It’s not often you see Robert De Niro become emotional in real life. Watch this interview with De Niro, Bradley Cooper and director David O. Russell.
(This is the full interview from KatieCouric.com)
It’s not often you see Robert De Niro become emotional in real life. Watch this interview with De Niro, Bradley Cooper and director David O. Russell.
(This is the full interview from KatieCouric.com)
That’s the title of the tweet from the New York Times that caught my eye.
From an article published yesterday, Warning Signs of Violent Acts Often Unclear:
No one but a deeply disturbed individual marches into an elementary school or a movie theater and guns down random, innocent people.
That hard fact drives the public longing for a mental health system that produces clear warning signals and can somehow stop the violence.
But is the public putting its faith and longing in the wrong place when they believe that a sound mental healthcare system alone will supply those clear warning signs everyone so desperately desires?
Assuming every killer is mentally ill and identifying killers before they have a chance to kill is extremely complex and most of the time idealistic at best.
As some of you have undoubtedly heard, New York State has already passed the most stringent gun laws in the nation, including a requirement that doctors and mental healthcare workers report to a mental healthcare director anyone whom they believe has made a credible threat to use a firearm “to engage in conduct that would result in serious harm to self or others.” The mental health director would then report serious threats to the state Department of Criminal Justice Services, who will presumably keep a database of all individuals reported. A patient’s gun could then be taken from him or her.
Not surprisingly, there’s been a backlash, citing both the obvious intrusion into the doctor-patient relationship and the likelihood people who need help will be discouraged from reaching out.
This new law also goes further in its criteria for who belongs in the database.
“The way I read the new law, it means I have to report voluntary as well as involuntary hospitalizations, as well as many people being treated for suicidal thinking, for instance, as outpatients,” said Dr. Paul S. Appelbaum, director of the Division of Law, Ethics, and Psychiatry at Columbia University’s medical school. “That is a much larger group of people than before, and most of whom will never be a serious threat to anyone.”
[Underline is mine.]
The article then goes on to state, “while more likely to commit aggressive acts than the average person, [people with serious mental disorders] account for only about 4 percent of violent crimes over all.”
[Again, underline is mine.]
After all of the carefully thought out policy and procedural changes around the mental illness component of revamped NY gun control laws, the reasonable person would assume there is a universally accepted definition of what constitutes a “major mental illness,” thereby giving all mental healthcare workers and doctors a standard set of criteria to work with. Alas, this is not the case. At least not when I sat down to write this post. The only mention of specific mental illness I could find while reading current articles was in the NYT piece. A forensic psychiatrist who has a database of 200 mass and serial killers cited, “likely to have had paranoid schizophrenia or severe depression or were psychopathic, meaning they were impulsive and remorseless,” as common threads.
What the New York law leaves us with is no clear definition of “severe mental illness,” a largely subjective definition of what constitutes a credible threat, the near-invasion of doctor-patient confidentiality and the forced documentation of those who were institutionalized by force along with those who voluntarily sought help. (By the way, God help the patients who have a risk-adverse doctor or MH professional handling their treatment. This new law will have those wishing to cover their proverbial butts reporting everything from serious suicide / homicide threats to shooting rubber bands across the room.)
Since a quick-fix to the mental illness / gun control issue is clearly what everyone wants, is there any existing diagnostic tool within our broken mental healthcare system that can be used as a stop-gap? There must be something that’s useful to us in the short term.
The sort of young, troubled males who seem to psychiatrists most likely to commit school shootings — identified because they have made credible threats — often do not qualify for any diagnosis, experts said. They might have elements of paranoia, of deep resentment, or of narcissism, a grandiose self-regard, that are noticeable but do not add up to any specific “disorder” according to strict criteria.
(Underlines are mine.)
This is where the nice, neat, and very convenient link of violence and mental illness is broken. The mental healthcare system in the US is sorely inadequate, but there is no credible way to unfailingly identify killers before they strike by using the currently accepted, standard set of mental health criteria.
