aren't mentally ready, he says, "That's not our policy. If that's the case, I'd like to know about it."

He's not sure what the policy is? He'd like to know about it? He's the head of mental health policy; you'd think he'd have some idea of what's going on. How depressing. He adds, "Our role is to apply standards and make sure people abide by them because we want people who are competent to do what we ask of them."

Even if he sounds like a putz, it's good to get him talking—and acting. Beginning in August, says the Psychiatric Times, "all branches of the service will intensify their use of psychological screening questions." Ireland, again: "They're not designed for population-based screens, but we are using them anyway. There are always questions about substance abuse, family relationships, and personal conflicts associated with what used to be called the annual physical examination. Now we'll be looking more at things that are indicated based on the person's age, medical history, and so on."

We'll see how that goes, but the military has always responded well to bad PR. After all, they know a little something about propoganda themselves.

Adequacy of Mental Health Screening and Care in the Military Is Questioned

Posted by liz at 12:40 PM | Permalink | Comments (0)

Recently someone I respect mentioned that she's tired of the word "consumer" to describe people who are mentally ill. She said she's no longer going to use it. I have always been leery of using the wo