In the end, is this new set of laws in NY helping identify would-be killers or is it merely throwing mental healthcare back to the stone age? Experts agree that those who have perpetrated the latest wave of mass killings would not have been identified because they do not fit into the categorizations of DSM mental disorders. Experts also agree, as previously stated, that these laws make voluntarily getting help much less appealing for those who need it.
What happens when laws surrounding mental health like those in New York are instituted nationally and those of us who voluntarily admitted to get the help we needed are now forever branded at the Federal level? (Of course that’s assuming the Feds can get their act together and implement a national database of the mentally ill.)
I am a strong advocate for gun control, make no mistake. I am also a strong advocate against mental illness stigma and persecution. Overreacting in the form of puncturing the sacred space of doctor-patient confidentiality and keeping track of people who voluntarily seek inpatient help no matter what their form of mental illness is nothing more than a passive-aggressive form of persecution.
I’d love to refine this post further , but President Obama is due to speak on his gun violence proposals within the next hour, and I’m out of time. CNN is reporting one of the proposed solutions surrounds funding for mental healthcare. I am hoping our President and Vice President were briefed at some time during the policy making process that branding all mentally ill individuals will not supply those clear warning signs everyone so desperately desires.
And, as a result of my Bipolar Disorder, every time shit goes down and I have to suddenly engage, I am always petrified when it’s all over. I took action to correct a bad situation, but was my judgement sound? Did I do the right thing? Did I over react? Did my Bipolar Disorder skew my perception of reality in the first place and cause me to react in an irrational manner? Am I going to get into trouble?
It’s a well-known litany that plays over and over and over in my mind. Whenever shit goes down.
Today’s example: I watched two kids stop their bicycles, dismount, choose the perfect rock and hurl it as the swan who was sitting in the pond outside my living room window. I went into overdrive. I went on to the deck. I yelled at the kids and told them to stop. What followed was an exchange not about them stopping their asinine behavior, but the fact I wasn’t speaking Dutch. Smarmy, pre-pubescent idiots.
The swan flew away and the kids left without further incident.
I came inside and then the warped machinations of the Bipolar mind took over. Oh, God. Did I make the right call? I can’t abide cruelty to animals in any form, so…yes? I just knew that any second there was going to be a parent on my doorstep, screaming at me, in the language of the hairball, some sort of insults about yelling at their kids that I wouldn’t be able to understand. It would escalate. Perhaps there would be some anti-American sentiments thrown in after I explained my language barrier. The whole encounter would have to end with me slamming the door.
See what I mean?
Of course, none of the above happened – no one came to my door. But the fact remains that I am forever questioning my judgement about – well, about pretty much everything that happens involving heightened emotions. Because, if I’m going from zero to pissed in 2.4 seconds over something that doesn’t really warrant it, then it’s time to evaluate whether or not the mania train is trying to pull into the station.
I think just about everyone who has had at least one hypomanic episode understands what I am talking about. Have your judgement compromised once by the illness, and it haunts you forever. Yeah, we can tell ourselves over and over and over – just the way our therapists taught us to! – that it is the illness putting these thoughts into our heads. That when we are in a remission we need to be gentler with ourselves and trust our non-manic / non-depressed judgement. Yeah, OK. Well, if you’ve never spent a month of your life not going to work but instead decided to drive around to every store that sells iPhone covers because you believe you need one embellished with Swarovski crystals…
I rest my case.
And, for the record, I stand by my actions today. If my yelling, “Knock it off!” at some brats kept a swan from being pelted with a rock, then the crazy train isn’t pulling into Manic Station. Just yet 🙂
From today’s New York Times:
[Updated Jan 11 – because the WP app for my phone I posted this from is less than stellar.]
Teenage years are very difficult. Trying to help a suicidal teen is ten times more difficult. What is as disturbing as it is unfortunate is the sense I get every time I read an article on teen depression and suicide: there is an undercurrent from the mental health establishment that they are somewhat at a loss on how to really treat these problems in this segment of the population. Dr. Brent of the University of Pittsburgh said it best. “We can treat components of the overall problem, but that’s about all.”
I know. And it haunts me every day.
Although I like to post a lot of nerdy, educational, scholarly med-type-stuff on Bipolar illness, the most popular posts I have written on Manic Muses by far are those featuring Homeland in the title. Not surprisingly, I saw spikes of activity for those posts on Sunday-Monday, using search terms like, “Carrie Bipolar Med” and “Can a CIA person have Bipolar.” Wow – this show has really struck a chord with viewers – people are really doing their homework on this one. I’ve even had some people mail me privately and ask my opinion on the characters and writing. So, since Season 2 is over in most countries, I figured I would revisit the show as someone who has Bipolar I and answer a few of the questions I get asked the most.
Warning: Irreverent and wise-acre answers ahead. Not all people with Bipolar are going to agree with my views. But, hey – it’s how I see it.
Q: Where did Carrie’s Bipolar go during Season 2?
Yes, well, even we Bipolar people are wondering about this. But, it brings up a great opportunity to talk about remission. Bipolars can and do have periods where there are no manic or depressive thoughts to be had. Periods of stability are possible for a lot of us. But not for all. Bipolar is a tricky disease – it doesn’t present exactly the same way in everyone who has it. Some can live symptom-free for stretches of time, others will have to cope with symptoms each day of their lives. As for Carrie – well, let’s just say that since her disease played so prominently in Season 1, it’s perfectly fair to ask where it went in Season 2.
Q: Do Bipolar people really love colored pens and highlighters?
Think back to Season 1 – when Carrie had turned her living room into a war room, had her pack of highlighters out and hung a bunch of color-coded, classified information on the wall to aid in her pursuit of the truth.
When that scene came on the screen, my husband and I burst into laughter. I am, you see, Post-It Queen. Organization – in my Manic Mind – is only 235 color-coded Post-Its away. (Yes, I also own several packs of highlighters as well.) Seriously, many (but not all) Bipolar people are extremely talented at finding the most illusory clues, making sense of them and putting order to chaos when the ordinary mind cannot. This is where Homeland got it right. Many Bipolar people (again, not all) are gifted, passionate people who can excel at their jobs when they find their niche.
Q: (Revisit) Is Homeland being responsible with their portrayal of Bipolar?
I am asked this question a lot. Let me just put my cards on the table up front. There are those who like to argue Homeland has a responsibility to portray Bipolar as sensitively and realistically as possible. To some degree that is true. It is the right thing to do when your main character has the disease. Personally, I would like to thank the producers, writers and star(s) for even making an effort to make this happen. But, viewers – ask yourselves: where does that responsibility end? This is a nighttime drama, not a NAMI stigma sensitivity PSA. Are expectations from the mental health community around an accurate and sensitive portrayal of Bipolar Disorder too high for Homeland? I think so. And this opinion is brought to you by someone who has Bipolar Disorder. Homeland is drama. And drama requires license be taken with just about every aspect of the story to make it interesting. As close as Homeland may be to some of the realities of fighting terrorism, human nature and mental illness, it is still a nighttime drama. Let’s not forget that.
Q: Can people with Bipolar actually perform and be successful at a job like Carrie’s?
There’s been a lot of discussion that Homeland’s depiction of Bipolar Disorder is off the mark because it is extremely unrealistic when it comes to Carrie’s ability to handle the demands of her job. She has to keep odd professional hours, travel a somewhat brutal schedule and still remain effective under extremely stressful situations. The reality is – it is possible. By no means is this the norm for most people with Bipolar. At all. Let me make that clear. However, I had a job with very similar demands for almost eight years and never failed to perform. I’ve also worked with and read blogs by other Bipolar professionals who keep it all going just fine.
Again, the point is not every Bipolar person is capable of this, but some of us are. Carrie is covered. And it’s pretty cool to see a capable Bipolar person on TV for a change!
Q: Is it responsible to show a Bipolar person having an affair with a terrorist?
[Eye roll – this is a real question someone asked me.] Really? Human beings can have their judgement clouded whether or not they are Bipolar, and whether or not they are in sensitive positions. I won’t even mention General Patreaus or General Allen or Paula Broadwell or that Kelly person. Next topic…
Q: Can someone with a mental illness hold a Clearance?
This sure is a hot topic . Here are the facts in an ordinary case. After that, it’s up to you to decide how far the US Govt would stretch the rules when a dire matter of National Security was at play. Simply put, it is possible for someone with Bipolar to hold a clearance. Being diagnosed with a mental illness is not in and of itself an immediate disqualifier for security clearance.
The security concern arises when the possibility of future unreliable or dysfunctional behavior is indicated by either abnormal behavior or the opinion of a qualified mental health practitioner. When a psychological condition (or the side effects of medication) adversely affects a person’s judgment and behavior, such things as disappointment, failure, or perceive injustice or betrayal may cause reactions that are irresponsible, self-destructive, retaliatory, and/or unlawful. This can result in willful or negligent compromise of classified information, violence, sabotage, or espionage.
If the answer on the clearance request form as to whether someone has submitted to qualified counseling or been hospitalized is ‘yes,’ then the treating physician must be consulted. Does the person under investigation have a condition that could impair his or her judgment, reliability or ability to properly safeguard classified national security information? If so, describe the nature of the condition and the extent and duration of the impairment or treatment. What is the prognosis? Subjective, yes. And crappy for the person who has a risk-adverse doctor. Are there people out there with a clearance who have a mental illness? Yes. Unfortunately, the government does not like to publish statistics on how many folks there actually are or a breakdown of the percentages of the types of illnesses they have. Now, would Carrie personally be able to hold clearance? Based on a former colleague’s experience, I would say no. But, again, I leave it up to you to decide and apply your own amount of willing suspension of disbelief and faith in the US Government to make it work.
Q: Are you really sick and tired of being asked questions about Bipolar Disorder because of Homeland?
🙂 Nah, not at all. If there’s one thing Homeland does, it’s get the conversation going. I never tire of pointing people in the right direction when it comes to accurate information about Bipolar Disorder. For those who want to do more reading, the following are great resources:
The National Institute of Mental Health’s Bipolar Page offers information on treatment, clinical trials and statistics.
The Depression and Bipolar Support Alliance features a What’s Happening section, including an Ask the Dr column. The core membership of DBSA is patients.
Understanding Bipolar Disorder
Link from CNN news: brain scans from patients in mania depicting lack of activity in frontal lobe. Truly fascinating.
Manic Muses turns two today. Hard to believe I’ve ranted for that long and still have subscribers! Thanks to everyone who reads and comments. Although I was skeptical about doing a blog at first, you guys make it a lot of fun.
And from my family to yours, have a very Merry Christmas!
At a press conference today (12/21/2012), National Rifle Association CEO Wayne LaPierre made the suggestion that a database of all ‘mentally ill’ individuals in the United States be created.
There is so much wrong with what LaPierre was on about, it’s going to be difficult to keep my comments to his database proclamation alone. However, let me kick off a conversation by asking everyone who reads this blog and has a mental illness how they feel about potentially being treated in a way similar to a sex offender.
Here is the quote from the transcript of the NRA press conference:
“How many more copycats are waiting in the wings for their moment of fame from a national media machine that rewards them with wall-to-wall attention and a sense of identity that they crave, while provoking others to try to make their mark?” LaPierre asked. “A dozen more killers, a hundred more? How can we possibly even guess how many, given our nation’s refusal to create an active national database of the mentally ill?”
Fun fact, LaPierre:
Creation of a mandatory national database probably would have had little impact on the ability of suspected shooters in four mass shootings since 2011 to get and use powerful weapons. The other people accused either stole the weapons used in the attacks or had not been ruled by courts to be “mentally defective” before the shootings.
Thanks to everyone who has responded so far. Let’s keep the conversation going.
I invite more discussion below.
It’s not often you hear one of psychiatry’s own speak out so vehemently against the establishment’s ‘dangerously close’ relationship with the pharmaceutical industry. But, that’s exactly what Dr. David Healy, a psychiatrist from Ireland, does.
In a Time Healthland article published this week, Dr Healy, “likened psychiatry’s attitude toward its faltering legitimacy to the Vatican’s widely derided response to its child-sex-abuse scandal by priests — essentially that psychiatry is brushing off justifiable concerns as hype instead of dealing with the source of the problem.” If that statement sounds harsh, well, it is. But, before you dismiss them as merely the words of a hater, remember that for most of his career, Healy has held the view that Prozac and SSRIs (selective serotonin re-uptake inhibitors) can lead tosuicide and has been critical of the amount of ghost writing in the current scientific literature. Healy’s views led to what has been termed “The Toronto Affair” which was, at its core, a debate about academic freedom.
Last week, Healy spoke at an American Psychiatric Association’s conference session on Conflicts of Interest. Which was sort of a coup since his views are so brutally honest and therefore controversial, that several of his colleagues once tried to have his medical license revoked.
Before we delve more into what Healy imparted to his audience, here is a statistic from the Healthland article that bears mentioning:
In 2004 alone, pharmaceutical companies spent about $58 billion on marketing, 87% of which was aimed squarely at the roughly 800,000 Americans with the power to prescribe drugs. The money was spent mainly on free drug samples and sales visits to doctors’ offices…
Now, let’s refocus on psychiatry alone and take the conversation one stop further.
Healy told his colleagues, “I’m going to argue that we need you to be biased. We want you to be biased by treatments that work,. I don’t mind if you’re my doctor and you’ve given talks for industry. My concern is not that you’ve been paid by industry, but that you’ve been fooled by industry. The key conflict is whether people are hiding data from you.” (Italics are mine.)
Healy went on to discuss how drug companies have repeatedly concealed important information about the risks of their medications, whether by hiring ghostwriters to spin the results of scientific studies and then getting renowned experts to put their names on the published papers; by employing tricks in clinical trials like using inadequate doses of comparison medications to make the company’s own drug look better; or by simply keeping unfavorable data out of the public domain.
Example? Data from clinical trials of the drug Zyprexa was hidden. “None of them mentioned [that the drug could cause] diabetes or [had] the highest suicide rate in clinical-trial history,” he said.
Referring back to the issue of antidepressants possibly raising suicide risk, Healy was asked whether a psychiatrist should just stop prescribing antidepressants. Healy responded, “No.”
Medical treatment is poison, and the art of medicine is trying to find the right dose.
I started writing a bang-up post with every intention of publishing before I departed for three whole weeks of vacation. I just didn’t get around to finishing it. But, I’m going on vacation anyway. 🙂
Manic Muses will be on a posting (and reading) hiatus until the end of September.
I hope everyone is well and has a great end to their summer!
The drug companies aren’t very happy, and we Bipolar patients shouldn’t be either.
According to an article in PharmaTimes, there are more atypical antipsychotics going generic, enough for a monetary, ‘precipitous decline’ to be felt within the drug class (although the article did not detail which drugs or when). But, with a decline in sales to just over $3 billion by 2021 in the seven major markets, (down from 6.3 billion in 2011) that’s bad news for Bipolar sufferers, because it means there isn’t much in the pipeline for us in the way of new and / or innovative treatment. In fact, there are only two new antipsychotics the article called out as becoming imminently available, Latuda (lurasidone) and cariprazine (RGH-188).
The article goes on to point out the area where the greatest financial gain is to be had. It may seem callous (or obvious) that big pharma is out for the big bucks in uncharted bipolar treatment territory, but their greed can perhaps be beneficial to us sufferers.
The study points out that more effective remission of bipolar depression is the largest unmet need in bipolar disorder, with experts consistently stating few therapies currently achieve sufficient efficacy in this market segment and that, therefore, this presents the greatest commercial opportunity in bipolar disorder.
The treatment of bipolar depression has long been a stubborn and controversial one, and alternatives to traditional antidepressants are truly needed. As someone who was sent spiraling into mania through the careless use of traditional antidepressants, I can only hope the researchers and drug companies are listening.
If this resource truly has an accurate, overarching view of the immediate future of Bipolar pharma, it’s not very encouraging. With the ‘treatment algorithm of bipolar largely unchanged,’ (lithium, mood stabilizer and atypical antipsychotics) it looks like we have a good news/bad news scenario playing out over the next decade. More drugs will going generic (great for the consumer) but not much in the way of new and perhaps better treatments to choose from (bad for the patient).